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Osteolytic changes accompanying degradation of absorbable fracture fixation implants.

We analysed the radiographs of 67 patients with displaced malleolar fractures treated by open reduction and internal fixation using absorbable polyglycolide rods. Seventeen patients developed a discharging inflammatory foreign-body reaction, a complication unique to these fixation devices. In 34 patients ovoid osteolytic foci, usually 5 to 10 mm in diameter, appeared within the implant channels six to 12 weeks after the operation. The same lesion occurred in 14 of the 17 patients who developed a foreign-body reaction, whereas only 20 out of the 50 patients with an uneventful course showed osteolytic areas (p less than 0.01). In patients with a foreign-body reaction the osteolytic foci tended to occur in the deepest parts of the implant channels. However, after one year the normal structure of the bone was restored.

Adult↗

Stress-absorbing elements in dental implants.

By means of finite element analysis, calculations, were made of the stress-distribution in bone around implants with and without stress-absorbing elements. A freestanding implant and an implant, it was concluded the variation in the E-modulus of the stress-absorbing element had no effect on the stresses in bone. Changing the shape of the stress-absorbing element had little effect on the stresses in cortical bone. For the implant connected with a natural tooth, it was concluded that a more uniform stress was obtained around the implant with a low E-modulus of the stress-absorbing element. It was also concluded that the bone surrounding the natural tooth showed a decrease in the height of the peak stresses.

Computer Simulation↗

Clinical experiences with a new maintenance-free shock absorbing element in titanium implants.

Until now, the biokinetic elements of one implant system were to be substituted once a year in order to prevent complications of fractures of fixation screws. In this article a new implant with a maintenance-free shock absorbing element was examined. During the last 6 years, 384 dental implants with a biokinetic element (mobile-implant, SIS Inc., Klagenfurt, Austria) were placed in 138 patients. The implants were loaded with prosthetic superstructures 4 months after implantation. For comparison, 160 patients were treated with 494 conventional titanium implants of the same design without biokinetic elements. All patients were examined radiologically and clinically. Periimplant probing depth, periimplant bleeding, Periotest-values (Siemens, Bensheim, Germany) at the time of prosthetic treatment and 3, 6, 9, 12, and 24 months after implant loading were registered. Implantation was successful in 97.2% of mobile-implants and 98% of conventional implants. There was a low degree of sulcus bleeding and high degree of physiological periimplant probing depths in both patients groups. In mobile-implants, the Periotest-values were positive and similar to that of the control. There was no difference between the values in the maxilla and mandible. In the group with conventional implants, the Periotest-values were negative and showed a low degree of negativity during the first 12 months after implant loading. Periotest-values in the upper jaw were higher than in the lower jaw. There was a lower degree of periimplant bone loss after implant loading in patients with mobile-implants. In conclusion, mobile-implants demonstrate the positive effects of implants with shock absorbing elements. They are maintenance free.

Alveolar Bone Loss↗

Bone formation in the goat maxillary sinus induced by absorbable collagen sponge implants impregnated with recombinant human bone morphogenetic protein-2.

This study assessed the efficacy, safety, and technical feasibility of inducing bone formation in an animal model of maxillary sinus floor augmentation using recombinant human bone morphogenetic protein-2 (rhBMP-2) impregnated on an absorbable collagen sponge (ACS). Bilateral antral maxillary sinus floor elevation procedures were surgically performed in six adult female Alpine-Saanen goats. Bone formation in response to the implant was evaluated using sequential radiographs, computerized tomography, and gross pathologic and histologic analysis performed at necropsy. Computerized tomographic scans documented nonosseous radiopacity in both sinuses postimplantation. Sinuses implanted with the rhBMP-2/ACS subsequently demonstrated increasing radiopacity local to the implant site, while radiopacity of the negative control sinuses remained unchanged or decreased. The results demonstrated the ability of an rhBMP-2/ACS implant to induce substantive new bone formation within the maxillary sinus of goats without adverse sequelae. The rhBMP-2/ACS composite implant may represent an acceptable alternative to traditional bone grafts and bone substitutes for maxillary sinus floor augmentation procedures in humans.

Animals↗

Tissue reactivity and degradation patterns of absorbable vascular ligating clips implanted in peritoneum and rectus fascia.

Absorbable vascular ligating clips are finding increasing use in intraabdominal surgery. We report the results of a light and scanning electron microscope investigation of the tissue reactivity and clip degradation patterns of two such materials, Absolok (polydioxanone) and Lactomer (copolymer of glycolic and lactic acid), implanted in the fascia and peritoneum of rabbits for intervals of 2 to 70 days. Cellular response to the clips, defined as the number of inflammatory cells/10(4) microns 2, was maximum at day 4 postimplantation, then gradually declined as the duration of implantation increased. This pattern, seen with both types of clips, was similar to that seen with polydioxanone (PDS) suture, but significantly greater than that associated with polypropylene (Prolene) suture. Although cellular response to the clips was greater in peritoneum than in fascia, especially on two occasions associated with adhesion formation, this was not statistically significant. Based on our morphological observations, the signs of clip degradation which were indicated by the appearance of surface crazing and cracks occurred earlier in peritoneum than in fascia.

Abdomen↗

[The role of plastic shock absorbers in dental implantation].

The mechanical behaviour of different plastics (PE, PP, PI, PA, ABS, POM) was examined by static and dynamic loading. Detection of microdeformations and photoelastic stress analysis served as the examination method. According to the results, polyethylene is unsuitable, however the other plastics, with clauses, are suitable as shock absorbers. Apart from the mechanical investigation photoelastic stress analysis also revealed the benefit of osseointegration in force transmission to the bone.

Dental Implants↗

[The dynamics of energy and metabolic exchange in kidneys after the new absorbable surgical sutures "Biophil" implantation].

The influence of a new surgical absorbable material Biofil on the energetical metabolism processes, contents and ratio of the nucleic acids in the operated kidney tissue was studied in experiment. The oxidizing phosphorylation inhibition, the RNA content and RNA/DNA coefficient lowering were noted on the 14th day after the catgut thread application in a sutured tissues. The phosphorilizing respiration activation, the respiration control and RNA synthesis rising were promoted by biofil application. It had a significance for stimulation of regeneration processes in kidneys and for more early restoration of their function.

Animals↗

[Implantation of UV-absorbing posterior chamber lenses].

The authors report on their experience with UV-absorbent posterior chamber IOLs (ORC) implanted between April 1, 1984 and April 1, 1985 (n = 125). Short-term complications and in particular post-operative sterile uveitis, corresponded to those in a group (n = 135) who had had regular PMMA lenses implanted. While no significant lowering of glare perception could be proved after implantation of the UV-block-lenses, color perception seemed to be more correct with these lenses. Because of the short observation time no significant statements can be made regarding the frequency of cystoid macular edema.

Aged↗

Economic considerations on avoiding implant removals after fracture fixation by using absorbable devices.

Pins and screws for internal fracture fixation made of absorbable polymers have been available since the latter half of the 1980s. When using these implants there is no need for a subsequent implant removal operation. During the 7-year period 1985-1991, a total of 1219 patients were treated with such absorbable fixation devices, the most common indications being displaced malleolar fractures of the ankle and fractures of the radial head. Considering the economic viewpoints, the high acquisition costs of the absorbable implants partially outweighed the benefit of avoiding all removal procedures. When all costs also for the implant removal procedure after metallic fixation were included, the average cost saved per patient by using absorbable implants in a trimalleolar fracture was FIM 2023 (4.4% of the total costs). However, the removal of metallic devices is in fact to some degree optional, and in case the metallic implants were not removed, the economic result was in favor of the metallic devices by FIM 3684 per patient. Consequently, the ultimate economic audit of the use of absorbable vs. metallic devices is linearly dependent on the actual implant removal frequency. According to the present cost analysis, the break-even point would be attained at a removal rate of 65% in trimalleolar ankle fractures, at 51% in uni-and bimalleolar fractures and at 30% in fractures of the radial head. Only at a higher removal rate the introduction of absorbable devices would be a financially more favorable alternative.

Bone Nails↗

Conventional spiral and low-dose computed mandibular tomography for dental implant planning.

Absorbed doses to radiosensitive organs in the head and neck from pre-implant conventional hypocycloidal, conventional spiral and computed tomography (CT) were measured with thermoluminescent dosimeters in an anthropomorphic phantom head. From conventional tomography organ doses, except to the major salivary glands, were below 0.2 mGy. They were considerably higher with CT than conventional tomography. Tomographic images of posterior lower jaw regions were evaluated regarding measurement reliability in conventional spiral tomograms. Observers measured the distance marginal crest-mandibular canal, marked their measuring points and estimated the length of an intended Brånemark implant. The variability between observers, mainly due to the intra-observer variation, decreased with multiple readings and optimized image quality. The suggested implant length was the same as the one inserted in 70% of the cases. Tomographic images from mandibular body segments were used to test the influence of radiation exposure and scanning mode on image quality in CT and compare the quality of the CT images with that in conventional spiral tomograms. Mandibular canal and marginal bone crest visibility was unaffected by radiation dose in CT examinations. Differences among CT scanning modes and between CT and conventional spiral tomography were highly significant. Frontal CT scans or conventional spiral tomograms were preferred. In cross-sectional images of the posterior lower jaw image quality in conventional spiral and reformatted CT at 40 mAs and 80 mAs was compared. Observers graded the acceptability of images for implant planning and traced the contours of the mandibular body and canal. Conventional, spiral tomograms were subjectively preferred over reformatted CT images. Differences between CT images at different mAs settings were not statistically significant. The mandibular canal was more frequently untraceable in high-dose CT. The use of tomography for dental implant planning was studied by means of a survey among oral radiology clinics in Sweden and implantology clinics in other countries. It was used by 93.4% but varied markedly between and within anatomic regions. CT was used by 73%. Radiation doses varied considerably within and between different CT brands. The availability rather than the clinical need strongly influenced the choice of technique. From the point of view of radiation dose and information necessary for implant planning conventional spiral tomography is to be preferred over reformatted CT. However, when CT is the only technique at hand, it can be performed with a lower than standard mA-setting.

Artifacts↗

Non-penetrating glaucoma surgery using AquaFlow(TM)collagen implants.

AquaFlow TM is an absorbable collagen implant for use in non-penetrating surgery for primary open angle glaucoma. Its purpose is to facilitate drainage of fluid from the eye, thereby reducing intraocular pressure. AquaFlow TM is approved for use in Canada in medically refractory cases of primary open angle glaucoma. Non-penetrating glaucoma surgery with the AquaFlow TM implant appears to be a relatively safe procedure. However, there is a steep learning curve for the surgeon and it is initially associated with a high rate of conversion to conventional surgery during the operation. Limited evidence from small non-randomized trials suggests that the AquaFlow TM implant may offer benefits over conventional surgical approaches in terms of reduced complication rates, reduced medication use, an earlier return of improved vision and sustained control of intraocular pressure. However, the efficacy and cost-effectiveness of this approach have not been established. January, 2001 for use in patients with uncontrolled

Canada↗

Absorbable mesh in placement of temporary implants.

PURPOSE: To evaluate absorbable mesh for the suturing of afterloading catheters in patients with tumors involving the chest wall. METHODS AND MATERIALS: Patients underwent thoracotomy and resection of tumor; a layer of absorbable mesh was then sutured to the tumor bed. Nylon flexiguide afterloading catheters were sutured into the mesh at about 1.5 cm distance from each other. A second layer of mesh was then sutured on top of the catheters. The chest wall was closed. Orthogonal radiographs and CT scans of the area of implants were done to verify catheter position in each patient on day 1 and on the last day of implant. Computer dosimetry by digitization of dummy sources was performed on each set of radiographs. The same seed for both sets of films was chosen as the origin of digitization. All seed coordinates were compared directly to offset for any rotation of the patient during the two sets of films. The distances were calculated from all seed positions to the origin, then tabulated and compared. RESULTS: The distances agreed within a few millimeters (7-8 mm). The differences may be attributed to the patient's breathing and to the localization uncertainty. The resulting dose alteration was negligible. CONCLUSION: This technique appears to provide adequate anchorage of catheters with resulting constant seed position and dose distribution in areas of scant tissues or in surgical beds of considerable size.

Aged↗

[Absorbable self-reinforced biomaterials used for fracture fixation implants].

A series of absorbable polymers used for osteosynthesis implants are introduced in this review. To reduce the degradation rate and increase the strength of them, some methods, such as self-reinforced or coating with other polymers, have been presented. Some clinical and animal's experiments have been discussed.

Absorbable Implants↗

Absorbed dose determination for tomographic implant site assessment techniques.

A set of data to compare the absorbed dose delivered by tomographic implant site assessment techniques was generated. Absorbed doses were measured in fourteen anatomic sites from (1) computed tomography scans and (2) a series of tomographic cuts performed on a linear tomography unit. The doses to the thyroid gland, the active bone marrow, the brain, the salivary glands, and the eyes were determined with the use of a tissue-equivalent phantom with lithium fluoride thermoluminescent dosimeters at the appropriate locations.

Absorption↗

Tissue-implant interface at an absorbable fracture fixation plug made of polylactide in cancellous bone of distal rabbit femur.

The tissue-implant interface at a self-reinforced poly-L-lactide (SR-PLLA) expansion plug implanted in distal rabbit femoral cancellous bone was studied histologically, histomorphometrically, and microradiographically in 35 rabbits during consolidation of a transverse transcondylar osteotomy fixed with the SR-PLLA expansion plug. The absorbable plug for internal fixation of fractures and osteotomies measured 4.5 mm in diameter and 30 mm in length and had an expandable distal locking blade system. The femoral specimens were harvested in groups of 5-10 rabbits after a follow-up time of 3, 6, 12, and 24 weeks. The intact contralateral femur served as a control. Vigorous osteogenic response to the implant was already observed at 3 weeks postoperatively, and the osteoid surface fraction at 24 weeks was still significantly higher than in the unoperated contralateral femur. Incomplete union of the osteotomy seemed to result in increased fibrous tissue formation at the tissue-implant boundary. No signs of degradation of the SR-PLLA was observed within the entire follow-up period. The number of inflammatory cells at the tissue-implant interface was low. Consequently, the short-term biocompatibility of the implant was deemed acceptable. Clinical application of the expansion plug is being planned.

Animals↗

Comparison of bioabsorbable and bioinert membranes for guided bone regeneration around non-submerged implants. An experimental study in the mongrel dog.

The aim of this clinical investigation was to evaluate the effect of guided bone regeneration around non-submerged implants using different barrier membranes. Five adult mongrel dogs were used in this investigation. After having all premolars extracted and implant osteotomies performed in the regions of the former premolars, buccal bone defects were created. Subsequently, 3 implants were placed and the defects treated with 1 of the following 3 modalities: a) guided bone regeneration using an expanded polytetrafluoroethylene membrane, b) guided bone regeneration using a bioabsorbable membrane made from a synthetic copolymer of glycolide and lactide and c) no membrane application. Following implant and membrane placement, the mucoperiosteal flaps were repositioned and tightly sutured around the neck of the implants allowing for a non-submerged healing. After a healing period of 6 months, the animals were sacrificed and the specimens processed for histologic evaluation. The clinical pre-treatment defects between the different treatment groups were not statistically different (bioinert membrane group: 4.9 mm; control group: 4.8 mm; bioabsorbable membrane group: 4.5 mm). The remaining histological defects after 6 months of healing amounted to approximately 2.5 mm in the bioinert membrane group, 5.7 mm in the control group and 6.0 mm in the bioabsorbable membrane group. A significant difference was observed between the bioinert membrane group and the other 2 groups. The mineralized bone-to-implant contact in the bioinert membrane group was 51.5%, in the control group 46.3% and in the bioabsorbable membrane group 37.5%. The values between the bioinert membrane group and the bioabsorbable membrane group were statistically different. The results of this study indicate that bone regeneration with bioinert e-PTFE membranes around non-submerged implants is possible. The utilized absorbable polyglycolic/polylactid membrane did not show any bone regenerative effect and the results did not differ from the control group without membrane application.

Absorbable Implants↗

A gelatin coated collagen-polyglycolic acid composite membrane as a dural substitute.

We designed a new biodegradable composite membrane for use as a dural substitute. This membrane is composed of polyglycolic acid (PGA) mesh, collagen sponge, and gelatin sponge. Collagen layers are attached on both sides of the PGA mesh. One side of the membrane is coated with freeze-dried gelatin to prevent tissue adhesion. We examined the mechanical properties of the membrane and evaluated its efficacy in vivo by implanting it into dogs. When the mechanical properties of the membrane were measured under wet conditions, tensile strength and resistance against cutting by a suture were approximately 20 N/cm and 13 N, respectively, which are adequate for a surgical material. In the in vivo experiment, our dural substitute was implanted into six adult beagle dogs to repair a 25 x 15 mm defect in the dura mater. Two dogs each were killed at 2 and 4 months after implantation and two were observed over 6 months. At 4 months after implantation, the implanted dural substitute was almost absorbed and a fibrous membrane resembling native host dura had regenerated at the site. No foreign body reaction or significant adhesion to the cerebral cortex was observed. These results indicate the clinical potential of our novel dural substitute.

Absorbable Implants↗