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Scintigraphic and Histopathologic Evaluation of Combined Bone Grafts

Atilgan, Hasan Ikbal MD*; Demirel, Koray MD; Kankaya, Yuksel MD; Oktay, Murat MD§; Sahiner, Cem MD§; Korkmaz, Meliha MD; Koca, Gökhan MD; Kocer, Ugur MD; Kankaya, Duygu MD

doi: 10.1097/SCS.0b013e3182a24742
Original Articles

Objectives We aimed to assess various bone grafts on bone formation using bone scintigraphy and histology, especially the first study that evaluated the demineralized bone matrix (DBM) + tricalcium phosphate (TCP) + hyaluronic acid (HA) combination.

Materials and Methods A total of 44 pieces in groups of autogenous bone graft, TCP, DBM, DBM + TCP combination, and DBM + TCP + HA combination were applied to parietal bones of 24 New Zealand rabbits. Bone scintigraphies of the rabbits were performed at 2, 6, and 12 weeks. The uptake ratios were compared for the different types of grafts. In addition, in 2, 6, and 12 weeks, the graft areas were taken from the sacrificed rabbits and examined histologically.

Results In the 2-week evaluation, DBM + TCP combination and DBM + TCP + HA combination had more osteoblastic activity accumulation than the TCP and DBM groups. These findings supported that the DBM + TCP combination group showed new bone formation earlier in the histopathological evaluation. The DBM + TCP + HA combination had more uptake than the TCP and DBM groups on bone scintigraphy at 2 weeks, and this uptake ratio decreased in the following weeks. It was thought that the increased uptake in DBM + TCP + HA combination at 2 weeks was due to severe inflammation seen in the histopathological evaluation.

Conclusion The DBM + TCP + HA combination should not be used for graft repair, although it was thought to be a good combination in the early weeks.

From the *Ministry of Health Kahramanmaras Necip Fazil City Hospital, Division of Nuclear Medicine, Kahramanmaras; †Ministry of Health Ankara Training and Research Hospital, Department of Nuclear Medicine; ‡Ministry of Health Ankara Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara; §Duzce University Faculty of Medicine, Department of Pathology, Duzce; and ∥Ankara University Faculty of Medicine, Department of Pathology, Ankara, Turkey.

Received March 28, 2013.

Accepted for publication June 23, 2013.

Address correspondence and reprint requests to Dr Hasan Ikbal Atilgan, Division of Nuclear Medicine, Ministry of Health, Kahramanmaras Necip Fazıl City Hospital, Karacasu Mevki, 46050 Kahramanmaras, Turkey; E-mail:

The authors report no conflicts of interest.

© 2013 by Mutaz B. Habal, MD.