The Feasibility of Demineralized Bone Matrix for Craniofacial Contour

Restoration: An Experimental Study

Tolga Eryilmaz*, Selahattin Ozmen*, Nese Lortlar**, Suna Omeroglu**, Suhan Ayhan*, Cemalettin Celebi*

Gazi University Faculty of Medicine, Ankara, Turkey* Department of Plastic, Reconstructive and Aesthetic Surgery

** Department of Histology and Embryology

Nothing to Disclose

Objective

• The histological behavior of DBM was investigated in different tissue planes to determine the proper application plane for restoration of craniofacial contour deformities

Materials and Methods

• 40 Wistar rats - 6 groups

• At the eighth week half of the rats and at the sixteenth week the remaining rats were sacrificed in each group and tissue samples were harvested

Materials and Methods

• 0.3 cc of 0.9% saline into subperiosteal plane of cranium (1)

• 0.3 cc of DBM into subperiosteal plane of cranium (2)

• 0.3 cc of 0.9% saline into subdermal plane on the left inguinal region (3)

Materials and Methods

• 0.3 cc of DBM into subdermal plane on the right inguinal region (4)

• 0.3 cc of 0.9% saline between left external and internal oblique muscles (5)

• 0.3 cc of DBM between right external and internal oblique muscles (6)

Materials and Methods

• Surgical procedures in Group 1 and 2 were performed on 10 different rats

• In groups 3 to 6 both left and right sides were used to decrease the number of the animals used in the study

Results

• Histological and immunohistochemical evaluation revealed new bone tissue and bone marrow formation in all planes, that DBM was given

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While there was no difference found in macroscopic evaluation in Group 1, demineralized bone matrix was found to be a localized, firm, hard tissue in the subperiosteal plane in Group 2. (*): demineralized bone matrix

While there was no difference found in macroscopic evaluation in Group 3, demineralized bone matrix was found to be a localized, firm, hard tissue in the subdermal plane in Group 4. (*): demineralized bone matrix

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While there was no difference found in the left intermuscular plane (Group 5), demineralized bone matrix was found to be a localized, firm, hard tissue in the right intermuscular plane (Group 6). (*): demineralized bone matrix

A BA. New bone tissue formation in the subperiosteal plane, at 8th week. B. New bone tissue formation in the subperiosteal plane, at 16th week. T: trabecular bone, C: collagen, P: periosteum, DBM: demineralized bone matrix, lc: lacuna, o: osteon, HC: Haversian channel (Hematoxylene – Eosine stain, x100)

A. New bone tissue formation in the subdermal plane, at 8th week. B. New bone tissue formation in the subdermal plane, at 16th week. T : trabecular bone, S : spicular bone, o : osteon, HC : Haversian channel, lc : lacuna, BM : bone marrow, AT : adipose tissue (Hematoxylene – Eosine stain, x100)

A B

A. New bone tissue formation in the intermuscular plane, at 8th week. B. New bone tissue formation in the intermuscular plane, in the sixteenth week. T : trabecular bone, CB : compact bone, HC : Haversian channel, M : muscle, p : perimisium (Hematoxylene – Eosine stain, x100)

A B

Immunohistochemical evaluation with CD 138 antibody revealed bone marrow formation, where demineralized bone matrix was given. T: trabecular bone, CB: compact bone, HC: Haversian channel, BM: bone marrow, (→): immune reactivity (CD138 stain, x100)

Conclusions

• Demineralized bone matrix can provide satisfactory results in craniofacial contour deformities including forehead, temporal, mental, malar and perialar augmentations and saddle nose corrections, with supraperiosteal or deep subcutaneous applications

• However, superficial applications must be avoided because of the possibility of palpation