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At least 595 records · Page 33Linked to original sources

PubMed1996

Geometry of porous hydroxyapatite implants influences osteogenesis in baboons (Papio ursinus).

Coral-derived porous hydroxyapatite disks of two geometric configurations were implanted in 16 calvarial defects, 25 mm in diameter, prepared in eight subadult male baboons (Papio ursinus). To determine whether the orientation of the exoskeletal microstructures (corallites) influences bone ingrowth and osteogenesis, hydroxyapatite disks were prepared by cutting the coral either longitudinally or transversally, to obtain two distinct implant geometries defined by the orientation of the corallites. In the same animals, 16 defects were left untreated to assess the regeneration potential of the subadult baboon calvaria. Disks of both geometric configurations were also implanted in heterotopic intramuscular sites to investigate their osteoinductive potential. Histomorphometric analysis on undecalcified and decalcified sections prepared from specimens harvested on day 90 after surgery showed that greater amounts of bone formed in porous hydroxyapatites cut in the longitudinal plane when compared with hydroxyapatites cut in the transversal plane (p < 0.01). Bone formed in hydroxyapatite specimens harvested from the intramuscular sites, but no difference in bone formation was found between the two geometric configurations. Untreated defects showed limited osteogenesis, comparable with a previous series of untreated defects identically prepared in adult baboon calvariae. This finding suggests that skeletally mature, adult primates may not be a requirement for evaluation of craniofacial bone substitutes. These results in a primate indicate that hydroxyapatite disks are able to induce bone differentiation when implanted in intramuscular sites, and that the geometric configuration of the porous hydroxyapatite influences bone ingrowth and osteogenesis in orthotopic calvarial sites. This should be taken into consideration when designing porous bone substitutes for craniofacial applications.

Age Factors↗

PubMed2006

Synthetic, pure-phase beta-tricalcium phosphate ceramic granules (Cerasorb) for bone regeneration in the reconstructive surgery of the jaws.

The aim of this study was to investigate the long-term effect of the ceramic beta-tricalcium phosphate (beta-TCP) at different sites of alveolar reconstruction and to evaluate its properties. From 1997 to 2002, beta-TCP was implanted as bone substitute in 152 patients using a standardized study protocol. Main indications were the filling of large mandibular cysts (n=52), secondary and tertiary alveolar cleft grafting (n=38), periodontal defects (n=24) and maxillary sinus floor augmentation (n=16). For defects exceeding 2cm in diameter, beta-TCP was combined with autologous bone taken from the retromolar area, the maxillary tuberosity or the chin region. A radiological, clinical and ultrasonographical examination was carried out 4, 12 and 52 weeks postoperative. In 16 cases, biopsies were taken after 12 months indicating complete bony regeneration. While wound-healing disturbances occurred in 9.2% of cases, partial loss of the bone substitute material was found in 5.9%, while total loss occurred in only 2%. Complete radiological replacement of beta-TCP by autologous bone was found after approximately 12 months, indicating its osteoconductive properties. Because of its versatility, low complication rate and good long-term results, synthetic, pure-phase beta-TCP is a suitable material for the filling of bone defects in the alveolar region.

Adolescent↗

PubMed2003

Synthesis of bioactive organic-inorganic nanohybrid for bone repair through sol-gel processing.

So-called bioactive ceramics have been attractive because they form bone-like apatite on their surfaces to bond directly to living bone when implanted in bony defects. However, they are much more brittle and much less flexible than natural bone. Organic-inorganic hybrids consisting of flexible organic polymers and the essential constituents of the bioactive ceramics (i.e., Si-OH groups and Ca2+ ions) are useful as novel bone substitutes, because of their bioactivity and mechanical properties analogous to those of natural bone. In the present study, organic-inorganic nanohybrids were synthesized from hydroxyethylmethacrylate (HEMA) and methacryloxypropyltrimethoxysilane (MPS), as well as various calcium salts. Bioactivity of the synthesized hybrids was assessed in vitro by examining their acceptance of apatite deposition in simulated body fluid (Kokubo solution). The prepared hybrids formed apatite in Kokubo solution when they were modified with calcium chloride (CaCl2) at 5 or 10 mol% of the total of MPS and HEMA. Deposition of a kind of calcium phosphate was observed for the hybrids modified with calcium acetate (Ca(CH3COO)2), although it could not be identified with apatite. The addition of glycerol up to 10 mol% of the total of MPS and HEMA or water up to 20 mol% as plasticizers did not appreciably decrease the acceptance of apatite formation of the hybrids. These findings allow wide selectivity in the design of bioactive nanohybrids developed by organic modification of the Si-OH group and calcium ion through sol-gel processing. Such nanohybrids have potential as novel bone substitutes with both high bioactivity and high flexibility.

Animals↗

PubMed2005

Primary stability of anterior lumbar stabilization: interdependence of implant type and endplate retention or removal.

This is a comparative in vitro biomechanical study of the primary stability of an anterior lumbar interbody stabilization. The objective was to compare the stability of a interbody stabilizing titanium cage with and without the retention of the bordering vertebral endplates, as well as to compare the titanium cage with a tricalcium phosphate block when the endplates are removed. An adequate blood supply is critical for interbody fusion, which suggests surgical treatment of the bordering endplates. On the other hand, primary stability is improved by the retention of the endplates. Furthermore, bone substitute materials are finding more frequent use due to complications associated with autologous bone grafts. Ten bovine lumbar spine motion segments (average age 6 months) were investigated. Pure bending loadings as well as eccentric axial compression loadings were applied. A titanium cage and tricalcium phosphate block, were tested in conjunction with an anterior augmentation (MACS). Range of motion, neutral zone (NZ) and bending stiffness were measured under pure bending to 10 Nm, and bending stiffness under axial loads of up to 1,500 N. Range of motion of both implants in flexion-extension was significantly smaller than physiologic (cage without endplates 4.3 degrees , cage with 2.8 degrees , block without 3.4 degrees , and physiologic 6.6 degrees , all p<0.001). The cage with endplates and the block without endplates were both significantly stiffer than physiologic in all directions except left lateral bending. The block without endplates and the cage with endplates were both stiffer than the cage without endplates. The results suggest that the use of the bone substitute block provides better stability than the cage when the endplates are removed.

Animals↗

PubMed1988

Tricalcium phosphate as a bone graft substitute in trauma: preliminary report.

Ceramic tricalcium phosphate (TCP) has been implanted in bony defects in 43 patients following trauma. It is an osteoconductive material that facilitates trabecular bone formation. The average follow-up time was 12 months, with a 6-month minimum. There were 33 fractures in 30 patients and 13 nonunions in 13 patients. Three of the patients with acute fractures were unavailable for follow-up observation. Ninety percent of the fractures and 85% of the nonunions were healed at the time of this review. The resorption of TCP was estimated from the roentgenograms to be approximately 10% per month, with complete resorption occurring in 6-24 months. There were eight complications, five among the 30 fractures and three among the 13 nonunions that were observed later. There were three fractures and two nonunions that failed to heal. There were two fractures that had initially been open and one previously infected nonunion that united but were complicated due to infection. These preliminary results demonstrate TCP's usefulness as a substitute for cancellous bone. This is accompanied by other advantages, including increased patient safety, lack of donor site morbidity, unlimited shelf life and reduced operating time.

Adolescent↗

PubMed2005

Porous single-phase NiTi processed under Ca reducing vapor for use as a bone graft substitute.

Porous nickel-titanium alloys (NiTi, nitinol) have recently attracted attention in clinical surgery because they are a very interesting alternative to the more brittle and less machinable conventional porous Ca-based ceramics. The main remaining limitations come from the chemical homogeneity of the as-processed porous nickel-titanium alloys, which always contain undesired secondary Ti- and Ni-rich phases. These are known to weaken the NiTi products, to favor their cavitation corrosion and to decrease their biocompatibility. Elemental nickel must also be avoided because it could give rise to several adverse tissue reactions. Therefore, the synthesis of porous single-phase NiTi alloys by using a basic single-step sintering procedure is an important step towards the processing of safe implant materials. The sintering process used in this work is based on a vapor phase calciothermic reduction operating during the NiTi compound formation. The as-processed porous nickel-titanium microstructure is single-phase and shows a uniformly open pore distribution with porosity of about 53% and pore diameters in the range 20-100 microm. Furthermore, due to the process, fine CaO layers grow on the NiTi outer and inner surfaces, acting as possible promoting agents for the ingrowth of bone cells at the implantation site.

Alloys↗

PubMed1995

Madreporic coral for cranial base reconstruction. 8 years experience.

The authors, since 1985, have used 587 Madreporic Coral grafts as bone substitute in a total of 183 patients, among them in 80 cases for repair of cranial base bone defects. They report their long-term results. Partial resorption to about 40% of the initial volume occurred in almost all cases within 8 to 10 months, with complete resorption after about one year. 20% of the coral blocks moved spontaneously or split into pieces, but could easily be withdrawn rhinoscopically through the nostrils. No CSF leakage was noticed afterwards. The local infection rate was only 4%, always close to the basal coral graft. This is lower than the infection rate after using autologous bone harvested from the inner table of the bone flap (20%). Infections were cured by removal of the coral graft. Despite the mentioned draw backs, Madreporic Coral graft implants can be recommended as bone substitute in cranial base surgery: 1. The material simplifies the surgical procedure; 2. Harvesting of autologous bone is no longer necessary; 3. Transmission of infections like AIDS, Hepatitis C or Creutzfeld-Jacob-disease can be avoided with certainty.

Biocompatible Materials↗

PubMed1998

Cranioplasty performed with a new osteoconductive osteoinducing hydroxyapatite-derived material.

OBJECT: Cranioplasty is required to protect underlying brain, correct major aesthetic deformities, or both. The ideal material for this purpose is autogenous bone. When this is not available, alloplastic or artificial materials may be used. These materials should be malleable, strong, lightweight, inert, noncarcinogenic, nonferromagnetic, and, if possible, inexpensive. The authors reviewed their surgical experience with a new bone substitute and discuss outcomes in patients in whom it was used. METHODS: The 11 patients presented in this series had bone defects resulting from bone-involving tumor (eight cases), trauma (two cases), or aesthetic deformity due to repeated craniotomies (one case). The defects were repaired using Osprogel, a bone substitute that consists of calcium hydroxyapatite combined with synthetic, human bone-derived gelatin, glycerol, and water. Osprogel is not only a bioinert material but also an osteoconductive and osteoinducing substrate; when it is placed in contact with healthy cancellous bone, it induces osteogenesis and angiogenesis, thus permitting the regrowth of nearly normal bone. The sheet of Osprogel was modeled onto the cranial defect intraoperatively and was kept in place either by using a titanium micronet secured to surrounding bone with microscrews (first two cases) or by using a single- or double-layer titanium mesh secured with stitches. No complications due to the procedure were observed. The results, evaluated at least 6 months after surgery by using three-dimensional (3-D) reconstructed computerized tomography scans, were excellent in seven patients, good in three, and fair in one. In the patient with a fair result, the repair was unsatisfactory because there was lack of experience in using the material. In part of the area to be repaired, the Osprogel was used as filler; here it was washed out and resorbed. The cases deemed as having a good result had good bone replacement; however, the curvature was faulty. CONCLUSIONS: In the near future, this technique may be refined to achieve good or excellent results either without the use of supporting material or with the use of individual, computer-designed 3-D prostheses.

Adult↗

PubMed2007

Development of a new calcium phosphate powder-binder system for the 3D printing of patient specific implants.

A key requirement for three-dimensional printing (3-DP) of medical implants is the availability of printable and biocompatible powder-binder systems. In this study we developed a powder mixture comprising tetracalcium phosphate (TTCP) as reactive component and beta-tricalcium phosphate (beta-TCP) or calcium sulfate as biodegradable fillers, which can be printed with an aqueous citric acid solution. The potential of this material combination was demonstrated printing various devices with intersecting channels and filigree structures. Two post-processing procedures, a sintering and a polymer infiltration process were established to substantially improve the mechanical properties of the printed devices. Preliminary examinations on relevant application properties including in vitro cytocompatibility testing indicate that the new powder-binder system represents an efficient approach to patient specific ceramic bone substitutes and scaffolds for bone tissue engineering.

3T3 Cells↗

PubMed2005

Ectopic bone formation by microporous calcium phosphate ceramic particles in sheep muscles.

Calcium phosphate ceramics are widely used in bone reconstructive surgery because of their osteconductive properties. However, these materials generally lack osteoinductive properties required to support bone healing in large defects. In this article, we study the osteoinductive potential of calcium phosphate ceramic particles implanted for 6 months into the dorsal muscles of eight adult female sheep. Microporous biphasic calcium phosphate (MBCP) granules of 1-2 mm composed of hydroxyapatite and beta-tricalcium phosphate (60/40) had macropores of 450 microm, micropores of 0.43 microm, and a specific surface area of 1.8 m(2)/g. After 6 months in the back muscles of sheep, the explants composed of MBCP granules were hard and encapsulated by normal muscle tissue. Ectopic bone formation with Haversian structures was observed in close contact with the MBCP granules in histological sections. Back-scattered electron microscopy and micro-computed tomography indicated that approximately 10% of well-mineralized bone with mature osteocytes had formed between or upon the granules. The ectopic bone showed trabeculae bridging the MBCP granules. Both the number and thickness of the trabeculae formed between the MBCP particles were comparable to those measured in spongious bone. The overall results therefore confirmed the presence of mature bone after intramuscular implantation of MBCP granules. The different hypotheses explaining ectopic bone formation induced by MBCP granules are discussed. Synthetic bone substitutes with osteoinductive properties could be used in bone reconstructive surgery.

Animals↗

PubMed2004

Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: a radiological study with a new evaluation system.

The capacity of two forms of porous beta-tricalcium phosphate bone substitutes (TCP) to promote bone healing in open wedge high tibial osteotomy (OWHTO) was studied. We reviewed the X-rays of 27 osteotomies, with either TCP wedges or TCP granules as filling material, to compare the bone healing rates and bone remodelling, at specific postoperative intervals. A new radiologic rating system for OWHTO was created and tested for clinical applicability. All osteotomies healed uneventfully and complete resorption of TCP was demonstrated at 1 year postoperative in 85% (n = 23) of the procedures. In 44% (n = 10) of these 23 procedures, the osteotomy site was no longer visible. No difference in bone healing rate and bone remodelling was found when comparing the use of granules to a wedge, and no adverse effects of TCP were observed. The good inter- (k = 0.7) and intraobserver (k = 0.6) reliability of the new radiologic rating system enables clinical use. Good bone healing was found in OWHTO with both wedges and granules of TCP.

Adult↗

PubMed2002

Natural and artificial chitosan-inorganic composites.

Taking inspiration from many chitin-inorganic composites in nature, a number of recent articles throw light on the manufacture of such composites based on calcium carbonate, calcium phosphate and silica. These novel materials are important in the field of blood-compatible materials, bone substitutes, and cements for bone repair and reconstruction. This approach provides an attractive alternative to the processing of inorganic thin films, especially in applications where substrates cannot be exposed to high temperatures.

Animals↗

PubMedDate not supplied

Experimentally induced peri-implantitis: a review of different treatment methods described in the literature.

The aim of this article was to present the experimental peri-implantitis models described in the literature and to provide a review of currently used treatment methods. For this purpose, 29 English- and German-language studies published in internationally reviewed journals were examined for similarities and differences regarding animal models, types of implants, and methods used for inducing peri-implantitis. In almost all studies, the implants were located in the mandible, which suggests that peri-implantitis of the maxilla has been researched very little. While in most studies, peri-implantitis was induced by means of ligature and plaque accumulation, only 3 studies have been published that attempted to induce peri-implantitis by means of mechanical overload. Of the latter, only one author observed peri-implant bone resorption. Eleven studies reporting on ligature-induced peri-implantitis presented enough data to be subjected to further statistical data analyses. Meta-analysis revealed that the period of ligature application, and thus the duration of plaque accumulation, generally had no influence on the resultant depth of the bone defect. However, when screw-type and cylindric implants were analyzed separately, a weakly significant positive effect of the duration of ligature application on the resultant defect depth was determined for cylindric implants (P = .092). This could imply that smooth screw-type implants were less susceptible to ligature-induced peri-implant inflammation. Regenerative treatment methods included the membrane technique using non-resorbable membranes (guided bone regeneration), augmentation with autogenous bone, augmentation with bone substitute materials (hydroxyapatite or demineralized freeze-dried bone) or with recombinant human bone morphogenetic protein-2, and a combination of membrane and augmentation procedures. While all described methods resulted in acceptable bone gain, it seems to be difficult to achieve new osseointegration (reosseointegration) of treated implants. Of all tested treatment methods, the combination of guided bone regeneration and augmentation with demineralized freeze-dried bone resulted in the most favorable results regarding bone gain and reosseointegration.

Animals↗

PubMed1996

Demineralized bone matrix supplied by bone banks for a carrier of recombinant human bone morphogenetic protein (rhBMP-2): a substitute for autogeneic bone grafts.

Four commercially available preparations of demineralized freeze-dried human bone powders (DFDB) were investigated for endogenous bone morphogenetic protein (BMP) as observed by osteoinductive activity. Composites of DFDB without and with 1 microgram or 10 micrograms of recombinant human bone morphogenetic protein-2 (rhBMP-2) were implanted into the hindquarter muscles of Swiss-Webster mice. The four batches of DFDB without rhBMP-2 were placed also in hindquarter muscles of athymic mice. Three weeks after implantation, the area of induced bone and cartilage formation was measured by radiographic and histomorphometric methods. In normal mice, without rhBMP-2, DFDB implants induced development of dense fibrous connective tissue with minimal, if any, new bone. In athymic mice, DFDB induced development of small patches of appositional new bone. In contrast, in normal mice, composites of DFDB and rhBMP-2 induced development of large areas of heterotopic bone and bone marrow formation. The bone morphogenetic response occurred with a statistically significant difference (p < 0.0001) between implants of 1 microgram and the 10-microgram rhBMP-2 composites. Thus, DFDB from all four bone banks demonstrated comparable capacity to serve as a carrier for rhBMP-2.

Analysis of Variance↗

PubMed2003

Noninvasive bone replacement with a new injectable calcium phosphate biomaterial.

The use of injectable calcium phosphate (CaP) biomaterials in noninvasive surgery should provide efficient bone colonization and implantation. Two different kinds of injectable biomaterials are presently under development: ionic hydraulic bone cements that harden in vivo after injection, and an association of biphasic calcium phosphate (BCP) ceramic granules and a water-soluble polymer vehicle (a technique particularly investigated by our group), providing an injectable CaP bone substitute (IBS). In our study, we compared these two approaches, using physicochemical characterizations and in vivo evaluations in light microscopy, scanning electron microscopy, and three-dimensional microtomography with synchrotron technology. Three weeks after implantation in rabbit bone, both biomaterials showed perfect biocompatibility and bioactivity, but new bone formation and degradation of the biomaterial were significantly greater for BCP granules than for ionic cement. Newly formed bone developed, binding the BCP granules together, whereas new bone grew only on the surface of the cement, which remained dense, with no obvious degradation 3 weeks after implantation. This study confirms that BCP granules carried by a cellulosic polymer conserve bioactivity and are conducive to earlier and more extensive bone substitution than a carbonated-hydroxyapatite bone cement. The presence of intergranular spaces in the BCP preparation, as shown on microtomography imaging, seems particularly favorable, allowing body fluids to reach each BCP granule immediately after implantation. Thus, the IBS functions as a completely interconnected ceramic with total open macroporosity. This new bone replacement approach should facilitate microinvasive bone surgery and local delivery of bone therapy agents.

Animals↗

PubMed1996

Sinus grafting related to implantology. Statistical analysis of 15 years of surgical experience (1979-1994).

Sinus cavities are often a major obstacle to the placement of dental implants in the posterior maxilla, especially when early tooth loss has occurred. Several grafting procedures aimed at reducing the expanded volume of these pneumatic cavities have been routinely utilized since 1979. Essentially, these techniques have consisted of recreating the necessary viable bone volume at the floor of sinus cavities by placing different bone substitute materials to allow for the insertion of endosseous implant devices. The progress achieved in the refinement of the surgical procedures and the knowledge acquired in the field of patient screening and selection, choice of biomaterials, management of complications, etc., have made sinus graft surgery highly codified and predictable. A comprehensive statistical study by multifactorial procedures was carried out to establish a Burt Contingency Chart. This chart visualizes the frequencies of all the "modality combinations" among the selected "qualitative parameters" and, by a " factorial analysis", the "multiple correlations", so that the "statistical affinities" that may exist among the same variables can be determined. This critical study endeavors to search for and reveal the favorable clinical, biologic and scientific parameters necessary for the success of sinus graft surgery on short-, medium-, and long-term bases (more than nine years). It is a particularly homogenous study, since all the operative procedures have been carried out exclusively by the author under standardized conditions. The wide variety of biomaterials utilized by the author since 1979 shows the development of bone substitute biomaterials as they have been introduced into the market during the past 15 years. The large number of patients treated, the variety of grafting materials, the important success rate obtained, and the long duration of patient follow-up have been instrumental in enabling us to establish scientifically significant results. Autogenous bone and its combinations with calcium- and phosphorus-containing biomaterials remain undoubtedly the best all-purpose biomaterials. The synthetic biomaterials have their own specific indications according to their stable (non-resorbable) or unstable (resorbable) nature and their rates of metabolic "turnover". Differently treated bones from the tissue bank (if not contaminated or immunologically questionable) behave in a fashion not unlike autogenous bone. Root-form implants are by far the best implants in the reconstructed sinus sites, while other implant types (subperiosteal implants, etc.) inserted beneath the reinforced osseous sinus floor, buccal wall, and pyramidal process, also have their indications.

Adult↗

PubMed2006

Accelerated degradation and improved bone-bonding ability of hydroxyapatite ceramics by the addition of glass.

Dense hydroxyapatite (HA) ceramics are useful bone substitutes, but they degrade minimally. One solution is to incorporate degradable materials in the HA. In this study, we manufactured glass-containing HA and investigated whether the degradability and bone-bonding ability of the HA were improved. The glass-containing HA was manufactured from a mixture of HA powder and 1.0 wt% glass powder. The control HA was manufactured from pure HA powder. In vitro degradability was evaluated by soaking in physiological saline, and a rabbit model was used to evaluate in vivo degradability and bone-bonding ability. Detaching tests were performed for all removed samples to quantify bone-bonding ability of each type of HA. The glass-containing HA showed higher degradability than the control HA, both in vitro and in vivo. The detaching failure load of the glass-containing HA was rapidly elevated after implantation and was higher than that of the control HA. Our results suggest that the dissolution of the added glass made the glass-containing HA degradable and that the detaching failure load of the glass-containing HA was elevated by reinforcement of the mechanical locking at the roughened interface. Incorporation of glass additives into HA can be concluded to be a good candidate for producing a bone substitute that can partially degrade and bond to bone firmly and rapidly.

Absorbable Implants↗

PubMed2006

Bone functions and the requirements for bone grafts and substitutes in the orofacial region.

Bone is the largest calcium storage, has distinctive plasticity and adaptability and is part of the supporting tissue. An adequate composition is thus necessary. The bone matrix consists of organic and anorganic structures. Osteoblasts, osteoclasts and osteocytes are responsible for bone formation, resorption and metabolism. The periosteum, endosteum and bone tissue are a functional unit and provide protection, nutrition and growth. Bone is subject to continuous remodelling.

Bone Remodeling↗