Abstract
Background:
In guided bone regeneration (GBR), there are various problems that occur in the bone defect after the wound healing period. This study aimed to investigate the enhancement of the osteogenic ability of the dual scaffold complex and identify the appropriate concentration of growth factors (GF) for new bone formation based on the novel GBR concept that is applying rapid bone forming GFs to the membrane outside of the bone defect.
Methods:
Four bone defects with a diameter of 8Â mm were formed in the calvaria of New Zealand white rabbits each to perform GBR. Collagen membrane and biphasic calcium phosphate (BCP) were applied to the bone defects with the four different concetration of BMP-2 or FGF-2. After 2, 4, and 8Â weeks of healing, histological, histomorphometric, and immunohistochemical analyses were conducted.
Results:
In the histological analysis, continuous forms of new bones were observed in the upper part of bone defect in the experimental groups, whereas no continuous forms were observed in the control group. In the histomorphometry, The group to which BMP-2 0.5Â mg/ml and FGF-2 1.0Â mg/ml was applied showed statistically significantly higher new bone formation. Also, the new bone formation according to the healing period was statistically significantly higher at 8Â weeks than at 2, 4Â weeks.
Conclusion:
The novel GBR method in which BMP-2, newly proposed in this study, is applied to the membrane is effective for bone regeneration. In addition, the dual scaffold complex is quantitatively and qualitatively advantageous for bone regeneration and bone maintenance over time.
This is a preview of subscription content, access via your institution.






References
Elgali I, Omar O, Dahlin C, Thomsen P. Guided bone regeneration: materials and biological mechanisms revisited. Eur J Oral Sci. 2017;125:315–37.
Retzepi M, Donos N. Guided bone regeneration: biological principle and therapeutic applications. Clin Oral Implants Res. 2010;21:567–76.
Tolstunov L, Hamrick JFE, Broumand V, Shilo D, Rachmiel A. Bone augmentation techniques for horizontal and vertical alveolar ridge deficiency in oral implantology. Oral Maxillofac Surg Clin North Am. 2019;31:163–91.
Khojasteh A, Kheiri L, Motamedian SR, Khoshkam V. Guided bone regeneration for the reconstruction of alveolar bone defects. Ann Maxillofac Surg. 2017;7:263–77.
Buser D, Dula K, Hess D, Hirt HP, Belser UC. Localized ridge augmentation with autografts and barrier membranes. Periodontol 2000. 1999;19:151–63.
Dahlin C, Linde A, Gottlow J, Nyman S. Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg. 1988;81:672–6.
Alrasheed A, Al-Ahmari F, Ramalingam S, Nooh N, Wang CY, Al-Hezaimi K. Real-time assessment of guided bone regeneration in standardized calvarial defects using a combination of bone graft and platelet-derived growth factor with and without collagen membrane: an in vivo microcomputed tomographic and histologic experiment in rats. Int J Periodontics Restorative Dent. 2016;36:s173–86.
Kaigler D, Silva EA, Mooney DJ. Guided bone regeneration using injectable vascular endothelial growth factor delivery gel. J Periodontol. 2013;84:230–8.
Michalska M, Kozakiewicz M, Bodek KH. Polymer angiogenic factor carrier. Part I. Chitosan-alginate membrane as carrier PDGF-AB and TGF-beta. Polim Med. 2008;38:19–28.
Caridade SG, Monge C, Almodóvar J, Guillot R, Lavaud J, Josserand V, et al. Myoconductive and osteoinductive free-standing polysaccharide membranes. Acta Biomater. 2015;15:139–49.
Benic GI, Joo MJ, Yoon SR, Cha JK, Jung UW. Primary ridge augmentation with collagenated xenogenic block bone substitute in combination with collagen membrane and rhBMP-2: a pilot histological investigation. Clin Oral Implants Res. 2017;28:1543–52.
Chang YY, Lee JS, Kim MS, Choi SH, Chai JK, Jung UW. Comparison of collagen membrane and bone substitute as a carrier for rhBMP-2 in lateral onlay graft. Clin Oral Implants Res. 2015;26:e13-9.
Bessa PC, Casal M, Reis RL. Bone morphogenetic proteins in tissue engineering: the road from the laboratory to the clinic, part I (basic concepts). J Tissue Eng Regen Med. 2008;2:1–13.
Murakami S. Periodontal tissue regeneration by signaling molecule(s): what role does basic fibroblast growth factor (FGF-2) have in periodontal therapy? Periodontol 2000. 2011;56:188–208.
Devescovi V, Leonardi E, Ciapetti G, Cenni E. Growth factors in bone repair. La Chirurgia degli organi di movimento. 2008;92:161–8.
van der Stok J, Wang H, Amin Yavari S, Siebelt M, Sandker M, Waarsing JH, et al. Enhanced bone regeneration of cortical segmental bone defects using porous titanium scaffolds incorporated with colloidal gelatin gels for time- and dose-controlled delivery of dual growth factors. Tissue Eng Part A. 2013;19:2605–14.
Su J, Xu H, Sun J, Gong X, Zhao H. Dual delivery of BMP-2 and bFGF from a new nano-composite scaffold, loaded with vascular stents for large-size mandibular defect regeneration. Int J Mol Sci. 2013;14:12714–28.
Oortgiesen DA, Walboomers XF, Bronckers AL, Meijer GJ, Jansen JA. Periodontal regeneration using an injectable bone cement combined with BMP-2 or FGF-2. J Tissue Eng Regen Med. 2014;8:202–9.
Charles LF, Woodman JL, Ueno D, Gronowicz G, Hurley MM, Kuhn LT. Effects of low dose FGF-2 and BMP-2 on healing of calvarial defects in old mice. Exp Gerontol. 2015;64:62–9.
Khorsand B, Nicholson N, Do AV, Femino JE, Martin JA, Petersen E, et al. Regeneration of bone using nanoplex delivery of FGF-2 and BMP-2 genes in diaphyseal long bone radial defects in a diabetic rabbit model. J Control Release. 2017;248:53–9.
Marie PJ, Miraoui H, Sévère N. FGF/FGFR signaling in bone formation: progress and perspectives. Growth Factors. 2012;30:117–23.
Rice R, Rice DP, Thesleff I. Foxc1 integrates Fgf and Bmp signalling independently of twist or noggin during calvarial bone development. Dev Dyn. 2005;233:847–52.
Lee SH, Park YB, Moon HS, Shim JS, Jung HS, Kim HJ, et al. The role of rhFGF-2 soaked polymer membrane for enhancement of guided bone regeneration. J Biomater Sci Polym Ed. 2018;29:825–43.
Nosho S, Tosa I, Ono M, Hara ES, Ishibashi K, Mikai A, et al. Distinct osteogenic potentials of BMP-2 and FGF-2 in extramedullary and medullary microenvironments. Int J Mol Sci. 2020;21:7967.
Kang W, Liang Q, Du L, Shang L, Wang T, Ge S. Sequential application of bFGF and BMP-2 facilitates osteogenic differentiation of human periodontal ligament stem cells. J Periodontal Res. 2019;54:424–34.
Wang H, Zou Q, Boerman OC, Nijhuis AW, Jansen JA, Li Y, et al. Combined delivery of BMP-2 and bFGF from nanostructured colloidal gelatin gels and its effect on bone regeneration in vivo. J Control Release. 2013;166:172–81.
Kuhn LT, Peng T, Gronowicz G, Hurley MM. Endogenous FGF-2 levels impact FGF-2/BMP-2 growth factor delivery dosing in aged murine calvarial bone defects. J Biomed Mater Res A. 2021;109:2545–55.
Chung EJ, Chien KB, Aguado BA, Shah RN. Osteogenic potential of BMP-2-releasing self-assembled membranes. Tissue Eng Part A. 2013;19:2664–73.
Geiger M, Li RH, Friess W. Collagen sponges for bone regeneration with rhBMP-2. Adv Drug Deliv Rev. 2003;55:1613–29.
Wang Z, Wang K, Lu X, Li M, Liu H, Xie C, et al. BMP-2 encapsulated polysaccharide nanoparticle modified biphasic calcium phosphate scaffolds for bone tissue regeneration. J Biomed Mater Res A. 2015;103:1520–32.
Hong I, Khalid AW, Pae HC, Cha JK, Lee JS, Paik JW, et al. Distinctive bone regeneration of calvarial defects using biphasic calcium phosphate supplemented ultraviolet-crosslinked collagen membrane. J Periodontal Implant Sci. 2020;50:14–27.
Sohn B, Hwang M, Kim S, Kim HI, Ku Y. Ridge preservation using basic fibroblast growth factor-2 and collagenated biphasic calcium phosphate in beagle dogs. J Periodontal Implant Sci. 2017;47:381–7.
Moon KS, Choi EJ, Oh S, Kim S. The effect of covalently immobilized FGF-2 on biphasic calcium phosphate bone substitute on enhanced biological compatibility and activity. Biomed Res Int. 2015;5:742192.
Boonrungsiman S, Gentleman E, Carzaniga R, Evans ND, McComb DW, Porter AE, et al. The role of intracellular calcium phosphate in osteoblast-mediated bone apatite formation. Proc Natl Acad Sci U S A. 2012;109:14170–5.
Johnson TB, Siderits B, Nye S, Jeong YH, Han SH, Rhyu IC, et al. Effect of guided bone regeneration on bone quality surrounding dental implants. J Biomech. 2018;80:166–70.
Schwarz F, Rothamel D, Herten M, Ferrari D, Sager M, Becker J. Lateral ridge augmentation using particulated or block bone substitutes biocoated with rhGDF-5 and rhBMP-2: an immunohistochemical study in dogs. Clin Oral Implants Res. 2008;19:642–52.
Klagsbrun M. The affinity of fibroblast growth factors (FGFs) for heparin; FGF-heparan sulfate interactions in cells and extracellular matrix. Curr Opin Cell Biol. 1990;2:857–63.
Pitaru S, Kotev-Emeth S, Noff D, Kaffuler S, Savion N. Effect of basic fibroblast growth factor on the growth and differentiation of adult stromal bone marrow cells: enhanced development of mineralized bone-like tissue in culture. J Bone Miner Res. 1993;8:919–29.
Frank O, Heim M, Jakob M, Barbero A, Schäfer D, Bendik I, et al. Real-time quantitative RT-PCR analysis of human bone marrow stromal cells during osteogenic differentiation in vitro. J Cell Biochem. 2002;85:737–46.
Naganawa T, Xiao L, Coffin JD, Doetschman T, Sabbieti MG, Agas D, et al. Reduced expression and function of bone morphogenetic protein-2 in bones of Fgf2 null mice. J Cell Biochem. 2008;103:1975–88.
Lee JS, Kim TW, Park S, Kim BS, Im GI, Cho KS, et al. Reduction of adipose tissue formation by the controlled release of BMP-2 using a hydroxyapatite-coated collagen carrier system for sinus-augmentation/extraction-socket grafting. Materials (Basel). 2015;8:7634–49.
Aryal R, Chen XP, Fang C, Hu YC. Bone morphogenetic protein-2 and vascular endothelial growth factor in bone tissue regeneration: new insight and perspectives. Orthop Surg. 2014;6:171–8.
Gittens SA, Bagnall K, Matyas JR, Löbenberg R, Uludag H. Imparting bone mineral affinity to osteogenic proteins through heparin-bisphosphonate conjugates. J Control Release. 2004;98:255–68.
Park Y, Lin S, Bai Y, Moeinzadeh S, Kim S, Huang J, et al. Dual delivery of BMP-2 and IGF-1 through injectable hydrogel promotes cranial bone defect healing. Tissue Eng Part A. 2022;28:760–9.
Lee JS, Lee SK, Kim BS, Im GI, Cho KS, Kim CS. Controlled release of BMP-2 using a heparin-conjugated carrier system reduces in vivo adipose tissue formation. J Biomed Mater Res A. 2015;103:545–54.
Lee JW, Lim HC, Lee EU, Park JY, Lee JS, Lee DW, et al. Paracrine effect of the bone morphogeneticprotein-2 at the experimental site on healing of the adjacent control site: a study in the rabbit calvarial defect model. J Periodontal Implant Sci. 2014;44:178–83.
Kim JW, Jung IH, Lee KI, Jung UW, Kim CS, Choi SH, et al. Volumetric bone regenerative efficacy of biphasic calcium phosphate-collagen composite block loaded with rhBMP-2 in vertical bone augmentation model of a rabbit calvarium. J Biomed Mater Res A. 2012;100:3304–13.
Chung SM, Jung IK, Yoon BH, Choi BR, Kim DM, Jang JS. Evaluation of different combinations of biphasic calcium phosphate and growth factors for bone formation in calvarial defects in a rabbit model. Int J Periodontics Restorative Dent. 2016;36:s49–59
Acknowledgements
We would like to acknowledge the help from Dr. Hyunmin Choi for the help with animal experiments. This research was funded by Yonsei University School of Dentistry Intramural Faculty Research Grant (Y110523) to Y.P.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no financial conflict of interest.
Ethical Statement
The breeding, management, and surgical procedures followed the animal testing standards of the Yonsei University Health System Institutional Animal Care and Use Committee, Seoul, Korea. The animal study plan for these experiments (2016–0062) was reviewed and approved by this committee.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Park, J., Jung, N., Lee, DJ. et al. Enhanced Bone Formation by Rapidly Formed Bony Wall over the Bone Defect Using Dual Growth Factors. Tissue Eng Regen Med 20, 767–778 (2023). https://doi.org/10.1007/s13770-023-00534-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13770-023-00534-z