What is Demineralized Bone Matrix (DBM) putty?

Demineralized Bone Matrix (DBM) Putty: Composition and Clinical Applications

Demineralized Bone Matrix (DBM) putty is an osteoconductive and osteoinductive biomaterial derived from acid-extracted organic matrix of human bone, formulated into a moldable consistency for bone defect filling and regeneration. 1

Composition and Properties

DBM putty consists of:

• Main component: Acid-extracted organic matrix from human bone sources
• Retained elements:
  • Proteinaceous components native to bone (including growth factors)
  • Small amounts of calcium-based solids
  • Inorganic phosphates
  • Trace cell debris 1

The putty formulation is created by combining DBM with various biocompatible carriers to achieve a moldable consistency that:

• Facilitates handling during surgical procedures
• Allows for easy packing into bone defects
• Maintains position at the implantation site 2

Biological Mechanism of Action

DBM functions through two primary mechanisms:

1. Osteoconduction: Provides a scaffold for native bone cells to migrate and form new bone
2. Osteoinduction: Contains bone morphogenetic proteins (BMPs) and growth factors that stimulate the differentiation of mesenchymal stem cells into bone-forming osteoblasts 3

The osteoinductive properties are attributed to matrix-associated bone morphogenetic proteins (BMPs) and growth factors that are made bioavailable through the demineralization process. 3

Commercial Forms

DBM is commercially available in various forms:

• Putty
• Paste
• Sheets
• Flexible pieces
• Injectable formulations
• Paste infused with chips 1, 2

Clinical Applications

DBM putty is widely used in:

• Orthopedic surgery
• Neurosurgery
• Plastic surgery
• Dental and maxillofacial procedures 3

Specific applications include:

• Filling bone defects and cavities
• Socket preservation after tooth extraction
• Spinal fusion procedures
• Reconstruction of bone defects following trauma
• Filling voids after tumor resection 2, 4

Clinical Considerations

• Not for structural support: DBM does not provide significant mechanical strength and should not be used in load-bearing applications without additional support 3
• Variable clinical response: Results can vary due to differences in processing methods among bone banks and commercial suppliers 3
• Safety profile: Generally considered safe with a long clinical track record (over 500,000 bone grafting procedures with DBM are performed annually in the US) 3

Advantages and Limitations

Advantages:

• Readily available off-the-shelf
• Eliminates donor site morbidity associated with autografts
• Moldable consistency allows for easy handling and adaptation to defect sites
• Promotes bone healing through both osteoconductive and osteoinductive properties 2, 4

Limitations:

• Lacks mechanical strength for load-bearing applications
• Variable osteoinductive potential between different commercial preparations
• Cannot completely replace autologous bone grafting in all scenarios 3

Recent Developments

Recent research has focused on combining DBM with other materials such as calcium sulfate to create composite graft materials with improved properties:

• Enhanced mechanical strength
• Better handling characteristics
• Controlled resorption rates 5

These composite DBM materials show promise for expanding the clinical applications of DBM in orthopedic repair and regenerative medicine contexts.