We will start with NovaBone in sockets. NovaBone is PerioGlas (bioactive glass) with an inert binder to make it more manageable. PerioGlas is the original bioglass 45S5 developed in the latter part of the last century and began clinical use in 1985. PerioGlas was introduced to the dental market in the 1990s. NovaBone is composed of calcium-phopho-silicate particulate (PerioGlas) and an absorbable binder of polyethylene glycol and glycerin. NovaBone coined the term osteostimulation and claims the product is
- “The only synthetic proven to signal genetic pathways to build strong bone fast.”
- “Capable of signaling and recruiting osteoprogenitor cells the “stem cells” for bone.”
- “The only bone graft substitute that controls the osteoblast cycle to favor proliferation and differentiation of bone-forming cells.”
Note that they claim that NovaBone stimulates the genetic pathway that builds strong bones fast, but they do not claim that NovaBone results in stimulating bone formation. Increasing the amount of bone produced is called stimulating osteogenesis, which requires a modification of the metabolic pathways that results in an increase in the amount of bone formed, which Novabone does not claim to do. If you take a culture of osteoblasts, preosteoblasts, or osteogenic stem cells that are deficient in calcium and phosphate, and you add elemental calcium and phosphate ions to the culture, you will “stimulate” the activity that NovaBone is claiming to stimulate. Without calcium and phosphate ions, the cellular process that makes bone cannot move forward, so adding calcium and phosphate simply allows cells to be “stimulated”. However, the normal human extracellular fluid is never deficient in calcium or phosphate ions and adding more does not result in more bone production.
While osteostimulation does not produce more bone, it does produce more sales. The problem with NovaBone claiming that it is osteostimulative by the release of calcium and phosphate ions is that the glass particles do not release relevant amounts of calcium and phosphate ions until bone forms around the particles and osteoclasts begin to resorb the particles as they release the ions. All resorbable bone graft granules will release calcium phosphate ions as they are resorbed, just like NovaBone, but because it does not result in more bone formation, no one else makes use of these marketing claims. If any graft materials should be considered to be osteostimulative, they would be SteinerBio bone grafts due to their composition. These bone grafts contain elemental calcium phosphate and calcium phosphate ions, which are incorporated into the bone during the process of bone formation (osteogenesis), not after bone has formed because then resorption of the particles have no value. However, lets allow the published research to determine what is marketing and what is science.