Bone grafting: What is Bio-Oss? What are membranes?

[Optimistic]

I spoke with Triaca about augmenting the infraorbital rims and other things, he mentioned how on the rare occasions he does it he uses Bio-Oss protected by membranes.

A quick search reveals the following: http://www.geistlich-na.com/en-us/professionals/bone-substitutes/combi-kit-collagen/

It is derived from the mineral portion of bovine bone.

Another good explanation of it: http://www.implantteam.com.au/faq_graft.asp

Apparently it lasts a long time: http://www.ncbi.nlm.nih.gov/pubmed/10186966

More on bone augmentation: http://www.geistlich-na.com/en-us/patients/container/dental-regeneration/bone-augmentation/


If Tiny would like to come in here and give her opinion would be great as she is knowledgable about this. Interestingly this is a bone-derived mineral graft which contains 10% collagen according to the surgery video. Does this mean it would be less prone to shattering / able to absorb impact more like real bone than say HA paste?

[Gregor Samsa]

Apparently it lasts a long time: http://www.ncbi.nlm.nih.gov/pubmed/10186966

That research paper only said that there were no signs of reabsorption after six years but that's not very long. If I'm going to do something like this then I want it to last for life.

[Optimistic]

That research paper only said that there were no signs of reabsorption after six years but that's not very long. If I'm going to do something like this then I want it to last for life.

Yes, but it's probably not feasible to have such a long-term study for what I presume is relatively new.

Assuming resorption occurs in a linear fashion then it would be reasonable to assume it is minimal to non-existent.

The other thing is that six years is still a very long time. What if it only lasts before being gone? That's not so bad if you ask me. I'd gladly get it touched up on a 10-15 year basis.

[Gregor Samsa]

The other thing is that six years is still a very long time. What if it only lasts before being gone? That's not so bad if you ask me. I'd gladly get it touched up on a 10-15 year basis.

I'm not paying 50k euro to Triaca every 10-15 years. 

[Optimistic]

I'm not paying 50k euro to Triaca every 10-15 years. 

It's not 50k euro for that lol. In fact I imagine it would be quite cheap. I'll PM you an exact price when I know.

Besides, don't you think in 15 years there may be better solutions again? Perhaps a bio-identical bone graft that doesn't resorb

[Tiny]

It looks like a better option than most or any others.  I've seen a case of someone missing their entire jaw bone and they grew a new one by implanting a porous framework in the back and then removing it, or something

Anyway, what you need to understand about the collagen in bone and how it contributes to the flexibility of bone is this - it is quite organised.  The fibres form large bundles, and they are quite long, the microfibres within the bundle also have a specific length.  It is also a very dense, crosslinked kind of collagen protein. So what I'm saying is they're not just random bits of collagen.   (for reference, collagen makes up about 20% of the DRY weight of bone.  The wet weight is larger as collagen is hygrophilic)

If this material allows the ingrowth of actual bone by osteoblasts etc. then yes, it looks like a good option, as the body will be providing it's own native collagen and minerals to grow the new bone.

[Optimistic]

It looks like a better option than most or any others.  I've seen a case of someone missing their entire jaw bone and they grew a new one by implanting a porous framework in the back and then removing it, or something

Anyway, what you need to understand about the collagen in bone and how it contributes to the flexibility of bone is this - it is quite organised.  The fibres form large bundles, and they are quite long, the microfibres within the bundle also have a specific length.  It is also a very dense, crosslinked kind of collagen protein. So what I'm saying is they're not just random bits of collagen.   (for reference, collagen makes up about 20% of the DRY weight of bone.  The wet weight is larger as collagen is hygrophilic)

If this material allows the ingrowth of actual bone by osteoblasts etc. then yes, it looks like a good option, as the body will be providing it's own native collagen and minerals to grow the new bone.

According to the literature and videos in-growth does occur. So that's good news. As for collagen, are you saying that for the collagen in the mixture to be worthwhile it needs to be similar to human collage in bone?

Finally, does the bone need to be cut or damaged for in growth to occur? What I mean is, if this was placed on top of un-touched bone would anything happen? Or does the surgeon needs to do something first, even if it's like bossing the bone just a fraction to induce a healing response?

[Tiny]

According to the literature and videos in-growth does occur. So that's good news. As for collagen, are you saying that for the collagen in the mixture to be worthwhile it needs to be similar to human collage in bone?

if there's bone ingrowth then there's collagen growth too.  Collagen in the mixture will have some effect but it won't be organised like bone-native collagen

Finally, does the bone need to be cut or damaged for in growth to occur? What I mean is, if this was placed on top of un-touched bone would anything happen? Or does the surgeon needs to do something first, even if it's like bossing the bone just a fraction to induce a healing response?

I'm a chemist not a biologist but I imagine yes.  Something has to trigger the osteoblasts to form bone.  However I'm not sure....you may want to the look out the growing-jawbone-in-the-back case

http://news.bbc.co.uk/2/hi/health/3598710.stm - a scaffold of synthetic bone mineral was infused with bone marrow and a protein to promote growth, then implanted in the back

There's also this - http://news.columbia.edu/record/1729  The patients own stem cells were used to partially grow a new TMJ joint on a scaffold of human bone (I guess cadaver) stripped of living cells

Both these cases involved bone marrow - which makes sense when you think about it.  I guess the osteoblasts are differentiating from the adult stem cells found in bone marrow


Research from 2004 - a collagen framework http://news.bbc.co.uk/2/hi/health/3861185.stm
Science is slow