Impact of Freeze-dried Corticocancellous Bone Allograft Combined with Enamel Matrix Derivative in the Treatment of Critical-sized Calvarial Bone Defects: An Animal Study.

Aim: This study compared the quality and quantity of newly formed bone in rabbits' critical-sized calvarial defects filled with enamel matrix derivative (EMD) combined with freeze-dried bone allograft (FDBA) vs FDBA alone.
Materials and Methods: A total of 24 adult male white New Zealand rabbits were included. In each rabbit, three bone defects with a diameter of 8 mm were created on the calvarium bone; the first defect was left untreated, while the second was filled with FDBA, and the third was filled with EMD + FDBA. Twelve rabbits were randomly euthanized after a month, and the remaining 2 month postsurgery. Bone sections were histologically evaluated by hematoxylin and eosin and vascular endothelial growth factor (VEGF), alkaline phosphatase (ALP), osteoprotegerin (OPG), and receptor activator of NF-kappaB (RANK) immune-histochemical staining.
Results: An improvement in the newly formed bone percentage was found in the defects filled with EMD + FDBA in comparison with FDBA and control defects at 1 month and 2 months postsurgery. Additionally, the expression of VEGF, ALP, OPG, and RANK showed highly significant differences in the defects filled with EMD + FDBA compared to the FDBA and control ones at 1 month postsurgery ( p = 0.001). Meanwhile, VEGF and ALP expression showed a significant decrease in defects filled with EMD + FDBA compared to the FDBA and control ones ( p = 0.001), while OPG and RANK expression showed non-significant differences between treated groups at 2 months postsurgery.
Conclusion: Enamel matrix derivative combined with FDBA has a synergistic effect on bone formation and graft substitution. This combination accelerates the expression of VEGF, ALP, OPG, and RANK.
Clinical Significance: The combination of EMD and FDBA accelerates and ameliorates the quality of newly formed bone, aiding in maxillofacial reconstruction. How to cite this article: Zakri RN, Grawish ME, Mowafey B, et al. Impact of Freeze-dried Corticocancellous Bone Allograft Combined with Enamel Matrix Derivative in the Treatment of Critical-sized Calvarial Bone Defects: An Animal Study. J Contemp Dent Pract 2024;25(5):424-431.