Eficácia da hidroxiapatita sintética particulada na formação óssea: revisão sistemática e meta-análise
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Data
2022-06-15
Autores
Lara, Mariana
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Universidade Estadual Paulista (Unesp)
Resumo
Atualmente, a engenharia tecidual óssea tem buscado desenvolver biomateriais que tenham capacidade de promover o reparo tecidual em defeitos ósseos extensos. A hidroxiapatita sintética na forma particulada tem mostrado resultados promissores nesse processo, porém algumas dúvidas ainda surgem quanto a sua eficácia. O objetivo desta revisão sistemática e meta-análise foi avaliar a formação óssea em defeitos preenchidos com hidroxiapatita sintética (HA) na forma particulada em modelos animais. Além disso, investigou-se a influência dos parâmetros físicoquímicos da HA, incluindo o tamanho da partícula, porosidade, tamanho dos poros e cristalinidade, na formação óssea e taxa de reabsorção das partículas. Buscas eletrônicas nas bases de dados PubMed/MEDLINE, Embase, Web of Science e Scopus foram realizadas para publicações até maio de 2021. Todos os artigos incluídos eram estudos in vivo que relataram defeitos ósseos em animais preenchidos com HA pura sintética particulada. A formação óssea em defeitos ósseos preenchidos com HA em comparação com coágulos sanguíneos foi avaliada por meio da meta-análise de efeitos aleatórios. Além disso, o efeito do tamanho das partículas na formação óssea foi avaliado por meio da análise de meta-regressão. Cinquenta e seis estudos foram incluídos na análise qualitativa (revisão sistemática) e 2 estudos compuseram a meta-análise/meta-regressão. Os estudos incluídos mostraram formação óssea nos defeitos preenchidos com HA sintética particulada. Em comparação aos defeitos preenchidos com coágulo sanguíneo, a HA apresentou superioridade na formação óssea nas análises qualitativa e quantitativa. Partículas pequenas, principalmente em nanoescala (nano-HA), apresentaram maior taxa de reabsorção óssea e maior formação óssea na análise qualitativa. No entanto, nenhuma influência do tamanho das partículas na formação óssea foi demonstrada na análise de meta-regressão (considerando apenas três observações). Maior porosidade e tamanho dos poros parecem promover maior formação óssea nos defeitos preenchidos com HA. Em conclusão, as partículas de HA são osteocondutoras, proporcionando uma superfície para a formação de novo osso. Além disso, alterações nas propriedades físico-químicas da HA, incluindo tamanho de partícula, porosidade e tamanho dos poros, influenciam diretamente o resultado da formação de osso novo e as taxas de reabsorção.
Currently, bone tissue engineering has sought to develop biomaterials that are able to promote tissue repair in extensive bone defects. Synthetic hydroxyapatite in particulate form has shown promising results in this process, but some doubts still arise about its effectiveness. The aim of this systematic review and meta-analysis of animal studies was to evaluate the bone formation in defects filled with synthetic hydroxyapatite (HA) in particulate forms. Moreover, we identified the influence of HA particle size, porosity, pore size, and crystallinity in bone formation outcomes and particle resorption. Electronic searches in the PubMed/MEDLINE, Embase, Web of Science, and Scopus databases were conducted for publications up to May 2021. All articles were in vivo studies that reported bone defects filled with synthetic pure HA in particulate form in animals. The bone formation in bone defects filled with synthetic pure HA in comparison to blood clots was calculated using a random-effects model meta-analysis. Moreover, the effect of particle size on bone formation was evaluated with a meta-regression analysis. Fifty-six studies were included in the qualitative analysis (systematic review) and 2 studies composed the meta-analyses/metaregression. The studies included showed bone formation in defects filled with HA particles. In comparison to defects filled with a blood clot, the HA showed superiority in bone formation outcomes in qualitative and quantitative analysis. Small particles, mainly at the nanoscale (nano-HA), showed a higher rate of bone resorption and greater bone formation in qualitative analysis. However, no influence of particle size in bone formation was shown in meta-regression analysis (considering only three observations). Higher porosity and pore size seem to increase bone formation in defects filled with HA. In conclusion, the HA particles are osteoconductive, providing surfaces for new bone formation. Moreover, alterations in HA physicochemical properties including particle size, porosity, and pore size directly influence the outcome of new bone formation and resorption rates.
Currently, bone tissue engineering has sought to develop biomaterials that are able to promote tissue repair in extensive bone defects. Synthetic hydroxyapatite in particulate form has shown promising results in this process, but some doubts still arise about its effectiveness. The aim of this systematic review and meta-analysis of animal studies was to evaluate the bone formation in defects filled with synthetic hydroxyapatite (HA) in particulate forms. Moreover, we identified the influence of HA particle size, porosity, pore size, and crystallinity in bone formation outcomes and particle resorption. Electronic searches in the PubMed/MEDLINE, Embase, Web of Science, and Scopus databases were conducted for publications up to May 2021. All articles were in vivo studies that reported bone defects filled with synthetic pure HA in particulate form in animals. The bone formation in bone defects filled with synthetic pure HA in comparison to blood clots was calculated using a random-effects model meta-analysis. Moreover, the effect of particle size on bone formation was evaluated with a meta-regression analysis. Fifty-six studies were included in the qualitative analysis (systematic review) and 2 studies composed the meta-analyses/metaregression. The studies included showed bone formation in defects filled with HA particles. In comparison to defects filled with a blood clot, the HA showed superiority in bone formation outcomes in qualitative and quantitative analysis. Small particles, mainly at the nanoscale (nano-HA), showed a higher rate of bone resorption and greater bone formation in qualitative analysis. However, no influence of particle size in bone formation was shown in meta-regression analysis (considering only three observations). Higher porosity and pore size seem to increase bone formation in defects filled with HA. In conclusion, the HA particles are osteoconductive, providing surfaces for new bone formation. Moreover, alterations in HA physicochemical properties including particle size, porosity, and pore size directly influence the outcome of new bone formation and resorption rates.
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Palavras-chave
Durapatita, Osteogênese, Regeneração óssea, Durapatite, Osteogenesis, Bone regeneration