The role of autogenous periosteum and ceramic composit graft for the healing of cavitary bone defects

Objective: The aim of this study is to investigate the role of composite graft constituting of free autologue periosteal particles along with osteoconductive ceramic bone graft extenders for the healing of cavitary bone defects.Materials and Method: 12 New Zealand type rabbits aged 8-12 months and weighing approximately 1000-1500 gr were used in this study. 24 femurs of the rabbits were separated to three groups of eight femurs. Bilateral lateral exposure of the femoral condyle was followed by the creation of cavitary defects with the use of an 5mm drill bit. In group I (eight limbs of four animals) the defect was left empty and so was attended as a control. In group II the right lower limbs of the remaining eight animals were only filled with ceramic graft particles. In group III the defects in the left lower limbs of the same animals for group II were filled with both ceramic graft particles and autogenous periosteal particles. The ceramic particles used was Cem-Ostetic? 5 cc granules (Berkeley Advanced Biomaterials, Inc. CA, U.S.A.). The periosteal particles administered in group III were harvested from the ipsilateral medial tibial metaphysis and were cut in to 1-2 mm2 particles with minimal manipulation. All animals were sacrificed at the end of sixth week and were evaluated histologycally for bone healing.Results: In group I (control) new bone formation was clearly inferior and defect was mostly obliterated with fibrous tissue. In group II (ceramic only) islets of new bone were scattered more frequent in the fibrous tissue background when compared to group I. New vasculature and osteocytes with dense nuclei were present within the newly formed bone tissue. In group III (ceramic and periosteum composite) the defects were obliterated with new bone tissue which was superior to the other groups, along with cartilage proliferation which was not notable in group I and II. The amount of fibrous tissue covered area was clearly less when compared to the control group and ceramic only group. The statistical evaluation of the histomorphometrically gathered quantitative results revealed meaningful increase in woven bone and decrease in fibrous tissue in group III, confirming the histological analysis. Furthermore, cartilage tissue seen only in group III is expected to transform into bone tissue by means of enchondral ossification process.Conclusion: The composite graft constituting of free autologue periosteal particles along with osteoconductive ceramic bone graft extenders appears to be facilitating the bone healing process far bypassing the ceramic bone graft extenders alone. We think that these findings can be owed to the osteoconductive properties of the ceramic graft and osteogenetic properties of periosteum acting in a synergistic behavior. We also think that the application method of the periosteum, which clearly helps to distribute osteogenic potential evenly throughout the defect is yet as important in achieving the results.