Bone Biology & Healing: Maxillofacial Region

BONE BIOLOGY &
HEALING
M A X I L L O FA C I A L REGION
PRESENTED BY- MODERATOR –

DR. SHEETAL KAPSE DR. RAJASEKHAR G.
CONTENTS
• Introduction
• Embryology and development
• Structure
• Chemical composition
• Mechanical properties
• Biomechanics of craniomaxillofacial skeleton
• Fracture and role of blood supply
• Biological reaction and healing of bone
• Complications of bone healing
• Metals, surfaces and tissue interactions
INTRODUCTION
• WHAT IS BONE ?
• FUNCTION ?
• NUMBERS
EMBRYOLOGY AND DEVELOPMENT
MEMBRANOUS ENDOCHONDRAL
OSSIFICATION OSSIFICATION
Frontal Skull base

Parietal Occipital bone
Nasal bones Nasal septum
Maxilla Internal
Zygoma
components of the nose
Mandible
STRUCTURE
CHEMICAL COMPOSITION
INORGANIC ORGANIC
1. Hydroxyapatite 1. 90% collagen, primarily type I

[Ca10(PO4)6(OH)2] 2. 10% Non-collagenous proteins
2. Magnesium and lipids

a. 23% osteonectin
3. Potassium
b. 15% osteocalcin
4. Chlorine c. 9% sialoprotein,
5. Iron d. 9% phosphoproteins
6. Carbonate e. 5% α2-HS-glycoproteins
f. 4% proteoglycans
g. 3% albumin
MECHANICAL PROPERTIES
Collagen fibers Mineral phase
Tensile forces Compressive forces
Specific Specific length

orientation
Shear forces
• Elongation of 2%
• Strength about 1Mpa
• Tensile strength = 2/3rd
compressive strength
BIOMECHANICS OF
CRANIOMAXILLOFACIAL SKELETON
Maximum bite forces in an average population
200 to 300 N - incisor area
300 to 500 N - premolar region
500 to 700 - molar area

R. C. W. Wong, H. Tideman, L. Kin, M. A. W. Merkx:
Biomechanics of mandibular reconstruction: a review. Int. J. Oral
Maxillofac. Surg. 2010; 39: 313–319.
FRACTURE AND ROLE OF
BLOOD SUPPLY
INJURY
INTRAVASCULAR CLOTTING CONGESTION
DECREASED BLOOD SUPPLY
OSTEOCLASTIC ACTIVITY NECROSIS
OSTEOBLASTIC ACTIVITY VASCULAR INVASION
BONY BRIDGING
BIOLOGICAL REACTION AND
HEALING OF BONE
Sufficient blood supply
Presence of specific cells Undisturbed

fracture healing
Adequate mechanical conditions
• Dependent on the biological and biomechanical environment, three basic

scenarios can be differentiated:
1. Primary bone healing (contact or gap healing)

2. Secondary bone healing via callus formation
1. PRIMARY BONE HEALING
(CONTACT OR GAP HEALING)
• In cases where inter-fragmentary motion can be completely avoided, a healing

pattern results which is characterized by an increased amount of intracortical
remodelling, inside and in between the fragment ends.
• As long as there is no destruction of bone in the contact areas, the motion in the
gap is small enough to keep inter-fragmentary strain below 2%.
• The pattern of direct healing per se is not a goal to strive for, but the absence of
this pattern, ie, the formation of periosteal callus under conditions of plate
fixation is an indicator that complete immobilization was not achieved.
a Functionally stable
fixation of a mandibular
fracture with excellent
repositioning as a precondition
for primary bone healing.
b Enlarged section of (a):

primary bone healing contact
area, direct bony bridging
showing osteons crossing the
fracture area.
a Stable fixation, load

sharing with contact area
superiorly and gap area
inferiorly.
b Enlarged section of (a):

primary healing gap area:
complete filling of the fracture
gap with lamellar bone in a
direction parallel to the
fracture surface.
2. SECONDARY BONE HEALING
VIA CALLUS FORMATION
• In cases when no fracture fixation or just loose adaptation fixation is done,

macromotion between the fragment ends occurs.
• The strain in between the fragments exceeds what bone can tolerate, and
new bone developing between the fracture ends would be destroyed before
it is formed.
Endosteal callus
Periosteal callus
In between the fracture ends a tissue differentiation cascade
takes place, during which stiffness and strength increases and
strain tolerance gradually decreases.
Hematoma
Granulation tissue
Connective tissue
Fibrocartilage
Mineralized cartilage
Woven bone
Compact bone
Secondary bone healing,
phase 1: hematoma filling the fracture gap.
phase 2: granulation tissue and connective tissue replacing the
hematoma in the fracture gap.
• The elongation to
rupture is found to
be between 5% and
17%.
• Fibrous tissue is
found in areas where
tensile forces act,
• Cartilage is formed
in zones of
hydrostatic pressure
phase 3: fibrocartilage replacing the connective tissue in the
fracture gap.
phase 4: woven bone replaced by lamellar bone through Haversian
remodelling.
COMPLICATIONS OF BONE HEALING
1. Non-union
2. Delayed union
3. Malunion
FACTORS
SYSTEMIC
PATIENT ASSOCIATED
LOCAL
OPERATOR ASSOCIATED
HARDWARE ASSOCIATED
METALS, SURFACES AND TISSUE
INTERACTIONS
316 L iron-base alloy

Titanium alloys
 62.5% iron
 18% chromium  Ti grades 1–4
 14% nickel  Ti-6Al-7Nb alloy
 2.5% molybdenum  Ti-15Mo alloy
 minor elemental (α & β)
Allergic reactions to nickel 3–15%

FIXATION DEVICE BLOOD
BLOOD PROTEINS COVERING

THE FIXATION DEVICE
(matrix for platelets and other cells)
HEMATOMA PLATELET
FORMATION DEGRANULATION
INFLAMMATION
(cytokines & growth factors)
Proliferation
Remodelling
BIODEGRADABLE MATERIALS
In the future, maxillofacial

fracture fixation may utilize
biodegradable bone adhesives
and composites in lieu of the
traditional titanium plate/screw
systems. The adhesives
currently under study are in the
cyanoacrylate polymer family,
namely, butyl-2-cyanoacrylate.
Water and CO2

REFERENCE
1. Fonseca Raymond J, Walker Robert V, Barber H Dexter, Powers, Michael P,

Frost David E. oral and maxillofacial trauma. China: Saunders; 2013.
2. Hom, Hebda, Gosain, Friedman. Essential tissue healing of the face and neck.
India. Peoples medical publishing house.
3. AOCMF principles of internal fixations of craniomaxillofacial skeleton, trauma

& orthognathic surgery.
4. Rowe NL, William JL. Maxillofacial injuries. 1 st ed. India ISBN 978-81-312-
1840—2 2009.
THANK YOU

Bone Biology & Healing: Maxillofacial Region

Uploaded by

Copyright:

Available Formats

Bone Biology & Healing: Maxillofacial Region

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Bone Biology & Healing: Maxillofacial Region

Uploaded by

Copyright:

Available Formats

BONE BIOLOGY &

PRESENTED BY- MODERATOR –

Frontal Skull base

1. Hydroxyapatite 1. 90% collagen, primarily type I

2. Magnesium and lipids

Specific Specific length

200 to 300 N - incisor area

300 to 500 N - premolar region

500 to 700 - molar area

INTRAVASCULAR CLOTTING CONGESTION

DECREASED BLOOD SUPPLY

OSTEOCLASTIC ACTIVITY NECROSIS

OSTEOBLASTIC ACTIVITY VASCULAR INVASION

Presence of specific cells Undisturbed

• Dependent on the biological and biomechanical environment, three basic

1. Primary bone healing (contact or gap healing)

• In cases where inter-fragmentary motion can be completely avoided, a healing

b Enlarged section of (a):

a Stable fixation, load

b Enlarged section of (a):

• In cases when no fracture fixation or just loose adaptation fixation is done,

316 L iron-base alloy

Allergic reactions to nickel 3–15%

BLOOD PROTEINS COVERING

In the future, maxillofacial

Water and CO2

1. Fonseca Raymond J, Walker Robert V, Barber H Dexter, Powers, Michael P,

3. AOCMF principles of internal fixations of craniomaxillofacial skeleton, trauma

You might also like