[Synthetic bone replacement : Current developments and perspectives]

Successful reconstruction of critical bone defects requires complete elimination of the underlying pathology, preservation or restoration of mechanical stability of the affected bone segment and, most importantly, an adequate filling material that supports the regeneration and formation of new bone within the treated defect in an optimal fashion. Currently available synthetic bone graft substitutes cannot address all requirements of such a complex biological process individually. Due their suboptimal and, with respect to physiological bone healing, asynchronous biodegradation properties, their specific foreign material-mediated side effects and complications and fairly modest overall osteogenic potential, their overall clinical performance typically lags behind conventional bone grafts. However, a defect and pathology specific combination of synthetic bone graft substitutes with appropriate carrier properties, therapeutic agents and/or conventional bone graft materials allows the creation of biologically enhanced composite constructs that can surpass the biological and therapeutic limits of autologous bone grafts. This monograph presents a new concept based on the biological enhancement of optimal therapeutic agent-carrier composites and provides a rationale for an individual, requirement-specific adaptation of a truly patient-specific bone defect reconstruction.