1. The Feasibility of Demineralized Bone Matrix for Craniofacial Contour Restoration: An Experimental Study
Tolga Eryilmaz*, Selahattin Ozmen*, Nese Lortlar**, Suna Omeroglu**, Suhan Ayhan*, Cemalettin Celebi*
Gazi University Faculty of Medicine, Ankara, Turkey
* Department of Plastic, Reconstructive and Aesthetic Surgery
** Department of Histology and Embryology
Nothing to Disclose

2. Objective
The histological behavior of DBM was investigated in different tissue planes to determine the proper application plane for restoration of craniofacial contour deformities

3. Materials and Methods 40 Wistar rats - 6 groups
At the eighth week half of the rats and at the sixteenth week the remaining rats were sacrificed in each group and tissue samples were harvested

4. Materials and Methods
0.3 cc of 0.9% saline into subperiosteal plane of cranium (1)
0.3 cc of DBM into subperiosteal plane of cranium (2)
0.3 cc of 0.9% saline into subdermal plane on the left inguinal region (3)

5. Materials and Methods
0.3 cc of DBM into subdermal plane on the right inguinal region (4)
0.3 cc of 0.9% saline between left external and internal oblique muscles (5)
0.3 cc of DBM between right external and internal oblique muscles (6)

6. Materials and Methods
Surgical procedures in Group 1 and 2 were performed on 10 different rats
In groups 3 to 6 both left and right sides were used to decrease the number of the animals used in the study

7. Results
Histological and immunohistochemical evaluation revealed new bone tissue and bone marrow formation in all planes, that DBM was given

8. *
While there was no difference found in macroscopic evaluation in Group 1, demineralized bone matrix was found to be a localized, firm, hard tissue in the subperiosteal plane in Group 2. (*): demineralized bone matrix

9. *
While there was no difference found in macroscopic evaluation in Group 3, demineralized bone matrix was found to be a localized, firm, hard tissue in the subdermal plane in Group 4. (*): demineralized bone matrix

10. * *
While there was no difference found in the left intermuscular plane (Group 5), demineralized bone matrix was found to be a localized, firm, hard tissue in the right intermuscular plane (Group 6). (*): demineralized bone matrix

11. A B
A. New bone tissue formation in the subperiosteal plane, at 8th week. B. New bone tissue formation in the subperiosteal plane, at 16th week. T: trabecular bone, C: collagen, P: periosteum, DBM: demineralized bone matrix, lc: lacuna, o: osteon, HC: Haversian channel (Hematoxylene – Eosine stain, x100)

12. A B
A. New bone tissue formation in the subdermal plane, at 8th week. B. New bone tissue formation in the subdermal plane, at 16th week. T : trabecular bone, S : spicular bone, o : osteon, HC : Haversian channel, lc : lacuna, BM : bone marrow, AT : adipose tissue (Hematoxylene – Eosine stain, x100)

13. A B
A. New bone tissue formation in the intermuscular plane, at 8th week. B. New bone tissue formation in the intermuscular plane, in the sixteenth week. T : trabecular bone, CB : compact bone, HC : Haversian channel, M : muscle, p : perimisium (Hematoxylene – Eosine stain, x100)

14. Immunohistochemical evaluation with CD 138 antibody revealed bone marrow formation, where demineralized bone matrix was given. T: trabecular bone, CB: compact bone, HC: Haversian channel, BM: bone marrow, (→): immune reactivity (CD138 stain, x100)

15. Conclusions
Demineralized bone matrix can provide satisfactory results in craniofacial contour deformities including forehead, temporal, mental, malar and perialar augmentations and saddle nose corrections, with supraperiosteal or deep subcutaneous applications
However, superficial applications must be avoided because of the possibility of palpation