Bioinert endosteal implants cause a foreign body reaction, whereas bioactive ones cause osseointegration. However, the mechanisms responsible for the two modi of host response remain unclear. COX-2(-/-) animal models showed the dependence of osseointegration on prostaglandins. PGE2, a product of COX-2, augments Wnt signalling, a pathway that promotes the regeneration in many types of tissues. Recently, we demonstrated the ability of bioactive implants to recruit neutrophils and to trigger neutrophil extracellular traps (NETs), which are a potent source of PGE2. In bioinert implants no PGE2 release has been ascertained. Collectively, these findings suggest that osseointegration might be the host response to bioactive implants, novel and quite different to the so-called foreign body reaction.
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