Regeneration of a Pediatric Alveolar Cleft Model Using Three-Dimensionally Printed Bioceramic Scaffolds and Osteogenic Agents: Comparison of Dipyridamole and rhBMP-2. Issue 2 (August 2019)

• Record Type: Journal Article
• Authors: Lopez, Christopher D.; Coelho, Paulo G.; Witek, Lukasz; Torroni, Andrea; Greenberg, Michael I.; Cuadrado, Dean L.; Guarino, Audrey M.; Bekisz, Jonathan M.; Cronstein, Bruce N.; Flores, Roberto L.
• Is Part Of: Plastic and reconstructive surgery. Volume 144:Issue 2(2019:Aug.)
• Publication Date: 2019-08
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000005840
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : Background: Alveolar clefts are traditionally treated with secondary bone grafting, but this is associated with morbidity and graft resorption. Although recombinant human bone morphogenetic protein-2 (rhBMP-2) is under investigation for alveolar cleft repair, safety concerns remain. Dipyridamole is an adenosine receptor indirect agonist with known osteogenic potential. This study compared dipyridamole to rhBMP-2 at alveolar cleft defects delivered using bioceramic scaffolds. Methods: Skeletally immature New Zealand White rabbits underwent unilateral, 3.5 × 3.5-mm alveolar resection adjacent to the growing suture. Five served as negative controls. The remaining defects were reconstructed with three-dimensionally printed bioceramic scaffolds coated with 1000 μm of dipyridamole ( n = 6), 10, 000 μm of dipyridamole ( n = 7), or 0.2 mg/ml of rhBMP-2 ( n = 5). At 8 weeks, new bone was quantified. Nondecalcified histologic evaluation was performed, and new bone was evaluated mechanically. Statistical analysis was performed using a generalized linear mixed model and the Wilcoxon rank sum test. Results: Negative controls did not heal, whereas new bone formation bridged all three-dimensionally printed bioceramic treatment groups. The 1000-μm dipyridamole scaffolds regenerated 28.03 ± 7.38 percent, 10, 000-μm dipyridamole scaffolds regenerated 36.18 ± 6.83 percent (1000 μm versus 10, 000 μm dipyridamole; p = 0.104), and rhBMP-2–coated scaffolds regenerated 37.17 ± 16.69 percent bone ( p = 0.124 versus 1000 μm dipyridamole, and p = 0.938 versus 10, 000 μm dipyridamole). On histology/electron microscopy, no changes in suture biology were evident for dipyridamole, whereas rhBMP-2 demonstrated early signs of suture fusion. Healing was highly cellular and vascularized across all groups. No statistical differences in mechanical properties were observed between either dipyridamole or rhBMP-2 compared with native bone. Conclusion: Dipyridamole generates new bone without osteolysis and early suture fusion associated with rhBMP-2 in skeletally immature bone defects.