A bone graft material is used to promote bone regeneration. A good bone graft material needs
to present osteo-conduction, for the osteoblast and osteoclast cells to penetrate and move
through the whole graft matrix, osteo-induction to stimulate the bone formation process (by
recruiting cells, stimulating their development, etc), and osteo-integration to be a part of the
formed bone [1].
nanOss is made from synthetic nano-structured hydroxyapatite (HA). It comes in three different
forms: nanOss Bioactive comes in granulates and contains a collagen extracellular matrix
scaffold used to absorb the bone marrow upon introduction in the body, nanOss Bioactive
Loaded is the same as the latter but comes inside a syringe for immediate use, and nanOss
Bioactive 3D granules form a three-dimensional porous porcine gelatin matrix [2]. These are
mainly applied as bone grafts in spinal fusion surgeries, where they are used (along with bone
marrow aspirate and autograft bone) to fill the voids between the vertebrae, serving as a
scaffold for bone in-growth [2].
Advantages of this biomaterial are its high surface area, porosity, synthetic nature, meaning
there is residual risk of disease transmission to the patient, a high process control, allowing
construction of structures similar to bone in size, shape (Fig.1) and composition (Ca/P), which
leads to a high osteoconductivity [1,2].
The success rate is high (93%) according to the manufaturers [2], due to a similar performance
to bone [3]. It was compared with micro sized hydroxyapatite in an in vitro study, where results
showed the same levels of osteoblast and osteoclast activity [3,4] as bone, as opposed to micro
HA. Additionally nano HA showed more resorption and larger resorption pits [3], explained by its
high porosity and surface area characteristics. Other studies measured the surface area (61
m2/g [3]) and (75 m2 /g [5]), which can be more than 300 times higher than other biomaterials
like synthetic Actifuse (0.25 m2 /g [5]), or even MinerOss (0.27 m2/g). In this in vivo study of
spinal fusion in a rabbit [5], results showed “nanOss Bioactive produced 3x as much new bone
as the Actifuse and twice as much as Autograft control” (Hill R.S. et al), on account of the
surface area, porosity and surface texture provided by nanOss, these being its principal
advantages.
A clinical study comparing the use of Vitoss and nanOss [6] in patients undergoing cervical
fusions disclosed 0% infection with nanOss compared with the 2.7% of Vitoss, which, even
though the number of patients of each material surgery cohort were different, further confirms
nanOss’ biocompatibility [7] and capacity of decreasing implant infection [3,4]. It was observed
[4] that nano dimension materials have the capacity of “improving bacteria and biofilm
penetration, generating reactive oxygen species, and killing bacteria” (Taylor et al).
A disadvantage is that this material cannot be used on its own due to a lack of mechanical
strength to support loads felt by bone [2], so it must be used in conjunction with standard
internal fixation techniques (plates and/or screws) [2], despite revealing the best mechanical
strength and stiffness compared with actifuse and autograft [5]. Another concern related with
nanomaterials in general, is their potential toxicity to their surrounding environment in
unpredictable ways [4], for example, carbon nanotubes were found to decrease bacteria activity
to the point of potentially diminishing microbial diversity, with unknown consequences [4]. So,
nanomaterials such as nanOss might influence the microorganisms inside the human body,
which needs to be thoroughly studied for a safer use of this material.
InterOss is a xenogeneic graft made from natural hydroxyapatite derived from Australia bovine
cancellous bone [8]. It exists in the form of small (0.25-1 mm) or large (1-2 mm) granules [8]. It
is called ‘anorganic’ because it goes through a purification process including chemical treatment
and calcination steps, to extract all organic content that could potentially transmit diseases [1].
This material is used in oral and dental surgeries to fill bone defects (alveolar ridge, periodontal
defects, maxillary sinus floor, etc) [8] for bone reconstruction.
Advantages of this material include high inner surface area, as measured in a characterization
study that compared InterOss (surface area = 88 m2/g [9]) with Bio-Oss (surface area = 70
m2/g [9]), the most widely used xenograft material [10], which is a similar bovine derived bone
graft. In this study micropore and mesopore size were measured [9], confirming InterOss’ high
porosity, which makes it osteoconductive. Due to this high porosity, InterOss produced more
than twice bone formation after 8 and 12 weeks, left less residual graft, but also lower bone
density compared with Bio-Oss in an animal pre-clinical study [11]. These were promising
results confirming InterOss’ potential as a xenograft.
Disadvantages include InterOss’ (1.57 [9]) calcium/phosphorus ratio lower and more distant
from bone (1.67 [9]), than the BioOss (1.62 [9]). Also, the use of this material showed
inflammation [11] for several weeks, but without necrosis.
to present osteo-conduction, for the osteoblast and osteoclast cells to penetrate and move
through the whole graft matrix, osteo-induction to stimulate the bone formation process (by
recruiting cells, stimulating their development, etc), and osteo-integration to be a part of the
formed bone [1].
nanOss is made from synthetic nano-structured hydroxyapatite (HA). It comes in three different
forms: nanOss Bioactive comes in granulates and contains a collagen extracellular matrix
scaffold used to absorb the bone marrow upon introduction in the body, nanOss Bioactive
Loaded is the same as the latter but comes inside a syringe for immediate use, and nanOss
Bioactive 3D granules form a three-dimensional porous porcine gelatin matrix [2]. These are
mainly applied as bone grafts in spinal fusion surgeries, where they are used (along with bone
marrow aspirate and autograft bone) to fill the voids between the vertebrae, serving as a
scaffold for bone in-growth [2].
Advantages of this biomaterial are its high surface area, porosity, synthetic nature, meaning
there is residual risk of disease transmission to the patient, a high process control, allowing
construction of structures similar to bone in size, shape (Fig.1) and composition (Ca/P), which
leads to a high osteoconductivity [1,2].
The success rate is high (93%) according to the manufaturers [2], due to a similar performance
to bone [3]. It was compared with micro sized hydroxyapatite in an in vitro study, where results
showed the same levels of osteoblast and osteoclast activity [3,4] as bone, as opposed to micro
HA. Additionally nano HA showed more resorption and larger resorption pits [3], explained by its
high porosity and surface area characteristics. Other studies measured the surface area (61
m2/g [3]) and (75 m2 /g [5]), which can be more than 300 times higher than other biomaterials
like synthetic Actifuse (0.25 m2 /g [5]), or even MinerOss (0.27 m2/g). In this in vivo study of
spinal fusion in a rabbit [5], results showed “nanOss Bioactive produced 3x as much new bone
as the Actifuse and twice as much as Autograft control” (Hill R.S. et al), on account of the
surface area, porosity and surface texture provided by nanOss, these being its principal
advantages.
A clinical study comparing the use of Vitoss and nanOss [6] in patients undergoing cervical
fusions disclosed 0% infection with nanOss compared with the 2.7% of Vitoss, which, even
though the number of patients of each material surgery cohort were different, further confirms
nanOss’ biocompatibility [7] and capacity of decreasing implant infection [3,4]. It was observed
[4] that nano dimension materials have the capacity of “improving bacteria and biofilm
penetration, generating reactive oxygen species, and killing bacteria” (Taylor et al).
A disadvantage is that this material cannot be used on its own due to a lack of mechanical
strength to support loads felt by bone [2], so it must be used in conjunction with standard
internal fixation techniques (plates and/or screws) [2], despite revealing the best mechanical
strength and stiffness compared with actifuse and autograft [5]. Another concern related with
nanomaterials in general, is their potential toxicity to their surrounding environment in
unpredictable ways [4], for example, carbon nanotubes were found to decrease bacteria activity
to the point of potentially diminishing microbial diversity, with unknown consequences [4]. So,
nanomaterials such as nanOss might influence the microorganisms inside the human body,
which needs to be thoroughly studied for a safer use of this material.
InterOss is a xenogeneic graft made from natural hydroxyapatite derived from Australia bovine
cancellous bone [8]. It exists in the form of small (0.25-1 mm) or large (1-2 mm) granules [8]. It
is called ‘anorganic’ because it goes through a purification process including chemical treatment
and calcination steps, to extract all organic content that could potentially transmit diseases [1].
This material is used in oral and dental surgeries to fill bone defects (alveolar ridge, periodontal
defects, maxillary sinus floor, etc) [8] for bone reconstruction.
Advantages of this material include high inner surface area, as measured in a characterization
study that compared InterOss (surface area = 88 m2/g [9]) with Bio-Oss (surface area = 70
m2/g [9]), the most widely used xenograft material [10], which is a similar bovine derived bone
graft. In this study micropore and mesopore size were measured [9], confirming InterOss’ high
porosity, which makes it osteoconductive. Due to this high porosity, InterOss produced more
than twice bone formation after 8 and 12 weeks, left less residual graft, but also lower bone
density compared with Bio-Oss in an animal pre-clinical study [11]. These were promising
results confirming InterOss’ potential as a xenograft.
Disadvantages include InterOss’ (1.57 [9]) calcium/phosphorus ratio lower and more distant
from bone (1.67 [9]), than the BioOss (1.62 [9]). Also, the use of this material showed
inflammation [11] for several weeks, but without necrosis.
