title: Strategies for stimulation of new bone formation: a critical review.
abstract: Large bone defects, congenital or caused by diseases, trauma or surgery, do not heal spontaneously and are usually a clinical challenge in the orthopedic and dental practices. A critical review concerning strategies to substitute lost bone or stimulate osteogenesis was undertaken. Pivotal concepts ranging from traditional bone grafting and use of biomaterials to local application of growth factors and gene therapy were addressed, including critical comments on the efficacy and safety, difficulties, advantages and disadvantages of each method. The most predictable results are still obtained with autogenous bone graft, despite the inconveniences of morbidity and limited availability of graft material. Satisfactory results have been reported for recombinant bone morphogenetic proteins (rhBMPs)-2 and -7, which distinguish for their osteoinductive property, the difficulty being the need for a degradable carrier that allows its continuous release in a rate compatible to that of new bone formation. Other bone growth factors are currently under evaluation in preclinical models of bone defects; however their efficacy is also dependent on the competence of a delivery strategy and on an appropriate delineation of "which one", "which dose" and "when". Parameters of efficiency and safety for gene therapy are still being established. In conclusion, given the variety of growth factors involved in the complex cascade of bone repair and the biological interactions between them, it remains a challenge to accomplish the ideal strategy to stimulate reparational bone formation in specific conditions of the medical as in the dental practices.
authors.affiliation: Department of Morphology, Stomatology and Physiology, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Juliana Alves
authors.initials: JA
authors.lastname: Peres
authors.forename: Teresa
authors.initials: T
authors.lastname: Lamano
mesh_terms: D001672:Biocompatible Materials / Q000627:therapeutic use; D001847:Bone Diseases / Q000601:surgery*; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation; D015316:Genetic Therapy; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use; D010012:Osteogenesis / Q000502:physiology*
chemical_list: D001672:Biocompatible Materials; D018786:Bone Substitutes; D036341:Intercellular Signaling Peptides and Proteins