The effect of fibrin sealant to absorbable coral in osteogenesis, vessel ingrowth and physical properties

ABSTRACT

Autogenous bone graft used for the contouring and reconstruction of craniofacial bone defect has many advantages over the alloplastic material implantations. However, there are several problems associated to the autogenous bone grafting obtaining the donor site is the most problematic; transplanted bone may be absorbed at the recipient site; and the molding to fit to the recipient site is difficult. Therefore, research in alloplastic materials is inevitable. The current research is focused on two types of hydroxyapatite, calcium phosphate and calcium carbonate. The calcium phosphate is known to show a limited osteogenesis. However, Coral(Biocoral, Inoteb B.P., Saint Gonnery, France) composed of calcium carbonate is known to be more effective in osteogenesis. Fibrin sealant(Duplojet system, Immuno AG. Vienna, Austria), a tissue glue, is known to increase tissue affinity, proliferation of fibroblast and vessel ingrowth. It is also known to have osteoinductive effect. We believe that fibrin sealant improves the effect of coral by increasing bone graft substitution, enhancement of plasticity and stability of the granular material. Therefore, we have undertaken an experimental investigation as following; Using high speed burr, three 10 mm in diameter skull defects were made on 24 New Zealand white rabbits. The defects were treated with implantations, which are divided into three samples A) Control in which on coral or fibrin sealant, B) Coral 50 mg with fibrin sealant 0.3 cc, C) Coral 50 mg with saline 0.3 cc. The specimens of its skull were collected at 3, 7, 14, 28, 42 and 56 days postoperatively. The operative sites were carefully examined grossly, microscopially and radiologically. The experimental results are as followings At 56 days post operation date, control group showed a thin layer of only fibrous connective tissue and minimal immature bone filling the defect. Coral with saline given group showed a thick layer of connective tissue and granule of coral, accompanied by partial new bone formation, mostly composed of woven bone, in the middle of the defect. In the group that were given coral with fibrin sealant, a thick layer of fibrous connective tissue and granules of coral, accompanied by more increased new bone formation in the middle of the defect were observed. Another difference from the Group B is a formed new bone replaced by lamellar bone.We concluded that by using coral and fibrin sealant together, contouring and reconstruction of bone defected areas were enhanced. It was difficult to prove directly that fibrin has osteoinductive effect. However, the plasticity and stability, the fibrin sealant gives to coral enhances the osteogenesis. Our study provides evidence that coral used with fibrin sealant will significantly improve the result of the craniofacial bone surgery.