New possibilities of contouring in the repair of skull bones (literature review)

Purpose of the study: to analyze and systematize the modern possibilities of contouring in the repair of cranial bones based on the literature data. Material and methods . Scientific articles in PubMed, eLibrary, Scopus, Medscape, and Cyberleninka databases were analyzed by keywords “repair”, “skull bones”, “contouring”, “implant”, “autograft”, “alloimplant”, “cell-free regenerative technologies”, “microvesicles” over the past 15 years. Data from 95 foreign and 47 domestic articles were selected on the topic under consideration. Results . Based on a review of the literature on the topic under study, it was found that despite enormous efforts to develop alternatives to autografts, no ideal bone graft substitute has been created. The surgeon must know the individual properties of each bone graft substitute in order to apply it correctly to a particular patient. The main synthetic bone substitutes consist of hydroxyapatite, tricalcium phosphate, calcium sulfate or a combination of these minerals, they have a number of advantages over allografts, including unlimited supply, ease of sterilization and storage. However, they also have disadvantages, such as fragility, different resorption rates, and low efficacy in some clinical cases. Recently, osteoinductive materials, such as demineralized bone matrix (DCM) and bone morphogenetic proteins, have attracted attention, but polymer and biocomposite matrices today seem to be the most promising materials in comparison with DCM. Special attention in the development of new types of matrices is paid to the possibility of fixation of osteogenic factors and targeted pharmaceutical substances on a carrier material for their controlled and prolonged release at the surgical implantation site. The use of composite carriers of various compositions in vivo demonstrates high rates of osteogenesis, promotes the launch of biomineralization and allows varying the rate of degradation of the material. Conclusion . Currently, the operating surgeon has a wide range of materials for performing plastic surgery of a bone defect of the skull using auto-, allo- or xenografts. Each of these options has its own strengths and weaknesses, and the choice of material and method of implantation should be decided individually for each patient. Scientists associate great prospects with the creation of bioactive skeletal materials with fixed osteogenic factors that are released directly in the area of the bone defect and accelerate regeneration. The development of this technology will allow cell-free regenerative medicine to cross the boundary of laboratory research on the replacement of bone defects and enter clinical use.