Chitosan as Bone Scaffold and Graft Materials for Bone Regeneration: A Systematic Review

Chitosan is a natural biodegradable polymer made from crustacean exoskeletons (shrimp and crab). Recently, natural material is preferably used in order to prevent any side effects from synthetic material. Previous research showed that chitosan has anti-bacterial properties, which can act as a bone graft scaffold material to increase in bone regeneration process. This article discusses the antibacterial effect of chitosan in the bone regeneration process. Bone graft consists of many primary graft materials which focus on alloplastic graft composite type. Bone graft is related to bone regeneration which associated with the process of secondary/indirect bone healing. The main trait of bone graft material is that it is not toxic to the chitosan's host cell. Chitosan's anti-bacterial effects can be associated with one of the three phases of bone defect healing, which is inflammation phase that acts to prevent bacterial invasion as an infectious disease in bone injury. Because of this, it can accelerate the polarization of macrophage M1 (secrete pro-inflammatory cytokine) to macrophage M2 (secrete anti-inflammatory cytokine) that relates to osteoblastogenesis. Osteoblastogenesis relates to the increase of osteoblast synthesis, deposition and mineralization of extracellular matrix leading to the maturation of osteoblast become osteocyte called ossification process.