What is Demineralized Bone Matrix?
Demineralized bone matrix (DBM) is an osteoinductive graft material prepared from human or animal bones through an acid extraction process. This process removes the mineral component of bone while leaving the collagen matrix intact. The collagen matrix contains inherent growth factors such as bone morphogenetic proteins (BMPs) that induce cellular differentiation and new bone formation.

How is DBM Processed and Prepared?
DBM is prepared through an acid extraction process that removes the mineral portion of bone while retaining the collagen-based organic components. Typically, the bone is cleaned, cut into small pieces, and demineralized in an acid solution such as hydrochloric acid. This extraction process removes inorganic mineral salts like hydroxyapatite, leaving behind an acellular, collagen-based material. The resulting putty or gel is then lyophilized into a powder or moldable putty form for usage as a graft material. The demineralization process allows the graft to be readily resorbed and replaced by new bone growth.

The Role of Growth Factors in Bone Formation
One of the major components retained in Demineralized Bone Matrix are bone morphogenetic proteins, or BMPs. These are growth factors that play a key role in bone formation by stimulating osteoblast differentiation and activity. During the remodeling and fracture healing process, BMPs recruit mesenchymal stem cells to the site and initiate their differentiation down the osteoblastic lineage. This promotes new bone formation through recruitment, proliferation, and differentiation of these cells. BMPs have been shown to induce all phases of bone regeneration including inflammation, soft callus formation, hard callus formation, and bone remodeling. Their presence in DBM makes it osteoinductive, allowing it to initiate new bone formation in places where it is placed in the body.

How is DBM Used in Bone Grafting Procedures?
DBM finds clinical application as a bone grafting material, commonly used in spinal fusions, foot and ankle surgeries, orthopaedic traumas and reconstructive procedures. It acts as a scaffolding material that helps repairs bones or joins bones. DBM initiates the bone healing cascade through its osteoinductive properties. When implanted, it activates local stem cells and triggers new bone ingrowth. Due to its collagenous structure, DBM also serves as a scaffold for cellular attachment, migration, and proliferation. Most commonly, DBM is mixed with autogenous bone graft to enhance new bone formation. It helps extend the limited supply of autogenous bone graft while maintaining the osteoconductive and osteoinductive properties required for optimal bone healing.

Research on DBM Efficacy and Characteristics
Considerable research has been done to characterize the clinical performance of DBM and validate its efficacy as a bone graft substitute. Studies have demonstrated comparable fusion rates when autogenous bone is extended or replaced with DBM in spinal fusion procedures. Reviews have found high fusion rates ranging from 86-95% when using DBM alone or mixed with autogenous bone. Comparative studies show equivalent or better outcomes with DBM compared to autogenous bone for treating non-union fractures and defects. Additional research looks at variables like donor age, processing methods, preparation forms and other factors that can influence DBM osteoinductivity, resorption properties, and clinical outcomes. Overall, DBM has proven effective for promoting new bone formation and is widely used to augment limited autograft supplies in an array of orthopaedic procedures.

Advantages of Using Demineralized Bone Matrix
- Osteoinductive - contains inherent BMPs and growth factors that stimulate bone growth
- Osteoconductive - collagen scaffold promotes cellular attachment, migration and new bone ingrowth
- Readily available and avoids donor site morbidity of autograft harvest
- Cost-effective alternative to replace or extend limited autograft volumes
- Versatile - can be used in multiple forms like strips, plates, morsels or as a putty or gel
- Clinically proven to be effective for fusion and repairing bony defects
- Well-tolerated and resorbed as new bone forms, similar to natural bone graft

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