Al-Maawi Sarah, Rutkowski James L, Sader Robert, Kirkpatrick C James, Ghanaati Shahram
FORM-Lab, Frankfurt Oral Regenerative Medicine, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University, Frankfurt, Germany.
Restorative Dentistry, School of Dental Medicine, State University of New York, Buffalo, NY.
J Oral Implantol. 2020 Jun 1;46(3):190-207. doi: 10.1563/aaid-joi-D-19-00201.
Several different biomaterials are being introduced for clinical applications. However, no current material-specific systematic studies define parameters for evaluating these materials. The aim of this retrospective animal study is to classify biomaterials according to the in vivo induced cellular reaction and outline the clinical consequence of the biomaterial-specific cellular reaction for the regeneration process. A retrospective histologic analysis was performed for 13 polymeric biomaterials and 19 bone substitute materials (BSMs) (of various compositions and origins) that were previously implanted in a standardized subcutaneous model. Semiquantitative analyses were performed at days 3, 15, and 30 after implantation according to a standardized score for the induction of multinucleated giant cells (MNGCs) and vascularization rate. The induced cellular reaction in response to different polymeric materials allowed their classification according to the MNGC score in the following groups: class I induced no MNGCs at any time point, class II induced and maintained a constant number of MNGCs over 30 days, and class III induced MNGCs and provided an increasing number over 30 days. All BSMs induced MNGCs to varying extents. Therefore, the resultant BSM classifications are as follows: class I induced MNGCs with a decreasing number, class II induced and maintained constant MNGCs over 30 days, and class III induced MNGCs with increasing number over 30 days. These observations were mostly related to the biomaterial physicochemical properties and were independent of the biomaterial origin. Consequently, the induction of MNGCs and their increase over 30 days resulted in disintegration of the biomaterial. By contrast, the absence of MNGCs resulted in an integration of the biomaterial within the host tissue. This novel classification provides clinicians a tool to assess the capacity and suitability of biomaterials in the intended clinical indication for bone and soft tissue implantations.
目前有几种不同的生物材料正在被引入临床应用。然而，目前尚无针对特定材料的系统性研究来确定评估这些材料的参数。这项回顾性动物研究的目的是根据体内诱导的细胞反应对生物材料进行分类，并概述特定生物材料的细胞反应对再生过程的临床影响。对先前植入标准化皮下模型的13种聚合物生物材料和19种骨替代材料（BSMs）（具有不同的成分和来源）进行了回顾性组织学分析。根据多核巨细胞（MNGCs）诱导和血管化率的标准化评分，在植入后第3天、第15天和第30天进行半定量分析。对不同聚合物材料诱导的细胞反应使其能够根据MNGC评分分为以下几组：I类在任何时间点均未诱导出MNGCs，II类在30天内诱导并维持恒定数量的MNGCs，III类诱导出MNGCs并在30天内数量增加。所有BSMs均不同程度地诱导了MNGCs。因此，最终的BSM分类如下：I类诱导的MNGCs数量逐渐减少，II类在30天内诱导并维持恒定的MNGCs数量，III类在30天内诱导的MNGCs数量增加。这些观察结果大多与生物材料的物理化学性质有关，与生物材料的来源无关。因此，MNGCs的诱导及其在30天内的增加导致生物材料解体。相比之下，未出现MNGCs则导致生物材料与宿主组织整合。这种新的分类为临床医生提供了一种工具，以评估生物材料在骨和软组织植入预期临床适应症中的能力和适用性。
