Development of synthetic bone-repair materials for craniofacial reconstruction

In an effort to minimize problems associated with use of bone grafts and bank bone for craniofacial reconstruction, synthetic biodegradable alternatives are under development at the U.S. Army Institute of Dental Research. The focus is on composite materials in which either d,l-polylactide co-glycolide or porous tricalcium phosphate function as degradable delivery systems for bone-inductive proteins. Availability of synthetic bone-repair materials would eliminate the need for invasive graft-harvesting procedures, the dangers of pathogen transmission from, and immunogenic reaction to bank bone. In addition, synthetics should be more easily sculpted to restore facial contours. Elimination of the disadvantages of natural bone grafts would result in improved reconstructive care for victims of trauma, disease, and congenital deformity. Military surgeons can especially appreciate the potential of a convenient synthetic bone replacement for use in mass casualty situations where access to, and storage facilities for natural bone will be extremely limited. This review updates current treatments and requirements for synthetic bone-repair materials and describes several experimental materials under evaluation at the U.S. Army Institute of Dental Research.