Comparison of the Pullout Strength of Different Pedicle Screw Designs and Augmentation Techniques in an Osteoporotic Bone Model.

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Kiyak, Gorkem; Balikci, Tevfik; Heydar, Ahmed Majid; Bezer, Murat

2018-02-01

Mechanical study. To compare the pullout strength of different screw designs and augmentation techniques in an osteoporotic bone model. Adequate bone screw pullout strength is a common problem among osteoporotic patients. Various screw designs and augmentation techniques have been developed to improve the biomechanical characteristics of the bone-screw interface. Polyurethane blocks were used to mimic human osteoporotic cancellous bone, and six different screw designs were tested. Five standard and expandable screws without augmentation, eight expandable screws with polymethylmethacrylate (PMMA) or calcium phosphate augmentation, and distal cannulated screws with PMMA and calcium phosphate augmentation were tested. Mechanical tests were performed on 10 unused new screws of each group. Screws with or without augmentation were inserted in a block that was held in a fixture frame, and a longitudinal extraction force was applied to the screw head at a loading rate of 5 mm/min. Maximum load was recorded in a load displacement curve. The peak pullout force of all tested screws with or without augmentation was significantly greater than that of the standard pedicle screw. The greatest pullout force was observed with 40-mm expandable pedicle screws with four fins and PMMA augmentation. Augmented distal cannulated screws did not have a greater peak pullout force than nonaugmented expandable screws. PMMA augmentation provided a greater peak pullout force than calcium phosphate augmentation. Expandable pedicle screws had greater peak pullout forces than standard pedicle screws and had the advantage of augmentation with either PMMA or calcium phosphate cement. Although calcium phosphate cement is biodegradable, osteoconductive, and nonexothermic, PMMA provided a significantly greater peak pullout force. PMMA-augmented expandable 40-mm four-fin pedicle screws had the greatest peak pullout force.

21 CFR 888.3027 - Polymethylmethacrylate (PMMA) bone cement.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Polymethylmethacrylate (PMMA) bone cement. 888... Polymethylmethacrylate (PMMA) bone cement. (a) Identification. Polymethylmethacrylate (PMMA) bone cement is a device...: Polymethylmethacrylate (PMMA) Bone Cement.” [67 FR 46855, July 17, 2002] ...

Low-modulus PMMA bone cement modified with castor oil.

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López, Alejandro; Hoess, Andreas; Thersleff, Thomas; Ott, Marjam; Engqvist, Håkan; Persson, Cecilia

2011-01-01

Some of the current clinical and biomechanical data suggest that vertebroplasty causes the development of adjacent vertebral fractures shortly after augmentation. These findings have been attributed to high injection volumes as well as high Young's moduli of PMMA bone cements compared to that of the osteoporotic cancellous bone. The aim of this study was to evaluate the use of castor oil as a plasticizer for PMMA bone cements. The Young's modulus, yield strength, maximum polymerization temperature, doughing time, setting time and the complex viscosity curves during curing, were determined. The cytotoxicity of the materials extracts was assessed on cells of an osteoblast-like cell line. The addition of up to 12 wt% castor oil decreased yield strength from 88 to 15 MPa, Young's modulus from 1500 to 446 MPa and maximum polymerization temperature from 41.3 to 25.6°C, without affecting the setting time. However, castor oil seemed to interfere with the polymerization reaction, giving a negative effect on cell viability in a worst-case scenario.

Augmented reality in bone tumour resection: An experimental study.

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Cho, H S; Park, Y K; Gupta, S; Yoon, C; Han, I; Kim, H-S; Choi, H; Hong, J

2017-03-01

We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model. We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice. The mean error of 164 resections in 82 femurs in the AR group was 1.71 mm (0 to 6). The mean error of 82 resections in 41 femurs in the conventional resection group was 2.64 mm (0 to 11) (p Augmented reality in bone tumour resection: An experimental study. Bone Joint Res 2017;6:137-143. © 2017 Cho et al.

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model.

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Osterhoff, Georg; Dodd, Andrew E; Unno, Florence; Wong, Angus; Amiri, Shahram; Lefaivre, Kelly A; Guy, Pierre

2016-11-01

Sacroiliac screw fixation in elderly patients with pelvic fractures is prone to failure owing to impaired bone quality. Cement augmentation has been proposed as a possible solution, because in other anatomic areas this has been shown to reduce screw loosening. However, to our knowledge, this has not been evaluated for sacroiliac screws. We investigated the potential biomechanical benefit of cement augmentation of sacroiliac screw fixation in a cadaver model of osteoporotic bone, specifically with respect to screw loosening, construct survival, and fracture-site motion. Standardized complete sacral ala fractures with intact posterior ligaments in combination with ipsilateral upper and lower pubic rami fractures were created in osteoporotic cadaver pelves and stabilized by three fixation techniques: sacroiliac (n = 5) with sacroiliac screws in S1 and S2, cemented (n = 5) with addition of cement augmentation, and transsacral (n = 5) with a single transsacral screw in S1. A cyclic loading protocol was applied with torque (1.5 Nm) and increasing axial force (250-750 N). Screw loosening, construct survival, and sacral fracture-site motion were measured by optoelectric motion tracking. A sample-size calculation revealed five samples per group to be required to achieve a power of 0.80 to detect 50% reduction in screw loosening. Screw motion in relation to the sacrum during loading with 250 N/1.5 Nm was not different among the three groups (sacroiliac: 1.2 mm, range, 0.6-1.9; cemented: 0.7 mm, range, 0.5-1.3; transsacral: 1.1 mm, range, 0.6-2.3) (p = 0.940). Screw subsidence was less in the cemented group (3.0 mm, range, 1.2-3.7) compared with the sacroiliac (5.7 mm, range, 4.7-10.4) or transsacral group (5.6 mm, range, 3.8-10.5) (p = 0.031). There was no difference with the numbers available in the median number of cycles needed until failure; this was 2921 cycles (range, 2586-5450) in the cemented group, 2570 cycles (range, 2500-5107) for the sacroiliac specimens, and

Nanofunctionalized zirconia and barium sulfate particles as bone cement additives

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Riaz Gillani

2009-12-01

Full Text Available Riaz Gillani1, Batur Ercan1, Alex Qiao3, Thomas J Webster1,21Division of Engineering, 2Department of Orthopaedics, Brown University, Providence, RI, USA; 3G3 Technology Innovations, LLC, Pittsford, NY, USAAbstract: Zirconia (ZrO2 and barium sulfate (BaSO4 particles were introduced into a methyl methacrylate monomer (MMA solution with polymethyl methacrylate (PMMA beads during polymerization to develop the following novel bone cements: bone cements with unfunctionalized ZrO2 micron particles, bone cements with unfunctionalized ZrO2 nanoparticles, bone cements with ZrO2 nanoparticles functionalized with 3-(trimethoxysilylpropyl methacrylate (TMS, bone cements with unfunctionalized BaSO4 micron particles, bone cements with unfunctionalized BaSO4 nanoparticles, and bone cements with BaSO4 nanoparticles functionalized with TMS. Results demonstrated that in vitro osteoblast (bone-forming cell densities were greater on bone cements containing BaSO4 ceramic particles after four hours compared to control unmodified bone cements. Osteoblast densities were also greater on bone cements containing all of the ceramic particles after 24 hours compared to unmodified bone cements, particularly those bone cements containing nanofunctionalized ceramic particles. Bone cements containing ceramic particles demonstrated significantly altered mechanical properties; specifically, under tensile loading, plain bone cements and bone cements containing unfunctionalized ceramic particles exhibited brittle failure modes whereas bone cements containing nanofunctionalized ceramic particles exhibited plastic failure modes. Finally, all bone cements containing ceramic particles possessed greater radio-opacity than unmodified bone cements. In summary, the results of this study demonstrated a positive impact on the properties of traditional bone cements for orthopedic applications with the addition of unfunctionalized and TMS functionalized ceramic nanoparticles

An experimental study of domestic bone cement used on percutaneous vertebroplasty

International Nuclear Information System (INIS)

Chen Long; Ni Caifang; Ding Yi; Liu Yizhi; Jin Yonghai; Zou Jianwei; Yang Huilin; Tang Tiansi; Wang Yijin

2004-01-01

Objective: To evaluate the material properties of domestic bone cement (DBC) and imported bone cement (IBC) with different mixing ratio, and to determine whether the biomechanical properties of vertebral bodies (VBs) subjected to compression fractures and subsequently treated by vertebroplasty with DBC or IBC were different. Methods: There were two groups in this study. One was DBC, whose ratio of powder/liquid (g/ml) was 3:2 and the percentage of BaSO 4 in powder was 20%, the other was IBC, whose mixing ratio followed manufacturer's recommendation. Polymerization time, strength, and stiffness of bone cement were measured respectively in each group. 20 lumbar VBs from four female cadavers (age, 75 ± 5 years) were disarticulated and compressed in a materials testing machine to determine initial strength and stiffness. The fractures were subsequently repaired using DBCor IBCon vertebroplasty. After augmentation, the VBs were scanned by CT, then recrushed, and stiffness and strength of VBs were measured again. Results: The stiffness of DBC whose mixing ratio was altered was (2711.8 ± 612.3) N/mm, while the stiffness of IBC was (2874.7 ± 457.6) N/mm, there was no significant differences between the two groups (t=0.609, P>0.05). But the strength of DBC (7271.3 ± 365.4) N was lower than that of IBC (8481.3 ± 397.3) N, (t=6.281, P 0.05), while the strength of VBs augmentated with DBC and IBC were(1.226 ± 0.44) MPa and (1.202 ± 0.38) Mpa, respectively (F=0.001, P>0.05). CT value of DBC and IBC used on VBs were (2982.9 ± 102.0) Hu and (1554.3 ± 172.7) HU, respectively, and there was significant differences in radiopacity between them (t=22.525, P<0.05). Conclusion: DBC has an excellent radiopacity. VBs augmented by both DBC or IBC could attain satisfactory biomechanical properties, but these results have yet to be substantiated in clinical studies. (authors)

Cement augmentation in the proximal femur to prevent stem subsidence in revision hip arthroplasty with Paprosky type II/IIIa defects

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Shang-Wen Tsai

2018-06-01

Full Text Available Background: Subsidence remains a common complication after revision hip arthroplasty which may lead to prolonged weight-bearing restrictions, leg-length discrepancies or considerable loss of function. We evaluated the effectiveness of cement augmentation in the proximal femoral metaphysis during a revision of femoral components to prevent post-operative stem subsidence. Methods: Forty patients were enrolled. Follow-up averaged 67.7 months (range: 24–149. Twenty-seven patients had a Paprosky type II defect and 13 had a type IIIa defect. All revision hip arthroplasty used a cementless, cylindrical, non-modular cobalt–chromium stem. The defect in the metaphysis was filled with antibiotic-loaded bone cement. Thirteen patients who had undergone stem revision only was allowed to walk immediately without weight-bearing restrictions. Twenty-seven patients who had undergone revision total hip arthroplasty was allowed partial weight-bearing within 6 weeks after surgery in the consideration of acetabular reconstruction. Results: Three patients (7.5% had post-surgery stem subsidences of three mm, five mm, and 10 mm, respectively, at three, one, and 14 months. There were no acute surgical site infections. There were three femoral stem failures: two delayed infections and one periprosthetic Vancouver B2 fracture. Both five- and 10-year survivorships of the femoral implant were 90.1%. Conclusion: An adequate length of the scratch-fit segment and diaphyseal ingrowth remain of paramount importance when revising femoral components. To fill metaphyseal bone defects with antibiotic-loaded bone cement may be an alternative method in dealing with proximal femoral bone loss during a femoral revision. Keywords: Bone defect, Cement augmentation, Femur, Revision hip arthroplasty, Subsidence

Anterior cement augmentation of adjacent levels after vertebral body replacement leads to superior stability of the corpectomy cage under cyclic loading-a biomechanical investigation.

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Oberkircher, Ludwig; Krüger, Antonio; Hörth, Dominik; Hack, Juliana; Ruchholtz, Steffen; Fleege, Christoph; Rauschmann, Michael; Arabmotlagh, Mohammad

2018-03-01

In the operative treatment of osteoporotic vertebral body fractures, a dorsal stabilization in combination with a corpectomy of the fractured vertebral body might be necessary with respect to the fracture morphology, whereby the osteoporotic bone quality may possibly increase the risk of implant failure. To achieve better stability, it is recommended to use cement-augmented screws for dorsal instrumentation. Besides careful end plate preparation, cement augmentation of the adjacent end plates has also been reported to lead to less reduction loss. The aim of the study was to evaluate biomechanically under cyclic loading whether an additional cement augmentation of the adjacent end plates leads to improved stability of the inserted cage. Methodical cadaver study. Fourteen fresh frozen human thoracic spines with proven osteoporosis were used (T2-T7). After removal of the soft tissues, the spine was embedded in Technovit (Kulzer, Germany). Subsequently, a corpectomy of T5 was performed, leaving the dorsal ligamentary structures intact. After randomization with respect to bone quality, two groups were generated: Dorsal instrumentation (cemented pedicle screws, Medtronic, Minneapolis, MN, USA)+cage implantation (CAPRI Corpectomy Cage, K2M, Leesburg, VA, USA) without additional cementation of the adjacent endplates (Group A) and dorsal instrumentation+cage implantation with additional cement augmentation of the adjacent end plates (Group B). The subsequent axial and cyclic loading was performed at a frequency of 1 Hz, starting at 400 N and increasing the load within 200 N after every 500 cycles up to a maximum of 2,200 N. Load failure was determined when the cages sintered macroscopically into the end plates (implant failure) or when the maximum load was reached. One specimen in Group B could not be clamped appropriately into the test bench for axial loading because of a pronounced scoliotic misalignment and had to be excluded. The mean strength for implant

Percutaneous Cement-Augmented Screws Fixation in the Fractures of the Aging Spine: Is It the Solution?

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Sébastien Pesenti

2014-01-01

Full Text Available Introduction. Management of elderly patients with thoracolumbar fractures is still challenging due to frequent osteoporosis and risk of screws pull-out. The aim of this study was to evaluate results of a percutaneous-only procedure to treat these fragile patients using cement-augmented screws. Methods. 12 patients diagnosed with a thoracolumbar fracture associated with an important loss of bone stock were included in this prospective study. Surgical procedure included systematically a percutaneous osteosynthesis using cemented fenestrated screws. When necessary, additional anterior support was performed using a kyphoplasty procedure. Clinical and radiographic evaluations were performed using CT scan. Results. On the whole series, 15 fractures were diagnosed and 96 cemented screws were inserted. The difference between the pre- and postoperative vertebral kyphosis was statistically significant (12.9° versus 4.4°, P=0.0006. No extrapedicular screw was reported and one patient was diagnosed with a cement-related pulmonary embolism. During follow-up period, no infectious complications, implant failures, or pull-out screws were noticed. Discussion. Aging spine is becoming an increasing public health issue. Management of these patients requires specific attention due to the augmented risk of complications. Using percutaneous-only screws fixation with cemented screw provides satisfactory results. A rigorous technique is mandatory in order to achieve best outcomes.

A modified PMMA cement (Sub-cement) for accelerated fatigue testing of cemented implant constructs using cadaveric bone.

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Race, Amos; Miller, Mark A; Mann, Kenneth A

2008-10-20

Pre-clinical screening of cemented implant systems could be improved by modeling the longer-term response of the implant/cement/bone construct to cyclic loading. We formulated bone cement with degraded fatigue fracture properties (Sub-cement) such that long-term fatigue could be simulated in short-term cadaver tests. Sub-cement was made by adding a chain-transfer agent to standard polymethylmethacrylate (PMMA) cement. This reduced the molecular weight of the inter-bead matrix without changing reaction-rate or handling characteristics. Static mechanical properties were approximately equivalent to normal cement. Over a physiologically reasonable range of stress-intensity factor, fatigue crack propagation rates for Sub-cement were higher by a factor of 25+/-19. When tested in a simplified 2 1/2-D physical model of a stem-cement-bone system, crack growth from the stem was accelerated by a factor of 100. Sub-cement accelerated both crack initiation and growth rate. Sub-cement is now being evaluated in full stem/cement/femur models.

Assessment of bone healing ability of calcium phosphate cements loaded with platelet lysate in rat calvarial defects.

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Babo, Pedro S; Carvalho, Pedro P; Santo, Vítor E; Faria, Susana; Gomes, Manuela E; Reis, Rui L

2016-11-01

Injectable calcium phosphate cements have been used as a valid alternative to autologous bone grafts for bone augmentation with the additional advantage of enabling minimally invasive implantation procedures and for perfectly fitting the tissue defect. Nevertheless, they have low biodegradability and lack adequate biochemical signaling to promote bone healing and remodeling. In previous in vitro studies, we observed that the incorporation of platelet lysate directly into the cement paste or loaded in hyaluronic acid microspheres allowed to modulate the cement degradation and the in vitro expression of osteogenic markers in seeded human adipose derived stem cells. The present study aimed at investigating the possible effect of this system in new bone formation when implanted in calvarial bilateral defects in rats. Different formulations were assessed, namely plain calcium phosphate cements, calcium phosphate cements loaded with human platelet lysate, hybrid injectable formulations composed of the calcium phosphate cement incorporating hyaluronin acid non-loaded microparticles (20% hyaluronin acid) or with particles loaded with platelet lysate. The degradability and new bone regrowth were evaluated in terms of mineral volume in the defect, measured by micro-computed tomography and histomorphometric analysis upon 4, 8 and 12 weeks of implantation. We observed that the incorporation of hyaluronin acid microspheres induced an overly rapid cement degradation, impairing the osteoconductive properties of the cement composites. Moreover, the incorporation of platelet lysate induced higher bone healing than the materials without platelet lysate, up to four weeks after surgery. Nevertheless, this effect was not found to be significant when compared to the one observed in the sham-treated group. © The Author(s) 2016.

Microindentation of Polymethyl Methacrylate (PMMA Based Bone Cement

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F. Zivic

2011-12-01

Full Text Available Characterization of polymethyl methacrylate (PMMA based bone cement subjected to cyclical loading using microindentation technique is presented in this paper. Indentation technique represents flexible mechanical testing due to its simplicity, minimal specimen preparation and short time needed for tests. The mechanical response of bone cement samples was studied. Realised microindentation enabled determination of the indentation testing hardness HIT and indentation modulus EIT of the observed bone cement. Analysis of optical photographs of the imprints showed that this technique can be effectively used for characterization of bone cements.

The mechanical study of acrylic bone cement reinforced with carbon nanotube

International Nuclear Information System (INIS)

Nien, Yu-Hsun; Huang, Chiao-li

2010-01-01

Bone cement is used as filler between prosthesis and bone for fixation and force distribution. The major composition of bone cement is polymethylmethacrylate (PMMA). Some disadvantages of PMMA bone cement are found such as significant poor mechanical properties which may cause failure of the cement. In this paper, we exploited carbon nanotube to enhance the mechanical properties of bone cement. The mechanical properties of the bone cement were characterized using tensile and compressive analysis as well as dynamic mechanical analysis (DMA). The result shows that carbon nanotube is able to enhance the mechanical properties of the modified bone cement.

The mechanical study of acrylic bone cement reinforced with carbon nanotube

Energy Technology Data Exchange (ETDEWEB)

Nien, Yu-Hsun, E-mail: nienyh@yuntech.edu.tw [Department of Chemical and Materials Engineering, National Yunlin University of Science and Technology, Douliou, Yunlin 64002, Taiwan (China); Huang, Chiao-li [Department of Chemical and Materials Engineering, National Yunlin University of Science and Technology, Douliou, Yunlin 64002, Taiwan (China)

2010-05-25

Bone cement is used as filler between prosthesis and bone for fixation and force distribution. The major composition of bone cement is polymethylmethacrylate (PMMA). Some disadvantages of PMMA bone cement are found such as significant poor mechanical properties which may cause failure of the cement. In this paper, we exploited carbon nanotube to enhance the mechanical properties of bone cement. The mechanical properties of the bone cement were characterized using tensile and compressive analysis as well as dynamic mechanical analysis (DMA). The result shows that carbon nanotube is able to enhance the mechanical properties of the modified bone cement.

[Augmentation technique on the proximal humerus].

Science.gov (United States)

Scola, A; Gebhard, F; Röderer, G

2015-09-01

The treatment of osteoporotic fractures is still a challenge. The advantages of augmentation with respect to primary in vitro stability and the clinical use for the proximal humerus are presented in this article. In this study six paired human humeri were randomized into an augmented and a non-augmented group. Osteosynthesis was performed with a PHILOS plate (Synthes®). In the augmented group the two screws finding purchase in the weakest cancellous bone were augmented. The specimens were tested in a 3-part fracture model in a varus bending test. The augmented PHILOS plates withstood significantly more load cycles until failure. The correlation to bone mineral density (BMD) showed that augmentation could partially compensate for low BMD. The augmentation of the screws in locked plating in a proximal humerus fracture model is effective in improving the primary stability in a cyclic varus bending test. The targeted augmentation of two particular screws in a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality could be more effective in enhancing the primary stability of a proximal humerus locking plate because the effect of augmentation can be exploited more effectively limiting it to the degree required. The technique of augmentation is simple and can be applied in open and minimally invasive procedures. When the correct procedure is used, complications (cement leakage into the joint) can be avoided.

Calcium phosphate barrier for augmentation of bone in noncontained periodontal osseous defects: a novel approach.

Science.gov (United States)

Chopra, Aditi; Sivaraman, Karthik; Awataramaney, Tarun K

2014-11-01

The aim of this technique is to augment bone in non-contained osseous deformities using a unique self-sustaining calcium phosphate barrier. Bone has the inherent ability to regenerate completely if it is provided with a fracture space or an undisturbed enclosed scaffold. A secluded environment is essential as it provides a secured, sterile and stable wound system that regenerates lost bone by a process of osteopromotion. Reconstructive techniques using bone grafts and barrier membranes utilize this principle for augmentation of deficient bony sites by providing a closed environment that promotes clot stability, graft retention, and facilitates correct cell repopulation. However, in noncontained bone defects like one walled infrabony periodontal defect or sites with horizontal bone loss, regeneration of bone still remains an unrealistic situation since osseous topography at such sites does not favor membrane stability or bone grafts retention. This case report presents a promising technique to augment bone in areas with horizontal loss. Augmentation of bone in the interdental area with horizontal bone loss was accomplished by building a contained defect using a unique self sustaining calcium phosphate cement formulation. The calcium phosphate barrier stimulates the lost cortical plates and promotes graft retention and clot stability. At 6 months, there was a significant bone fill and trabecular formation in the interdental area and reduction in tooth mobility. This promising technique could prove to be a good alternative to the conventional approaches for treating osseous deformities. Calcium phosphate is a promising barrier graft for repair of noncontained periodontal osseous defect. This technique cues both the clinicians and manufacturers to develop moldable tissue engineered constructs for osseous repair.

Preclinical evaluation of strontium-containing bioactive bone cement

International Nuclear Information System (INIS)

Li, Zhaoyang; Yuan, Ning; Lam, Raymond Wing Moon; Cui, Zhenduo; Yang, Xianjin; Lu, William Weijia

2013-01-01

Strontium (Sr) has become more attractive for orthopaedic applications as they can simultaneously stimulate bone formation and prevent bone loss. A Sr-containing bioactive bone cement (Sr-BC) has been designed to fix osteoporotic bone fracture. Sr is a trace element, so the safety of containing Sr is concerned when Sr-BC is implanted in human body. The preclinical assessment of biocompatibility of Sr-BC was conducted according to ISO 10993 standards. MTT assay showed that this bioactive bone cement was non-toxic to mouse fibroblasts, and it met the basic requirement for the orthopaedic implant. The three independent genetic toxicity studies including Ames, chromosome aberration and bone marrow micronucleus assays demonstrated absence of genotoxic components in Sr-BC, which reassured the safety concerns of this novel bone cement. The muscle implantation results in present study were also encouraging. The acute inflammation around the cement was observed at 1 week post-implantation; however, no significant difference was observed between control and Sr-BC groups. These responses may be attributed to the presence of the foreign body, but the tissue healed after 12 weeks implantation. In summary, the above preclinical results provide additional assurance for the safety of this implant. Sr-BC can be used as a potential alternative to the traditional bone cement. - Highlights: • Strontium-containing bioactive bone cement (Sr-BC) was designed. • The biocompatibility of Sr-BC was evaluated according ISO 10993 standards. • Preclinical results provide additional assurance for the safety of Sr-BC

Preclinical evaluation of strontium-containing bioactive bone cement

Energy Technology Data Exchange (ETDEWEB)

Li, Zhaoyang, E-mail: lizy@hku.hk [School of Materials Science and Engineering, Tianjin University, Tianjin 300072 (China); Tianjin Key Laboratory of Composite and Functional Materials, Tianjin 300072 (China); Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong (China); Yuan, Ning [Department of Laboratory Medicine, Tianjin Chest Hospital, Tianjin 300051 (China); Lam, Raymond Wing Moon [Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong (China); Cui, Zhenduo; Yang, Xianjin [School of Materials Science and Engineering, Tianjin University, Tianjin 300072 (China); Tianjin Key Laboratory of Composite and Functional Materials, Tianjin 300072 (China); Lu, William Weijia, E-mail: wwlu@hku.hk [Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong (China)

2013-12-01

Strontium (Sr) has become more attractive for orthopaedic applications as they can simultaneously stimulate bone formation and prevent bone loss. A Sr-containing bioactive bone cement (Sr-BC) has been designed to fix osteoporotic bone fracture. Sr is a trace element, so the safety of containing Sr is concerned when Sr-BC is implanted in human body. The preclinical assessment of biocompatibility of Sr-BC was conducted according to ISO 10993 standards. MTT assay showed that this bioactive bone cement was non-toxic to mouse fibroblasts, and it met the basic requirement for the orthopaedic implant. The three independent genetic toxicity studies including Ames, chromosome aberration and bone marrow micronucleus assays demonstrated absence of genotoxic components in Sr-BC, which reassured the safety concerns of this novel bone cement. The muscle implantation results in present study were also encouraging. The acute inflammation around the cement was observed at 1 week post-implantation; however, no significant difference was observed between control and Sr-BC groups. These responses may be attributed to the presence of the foreign body, but the tissue healed after 12 weeks implantation. In summary, the above preclinical results provide additional assurance for the safety of this implant. Sr-BC can be used as a potential alternative to the traditional bone cement. - Highlights: • Strontium-containing bioactive bone cement (Sr-BC) was designed. • The biocompatibility of Sr-BC was evaluated according ISO 10993 standards. • Preclinical results provide additional assurance for the safety of Sr-BC.

Chemical and physical properties of bone cement for vertebroplasty

Directory of Open Access Journals (Sweden)

Po-Liang Lai

2013-08-01

Full Text Available Vertebral compression fracture is the most common complication of osteoporosis. It may result in persistent severe pain and limited mobility, and significantly impacts the quality of life. Vertebroplasty involves a percutaneous injection of bone cement into the collapsed vertebrae by fluorescent guide. The most commonly used bone cement in percutaneous vertebroplasty is based on the polymerization of methylmethacrylate monomers to polymethylmethacrylate (PMMA polymers. However, information on the properties of bone cement is mostly published in the biomaterial sciences literature, a source with which the clinical community is generally unfamiliar. This review focuses on the chemistry of bone cement polymerization and the physical properties of PMMA. The effects of altering the portions and contents of monomer liquid and polymer powders on the setting time, polymerization temperature, and compressive strength of the cement are also discussed. This information will allow spine surgeons to manipulate bone cement characteristics for specific clinical applications and improve safety.

[Significance of bone mineral density and modern cementing technique for in vitro cement penetration in total shoulder arthroplasty].

Science.gov (United States)

Pape, G; Raiss, P; Kleinschmidt, K; Schuld, C; Mohr, G; Loew, M; Rickert, M

2010-12-01

Loosening of the glenoid component is one of the major causes of failure in total shoulder arthroplasty. Possible risk factors for loosening of cemented components include an eccentric loading, poor bone quality, inadequate cementing technique and insufficient cement penetration. The application of a modern cementing technique has become an established procedure in total hip arthroplasty. The goal of modern cementing techniques in general is to improve the cement-penetration into the cancellous bone. Modern cementing techniques include the cement vacuum-mixing technique, retrograde filling of the cement under pressurisation and the use of a pulsatile lavage system. The main purpose of this study was to analyse cement penetration into the glenoid bone by using modern cement techniques and to investigate the relationship between the bone mineral density (BMD) and the cement penetration. Furthermore we measured the temperature at the glenoid surface before and after jet-lavage of different patients during total shoulder arthroplasty. It is known that the surrounding temperature of the bone has an effect on the polymerisation of the cement. Data from this experiment provide the temperature setting for the in-vitro study. The glenoid surface temperature was measured in 10 patients with a hand-held non-contact temperature measurement device. The bone mineral density was measured by DEXA. Eight paired cadaver scapulae were allocated (n = 16). Each pair comprised two scapulae from one donor (matched-pair design). Two different glenoid components were used, one with pegs and the other with a keel. The glenoids for the in-vitro study were prepared with the bone compaction technique by the same surgeon in all cases. Pulsatile lavage was used to clean the glenoid of blood and bone fragments. Low viscosity bone cement was applied retrogradely into the glenoid by using a syringe. A constant pressure was applied with a modified force sensor impactor. Micro-computed tomography

Bone cement allocation analysis in artificial cancellous bone structures

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Ivan Zderic

2017-01-01

Conclusion: The simulated leakage path seemed to be the most important adverse injection factor influencing the uniformity of cement distribution. Another adverse factor causing dispersion of this distribution was represented by the simulated bone marrow. However, the rather uniform distribution of the totally injected cement amount, considered as one unit, could be ascribed to the medium viscosity of the used cement. Finally, with its short waiting time of 45 s, the stepwise injection procedure was shown to be ineffective in preventing cement leakage.

Effect of process variables on the preparation of artificial bone cements

Energy Technology Data Exchange (ETDEWEB)

Santos Junior, J.G.F.; Melo, P.A.; Pinto, J.C., E-mail: pinto@peq.coppe.ufrj.br, E-mail: jjunior@peq.coppe.ufrj.br, E-mail: melo@peq.coppe.ufrj.br [Coordenacao dos Programas de Pos-Graduacao de Engenharia (COPPE/UFRJ), RJ (Brazil). Programa de Engenharia Quimica; Pita, V.J.R.R., E-mail: vjpita@ima.ufrj.br [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Instituto de Macromoleculas; Nele, M., E-mail: nele@eq.ufrj.br [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Escola de Quimica

2013-10-15

The present work concerns the preparation of bone cements based on poly(methyl methacrylate) (PMMA), used mainly for prosthesis fixation and cavity filling for correction of human bone failures. A typical bone cement recipe contains methyl methacrylate, which polymerizes in situ during cement application. An inherent problem of this reaction is the large amount of heat released during the cement preparation, which may lead to irreparable damage of living tissues. Optimization of PMMA-based bone cement recipes is thus an important step towards safe and reliable clinical usage of these materials. Important process variables related to the reaction temperature profile and the mixing of the recipe constituents were studied in order to allow for the adequate production of bone cements. It is shown that the average molar mass and size of the PMMA particles used in the production of the bone cement, as well as incorporation of radiopaque contrast, co-monomers and fillers into the bone recipe play fundamental roles in the course of the polymerization reaction. Furthermore, the injection vessel geometry may interfere dramatically with the temperature profile and the time for its occurrence. Finally, it has been observed that the morphology of the PMMA particles strongly affects the mixing of the bone cement components. (author)

Effect of process variables on the preparation of artificial bone cements

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J. G. F. Santos Jr.

2013-12-01

Full Text Available The present work concerns the preparation of bone cements based on poly(methyl methacrylate (PMMA, used mainly for prosthesis fixation and cavity filling for correction of human bone failures. A typical bone cement recipe contains methyl methacrylate, which polymerizes in situ during cement application. An inherent problem of this reaction is the large amount of heat released during the cement preparation, which may lead to irreparable damage of living tissues. Optimization of PMMA-based bone cement recipes is thus an important step towards safe and reliable clinical usage of these materials. Important process variables related to the reaction temperature profile and the mixing of the recipe constituents were studied in order to allow for the adequate production of bone cements. It is shown that the average molar mass and size of the PMMA particles used in the production of the bone cement, as well as incorporation of radiopaque contrast, co-monomers and fillers into the bone recipe play fundamental roles in the course of the polymerization reaction. Furthermore, the injection vessel geometry may interfere dramatically with the temperature profile and the time for its occurrence. Finally, it has been observed that the morphology of the PMMA particles strongly affects the mixing of the bone cement components.

Influence of HAp on the polymerization processes of a possible radioactive bone cement

Energy Technology Data Exchange (ETDEWEB)

Montaño, Carlos J.; Campos, Tarcísio P.R., E-mail: carlmont@ucm.es, E-mail: tprcampos@yahoo.com.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (Brazil). Dept. de Engenharia Nuclear. Lab. de Radiações Ionizantes; Silva, Adolfo H.M.; Araujo, Maria H., E-mail: adolfohmoraes@ufmg.br, E-mail: mharaujo1993@gmail.com [Universidade Federal de Minas Gerais (RMN/UFMG), Belo Horizonte (Brazil). Dept. de Ressonância Magnética Nuclear

2017-07-01

Polymethylmethacrylate PMMA is an acrylic that has been already proposed as a composite to adhere together the fractured bone structures. Subsequently, augmentation bone cements have incorporated Calcium Biophosphonates as vital part of its components to increase the biocompatibility with osseous tissues. Minimally invasive percutaneous techniques such as Vertebroplasty and Kyphoplasty have been developed to reduce surgical impact on patients, but in turn have been reported undesirable effects as extravasation of the cement outside of the planning target volume due to the compression of the internal bone fluids or other tissues. An in situ variable that helps favoring of the PMMA polymerization process is the temperature; however, it may bring deleterious effects. On the methodology, an assay was addressed varying the Hydroxyapatite HAp concentration. Also the cement processing was modified by setting water as a vehicle for particle dispersion. The ratios of HAp/PMMA concentrations were: 0.00000, 0.02167, 0.09062, 0.16619 and 0.50000 mixed in PMMA and liquid catalyst and monomer. The thermal profiles were measured during polymerization and analyzed. Nuclear magnetic resonance NMR analysis was carried out on the polymerization process in an aqueous state to monitor the H-H{sub 2}O proton signal. As results, an increasing in the cement hardness time was found in the proportion of the HAp concentration. The highest τ polymerization time was found for the x{sub 5} concentration and the signal from the water trapped in the HAp amorphous lattice was determined around ∼5 ppm in the {sup 1}H NMR spectra. (author)

Influence of HAp on the polymerization processes of a possible radioactive bone cement

International Nuclear Information System (INIS)

Montaño, Carlos J.; Campos, Tarcísio P.R.; Silva, Adolfo H.M.; Araujo, Maria H.

2017-01-01

Polymethylmethacrylate PMMA is an acrylic that has been already proposed as a composite to adhere together the fractured bone structures. Subsequently, augmentation bone cements have incorporated Calcium Biophosphonates as vital part of its components to increase the biocompatibility with osseous tissues. Minimally invasive percutaneous techniques such as Vertebroplasty and Kyphoplasty have been developed to reduce surgical impact on patients, but in turn have been reported undesirable effects as extravasation of the cement outside of the planning target volume due to the compression of the internal bone fluids or other tissues. An in situ variable that helps favoring of the PMMA polymerization process is the temperature; however, it may bring deleterious effects. On the methodology, an assay was addressed varying the Hydroxyapatite HAp concentration. Also the cement processing was modified by setting water as a vehicle for particle dispersion. The ratios of HAp/PMMA concentrations were: 0.00000, 0.02167, 0.09062, 0.16619 and 0.50000 mixed in PMMA and liquid catalyst and monomer. The thermal profiles were measured during polymerization and analyzed. Nuclear magnetic resonance NMR analysis was carried out on the polymerization process in an aqueous state to monitor the H-H 2 O proton signal. As results, an increasing in the cement hardness time was found in the proportion of the HAp concentration. The highest τ polymerization time was found for the x 5 concentration and the signal from the water trapped in the HAp amorphous lattice was determined around ∼5 ppm in the 1 H NMR spectra. (author)

Outcome of long-axis percutaneous sacroplasty for the treatment of sacral insufficiency fractures with a radiofrequency-induced, high-viscosity bone cement

Energy Technology Data Exchange (ETDEWEB)

Eichler, Katrin [University of Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); J. W. Goethe University of Frankfurt, Institute for Diagnostic and Interventional Radiology, Frankfurt (Germany); Zangos, Stephan; Vogl, Thomas J. [University of Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Mack, Martin G. [Radiology Munich, Munich (Germany); Marzi, Ingo [University of Frankfurt, Department of Trauma, Hand and Reconstructive Surgery, Frankfurt (Germany)

2014-04-15

Our goal was to assess the technical results in patients who underwent long-axis sacroplasty for the treatment of sacral insufficiency fractures (SIF) by radiofrequency-induced high-viscosity bone cement augmentation. Twelve patients with bilateral sacral fractures were treated by augmentation with radiofrequency-activated, high-viscosity polymethylmethacrylate (PMMA) bone cement under local anesthesia. CT-guided sacroplasty was performed by using a long-axis approach through a single entry point. Thirty-six vertebrae were treated in 12 sessions under a combination of CT and fluoroscopic guidance using a bilateral access and a cavity-creating osteotome prior to remote-controlled, hydraulically driven cement injection. The visual analogue scale (VAS) score before sacroplasty and at 1 and 3 months after the treatment was obtained. PMMA leaks were evaluated retrospectively using the post-interventional CT. The mean amount of high-viscosity PMMA injected per patient was 7.8 ml. No major adverse events were observed. In the first 4 days after the procedure, the mean VAS score decreased from 8.1 ± 1.9 to mean 3.1 ± 1.2 and was followed by a gradual but continuous decrease throughout the rest of the follow-up period at 24 weeks (mean 2.2 ± 1.1) and 48 weeks (mean 2.1 ± 1.4). CT fluoroscopy-guided sacral augmentation was safe and effective in all 12 patients with osteoporotic SIF. (orig.)

Effect of heat generation from bone cement on bone tissue in total knee arthroplasty; Jinko kansetsu okikaeji no one cement no hatsunetsu ga seitai soshiki ni oyobosu eikyo ni kansuru kenkyu

Energy Technology Data Exchange (ETDEWEB)

Matsuda, M.; Uchida, T. [Kobe University, Kobe (Japan); Iwatsubo, T. [Kobe University, Kobe (Japan). Faculty of Engineering; Kurosawa, M.; Hashimoto, Y. [Kobe University, Kobe (Japan). Faculty of Medicine; Fukushima, H.

1998-01-25

Bone cement is often applied to fix the components in a surgical operation, such as TKA (total knee arthroplasty). In this paper, we consider the effect of heat generation from bone cement on bone tissue in TKA by using numerical simulation. First, we applied an axisymmetric model of tibia to finite element method and analyzed heat generation of bone cement. To confirm the results of analysis by experiment, we measured the temperature determined by 6 points i.e., 2 points each in component-cement interface, cement and bone-cement interface. As a result, the temperature determined by analysis agrees with that determined by experiment. Next, we proposed the evaluation formula of the bone necrosis. We constructed a bone necrosis map from the simulation. From the map, we found that the bone necrosis region was about 2 mm from the bone-cement interface. In addition, the bone necrosis is severe at the base of the tibial component. 7 refs., 15 figs., 3 tabs.

Fracture prevention by prophylactic femoroplasty of the proximal femur--metallic compared with cemented augmentation.

Science.gov (United States)

Springorum, Hans-Robert; Gebauer, Matthias; Mehrl, Alexander; Stark, Olaf; Craiovan, Benjamin; Püschel, Klaus; Amling, Michael; Grifka, Joachim; Beckmann, Johannes

2014-07-01

To compare 2 different femoral neck augmentation techniques at improving the mechanical strength of the femoral neck. Twenty pairs of human cadaveric femora were randomly divided into 2 groups. In 1 group, the femora were augmented with a steel spiral; the other group with the cemented technique. The untreated contralateral side served as an intraindividual control. Fracture strength was evaluated using an established biomechanical testing scenario mimicking a fall on the greater trochanter (Hayes fall). The peak load to failure was significantly higher in the steel spiral group (P = 0.0024) and in the cemented group (P = 0.001) compared with the intraindividual controls. The peak load to failure showed a median of 3167 N (1825-5230 N) in the spiral group and 2485 N (1066-4395 N) in the spiral control group. The peak load to failure in the cemented group was 3698 N (SD ± 1249 N) compared with 2763 N (SD ± 1335 N) in the cement control group. Furthermore, fracture displacement was clearly reduced in the steel spiral group. Femoral augmentations using steel spirals or cement-based femoroplasty are technically feasible procedures. Our results demonstrate that a prophylactic reinforced proximal femur has higher strength when compared with the untreated contralateral limb. Prophylactic augmentation has potential to become an auxiliary treatment option to protect the osteoporotic proximal femur against fracture.

Pullout characteristics of percutaneous pedicle screws with different cement augmentation methods in elderly spines: An in vitro biomechanical study.

Science.gov (United States)

Charles, Y P; Pelletier, H; Hydier, P; Schuller, S; Garnon, J; Sauleau, E A; Steib, J-P; Clavert, P

2015-05-01

Vertebroplasty prefilling or fenestrated pedicle screw augmentation can be used to enhance pullout resistance in elderly patients. It is not clear which method offers the most reliable fixation strength if axial pullout and a bending moment is applied. The purpose of this study is to validate a new in vitro model aimed to reproduce a cut out mechanism of lumbar pedicle screws, to compare fixation strength in elderly spines with different cement augmentation techniques and to analyze factors that might influence the failure pattern. Six human specimens (82-100 years) were instrumented percutaneously at L2, L3 and L4 by non-augmented screws, vertebroplasty augmentation and fenestrated screws. Cement distribution (2 ml PMMA) was analyzed on CT. Vertebral endplates and the rod were oriented at 45° to the horizontal plane. The vertebral body was held by resin in a cylinder, linked to an unconstrained pivot, on which traction (10 N/s) was applied until rupture. Load-displacement curves were compared to simultaneous video recordings. Median pullout forces were 488.5 N (195-500) for non-augmented screws, 643.5 N (270-1050) for vertebroplasty augmentation and 943.5 N (750-1084) for fenestrated screws. Cement augmentation through fenestrated screws led to significantly higher rupture forces compared to non-augmented screws (P=0.0039). The pullout force after vertebroplasty was variable and linked to cement distribution. A cement bolus around the distal screw tip led to pullout forces similar to non-augmented screws. A proximal cement bolus, as it was observed in fenestrated screws, led to higher pullout resistance. This cement distribution led to vertebral body fractures prior to screw pullout. The experimental setup tended to reproduce a pullout mechanism observed on radiographs, combining axial pullout and a bending moment. Cement augmentation with fenestrated screws increased pullout resistance significantly, whereas the fixation strength with the vertebroplasty

Biocompatibility of calcium phosphate bone cement with optimised mechanical properties: an in vivo study.

Science.gov (United States)

Palmer, Iwan; Nelson, John; Schatton, Wolfgang; Dunne, Nicholas J; Buchanan, Fraser; Clarke, Susan A

2016-12-01

This work establishes the in vivo performance of modified calcium phosphate bone cements for vertebroplasty of spinal fractures using a lapine model. A non-modified calcium phosphate bone cement and collagen-calcium phosphate bone cements composites with enhanced mechanical properties, utilising either bovine collagen or collagen from a marine sponge, were compared to a commercial poly(methyl methacrylate) cement. Conical cement samples (8 mm height × 4 mm base diameter) were press-fit into distal femoral condyle defects in New Zealand White rabbits and assessed after 5 and 10 weeks. Bone apposition and tartrate-resistant acid phosphatase activity around cements were assessed. All implants were well tolerated, but bone apposition was higher on calcium phosphate bone cements than on poly(methyl methacrylate) cement. Incorporation of collagen showed no evidence of inflammatory or immune reactions. Presence of positive tartrate-resistant acid phosphatase staining within cracks formed in calcium phosphate bone cements suggested active osteoclasts were present within the implants and were actively remodelling within the cements. Bone growth was also observed within these cracks. These findings confirm the biological advantages of calcium phosphate bone cements over poly(methyl methacrylate) and, coupled with previous work on enhancement of mechanical properties through collagen incorporation, suggest collagen-calcium phosphate bone cement composite may offer an alternative to calcium phosphate bone cements in applications where low setting times and higher mechanical stability are important.

Bone-Cement: The New Medical Quick Fix

Directory of Open Access Journals (Sweden)

Dinesh Bhatia

2010-01-01

Full Text Available

Bone Cement is being widely used in vertebroplasty, a minimally invasive surgical procedure to treat spinal fractures and collapsed vertebrae. It is being labeled as a concrete success in medical field. It is being used to treat fractures due to osteoporosis, menopause, steroids, hyperthyroidism and chronic obstructive pulmonary diseases.  In this technique a needle with bone cement (PMMA, polymethylmethacrylate is injected into the collapsed vertebra after administering local anesthesia to patient. It solidifies within few minutes and provides support to damaged bone resulting in relief to the patient. It also prevents the movement between different parts of the broken bone. Hence it requires a short hospital stay for the patient and the procedure can be performed with much ease and at significant lower costs. Patient can resume normal activity within a day or so. Bone cement is now being referred to as the quick medical fix material for early repair of fractures.

A New Biphasic Dicalcium Silicate Bone Cement Implant

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Fausto Zuleta

2017-07-01

Full Text Available This study aimed to investigate the processing parameters and biocompatibility of a novel biphasic dicalcium silicate (C2S cement. Biphasic α´L + β-C2Sss was synthesized by solid-state processing, and was used as a raw material to prepare the cement. In vitro bioactivity and biocompatibility studies were assessed by soaking the cement samples in simulated body fluid (SBF and human adipose stem cell cultures. Two critical-sized defects of 6 mm Ø were created in 15 NZ tibias. A porous cement made of the high temperature forms of C2S, with a low phosphorous substitution level, was produced. An apatite-like layer covered the cement’s surface after soaking in SBF. The cell attachment test showed that α´L + β-C2Sss supported cells sticking and spreading after 24 h of culture. The cement paste (55.86 ± 0.23 obtained higher bone-to-implant contact (BIC percentage values (better quality, closer contact in the histomorphometric analysis, and defect closure was significant compared to the control group (plastic. The residual material volume of the porous cement was 35.42 ± 2.08% of the initial value. The highest BIC and bone formation percentages were obtained on day 60. These results suggest that the cement paste is advantageous for initial bone regeneration.

Bone cements for percutaneous vertebroplasty and balloon kyphoplasty: Current status and future developments

Directory of Open Access Journals (Sweden)

Zhiwei He

2015-01-01

Full Text Available Osteoporotic vertebral compression fractures (OVCFs have gradually evolved into a serious health care problem globally. In order to reduce the morbidity of OVCF patients and improve their life quality, two minimally invasive surgery procedures, vertebroplasty (VP and balloon kyphoplasty (BKP, have been developed. Both VP and BKP require the injection of bone cement into the vertebrae of patients to stabilize fractured vertebra. As such, bone cement as the filling material plays an essential role in the effectiveness of these treatments. In this review article, we summarize the bone cements that are currently available in the market and those still under development. Two major categories of bone cements, nondegradable acrylic bone cements (ABCs and degradable calcium phosphate cements (CPCs, are introduced in detail. We also provide our perspectives on the future development of bone cements for VP and BKP.

Analysis of rheological properties of bone cements.

Science.gov (United States)

Nicholas, M K D; Waters, M G J; Holford, K M; Adusei, G

2007-07-01

The rheological properties of three commercially available bone cements, CMW 1, Palacos R and Cemex ISOPLASTIC, were investigated. Testing was undertaken at both 25 and 37 degrees C using an oscillating parallel plate rheometer. Results showed that the three high viscosity cements exhibited distinct differences in curing rate, with CMW 1 curing in 8.7 min, Palacos R and Cemex ISOPLASTIC in 13 min at 25 degrees C. Furthermore it was found that these curing rates were strongly temperature dependent, with curing rates being halved at 37 degrees C. By monitoring the change of viscosity with time over the entire curing process, the results showed that these cements had differing viscosity profiles and hence exhibit very different handling characteristics. However, all the cements reached the same maximum viscosity of 75 x 10(3) Pa s. Also, the change in elastic/viscous moduli and tan delta with time, show the cements changing from a viscous material to an elastic solid with a clear peak in the viscous modulus during the latter stages of curing. These results give valuable information about the changes in rheological properties for each commercial bone cement, especially during the final curing process.

Creep and fatigue behavior of a novel 2-component paste-like formulation of acrylic bone cements.

Science.gov (United States)

Köster, Ulrike; Jaeger, Raimund; Bardts, Mareike; Wahnes, Christian; Büchner, Hubert; Kühn, Klaus-Dieter; Vogt, Sebastian

2013-06-01

The fatigue and creep performance of two novel acrylic bone cement formulations (one bone cement without antibiotics, one with antibiotics) was compared to the performance of clinically used bone cements (Osteopal V, Palacos R, Simplex P, SmartSet GHV, Palacos R+G and CMW1 with Gentamicin). The preparation of the novel bone cement formulations involves the mixing of two paste-like substances in a static mixer integrated into the cartridge which is used to apply the bone cement. The fatigue performance of the two novel bone cement formulations is comparable to the performance of the reference bone cements. The creep compliance of the bone cements is significantly influenced by the effects of physical ageing. The model parameters of Struik's creep law are used to compare the creep behavior of different bone cements. The novel 2-component paste-like bone cement formulations are in the group of bone cements which exhibit a higher creep resistance.

In vivo performance of a reduced-modulus bone cement

Science.gov (United States)

Forehand, Brett Ramsey

Total joint replacement has become one of the most common procedures in the area of orthopedics and is often the solution in patients with diseased or injured hip joints. Component loosening is a significant problem and is primarily caused by bone resorption at the bone-cement interface in cemented implants. It is our hypothesis that localized shear stresses are responsible for the resorption. It was previously shown analytically that local stresses at the interface could be reduced by using a cement of lower modulus. A new reduced modulus cement, polybutyl methylmethacrylate (PBMMA), was developed to test the hypothesis. PBMMA was formulated to exist as polybutyl methacrylate filler in a polymethyl methacrylate matrix. The success of PBMMA cement is based largely on the fact that the polybutyl component of the cement will be in the rubbery state at body temperature. In vitro characterization of the cement was undertaken previously and demonstrated a modulus of approximately one-eighth that of conventional bone cement, polymethyl methacrylate (PMMA) and increased fracture toughness. The purpose of this experiment was to perform an in vivo comparison of the two cements. A sheep model was selected. Total hip arthroplasty was performed on 50 ewes using either PBMMA or PMMA. Radiographs were taken at 6 month intervals. At one year, the contralateral femur of each sheep was implanted so that each animal served as its own control, and the animals were sacrificed. The stiffness of the bone-cement interface of the femoral component within the femur was assessed by applying a torque to the femoral component and demonstrated a significant difference in loosening between the cements when the specimens were tested in external rotation (p sheep had a greater amount of loosening for each subject, 59% versus 4% for standard PMMA. A radiographic analysis demonstrated more signs of loosening in the PMMA series of subjects. A brief histological examination showed similar bony

Influence of bone density on the cement fixation of femoral hip resurfacing components.

Science.gov (United States)

Bitsch, Rudi G; Jäger, Sebastian; Lürssen, Marcus; Loidolt, Travis; Schmalzried, Thomas P; Clarius, Michael

2010-08-01

In clinical outcome studies, small component sizes, female gender, femoral shape, focal bone defects, bad bone quality, and biomechanics have been associated with failures of resurfacing arthroplasties. We used a well-established experimental setup and human bone specimens to analyze the effects of bone density on cement fixation of femoral hip resurfacing components. Thirty-one fresh frozen femora were prepared for resurfacing using the original instruments. ASR resurfacing prostheses were implanted after dual-energy X-ray densitometer scans. Real-time measurements of pressure and temperature during implantation, analyses of cement penetration, and measurements of micro motions under torque application were performed. The associations of bone density and measurement data were examined calculating regression lines and multiple correlation coefficients; acceptability was tested with ANOVA. We found significant relations between bone density and micro motion, cement penetration, cement mantle thickness, cement pressure, and interface temperature. Mean bone density of the femora was 0.82 +/- 0.13 g/cm(2), t-score was -0.7 +/- 1.0, and mean micro motion between bone and femoral resurfacing component was 17.5 +/- 9.1 microm/Nm. The regression line between bone density and micro motion was equal to -56.7 x bone density + 63.8, R = 0.815 (p density scans are most helpful for patient selection in hip resurfacing, and a better bone quality leads to higher initial component stability. A sophisticated cementing technique is recommended to avoid vigorous impaction and incomplete seating, since increasing bone density also results in higher cement pressures, lower cement penetration, lower interface temperatures, and thicker cement mantles. Copyright 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Influence of Nano-HA Coated Bone Collagen to Acrylic (Polymethylmethacrylate Bone Cement on Mechanical Properties and Bioactivity.

Directory of Open Access Journals (Sweden)

Tao Li

Full Text Available This research investigated the mechanical properties and bioactivity of polymethylmethacrylate (PMMA bone cement after addition of the nano-hydroxyapatite(HA coated bone collagen (mineralized collagen, MC.The MC in different proportions were added to the PMMA bone cement to detect the compressive strength, compression modulus, coagulation properties and biosafety. The MC-PMMA was embedded into rabbits and co-cultured with MG 63 cells to exam bone tissue compatibility and gene expression of osteogenesis.15.0%(wt impregnated MC-PMMA significantly lowered compressive modulus while little affected compressive strength and solidification. MC-PMMA bone cement was biologically safe and indicated excellent bone tissue compatibility. The bone-cement interface crosslinking was significantly higher in MC-PMMA than control after 6 months implantation in the femur of rabbits. The genes of osteogenesis exhibited significantly higher expression level in MC-PMMA.MC-PMMA presented perfect mechanical properties, good biosafety and excellent biocompatibility with bone tissues, which has profoundly clinical values.

The initial instability of cemented and non-cemented femoral stems fixated with a bone grafting technique

NARCIS (Netherlands)

Schreurs, B.W.; Huiskes, H.W.J.; Slooff, T.J.J.H.

1994-01-01

To reconstruct intramedullary bone stock in revision surgery of failed total hip arthroplasties, a method was developed using impacted trabecular bone grafts. In an in vitro model with femora of the goat, the initial stabilities of both cemented and non-cemented hydroxylapatite-coated stems in this

[The injection of acrylic bone cement prevents bone collapse in the intercalar bones lacking bony support: an experimental sheep semilunar bone model].

Science.gov (United States)

Unsal, Murat; Tetik, Cihangir; Erol, Bülent; Cabukoğlu, Cengiz

2003-01-01

In a sheep semilunar bone model, we investigated whether collapse in the intercalar bones lacking bony support could be prevented by the injection of acrylic bone cement. The study included 16 limbs of eight sheep. Preoperatively, anteroposterior and lateral views of the carpal joints in the fore limbs were obtained. The animals were divided into four groups. In group 1 (n=3) no surgical procedure was performed in the right semilunar bones, whereas the periosteum on the contralateral side was elevated (group 2; n=3). The first two groups were left as controls. In Group 3 (n=5) the left semilunar bones were filled with acrylic bone cement following decancellation of the bone, while the right semilunar bones were left decancellated (group 4; n=5). The sheep were monitored for three months. Radiographs of the carpal joints were obtained to evaluate collapse occurrence in the semilunar bones. Thereafter, the animals were sacrificed and the semilunar bones were excised for biomechanical and histological examinations. Osteonecrosis and cartilage damage were sought and resistance to compressive forces was investigated. Radiologically, the extent of collapse was statistically significant in the semilunar bones in group 4 (pbone cement was found to prevent collapse in group 3, with no significant difference being noted between preoperative and postoperative semilunar bone heights (p>0.05). Biomechanically, the least resistance to compressive forces was measured in group 4 (pbone cement prevents collapse in the semilunar bones, without inducing any cartilage damage or osteonecrosis.

Biomechanical in vitro assessment of screw augmentation in locked plating of proximal humerus fractures.

Science.gov (United States)

Röderer, Götz; Scola, Alexander; Schmölz, Werner; Gebhard, Florian; Windolf, Markus; Hofmann-Fliri, Ladina

2013-10-01

Proximal humerus fracture fixation can be difficult because of osteoporosis making it difficult to achieve stable implant anchorage in the weak bone stock even when using locking plates. This may cause implant failure requiring revision surgery. Cement augmentation has, in principle, been shown to improve stability. The aim of this study was to investigate whether augmentation of particular screws of a locking plate aimed at a region of low bone quality is effective in improving stability in a proximal humerus fracture model. Twelve paired human humerus specimens were included. Quantitative computed tomography was performed to determine bone mineral density (BMD). Local bone quality in the direction of the six proximal screws of a standard locking plate (PHILOS, Synthes) was assessed using mechanical means (DensiProbe™). A three-part fracture model with a metaphyseal defect was simulated and fixed with the plate. Within each pair of humeri the two screws aimed at the region of the lowest bone quality according to the DensiProbe™ were augmented in a randomised manner. For augmentation, 0.5 ml of bone cement was injected in a screw with multiple outlets at its tip under fluoroscopic control. A cyclic varus-bending test with increasing upper load magnitude was performed until failure of the screw-bone fixation. The augmented group withstood significantly more load cycles. The correlation of BMD with load cycles until failure and BMD with paired difference in load cycles to failure showed that augmentation could compensate for a low BMD. The results demonstrate that augmentation of screws in locked plating in a proximal humerus fracture model is effective in improving primary stability in a cyclic varus-bending test. The augmentation of two particular screws aimed at a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality

Bone density and anisotropy affect periprosthetic cement and bone stresses after anatomical glenoid replacement: A micro finite element analysis.

Science.gov (United States)

Chevalier, Yan; Santos, Inês; Müller, Peter E; Pietschmann, Matthias F

2016-06-14

Glenoid loosening is still a main complication for shoulder arthroplasty. We hypothesize that cement and bone stresses potentially leading to fixation failure are related not only to glenohumeral conformity, fixation design or eccentric loading, but also to bone volume fraction, cortical thickness and degree of anisotropy in the glenoid. In this study, periprosthetic bone and cement stresses were computed with micro finite element models of the replaced glenoid depicting realistic bone microstructure. These models were used to quantify potential effects of bone microstructural parameters under loading conditions simulating different levels of glenohumeral conformity and eccentric loading simulating glenohumeral instability. Results show that peak cement stresses were achieved near the cement-bone interface in all loading schemes. Higher stresses within trabecular bone tissue and cement mantle were obtained within specimens of lower bone volume fraction and in regions of low anisotropy, increasing with decreasing glenohumeral conformity and reaching their maxima below the keeled design when the load is shifted superiorly. Our analyses confirm the combined influences of eccentric load shifts with reduced bone volume fraction and anisotropy on increasing periprosthetic stresses. They finally suggest that improving fixation of glenoid replacements must reduce internal cement and bone tissue stresses, in particular in glenoids of low bone density and heterogeneity. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Experiment of porous calcium phosphate/bone matrix gelatin composite cement for repairing lumbar vertebral bone defect in rabbit].

Science.gov (United States)

Wang, Song; Yang, Han; Yang, Jian; Kang, Jianping; Wang, Qing; Song, Yueming

2017-12-01

To investigate the effect of a porous calcium phosphate/bone matrix gelatin (BMG) composite cement (hereinafter referred to as the "porous composite cement") for repairing lumbar vertebral bone defect in a rabbit model. BMG was extracted from adult New Zealand rabbits according to the Urist's method. Poly (lactic-co-glycolic) acid (PLGA) microsphere was prepared by W/O/W double emulsion method. The porous composite cement was developed by using calcium phosphate cement (CPC) composited with BMG and PLGA microsphere. The physicochemical characterizations of the porous composite cement were assessed by anti-washout property, porosity, and biomechanical experiment, also compared with the CPC. Thirty 2-month-old New Zealand rabbits were used to construct vertebral bone defect at L 3 in size of 4 mm×3 mm×3 mm. Then, the bone defect was repaired with porous composite cement (experimental group, n =15) or CPC (control group, n =15). At 4, 8, and 12 weeks after implantation, each bone specimen was assessed by X-ray films for bone fusion, micro-CT for bone mineral density (BMD), bone volume fraction (BVF), trabecular thickness (Tb. Th.), trabecular number (Tb.N.), and trabecular spacing (Tb. Sp.), and histological section with toluidine blue staining for new-born bone formation. The study demonstrated well anti-washout property in 2 groups. The porous composite cement has 55.06%±1.18% of porosity and (51.63±6.73) MPa of compressive strength. The CPC has 49.38%±1.75% of porosity and (63.34±3.27) MPa of compressive strength. There were significant differences in porosity and compressive strength between different cements ( t =4.254, P =0.006; t =2.476, P =0.034). X-ray films revealed that the zone between the cement and host bone gradually blurred with the time extending. At 12 weeks after implantation, the zone was disappeared in the experimental group, but clear in the control group. There were significant differences in BMD, BVF, Tb. Th., Tb. N., and Tb. Sp. between

Experimental and numerical study of cemented bone-implant interface behaviour

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P. Zlamal

2011-01-01

Full Text Available Although the total hip replacement (THR is a long-proven method of surgical treatment of diseases and disorders of the human hip, the surgery brings some risk of long-term instability of the joint. The aim of the research was to investigate the cemented bone-implant interface behavior. The main problems (cement layer degradation and bone-cement interface debonding during physiological loading conditions have been investigated using a custom hip simulator. The experimental setup was designed to allow cyclic loading of the sample of pelvic bone with implanted cemented acetabular component. The hip contact force of required direction and magnitude was applied to the implant using a spherical femoral component head. The most unfavorable activity (downstairs walking was simulated. The process of damage accumulation in the fixation was monitored by repeated scanning using high resolution micro Computed Tomography (µCT. Use of micro-focus source and large high-resolution flat panel detector allows investigation of structural changes and crack propagation both in the cement layer and the trabecular bone.

Structural degradation of acrylic bone cements due to in vivo and simulated aging.

Science.gov (United States)

Hughes, Kerry F; Ries, Michael D; Pruitt, Lisa A

2003-05-01

Acrylic bone cement is the primary load-bearing material used for the attachment of orthopedic devices to adjoining bone. Degradation of acrylic-based cements in vivo results in a loss of structural integrity of the bone-cement-prosthesis interface and limits the longevity of cemented orthopedic implants. The purpose of this study is to investigate the effect of in vivo aging on the structure of the acrylic bone cement and to develop an in vitro artificial aging protocol that mimics the observed degradation. Three sets of retrievals are examined in this study: Palacos brand cement retrieved from hip replacements, and Simplex brand cement retrieved from both hip and knee replacement surgeries. In vitro aging is performed using oxidative and acidic environments on three acrylic-based cements: Palacos, Simplex, and CORE. Gel permeation chromatography (GPC) and Fourier transform infrared spectroscopy (FTIR) are used to examine the evolution of molecular weight and chemical species within the acrylic cements due to both in vivo and simulated aging. GPC analysis indicates that molecular weight is degraded in the hip retrievals but not in the knee retrievals. Artificial aging in an oxidative environment best reproduces this degradation mechanism. FTIR analysis indicates that there exists a chemical evolution within the cement due to in vivo and in vitro aging. These findings are consistent with scission-based degradation schemes in the cement. Based on the results of this study, a pathway for structural degradation of acrylic bone cement is proposed. The findings from this investigation have broad applicability to acrylic-based cements and may provide guidance for the development of new bone cements that resist degradation in the body. Copyright 2003 Wiley Periodicals, Inc.

Method of adhering bone to a rigid substrate using a graphite fiber reinforced bone cement

Science.gov (United States)

Knoell, A. C.; Maxwell, H. G. (Inventor)

1977-01-01

A method is described for adhering bone to the surface of a rigid substrate such as a metal or resin prosthesis using an improved surgical bone cement. The bone cement has mechanical properties more nearly matched to those of animal bone and thermal curing characteristics which result in less traumatization of body tissues and comprises a dispersion of short high modulus graphite fibers within a bonder composition including polymer dissolved in reactive monomer such as polymethylmethacrylate dissolved in methylmethacrylate monomer.

CT evaluation of local leakage of bone cement after percutaneous kyphoplasty and vertebroplasty

International Nuclear Information System (INIS)

Lee, In Jae; Choi, A. Lam; Yie, Mi-Yeon; Yoon, Ji Young; Jeon, Eui Yong; Koh, Sung Hye; Yoon, Dae Young; Lim, Kyung Ja; Im, Hyoung June

2010-01-01

Background: Percutaneous injection of bone cement (acrylic cement) during percutaneous kyphoplasty and vertebroplasty can cause symptomatic or asymptomatic complications due to leakage, extravasation or vascular migration of cement. Purpose: To investigate and to compare the incidence and site of local leakage or complications of bone cement after percutaneous kyphoplasty and vertebroplasty using bone cement. Material and Methods: We retrospectively reviewed 473 cases of percutaneous kyphoplasty or vertebroplasty performed under fluoroscopic guidance. Of the 473 cases, follow-up CT scans that covered the treated bones were available for 83 cases (59 kyphoplasty and 24 vertebroplasty). Results: The rate of local leakage of bone cement was 87.5% (21/24) for percutaneous vertebroplasty and 49.2% (29/59) for kyphoplasty. The most common site of local leakage was perivertebral soft tissue (n=8, 38.1%) for vertebroplasty. The most common site of local leakage was a perivertebral vein (n=7, 24.1%) for kyphoplasty. Two cases of pulmonary cement embolism developed: one case after kyphoplasty and one case after vertebroplasty. Conclusion: Local leakage of bone cement was more common for percutaneous vertebroplasty compared with kyphoplasty (P<0.005). The most common sites of local leakage were perivertebral soft tissue and perivertebral vein.

Prediction of the Setting Properties of Calcium Phosphate Bone Cement

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Seyed Mahmud Rabiee

2012-01-01

Full Text Available Setting properties of bone substitutes are improved using an injectable system. The injectable bone graft substitutes can be molded to the shape of the bone cavity and set in situ when injected. Such system is useful for surgical operation. The powder part of the injectable bone cement is included of β-tricalcium phosphate, calcium carbonate, and dicalcium phosphate and the liquid part contains poly ethylene glycol solution with different concentrations. In this way, prediction of the mechanical properties, setting times, and injectability helps to optimize the calcium phosphate bone cement properties. The objective of this study is development of three different adaptive neurofuzzy inference systems (ANFISs for estimation of compression strength, setting time, and injectability using the data generated based on experimental observations. The input parameters of models are polyethylene glycol percent and liquid/powder ratio. Comparison of the predicted values and measured data indicates that the ANFIS model has an acceptable performance to the estimation of calcium phosphate bone cement properties.

Signal-inducing bone cements for MRI-guided spinal cementoplasty: evaluation of contrast-agent-based polymethylmethacrylate cements

International Nuclear Information System (INIS)

Bail, Hermann Josef; Tsitsilonis, Serafim; Wichlas, Florian; Sattig, Christoph; Papanikolaou, Ioannis; Teichgraeber, Ulf Karl Mart

2012-01-01

The purpose of this work is to evaluate two signal-inducing bone cements for MRI-guided spinal cementoplasty. The bone cements were made of polymethylmethacrylate (PMMA, 5 ml monomeric, 12 g polymeric) and gadoterate meglumine as a contrast agent (CA, 0-40 μl) with either saline solution (NaCl, 2-4 ml) or hydroxyapatite bone substitute (HA, 2-4 ml). The cement's signal was assessed in an open 1-Tesla MR scanner, with T1W TSE and fast interventional T1W TSE pulse sequences, and the ideal amount of each component was determined. The compressive and bending strength for different amounts of NaCl and HA were evaluated. The cement's MRI signal depended on the concentration of CA, the amount of NaCl or HA, and the pulse sequence. The signal peaks were recorded between 1 and 10 μl CA per ml NaCl or HA, and were higher in fast T1W TSE than in T1W TSE images. The NaCl-PMMA-CA cements had a greater MRI signal intensity and compressive strength; the HA-PMMA-CA cements had a superior bending strength. Concerning the MR signal and biomechanical properties, these cements would permit MRI-guided cementoplasty. Due to its higher signal and greater compressive strength, the NaCl-PMMA-CA compound appears to be superior to the HA-PMMA-CA compound. (orig.)

Sr-substituted bone cements direct mesenchymal stem cells, osteoblasts and osteoclasts fate.

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Monica Montesi

Full Text Available Strontium-substituted apatitic bone cements enriched with sodium alginate were developed as a potential modulator of bone cells fate. The biological impact of the bone cement were investigated in vitro through the study of the effect of the nanostructured apatitic composition and the doping of strontium on mesenchymal stem cells, pre-osteoblasts and osteoclasts behaviours. Up to 14 days of culture the bone cells viability, proliferation, morphology and gene expression profiles were evaluated. The results showed that different concentrations of strontium were able to evoke a cell-specific response, in fact an inductive effect on mesenchymal stem cells differentiation and pre-osteoblasts proliferation and an inhibitory effect on osteoclasts activity were observed. Moreover, the apatitic structure of the cements provided a biomimetic environment suitable for bone cells growth. Therefore, the combination of biological features of this bone cement makes it as promising biomaterials for tissue regeneration.

Creep and fatigue behavior of a novel 2-component paste-like formulation of acrylic bone cements

OpenAIRE

Köster, U.; Jaeger, R.; Bardts, M.; Wahnes, C.; Büchner, H.; Kühn, K.-D.; Vogt, S.

2013-01-01

The fatigue and creep performance of two novel acrylic bone cement formulations (one bone cement without antibiotics, one with antibiotics) was compared to the performance of clinically used bone cements (Osteopal V, Palacos R, Simplex P, SmartSet GHV, Palacos R+G and CMW1 with Gentamicin). The preparation of the novel bone cement formulations involves the mixing of two paste-like substances in a static mixer integrated into the cartridge which is used to apply the bone cement. The fatigue pe...

The influence of orientation and practical size on the interface fracture of a bone-nano composite cement

International Nuclear Information System (INIS)

Ilik, Igor; Khandaker, Morshed

2010-01-01

Clinical follow-up studies in cemented total hip arthroplasties found that femoral prosthesis loosening is caused by the fracture of the bone-cement interfaces. The research objectives were to determine whether orientation of the bone has any influence on the interface fracture strength, and to determine whether inclusion of micro/nano sizes MgO particles on Cobalt HV bone cement has any influence on the interface fracture strength. Flexural tests were conducted on five groups of specimens to find Young Modulus and bending strength: (1) longitudinal bone, (2) transverse bone, (3) pure cement particles, (4) cement with 36 im and 27 nm MgO particles, and (5) cement with 27nm MgO particles. Also, fracture tests were conducted on six groups of bone-cement specimen to find interface fracture toughness: (1) longitudinal bone-cement without MgO particles, (2) transverse bone-cement without MgO particles, (3) longitudinal bone-cement with 36 im MgO particles, (4) transverse bone-cement with 36 im MgO particles, (5) , longitudinal bone-cement with 27 nm MgO particles, and (6) transverse bone-cement with 27 nm MgO particles. Transverse bone specimen was 14% stiffer than longitudinal specimen, while bending strength and fracture toughness of longitudinal specimen was 29% and 2.6 times lower than the transverse specimen, respectively. Reduction of Young's modulus (7.3%), bending strength (27%) and fracture toughness (16%) was observed by the inclusion of microsize MgO particles, and a reduction of the Young's Modulus (19%), bending strength (21%),and fracture toughness (19%) for nanosize MgO particles. The interface toughness of the transverse bone infused with 27nm MgO was about 6 times higher than transverse bone infused with 36 im particles of MgO. Preliminary studies show that orientation of the bone has significant influence on the interface fracture. MgO particles size have a significant effect on the strength of the bone - cement interface.(Author)

Experimental study with domestic bone cement in the percutaneous vertebroplasty

International Nuclear Information System (INIS)

Ni Caifang; Liu Xisheng; Chen Long; Yang Huilin; Tang Tiansi; Ding Yi

2004-01-01

Objective: To study the feasibility of injecting domestic bone cement in the process of the percutaneous vertebroplasty. Methods: (1) Various types cement were disposed with domestic PMMA. The concretionary phases of cement were observed according to the stages and holding time. Then the most ideal ratio of the mixed cement was selected and ten cement columns were made with this ratio, which was taken as the trial group. The other ten referring to was taken as the contrast one. The biological mechanics was measured with a load and the data of the results were compared. (2) Twenty thoracic and lumbar adjacent bodies were removed intact from five human corpses. These bodies were divided into two groups, in one group PMMA were injected, the other was severed as the contrast one. Then in these twenty vertebral bodies the biological mechanics was measured and the treatment effect was evaluated. (3) In 12 healthy dogs PVP in lumber was tried so as to observe the operational difficulty during the process of injected this bone cement and CT was used to evaluate the result of PMMA, diffusion and the complications caused by it. Results: The most ideal ratio was 4:2.6:1 (g, ml, ml) between powder, monome and contrast. After injecting this kind of cement, the loading strength of these vertebral bodies was increased remarkably (P<0.01). Conclusion: Injecting domestic bone cement provides the theoretical foundations for the clinical application of PVP. (author)

Mechanical behaviour of a new acryclic radiopaque iodine-containing bone cement

NARCIS (Netherlands)

Hooy-Corstjens, van C.S.J.; Govaert, L.E.; Spoelstra, A.B.; Bulstra, S.K.; Wetzels, G.M.R.; Koole, L.H.

2004-01-01

In total hip replacement, fixation of a prosthesis is in most cases obtained by the application of methacrylic bone cements. Most of the commercially available bone cements contain barium sulphate or zirconium dioxide as radiopacifier. As is shown in the literature, the presence of these inorganic

Benefits and drawbacks of zinc in glass ionomer bone cements

Energy Technology Data Exchange (ETDEWEB)

Brauer, Delia S; Hill, Robert G [Unit of Dental Physical Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Mile End Road, London E1 4NS (United Kingdom); Gentleman, Eileen; Stevens, Molly M [Department of Materials, Imperial College London, Exhibition Road, London SW7 2AZ (United Kingdom); Farrar, David F, E-mail: d.brauer@qmul.ac.uk [Smith and Nephew Research Centre, York Science Park, Heslington YO10 5DF (United Kingdom)

2011-08-15

Glass polyalkenoate (ionomer) cements (GPCs) based on poly(acrylic acid) and fluoro-alumino-silicate glasses are successfully used in a variety of orthopaedic and dental applications; however, they release small amounts of aluminium, which is a neurotoxin and inhibits bone mineralization in vivo. Therefore there has been significant interest in developing aluminium-free glasses containing zinc for forming GPCs because zinc can play a similar structural role in the glass, allowing for glass degradation and subsequent cement setting, and is reported to have beneficial effects on bone formation. We created zinc-containing GPCs and characterized their mechanical properties and biocompatibility. Zinc-containing cements showed adhesion to bone close to 1 MPa, which was significantly greater than that of zinc-free cements (<0.05 MPa) and other currently approved biological adhesives. However, zinc-containing cements produced significantly lower metabolic activity in mouse osteoblasts exposed to cell culture medium conditioned with the cements than controls. Results show that although low levels of zinc may be beneficial to cells, zinc concentrations of 400 {mu}M Zn{sup 2+} or more resulted in cell death. In summary, we demonstrate that while zinc-containing GPCs possess excellent mechanical properties, they fail basic biocompatibility tests, produce an acute cytotoxic response in vitro, which may preclude their use in vivo.

Benefits and drawbacks of zinc in glass ionomer bone cements

International Nuclear Information System (INIS)

Brauer, Delia S; Hill, Robert G; Gentleman, Eileen; Stevens, Molly M; Farrar, David F

2011-01-01

Glass polyalkenoate (ionomer) cements (GPCs) based on poly(acrylic acid) and fluoro-alumino-silicate glasses are successfully used in a variety of orthopaedic and dental applications; however, they release small amounts of aluminium, which is a neurotoxin and inhibits bone mineralization in vivo. Therefore there has been significant interest in developing aluminium-free glasses containing zinc for forming GPCs because zinc can play a similar structural role in the glass, allowing for glass degradation and subsequent cement setting, and is reported to have beneficial effects on bone formation. We created zinc-containing GPCs and characterized their mechanical properties and biocompatibility. Zinc-containing cements showed adhesion to bone close to 1 MPa, which was significantly greater than that of zinc-free cements ( 2+ or more resulted in cell death. In summary, we demonstrate that while zinc-containing GPCs possess excellent mechanical properties, they fail basic biocompatibility tests, produce an acute cytotoxic response in vitro, which may preclude their use in vivo.

Evaluation of four biodegradable, injectable bone cements in an experimental drill hole model in sheep.

Science.gov (United States)

von Rechenberg, Brigitte; Génot, Oliver R; Nuss, Katja; Galuppo, Larry; Fulmer, Mark; Jacobson, Evan; Kronen, Peter; Zlinszky, Kati; Auer, Jörg A

2013-09-01

Four cement applications were tested in this investigation. Two dicalcium phosphate dihydrate (DCPD-brushite) hydraulic cements, an apatite hydraulic fiber loaded cement, and a calcium sulfate cement (Plaster of Paris) were implanted in epiphyseal and metaphyseal cylindrical bone defects in sheep. The in vivo study was performed to assess the biocompatibility and bone remodeling of four cement formulations. After time periods of 2, 4, and 6 months, the cement samples were clinically and histologically evaluated. Histomorphometrically, the amount of new bone formation, fibrous tissue, and bone marrow and the area of remaining cement were measured. In all specimens, no signs of inflammation were detectable either macroscopically or microscopically. Cements differed mainly in their resorption time. Calcium sulfate was already completely resorbed at 2 months and showed a variable amount of new bone formation and/or fibrous tissue in the original drill hole over all time periods. The two DCPD cements in contrast were degraded to a large amount at 6 months, whereas the apatite was almost unchanged over all time periods. Copyright © 2013. Published by Elsevier B.V.

A Novel Composite PMMA-based Bone Cement with Reduced Potential for Thermal Necrosis.

Science.gov (United States)

Lv, Yang; Li, Ailing; Zhou, Fang; Pan, Xiaoyu; Liang, Fuxin; Qu, Xiaozhong; Qiu, Dong; Yang, Zhenzhong

2015-06-03

Percutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) are now widely used to treat patients who suffer painful vertebral compression fractures. In each of these treatments, a bone cement paste is injected into the fractured vertebral body/bodies, and the cement of choice is a poly(methyl methacrylate) (PMMA) bone cement. One drawback of this cement is the very high exothermic temperature, which, it has been suggested, causes thermal necrosis of surrounding tissue. In the present work, we prepared novel composite PMMA bone cement where microcapsules containing a phase change material (paraffin) (PCMc) were mixed with the powder of the cement. A PCM absorbs generated heat and, as such, its presence in the cement may lead to reduction in thermal necrosis. We determined a number of properties of the composite cement. Compared to the values for a control cement (a commercially available PMMA cement used in VP and BKP), each composite cement was found to have significantly lower maximum exothermic temperature, increased setting time, significantly lower compressive strength, significantly lower compressive modulus, comparable biocompatibility, and significantly smaller thermal necrosis zone. Composite cement containing 20% PCMc may be suitable for use in VP and BKP and thus deserves further evaluation.

PMMA/Ca2+ bone cements. Hydrolytic properties and bioactivity

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Mónica L. Hernández

2012-01-01

Full Text Available Bone cements of poly (methyl methacrylate (PMMA have been used for about 40 years to fix artificial prosthesis to bone structure. The aim of this study was to evaluate the absorption, solubility, degradation and bioactivity of novel formulations of PMMA/Ca2+ bone cements. These properties were evaluated using a fractional experimental design. Hydrolytic parameters were determined, from which we found that 7/8 of the formulations for absorption and 6/8 for solubility fulfill the ISO 4049:2000 requirements. The final degradation values ranged between 1 and 5%, except for one of the formulations. Besides, some formulations showed bioactivity after seven days of immersion in SBF solution.

Nanoparticulate fillers improve the mechanical strength of bone cement.

Science.gov (United States)

Gomoll, Andreas H; Fitz, Wolfgang; Scott, Richard D; Thornhill, Thomas S; Bellare, Anuj

2008-06-01

Polymethylmethacrylate (PMMA-) based bone cement contains micrometer-size barium sulfate or zirconium oxide particles to radiopacify the cement for radiographic monitoring during follow-up. Considerable effort has been expended to improve the mechanical qualities of cements, largely through substitution of PMMA with new chemical structures. The introduction of these materials into clinical practice has been complicated by concerns over the unknown long-term risk profile of these new structures in vivo. We investigated a new composite with the well characterized chemical composition of current cements, but with nanoparticles instead of the conventional, micrometer-size barium sulfate radiopacifier. In this study, we replaced the barium sulfate microparticles that are usually present in commercial PMMA cements with barium sulfate nanoparticles. The resultant "microcomposite" and "nanocomposite" cements were then characterized through morphological investigations such as ultra-small angle X-ray scattering (USAXS) and scanning electron microscopy (SEM). Mechanical characterization included compression, tensile, compact tension, and fatigue testing. SEM and USAXS showed excellent dispersion of nanoparticles. Substitution of nanoparticles for microparticles resulted in a 41% increase in tensile strain-to-failure (p = 0.002) and a 70% increase in tensile work-of-fracture (p = 0.005). The nanocomposite cement also showed a two-fold increase in fatigue life compared to the conventional, microcomposite cement. In summary, nanoparticulate substitution of radiopacifiers substantially improved the in vitro mechanical properties of PMMA bone cement without changing the known chemical composition.

Cement stress predictions after anatomic total shoulder arthroplasty are correlated with preoperative glenoid bone quality.

Science.gov (United States)

Terrier, Alexandre; Obrist, Raphaël; Becce, Fabio; Farron, Alain

2017-09-01

We hypothesized that biomechanical parameters typically associated with glenoid implant failure after anatomic total shoulder arthroplasty (aTSA) would be correlated with preoperative glenoid bone quality. We developed an objective automated method to quantify preoperative glenoid bone quality in different volumes of interest (VOIs): cortical bone, subchondral cortical plate, subchondral bone after reaming, subchondral trabecular bone, and successive layers of trabecular bone. Average computed tomography (CT) numbers (in Hounsfield units [HU]) were measured in each VOI from preoperative CT scans. In parallel, we built patient-specific finite element models of simulated aTSAs to predict cement stress, bone-cement interfacial stress, and bone strain around the glenoid implant. CT measurements and finite element predictions were obtained for 20 patients undergoing aTSA for primary glenohumeral osteoarthritis. We tested all linear correlations between preoperative patient characteristics (age, sex, height, weight, glenoid bone quality) and biomechanical predictions (cement stress, bone-cement interfacial stress, bone strain). Average CT numbers gradually decreased from cortical (717 HU) to subchondral and trabecular (362 HU) bone. Peak cement stress (4-10 MPa) was located within the keel hole, above the keel, or behind the glenoid implant backside. Cement stress, bone-cement interfacial stress, and bone strain were strongly negatively correlated with preoperative glenoid bone quality, particularly in VOIs behind the implant backside (subchondral trabecular bone) but also in deeper trabecular VOIs. Our numerical study suggests that preoperative glenoid bone quality is an important parameter to consider in aTSA, which may be associated with aseptic loosening of the glenoid implant. These initial results should now be confronted with clinical and radiologic outcomes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc

Peri-implant stress correlates with bone and cement morphology: Micro-FE modeling of implanted cadaveric glenoids.

Science.gov (United States)

Wee, Hwabok; Armstrong, April D; Flint, Wesley W; Kunselman, Allen R; Lewis, Gregory S

2015-11-01

Aseptic loosening of cemented joint replacements is a complex biological and mechanical process, and remains a clinical concern especially in patients with poor bone quality. Utilizing high resolution finite element analysis of a series of implanted cadaver glenoids, the objective of this study was to quantify relationships between construct morphology and resulting mechanical stresses in cement and trabeculae. Eight glenoid cadavers were implanted with a cemented central peg implant. Specimens were imaged by micro-CT, and subject-specific finite element models were developed. Bone volume fraction, glenoid width, implant-cortex distance, cement volume, cement-cortex contact, and cement-bone interface area were measured. Axial loading was applied to the implant of each model and stress distributions were characterized. Correlation analysis was completed across all specimens for pairs of morphological and mechanical variables. The amount of trabecular bone with high stress was strongly negatively correlated with both cement volume and contact between the cement and cortex (r = -0.85 and -0.84, p implant-cortex distance. Contact between the cement and underlying cortex may dramatically reduce trabecular bone stresses surrounding the cement, and this contact depends on bone shape, cement amount, and implant positioning. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Bone augmentation for cancellous bone- development of a new animal model

Science.gov (United States)

2013-01-01

Background Reproducible and suitable animal models are required for in vivo experiments to investigate new biodegradable and osteoinductive biomaterials for augmentation of bones at risk for osteoporotic fractures. Sheep have especially been used as a model for the human spine due to their size and similar bone metabolism. However, although sheep and human vertebral bodies have similar biomechanical characteristics, the shape of the vertebral bodies, the size of the transverse processes, and the different orientation of the facet joints of sheep are quite different from those of humans making the surgical approach complicated and unpredictable. Therefore, an adequate and safe animal model for bone augmentation was developed using a standardized femoral and tibia augmentation site in sheep. Methods The cancellous bone of the distal femur and proximal tibia were chosen as injection sites with the surgical approach via the medial aspects of the femoral condyle and proximal tibia metaphysis (n = 4 injection sites). For reproducible drilling and injection in a given direction and length, a custom-made c-shaped aiming device was designed. Exact positioning of the aiming device and needle positioning within the intertrabecular space of the intact bone could be validated in a predictable and standardized fashion using fluoroscopy. After sacrifice, bone cylinders (∅ 32 mm) were harvested throughout the tibia and femur by means of a diamond-coated core drill, which was especially developed to harvest the injected bone area exactly. Thereafter, the extracted bone cylinders were processed as non-decalcified specimens for μCT analysis, histomorphometry, histology, and fluorescence evaluation. Results The aiming device could be easily placed in 63 sheep and assured a reproducible, standardized injection area. In four sheep, cardiovascular complications occurred during surgery and pulmonary embolism was detected by computed tomography post surgery in all of these animals

The influence of cyclic loading on gentamicin release from acrylic bone cements

NARCIS (Netherlands)

Hendriks, JGE; Neut, D; Hazenberg, JG; Verkerke, GJ; van Horn, [No Value; van der Mei, HC; Busscher, HJ

Antibiotic-loaded acrylic bone cement is widely used in total joint replacement to reduce infections. Walking results in cyclic loading, which has been suggested to stimulate antibiotic release. The goal of this study is to compare antibiotic release from cyclically loaded bone cement with the

The long-term in vivo behavior of polymethyl methacrylate bone cement in total hip arthroplasty.

Science.gov (United States)

Oonishi, Hiroyuki; Akiyama, Haruhiko; Takemoto, Mitsuru; Kawai, Toshiyuki; Yamamoto, Koji; Yamamuro, Takao; Oonishi, Hironobu; Nakamura, Takashi

2011-10-01

The long-term success of cemented total hip arthroplasty (THA) has been well established. Improved outcomes, both radiographically and clinically, have resulted mainly from advances in stem design and improvements in operating techniques. However, there is concern about the durability of bone cement in vivo. We evaluated the physical and chemical properties of CMW1 bone cements retrieved from patients undergoing revision THA. CMW1 cements were retrieved from 14 patients who underwent acetabular revision because of aseptic loosening. The time in vivo before revision was 7-30 years. The bending properties of the retrieved bone cement were assessed using the three-point bending method. The molecular weight and chemical structure were analyzed by gel permeation chromatography and Fourier-transform infrared spectroscopy. The porosity of the bone cements was evaluated by 3-D microcomputer tomography. The bending strength decreased with increasing time in vivo and depended on the density of the bone cement, which we assume to be determined by the porosity. There was no correlation between molecular weight and time in vivo. The infrared spectra were similar in the retrieved cements and in the control CMW1 cements. Our results indicate that polymer chain scission and significant hydrolysis do not occur in CMW1 cement after implantation in vivo, even in the long term. CMW1 cement was stable through long-term implantation and functional loading.

Calcium carbonate-calcium phosphate mixed cement compositions for bone reconstruction.

Science.gov (United States)

Combes, C; Bareille, R; Rey, C

2006-11-01

The feasibility of making calcium carbonate-calcium phosphate (CaCO(3)-CaP) mixed cements, comprising at least 40% (w/w) CaCO(3) in the dry powder ingredients, has been demonstrated. Several original cement compositions were obtained by mixing metastable crystalline CaCO(3) phases with metastable amorphous or crystalline CaP powders in aqueous medium. The cements set within at most 1 h at 37 degrees C in atmosphere saturated with water. The hardened cement is microporous and exhibits weak compressive strength. The setting reaction appeared to be essentially related to the formation of a highly carbonated nanocrystalline apatite phase by reaction of the metastable CaP phase with part or almost all of the metastable CaCO(3) phase. The recrystallization of metastable CaP varieties led to a final cement consisting of a highly carbonated poorly crystalline apatite analogous to bone mineral associated with various amounts of vaterite and/or aragonite. The presence of controlled amounts of CaCO(3) with a higher solubility than that of the apatite formed in the well-developed CaP cements might be of interest to increase resorption rates in biomedical cement and favors its replacement by bone tissue. Cytotoxicity testing revealed excellent cytocompatibility of CaCO(3)-CaP mixed cement compositions.

Long-term effects of vertical bone augmentation: a systematic review

Directory of Open Access Journals (Sweden)

Johan Anton Jochum Keestra

2016-02-01

Full Text Available ABSTRACT Extraction, periodontitis, or trauma can cause a reduction on the alveolar ridge. This could result in an insufficient alveolar bone width and height. Different techniques of vertical bone augmentation are described in literature. However, nowadays there is not enough evidence against lateral augmentation procedures to verify if these techniques are stable over a long period of time. Objective This review analyses the different techniques that are used to vertically augment the bone and evaluate if these techniques are stable over a long period of time. Material and Methods The MEDLINE-PubMed database was searched from its earliest records until December 22, 2014. The following search term was used: Alveolar Ridge augmentation [MESH]. Several journals were hand searched and some authors were contacted for additional information. The primary outcome measure that was analyzed was marginal bone level change around dental implants in the augmented sites, and the secondary outcomes were survival and success rates of dental implants placed in the augmented sites. Results The search yielded 203 abstracts. Ultimately, 90 articles were selected, describing 51 studies meeting the eligibility criteria. The marginal bone level change for the inlay technique and vertical guided bone regeneration are in agreement with the success criteria. Alveolar distraction showed more marginal bone level change after the first year of loading, and for the inlay technique very few studies were available. Conclusions Based on the available data in the current existing studies with a follow-up period of at least 4 to 5 years, one can summarize that there seems to be a trend that the onlay technique, alveolar distraction, and vertical guided bone regeneration are stable for at least 4 to 5 years.

Surface roughness, porosity and wettability of gentamicin-loaded bone cements and their antibiotic release

NARCIS (Netherlands)

van de Belt, H; Neut, D; Uges, DRA; Schenk, W; van Horn, [No Value; van der Mei, HC; Busscher, HJ

2000-01-01

In this study, the release of gentamicin as a function of time was measured for six different gentamicin-loaded bone cements and related with the surface roughness, porosity and wettability of the cements. Initial release rates varied little between the six bone cements (CMW1, CMW3, CMW Endurance,

Mechanical properties and antibiotic release characteristics of poly(methyl methacrylate)-based bone cement formulated with mesoporous silica nanoparticles.

Science.gov (United States)

Letchmanan, Kumaran; Shen, Shou-Cang; Ng, Wai Kiong; Kingshuk, Poddar; Shi, Zhilong; Wang, Wilson; Tan, Reginald B H

2017-08-01

The influence of mesoporous silica nanoparticles (MSNs) loaded with antibiotics on the mechanical properties of functional poly(methyl methacrylate)-(PMMA) based bone cements is investigated. The incorporation of MSNs to the bone cements (8.15wt%) shows no detrimental effects on the biomechanical properties of the freshly solidified bone cements. Importantly, there are no significant changes in the compression strength and bending modulus up to 6 months of aging in PBS buffer solution. The preserved mechanical properties of MSN-functionalized bone cements is attributed to the unchanged microstructures of the cements, as more than 96% of MSNs remains in the bone cement matrix to support the cement structures after 6 months of aging. In addition, the MSN-functionalized bone cements are able to increase the drug release of gentamicin (GTMC) significantly as compared with commercially available antibiotic-loaded bone cements. It can be attributed to the loaded nano-sized MSNs with uniform pore channels which build up an effective nano-network path enable the diffusion and extended release of GTMC. The combination of excellent mechanical properties and sustainable drug delivery efficiency demonstrates the potential applicability of MSN-functionalized PMMA bone cements for orthopedic surgery to prevent post-surgery infection. Copyright © 2017 Elsevier Ltd. All rights reserved.

3D-Printed Bioactive Ca3SiO5 Bone Cement Scaffolds with Nano Surface Structure for Bone Regeneration.

Science.gov (United States)

Yang, Chen; Wang, Xiaoya; Ma, Bing; Zhu, Haibo; Huan, Zhiguang; Ma, Nan; Wu, Chengtie; Chang, Jiang

2017-02-22

Silicate bioactive materials have been widely studied for bone regeneration because of their eminent physicochemical properties and outstanding osteogenic bioactivity, and different methods have been developed to prepare porous silicate bioactive ceramics scaffolds for bone-tissue engineering applications. Among all of these methods, the 3D-printing technique is obviously the most efficient way to control the porous structure. However, 3D-printed bioceramic porous scaffolds need high-temperature sintering, which will cause volume shrinkage and reduce the controllability of the pore structure accuracy. Unlike silicate bioceramic, bioactive silicate cements such as tricalcium silicate (Ca 3 SiO 5 and C 3 S) can be self-set in water to obtain high mechanical strength under mild conditions. Another advantage of using C 3 S to prepare 3D scaffolds is the possibility of simultaneous drug loading. Herein, we, for the first time, demonstrated successful preparation of uniform 3D-printed C 3 S bone cement scaffolds with controllable 3D structure at room temperature. The scaffolds were loaded with two model drugs and showed a loading location controllable drug-release profile. In addition, we developed a surface modification process to create controllable nanotopography on the surface of pore wall of the scaffolds, which showed activity to enhance rat bone-marrow stem cells (rBMSCs) attachment, spreading, and ALP activities. The in vivo experiments revealed that the 3D-printed C 3 S bone cement scaffolds with nanoneedle-structured surfaces significantly improved bone regeneration, as compared to pure C 3 S bone cement scaffolds, suggesting that 3D-printed C 3 S bone cement scaffolds with controllable nanotopography surface are bioactive implantable biomaterials for bone repair.

Mechanical, material, and antimicrobial properties of acrylic bone cement impregnated with silver nanoparticles.

Science.gov (United States)

Slane, Josh; Vivanco, Juan; Rose, Warren; Ploeg, Heidi-Lynn; Squire, Matthew

2015-03-01

Prosthetic joint infection is one of the most serious complications that can lead to failure of a total joint replacement. Recently, the rise of multidrug resistant bacteria has substantially reduced the efficacy of antibiotics that are typically incorporated into acrylic bone cement. Silver nanoparticles (AgNPs) are an attractive alternative to traditional antibiotics resulting from their broad-spectrum antimicrobial activity and low bacterial resistance. The purpose of this study, therefore, was to incorporate metallic silver nanoparticles into acrylic bone cement and quantify the effects on the cement's mechanical, material and antimicrobial properties. AgNPs at three loading ratios (0.25, 0.5, and 1.0% wt/wt) were incorporated into a commercial bone cement using a probe sonication technique. The resulting cements demonstrated mechanical and material properties that were not substantially different from the standard cement. Testing against Staphylococcus aureus and Staphylococcus epidermidis using Kirby-Bauer and time-kill assays demonstrated no antimicrobial activity against planktonic bacteria. In contrast, cements modified with AgNPs significantly reduced biofilm formation on the surface of the cement. These results indicate that AgNP-loaded cement is of high potential for use in primary arthroplasty where prevention of bacterial surface colonization is vital. Copyright © 2014 Elsevier B.V. All rights reserved.

Injectable biphasic calcium phosphate cements as a potential bone substitute

NARCIS (Netherlands)

Sariibrahimoglu, K.; Wolke, J.G.C.; Leeuwenburgh, S.C.G.; Yubao, L.; Jansen, J.A.

2014-01-01

Apatitic calcium phosphate cements (CPCs) have been widely used as bone grafts due to their excellent osteoconductive properties, but the degradation properties are insufficient to stimulate bone healing in large bone defects. A novel approach to overcome the lack of degradability of apatitic CPC

Improvement of disintegrable properties of bone prosthetic phosphate cements

International Nuclear Information System (INIS)

Kaneda, Mitsumasa

2007-01-01

The author added a viscoelastic binder or bio-disintegrable polymer filler in αDT-cement (DTC) base, which consisting of α-tricalcium phosphate, tetracalcium phosphate and dicalcium phosphate anhydrous, in order to examine whether disintegrable properties of the bone prosthetic materials could be improved. The additive for the former binder was hydroxypropyl-cellulose and the latter filler, poly-(DL-lactide-co-glycolide) and they were mixed in various proportions with the base. At both sides of the cranial coronary suture of Japanese white rabbit, cavities (4 in total) were made at anteroposterior sites where those prosthetic cements were filled. At 1, 2 and 4 weeks later, the operated bone region was dissected out, its soft X-ray image was taken by the machine OMC603 (OHMICRON), and three-dimensional (3D) micro-focused XCT images, by Shimadzu SMX-130CT-SV. The trabecular thickness, bone volume and tissue volume ratio were calculated from the latter images by the trabecular structural measure software TRI/3Dbon (ROTAC). Disintegration rate of the cements was tested in water. Disintegrable properties were found to affect osteogenesis by giving the space for it, and thereby the choice of the ratio of the binder and disintegrable filler in the DTC makes it possible to design the most suitable cement needed. (R.T.)

Studies to compare radioactivity of bone cements and their ingredient X-ray contrast media

International Nuclear Information System (INIS)

Hopf, C.; Gloebel, B.; Hopf, T.; Universitaet des Saarlandes, Homburg/Saar; Universitaet des Saarlandes, Homburg/Saar

1990-01-01

Various PMMA bone cements/containing zirconium oxide (ZrO 2 ) as an X-ray contrast medium and zirconium oxides of several manufacturers were tested for their radioactivity by means of a gamma spectrometer. All the bone cements tested (Implast, Palacos R, and Sulfix-6) showed a certain degree of radioactivity. The radiation source in the bone cement is the added zirconium oxide, which is polluted by radioactive elements. The examination of various zirconium oxides showed some high radioactive emissions. (orig./GDG) [de

Production of bone cement composites: effect of fillers, co-monomer and particles properties

Energy Technology Data Exchange (ETDEWEB)

Santos Junior, J.G.F.; Melo, P.A.; Pinto, J.C., E-mail: jjunior@peq.coppe.ufrj.b, E-mail: melo@peq.coppe.ufrj.b, E-mail: pinto@peq.coppe.ufrj.b [Coordenacao dos Programas de Pos-Graduacao de Engenharia. (PEQ/COPPE/UFRJ), RJ (Brazil). Programa de Engenharia Quimica; Pita, V.J.R.R., E-mail: vjpita@ima.ufrj.b [Universidade Federal do Rio de Janeiro (IMA/UFRJ), RJ (Brazil). Inst. de Macromoleculas Eloisa Mano; Nele, M. [Universidade Federal do Rio de Janeiro (EQ/UFRJ), RJ (Brazil). Escola de Quimica

2011-04-15

Artificial bone cements (BCs) based on poly(methyl methacrylate) (PMMA) powders and methyl methacrylate (MMA) liquid monomer also present in their formulation small amounts of other substances, including a chemical initiator compound and radiopaque agents. Because inadequate mixing of the recipe components during the manufacture of the bone cement may compromise the mechanical properties of the final pieces, new techniques to incorporate the fillers into the BC and their effect upon the mechanical properties of BC pieces were investigated in the present study. PMMA powder composites were produced in situ in the reaction vessel by addition of X-ray contrasts to the reacting MMA mixture. It is shown that this can lead to much better mechanical properties of test pieces, when compared to standard bone cement formulations, because enhanced dispersion of the radiopaque agents can be achieved. Moreover, it is shown that the addition of hydroxyapatite (HA) and acrylic acid (AA) to the bone cement recipe can be beneficial for the mechanical performance of the final material. It is also shown that particle morphology can exert a tremendous effect upon the performance of test pieces, indicating that the suspension polymerization step should be carefully controlled when optimization of the bone cement formulation is desired. (author)

Production of bone cement composites: effect of fillers, co-monomer and particles properties

Directory of Open Access Journals (Sweden)

J. G. F. Santos Jr.

2011-06-01

Full Text Available Artificial bone cements (BCs based on poly(methyl methacrylate (PMMA powders and methyl methacrylate (MMA liquid monomer also present in their formulation small amounts of other substances, including a chemical initiator compound and radiopaque agents. Because inadequate mixing of the recipe components during the manufacture of the bone cement may compromise the mechanical properties of the final pieces, new techniques to incorporate the fillers into the BC and their effect upon the mechanical properties of BC pieces were investigated in the present study. PMMA powder composites were produced in-situ in the reaction vessel by addition of X-ray contrasts to the reacting MMA mixture. It is shown that this can lead to much better mechanical properties of test pieces, when compared to standard bone cement formulations, because enhanced dispersion of the radiopaque agents can be achieved. Moreover, it is shown that the addition of hydroxyapatite (HA and acrylic acid (AA to the bone cement recipe can be beneficial for the mechanical performance of the final material. It is also shown that particle morphology can exert a tremendous effect upon the performance of test pieces, indicating that the suspension polymerization step should be carefully controlled when optimization of the bone cement formulation is desired.

Bactericidal strontium-releasing injectable bone cements based on bioactive glasses

OpenAIRE

Brauer, Delia S.; Karpukhina, Natalia; Kedia, Gopal; Bhat, Aditya; Law, Robert V.; Radecka, Izabela; Hill, Robert G.

2013-01-01

Strontium-releasing injectable bone cements may have the potential to prevent implant-related infections through the bactericidal action of strontium, while enhancing bone formation in patients suffering from osteoporosis. A melt-derived bioactive glass (BG) series (SiO2–CaO–CaF2–MgO) with 0–50% of calcium substituted with strontium on a molar base were produced. By mixing glass powder, poly(acrylic acid) and water, cements were obtained which can be delivered by injection and set in situ, gi...

Recombinant human bone morphogenetic protein 2 in augmentation procedures: case reports.

Science.gov (United States)

Luiz, Jaques; Padovan, Luis Eduardo Marques; Claudino, Marcela

2014-01-01

To successfully rehabilitate edentulous patients using endosseous implants, there must be enough available bone. Several techniques have been proposed for augmentation of sites with insufficient bone volume. Although autogenous bone has long been considered the gold standard for such procedures, the limited availability of graft material and a high morbidity rate are potential disadvantages of this type of graft. An alternative is to use recombinant human bone morphogenetic protein 2 (rhBMP-2), which is able to support bone regeneration in the oral environment. These cases demonstrate the applicability of rhBMP-2 in maxillary sinus elevation and augmentation procedures in the maxilla to enable dental implant placement. The use of rhBMP-2 in alveolar augmentation procedures had several clinical benefits for these patients.

[Effects of surface roughness of bone cements on histological characteristics of induced membranes].

Science.gov (United States)

Liu, Hai-Xiao; Xu, Hua-Zi; Zhang, Yu; Hu, Gang; Shen, Yue; Cheng, Xiao-Jie; Peng, Lei

2012-08-01

To explore surface roughness of bone cement and surround tissue on histological characteristic of induced membranes. Bone cements with smooth and rough surface were implanted in radius bone defect, intramuscular and subcutaneous sites of rabbits, and formed induced membranes. Membranes were obtained and stained (HE) 6 weeks later. Images of membrane tissue were obtained and analyzed with an automated image analysis system. Five histological parameters of membranes were measured with thickness,area,cell density,ECM density and microvessel density. Double factor variance analysis was used to evaluate the effect of the two factors on histological characteristics of induced membranes. Membranes can be induced by each kind of bone cement and at all the three tissue sites. In histological parameters of thickness,area and micro vessel,there were significant differences among the membranes induced at different tissue sites (P = 0.000, P = 0.000, P = 0.000); whereas, there were no significant differences in histological parameters of cell density and ECM density (P = 0.734, P = 0.638). In all five histological parameters of membranes, there were no significant differences between the membranes induced by bone cements with different surface roughness (P = 0.506, P = 0.185, P = 0.883, P = 0.093, P = 0.918). Surround tissue rather than surface roughness of bone cements can affect the histological characteristics of induced membranes. The fibrocystic number, vascularity, mechanical tension and micro motion of the surround tissue may be closely correlated with the histological characteristics of induced membranes.

Influence of lactose addition to gentamicin-loaded acrylic bone cement on the kinetics of release of the antibiotic and the cement properties.

Science.gov (United States)

Frutos, Gloria; Pastor, José Ygnacio; Martínez, Noelia; Virto, María Rosa; Torrado, Susana

2010-03-01

The purpose of this study was to characterize a poly(methyl methacrylate) bone cement that was loaded with the antibiotic gentamicin sulphate (GS) and lactose, which served to modulate the release of GS from cement specimens. The release of GS when the cement specimens were immersed in phosphate-buffered saline at 37 degrees Celsius was determined spectrophotometrically. The microstructure, porosity, density, tensile properties and flexural properties of the cements were determined before and after release of GS. A kinetics model of the release of GS from the cement that involved a coupled mechanism based on dissolution/diffusion processes and an initial burst effect was proposed. Dissolution assay results showed that drug elution was controlled by a diffusion mechanism which can be modulated by lactose addition. Density values and mechanical properties (tensile strength, flexural strength, elastic modulus and fracture toughness) were reduced by the increased porosity resulting from lactose addition, but maintained acceptable values for the structural functions of bone cement. The present results suggest that lactose-modified, gentamicin-loaded acrylic bone cements are potential candidates for use in various orthopaedic and dental applications. Copyright 2009 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

[Effect of different bone cement dispersion types in the treatment of osteoporotic vertebral compression fracture].

Science.gov (United States)

Zhao, Yong-Sheng; Li, Qiang; Li, Qiang; Zheng, Yan-Ping

2017-05-25

To observe different bone cement dispersion types of PVP, PKP and manipulative reduction PVP and their effects in the treatment of senile osteoporotic vertebral compression fractures and the bone cement leakage rate. The clinical data of patients with osteoporotic vertebral compression fractures who underwent unilateral vertebroplasty from January 2012 to January 2015 was retrospectively analyzed. Of them, 56 cases including 22 males and 34 females aged from 60 to 78 years old were treated by PVP operation; Fouty-eight cases including 17 males and 31 females aged from 61 to 79 years old were treated by PKP operation; Forty-three cases including 15 males and 28 females aged from 60 to 76 years old were treated by manipulative reduction PVP operation. AP and lateral DR films were taken after the operation; the vertebral bone cement diffusion district area and mass district area were calculated with AutoCAD graphics processing software by AP and lateral DR picture, then ratio(K) of average diffusion area and mass area were calculated, defining K100% as diffusion type. Different bone cement dispersion types of PVP, PKP and manipulative reduction PVP operation were analyzed. According to bone cement dispersion types, patients were divided into diffusion type, mixed type and mass type groups.Visual analogue scale (VAS), vertebral body compression rate, JOA score and bone cement leakage rate were observed. All patients were followed up for 12-24 months with an average of 17.2 months. There was significant difference in bone cement dispersion type among three groups ( P <0.05). The constituent ratio of diffusion type, mixed type and mass type in PVP operation was 46.43%, 35.71%, 17.86%, in PKP was 16.67%, 37.50% , 45.83%, and in manipulative reduction PVP was 37.21%, 44.19% and 18.60%, respectively. PVP operation and manipulative reduction PVP were mainly composed of diffusion type and mixed type, while PKP was mainly composed of mass type and mixed type. There was no

Experimental ex-vivo validation of PMMA-based bone cements loaded with magnetic nanoparticles enabling hyperthermia of metastatic bone tumors

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Mariem Harabech

2017-05-01

Full Text Available Percutaneous vertebroplasty comprises the injection of Polymethylmethacrylate (PMMA bone cement into vertebrae and can be used for the treatment of compression fractures of vertebrae. Metastatic bone tumors can cause such compression fractures but are not treated when injecting PMMA-based bone cement. Hyperthermia of tumors can on the other hand be attained by placing magnetic nanoparticles (MNPs in an alternating magnetic field (AMF. Loading the PMMA-based bone cement with MNPs could both serve vertebra stabilization and metastatic bone tumor hyperthermia when subjecting this PMMA-MNP to an AMF. A dedicated pancake coil is designed with a self-inductance of 10 μH in series with a capacitance of 0.1 μF that acts as resonant inductor-capacitor circuit to generate the AMF. The thermal rise is appraised in beef vertebra placed at 10 cm from the AMF generating circuit using optical temperatures sensors, i.e. in the center of the PMMA-MNP bone cement, which is located in the vicinity of metastatic bone tumors in clinical applications; and in the spine, which needs to be safeguarded to high temperature exposures. Results show a temperature rise of about 7 °C in PMMA-MNP whereas the temperature rise in the spine remains limited to 1 °C. Moreover, multicycles heating of PMMA-MNP is experimentally verified, validating the technical feasibility of having PMMA-MNP as basic component for percutaneous vertebroplasty combined with hyperthermia treatment of metastatic bone tumors.

Electrocoagulation improving bone cement use in middle-ear surgery: short-term and middle-term results.

Science.gov (United States)

Galy-Bernadoy, C; Akkari, M; Mondain, M; Uziel, A; Venail, F

2016-12-01

Bone cement is used for ossicular chain repair and revision stapes surgery. Its efficient use requires cautious removal of mucosa from the ossicles. This paper reports a technique for easy, fast and safe removal of this mucosa prior to cement application. It consists of the application of monopolar electrocoagulation on the ossicles prior to bone cement application. The outcomes of six cases of revision stapes surgery and seven cases of partial ossiculoplasty, conducted between 2007 and 2012 using this new technique, were evaluated. Intra-operative reports and audiometric data were collected. During the last assessment, reconstruction using bone cement resulted in mean post-operative air-bone gaps of 4.1 ± 6.5 dB in revision stapes surgery cases and 5.7 ± 5.5 dB in partial ossiculoplasty cases, reflecting a significant hearing improvement (p = 0.03). No complications were observed. Electrocoagulation allows the removal of mucosa from the ossicles in an easy, fast and safe manner, enabling the use of bone cement for ossicular chain reconstruction.

Bactericidal strontium-releasing injectable bone cements based on bioactive glasses.

Science.gov (United States)

Brauer, Delia S; Karpukhina, Natalia; Kedia, Gopal; Bhat, Aditya; Law, Robert V; Radecka, Izabela; Hill, Robert G

2013-01-06

Strontium-releasing injectable bone cements may have the potential to prevent implant-related infections through the bactericidal action of strontium, while enhancing bone formation in patients suffering from osteoporosis. A melt-derived bioactive glass (BG) series (SiO2–CaO–CaF2–MgO) with 0–50% of calcium substituted with strontium on a molar base were produced. By mixing glass powder, poly(acrylic acid) and water, cements were obtained which can be delivered by injection and set in situ, giving compressive strength of up to 35 MPa. Strontium release was dependent on BG composition with increasing strontium substitution resulting in higher concentrations in the medium. Bactericidal effects were tested on Staphylococcus aureus and Streptococcus faecalis; cell counts were reduced by up to three orders of magnitude over 6 days. Results show that bactericidal action can be increased through BG strontium substitution, allowing for the design of novel antimicrobial and bone enhancing cements for use in vertebroplasty or kyphoplasty for treating osteoporosis-related vertebral compression fractures.

Hypothermic manipulation of bone cement can extend the handling time during vertebroplasty

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Lai Po-Liang

2012-10-01

Full Text Available Abstract Background Polymethylmethacrylate (PMMA is commonly used for clinical applications. However, the short handling time increases the probability of a surgeon missing the crucial period in which the cement maintains its ideal viscosity for a successful injection. The aim of this article was to illustrate the effects a reduction in temperature would have on the cement handling time during percutaneous vertebroplasty. Methods The injectability of bone cement was assessed using a cement compressor. By twisting the compressor, the piston transmits its axial load to the plunger, which then pumps the bone cement out. The experiments were categorized based on the different types of hypothermic manipulation that were used. In group I (room temperature, sham group, the syringes were kept at 22°C after mixing the bone cement. In group 2 (precooling the bone cement and the container, the PMMA powder and liquid, as well as the beaker, spatula, and syringe, were stored in the refrigerator (4°C overnight before mixing. In group 3 (ice bath cooling, the syringes were immediately submerged in ice water after mixing the bone cement at room temperature. Results The average liquid time, paste time, and handling time were 5.1 ± 0.7, 3.4 ± 0.3, and 8.5 ± 0.8 min, respectively, for group 1; 9.4 ± 1.1, 5.8 ± 0.5, and 15.2 ± 1.2 min, respectively, for group 2; and 83.8 ± 5.2, 28.8 ± 6.9, and 112.5 ± 11.3 min, respectively, for group 3. The liquid and paste times could be increased through different cooling methods. In addition, the liquid time (i.e. waiting time for ice bath cooling was longer than for that of the precooling method (p Conclusions Both precooling (i.e. lowering the initial temperature and ice bath cooling (i.e. lowering the surrounding temperature can effectively slow polymerization. Precooling is easy for clinical applications, while ice bath cooling might be more suitable for multiple-level vertebroplasty. Clinicians can take

Hypothermic manipulation of bone cement can extend the handling time during vertebroplasty.

Science.gov (United States)

Lai, Po-Liang; Tai, Ching-Lung; Chu, I-Ming; Fu, Tsai-Sheng; Chen, Lih-Huei; Chen, Wen-Jer

2012-10-16

Polymethylmethacrylate (PMMA) is commonly used for clinical applications. However, the short handling time increases the probability of a surgeon missing the crucial period in which the cement maintains its ideal viscosity for a successful injection. The aim of this article was to illustrate the effects a reduction in temperature would have on the cement handling time during percutaneous vertebroplasty. The injectability of bone cement was assessed using a cement compressor. By twisting the compressor, the piston transmits its axial load to the plunger, which then pumps the bone cement out. The experiments were categorized based on the different types of hypothermic manipulation that were used. In group I (room temperature, sham group), the syringes were kept at 22°C after mixing the bone cement. In group 2 (precooling the bone cement and the container), the PMMA powder and liquid, as well as the beaker, spatula, and syringe, were stored in the refrigerator (4°C) overnight before mixing. In group 3 (ice bath cooling), the syringes were immediately submerged in ice water after mixing the bone cement at room temperature. The average liquid time, paste time, and handling time were 5.1 ± 0.7, 3.4 ± 0.3, and 8.5 ± 0.8 min, respectively, for group 1; 9.4 ± 1.1, 5.8 ± 0.5, and 15.2 ± 1.2 min, respectively, for group 2; and 83.8 ± 5.2, 28.8 ± 6.9, and 112.5 ± 11.3 min, respectively, for group 3. The liquid and paste times could be increased through different cooling methods. In addition, the liquid time (i.e. waiting time) for ice bath cooling was longer than for that of the precooling method (p < 0.05). Both precooling (i.e. lowering the initial temperature) and ice bath cooling (i.e. lowering the surrounding temperature) can effectively slow polymerization. Precooling is easy for clinical applications, while ice bath cooling might be more suitable for multiple-level vertebroplasty. Clinicians can take advantage of the improved injectability without any

Nostril Base Augmentation Effect of Alveolar Bone Graft

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Woojin Lee

2013-09-01

Full Text Available Background The aims of alveolar bone grafting are closure of the fistula, stabilization ofthe maxillary arch, support for the roots of the teeth adjacent to the cleft on each side.We observed nostril base augmentation in patients with alveolar clefts after alveolar bonegrafting. The purpose of this study was to evaluate the nostril base augmentation effect ofsecondary alveolar bone grafting in patients with unilateral alveolar cleft.Methods Records of 15 children with alveolar clefts who underwent secondary alveolar bonegrafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 werereviewed. Preoperative and postoperative worm’s-eye view photographs and reconstructedthree-dimensional computed tomography (CT scans were used for photogrammetry. Thedepression of the nostril base and thickness of the philtrum on the cleft side were measuredin comparison to the normal side. The depression of the cleft side pyriform aperture wasmeasured in comparison to the normal side on reconstructed three-dimensional CT.Results Significant changes were seen in the nostril base (P=0.005, the philtrum length(P=0.013, and the angle (P=0.006. The CT measurements showed significant changes in thepyriform aperture (P<0.001 and the angle (P<0.001.Conclusions An alveolar bone graft not only fills the gap in the alveolar process but alsoaugments the nostril base after surgery. In this study, only an alveolar bone graft was performedto prevent bias from other procedures. Nostril base augmentation can be achieved byperforming alveolar bone grafts in children, in whom invasive methods are not advised.

Magnesium substitution in brushite cements for enhanced bone tissue regeneration

Energy Technology Data Exchange (ETDEWEB)

Cabrejos-Azama, Jatsue, E-mail: jacaza@farm.ucm.es [Departamento de Química-Física II, Facultad de Farmacia, UCM, Madrid (Spain); Departamento de Estomatología III, Facultad de Odontología UCM, Madrid (Spain); Alkhraisat, Mohammad Hamdan; Rueda, Carmen [Departamento de Química-Física II, Facultad de Farmacia, UCM, Madrid (Spain); Torres, Jesús [Facultad de Ciencias de la salud URJC, Alcorcón, Madrid (Spain); Blanco, Luis [Departamento de Estomatología III, Facultad de Odontología UCM, Madrid (Spain); López-Cabarcos, Enrique [Departamento de Química-Física II, Facultad de Farmacia, UCM, Madrid (Spain)

2014-10-01

We have synthesized calcium phosphate cements doped with different amounts of magnesium (Mg-CPC) with a twofold purpose: i) to evaluate in vitro the osteoblast cell response to this material, and ii) to compare the bone regeneration capacity of the doped material with a calcium cement prepared without magnesium (CPC). Cell proliferation and in vivo response increased in the Mg-CPCs in comparison with CPC. The Mg-CPCs have promoted higher new bone formation than the CPC (p < 0.05). The cytocompatibility and histomorfometric analysis performed in the rabbit calvaria showed that the incorporation of magnesium ions in CPC improves osteoblasts proliferation and provides higher new bone formation. The development of a bone substitute with controllable biodegradable properties and improved bone regeneration can be considered a step toward personalized therapy that can adapt to patient needs and clinical situations. - Highlights: • The Mg-CPCs promote higher new bone formation than the CPC. • The incorporation of magnesium ions in CPC improves osteoblasts proliferation. • Mg-CPC is a bone substitute with controllable biodegradable properties. • We suggest that the use of Mg ions could improve the clinical efficiency of CPCs.

Fatigue crack propagation of acrylic bone cements. Influence of the radio-opaque agents

International Nuclear Information System (INIS)

Ginebra, M. P.; Albuixech, L.; Fernandez-Barragan, E.; Gil, F. J.; Planell, J. A.; San Roman, J.; Vazquez, B.

2001-01-01

In this work the 2,5-diiodo-8-quinolyl methacrylate (IHQM), is proposed as a new radiopaque agent. The addition of the iodine containing methacrylate provided a statistically significant increase in the tensile strength, fracture toughness and ductility, with respect to the barium sulphate containing cement. This effect was attributed to the fact that the use of a radiopaque monomer eliminated the porosity associated to the barium sulphate particles. However, since fatigue resistance is one of the main properties required to ensure a good long-term performance of permanent pros these, as is the case of acrylic bone cements, it is important to compare the fatigue properties of this new bone cement formulation with the radiolucent and the BaSO 4 containing bone cements. The results show that the absence of inorganic particles with no matrix adhesion plays a negative role when the fatigue crack propagation is considered. (Author) 26 refs

The Use of Micro and Nano Particulate Fillers to Modify the Mechanical and Material Properties of Acrylic Bone Cement

Science.gov (United States)

Slane, Joshua A.

Acrylic bone cement (polymethyl methacrylate) is widely used in total joint replacements to provide long-term fixation of implants. In essence, bone cement acts as a grout by filling in the voids left between the implant and the patient's bone, forming a mechanical interlock. While bone cement is considered the `gold standard' for implant fixation, issues such as mechanical failure of the cement mantle (aseptic loosening) and the development of prosthetic joint infection (PJI) still plague joint replacement procedures and often necessitate revision arthroplasty. In an effort to address these failures, various modifications are commonly made to bone cement such as mechanical reinforcement with particles/fibers and the addition of antibiotics to mitigate PJI. Despite these attempts, issues such as poor particle interfacial adhesion, inadequate drug release, and the development of multidrug resistant bacteria limit the effectiveness of bone cement modifications. Therefore, the overall goal of this work was to use micro and nanoparticles to enhance the properties of acrylic bone cement, with particular emphasis placed on improving the mechanical properties, cumulative antibiotic release, and antimicrobial properties. An acrylic bone cement (Palacos R) was modified with three types of particles in various loading ratios: mesoporous silica nanoparticles (for mechanical reinforcement), xylitol microparticles (for increased antibiotic release), and silver nanoparticles (as an antimicrobial agent). These particles were used as sole modifications, not in tandem with one another. The resulting cement composites were characterized using a variety of mechanical (macro to nano, fatigue, fracture, and dynamic), imaging, chemical, thermal, biological, and antimicrobial testing techniques. The primary outcomes of this dissertation demonstrate that: (1) mesoporous silica, as used in this work, is a poor reinforcement phase for acrylic bone cement, (2) xylitol can significantly

[Correlation analysis of cement leakage with volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence in percutaneous vertebroplasty for osteoporotic vertebral compression fractures].

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Liang, De; Ye, Linqiang; Jiang, Xiaobing; Huang, Weiquan; Yao, Zhensong; Tang, Yongchao; Zhang, Shuncong; Jin, Daxiang

2014-11-01

To investigate the risk factors of cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Between March 2011 and March 2012, 98 patients with single level OVCF were treated by PVP, and the clinical data were analyzed retrospectively. There were 13 males and 85 females, with a mean age of 77.2 years (range, 54-95 years). The mean disease duration was 43 days (range, 15-120 days), and the mean T score of bone mineral density (BMD) was -3.8 (range, -6.7- -2.5). Bilateral transpedicular approach was used in all the patients. The patients were divided into cement leakage group and no cement leakage group by occurrence of cement leakage based on postoperative CT. Single factor analysis was used to analyze the difference between 2 groups in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, preoperative vertebral body wall incompetence, cement volume, and volume ratio of intravertebral bone cement to vertebral body. All relevant factors were introduced to logistic regression analysis to analyze the risk factors of cement leakage. All procedures were performed successfully. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean volume ratio of intravertebral bone cement to vertebral body was 24.88% (range, 7.84%-38.99%). Back pain was alleviated significantly in all the patients postoperatively. All patients were followed up with a mean time of 8 months (range, 6-12 months). Cement leakage occurred in 49 patients. Single factor analysis showed that there were significant differences in the volume ratio of intravertebral bone cement to vertebral body and preoperative vertebral body wall incompetence between 2 groups (P 0.05). The logistic regression analysis showed that the volume ratio of intravertebral bone cement to vertebral body (P

Antibiotic-eluting hydrophilized PMMA bone cement with prolonged bactericidal effect for the treatment of osteomyelitis.

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Oh, Eun Jo; Oh, Se Heang; Lee, In Soo; Kwon, Oh Soo; Lee, Jin Ho

2016-05-01

Osteomyelitis is still considered to be one of the major challenges for orthopedic surgeons despite advanced antiseptic surgical procedures and pharmaceutical therapeutics. In this study, hydrophilized poly(methyl methacrylate) (PMMA) bone cements containing Pluronic F68 (EG79PG28EG79) as a hydrophilic additive and vancomycin (F68-VAcements) were prepared to allow the sustained release of the antibiotic for adequate periods of time without any significant loss of mechanical properties. The compressive strengths of the bone cements with Pluronic F68 compositions less than 7 wt% were not significantly different compared with the control vancomycin-loaded bone cement (VAcement). TheF68 (7 wt%)-VAcement showed sustained release of the antibiotic for up to 11 weeks and almost 100% release from the bone cement. It also prohibited the growth ofS. aureus(zone of inhibition) over six weeks (the required period to treat osteomyelitis), and it did not show any notable cytotoxicity. From an animal study using a femoral osteomyelitis rat model, it was observed that theF68 (7 wt%)-VAcement was effective for the treatment of osteomyelitis, probably as a result of the prolonged release of antibiotic from the PMMA bone cement. On the basis of these findings, it can be suggested that the use of Pluronic F68 as a hydrophilic additive for antibiotic-eluting PMMA bone cement can be a promising strategy for the treatment of osteomyelitis. © The Author(s) 2016.

Micro-mechanical modeling of the cement-bone interface: the effect of friction, morphology and material properties on the micromechanical response.

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Janssen, Dennis; Mann, Kenneth A; Verdonschot, Nico

2008-11-14

In order to gain insight into the micro-mechanical behavior of the cement-bone interface, the effect of parametric variations of frictional, morphological and material properties on the mechanical response of the cement-bone interface were analyzed using a finite element approach. Finite element models of a cement-bone interface specimen were created from micro-computed tomography data of a physical specimen that was sectioned from an in vitro cemented total hip arthroplasty. In five models the friction coefficient was varied (mu=0.0; 0.3; 0.7; 1.0 and 3.0), while in one model an ideally bonded interface was assumed. In two models cement interface gaps and an optimal cement penetration were simulated. Finally, the effect of bone cement stiffness variations was simulated (2.0 and 2.5 GPa, relative to the default 3.0 GPa). All models were loaded for a cycle of fully reversible tension-compression. From the simulated stress-displacement curves the interface deformation, stiffness and hysteresis were calculated. The results indicate that in the current model the mechanical properties of the cement-bone interface were caused by frictional phenomena at the shape-closed interlock rather than by adhesive properties of the cement. Our findings furthermore show that in our model maximizing cement penetration improved the micromechanical response of the cement-bone interface stiffness, while interface gaps had a detrimental effect. Relative to the frictional and morphological variations, variations in the cement stiffness had only a modest effect on the micro-mechanical behavior of the cement-bone interface. The current study provides information that may help to better understand the load-transfer mechanisms taking place at the cement-bone interface.

Evaluation of an injectable bioactive borate glass cement to heal bone defects in a rabbit femoral condyle model

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Cui, Xu [Institute of Bioengineering and Information Technology Materials, Tongji University, Shanghai 200092 (China); Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055 (China); Huang, Wenhai [Institute of Bioengineering and Information Technology Materials, Tongji University, Shanghai 200092 (China); Zhang, Yadong, E-mail: zhangyadong6@126.com [Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120 (China); Huang, Chengcheng; Yu, Zunxiong; Wang, Lei; Liu, Wenlong; Wang, Ting [Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055 (China); Zhou, Jie; Wang, Hui; Zhou, Nai; Wang, Deping [Institute of Bioengineering and Information Technology Materials, Tongji University, Shanghai 200092 (China); Pan, Haobo, E-mail: hb.pan@siat.ac.cn [Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055 (China); Rahaman, Mohamed N., E-mail: rahaman@mst.edu [Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120 (China); Department of Materials Science and Engineering, Missouri University of Science and Technology, Rolla, MO 65409-0340 (United States)

2017-04-01

There is a need for synthetic biomaterials to heal bone defects using minimal invasive surgery. In the present study, an injectable cement composed of bioactive borate glass particles and a chitosan bonding solution was developed and evaluated for its capacity to heal bone defects in a rabbit femoral condyle model. The injectability and setting time of the cement in vitro decreased but the compressive strength increased (8 ± 2 MPa to 31 ± 2 MPa) as the ratio of glass particles to chitosan solution increased (from 1.0 g ml{sup −1} to 2.5 g ml{sup −1}). Upon immersing the cement in phosphate-buffered saline, the glass particles reacted and converted to hydroxyapatite, imparting bioactivity to the cement. Osteoblastic MC3T3-E1 cells showed enhanced proliferation and alkaline phosphatase activity when incubated in media containing the soluble ionic product of the cement. The bioactive glass cement showed a better capacity to stimulate bone formation in rabbit femoral condyle defects at 12 weeks postimplantation when compared to a commercial calcium sulfate cement. The injectable bioactive borate glass cement developed in this study could provide a promising biomaterial to heal bone defects by minimal invasive surgery. - Highlights: • New class of injectable bone cement composed of bioactive borate glass particles and chitosan bonding phase was created. • The cement is biocompatible and bioactive, and has a much lower temperature increase during setting than PMMA cement. • The cement has a more controllable degradation rate and higher strength over a longer time than calcium sulfate cement. • The cement showed a better ability to heal bone defects than calcium sulfate over a twelve-week implantation period.

Regenerate augmentation with bone marrow concentrate after traumatic bone loss

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Jan Gessmann

2012-03-01

Full Text Available Distraction osteogenesis after post-traumatic segmental bone loss of the tibia is a complex and time-consuming procedure that is often complicated due to prolonged consolidation or complete insufficiency of the regenerate. The aim of this feasibility study was to investigate the potential of bone marrow aspiration concentrate (BMAC for percutaneous regenerate augmentation to accelerate bony consolidation of the regenerate. Eight patients (age 22-64 with an average posttraumatic bone defect of 82.4 mm and concomitant risk factors (nicotine abuse, soft-tissue defects, obesity and/or circulatory disorders were treated with a modified Ilizarov external frame using an intramedullary cable transportation system. At the end of the distraction phase, each patient was treated with a percutaneously injection of autologous BMAC into the centre of the regenerate. The concentration factor was analysed using flow cytometry. The mean follow up after frame removal was 10 (4-15 months. With a mean healing index (HI of 36.9 d/cm, bony consolidation of the regenerate was achieved in all eight cases. The mean concentration factor of the bone marrow aspirate was 4.6 (SD 1.23. No further operations concerning the regenerate were needed and no adverse effects were observed with the BMAC procedure. This procedure can be used for augmentation of the regenerate in cases of segmental bone transport. Further studies with a larger number of patients and control groups are needed to evaluate a possible higher success rate and accelerating effects on regenerate healing.

Nanomechanical properties of bone around cement-retained abutment implants. A minipig study

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R.R.M. de Barros

2016-06-01

Full Text Available Aim The nanomechanical evaluation can provide additional information about the dental implants osseointegration process. The aim of this study was to quantify elastic modulus and hardness of bone around cemented-retained abutment implants positioned at two different crestal bone levels. Materials and methods The mandibular premolars of 7 minipigs were extracted. After 8 weeks, 8 implants were inserted in each animal: crestally on one side of the mandible and subcrestally on the other (crestal and subcrestal groups. Functional loading were immediately provided with abutments cementation and prostheses installation. Eight weeks later, the animals euthanasia was performed and nanoindentation analyses were made at the most coronal newly formed bone region (coronal group, and below in the threaded region (threaded group of histologic sections. Results The comparisons between subcrestal and crestal groups did not achieve statistical relevance; however the elastic modulus and hardness levels were statistically different in the two regions of evaluation (coronal and threaded. Conclusions The crestal and subcrestal placement of cement-retained abutment implants did not affect differently the nanomechanical properties of the surrounding bone. However the different regions of newly formed bone (coronal and threaded groups were extremely different in both elastic modulus and hardness, probably reflecting their differences in bone composition and structure.

The Use of Structural Allograft in Primary and Revision Knee Arthroplasty with Bone Loss

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Raul A. Kuchinad

2011-01-01

Full Text Available Bone loss around the knee in the setting of total knee arthroplasty remains a difficult and challenging problem for orthopaedic surgeons. There are a number of options for dealing with smaller and contained bone loss; however, massive segmental bone loss has fewer options. Small, contained defects can be treated with cement, morselized autograft/allograft or metal augments. Segmental bone loss cannot be dealt with through simple addition of cement, morselized autograft/allograft, or metal augments. For younger or higher demand patients, the use of allograft is a good option as it provides a durable construct with high rates of union while restoring bone stock for future revisions. Older patients, or those who are low demand, may be better candidates for a tumour prosthesis, which provides immediate ability to weight bear and mobilize.

Investigation of the histology and interfacial bonding between carbonated hydroxyapatite cement and bone

International Nuclear Information System (INIS)

Mao Keya; Hao Libo; Tang Peifu; Wang Zheng; Wen Ning; Du Mingkui; Wang Jifang; Wang Yan; Yang Yun; Li Jiangtao

2009-01-01

An ideal bone implant should facilitate the formation of a new bone layer as an osteo-integrated interface between bone and the implanted biomaterials. In the present work, the interface between carbonated hydroxyapatite (CHA) cement and bone was evaluated by interfacial bonding strength measurements and histological characterizations. CHA cement was implanted into a mongrel dog's femoral supracondylar and below the tibial plateau area, and was then tested ex vivo by, respectively, detaching and pullout experiments. Polymethylmethacrylate (PMMA) was used as a control. CHA cement could be directly injected and solidified in situ to repair bone defects. Histology results showed that CHA bonded with bone through gradual remodeling and was replaced by new bone tissue, which is an attribute for excellent biocompatibility. The interfacial bonding strength increased with implantation time. After 16 weeks implantation, the measured detaching force and the pullout force between CHA and bone were 281 ± 16 N and 512.5 ± 14.5 N, respectively. These values were several times higher compared to 5 days implantation. In contrast, the control showed a fibrous microstructure between PMMA and bone, and the detaching force and the pullout force decreased with implantation time. The results strongly suggest that CHA can form a better osteo-integrated interface compared to PMMA, and could be used as an ideal biomaterial for bone defect repair.

PMMA-hydroxyapatite composite material retards fatigue failure of augmented bone compared to augmentation with plain PMMA: in vivo study using a sheep model.

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Arabmotlagh, Mohammad; Bachmaier, Samuel; Geiger, Florian; Rauschmann, Michael

2014-11-01

Polymethylmethacrylate (PMMA) is the most commonly used void filler for augmentation of osteoporotic vertebral fracture, but the differing mechanical features of PMMA and osteoporotic bone result in overload and failure of adjacent bone. The aim of this study was to compare fatigue failure of bone after augmentation with PMMA-nanocrystalline hydroxyapatite (HA) composite material or with plain PMMA in a sheep model. After characterization of the mechanical properties of a composite material consisting of PMMA and defined amounts (10, 20, and 30% volume fraction) of HA, the composite material with 30% volume fraction HA was implanted in one distal femur of sheep; plain PMMA was implanted in the other femur. Native non-augmented bone served as control. Three and 6 months after implantation, the augmented bone samples were exposed to cyclic loading and the evolution of damage was investigated. The fatigue life was highest for the ovine native bone and lowest for bone-PMMA specimens. Bone-composite specimens showed significantly higher fatigue life than the respective bone-PMMA specimens in both 3- and 6-month follow-up groups. These results suggest that modification of mechanical properties of PMMA by addition of HA to approximate those of cancellous bone retards fatigue failure of the surrounding bone compared to augmented bone with plain PMMA. © 2014 Wiley Periodicals, Inc.

The Effect of Polymethyl Methacrylate Augmentation on the Primary Stability of Cannulated Bone Screws in an Anterolateral Plate in Osteoporotic Vertebrae: A Human Cadaver Study.

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Rüger, Matthias; Sellei, Richard M; Stoffel, Marcus; von Rüden, Christian

2016-02-01

Study Design Cohort study. Objective Expandable anterolateral plates facilitate the reduction of posttraumatic deformities of thoracolumbar spine injuries and are commonly used in cases of unstable injuries or compromised bone quality. In this in vitro study, the craniocaudal yield load of the osseous fixation of an anterior angular stable plate fixation system and the effect of polymethyl methacrylate (PMMA) screw augmentation on the primary stability of the screw-bone interface during kyphosis reduction was evaluated in 12 osteoporotic human thoracolumbar vertebrae. Methods The anterolateral stabilization device used for this study is comprised of two swiveling flanges and an expandable midsection. It facilitates the controlled reduction of kyphotic deformities in situ with a geared distractor. Single flanges were attached to 12 thoracolumbar vertebrae. Six specimens were augmented with PMMA by means of cannulated bone screws. The constructs were subjected to static, displacement-controlled craniocaudal loading to failure in a servohydraulic testing machine. Results The uncemented screws cut out at a mean 393 ± 66 N, whereas the cemented screws showed significantly higher yield load of 966 ± 166 N (p augmentation is an effective method to increase two- to threefold the primary stability of the screw-bone interface of an anterolateral spine stabilization system in osteoporotic bone. We recommend it in cases of severely compromised bone quality to reduce the risk of screw loosening during initial kyphosis correction and to increase long-term construct stability.

The effect of patient age on bone formation using a fully synthetic nanocrystalline bone augmentation material in maxillary sinus grafting.

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Wolf, Michael; Wurm, Alexander; Heinemann, Friedhelm; Gerber, Thomas; Reichert, Christoph; Jäger, Andreas; Götz, Werner

2014-01-01

Maxillary sinus floor augmentation is a treatment that has been proposed for patients in whom the alveolar bone height is insufficient. This procedure is commonly used in patients aged 40 to 70 years and older. However, little information exists whether the factor of age might influence the outcome of augmentation procedures. The aim of this study was to investigate whether the patient's age has an effect on bone formation and incorporation in maxillary sinus floor augmentation procedures. A fully synthetic nanocrystalline bone augmentation material (NanoBone, Artoss) was used for sinus floor augmentation in patients with a subantral vertical bone height of at least 3 mm and maximum of 7 mm. After 7 months healing time, biopsy specimens were taken and were divided into two groups according to the patient's age. Exclusion criteria were poor general health (eg, severe renal/and or liver disease), history of a radiotherapy in the head region, chemotherapy at the time of surgical procedure, noncompensated diabetes mellitus, symptoms of a maxillary sinus disease, active periodontal or systemic diseases, smoking, and poor oral hygiene. Histologic analyses with hematoxylin-eosin stain were performed. Multinucleated osteoclast-like cells were identified by histochemical staining (tartrate-resistant acid phosphatase [TRAP]). Quantitative and age-dependent assessment of bone formation, residual bone grafting material, and soft tissue formation following sinus augmentation was performed using histomorphometric analysis and the Bonferroni adjustment of the Student t test. Twenty biopsy specimens from 17 patients were taken and divided into two groups according to age (group 1: 41 to 52 years; group 2: 66 to 71 years) containing 10 specimens each, which were analyzed in triplicate resulting in a total of 30 specimens per group. A regeneration process with varying amounts of newly formed bone surrounded by marrow-like tissue was present in all augmented regions. No signs of

Creep behavior of bone cement: a method for time extrapolation using time-temperature equivalence.

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Morgan, R L; Farrar, D F; Rose, J; Forster, H; Morgan, I

2003-04-01

The clinical lifetime of poly(methyl methacrylate) (PMMA) bone cement is considerably longer than the time over which it is convenient to perform creep testing. Consequently, it is desirable to be able to predict the long term creep behavior of bone cement from the results of short term testing. A simple method is described for prediction of long term creep using the principle of time-temperature equivalence in polymers. The use of the method is illustrated using a commercial acrylic bone cement. A creep strain of approximately 0.6% is predicted after 400 days under a constant flexural stress of 2 MPa. The temperature range and stress levels over which it is appropriate to perform testing are described. Finally, the effects of physical aging on the accuracy of the method are discussed and creep data from aged cement are reported.

[Experimental study of percutaneous vertebroplasty with a novel bone void filling container system].

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Wang, Tai-Ping; Zhang, Kui-bo; Zheng, Zhao-min; Liu, Hui; Yu, Bin-sheng

2011-04-19

To investigate vertebral augmentation with a novel reticulate bone filling container system by polymethyl methacrylate (PMMA) injection in cadaveric simulated vertebral compressive fracture and explore the effect of reticulate bone filling container on cement distribution controlling within vertebral body and the restoration of biomechanical properties after augmentation. A total of 28 freshly frozen human vertebrae specimens were randomly divided into 4 groups. After the measurements of bone mineral density (BMD) and vertebral height, each vertebra received an axle load by a MTS (material testing system) machine to test the initial strength and stiffness. Subsequently a simultaneous compressive fracture model was created to measure the stiffness and height of fractured vertebrae. Then the augmentation procedure was performed. Afterward the biomechanical properties and the vertebral height were similarly measured as pre-operatively. The expansion of bone filling container and the distribution of cement within vertebral body were morphologically observed by crossing the specimens in sagittal midline and also integrated with the radiographic results. Stiffness was significantly restored comparing with that of fractured level (P container groups while it was irregular in single-layer groups. After crossing, the double-layer version expanded well in vertebral body and could enwrap most of injected cement. There was only a little leakage near the vessel layer. But the single-layer version had a poor expansion and a large amount of cement leakage. This novel reticulate bone void filling container system with different layers may restore both the biomechanical properties and the height of fractured vertebrae. But, with the benefit of reducing cement leakage, a double-layer design can enwrap most of injected PMMA and has a brighter prospect of clinical application.

Biological responses of brushite-forming Zn- and ZnSr- substituted beta-tricalcium phosphate bone cements

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S Pina

2010-09-01

Full Text Available The core aim of this study was to investigate zinc (Zn- and zinc and strontium (ZnSr-containing brushite-forming beta-tricalcium phosphate (TCP cements for their effects on proliferation and differentiation of osteoblastic-like cells (MC3T3-E1 cell line as well as for their in vivo behaviour in trabecular bone cylindrical defects in a pilot study. In vitro proliferation and maturation responses of MC3T3-E1 osteoblastic-like cells to bone cements were studied at the cellular and molecular levels. The Zn- and Sr-containing brushite cements were found to stimulate pre-osteoblastic proliferation and osteoblastic maturation. Indeed, MC3T3-E1 cells exposed to the powdered cements had increased proliferative rates and higher adhesiveness capacity, in comparison to control cells. Furthermore, they exhibited higher alkaline phosphatase (ALP activity and increased Type-I collagen secretion and fibre deposition into the extracellular matrix. Proliferative and collagen deposition properties were more evident for cells grown in cements doped with Sr. The in vivo osteoconductive propertiesof the ZnCPC and ZnSrCPC cements were also pursued. Histological and histomorphometric analyses were performed at 1 and 2 months after implantation, using carbonated apatite cement (Norian SRS® as control. There was no evidence of cement-induced adverse foreign body reactions, and furthermore ZnCPC and ZnSrCPC cements revealed better in vivo performance in comparison to the control apatite cement. Additionally, the presence of both zinc and strontium resulted in the highest rate of new bone formation. These novel results indicate that the investigated ZnCPC and ZnSrCPC cements are both biocompatible and osteoconductive, being good candidate materials to use as bone substitutes.

Localized ridge defect augmentation using human pericardium membrane and demineralized bone matrix.

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Vidyadharan, Arun Kumar; Ravindran, Anjana

2014-01-01

Patient wanted to restore her lost teeth with implants in the lower left first molar and second premolar region. Cone beam computerized tomography (CBCT) revealed inadequate bone width and height around future implant sites. The extraction socket of second premolar area revealed inadequate socket healing with sparse bone fill after 4 months of extraction. To evaluate the clinical feasibility of using a collagen physical resorbable barrier made of human pericardium (HP) to augment localized alveolar ridge defects for the subsequent placement of dental implants. Ridge augmentation was done in the compromised area using Puros® demineralized bone matrix (DBM) Putty with chips and an HP allograft membrane. Horizontal (width) and vertical hard tissue measurements with CBCT were recorded on the day of ridge augmentation surgery, 4 month and 7 months follow-up. Intra oral periapical taken 1 year after implant installation showed minimal crestal bone loss. Bone volume achieved through guided bone regeneration was a gain of 4.8 mm horizontally (width) and 6.8 mm vertically in the deficient ridge within a period of 7 months following the procedure. The results suggested that HP Allograft membrane may be a suitable component for augmentation of localized alveolar ridge defects in conjunction with DBM with bone chips.

The effect of bone cement particles on the friction of polyethylene and polyurethane knee bearings

International Nuclear Information System (INIS)

Ash, H E; Scholes, S C; Unsworth, A; Jones, E

2004-01-01

Compliant layer knee joints have been considered for use in an attempt to increase the serviceable life of artificial joints. If designed correctly, these joints should operate within the full-fluid film lubrication regime. However, adverse tribological conditions, such as the presence of bone and bone cement particles, may breach the fluid film and cause surface wear. The frictional behaviour of both polyurethane (PU) and conventional polyethylene (PE) tibial components against a metallic femoral component was therefore assessed when bone cement particles were introduced into the lubricant. The bone cement particles caused a large increase in the frictional torque of both the PE and PU bearings; however, the friction produced by the PU bearings was still considerably lower than that produced by the PE bearings. The volume of bone cement particles between each of the bearings and the resultant frictional torque both decreased over time. This occurred more quickly with the PE bearings but greater damage was caused to the surface of the PE bearings than the PU components

Radiofrequency-activated PMMA-augmentation through cannulated pedicle screws: A cadaver study to determine the biomechanical benefits in the osteoporotic spine.

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Karius, T; Deborre, C; Wirtz, D C; Burger, C; Prescher, A; Fölsch, A; Kabir, K; Pflugmacher, R; Goost, H

2017-01-01

PMMA-augmentation of pedicle screws strengthens the bone-screw-interface reducing cut-out risk. Injection of fluid cement bears a higher risk of extravasation, with difficulty of application because of inconsistent viscosity and limited injection time. To test a new method of cement augmentation of pedicle screws using radiofrequency-activated PMMA, which is suspected to be easier to apply and have less extravasations. Twenty-seven fresh-frozen human cadaver lumbar spines were divided into 18 osteoporotic (BMD ≤ 0.8 g/cm2) and 9 non-osteoporotic (BMD > 0.8 g/cm2) vertebral bodies. Bipedicular cannulated pedicle screws were implanted into the vertebral bodies; right screws were augmented with ultra-high viscosity PMMA, whereas un-cemented left pedicle screws served as negative controls. Cement distribution was controlled with fluoroscopy and CT scans. Axial pullout forces of the screws were measured with a material testing machine, and results were analyzed statistically. Fluoroscopy and CT scans showed that in all cases an adequately big cement depot with homogenous form and no signs of extravasation was injected. Pullout forces showed significant differences (p < 0.001) between the augmented and non-augmented pedicle screws for bone densities below 0.8 g/cm2 (661.9 N ± 439) and over 0.8 g/cm2 (744.9 N ± 415). Pullout-forces were significantly increased in osteoporotic as well as in non-osteoporotic vertebral bodies without a significant difference between these groups using this standardized, simple procedure with increased control and less complications like extravasation.

Preliminary focus on the mechanical and antibacterial activity of a PMMA-based bone cement loaded with gold nanoparticles

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T. Russo

2017-09-01

As reported in the literature, the stress distribution may be altered in bones after the implantation of a total joint prosthesis. Some scientific works have also correlated uncemented TKA to a progressive decrease of bone density below the tibial component. Antibiotic-loaded bone cements are commonly employed in conjunction with systemic antibiotics to treat infections. Furthermore, nanoparticles with antimicrobial activity have been widely analysed. Accordingly, the current research was focused on a preliminary analysis of the mechanical and antibacterial activity of a PMMA-based bone cement loaded with gold nanoparticles. The obtained results demonstrated that nanocomposite cements with a specific concentration of gold nanoparticles improved the punching performance and antibacterial activity. However, critical aspects were found in the optimization of the nanocomposite bone cement.

Micromechanical modeling of the cement-bone interface: the effect of friction, morphology and material properties on the micromechanical response

OpenAIRE

Janssen, Dennis; Mann, Kenneth A.; Verdonschot, Nico

2008-01-01

In order to gain insight into the micro-mechanical behavior of the cement-bone interface, the effect of parametric variations of frictional, morphological and material properties on the mechanical response of the cement-bone interface were analyzed using a finite element approach. Finite element models of a cement-bone interface specimen were created from micro-computed tomography data of a physical specimen that was sectioned from an in vitro cemented total hip arthroplasty. In five models t...

Radiographic and Histologic Evaluation of a Bone Void that Formed After Recombinant Human Bone Morphogenetic Protein-2-Mediated Sinus Graft Augmentation: A Case Report.

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Kang, Hyun-Joo; Jun, Choong-Man; Yun, Jeong-Ho

2016-01-01

In the present case report, the authors describe radiographic and histologic observations of a bone void that formed after a sinus augmentation using a graft material that contained recombinant human bone morphogenetic protein-2 (rhBMP-2) and discuss clinical and histologic implications of their findings. Sinus augmentation was performed using a graft material comprising 1 g of hydroxyapatite/β-tricalcium phosphate, which contained 1 mg of rhBMP-2. Radiographic evaluation was conducted with panoramic radiographs and computed tomography images of the augmented maxillary sinus, which were analyzed using a three-dimensional image-reconstruction program. Histologic evaluation was also performed on a biopsy specimen obtained 6 months after the sinus augmentation. The total augmented volume increased from 1,582.2 mm(3) immediately after the sinus augmentation to 3,344.9 mm3 at 6 months after the augmentation because of the formation of a bone void. Twenty-six months after the sinus augmentation, the bone void remained but had reduced in volume, with the total augmented volume reduced to 2,551.7 mm(3). Histologically, new bone was observed to be in contact with the grafted particles, and a fatty marrow-like tissue was present in the area of the bone void. This case report shows that the bone void that had formed after sinus augmentation resolved over time and seemed to be partially replaced with new bone. Furthermore, none of the implants failed, and clinical adverse events were not observed during the follow-up period.

Analysis of linezolid and tigecycline as candidates for local prophylaxis via antibiotic-loaded bone cement.

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Nichol, T; Smith, T J; Townsend, R; Stockley, I; Akid, R

2017-02-01

To assess the Gram-positive-specific antibiotic linezolid and the broad-spectrum antibiotic tigecycline for use in local antibiotic delivery via antibiotic-loaded bone cement. Linezolid and tigecycline were added to Biomet bone cement at varying concentrations. Antibiotic elution over 1 week was quantified by HPLC-MS. The effect of wear on elution over 51 h was determined using a modified TE-66 wear tester. Eluted antibiotics were used to determine the MICs for a panel of clinically relevant bacteria. The impact strength of antibiotic-loaded samples was determined using a Charpy-type impact testing apparatus. Cytotoxicity of eluted antibiotics against MG-63 cells was evaluated using an MTT assay. Linezolid and tigecycline eluted from bone cement to clinically relevant levels within 1 h and retained activity over 1 week. Mechanical wear significantly reduced elution of tigecycline, but had little effect on elution of linezolid. Linezolid showed low cytotoxicity towards MG-63 cells with ≤300 mg/mL resulting in >50% cell activity. Cytotoxicity of tigecycline was higher, with an IC 50 of 5-10 mg/L. Linezolid and tigecycline retain activity after elution from bone cement. The concentration of tigecycline may need to be carefully controlled due to cytotoxicity. The effect of wear on bone cement may need to be considered if tigecycline is to be used for local delivery. Up to 10% linezolid can be added without affecting the impact strength of the bone cement. These results are promising indications for future investigation of these antibiotics for use in local antibiotic delivery strategies. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Activity of Fosfomycin- and Daptomycin-Containing Bone Cement on Selected Bacterial Species Being Associated with Orthopedic Infections

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Sigrun Eick

2017-01-01

Full Text Available The purpose of this study was to determine activity of fosfomycin/gentamicin and daptomycin/gentamicin-containing PMMA bone-cement against Staphylococcus aureus (MRSA, MSSA, Staphylococcus epidermidis, Enterococcus faecium (VRE, and E. coli (ESBL; only fosfomycin. Test specimens of the bone cement were formed and bacteria in two concentrations were added one time or repeatedly up to 96 h. All fosfomycin-containing cement killed ultimately all MSSA, Staphylococcus epidermidis, and E. coli within 24 h; growth of MRSA was suppressed up to 48 h. Activity of daptomycin-containing cement depended on the concentration; the highest concentrated bone cement used (1.5 g daptomycin/40 g of powder was active against all one-time added bacteria. When bacteria were added repeatedly to fosfomycin-containing cement, growth was suppressed up to 96 h and that of MRSA and VRE only up to 24 h. The highest concentration of daptomycin suppressed the growth of repeated added bacteria up to 48 h (VRE until 96 h (MSSA, MRSA. In conclusion, PMMA bone cement with 1.5 g of daptomycin and 0.5 g of gentamicin may be an alternative in treatment of periprosthetic infections caused by Gram-positive bacteria.

Bone formation in sinus augmentation procedures using autologous bone, porcine bone, and a 50 : 50 mixture: a human clinical and histological evaluation at 2 months.

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Cassetta, Michele; Perrotti, Vittoria; Calasso, Sabrina; Piattelli, Adriano; Sinjari, Bruna; Iezzi, Giovanna

2015-10-01

The aim of this study was to perform a 2 months clinical and histological comparison of autologous bone, porcine bone, and a 50 : 50 mixture in maxillary sinus augmentation procedures. A total of 10 consecutive patients, undergoing two-stage sinus augmentation procedures using 100% autologous bone (Group A), 100% porcine bone (Group B), and a 50 : 50 mixture of autologous and porcine bone (Group C) were included in this study. After a 2-month healing period, at the time of implant insertion, clinical evaluation was performed and bone core biopsies were harvested and processed for histological analysis. The postoperative healing was uneventful regardless of the materials used for the sinus augmentation procedures. The histomorphometrical analysis revealed comparable percentages of newly formed bone, marrow spaces, and residual grafted material in the three groups. The clinical and histological results of this study indicated that porcine bone alone or in combination with autologous bone are biocompatible and osteoconductive materials and can be successfully used in sinus augmentation procedures. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Radiographic Comparison of Bovine Bone Substitute Alone versus Bovine Bone Substitute and Simvastatin for Human Maxillary Sinus Augmentation

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Amir Ali Reza Rasouli Ghahroudi

2018-01-01

Full Text Available Objectives: The aim of this study was to compare the efficacy of bovine bone substitute (Compact Bone B. ® alone versus bovine bone substitute and simvastatin for human maxillary sinus augmentation.Materials and Methods: This study was conducted on 16 sinuses in eight patients. Radiographic assessments were done preoperatively (T0, immediately (T1 and at nine months after sinus grafting (T2. Alveolar bone height and density were assessed on cone beam computed tomography (CBCT scans using Planmeca Romexis™ Imaging Software 2.2.Results: The change in alveolar bone height and density between T0, T1 and T2 was significant in both groups. Alveolar bone height (h0, h1, h2 and vertical height of the grafted bone (g1, g2 in three lines (anterior, middle and posterior were not significantly different between groups. The grafted bone height shrinkage (% in the anterior, middle and posterior limits of the augmented area were not significantly different between groups. The existing alveolar and grafted bone density increased significantly in both groups between T1 and T2, except for the existing alveolar bone density in the control group. There were no statistically significant differences between the alveolar bone density values obtained in TI and T2 between groups, except for the existing alveolar bone density at T1.Conclusions: This study did not show any significant positive effect for simvastatin in maxillary sinus augmentation based on radiographic examination.

Crevice corrosion of biomedical alloys: a novel method of assessing the effects of bone cement and its chemistry.

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Bryant, Michael; Hu, Xinming; Farrar, Richard; Brummitt, Ken; Freeman, Robert; Neville, Anne

2013-07-01

In this study, five commercially available poly(methyl methacrylate) PMMA bone cements were tested to investigate the effects of antibiotics on the severity of crevice corrosion. Bone cements with varying chemistry were also tested. A test method was developed in part reference to ASTM F746-04. Cylindrical specimens were fitted with a bone cement tapered collar, creating consistent crevice conditions. Crevice corrosion was then studied using potentiodynamic polarization techniques in 0.9% NaCl solution (pH7.4) at 37°C. Surface analyses using a light microscope and scanning electron microscopy were also conducted to investigate the surface morphology after accelerated electrochemical testing. Initial testing of commercially available bone cements indicated that different PMMA bone cements can affect the initiation and propagation mechanism of crevice corrosion. Further studies, utilising electrochemical and mass spectroscopy techniques, have identified that the addition of radiopaque agent and antibiotics affect the initiation mechanisms of 316L stainless steel, whilst significantly increasing the extent of propagation in CoCrMo alloys. Copyright © 2013 Wiley Periodicals, Inc.

Clinical applications of cell-based approaches in alveolar bone augmentation: a systematic review.

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Shanbhag, Siddharth; Shanbhag, Vivek

2015-01-01

Cell-based approaches, utilizing adult mesenchymal stem cells (MSCs), are reported to overcome the limitations of conventional bone augmentation procedures. The study aims to systematically review the available evidence on the characteristics and clinical effectiveness of cell-based ridge augmentation, socket preservation, and sinus-floor augmentation, compared to current evidence-based methods in human adult patients. MEDLINE, EMBASE, and CENTRAL databases were searched for related literature. Both observational and experimental studies reporting outcomes of "tissue engineered" or "cell-based" augmentation in ≥5 adult patients alone, or in comparison with non-cell-based (conventional) augmentation methods, were eligible for inclusion. Primary outcome was histomorphometric analysis of new bone formation. Effectiveness of cell-based augmentation was evaluated based on outcomes of controlled studies. Twenty-seven eligible studies were identified. Of these, 15 included a control group (8 randomized controlled trials [RCTs]), and were judged to be at a moderate-to-high risk of bias. Most studies reported the combined use of cultured autologous MSCs with an osteoconductive bone substitute (BS) scaffold. Iliac bone marrow and mandibular periosteum were frequently reported sources of MSCs. In vitro culture of MSCs took between 12 days and 1.5 months. A range of autogenous, allogeneic, xenogeneic, and alloplastic scaffolds was identified. Bovine bone mineral scaffold was frequently reported with favorable outcomes, while polylactic-polyglycolic acid copolymer (PLGA) scaffold resulted in graft failure in three studies. The combination of MSCs and BS resulted in outcomes similar to autogenous bone (AB) and BS. Three RCTs and one controlled trial reported significantly greater bone formation in cell-based than conventionally grafted sites after 3 to 8 months. Based on limited controlled evidence at a moderate-to-high risk of bias, cell-based approaches are comparable, if

Bone cement distribution is a potential predictor to the reconstructive effects of unilateral percutaneous kyphoplasty in OVCFs: a retrospective study.

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Lin, Jiachen; Qian, Lie; Jiang, Changqing; Chen, Xiuyuan; Feng, Fan; Lao, Lifeng

2018-06-07

Osteoporotic vertebral compression fracture (OVCF) is a common type of fracture, and percutaneous kyphoplasty (PKP) is an eligible solution to it. Previous studies have revealed that both the volume and filling pattern of bone cement correlate with the clinical outcomes after PKP procedure. However, the role of bone cement distribution remains to be illustrated. To retrospectively evaluate the relationship between the bone cement distribution and the clinical outcomes of unilateral PKP, we enrolled 73 OVCF patients receiving unilateral PKP treatment. All the intervened vertebrae were classified into three groups based on the bone cement distribution observed on postoperative X-ray films. Preoperative and postoperative radiographic parameters including the vertebral height and kyphotic Cobb angle were recorded, and anterior vertebral height restoration rate (AVHRR) and Cobb angle correction (CR) were then calculated to assess the vertebral height reconstruction. Preoperative and postoperative Oswestry Disability Index (ODI) and visual analogue scale (VAS) were adopted by interviewing patients to assess the mobility improvement and pain relief. Demographic data, body mass index (BMI), lumbar bone mineral density (evaluated by BMD T-score) of each patient, bone cement volume (BV), and bone cement extravasation (BE) were also recorded. Between- and within-group comparisons and multivariable correlation analysis were carried out to analyze the data. VAS and ODI scores were both significantly improved in all of the enrolled cases with no significant differences between groups. Among the three groups, the average age, AVHRR, and BV were significantly different. Occurrence of BE was significantly different between two of the three groups. AVHRR was demonstrated to correlate negatively with preoperative anterior vertebral height ratio and positively with preoperative Cobb angle, CR, diffusion score, and ODI changes. Bone cement distribution is a potential predictor to the

BoneSource hydroxyapatite cement: a novel biomaterial for craniofacial skeletal tissue engineering and reconstruction.

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Friedman, C D; Costantino, P D; Takagi, S; Chow, L C

1998-01-01

BoneSource-hydroxyapatite cement is a new self-setting calcium phosphate cement biomaterial. Its unique and innovative physical chemistry coupled with enhanced biocompatibility make it useful for craniofacial skeletal reconstruction. The general properties and clinical use guidelines are reviewed. The biomaterial and surgical applications offer insight into improved outcomes and potential new uses for hydroxyapatite cement systems.

Bone Formation Following Sinus Augmentation with an Equine-Derived Bone Graft: A Retrospective Histologic and Histomorphometric Study with 36-Month Follow-up.

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Di Stefano, Danilo Alessio; Gastaldi, Giorgio; Vinci, Raffaele; Polizzi, Elisabetta Maria; Cinci, Lorenzo; Pieri, Laura; Gherlone, Enrico

2016-01-01

The aim of this study was to investigate bone formation over time following maxillary sinus augmentation with an enzyme-deantigenic, bone collagen-preserving equine bone graft by retrospective assessment of histomorphometric data. Records of patients with atrophic ridges who underwent maxillary sinus augmentation with the enzyme-deantigenic equine bone graft and two-step implant placement between 3 and 12 months after the sinus-augmentation surgery were assessed retrospectively. The histomorphometric data were clustered in three classes according to time of collection from the augmentation surgery and analyzed to assess newly formed bone deposition and residual biomaterial degradation rates. Data concerning the 36-month clinical follow-up were also assessed. Records of 77 patients and 115 biopsy specimens were retrieved, and histomorphometric data were clustered (3 to 5 months, n = 33; 6 to 8 months, n = 57; 9 to 12 months, n = 25). Mean minimum atrophic ridge thickness was 4.9 ± 0.5 mm (range, 4.0 to 7.1 mm). The amount of newly formed bone and residual biomaterial did not significantly differ among the three clusters. Qualitative analysis showed a denser trabecular structure in late (> 8 months) samples. At the 36-month clinical follow-up, no differences were found among the implant success rates in the three groups, according to the Albrektsson and Zarb criteria for success. The overall implant success rate was 98.3%. Based upon this retrospective human study of 77 patients with 4 to 7 mm of residual bone, when enzyme-deantigenic equine bone is used for sinus augmentation, new bone formation occurs at an early time (augmentation surgery.

Thermal Manifestations and Nanoindentation of Bone Cements for Orthopaedic Surgery

Czech Academy of Sciences Publication Activity Database

Hloch, Sergej; Monka, P.; Hvizdoš, P.; Jakubéczyová, D.; Kozak, D.; Čolič, K.; Kloc, J.; Magurová, D.

2013-01-01

Roč. 17, č. 1 (2013), s. 251-258 ISSN 0354-9836 Institutional support: RVO:68145535 Keywords : bone cement * exothermic behaviour * nanoindentation * porosity * osteonecrosis Subject RIV: FJ - Surgery incl. Transplants Impact factor: 0.962, year: 2013

Bone Augmentation in Rabbit Tibia Using Microfixed Cobalt-Chromium Membranes with Whole Blood and Platelet-Rich Plasma

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Oscar A. Decco

2015-07-01

Full Text Available Background: Bone augmentation is a subject of intensive investigation in regenerative bone medicine and constitutes a clinical situation in which autogenous bone grafts or synthetic materials are used to aid new bone formation. Method: Based on a non-critical defect, Co-Cr barrier membranes were placed on six adult Fauve de Bourgogne rabbits, divided into two groups: whole blood and PRP. Three densitometric controls were performed during the experiment. The animals were euthanized at 30, 45, 60, and 110 days. The presence of newly formed bone was observed. Samples for histological studies were taken from the augmentation center. Results: External and internal bone tissue augmentation was observed in almost all cases. Significant differences between PRP- and whole blood–stimulated bone augmentation were not observed. At 60 days, bones with PRP presented higher angiogenesis, which may indicate more proliferation and cellular activity. Conclusion: PRP activates the bone regeneration process under optimized conditions by stimulation of osteoblast proliferation after six weeks, when a significant difference in cellular activity was observed. Membranes could stimulate bone augmentation at the site of placement and in the surrounding areas.

Sinus Floor Elevation and Augmentation Using Synthetic Nanocrystalline and Nanoporous Hydroxyapatite Bone Substitute Materials: Preliminary Histologic Results.

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Belouka, Sofia-Maria; Strietzel, Frank Peter

To compare the tissue composition of augmented sites after using two different synthetic bone substitute materials, nanocrystalline and nanoporous hydroxyapatite (HA), for sinus floor elevation and augmentation. Forty-four patients received 88 titanium screw implants (Camlog Promote plus) of 4.3-mm diameter and 11- or 13-mm length, placed simultaneously during sinus floor elevation and augmentation. Nanocrystalline (Ostim) or nanoporous (NanoBone) HA were used exclusively. Bone substitute materials and implant lengths were allocated by randomization. Bone biopsy specimens were obtained from the former area of the lateral access window at implant exposure during healing abutment placement after 6 months. Biopsy specimens were prepared and examined histologically and histomorphometrically. All implants were osseointegrated at the time of exposure. Clinically and histologically, no signs of inflammation in the augmented sites were present. The histomorphometric analysis of 44 biopsy specimens revealed 31.8% ± 11.6% newly formed bone for sites augmented with nanocrystalline HA and 34.6% ± 9.2% for nanoporous HA (P = .467). The proportion of remaining bone substitute material was 28.4% ± 18.6% and 30% ± 13%, respectively (P = .453). The proportion of soft tissue within the biopsy specimens was 39.9% ± 11.1% and 35.4% ± 6.8%, respectively (P = .064). No significant differences were found between the area fractions of bone, bone substitute material, and soft tissue concerning the bone substitute material utilized. Within the present study, both synthetic bone substitute materials, nanocrystalline and nanoporous HA, were found to support bone formation in sinus floor elevation and augmentation procedures by osteoconductivity. They were not completely resorbed after 6 months. The amounts of newly formed bone, soft tissue, and bone substitute material remnants were found to be similar, indicating that both materials are likewise suitable for sinus floor elevation and

Wear and Mechanical Behaviour of Various Polymethylmethacrylate Bone Cements

Czech Academy of Sciences Publication Activity Database

Balko, J.; Ballóková, B.; Jakubéczyová, D.; Hvizdoš, P.; Hloch, Sergej; Kloc, J.; Monka, P.

2013-01-01

Roč. 13, č. 1 (2013), s. 34-43 ISSN 1335-8987 Institutional support: RVO:68145535 Keywords : bone cements * mixing * pin-on-plate * porosity * nano-hardness Subject RIV: JQ - Machines ; Tools http://www.imr.saske.sk/pmp/issue/1-2013/PMP_Vol13_No1_p_034-043.pdf

Silver-Doped Calcium Phosphate Bone Cements with Antibacterial Properties

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J. V. Rau

2016-04-01

Full Text Available Calcium phosphate bone cements (CPCs with antibacterial properties are demanded for clinical applications. In this study, we demonstrated the use of a relatively simple processing route based on preparation of silver-doped CPCs (CPCs-Ag through the preparation of solid dispersed active powder phase. Real-time monitoring of structural transformations and kinetics of several CPCs-Ag formulations (Ag = 0 wt %, 0.6 wt % and 1.0 wt % was performed by the Energy Dispersive X-ray Diffraction technique. The partial conversion of β-tricalcium phosphate (TCP phase into the dicalcium phosphate dihydrate (DCPD took place in all the investigated cement systems. In the pristine cement powders, Ag in its metallic form was found, whereas for CPC-Ag 0.6 wt % and CPC-Ag 1.0 wt % cements, CaAg(PO33 was detected and Ag (met. was no longer present. The CPC-Ag 0 wt % cement exhibited a compressive strength of 6.5 ± 1.0 MPa, whereas for the doped cements (CPC-Ag 0.6 wt % and CPC-Ag 1.0 wt % the reduced values of the compressive strength 4.0 ± 1.0 and 1.5 ± 1.0 MPa, respectively, were detected. Silver-ion release from CPC-Ag 0.6 wt % and CPC-Ag 1.0 wt % cements, measured by the Atomic Emission Spectroscopy, corresponds to the average values of 25 µg/L and 43 µg/L, respectively, rising a plateau after 15 days. The results of the antibacterial test proved the inhibitory effect towards pathogenic Escherichia coli for both CPC-Ag 0.6 wt % and CPC-Ag 1.0 wt % cements, better performances being observed for the cement with a higher Ag-content.

Effect of sodium carbonate solution on self-setting properties of tricalcium silicate bone cement.

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Zhiguang Huan; Jiang Chang

2008-11-01

In this study, the effects of sodium carbonate (Na(2)CO(3) ) solution with different concentrations (10, 15, 20, and 25 wt%) as liquid phase on the setting time and compressive strength of tricalcium silicate bone cements are investigated. The in vitro bioactivity and degradability of the resultant Ca(3)SiO(5)-Na(2)CO(3) solution paste was also studied. The results indicate that as the concentration of Na(2)CO(3) solution varies from 0 to 25 wt%, the initial and final setting time of the cement decrease significantly from 90 to 20 min and from 180 to 45 min, respectively. After setting for 24 h, the compressive strength of Ca(3)SiO(5)-Na(2)CO(3) solution paste reaches 5.1 MPa, which is significantly higher than that of Ca( 3)SiO(5)-water cement system. The in vitro bioactivity of the cements is investigated by soaking in simulated body fluid (SBF) for 7 days. The results show that the Ca(3)SiO(5)-Na(2)CO( 3) solution bone cement has a good bioactivity and can degrade in Ringer's solution. The results indicate that Na(2)CO(3) solution as a liquid phase significantly improves the self-setting properties of Ca( 3)SiO(5) cement as compared to water. The Ca(3)SiO( 5) cement paste prepared using Na(2)CO(3) solution shows good bioactivity and moderate degradability, and the Ca(3)SiO( 5)-Na(2)CO(3) solution system may be used as degradable and bioactive bone defect filling materials.

Biology and augmentation of tendon-bone insertion repair

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Lui PPY

2010-08-01

Full Text Available Abstract Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis" which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be paid to augment tendon to bone insertion (TBI healing. Apart from surgical fixation, biological and biophysical interventions have been studied aiming at regeneration of TBI healing complex, especially the regeneration of interpositioned fibrocartilage and new bone at the healing junction. This paper described the biology and the factors influencing TBI healing using patella-patellar tendon (PPT healing and tendon graft to bone tunnel healing in ACL reconstruction as examples. Recent development in the improvement of TBI healing and directions for future studies were also reviewed and discussed.

Effect of fabrication pressure on the fatigue performance of Cemex XL acrylic bone cement.

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Lewis, Gladius; Janna, S I

2004-01-01

During a cemented arthroplasty, the prepared polymerizing dough of acrylic bone cement is subjected to pressurization in a number of ways; first, during delivery into the freshly prepared bone bed, second, during packing in that bed (either digitally or with the aid of a mechanical device), and, third, during the insertion of the prosthesis. Only a few studies have reported on the influence of the level of pressurization experienced during these events (which, depending on the cementing technique used, has been put at between 8 and 273 kPa) on various properties of the cement. That was the focus of the present study, in which the fully reversed tension-compression (+/-15 MPa; 5 Hz) fatigue lives (expressed as number of cycles to fracture, N(f)) of rectangular cross-sectioned "dog-bone" specimens (Type V, per ASTM D 638) fabricated from Cemex XL cement, at pressure applied continuously to the cement dough during curing in the specimen mold, p=75,150, and 300 kPa, were determined. The N(f) results were analyzed using the linearized transformation of the three-parameter Weibull relationship to obtain estimates of the Weibull mean, N(WM), which was taken to be the index of fatigue performance of the specimen set. Over the range of p studied, N(WM) increased as p increased (for example, from 329,118 cycles when p was 75 kPa to 388,496 cycles when p was 300 kPa); however, the increase was not significant over any pair of p increment steps (Mann-Whitney U-test; alpha<0.05).

Microencapsulation of rifampicin: A technique to preserve the mechanical properties of bone cement.

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Sanz-Ruiz, Pablo; Carbó-Laso, Esther; Del Real-Romero, Juan Carlos; Arán-Ais, Francisca; Ballesteros-Iglesias, Yolanda; Paz-Jiménez, Eva; Sánchez-Navarro, Magdalena; Pérez-Limiñana, María Ángeles; Vaquero-Martín, Javier

2018-01-01

Two-stage exchange with antibiotic-loaded bone cement spacers remains the gold standard for chronic periprosthetic joint infection (PJI). Rifampicin is highly efficient on stationary-phase staphylococci in biofilm; however, its addition to PMMA to manufacture spacers prevents polymerization and reduces mechanical properties. Isolation of rifampicin during polymerization by microencapsulation could allow manufacturing rifampicin-loaded bone cement maintaining elution and mechanical properties. Microcapsules of rifampicin with alginate, polyhydroxybutyratehydroxyvalerate (PHBV), ethylcellulose and stearic acid (SA) were synthesized. Alginate and PHBV microcapsules were added to bone cement and elution, compression, bending, hardness, setting time and microbiological tests were performed. Repeated measures ANOVA and Bonferroni post-hoc test were performed, considering a p cement specimens containing alginate microcapsules eluted more rifampicin than PHBV microcapsules or non-encapsulated rifampicin over time (p Cement with alginate microcapsules showed similar behavior in hardness tests to control cement over the study period (73 ± 1.68H D ). PMMA with alginate microcapsules exhibited the largest zones of inhibition in microbiological tests. Statistically significant differences in mean diameters of zones of inhibition between PMMA loaded with alginate-rifampicin (p = 0.0001) and alginate-PHBV microcapsules (p = 0.0001) were detected. Rifampicin microencapsulation with alginate is the best choice to introduce rifampicin in PMMA preserving mechanical properties, setting time, elution, and antimicrobial properties. The main applicability of this study is the opportunity for obtaining rifampicin-loaded PMMA by microencapsulation of rifampicin in alginate microparticles, achieving high doses of rifampicin in infected tissues, increasing the successful of PJI treatment. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report

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Rittirsch Daniel

2012-01-01

Full Text Available Abstract Malignant pheochromocytoma is a neuroendocrine tumor that originates from chromaffin tissue. Although osseous metastases are common, metastatic dissemination to the spine rarely occurs. Five years after primary diagnosis of extra-adrenal, abdominal pheochromocytoma and laparoscopic extirpation, a 53-year old patient presented with recurrence of pheochromocytoma involving the spine, the pelvis, both proximal femora and the right humerus. Magnetic resonance imaging and computed tomography revealed osteolytic lesions of numerous vertebrae (T1, T5, T10, and T12. In the case of T10, total destruction of the vertebral body with involvement of the rear edge resulted in the risk of vertebral collapse and subsequent spinal stenosis. Thus, dorsal instrumentation (T8-T12 and cement augmentation of T12 was performed after perioperative alpha- and beta-adrenergic blockade with phenoxybenzamine and bisoprolol. After thorough preoperative evaluation to assess the risk for surgery and anesthesia, and appropriate perioperative management including pharmacological antihypertensive treatment, dorsal instrumentation of T8-T12 and cement augmentation of T12 prior to placing the corresponding pedicle screws did not result in hypertensive crisis or hemodynamic instability due to the release of catecholamines from metastatic lesions. To the authors' knowledge, this is the first report describing cement-augmentation in combination with dorsal instrumentation to prevent osteolytic vertebral collapse in a patient with metastatic pheochromocytoma. With appropriate preoperative measures, cement-augmented dorsal instrumentation represents a safe approach to stabilize vertebral bodies with metastatic malignant pheochromocytoma. Nevertheless, direct manipulation of metastatic lesions should be avoided as far as possible in order to minimize the risk of hemodynamic complications.

Concepts for increasing gentamicin release from handmade bone cement beads

NARCIS (Netherlands)

Rasyid, Hermawan N; van der Mei, Henny C; Frijlink, Henderik W; Soegijoko, Soegijardjo; Van Horn, Jim R; Busscher, Hendrik; Neut, Daniëlle

2009-01-01

BACKGROUND AND PURPOSE: Commercial gentamicin-loaded bone cement beads (Septopal) constitute an effective delivery system for local antibiotic therapy. These beads are not available in all parts of the world, and are too expensive for frequent use in others. Thus, orthopedic surgeons worldwide make

Effect of pulsed ultrasound in combination with gentamicin on bacterial viability in biofilms on bone cements in vivo

NARCIS (Netherlands)

Ensing, GT; Roeder, BL; Nelson, JL; van Horn, [No Value; van der Mei, HC; Busscher, HJ; Pitt, WG

2005-01-01

Aims: The aim of this study is to investigate whether pulsed ultrasound (US) in combination with gentamicin yields a decreased viability of bacteria in biofilms on bone cements in vivo. Methods and Results: Bacterial survival on bone cement in the presence and absence of ultrasound was compared in a

Effects of Incorporating Carboxymethyl Chitosan into PMMA Bone Cement Containing Methotrexate.

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Bo-Ming Liu

Full Text Available Treatment of bone metastases usually includes surgical resection with local filling of methotrexate (MTX in polymethyl methacrylate (PMMA cement. We investigated whether incorporating carboxymethyl chitosan (CMCS in MTX-PMMA cement might overcome disadvantages associated with MTX. To determine the optimal CMCS+MTX concentration to suppress the viability of cancer cells, an integrated microfluidic chip culturing highly metastatic lung cancer cells (H460 was employed. The mechanical properties, microstructure, and MTX release of (CMCS+MTX-PMMA cement were evaluated respectively by universal mechanical testing machine, scanning electron microscopy (SEM, and incubation in simulated body fluid with subsequent HPLC-MS. Implants of MTX-PMMA and (CMCS+MTX-PMMA cement were evaluated in vivo in guinea pig femurs over time using spiral computed tomography with three-dimensional image reconstruction, and SEM at 6 months. Viability of H460 cells was significantly lowest after treatment with 57 μg/mL CMCS + 21 μg/mL MTX, which was thus used in subsequent experiments. Incorporation of 1.6% (w/w CMCS to MTX-PMMA significantly increased the bending modulus, bending strength, and compressive strength by 5, 2.8, and 5.2%, respectively, confirmed by improved microstructural homogeneity. Incorporation of CMCS delayed the time-to-plateau of MTX release by 2 days, but increased the fraction released at the plateau from 3.24% (MTX-PMMA to 5.34%. Relative to the controls, the (CMCS+MTX-PMMA implants integrated better with the host bone. SEM revealed pores in the cement of the (CMCS+MTX-PMMA implants that were not obvious in the controls. In conclusion, incorporation of CMCS in MTX-PMMA appears a feasible and effective modification for improving the anti-tumor properties of MTX-PMMA cement.

Trochanteric fragility fractures : Treatment using the cement-augmented proximal femoral nail antirotation.

Science.gov (United States)

Neuerburg, C; Mehaffey, S; Gosch, M; Böcker, W; Blauth, M; Kammerlander, C

2016-06-01

Use of standardized cement augmentation of the proximal femur nail antirotation (PFNA) for the treatment of trochanteric fragility fractures, which are associated with high morbidity and mortality, to achieve safer conditions for immediate full weight-bearing and mobilization, thus, improving preservation of function and independency of orthogeriatric patients. Trochanteric fragility fractures (type 31-A1-3). Ipsilateral arthritis of the hip, leakage of contrast agent into the hip joint, femoral neck fractures. Reduction of the fracture on a fracture table if possible, or minimally invasive open reduction of the proximal femur, i. e., using collinear forceps if necessary. Positioning of guidewires for adjustment of the PFNA and the spiral blade, respectively. Exclusion of leakage of contrast agent and subsequent injection of TRAUMACEM™ V(+) into the femoral head-neck fragment via a trauma needle kit introduced into the spiral blade. Dynamic or static locking of the PFNA at the diaphyseal level. Immediate mobilization of the patients with full weight-bearing and secondary prevention, such as osteoporosis management is necessary to avoid further fractures in the treatment of these patients. A total of 110 patients older than 65 years underwent the procedure. Of the 72 patients available for follow-up (average age 85.3 years), all fractures healed after an average of 15.3 months. No complications related with cement augmentation were observed. Approximately 60 % of patients achieved the mobility level prior to trauma.

Incorporation of multiwalled carbon nanotubes to acrylic based bone cements: effects on mechanical and thermal properties.

Science.gov (United States)

Ormsby, Ross; McNally, Tony; Mitchell, Christina; Dunne, Nicholas

2010-02-01

Polymethyl methacrylate (PMMA) bone cement-multiwalled carbon nanotube (MWCNT) nanocomposites with a weight loading of 0.1% were prepared using 3 different methods of MWCNT incorporation. The mechanical and thermal properties of the resultant nanocomposite cements were characterised in accordance with the international standard for acrylic resin cements. The mechanical properties of the resultant nanocomposite cements were influenced by the type of MWCNT and method of incorporation used. The exothermic polymerisation reaction for the PMMA bone cement was significantly reduced when thermally conductive functionalised MWCNTs were added. This reduction in exotherm translated in a decrease in thermal necrosis index value of the respective nanocomposite cements, which potentially could reduce the hyperthermia experienced in vivo. The morphology and degree of dispersion of the MWCNTs in the PMMA matrix at different scales were analysed using scanning electron microscopy. Improvements in mechanical properties were attributed to the MWCNTs arresting/retarding crack propagation through the cement by providing a bridging effect into the wake of the crack, normal to the direction of crack growth. MWCNT agglomerations were evident within the cement microstructure, the degree of these agglomerations was dependent on the method used to incorporate the MWCNTs into the cement. Copyright 2009. Published by Elsevier Ltd.

Human Studies of Vertical and Horizontal Alveolar Ridge Augmentation Comparing Different Types of Bone Graft Materials: A Systematic Review.

Science.gov (United States)

Chavda, Suraj; Levin, Liran

2018-02-01

Alveolar ridge augmentation can be completed with various types of bone augmentation materials (autogenous, allograft, xenograft, and alloplast). Currently, autogenous bone is labeled as the "gold standard" because of faster healing times and integration between native and foreign bone. No systematic review has currently determined whether there is a difference in implant success between various bone augmentation materials. The purpose of this article was to systematically review comparative human studies of vertical and horizontal alveolar ridge augmentation comparing different types of bone graft materials (autogenous, allograft, xenograft, and alloplast). A MEDLINE search was conducted under the 3 search concepts of bone augmentation, dental implants, and alveolar ridge augmentation. Studies pertaining to socket grafts or sinus lifts were excluded. Case reports, small case series, and review papers were excluded. A bias assessment tool was applied to the final articles. Overall, 219 articles resulted from the initial search, and 9 articles were included for final analysis. There were no discernible differences in implant success between bone augmentation materials. Generally, patients preferred nonautogenous bone sources as there were fewer hospital days, less pain, and better recovery time. Two articles had industrial support; however, conclusions of whether that support influenced the outcomes could not be determined. Future comparative studies should compare nonautogenous bone sources and have longer follow-up times.

A novel and easy-to-prepare strontium(II) modified calcium phosphate bone cement with enhanced mechanical properties.

Science.gov (United States)

Schumacher, M; Henß, A; Rohnke, M; Gelinsky, M

2013-07-01

The aim of this study was to evaluate two different approaches to obtaining strontium-modified calcium phosphate bone cements (SrCPCs) without elaborate synthesis of Sr-containing calcium phosphate species as cement precursors that could release biologically effective doses of Sr(2+) and thus could improve the healing of osteoporotic bone defects. Using strontium carbonate as a strontium(II) source, it was introduced into a hydroxyapatite-forming cement either by the addition of SrCO3 to an α-tricalcium phosphate-based cement precursor mixture (A-type) or by substitution of CaCO3 by SrCO3 during precursor composition (S-type). The cements, obtained after setting in a water-saturated atmosphere, contained up to 2.2at.% strontium in different distribution patterns as determined by time-of-flight secondary ion mass spectrometry and energy-dispersive X-ray spectroscopy. The setting time of CPC and A-type cements was in the range of 6.5-7.5min and increased for substitution-type cements (12.5-13.0min). Set cements had an open porosity between 26 and 42%. Compressive strength was found to increase from 29MPa up to 90% in substituted S-type cements (58MPa). SrCPC samples released between 0.45 and 1.53mgg(-1) Sr(2+) within 21days and showed increased radiopacity. Based on these findings, the SrCPC developed in this study could be beneficial for the treatment of defects of systemically impaired (e.g. osteoporotic) bone. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Comparison of Bone Resorption Rates after Intraoral Block Bone and Guided Bone Regeneration Augmentation for the Reconstruction of Horizontally Deficient Maxillary Alveolar Ridges

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B. Alper Gultekin

2016-01-01

Full Text Available Purpose. Bone atrophy after tooth loss may leave insufficient bone for implant placement. We compared volumetric changes after autogenous ramus block bone grafting (RBG or guided bone regeneration (GBR in horizontally deficient maxilla before implant placement. Materials and Methods. In this retrospective study, volumetric changes at RBG or GBR graft sites were evaluated using cone-beam computed tomography. The primary outcome variable was the volumetric resorption rate. Secondary outcomes were bone gain, graft success, and implant insertion torque. Results. Twenty-four patients (28 grafted sites were included (GBR, 15; RBG, 13. One patient (RBG suffered mucosal dehiscence at the recipient site 6 weeks after surgery, which healed spontaneously. Mean volume reduction in the GBR and RBG groups was 12.48 ± 2.67% and 7.20 ± 1.40%, respectively. GBR resulted in significantly more bone resorption than RBG (P0.05. Conclusions. Both RBG and GBR hard-tissue augmentation techniques provide adequate bone graft volume and stability for implant insertion. However, GBR causes greater resorption at maxillary augmented sites than RBG, which clinicians should consider during treatment planning.

Advances in bone augmentation to enable dental implant placement: Consensus Report of the Sixth European Workshop on Periodontology.

Science.gov (United States)

Tonetti, Maurizio S; Hämmerle, Christoph H F

2008-09-01

Bone augmentation procedures to enable dental implant placement are frequently performed in practice. In this session the European Workshop on Periodontology discussed the evidence in support of the procedures and examined both adverse events and implant performance in the augmented bone. While the available evidence improved both in quantity and quality since previous workshops the conclusions that could be drawn were limited by elements of design and/or reporting that are amenable to improvement. With regards to lateral bone augmentation, a sizable body of evidence supports its use to enable dental implant placement. The group recognized the potential for vertical ridge augmentation procedures to allow implant placement in clinical practice but questioned the applicability of these data to a wider array of operators and clinical settings. With regards to sinus floor augmentation, perforation of the sinus membrane, graft infection and graft loss resulting in inability of implant placement were the major reported adverse events. In cases with dental implants placed in pristine sites. The consensus emphasized the research need to answer questions on: (i) long-term performance of dental implants placed in augmented bone; (ii) the clinical performance of dental implants placed in augmented or pristine sites; and (iii) the clinical benefits of bone augmentation with respect to alternative treatments.

Evaluation of the sealing ability of bone cement as furcation perforation repair material when compared with mineral trioxide aggregate and calcium phosphate cement: An in-vitro study

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Rashmi Chordiya

2010-01-01

Full Text Available Aim: This study was undertaken to compare the sealing ability of bone cement as furcation perforation repair material when compared with mineral trioxide aggregate and calcium phosphate cement. Materials and Methods: A total of 70 sound mandibular molars were selected for this study. The sample teeth were randomly divided into five groups: group I - n=20, perforation repair material used, mineral trioxide aggregate; group II - n=20, perforation repair material used, calcium phosphate cement; group III - n=20, perforation repair material used, bone cement; group IV - positive control, n=5, the furcation were not repaired with any material; group V - negative control, n=5, furcation area intact, no perforation done. The teeth were immersed in silver nitrate solution for 2 hours and then rinsed with photographic developer solution for 6 hours. They were then sectioned in a longitudinal direction and examined under a stereomicroscope. In each section the actual values of dye leakage were calculated from outer margins of perforation to the level of pulpal floor and were then subjected to statistical analysis. Results: An unpaired ′t′ test revealed that different groups exhibited significantly different dye penetrations (P<0.01. Conclusion: Furcation perforation repaired with MTA showed minimum microleakage (mean 54.5%, calcium phosphate cement showed maximum microleakage (100%, and bone cement showed moderate dye leakage (87.8%.

Maxillary anterior ridge augmentation with recombinant human bone morphogenetic protein 2.

Science.gov (United States)

Edmunds, Ryan K; Mealey, Brian L; Mills, Michael P; Thoma, Daniel S; Schoolfield, John; Cochran, David L; Mellonig, Jim

2014-01-01

No human studies exist on the use of recombinant human bone morphogenetic protein 2 (rhBMP-2) on an absorbable collagen sponge (ACS) as a sole graft material for lateral ridge augmentation in large ridge defect sites. This series evaluates the treatment outcome of maxillary anterior lateral ridge augmentation with rhBMP-2/ACS. Twenty patients were treated with rhBMP-2/ACS and fixation screws for space maintenance. Cone beam volumetric tomography measurements were used to determine gain in ridge width, and a bone core biopsy was obtained. The mean horizontal ridge gain was 1.2 mm across sites, and every site gained width.

Design of ceramic-based cements and putties for bone graft substitution

Directory of Open Access Journals (Sweden)

M Bohner

2010-07-01

Full Text Available In the last 15 years, a large number of commercial ceramic-based cements and putties have been introduced as bone graft substitutes. As a result, large efforts have been made to improve our understanding of the specific properties of these materials, such as injectability, cohesion, setting time (for cements, and in vivo properties. The aim of this manuscript is to summarize our present knowledge in the field. Instead of just looking at scientific aspects, industrial needs are also considered, including mixing and delivery, sterilization, and shelf-life.

Effect of pulsed ultrasound in combination with gentamicin on bacterial killing of biofilms on bone cements in vivo

Science.gov (United States)

Ensing, G.T.; Roeder, B.L.; Nelson, J.L.; van Horn, J.R.; van der Mei, H.C.; Busscher, H.J.; Pitt, W.G.

2008-01-01

Aim The aim of this study is to investigate whether pulsed ultrasound in combination with gentamicin yields increased killing of bacterial biofilms on bone cements in vivo. Methods and Results Bacterial survival on bone cement in the presence and absence of ultrasound was compared in a rabbit model. Two bone cement samples with E. coli ATCC 10798 biofilm were implanted in a total of nine rabbits. In two groups bone cement disks loaded with gentamicin were used, and in one group unloaded bone cement disks in combination with systemically administered gentamicin were used. Pulsed ultrasound with a mean acoustic intensity of 167 mW cm−2 and a maximum acoustic intensity of 500 mW cm−2 was applied from 24 h till 72 h post surgery on one of the two implanted disks. After euthanization, the bacteria removed from the disk were quantified. Application of ultrasound, combined with gentamicin, reduced the biofilm in all three groups varying between 58 to 69% compared to the negative control. Ultrasound proved to be safe with respect to creating skin lesions. Conclusions Ultrasound resulted in an tendency of improved efficacy of gentamicin, either applied locally or systemically. Significance and impact of Study This study implies that ultrasound could improve the prevention of infection, especially because the biomaterials, gentamicin and ultrasound used in this model are all in clinical usage, but not yet combined in clinical practice. PMID:16108785

HDAC inhibitor-loaded bone cement for advanced local treatment of osteosarcoma and chondrosarcoma.

Science.gov (United States)

Tonak, Marcus; Becker, Marc; Graf, Claudine; Eckhard, Lukas; Theobald, Matthias; Rommens, Pol-Maria; Wehler, Thomas C; Proschek, Dirk

2014-11-01

The treatment of osteosarcoma, especially wide resection, is challenging. An additional local drug therapy after resection using anti-neoplastic bone cement (Polymethylmethacrylate (PMMA)) could help improve the outcome of therapy. In this study, we evaluated the effects of PMMA loaded with valproic acid (VPA) and suberoylanilide hydroxamic acid (SAHA) on the cell activity of a SaOs-2 cell culture, as well as the elution rate of the drugs out of the bone cement. In our experiments, we used the SaOs-2 osteosarcoma and the SW1353 chondrosarcoma cell line. Bone cement clots (5 g) were prepared and loaded with different drug concentrations of VPA (25 mg and 50 mg) and SAHA (1 mg, 2.5 mg and 5 mg). Two control groups were established, one with a native cement clot, the other with human mesenchymal stem cells, in order to evaluate toxicity on non tumor-cells. Cell activity was measured using an Alamar Blue assay on days 1, 2, 3, 4 and 7. The cement clots were additionally examined in a material testing unit for biomechanical and structural changes. Tumor cells showed a significant and complete reduction of activity under therapy with VPA and SAHA. Drug release of VPA was extensive between days 0 and 3 and decreased progressively to day 7. Cumulative drug concentration in the medium continuously increased. Biomechanical testing of the cement clots showed no differences in stability and architecture compared to the control group. SaOs-2 and SW1353 cells with medium from native cement clots without drug therapy presented a cell activity of 100% in all groups and during all measurements. Human mesenchymal stem cells were not significantly affected during therapy with VPA and low concentrations of SAHA. In contrast, cell activity of human mesenchymal stem cells was significantly reduced under therapy with higher concentrations of SAHA, with an approximately linear decrease between days 0-3 and a rapidly decreasing activity between days 4-7. A local cytotoxic therapy in the

Highly porous hydroxyapatite with and without local harvested bone in sinus floor augmentation: a histometric study in pigs.

Science.gov (United States)

Möller, Björn; Acil, Yahya; Birkenfeld, Falk; Behrens, Eleonore; Terheyden, Hendrik; Wiltfang, Jörg

2014-07-01

Sinus floor augmentation with autologous bone is an accepted treatment option in dental implantology. In this study, an entirely synthetic, nano-structured, hydroxyapatite-based bone substitute material (SBSM, NanoBone(®); Artoss, Rostock, Germany) was supplemented with a mixture of locally harvested bone to enhance osteogenesis. Bilateral sinus augmentation procedures were performed in eight domestic pigs using the lateral window technique. On the right side (control), 2.6 ml of SBSM was used, and on the left side (test), 2.6 ml of SBSM with additional 15% (390 μl) autologous bone was used. At the time of augmentation, a titanium implant (ITI(®)) was inserted from a laterocaudal direction. After 3 months, the sites of augmentation were removed and examined in non-decalcified sections by microradiography and fluorescence microscopy of sequentially labelled specimens and histometry. On both sides, a significant amount of newly formed bone was observed. However, a statistically significant difference in the bone-implant contact was observed in the control group (median, 28.9%) compared with the test side with the additional autologous bone (median, 40.6%) (P = 0.01). Different bone density was achieved from the coronal to apical surfaces (medians, 54.6%, 9.6%, and 27.5%) compared with the test side (medians, 55.2%, 40.6%, and 44.2%). The median of augmentation height was 8.6 mm on the control side and 11.5 mm on the test side (P = 0.01). Bone apposition was observed in both groups after 15 days. The SBSM shows acceptable results in sinus floor augmentation. The additional use of locally harvested autologous bone enhances bone density and osseointegration of the implants. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Biphasic calcium sulfate dihydrate/iron-modified alpha-tricalcium phosphate bone cement for spinal applications: in vitro study

International Nuclear Information System (INIS)

Vlad, M D; Lopez, J; Torres, R; Barraco, M; Fernandez, E; Valle, L J; Poeata, I

2010-01-01

In this study, the cytocompatibility of new 'iron-modified/alpha-tricalcium phosphate (IM/α-TCP) and calcium sulfate dihydrate (CSD)' bone cement (IM/α-TCP/CSD-BC) intended for spinal applications has been approached. The objective was to investigate by direct-contact osteoblast-like cell cultures (from 1 to 14 days) the in vitro cell adhesion, proliferation, morphology and cytoskeleton organization of MG-63 cells seeded onto the new cements. The results were as follows: (a) quantitative MTT-assay and scanning electron microscopy (SEM) showed that cell adhesion, proliferation and viability were not affected with time by the presence of iron in the cements; (b) double immunofluorescent labeling of F-actin and α-tubulin showed a dynamic interaction between the cell and its porous substrates sustaining the locomotion phenomenon on the cements' surface, which favored the colonization, and confirming the biocompatibility of the experimental cements; (c) SEM-cell morphology and cytoskeleton observations also evidenced that MG-63 cells were able to adhere, to spread and to attain normal morphology on the new IM/α-TCP/CSD-BC which offered favorable substratum properties for osteoblast-like cells proliferation and differentiation in vitro. The results showed that these new iron-modified cement-like biomaterials have cytocompatible features of interest not only as possible spinal cancellous bone replacement biomaterial but also as bone tissue engineering scaffolds.

Reimplantation of cultivated human bone cells from the posterior maxilla for sinus floor augmentation. Histological results from a randomized controlled clinical trial

DEFF Research Database (Denmark)

Hermund, N.U.; Stavropoulos, Andreas; Donatsky, O

2012-01-01

OBJECTIVES: The aim of the present randomized clinical study was to evaluate histologically whether the addition of cultivated, autogenous bone cells to a composite graft of deproteinized bovine bone mineral (DBBM) and autogenous bone (AB) for sinus floor augmentation (SFA) enhance bone formation...... bone cells, which were cultivated from a bone biopsy harvested earlier from the tuberosity area. Four months after SFA, two cylindrical biopsies were taken from the augmented sinuses concomitantly with the implant site preparation by means of a trephine bur. An additional biopsy was taken from...... the tuberosity area. Bone density at the augmented sinus and the tuberosity area and the height of augmentation were estimated on non-decalcified histological sections prepared from the biopsies. A relative bone density index (RBD) was also calculated by dividing bone density at the augmented sinus with bone...

Micro-mechanical modeling of the cement-bone interface: the effect of friction, morphology and material properties on the micromechanical response.

NARCIS (Netherlands)

Janssen, D.; Mann, K.A.; Verdonschot, N.J.J.

2008-01-01

In order to gain insight into the micro-mechanical behavior of the cement-bone interface, the effect of parametric variations of frictional, morphological and material properties on the mechanical response of the cement-bone interface were analyzed using a finite element approach. Finite element

Percutaneous Vertebral Augmentation with Polyethylene Mesh and Allograft Bone for Traumatic Thoracolumbar Fractures

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C. Schulz

2015-01-01

Full Text Available Purpose. In cases of traumatic thoracolumbar fractures, percutaneous vertebral augmentation can be used in addition to posterior stabilisation. The use of an augmentation technique with a bone-filled polyethylene mesh as a stand-alone treatment for traumatic vertebral fractures has not yet been investigated. Methods. In this retrospective study, 17 patients with acute type A3.1 fractures of the thoracic or lumbar spine underwent stand-alone augmentation with mesh and allograft bone and were followed up for one year using pain scales and sagittal endplate angles. Results. From before surgery to 12 months after surgery, pain and physical function improved significantly, as indicated by an improvement in the median VAS score and in the median pain and work scale scores. From before to immediately after surgery, all patients showed a significant improvement in mean mono- and bisegmental kyphoses. During the one-year period, there was a significant loss of correction. Conclusions. Based on this data a stand-alone approach with vertebral augmentation with polyethylene mesh and allograft bone is not a suitable therapy option for incomplete burst fractures for a young patient collective.

Effect of the sterilization process on physical and mechanical properties of the bonacryl bone cement

International Nuclear Information System (INIS)

Morejon, L.; Delgado, J.A.; Aguero, L.; Rapado, M.; Ginebra, M.P.; Gil, F.J.; Mendizabal, E.

2008-01-01

The use of bone cements of poly(methyl methacrylate) (PMMA) to fix artificial prosthesis to the human body is a habitual method in orthopedic surgery. The hip and the knee joints have a very complex biomechanics and support high loads, for these reasons, acrylic bone cements have to comply with international standards in order to secure the biofuncionality and durability of the implant. In this work we report the effect of sterilization by ethylene oxide or gamma radiation on the BONACRYL Cuban cement. We determined how sterilization methods affect the molecular weight of the polymer as well as its quasi-static mechanical properties. The results demonstrated that the gamma radiation modifies the molecular weight of the PMMA although the compression and bending strength were not affected by the sterilization process applied. (authors)

Large Bone Vertical Augmentation Using a Three-Dimensional Printed TCP/HA Bone Graft: A Pilot Study in Dog Mandible

OpenAIRE

Carrel, Jean-Pierre; Wiskott, Anselm; Scherrer, Susanne; Durual, Stéphane

2016-01-01

Osteoflux is a three-dimensional printed calcium phosphate porous structure for oral bone augmentation. It is a mechanically stable scaffold with a well-defined interconnectivity and can be readily shaped to conform to the bone bed's morphology

Nanocrystalline hydroxyapatite bone substitute leads to sufficient bone tissue formation already after 3 months: histological and histomorphometrical analysis 3 and 6 months following human sinus cavity augmentation.

Science.gov (United States)

Ghanaati, Shahram; Barbeck, Mike; Willershausen, Ines; Thimm, Benjamin; Stuebinger, Stefan; Korzinskas, Tadas; Obreja, Karina; Landes, Constantin; Kirkpatrick, Charles J; Sader, Robert A

2013-12-01

In this study the de novo bone formation capacity of a nanocrystalline hydroxyapatite bone substitute was assessed 3 and 6 months after its insertion into the human sinus cavity. Sinus cavity augmentation was performed in a total of 14 patients (n = 7 implantation after 3 months; n = 7 implantation after 6 months) with severely atrophic maxillary bone. The specimens obtained after 3 and 6 months were analyzed histologically and histomorphometrically with special focus on bone metabolism within the residual bone and the augmented region. This study revealed that bone tissue formation started from the bone-biomaterial-interface and was directed into the most cranial parts of the augmented region. There was no statistically significant difference in new bone formation after 3 and 6 months (24.89 ± 10.22% vs 31.29 ± 2.29%), respectively. Within the limits of the present study and according to previously published data, implant insertion in regions augmented with this bone substitute material could be considered already after 3 months. Further clinical studies with bone substitute materials are necessary to validate these findings. © 2012 Wiley Periodicals, Inc.

Safety of recombinant human platelet-derived growth factor-BB in Augment® Bone Graft

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Luis A Solchaga

2012-12-01

Full Text Available This article discusses nonclinical and clinical data regarding the safety of recombinant human platelet-derived growth factor-BB as a component of the Augment® Bone Graft (Augment. Augment is a bone graft substitute intended to be used as an alternative to autologous bone graft in the fusion of hindfoot and ankle joints. Nonclinical studies included assessment of the pharmacokinetic profile of intravenously administered recombinant human platelet-derived growth factor-BB in rat and dog, effects of intravenous administration of recombinant human platelet-derived growth factor-BB in a reproductive and development toxicity study in rats, and chronic toxicity and carcinogenicity of Augment in a 12-month implantation model. These studies showed that systemic exposure was brief and clearance was rapid. No signs of toxicity, carcinogenicity, or tumor promotion were observed even with doses far exceeding the maximum clinical dose. Results of clinical trials (605 participants and commercial use of recombinant human platelet-derived growth factor-BB containing products indicate that these products are not associated with increased incidence of adverse events or cancer. The safety data presented provide evidence that recombinant human platelet-derived growth factor-BB is a safe therapeutic when used in combination products as a single administration during surgical procedures for bone repair and fusion. There is no evidence associating use of recombinant human platelet-derived growth factor-BB in Augment with chronic toxicity, carcinogenicity, or tumor promotion.

Gentamicin release from commercially-available gentamicin-loaded PMMA bone cements in a prosthesis-related interfacial gap model and their antibacterial efficacy

Directory of Open Access Journals (Sweden)

van der Mei Henny C

2010-11-01

Full Text Available Abstract Background Around about 1970, a gentamicin-loaded poly (methylmethacrylate (PMMA bone cement brand (Refobacin Palacos R was introduced to control infection in joint arthroplasties. In 2005, this brand was replaced by two gentamicin-loaded follow-up brands, Refobacin Bone Cement R and Palacos R + G. In addition, another gentamicin-loaded cement brand, SmartSet GHV, was introduced in Europe in 2003. In the present study, we investigated differences in gentamicin release and the antibacterial efficacy of the eluent between these four cement brands. Methods 200 μm-wide gaps were made in samples of each cement and filled with buffer in order to measure the gentamicin release. Release kinetics were related to bone cement powder particle characteristics and wettabilities of the cement surfaces. Gaps were also inoculated with bacteria isolated from infected prostheses for 24 h and their survival determined. Gentamicin release and bacterial survival were statistically analysed using the Student's t-test. Results All three Palacos variants showed equal burst releases but each of the successor Palacos cements showed significantly higher sustained releases. SmartSet GHV showed a significantly higher burst release, while its sustained release was comparable with original Palacos. A gentamicin-sensitive bacterium did not survive in the high gentamicin concentrations in the interfacial gaps, while a gentamicin-resistant strain did, regardless of the type of cement used. Survival was independent of the level of burst release by the bone cement. Conclusions Although marketed as the original gentamicin-loaded Palacos cement, orthopaedic surgeons should be aware that the successor cements do not appear to have the same release characteristics as the original one. Overall, high gentamicin concentrations were reached inside our prosthesis-related interfacial gap model. These concentrations may be expected to effectively decontaminate the prosthesis

Effect of pulsed ultrasound in combination with gentamicin on bacterial viability in biofilms on bone cements in vivo.

Science.gov (United States)

Ensing, G T; Roeder, B L; Nelson, J L; van Horn, J R; van der Mei, H C; Busscher, H J; Pitt, W G

2005-01-01

The aim of this study is to investigate whether pulsed ultrasound (US) in combination with gentamicin yields a decreased viability of bacteria in biofilms on bone cements in vivo. Bacterial survival on bone cement in the presence and absence of ultrasound was compared in a rabbit model. Two bone cement samples with an Escherichia coli ATCC 10798 biofilm were implanted in a total of nine rabbits. In two groups bone cement discs loaded with gentamicin, freshly prepared and aged were used, and in one group unloaded bone cement discs in combination with systemically administered gentamicin. Pulsed ultrasound with a frequency of 28.48 kHz and a maximum acoustic intensity of 500 mW cm(-2) was applied continuously from 24 h till 72 h postsurgery on one of the two implanted discs. After euthanization and removal of the bacteria from the discs, the number of viable bacteria were quantified and skin samples were analysed for histopathological examination. Application of ultrasound, combined with gentamicin, reduced the viability of the biofilms in all three groups varying between 58 and 69% compared with the negative control. Histopathological examinations showed no skin lesions. Ultrasound resulted in a tendency of improved efficacy of gentamicin, either applied locally or systemically. Usage of ultrasound in this model proved to be safe. This study implies that ultrasound could improve the prevention of infection immediately after surgery, especially because the biomaterials, gentamicin and ultrasound used in this model are all in clinical usage, but not yet combined in clinical practice.

Disintegration of Bone Cement by Continuous and Pulsating Water Jet

Czech Academy of Sciences Publication Activity Database

Hloch, S.; Foldyna, Josef; Sitek, Libor; Zeleňák, Michal; Hlaváček, Petr; Hvizdoš, P.; Kloc, J.; Monka, P.; Monková, K.; Kozak, D.; Magurová, D.

2013-01-01

Roč. 20, č. 4 (2013), s. 593-598 ISSN 1330-3651 R&D Projects: GA MŠk ED2.1.00/03.0082 Institutional support: RVO:68145535 Keywords : bone cement * disintegration * water jet Subject RIV: JQ - Machines ; Tools Impact factor: 0.615, year: 2013 http://hrcak.srce.hr/index.php?show=clanak&id_clanak_jezik=157195

Wear and Mechanical Properties of Various Bone Cements – Influence of Saline Environment

Czech Academy of Sciences Publication Activity Database

Balko, J.; Fides, M.; Sedlák, R.; Hvizdoš, P.; Hloch, Sergej; Kloc, J.; Monka, P.

-, č. 662 (2015), s. 147-150 ISSN 1662-9795 Institutional support: RVO:68145535 Keywords : wear * saline * hardness * bone cement Subject RIV: JQ - Machines ; Tools http://www.scientific.net/KEM.662.147

Crestal Sinus Augmentation with Recombinant Human Bone Morphogenetic Protein 2: Clinical and Radiographic Outcomes of 2-Year Pilot Trial.

Science.gov (United States)

Kuchler, Ulrike; Rudelstorfer, Claudia M; Barth, Barbara; Tepper, Gabor; Lidinsky, Dominika; Heimel, Patrick; Watzek, Georg; Gruber, Reinhard

Recombinant human bone morphogenetic protein 2 (rhBMP-2) together with an absorbable collagen carrier (ACS) was approved for augmentation of the maxillary sinus prior to implant placement. The original registration trial was based on a lateral window approach. Clinical outcomes of crestal sinus augmentation with rhBMP-2 have not been reported so far. An uncontrolled pilot trial in which seven patients with a residual maxillary height below 5 mm were enrolled to receive crestal sinus augmentation with rhBMP-2/ACS was conducted. Elevation of the sinus mucosa was performed by gel pressure. Primary endpoints were the gain in augmentation height and volume measured by computed tomography after 6 months. Evaluation of bone quality at the time of implant placement was based on histology. Secondary endpoints were the clinical and radiologic evaluation of the implants and patient satisfaction by visual analog scale (VAS) at the 2-year follow-up. Median gain in augmentation height was 7.2 mm (range 0.0 to 17.5 mm). Five patients gained at least 5 mm of bone height. Two patients with a perforation of the sinus mucosa failed to respond to rhBMP-2/ACS and underwent lateral window augmentation. The median gain in augmentation volume of the five patients was 781.3 mm³ (range 426.9 to 1,242.8 mm³). Biopsy specimens showed a cancellous network consisting of primary plexiform bone with little secondary lamellar bone. After 2 years, implants were in function with no signs of inflammation or peri-implant bone loss. Patients were satisfied with the esthetic outcomes and chewing function. This pilot clinical trial supports the original concept that rhBMP-2/ACS supports bone formation, also in crestal sinus augmentation, and emphasizes the relevance of the integrity of the sinus mucosa to predict the bone gain.

High proximal migration in cemented acetabular revisions operated with bone impaction grafting; 47 revision cups followed with RSA for 17 years.

Science.gov (United States)

Mohaddes, Maziar; Herberts, Peter; Malchau, Henrik; Johanson, Per-Erik; Kärrholm, Johan

2017-05-12

Bone impaction grafting is a biologically and mechanically appealing option in acetabular revision surgery, allowing restitution of the bone stock and restoration of the biomechanics. We analysed differences in proximal migration of the revision acetabular components when bone impaction grafting is used together with a cemented or an uncemented cup. 43 patients (47 hips), revised due to acetabular loosening and judged to have less than 50% host bone-implant contact were included. The hips were randomised to either an uncemented (n = 20) or a cemented (n = 27) revision cup. Radiostereometry and radiography was performed postoperatively, at 3 and 6 months, 1, 2, 3, 5, 7, 10 and 13 and 17 years postoperatively. Clinical follow-up was performed at 1, 2 and 5 years postoperatively and thereafter at the same interval as in the radiographic follow-up. There were no differences in the base line demographic data between the 2 groups. At the last follow-up (17 years) 14 hips (10 cemented, 4 uncemented) had been re-revised due to loosening. 3 additional cups (1 uncemented and 2 cemented) were radiographically loose. There was a higher early proximal migration in the cemented cups. Cups operated on with cement showed a higher early migration measured with RSA and also a higher number of late revisions. The reason for this is not known, but factors such as inclusion of cases with severe bone defects, use of smaller bone chips and issues related to the impaction technique might have had various degrees of influence.

Bone augmentation of the osteo-odonto alveolar lamina in MOOKP--will it delay laminar resorption?

Science.gov (United States)

Iyer, Geetha; Srinivasan, Bhaskar; Agarwal, Shweta; Rishi, Ekta; Rishi, Pukhraj; Rajan, Gunaseelan; Shanmugasundaram, Shanmugasundaram

2015-07-01

We aimed to describe a new technique and analyse the early outcomes of augmenting the canine tooth using a mandibular bone graft in an attempt to delay or retard the process of laminar resorption following the modified osteo odonto keratoprosthesis (MOOKP) procedure. This was a retrospective case series. Eyes that underwent the bone augmentation procedure between December 2012 and February 2014 were retrospectively analysed. The procedure, performed by the oromaxillofacial surgeon, involved securing a mandibular bone graft beneath the periosteum on the labial aspect of the canine tooth chosen to be harvested for the MOOKP procedure. This procedure was performed simultaneously with the Stage 1 A of the MOOKP. Three months later, the tooth was harvested and fashioned into the osteo-odonto alveolar lamina similar to the method described in the Rome-Vienna Protocol. The bone augmentation procedure was performed in 11 eyes (five SJS/ six chemical injuries). The mean follow-up after Stage 2 of MOOKP procedure in these eyes was 7.45 months (2 to 20 months). Complications noted were peripheral laminar exposure (three eyes-SJS) and bone graft exposure and necrosis in the mouth (nine-SJS). No evidence of clinical laminar resorption was noted in any of the eyes. Laminar resorption in MOOKP can lead to vision and globe threatening complications due to the consequent cylinder instability and chances of extrusion. Augmenting the bone on the labial aspect of the canine tooth might have a role to play in delaying or preventing laminar resorption.

Preparation of in situ hardening composite microcarriers: Calcium phosphate cement combined with alginate for bone regeneration

Science.gov (United States)

Park, Jung-Hui; Lee, Eun-Jung; Knowles, Jonathan C

2014-01-01

Novel microcarriers consisting of calcium phosphate cement and alginate were prepared for use as three-dimensional scaffolds for the culture and expansion of cells that are effective for bone tissue engineering. The calcium phosphate cement-alginate composite microcarriers were produced by an emulsification of the composite aqueous solutions mixed at varying ratios (calcium phosphate cement powder/alginate solution = 0.8–1.2) in an oil bath and the subsequent in situ hardening of the compositions during spherodization. Moreover, a porous structure could be easily created in the solid microcarriers by soaking the produced microcarriers in water and a subsequent freeze-drying process. Bone mineral-like apatite nanocrystallites were shown to rapidly develop on the calcium phosphate cement–alginate microcarriers under moist conditions due to the conversion of the α-tricalcium phosphate phase in the calcium phosphate cement into a carbonate–hydroxyapatite. Osteoblastic cells cultured on the microspherical scaffolds were proven to be viable, with an active proliferative potential during 14 days of culture, and their osteogenic differentiation was confirmed by the determination of alkaline phosphatase activity. The in situ hardening calcium phosphate cement–alginate microcarriers developed herein may be used as potential three-dimensional scaffolds for cell delivery and tissue engineering of bone. PMID:23836845

Optimization of a biomimetic bone cement: role of DCPD.

Science.gov (United States)

Panzavolta, Silvia; Bracci, Barbara; Rubini, Katia; Bigi, Adriana

2011-08-01

We previously proposed a biomimetic α-tricalcium phosphate (α-TCP) bone cement where gelatin controls the transformation of α-TCP into calcium deficient hydroxyapatite (CDHA), leading to improved mechanical properties. In this study we investigated the setting and hardening processes of biomimetic cements containing increasing amounts of CaHPO(4)·2H2O (DCPD) (0, 2.5, 5, 10, 15 wt.%), with the aim to optimize composition. Both initial and final setting times increased significantly when DCPD content accounts for 10 wt.%, whereas cements containing 15 wt.% DCPD did not set at all. Differential scanning calorimetry (DSC), X-ray diffraction (XRD), thermogravimetry (TG) and scanning electron microscopy (SEM) investigations were performed on samples maintained in physiological solution for different times. DCPD dissolution starts soon after cement preparation, but the rate of transformation decreases on increasing DCPD initial content in the samples. The rate of α-TCP to CDHA conversion during hardening decreases on increasing DCPD initial content. Moreover, the presence of DCPD prevents gelatin release during hardening. The combined effects of gelatin and DCPD on the rate of CDHA formation and porosity lead to significantly improved mechanical properties, with the best composition displaying a compressive strength of 35 MPa and a Young modulus of 1600 MPa. Copyright © 2011 Elsevier Inc. All rights reserved.

Improvement of in vitro physicochemical properties and osteogenic activity of calcium sulfate cement for bone repair by dicalcium silicate

International Nuclear Information System (INIS)

Chen, Chun-Cheng; Wang, Chien-Wen; Hsueh, Nai-Shuo; Ding, Shinn-Jyh

2014-01-01

Highlights: • Dicalcium silicate can improve osteogenic activity of calcium sulfate cement. • The higher the calcium sulfate content, the shorter the setting time in the composite cement. • The results were useful for designing calcium-based cement with optimal properties. -- Abstract: An ideal bone graft substitute should have the same speed of degradation as formation of new bone tissue. To improve the properties of calcium sulfate hemihydrate (CSH) featured for its rapid resorption, a low degradation material of dicalcium silicate (DCS) was added to the CSH cement. This study examined the effect of DCS (20, 40, 60 and 80 wt%) on the in vitro physicochemical properties and osteogenic activities of the calcium-based composite cements. The diametral tensile strength, porosity and weight loss of the composite cements were evaluated before and after soaking in a simulated body fluid (SBF). The osteogenic activities, such as proliferation, differentiation and mineralization, of human mesenchymal stem cells (hMSCs) seeded on cement surfaces were also examined. As a result, the greater the DCS amount, the higher the setting time was in the cement. Before soaking in SBF, the diametral tensile strength of the composite cements was decreased due to the introduction of DCS. On 180-day soaking, the composite cements containing 20, 40, 60 and 80 wt% DCS lost 80%, 69%, 61% and 44% in strength, respectively. Regarding in vitro bioactivity, the DCS-rich cements were covered with clusters of apatite spherulites after soaking for 7 days, while there was no formation of apatite spherulites on the CSH-rich cement surfaces. The presence of DCS could reduce the degradation of the CSH cements, as evidenced in the results of weight loss and porosity. More importantly, DCS may promote effectively the cell proliferation, proliferation and mineralization. The combination of osteogenesis of DCS and degradation of CSH made the calcium-based composite cements an attractive choice for

Experimental and numerical study of cemented bone-implant interface behaviour

Czech Academy of Sciences Publication Activity Database

Kytýř, Daniel; Doktor, Tomáš; Jiroušek, Ondřej; Zlámal, Petr; Pokorný, D.

2011-01-01

Roč. 15, č. 15 (2011), s. 5-13 ISSN 1971-8993 R&D Projects: GA ČR(CZ) GAP105/10/2305 Institutional research plan: CEZ:AV0Z20710524 Keywords : bone-cement interface * computed tomography * hip simulator * crack detection Subject RIV: FI - Traumatology, Orthopedics http://www.gruppofrattura.it/index.php?option=com_content&task=view&id=90&Itemid=284

Validation of a measuring technique with computed tomography for cement penetration into trabecular bone underneath the tibial tray in total knee arthroplasty on a cadaver model

International Nuclear Information System (INIS)

Verburg, Hennie; Ridder, Laurens C van de; Verhoeven, Vincent WJ; Pilot, Peter

2014-01-01

In total knee arthroplasty (TKA), cement penetration between 3 and 5 mm beneath the tibial tray is required to prevent loosening of the tibia component. The objective of this study was to develop and validate a reliable in vivo measuring technique using CT imaging to assess cement distribution and penetration depth in the total area underneath a tibia prosthesis. We defined the radiodensity ranges for trabecular tibia bone, polymethylmethacrylate (PMMA) cement and cement-penetrated trabecular bone and measured the percentages of cement penetration at various depths after cementing two tibia prostheses onto redundant femoral heads. One prosthesis was subsequently removed to examine the influence of the metal tibia prostheses on the quality of the CT images. The percentages of cement penetration in the CT slices were compared with percentages measured with photographs of the corresponding transversal slices. Trabecular bone and cement-penetrated trabecular bone had no overlap in quantitative scale of radio-density. There was no significant difference in mean HU values when measuring with or without the tibia prosthesis. The percentages of measured cement-penetrated trabecular bone in the CT slices of the specimen were within the range of percentages that could be expected based on the measurements with the photographs (p = 0.04). CT scan images provide valid results in measuring the penetration and distribution of cement into trabecular bone underneath the tibia component of a TKA. Since the proposed method does not turn metal elements into artefacts, it enables clinicians to assess the width and density of the cement mantle in vivo and to compare the results of different cementing methods in TKA

The Mechanical Behavior of Bone Cement in THR in the Presense of Cavities

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A. Benouis

2014-06-01

Full Text Available In this work we analyze three-dimensionally using the finite element method, the level and the Von Mises stress equivalent distribution induced around a cavity and between two cavities located in the proximal and distal bone cement polymethylmethacrylate (PMMA. The effects of the position around two main axes (vertical and horizontal of the cavity with respect to these axes, of the cavity - cavity interdistance and of the type of loading (static on the mechanical behavior of cement orthopedic are highlighted. We show that the breaking strain of the cement is largely taken when the cement in its proximal-lateral part contains cavities very close adjacent to each other. This work highlights not only the effect of the density of cavities, in our case simulated by cavity-cavity interdistance, but also the nature of the activity of the patient (patient standing corresponding to static efforts on the mechanical behavior of cement.

Protocol for Bone Augmentation with Simultaneous Early Implant Placement: A Retrospective Multicenter Clinical Study

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Peter Fairbairn

2015-01-01

Full Text Available Purpose. To present a novel protocol for alveolar bone regeneration in parallel to early implant placement. Methods. 497 patients in need of extraction and early implant placement with simultaneous bone augmentation were treated in a period of 10 years. In all patients the same specific method was followed and grafting was performed utilizing in situ hardening fully resorbable alloplastic grafting materials consisting of β-tricalcium phosphate and calcium sulfate. The protocol involved atraumatic extraction, implant placement after 4 weeks with simultaneous bone augmentation, and loading of the implant 12 weeks after placement and grafting. Follow-up periods ranged from 6 months to 10 years (mean of 4 years. Results. A total of 601 postextraction sites were rehabilitated in 497 patients utilizing the novel protocol. Three implants failed before loading and three implants failed one year after loading, leaving an overall survival rate of 99.0%. Conclusions. This standardized protocol allows successful long-term functional results regarding alveolar bone regeneration and implant rehabilitation. The concept of placing the implant 4 weeks after extraction, augmenting the bone around the implant utilizing fully resorbable, biomechanically stable, alloplastic materials, and loading the implant at 12 weeks seems to offer advantages when compared with traditional treatment modalities.

Staphylococcus aureus biofilm formation on different gentamicin-loaded polymethylmethacrylate bone cements

NARCIS (Netherlands)

van de Belt, H; Neut, D; Schenk, W; van Horn, [No Value; van der Mei, HC; Busscher, HJ

In this in vitro study, the formation of a Staphylococcus aureus biofilm on six gentamicin-loaded bone cements (CMW1, CMW3, CMW Endurance, CMW2000, Palacos. and Palamed) was determined in a modified Robbins device over a 3 days time span and related with previously (Van de Belt et al., Biomaterials

Histological evaluation of healing after transalveolar maxillary sinus augmentation with bioglass and autogenous bone

DEFF Research Database (Denmark)

Stavropoulos, Andreas; Sima, Catalin; Sima, Andrea

2012-01-01

the transalveolar osteotomy by means of a trephine bur and non-decalcified sections through the long axis of the cylinder were produced. After a strict selection process, taking into account the presurgical residual bone height and biopsy length, 8 and 15 biopsies representing the new tissues formed inside......OBJECTIVES: The aim was to evaluate histologically the outcome of a bioglass and autogenous bone (at 1 : 1 ratio) composite implantation for transalveolar sinus augmentation. METHODS: In 31 patients, during implant installation ca. 4 months after sinus augmentation, biopsies were harvested through...... the sinus and the transalveolar osteotomy, respectively, qualified for analysis. The tissue fractions occupied by newly formed bone (mineralized tissue+bone marrow), soft connective tissue, residual biomaterial+empty spaces, and debris inside the sinus cavity or the transalveolar osteotomy were estimated...

Physical and chemical characterization of pastes of bone cements with ZrO2

International Nuclear Information System (INIS)

Quinto H, A.; Pina B, M.C.

2003-01-01

Setting times and temperature of sixteen calcium phosphate cements added with ZrO 2 were evaluated. Their behaviors were analysed to be used like injectable formulations in surgery of bone. Two cements of calcium phosphates enriched with ZrO 2 with the best characteristics in setting times and temperature, were mechanically tested after 1 and 7 days of prepared. Density was determined using a pycnometer, chemical composition was determined by X-ray diffraction and the molecular structure was determined by infrared spectroscopy. (Author)

Vertical ridge augmentation using xenogenous bone blocks: a comparison between the flap and tunneling procedures.

Science.gov (United States)

Xuan, Feng; Lee, Chun-Ui; Son, Jeong-Seog; Fang, Yiqin; Jeong, Seung-Mi; Choi, Byung-Ho

2014-09-01

Previous studies have shown that the subperiosteal tunneling procedure in vertical ridge augmentation accelerates healing after grafting and prevents graft exposure, with minor postoperative complications. It is conceivable that new bone formation would be greater with the tunneling procedure than with the flap procedure, because the former is minimally invasive. This hypothesis was tested in this study by comparing new bone formation between the flap and tunneling procedures after vertical ridge augmentation using xenogenous bone blocks in a canine mandible model. Two Bio-Oss blocks were placed on the edentulous ridge in each side of the mandibles of 6 mongrel dogs. The blocks in each side were randomly assigned to grafting with a flap procedure (flap group) or grafting with a tunneling procedure (tunneling group). The mean percentage of newly formed bone within the block was 15.3 ± 6.6% in the flap group and 46.6 ± 23.4% in the tunneling group. Based on data presented in this study, when a tunneling procedure is used to place xenogenous bone blocks for vertical ridge augmentation, bone formation in the graft sites is significantly greater than when a flap procedure is used. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Peri-Implant Distribution of Polyethylene Debris in Postmortem-Retrieved Knee Arthroplasties: Can Polyethylene Debris Explain Loss of Cement-Bone Interlock in Successful Total Knee Arthroplasties?

Science.gov (United States)

Cyndari, Karen I; Goodheart, Jacklyn R; Miller, Mark A; Oest, Megan E; Damron, Timothy A; Mann, Kenneth A

2017-07-01

Loss of mechanical interlock between cement and bone with in vivo service has been recently quantified for functioning, nonrevised, cemented total knee arthroplasties (TKAs). The cause of interlocking trabecular resorption is not known. The goal of this study is to quantify the distribution of PE debris at the cement-bone interface and determine if polyethylene (PE) debris is locally associated with loss of interlock. Fresh, nonrevised, postmortem-retrieved TKAs (n = 8) were obtained en bloc. Laboratory-prepared constructs (n = 2) served as negative controls. The intact cement-bone interface of each proximal tibia was embedded in Spurr's resin, sectioned, and imaged under polarized light to identify birefringent PE particles. PE wear particle number density was quantified at the cement-bone interface and distal to the interface, and then compared with local loss of cement-bone interlock. The average PE particle number density for postmortem-retrieved TKAs ranged from 8.6 (1.3) to 24.9 (3.1) particles/mm 2 (standard error) but was weakly correlated with years in service. The average particle number density was twice as high as distal (>5mm) to the interface compared to at the interface. The local loss of interlock at the interface was not related to the presence, absence, or particle density of PE. PE debris can migrate extensively along the cement-bone interface of well-fixed tibial components. However, the amount of local bone loss at the cement-bone interface was not correlated with the amount of PE debris at the interface, suggesting that the observed loss of trabecular interlock in these well-fixed TKAs may be due to alternative factors. Copyright © 2017 Elsevier Inc. All rights reserved.

Calcium phosphate holmium-166 ceramic to addition in bone cement: synthesis and characterization

Energy Technology Data Exchange (ETDEWEB)

Donanzam, Blanda A.; Campos, Tarcisio P.R., E-mail: campos@nuclear.ufmg.b [Universidade do Federal de Minas Gerais (DEN/UFMG), Belo Horizonte, MG (Brazil). Escola de Engenharia. Dept. de Engenharia Nuclear; Dalmazio, Ilza; Valente, Eduardo S., E-mail: id@cdtn.b, E-mail: valente@cdtn.b [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil)

2011-07-01

Spine metastases are a common and painful complication of cancer. The treatment often consists of bone cement injection (vertebroplasty or kyphoplasty) within vertebral body for vertebrae stabilization, followed by external beam radiation therapy. Recently, researchers introduced the concept of radioactive bone cement for spine tumors therapy. Then, investigations about bioactive and radioactive materials became interesting. In this study, we present the synthesis of calcium phosphate incorporated holmium (CaP-Ho) via sol-gel technique, and its characterization by XRD, FT-IR, NA and SEM. Results showed a multiphasic bioceramic composed mainly of hydroxyapatite, {beta}-tricalcium phosphate, holmium phosphate and traces of calcium pyrophosphate. Furthermore, the nuclide Ho-166 was the major radioisotope produced. Despite that, the radioactive bioceramic CaP-{sup 166}Ho must be investigated in clinical trials to assure its efficacy and safety on spine tumors treatment (author)

Calcium phosphate holmium-166 ceramic to addition in bone cement: synthesis and characterization

International Nuclear Information System (INIS)

Donanzam, Blanda A.; Campos, Tarcisio P.R.

2011-01-01

Spine metastases are a common and painful complication of cancer. The treatment often consists of bone cement injection (vertebroplasty or kyphoplasty) within vertebral body for vertebrae stabilization, followed by external beam radiation therapy. Recently, researchers introduced the concept of radioactive bone cement for spine tumors therapy. Then, investigations about bioactive and radioactive materials became interesting. In this study, we present the synthesis of calcium phosphate incorporated holmium (CaP-Ho) via sol-gel technique, and its characterization by XRD, FT-IR, NA and SEM. Results showed a multiphasic bioceramic composed mainly of hydroxyapatite, β-tricalcium phosphate, holmium phosphate and traces of calcium pyrophosphate. Furthermore, the nuclide Ho-166 was the major radioisotope produced. Despite that, the radioactive bioceramic CaP- 166 Ho must be investigated in clinical trials to assure its efficacy and safety on spine tumors treatment (author)

[Effect of bone cement application on the incidence of deep vein thrombosis in major joint arthroplasties].

Science.gov (United States)

Aslan, Ahmet; Ağar, Emre; Aydoğan, Nevres Hürriyet; Atay, Tolga; Baydar, Metin Lütfi; Kırdemir, Vecihi; Ozden, Ahmet

2011-12-01

In this study, we have investigated whether the application of bone cement has an effect on the frequency of deep vein thrombosis (DVT) in major joint arthroplasties (MJA). A total of 95 MJA cases meeting the inclusion criteria of this study between January 2004 and January 2005 were divided into cemented and cementless groups. For prophylaxis, all patients were given low molecular weight heparin (LMWH). The patients were scanned for DVT preoperatively and on the postoperative 12(th) day by color Doppler ultrasonography. In hip arthroplasties, in knee arthroplasties and in general, DVT was seen more frequently in cemented group, however, there was no statistically significant difference between groups in the frequency of DVT (p=0.549, p=0.749 and p=0.462, respectively). Also, there was no significant difference between the results of the different LMWH groups (p=0.616). The results of this study shows that bone cement application in MJAs such as hip or knee arthroplasties has no significant effect on the frequency of DVT.

Kummel Disease Treatment by Unipedicular Vertebral Augmentation Using Curved Injection Cannula

International Nuclear Information System (INIS)

Masala, Salvatore; Nano, Giovanni; Mammucari, Matteo; Simonetti, Giovanni

2011-01-01

Purpose: This study was designed to evaluate the efficacy of the blunt-tipped curved injection needle (BCN) AVAflex (Care Fusion) for vertebral augmentation in cases of Kummel’s disease. Methods: We performed 25 vertebral augmentation procedures on 25 consecutive patients (11 men/14 women; mean age, 67 years) with Kummel’s disease using the blunt-tipped curved injection needle with PMMA cement. We performed all 25 procedures by unipedicular left approach with patients in prone position under local anesthesia and mild sedation. In all cases, an intravertebral cleft was evident on preprocedural imaging. We evaluated pain intensities by Visual Analogic Scale (VAS) before and at first day, 6 months, and 1 year after procedure. Results: In all cases the curved injection cannula permitted the filling of the clefts and surrounding cancellous bone without any complication. A significant reduction of kyphotic deformities of the treated vertebral bodies was evident. A significance decrease in VAS values at 1 year also was evident (mean decrease 7.2). At plain dynamic postprocedural X-rays checks, there was no sign of pathologic intravertebral motion as evidence of optimal stabilization. Conclusions: BCN AVAflex is a safe and effective device for targeted vertebral augmentation in cases of Kummel’s disease. Its distinctive characteristic is the curved injection cannula, which enables targeting the cement injection to areas far off the trajectory of the straight access cannula, thus providing excellent cement spread throughout the entire volume of vertebral body.

Development of a degradable cement of calcium phosphate and calcium sulfate composite for bone reconstruction

International Nuclear Information System (INIS)

Guo, H; Wei, J; Liu, C S

2006-01-01

A new type of composite bone cement was prepared and investigated by adding calcium sulfate (CS) to calcium phosphate cement (CPC). This composite cement can be handled as a paste and easily shaped into any contour, which can set within 5-20 min, the setting time largely depending on the liquid-solid (L/S) ratio; adding CS to CPC had little effect on the setting time of the composite cements. No obvious temperature increase and pH change were observed during setting and immersion in simulated body fluid (SBF). The compressive strength of the cement decreased with an increase in the content of CS. The degradation rate of the composite cements increased with time when the CS content was more than 20 wt%. Calcium deficient apatite could form on the surface of the composite cement because the release of calcium into SBF from the dissolution of CS and the apatite of the cement induced the new apatite formation; increasing the content of CS in the composite could improve the bioactivity of the composite cements. The results suggested that composite cement has a reasonable setting time, excellent degradability and suitable mechanical strength and bioactivity, which shows promising prospects for development as a clinical cement

Effect of endodontic cement on bone mineral density using serial dual-energy x-ray absorptiometry.

Science.gov (United States)

Saghiri, Mohammad Ali; Orangi, Jafar; Tanideh, Nader; Janghorban, Kamal; Sheibani, Nader

2014-05-01

Materials with new compositions were tested in order to develop dental materials with better properties. Calcium silicate-based cements, including white mineral trioxide aggregate (WMTA), may improve osteopromotion because of their composition. Nano-modified cements may help researchers produce ideal root-end filling materials. Serial dual-energy x-ray absorptiometry measurement was used to evaluate the effects of particle size and the addition of tricalcium aluminate (C3A) to a type of mineral trioxide aggregate-based cement on bone mineral density and the surrounding tissues in the mandible of rabbits. Forty mature male rabbits (N = 40) were anesthetized, and a bone defect measuring 7 × 1 × 1 mm was created on the semimandible. The rabbits were divided into 2 groups, which were subdivided into 5 subgroups with 4 animals each based on the defect filled by the following: Nano-WMTA (patent application #13/211.880), WMTA (as standard), WMTA without C3A, Nano-WMTA + 2% Nano-C3A (Fujindonjnan Industrial Co, Ltd, Fujindonjnan Xiamen, China), and a control group. Twenty and forty days postoperatively, the animals were sacrificed, and the semimandibles were removed for DXA measurement. The Kruskal-Wallis test followed by the Mann-Whitney U test showed significant differences between the groups at a significance level of P density at both intervals and P20 day = .004 and P40 day = .005 for bone mineral content. This study showed that bone regeneration was enhanced by reducing the particle size (nano-modified) and C3A mixture. This may relate to the existence of an external supply of minerals and a larger surface area of nano-modified material, which may lead to faster release rate of Ca(2+), inducing bone formation. Adding Nano-C3A to Nano-WMTA may improve bone regeneration properties. Copyright © 2014 American Association of Endodontists. All rights reserved.

Photocurable bioactive bone cement based on hydroxyethyl methacrylate-poly(acrylic/maleic) acid resin and mesoporous sol gel-derived bioactive glass

Energy Technology Data Exchange (ETDEWEB)

Hesaraki, S., E-mail: S-hesaraki@merc.ac.ir

2016-06-01

This paper reports on strong and bioactive bone cement based on ternary bioactive SiO{sub 2}-CaO-P{sub 2}O{sub 5} glass particles and a photocurable resin comprising hydroxyethyl methacrylate (HEMA) and poly(acrylic/maleic) acid. The as-cured composite represented a compressive strength of about 95 MPa but it weakened during soaking in simulated body fluid, SBF, qua its compressive strength reached to about 20 MPa after immersing for 30 days. Biodegradability of the composite was confirmed by reducing its initial weight (~ 32%) as well as decreasing the molecular weight of early cured resin during the soaking procedure. The composite exhibited in vitro calcium phosphate precipitation in the form of nanosized carbonated hydroxyapatite, which indicates its bone bonding ability. Proliferation of calvarium-derived newborn rat osteoblasts seeded on top of the composite was observed during incubation at 37 °C, meanwhile, an adequate cell supporting ability was found. Consequently, it seems that the produced composite is an appropriate alternative for bone defect injuries, because of its good cell responses, high compressive strength and ongoing biodegradability, though more in vivo experiments are essential to confirm this assumption. - Highlights: • Light cure cement based on SiO{sub 2}-CaO-P{sub 2}O{sub 5} glass and polymer-like matrix was formed. • The matrix includes poly(acrylic/maleic acid) and poly(hydroxyethyl methacrylate). • The cement is as strong as polymethylmethacrylate bone cement. • The cement exhibits apatite formation ability in simulated body fluid. • The cement is biodegradable and supports proliferation of osteoblastic cells.

Experimental Evaluation of the Effectiveness of Demineralized Bone Matrix and Collagenated Heterologous Bone Grafts Used Alone or in Combination with Platelet-Rich Fibrin on Bone Healing in Sinus Floor Augmentation.

Science.gov (United States)

Peker, Elif; Karaca, Inci Rana; Yildirim, Benay

2016-01-01

The aim of this study was an experimental evaluation of the effectiveness of demineralized bone matrix (DBM) and collagenated heterologous bone graft (CHBG) used alone or in combination with platelet-rich fibrin on bone healing in sinus floor augmentation procedures. In this study, 36 New Zealand rabbits were used. The bilateral sinus elevation was performed, and 72 defects were obtained. The rabbit maxillary sinuses were divided into four groups according to the augmentation biomaterials obtained: demineralized bone matrix (Grafton DBM Putty, Osteotech; DBM group), DBM combined with platelet-rich fibrin (PRF; DBM + PRF group), collagenated heterologous bone graft (CHBG; Apatos Mix, OsteoBiol, Tecnoss; CHBG group), CHBG combined with PRF (CHBG + PRF group). All groups were sacrificed at 2, 4, and 8 weeks after surgery for histologic, histomorphometric, and immunohistochemical analyses. The inflammatory reaction was moderate to intense at the second week in all groups and declined from 2 to 8 weeks. New bone formation was started at the second week and increased from 2 to 8 weeks in all groups. There was no significant difference in bone formation between the experimental groups that used PRF mixed graft material and control groups that used only graft material. The percentage of new bone formation showed a significant difference in DBM groups and DBM + PRF groups compared with other groups. There were osteoclasts around all the bone graft materials used, but the percentage of residual graft particles was significantly higher in CHBG groups and CHBG + PRF groups at the eighth week. There is no beneficial effect of the application of PRF in combination with demineralized bone matrix or collagenated heterologous bone graft on bone formation in sinus floor augmentation. The results of this study showed that both collagenated heterologous bone graft and demineralized bone matrix have osteoconductive properties, but demineralized bone matrix showed more bone formation

Influence of multiwall carbon nanotube functionality and loading on mechanical properties of PMMA/MWCNT bone cements.

Science.gov (United States)

Ormsby, Ross; McNally, Tony; Mitchell, Christina; Dunne, Nicholas

2010-08-01

Poly (methyl methacrylate) (PMMA) bone cement-multi walled carbon nanotube (MWCNT) nanocomposites with weight loadings ranging from 0.1 to 1.0 wt% were prepared. The MWCNTs investigated were unfunctionalised, carboxyl and amine functionalised MWCNTs. Mechanical properties of the resultant nanocomposite cements were characterised as per international standards for acrylic resin cements. These mechanical properties were influenced by the type and wt% loading of MWCNT used. The morphology and degree of dispersion of the MWCNTs in the PMMA matrix at different length scales were examined using field emission scanning electron microscopy. Improvements in mechanical properties were attributed to the MWCNTs arresting/retarding crack propagation through the cement by providing a bridging effect and hindering crack propagation. MWCNTs agglomerations were evident within the cement microstructure, the degree of these agglomerations was dependent on the weight fraction and functionality of MWCNTs incorporated into the cement.

Bulk physicochemical, interconnectivity, and mechanical properties of calcium phosphate cements-fibrin glue composites for bone substitute applications

NARCIS (Netherlands)

Lopez-Heredia, M.A.; Pattipeilohy, J.; Hsu, S.; Grykien, M.; Weijden, B. van der; Leeuwenburgh, S.C.G.; Salmon, P.; Wolke, J.G.C.; Jansen, J.A.

2013-01-01

Calcium phosphate cements (CPCs) and fibrin glue (FG) are used for surgical applications. Their combination is promising to create bone substitutes able to promote cell attachment and bone remodeling. This study proposes a novel approach to create CPC-FG composites by simultaneous CPC setting and FG

Microarchitecture of the Augmented Bone Following Sinus Elevation with an Albumin Impregnated Demineralized Freeze-Dried Bone Allograft (BoneAlbumin versus Anorganic Bovine Bone Mineral: A Randomized Prospective Clinical, Histomorphometric, and Micro-Computed Tomography Study

Directory of Open Access Journals (Sweden)

Kivovics Márton

2018-01-01

Full Text Available Serum albumin has been identified as an endogenous protein that is integral to early bone regeneration. We hypothesized that albumin addition to allografts may result in better bone remodeling than what can be achieved with anorganic xenografts. Sinus elevations were performed at 32 sites of 18 patients with the lateral window technique. Sites either received filling with an anorganic bovine bone mineral (ABBM, BioOss, Geistlich, CH or albumin impregnated allograft (BoneAlbumin, OrthoSera, AT. After 6-months patients received dental implants and 16 bone core biopsy samples were obtained from the ABBM filled, and 16 from the BoneAlbumin augmented sites. The biopsies were examined by histomorphometry and µCT. Percentage of the residual graft in the BoneAlbumin group was 0–12.7%, median 5.4% vs. ABBM 6.3–35.9%, median 16.9%, p < 0.05. Results of the µCT analysis showed that the microarchitecture of the augmented bone in the BoneAlbumin group resembles that of the native maxilla in morphometric parameters Trabecular Pattern Factor and Connectivity. Our data show that while ABBM successfully integrates into the newly formed bone tissue as persisting particles, BoneAlbumin is underway towards complete remodeling with new bone closely resembling that of the intact maxilla.

Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws

Directory of Open Access Journals (Sweden)

Jan-Helge Klingler

2015-01-01

Full Text Available Purpose. To describe the minimally invasive technique for cement augmentation of cannulated and fenestrated screws using an injection cannula as well as to report its safety and efficacy. Methods. A total of 157 cannulated and fenestrated pedicle screws had been cement-augmented during minimally invasive posterior screw-rod spondylodesis in 35 patients from January to December 2012. Retrospective evaluation of cement extravasation and screw loosening was carried out in postoperative plain radiographs and thin-sliced triplanar computed tomography scans. Results. Twenty-seven, largely prevertebral cement extravasations were detected in 157 screws (17.2%. None of the cement extravasations was causing a clinical sequela like a new neurological deficit. One screw loosening was noted (0.6% after a mean follow-up of 12.8 months. We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency. Conclusions. The presented minimally invasive cement augmentation technique using an injection cannula facilitates convenient and safe cement delivery through polyaxial cannulated and fenestrated screws during minimally invasive screw-rod spondylodesis. Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified. This trial is registered with German Clinical Trials DRKS00006726.

Composite bone cements loaded with a bioactive and ferrimagnetic glass-ceramic: Leaching, bioactivity and cytocompatibility

International Nuclear Information System (INIS)

Verné, Enrica; Bruno, Matteo; Miola, Marta; Maina, Giovanni; Bianco, Carlotta; Cochis, Andrea; Rimondini, Lia

2015-01-01

In this work, composite bone cements, based on a commercial polymethylmethacrylate matrix (Palamed®) loaded with ferrimagnetic bioactive glass-ceramic particles (SC45), were produced and characterized in vitro. The ferrimagnetic bioactive glass-ceramic belongs to the system SiO 2 –Na 2 O–CaO–P 2 O 5 –FeO–Fe 2 O 3 and contains magnetite (Fe 3 O 4 ) crystals into a residual amorphous bioactive phase. Three different formulations (containing 10, 15 and 20 wt.% of glass-ceramic particles respectively) have been investigated. These materials are intended to be applied as bone fillers for the hyperthermic treatment of bone tumors. The morphological, compositional, calorimetric and mechanical properties of each formulation have been already discussed in a previous paper. The in vitro properties of the composite bone cements described in the present paper are related to iron ion leaching test (by graphite furnace atomic absorption spectrometer), bioactivity (i.e. the ability to stimulate the formation of a hydroxyapatite – HAp – layer on their surface after soaking in simulated body fluid SBF) and cytocompatibility toward human osteosarcoma cells (ATCC CRL-1427, Mg63). Morphological and chemical characterizations by scanning electron microscopy and energy dispersion spectrometry have been performed on the composite samples after each test. The iron release was negligible and all the tested samples showed the growth of HAp on their surface after 28 days of immersion in a simulated body fluid (SBF). Cells showed good viability, morphology, adhesion, density and the ability to develop bridge-like structures on all investigated samples. A synergistic effect between bioactivity and cell mineralization was also evidenced. - Highlights: • An in vitro biological characterization was carried out on ferromagnetic and bioactive composite cements. • No release of iron was revealed in the physiological solution. • Bioactivity tests show hydroxyapatite precipitates

Composite bone cements loaded with a bioactive and ferrimagnetic glass-ceramic: Leaching, bioactivity and cytocompatibility

Energy Technology Data Exchange (ETDEWEB)

Verné, Enrica, E-mail: enrica.verne@polito.it [Institute of Materials Physics and Engineering, Applied Science and Technology Department, Politecnico di Torino, C. so Duca degli Abruzzi 24, 10129 Torino (Italy); Bruno, Matteo [Institute of Materials Physics and Engineering, Applied Science and Technology Department, Politecnico di Torino, C. so Duca degli Abruzzi 24, 10129 Torino (Italy); Miola, Marta [Institute of Materials Physics and Engineering, Applied Science and Technology Department, Politecnico di Torino, C. so Duca degli Abruzzi 24, 10129 Torino (Italy); Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, Via Solaroli 17, 28100 Novara (Italy); Maina, Giovanni; Bianco, Carlotta [Traumatology Orthopedics and Occupational Medicine Dept., Università di Torino, Via G. Zuretti 29, 10126 Torino (Italy); Cochis, Andrea [Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, Via Solaroli 17, 28100 Novara (Italy); Rimondini, Lia [Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, Via Solaroli 17, 28100 Novara (Italy); Consorzio Interuniversitario Nazionale per la Scienza e Tecnologia dei Materiali, Via G. Giusti, 9, 50121 Firenze (Italy)

2015-08-01

In this work, composite bone cements, based on a commercial polymethylmethacrylate matrix (Palamed®) loaded with ferrimagnetic bioactive glass-ceramic particles (SC45), were produced and characterized in vitro. The ferrimagnetic bioactive glass-ceramic belongs to the system SiO{sub 2}–Na{sub 2}O–CaO–P{sub 2}O{sub 5}–FeO–Fe{sub 2}O{sub 3} and contains magnetite (Fe{sub 3}O{sub 4}) crystals into a residual amorphous bioactive phase. Three different formulations (containing 10, 15 and 20 wt.% of glass-ceramic particles respectively) have been investigated. These materials are intended to be applied as bone fillers for the hyperthermic treatment of bone tumors. The morphological, compositional, calorimetric and mechanical properties of each formulation have been already discussed in a previous paper. The in vitro properties of the composite bone cements described in the present paper are related to iron ion leaching test (by graphite furnace atomic absorption spectrometer), bioactivity (i.e. the ability to stimulate the formation of a hydroxyapatite – HAp – layer on their surface after soaking in simulated body fluid SBF) and cytocompatibility toward human osteosarcoma cells (ATCC CRL-1427, Mg63). Morphological and chemical characterizations by scanning electron microscopy and energy dispersion spectrometry have been performed on the composite samples after each test. The iron release was negligible and all the tested samples showed the growth of HAp on their surface after 28 days of immersion in a simulated body fluid (SBF). Cells showed good viability, morphology, adhesion, density and the ability to develop bridge-like structures on all investigated samples. A synergistic effect between bioactivity and cell mineralization was also evidenced. - Highlights: • An in vitro biological characterization was carried out on ferromagnetic and bioactive composite cements. • No release of iron was revealed in the physiological solution. • Bioactivity tests

Calcium Orthophosphate Cements and Concretes

Directory of Open Access Journals (Sweden)

Sergey V. Dorozhkin

2009-03-01

Full Text Available In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are a bioactive and biodegradable grafting material in the form of a powder and a liquid. Both phases form after mixing a viscous paste that after being implanted, sets and hardens within the body as either a non-stoichiometric calcium deficient hydroxyapatite (CDHA or brushite, sometimes blended with unreacted particles and other phases. As both CDHA and brushite are remarkably biocompartible and bioresorbable (therefore, in vivo they can be replaced with newly forming bone, calcium orthophosphate cements represent a good correction technique for non-weight-bearing bone fractures or defects and appear to be very promising materials for bone grafting applications. Besides, these cements possess an excellent osteoconductivity, molding capabilities and easy manipulation. Furthermore, reinforced cement formulations are available, which in a certain sense might be described as calcium orthophosphate concretes. The concepts established by calcium orthophosphate cement pioneers in the early 1980s were used as a platform to initiate a new generation of bone substitute materials for commercialization. Since then, advances have been made in the composition, performance and manufacturing; several beneficial formulations have already been introduced as a result. Many other compositions are in experimental stages. In this review, an insight into calcium orthophosphate cements and concretes, as excellent biomaterials suitable for both dental and bone grafting application, has been provided.

Developing a novel magnesium glycerophosphate/silicate-based organic-inorganic composite cement for bone repair.

Science.gov (United States)

Ding, Zhengwen; Li, Hong; Wei, Jie; Li, Ruijiang; Yan, Yonggang

2018-06-01

Considering that the phospholipids and glycerophosphoric acid are the basic materials throughout the metabolism of the whole life period and the bone is composed of organic polymer collagen and inorganic mineral apatite, a novel self-setting composite of magnesium glycerophosphate (MG) and di-calcium silicate(C2S)/tri-calcium silicate(C3S) was developed as bio-cement for bone repair, reconstruction and regeneration. The composite was prepared by mixing the MG, C2S and C3S with the certain ratios, and using the deionized water and phosphoric acid solution as mixed liquid. The combination and formation of the composites was characterized by FTIR, XPS and XRD. The physicochemical properties were studied by setting time, compressive strength, pH value, weight loss in the PBS and surface change by SEM-EDX. The biocompatibility was evaluated by cell culture in the leaching solution of the composites. The preliminary results showed that when di- and tri-calcium silicate contact with water, there are lots of Ca(OH) 2 generated making the pH value of solution is higher than 9 which is helpful for the formation of hydroxyapatite(HA) that is the main bone material. The new organic-inorganic self-setting bio-cements showed initial setting time is ranged from 20 min to 85 min and the compressive strength reached 30 MPa on the 7th days, suitable as the bone fillers. The weight loss was 20% in the first week, and 25% in the 4th week. Meanwhile, the new HA precipitated on the composite surface during the incubation in the SBF showed bioactivity. The cell cultured in the leaching liquid of the composite showed high proliferation inferring the new bio-cement has good biocompatibility to the cells. Copyright © 2018 Elsevier B.V. All rights reserved.

Complexity in modeling of residual stresses and strains during polymerization of bone cement: effects of conversion, constraint, heat transfer, and viscoelastic property changes.

Science.gov (United States)

Gilbert, Jeremy L

2006-12-15

Aseptic loosening of cemented joint prostheses remains a significant concern in orthopedic biomaterials. One possible contributor to cement loosening is the development of porosity, residual stresses, and local fracture of the cement that may arise from the in-situ polymerization of the cement. In-situ polymerization of acrylic bone cement is a complex set of interacting processes that involve polymerization reactions, heat generation and transfer, full or partial mechanical constraint, evolution of conversion- and temperature-dependent viscoelastic material properties, and thermal and conversion-driven changes in the density of the cement. Interactions between heat transfer and polymerization can lead to polymerization fronts moving through the material. Density changes during polymerization can, in the presence of mechanical constraint, lead to the development of locally high residual strain energy and residual stresses. This study models the interactions during bone cement polymerization and determines how residual stresses develop in cement and incorporates temperature and conversion-dependent viscoelastic behavior. The results show that the presence of polymerization fronts in bone cement result in locally high residual strain energies. A novel heredity integral approach is presented to track residual stresses incorporating conversion and temperature dependent material property changes. Finally, the relative contribution of thermal- and conversion-dependent strains to residual stresses is evaluated and it is found that the conversion-based strains are the major contributor to the overall behavior. This framework provides the basis for understanding the complex development of residual stresses and can be used as the basis for developing more complex models of cement behavior.

Reconstruction of the Shallow Acetabulum With a Combination of Autologous Bulk and Impaction Bone Grafting Fixed by Cement.

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Maruyama, Masaaki; Wakabayashi, Shinji; Ota, Hiroshi; Tensho, Keiji

2017-02-01

Acetabular bone deficiency, especially proximal and lateral deficiency, is a difficult technical problem during primary total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH). We report a new reconstruction method using a medial-reduced cemented socket and additional bulk bone in conjunction with impaction morselized bone grafting (additional bulk bone grafting method). In a population of patients with acetabular dysplasia undergoing THA using a medial-reduced cemented socket and additional bulk bone with impacted morselized bone grafting, we evaluated (1) the radiographic appearance of bone graft; (2) the proportion of cups that developed loosening and subsequent revision; and (3) clinical results (outcome scores and complications). Forty percent of 330 THAs for DDH performed at one center between 1999 and 2009 were defined as shallow dysplastic hips. The additional bulk bone grafting method was performed on 102 THAs with shallow acetabulum (31% for DDH) at one center between 1999 and 2009. We used this approach and technique for shallow acetabuli when a cup protruded from the lateral acetabular edge in preoperative templating. The other 132 dysplastic hips without bone grafting had THA performed at the same periods and served as a control. Acetabuli were defined as shallow when the depth was less than or equal to one-fifth of the pelvic height (cranial-caudal length on radiograph). The additional bulk bone grafting technique was as follows: the resected femoral head was sectioned at 1 to 2 cm thickness, and a suitable size of the bulk bone graft was placed on the lateral iliac cortex and fixed by poly-L-lactate absorbable screws. Autologous impaction morselized bone grafting, with or without hydroxyapatite granules, was performed along with the implantation of a medial-reduced cemented socket. We defined an "incorporated" graft as remodeling and trabeculation including rounding off of the protruding edge of a graft beyond the socket

Complications Associated With the Use of Recombinant Human Bone Morphogenic Protein-2 in Ridge Augmentation: A Case Report.

Science.gov (United States)

Dragonas, Panagiotis; Palin, Charles; Khan, Saba; Gajendrareddy, Praveen K; Weiner, Whitney D

2017-10-01

This case report aims to describe in detail a complication associated with resorption of regenerated bone following implant placement and ridge augmentation using recombinant human bone morphogenic protein-2 (rhBMP-2) in combination with allograft and xenograft. Bilateral maxillary sinus and ridge augmentation procedures were completed using rhBMP-2 combined with allograft and xenograft. Five months later, significant bone augmentation was achieved, which allowed for the placement of 4 implants. Upon stage 2 surgery, significant dehiscence was noted in all implants. Treatment steps to address this complication included implant removal, guided bone regeneration with xenograft only, and placement of new implants followed by soft-tissue grafting. At the time of publication, this patient is status 1½ years post case completion with maintenance of therapy outcomes. Off-label use of rhBMP-2 has gained significant acceptance in implant dentistry. However, there is limited evidence regarding the bone maturation process when rhBMP-2 is combined with other biomaterials. More research may be needed regarding the timing and process of bone healing in the presence of rhBMP-2, in an effort to avoid surgical complications.

Femoral component revision with use of impaction bone-grafting and a cemented polished stem.

NARCIS (Netherlands)

Schreurs, B.W.; Arts, J.J.C.; Verdonschot, N.J.J.; Buma, P.; Slooff, T.J.J.H.; Gardeniers, J.W.M.

2005-01-01

BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of revision of the femoral component of a hip arthroplasty with use of an impaction bone-grafting technique and a cemented polished stem. METHODS: Thirty-three consecutive femoral reconstructions that were

A Model of the Action of the Shockwave Generated by a Multichannel Discharge on the Union of Bone Tissue with Bone Cement

Czech Academy of Sciences Publication Activity Database

Zeman, J.; Hach, J.; Mikulaková, W.; Derňarová, Ľ.; Eliášová, A.; Lukeš, Petr; Balážová, L.; Beneš, J.

2016-01-01

Roč. 30, č. 3 (2016), s. 237-242 ISSN 0258-851X Institutional support: RVO:61389021 Keywords : Shockwave * bone cement extractions * surgical revision Subject RIV: BL - Plasma and Gas Discharge Physics Impact factor: 0.953, year: 2016

In vitro and in vivo biological responses to a novel radiopacifying agent for bone cement

Science.gov (United States)

Wang, J.S; Diaz, J; Sabokbar, A; Athanasou, N; Kjellson, F; Tanner, K.E; McCarthy, I.D; Lidgren, L

2005-01-01

Iodixanol (IDX) and iohexol (IHX) have been investigated as possible radiopacification agents for polymethylmethacrylate (PMMA) bone cement, to replace the currently used barium sulphate and zirconia. IDX and IHX are both water-soluble iodine-based contrast media and for the last 20 years have been used extensively in clinical diagnostic procedures such as contrast media enhanced computed tomography, angiography and urography. One of the major reasons to remove the current radiopacifying agents is their well-documented cytotoxicity and their potential to increase bone resorption. Using in vitro bone resorption assays, the effect of PMMA particles plus IDX or IHX to induce osteoclast formation and lacunar resorption on dentine slices has been investigated. These responses have been compared with the in vitro response to PMMA particles containing the conventional radiopacifying agents, that is, barium sulphate and zirconia. In parallel, the in vivo reaction, in terms of new bone formation, to particles of these materials has been tested using a bone harvest chamber in rabbit tibiae. In vitro cell culture showed that PMMA containing IHX resulted in significantly less bone resorption than PMMA containing the conventional opacifiers. In vivo testing, however, showed no significant differences between the amounts of new bone formed around cement samples containing the two iodine-based opacifying agents in particulate form, although both led to fewer inflammatory cells than particles of PMMA containing zirconia. Our results suggest that a non-ionic radiopacifier could be considered as an alternative to the conventional radiopacifying agents used in biomaterials in orthopaedic surgery. PMID:16849166

Comparing membranes and bone substitutes in a one-stage procedure for horizontal bone augmentation. A double-blind randomised controlled trial.

Science.gov (United States)

Merli, Mauro; Moscatelli, Marco; Mariotti, Giorgia; Pagliaro, Umberto; Raffaelli, Eugenia; Nieri, Michele

2015-01-01

The objective of this parallel randomised controlled trial is to compare two bone substitutes and collagen membranes in a one-stage procedure for horizontal bone augmentation: anorganic bovine bone (Bio-Oss) and collagen porcine membranes (Bio-Gide) (BB group) versus a synthetic resorbable bone graft substitute made of pure β-tricalcium phosphate (Ceros TCP) and porcine pericardium collagen membranes (Jason) (CJ group). Patients in need of implant treatment having at least one site with horizontal osseous defects at a private clinic in Rimini (Italy) were included in this study. Patients were randomised to receive either the BB or CJ treatment. Randomisation was computer-generated with allocation concealment by opaque sequentially numbered sealed envelopes. Patients and the outcome assessor were blinded to group assignment. The main outcome measures were implant failure, complications, clinical bone gain at augmented sites, and complete filling of the bone defect. Secondary outcome measures were chair-time, postoperative pain and peri-implant marginal bone level changes. Twenty-five patients with 32 implants were allocated to the BB group and 25 patients with 29 implants to the CJ group. All 50 randomised patients received the treatment as allocated and there were no dropouts up to 6-months post-loading (12 months post-surgery). There were no failures and there were three complications in the BB group and three complications in the CJ group (relative risk: 1.00, 95% CI from 0.22 to 4.49, P = 1.00). The estimated difference between treatments in the vertical defect bone gain was -0.15 mm (95% CI from -0.65 to 0.35, P = 0.5504) favouring the BB group, and the estimated difference between treatments in the horizontal defect bone gain was -0.27 mm (95%CI from -0.73 to 0.19, P = 0.3851) favouring the BB group. There was no difference in the complete filling of the defect (relative risk: 0.88, 95%CI from 0.58 to 1.34, P = 0.7688). No significant differences were

Impact of implant size on cement filling in hip resurfacing arthroplasty.

Science.gov (United States)

de Haan, Roel; Buls, Nico; Scheerlinck, Thierry

2014-01-01

Larger proportions of cement within femoral resurfacing implants might result in thermal bone necrosis. We postulate that smaller components are filled with proportionally more cement, causing an elevated failure rate. A total of 19 femoral heads were fitted with polymeric replicas of ReCap (Biomet) resurfacing components fixed with low-viscosity cement. Two specimens were used for each even size between 40 and 56 mm and one for size 58 mm. All specimens were imaged with computed tomography, and the cement thickness and bone density were analyzed. The average cement mantle thickness was 2.63 mm and was not correlated with the implant size. However, specimen with low bone density had thicker cement mantles regardless of size. The average filling index was 36.65% and was correlated to both implant size and bone density. Smaller implants and specimens with lower bone density contained proportionally more cement than larger implants. According to a linear regression model, bone density but not implant size influenced cement thickness. However, both implant size and bone density had a significant impact on the filling index. Large proportions of cement within the resurfacing head have the potential to generate thermal bone necrosis and implant failure. When considering hip resurfacing in patients with a small femoral head and/or osteoporotic bone, extra care should be taken to avoid thermal bone necrosis, and alternative cementing techniques or even cementless implants should be considered. This study should help delimiting the indications for hip resurfacing and to choose an optimal cementing technique taking implant size into account.

The economics of using prophylactic antibiotic-loaded bone cement in total knee replacement.

Science.gov (United States)

Gutowski, C J; Zmistowski, B M; Clyde, C T; Parvizi, J

2014-01-01

The rate of peri-prosthetic infection following total joint replacement continues to rise, and attempts to curb this trend have included the use of antibiotic-loaded bone cement at the time of primary surgery. We have investigated the clinical- and cost-effectiveness of the use of antibiotic-loaded cement for primary total knee replacement (TKR) by comparing the rate of infection in 3048 TKRs performed without loaded cement over a three-year period versus the incidence of infection after 4830 TKRs performed with tobramycin-loaded cement over a later period of time of a similar duration. In order to adjust for confounding factors, the rate of infection in 3347 and 4702 uncemented total hip replacements (THR) performed during the same time periods, respectively, was also examined. There were no significant differences in the characteristics of the patients in the different cohorts. The absolute rate of infection increased when antibiotic-loaded cement was used in TKR. However, this rate of increase was less than the rate of increase in infection following uncemented THR during the same period. If the rise in the rate of infection observed in THR were extrapolated to the TKR cohort, 18 additional cases of infection would have been expected to occur in the cohort receiving antibiotic-loaded cement, compared with the number observed. Depending on the type of antibiotic-loaded cement that is used, its cost in all primary TKRs ranges between USD $2112.72 and USD $112 606.67 per case of infection that is prevented.

Intralesional curettage and cementation for low-grade chondrosarcoma of long bones: retrospective study and literature review.

Science.gov (United States)

Mermerkaya, Musa Ugur; Bekmez, Senol; Karaaslan, Fatih; Danisman, Murat; Kosemehmetoglu, Kemal; Gedikoglu, Gokhan; Ayvaz, Mehmet; Tokgozoglu, Ahmet Mazhar

2014-11-10

Various treatment strategies for low-grade chondrosarcomas with variable outcomes have been reported in the literature. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage followed by adjuvant therapy comprising high-speed burring, thermal cauterization, and bone cementation with polymethylmethacrylate. We performed a retrospective review of 21 consecutive patients with intramedullary low-grade chondrosarcoma of long bones treated by intralesional curettage and adjuvant therapy comprising high-speed burring, thermal cauterization, and cementation at our institution from 2007 to 2012. The average age of the patients was 48.7 (range, 18-71) years. There were 7 male and 14 female patients. The mean follow-up period was 58.4 (range, 26-85) months after surgery. The treated lesions were located in the proximal humerus (n=10), proximal tibia (n=6), and distal femur (n=5). At the average follow-up time point of 58.4 (range, 26-85) months, no patient had developed local recurrence and no distant metastases were observed. The average Musculoskeletal Tumor Society score among all 21 patients was 95% (84-100). The combination of intralesional curettage, application of high-speed burring, thermal cauterization, and cementation is an effective treatment strategy for low-grade intramedullary chondrosarcoma of long bones. Excellent oncological and functional results can be obtained.

Fixation of a human rib by an intramedullary telescoping splint anchored by bone cement.

Science.gov (United States)

Liovic, Petar; Šutalo, Ilija D; Marasco, Silvana F

2016-09-01

A novel concept for rib fixation is presented that involves the use of a bioresorbable polymer intramedullary telescoping splint. Bone cement is used to anchor each end of the splint inside the medullary canal on each side of the fracture site. In this manner, rib fixation is achieved without fixation device protrusion from the rib, making the splint completely intramedullary. Finite element analysis is used to demonstrate that such a splint/cement composite can preserve rib fixation subjected to cough-intensity force loadings. Computational fluid dynamics and porcine rib experiments were used to study the anchor formation process required to complete the fixation.

Aluminum-free glass-ionomer bone cements with enhanced bioactivity and biodegradability

Energy Technology Data Exchange (ETDEWEB)

Gomes, Filipa O.; Pires, Ricardo A., E-mail: rpires@dep.uminho.pt; Reis, Rui L.

2013-04-01

Al-free glasses of general composition 0.340SiO{sub 2}:0.300ZnO:(0.250-a-b)CaO:aSrO:bMgO:0.050Na{sub 2}O:0.060P{sub 2}O{sub 5} (a, b = 0.000 or 0.125) were synthesized by melt quenching and their ability to form glass-ionomer cements was evaluated using poly(acrylic acid) and water. We evaluated the influence of the poly(acrylic acid) molecular weight and glass particle size in the cement mechanical performance. Higher compressive strength (25 ± 5 MPa) and higher compressive elastic modulus (492 ± 17 MPa) were achieved with a poly(acrylic acid) of 50 kDa and glass particle sizes between 63 and 125 μm. Cements prepared with glass formulation a = 0.125 and b = 0.000 were analyzed after immersion in simulated body fluid; they presented a surface morphology consistent with a calcium phosphate coating and a Ca/P ratio of 1.55 (similar to calcium-deficient hydroxyapatite). Addition of starch to the cement formulation induced partial degradability after 8 weeks of immersion in phosphate buffer saline containing α-amylase. Micro-computed tomography analysis revealed that the inclusion of starch increased the cement porosity from 35% to 42%. We were able to produce partially degradable Al-free glass-ionomer bone cements with mechanical performance, bioactivity and biodegradability suitable to be applied on non-load bearing sites and with the appropriate physical characteristics for osteointegration upon partial degradation. Zn release studies (concentrations between 413 μM and 887 μM) evidenced the necessity to tune the cement formulations to reduce the Zn concentration in the surrounding environment. Highlights: ► We developed partially degradable, bioactive, Al-free glass-ionomer cements (GICs). ► Enhanced mechanical behavior was achieved using 63–125 μm glass particle size range. ► The highest mechanical resistance was obtained using poly(acrylic acid) of 50 kDa. ► Biodegradation was successfully tuned to start 8 weeks after GIC preparation. ► Zn

Aluminum-free glass-ionomer bone cements with enhanced bioactivity and biodegradability

International Nuclear Information System (INIS)

Gomes, Filipa O.; Pires, Ricardo A.; Reis, Rui L.

2013-01-01

Al-free glasses of general composition 0.340SiO 2 :0.300ZnO:(0.250-a-b)CaO:aSrO:bMgO:0.050Na 2 O:0.060P 2 O 5 (a, b = 0.000 or 0.125) were synthesized by melt quenching and their ability to form glass-ionomer cements was evaluated using poly(acrylic acid) and water. We evaluated the influence of the poly(acrylic acid) molecular weight and glass particle size in the cement mechanical performance. Higher compressive strength (25 ± 5 MPa) and higher compressive elastic modulus (492 ± 17 MPa) were achieved with a poly(acrylic acid) of 50 kDa and glass particle sizes between 63 and 125 μm. Cements prepared with glass formulation a = 0.125 and b = 0.000 were analyzed after immersion in simulated body fluid; they presented a surface morphology consistent with a calcium phosphate coating and a Ca/P ratio of 1.55 (similar to calcium-deficient hydroxyapatite). Addition of starch to the cement formulation induced partial degradability after 8 weeks of immersion in phosphate buffer saline containing α-amylase. Micro-computed tomography analysis revealed that the inclusion of starch increased the cement porosity from 35% to 42%. We were able to produce partially degradable Al-free glass-ionomer bone cements with mechanical performance, bioactivity and biodegradability suitable to be applied on non-load bearing sites and with the appropriate physical characteristics for osteointegration upon partial degradation. Zn release studies (concentrations between 413 μM and 887 μM) evidenced the necessity to tune the cement formulations to reduce the Zn concentration in the surrounding environment. Highlights: ► We developed partially degradable, bioactive, Al-free glass-ionomer cements (GICs). ► Enhanced mechanical behavior was achieved using 63–125 μm glass particle size range. ► The highest mechanical resistance was obtained using poly(acrylic acid) of 50 kDa. ► Biodegradation was successfully tuned to start 8 weeks after GIC preparation. ► Zn release should be

Evaluation of the treatment modalities for neurosensory disturbances of the inferior alveolar nerve following retromolar bone harvesting for bone augmentation.

Science.gov (United States)

Nogami, Shinnosuke; Yamauchi, Kensuke; Shiiba, Shunji; Kataoka, Yoshihiro; Hirayama, Bunichi; Takahashi, Tetsu

2015-03-01

The purpose of this study was to evaluate the treatment modalities for neurosensory disturbances (NSDs) of the inferior alveolar nerve occurring after retromolar bone harvesting for bone augmentation procedures before implant placement. One hundred four patients, of which 49 and 55 exhibited vertical or horizontal alveolar ridge defects in the mandible and maxilla, respectively, were enrolled. Nineteen patients underwent block bone grafting, 38 underwent guided bone generation or autogenous bone grafting combined with titanium mesh reconstruction, and 47 underwent sinus floor augmentation. Using a visual analog scale, we examined subjective symptoms and discomfort related to sensory alteration within the area of the NSDs in these patients. NSDs were clinically investigated using a two-point discrimination test with blunt-tipped calipers. In addition, neurometry was used for evaluation of trigeminal nerve injury. We tested three treatment modalities for NSDs: follow-up observation (no treatment), medication, and stellate ganglion block (SGB). A week after surgery, 26 patients (25.0%) experienced NSDs. Five patients received no treatment, 10 patients received medication, and 11 patients received SGB. Three months after surgery, patients in the medication and SGB group achieved complete recovery. Current perception threshold values recovered to near-baseline values at 3 months: recovery was much earlier in this group than in the other two groups. SGB can accelerate recovery from NSDs. Our results justify SGB as a reasonable treatment modality for NSDs occurring after the harvesting of retromolar bone grafts. Wiley Periodicals, Inc.

Platelet-Rich Fibrin with β-Tricalcium Phosphate—A Noval Approach for Bone Augmentation in Chronic Periapical Lesion: A Case Report

Directory of Open Access Journals (Sweden)

K. B. Jayalakshmi

2012-01-01

Full Text Available Introduction. This paper describes a case of bone augmentation with combination of Platelet-Rich Fibrin (PRF and β-TCP for treatment of chronic periapical cyst. The case was followed for 12 months. Methods. Patient presented with chronic periapical lesion in maxillary anterior teeth with history of trauma 8 years back. Radiographically, a periapical cyst was seen in relation to maxillary left central and lateral incisors. Conventional endodontic treatment was started. Since it was not successful, apical surgery was performed. Bone augmentation was done using PRF in combination with β-TCP bone graft to achieve faster healing of the periapical region. Regular followups at 3, 6, 9, and 12 months were done. Results. Healing was uneventful. Follow-up examinations revealed progressive, significant, and predictable clinical and radiographic bone regeneration/healing without any clinical symptoms. Conclusions. Combined use of PRF and β-TCP for bone augmentation in treatment of periapical defects is a potential treatment alternative for faster healing than using these biomaterials alone.

[Use of pedicle percutaneous cemented screws in the management of patients with poor bone stock].

Science.gov (United States)

Pesenti, S; Graillon, T; Mansouri, N; Adetchessi, T; Tropiano, P; Blondel, B; Fuentes, S

2016-12-01

Management of patients with poor bone stock remains difficult due to the risks of mechanical complications such as screws pullouts. At the same time, development of minimal invasive spinal techniques using a percutaneous approach is greatly adapted to these fragile patients with a reduction in operative time and complications. The aim of this study was to report our experience with cemented percutaneous screws in the management of patients with a poor bone stock. Thirty-five patients were included in this retrospective study. In each case, a percutaneous osteosynthesis using cemented screws was performed. Indications were osteoporotic fractures, metastasis or fractures on ankylosing spine. Depending on radiologic findings, short or long constructs (2 levels above and below) were performed and an anterior column support (kyphoplasty or anterior approach) was added. Evaluation of patients was based on pre and postoperative CT-scans associated with clinical follow-up with a minimum of 6 months. Eleven men and 24 women with a mean age of 73 years [60-87] were included in the study. Surgical indication was related to an osteoporotic fracture in 20 cases, a metastasis in 13 cases and a fracture on ankylosing spine in the last 2 cases. Most of the fractures were located between T10 and L2 and a long construct was performed in 22 cases. Percutaneous kyphoplasty was added in 24 cases and a complementary anterior approach in 3 cases. Average operative time was 86minutes [61-110] and blood loss was estimated as minor in all the cases. In the entire series, average volume of cement injected was 1.8 cc/screw. One patient underwent a major complication with a vascular leakage responsible for a cement pulmonary embolism. With a 9 months average follow-up [6-20], no cases of infection or mechanical complication was reported. Minimal invasive spinal techniques are greatly adapted to the management of fragile patients. The use of percutaneous cemented screws is, in our experience

Towards optimization of the silanization process of hydroxyapatite for its use in bone cement formulations

International Nuclear Information System (INIS)

Cisneros-Pineda, Olga G.; Herrera Kao, Wilberth; Loría-Bastarrachea, María I.; Veranes-Pantoja, Yaymarilis; Cauich-Rodríguez, Juan V.; Cervantes-Uc, José M.

2014-01-01

The aim of this work was to provide some fundamental information for optimization of silanization of hydroxyapatite intended for bone cement formulations. The effect of 3-(trimethoxysilyl) propyl methacrylate (MPS) concentration and solvent system (acetone/water or methanol/water mixtures) during HA silanization was monitored by X-ray diffraction (XRD), FTIR spectroscopy and EDX analysis. The effect of silanized HA on the mechanical properties of acrylic bone cements is also reported. It was found that the silanization process rendered hydroxyapatite with lower crystallinity compared to untreated HA. Through EDX, it was observed that the silicon concentration in the HA particles was higher for acetone–water than that obtained for methanol–water system, although the mechanical performance of cements prepared with these particles exhibited the opposite behavior. Taking all these results together, it is concluded that methanol–water system containing MPS at 3 wt.% provides the better results during silanization process of HA. - Highlights: • Effect of MPS concentration and solvents during HA silanization was studied. • Silanization rendered HA has lower crystallinity compared to untreated HA. • Silicon concentration was higher for acetone than that obtained using methanol. • Methanol–water system containing MPS at 3 wt.% provides the better results

Towards optimization of the silanization process of hydroxyapatite for its use in bone cement formulations

Energy Technology Data Exchange (ETDEWEB)

Cisneros-Pineda, Olga G.; Herrera Kao, Wilberth; Loría-Bastarrachea, María I. [Centro de Investigación Científica de Yucatán, A.C., Unidad de Materiales, Calle 43 No. 130, Col. Chuburná de Hidalgo, C.P. 97200 Mérida, Yucatán (Mexico); Veranes-Pantoja, Yaymarilis [Centro de Biomateriales, Universidad de la Habana, Avenida Universidad, s/n, e/G y Ronda, C.P. 10600 C. de La Habana (Cuba); Cauich-Rodríguez, Juan V. [Centro de Investigación Científica de Yucatán, A.C., Unidad de Materiales, Calle 43 No. 130, Col. Chuburná de Hidalgo, C.P. 97200 Mérida, Yucatán (Mexico); Cervantes-Uc, José M., E-mail: manceruc@cicy.mx [Centro de Investigación Científica de Yucatán, A.C., Unidad de Materiales, Calle 43 No. 130, Col. Chuburná de Hidalgo, C.P. 97200 Mérida, Yucatán (Mexico)

2014-07-01

The aim of this work was to provide some fundamental information for optimization of silanization of hydroxyapatite intended for bone cement formulations. The effect of 3-(trimethoxysilyl) propyl methacrylate (MPS) concentration and solvent system (acetone/water or methanol/water mixtures) during HA silanization was monitored by X-ray diffraction (XRD), FTIR spectroscopy and EDX analysis. The effect of silanized HA on the mechanical properties of acrylic bone cements is also reported. It was found that the silanization process rendered hydroxyapatite with lower crystallinity compared to untreated HA. Through EDX, it was observed that the silicon concentration in the HA particles was higher for acetone–water than that obtained for methanol–water system, although the mechanical performance of cements prepared with these particles exhibited the opposite behavior. Taking all these results together, it is concluded that methanol–water system containing MPS at 3 wt.% provides the better results during silanization process of HA. - Highlights: • Effect of MPS concentration and solvents during HA silanization was studied. • Silanization rendered HA has lower crystallinity compared to untreated HA. • Silicon concentration was higher for acetone than that obtained using methanol. • Methanol–water system containing MPS at 3 wt.% provides the better results.

The use of bone block allografts in sinus augmentation, followed by delayed implant placement: A case series

Directory of Open Access Journals (Sweden)

Eurico D Aloja

2013-01-01

Full Text Available Purpose: This article reports the clinical outcomes observed in a large number of patients receiving block bone allograft used for sinus augmentation and delayed implant placement. Patients and Methods: In total, 28 patients (13 males with a mean age of 49.8 ± 10.1 years (range: 33-67 years were included in this case series. All selected patients suffered from severe alveolar ridge atrophy in the posterior maxilla and required bone augmentation procedures, followed by implant placement after 6 months. All patients were followed for 18 months after the grafting, with scheduled monthly visits and/or more frequent visits if required. The survival rates for both the bone blocks and placed implants were then evaluated. Results: A total of 42 blocks and 90 implants were placed. Only one bone graft and 5 implants failed; the survival rate was 97.2% and 95.5% for the bone grafts and implants, respectively. The graft failed due to the onset of post-surgical infectious sinusitis, while in some patients′ implants showed absence of osteointegration at the end of the healing phase. Of note, all failed implants were observed in heavy smokers; in all other patients, blocks and implants were successful. Conclusions: This preliminary case series suggests that the grafting of bone allograft followed by delayed implant placement may be a promising strategy for sinus augmentation. More extended and larger follow-up studies are needed to confirm this preliminary data.

Esthetic evaluation of single-tooth implants in the anterior maxilla following autologous bone augmentation.

Science.gov (United States)

Hof, M; Pommer, B; Strbac, G D; Sütö, D; Watzek, G; Zechner, W

2013-08-01

Autologous bone augmentation to rebuild compromised alveolar ridge contour prior to implant placement allows for favorable three-dimensional implant positioning to achieve optimum implant esthetics. The aim of the present study was to evaluate peri-implant soft tissue conditions around single-tooth implants following bone grafts in the esthetic zone of the maxilla. Sixty patients underwent autologous bone augmentation of deficient maxillary sites prior to placement of 85 implants in the esthetic zone. In case of multiple implants per patient, one implant was randomly selected. Objective evaluation of 60 single-tooth implants was performed using the Pink-Esthetic-Score (PES) and Papilla Index (PI) and supplemented by subjective patient evaluation, as well as clinical and radiologic examination. Objective ratings of implant esthetics were satisfactory (median PES: 11, median PI: 2) and significantly correlated with high patient satisfaction (mean VAS score: 80%). Both esthetic indices demonstrated respectable levels of inter- as well as intra-observer agreement. Poor implant esthetics (low PES and PI ratings) were significantly associated with increased anatomic crown height, while no influence of horizontal implant-tooth distance could be found. The present investigation indicates that favorable esthetic results may be achieved in the augmented anterior maxilla. However, bony reconstruction of compromised alveolar ridges does not guarantee optimum implant esthetics. © 2011 John Wiley & Sons A/S.

The clinical value of membranes in bone augmentation procedures in oral implantology: 
A systematic review of randomised controlled trials

NARCIS (Netherlands)

Jonker, Brend P.; Roeloffs, Maarten W. K.; Wolvius, Eppo B.; Pijpe, Justin

2016-01-01

To determine the clinical value of membranes in bone augmentation procedures such as ridge augmentation with simultaneous (one-stage) and delayed (two-stage) implant placement, sinus augmentation surgery, ridge preservation and immediate implant placement. In April 2016, Embase, Medline (Ovid-SP),

Determination of bone and tissue concentrations of teicoplanin mixed with hydroxyapatite cement to repair cortical defects.

Science.gov (United States)

Eggenreich, K; Zeipper, U; Schwendenwein, E; Hadju, S; Kaltenecker, G; Laslo, I; Lang, S; Roschger, P; Vecsei, V; Wintersteiger, R

2002-01-01

A highly specific and sensitive isocratic reversed-phase high performance liquid chromatography (HPLC) method for the determination of the major component of teicoplanin in tissue is reported. Comparing fluorescamine and o-phthalaldehyde (OPA) as derivatizing agents, the derivative formed with the latter exhibits superior fluorescence intensity allowing detection of femtomole quantities. Pretreatment for tissue samples is by solid-phase extraction which uses Bakerbond PolarP C(18) cartridges and gives effective clean up from endogenous by-products. Linearity was given from 0.6 to 100 ng per injection. The coefficient of variation did not exceed 5.8% for both interday and intraday assays. It was found that when bone defects are repaired with a hydroxyapatite-teicoplanin mixture, the antibiotic does not degrade, even when it is in the cement for several months. The stability of teicoplanin in bone cement was determined fluorodensitometrically.

Augmentation of failed human vertebrae with critical un-contained lytic defect restores their structural competence under functional loading: An experimental study.

Science.gov (United States)

Alkalay, Ron N; von Stechow, Dietrich; Hackney, David B

2015-07-01

Lytic spinal lesions reduce vertebral strength and may result in their fracture. Vertebral augmentation is employed clinically to provide mechanical stability and pain relief for vertebrae with lytic lesions. However, little is known about its efficacy in strengthening fractured vertebrae containing lytic metastasis. Eighteen unembalmed human lumbar vertebrae, having simulated uncontained lytic defects and tested to failure in a prior study, were augmented using a transpedicular approach and re-tested to failure using a wedge fracture model. Axial and moment based strength and stiffness parameters were used to quantify the effect of augmentation on the structural response of the failed vertebrae. Effects of cement volume, bone mineral density and vertebral geometry on the change in structural response were investigated. Augmentation increased the failed lytic vertebral strength [compression: 85% (Paugmentation is effective in bolstering the failed lytic vertebrae compressive and axial structural competence, showing strength estimates up to 50-90% of historical values of osteoporotic vertebrae without lytic defects. This modest increase suggests that lytic vertebrae undergo a high degree of structural damage at failure, with strength only partially restored by vertebral augmentation. The positive effect of cement volume is self-limiting due to extravasation. Copyright © 2015. Published by Elsevier Ltd.

Maxillary Sinus Floor Augmentation With Synthetic Bone Substitutes Compared With Other Grafting Materials

DEFF Research Database (Denmark)

Starch-Jensen, Thomas; Mordenfeld, Arne; Becktor, Jonas Peter

2018-01-01

OBJECTIVE: To test the hypotheses of no differences in implant treatment outcome after maxillary sinus floor augmentation (MSFA) with synthetic bone substitutes (SBS) compared with other grafting materials applying the lateral window technique. MATERIALS AND METHODS: A MEDLINE/PubMed, Embase and ...

Can we improve fixation and outcomes? Use of bone substitutes.

Science.gov (United States)

Moroni, Antonio; Larsson, Sune; Hoang Kim, Amy; Gelsomini, Letizia; Giannoudis, Peter V

2009-07-01

Hip fractures secondary to osteoporosis are common in the elderly. Stabilizing these fractures until union is achieved is a challenge due to poor bone stock and insufficient purchase of the implant to the bone. The reported high rate of complications has prompted extensive research in the development of fixation techniques. Furthermore, manipulation of both the local fracture environment in terms of application of growth factors, scaffolds, and mesenchymal cells and the systemic administration of agents promoting bone formation and bone strength has been considered as a treatment option with promising results. There are only a few evidence-based studies reporting on fixation augmentation techniques. This article reports on the efficacy of bone graft substitutes for the fixation of hip fractures, in particular calcium phosphates, which have been used as granules, cements, and implant coatings.

Antibacterial Efficacy of a New Gentamicin-Coating for Cementless Prostheses Compared to Gentamicin-Loaded Bone Cement

NARCIS (Netherlands)

Neut, Danielle; Dijkstra, Rene J. B.; Thompson, Jonathan I.; van der Mei, Henny C.; Busscher, Henk J.

Cementless prostheses are increasingly popular but require alternative prophylactic measures than the use of antibiotic-loaded bone cements. Here, we determine the 24-h growth inhibition of gentamicin-releasing coatings from grit-blasted and porous-coated titanium alloys, and compare their

Effect of the calcium to phosphorus ratio on the setting properties of calcium phosphate bone cements.

Science.gov (United States)

Vlad, M D; Gómez, S; Barracó, M; López, J; Fernández, E

2012-09-01

α-Tricalcium phosphate (α-TCP) has become the main reactant of most experimental and commercial ceramic bone cements. It has calcium-to-phosphorus (Ca/P) ratio of 1.50. The present study expands and reports on the microstructures and mechanical properties of calcium phosphate (CP) cements containing sintered monolithic reactants obtained in the interval 1.29 properties as well as on their microstructure and crystal phase evolution. The results showed that: (a) CP-cements made with reactants with Ca/P ratio other than 1.50 have longer setting and lower hardening properties; (b) CP-cements reactivity was clearly affected by the Ca/P ratio of the starting reactant; (c) reactants with Ca/P calcium pyrophosphate and α- and β-TCP. Similarly, reactants with Ca/P > 1.50 were composed of α-TCP, tetracalcium phosphate and hydroxyapatite; (d) only the reactant with Ca/P = 1.50 was monophasic and was made of α-TCP, which transformed during the setting into calcium deficient hydroxyapatite; (e) CP-cements developed different crystal microstructures with specific features depending on the Ca/P ratio of the starting reactant.

Material properties and in vitro biocompatibility of a newly developed bone cement

Directory of Open Access Journals (Sweden)

Elke Mitzner

2009-01-01

Full Text Available In this study mechanical properties and biocompatibility (In Vitro of a new bone cement were investigated. A new platform technology named COOL is a variable composite of dissolved, chemically modified PMMA and different bioceramics. COOL cures at body temperature via a classical cementation reaction. Compressive strengths ranging from 3.6 ± 0.8 to 62.8 ± 1.3 MPa and bending strengths ranging from 9.9 ± 2.4 to 26.4 ± 3.0 MPa were achieved with different COOL formulations. Porosity varied between 31 and 43%. Varying the components of each formulation mechanical properties and porosity could be adjusted. In Vitro biocompatibility studies with primary human osteoblasts (pHOB in direct contact with different COOL formulations, did not reveal any signs of toxicity. In contrast to Refobacin® R, cells incubated with COOL showed similar density, viability and ALP activity compared to control, if specimen were added immediately to the cell monolayer after preparation. In conclusion, COOL has promising mechanical properties in combination with high biocompatibility In Vitro and combines different advantages of both CPCs and PMMA cements by avoiding some of the respective shortcomings.

Real-time synchronous measurement of curing characteristics and polymerization stress in bone cements with a cantilever-beam based instrument

Science.gov (United States)

Palagummi, Sri Vikram; Landis, Forrest A.; Chiang, Martin Y. M.

2018-03-01

An instrumentation capable of simultaneously determining degree of conversion (DC), polymerization stress (PS), and polymerization exotherm (PE) in real time was introduced to self-curing bone cements. This comprises the combination of an in situ high-speed near-infrared spectrometer, a cantilever-beam instrument with compliance-variable feature, and a microprobe thermocouple. Two polymethylmethacrylate-based commercial bone cements, containing essentially the same raw materials but differ in their viscosity for orthopedic applications, were used to demonstrate the applicability of the instrumentation. The results show that for both the cements studied the final DC was marginally different, the final PS was different at the low compliance, the peak of the PE was similar, and their polymerization rates were significantly different. Systematic variation of instrumental compliance for testing reveals differences in the characteristics of PS profiles of both the cements. This emphasizes the importance of instrumental compliance in obtaining an accurate understanding of PS evaluation. Finally, the key advantage for the simultaneous measurements is that these polymerization properties can be correlated directly, thus providing higher measurement confidence and enables a more in-depth understanding of the network formation process.

The combined use of rhBMP-2/ACS, autogenous bone graft, a bovine bone mineral biomaterial, platelet-rich plasma, and guided bone regeneration at nonsubmerged implant placement for supracrestal bone augmentation. A case report.

Science.gov (United States)

Sclar, Anthony G; Best, Steven P

2013-01-01

This case report presents the clinical application and outcomes of the use of a combined approach to treat a patient with a severe alveolar defect. Recombinant human bone morphogenetic protein-2 in an absorbable collagen sponge carrier, along with autogenous bone graft, bovine bone mineral, platelet-rich plasma, and guided bone regeneration, were used simultaneous with nonsubmerged implant placement. At 1 year postsurgery, healthy peri-implant soft tissues and radiographically stable peri-implant crestal bone levels were observed along with locally increased radiographic bone density. In addition, a cone beam computed tomography (CBCT) scan demonstrated apparent supracrestal peri-implant bone augmentation with the appearance of normal alveolar ridge contours, including the facial bone wall.

The combination of ultrasound with antibiotics released from bone cement decreases the viability of planktonic and biofilm bacteria: an in vitro study with clinical strains.

Science.gov (United States)

Ensing, Geert T; Neut, Daniëlle; van Horn, Jim R; van der Mei, Henny C; Busscher, Henk J

2006-12-01

Antibiotic-loaded bone cements are used for the permanent fixation of joint prostheses. Antibiotic-loaded cements significantly decrease the incidence of infection. The objective of this study was to investigate whether the viability of bacteria derived from patients with a prosthesis-related infection could be further decreased when antibiotic release from bone cements was combined with application of pulsed ultrasound. Escherichia coli ATCC 10798, Staphylococcus aureus 7323, coagulase-negative staphylococci (CoNS 7368 and CoNS 7391) and Pseudomonas aeruginosa 5148 were grown planktonically in suspension and as a biofilm on three different bone cements: Palacos R without gentamicin as control, gentamicin-loaded Palacos R-G and gentamicin/clindamycin-loaded Copal. The viability of planktonic and biofilm bacteria was measured in the absence and presence of pulsed ultrasound for 40 h. Ultrasound itself did not affect bacterial viability. However, application of pulsed ultrasound in combination with antibiotic release by antibiotic-loaded bone cements yielded a reduction of both planktonic and biofilm bacterial viability compared with antibiotic release without application of ultrasound. This study shows that antibiotic release in combination with ultrasound increases the antimicrobial efficacy further than antibiotic release alone against a variety of clinical isolates. Application of ultrasound in combination with antibiotic release in clinical practice could therefore lead to better prevention or treatment of prosthesis-related infections.

Systematic Review and Meta-Analysis of Recombinant Human Bone Morphogenetic Protein-2 in Localized Alveolar Ridge and Maxillary Sinus Augmentation.

Science.gov (United States)

Kelly, Mick P; Vaughn, Olushola L Akinshemoyin; Anderson, Paul A

2016-05-01

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is approved by the Food and Drug Administration as a viable alternative to bone graft in spinal fusion and maxillary sinus lift. The research questions for meta-analysis were: Is rhBMP-2 an effective bone graft substitute in localized alveolar ridge augmentation and maxillary sinus floor augmentation? What are the potential adverse events? A search of MEDLINE from January 1980 to January 2014 using PubMed, the Cochrane Database of Systematic Reviews and Controlled Trials, CINAHL, and EMBASE was performed. Searches were performed from Medical Subject Headings. The quality of each study included was graded by Review Manager software. The primary outcome variable was bone formation measured as change in bone height on computed tomogram. A systematic review of adverse events also was performed. A random-effects model was chosen. Continuous variables were calculated using the standardized mean difference and 95% confidence intervals (CIs) comparing improvement from baseline of the experimental group with that of the control group. Change in bone height was calculated using logarithmic odds ratio. Test of significance used the Z statistic with a P value of .05. Ten studies met the criteria for systematic review; 8 studies were included in the meta-analysis. Five studies assessed localized alveolar ridge augmentation and resulted in an overall standardized mean difference of 0.56 (CI, 0.20-0.92) in favor of BMP; this result was statistically important. Three studies assessed maxillary sinus floor augmentation and resulted in an overall standardized mean difference of -0.50 (CI, -0.93 to -0.09), which was meaningfully different in favor of the control group. Adverse events were inconsistently reported, ranging from no complications to widespread adverse events. For localized alveolar ridge augmentation, this meta-analysis showed that rhBMP-2 substantially increases bone height. However, rhBMP-2 does not perform as

A new acoustic method to determine the setting time of calcium sulfate bone cement mixed with antibiotics

International Nuclear Information System (INIS)

Cooper, J J; Brayford, M J; Laycock, P A

2014-01-01

A new method is described which can be used to determine the setting times of small amounts of high value bone cements. The test was developed to measure how the setting times of a commercially available synthetic calcium sulfate cement (Stimulan, Biocomposites, UK) in two forms (standard and Rapid Cure) varies with the addition of clinically relevant antibiotics. The importance of being able to accurately quantify these setting times is discussed. The results demonstrate that this new method, which is shown to correlate to the Vicat needle, gives reliable and repeatable data with additional benefits expressed in the article. The majority of antibiotics mixed were found to retard the setting reaction of the calcium sulfate cement. (paper)

A new acoustic method to determine the setting time of calcium sulfate bone cement mixed with antibiotics.

Science.gov (United States)

Cooper, J J; Brayford, M J; Laycock, P A

2014-08-01

A new method is described which can be used to determine the setting times of small amounts of high value bone cements. The test was developed to measure how the setting times of a commercially available synthetic calcium sulfate cement (Stimulan, Biocomposites, UK) in two forms (standard and Rapid Cure) varies with the addition of clinically relevant antibiotics. The importance of being able to accurately quantify these setting times is discussed. The results demonstrate that this new method, which is shown to correlate to the Vicat needle, gives reliable and repeatable data with additional benefits expressed in the article. The majority of antibiotics mixed were found to retard the setting reaction of the calcium sulfate cement.

Bone Regeneration Using N-Methyl-2-pyrrolidone as an Enhancer for Recombinant Human Bone Morphogenetic Protein-2 in a Rabbit Sinus Augmentation Model.

Science.gov (United States)

Lim, Hyun-Chang; Thoma, Daniel S; Yoon, So-Ra; Cha, Jae-Kook; Lee, Jung-Seok; Jung, Ui-Won

2017-01-01

The aim of this study was to determine whether N-methyl-2-pyrrolidone (NMP) can decrease the dose of recombinant human bone morphogenetic protein-2 (rhBMP-2) in sinus augmentation of rabbits. In each of 15 rabbits, 2 sinuses were randomly grafted using 1 of 3 treatment modalities: (i) biphasic calcium phosphate (BCP; control), (ii) rhBMP-2-coated BCP (BMP), or (iii) rhBMP-2-coated BCP soaked in NMP solution (BMP/NMP). The rabbits were sacrificed 2 weeks postoperatively. Histologic and histomorphometric analyses were performed. Bone formation in all groups was predominantly located close to the access window and the lateral walls. Newly formed bone within the total augmented area (NB TA ) was greatest in BMP/NMP (1.94 ± 0.69 mm 2 ), followed by BMP (1.50 ± 0.72 mm 2 ) and BCP (1.28 ± 0.52 mm 2 ) ( P > 0.05). In the center of the augmentation (NB ROI_C ) and the area close to the sinus membrane (NB ROI_M ), BMP/NMP produced the largest area of NB (NB ROI_C : 0.10 ± 0.11 mm 2 ; NB ROI_M : 0.17 ± 0.08 mm 2 ); the corresponding NB values for BCP were 0.05 ± 0.05 mm 2 and 0.08 ± 0.09 mm 2 , respectively ( P > 0.05 for all comparisons). The effect of NMP on bone regeneration was inconsistent between the specimens. Adding NMP as an adjunct to rhBMP-2-coated BCP produced inconsistent effects on bone regeneration, resulting in no significant benefit compared to controls.

Femoral component revision with use of impaction bone-grafting and a cemented polished stem. Surgical technique.

NARCIS (Netherlands)

Schreurs, B.W.; Arts, J.J.C.; Verdonschot, N.J.J.; Buma, P.; Slooff, T.J.J.H.; Gardeniers, J.W.M.

2006-01-01

BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of revision of the femoral component of a hip arthroplasty with use of an impaction bone-grafting technique and a cemented polished stem. METHODS: Thirty-three consecutive femoral reconstructions that were

21 CFR 888.4200 - Cement dispenser.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cement dispenser. 888.4200 Section 888.4200 Food... DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4200 Cement dispenser. (a) Identification. A cement dispenser is a nonpowered syringe-like device intended for use in placing bone cement (§ 888.3027) into...

Microencapsulation of 2-octylcyanoacrylate tissue adhesive for self-healing acrylic bone cement.

Science.gov (United States)

Brochu, Alice B W; Chyan, William J; Reichert, William M

2012-10-01

Here, we report the first phase of developing self-healing acrylic bone cement: the preparation and characterization of polyurethane (PUR) microcapsules containing a medical cyanoacrylate tissue adhesive. Capsules were prepared by interfacial polymerization of a toluene-2,4-diisocyanate-based polyurethane prepolymer with 1,4-butanediol to encapsulate 2-octylcyanoacrylate (OCA). Various capsule characteristics, including: resultant morphology, average size and size distribution, shell thickness, content and reactivity of encapsulated agent, and shelf life are investigated and their reliance on solvent type and amount, surfactant type and amount, temperature, pH, agitation rate, reaction time, and mode of addition of the oil phase to the aqueous phase are presented. Capsules had average diameters ranging from 74 to 222 μm and average shell thicknesses ranging from 1.5 to 6 μm. The capsule content was determined via thermogravimetric analysis and subsequent analysis of the capsules following up to 8 weeks storage revealed minimal loss of core contents. Mechanical testing of OCA-containing capsules showed individual capsules withstood compressive forces up to a few tenths of Newtons, and the contents released from crushed capsules generated tensile adhesive forces of a few Newtons. Capsules were successfully mixed into the poly(methyl methacrylate) bone cement, surviving the mixing process, exposure to methyl methacrylate monomer, and the resulting exothermic matrix curing. Copyright © 2012 Wiley Periodicals, Inc.

Experimental in-vitro bone cements disintegration with ultrasonic pulsating water jet for revision arthroplasty

Czech Academy of Sciences Publication Activity Database

Hloch, Sergej; Foldyna, Josef; Pude, F.; Kloc, J.; Zeleňák, Michal; Hvizdoš, P.; Monka, P.; Smolko, I.; Ščučka, Jiří; Kozak, D.; Sedmak, A.; Mihalčinová, E.

2015-01-01

Roč. 22, č. 6 (2015), s. 1609-1616 ISSN 1330-3651 R&D Projects: GA MŠk ED2.1.00/03.0082; GA MŠk(CZ) LO1406 Institutional support: RVO:68145535 Keywords : bone cement * revision arthroplasty * ultrasonic pulsating water jet Subject RIV: JQ - Machines ; Tools Impact factor: 0.464, year: 2015 http://www.tehnicki-vjesnik.com/web/public/archive

Anti-inflammation performance of curcumin-loaded mesoporous calcium silicate cement.

Science.gov (United States)

Chen, Yuan-Chien; Shie, Ming-You; Wu, Yuan-Haw Andrew; Lee, Kai-Xing Alvin; Wei, Li-Ju; Shen, Yu-Fang

2017-09-01

Calcium silicate (CS) cements have excellent bioactivity and can induce the bone-like apatite formation. They are good biomaterials for bone tissue engineering and bone regenerative medicine. However, they have degradability and the dissolved CS can cause the inflammatory response at the early post-implantation stage. The purpose of this study was to design and prepare the curcumin-loaded mesoporous CS (MesoCS/curcumin) cements as a strategy to reduce the inflammatory reaction after implantation. The MesoCS/curcumin cements were designed and prepared. The characteristics of MesoCS/curcumin specimens were examined by transmission electron microscopy (TEM), X-ray diffraction (XRD) and scanning electron microscopy (SEM). Their physical properties, biocompatibility, and anti-inflammatory ability were also evaluated. The MesoCS/curcumin cements displayed excellent biocompatibility and physical properties. Their crystalline characterizations were very similar with MesoCS cements. After soaking in simulated body fluid, the bone-like apatite layer of the MesoCS/curcumin cements could be formed. In addition, it could inhibit the expression of tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1) after inflammation reaction induced by lipopolysaccharides and had good anti-inflammatory ability. Adding curcumin in MesoCS cements can reduce the inflammatory reaction, but does not affect the original biological activity and properties of MesoCS cements. It can provide a good strategy to inhibit the inflammatory reaction after implantation for bone tissue engineering and bone regenerative medicine. Copyright © 2017. Published by Elsevier B.V.

The mechanical and biological studies of calcium phosphate cement-fibrin glue for bone reconstruction of rabbit femoral defects

Directory of Open Access Journals (Sweden)

Dong J

2013-03-01

Full Text Available Jingjing Dong,1,* Geng Cui,2,* Long Bi,1,* Jie Li,3 Wei Lei11Institute of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China; 2Institute of Orthopedics, General Hospital of PLA, Beijing, People’s Republic of China; 3Institute of Gynecology and Obstetrics, General Hospital of PLA, Beijing, People’s Republic of China*These authors contributed equally to this workAbstract: In order to improve the mechanical and biological properties of calcium phosphate cement (CPC, nanometer-biomaterial for bone reconstruction in the rabbit femoral defect model, fibrin glue (FG, the natural product, purified from the blood was introduced at three different ratios. The CPC powder and the FG solution were mixed, respectively, at the powder/liquid (P/L ratios (g/mL of 1:1, 3:1, and 5:1 (g/mL, and pure CPC was used as a control. After being implanted into the femoral defect in rabbit, the healing process was evaluated by micro-computed tomography scan, biomechanical testing, and histological examination. By micro-computed tomography analysis, the P/L ratio of 1:1 (g/mL group indicated the largest quantity of new bone formation at 4 weeks, 8 weeks, and 12 weeks after implantation, respectively. Bone volume per trabecular volume of the 1:1 group was highest in the four groups, which was 1.45% ± 0.42%, 7.35% ± 1.45%, and 29.10% ± 1.67% at 4 weeks, 8 weeks, and 12 weeks after the operation, respectively. In the biomechanical tests, the compressive strength and the elastic modulus of the three CPC–FG groups were much higher than those of the pure CPC group at the determined time point (P < 0.05. The histological evaluation also showed the best osseointegration in the 1:1 group at 4 weeks, 8 weeks, and 12 weeks after the operation, respectively. In the 1:1 group, the bone grew into the pore of the cement in the laminar arrangement and connected with the cement tightly at the 12th week after the operation

A high concentration of recombinant human bone morphogenetic protein-2 induces low-efficacy bone regeneration in sinus augmentation: a histomorphometric analysis in rabbits.

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Hong, Ji-Youn; Kim, Min-Soo; Lim, Hyun-Chang; Lee, Jung-Seok; Choi, Seong-Ho; Jung, Ui-Won

2016-12-01

The aim of the study was to elucidate the efficacy of bone regeneration at the early stage of healing in rabbit sinuses grafted with a biphasic calcium phosphate (BCP) carrier soaked in a high concentration of recombinant human bone morphogenetic protein-2 (rhBMP-2). Both maxillary sinuses of eight male rabbits were used. The sinus on one side (assigned randomly) was grafted with BCP loaded with rhBMP-2 (1.5 mg/ml; test group) using a soaking method, while the other was grafted with saline-soaked BCP (control group). After a 2-week healing period, the sinuses were analyzed by micro-computed tomography and histomorphometry. The total augmented area and soft tissue space were significantly larger in the test group than in the control group, whereas the opposite was true for the area of residual material and newly formed bone. Most of the new bone in the test group was localized to the Schneiderian membrane (SM), while very little bone formation was observed in the window and center regions of the sinus. New bone was distributed evenly in the control group sinuses. Within the limitations of this study, it appeared that application of a high concentration of rhBMP-2 soaked onto a BCP carrier inhibited bone regeneration from the pristine bone and increased soft tissue swelling and inflammatory response at the early healing stage of sinus augmentation, although osteoinductive potential was found along the SM. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Micro-stereotactic frame utilizing bone cement for individual fabrication: an initial investigation of its accuracy

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Rau, Thomas S.; Lexow, G. Jakob; Blume, Denise; Kluge, Marcel; Lenarz, Thomas; Majdani, Omid

2017-03-01

A new method for template-guided cochlear implantation surgery is proposed which has been developed to create a minimally invasive access to the inner ear. A first design of the surgical template was drafted, built, and finally tested regarding its accuracy. For individual finalization of the micro-stereotactic frame bone cement is utilized as this well-known and well-established material suggests ease of use as well as high clinical acceptance and enables both sterile and rapid handling. The new concept includes an alignment device, based on a passive hexapod with manually adjustable legs for temporary fixation of the separate parts in the patient-specific pose until the bone cement is spread and finally cured. Additionally, a corresponding evaluation method was developed to determine the accuracy of the microstereotactic frame in some initial experiments. In total 18 samples of the surgical template were fabricated based on previously planned trajectories. The mean positioning error at the target point was 0.30 mm with a standard deviation of 0.25 mm.

Mechanical and thermal properties of castor oil polyurethane bone cement after gamma irradiation

International Nuclear Information System (INIS)

Azevedo, E.C.; Chierice, G.O.; Claro Neto, S.; Lepiesnki, C.M.; Nascimento, E.M.

2009-01-01

Polyurethanes from castor oil are being employed as bone cement in medical applications. In this work the thermal and mechanical properties of gamma irradiated polyurethanes derivative from castor oil were investigated by instrumented indentation, thermogravimetry and scanning electron microscopy. A slightly increase in hardness is observed only for doses as high as 100 kGy. Thermal analysis indicates stability at human body temperature. The glass transition temperature has small changes after gamma irradiation. (author)

Theoretical prediction and experimental determination of the effect of mold characteristics on temperature and monomer conversion fraction profiles during polymerization of a PMMA-based bone cement.

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Vallo, Claudia I

2002-01-01

The present work is concerned with applications of a kinetic model for free-radical polymerization of a polymethylmethacrylate-based bone cement. Autocatalytic behavior at the first part of the reaction as well as a diffusion control phenomenon near vitrification are described by the model. Comparison of theoretical computations with experimental measurements for the temperature evolution during batch casting demonstrated the capacity of the proposed model to represent the kinetic behavior of the polymerization reaction. Temperature evolution and monomer conversion were simulated for the cure of the cement in molds made of different materials. The maximum monomer conversion fraction was markedly influenced by the physical properties of the mold material. The unreacted monomer acts as a plasticizer that influences the mechanical behavior of the cement. Hence, the same cement formulation cured in molds of different materials may result in different mechanical response because of the differences in the amounts of residual monomer. Standardization of the mold type to prepare specimens for the mechanical characterization of bone cements is recommended. Theoretical prediction of temperature evolution during hip replacement indicated that for cement thickness lower than 6 mm the peak temperature at the bone-cement interface was below the limit stated for thermal injury (50 degrees C for more than 1 min). The use of thin cement layers is recommended to diminish the risk of thermal injury; however, it is accompanied by an increase in the amount of unreacted monomer present in the cured material. Copyright 2002 Wiley Periodicals, Inc. J Biomed Mater Res (Appl Biomater) 63: 627-642, 2002

Fatigue crack propagation of acrylic bone cements. Influence of the radio-opaque agents; Propagacion de grietas por fatiga de cementos oseos acrilicos. Influencia de los agentes radiopacos

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Ginebra, M. P.; Albuixech, L.; Fernandez-Barragan, E.; Gil, F. J.; Planell, J. A.; San Roman, J.; Vazquez, B.

2001-07-01

In this work the 2,5-diiodo-8-quinolyl methacrylate (IHQM), is proposed as a new radiopaque agent. The addition of the iodine containing methacrylate provided a statistically significant increase in the tensile strength, fracture toughness and ductility, with respect to the barium sulphate containing cement. This effect was attributed to the fact that the use of a radiopaque monomer eliminated the porosity associated to the barium sulphate particles. However, since fatigue resistance is one of the main properties required to ensure a good long-term performance of permanent pros these, as is the case of acrylic bone cements, it is important to compare the fatigue properties of this new bone cement formulation with the radiolucent and the BaSO{sub 4} containing bone cements. The results show that the absence of inorganic particles with no matrix adhesion plays a negative role when the fatigue crack propagation is considered. (Author) 26 refs.

Recombinant human bone morphogenetic protein 2 outcomes for maxillary sinus floor augmentation: a systematic review and meta-analysis.

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Lin, Guo-Hao; Lim, Glendale; Chan, Hsun-Liang; Giannobile, William V; Wang, Hom-Lay

2016-11-01

To study the effect of the recombinant human bone morphogenetic protein 2 (rhBMP-2) on sinus volumetric and histometric changes after sinus floor augmentation compared to a conventional approach of non-biologic bone grafting materials. An electronic search of 4 databases (January 1990-February 2015), including PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Central, and a hand search of peer-reviewed journals for relevant articles were performed. Human clinical trials with data on comparison of sinus volumetric and/or histometric outcomes with and without the use of rhBMP-2 in sinus grafting procedures, with ≥10 augmentation sites in each study group, and with a follow-up period of at least 6 months, were included. Random-effects meta-analyses were performed to analyze weighted mean difference (WMD) and confidence interval (CI) for the recorded variables according to PRISMA guidelines. Six randomized controlled trials (RCTs) were included. The results of the meta-analyses showed that the WMD of vertical bone height gain was -0.14 mm (95% CI = -1.91 to 1.62 mm, P = 0.87), the WMD of bone density was -142.42 mg/cm 3 (95% CI = -310.62-25.78 mg/cm 3 , P = 0.10), the WMD of the percentage of vital bone was -4.59% (95% CI = -11.73-2.56%, P = 0.21), and the WMD of the percentage of residual bone grafting materials was -9.90% (95% CI = -26.38-6.58%, P = 0.21). The comparison of implant survival rate presented an overall risk ratio of 1.00 (95% CI = 0.94-1.07). The two approaches (conventional bone grafting compared to BMPs) demonstrated comparable effectiveness for both clinical and histomorphometric measures. This systematic review revealed that the use of rhBMP-2 in maxillary sinus floor augmentation achieved similar clinical and histometric outcomes when compared to conventional sinus grafting procedures after a healing period of 6-9 months. However, previous studies showed the morbidity and other patient-reported outcomes were improved in

Onlay bone augmentation on mouse calvarial bone using a hydroxyapatite/collagen composite material with total blood or platelet-rich plasma.

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Ohba, Seigo; Sumita, Yoshinori; Umebayashi, Mayumi; Yoshimura, Hitoshi; Yoshida, Hisato; Matsuda, Shinpei; Kimura, Hideki; Asahina, Izumi; Sano, Kazuo

2016-01-01

The aim of this study was to assess newly formed onlay bone on mouse calvarial bone using a new artificial bone material, a hydroxyapatite/collagen composite, with total blood or platelet-rich plasma. The hydroxyapatite/collagen composite material with normal saline, total blood or platelet-rich plasma was transplanted on mouse calvarial bone. The mice were sacrificed and the specimens were harvested four weeks after surgery. The newly formed bone area was measured on hematoxylin and eosin stained specimens using Image J software. The hydroxyapatite/collagen composite materials with total blood or platelet-rich plasma induced a significantly greater amount of newly formed bone than that with normal saline. Moreover, bone marrow was observed four weeks after surgery in the transplanted materials with total blood or platelet-rich plasma but not with normal saline. However, there were no significant differences in the amount of newly formed bone between materials used with total blood versus platelet-rich plasma. The hydroxyapatite/collagen composite material was valid for onlay bone augmentation and this material should be soaked in total blood or platelet-rich plasma prior to transplantation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Tissue engineering for lateral ridge augmentation with recombinant human bone morphogenetic protein 2 combination therapy: a case report.

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Mandelaris, George A; Spagnoli, Daniel B; Rosenfeld, Alan L; McKee, James; Lu, Mei

2015-01-01

This case report describes a tissue-engineered reconstruction with recombinant human bone morphogenetic protein 2/acellular collagen sponge (rhBMP-2/ ACS) + cancellous allograft and space maintenance via Medpor Contain mesh in the treatment of a patient requiring maxillary and mandibular horizontal ridge augmentation to enable implant placement. The patient underwent a previously unsuccessful corticocancellous bone graft at these sites. Multiple and contiguous sites in the maxilla and in the mandibular anterior, demonstrating advanced lateral ridge deficiencies, were managed using a tissue engineering approach as an alternative to autogenous bone harvesting. Four maxillary and three mandibular implants were placed 9 and 10 months, respectively, after tissue engineering reconstruction, and all were functioning successfully after 24 months of follow-up. Histomorphometric analysis of a bone core obtained at the time of the maxillary implant placement demonstrated a mean of 76.1% new vital bone formation, 22.2% marrow/cells, and 1.7% residual graft tissue. Tissue engineering for lateral ridge augmentation with combination therapy requires further research to determine predictability and limitations.

Synthesis and evaluation of bone cement with different concentrations of brushite; Sintese e avaliacao de cimento osseo com diferentes concentracoes de brushita

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Morua, O.C.; Cardoso, M.J.B.; Farias, K.A.S.; Barbero, M.A.R.; Carrodeguas, R.G.; Fook, M.V.L., E-mail: cumberbatch.otto@gmail.com [Universidade Federal de Campina Grande (UFCG), PB (Brazil). Dept. de Ciencias e Engenharia de Materiais; Laboratorio de Desenvolvimento e Avaliacao de Biomateriais (CERTBIO/UFCG), PB (Brazil); Instituto de Ceramica y Vidrio (CSIC), Madrid (Spain); AzureBio SL, Tres Cantos, Madrid (Spain)

2017-10-01

The objective of this study was to chemically synthesize brushite bone cement in different compositions and to evaluate the microstructural formation, crystalline phases present and the influence of the compositions and amount of water on the mechanical property of compression resistance. Characterized by X-ray diffraction, Raman spectroscopy, scanning electron microscopy and mechanical properties. The XRD results confirmed the presence of the brushite and wollastonite phases. In the SEM it was verified the presence of particle agglomerates of each phase and a reduction of the particle sizes. In mechanical properties, it was observed that the amount of water influenced both the porosity and the compressive strength of the compositions. It was concluded that the synthesized brushite bone cement presented the expected crystalline phases and morphology, both the compositions and the amount of water influenced the mechanical properties of the developed cement. (author)

Wollastonite nanofiber–doped self-setting calcium phosphate bioactive cement for bone tissue regeneration

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Guo H

2012-07-01

incorporation of WNFs into CPC improved the biological properties for wnf-CPC. Following the implantation of wnf-CPC into bone defects of rabbits, histological evaluation showed that wnf-CPC enhanced the efficiency of new bone formation in comparison with CPC, indicating excellent biocompatibility and osteogenesis of wnf-CPC. In conclusion, wnf-CPC exhibited promising prospects in bone regeneration.Keywords: calcium phosphate cement, degradability, cell and tissue responses, biocompatibility

Temperature Measurement During Polymerization of Bone Cement in Percutaneous Vertebroplasty: An In Vivo Study in Humans

International Nuclear Information System (INIS)

Anselmetti, Giovanni Carlo; Manca, Antonio; Kanika, Khanna; Murphy, Kieran; Eminefendic, Haris; Masala, Salvatore; Regge, Daniele

2009-01-01

Aim of the study was to 'in vivo' measure temperature, during percutaneous vertebroplasty (PV), within a vertebral body injected with different bone cements. According to the declaration of Helsinki, 22 women (60-80 years; mean, 75 years) with painful osteoporotic vertebral collapse underwent bilateral transpedicular PV on 22 lumbar vertebrae. Two 10-G vertebroplasty needles were introduced into the vertebra under digital fluoroscopy; a 16-G radiofrequency thermoablation needle (Starburst XL; RITA Medical System Inc., USA), carrying five thermocouples, was than coaxially inserted. Eleven different bone cements were injected and temperatures were measured every 30 s until temperatures dropped under 45 o C. After the thermocouple needle was withdrawn, bilateral PV was completed with cement injection through the vertebroplasty needle. Unpaired Student's t-tests, Kruskal-Wallis test, and Wilcoxon signed rank test were used to evaluate significant differences (p o C), B (from 50 o to 60 o C), and C (below 50 o C). Peak temperature in Group A (86.7 ± 10.7 o C) was significantly higher (p = 0.0172) than that in Groups B (60.5 ± 3.7 o C) and C (44.8 ± 2.6 o C). The average of all thermocouples showed an extremely significant difference (p = 0.0002) between groups. None of the tested cements maintained a temperature ≥45 o C for more than 30 min. These data suggest that back-pain improvement is obtained not by thermal necrosis but by mechanical consolidation only. The relative necrotic thermal effect in vertebral metastases seems to confirm that analgesia must be considered the main intent of PV.

Utility of cement injection to stabilize split-depression tibial plateau fracture by minimally invasive methods: A finite element analysis.

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Belaid, D; Vendeuvre, T; Bouchoucha, A; Brémand, F; Brèque, C; Rigoard, P; Germaneau, A

2018-05-08

Treatment for fractures of the tibial plateau is in most cases carried out by stable fixation in order to allow early mobilization. Minimally invasive technologies such as tibioplasty or stabilization by locking plate, bone augmentation and cement filling (CF) have recently been used to treat this type of fracture. The aim of this paper was to determine the mechanical behavior of the tibial plateau by numerically modeling and by quantifying the mechanical effects on the tibia mechanical properties from injury healing. A personalized Finite Element (FE) model of the tibial plateau from a clinical case has been developed to analyze stress distribution in the tibial plateau stabilized by balloon osteoplasty and to determine the influence of the cement injected. Stress analysis was performed for different stages after surgery. Just after surgery, the maximum von Mises stresses obtained for the fractured tibia treated with and without CF were 134.9 MPa and 289.9 MPa respectively on the plate. Stress distribution showed an increase of values in the trabecular bone in the treated model with locking plate and CF and stress reduction in the cortical bone in the model treated with locking plate only. The computed results of stresses or displacements of the fractured models show that the cement filling of the tibial depression fracture may increase implant stability, and decrease the loss of depression reduction, while the presence of the cement in the healed model renders the load distribution uniform. Copyright © 2018 Elsevier Ltd. All rights reserved.

Efficacy of different bone volume expanders for augmenting lumbar fusions.

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Epstein, Nancy E

2008-01-01

A wide variety of bone volume expanders are being used in performing posterolateral lumbar noninstrumented and instrumented lumbar fusions. This article presents a review of their efficacy based on fusion rates, complications, and outcomes. Lumbar noninstrumented and instrumented fusions frequently use laminar autografts and different bone graft expanders. This review presents the utility of multiple forms/ratios of DBMs containing allografts. It also discusses the efficacy of artificial bone graft substitutes, including HA and B-TCP. Dynamic x-ray and/or CT examinations were used to document fusion in most series. Outcomes were variously assessed using Odom's criteria or different outcome questionnaires (Oswestry Questionnaire, SF-36, Dallas Pain Questionnaire, and/or Low Back Pain Rating Scale). Performing noninstrumented and instrumented lumbar posterolateral fusions resulted in comparable fusion rates in many series. Similar outcomes were also documented based on Odom's criteria or the multiple patient-based questionnaires. However, in some studies, the addition of spinal instrumentation increased the reoperation rate, operative time, blood loss, and cost. Various forms of DBMs, applied in different ratios to autografts, effectively supplemented spinal fusions in animal models and patient series. beta-Tricalcium phosphate, which is used to augment autograft fusions addressing idiopathic scoliosis or lumbar disease, also proved to be effective. Different types of bone volume expanders, including various forms of allograft-based DBMs, and artificial bone graft substitutes (HA and B-TCP) effectively promote posterolateral lumbar noninstrumented and instrumented fusions when added to autografts.

The combination of ultrasound with antibiotics released from bone cement decreases the viability of planktonic and biofilm bacteria : an in vitro study with clinical strains

NARCIS (Netherlands)

Ensing, Geert T.; Neut, Danielle; Horn, Jim R. van; van der Mei, Henny C.; Busscher, Henk J.

2006-01-01

Objectives: Antibiotic-loaded bone cements are used for the permanent fixation of joint prostheses. Antibiotic-loaded cements significantly decrease the incidence of infection. The objective of this study was to investigate whether the viability of bacteria derived from patients with a

Improved workability of injectable calcium sulfate bone cement by regulation of self-setting properties

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Chen, Zonggang, E-mail: chenzg@sdu.edu.cn [National Glycoengineering Research Center, Shandong University, Jinan 250100 (China); Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China); Liu, Huanye [Department of Orthodontics, School of Stomatology, China Medical University, Shenyang 110001 (China); Liu, Xi [Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China); Lian, Xiaojie [College of Mechanics, Taiyuan University of Technology, Taiyuan 030024 (China); Guo, Zhongwu [National Glycoengineering Research Center, Shandong University, Jinan 250100 (China); Jiang, Hong-Jiang [Wendeng Hospital of Traditional Chinese Orthopedics and Traumatology, Shandong 264400 (China); Cui, Fu-Zhai, E-mail: cuifz@mail.tsinghua.edu.cn [Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China)

2013-04-01

Calcium sulfate hemihydrate (CSH) powder as an injectable bone cement was prepared by hydrothermal synthesis of calcium sulfate dihydrate (CSD). The prepared materials showed X-ray diffraction peaks corresponding to the CSH structure without any secondary phases, implying complete conversion from CSD phase to CSH phase. Thermogravimetric (TG) analyses showed the crystal water content of CSH was about 6.0% (wt.), which is near to the theoretic crystal water value of CSH. From scanning electron microscopy (SEM) micrographs, sheet crystal structure of CSD was observed to transform into rod-like crystal structure of CSH. Most interesting and important of all, CSD as setting accelerator was also introduced into CSH powder to regulate self-setting properties of injectable CSH paste, and thus the self-setting time of CSH paste can be regulated from near 30 min to less than 5 min by adding various amounts of setting accelerator. Because CSD is not only the reactant of preparing CSH but also the final solidified product of CSH, the setting accelerator has no significant effect on the other properties of materials, such as mechanical properties. In vitro biocompatibility and in vivo histology studies have demonstrated that the materials have good biocompatibility and good efficacy in bone regeneration. All these will further improve the workability of CSH in clinic applications. Highlights: ► Calcium sulfate hemihydrate (CSH) can be an injectable bone cement. ► CSH was produced by hydrothermal synthesis of calcium sulfate dihydrate (CSD). ► CSD was introduced into CSH powder to regulate self-setting properties of CSH. ► Setting accelerator has no significant effect on the other properties of materials. ► Injectable CSH has good biocompatibility and good efficacy in bone regeneration.

Improved workability of injectable calcium sulfate bone cement by regulation of self-setting properties

International Nuclear Information System (INIS)

Chen, Zonggang; Liu, Huanye; Liu, Xi; Lian, Xiaojie; Guo, Zhongwu; Jiang, Hong-Jiang; Cui, Fu-Zhai

2013-01-01

Calcium sulfate hemihydrate (CSH) powder as an injectable bone cement was prepared by hydrothermal synthesis of calcium sulfate dihydrate (CSD). The prepared materials showed X-ray diffraction peaks corresponding to the CSH structure without any secondary phases, implying complete conversion from CSD phase to CSH phase. Thermogravimetric (TG) analyses showed the crystal water content of CSH was about 6.0% (wt.), which is near to the theoretic crystal water value of CSH. From scanning electron microscopy (SEM) micrographs, sheet crystal structure of CSD was observed to transform into rod-like crystal structure of CSH. Most interesting and important of all, CSD as setting accelerator was also introduced into CSH powder to regulate self-setting properties of injectable CSH paste, and thus the self-setting time of CSH paste can be regulated from near 30 min to less than 5 min by adding various amounts of setting accelerator. Because CSD is not only the reactant of preparing CSH but also the final solidified product of CSH, the setting accelerator has no significant effect on the other properties of materials, such as mechanical properties. In vitro biocompatibility and in vivo histology studies have demonstrated that the materials have good biocompatibility and good efficacy in bone regeneration. All these will further improve the workability of CSH in clinic applications. Highlights: ► Calcium sulfate hemihydrate (CSH) can be an injectable bone cement. ► CSH was produced by hydrothermal synthesis of calcium sulfate dihydrate (CSD). ► CSD was introduced into CSH powder to regulate self-setting properties of CSH. ► Setting accelerator has no significant effect on the other properties of materials. ► Injectable CSH has good biocompatibility and good efficacy in bone regeneration

Guided bone augmentation using ceramic space-maintaining devices: the impact of chemistry

Directory of Open Access Journals (Sweden)

Anderud J

2015-03-01

Full Text Available Jonas Anderud,1,2 Peter Abrahamsson,2 Ryo Jimbo,1 Sten Isaksson,2 Erik Adolfsson,3 Johan Malmström,2 Yoshihito Naito,4 Ann Wennerberg1 1Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; 2Maxillofacial Unit Halmstad, Region Halland, Halmstad, Sweden; 3Swedish Ceramic Institute, IVF, Mölndal, Sweden; 4Department of Oral and Maxillofacial Prosthodontics and Oral Implantology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan Abstract: The purpose of the study was to evaluate histologically, whether vertical bone augmentation can be achieved using a hollow ceramic space maintaining device in a rabbit calvaria model. Furthermore, the chemistry of microporous hydroxyapatite and zirconia were tested to determine which of these two ceramics are most suitable for guided bone generation. 24 hollow domes in two different ceramic materials were placed subperiosteal on rabbit skull bone. The rabbits were sacrificed after 12 weeks and the histology results were analyzed regarding bone-to-material contact and volume of newly formed bone. The results suggest that the effect of the microporous structure of hydroxyapatite seems to facilitate for the bone cells to adhere to the material and that zirconia enhance a slightly larger volume of newly formed bone. In conclusion, the results of the current study demonstrated that ceramic space maintaining devices permits new bone formation and osteoconduction within the dome. Keywords: hydroxyapatite, zirconia, guided bone regeneration, GBR, histology, membrane

Graphene oxide versus graphene for optimisation of PMMA bone cement for orthopaedic applications.

Science.gov (United States)

Paz, E; Forriol, F; Del Real, J C; Dunne, N

2017-08-01

Graphene (G) and graphene oxide (GO) nano-sized powders with loadings ranging from 0.1 to 1.0wt% were investigated as reinforced agents for polymethyl methacrylate (PMMA) bone cements. The mechanical properties (i.e. bend strength, bend modulus, compression strength, fracture toughness and fatigue performance) and the thermal properties (i.e. maximum temperature, setting time, curing heat and residual monomer) of the resultant nanocomposites were characterised. The mechanical performance of G-PMMA and GO-PMMA bone cements has been improved at low loadings (≤0.25wt%), especially the fracture toughness and fatigue performance. These improvements were attributed to the fact that the G and GO induced deviations in the crack fronts and hampered crack propagation. The high functionalisation of GO compared with G resulted in greater enhancements because it facilitated the creation of a stronger interfacial adhesion between the GO and PMMA. The use of loadings ≥0.25wt% showed a detriment in the mechanical performance as consequence of the formation of agglomerates as well as to an increase in the porosity. The increase in the residual monomer and the decrease in the curing heat, observed with the increase in the level of G and GO added, suggests that such materials retard and inhibit the curing reaction at high levels of loading by interfering in the radical reaction. Copyright © 2017 Elsevier B.V. All rights reserved.

Periodontal Therapy in Dogs Using Bone Augmentation Products Marketed for Veterinary Use.

Science.gov (United States)

Angel, Molly

Periodontal disease is extremely common in companion animal practice. Patients presenting for a routine oral examination and prophylaxis may be found to have extensive periodontal disease and attachment loss. Vertical bone loss is a known sequela to periodontal disease and commonly involves the distal root of the mandibular first molar. This case report outlines two dogs presenting for oral examination and prophylaxis with general anesthesia. Both patients did not have any clinical symptoms of periodontal disease other than halitosis. Both patients were diagnosed with three-walled vertical bone loss defects of one or both mandibular first molars utilizing dental radiography as well as periodontal probing, measuring, and direct visual inspection. These defects were consistent with periodontal disease index stage 4 (>50% attachment loss). The lesions were treated with appropriate root planing and debridement. Bone augmentation products readily available and marketed for veterinary use were then utilized to fill the defects to promote both the re-establishment of normal alveolar bone height and periodontal ligament reattachment to the treated surface. Follow-up assessment and owner dedication is critical to treatment outcome. Both patients' 6 mo follow-up examinations radiographically indicated bone repair and replacement with visible periodontal ligament space.

Development of a 3-D x-ray micro-tomography system and its application to trabecular bone/cement interface

International Nuclear Information System (INIS)

Chi, Yong Ki; Cho, Gyuseong

2004-01-01

In recent years, the interface analysis of micro-structure based objects is an important research in osteoporosis, vascular imaging since a 3-D X-ray micro-tomography system was developed. However, the micro-tomographic image shows the white-out appearance in case of imaging of similar density objects with low energy X-ray. Therefore these images must be analyzed about the interface between microstructure based objects for its application to biomechanical study. Many published studies suggested approximately assumed model of interface and predicted mechanical failure by means of Finite Element Method (FEM) but these FEM analysis has not used for modeling the real structure and interface between objects such as roughness, voids and pores of objects. We developed micro-tomography system and suggest the application of micro-tomographic image for predicting mechanical failure at the interface. The micro-tomography system consists of a 5 μm micro-focus X-ray tube, a CMOS-based image sensor and a rotating sample holder controlled by a precision motor. CMOS image sensor has 62x62 mm 2 sensing area and uses optical lenses system for increasing resolution. The sample which was manufactured by implanting cement in a pig hip bone was used and its fracture is considered to be an important cause of loosening of hip joint replacement in orthopedic implants. A Feldkamp's cone-beam reconstruction algorithm on the equispatial detector case was used for bone/cement 3D volume data and the analysis of a trabecular bone/cement interface containing white-out appearance was performed by using multiple criterion segmentation of region and volume. Finally, the segmented data can be used for fracture prediction of FEM by determining node of hexahedron meshing. In this paper, we present development of a 3-D cone beam micro-tomographic system with CMOS image sensor and its application to a complex structure of a trabecular bone and implanted cement for predicting the failure mechanism of

Bone regeneration in experimental animals using calcium phosphate cement combined with platelet growth factors and human growth hormone.

Science.gov (United States)

Emilov-Velev, K; Clemente-de-Arriba, C; Alobera-García, M Á; Moreno-Sansalvador, E M; Campo-Loarte, J

2015-01-01

Many substances (growth factors and hormones) have osteoinduction properties and when added to some osteoconduction biomaterial they accelerate bone neoformation properties. The materials included 15 New Zealand rabbits, calcium phosphate cement (Calcibon(®)), human growth hormone (GH), and plasma rich in platelets (PRP). Each animal was operated on in both proximal tibias and a critical size bone defect of 6mm of diameter was made. The animals were separated into the following study groups: Control (regeneration only by Calcibon®), PRP (regeneration by Calcibon® and PRP), GH (regeneration by Calcibon® and GH). All the animals were sacrificed at 28 days. An evaluation was made of the appearance of the proximal extreme of rabbit tibiae in all the animals, and to check the filling of the critical size defect. A histological assessment was made of the tissue response, the presence of new bone formation, and the appearance of the biomaterial. Morphometry was performed using the MIP 45 image analyser. ANOVA statistical analysis was performed using the Statgraphics software application. The macroscopic appearance of the critical defect was better in the PRP and the GH group than in the control group. Histologically greater new bone formation was found in the PRP and GH groups. No statistically significant differences were detected in the morphometric study between bone formation observed in the PRP group and the control group. Significant differences in increased bone formation were found in the GH group (p=0.03) compared to the other two groups. GH facilitates bone regeneration in critical defects filled with calcium phosphate cement in the time period studied in New Zealand rabbits. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

A small punch test technique for characterizing the elastic modulus and fracture behavior of PMMA bone cement used in total joint replacement.

Science.gov (United States)

Giddings, V L; Kurtz, S M; Jewett, C W; Foulds, J R; Edidin, A A

2001-07-01

Polymethylmethacrylate (PMMA) bone cement is used in total joint replacements to anchor implants to the underlying bone. Establishing and maintaining the integrity of bone cement is thus of critical importance to the long-term outcome of joint replacement surgery. The goal of the present study was to evaluate the suitability of a novel testing technique, the small punch or miniaturized disk bend test, to characterize the elastic modulus and fracture behavior of PMMA. We investigated the hypothesis that the crack initiation behavior of PMMA during the small punch test was sensitive to the test temperature. Miniature disk-shaped specimens, 0.5 mm thick and 6.4 mm in diameter, were prepared from PMMA and Simplex-P bone cement according to manufacturers' instructions. Testing was conducted at ambient and body temperatures, and the effect of test temperature on the elastic modulus and fracture behavior was statistically evaluated using analysis of variance. For both PMMA materials, the test temperature had a significant effect on elastic modulus and crack initiation behavior. At body temperature, the specimens exhibited "ductile" crack initiation, whereas at room temperature "brittle" crack initiation was observed. The small punch test was found to be a sensitive and repeatable test method for evaluating the mechanical behavior of PMMA. In light of the results of this study, future small punch testing should be conducted at body temperature.

Composite bone cements loaded with a bioactive and ferrimagnetic glass-ceramic: Leaching, bioactivity and cytocompatibility.

Science.gov (United States)

Verné, Enrica; Bruno, Matteo; Miola, Marta; Maina, Giovanni; Bianco, Carlotta; Cochis, Andrea; Rimondini, Lia

2015-08-01

In this work, composite bone cements, based on a commercial polymethylmethacrylate matrix (Palamed®) loaded with ferrimagnetic bioactive glass-ceramic particles (SC45), were produced and characterized in vitro. The ferrimagnetic bioactive glass-ceramic belongs to the system SiO2-Na2O-CaO-P2O5-FeO-Fe2O3 and contains magnetite (Fe3O4) crystals into a residual amorphous bioactive phase. Three different formulations (containing 10, 15 and 20 wt.% of glass-ceramic particles respectively) have been investigated. These materials are intended to be applied as bone fillers for the hyperthermic treatment of bone tumors. The morphological, compositional, calorimetric and mechanical properties of each formulation have been already discussed in a previous paper. The in vitro properties of the composite bone cements described in the present paper are related to iron ion leaching test (by graphite furnace atomic absorption spectrometer), bioactivity (i.e. the ability to stimulate the formation of a hydroxyapatite - HAp - layer on their surface after soaking in simulated body fluid SBF) and cytocompatibility toward human osteosarcoma cells (ATCC CRL-1427, Mg63). Morphological and chemical characterizations by scanning electron microscopy and energy dispersion spectrometry have been performed on the composite samples after each test. The iron release was negligible and all the tested samples showed the growth of HAp on their surface after 28 days of immersion in a simulated body fluid (SBF). Cells showed good viability, morphology, adhesion, density and the ability to develop bridge-like structures on all investigated samples. A synergistic effect between bioactivity and cell mineralization was also evidenced. Copyright © 2015 Elsevier B.V. All rights reserved.

Effects of Recombinant Human Bone Morphogenetic Protein-2 on Vertical Bone Augmentation in a Canine Model.

Science.gov (United States)

Hsu, Yung-Ting; Al-Hezaimi, Khalid; Galindo-Moreno, Pablo; O'Valle, Francisco; Al-Rasheed, Abdulaziz; Wang, Hom-Lay

2017-09-01

Vertical bone augmentation (VBA) remains unpredictable and challenging for most clinicians. This study aims to compare hard tissue outcomes of VBA, with and without recombinant human bone morphogenetic protein (rhBMP)-2, under space-making titanium mesh in a canine model. Eleven male beagle dogs were used in the study. Experimental ridge defects were created to form atrophic ridges. VBA was performed via guided bone regeneration using titanium mesh and allografts. In experimental hemimandibles, rhBMP-2/absorbable collagen sponge was well mixed with allografts prior to procedures, whereas a control buffer was applied within controls. Dogs were euthanized after a 4-month healing period. Clinical and radiographic examinations were performed to assess ridge dimensional changes. In addition, specimens were used for microcomputed tomography (micro-CT) assessment and histologic analysis. Membrane exposure was found on five of 11 (45.5%) rhBMP-2-treated sites, whereas it was found on nine of 11 (81.8%) non-rhBMP-2-treated sites. Within 4 months of healing, rhBMP-2-treated sites showed better radiographic bone density, greater defect fill, and significantly more bone gain in ridge height (P 0.05). Under light microscope, predominant lamellar patterns were found in the specimen obtained from rhBMP-2 sites. With inherent limitations of the canine model and the concern of such a demanding surgical technique, current findings suggest that the presence of rhBMP-2 in a composite graft allows an increase of vertical gain, with formation of ectopic bone over the titanium mesh in comparison with non-rhBMP-2 sites.

Parathyroid Hormone (1-34 Might Not Improve Early Bone Healing after Sinus Augmentation in Healthy Rabbits

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Jisun Huh

2017-01-01

Full Text Available Purpose. This study evaluated the effect of administering intermittent parathyroid hormone [PTH (1-34, henceforth PTH] on the early-stage bone healing of maxillary sinus augmentation in healthy rabbits. Materials and Methods. Bovine bone mineral was grafted on the sinuses of 20 female New Zealand white rabbits. The animals were randomly divided into two groups, PTH (n=10 or saline (n=10, in which either PTH or saline was injected subcutaneously 5 days a week for 2 weeks. Half of the animals in each group were killed at 2 weeks postoperatively and the other half were killed at 4 weeks postoperatively. The dosage of PTH was 10 μg/kg/day. Radiographic and histomorphometric analyses were performed. Result. The new bone area (NBA did not differ significantly between the PTH and saline groups. The NBA in the PTH group in the total augmented area and in the demarcated window, center, and Schneiderian membrane regions increased significantly from 2 to 4 weeks. The number of osteoclasts decreased significantly from 2 to 4 weeks in both groups, with no difference between the two groups. Conclusion. Intermittent PTH might not stimulate new bone formation in healthy rabbits during the first 4 weeks of healing.

Predictive value of ridge dimensions on autologous bone graft resorption in staged maxillary sinus augmentation surgery using Cone-Beam CT.

NARCIS (Netherlands)

Klijn, R.J.; Beucken, J.J.J.P van den; Bronkhorst, E.M.; Berge, S.J.; Meijer, G.J.; Jansen, J.B.M.J.

2012-01-01

INTRODUCTION: No studies are available that provide predictive parameters regarding the expected amount of resorption after maxillary sinus augmentation surgery using autologous bone grafts. Therefore, the aim of this study was to determine parameters influencing the outcome of the bone graft

Bone formation in mono cortical mandibular critical size defects after augmentation with two synthetic nanostructured and one xenogenous hydroxyapatite bone substitute - in vivo animal study.

Science.gov (United States)

Dau, Michael; Kämmerer, Peer W; Henkel, Kai-Olaf; Gerber, Thomas; Frerich, Bernhard; Gundlach, Karsten K H

2016-05-01

Healing characteristics as well as level of tissue integration and degradation of two different nanostructured hydroxyapatite bone substitute materials (BSM) in comparison with a deproteinized hydroxyapatite bovine BSM were evaluated in an in vivo animal experiment. In the posterior mandible of 18 minipigs, bilateral mono cortical critical size bone defects were created. Randomized augmentation procedures with NanoBone(®) (NHA1), Ostim(®) (NHA2) or Bio-Oss(®) (DBBM) were conducted (each material n = 12). Samples were analyzed after five (each material n = 6) and 8 months (each material n = 6). Defect healing, formation of soft tissue and bone as well as the amount of remaining respective BSM were quantified both macro- and microscopically. For NHA2, the residual bone defect after 5 weeks was significantly less compared to NHA1 or DBBM. There was no difference in residual BSM between NHA1 and DBBM, but the amount in NHA2 was significantly lower. NHA2 also showed the least amount of soft tissue and the highest amount of new bone after 5 weeks. Eight months after implantation, no significant differences in the amount of residual bone defects, in soft tissue or in bone formation were detected between the groups. Again, NHA2 showed significant less residual material than NHA1 and DBBM. We observed non-significant differences in the biological hard tissue response of NHA1 and DBBM. The water-soluble NHA2 initially induced an increased amount of new bone but was highly compressed which may have a negative effect in less stable augmentations of the jaw. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Evaluation of a setting reaction pathway in the novel composite TiHA-CSD bone cement by FT-Raman and FT-IR spectroscopy

Science.gov (United States)

Paluszkiewicz, Czesława; Czechowska, Joanna; Ślósarczyk, Anna; Paszkiewicz, Zofia

2013-02-01

The aim of this study was to determine a setting reaction pathway in a novel, surgically handy implant material, based on calcium sulfate hemihydrate (CSH) and titanium doped hydroxyapatite (TiHA). The previous studies confirmed superior biological properties of TiHA in comparison to the undoped hydroxyapatite (HA) what makes it highly attractive for future medical applications. In this study the three types of titanium modified HA powders: untreated, calcined at 800 °C, sintered at 1250 °C and CSH were used to produce bone cements. The Fourier Transform-InfraRed (FT-IR) spectroscopy and Raman spectroscopy were applied to evaluate processes taking place during the setting of the studied materials. Our results undoubtedly confirmed that the reaction pathways and the phase compositions differed significantly for set cements and were dependent on the initial heat treatment of TiHA powder. Final materials were multiphase composites consisting of calcium sulfate dihydrate, bassanite, tricalcium phosphate, hydroxyapatite and calcium titanate (perovskite). The FT-IR and Scanning Electron Microscopy (SEM) measurements performed after the incubation of the cement samples in the simulated body fluid (SBF), indicate on high bioactive potential of the obtained bone cements.

Brittle and ductile adjustable cement derived from calcium phosphate cement/polyacrylic acid composites.

Science.gov (United States)

Chen, Wen-Cheng; Ju, Chien-Ping; Wang, Jen-Chyan; Hung, Chun-Cheng; Chern Lin, Jiin-Huey

2008-12-01

Bone filler has been used over the years in dental and biomedical applications. The present work is to characterize a non-dispersive, fast setting, modulus adjustable, high bioresorbable composite bone cement derived from calcium phosphate-based cement combined with polymer and binding agents. This cement, we hope, will not swell in simulated body fluid and keep the osteogenetic properties of the dry bone and avoid its disadvantages of being brittle. We developed a calcium phosphate cement (CPC) of tetracalcium phosphate/dicalcium phosphate anhydrous (TTCP/DCPA)-polyacrylic acid with tartaric acid, calcium fluoride additives and phosphate hardening solution. The results show that while composite, the hard-brittle properties of 25wt% polyacrylic acid are proportional to CPC and mixing with additives is the same as those of the CPC without polyacrylic acid added. With an increase of polyacrylic acid/CPC ratio, the 67wt% samples revealed ductile-tough properties and 100wt% samples kept ductile or elastic properties after 24h of immersion. The modulus range of this development was from 200 to 2600MPa after getting immersed in simulated body fluid for 24h. The TTCP/DCPA-polyacrylic acid based CPC demonstrates adjustable brittle/ductile strength during setting and after immersion, and the final reaction products consist of high bioresorbable monetite/brushite/calcium fluoride composite with polyacrylic acid.

[The relationship between angle of puncture and distribution of bone cement of unilateral percutaneous kyphoplasty for the treatment of thoracolumbar compression fractures].

Science.gov (United States)

Wang, Xiang-fu; Fan, You-fu; Shi, Rui-fang; Deng, Qiang; Li, Zhong-feng

2015-08-01

To explore the relationship of bone cement distribution and the puncture angle in the treatment of thoracolumbar compression fractures with unilateral percutaneous kyphoplasty (PKP). The clinical data of 37 patients with thoracolumbar osteoporotic compression fractures underwent PKP between January 2013 to March 2014 were retrospectively analyzed, all punctures were performed unilaterally. There were 6 males, aged from 65 to 78 years old with an average of (71.83 ± 6.15) years; and 31 females, aged from 57 to 89 years old with an average of (71.06 ± 7.89) years. Imaging data were analyzed and puncture angle and puncture point were measured before operation. According to the measured data, the puncture were performeds during the operation. Distribution area of bone cement were calculated by X-rays data after operation. The effect of bone cement distribution on suitable puncture angle was analyzed; VAS score was used to evaluate the clinical effects. The puncture angle of thoracic vertebrae in T8-T12 was from 28° to 33° with an average 30.4°; and the puncture angle of lumbar vertebrae in L1-L5 was from 28° to 35° with an average of 31.3°. Postoperative X-rays showed the area ratios of bilateral bone cement was 0.97 ± 0.15. Bilateral diffuse area were basic equal. Postoperative VAS score decreased significantly (1.89 ± 1.29 vs 7.03 ± 1.42). Through measure imaging data before operation with PKP,the puncture point and entry point can be confirmed. According the measured data to puncture during operation, unilateral puncture can reach the distribution effect of the bilateral puncture in the treatment of thoracolumbar compression fractures.

Development of multi-walled carbon nanotubes reinforced monetite bionanocomposite cements for orthopedic applications

International Nuclear Information System (INIS)

Boroujeni, Nariman Mansoori; Zhou, Huan; Luchini, Timothy J.F.; Bhaduri, Sarit B.

2013-01-01

In this study, we present results of our research on biodegradable monetite (DCPA, CaHPO 4 ) cement with surface-modified multi-walled carbon nanotubes (mMWCNTs) as potential bone defect repair material. The cement pastes showed desirable handling properties and possessed a suitable setting time for use in surgical setting. The incorporation of mMWCNTs shortened the setting time of DCPA and increased the compressive strength of DCPA cement from 11.09 ± 1.85 MPa to 21.56 ± 2.47 MPa. The cytocompatibility of the materials was investigated in vitro using the preosteoblast cell line MC3T3-E1. An increase of cell numbers was observed on both DCPA and DCPA-mMWCNTs. Scanning electron microscopy (SEM) results also revealed an obvious cell growth on the surface of the cements. Based on these results, DCPA-mMWCNTs composite cements can be considered as potential bone defect repair materials. - Highlights: • A monetite bone cement for orthopedic applications is reported. • Incorporation of MWCNTs into monetite bone cement is discussed. • Surface functionalized MWCNTs can improve the mechanical strength of monetite cement. • MWCNTs have no impacts on the cytocompatibility of monetite cements

Development of multi-walled carbon nanotubes reinforced monetite bionanocomposite cements for orthopedic applications

Energy Technology Data Exchange (ETDEWEB)

Boroujeni, Nariman Mansoori [Department of Mechanical, Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH (United States); Zhou, Huan, E-mail: Huan.Zhou@Rockets.utoledo.edu [Department of Mechanical, Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH (United States); Luchini, Timothy J.F. [Department of Mechanical, Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH (United States); Bhaduri, Sarit B. [Department of Mechanical, Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH (United States); Division of Dentistry, The University of Toledo, Toledo, OH (United States)

2013-10-15

In this study, we present results of our research on biodegradable monetite (DCPA, CaHPO{sub 4}) cement with surface-modified multi-walled carbon nanotubes (mMWCNTs) as potential bone defect repair material. The cement pastes showed desirable handling properties and possessed a suitable setting time for use in surgical setting. The incorporation of mMWCNTs shortened the setting time of DCPA and increased the compressive strength of DCPA cement from 11.09 ± 1.85 MPa to 21.56 ± 2.47 MPa. The cytocompatibility of the materials was investigated in vitro using the preosteoblast cell line MC3T3-E1. An increase of cell numbers was observed on both DCPA and DCPA-mMWCNTs. Scanning electron microscopy (SEM) results also revealed an obvious cell growth on the surface of the cements. Based on these results, DCPA-mMWCNTs composite cements can be considered as potential bone defect repair materials. - Highlights: • A monetite bone cement for orthopedic applications is reported. • Incorporation of MWCNTs into monetite bone cement is discussed. • Surface functionalized MWCNTs can improve the mechanical strength of monetite cement. • MWCNTs have no impacts on the cytocompatibility of monetite cements.

A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: A double-blinded randomized placebo-controlled 1-year intervention

DEFF Research Database (Denmark)

Viljakainen, H.T.; Natri, A.M.; Karkkainen, M.

2006-01-01

The effect of vitamin D supplementation on bone mineral augmentation in 212 adolescent girls with adequate calcium intake was studied in a randomized placebo-controlled setting. Bone mineral augmentation determined by DXA increased with supplementation both in the femur and the lumbar vertebrae i...

Clinical and Histomorphometric Assessment of Lateral Alveolar Ridge Augmentation Using a Corticocancellous Freeze-Dried Allograft Bone Block.

Science.gov (United States)

Ahmadi, Roya Shariatmadar; Sayar, Ferena; Rakhshan, Vahid; Iranpour, Babak; Jahanbani, Jahanfar; Toumaj, Ahmad; Akhoondi, Nasrin

2017-06-01

Horizontal ridge augmentation with allografts has attracted notable attention because of its proper success rate and the lack of disadvantages of autografts. Corticocancellous block allografts have not been adequately studied in humans. Therefore, this study clinically and histomorphometrically evaluated the increase in ridge width after horizontal ridge augmentation using corticocancellous block allografts as well as implant success after 12 to 18 months after implantation. In 10 patients receiving implants (3 women, 7 men; mean age = 45 years), defective maxillary alveolar ridges were horizontally augmented using freeze-dried bone allograft blocks. Ridge widths were measured before augmentation, immediately after augmentation, and ∼6 months later in the reentry surgery for implantation. This was done at points 2 mm (A) and 5 mm (B) apically to the crest. Biopsy cores were acquired from the implantation site. Implant success was assessed 15.1 ± 2.7 months after implantation (range = 12-18 months). Data were analyzed using Friedman and Dunn tests (α = 0.05). At point A, ridge widths were 2.77 ± 0.37, 8.02 ± 0.87, and 6.40 ± 0.66 mm, respectively, before surgery, immediately after surgery, and before implantation. At point B, ridge widths were 3.40 ± 0.39, 9.35 ± 1.16, and 7.40 ± 1.10 mm, respectively, before surgery, immediately after surgery, and before implantation. The Friedman test showed significant increases in ridge widths, both at point A and point B (both P = .0000). Postaugmentation resorption was about 1.5-2 mm and was statistically significant at points A and B (P < .05, Dunn). The percentage of newly formed bone, residual graft material, and soft tissue were 33.0% ± 11.35% (95% confidence interval [CI] = 24.88%-41.12%), 37.50% ± 19.04% (95% CI = 23.88%-51.12%), and 29.5%, respectively. The inflammation was limited to grades 1 or zero. Twelve to 18 months after implantation, no implants caused pain or showed exudates or pockets. Radiographic

Peen treatment on a titanium implant: effect of roughness, osteoblast cell functions, and bonding with bone cement

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Khandaker M

2016-02-01

Full Text Available Morshed Khandaker,1,4 Shahram Riahinezhad,1 Fariha Sultana,1 Melville B Vaughan,2,4 Joshua Knight,2 Tracy L Morris3,4 1Department of Engineering & Physics, 2Department of Biology, 3Department of Mathematics and Statistics, 4Center for Interdisciplinary Biomedical Education and Research, University of Central Oklahoma, Edmond, OK, USA Abstract: Implant failure due to poor integration of the implant with the surrounding biomaterial is a common problem in various orthopedic and orthodontic surgeries. Implant fixation mostly depends upon the implant surface topography. Micron to nanosize circular-shaped groove architecture with adequate surface roughness can enhance the mechanical interlock and osseointegration of an implant with the host tissue and solve its poor fixation problem. Such groove architecture can be created on a titanium (Ti alloy implant by laser peening treatment. Laser peening produces deep, residual compressive stresses in the surfaces of metal parts, delivering increased fatigue life and damage tolerance. The scientific novelty of this study is the controlled deposition of circular-shaped rough spot groove using laser peening technique and understanding the effect of the treatment techniques for improving the implant surface properties. The hypothesis of this study was that implant surface grooves created by controlled laser peen treatment can improve the mechanical and biological responses of the implant with the adjoining biomaterial. The objective of this study was to measure how the controlled laser-peened groove architecture on Ti influences its osteoblast cell functions and bonding strength with bone cement. This study determined the surface roughness and morphology of the peen-treated Ti. In addition, this study compared the osteoblast cell functions (adhesion, proliferation, and differentiation between control and peen-treated Ti samples. Finally, this study measured the fracture strength between each kind of Ti samples

In Vivo Evaluation of an Injectable Premixed Radiopaque Calcium Phosphate Cement

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Jonas Åberg

2011-01-01

Full Text Available In this work a radiopaque premixed calcium phosphate cement (pCPC has been developed and evaluated in vivo. Radiopacity was obtained by adding 0–40 % zirconia to the cement paste. The effects of zirconia on setting time, strength and radiopacity were evaluated. In the in vivo study a 2 by 3.5 mm cylindrical defect in a rat vertebrae was filled with either the pCPC, PMMA or bone chips. Nano-SPECT CT analysis was used to monitor osteoblast activity during bone regeneration. The study showed that by adding zirconia to the cement the setting time becomes longer and the compressive strength is reduced. All materials evaluated in the in vivo study filled the bone defect and there was a strong osteoblast activity at the injury site. In spite of the osteoblast activity, PMMA blocked bone healing and the bone chips group showed minimal new bone formation. At 12 weeks the pCPC was partially resorbed and replaced by new bone with good bone ingrowth. The radiopaque pCPC may be considered to be used for minimal invasive treatment of vertebral fractures since it has good handling, radiopacity and allows healing of cancellous bone in parallel with the resorption of the cement.

Use of antibiotic-loaded cement in total knee arthroplasty.

OpenAIRE

Hinarejos Gómez, Pedro Angel; Guirro Castellnou, Pau; Puig Verdié, Luís; Torres Claramunt, Raúl; Leal Blanquet, Joan; Sánchez Soler, JF.; Monllau García, Juan Carlos

2015-01-01

Bone cement has the capacity to release antibiotic molecules if any antibiotic is included in it, and these elution properties are improved as cement porosity is increased. In vitro studies have shown high local antibiotic concentration for many hours or few days after its use. Antibiotic loaded bone cement (ALBC) is helpful when treating an infection in total knee arthroplasty (TKA) revision surgery. The purpose of this paper was to review the evidence for the routine use of ALBC in TKA in t...

VARIANTS OF SPINE OSTEOSYNTESIS AT LOW MINERAL DENSITY OF BONE

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V. D. Usikov

2010-01-01

Full Text Available The analysis of the results of transpedicular screw fixation in the treatment of patients with osteoporotic vertebral compression fractures was done. In the first group (N=27 the polysegmental transpedicular screw fixation was applied. In the second group (N=20 we used short-level stabilization with additional augmentation of transpedicular screws by bone cement. The spinal stability, restoration of function, correction of spine's deformation and pain relief was same in both groups. But in the second group the results was achieved with less traumatization and time of rehabilitation of the patients.

Clinical efficacy of bone cement injectable pedicle screw system combined with intervertebral fusion in treatment of lumbar spondylolysis and osteoporosis

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Peng-yi DAI

2016-10-01

Full Text Available Objective 　To observe the therapeutic effect of bone cement injectable pedicle screw system combined with intervertebral fusion for lumbar spondylolysis and osteoporosis. Methods 　The clinical data were analyzed retrospectively of 21 patients with lumbar spondylolysis and osteoporosis who received treatment of bone cement injectable pedicle screw system and intervertebral fusion from Aug. 2013 to Nov. 2015. The 21 patients (9 males and 12 females aged from 60 to 80 years (mean 64 years old; 6 of them presented degenerative spondylolysis, 15 with isthmic spondylolisthesis; 2 cases had I degree slippage, 13 had Ⅱdegree slippage, 6 had Ⅲdegree slippage, and all the cases were unisegmental slippage including 9 cases in L4 and 12 cases in L5. Bone mineral density of lumbar vertebrae (L2-L5 was measured with dual-energy X-ray absorptiometry, and T values conforming to the diagnostic criteria of osteoporosis were less than or equal to -2.5; All patients were operated with whole lamina resection for decompression, bone cement injectable pedicle screws system implantation, propped open reduction and fixation intervertebral fusion. The clinical outcomes were determined by the radiographic evaluation including intervertebral height, height of intervertebral foramen, slip distance, slip rate and slip angle, and Oswestry disability index (ODI on preoperative, 3 months after operation and the end of the time, and the interbody fusion were followed up. Results 　Cerebrospinal fluid leakage of incision was observed in two cases after operation, compression and dressing to incision, Trendelenburg position, dehydration and other treatments were taken, and the stitches of incisions were taken out on schedule. Slips in the 21 patients were reset to different extent, and lumbar physiological curvatures were recovered. The intervertebral height and height of intervertebral foramen were obviously higher 3 months after operation than that before operation (P0

THE INFLUENCE OF CaO AND P2O5 OF BONE ASH UPON THE REACTIVITY AND THE BURNABILITY OF CEMENT RAW MIXTURES

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TOMÁŠ IFKA

2012-03-01

Full Text Available The influence of CaO and P2O5 upon the reactivity of cement raw meal was investigated in this paper. Ash of bone meal containing Ca3(PO42 - 3CaO·P2O5 was used as the source of P2O5. Two series of samples with different content of the ash of bone meal were prepared. In the first series, the ash of bone was added into cement raw meal. The second series of samples were prepared by considering ash as one of CaO sources. Therefore, the total content of CaO in cement raw meal was kept constant, while the amount of P2O5 increased. These different series of samples were investigated by analyzing free lime content in the clinkers. The XRD analysis and Electron Micro Probe Analyzer analysis of the clinkers were also carried out. Two parameters were used to characterize the reactivity of cement raw meal: content of free lime and Burnability Index (BI calculated from free lime content in both series of samples burnt at 1350 ºC, 1400 ºC, 1450 ºC and 1500 ºC. According to the first parameter, P2O5 content that drastically makes worse the reactivity of cement raw meal was found at 1.11 wt.% in the first series, while this limit has reached 1.52 wt.% in the second one. According to the BI, the limit of P2O5 was found at 1.42 wt. % in the first series and 1, 61 wt.% in the second one. Furthermore, EPMA has demonstrated the presence of P2O5 in both calcium silicate phases forming thus solid solutions.

Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept

International Nuclear Information System (INIS)

Kelekis, A.; Filippiadis, D.; Anselmetti, G.; Brountzos, E.; Mavrogenis, A.; Papagelopoulos, P.; Kelekis, N.; Martin, J.-B.

2016-01-01

PurposeTo evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up.Materials and MethodsPercutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25–50 medical grade stainless steel micro-needles (22 G, 2–6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment.ResultsClinical evaluation included immediate and delayed follow-up studies of patient’s general condition, NVS pain score, and neurological status. Imaging assessed implant’s long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2–36 months). Comparing patients’ scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed.ConclusionPercutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing

Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept

Energy Technology Data Exchange (ETDEWEB)

Kelekis, A., E-mail: akelekis@med.uoa.gr; Filippiadis, D., E-mail: dfilippiadis@yahoo.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Anselmetti, G., E-mail: gc.anselmetti@fastwebnet.it [GVM Care and Research Maria Pia Hospital (Italy); Brountzos, E., E-mail: ebrountz@med.uoa.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Mavrogenis, A., E-mail: afm@otenet.gr; Papagelopoulos, P., E-mail: pjp@hol.gr [University General Hospital “ATTIKON”, A Orthopedic Clinic (Greece); Kelekis, N., E-mail: kelnik@med.uoa.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Martin, J.-B., E-mail: jbmartin@cird.ch [Centre Imaginerie Rive Droite & Gauche (Switzerland)

2016-01-15

PurposeTo evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up.Materials and MethodsPercutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25–50 medical grade stainless steel micro-needles (22 G, 2–6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment.ResultsClinical evaluation included immediate and delayed follow-up studies of patient’s general condition, NVS pain score, and neurological status. Imaging assessed implant’s long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2–36 months). Comparing patients’ scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed.ConclusionPercutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing.

Pulmonary Cement Embolism following Percutaneous Vertebroplasty

Directory of Open Access Journals (Sweden)

Ümran Toru

2014-01-01

Full Text Available Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

Biocompatibility of calcium phosphate bone cement with optimized mechanical properties.

Science.gov (United States)

Palmer, Iwan; Nelson, John; Schatton, Wolfgang; Dunne, Nicholas J; Buchanan, Fraser J; Clarke, Susan A

2016-02-01

The broad aim of this work was to investigate and optimize the properties of calcium phosphate bone cements (CPCs) for use in vertebroplasty to achieve effective primary fixation of spinal fractures. The incorporation of collagen, both bovine and from a marine sponge (Chondrosia reniformis), into a CPC was investigated. The biological properties of the CPC and collagen-CPC composites were assessed in vitro through the use of human bone marrow stromal cells. Cytotoxicity, proliferation, and osteoblastic differentiation were evaluated using lactate dehydrogenase, PicoGreen, and alkaline phosphatase activity assays, respectively. The addition of both types of collagen resulted in an increase in cytotoxicity, albeit not to a clinically relevant level. Cellular proliferation after 1, 7, and 14 days was unchanged. The osteogenic potential of the CPC was reduced through the addition of bovine collagen but remained unchanged in the case of the marine collagen. These findings, coupled with previous work showing that incorporation of marine collagen in this way can improve the physical properties of CPCs, suggest that such a composite may offer an alternative to CPCs in applications where low setting times and higher mechanical stability are important. © 2015 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc.

Large Bone Vertical Augmentation Using a Three-Dimensional Printed TCP/HA Bone Graft: A Pilot Study in Dog Mandible.

Science.gov (United States)

Carrel, Jean-Pierre; Wiskott, Anselm; Scherrer, Susanne; Durual, Stéphane

2016-12-01

Osteoflux is a three-dimensional printed calcium phosphate porous structure for oral bone augmentation. It is a mechanically stable scaffold with a well-defined interconnectivity and can be readily shaped to conform to the bone bed's morphology. An animal experiment is reported whose aim was to assess the performance and safety of the scaffold in promoting vertical growth of cortical bone in the mandible. Four three-dimensional blocks (10 mm length, 5 mm width, 5 mm height) were affixed to edentulous segments of the dog's mandible and covered by a collagen membrane. During bone bed preparation, particular attention was paid not to create defects 0.5 mm or more so that the real potential of the three-dimensional block in driving vertical bone growth can be assessed. Histomorphometric analyses were performed after 8 weeks. At 8 weeks, the three-dimensional blocks led to substantial vertical bone growth up to 4.5 mm from the bone bed. Between 0 and 1 mm in height, 44% of the surface was filled with new bone, at 1 to 3 mm it was 20% to 35%, 18% at 3 to 4, and ca. 6% beyond 4 mm. New bone was evenly distributed along in mesio-distal direction and formed a new crest contour in harmony with the natural mandibular shape. After two months of healing, the three-dimensional printed blocks conducted new bone growth above its natural bed, up to 4.5 mm in a canine mandibular model. Furthermore, the new bone was evenly distributed in height and density along the block. These results are very promising and need to be further evaluated by a complete powerful study using the same model. © 2016 Wiley Periodicals, Inc.

Lateral ridge augmentation with Bio-Oss alone or Bio-Oss mixed with particulate autogenous bone graft: a systematic review.

Science.gov (United States)

Aludden, H C; Mordenfeld, A; Hallman, M; Dahlin, C; Jensen, T

2017-08-01

The objective of this systematic review was to test the hypothesis of no difference in implant treatment outcomes when using Bio-Oss alone or Bio-Oss mixed with particulate autogenous bone grafts for lateral ridge augmentation. A search of the MEDLINE, Cochrane Library, and Embase databases in combination with a hand-search of relevant journals was conducted. Human studies published in English from 1 January 1990 to 1 May 2016 were included. The search provided 337 titles and six studies fulfilled the inclusion criteria. Considerable variation prevented a meta-analysis from being performed. The two treatment modalities have never been compared within the same study. Non-comparative studies demonstrated a 3-year implant survival of 96% with 50% Bio-Oss mixed with 50% autogenous bone graft. Moreover, Bio-Oss alone or Bio-Oss mixed with autogenous bone graft seems to increase the amount of newly formed bone as well as the width of the alveolar process. Within the limitations of this systematic review, lateral ridge augmentation with Bio-Oss alone or in combination with autogenous bone graft seems to induce newly formed bone and increase the width of the alveolar process, with high short-term implant survival. However, long-term studies comparing the two treatment modalities are needed before final conclusions can be drawn. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Piezosurgery in Bone Augmentation Procedures Previous to Dental Implant Surgery: A Review of the Literature

Science.gov (United States)

Magrin, Gabriel Leonardo; Sigua-Rodriguez, Eder Alberto; Goulart, Douglas Rangel; Asprino, Luciana

2015-01-01

The piezosurgery has been used with increasing frequency and applicability by health professionals, especially those who deal with dental implants. The concept of piezoelectricity has emerged in the nineteenth century, but it was applied in oral surgery from 1988 by Tomaso Vercellotti. It consists of an ultrasonic device able to cut mineralized bone tissue, without injuring the adjacent soft tissue. It also has several advantages when compared to conventional techniques with drills and saws, such as the production of a precise, clean and low bleed bone cut that shows positive biological results. In dental implants surgery, it has been used for maxillary sinus lifting, removal of bone blocks, distraction osteogenesis, lateralization of the inferior alveolar nerve, split crest of alveolar ridge and even for dental implants placement. The purpose of this paper is to discuss the use of piezosurgery in bone augmentation procedures used previously to dental implants placement. PMID:26966469

Three-Dimensional Finite Element Analysis of Maxillary Sinus Floor Augmentation with Optimal Positioning of a Bone Graft Block

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Peter Schuller-Götzburg

2018-01-01

Full Text Available Purpose: the aim of the computational 3D-finite element study is to evaluate the influence of an augmented sinus lift with additional inserted bone grafting. The bone graft block stabilizes the implant in conjunction with conventional bone augmentation. Two finite element models were applied: the real geometry based bone models and the simplified geometry models. The bone graft block was placed in three different positions. The implants were loaded first with an axial force and then with forces simulating laterotrusion and protrusion. This study examines whether the calculated stress behavior is symmetrical for both models. Having established a symmetry between the primary axis, the laterotrusion and protrusion behavior reduces calculation efforts, by simplifying the model. Material and Methods: a simplified U-shaped 3D finite element model of the molar region of the upper jaw and a more complex anatomical model of the left maxilla with less cortical bone were created. The bone graft block was placed in the maxillary sinus. Then the von Mises stress distribution was calculated and analyzed at three block positions: at contact with the sinus floor, in the middle of the implant helix and in the upper third of the implant. The two finite element models were then compared to simplify the modelling. Results: the position of the bone graft block significantly influences the magnitude of stress distribution. A bone graft block positioned in the upper third or middle of the implant reduces the quantity of stress compared to the reference model without a bone graft block. The low bone graft block position is clearly associated with lower stress distribution in compact bone. We registered no significant differences in stress in compact bone with regard to laterotrusion or protrusion. Conclusions: maximum values of von Mises stresses in compact bone can be reduced significantly by using a bone graft block. The reduction of stress is nearly the same for

Preparation and characterization of a novel injectable strontium-containing calcium phosphate cement with collagen

Directory of Open Access Journals (Sweden)

Zhou Ziqiang

2015-07-01

Full Text Available Purpose: To develop a novel injectable strontium-containing calcium phosphate cement with collagen. Methods: A novel calcium phosphate bone cement (CPC was prepared with the addition of strontium element, collagenⅠ, and modified starch; the injectability, solidification time, microstructure, phase composition, compressive strength, anti-collapsibility and histological properties of material were evaluated. Results: The results showed that the material could be injected with an excellent performance; the modified starch significantly improved the anti-washout property of cement; with the liquid to solid ratio of 0.3, the largest compressive strength of cement was obtained (48.0 MPa ± 2.3 MPa; histological examination of repair tissue showed that the bone was repaired after 16 weeks; the degradation of cement was consistent with the new bone growth. Conclusion: A novel injectable collagen-strontium-containing CPC with excellent compressive strength and suitable setting time was prepared, with addition of modified starch. The CPC showed a good antiwashout property and the degradation time of the cement met with the new bone growing. This material is supposed to be used in orthopedic and maxillofacial surgery for bone defects.

Development of hydroxyapatite bone cement for controlled drug ...

Indian Academy of Sciences (India)

The purpose of this work was to study the preparation and characterization of drug–hydroxyapatite cement. The hydroxyapatite (HA) cement has been synthesized by using tricalcium phosphate, calcium carbonate and dicalcium phosphate anhydrous with sodium hydrogen phosphate as liquid phase. The effect of added ...

Contact damage failure analyses of fretting wear behavior of the metal stem titanium alloy-bone cement interface.

Science.gov (United States)

Zhang, Lanfeng; Ge, Shirong; Liu, Hongtao; Wang, Qingliang; Wang, Liping; Xian, Cory J

2015-11-01

Although cemented titanium alloy is not favored currently in the Western world for its poor clinical and radiography outcomes, its lower modulus of elasticity and good biocompatibility are instrumental for its ability supporting and transforming physical load, and it is more suitable for usage in Chinese and Japanese populations due to their lower body weights and unique femoral characteristics. Through various friction tests of different cycles, loads and conditions and by examining fretting hysteresis loops, fatigue process curves and wear surfaces, the current study investigated fretting wear characteristics and wear mechanism of titanium alloy stem-bone cement interface. It was found that the combination of loads and displacement affected the wear quantity. Friction coefficient, which was in an inverse relationship to load under the same amplitude, was proportional to amplitudes under the same load. Additionally, calf serum was found to both lubricate and erode the wear interface. Moreover, cement fatigue contact areas appeared black/oxidative in dry and gruel in 25% calf serum. Fatigue scratches were detected within contact areas, and wear scars were found on cement and titanium surfaces, which were concave-shaped and ring concave/ convex-shaped, respectively. The coupling of thermoplastic effect and minimal torque damage has been proposed to be the major reason of contact damage. These data will be important for further studies analyzing metal-cement interface failure performance and solving interface friction and wear debris production issues. Copyright © 2015 Elsevier Ltd. All rights reserved.

Soft-tissue Necrosis Complicating Bone-cement Filling in a Patient with Proximal Tibia Giant cell Tumour and Co-morbid Depressive Illness

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Sagar Narang

2013-12-01

Full Text Available Giant-cell tumors are common around the knee. Proximal tibia is a challenging location for limb-salvage due to paucity of soft-tissue cover. Bone cement has been used in treatment of giant-cell tumors after curettage. Tissue irritant properties of its monomer and exothermic reaction involved in polymerization may compromise surgical outcome to varying degrees. Preoperative planning and intra-operative positioning during cementing process are of importance to avoid complications. Co-occurrence of psychiatric illness in tumor patients should be managed by psychiatric counselling and drug therapy. This case has been presented to suggest measures for preventing soft-tissue complications during cement filling in proximal tibia, and for dealing with concomitant psychiatric problems for a holistic improvement in tumor patients.

Novel Approach in the Use of Plasma Spray: Preparation of Bulk Titanium for Bone Augmentations

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Michaela Fousova

2017-08-01

Full Text Available Thermal plasma spray is a common, well-established technology used in various application fields. Nevertheless, in our work, this technology was employed in a completely new way; for the preparation of bulk titanium. The aim was to produce titanium with properties similar to human bone to be used for bone augmentations. Titanium rods sprayed on a thin substrate wire exerted a porosity of about 15%, which yielded a significant decrease of Young′s modulus to the bone range and provided rugged topography for enhanced biological fixation. For the first verification of the suitability of the selected approach, tests of the mechanical properties in terms of compression, bending, and impact were carried out, the surface was characterized, and its compatibility with bone cells was studied. While preserving a high enough compressive strength of 628 MPa, the elastic modulus reached 11.6 GPa, thus preventing a stress-shielding effect, a generally known problem of implantable metals. U-2 OS and Saos-2 cells derived from bone osteosarcoma grown on the plasma-sprayed surface showed good viability.

The use of first stage bone augmentation screws to stabilize the surgical template in the second stage.

NARCIS (Netherlands)

Verhamme, L.M.; Meijer, G.J.; Berge, S.J.; Maal, T.J.J.

2015-01-01

A new method is presented in which the osteosynthesis screws from a first stage bone augmentation of the maxilla are used to stabilize the surgical template during implant placement in the second stage. This method was evaluated in one patient and the results compared to those of previous studies.

The use of first stage bone augmentation screws to stabilize the surgical template in the second stage

NARCIS (Netherlands)

Verhamme, L. M.; Meijer, G. J.; Bergé, S. J.; Maal, T. J J

2015-01-01

A new method is presented in which the osteosynthesis screws from a first stage bone augmentation of the maxilla are used to stabilize the surgical template during implant placement in the second stage. This method was evaluated in one patient and the results compared to those of previous studies.

Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft in animals

DEFF Research Database (Denmark)

Jensen, T; Schou, S; Stavropoulos, Andreas

2012-01-01

The objective of the present systematic review was to test the hypothesis of no differences between the use of Bio-Oss or Bio-Oss mixed with autogenous bone as graft for maxillary sinus floor augmentation (MSFA) applying the lateral window technique, as evaluated in animals. A MEDLINE (Pub...... of the graft improved significantly with increased proportion of Bio-Oss. Bone regeneration, bone-to-implant contact (BIC), biomechanical implant test values, and biodegradation of Bio-Oss after MSFA with Bio-Oss or Bio-Oss mixed with autogenous bone have never been compared within the same study in animals....... Thus, the hypothesis of no differences between the use of Bio-Oss and Bio-Oss mixed with autogenous bone as graft for MSFA could neither be confirmed nor rejected based on existing animal studies....

Evaluation of Heat Transfer to the Implant-Bone Interface During Removal of Metal Copings Cemented onto Titanium Abutments.

Science.gov (United States)

Cakan, Umut; Cakan, Murat; Delilbasi, Cagri

2016-01-01

The aim of this investigation was to measure the temperature increase due to heat transferred to the implant-bone interface when the abutment screw channel is accessed or a metal-ceramic crown is sectioned buccally with diamond or tungsten carbide bur using an air rotor, with or without irrigation. Cobalt-chromium copings were cemented onto straight titanium abutments. The temperature changes during removal of the copings were recorded over a period of 1 minute. The sectioning of coping with diamond bur and without water irrigation generated the highest temperature change at the cervical part of the implant. Both crown removal methods resulted in an increase in temperature at the implant-bone interface. However, this temperature change did not exceed 47°C, the potentially damaging threshold for bone reported in the literature.

Effect of Poly(Vinyl Alcohol) Addition on the Properties of Hydrothermal Derived Calcium Phosphate Cement for Bone Filling Materials

Science.gov (United States)

Razali, N. N.; Sopyan, I.; Mel, M.; Salleh, H. M.; Rahman, M. M.; Singh, R.

2017-06-01

The effect of addition of poly(vinyl alcohol) on hydrothermal derived calcium phosphate cement has been studied. The precursors used to prepare the cement were calcium oxide (CaO) and ammonium dihydrogen phosphate (NH4H2PO4); the reaction was conducted in water at 80-100°C. To improve properties of CPC, poly(vinyl alcohol) (PVA) of 1wt% and 2wt% was added to the liquid phase of CPC and the results were compared to CPC without PVA addition. The addition of PVA was proved to bring remarkable effects on cohesion, setting time and mechanical strength of CPC which make it suitable physically for injectable bone filler applications.

Development of a fully injectable calcium phosphate cement

Indian Academy of Sciences (India)

Permanent link: https://www.ias.ac.in/article/fulltext/boms/026/04/0415-0422. Keywords. Calcium phosphate cements; hydroxyapatite; bioceramics; bone substitute; orthopedic; dental. Abstract. A study on the development of a fully injectable calcium phosphate cement for orthopedic and dental applications is presented.

Biphasic products of dicalcium phosphate-rich cement with injectability and nondispersibility

International Nuclear Information System (INIS)

Ko, Chia-Ling; Chen, Jian-Chih; Hung, Chun-Cheng; Wang, Jen-Chyan; Tien, Yin-Chun; Chen, Wen-Cheng

2014-01-01

In this study, a calcium phosphate cement was developed using tetracalcium phosphate and surface-modified dicalcium phosphate anhydrous (DCPA). This developed injectable bone graft substitute can be molded to the shape of the bone cavity and set in situ through the piping system that has an adequate mechanical strength, non-dispersibility, and biocompatibility. The materials were based on the modified DCPA compositions of calcium phosphate cement (CPC), where the phase ratio of the surface-modified DCPA is higher than that of the conventional CPC for forming dicalcium phosphate (DCP)-rich cement. The composition and morphology of several calcium phosphate cement specimens during setting were analyzed via X-ray diffractometry and transmission electron microscopy coupled with an energy dispersive spectroscopy system. The compressive strength of DCP-rich CPCs was greater than 30 MPa after 24 h of immersion in vitro. The reaction of the CPCs produced steady final biphasic products of DCPs with apatite. The composites of calcium phosphate cements derived from tetracalcium phosphate mixed with surface-modified DCPA exhibited excellent mechanical properties, injectability, and interlocking forces between particles, and they also featured nondispersive behavior when immersed in a physiological solution. - Highlights: • Bone cement precursor with nanocrystals is characterized. • DCP-rich CPCs with nanocrystals exhibited biphasic product phases. • Nanocrystals in cement significantly affected the interlocking ability. • Nanocrystals in cement exhibited higher strength and anti-dispersion. • DCP-rich CPCs increase the potential of bioresorption after reaction

The Use of a Supra-Acetabular Antibiotic-Loaded Cement Shelf to Improve Hip Stability in First-Stage Infected Total Hip Arthroplasty.

Science.gov (United States)

Drexler, Michael; Kuzyk, Paul R T; Koo, Kevin; Gross, Allan E; Kosashvili, Yona; Reischl, Nickola; Rutenberg, Tal Frenkel; Safir, Oleg

2016-11-01

Antibiotic-loaded cement spacers in first-stage revision total hip arthroplasty (THA) for managing infection are associated with high dislocation and fracture rates. The aim of this study was to report the use of an antibiotic-loaded cemented supra-acetabular roof augmentation to reinforce hip stability after cement spacer insertion for first-stage total hip revision in the treatment of infected THA. We retrospectively reviewed a consecutive series of 50 THAs involving 47 patients with an infected hip requiring staged revisions of THA. We documented dislocation, reinfection, and time for revision and outcome. There were no cases of hip dislocation, cement fractures, or any other technical complications associated with the use of the roof augmentation lip. Thirteen cases (26%) had a cemented spacer for longer than 120 days. Seven (14%) cases had recurrent infection after staged revision THA. The antibiotic-loaded cemented supra-acetabular roof augment improved femoral head spacer coverage for patients requiring a staged revision THA for infection. Copyright © 2016 Elsevier Inc. All rights reserved.

Minimum Abutment Height to Eliminate Bone Loss: Influence of Implant Neck Design and Platform Switching.

Science.gov (United States)

Spinato, Sergio; Galindo-Moreno, Pablo; Bernardello, Fabio; Zaffe, Davide

This retrospective study quantitatively analyzed the minimum prosthetic abutment height to eliminate bone loss after 4.7-mm-diameter implant placement in maxillary bone and how grafting techniques can affect the marginal bone loss in implants placed in maxillary areas. Two different implant types with a similar neck design were singularly placed in two groups of patients: the test group, with platform-switched implants, and the control group, with conventional (non-platform-switched) implants. Patients requiring bone augmentation underwent unilateral sinus augmentation using a transcrestal technique with mineralized xenograft. Radiographs were taken immediately after implant placement, after delivery of the prosthetic restoration, and after 12 months of loading. The average mesial and distal marginal bone loss of the control group (25 patients) was significantly more than twice that of the test group (26 patients), while their average abutment height was similar. Linear regression analysis highlighted a statistically significant inverse relationship between marginal bone loss and abutment height in both groups; however, the intercept of the regression line, both mesially and distally, was 50% lower for the test group than for the control group. The marginal bone loss was annulled with an abutment height of 2.5 mm for the test group and 3.0 mm for the control group. No statistically significant differences were found regarding marginal bone loss of implants placed in native maxillary bone compared with those placed in the grafted areas. The results suggest that the shorter the abutment height, the greater the marginal bone loss in cement-retained prostheses. Abutment height showed a greater influence in platform-switched than in non-platform-switched implants on the limitation of marginal bone loss.

10-year results of a new low-monomer cement: follow-up of a randomized RSA study.

Science.gov (United States)

Söderlund, Per; Dahl, Jon; Röhrl, Stephan; Nivbrant, Bo; Nilsson, Kjell G

2012-12-01

The properties and performance of a new low-monomer cement were examined in this prospective randomized, controlled RSA study. 5-year data have already been published, showing no statistically significant differences compared to controls. In the present paper we present the 10-year results. 44 patients were originally randomized to receive total hip replacement with a Lubinus SPII titanium-aluminum-vanadium stem cemented either with the new Cemex Rx bone cement or with control bone cement, Palacos R. Patients were examined using RSA, Harris hip score, and conventional radiographs. At 10 years, 33 hips could be evaluated clinically and 30 hips could be evaluated with RSA (16 Cemex and 14 Palacos). 9 patients had died and 4 patients were too old or infirm to be investigated. Except for 1 hip that was revised for infection after less than 5 years, no further hips were revised before the 10-year follow-up. There were no statistically significant clinical differences between the groups. The Cemex cement had magnitudes of migration similar to or sometimes lower than those of Palacos cement. In both groups, most hips showed extensive radiolucent lines, probably due to the use of titanium alloy stems. At 10 years, the Cemex bone cement tested performed just as well as the control (Palacos bone cement).

Augmented Endoscopic Images Overlaying Shape Changes in Bone Cutting Procedures.

Science.gov (United States)

Nakao, Megumi; Endo, Shota; Nakao, Shinichi; Yoshida, Munehito; Matsuda, Tetsuya

2016-01-01

In microendoscopic discectomy for spinal disorders, bone cutting procedures are performed in tight spaces while observing a small portion of the target structures. Although optical tracking systems are able to measure the tip of the surgical tool during surgery, the poor shape information available during surgery makes accurate cutting difficult, even if preoperative computed tomography and magnetic resonance images are used for reference. Shape estimation and visualization of the target structures are essential for accurate cutting. However, time-varying shape changes during cutting procedures are still challenging issues for intraoperative navigation. This paper introduces a concept of endoscopic image augmentation that overlays shape changes to support bone cutting procedures. This framework handles the history of the location of the measured drill tip as a volume label and visualizes the remains to be cut overlaid on the endoscopic image in real time. A cutting experiment was performed with volunteers, and the feasibility of this concept was examined using a clinical navigation system. The efficacy of the cutting aid was evaluated with respect to the shape similarity, total moved distance of a cutting tool, and required cutting time. The results of the experiments showed that cutting performance was significantly improved by the proposed framework.

Percutaneous bone cement refixation of aseptically loose hip prostheses: the effect of interface tissue removal on injected cement volumes

Energy Technology Data Exchange (ETDEWEB)

Malan, Daniel F. [Leiden University Medical Center, Department of Orthopaedics, Leiden (Netherlands); Delft University of Technology, Department of Intelligent Systems, Delft (Netherlands); Valstar, Edward R. [Leiden University Medical Center, Department of Orthopaedics, Leiden (Netherlands); Delft University of Technology, Department of Biomechanical Engineering, Delft (Netherlands); Nelissen, Rob G.H.H. [Leiden University Medical Center, Department of Orthopaedics, Leiden (Netherlands)

2014-11-15

To quantify whether injected cement volumes differed between two groups of patients who underwent experimental minimally invasive percutaneous cement injection procedures to stabilize aseptically loose hip prostheses. One patient group was preoperatively treated using gene-directed enzyme prodrug therapy to remove fibrous interface tissue, while the other group received no preoperative treatment. It was hypothesized that cement penetration may have been inhibited by the presence of fibrous interface tissue in periprosthetic lesions. We analyzed 17 patients (14 female, 3 male, ages 72-91, ASA categories 2-4) who were treated at our institution. Osteolytic lesions and injected cement were manually delineated using 3D CT image segmentation, and the deposition of injected cement was quantified. Patients who underwent preoperative gene-directed enzyme therapy to remove fibrous tissue exhibited larger injected cement volumes than those who did not. The observed median increase in injected cement volume was 6.8 ml. Higher cement leakage volumes were also observed for this group. We conclude that prior removal of periprosthetic fibrous interface tissue may enable better cement flow and penetration. This might lead to better refixation of aseptically loosened prostheses. (orig.)

The effect of cup outer sizes on the contact mechanics and cement fixation of cemented total hip replacements.

Science.gov (United States)

Hua, Xijin; Li, Junyan; Wang, Ling; Wilcox, Ruth; Fisher, John; Jin, Zhongmin

2015-10-01

One important loosening mechanism of the cemented total hip arthroplasty is the mechanical overload at the bone-cement interface and consequent failure of the cement fixation. Clinical studies have revealed that the outer diameter of the acetabular component is a key factor in influencing aseptic loosening of the hip arthroplasty. The aim of the present study was to investigate the influence of the cup outer diameter on the contact mechanics and cement fixation of a cemented total hip replacement (THR) with different wear penetration depths and under different cup inclination angles using finite element (FE) method. A three-dimensional FE model was developed based on a typical Charnley hip prosthesis. Two acetabular cup designs with outer diameters of 40 and 43 mm were modelled and the effect of cup outer diameter, penetration depth and cup inclination angle on the contact mechanics and cement fixation stresses in the cemented THR were studied. The results showed that for all penetration depths and cup inclination angles considered, the contact mechanics in terms of peak von Mises stress in the acetabular cup and peak contact pressure at the bearing surface for the two cup designs were similar (within 5%). However, the peak von Mises stress, the peak maximum principal stress and peak shear stress in the cement mantle at the bone-cement interface for the 43 mm diameter cup design were predicted to be lower compared to those for the 40 mm diameter cup design. The differences were predicted to be 15-19%, 15-22% and 18-20% respectively for different cup penetration depths and inclination angles, which compares to the clinical difference of aseptic loosening incidence of about 20% between the two cup designs. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

High resolution X-ray imaging of bone-implant interface by large area flat-panel detector

International Nuclear Information System (INIS)

Kytyr, D; Jirousek, O; Dammer, J

2011-01-01

The aim of the research was to investigate the cemented bone-implant interface behavior (cement layer degradation and bone-cement interface debonding) with emphasis on imaging techniques suitable to detect the early defects in the cement layer. To simulate in vivo conditions a human pelvic bone was implanted with polyurethane acetabular cup using commercial acrylic bone cement. The implanted cup was then loaded in a custom hip simulator to initiate fatigue crack propagation in the bone cement. The pelvic bone was then repetitively scanned in a micro-tomography device. Reconstructed tomography images showed failure processes that occurred in the cement layer during the first 250,000 cycles. A failure in cemented acetabular implant - debonding, crumbling and smeared cracks - has been found to be at the bone-cement interface. Use of micro-focus source and high resolution flat panel detector of large physical dimensions allowed to reconstruct the micro-structural models suitable for investigation of migration, micro-motions and consecutive loosening of the implant. The large area flat panel detector with physical dimensions 120 x 120mm with 50μm pixel size provided a superior image quality compared to clinical CT systems with 300-150μm pixel size.

Long-term stability of contour augmentation in the esthetic zone

DEFF Research Database (Denmark)

Jensen, Simon S; Bosshardt, Dieter D; Gruber, Reinhard

2014-01-01

, recent data from cone beam computed tomography studies have shown the augmented volume to be stable long-term. However, no human histologic data are available to document the tissue reactions to this bone augmentation procedure. METHODS: Over an 8-year period, 12 biopsies were harvested 14 to 80 months......BACKGROUND: Contour augmentation around early-placed implants (Type 2 placement) using autogenous bone chips combined with deproteinized bovine bone mineral (DBBM) and a collagen barrier membrane has been documented to predictably provide esthetically satisfactory clinical outcomes. In addition...... after implant placement with simultaneous contour augmentation in 10 patients. The biopsies were subjected to histologic and histomorphometric analysis. RESULTS: The biopsies consisted of 32.0% ± 9.6% DBBM particles and 40.6% ± 14.6% mature bone. 70.3% ± 14.5% of the DBBM particle surfaces were covered...

Alternative Fuels in Cement Production

DEFF Research Database (Denmark)

Larsen, Morten Boberg

The substitution of alternative for fossil fuels in cement production has increased significantly in the last decade. Of these new alternative fuels, solid state fuels presently account for the largest part, and in particular, meat and bone meal, plastics and tyre derived fuels (TDF) accounted...... for the most significant alternative fuel energy contributors in the German cement industry. Solid alternative fuels are typically high in volatile content and they may differ significantly in physical and chemical properties compared to traditional solid fossil fuels. From the process point of view......, considering a modern kiln system for cement production, the use of alternative fuels mainly influences 1) kiln process stability (may accelerate build up of blockages preventing gas and/or solids flow), 2) cement clinker quality, 3) emissions, and 4) decreased production capacity. Kiln process stability...

Mechanical aspects of degree of cement bonding and implant wedge effect.

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Yoon, Yong-San; Oxland, Thomas R; Hodgson, Antony J; Duncan, Clive P; Masri, Bassam A; Choi, Donok

2008-11-01

The degree of bonding between the femoral stem and cement in total hip replacement remains controversial. Our objective was to determine the wedge effect by debonding and stem taper angle on the structural behavior of axisymmetric stem-cement-bone cylinder models. Stainless steel tapered plugs with a rough (i.e. bonded) or smooth (i.e. debonded) surface finish were used to emulate the femoral stem. Three different stem taper angles (5 degrees , 7.5 degrees , 10 degrees ) were used for the debonded constructs. Non-tapered and tapered (7.5 degrees ) aluminum cylindrical shells were used to emulate the diaphyseal and metaphyseal segments of the femur. The cement-aluminum cylinder interface was designed to have a shear strength that simulated bone-cement interfaces ( approximately 8MPa). The test involved applying axial compression at a rate of 0.02mm/s until failure. Six specimens were tested for each combination of the variables. Finite element analysis was used to enhance the understanding of the wedge effect. The debonded stems sustained about twice as much load as the bonded stem, regardless of taper angle. The metaphyseal model carried 35-50% greater loads than the diaphyseal models and the stem taper produced significant differences. Based on the finite element analysis, failure was most probably by shear at the cement-bone interface. Our results in this simplified model suggest that smooth (i.e. debonded) stems have greater failure loads and will incur less slippage or shear failure at the cement-bone interface than rough (i.e. bonded) stems.

Bone marrow endothelial progenitors augment atherosclerotic plaque regression in a mouse model of plasma lipid lowering

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Yao, Longbiao; Heuser-Baker, Janet; Herlea-Pana, Oana; Iida, Ryuji; Wang, Qilong; Zou, Ming-Hui; Barlic-Dicen, Jana

2012-01-01

The major event initiating atherosclerosis is hypercholesterolemia-induced disruption of vascular endothelium integrity. In settings of endothelial damage, endothelial progenitor cells (EPCs) are mobilized from bone marrow into circulation and home to sites of vascular injury where they aid endothelial regeneration. Given the beneficial effects of EPCs in vascular repair, we hypothesized that these cells play a pivotal role in atherosclerosis regression. We tested our hypothesis in the atherosclerosis-prone mouse model in which hypercholesterolemia, one of the main factors affecting EPC homeostasis, is reversible (Reversa mice). In these mice normalization of plasma lipids decreased atherosclerotic burden; however, plaque regression was incomplete. To explore whether endothelial progenitors contribute to atherosclerosis regression, bone marrow EPCs from a transgenic strain expressing green fluorescent protein under the control of endothelial cell-specific Tie2 promoter (Tie2-GFP+) were isolated. These cells were then adoptively transferred into atheroregressing Reversa recipients where they augmented plaque regression induced by reversal of hypercholesterolemia. Advanced plaque regression correlated with engraftment of Tie2-GFP+ EPCs into endothelium and resulted in an increase in atheroprotective nitric oxide and improved vascular relaxation. Similarly augmented plaque regression was also detected in regressing Reversa mice treated with the stem cell mobilizer AMD3100 which also mobilizes EPCs to peripheral blood. We conclude that correction of hypercholesterolemia in Reversa mice leads to partial plaque regression that can be augmented by AMD3100 treatment or by adoptive transfer of EPCs. This suggests that direct cell therapy or indirect progenitor cell mobilization therapy may be used in combination with statins to treat atherosclerosis. PMID:23081735

Long-term stability of contour augmentation in the esthetic zone: histologic and histomorphometric evaluation of 12 human biopsies 14 to 80 months after augmentation.

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Jensen, Simon S; Bosshardt, Dieter D; Gruber, Reinhard; Buser, Daniel

2014-11-01

Contour augmentation around early-placed implants (Type 2 placement) using autogenous bone chips combined with deproteinized bovine bone mineral (DBBM) and a collagen barrier membrane has been documented to predictably provide esthetically satisfactory clinical outcomes. In addition, recent data from cone beam computed tomography studies have shown the augmented volume to be stable long-term. However, no human histologic data are available to document the tissue reactions to this bone augmentation procedure. Over an 8-year period, 12 biopsies were harvested 14 to 80 months after implant placement with simultaneous contour augmentation in 10 patients. The biopsies were subjected to histologic and histomorphometric analysis. The biopsies consisted of 32.0% ± 9.6% DBBM particles and 40.6% ± 14.6% mature bone. 70.3% ± 14.5% of the DBBM particle surfaces were covered with bone. On the remaining surface, multinucleated giant cells with varying intensity of tartrate-resistant acid phosphatase staining were regularly present. No signs of inflammation were visible, and no tendency toward a decreasing volume fraction of DBBM over time was observed. The present study confirms previous findings that osseointegrated DBBM particles do not tend to undergo substitution over time. This low substitution rate may be the reason behind the clinically and radiographically documented long-term stability of contour augmentation using a combination of autogenous bone chips, DBBM particles, and a collagen membrane.

Sliding Malar Bone Augmentation Technique with a High Le Fort I ...

African Journals Online (AJOL)

2016-02-03

Feb 3, 2016 ... Upon clinical evaluation of the frontal view, maxillary hypoplasia is often associated ... resin. For the cementation of the appliance, light-cured glass ionomer cement (Unitek Multi-Cure Glass Ionomer. Orthodontic Band Cement ...

Cemental tear: To know what we have neglected in dental practice

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Po-Yuan Jeng

2018-04-01

Full Text Available Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction. Keywords: Cemental tear, Clinical characteristics, Surface root fracture, Periodontal/periapical breakdown, Recurrence, Predisposing factors

Peri-Implantitis Associated with Type of Cement: A Retrospective Analysis of Different Types of Cement and Their Clinical Correlation to the Peri-Implant Tissue.

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Korsch, Michael; Walther, Winfried

2015-10-01

The cementation of fixed implant-supported dental restorations involves the risk of leaving excess cement in the mouth which can promote biofilm formation in the peri-implant sulcus. As a result, an inflammation may develop. The aim of the present study was to investigate the clinical effect of two different luting cements on the peri-implant tissue. Within the scope of a retrospective clinical follow-up study, the prosthetic structures of 22 patients with 45 implants were revised. In all cases, a methacrylate cement (Premier Implant Cement [PIC], Premier® Dental Products Company, Plymouth Meeting, PA, USA) had been used for cementation. In 16 additional patients with 28 implants, the suprastructures were retained with a zinc oxide-eugenol cement (Temp Bond [TB], Kerr Sybron Dental Specialities, Glendora, CA, USA). These patients were evaluated in the course of routine treatment. In both populations, the retention time of the suprastructures was similar (TB 3.77 years, PIC 4.07 years). In the PIC cases, 62% of all implants had excess cement. In the TB cases, excess cement was not detectable on any of the implants. Bleeding on probing was significantly more frequent on implants cemented with PIC (100% with and 94% without excess cement) than on implants cemented with TB (46%). Pocket suppuration was observed on 89% of the PIC-cemented implants with excess cement (PIC without excess cement 24%), whereas implants with TB were not affected by it at all. The peri-implant bone loss was significantly greater in the PIC patients (with excess cement 1.37 mm, without excess cement 0.41 mm) than it was in the TB patients (0.07 mm). The frequency of undetected excess cement depends essentially on the type of cement used. Cements that tend to leave more undetected excess have a higher prevalence for peri-implant inflammation and cause a more severe peri-implant bone loss. © 2014 Wiley Periodicals, Inc.

Health hazards of cement dust

International Nuclear Information System (INIS)

Meo, Sultan A.

2004-01-01

ven in the 21st century, millions of people are working daily in a dusty environment. They are exposed to different types of health hazards such as fume, gases and dust, which are risk factors in developing occupational disease. Cement industry is involved in the development of structure of this advanced and modern world but generates dust during its production. Cement dust causes lung function impairment, chronic obstructive lung disease, restrictive lung disease, pneumoconiosis and carcinoma of the lungs, stomach and colon. Other studies have shown that cement dust may enter into the systemic circulation and thereby reach the essentially all the organs of body and affects the different tissues including heart, liver, spleen, bone, muscles and hairs and ultimately affecting their micro-structure and physiological performance. Most of the studies have been previously attempted to evaluate the effects of cement dust exposure on the basis of spirometry or radiology, or both. However, collective effort describing the general effects of cement dust on different organ and systems in humans or animals, or both has not been published. Therefore, the aim of this review is to gather the potential toxic effects of cement dust and to minimize the health risks in cement mill workers by providing them with information regarding the hazards of cement dust. (author)

The Palatal Window for Treating an Incompletely Augmented Maxillary Sinus.

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Florio, Salvatore; Suzuki, Takanori; Cho, Sang-Choon

2017-04-01

Maxillary sinus augmentation through a lateral window is reported as one of the most predictable bone augmentation procedures before implant placement. The elevation of the membrane represents a delicate and crucial step that allows the creation of the space for the bone graft material. If the elevation is not completed, the regenerated bone might be inadequate for the implant placement. In this case, a new intervention will be necessary to complete the bone augmentation. Reaccessing from a lateral window, however, would be challenging due to thickness of the buccal boney wall because of the first grafting procedure; therefore, a different approach has to be used. The aim of this case report is to present the palatal window technique for treating incompletely augmented maxillary sinus. The detailed step-by-step diagnostic and surgical procedures are described, and the advantages and limitations of the technique are discussed through a review of the literature.

Enhanced healing of rabbit segmental radius defects with surface-coated calcium phosphate cement/bone morphogenetic protein-2 scaffolds

Energy Technology Data Exchange (ETDEWEB)

Wu, Yi; Hou, Juan; Yin, ManLi [Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237 (China); Wang, Jing, E-mail: biomatwj@163.com [Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237 (China); Liu, ChangSheng, E-mail: csliu@sh163.net [Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237 (China); The State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai 200237 (China); Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237 (China)

2014-11-01

Large osseous defects remain a difficult clinical problem in orthopedic surgery owing to the limited effective therapeutic options, and bone morphogenetic protein-2 (BMP-2) is useful for its potent osteoinductive properties in bone regeneration. Here we build a strategy to achieve prolonged duration time and help inducting new bone formation by using water-soluble polymers as a protective film. In this study, calcium phosphate cement (CPC) scaffolds were prepared as the matrix and combined with sodium carboxymethyl cellulose (CMC-Na), hydroxypropylmethyl cellulose (HPMC), and polyvinyl alcohol (PVA) respectively to protect from the digestion of rhBMP-2. After being implanted in the mouse thigh muscles, the surface-modified composite scaffolds evidently induced ectopic bone formation. In addition, we further evaluated the in vivo effects of surface-modified scaffolds in a rabbit radius critical defect by radiography, three dimensional micro-computed tomographic (μCT) imaging, synchrotron radiation-based micro-computed tomographic (SRμCT) imaging, histological analysis, and biomechanical measurement. The HPMC-modified CPC scaffold was regarded as the best combination for segmental bone regeneration in rabbit radius. - Highlights: • A simple surface-coating method was used to fabricate composite scaffolds. • Growth factor was protected from rapid depletion via superficial coating. • Significant promotion of bone regeneration was achieved. • HPMC-modification displayed optimal effect of bone regeneration.

Bone tissue engineering using silica-based mesoporous nanobiomaterials:Recent progress.

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Shadjou, Nasrin; Hasanzadeh, Mohammad

2015-10-01

Bone disorders are of significant concern due to increase in the median age of our population. It is in this context that tissue engineering has been emerging as a valid approach to the current therapies for bone regeneration/substitution. Tissue-engineered bone constructs have the potential to alleviate the demand arising from the shortage of suitable autograft and allograft materials for augmenting bone healing. Silica based mesostructured nanomaterials possessing pore sizes in the range 2-50 nm and surface reactive functionalities have elicited immense interest due to their exciting prospects in bone tissue engineering. In this review we describe application of silica-based mesoporous nanomaterials for bone tissue engineering. We summarize the preparation methods, the effect of mesopore templates and composition on the mesopore-structure characteristics, and different forms of these materials, including particles, fibers, spheres, scaffolds and composites. Also, the effect of structural and textural properties of mesoporous materials on development of new biomaterials for production of bone implants and bone cements was discussed. Also, application of different mesoporous materials on construction of manufacture 3-dimensional scaffolds for bone tissue engineering was discussed. It begins by giving the reader a brief background on tissue engineering, followed by a comprehensive description of all the relevant components of silica-based mesoporous biomaterials on bone tissue engineering, going from materials to scaffolds and from cells to tissue engineering strategies that will lead to "engineered" bone. Copyright © 2015 Elsevier B.V. All rights reserved.

[Bone Cell Biology Assessed by Microscopic Approach. Bone histomorphometry of remodeling, modeling and minimodeling].

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Yamamoto, Noriaki; Shimakura, Taketoshi; Takahashi, Hideaki

2015-10-01

Bone histomorphometry is defined as a quantitative evaluation of bone remodeling. In bone remodeling, bone resorption and bone formation are coupled with scalloped cement lines. Another mechanism of bone formation is minimodeling which bone formation and resorption are independent. The finding of minimodeling appeared in special condition with metabolic bone disease or anabolic agents. We need further study for minimodeling feature and mechanism.

Significance of buccopalatal implant position, biotype, platform switching, and pre-implant bone augmentation on the level of the midbuccal mucosa

NARCIS (Netherlands)

Zuiderveld, Elise G; den Hartog, Laurens; Vissink, Arjan; Raghoebar, Gerry M; Meijer, Henny J A

2014-01-01

This study assessed whether buccopalatal implant position, biotype, platform switching, and pre-implant bone augmentation affects the level of the midbuccal mucosa (MBM). Ninety patients with a single-tooth implant in the esthetic zone were included. The level of the MBM was measured on photographs

Cemented total knee replacement in 24 dogs: surgical technique, clinical results, and complications.

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Allen, Matthew J; Leone, Kendall A; Lamonte, Kimberly; Townsend, Katy L; Mann, Kenneth A

2009-07-01

To characterize the performance of cemented total knee replacement (TKR) in dogs. Preclinical research study. Skeletally mature, male Hounds (25-30 kg; n=24) with no preexisting joint pathology. Dogs had unilateral cemented TKR and were evaluated at 6, 12, 26, or 52 weeks (6 dogs/time point) by radiography, bone density analysis, visual gait assessment, and direct measurement of thigh circumference and stifle joint range of motion as indicators of functional recovery. At study end, the stability of the cemented tibial component was determined by destructive mechanical testing. Joint stability was excellent in 16 dogs (67%) and good in 8 dogs. None of the tibial components had evidence of migration or periprosthetic osteolysis whereas 1 femoral component was loose at 52 weeks. There was an early and significant decrease in tibial bone density, likely because of disuse of the operated limb. Dogs returned to full activity by 12 weeks. The tibial cement-bone interface maintained its strength over 52 weeks. Cement provides stable fixation of the tibial component in canine TKR. Cemented TKR yields adequate clinical function and stifle joint excursion in the dog. Clinical studies are needed to determine the long-term fate of cemented TKR implants, to assess the influence of implant design on implant fixation and wear, and to obtain objective functional data.

The effect of growth factors for bone augmentation to enable dental implant placement: A systematic review

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Kengo Shimono

2010-02-01

Differing levels and quantity of evidence were noted to be available for the growth factors evaluated, revealing that rhBMP-2, rhPDGF, and PRGF may stimulate local bone augmentation to various conditions. Especially the potential of rhBMP-2 is supportive. However, the confined number of investigators using these techniques and the low number of patient treatments reported in the literature, the generalizability of this approach is limited at this time.

Influence of two barrier membranes on staged guided bone regeneration and osseointegration of titanium implants in dogs: part 1. Augmentation using bone graft substitutes and autogenous bone.

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Schwarz, Frank; Mihatovic, Ilja; Golubovic, Vladimir; Hegewald, Andrea; Becker, Jürgen

2012-01-01

To assess the influence of two barrier membranes and two bone graft substitutes mixed with autogenous bone (AB) on staged guided bone regeneration and osseointegration of titanium implants in dogs. Four saddle-type defects each were prepared in the upper jaw of six fox hounds and randomly filled with a natural bone mineral (NBM)+AB and a biphasic calcium phosphate (SBC)+AB and allocated to either an in situ gelling polyethylene glycol (PEG) or a collagen membrane (CM). At 8 weeks, modSLA titanium implants were inserted and left to heal in a submerged position. At 8+2 weeks, dissected blocks were processed for histomorphometrical analysis (e.g., treated area [TA], bone-to-implant contact [BIC]). The mean TA values (mm(2) ) and BIC values (%) tended to be higher in the PEG groups(TA: NBM+AB [10.4 ± 2.5]; SBC+AB [10.4 ± 5.8]/BIC: NBM+AB [86.4 ± 20.1]; SBC+AB [80.1 ± 21.5]) when compared with the corresponding CM groups (TA: NBM+AB [9.7 ± 4.8]; SBC+AB [7.8 ± 4.3]/BIC: NBM+AB [71.3 ± 20.8]; SBC+AB [72.4 ± 20.3]). A significant difference was observed for the mean TA values in the SBC+AB groups. It was concluded that all augmentation procedures investigated supported bone regeneration and staged osseointegration of modSLA titanium implants. However, the application of PEG may be associated with increased TA values. © 2011 John Wiley & Sons A/S.

The effect of endoskeleton on antibiotic impregnated cement spacer for treating deep hip infection

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Hsu Wei-Hsiu

2011-01-01

Full Text Available Abstract Backgrounds A two-stage revision arthroplasty was suggested optimal treatment for deep infections in hip joint. The effect of endoskeleton of cement spacers on the interim function and infection control remains unclear. Methods From Jan. 2004 to Dec. 2007, we collected a prospective cohort of consecutive 34 patients who treated with two-stage revision total hip arthroplasty for deep infection of hip joint. In group 1, fifteen patients were treated by a novel design augmented with hip compression screw while nineteen patients were treated by traditional design in group 2. Results No fracture of cement spacer occurred in group 1 while 6 cases developed spacer failure in group 2. (p Conclusions Patients being treated for deep infection of hip joint using cement spacer augmented with stronger endoskeleton have lower pain levels and better joint function between stages.

Regulation of physicochemical properties, osteogenesis activity, and fibroblast growth factor-2 release ability of β-tricalcium phosphate for bone cement by calcium silicate

International Nuclear Information System (INIS)

Su, Ching-Chuan; Kao, Chia-Tze; Hung, Chi-Jr; Chen, Yi-Jyun; Huang, Tsui-Hsien; Shie, Ming-You

2014-01-01

β-Tricalcium phosphate (β-TCP) is an osteoconductive material. For this research we have combined it with a low degradation calcium silicate (CS) to enhance its bioactive and osteostimulative properties. To check its effectiveness, a series of β-TCP/CS composites with different ratios were prepared to make new bioactive and biodegradable biocomposites for bone repair. Formation of bone-like apatite, the diametral tensile strength, and weight loss of composites were considered before and after immersion in simulated body fluid (SBF). In addition, we also examined the effects of fibroblast growth factor-2 (FGF-2) released from β-TCP/CS composites and in vitro human dental pulp cell (hDPC) and studied its behavior. The results showed that the apatite deposition ability of the β-TCP/CS composites was enhanced as the CS content was increased. For composites with more than 50% CS contents, the samples were completely covered by a dense bone-like apatite layer. At the end of the immersion point, weight losses of 19%, 24%, 33%, 42%, and 51% were observed for the composites containing 0%, 30%, 50%, 70% and 100% β-TCP cements, respectively. In vitro cell experiments show that the CS-rich composites promote human dental pulp cell (hDPC) proliferation and differentiation. However, when the CS quantity in the composite is less than 70%, the amount of cells and osteogenesis protein of hDPCs was stimulated by FGF-2 released from β-TCP/CS composites. The combination of FGF-2 in degradation of β-TCP and osteogenesis of CS gives a strong reason to believe that these calcium-based composite cements may prove to be promising bone repair materials. - Highlights: • CS improved physicochemical properties and osteogenic activity of β-TCP. • The higher the CS in the cement, the shorter the setting time and the higher the DTS. • The cell behavior was stimulated by FGF-2 released from composite containing 50% CS. • β-TCP/CS composite with FGF-2 has optimal properties for

Relleno de cavidades óseas en cirugía maxilofacial con materiales autólogos Bone cavity augmentation in maxillofacial surgery using autologous material

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P. Infante-Cossío

2007-02-01

Full Text Available Aunque se han descrito numerosos materiales para rellenar una cavidad ósea, el mejor material sigue siendo el hueso autólogo corticoesponjoso o particulado, que puede formar hueso nuevo por mecanismos de osteogénesis, osteinducción y osteoconducción. El cirujano oral y maxilofacial debe conocer las propiedades biológicas y las características fundamentales de los materiales autólogos, las diferentes técnicas de obtención y sus aplicaciones clínicas. Como zonas donantes se emplean preferentemente las intraorales, el filtro de hueso y los raspadores para pequeños defectos, y el hueso ilíaco, tibia o calota cuando se requiere más cantidad. No existen estudios concluyentes respecto a la asociación de injertos óseos con membranas. La combinación de injertos autólogos con otros materiales de relleno, ha desembocado en múltiples estudios, sin que se puedan establecer conclusiones definitivas por el momento. El hueso autólogo es de elección para el relleno de cavidades óseas, ya que es útil para dar solución a variadas situaciones clínicas de forma simple, rápida y segura.Although a large number of materials have been described for augmenting bone cavities, the best material is still autologous cortical-cancellous bone or bone chip, which can form new bone through osteogenesis, osteoinduction and osteoconduct ion mechanisms. The oral and maxillofacial surgeon needs to be familiar with the biological properties and the fundamental characteristics of autologous material, the different techniques for obtaining it and its clinical application. Donor sites should preferably be intraoral. Bone filters and scrapers should be used for small defects, and the iliac, tibial or calvaria bones [should be used] when more quantity is required. There are no conclusive studies with regard to combining bone grafts with membranes. The combination of autologous grafts with other augmentation material has led to multiple studies, although

On the Feasibility of Utilizing Allogeneic Bone Blocks for Atrophic Maxillary Augmentation

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Alberto Monje

2014-01-01

Full Text Available Purpose. This systematic review was aimed at assessing the feasibility by means of survival rate, histologic analysis, and causes of failure of allogeneic block grafts for augmenting the atrophic maxilla. Material and Methods. A literature search was conducted by one reviewer in several databases. Articles were included in this systematic review if they were human clinical trials in which outcomes of allogeneic bone block grafts were studied by means of survival rate. In addition other factors were extracted in order to assess their influence upon graft failure. Results. Fifteen articles fulfilled the inclusion criteria and subsequently were analyzed in this systematic review. A total of 361 block grafts could be followed 4 to 9 months after the surgery, of which 9 (2.4% failed within 1 month to 2 months after the surgery. Additionally, a weighed mean 4.79 mm (95% CI: 4.51–5.08 horizontal bone gain was computed from 119 grafted sites in 5 studies. Regarding implant cumulative survival rate, the weighed mean was 96.9% (95% CI: 92.8–98.7%, computed from 228 implants over a mean follow-up period of 23.9 months. Histologic analysis showed that allogeneic block grafts behave differently in the early stages of healing when compared to autogenous block grafts. Conclusion. Atrophied maxillary reconstruction with allogeneic bone block grafts represents a reliable option as shown by low block graft failure rate, minimal resorption, and high implant survival rate.

Pull out Strength of Dual Outer Diameter Pedicle Screws Compared to Uncemented and Cemented Standard Pedicle Screws: A Biomechanical in vitro Study.

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Lorenz, Andrea; Leichtle, Carmen I; Frantz, Sandra; Bumann, Marte; Tsiflikas, Ilias; Shiozawa, Thomas; Leichtle, Ulf G

2017-05-01

To analyze the potential of the dual outer diameter screw and systematically evaluate the pull-out force of the dual outer diameter screw compared to the uncemented and cemented standard pedicle screws with special regard to the pedicle diameter and the vertebra level. Sixty vertebrae of five human spines (T 6 -L 5 ) were sorted into three study groups for pairwise comparison of the uncemented dual outer diameter screw, the uncemented standard screw, and the cemented standard screw, and randomized with respect to bone mineral density (BMD) and vertebra level. The vertebrae were instrumented, insertion torque was determined, and pull-out testing was performed using a material testing machine. Failure load was evaluated in pairwise comparison within each study group. The screw-to-pedicle diameter ratio was determined and the uncemented dual outer diameter and standard screws were compared for different ratios as well as vertebra levels. Significantly increased pull-out forces were measured for the cemented standard screw compared to the uncemented standard screw (+689 N, P dual outer diameter screw (+403 N, P dual outer diameter screw to the uncemented standard screw in the total study group, a distinct but not significant increase was measured (+149 N, P = 0.114). Further analysis of these two screws, however, revealed a significant increase of pull-out force for the dual outer diameter screw in the lumbar region (+247 N, P = 0.040), as well as for a screw-to-pedicle diameter ratio between 0.6 and 1 (+ 488 N, P = 0.028). For clinical application, cement augmentation remains the gold standard for increasing screw stability. According to our results, the use of a dual outer diameter screw is an interesting option to increase screw stability in the lumbar region without cement augmentation. For the thoracic region, however, the screw-to-pedicle diameter should be checked and attention should be paid to screw cut out, if the dual outer diameter screw is considered. �

Microwave assisted preparation of magnesium phosphate cement (MPC) for orthopedic applications: A novel solution to the exothermicity problem

International Nuclear Information System (INIS)

Zhou, Huan; Agarwal, Anand K.; Goel, Vijay K.; Bhaduri, Sarit B.

2013-01-01

There are two interesting features of this paper. First, we report herein a novel microwave assisted technique to prepare phosphate based orthopedic cements, which do not generate any exothermicity during setting. The exothermic reactions during the setting of phosphate cements can cause tissue damage during the administration of injectable compositions and hence a solution to the problem is sought via microwave processing. This solution through microwave exposure is based on a phenomenon that microwave irradiation can remove all water molecules from the alkaline earth phosphate cement paste to temporarily stop the setting reaction while preserving the active precursor phase in the formulation. The setting reaction can be initiated a second time by adding aqueous medium, but without any exothermicity. Second, a special emphasis is placed on using this technique to synthesize magnesium phosphate cements for orthopedic applications with their enhanced mechanical properties and possible uses as drug and protein delivery vehicles. The as-synthesized cements were evaluated for the occurrences of exothermic reactions, setting times, presence of Mg-phosphate phases, compressive strength levels, microstructural features before and after soaking in (simulated body fluid) SBF, and in vitro cytocompatibility responses. The major results show that exposure to microwaves solves the exothermicity problem, while simultaneously improving the mechanical performance of hardened cements and reducing the setting times. As expected, the cements are also found to be cytocompatible. Finally, it is observed that this process can be applied to calcium phosphate cements system (CPCs) as well. Based on the results, this microwave exposure provides a novel technique for the processing of injectable phosphate bone cement compositions. - Highlights: • A microwave assisted system for bone cement manufacturing • A solution to exothermicity problem of acid–base reaction based bone cement �

Microwave assisted preparation of magnesium phosphate cement (MPC) for orthopedic applications: A novel solution to the exothermicity problem

Energy Technology Data Exchange (ETDEWEB)

Zhou, Huan, E-mail: Huan.Zhou@rockets.utoledo.edu [Department of Mechanical, Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH 43606 (United States); Agarwal, Anand K.; Goel, Vijay K. [Department of Bioengineering, The University of Toledo, Toledo, OH 43606 (United States); Bhaduri, Sarit B. [Department of Mechanical, Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH 43606 (United States); Division of Dentistry, The University of Toledo, Toledo, OH 43606 (United States)

2013-10-15

There are two interesting features of this paper. First, we report herein a novel microwave assisted technique to prepare phosphate based orthopedic cements, which do not generate any exothermicity during setting. The exothermic reactions during the setting of phosphate cements can cause tissue damage during the administration of injectable compositions and hence a solution to the problem is sought via microwave processing. This solution through microwave exposure is based on a phenomenon that microwave irradiation can remove all water molecules from the alkaline earth phosphate cement paste to temporarily stop the setting reaction while preserving the active precursor phase in the formulation. The setting reaction can be initiated a second time by adding aqueous medium, but without any exothermicity. Second, a special emphasis is placed on using this technique to synthesize magnesium phosphate cements for orthopedic applications with their enhanced mechanical properties and possible uses as drug and protein delivery vehicles. The as-synthesized cements were evaluated for the occurrences of exothermic reactions, setting times, presence of Mg-phosphate phases, compressive strength levels, microstructural features before and after soaking in (simulated body fluid) SBF, and in vitro cytocompatibility responses. The major results show that exposure to microwaves solves the exothermicity problem, while simultaneously improving the mechanical performance of hardened cements and reducing the setting times. As expected, the cements are also found to be cytocompatible. Finally, it is observed that this process can be applied to calcium phosphate cements system (CPCs) as well. Based on the results, this microwave exposure provides a novel technique for the processing of injectable phosphate bone cement compositions. - Highlights: • A microwave assisted system for bone cement manufacturing • A solution to exothermicity problem of acid–base reaction based bone cement �

Preparation, physical-chemical characterisation and cytocompatibility of calcium carbonate cements.

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Combes, C; Miao, Baoji; Bareille, Reine; Rey, Christian

2006-03-01

The feasibility of calcium carbonate cements involving the recrystallisation of metastable calcium carbonate varieties has been demonstrated. Calcium carbonate cement compositions presented in this paper can be prepared straightforwardly by simply mixing water (liquid phase) with two calcium carbonate phases (solid phase) which can be easily obtained by precipitation. An original cement composition was obtained by mixing amorphous calcium carbonate and vaterite with an aqueous medium. The cement set and hardened within 2h at 37 degrees C in an atmosphere saturated with water and the final composition of the cement consisted mostly of aragonite. The hardened cement was microporous and showed poor mechanical properties. Cytotoxicity tests revealed excellent cytocompatibility of calcium carbonate cement compositions. Calcium carbonates with a higher solubility than the apatite formed for most of the marketed calcium phosphate cements might be of interest to increase biomedical cement resorption rates and to favour its replacement by bone tissue.

Positive effect of removal of subchondral bone plate for cemented acetabular component fixation in total hip arthroplasty: a randomised RSA study with ten-year follow-up.

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Flivik, G; Kristiansson, I; Ryd, L

2015-01-01

We hypothesised that the removal of the subchondral bone plate (SCBP) for cemented acetabular component fixation in total hip arthroplasty (THA) offers advantages over retention by improving the cement-bone interface, without jeopardising implant stability. We have previously published two-year follow-up data of a randomised controlled trial (RCT), in which 50 patients with primary osteoarthritis were randomised to either retention or removal of the SCBP. The mean age of the retention group (n = 25, 13 males) was 70.0 years (sd 6.8). The mean age in the removal group (n = 25, 16 males) was 70.3 years (sd 7.9). Now we have followed up the patients at six (retention group, n = 21; removal group, n = 20) and ten years (retention group: n = 17, removal group: n = 18), administering clinical outcome questionnaires and radiostereometric analysis (RSA), and determining the presence of radiolucent lines (RLLs) on conventional radiographs. RSA demonstrated similar translation and rotation patterns up to six years. Between six and ten years, proximal acetabular component migration and changes of inclination were larger in the retention group, although the mean differences did not reach statistical significance. Differences in migration were driven by two patients in the SCBP retention group with extensive migration versus none in the SCBP removal group. The significant difference (p < 0.001) in the development of radiolucent lines in the retention group, previously observed at two years, increased even further during the course of follow-up (p < 0.001). While recognising SCBP removal is a more demanding technique, we conclude that, wherever possible, the SCBP should be removed to improve the cement-bone interface in order to maximise acetabular component stability and longevity. ©2015 The British Editorial Society of Bone & Joint Surgery.

[PVD-silicoating before cementation of zirconia-based knee prostheses effects better cement adhesion and lower aseptic loosening rates].

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Marx, R; Faramarzi, R; Oberbach, T; Begand, S; Grätz, N; Wirtz, D C

2012-02-01

CoCrMo alloys are contraindicated for allergy patients. For these patients, cemented or uncemented prostheses made of titanium alloy are indicated. Uncemented prostheses, however, have low primary retention, particularly the tibial components of knee joint prostheses because of the lack of a positive locking. Therefore, for knee replacement cemented CoCrMo prostheses may be suitable also for allergy sufferers if these are masked by ZrN or TiNbN layers. Alternatively the CoCrMo alloy may be replaced by high-strength oxide ceramics. For adhesion of bone cement to the ceramic surface, however, only inefficient mechanical retention spots are exposed as compared with a metal surface. Undercuts generated by corundum blasting, although highly efficient on a CoCrMo surface, are not such efficient centres on a ceramic surface due to its brittleness. Therefore, the mechanical component of retention is significantly reduced. When specific adhesion between bone cement and surface does not exist due to physical and chemical forces, the hydrolytic stability will be insufficient. Micromotions are promoted and early aseptic loosening is predictable. Silicoating of the ceramic surface will allow specific adhesion and can result in better hydrolytic stability of bonding. In order to evaluate the effectiveness of silicoating the bond strengths of blasted (mean size of corundum grains 50 µm) and silicate layered alumina-toughened zirconia (ATZ) surfaces were compared with "as fired" surfaces by utilising TiAlV probes (diameter 6 mm) for traction-adhesive strength testing. Samples machined out of CoCrMo alloy were utilised for reference. After preparing the samples for traction-adhesive strength testing (sequence: substrate, silicate and silane, protective lacquer [PolyMA], bone cement, TiAlV probe) they were aged up to 360 days at 37 °C in Ringer's solution. The bond strengths observed for all ageing intervals were well above 20 MPa and much higher and more hydrolytically

Microbial resistance related to antibiotic-loaded bone cement: a historical review.

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Walker, Lucy C; Baker, Paul; Holleyman, Richard; Deehan, David

2017-12-01

The use of antibiotic-loaded bone cement (ALBC) has a range of indications for use in orthopaedics. It has the advantage of delivering high loads of antibiotics to a targeted site, thereby avoiding the side effects associated with systemic administration. However, there is concern that the use of ALBC may precipitate the development of antibiotic-resistant bacteria. This review focuses on (1) the published research using both animal and human models examining the association between ALBC and the induction of microbial resistance (2) the mechanisms by which antimicrobial resistance develop (3) the research pertaining to specific classes of antibiotics commonly used in orthopaedic practice (4) the recent developments in calcium sulphate beads, nanoparticles and chitosan, as alternative antimicrobial treatments for periprosthetic joint infections. The literature for and against a link between ALBC and the development of microbiological resistance is reviewed and presented. It is concluded that further research is needed to develop a defined set of indications for the use of ALBC in the management of periprosthetic joint infection. In addition, further research into alternative antimicrobial therapies in this area should be encouraged.

Vertical Ridge Augmentation of the Atrophic Posterior Mandible with Sandwich Technique: Bone Block from the Chin Area versus Corticocancellous Bone Block Allograft—Clinical and Histological Prospective Randomized Controlled Study

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Luigi Laino

2014-01-01

Full Text Available The aim of the present study is to compare the histological aspects of bone formation in atrophic posterior mandibles augmented by autologous bone block from chin area with corticocancellous bone block allograft used as inlays with the sandwich technique. Materials and Methods. Sixteen patients with bilateral partial edentulism in the posterior mandible were selected. The residual bone height, preliminarily measured by computed tomography scans, ranged between 5 and 7 mm from the inferior alveolar nerve. All patients required regeneration procedure with autologous bone block from chin area (control group versus bone block allograft Puros (Zimmer Dental, 1900 Aston Avenue, Carlsbad, CA, USA (test group. Histological and histomorphometric samples were collected at the time of implant positioning in order to analyze the percentage of newly formed bone, the residual graft material, and marrow spaces/soft tissue. Results. No statistically significant differences between the two groups were found regarding the percentage of newly formed bone. The percentage of residual grafted material was significantly higher in the test group, whilst the percentage of marrow spaces was higher in control group. Conclusions. In conclusion, both procedures supported good results, although the use of bone blocks allograft was less invasive and preferable than harvesting bone from the mental symphysis.

Immediate Loading of Implants in the Edentulous Maxilla with a Fixed Provisional Restoration without Bone Augmentation: A Report on 5-Year Outcomes Data Obtained from a Prospective Clinical Trial.

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Toljanic, Joseph A; Ekstrand, Karl; Baer, Russell A; Thor, Andreas

2016-01-01

Successful immediate loading of implants in the edentulous maxilla has been previously reported. The purpose of this 5-year prospective study was to further assess long-term outcomes following immediate loading of implants in the edentulous maxilla with fixed provisional restorations without the use of bone augmentation procedures. Subjects with edentulous maxillary arches each received six implants placed in native bone without augmentation. Where insufficient posterior bone volume existed, angled implant placement was employed. Fixed provisional restorations were delivered within 24 hours of implant placement. Implant placement locations, insertion torque values, and implant dimensions were recorded. Definitive fixed prostheses were placed within 24 weeks following implantation. Baseline implant site marginal bone levels were measured using periapical radiographs. Baseline peri-implant plaque and bleeding scores were obtained. Subjects were examined 6 months after implant placement and then annually for 5 years with follow-up periapical radiographs and plaque/bleeding scores obtained. Fifty-one subjects received a total of 306 implants. Forty subjects with 232 implants returned for the final follow-up appointment representing a 5-year implant survival proportion of 93% with a mean marginal bone loss of 0.44 ± 1.25 mm for this group. Thirty-nine of these 40 subjects continued to function with fixed restorations with the remaining subject functioning with a non-implant-retained removable prosthesis. Within the limitations of this study, predictable long-term implant rehabilitation outcomes were demonstrated for the edentulous maxilla using an immediate loading protocol without bone augmentation.

Antibiotic-loaded acrylic bone cements: An in vitro study on the release mechanism and its efficacy

Energy Technology Data Exchange (ETDEWEB)

Miola, Marta, E-mail: marta.miola@polito.it [Applied Science and Technology Department, Politecnico di Torino (Italy); Bistolfi, Alessandro [Department of Orthopaedics, Traumatology and HM, University of Turin (Italy); AO CTO, M Adelaide Hospital, Turin (Italy); Valsania, Maria Carmen; Bianco, Carlotta [Department of Orthopaedics, Traumatology and HM, University of Turin (Italy); Fucale, Giacomo [Chemical, Clinical and Microbiological Analyses Dept., CTO, Turin (Italy); Verné, Enrica [Applied Science and Technology Department, Politecnico di Torino (Italy)

2013-07-01

An in vitro study was carried out in order to investigate the antibiotic release mechanism and the antibacterial properties of commercially (Palacos® R + G and Palacos® LV + G) and manually (Palacos® R + GM and Palacos® LV + GM) blended gentamicin-loaded bone cements. Samples were characterized by means of scanning electron microscopy (SEM) and compression strength was evaluated. The antibiotic release was investigated by dipping sample in simulated body fluid (SBF) and periodically analyzing the solution by means of high pressure liquid chromatography (HPLC). Different antibacterial tests were performed to investigate the possible influence of blending technique on antibacterial properties. Only some differences were observed between gentamicin manually added and commercial ones, in the release curves, while the antibacterial effect and the mechanical properties seem to not feel the blending technique. Highlights: • The efficacy of commercially and manually mixed antibiotic-loaded cements is studied. • Exhaustive mechanical, drug release and antibacterial studies are carried out. • The blending technique does not affect the antibacterial and mechanical properties. • The blending process influences only the release curve, not the released drug amount.

Antibiotic-loaded acrylic bone cements: An in vitro study on the release mechanism and its efficacy

International Nuclear Information System (INIS)

Miola, Marta; Bistolfi, Alessandro; Valsania, Maria Carmen; Bianco, Carlotta; Fucale, Giacomo; Verné, Enrica

2013-01-01

An in vitro study was carried out in order to investigate the antibiotic release mechanism and the antibacterial properties of commercially (Palacos® R + G and Palacos® LV + G) and manually (Palacos® R + GM and Palacos® LV + GM) blended gentamicin-loaded bone cements. Samples were characterized by means of scanning electron microscopy (SEM) and compression strength was evaluated. The antibiotic release was investigated by dipping sample in simulated body fluid (SBF) and periodically analyzing the solution by means of high pressure liquid chromatography (HPLC). Different antibacterial tests were performed to investigate the possible influence of blending technique on antibacterial properties. Only some differences were observed between gentamicin manually added and commercial ones, in the release curves, while the antibacterial effect and the mechanical properties seem to not feel the blending technique. Highlights: • The efficacy of commercially and manually mixed antibiotic-loaded cements is studied. • Exhaustive mechanical, drug release and antibacterial studies are carried out. • The blending technique does not affect the antibacterial and mechanical properties. • The blending process influences only the release curve, not the released drug amount

Pre-clinical evaluation of the mechanical properties of a low-stiffness cement-injectable hip stem.

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Eldesouky, Ibrahim; Harrysson, Ola; Marcellin-Little, Denis J; West, Harvey; El-Hofy, Hassan

2017-11-01

In total hip arthroplasty (THA), the femoral stem can be fixed with or without bone cement. Cementless stem fixation is recommended for young and active patients as it eliminates the risk of loss of fixation at the bone-cement and cement-implant interfaces. Cementless fixation, however, suffers from a relatively high early revision rate. In the current research, a novel low-stiffness hip stem was designed, fabricated and tested. The stem design provided the option to inject biodegradable bone cement that could enhance initial stem stability. The stem was made of Ti6Al4V alloy. The proximal portion of the stem was porous, with cubic cells. The stem was fabricated using electron beam melting (EBM) technology and tested in compression and bending. Finite-element analysis was used to evaluate stem performance under a dynamic load representing a stair descending cycle and compare it to the performance of a solid stem with similar geometry. The von Mises stresses and maximum principal strains generated within the bone increased after porous stem insertion compared to solid stem insertion. The low-modulus stem tested in this study has acceptable mechanical properties and generates strain patterns in bone that appear compatible with clinical use.

Cyst-Like Osteolytic Formations in Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) Augmented Sheep Spinal Fusion.

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Pan, Hsin Chuan; Lee, Soonchul; Ting, Kang; Shen, Jia; Wang, Chenchao; Nguyen, Alan; Berthiaume, Emily A; Zara, Janette N; Turner, A Simon; Seim, Howard B; Kwak, Jin Hee; Zhang, Xinli; Soo, Chia

2017-07-01

Multiple case reports using recombinant human bone morphogenetic protein-2 (rhBMP-2) have reported complications. However, the local adverse effects of rhBMP-2 application are not well documented. In this report we show that, in addition to promoting lumbar spinal fusion through potent osteogenic effects, rhBMP-2 augmentation promotes local cyst-like osteolytic formations in sheep trabecular bones that have undergone anterior lumbar interbody fusion. Three months after operation, conventional computed tomography showed that the trabecular bones of the rhBMP-2 application groups could fuse, whereas no fusion was observed in the control group. Micro-computed tomography analysis revealed that the core implant area's bone volume fraction and bone mineral density increased proportionately with rhBMP-2 dose. Multiple cyst-like bone voids were observed in peri-implant areas when using rhBMP-2 applications, and these sites showed significant bone mineral density decreases in relation to the unaffected regions. Biomechanically, these areas decreased in strength by 32% in comparison with noncystic areas. Histologically, rhBMP-2-affected void sites had an increased amount of fatty marrow, thinner trabecular bones, and significantly more adiponectin- and cathepsin K-positive cells. Despite promoting successful fusion, rhBMP-2 use in clinical applications may result in local adverse structural alterations and compromised biomechanical changes to the bone. Copyright © 2017 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Alveolar ridge augmentation by osteoinduction in rats

DEFF Research Database (Denmark)

Pinholt, E M; Bang, G; Haanaes, H R

1990-01-01

The purpose of this study was to evaluate bone substitutes for alveolar ridge augmentation by osteoinduction. Allogenic, demineralized, and lyophilized dentin and bone was tested for osteoinductive properties in order to establish an experimental model for further studies. Implantations were perf...

Comparative histomorphometric analysis between α-Tcp cement and β-Tcp/Ha granules in the bone repair of rat calvaria

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Gisela Grandi

2011-03-01

Full Text Available This study compared the effect of two bioceramics on the process of bone repair: α-tricalcium phosphate (α-TCP cement and β-tricalcium phosphate hydroxyapatite particles (β-TCP/HA. Calvarial defects were created in 50 rats, divided into two groups (α and β/HA. Software was used at 7, 21, 60, 90 and 120 days to assess bone formation. Mean new bone formation rates were as follows: α group, 1.6% at 7 days, 5.24% at 21 days, 24% at 60 days, 30.21% at 90 days and 50.59% at 120 days; β/HA group, 1.94% at 7 days, 2.53% at 21 days, 12.47% at 60 days, 26.84% at 90 days and 38.82% at 120 days; control group, 0.15% at 7 days, 10.12% at 21 days, 15.10% at 60 days, 18.94% at 90 days, 48.50% at 120 days. Both materials are osteoconductive and biocompatible. Perhaps the larger rate of new bone formation observed in the α-TCP group, it also occurs in the β-TCP/HA group within a longer time period.

Localized ridge augmentation in the anterior maxilla using titanium mesh, an alloplast, and a nano-bone graft: a case report.

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Alagl, Adel S; Madi, Marwa

2018-05-01

Alveolar ridge deficiency is considered a major limitation for successful implant placement, as well as for the long-term success rate, especially in the anterior maxillary region. Various approaches have been developed to increase bone volume. Among those approaches, inlay and onlay grafts, alveolar ridge distraction, and guided bone regeneration have been suggested. The use of titanium mesh is a reliable method for ridge augmentation. We describe a patient who presented with a localized, combined, horizontal and vertical ridge defect in the anterior maxilla. The patient was treated using titanium mesh and alloplast material mixed with a nano-bone graft to treat the localized ridge deformity for future implant installation. The clinical and radiographic presentation, as well as relevant literature, are presented.

Influence of two barrier membranes on staged guided bone regeneration and osseointegration of titanium implants in dogs. Part 2: augmentation using bone graft substitutes.

Science.gov (United States)

Mihatovic, Ilja; Becker, Jürgen; Golubovic, Vladimir; Hegewald, Andrea; Schwarz, Frank

2012-03-01

To assess the influence of two barrier membranes and two bone graft substitutes on staged guided bone regeneration and osseointegration of titanium implants in dogs. Saddle-type defects were prepared in the lower jaws of 6 fox hounds and randomly filled with a natural bone mineral (NBM) and a biphasic calcium phosphate (SBC) and allocated to either an in situ gelling polyethylene glycol (PEG) or a collagen membrane (CM). At 8 weeks, modSLA titanium implants were inserted and left to heal in a submerged position. At 8+2 weeks, respectively, dissected blocks were processed for histomorphometrical analysis (e.g., mineralized tissue [MT], bone-to-implant contact [BIC]). The mean MT values (mm2) and BIC values (%) tended to be higher in the PEG groups (MT: NBM [3.4±1.7]; SBC [4.2±2]/BIC: NBM [67.7±16.9]; SBC [66.9±17.8]) when compared with the corresponding CM groups (MT: NBM [2.5±0.8]; SBC [2.3±1.6]/BIC: NBM [54.1±22.6]; SBC [61±8.7]). These differences, however, did not reach statistical significance. It was concluded that all augmentation procedures investigated supported bone regeneration and staged osseointegration of modSLA titanium implants. © 2011 John Wiley & Sons A/S.

Acceleration of Alveolar Ridge Augmentation Using a Low Dose of Recombinant Human Bone Morphogenetic Protein-2 Loaded on a Resorbable Bioactive Ceramic.

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Fahmy, Rania A; Mahmoud, Naguiba; Soliman, Samia; Nouh, Samir R; Cunningham, Larry; El-Ghannam, Ahmed

2015-12-01

The aim of the present study was to evaluate the effect of a porous silica-calcium phosphate composite (SCPC50) loaded with and without recombinant human bone morphogenetic protein-2 (rhBMP-2) on alveolar ridge augmentation in saddle-type defects. Micro-granules of SCPC50 resorbable bioactive ceramic were coated with rhBMP-2 10 mg and then implanted into a saddle-type defect (12 × 7 mm) in a dog mandible and covered with a collagen membrane. Control groups included defects grafted with SCPC50 granules without rhBMP-2 and un-grafted defects. Bone healing was evaluated at 8 and 16 weeks using histologic and histomorphometric techniques. The increase in bone height and total defect fill were assessed for each specimen using the ImageJ 1.46 program. The release kinetics of rhBMP-2 was determined in vitro. The height of the bone in the grafted defects and the total defect fill were statistically analyzed. SCPC50 enhanced alveolar ridge augmentation as indicated by the increased vertical bone height, bone surface area, and bone volume after 16 weeks. SCPC50-rhBMP-2 provided a sustained release profile of a low effective dose (BMP-2 4.6 ± 1.34 pg/mL per hour) during the 1- to 21-day period. The slow rate of release of rhBMP-2 from SCPC50 accelerated synchronized complete bone regeneration and graft material resorption in 8 weeks. Successful rapid reconstruction of the alveolar ridge by SCPC50 and SCPC50-rhBMP-2 occurred without any adverse excessive bone formation, inflammation, or fluid-filled voids. Results of this study suggest that SCPC50 is an effective graft material to preserve the alveolar ridge after tooth extraction. Coating SCPC50-rhBMP-2 further accelerated bone regeneration and a considerable increase in vertical bone height. These findings make SCPC50 the primary choice as a carrier for rhBMP-2. SCPC50-rhBMP-2 can serve as an alternative to autologous bone grafting. Published by Elsevier Inc.

Maxillary sinus augmentation

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A B Tarun Kumar

2015-01-01

Full Text Available Placing dental implants in the maxillary posterior region can be both challenging and un-nerving for a regular implant dentist who is not well versed with advanced surgical procedures. It is vital for a general dentist to understand the fundamentals of bone grafting the maxillary sinus if he/she is really committed to providing the best health care for their patients. The dental practice is seeing an increasing group of patients who are living longer, and this group of older baby boomers often has an edentulous posterior maxilla either unilateral or bilateral. When edentulous, the posterior maxilla more likely has diminished bone height, which does not allow for the placement of dental implants without creating additional bone. Through grafting the maxillary sinus, bone of ideal quality can be created (allowing for placement of dental implants, which offer many advantages over other tooth replacement modalities. The sinus graft offers the dental patient a predictable procedure of regenerating lost osseous structure in the posterior maxilla. This offers the patient many advantages for long-term success. If dentists understand these concepts, they can better educate their patients and guide them to have the procedure performed. This article outlines bone grafting of the maxillary sinus for the purpose of placing dental implants. This review will help the readers to understand the intricacies of sinus augmentation. They can relate their patient's condition with the available literature and chalk out the best treatment plan for the patient, especially by using indirect sinus augmentation procedures which are less invasive and highly successful if done using prescribed technique.

Does Vertebroplasty Affect Radiation Dose Distribution?: Comparison of Spatial Dose Distributions in a Cement-Injected Vertebra as Calculated by Treatment Planning System and Actual Spatial Dose Distribution