Effects of occlusiveness of a titanium cap on bone generation beyond the skeletal envelope in the rabbit calvarium

We evaluate the effects of occlusiveness of a titanium cap on bone generation beyond the skeletal envelope. In eight rabbits, the calvarial bone was exposed and a circular groove was prepared with a trephine drill. After marrow penetration, a standardized hemispherical titanium cap, either with or without small holes (1.5 mm in diameter), was then placed into the bone and covered by a cutaneous flap. After 1 month or 3 months of healing, the animals were euthanized and examined histologically. The percentage area of newly generated tissue consisting of mineralized bone and marrow spaces in each section was calculated relative to the area bounded by the hemispherical shape of the titanium cap and the parent bone; this latter volume was taken to be 100%. Furthermore, the cross-sectional areas of generated mineralized bone expressed as percentages of the total tissue area generated within each space were determined. In the 1-month specimens, there was no statistically significant difference between the two caps in the amount of tissue generated, 54.7%+/-12.2% with holes vs. 60.4%+/-8.8% without holes (p = 0.225). However, in the 3-month specimens, we observed a significant difference between the caps (55.9%+/-7.4% with holes vs. 89.9%+/-6.5% without holes, P<0.05). Also, there was a statistically significant difference between 1- and 3-month specimens in the amount of tissue generated under the cap without holes (60.4%+/-8.8% vs. 89.9%+/-6.5%, P<0.05). Although there was no significant difference in the relative amount of mineralized bone generated between the caps with holes and those without holes in the 1-month specimens (27.7%+/-4.8% vs. 30.8%+/-6.4%, P=0.225), there was a statistically significant difference between the two caps in the 3-month specimens (24.3%+/-4.1% with holes vs. 34.0%+/-8.6% without holes, P<0.05). A substantial ingrowth of fibrous connective tissue through the holes appeared to prevent further new tissue generation in a defined area adjacent to the bone surface. We concluded that total occlusiveness, sufficient stiffness of the cap, as well as the passage of time will allow predictable mineralized bone augmentation to occur in spaces beyond the skeletal envelope.