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J Oral Maxillofac Surg. 2014 May;72(5):1000.e1-11. doi: 10.1016/j.joms.2014.01.017. Epub 2014 Jan 31.

Bone tissue engineering by way of allograft revitalization: mechanistic and mechanical investigations using a porcine model.

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Resident, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Medical Student, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Resident, Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA.
Resident, Department of Surgery, Medical University of South Carolina, Charleston, SC.
Attending Surgeon, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Attending Surgeon, Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address:



"Allograft revitalization" is a process in which cadaveric bone is used to generate well-vascularized living bone. We had previously found that porcine allograft hemimandibles filled with autologous adipose-derived stem cells (ASCs) and recombinant human bone morphogenetic protein-2-soaked absorbable collagen sponge (rhBMP-2/ACS) were completely replaced by vascularized bone, provided the construct had been incubated within a periosteal envelope. The present study sought to deepen our understanding of allograft revitalization by investigating the individual contributions of ASCs and rhBMP-2 in the process and the mechanical properties of the revitalized allograft.


Porcine allograft hemimandible constructs were implanted bilaterally into rib periosteal envelopes in 8 pigs. To examine the contributions of ASCs and rhBMP-2, the following groups were assessed: group 1, periosteum alone; group 2, periosteum+ASCs; group 3, periosteum+rhBMP-2/ACS; and group 4, periosteum+ASCs+rhBMP-2/ACS. After 8 weeks, the allograft constructs were harvested for micro-computed tomography (CT) and histologic analyses and 3-point bending to assess the strength.


On harvesting, the constructs receiving rhBMP-2/ACS had significantly greater bone shown by micro-CT than those receiving periosteum only (51,463 vs. 34,310 mm3; P = .031). The constructs receiving ASCs had increased bone compared to group 1 (periosteum only), although not significantly (P = .087). The combination of rhBMP-2/ACS with ASCs produced bone (50,399 mm3) equivalent to that of the constructs containing rhBMP-2/ACS only. The 3-point bending tests showed no differences between the 4 groups and a nonimplanted allograft or native mandible (P = .586), suggesting the absence of decreased strength of the allograft bone when revitalized.


These data have shown that rhBMP-2/ACS significantly stimulates new bone formation by way of allograft revitalization and that the revitalized allograft has equivalent mechanical strength to native bone.

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