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Cranial Particulate Bone Graft Ossifies Calvarial Defects by Osteogenesis
Aladdin H. Hassanein, MD, MMSc1, Praveen R. Arany, BDS, MDS2, John B. Mulliken, MD1, Julie Glowacki, PhD3, Gary F. Rogers, MD, JD, MBA, MPH1, James E. Clune, MD1, Arin K. Greene, MD, MMSc1.
1Children's Hospital Boston, Harvard Medical School, Boston, MA, USA, 2Harvard School of Dental Medicine, Boston, MA, USA, 3Brigham and Women's Hospital, Boston, MA, USA.

BACKGROUND:
Particulate bone graft (PBG) heals critical-size defects and can be harvested from the cranium as early as infancy. The purpose of this study was to test the hypothesis that PBG promotes ossification by osteogenesis.
METHODS:
Freshly harvested PBG, devitalized PBG, and bone dust from rabbit calvaria were assayed for metabolic activity (resazurin) and viable osteoblasts (alkaline phosphatase). A leporid calvarial defect model was used to test the effect of PBG devitalization on in vivo ossification. A parietal critical-size defect was created and managed in 3 ways: (1) no implant (n=6); (2) PBG implant (n=6); (3) devitalized PBG implant (n=6). Micro-computed tomography was used to measure ossification 16 weeks later; histology also was studied.
RESULTS:
PBG contained more viable cells (0.94% transmittance/mg) compared to devitalized PBG (0.007%) or bone dust (0.21%) (p=0.01). PBG had greater alkaline phosphatase activity (0.13 RFU/µg) than devitalized PBG (0.000) or bone dust (0.06) (p=0.01). Critical-size defects treated with PBG had more ossification (99.7%) compared to devitalized PBG implants (42.2%) (p=0.01); no difference was found between devitalized PBG and no implant(40.8%) (p=0.9).
CONCLUSIONS:
PBG contains living cells, including osteoblasts, which are required to heal critical-size defects. These data support the hypothesis that PBG promotes ossification primarily by osteogenesis.


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