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Sample records for bone cement augmentation

  1. Pedicle screw augmentation with bone cement enforced Vicryl mesh.

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    Schmid, Samuel L; Bachmann, Elias; Fischer, Michael; Meyer, Dominik C; Gerber, Christoph A; Snedeker, Jess G; Farshad, Mazda

    2018-01-01

    Achieving sufficient mechanical purchase of pedicle screws in osteoporotic or previously instrumented bone is technically and biologically challenging. Techniques using different kinds of pedicle screws or methods of cement augmentation have been used to address this challenge, but are associated with difficult revisions and complications. The purpose of this biomechanical trial was to investigate the use of biocompatible textile materials in combination with bone cement to augment pullout strength of pedicle screws while reducing the risk of cement extrusion. Pedicle screws (6/40 mm) were either augmented with standard bone-cement (Palacos LV + G) in one group (BC, n = 13) or with bone-cement enforced by Vicryl mesh in another group (BCVM, n = 13) in osteoporosis-like saw bone blocks. Pullout testing was subsequently performed. In a second experimental phase, similar experiments were performed using human cadaveric lumbar vertebrae (n = 10). In osteoporosis-like saw bone blocks, a mean screw pullout force of 350 N (±125) was significantly higher with the Bone cement (BC) compared to bone-cement enforced by Vicryl mesh (BCVM) technique with 240 N (±64) (p = 0.030). In human cadaveric lumbar vertebrae the mean screw pullout force was 784 ± 366 N with BC and not statistically different to BCVM with 757 ± 303 N (p = 0.836). Importantly, cement extrusion was only observed in the BC group (40%) and never with the BCVM technique. In vitro textile reinforcement of bone cement for pedicle screw augmentation successfully reduced cement extrusion compared to conventionally delivered bone cement. The mechanical strength of textile delivered cement constructs was more reproducible than standard cementing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:212-216, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  2. A Particle Model for Prediction of Cement Infiltration of Cancellous Bone in Osteoporotic Bone Augmentation

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    Basafa, Ehsan; Murphy, Ryan J.; Kutzer, Michael D.; Otake, Yoshito; Armand, Mehran

    2013-01-01

    Femoroplasty is a potential preventive treatment for osteoporotic hip fractures. It involves augmenting mechanical properties of the femur by injecting Polymethylmethacrylate (PMMA) bone cement. To reduce the risks involved and maximize the outcome, however, the procedure needs to be carefully planned and executed. An important part of the planning system is predicting infiltration of cement into the porous medium of cancellous bone. We used the method of Smoothed Particle Hydrodynamics (SPH) to model the flow of PMMA inside porous media. We modified the standard formulation of SPH to incorporate the extreme viscosities associated with bone cement. Darcy creeping flow of fluids through isotropic porous media was simulated and the results were compared with those reported in the literature. Further validation involved injecting PMMA cement inside porous foam blocks — osteoporotic cancellous bone surrogates — and simulating the injections using our proposed SPH model. Millimeter accuracy was obtained in comparing the simulated and actual cement shapes. Also, strong correlations were found between the simulated and the experimental data of spreading distance (R2 = 0.86) and normalized pressure (R2 = 0.90). Results suggest that the proposed model is suitable for use in an osteoporotic femoral augmentation planning framework. PMID:23840794

  3. A Particle Model for Prediction of Cement Infiltration of Cancellous Bone in Osteoporotic Bone Augmentation.

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    Ehsan Basafa

    Full Text Available Femoroplasty is a potential preventive treatment for osteoporotic hip fractures. It involves augmenting mechanical properties of the femur by injecting Polymethylmethacrylate (PMMA bone cement. To reduce the risks involved and maximize the outcome, however, the procedure needs to be carefully planned and executed. An important part of the planning system is predicting infiltration of cement into the porous medium of cancellous bone. We used the method of Smoothed Particle Hydrodynamics (SPH to model the flow of PMMA inside porous media. We modified the standard formulation of SPH to incorporate the extreme viscosities associated with bone cement. Darcy creeping flow of fluids through isotropic porous media was simulated and the results were compared with those reported in the literature. Further validation involved injecting PMMA cement inside porous foam blocks - osteoporotic cancellous bone surrogates - and simulating the injections using our proposed SPH model. Millimeter accuracy was obtained in comparing the simulated and actual cement shapes. Also, strong correlations were found between the simulated and the experimental data of spreading distance (R(2 = 0.86 and normalized pressure (R(2 = 0.90. Results suggest that the proposed model is suitable for use in an osteoporotic femoral augmentation planning framework.

  4. Biomechanical evaluation of a novel fenestrated pedicle screw augmented with bone cement in osteoporotic spines.

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    Paré, Philippe E; Chappuis, James L; Rampersaud, Raja; Agarwala, Amit O; Perra, Joseph H; Erkan, Serkan; Wu, Chunhui

    2011-08-15

    Comparative biomechanical study was conducted in osteoporotic human cadaveric spines. Determine the influence of the volume of polymethyl methacrylate injected through a fenestrated pedicle screw on the pullout strength and on the ability to safely remove the implant. Pedicle screw fixation in the osteoporotic spine can be improved by the addition of bone cement. Various injection techniques have been used. While improvement has been shown for the pullout strength, the optimal volume of cement to inject has not been previously studied. Seven osteoporotic spines were instrumented with a standard and a fenestrated pedicle screw augmented with polymethyl methacrylate at each level (T7-L5). Three volumes of bone cement were randomly injected and stratified to the thoracic (0.5 cc, 1.0 cc, and 1.5 cc) and lumbar spine (1.5 cc, 2.0 cc, and 2.5 cc). Axial pullout strength and removal torque of the pedicle screws were quantified. The pullout strength of the fenestrated screw was normalized with respect to its contralateral control. Student paired t tests were conducted and a statistically significant increase was noted for 1.0 cc (186 ± 45%) and 1.5 cc (158 ± 46%) in the thoracic spine and for 1.5 cc (264 ± 193%), 2.0 cc (221 ± 93%), and 2.5 cc (198 ± 42%) in the lumbar spine. There was no significant difference with higher volumes of cement. The median removal torque was 0.34 Nm for the standard and 1.83 Nm for the augmented screws. When the augmented implants were removed, the bone cement sheared completely off at the fenestrations in 15 of the 17 cases. Significant increases in pullout strength can be accomplished by injecting a limited quantity of bone cement through a fenestrated screw while minimizing the risks associated with higher volume. The majority of implants were removed without damaging the vertebra as the bone cement sheared off at the fenestrations.

  5. The Benefits of Cement Augmentation of Pedicle Screw Fixation Are Increased in Osteoporotic Bone: A Finite Element Analysis.

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    Wang, Wenhai; Baran, George R; Garg, Hitesh; Betz, Randal R; Moumene, Missoum; Cahill, Patrick J

    2014-07-01

    Biomechanical study using a finite element model of a normal and osteoporotic lumbar vertebrae comparing resistance with axial pullout and bending forces on polymethylmethacrylate-augmented and non-augmented pedicle screws. To compare the effect of cement augmentation of pedicle screw fixation in normal and osteoporotic bone with 2 different techniques of cement delivery. Various clinical and biomechanical studies have addressed the benefits of cement augmentation of pedicle screws, but none have evaluated whether this effect is similar, magnified, or attenuated in osteoporotic bone compared with normal bone. In addition, no study has compared the biomechanical strength of augmented pedicle screws using cement delivery through the pedicle screw with delivery through a pilot hole. This study was funded by a grant from DePuy Synthes Spine. Normal and osteoporotic lumbar vertebrae with pedicle screws were simulated. The models were tested for screw pullout strength with and without cement augmentation. Two methods of cement delivery were also tested. Both methods were tested using 1 and 2.5 cm 3 volume of cement infiltrated in normal and osteoporotic bone. The increase in screw pullout force was proportionally greater in osteoporotic bone with equivalent volumes of cement delivered. The researchers found that 1 and 2.5 cm 3 of cement infiltrated bone volume resulted in an increase in pullout force by about 50% and 120% in normal bone, and by about 64% and 156% in osteoporotic bone, respectively. The delivery method had only a minimal effect on pullout force when 2.5 cm 3 of cement was injected (strength of pedicle screws, and this effect is proportionately greater in osteoporotic bone. Cement delivery through fenestrated screws and delivery through a pilot hole result in comparable pullout strength at higher cement volumes. Copyright © 2014 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  6. [Polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar diseases with osteoporosis].

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    Sun, H L; Li, C D; Yang, Z C; Yi, X D; Liu, H; Lu, H L; Li, H; Wang, Y

    2016-12-18

    To describe the application of polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar diseases with osteoporosis. Observation group included 14 cases of degenerative lumbar diseases with osteoporosis received polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws from November 2014 to July 2015, control group included 12 cases of degenerative lumbar diseases with osteoporosis received polymethylmethacrylate augmentation with traditional pedicle screws.The operation time, blood loss, number of pedicle screws and number of augmented pedicle screws in the two groups were compared. The bone cement leakage and pulmonary bone cement embolism in the two groups were also compared. The fusion rate and pedicle screws loosening by lumbar X ray and dynamic X ray were evaluated. The clinical results were assessed by visual analog scale (VAS) of pain on lumbar and lower limbers, lumbar Japanese Orthopaedic Association scores (JOA), Prolo functional scores and Oswestry disability (ODI) scores. Differences of operation time and blood loss in the two groups were not statistically significant. The average number of pedicle screws was 9.9±4.7 and the average number of augmented pedicle screws was 5.9±2.6 in observation group while the average number of pedicle screws was 7.1±2.8 and the average number of augmented pedicle screws was 3.0±1.9 in control group. The ratio of augmented pedicle screws was higher in observation group than in control group (0.69±0.30 vs.0.47±0.30,Pdegenerative lumbar diseases with osteoporosis was effective, with simple working processes and lower risk of bone cement leakage. The short-term clinical result was good.

  7. Biomechanical analysis of pedicle screws in osteoporotic bone with bioactive cement augmentation using simulated in vivo multicomponent loading.

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    Choma, Theodore J; Frevert, Wesley F; Carson, William L; Waters, Nicole P; Pfeiffer, Ferris M

    2011-03-15

    Biomechanical analysis of bioactive cements augmenting pedicle screw resistance to loosening in osteoporotic synthetic bone. To simulate in vivo loading-loosening of pedicle screws in osteoporotic vertebrae; and to compare biomechanical efficacy of the following bioactive cements: calcium phosphate (CP), calcium sulfate (CS), and proprietary mixture (M). Pedicle screw instrumentation in osteoporotic spines is limited by poor bone-screw interface strength, resulting in screw loosening fixation failure. Previous in vivo studies evaluated augmented pedicle screw resistance to pure pullout, not simulating in vivo loading/failure. A pedicle screw-instrumented osteoporotic thoracic vertebra subjected to combined pullout, transverse, moment loading was simulated. Unconstrained 3-dimensional screw motion relative to vertebra was optically measured during quasi-static, and dynamic loading. Augmented groups (CP, CS, M) produced (P CS > M failure initiation force (P < 0.006) was because of differences in cement distribution. Animal studies may be required to characterize the remodeling activity of bioactive cements and their longer term efficacies.

  8. Curettage with cement augmentation of large bone defects in giant cell tumors with pathological fractures in lower-extremity long bones.

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    Gupta, Som P; Garg, Gaurav

    2016-09-01

    Thorough curettage and cement augmentation is the procedure of choice for treating giant cell tumor lesions, particularly those associated with large defects. Its association with pathological fractures has not been studied to a great extent, although a pathological fracture following a giant cell tumor is not a contraindication to treatment by curettage and cementation. We present our experience of bone cementation following intralesional curettage for treatment of giant cell tumors of the long bones of lower limbs with associated pathological fractures. A total of 38 patients who had undergone a procedure in the weight-bearing long bones of lower limbs were included in the study. The age of the patients ranged from 18-79 years with a mean age of 38.57 years. The average follow-up was 102.42 months (8.5 years) ranging from 60-186 months (5-15.5 years). Results were based on serial radiographs showing consolidation of the lesion along with a subjective clinical examination and Enneking functional evaluation noted in the patient's records. Approximately 76 % of the lesions occurred around the knee. The results were graded as excellent (72 %), good (12.82 %) fair (10.25 %) and poor (5.12 %). Four cases developed a recurrence. Apart from a few documented complications, the lesions showed good consolidation and healed well. Giant cell tumors of the long bones of lower limbs with an associated pathological fracture at diagnosis can be managed with thorough curettage and cement augmentation of the bone defect with a satisfactory outcome. Level IV.

  9. The quantity of bone cement influences the anchorage of augmented pedicle screws in the osteoporotic spine: A biomechanical human cadaveric study.

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    Pishnamaz, Miguel; Lange, Henning; Herren, Christian; Na, Hong-Sik; Lichte, Philipp; Hildebrand, Frank; Pape, Hans-Christoph; Kobbe, Philipp

    2018-02-01

    The aim of this comparative biomechanical human cadaveric study was to investigate the anchorage of augmented screws with two different volumes of bone cement. For this purpose the effect of cranio-caudal loadings on pedicle screws was evaluated and axial pullout tests were performed. A total of 50 pedicle screws (25 augmented/25 non-augmented) were instrumented into osteoporotic vertebra of fresh human cadavers. The augmented screws were grounded by two different volumes of bone cement (1.5cm 3 vs 4cm 3 ). Biomechanical performance was assessed by performing a cyclic loading protocol (frequency: 3Hz, load range: 20-200N, number of cycles: 100,000), followed by axial pullout (13 augmented/11 non-augmented) or by either directly measuring axial pullout strength (12 augmented/12 non-augmented). The median T-score of the specimens was -4.25 (range: -6.38 to -2.4). Pullout tests with and without cyclic preloading showed significantly increased pullout strength in augmented screws (Fmax: augmented: 1159N (SD 395N); non-augmented: 532N (SD 297N); p0.05). The pullout strength significantly decreased in high-volume augmented screws after cyclic loading (Fmax (4.0cm 3 ): direct pullout 1463N (SD 307N); cyclic preload: 902N (SD 435N); p<0.05). Biomechanical advantages of augmented pedicle screws can also be found after cyclic preload. However, our results indicate that the anchoring stability of high-volume augmented pedicle screws after cyclic loading is disadvantageous compared to moderate augmented screws; thus high-volume augmentation should be avoided. Copyright © 2018 Elsevier Ltd. All rights reserved.

  10. Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine: Does it Correlate With Level-specific Bone Mineral Density Scores?

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    Hey, Hwee Weng Dennis; Hwee Weng, Dennis Hey; Tan, Jun Hao; Jun, Hao Tan; Tan, Chuen Seng; Chuen, Seng Tan; Tan, Hsi Ming Bryan; Ming, Bryan Tan Hsi; Lau, Puang Huh Bernard; Huh, Bernard Lau Puang; Hee, Hwan Tak; Hwan, Tak Hee

    2015-12-01

    A case-control study. In this study, we investigated the correlation between level-specific preoperative bone mineral density and subsequent vertebral fractures. We also identified factors associated with subsequent vertebral fractures. Complications of cement augmentation of the spine include subsequent vertebral fractures, leading to unnecessary morbidity and more treatment. Ability to predict at-risk vertebra will help guide management. We studied all patients with osteoporotic compression fractures who underwent cement augmentation in a single institution from November 2001 to December 2010 by a single surgeon. Association between level-specific bone mineral density T-scores and subsequent fractures was assessed. Multivariable analysis was performed to identify significant factors associated with subsequent vertebral fractures. 93 patients followed up for a mean duration of 25.1 months (12-96) had a mean age of 76.8 years (47-99). Vertebroplasty was performed in 58 patients (62.4%) on 68 levels and kyphoplasty in 35 patients (37.6%) on 44 levels. Refracture was seen in 16 patients (17.2%). The time to subsequent fracture post cement augmentation was 20.5 months (2-90). For refracture cases, 43.8% (7/16) fractured in the adjacent vertebrae. Subsequently fractured vertebra had a mean T-score of -2.860 (95% confidence interval -3.268 to -2.452) and nonfractured vertebra had a mean T-score of -2.180 (95% confidence interval -2.373 to -1.986). A T-score of -2.2 or lower is predictive of refracture at that vertebra (P = 0.047). Odds ratio increases with decreasing T-scores from -2.2 or lower to -2.6 or lower. A T-score of -2.6 or lower gives no additional predictive advantage. After multivariable analysis, age (P = 0.049) and loss of preoperative anterior vertebral height (P = 0.017) are associated with refracture. Level-specific T-scores are predictive of subsequent fractures and the odds ratio increases with lower T-scores from -2.2 or less to -2.6 or less. They

  11. Percutaneous cement augmentation for osteoporotic vertebral fractures.

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    Sebaaly, Amer; Rizkallah, Maroun; Bachour, Falah; Atallah, Firas; Moreau, Pierre Emmanuel; Maalouf, Ghassan

    2017-06-01

    Thoracolumbar vertebral fracture incidents usually occur secondary to a high velocity trauma in young patients and to minor trauma or spontaneously in older people.Osteoporotic vertebral fractures are the most common osteoporotic fractures and affect one-fifth of the osteoporotic population.Percutaneous fixation by 'vertebroplasty' is a tempting alternative for open surgical management of these fractures.Despite discouraging initial results of early trials for vertebroplasty, cement augmentation proved its superiority for the treatment of symptomatic osteoporotic vertebral fracture when compared with optimal medical treatment.Early intervention is also gaining ground recently.Kyphoplasty has the advantage over vertebroplasty of reducing kyphosis and cement leak.Stentoplasty, a new variant of cement augmentation, is also showing promising outcomes.In this review, we describe the additional techniques of cement augmentation, stressing the important aspects for success, and recommend a thorough evaluation of thoracolumbar fractures in osteoporotic patients to select eligible patients that will benefit the most from percutaneous augmentation. A detailed treatment algorithm is then proposed. Cite this article: EFORT Open Rev 2017;2:293-299. DOI: 10.1302/2058-5241.2.160057.

  12. Rheology of acrylic bone cements.

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    Ferracane, J L; Greener, E H

    1981-01-01

    The rheological properties of setting acrylic bone cements were examined with a rotational cone and plate viscometer. The cements were tested over two orders of magnitude of shear rate to determine the nature of any non-Newtonian flow behavior. All three cements behaved with moderate pseudoplasticity (i.e., shear thinning) during setting, suggesting the use of higher pressures during administration for better flow and penetration. The low viscosity brand was found to be nearly one-half as viscous as the conventional cements during the working time (i.e., 2-5 minutes). A series of sieving experiments were performed to determine the particle size distributions of the powder components. Statistical analysis (chi square) showed the cements to have different distributions, with the low viscosity brand containing a larger proportion of smaller polymer particles. This difference is thought to contribute to the lower viscosity of this cement.

  13. Pedicle screw design and cement augmentation in osteoporotic vertebrae: effects of fenestrations and cement viscosity on fixation and extraction.

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    Choma, Theodore J; Pfeiffer, Ferris M; Swope, Ryan W; Hirner, Jesse P

    2012-12-15

    Experimental, human cadaveric study. To assess the fixation effects of injecting cement augmentation before screw insertion or after insertion of fenestrated screws; the effect of modulating cement viscosity; and the effects of these techniques on screw removal. It seems clear that cement augmentation can enhance pedicle screw fixation in osteoporotic bone. What remains to be demonstrated is the aspects of optimal technique such that fixation is enhanced with the greatest safety profile. Part I: Human osteoporotic vertebrae were instrumented with solid (nonaugmented) screws, solid screws with polymethylmethacrylate (PMMA), partially cannulated fenestrated (Pfen) screws, or fully cannulated fenestrated (Ffen) screws through which PMMA was injected. Screw fixation was tested in pullout. Part II: Ffen screws were augmented with standard low-viscosity PMMA versus high-viscosity PMMA. Part III: Sample cohorts were extracted from vertebrae to assess required torque and characterize difficulty of extraction. Part I: Pfen screws demonstrated the greatest fixation with mean failure force of 690 ± 182 N. All methods of cement augmentation demonstrated significant increases in screw fixation. Part II: Ffen screws did not demonstrate a significant difference in pullout strength when high-viscosity PMMA was used as compared with low-viscosity PMMA. Part III: Mean extraction torque values for solid augmented screws, Ffen screws, and Pfen screws were 1.167, 1.764, and 1.794 Nm, respectively, but these differences did not reach significance. None of the osteoporotic vertebrae sustained catastrophic failure during augmented screw extraction. Polymethylmethacrylate cement augmentation clearly enhances pedicle screw fixation in osteoporotic vertebrae when tested in pure pullout. The technique used for cement injection and choice of specialty screws can have a significant impact on the magnitude of this effect. Fenestrated screws have the capacity to confine cement placement in the

  14. Augmented reality in bone tumour resection

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

    2017-01-01

    Objectives We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model. Methods 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. Results 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. PMID:28258117

  15. Porous surface modified bioactive bone cement for enhanced bone bonding.

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    Qiang He

    Full Text Available Polymethylmethacrylate bone cement cannot provide an adhesive chemical bonding to form a stable cement-bone interface. Bioactive bone cements show bone bonding ability, but their clinical application is limited because bone resorption is observed after implantation. Porous polymethylmethacrylate can be achieved with the addition of carboxymethylcellulose, alginate and gelatin microparticles to promote bone ingrowth, but the mechanical properties are too low to be used in orthopedic applications. Bone ingrowth into cement could decrease the possibility of bone resorption and promote the formation of a stable interface. However, scarce literature is reported on bioactive bone cements that allow bone ingrowth. In this paper, we reported a porous surface modified bioactive bone cement with desired mechanical properties, which could allow for bone ingrowth.The porous surface modified bioactive bone cement was evaluated to determine its handling characteristics, mechanical properties and behavior in a simulated body fluid. The in vitro cellular responses of the samples were also investigated in terms of cell attachment, proliferation, and osteoblastic differentiation. Furthermore, bone ingrowth was examined in a rabbit femoral condyle defect model by using micro-CT imaging and histological analysis. The strength of the implant-bone interface was also investigated by push-out tests.The modified bone cement with a low content of bioactive fillers resulted in proper handling characteristics and adequate mechanical properties, but slightly affected its bioactivity. Moreover, the degree of attachment, proliferation and osteogenic differentiation of preosteoblast cells was also increased. The results of the push-out test revealed that higher interfacial bonding strength was achieved with the modified bone cement because of the formation of the apatite layer and the osseointegration after implantation in the bony defect.Our findings suggested a new bioactive

  16. Cement augmentation versus extended dorsal instrumentation in the treatment of osteoporotic vertebral fractures: a biomechanical comparison.

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    Weiser, L; Dreimann, M; Huber, G; Sellenschloh, K; Püschel, K; Morlock, M M; Rueger, J M; Lehmann, W

    2016-08-01

    Loosening of pedicle screws is a major complication of posterior spinal stabilisation, especially in the osteoporotic spine. Our aim was to evaluate the effect of cement augmentation compared with extended dorsal instrumentation on the stability of posterior spinal fixation. A total of 12 osteoporotic human cadaveric spines (T11-L3) were randomised by bone mineral density into two groups and instrumented with pedicle screws: group I (SHORT) separated T12 or L2 and group II (EXTENDED) specimen consisting of T11/12 to L2/3. Screws were augmented with cement unilaterally in each vertebra. Fatigue testing was performed using a cranial-caudal sinusoidal, cyclic (1.0 Hz) load with stepwise increasing peak force. Augmentation showed no significant increase in the mean cycles to failure and fatigue force (SHORT p = 0.067; EXTENDED p = 0.239). Extending the instrumentation resulted in a significantly increased number of cycles to failure and a significantly higher fatigue force compared with the SHORT instrumentation (EXTENDED non-augmented + 76%, p osteoporotic spine compared with cement augmentation. Cite this article: Bone Joint J 2016;98-B:1099-1105. ©2016 The British Editorial Society of Bone & Joint Surgery.

  17. 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

  18. Development of a biodegradable bone cement

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    Yusof Abdullah; Nurhaslinda Ee Abdullah; Wee Pee Chai; Norita Mohd Zain

    2002-01-01

    Biodegradable bone cement is a newly developed bone repair material, which is able to give immediate support to the implant area, and does not obstruct the bone repairing and regeneration process through appropriate biodegradation rate, which is synchronized with the mechanical load it should bear. The purpose of this study is to locally produce biodegradable bone cement using HA as absorbable filler. The cement is composed of an absorbable filler and unsaturated polyester for 100% degradation. Cross-linking effect is achieved through the action of poly (vinyl pyrrol lidone) (PVP) and an initiator. On the other hand, PPF was synthesized using direct esterification method. Characteristics of the bone cement were studied; these included the curing time, cross-linking effect and curing temperature. The products were characterized using X-Ray diffraction (XRD) to perform phase analysis and Scanning Electrons Microscopes to determine the morphology. The physical and mechanical properties of the bone cement were also investigated. The biocompatibility of the bone cement was tested using simulated body physiological solution. (Author)

  19. Horizontal bone augmentation by means of guided bone regeneration.

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    Benic, Goran I; Hämmerle, Christoph H F

    2014-10-01

    The development of bone augmentation procedures has allowed placement of dental implants into jaw bone areas lacking an amount of bone sufficient for standard implant placement. Thus, the indications for implants have broadened to include jaw regions with bone defects and those with a bone anatomy that is unfavorable for implant anchorage. Of the different techniques, the best documented and the most widely used method to augment bone in localized alveolar defects is guided bone regeneration. A large body of evidence has demonstrated the successful use of guided bone regeneration to regenerate missing bone at implant sites with insufficient bone volume and the long-term success of implants placed simultaneously with, or after, guided bone regeneration. However, the influence of guided bone regeneration on implant survival and success rates, and the long-term stability of the augmented bone, remain unknown. Many of the materials and techniques currently available for bone regeneration of alveolar ridge defects were developed many years ago. Recently, various new materials and techniques have been introduced. Many of them have, however, not been sufficiently documented in clinical studies. The aim of this review was to present the scientific basis of guided bone regeneration and the accepted clinical procedures. A classification of bone defects has been presented, aiming at simplifying the decision-making process regarding the choice of strategy for bone augmentation. Finally, an outlook into actual research and the possible future options related to bone augmentation has been provided. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. 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.

  1. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

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    Rakesh Kumar Gupta

    2012-01-01

    Full Text Available Background: Dynamic hip screw (DHS has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients with an average age of 72 years (60 − 94 years of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31, good (score 24 − 31, fair (score 16 − 23, and poor (score < 16. Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 − 16 weeks. At an average followup of 18 months (range 12 − 24 months, no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears

  2. Augmented reality in bone tumour resection: An experimental study.

    Science.gov (United States)

    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.

  3. Preparation and Characterization of Injectable Brushite Filled-Poly (Methyl Methacrylate Bone Cement

    Directory of Open Access Journals (Sweden)

    Lucas C. Rodriguez

    2014-09-01

    Full Text Available Powder-liquid poly (methyl methacrylate (PMMA bone cements are widely utilized for augmentation of bone fractures and fixation of orthopedic implants. These cements typically have an abundance of beneficial qualities, however their lack of bioactivity allows for continued development. To enhance osseointegration and bioactivity, calcium phosphate cements prepared with hydroxyapatite, brushite or tricalcium phosphates have been introduced with rather unsuccessful results due to increased cement viscosity, poor handling and reduced mechanical performance. This has limited the use of such cements in applications requiring delivery through small cannulas and in load bearing. The goal of this study is to design an alternative cement system that can better accommodate calcium-phosphate additives while preserving cement rheological properties and performance. In the present work, a number of brushite-filled two-solution bone cements were prepared and characterized by studying their complex viscosity-versus-test frequency, extrusion stress, clumping tendency during injection through a syringe, extent of fill of a machined void in cortical bone analog specimens, and compressive strength. The addition of brushite into the two-solution cement formulations investigated did not affect the pseudoplastic behavior and handling properties of the materials as demonstrated by rheological experiments. Extrusion stress was observed to vary with brushite concentration with values lower or in the range of control PMMA-based cements. The materials were observed to completely fill pre-formed voids in bone analog specimens. Cement compressive strength was observed to decrease with increasing concentration of fillers; however, the materials exhibited high enough strength for consideration in load bearing applications. The results indicated that partially substituting the PMMA phase of the two-solution cement with brushite at a 40% by mass concentration provided the best

  4. Preparation and Characterization of Injectable Brushite Filled-Poly (Methyl Methacrylate) Bone Cement

    Science.gov (United States)

    Rodriguez, Lucas C.; Chari, Jonathan; Aghyarian, Shant; Gindri, Izabelle M.; Kosmopoulos, Victor; Rodrigues, Danieli C.

    2014-01-01

    Powder-liquid poly (methyl methacrylate) (PMMA) bone cements are widely utilized for augmentation of bone fractures and fixation of orthopedic implants. These cements typically have an abundance of beneficial qualities, however their lack of bioactivity allows for continued development. To enhance osseointegration and bioactivity, calcium phosphate cements prepared with hydroxyapatite, brushite or tricalcium phosphates have been introduced with rather unsuccessful results due to increased cement viscosity, poor handling and reduced mechanical performance. This has limited the use of such cements in applications requiring delivery through small cannulas and in load bearing. The goal of this study is to design an alternative cement system that can better accommodate calcium-phosphate additives while preserving cement rheological properties and performance. In the present work, a number of brushite-filled two-solution bone cements were prepared and characterized by studying their complex viscosity-versus-test frequency, extrusion stress, clumping tendency during injection through a syringe, extent of fill of a machined void in cortical bone analog specimens, and compressive strength. The addition of brushite into the two-solution cement formulations investigated did not affect the pseudoplastic behavior and handling properties of the materials as demonstrated by rheological experiments. Extrusion stress was observed to vary with brushite concentration with values lower or in the range of control PMMA-based cements. The materials were observed to completely fill pre-formed voids in bone analog specimens. Cement compressive strength was observed to decrease with increasing concentration of fillers; however, the materials exhibited high enough strength for consideration in load bearing applications. The results indicated that partially substituting the PMMA phase of the two-solution cement with brushite at a 40% by mass concentration provided the best combination of the

  5. Is More Cortical Bone Decortication Effective on Guided Bone Augmentation?

    Science.gov (United States)

    Acar, Ahmet Hüseyin; Alan, Hilal; Özgür, Cem; Vardi, Nigar; Asutay, Fatih; Güler, Çiğdem

    2016-10-01

    This study aims to evaluate the possible effect of more cortical bone decortication (CBD) on guided bone augmentation. A total of 16 New Zealand rabbits and 32 titanium domes were used. No cortical bone decortication was applied to the control group and in the study groups, the cortical bones were decorticated with a round burr (Group A: 1 hole with bleeding, Group B: 5 holes with bleeding, Group C: a thin layer of compact bone was completely removed with no bleeding). Then 2 titanium domes were placed on the calvarium of each rabbit with hydroxyapatite/beta-tricalcium phosphate. After 3 months, the animals were sacrificed and specimens were sent for histological and histomorphometric analysis. Histological and histomorphometric analysis showed that bone decortication with burr significantly increased new bone regeneration in all the experimental groups compared with the control group (P guided bone augmentation. However, a greater amount of CBD does not have a greater effect.

  6. Preparation and characterization of a novel bioactive bone cement: glass based nanoscale hydroxyapatite bone cement.

    Science.gov (United States)

    Fu, Qiang; Zhou, Nai; Huang, Wenhai; Wang, Deping; Zhang, Liying; Li, Haifeng

    2004-12-01

    A novel type of glass-based nanoscale hydorxypatite (HAP) bioactive bone cement (designed as GBNHAPC) was synthesized by adding nanoscale hydroxyapatite (HAP) crystalline (20-40 nm), into the self-setting glass-based bone cement (GBC). The inhibition rate of nanoscale HAP and micron HAP on osteosarcoma U2-OS cells was examined. The effects of nanoscale HAP on the crystal phase, microstructure and compressive strength of GBNHAPC were studied respectively. It was concluded that nanoscale HAP could inhibit the cell proliferation, while micron HAP could not, and that nanoscale HAP could be dispersed in the cement evenly and the morphology did not change significantly after a longer immersion time. XRD and FTIR results show nanoscale HAP did not affect the setting reaction of the cement. Furthermore, GBNHAPC had a higher compressive strength (92 MPa) than GBC. It was believed that GBNHAPC might be a desirable biomaterial that could not only fill bone defects but also inhibit cancer cell growth.

  7. Polyethylene glycol improves elution properties of polymethyl methacrylate bone cements.

    Science.gov (United States)

    Handal, John A; Tiedeken, Nathan C; Gershkovich, Grigory E; Kushner, Jeffrey A; Dratch, Benjamin; Samuel, Solomon P

    2015-03-01

    Bone cements are used as adjuncts to fracture fixation methods and can also function as a local drug delivery system. The ability to elute drugs makes bone cement a promising and powerful chemotherapy treatment modality for osseous tumors. However, because of poor elution rates, the clinical application of this drug delivery mode remains challenging. Soluble fillers, such as sugars, salts, or biocompatible polymers, offer a solution to improve elution rates. This study quantified the effect of polyethylene glycol (PEG) on the elution properties of three commercially available bone cements. Two grams of Vertebroplastic, Palacos, and Confidence bone cement powder containing three concentrations (0%, 20%, or 50%) of PEG filler were hand mixed with 10 mg of methotrexate. This powder mixture was then polymerized with 1.0 mL of the cement specific liquid monomer. The cylindrical elution samples were placed in saline solution and methotrexate elution was recorded for 720 h. The cumulative and daily elution rate increased as the concentration of PEG increased for each bone cement. However, the percent of increase depended on the bone cement used. Cumulative methotrexate elution increased by 40%-54% in case of the highest PEG filler concentration when compared with controls. PEG soluble filler offers a promising method for improving methotrexate drug elution in bone cement. Future studies need to optimize the PEG and bone cement ratio that produces the greatest drug elution profile without sacrificing the biomechanical properties of bone cement. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Regenerative capacity of augmented bone in rat calvarial guided bone augmentation model.

    Science.gov (United States)

    Kubota, Tatsuya; Hasuike, Akira; Ozawa, Yasumasa; Yamamoto, Takanobu; Tsunori, Katsuyoshi; Yamada, Yutaka; Sato, Shuichi

    2017-04-01

    Guided bone regeneration (GBR) is the most widely used technique to regenerate and augment bones. Even though augmented bones (ABs) have been examined histologically in many studies, few studies have been conducted to examine the biological potential of these bones and the healing dynamics following their use. Moreover, whether the bone obtained from the GBR procedure possesses the same functions as the existing autogenous bone is uncertain. In particular, little attention has been paid to the regenerative ability of GBR bone. Therefore, the present study histologically evaluated the regenerative capacity of AB in the occlusive space of a rat guided bone augmentation (GBA) model. The calvaria of 30 rats were exposed, and plastic caps were placed on the right of the calvaria in 10 of the 30 rats. After a 12-week healing phase, critical-sized calvarial bone defects (diameter: 5.0 mm) were trephined into the dorsal parietal bone on the left of the calvaria. Bone particles were harvested from the AB or the cortical bone (CB) using a bone scraper and transplanted into the critical defects. The newly generated bone at the defects' edge was evaluated using micro-computed tomography (micro-CT) and histological sections. In the micro-CT analysis, the radiopacity in both the augmented and the CB groups remained high throughout the observational period. In the histological analysis, the closure rate of the CB was significantly higher than in the AB group. The numbers of cells positive for runt-related transcription factor 2 (Runx2) and tartrate-resistant acid phosphatase (TRAP) in the AB group were larger than in the CB group. The regenerative capacity of AB in the occlusive space of the rat GBA model was confirmed. Within the limitations of this study, the regenerative ability of the AB particulate transplant was inferior to that of the CB particulate transplant.

  9. Low-modulus PMMA bone cement modified with castor oil.

    Science.gov (United States)

    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.

  10. Microindentation of Polymethyl Methacrylate (PMMA Based Bone Cement

    Directory of Open Access Journals (Sweden)

    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.

  11. Augmentation of anterior vertebral body screw fixation by an injectable, biodegradable calcium phosphate bone substitute.

    Science.gov (United States)

    Bai, B; Kummer, F J; Spivak, J

    2001-12-15

    A biomechanical study to evaluate the effects of a biodegradable calcium phosphate (Ca-P) bone substitute on the fixation strength and bending rigidity of vertebral body screws. To determine if an injectable, biodegradable Ca-P bone substitute provides significant augmentation of anterior vertebral screw fixation in the osteoporotic spine. Polymethylmethacrylate (PMMA) augmented screws have been used clinically; however, there is concern about thermal damage to the neural elements during polymerization of the PMMA as well as its negative effects on bone remodeling. Injectable, biodegradable Ca-P bone substitutes have shown enhanced fixation of pedicle screws. Sixteen fresh cadaveric thoracolumbar vertebrae were randomly divided into two groups: control (no augmentation) (n = 8) and Ca-P bone substitute augmentation (n = 8) groups. Bone-screw fixation rigidity in bending was determined initially and after 10(5) cycles, followed by pullout testing of the screw to failure to determine pullout strength and stiffness. The bone-screw bending rigidity for the Ca-P bone substitute group was significantly greater than the control group, initially (58%) and after cyclic loading (125%). The pullout strength for Ca-P bone substitute group (1848 +/- 166 N) was significantly greater than the control group (665 +/- 92 N) (P pullout for the Ca-P bone substitute groups (399 +/- 69 N/mm) was significantly higher than the control group (210 +/- 51 N/mm) (P screw fixation with a biodegradable Ca-P bone substitute is a potential alternative to the use of PMMA cement.

  12. Biomechanical evaluation of fixation strength of conventional and expansive pedicle screws with or without calcium based cement augmentation.

    Science.gov (United States)

    Gao, Mingxuan; Lei, Wei; Wu, Zixiang; Liu, Da; Shi, Lei

    2011-03-01

    The expansive pedicle screw was originally developed to be installed in the bone of compromised quality, but there are some concerns whether it can provide enough fixation strength in the spine with osteoporosis or severe osteoporosis. Twelve fresh human cadaver spines were stratified into four levels: normal, osteopenia, osteoporosis and severe osteoporosis. The vertebra was bilaterally instrumented with pedicle screws according to four protocols, including conventional pedicle screw without augmentation, expansive pedicle screw without augmentation, conventional screw with augmentation and expansive screw with augmentation. Screw pullout tests were conducted. Given the same specimen, the fixation strength of expansive screw was significantly higher than that of the conventional screw. When the same type of screw was used, the fixation strength of the calcium based cement augmented group was stronger than that of the non-augmented group. The pullout strength and stiffness of the expansive screw, augmented conventional screw and augmented expansive screw groups at the osteoporotic level were comparable to those of the conventional pedicle screw group at the osteopenic level. However, under the severely osteoporotic bone environment, the pullout strength of pedicle screw with whatever placement protocol was significantly lower than that of the conventional screw group at the osteopenic level. Our results demonstrate that (i) the expansive pedicle screw appears feasible and safe in either osteopenic or osteoporotic spine; (ii) calcium based cement augmentation can offer improved initial fixation strength of pedicle screws.; and (iii) no screw placement protocol we examined is efficacious in the bone at the severely osteoporotic level. Copyright © 2010 Elsevier Ltd. All rights reserved.

  13. 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.

  14. Bone Grafts, Substitutes, and Augments in Benign Orthopaedic Conditions Current Concepts.

    Science.gov (United States)

    Blank, Alan; Riesgo, Aldo; Gitelis, Steven; Rapp, Timothy

    2017-04-01

    Musculoskeletal tumors are relatively rare diagnoses made by orthopaedic surgeons. While approximately 2,500 primary bone sarcomas are diagnosed annually in the USA, the number of benign orthopaedic tumors encountered annually is far more difficult to quantify. Some studies have documented between 3% and 10% of the general population having benign bony lesions. Many of these conditions can be simply observed, while others will require surgical intervention. Surgical treatments for benign conditions range from a one-step curettage to extensive resection and reconstruction. With treatment of larger lesions, significant bony defects may need to be addressed surgically. Treatment options have evolved over time with the use of various bone graft and bone void fillers, including methyl methacrylate cement, autograft, allograft bone chips, struts and osteoarticular segments, synthetic bone graft substitutes, and metal augments. This review provides an overview of the present status of bone graft, substitutes, and augment options for the orthopaedic surgeon treating benign musculoskeletal conditions.

  15. Bone cement implantation syndrome in hip replacement procedure

    Directory of Open Access Journals (Sweden)

    Onur Palabiyik

    2013-06-01

    Full Text Available Total hip replacement procedures are common in geriatric patients with osteoarthrosis of the hip or femur fracture. We planned combined spinal epidural anesthesia for total hip replacement operation due to femur fracture in a ninety-five female case with cardiorespiratory failure. Although the regional anesthesia had applied smoothly, intraoperative cardiac arrest during the placement of cement was thought to be a case with bone cement implantation syndrome. Bone cement implantation syndrome is occured in cemented prosthesis operations and a life-threatened complication. Clinic presentation is characterized by hypoxia, hypotension, unexpected loss of consciousness and cardiac arrest. Mortality rate due to bone cement implantation syndrome is approximately 0.1%. In this present, we examined bone cement implantation syndrome, which is a severe complication. [J Contemp Med 2013; 3(2.000: 121-124

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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.

  18. 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.

  19. Regenerate augmentation with bone marrow concentrate after traumatic bone loss

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  1. 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.

  2. 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

  3. Ergotropic effect of bone cement on pedicle screw fixation in treatment of osteoporotic thoracolumbar fracture

    Directory of Open Access Journals (Sweden)

    Da LIU

    2017-02-01

    Full Text Available Objective To evaluate the ergotropic effect of bone cement on pedicle screw fixation in treatment of osteopo¬rotic thoracolumbar fracture. Methods Fifty-three patients with osteoporotic thoracolumbar fracture, admitted from Jun. 2013 to Dec. 2014, were included for treatment by augmentation of pedicle screw fixation with bone cement. All patients underwent pre-operative examination of bone mineral density with T-score ≤-2.5 and augmentation of pedicle screw fixation with injection of 1.5 ml bone cement in adjacent to fractured vertebra. All patients were treated with anti-osteoporosis therapy pre- and post-operation, ob¬served and recorded with basic conditions and complications. At pre-operation, one-week post-operation and last follow-up, pain vi¬sual analogue scale (VAS and neurological function score (ASIA of all patients were recorded, and the compression rats of anterior and posterior edge of fractured vertebra, and compression rats of spinal canal and Cobb angel of all patients were measured. Results All the 53 patients were successfully undergone operation in about 90-140 min with blood loss of about 150-350 ml. No spinal cord or nerve injury, dural tear and obvious leakage of bone cement and screw loosening occurred during operation. All patients were followed up for 12 to 36 months and the neurological function obviously recovered contrasted with pre-operation. X-ray and CT examination at last follow-up showed good fractures healing, good position and non-loosening of internal fixation device and non-leakage of bone cement. At one week post-operation and last follow-up, VAS, compression rats of anterior edge and posterior edge of fractured vertebra, compression rats of spinal canal and Cobb angel were significantly lower than those at pre-operation (P0.05. Conclusions Augmentation of pedicle screw fixation with bone cement can effectively strengthen the initial stability of pedicle screw in osteo¬porosis, restore the

  4. Injectable calcium phosphate cement as a graft material for maxillary sinus augmentation: an experimental pilot study.

    NARCIS (Netherlands)

    Aral, A.; Yalcin, S.; Karabuda, Z.C.; Anil, A.; Jansen, J.A.; Mutlu, Z.

    2008-01-01

    OBJECTIVES: The aim of the present study was to evaluate the efficiency of injectable CaP cement as a graft material around dental implants in the maxillary sinus augmentation procedure. MATERIAL AND METHODS: Bilateral sinus augmentation process was carried out in three sheep and two implants were

  5. 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)

  6. 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.

  7. 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.

  8. Enhancing pedicle screw fixation in the aging spine with a novel bioactive bone cement: an in vitro biomechanical study.

    Science.gov (United States)

    Zhu, Qingan; Kingwell, Stephen; Li, Zhaoyang; Pan, Haobo; Lu, William W; Oxland, Thomas R

    2012-08-01

    A paired biomechanical study of pedicle screws augmented with bone cement in a human cadaveric and osteoporotic lumbar spine model. OBJECTIVES.: To evaluate immediate strength and stiffness of pedicle screw fixation augmented with a novel bioactive bone cement in an osteoporotic spine model and compare it with polymethylmethacrylate (PMMA) cement. A novel bioactive bone cement, containing nanoscale particles of strontium and hydroxyapatite (Sr-HA), can promote new bone formation and osteointegration and provides a promising reinforcement to the osteoporotic spine. Its immediate mechanical performance in augmenting pedicle screw fixation has not been evaluated. Two pedicle screws augmented with Sr-HA and PMMA cement were applied to each of 10 isolated cadaveric L3 vertebrae. Each screw was subjected to a toggling test and screw kinematics were calculated. The pedicle screw was subjected to a pullout test until failure. Finally, the screw coverage with cement was measured on computed tomographic images. Screw translations in the toggling test were consistently larger in the Sr-HA group than in the PMMA group (1.4 ± 1.2 mm vs. 1.0 ± 1.1 mm at 1000 cycles). The rotation center was located closer to the screw tip in the Sr-HA group (19% of screw length) than in the PMMA group (37%). The only kinematic difference between Sr-HA and PMMA cements was the screw rotation at 1000 cycles (1.5° ± 0.9° vs. 1.3° ± 0.6°; P = 0.0026). All motion parameters increased significantly with more loading cycles. The pullout force was higher in the PMMA group than the Sr-HA group (1.40 ± 0.63 kN vs. 0.93 ± 0.70 kN), and this difference was marginally significant (P = 0.051). Sr-HA cement covered more of the screw length than PMMA cement (79 ± 19% vs. 43 ± 19%) (P = 0.036). This paired-design study identified some subtle but mostly nonsignificant differences in immediate biomechanical fixation of pedicle screws augmented with the Sr-HA cement compared with the PMMA cement.

  9. 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.

  10. Effect of maxillary sinus floor augmentation without bone grafts

    Directory of Open Access Journals (Sweden)

    D Shiva Kumar

    2013-01-01

    Full Text Available Objective: The objective of the present review was to determine the effectiveness of maxillary sinus floor augmentation without bone grafts using lateral window technique. Materials and Methods: PubMed and Cochrane databases were searched for relevant articles. We also included articles by hand search until June 2012. The analysis included both human and animal studies which satisfied the following criteria: Minimum of 6 months follow-up, no use of bone grafts, and lateral window approach to the sinus. Results: We included 22 articles in the review. A descriptive analysis of the constructed evidence tables indicated that there is evidence of predictable a mount of bone formation in the maxillary sinus augmentation without the use of bone grafts. Conclusion: Within the limits of the articles and data available, maxillary sinus augmentation without bone graft might be considered effective inpredictable bone formation.

  11. Antimicrobial activity of bone cements embedded with organic nanoparticles

    Directory of Open Access Journals (Sweden)

    Perni S

    2015-10-01

    Full Text Available Stefano Perni,1,2 Victorien Thenault,1 Pauline Abdo,1 Katrin Margulis,3 Shlomo Magdassi,3 Polina Prokopovich1,2 1School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK; 2Center for Biomedical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA; 3Casali Institute, Institute of Chemistry, The Center for Nanoscience and Nanotechnology, The Hebrew University of Jerusalem, Jerusalem, IsraelAbstract: Infections after orthopedic surgery are a very unwelcome outcome; despite the widespread use of antibiotics, their incidence can be as high as 10%. This risk is likely to increase as antibiotics are gradually losing efficacy as a result of bacterial resistance; therefore, novel antimicrobial approaches are required. Parabens are a class of compounds whose antimicrobial activity is employed in many cosmetic and pharmaceutical products. We developed propylparaben nanoparticles that are hydrophilic, thus expanding the applicability of parabens to aqueous systems. In this paper we assess the possibility of employing paraben nanoparticles as antimicrobial compound in bone cements. The nanoparticles were embedded in various types of bone cement (poly(methyl methacrylate [PMMA], hydroxyapatite, and brushite and the antimicrobial activity was determined against common causes of postorthopedic surgery infections such as: Staphylococcus aureus, methicillin-resistant S. aureus, Staphylococcus epidermidis, and Acinetobacter baumannii. Nanoparticles at concentrations as low as 1% w/w in brushite bone cement were capable of preventing pathogens growth, 5% w/w was needed for hydroxyapatite bone cement, while 7% w/w was required for PMMA bone cement. No ­detrimental effect was determined by the addition of paraben nanoparticles on bone cement compression strength and cytocompatibility. Our results demonstrate that paraben nanoparticles can be encapsulated in bone cement, providing concentration-dependent antimicrobial

  12. A comparison of high viscosity bone cement and low viscosity bone cement vertebroplasty for severe osteoporotic vertebral compression fractures.

    Science.gov (United States)

    Zhang, Liang; Wang, Jingcheng; Feng, Xinmin; Tao, Yuping; Yang, Jiandong; Wang, Yongxiang; Zhang, Shengfei; Cai, Jun; Huang, Jijun

    2015-02-01

    To compare the clinical outcome and complications of high viscosity and low viscosity poly-methyl methacrylate bone cement PVP for severe OVCFs. From December 2010 to December 2012, 32 patients with severe OVCFs were randomly assigned to either group H using high viscosity cement (n=14) or group L using low viscosity cement (n=18). The clinical outcomes were assessed by the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Short Form-36 General Health Survey (SF-36), kyphosis Cobb's angle, vertebral height, and complications. Significant improvement in the VAS, ODI, SF-36 scores, kyphosis Cobb's angle, and vertebral height were noted in both the groups, and there were no significant differences between the two groups. Cement leakage was seen less in group H. Postoperative assessment using computed tomography identified cement leakage in 5 of 17 (29.4%) vertebrae in group H and in 15 of 22 (68.2%) vertebrae in group L (P=0.025). The PVP using high viscosity bone cement can provide the same clinical outcome and fewer complications compared with PVP using low viscosity bone cement. Copyright © 2014. Published by Elsevier B.V.

  13. Ageing and moisture uptake in polymethyl methacrylate (PMMA) bone cements.

    Science.gov (United States)

    Ayre, Wayne Nishio; Denyer, Stephen P; Evans, Samuel L

    2014-04-01

    Bone cements are extensively employed in orthopaedics for joint arthroplasty, however implant failure in the form of aseptic loosening is known to occur after long-term use. The exact mechanism causing this is not well understood, however it is thought to arise from a combination of fatigue and chemical degradation resulting from the hostile in vivo environment. In this study, two commercial bone cements were aged in an isotonic fluid at physiological temperatures and changes in moisture uptake, microstructure and mechanical and fatigue properties were studied. Initial penetration of water into the cement followed Fickian diffusion and was thought to be caused by vacancies created by leaching monomer. An increase in weight of approximately 2% was experienced after 30 days ageing and was accompanied by hydrolysis of poly(methyl methacrylate) (PMMA) in the outermost layers of the cement. This molecular change and the plasticising effect of water resulted in reduced mechanical and fatigue properties over time. Cement ageing is therefore thought to be a key contributor in the long-term failure of cemented joint replacements. The results from this study have highlighted the need to develop cements capable of withstanding long-term degradation and for more accurate test methods, which fully account for physiological ageing. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. 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.

  15. 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.

  16. Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection

    NARCIS (Netherlands)

    Hendriks, JGE; van Horn, [No Value; van der Mei, HC; Busscher, HJ

    Antibiotic-loaded bone cement has been in use for over 30 years for the fixation of total joint arthroplasties, although its mechanism of action is still poorly understood. This review presents the backgrounds of bone cements, prosthesis-related infection and antibiotic-loaded bone cements. It is

  17. Total hip replacement with dorsal acetabular rim augmentation using the SOP(TM) implant and polymethylmethacrylate cement in seven dogs with dorsal acetabular rim deficiency.

    Science.gov (United States)

    Fitzpatrick, Noel; Bielecki, Malgorzata; Yeadon, Russell; Hamilton, Michael

    2012-01-01

    To describe a surgical technique for reinforced augmentation of the dorsal acetabular rim (DAR) using a string-of-pearls (SOP™) locking plate and polymethylmethacrylate (PMMA) bone cement, and to report clinical outcome in 7 dogs. Case series. Dogs (n=7). Medical records (November 2009-April 2010) of 7 dogs with large DAR deficits, that had total hip replacement (THR) with reinforced augmentation of the DAR using a SOP™ plate and PMMA were evaluated retrospectively. Reinforced augmentation of the DAR involved anchorage of a precontoured 2.0 or 2.7 mm SOP™ plate dorsal to the acetabulum followed by application of PMMA cement to cover the reamed acetabulum and plate. Cemented acetabular components were used. Implant associated complications were recorded and ≥6-month follow-up obtained. In all dogs, lameness improved at medium-term reassessment (median, 8 months; range, 6-11 months). Complications included transient sciatic neurapraxia in 2 dogs, which resolved by 3 months. Reinforced augmentation of the DAR using a SOP™ plate and PMMA cement may facilitate placement of acetabular THR component implantation in dogs with severe DAR insufficiency. © Copyright 2011 by The American College of Veterinary Surgeons.

  18. 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.

  19. Bone tissue aging affects mineralization of cement lines.

    Science.gov (United States)

    Milovanovic, Petar; Vom Scheidt, Annika; Mletzko, Kathrin; Sarau, George; Püschel, Klaus; Djuric, Marija; Amling, Michael; Christiansen, Silke; Busse, Björn

    2018-02-07

    Cement lines are known as thin peripheral boundaries of the osteons. With a thickness below 5 μm their composition of inorganic and organic compounds has been a matter of debate. Here, we hypothesized that cement lines become hypermineralized and their degree of mineralization is not constant but related to the tissue age of the osteon. Therefore, we analyzed the calcium content of osteons and their corresponding cement lines in a range of different tissue ages reflected by osteonal mineralization levels in femoral cortical bone of both postmenopausal women with osteoporosis and bisphosphonate-treated cases. Quantitative backscattered electron imaging (qBEI) showed that cement lines are hypermineralized entities with consistently higher calcium content than their corresponding osteons (mean calcium content: 29.46 ± 0.80 vs. 26.62 ± 1.11 wt%; p lines compared to the osteonal bone (8.78 ± 0.66 vs. 6.33 ± 0.58, p lines. A clear positive correlation of cement line mineralization and the mineralization of the osteon was observed (r = 0.839, p = 0.003). However, the magnitude of the difference between cement line and osteonal calcium content decreased with increased osteonal calcium content (r = -0.709, p line calcium content (p lines may represent another tissue-age related phenomenon, given that it strongly relates to the osteonal mineralization level. Understanding of the cement lines' mineralization and their changes in aging and disease states is important for predicting crack propagation pathways and fracture resistance mechanisms in human cortical bone. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. 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

  1. 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.

  2. PMMA/Ca2+ bone cements. Hydrolytic properties and bioactivity

    Directory of Open Access Journals (Sweden)

    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.

  3. A rat osteoporotic spine model for the evaluation of bioresorbable bone cements.

    Science.gov (United States)

    Wang, Mark L; Massie, Jennifer; Perry, Andrew; Garfin, Steven R; Kim, Choll W

    2007-01-01

    mineral density (BMD), average cortical thickness (ACT), average trabecular thickness (TbTh), and average trabecular spacing (TbSp). Strength and stiffness of both NL and OVX vertebral bodies were assessed under axial compression at 0.1 mm/s, whereas displacement (mm) and force (N) were measured at 10 Hz until completion to failure. After the implantation of an injectable form of CaSO(4) bone cement into caudal vertebrae, radiomorphometric analysis of cement volume, based on its unique CT absorption profile, was performed over the 8-week time period, as well as the subsequent bone response of both NL and OVX caudal vertebrae to CaSO4. OVX caudal vertebrae showed an 18% decrease in BMD, a 28% decrease in diaphyseal ACT, a 55% decrease in TbTh, and a 2.4-fold increase in TbSp compared with NL (pvertebrae exhibited a 21% decrease in BMD, a 24% decrease in anterior body ACT, a 48% decrease in TbTh, and a 4.7-fold increase in TbSp (pvertebrae, CaSO(4) cement exhibited a 50% decrease in initial cement volume at 2 weeks and complete resorption by 4 weeks, whereas CaSO(4) injected into NL vertebrae exhibited a 79% decrease in initial cement volume at 4 weeks, trace amounts at 6 weeks, and complete resorption by 8 weeks. At 8 weeks, NL vertebrae implanted with CaSO(4) cement exhibited increased cortical bone thickness compared with NL sham vertebrae. This CaSO(4) cement-mediated bone augmentation was altered in osteoporotic vertebrae that exhibited porous irregular cortical bone not noted in cement-treated NL vertebrae or OVX sham vertebrae. Future investigation of potential biomaterials intended for the local treatment of osteoporosis will require their study within an appropriate osteoporosis animal model. The OVX rat caudal spine exhibits pathologic bone changes consistent with the osteoporosis phenotype, including decreased BMD, diminished trabecular network density, cortical thinning, and decreased mechanical strength. These derangements in bone microarchitecture and

  4. Minimum cement volume required in vertebral body augmentation--A biomechanical study comparing the permanent SpineJack device and balloon kyphoplasty in traumatic fracture.

    Science.gov (United States)

    Rotter, Robert; Schmitt, Lena; Gierer, Philip; Schmitz, Klaus-Peter; Noriega, David; Mittlmeier, Thomas; Meeder, Peter-J; Martin, Heiner

    2015-08-01

    Minimally invasive treatment of vertebral fractures is basically characterized by cement augmentation. Using the combination of a permanent implant plus cement, it is now conceivable that the amount of cement can be reduced and so this augmentation could be an attractive opportunity for use in traumatic fractures in young and middle-aged patients. The objective of this study was to determine the smallest volume of cement necessary to stabilize fractured vertebrae comparing the SpineJack system to the gold standard, balloon kyphoplasty. 36 fresh frozen human cadaveric vertebral bodies (T11-L3) were utilized. After creating typical compression wedge fractures (AO A1.2.1), the vertebral bodies were reduced by SpineJack (n=18) or kyphoplasty (n=18) under preload (100N). Subsequently, different amounts of bone cement (10%, 16% or 30% of the vertebral body volume) were inserted. Finally, static and dynamic biomechanical tests were performed. Following augmentation and fatigue tests, vertebrae treated with SpineJack did not show any significant loss of intraoperative height gain, in contrast to kyphoplasty. In the 10% and 16%-group the height restoration expressed as a percentage of the initial height was significantly increased with the SpineJack (>300%). Intraoperative SpineJack could preserve the maximum height gain (mean 1% height loss) better than kyphoplasty (mean 16% height loss). In traumatic wedge fractures it is possible to reduce the amount of cement to 10% of the vertebral body volume when SpineJack is used without compromising the reposition height after reduction, in contrast to kyphoplasty that needs a 30% cement volume. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. 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.

  6. 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.

  7. Magnesium substitution in brushite cements for enhanced bone tissue regeneration

    International Nuclear Information System (INIS)

    Cabrejos-Azama, Jatsue; Alkhraisat, Mohammad Hamdan; Rueda, Carmen; Torres, Jesús; Blanco, Luis; López-Cabarcos, Enrique

    2014-01-01

    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

  8. Preparation of calcium phosphate cement and polymethyl methacrylate for biological composite bone cements.

    Science.gov (United States)

    Yang, Jun; Zhang, Kairui; Zhang, Sheng; Fan, Jiping; Guo, Xinhui; Dong, Weiqiang; Wang, Shengnan; Chen, Yirong; Yu, Bin

    2015-04-23

    We studied the biological safety, biomechanics, and tissue compatibility of calcium phosphate cement and Polymethyl Methacrylate composite bone cement mixed in different ratios. CPC and PMMA were mixed in different ratios (3:1, 2:1, 1:1, 1:2, 1:5, 1:10, 1:15, and 1:20). PMMA solvent is a general solvent containing a dissolved preparation of the composite bone cement specific to a given specimen to determine biological safety, biomechanics, and tissue compatibility. The CPC/PMMA (33%) group, CPC/PMMA (50%) group, CPC/PMMA (67%) group, and CPC/PMMA (75%) group were more in line with the composite bone cement without cytotoxicity requirements. The compressive strength of the CPC/PMMA (67%) group and CPC/PMMA (75%) group was 20 Mpa-30 Mpa, while that of the CPC/PMMA (4.8%) group, CPC/PMMA (6.25%) group, CPC/PMMA (9.1%) group, CPC/PMMA (16.7%) group, CPC/PMMA (33%) group, and CPC/PMMA (50%) group was 40 Mpa-70 Mpa. Curing time was longer in the CPC group (more than 11 min) and shorter in the PMMA group (less than 2 min). The results of weight loss rate showed that there were no significant differences between the CPC/PMMA group (4.8%, 6.25%, 9.1%, 16.7%, 33%) and PMMA control group (p>0.05). With the decrease of CPC content, the rate of weight loss gradually decreased. The CPC/PMMA (50%) group, CPC/PMMA (67%) group, and CPC/PMMA (75%) group provide greater variability and selectivity for the composite bone cement in obtaining better application.

  9. Suture anchor fixation strength with or without augmentation in osteopenic and severely osteoporotic bones in rotator cuff repair: a biomechanical study on polyurethane foam model.

    Science.gov (United States)

    Er, Mehmet Serhan; Altinel, Levent; Eroglu, Mehmet; Verim, Ozgur; Demir, Teyfik; Atmaca, Halil

    2014-08-22

    The purpose of the present study was to compare the results of various types of anchor applications with or without augmentation in both osteopenic and severely osteoporotic bone models. Two different types of suture anchors were tested in severely osteoporotic (SOP) and osteopenic polyurethane (PU) foam blocks using an established protocol. An Instron machine applied static loading parallel to the axis of insertion until failure, and the mean anchor failure strengths were calculated. The mode of failure (anchor pullout, suture tear) was recorded. The anchors tested included the Corkscrew (CS) (Arthrex Inc., Naples, FL, USA) (without augmentation, polymethylmethacrylate (PMMA)-augmented, and bioabsorbable tricalcium phosphate (TCP) cement-augmented) and Corkscrew FT II (CS FT II) 5.5 mm (without augmentation as used routinely). The mean failure loads for both SOP and osteopenic PU foam blocks, respectively, were as follows: CS, 16.2 and 212.4 N; CS with TCP, 75.2 and 396 N; CS with PMMA, 101.2 and 528.8 N; CS FT II, 13.8 and 339.8 N. Augmentation of CS with TCP or PMMA would be essential to SOP bones. In the osteopenic bone model, although anchor fixation augmented with PMMA is the best fixation method, CS augmented with TCP cement or CS FT II without any need for augmentation may also be used as an alternative.

  10. 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.

  11. Dynamic characteristics of osteoporotic lumbar spine under vertical vibration after cement augmentation.

    Science.gov (United States)

    Su, Xinlin; Shen, Hao; Shi, Weidong; Yang, Huilin; Lv, Feng; Lin, Jun

    2017-01-01

    Being beneficial in restoring stability and stiffness of osteoporotic vertebraes, cement augmentation techniques including vertebroplasty (VP) and kyphoplasty (KP) have been demonstrated to be effective for the treatment of patients with osteoporotic vertebral compressive fractures (OVCFs). However, it is unclear the influence of cement augmentation on the dynamics of pathologic and adjacent vertebraes under vibration condition. In this study, we developed a three-dimensional (3D) finite-element (FE) model of the spinal T12-Pelvis segment by using CT scan data of lumbar spine of an adult woman with no physical abnormalities. By modulating model parameters we further simulated osteoporotic conditions of the T12-Pelvis FE model with or without polymethyl methacrylate (PMMA) augmentation. Dynamic characteristics of the osteoporotic T12-Pelvis model were detected at the first order of vertical resonant frequencies (FOVRFs) under vertical vibration, which included vertical axial displacements, anteroposterior (AP) displacements and rotational angles of each vertebrae and intervertebral disc (IVD). The results showed that axial and AP displacements of both vertebraes and IVDs decreased in some point after PMMA augmentation. Axial displacements of the L4-L5 motion segment decreased most significantly and the changing ratios ranged from 20% to 30%. AP displacements of L5, D 1-2 (the IVD between vertebraes L1 and L2) and D 3-4 reduced most obviously after 1, 2 or 3 levels PMMA augmentation. No significant difference of axial or AP displacements of each vertebrae and IVD was observed between one-level and multilevel PMMA augmentation. Thus, we demonstrated that PMMA augmentation could reduce vertical axial and AP deformations of the osteoporotic lumbar motion segments under vertical vibration, especially for the inferior adjacent motion segments. However, the influence of the number of vertebraes with PMMA augmentation on the dynamics of osteoporotic lumbar spine was

  12. 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)

  13. Polymer--calcium phosphate cement composites for bone substitutes.

    Science.gov (United States)

    Mickiewicz, Rafal A; Mayes, Anne M; Knaack, David

    2002-09-15

    The use of self-setting calcium phosphate cements (CPCs) as bioresorbable bone-replacement implant materials presently is limited to non-load-bearing applications because of their low compressive strength relative to natural bone. The present study investigated the possibility of strengthening a commercially available CPC, alpha-BSM, by incorporating various water-soluble polymers into the cement paste during setting. Several polyelectrolytes, poly(ethylene oxide), and the protein bovine serum albumin (BSA) were added in solution to the cement paste to create calcium phosphate-polymer composites. Composites formulated with the polycations poly(ethylenimine) and poly(allylamine hydrochloride) exhibited compressive strengths up to six times greater than that of pure alpha-BSM material, with a maximum value reached at intermediate polymer content and for the highest molecular weight studied. Composites containing BSA developed compressive strengths twice that of the original cement at protein concentrations of 13-25% by weight. In each case, XRD studies correlate the improvement in compressive strength with reduced crystallite dimensions, as evidenced by a broadening of the (0,0,2) reflection. This suggests that polycation or BSA adsorption inhibits crystal growth and possibly leads to a larger crystal aspect ratio. SEM results indicate a denser, more interdigitated microstructure. The increased strength was attributed to the polymer's capacity to bridge between multiple crystallites (thus forming a more cohesive composite) and to absorb energy through plastic flow. Copyright 2002 Wiley Periodicals, Inc.

  14. Bone-Cement: The New Medical Quick Fix

    OpenAIRE

    Dinesh Bhatia

    2010-01-01

    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, hyperthyroidis...

  15. Bone Inflammation, Bone Infection and Dental Implants Failure: Histological and Cytological Aspects Related to Cement Excess

    Science.gov (United States)

    Tatullo, Marco; Marrelli, Massimo; Mastrangelo, Filiberto; Gherlone, Enrico

    2017-01-01

    Background: Dental implant failure can recognize several causes and many of them are quite preventable with the right knowledge of some clinical critical factors. Aim of this paper is to investigate about the histological aspects related to dental implants failure in such cases related to cement excess, how such histological picture can increase the risk of bacterial infections and how the different type of cement can interact with osteoblasts in-vitro. Methods: We randomly selected 5 patients with a diagnosis of dental implant failure requiring to be surgically removed: in all patients was observed an excess of dental cement around the failed implants. Histological investigations were performed of the perimplant bone. Cell culture of purchased human Osteoblasts was performed in order to evaluate cell proliferation and cell morphology at 3 time points among 3 cement types and a control surface. Results: Dental cement has been related to a pathognomonic histological picture with a foreign body reaction and many areas with black particles inside macrophage cells. Finally, cell culture on different dental cements resulted in a lower osteoblasts survival rate. Conclusions: It is appropriate that the dentist puts a small amount of dental cement in the prosthetic crown, so to avoid the clinical alterations related to the excess of cement. PMID:28529868

  16. Nostril Base Augmentation Effect of Alveolar Bone Graft

    Directory of Open Access Journals (Sweden)

    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.

  17. Biology and augmentation of tendon-bone insertion repair

    Directory of Open Access Journals (Sweden)

    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.

  18. Porous tantalum patellar augmentation: the importance of residual bone stock.

    Science.gov (United States)

    Ries, Michael D; Cabalo, Adam; Bozic, Kevin J; Anderson, Martin

    2006-11-01

    Trabecular metal augmentation of bone defects has been associated with favorable bone ingrowth. Animal studies also suggest fibrous tissue attachment to trabecular metal can be achieved. We treated 16 patients with total knee arthroplasty (18 knees) with severe patellar bone loss using trabecular metal patellar reconstruction. The patients were divided into two groups based on the amount of residual patellar bone stock present at the time of surgery: Group 1 (six patients, seven knees) with no patellar bone stock and Group 2 (10 patients, 11 knees) in whom at least 50% of the patellar component surface was covered by host bone. All seven patellar components in Group 1 loosened within 1 year. Two of these developed necrosis of the extensor mechanism leading to extensor mechanism discontinuity. One component in Group 2 became infected and loosened, whereas the remaining 10 components remained stable at minimum 12-month followup. Our results suggest stable fixation of a trabecular metal patellar component can be achieved when residual bone is present for implant fixation, but early loosening is likely to occur when soft tissue is used for fixation to the implant.

  19. Stem Cells and Calcium Phosphate Cement Scaffolds for Bone Regeneration.

    Science.gov (United States)

    Wang, P; Zhao, L; Chen, W; Liu, X; Weir, M D; Xu, H H K

    2014-07-01

    Calcium phosphate cements (CPCs) have excellent biocompatibility and osteoconductivity for dental, craniofacial, and orthopedic applications. This article reviews recent developments in stem cell delivery via CPC for bone regeneration. This includes: (1) biofunctionalization of the CPC scaffold, (2) co-culturing of osteoblasts/endothelial cells and prevascularization of CPC, (3) seeding of CPC with different stem cell species, (4) human umbilical cord mesenchymal stem cell (hUCMSC) and bone marrow MSC (hBMSC) seeding on CPC for bone regeneration, and (5) human embryonic stem cell (hESC) and induced pluripotent stem cell (hiPSC) seeding with CPC for bone regeneration. Cells exhibited good attachment/proliferation in CPC scaffolds. Stem-cell-CPC constructs generated more new bone and blood vessels in vivo than did the CPC control without cells. hUCMSCs, hESC-MSCs, and hiPSC-MSCs in CPC generated new bone and blood vessels similar to those of hBMSCs; hence, they were viable cell sources for bone engineering. CPC with hESC-MSCs and hiPSC-MSCs generated new bone two- to three-fold that of the CPC control. Therefore, this article demonstrates that: (1) CPC scaffolds are suitable for delivering cells; (2) hUCMSCs, hESCs, and hiPSCs are promising alternatives to hBMSCs, which require invasive procedures to harvest with limited cell quantity; and (3) stem-cell-CPC constructs are highly promising for bone regeneration in dental, craniofacial, and orthopedic applications. © International & American Associations for Dental Research.

  20. Augmentation of bone healing in delayed and atrophic nonunion of fractures of long bones by partially decalcified bone allograft (decal bone

    Directory of Open Access Journals (Sweden)

    Anuj Jain

    2015-01-01

    Conclusion: The partially decalcified bone allograft is an effective modality for augmentation of bone healing without complication associated with autograft like donor site morbidity, increased blood loss and increase in the surgical time.

  1. 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.

  2. 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)

  3. Pulmonary bone cement embolism: CT angiographic evaluation with material decomposition using gemstone special imaging

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Sun; Lee, Heon [Dept. of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon (Korea, Republic of)

    2014-08-15

    We report a case of pulmonary bone cement embolism in a female who presented with dyspnea following multiple sessions of vertebroplasty. She underwent spectral CT pulmonary angiography and the diagnosis was made based on enhanced visualization of radiopaque cement material in the pulmonary arteries and a corresponding decrease in the parenchymal iodine content. Here, we describe the CT angiography findings of bone cement embolism with special emphasis on the potential benefits of spectral imaging, providing additional information on the material composition.

  4. Enhanced osteointegration of poly(methylmethacrylate) bone cements by incorporating strontium-containing borate bioactive glass.

    Science.gov (United States)

    Cui, Xu; Huang, Chengcheng; Zhang, Meng; Ruan, Changshun; Peng, Songlin; Li, Li; Liu, Wenlong; Wang, Ting; Li, Bing; Huang, Wenhai; Rahaman, Mohamed N; Lu, William W; Pan, Haobo

    2017-06-01

    Although poly(methylmethacrylate) (PMMA) cements are widely used in orthopaedics, they have numerous drawbacks. This study aimed to improve their bioactivity and osseointegration by incorporating strontium-containing borate bioactive glass (SrBG) as the reinforcement phase and bioactive filler of PMMA cement. The prepared SrBG/PMMA composite cements showed significantly decreased polymerization temperature when compared with PMMA and retained properties of appropriate setting time and high mechanical strength. The bioactivity of SrBG/PMMA composite cements was confirmed in vitro , evidenced by ion release (Ca, P, B and Sr) from SrBG particles. The cellular responses of MC3T3-E1 cells in vitro demonstrated that SrBG incorporation could promote adhesion, migration, proliferation and collagen secretion of cells. Furthermore, our in vivo investigation revealed that SrBG/PMMA composite cements presented better osseointegration than PMMA bone cement. SrBG in the composite cement could stimulate new-bone formation around the interface between the composite cement and host bone at eight and 12 weeks post-implantation, whereas PMMA bone cement only stimulated development of an intervening connective tissue layer. Consequently, the SrBG/PMMA composite cement may be a better alternative to PMMA cement in clinical applications and has promising orthopaedic applications by minimal invasive surgery. © 2017 The Author(s).

  5. 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.

  6. Extended fatigue life of a catalyst-free self-healing acrylic bone cement using microencapsulated 2-octyl cyanoacrylate

    Science.gov (United States)

    Brochu, Alice B.W.; Matthys, Oriane B.; Craig, Stephen L.; Reichert, William M.

    2014-01-01

    The tissue adhesive 2-octyl cyanoacrylate (OCA) was encapsulated in polyurethane microshells and incorporated into bone cement to form a catalyst free, self-healing bone cement comprised of all clinically approved components. The bending strength, modulus, and fatigue lifetime were investigated in accordance with ASTM and ISO standards for the testing of PMMA bone cement. The bending strength of bone cement specimens decreased with increasing wt% capsules content for capsules without or with OCA, with specimens of formulation. PMID:24825796

  7. In vitro study investigating the mechanical properties of acrylic bone cement containing calcium carbonate nanoparticles.

    Science.gov (United States)

    Hill, Janet; Orr, John; Dunne, Nicholas

    2008-11-01

    A successful total hip replacement has an expected service life of 10-20 years with over 75% of failures due to aseptic loosening which is directly related to cement mantle failure. The aim of the present study was to investigate the addition of nanoparticles of calcium carbonate to acrylic bone cement. It was anticipated that an improvement in mechanical performance of the resultant nanocomposite bone cement would be achieved. A design of experiment approach was adopted to maximise the mechanical properties of the bone cement containing nanoparticles of calcium carbonate and to determine the constituents and preparation methods for which these occur. The selected conditions provided improvements of 21% in energy to maximum load, 10% in elastic modulus, 7% in bending strength and 8% in bending modulus when compared with bone cement without nanoparticles. Although cement containing nanoCaCO(3) coated in sodium citrate also enhanced the energy to maximum load by 28% and the elastic modulus by 14% when compared with control cement, it is not recommended as a factor in the production of nanocomposite bone cement due to reduction in the bending properties of the final bone cement.

  8. Percutaneous Imaging-Guided Screw Fixation of Osteoporotic Transverse Fractures of the Lower Sacrum with Cement Augmentation: Report of 2 Cases.

    Science.gov (United States)

    Garnon, Julien; Koch, Guillaume; Ramamurthy, Nitin; Bauones, Salem; Caudrelier, Jean; Tsoumakidou, Georgia; Cazzato, Roberto Luigi; Gangi, Afshin

    2017-07-01

    Osteoporotic fractures of the sacrum usually involve the sacral ala and can be managed with percutaneous cementoplasty if conservative therapy failed to achieve bone consolidation. On the other hand, isolated transverse fractures of the lowest sacrum are more rare, with little literature focusing on their management in the osteoporotic population. If pseudoarthrosis occurs in this location, sacroplasty is not an optimal therapeutic option because of the poor biomechanical resistance of cement to multi-directional stresses. Hence, we report two cases of chronic unhealed transverse fractures of the lowest sacrum successfully managed with percutaneous image-guided screw fixation augmented with cement injection. At last follow-up available, both patients experienced complete pain relief, without evidences of failure of the osteosynthesis on CT-scan controls.

  9. EMG-Guided Percutaneous Placement of Cement-Augmented Pedicle Screws for Osteoporotic Thoracolumbar Burst Fractures.

    Science.gov (United States)

    Iacopino, Domenico Gerardo; Certo, Francesco; Graziano, Francesca; Basile, Luigi; Gulì, Carlo; Visocchi, Massimiliano; Conti, Alfredo; Maugeri, Rosario

    2017-01-01

    Percutaneous techniques have increasingly gained popularity in recent years. The application of technological innovation, including neuromonitoring techniques, has the potential to increase the safety and efficacy of these procedures. Thirty patients suffering from osteoporotic dorsolumbar burst fracture were prospectively enrolled in this study. The patients underwent percutaneous fenestrated pedicle screw fixation augmented with polymethylmethacrylate (PMMA) injection. A novel surgeon-dedicated neuromonitoring device was used in order to increase the safety and the accuracy of the screw insertion. A second group of 30 patients who did not undergo neuromonitoring during percutaneous pedicle screw placement, matched for demographic characteristics, constituted the control group. A total of 296 screws were inserted. All treated patients had a good outcome, documented by an improvement in visual analogue scale (VAS) scores. Excellent trajectories were achieved in all patients. Cobb's angle and anterior vertebral height were satisfactorily restored in all study group patients. Three misplaced screws in three patients and a case of PMMA leakage without neurological deficits were observed in the control group, whereas no complication was recorded in the study group (p = 0.03). Neuromonitoring in cement-augmented percutaneous pedicle screw placement appears to improve surgeon confidence during surgery, reducing the risk of screw misplacement or cement leakage.

  10. Tensile properties of a bone cement containing non-ionic contrast media.

    Science.gov (United States)

    Kjellson, F; Wang, J S; Almén, T; Mattsson, A; Klaveness, J; Tanner, K E; Lidgren, L

    2001-01-01

    The addition of contrast media such as BaSO4 or ZrO2 to bone cement has adverse effects in joint replacements, including third body wear and particle-induced bone resorption. Ground PMMA containing particles of the non-ionic water-soluble iodine-based X-ray contrast media, iohexol (IHX) and iodixanol (IDX), has, in bone tissue culture, shown less bone resorption than commercial cements. These water-soluble non-ceramic contrast media may change the mechanical properties of acrylic bone cement. The static mechanical properties of bone cement containing either IHX or IDX have been investigated. There was no significant difference in ultimate stress between Palacos R (with 15.0 wt % of ZrO2) and plain cement with 8.0 wt % of IHX or IDX with mass median diameter (MMD) of 15.0 or 16.0 microm, while strain to failure was higher for the latter (p polymer beads, which may prevent areas of the acrylate bead surface from participating in the polymerization. In conclusion, the mechanical properties of bone cement were influenced by the size and amount of contrast medium particles. By choosing the appropriate amount and size of particles of water-soluble non-ionic contrast media the mechanical properties of the new radio-opaque bone cement can be optimized, thus reaching and surpassing given regulatory standards. Copyright 2001 Kluwer Academic Publishers

  11. Bone cement penetration pattern and primary stability testing in keeled and pegged glenoid components.

    Science.gov (United States)

    Raiss, Patric; Pape, Guido; Kleinschmidt, Kerstin; Jäger, Sebastian; Sowa, Boris; Jakubowitz, Eike; Loew, Markus; Bruckner, Thomas; Rickert, Markus

    2011-07-01

    It has been proposed that bone mineral density has an influence on cement penetration in hip and knee arthroplasty. The hypotheses of this study were that: 1) there is a negative correlation between bone mineral density (BMD) and cement penetration in cemented glenoid components; and 2) that implant design has an influence on cement penetration into the glenoid bone. BMD of 10 pairs of fresh frozen scapulas was measured. Micro-computed tomography (micro-CT) scans in 3 different sections were analyzed after implantation of keeled and pegged glenoid components using a 3(rd)-generation cementing technique with a vacuum mixing system. Cement penetration was analyzed and correlated with BMD. Pull-out strength testing was performed to analyze primary stability. The overall peak BMD was 0.6 [g/cm(2)] (range, 0.33-0.98). A strong negative correlation between BMD and mean cement penetration was found for the peg (R(2) = -.83; P penetration was 78.4 mm(2) (range, 60.6-94.2) in the keel and 113.9 mm(2) (range, 78.2-143.4) in the peg group (P < .0001). In all cases, the components were pulled out of the cement mantle, whereas the bone-cement interfaces remained intact. The mean pull-out strength was 1093N (764-1343N) for keeled and 884N (650-1264N) for pegged components (P < .05). A modern cementing technique, leading to a deep bonding between bone and cement, is crucial to prevent loosening of glenoid components. The findings of this study might help us to better understand the results of follow-up studies of cemented glenoid implants. Our results could be helpful for the choice of implants in patients with poor bone quality like osteoporosis or rheumatoid arthritis. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  12. The structural changes in the bone tissue and regional lymph nodes when using bone cement

    Science.gov (United States)

    Zhukov, D. V.; Zajdman, A. M.; Prohorenko, V. M.; Ustikova, N. V.

    2017-09-01

    In orthopedics bone cement is used to replace defects. However, it is known that it possesses toxic properties, due to its composition monomer methyl methacrylate. There are some unresolved issues, in particular its local action, not investigated reaction of the immune system to respond to any fluctuations of endoecological equilibrium. All this helps to explain not only the intraoperative complications such as acute heart and lung failure, but also many deferred pathological processes, complications in the postoperative period.

  13. Comparison of implant and provisional placement protocols in sinus-augmented bone: a preliminary report.

    Science.gov (United States)

    Lang, Lisa A; Edgin, Wendell A; Garcia, Lily T; Olvera, Norma; Verrett, Ronald; Bohnenkamp, David; Haney, Stephen J

    2015-01-01

    To evaluate preliminary data on clinical outcomes associated with timing of placement of single implant-supported provisional crowns and implants in augmented bone. Twenty patients underwent sinus elevation bone grafting followed by a 6-month healing period before implant placement and immediate placement of a provisional crown (group [G] 1); 20 patients received sinus elevation bone grafting at the time of implant placement and immediate placement of a provisional crown (G2); 20 patients required no bone augmentation before implant placement and immediate placement of a provisional crown (G3); and 20 patients received sinus elevation bone grafting followed by a 6-month healing period before implant placement followed by a 6-month healing period before restoration (G4). The height of the crestal bone was measured and recorded to determine mean bone changes, and success rates were determined. Mean bone level comparisons were made between G2 and G3, G2 and G4, and G3 and G4. No statistically significant differences were found between the groups (P crown placement. Implants that were restored immediately regardless of the timing of bone augmentation showed greater failure rates than implants in augmented bone with delayed restoration protocols or those that were restored immediately in sites without bone augmentation. Neither the timing of loading nor timing of implant placement in relation to bone augmentation surgery affected mean bone loss.

  14. Preparation and in vivo evaluation of a silicate-based composite bone cement.

    Science.gov (United States)

    Ma, Bing; Huan, Zhiguang; Xu, Chen; Ma, Nan; Zhu, Haibo; Zhong, Jipin; Chang, Jiang

    2017-08-01

    Silicate-based cements have been developed as a class of bioactive and biodegradable bone cements owing to their good in vitro bioactivity and ability to dissolve in a simulated body fluid. Until recently, however, the in vivo evidence of their ability to support bone regeneration is still scarce. In the present study, a pilot in vivo evaluation of a silicate-based composite bone cement (CSC) was carried out in a rabbit femur defect model. The cement was composed of tricalcium silicate, 45S5 bioglass and calcium sulfate, and the self-setting properties of the material were established. The in vivo bone integration and biodegradability of CSC were investigated and compared with those of bioactive glass particulates, and a calcium phosphate cement. The results showed that CSC underwent a relatively slower in vivo degradation as compared with bioactive glass and calcium phosphate cement. Histological observation demonstrated that bone contact area at the interface between the surrounding bone and CSC gradually increased with time proceeding. CSC kept its structural integrity during implantation in vivo because of its acceptable mechanical strength. These results provide evidence of effectiveness in vivo and suggest potential clinical applications of the silicate-based composite bone cements.

  15. The cement-augmented transiliacal internal fixator (caTIFI): an innovative surgical technique for stabilization of fragility fractures of the pelvis.

    Science.gov (United States)

    Schmitz, Paul; Baumann, Florian; Grechenig, Stephan; Gaensslen, Axel; Nerlich, Michael; Müller, Michael B

    2015-10-01

    Analyzing the different age groups in a population who suffered a pelvic ring fracture it becomes obvious that there are important differences between the pelvic ring lesions of an elderly patient compared to a young adult concerning trauma mechanism, fracture pattern and therapeutic options. In the elderly patient it is very important to achieve maximum of stability if surgery is necessary in order to avoid early failure of the ostheosynthesis under mobilization with full weight bearing. 15 patients (14 female) with fragility fractures of the pelvis that required surgical stabilization were eligible to participate in this study from December 2012 to December 2014. Such details were documented and analysed as patient demographics, mechanism of injury, fracture classification, operative treatment and postoperative radiological parameters of achieved bone-implant interface. The average age of the patients was 79.9 years (SD 9.0 years). According to Rommens five patients had a fragility fracture of the pelvis Type II-c, one a Type III-c, six a Type IV-b and three a Type IV-c. Four patients were treated by a cement augmented transiliac internal fixation (caTIFI). Seven patients received a cement augmented iliolumbar fixation. In all these patients the Schanz screws applied to the ilium were placed in an oblique dorsoventral direction into the supraacetabular bone canal (mean length of screws 100 ± 20mm, max. 135 mm, min. 70 mm). Even though in four patients the iliosacral joint was hit tangential and one cortex perforation without any cement leakage appeared no revision surgery was necessary. Overall the clinical findings including mobilisation with full weight bearing showed a sufficient mechanically stability in all patients. The focus of this study was to describe the modified surgical technique of the caTIFI with placing the Schanz screws from the posterior superior iliac spine to the anterior inferior iliac spine into the supraacetabular bone canal. Usage of

  16. Height restoration and maintenance after treating unstable osteoporotic vertebral compression fractures by cement augmentation is dependent on the cement volume used.

    Science.gov (United States)

    Krüger, Antonio; Baroud, Gamal; Noriega, David; Figiel, Jens; Dorschel, Christine; Ruchholtz, Steffen; Oberkircher, Ludwig

    2013-08-01

    Two different procedures, used for percutaneous augmentation of vertebral compression fractures were compared, with respect to height restoration and maintenance after cyclic loading. Additionally the impact of the cement volume used was investigated. Wedge compression fractures were created in 36 human cadavaric vertebrae (T10-L3). Twenty-seven vertebrae were treated with the SpineJack® with different cement volumes (maximum, intermediate, and no cement), and 9 vertebrae were treated with Balloon Kyphoplasty. Vertebral heights were measured pre- and postfracture as well as after treatment and loading. Cyclic loading was performed with 10,000cycles (1Hz, 100-600N). The average anterior height after restoration was 85.56% for Kyphoplasty; 96.20% for SpineJack® no cement; 93.44% for SpineJack® maximum and 96% for the SpineJack® intermediate group. The average central height after restoration was 93.89% for Kyphoplasty; 100.20% for SpineJack® no cement; 99.56% for SpineJack® maximum and 101.13% for the SpineJack® intermediate group. The average anterior height after cyclic loading was 85.33 % for Kyphoplasty; 87.30% in the SpineJack® no cement, 92% in the SpineJack® maximum and 87% in the SpineJack® intermediate group. The average central height after cyclic loading was 92% for Kyphoplasty; 93.80% in the SpineJack® no cement; 98.56% in the SpineJack® maximum and 94.25% in the SpineJack® intermediate group. Height restoration was significantly better for the SpineJack® group compared to Kyphoplasty. Height maintenance was dependent on the cement volume used. The group with the SpineJack® without cement nevertheless showed better results in height maintenance, yet the statistical significance could not be demonstrated. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. 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.

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

    Science.gov (United States)

    Tsai, Shang-Wen; Chen, Cheng-Fong; Wu, Po-Kuei; Chen, Chao-Ming; Chen, Wei-Ming

    2018-02-07

    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. 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. 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%. 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. Copyright © 2018. Published by Elsevier Taiwan LLC.

  19. Augmentation procedures using bone substitute materials or autogenous bone - a systematic review and meta-analysis.

    Science.gov (United States)

    Al-Nawas, Bilal; Schiegnitz, Eik

    2014-01-01

    Bone substitute materials (BSM) are described as a reasonable alternative to autologous bone (AB) to simplify the grafting procedure. In a systematic review and meta-analysis, the influence of BSM compared to AB on treatment success in augmentation procedures of the edentulous jaw was analysed. Literature analysis resulted in only two studies addressing reconstruction of the totally edentulous jaw using BSM. Therefore the literature analysis was extended to partially and totally edentulous jaws. The following augmentation procedures were analysed: maxillary sinus floor augmentation (MSFA) and vertical and/or lateral alveolar ridge augmentation; guided bone regeneration (minor and contained defects) were excluded. Meta-analysis was implemented using the literature from the years 2000 to early 2014 and only studies with a mean follow-up of at least 10 months were included. After screening 843 abstracts from the electronic database, 52 studies in qualitative and 14 in quantitative synthesis were included. In studies examining MSFA, the mean implant survival rate was 98.6% ± 2.6 for BSM, 88.6 ± 4.1% for BSM mixed with AB and 97.4 ± 2.2% for AB alone. For MSFA, meta-analysis showed a trend towards a higher implant survival when using BSM compared to AB, however the difference was not statistically significant ([OR], 0.59; [CI], 0.33-1.03). No statistically significant difference in implant survival for MSFA between BSM mixed with AB and AB was seen ([OR], 0.84; [CI], 0.5-1.42). Concerning ridge augmentation, the mean implant survival rate was 97.4 ± 2.5% for BSM, 100 ± 0% for BSM mixed with AB and 98.6 ± 2.9% for AB alone. Metaanalysis revealed no statistically significant difference in implant survival for ridge augmentation using BSM or AB ([OR], 1.85; [CI], 0.38 to 8.94). For BSM mixed with AB versus AB alone, a meta-analysis was not possible due to missing data. Within the limitation of the meta-analytical approach taken, implant survival seems to be

  20. Comparison of various vacuum mixing systems and bone cements as regards reliability, porosity and bending strength.

    Science.gov (United States)

    Mau, Hans; Schelling, Katrin; Heisel, Christian; Wang, Jian-Shang; Breusch, Steffen J

    2004-04-01

    There are several vacuum mixing systems on the market which are arbitrarily used with various bone cements in clinical work. Hardly any studies have been done on the performance and handling of these systems in combination with different cement brands. We therefore tested 6 vacuum mixing systems (Palamix, Summit, Cemvac, Optivac, Vacumix, MixOR) in combination with 6 cement brands (Palacos R, Simplex P, CWM 1, CWM 2000, Palamed G, VersaBond) concerning their reliability, user-friendliness, porosity and bending strength. Our study indicated that each system has weak points. The preparation of the mixed cement for gun injection can present problems. If cement collection under vacuum fails, porosity is increased. Manual collection without a vacuum carries the risk of intermixing air. For comfortable and effective retrograde cement application, cement guns should have a stable connection with the cartridge and a high piston stroke. There are marked differences between the systems as regards overall porosity when all tested cements are considered (range 2-18%), and between the cements when all tested systems are considered (range 2-17%). All test samples exceeded the required bending strength of 50 MPa, according to ISO 5833. Palaces specimens showed excessive plastic deformation in the bending test. There are better and worse mixing system/cement combinations for a given system and a given cement. Systems with cement collection under vacuum reduce porosity best.

  1. 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

  2. Development of hydroxyapatite bone cement for controlled drug ...

    Indian Academy of Sciences (India)

    ... difference could be detected in XRD patterns of the TCH–HA cement with various amounts of drug. By increasing the drug concentration, mechanical strength of cement was decreased and its setting time was increased. The results of this study demonstrate the potential of using HA cement as a carrier for drug delivery.

  3. 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.

  4. Blooming gelatin: an individual additive for enhancing nanoapatite precipitation, physical properties, and osteoblastic responses of nanostructured macroporous calcium phosphate bone cements.

    Science.gov (United States)

    Orshesh, Ziba; Hesaraki, Saeed; Khanlarkhani, Ali

    2017-01-01

    In recent years, there has been a great interest in using natural polymers in the composition of calcium phosphate bone cements to enhance their physical, mechanical, and biological performance. Gelatin is a partially hydrolyzed form of collagen, a natural component of bone matrix. In this study, the effect of blooming gelatin on the nanohydroxyapatite precipitation, physical and mechanical properties, and cellular responses of a calcium phosphate bone cement (CPC) was investigated. Various concentrations of blooming gelatin (2, 5, and 8 wt.%) were used as the cement liquid and an equimolar mixture of tetracalcium phosphate and dicalcium phosphate was used as solid phase. The CPC without any gelatin additive was also evaluated as a control group. The results showed that gelatin accelerated hydraulic reactions of the cement paste, in which the reactants were immediately converted into nanostructured apatite precipitates after hardening. Gelatin molecules induced 4%-10% macropores (10-300 μm) into the cement structure, decreased initial setting time by ~190%, and improved mechanical strength of the as-set cement. Variation in the above-mentioned properties was influenced by the gelatin concentration and progressed with increasing the gelatin content. The numbers of the G-292 osteoblastic cells on gelatin-containing CPCs were higher than the control group at entire culture times (1-14 days), meanwhile better alkaline phosphatase (ALP) activity was determined using blooming gelatin additive. The observation of cell morphologies on the cement surfaces revealed an appropriate cell attachment with extended cell membranes on the cements. Overall, adding gelatin to the composition of CPC improved the handling characteristics such as setting time and mechanical properties, enhanced nanoapatite precipitation, and augmented the early cell proliferation rate and ALP activity.

  5. Effect of misfit of cement-retained implant single crowns on crestal bone changes.

    Science.gov (United States)

    Chen, Chun-Jung; Papaspyridakos, Panos; Guze, Kevin; Singh, Medha; Weber, Hans-Peter; Gallucci, German O

    2013-01-01

    The purpose of this clinical study was to compare peri-implant crestal bone levels between misfitting (overhanging/open margin) cement-retained implant single crowns (SCs) vs accurately fitted implant SCs. Seventeen subjects were divided into two groups: test group (misfitting crowns, n = 10) and control group (accurately fitted crowns, n = 7). Crestal bone level changes were assessed using digital software. The average differences in mean bone loss within and between the two groups were statistically significant. Cement-retained implant SCs with marginal misfit resulted in more crestal bone loss than accurately fitted crowns after a mean of 3 years in function.

  6. Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation

    Directory of Open Access Journals (Sweden)

    Zeeshan Sheikh

    2015-05-01

    Full Text Available Alveolar bone augmentation in vertical dimension remains the holy grail of periodontal tissue engineering. Successful dental implant placement for restoration of edentulous sites depends on the quality and quantity of alveolar bone available in all spatial dimensions. There are several surgical techniques used alone or in combination with natural or synthetic graft materials to achieve vertical alveolar bone augmentation. While continuously improving surgical techniques combined with the use of auto- or allografts provide the most predictable clinical outcomes, their success often depends on the status of recipient tissues. The morbidity associated with donor sites for auto-grafts makes these techniques less appealing to both patients and clinicians. New developments in material sciences offer a range of synthetic replacements for natural grafts to address the shortcoming of a second surgical site and relatively high resorption rates. This narrative review focuses on existing techniques, natural tissues and synthetic biomaterials commonly used to achieve vertical bone height gain in order to successfully restore edentulous ridges with implant-supported prostheses.

  7. Calcium phosphate bone cements for local vancomycin delivery.

    Science.gov (United States)

    Loca, Dagnija; Sokolova, Marina; Locs, Janis; Smirnova, Anastasija; Irbe, Zilgma

    2015-04-01

    Among calcium phosphate biomaterials, calcium phosphate bone cements (CPCs) have attracted increased attention because of their ability of self-setting in vivo and injectability, opening the new opportunities for minimally invasive surgical procedures. However, any surgical procedure carries potential inflammation and bone infection risks, which could be prevented combining CPC with anti-inflammatory drugs, thus overcoming the disadvantages of systemic antibiotic therapy and controlling the initial burst and total release of active ingredient. Within the current study α-tricalcium phosphate based CPCs were prepared and it was found that decreasing the solid to liquid phase ratio from 1.89g/ml to 1.23g/ml, initial burst release of vancomycin within the first 24h increased from 40.0±2.1% up to 57.8±1.2% and intrinsic properties of CPC were changed. CPC modification with vancomycin loaded poly(lactic acid) (PLA) microcapsules decreased the initial burst release of drug down to 7.7±0.6%, while only 30.4±1.3% of drug was transferred into the dissolution medium within 43days, compared to pure vancomycin loaded CPC, where 100% drug release was observed already after 12days. During the current research a new approach was found in order to increase the drug bioavailability. Modification of CPC with novel PLA/vancomycin microcapsules loaded and coated with nanosized hydroxyapatite resulted in 85.3±3.1% of vancomycin release within 43days. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. [Application of an amphiphilic bonder in a goat model to increase the femoral cement-bone adhesion in cemented hip arthroplasty].

    Science.gov (United States)

    Müller-Rath, R; Wirtz, D; Andereya, S; Gravius, S; Hermanns-Sachweh, B; Marx, R; Mumme, T

    2007-01-01

    Cemented revision of femoral components in total hip arthroplasty has shown high rates of early loosening due to reduced micro- and macroretention of the cement to the endostal bone stock. Enhanced stability can be reached by an amphiphilic bonder, which offers a covalent bonding of the hydrophobic cement to the hydrophilic bone. The aim of this study is to evaluate the biocompatibility of such a bonder and its effects on the mechanical stability of cemented hip arthroplasty stems in vivo. Total cemented hip arthroplasties were performed in 20 sheep. In the verum group (n = 10) the implant bed was preconditioned by application of the bonder prior to femoral stem implantation. To study the biocompatibility around the bone-cement interface fluorescent marking of osteoblasts was applied in vivo throughout the observation period of 9 months. Native X-rays of the hip joints were obtained immediately after implantation and after euthanasia. The bone-cement interface was examined histologically. All stems of the verum group showed firm bonding of cement to bone in manual testing, while in 7 of the 10 controls the stems with adherent cement could be easily pulled out off the bony implant bed. This was coherent with significantly higher rates of progredient radiolucent lines and soft-tissue interpositions between bone and cement in the control group. The bonder was biocompatible. When preconditioned with an amphiphilic bonder, cemented stems showed a markedly higher adhesive strength to the cancellous bone without signs of inflammation or neoplasia. This procedure might offer enhanced longevity of cemented femoral revision stems in hip arthroplasty.

  9. 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.

  10. 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.)

  11. 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

  12. 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.

  13. Systematic review of the use of bone cement in ossicular chain reconstruction and revision stapes surgery

    NARCIS (Netherlands)

    Wegner, Inge; van den Berg, Jelle W G; Smit, Adriana L; Grolman, Wilko

    OBJECTIVES/HYPOTHESIS: To evaluate the effectiveness of bone cement on mean postoperative air-bone gap (ABG) and the proportion of ABG closure to within 20 dB in patients undergoing ossicular chain reconstruction or revision stapes surgery. DATA SOURCES: PubMed, Embase, and Central. METHODS: A

  14. Extended fatigue life of a catalyst free self-healing acrylic bone cement using microencapsulated 2-octyl cyanoacrylate.

    Science.gov (United States)

    Brochu, Alice B W; Matthys, Oriane B; Craig, Stephen L; Reichert, William M

    2015-02-01

    The tissue adhesive 2-octyl cyanoacrylate (OCA) was encapsulated in polyurethane microshells and incorporated into bone cement to form a catalyst free, self-healing bone cement comprised of all clinically approved components. The bending strength, modulus, and fatigue lifetime were investigated in accordance with ASTM and ISO standards for the testing of PMMA bone cement. The bending strength of bone cement specimens decreased with increasing wt % capsules content for capsules without or with OCA, with specimens of formulation. © 2014 Wiley Periodicals, Inc.

  15. Periosteal augmentation of allograft bone and its effect on implant fixation - an experimental study on 12 dogs()

    DEFF Research Database (Denmark)

    Barckman, Jeppe; Baas, Jorgen; Sørensen, Mette

    2013-01-01

    Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants.......Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants....

  16. Novel Injectable Calcium Phosphate Bone Cement from Wet Chemical Precipitation Method

    Science.gov (United States)

    Hablee, S.; Sopyan, I.; Mel, M.; Salleh, H. M.; Rahman, M. M.; Singh, R.

    2017-06-01

    Calcium phosphate cement has been prepared via chemical precipitation method for injectable bone filling materials. Calcium hydroxide, Ca(OH)2, and diammonium hydrogen phosphate, (NH4)2HPO4, were used as calcium and phosphorus precursors respectively. The synthesized powder was mixed with water at different powder-to-liquid (P/L) ratios, which was adjusted at 0.8, 0.9, 1.0, 1.1 and 1.2. The influence of P/L ratio on the injectability, setting time and mechanical strength of calcium phosphate cement paste has been evaluated. The synthesized powder appeared as purely hydroxyapatite with nanosized and agglomerated spherical particles. All cement pastes show excellent injectability except for the paste with P/L ratio 1.2. Calcium phosphate cement with P/L ratio 1.1 shows the ideal cement for bone filler application with good injectability, the initial and final setting times of 30 min and 160 min, and the compression strength of 2.47 MPa. The result indicated that the newly developed calcium phosphate cement is physically suitable for bone filler application. This paper presents our investigation on the effect of P/L ratio on the handling and mechanical properties of calcium phosphate cement prepared via wet chemical precipitation method.

  17. 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.

  18. Development of hydroxyapatite bone cement for controlled drug ...

    Indian Academy of Sciences (India)

    Abstract. 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 ...

  19. 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 ...

  20. Is it safe to back out pedicle screws after augmentation with polymethyl methacrylate or calcium phosphate cement? A biomechanical study.

    Science.gov (United States)

    Cho, Woojin; Wu, Chunhui; Zheng, Xiujun; Erkan, Serkan; Suratwala, Sanjeev J; Mehbod, Amir A; Transfeldt, Ensor E

    2011-06-01

    Biomechanical cadaveric study. To determine the torque required to remove pedicle screws augmented with polymethyl methacrylate (PMMA) or calcium phosphate cement (CPC); thus, proving the safety of back out of augmented screws in the osteopotoric model, which would be a more dangerous setting than the nonosteoporotic model. To our knowledge, no earlier study has characterized the safety of backing out pedicle screw augmented with PMMA or CPC. Pedicle screws were inserted in 24 osteoporotic vertebrae (48 pedicles). The maximal insertion torque and pullout strength of each screw were recorded. After pullout of the pedicle screws, the vertebrae were then randomized into 2 groups of 12 (24 pedicles) each. PMMA was injected into the pedicles in the first group and CPC was injected into the second group after which the pedicle screws were inserted. The pedicle screws were inserted into the pedicle holes augmented with PMMA or CPC, respectively. Finally, all augmented screws were backed out and the maximal removal torque was recorded using a digital torque wrench. Throughout the study, no incidence of pedicle or lamina fractures was observed. The average insertion torque was 0.5±0.27 and 0.45±0.29 N·m for groups 1 and 2, respectively (P=0.724). The average pullout strength was 723.1±391.7 and 671.2±383.0 N (P=0.950). After cement augmentation, the average removal torque was 0.77±0.31 and 0.81±0.26 N·m for PMMA and CPC, respectively (P=0.494). The results of this study showed that pedicle screws can be easily and safely backed out after augmentation with PMMA or CPC. The result of CPC, however, may only be valid before any bony ingrowth.

  1. Removal of hydroxyapatite cement from cadaveric temporal bones after transtemporal surgery.

    Science.gov (United States)

    Ying, Yu-Lan Mary; Durel, Jason; Arriaga, Moises A

    2013-10-01

    To determine the best method of removing hydroxyapatite cement from the temporal bone in the postoperative period. The advent of hydroxyapatite cement in neurotologic surgery of the temporal bone has dramatically decreased the rate of postoperative cerebrospinal fluid leaks. However, there is no literature currently available on how to manage these patients in the setting of postoperative hematomas of the cerebellopontine angle. Nine cadaveric temporal bones were obtained that had previously undergone translabyrinthine approach drilling in an academic temporal bone lab. Fascia and adipose tissue were placed medial to the facial nerve and the temporal bone was then filled with hydroxyapatite cement to the level of the cortex. Removal of hydroxyapatite cement was undertaken using a Freer elevator, mastoid bone curette, and finally, a drill in sequential fashion. This occurred at 9 predetermined time intervals from 1 to 30 hours and was timed in each case. Removal using the freer and curette failed in each case, and the drill was ultimately used to remove the hydroxyapatite cement in all cases. The time to reach the packed fascia and adipose tissue varied from 3 to 6 minutes, average time is 4.27 ± 0.84 minutes. Although hydroxyapatite cement has dramatically decreased the rate of postoperative cerebrospinal fluid leak in translabyrinthine surgery, its use has also brought a new set of considerations. This study suggests that hydroxyapatite cement removal in the setting of postoperative hematoma after translabyrinthine surgery would require drilling rather than bedside incisional opening alone. Like standard craniotomy approaches, postoperative hemorrhage management requires intraoperative drainage.

  2. Bone creep and short and long term subsidence after cemented stem total hip arthroplasty (THA).

    Science.gov (United States)

    Norman, T L; Shultz, T; Noble, G; Gruen, T A; Blaha, J D

    2013-03-15

    Stem-cement and cement-bone interfacial failures as well as cement fractures have been noted in cemented total hip arthroplasty (THA) as the cause of aseptic loosening. Attempts to reduce the risk of femoral component loosening include improving the stem-cement interface by various coatings, using a textured or porous coated stem surfaces or by using a tapered stem having a highly-polished surface. The latter approach, often referred to as "force-closed" femoral stem design, would theoretically result in stem stabilization subsequent to debonding and 'taper-lock'. Previous work using three-dimensional finite element analysis has shown a state of stress at the stem-cement interface indicative of 'taper-lock' for the debonded stem and indicated that stem-cement interface friction and bone cement creep played a significant role in the magnitudes of stresses and subsidence of the stem. However, the previous analysis did not include the viscoelastic properties of bone, which has been hypothesized to permit additional expansion of the bone canal and allow additional stem subsidence (Lu and McKellop, 1997). The goal of this study was to investigate the effect of bone viscoelastic behavior on stem subsidence using a 3D finite element analysis. It was hypothesized that the viscoelastic behavior of bone in the hoop direction would allow expansion of the bone reducing the constraint on bone over time and permit additional stem subsidence, which may account for the discrepancies between predicted and clinical subsidence measurements. Analyses were conducted using physiological loads, 'average peak loads' and 'high peak loads' for 'normal patient' and 'active patient' (Bergmann et al., 2010) from which short and long term subsidence was predicted. Results indicated that bone creep does contribute to higher stem subsidence initially and after 10 years of simulated loading. However, it was concluded that the "constraint" upon the cement mantle is not mitigated enough to result in

  3. Multiple bone metastases detected 10 years after mastectomy with silicone reconstruction for DCIS and contralateral augmentation

    OpenAIRE

    Mori, Ryutaro; Nagao, Yasuko

    2013-01-01

    Key Clinical Message The patient developed multiple bone metastases following mastectomy with silicone reconstruction and contralateral augmentation for ductal carcinoma in situ (DCIS) of the breast. She was diagnosed with contralateral invasive cancer. Distant metastasis of DCIS is rare, and other metastatic origins must be screened. However, screening of augmented breasts is difficult.

  4. 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)

  5. 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.

  6. Effects of Ultraviolet Photofunctionalization on Bone Augmentation and Integration Capabilities of Titanium Mesh and Implants.

    Science.gov (United States)

    Hirota, Makoto; Ikeda, Takayuki; Tabuchi, Masako; Ozawa, Tomomichi; Tohnai, Iwai; Ogawa, Takahiro

    Ultraviolet (UV)-mediated photofunctionalization has earned considerable attention for the enhancement of the biologic capabilities of titanium. The effects of photofunctionalization on bone augmentation and gap closure were examined using titanium implants and mesh in a rat femur model. An acid-etched titanium implant (4-mm length, 1-mm diameter) was placed in the gluteal tuberosity that resembles a knife-edge-like edentulous ridge. The lower half of the implant was located in a 2-mm-diameter defect created in the bone without cortical bone support; the upper half was exposed and covered with a titanium mesh to provide augmentation space. After 12 and 24 days of healing, specimens were subjected to microcomputed tomography (micro-CT)- and histology-based bone morphometry in three zones of analysis: augmentation, cortical bone-implant gap, and bone marrow. A biomechanical push-in test was performed to examine the strength of bone-implant integration. Photofunctionalization was performed by treating titanium implants and mesh with UV light for 12 minutes. Photofunctionalized titanium mesh and implants were hydrophilic, whereas untreated controls were hydrophobic. Bone volume was significantly greater in photofunctionalized implants and mesh than in untreated implants in all zones on days 12 and 24. Bone-to-implant contact of photofunctionalized implants was greater than that of untreated implants, not just in the bone marrow but also in the gap and augmented zones. The strength of osseointegration was three times greater for photofunctionalized implants than for untreated implants. Use of photofunctionalized titanium mesh and implants effectively enhanced vertical bone augmentation, cortical bone-implant gap closure, and osseointegration without innate bone support.

  7. 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)

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

    Science.gov (United States)

    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

  9. 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.

  10. A new biphasic osteoinductive calcium composite material with a negative Zeta potential for bone augmentation

    Directory of Open Access Journals (Sweden)

    Maciejewski Oliver

    2009-06-01

    Full Text Available Abstract The aim of the present study was to analyze the osteogenic potential of a biphasic calcium composite material (BCC with a negative surface charge for maxillary sinus floor augmentation. In a 61 year old patient, the BCC material was used in a bilateral sinus floor augmentation procedure. Six months postoperative, a bone sample was taken from the augmented regions before two titanium implants were inserted at each side. We analyzed bone neoformation by histology, bone density by computed tomography, and measured the activity of voltage-activated calcium currents of osteoblasts and surface charge effects. Control orthopantomograms were carried out five months after implant insertion. The BCC was biocompatible and replaced by new mineralized bone after being resorbed completely. The material demonstrated a negative surface charge (negative Zeta potential which was found to be favorable for bone regeneration and osseointegration of dental implants.

  11. Combined micro computed tomography and histology study of bone augmentation and distraction osteogenesis

    Science.gov (United States)

    Ilgenstein, Bernd; Deyhle, Hans; Jaquiery, Claude; Kunz, Christoph; Stalder, Anja; Stübinger, Stefan; Jundt, Gernot; Beckmann, Felix; Müller, Bert; Hieber, Simone E.

    2012-10-01

    Bone augmentation is a vital part of surgical interventions of the oral and maxillofacial area including dental implantology. Prior to implant placement, sufficient bone volume is needed to reduce the risk of peri-implantitis. While augmentation using harvested autologous bone is still considered as gold standard, many surgeons prefer bone substitutes to reduce operation time and to avoid donor site morbidity. To assess the osteogenic efficacy of commercially available augmentation materials we analyzed drill cores extracted before implant insertion. In younger patients, distraction osteogenesis is successfully applied to correct craniofacial deformities through targeted bone formation. To study the influence of mesenchymal stem cells on bone regeneration during distraction osteogenesis, human mesenchymal stem cells were injected into the distraction gap of nude rat mandibles immediately after osteotomy. The distraction was performed over eleven days to reach a distraction gap of 6 mm. Both the rat mandibles and the drill cores were scanned using synchrotron radiation-based micro computed tomography. The three-dimensional data were manually registered and compared with corresponding two-dimensional histological sections to assess bone regeneration and its morphology. The analysis of the rat mandibles indicates that bone formation is enhanced by mesenchymal stem cells injected before distraction. The bone substitutes yielded a wide range of bone volume and degree of resorption. The volume fraction of the newly formed bone was determined to 34.4% in the computed tomography dataset for the augmentation material Geistlich Bio-Oss®. The combination of computed tomography and histology allowed a complementary assessment for both bone augmentation and distraction osteogenesis.

  12. 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

  13. Gentamicin release from modified acrylic bone cements with lactose and hydroxypropylmethylcellulose.

    Science.gov (United States)

    Virto, M R; Frutos, P; Torrado, Susana; Frutos, G

    2003-01-01

    Modified polymethylmethacrylate (PMMA) bone cements formulations were prepared by including different proportions of gentamicin and release modulators such as lactose or hydroxypropylmethylcellulose (HPMC). Surface aspect, gentamicin release and porosity of these modified formulations were studied by means of scanning electron microscopy (SEM), a specially designed system for the dissolution studies of the bone cements, and mercury intrusion porosimetry. Lactose modified cements presented an irregular surface with numerous hollows and voids due to the lactose dissolution. HPMC cements presented a characteristic laminated and flaky surface. The drug release of lactose formulations was up to four-fold greater (13%) than the commercial bone cement CMW1 Gentamicin one (3%). The amount of gentamicin eluted at the first withdrawn sample ranged from 30% to 60% of total gentamicin released over the assay. Gentamicin release from lactose formulations increased as lactose percentage was increased which agree with the porosity results. Nevertheless, the use of release modulator HPMC increased porosity, but did not produce an increase in the gentamicin release. HPMC dissolution creates a surrounding sticky and viscous medium similar to a gel that makes the gentamicin release from the cement matrix difficult. Copyright 2002 Elsevier Science Ltd.

  14. Performance of the Straumann Bone Level Implant system for anterior single-tooth replacements in augmented and nonaugmented sites: a prospective cohort study with 60 consecutive patients.

    Science.gov (United States)

    Santing, Hendrik J; Raghoebar, Gerry M; Vissink, Arjan; den Hartog, Laurens; Meijer, Henny J A

    2013-08-01

    The purpose of this prospective study was to evaluate radiographic, clinical and aesthetic outcomes and patient satisfaction of cases treated with platform-switched single implant restorations in the aesthetic region of the maxilla. Furthermore, the influence of an augmentation procedure 3 months before implant placement and the type of restoration (screw-retained vs. cement-retained) was evaluated. Sixty patients with a missing anterior tooth in the maxilla were treated with a Straumann Bone Level Implant. Bone augmentation was performed in 29 patients at 3 months before implant placement. Implants were loaded after 3 months of submerged healing. Follow-up was conducted at 7 and 18 months after implant placement. Peri-implant mucosa and implant crown aesthetic outcomes were determined using the Implant Crown Aesthetic Index (ICAI) and the Pink Esthetic Score-White Esthetic Score (PES-WES). No implants were lost. At 18 months after implant placement, mean bone level change was -0.10 ± 0.27 mm and mean probing pocket depth was 2.57 mm. No differences were found between augmented and nonaugmented sites (P = 0.28). The ICAI indicated satisfactory mucosa and crown aesthetics in 67% and 75% of the cases, respectively, while the PES score was 14.4. ICAI mucosa (P = 0.004) and PES (P = 0.02) scores were significantly less favourable for augmented sites compared with nonaugmented sites. Patient satisfaction was high (8.9 ± 1.1 on VAS-score). From the present prospective, clinical study, it can be concluded that the Straumann Bone Level Implant shows an excellent survival rate, marginal bone stability and good clinical and aesthetic results. Bone augmentation before implant placement does not lead to more marginal bone loss. However, less favourable pink aesthetic outcomes were found in augmented sites compared with nonaugmented sites, while no differences were found between cement-retained and screw-retained restorations. © 2012 John Wiley & Sons A/S.

  15. [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

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

    Science.gov (United States)

    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.

  17. Treatment concepts for the posterior maxilla and mandible: short implants versus long implants in augmented bone.

    Science.gov (United States)

    Thoma, Daniel Stefan; Cha, Jae-Kook; Jung, Ui-Won

    2017-02-01

    The aim of this narrative review is to describe treatment options for the posterior regions of the mandible and the maxilla, comparing short implants vs. longer implants in an augmented bone. The dental literature was screened for treatment options enabling the placement of dental implants in posterior sites with a reduced vertical bone height in the maxilla and the mandible. Short dental implants have been increasingly used recently, providing a number of advantages including reduced patient morbidity, shorter treatment time, and lower costs. In the posterior maxilla, sinus elevation procedures were for long considered to be the gold standard using various bone substitute materials and rendering high implant survival rates. More recently, implants were even placed without any further use of bone substitute materials, but the long-term outcomes have yet to be documented. Vertical bone augmentation procedures in the mandible require a relatively high level of surgical skill and allow the placement of standard-length dental implants by the use of autogenous bone blocks. Both treatment options, short dental implants, and standard-length implants in combination with vertical bone augmentation procedures, appear to result in predictable outcomes in terms of implant survival rates. According to recent clinical studies comparing the therapeutic options of short implants vs. long implants in augmented bone, the use of short dental implants leads to a number of advantages for the patients and the clinician.

  18. 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...

  19. 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

  20. 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.

  1. Rehabilitation of postrior atrophic edentulous jaws: prostheses supported by 5 mm short implants or by longer implants in augmented bone? One-year results from a pilot randomised clinical trial.

    Science.gov (United States)

    Esposito, Marco; Pellegrino, Gerardo; Pistilli, Roberto; Felice, Pietro

    2011-01-01

    To evaluate whether 5 mm short dental implants could be an alternative to augmentation with anorganic bovine bone and placement of at least 10 mm long implants in posterior atrophic jaws. Fifteen patients with bilateral atrophic mandibles (5-7 mm bone height above the mandibular canal), and 15 patients with bilateral atrophic maxillae (4-6 mm bone height below the maxillary sinus) and bone thickness of at least 8 mm, were randomised according to a splitmouth design to receive one to three 5 mm short implants or at least 10 mm long implants in augmented bone. Mandibles were vertically augmented with interpositional bone blocks and maxillary sinuses with particulated bone via a lateral window. Implants were placed after 4 months, submerged and loaded, after 4 months, with provisional prostheses. Four months later, definitive provisionally cemented prostheses were delivered. Outcome measures were: prosthesis and implant failures, any complication and peri-implant marginal bone level changes. In 5 augmented mandibles, the planned 10 mm long implants could not be placed and shorter implants (7 and 8.5 mm) had to be used instead. One year after loading no patient dropped out. Two long (8.5 mm in the mandible and 13 mm in the maxilla) implants and one 5 mm short maxillary implant failed. There were no statistically significant differences in failures or complications. Patients with short implants lost on average 1 mm of peri-implant bone and patients with longer implants lost 1.2 mm. This difference was statistically significant. This pilot study suggests that 1 year after loading, 5 mm short implants achieve similar if not better results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation since the treatment is faster, cheaper and associated with less morbidity, however their long-term prognosis is unknown.

  2. [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.

  3. On the development of an apatitic calcium phosphate bone cement

    Indian Academy of Sciences (India)

    Unknown

    of the putty were measured using a Vicat type apparatus and the compressive strength was determined with a. Universal Testing Machine. The nature of the precipitated cement was analyzed through X-ray diffraction. (XRD), fourier transform infrared spectrometry (FTIR) and energy dispersive electron microprobe (EDAX).

  4. On the development of an apatitic calcium phosphate bone cement

    Indian Academy of Sciences (India)

    The setting times of the putty were measured using a Vicat type apparatus and the compressive strength was determined with a Universal Testing Machine. The nature of the precipitated cement was analyzed through X-ray diffraction (XRD), fourier transform infrared spectrometry (FTIR) and energy dispersive electron ...

  5. On the development of an apatitic calcium phosphate bone cement

    Indian Academy of Sciences (India)

    The wetting medium used was distilled water with Na2HPO4 as accelerator to manipulate the setting time. The cement powder, on wetting with the medium, formed a workable putty. The setting times of the putty were measured using a Vicat type apparatus and the compressive strength was determined with a Universal ...

  6. 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)

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Acetabular reconstruction with bone impaction grafting and a cemented cup: 20 years' experience.

    NARCIS (Netherlands)

    Schreurs, B.W.; Slooff, T.J.J.H.; Gardeniers, J.W.M.; Buma, P.

    2001-01-01

    Acetabular bone stock loss compromises the outcome in primary and revision total hip arthroplasty. In 1979, a biologic method was introduced with tightly impacted cancellous allografts in combination with a cemented polyethylene cup for acetabular reconstruction. With this technique, it is possible

  9. Effects of self-blood on the molding process of polymethyl methacrylate bone cement.

    Science.gov (United States)

    Guo, Ying-Jun; Nie, Lin; Zhang, Wen; Mu, Qing

    2014-01-01

    To evaluate whether the self-blood has influence on the molding process of polymethyl methacrylate (PMMA) bone cement, and to make sure whether it is valuable for the clinical practice. An in vitro study was performed to evaluate the prolonging-effect of self-blood on PMMA bone cement. The effect of prolonging was evaluated by the dough time (TD) and operable time (TO). Moreover, hardness test, squeezing value test and peak temperature test were also conducted to complete the evaluation of this program. The self-blood, especially the plasma, could greatly prolong the handling time of PMMA bone cement without affecting its basic characteristics including hardness, leakage level and peak temperature. On the other hand, we found that in some abnormal conditions, for example with hyperlipemia, self-blood though can also prolong the handling time, would cause some side-effects. We report a new effective way to prolong the handling time of PMMA bone cement by adding moderate amount of self-blood. But "individualized medicine" should be noticed because some abnormal conditions like hyperlipemia would cause undesired side-effects.

  10. 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

  11. A novel bone cement impregnated with silver–tiopronin nanoparticles: its antimicrobial, cytotoxic, and mechanical properties

    Science.gov (United States)

    Prokopovich, Polina; Leech, Ralph; Carmalt, Claire J; Parkin, Ivan P; Perni, Stefano

    2013-01-01

    Post-operatory infections in orthopedic surgeries pose a significant risk. The common approach of using antibiotics, both parenterally or embedded in bone cement (when this is employed during surgery) faces the challenge of the rising population of pathogens exhibiting resistance properties against one or more of these compounds; therefore, novel approaches need to be developed. Silver nanoparticles appear to be an exciting prospect because of their antimicrobial activity and safety at the levels used in medical applications. In this paper, a novel type of silver nanoparticles capped with tiopronin is presented. Two ratios of reagents during synthesis were tested and the effect on the nanoparticles investigated through TEM, TGA, and UV-Vis spectroscopy. Once encapsulated in bone cement, only the nanoparticles with the highest amount of inorganic fraction conferred antimicrobial activity against methicillin resistant Staphylococcus aureus (MRSA) at concentrations as low as 0.1% w/w. No other characteristics of the bone cement, such as cytotoxicity or mechanical properties, were affected by the presence of the nanoparticles. Our work presents a new type of silver nanoparticles and demonstrates that they can be embedded in bone cement to prevent infections once the synthetic conditions are tailored for such applications. PMID:23818779

  12. Micromechanical characterisation of failure in acrylic bone cement: the effect of barium sulphate agglomerates.

    Science.gov (United States)

    Shearwood-Porter, N; Browne, M; Sinclair, I

    2012-09-01

    Acrylic bone cement has been established as a method of fixation of load-bearing orthopaedic implants for nearly five decades, and has produced excellent long term clinical results. However, increasing patient BMI values and longer life expectancies are placing ever greater demands on joint replacements, so there is a need to further improve the performance of cemented fixation. Damage accumulation in the in vivo cement mantle due to initiation and coalescence of fatigue micro-cracks has been implicated in the aseptic loosening and failure of implants. While the effect of porosity on crack initiation processes has been widely reported, the relative influence of different radiopacifying agents is less well studied. In particular, barium sulphate radiopacifier particles have been reported to form large agglomerates within the cement that have been linked to initiation of fatigue cracks in vitro. However, there appears to be little understanding of the micromechanical aspects of cement failure due to barium sulphate agglomeration. The present study utilised micro-computed tomography (μCT) and field emission gun scanning electron microscopy (FEG-SEM), alongside mechanical testing, to provide a systematic, quantitative assessment of the effect of barium sulphate agglomeration on crack initiation processes in a conventional, vacuum-mixed acrylic cement. Three-dimensional characterisation of defect populations was performed, with agglomerates of barium sulphate particles found to be large (up to 0.37 mm equivalent spherical diameter), present at spatial densities up to 22 per mm³, and evenly distributed through each cement specimen. Fatigue cracks consistently initiated at the largest agglomerates; furthermore, fatigue life was found to scale consistently with largest defect size. As such, the tendency of barium sulphate particles to agglomerate is clearly evidenced to be detrimental to the fatigue performance of this cement in vitro. Optimisation of mixing techniques

  13. 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

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

    Directory of Open Access Journals (Sweden)

    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

  15. Piroxicam treatment augments bone abnormalities in interleukin-10 knockout mice

    DEFF Research Database (Denmark)

    Holgersen, Kristine; Dobie, Ross; Farquharson, Colin

    2015-01-01

    BACKGROUND: Osteoporosis and fractures are common complications of inflammatory bowel disease. The pathogenesis is multifactorial and has been partly attributed to intestinal inflammation. The aim of this study was to evaluate bone status and assess the association between bone loss and gut...... inflammation in an experimental colitis model. METHODS: Colitis was induced in interleukin-10 knockout mice (PAC IL-10 k.o.) by peroral administration of piroxicam for 12 days. The degree of colitis was assessed by clinical, macroscopic, and microscopic evaluation. Trabecular and cortical bone...... microarchitecture of tibia were determined using micro-computed tomography. Moreover, the serum levels of bone formation and bone resorption biomarkers were measured, and inflammatory protein profiling was performed on colons. RESULTS: PAC IL-10 k.o. mice developed severe colitis, characterized by hyperplasia...

  16. Piroxicam treatment augments bone abnormalities in interleukin-10 knockout mice.

    Science.gov (United States)

    Holgersen, Kristine; Dobie, Ross; Farquharson, Colin; vanʼt Hof, Rob; Ahmed, Syed Faisal; Hansen, Axel Kornerup; Holm, Thomas L

    2015-02-01

    Osteoporosis and fractures are common complications of inflammatory bowel disease. The pathogenesis is multifactorial and has been partly attributed to intestinal inflammation. The aim of this study was to evaluate bone status and assess the association between bone loss and gut inflammation in an experimental colitis model. Colitis was induced in interleukin-10 knockout mice (PAC IL-10 k.o.) by peroral administration of piroxicam for 12 days. The degree of colitis was assessed by clinical, macroscopic, and microscopic evaluation. Trabecular and cortical bone microarchitecture of tibia were determined using micro-computed tomography. Moreover, the serum levels of bone formation and bone resorption biomarkers were measured, and inflammatory protein profiling was performed on colons. PAC IL-10 k.o. mice developed severe colitis, characterized by hyperplasia and focal transmural inflammation, which was consistent with Crohn's disease-like pathology. The gut inflammation was accompanied by a 14% and 12% reduction in trabecular thickness relative to piroxicam-treated wild type and untreated wild type mice, respectively (P < 0.001). The trabecular bone structure was also changed in PAC IL-10 k.o. mice, whereas no differences in cortical bone geometry were observed. The trabecular thickness was inversely correlated with serum levels of CTX (r = -0.93, P = 0.006). Moreover, numerous inflammatory mediators, including RANKL and osteoprotegerin, were significantly increased in the colon of PAC IL-10 k.o. mice. PAC IL-10 k.o. mice develop bone loss and changed trabecular structure, as a result of increased bone resorption. Thus, the PAC IL-10 k.o. model could be a useful experimental model in preclinical research of inflammatory bowel disease-associated bone loss.

  17. Strontium doped injectable bone cement for potential drug delivery applications.

    Science.gov (United States)

    Taha, Ali; Akram, Muhammad; Jawad, Zaidoon; Alshemary, Ammar Z; Hussain, Rafaqat

    2017-11-01

    Microwave assisted wet precipitation method was used to synthesize calcium deficient strontium doped β-tricalcium phosphate (Sr-βTCP) with a chemical formula of Ca 2.96-x Sr x (PO 4 ) 2 . Sr-βTCP was reacted with monocalcium phosphate monohydrate [Ca(H 2 PO 4 ) 2 .H 2 O, MCPM] in presence of water to furnish corresponding Sr containing brushite cement (Sr-Brc). The samples were characterized by using X-ray diffractometry (XRD), Fourier transform infrared spectroscopy (FTIR) and field emission scanning electron microscopy (FESEM). Strontium content in the prepared samples was determined by using inductively coupled plasma optical emission spectrometry (ICP-OES). The effect of Sr 2+ ions on the structural, mechanical, setting properties and drug release of the cement is reported. Incorporation of Sr 2+ ions improved the injectability, setting time and mechanical properties of the Brc. The release profiles of antibiotics incorporated in Brc and Sr-Brc confirmed that the Sr incorporation into the Brc results in the efficient release of the antibiotics from the cement. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Implant-Guided Vertical Bone Augmentation Around Extra-Short Implants for the Management of Severe Bone Atrophy.

    Science.gov (United States)

    Anitua, Eduardo; Murias-Freijo, Alia; Alkhraisat, Mohammad H; Orive, Gorka

    2015-10-01

    The purpose of this study is to describe the conservative treatment of severe vertical bone atrophy by combining the insertion of extra-short implants and implant-guided bone augmentation. For that, a low-speed drilling protocol was selected to facilitate the collection of bone particles and to maintain graft osteogenic properties. Extra-short implants were incompletely inserted because of the severe atrophy, and the denuded implant surface was covered by autologous bone particles held together by the adhesive properties of plasma rich in growth factors. The surgical site was then covered with resorbable fibrin membrane, and the flap was repositioned and sutured. Eight patients with a mean residual bone height of 4.19 ± 0.97 mm were treated according to the described treatment protocol. The distance between the implant shoulder and the bony crest was 1.77 ± 0.18, 2.16 ± 0.23, and 1.97 ± 0.26 mm at the mesial, central, and distal aspects, respectively. Vertical bone augmentation resulted in the coverage of 85% of exposed surface by stimulating 1.6 ± 0.5 mm of supra-alveolar bone growth. All 10 extra-short implants placed were successfully osseointegrated. After a mean of 5 ± 1.6 months, provisional screw-retained prostheses were placed. Within the limitations of this study, we conclude that the minimally invasive approach described may successfully rehabilitate extreme vertical bone atrophy in the posterior mandible.

  19. 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

    Science.gov (United States)

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

    2015-01-01

    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 < 0.02). We detected no significant correlation between bone mineral density and yield load in this setting. Conclusion Our results indicate that PMMA 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. PMID:26835201

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

    Directory of Open Access Journals (Sweden)

    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.

  1. New method for antibiotic release from bone cement (polymethylmethacrylate): Redefining boundaries.

    Science.gov (United States)

    Carbó-Laso, E; Sanz-Ruiz, P; Del Real-Romero, J C; Ballesteros-Iglesias, Y; Paz-Jiménez, E; Arán-Ais, F; Sánchez-Navarro, M; Pérez-Limiñana, M A; López-Torres, I; Vaquero-Martín, J

    The increasing antimicrobial resistance is promoting the addition of antibiotics with high antistaphylococcal activity to polymethylmethacrylate (PMMA), for use in cement spacers in periprosthetic joint infection. Linezolid and levofloxacin have already been used in in-vitro studies, however, rifampicin has been shown to have a deleterious effect on the mechanical properties of PMMA, because it inhibits PMMA polymerization. The objective of our study was to isolate the rifampicin during the polymerization process using microencapsulation techniques, in order to obtain a PMMA suitable for manufacturing bone cement spacers. Microcapsules of rifampicin were synthesized with alginate and PHBV, using Rifaldin ® . The concentration levels of rifampicin were studied by UV-visible spectrophotometry. Compression, hardness and setting time tests were performed with CMW ® 1 cement samples alone, with non-encapsulated rifampicin and with alginate or PHBV microcapsules. The production yield, efficiency and microencapsulation yield were greater with alginate (P = .0001). The cement with microcapsules demonstrated greater resistance to compression than the cement with rifampicin (91.26±5.13, 91.35±6.29 and 74.04±3.57 MPa in alginate, PHBV and rifampicin, respectively) (P = .0001). The setting time reduced, and the hardness curve of the cement with alginate microcapsules was similar to that of the control. Microencapsulation with alginate is an appropriate technique for introducing rifampicin into PMMA, preserving compression properties and setting time. This could allow intraoperative manufacturing of bone cement spacers that release rifampicin for the treatment of periprosthetic joint infection. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Volume changes of grafted autogenous bone in sinus augmentation procedure.

    Science.gov (United States)

    Sbordone, Carolina; Sbordone, Ludovico; Toti, Paolo; Martuscelli, Ranieri; Califano, Luigi; Guidetti, Franco

    2011-06-01

    To evaluate associations between the osseous remodeling and the 3-dimensional features of both the grafted bone and the recipient site, as well as the density of the grafted bone, and to assess the relation between the degree of bone resorption and the type of autogenous bone-grafting procedure or the source (block or particulate bone from iliac crest or block bone from chin). A retrospective chart review of patients receiving sinus lifting and grafting procedures for implant positioning was conducted: radiographic analysis of the volume and area of both sinuses and autogenous bone grafts was performed, as per Smolka et al and Krennmair et al. The volumetric remodeling--measured at 1 year after implant positioning as the percentage of residual bone (%R)--was correlated, with Spearman analysis, to 3-dimensional features of both graft and recipient sites. All quantities correlated with %R at a statistically significant level were used for 2-dimensional and multidimensional visualizations with scattergrams. Twenty-five iliac crest or chin grafts were inlay positioned in the maxillary sinuses of patients. Computed tomography scans, taken before implant positioning and after 1 year, showed a 1-year negligible volume remodeling for block graft from chin (97.9%) but slightly greater resorption values (%R) for particulate and block grafts from iliac crest (93.8% and 83.3%, respectively). Three- and four-dimensional scattergrams of significant data resulting from Spearman correlation tests (particulate and block grafts both from iliac crest) showed a variation of the remodeling pattern dependent on 3-dimensional features, namely inlay graft thickness, surface area of the graft in contact with basal bone, volume of the recipient site, and surface area of the graft projecting into the sinus cavity. Retrospective data analysis shows that iliac crest grafts positioned on a small basal bone volume (≤ 2.5 mL) may point to a very favorable remodeling of the volume when the

  3. 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

  4. Effects of nano HAP on biological and structural properties of glass bone cement.

    Science.gov (United States)

    Fu, Qiang; Zhou, Nai; Huang, Wenhai; Wang, Deping; Zhang, Liying; Li, Haifeng

    2005-08-01

    A novel type of glass-based nanoscale hydroxyapatite (HAP) bioactive bone cement (designed as GBNHAPC) was synthesized by adding nanoscale hydroxyapatite crystalline (20-40 nm), into the self-setting glass-based bone cement (GBC). The inhibition rate of nanoscale HAP and micron HAP on osteosarcoma U2-OS cells was examined. The effects of nanoscale HAP on the crystal phase, microstructure and compressive strength of GBNHAPC were studied, respectively. It was concluded that nanoscale HAP could inhibit the cell proliferation, whereas micron HAP could not, and that nanoscale HAP could be dispersed in the cement evenly and the morphology did not change significantly after a longer immersion time. XRD and FTIR results show nanoscale HAP did not affect the setting reaction of the cement. Furthermore, GBNHAPC had a higher compressive strength (92.6 +/- 3.8 MPa) than GBC (80.1 +/- 3.0 MPa). It was believed that GBNHAPC might be a desirable biomaterial that could not only fill bone defects but also inhibit cancer cell growth. (c) 2005 Wiley Periodicals, Inc.

  5. Influence of initial component temperature on the apparent viscosity and handling characteristics of acrylic (PMMA) bone cement.

    Science.gov (United States)

    Sullivan, Stacey J Losaw; Topoleski, L D Timmie

    2007-04-01

    The flow and polymerization characteristics of poly(methylmethacrylate) (PMMA) bone cement can be changed by manipulating the temperature of the bone cement components or the environment that they are prepared in. To quantify the effects of the initial component temperature (T(ic)) of acrylic bone cement on the rheological and handling characteristics, ASTM F451-99a compliant methods and clinically relevant testing methods were utilized. A rheometer was designed and fabricated using the dimensions of a clinical, commercially available, cement gun and nozzle. The influence on the apparent viscosity and handling characteristics (setting time, working time, and peak exotherm temperature) for a high viscosity (HV) commercially-available acrylic bone cement, Palacos R, were determined. The values of T(ic) used were 23 degrees C (room), 6 degrees C (refrigerator), and -14 degrees C (freezer). Using the apparent viscosity of a medium viscosity (MV) bone cement as a benchmark (Simplex P at room temperature), it was found that by adjusting the T(ic) the HV cement was able to mimic the flow characteristics of the MV cement. Lowering the T(ic) lowered the apparent viscosity of the bone cement. The effects of T(ic) on the polymerization of bone cement were studied in dynamic and static conditions. The dynamic test recorded temperature and torque from stirring resistance. Setting times were also determined using the ASTM exotherm mold method. The setting times determined by the dynamic testing conditions were consistently shorter than those determined by the ASTM method. Lowering the T(ic) increased the working and setting times; however, it did not have a significant effect on the peak exotherm temperature. (c) 2006 Wiley Periodicals, Inc.

  6. Augmented Osteolysis in SPARC-Deficient Mice with Bone-Residing Prostate Cancer

    Directory of Open Access Journals (Sweden)

    N. Patrick McCabe

    2011-01-01

    Full Text Available Prostate cancer preferentially metastasizes to bone, which is rich in structural and matricellular proteins capable of altering prostate cancer progression. This study explores the role of the bone stromal matricellular protein SPARC (osteonectin/BM-40 in the progression of bone metastatic prostate cancer. Quantification of bone destruction analyzed by micro–computed tomography showed augmented osteoclastic resorption, characterized by decreases in several morphometric bone parameters in SPARC knock out (KO tibiae harboring RM1 murine prostate cancer cells compared with wild type (WT animals. Tumor progression stimulated osteoclast formation, which was augmented in SPARC KO mice. In vitro differentiation of SPARC KO osteoclasts indicated accelerated progenitor expansion and formation of tartrate-resistant acid phosphatase–positive osteoclast-like cells with increased resorptive capacity, a mechanism resulting in enhanced tumor-induced bone loss in vivo. Whereas altered bone structure due to SPARC KO played a role in increased osteolysis, the enhanced osteolysis was primarily the result of increased resorption by SPARC KO osteoclasts. Our findings indicate that bone stromal SPARC suppresses tumor-induced bone lesion expansion by limiting osteoclast maturation and function.

  7. Treatment concepts for the posterior maxilla and mandible: short implants versus long implants in augmented bone

    OpenAIRE

    Thoma, Daniel Stefan; Cha, Jae-Kook; Jung, Ui-Won

    2017-01-01

    The aim of this narrative review is to describe treatment options for the posterior regions of the mandible and the maxilla, comparing short implants vs. longer implants in an augmented bone. The dental literature was screened for treatment options enabling the placement of dental implants in posterior sites with a reduced vertical bone height in the maxilla and the mandible. Short dental implants have been increasingly used recently, providing a number of advantages including reduced patient...

  8. The influence of ultrasound on the release of gentamicin from antibiotic-loaded acrylic beads and bone cements

    NARCIS (Netherlands)

    Ensing, GT; Hendriks, JGE; Jongsma, JE; van Horn, [No Value; van der Mei, HC; Busscher, HJ

    2005-01-01

    Gentamicin-loaded acrylic beads are loosely placed in infected bone cavities, whereas gentamicin-loaded acrylic bone cement is used as a mechanical filler in bone to anchor prosthetic components. Both drug delivery systems are used to decrease infection rates by gentamicin release. The objective of

  9. Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study

    DEFF Research Database (Denmark)

    Jensen, Anders Torp; Jensen, Simon Storgård; Worsaae, Nils

    2016-01-01

    PURPOSE: This retrospective clinical study aims to evaluate complications after augmentation of localized bone defects of the alveolar ridge. METHODS: From standardized registrations, the following complications related to bone augmentation procedures were recorded: soft tissue dehiscence......, infection, sensory disturbance, additional augmentation procedures needed, and early implant failure. RESULTS: A total of 223 patients (132 women, 91 men; mean age 23.5 years; range 17-65 years) with 331 bone defects had bone augmentation performed into which 350 implants were placed. Soft tissue dehiscence.......7 %), four after GBR procedures (1.6 %), and two (12 %) after staged vertical ridge augmentation. CONCLUSIONS: Predictable methods exist to augment localized defects in the alveolar ridge, as documented by low complication rates and high early implant survival rates....

  10. The progress of early phase bone healing using porous granules produced from calcium phosphate cement

    Directory of Open Access Journals (Sweden)

    Jungbluth P

    2010-05-01

    Full Text Available Abstract Objective Bone grafting is a vital component in many surgical procedures to facilitate the repair of bone defects or fusions. Autologous bone has been the gold standard to date in spite of associated donor-site morbidity and the limited amount of available donor bone. The aim of this study was to investigate the progress of bone regeneration and material degradation of calcium phosphate granules (CPG produced from a calcium phosphate self-setting cement powder compared to the use of autologous bone grafting in the treatment of "critical size defects" on load-bearing long bones of minipigs. Methods A critical size defect in the tibial metaphysis of 16 mini-pigs was filled either with autologous cancellous graft or with micro- and macroporous carbonated, apatic calcium phosphate granules (CPG produced from a calcium phosphate self-setting cement powder. After 6 weeks, the specimens were assessed by X-ray and histological evaluation. The amount of new bone formation was analysed histomorphometrically. Results The semi-quantitative analysis of the radiological results showed a complete osseous bridging of the defect in three cases for the autograft group. In the same group five animals showed a beginning, but still incomplete bridging of the defect, whereas in the CPG group just two animals developed this. All other animals of the CPG group showed only a still discontinuous new bone formation. Altogether, radiologically a better osseous bridging was observed in the autograft group compared to the CPG group. Histomorphometrical analysis after six weeks of healing revealed that the area of new bone was significantly greater in the autograft group concerning the central area of the defect zone (p Conclusions Within the limits of the present study it could be demonstrated that autologous cancellous grafts lead to a significantly better bone regeneration compared to the application of calcium phosphate granules (CPG produced from a calcium

  11. 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

    Directory of Open Access Journals (Sweden)

    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%.

  12. SINUS FLOOR AUGMENTATION WITH BONE BLOCK GRAFTING AND SIMULTANEOUS IMPLANT PLACEMENT.

    Directory of Open Access Journals (Sweden)

    George S. Manev

    2013-07-01

    Full Text Available Placement of dental implants in the posterior maxillary edentulous areas is often compromised by the limited volume of bone due to the anatomy of the maxillary sinuses. In such cases, the technique of Sinus Lift is indicated to provide a sufficient volume of hard tissue in order to achieve primary stability at implant placement. Simultaneous augmentation of the sinus floor and implant placement is severely limited by the amount of residual bone of the floor of the sinus.A clinical case of minimal residual bone at the bottom of the sinus is demonstrated. A sinus floor augmentation with bone block harvested from the mandibular symphysis is performed. The bone block is placed in the sinus after membrane elevation and fixed with a screw to the sinus floor. After fixation of the bone block in the sinus implant (10/4.1 mm TSV (Zimmer is placed in reconstructed bone with good primary stability. Healing occurs without complications and the third month X-ray showed normal density of bone around the implant. The technique is very sensitive to surgeon’s skills.

  13. The sealing ability of novel Kryptonite adhesive bone cement as a retrograde filling material

    Directory of Open Access Journals (Sweden)

    İsmail Uzun

    2016-08-01

    Full Text Available Background. This study evaluated the ability of Kryptonite bone cement in sealing retrograde cavities. Methods. The root canals of one hundred extracted human maxillary incisor teeth were instrumented up to master apical file #40 using Mtwo rotary system and obturated with gutta-percha and AH Plus sealer by cold lateral compaction method. The specimens were assigned to one control group and four experimental groups based on the retrograde filling materials (n=20. The specimens were immersed in 0.5% Rhodamine B solution for 48h. Then the specimens were divided longitudinally into two parts and the depth of dye penetration was assessed under ×10 magnification. Data were analyzed using one-way ANOVA and Bonferroni tests. Results. There were statistically significant difference between the experimental groups and the control group (P0.05. Conclusion. Kryptonite cement provided optimal apical seal in a manner similar to MTA, amalgam and IRM when used as a retrograde filling cement.

  14. Calcium Phosphate Bone Cements Including Sugar Surfactants: Part Two-Injectability, Adhesive Properties and Biocompatibility.

    Science.gov (United States)

    Bercier, Ariane; Gonçalves, Stéphane; Autefage, Helène; Briand-Mesange, Fabienne; Lignon, Olivier; Fitremann, Juliette

    2010-12-02

    Addition of sugar surfactants, sucrose fatty acid esters and alkylpolyglucosides to a calcium phosphate cement, designed for bone reconstruction, is described. Thanks to their adsorption at the surface of the calcium phosphate particles, the sugar surfactants allowed a full injectability and brought a very good workability. Injectability was measured by monitoring force-distance curves. With some of the selected sugar surfactants adhesive properties of the cement pastes were also observed, which were measured by tack tests. Finally, some properties related to biological applications are described, including gentamicine release and osteoblast viability experiments. The whole study demonstrates that addition of these mild surfactants improved several properties of the calcium phosphate cement, without impairing function.

  15. Calcium Phosphate Bone Cements Including Sugar Surfactants: Part Two—Injectability, Adhesive Properties and Biocompatibility

    Directory of Open Access Journals (Sweden)

    Fabienne Briand-Mesange

    2010-12-01

    Full Text Available Addition of sugar surfactants, sucrose fatty acid esters and alkylpolyglucosides to a calcium phosphate cement, designed for bone reconstruction, is described. Thanks to their adsorption at the surface of the calcium phosphate particles, the sugar surfactants allowed a full injectability and brought a very good workability. Injectability was measured by monitoring force-distance curves. With some of the selected sugar surfactants adhesive properties of the cement pastes were also observed, which were measured by tack tests. Finally, some properties related to biological applications are described, including gentamicine release and osteoblast viability experiments. The whole study demonstrates that addition of these mild surfactants improved several properties of the calcium phosphate cement, without impairing function.

  16. Acetabular reconstruction with impaction bone grafting and cemented polyethylene socket in total hip revision arthroplasty.

    Science.gov (United States)

    Kostensalo, I; Seppänen, M; Virolainen, P; Mokka, J; Koivisto, M; Mäkelä, K T

    2015-12-01

    Bone deficiency in revision total hip arthroplasty is a challenge to the surgeon. One option for restoration of the bone stock is impaction bone grafting and use of a cemented socket. The aim of this study was to evaluate the mid-term clinical outcome of impaction bone grafting and cemented socket revisions. A total of 59 patients (60 hips) underwent revision arthroplasty with impaction bone grafting and application of a cemented socket on the acetabular side in the Turku University Hospital from 1999 to 2004. The study end-point was re-revision for any reason. The cumulative percentages for survival were followed and estimated with Kaplan-Meier curves. Associations between occurrence of re-revision and potential risk factors were analyzed with logistic regression. Results were quantified by odd ratios and 95% confidence intervals. The mean age of the patients was 69 years (33% male). A total of 3% of the patients had a class I Paprosky acetabular defect, 38% had class II, and 55% had class III. The overall survival rate was 73%. The mean follow-up time was 7 years. The most common reason for re-revision was aseptic loosening of the acetabular component (13 patients, 81% of re-revisions). Cox's regression analysis did not identify any risk factors for re-revision. Our results were inferior compared to some previous studies. Impaction bone grafting of acetabular defects in revision total hip arthroplasty may not always provide a reliable bone stock in long-term. © The Finnish Surgical Society 2015.

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

    Science.gov (United States)

    Cui, Xu; Huang, Wenhai; Zhang, Yadong; Huang, Chengcheng; Yu, Zunxiong; Wang, Lei; Liu, Wenlong; Wang, Ting; Zhou, Jie; Wang, Hui; Zhou, Nai; Wang, Deping; Pan, Haobo; Rahaman, Mohamed N

    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±2MPa to 31±2MPa) as the ratio of glass particles to chitosan solution increased (from 1.0gml -1 to 2.5gml -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 12weeks 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. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Multi-axial loading micromechanics of the cement-bone interface in postmortem retrievals and lab-prepared specimens

    NARCIS (Netherlands)

    Miller, M.A.; Race, A.; Waanders, D.; Cleary, R.; Janssen, D.; Verdonschot, N.J.J.; Mann, K.A.

    2011-01-01

    Maintaining adequate fixation between cement and bone is important for successful long term survival of cemented total joint replacements. Mixed-mode loading conditions (combination of tension/compression and shear) are present during in vivo loading, but the micromotion response of the interface to

  19. Augmentation of localized defects of the anterior maxillary ridge with autogenous bone before insertion of implants

    NARCIS (Netherlands)

    Raghoebar, GM; Batenburg, RHK; Vissink, A; Reintsema, H

    1996-01-01

    Purpose: This study evaluated the applicability of intraorally harvested autogenous bone grafts for the augmentation of the narrow maxillary alveolar ridge to enable insertion of implants for single tooth replacement. Materials and Methods: Local defects of the anterior maxilla were reconstructed in

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials

    DEFF Research Database (Denmark)

    Jensen, Simon Storgård; Terheyden, Hendrik

    2009-01-01

    PURPOSE: The objective of this review was to evaluate the efficacy of different grafting protocols for the augmentation of localized alveolar ridge defects. MATERIALS AND METHODS: A MEDLINE search and an additional hand search of selected journals were performed to identify all levels of clinical...... in the augmented bone. RESULTS AND CONCLUSION: Based on 2,006 abstracts, 424 full-text articles were evaluated, of which 108 were included. Eleven studies were randomized controlled clinical trials. The majority were prospective or retrospective studies including a limited number of patients and short observation...... of evidence (level A to B) to support that survival rates of implants placed in augmented bone are comparable to rates of implants placed in pristine bone....

  2. Probability based design of concrete mixes with cow-bone ash admixed cement

    Directory of Open Access Journals (Sweden)

    Mahmud ABUBAKAR

    2016-06-01

    Full Text Available A probability-based procedure for design of concrete mixes with cow-cone ash admixed cement has been developed considering the strength as a random variable. However, the compressive strength of concrete in turn, depends on the properties of its constituent materials: cement, fine aggregate, coarse aggregate and cow-bone ash. The compressive strength data generated experimentally has been analysed using normal-probability distribution functions based on 95% confidence interval. The proposed probability based design was compared to the method of trial mixture. It was observed that for reliability index (β of 1.3, the proposed probability methodology uses 10.2% less cement content than the method of trial mixture; thus, indicating that the method is conservative. It was also observed that, for concrete grade 25, the proposed methodology gives higher compressive strength at both 7 and 28 days. Hence, the probability-based design procedure was found appropriate and is therefore recommended for the design of concrete mixes with cow-bone ash admixed cement.

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. 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 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.

  6. An experimental approach to the study of the rheology behaviour of synthetic bone calcium phosphate cements

    Energy Technology Data Exchange (ETDEWEB)

    Friberg, J.; Fernandez, E.; Sarda, S.; Nilsson, M.; Ginebra, M.P.; Planell, J.A. [Universidad Politecnica de Catalunya, Barcelona (Spain). Dept. of Materials Science and Metallurgical Engineering; Martinez, S. [Barcelona Univ. (Spain). Mineralogia i Recursos Minerals

    2001-07-01

    Calcium phosphate cements were developed to fit surgical needs in biomedical fields such as odontology or traumatology. Nowadays, a broad field of new applications have been found for this kind of materials. Drug delivery systems, tissue-engineering scaffolds and osteoporotic bone filling applications are some of the new fields that are being benefited with these materials. Looking at both, commercial and new experimental calcium phosphate cements it is found that {alpha}-tricalcium phosphate is the main reactive powder responsible for the setting and the hardening of the cement. Thus, it is important to know how {alpha}-tricalcium phosphate affects injectability of these cements. The aim of this study was to investigate the rheological behaviour of {alpha}-tricalcium phosphate slurries in order to know how the cement injectability should be modified. Factors such as liquid to powder ratio, particle size of the main reactive powder and the addition of dispersants have been considered. The results showed that viscosity decreased when particle size of reactant was increased and when liquid to powder ratio was increased. It was also found that a minimum of viscosity exists at an optimum value of the weight percentage of dispersant. (orig.)

  7. 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)

  8. 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)

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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

  11. 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

  12. [Cement-augmented anterior odontoid screw fixation of a Anderson-D'Alonzo type II fracture with massive osteoporosis. Case report].

    Science.gov (United States)

    Scholz, M; Schnake, K J; Hoffmann, R; Kandziora, F

    2011-06-01

    Anterior screw fixation is a standard treatment procedure in the case of an uncomplicated Anderson-D'Alonzo type II odontoid fracture in younger patients. Insufficient bony screw hold can cause severe procedure-related complications and result in screw breakouts with secondary fracture dislocation. Hence, the procedure is limited to patients with an adequate bone mineral density. This case report summarises a technical modification of anterior screw fixation in elderly patients suffering from severe osteoporosis to avoid a posterior spondylodesis of C1/2. Two patients with odontoid fractures of Anderson-D'Alonzo type II were operated using anterior screw fixation and additional vertebroplasty of C2 to increase the screw hold. During follow-up a regular bony healing without screw complication was observed. In conclusion, cement-augmented anterior screw fixation of odontoid fractures type II according to Anderson-D'Alonzo and persistent severe osteoporosis can be an alternative to posterior C1/2 spondylodesis in individual cases. © Georg Thieme Verlag KG Stuttgart · New York.

  13. 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.

  14. Horizontal bone-augmentation procedures in implant dentistry: prosthetically guided regeneration.

    Science.gov (United States)

    Chiapasco, Matteo; Casentini, Paolo

    2018-02-25

    The rehabilitation of partially or totally edentulous patients with implant-supported prostheses has become routine, with excellent long-term outcome. A proper implant position is mandatory to achieve good functional and esthetic outcome and may require an adequate amount of alveolar bone and surrounding soft tissue. When this is lacking because of atrophy, sequelae of periodontal disease, traumas or congenital malformations, increased bone volume and/or keratinized mucosa can be obtained by guided bone regeneration, bone-grafting techniques and alveolar bone expansion. This article presents an evidence-based, prosthetically driven approach for the treatment of edentulous ridges with horizontal defects. The classification of bony defects, the main augmentation techniques, the selection criteria among different surgical procedures for different types of bony defects, and the advantages, disadvantages and limitations of each technique, are described in detail. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    Eick, Sigrun; Hofpeter, Kevin; Sculean, Anton; Ender, Claudia; Klimas, Susann; Vogt, Sebastian; Nietzsche, Sandor

    2017-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Bone Inflammation, Bone Infection and Dental Implants Failure: Histological and Cytological Aspects Related to Cement Excess

    OpenAIRE

    Tatullo, Marco; Marrelli, Massimo; Mastrangelo, Filiberto; Gherlone, Enrico

    2017-01-01

    Background: Dental implant failure can recognize several causes and many of them are quite preventable with the right knowledge of some clinical critical factors. Aim of this paper is to investigate about the histological aspects related to dental implants failure in such cases related to cement excess, how such histological picture can increase the risk of bacterial infections and how the different type of cement can interact with osteoblasts in-vitro. Methods: We randomly selected 5 patient...

  19. Bone augmentation using a highly porous PLGA/β-TCP scaffold containing fibroblast growth factor-2.

    Science.gov (United States)

    Yoshida, T; Miyaji, H; Otani, K; Inoue, K; Nakane, K; Nishimura, H; Ibara, A; Shimada, A; Ogawa, K; Nishida, E; Sugaya, T; Sun, L; Fugetsu, B; Kawanami, M

    2015-04-01

    Beta-tricalcium phosphate (β-TCP), a bio-absorbable ceramic, facilitates bone conductivity. We constructed a highly porous three-dimensional scaffold, using β-TCP, for bone tissue engineering and coated it with co-poly lactic acid/glycolic acid (PLGA) to improve the mechanical strength and biological performance. The aim of this study was to examine the effect of implantation of the PLGA/β-TCP scaffold loaded with fibroblast growth factor-2 (FGF-2) on bone augmentation. The β-TCP scaffold was fabricated by the replica method using polyurethane foam, then coated with PLGA. The PLGA/β-TCP scaffold was characterized by scanning electron miscroscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction, compressive testing, cell culture and a subcutaneous implant test. Subsequently, a bone-forming test was performed using 52 rats. The β-TCP scaffold, PLGA-coated scaffold, and β-TCP and PLGA-coated scaffolds loaded with FGF-2, were implanted into rat cranial bone. Histological observations were made at 10 and 35 d postsurgery. SEM and TEM observations showed a thin PLGA layer on the β-TCP particles after coating. High porosity (> 90%) of the scaffold was exhibited after PLGA coating, and the compressive strength of the PLGA/β-TCP scaffold was six-fold greater than that of the noncoated scaffold. Good biocompatibility of the PLGA/β-TCP scaffold was found in the culture and implant tests. Histological samples obtained following implantation of PLGA/β-TCP scaffold loaded with FGF-2 showed significant bone augmentation. The PLGA coating improved the mechanical strength of β-TCP scaffolds while maintaining high porosity and tissue compatibility. PLGA/β-TCP scaffolds, in combination with FGF-2, are bioeffective for bone augmentation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. 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.

  1. Minimally invasive plate augmentation in the treatment of long-bone non-unions.

    Science.gov (United States)

    Park, Ki-Chul; Oh, Chang-Wug; Kim, Joon-Woo; Park, Kyeong-Hyeon; Oh, Jong-Keon; Park, Il-Hyung; Kyung, Hee-Soo; Heo, Jeong

    2017-11-01

    Exchange nailing is most acceptable for treating hypertrophic non-union of the long bones, requiring the removal of previously fixed implant. However, its main effect of mechanical stabilization is controversial in non-isthmal area. We hypothesized that minimally invasive plate augmentation over the non-union site may have a better option, without the need of bone grafting or removing pre-existing implants. Seventeen patients with hypertrophic non-union of the long bones between 2010 and 2014 on radiography who previously underwent intramedullary (IM) nailing or plate osteosynthesis for long-bone fractures were included. A locking compression plate was inserted with at least three mono- or bicortical screws at each proximal and distal segment. Broken or loosened interlocking screws of IM nail were simultaneously re-fixed. Fracture site exposure, pre-fixed implant removal, and bone grafting were not performed. We investigated whether union occurred and analyzed functional outcomes and complications. Eleven femoral and six tibial non-unions were prospectively included. In the pre-existing implants, 13 nails and 4 plates were found. All cases achieved union at a mean 22.7 weeks. One case of superficial infection was managed with oral antibiotics. Deep infection or implant failure did not occur. Minimally invasive plate augmentation can achieve additional stability and promote healing of hypertrophic non-union of the long bones. When indicated, this technique is the least invasive alternative to exchange nailing and reduces surgical risks in the treatment of diaphyseal non-union.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. The effect of posterior spinal fixation with bone cement upon vertebral growth in dogs. An experimental study.

    Science.gov (United States)

    Moon, M S; Ok, I Y

    1980-01-01

    In an experimental study the authors tried to clarify the effect on vertebral growth and spinal curvature in dogs following fixation of the posterior elements of the spine at different levels using bone cement. In three separate experimental groups a segment of the dorsal spine, the dorso-lumbar spine or the lumbar spine was securely fixed with bone cement incorporating a radio-opaque wire marker. Growth of the spine was observed with renal X-rays over a six-month period and the following results obtained: 1. Growth in height of the vertebra was not affected by the fixation; 2. The intervertebral disc spaces widened anteriorly and narrowed posteriorly even when fracture of the bone cement occurred; 3. Increasing lordosis developed in all three experimental groups even when a physiological kyphosis was normally present. The greatest increase occurred in the lumbar spine; 4. Fracture of the cement occurred consistently when attempting to secure the dorso-lumbar junction.

  4. 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

  5. Synthesis and characterization of core-shell nanoparticles and their influence on the mechanical behavior of acrylic bone cements.

    Science.gov (United States)

    Gutiérrez-Mejía, A; Herrera-Kao, W; Duarte-Aranda, S; Loría-Bastarrachea, M I; Canché-Escamilla, G; Moscoso-Sánchez, F J; Cauich-Rodríguez, J V; Cervantes-Uc, J M

    2013-04-01

    Core-shell nanoparticles consisting of polybutyl acrylate (PBA) rubbery core and a polymethyl methacrylate (PMMA) shell, with different core-shell ratios, were synthesized in order to enhance the fracture toughness of the acrylic bone cements prepared with them. It was observed by TEM and SEM that the core-shell nanoparticles exhibited a spherical morphology with ca. 120 nm in diameter and that both modulus and tensile strength decreased by increasing the PBA content; the desired structuring pattern in the synthesized particles was confirmed by DMA. Also, experimental bone cements were prepared with variable amounts (0, 5, 10 and 20 wt.%) of nanoparticles with a core-shell ratio of 30/70 in order to study the influence of these nanostructured particles on the physicochemical, mechanical and fracture properties of bone cements. It was found that the addition of nanostructured particles to bone cements caused a significant reduction in the peak temperature and setting time while the glass transition temperature (Tg) of cements increased with increasing particles content. On the other hand, modulus and strength of bone cements decreased when particles were incorporated but fracture toughness was increased. Copyright © 2012 Elsevier B.V. All rights reserved.

  6. Bilateral maxillary sinus floor augmentation with tissue-engineered autologous osteoblasts and demineralized freeze-dried bone

    Directory of Open Access Journals (Sweden)

    Aashish Deshmukh

    2015-01-01

    Full Text Available The pneumatization of the maxillary sinus often results in a lack of sufficient alveolar bone for implant placement. In the last decades, maxillary sinus lift has become a very popular procedure with predictable results. Sinus floor augmentation procedures are generally carried out using autologous bone grafts, bone substitutes, or composites of bone and bone substitutes. However, the inherent limitations associated with each of these, have directed the attention of investigators to new technologies like bone tissue engineering. Bone marrow stromal cells have been regarded as multi-potent cells residing in bone marrow. These cells can be harvested from a person, multiplied outside his body using bioengineering principles and technologies and later introduced into a tissue defect. We present a case where tissue-engineered autologous osteoblasts were used along with demineralized freeze-dried bone for sinus floor augmentation.

  7. 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

  8. 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.

  9. 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

  10. Giant Cell Tumor Of The Long Bones: Results With Combination Of Cryosurgery, Curettage, And Cementation

    Directory of Open Access Journals (Sweden)

    Mortazavi S.M.J

    2005-07-01

    Full Text Available Background: In this study we evaluated the treatment of giant cell tumor (GCT of long bones using cryosurgery combined with curettage and polymethylmetacrylate (PMMA cementing. Material and methods: From January 1999 to December 2004, twenty patients (mean age at the time of surgery 29.2 years; 13 females and 7 males; were included in the study. Cortical disruption were presented in 7 patients; 4 with soft tissue extension, but none of them had intra-articular extension of tumor, 3 patients presented with pathologic fracture of distal femoral lesions. These tumors were located in distal femur in 6 patients, proximal tibia in 7, distal radius in 3, proximal femur in 2, and each of proximal humerus and distal ulna in one patient. In each case diagnostic biopsy was done and surgical procedure performed including curettage, power burr of the wall, cryosurgery with liquid nitrogen and finally filling the space with PMMA cementing. The mean follow-up was 34 months (7 to 61 . Results: During follow-up, we observed one recurrence of GCT of proximal tibia. Secondary Aneurysmal bone cyst was reported at the site of one primary distal femoral lesion, without any finding in favor of a recurrence. Neurapraxia of the proneal nerve was occurred in one patient with proximal tibia tumor improved after 8 months. Conclusion: Cryosurgery combined with power burr and PMMA cementing in the treatment of GCT could be an effective approach in tumor eradication. This method obviates the need for extensive resections and reconstructive procedure.

  11. 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

  12. 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.

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

    Science.gov (United States)

    Harabech, Mariem; Kiselovs, Normunds Rungevics; Maenhoudt, Wim; Crevecoeur, Guillaume; Van Roost, Dirk; Dupré, Luc

    2017-05-01

    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.

  14. 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

  15. Short implants compared to implants in vertically augmented bone: a systematic review.

    Science.gov (United States)

    Nisand, D; Picard, N; Rocchietta, I

    2015-09-01

    To assess relevant data comparing short implants or implants associated with vertical ridge augmentation derived from RCT's and CCT's. A PubMed and hand search was performed to identify all RCT's and CCT's published in English language comparing short implants to implants associated with vertical ridge augmentation. The initial search resulted in 3387 articles. A total of 17 articles were eligible for full-text analysis and four were finally included. This review tends to demonstrate similar implant survival rates between implants placed in vertically augmented bone and short implants (95.09% vs. 96.24%, respectively) with a follow-up ranging from 1 to 5 years. In terms of prosthetic survival rates, there were no differences between the treatments. More surgical complications were reported when using implants placed in vertically augmented bone compared to short implants (56 patients with surgical complications compared to 18 patients, respectively). This evidence should, however, be interpreted with caution as it is derived from four RCT's with limited sample size (ranging from 15 to 30 per group), limited follow-up and performed by the same research group. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. A novel injectable borate bioactive glass cement for local delivery of vancomycin to cure osteomyelitis and regenerate bone.

    Science.gov (United States)

    Cui, Xu; Zhao, Cunju; Gu, Yifei; Li, Le; Wang, Hui; Huang, Wenhai; Zhou, Nai; Wang, Deping; Zhu, Yi; Xu, Jun; Luo, Shihua; Zhang, Changqing; Rahaman, Mohamed N

    2014-03-01

    Osteomyelitis (bone infection) is often difficult to cure. The commonly-used treatment of surgical debridement to remove the infected bone combined with prolonged systemic and local antibiotic treatment has limitations. In the present study, an injectable borate bioactive glass cement was developed as a carrier for the antibiotic vancomycin, characterized in vitro, and evaluated for its capacity to cure osteomyelitis in a rabbit tibial model. The cement (initial setting time = 5.8 ± 0.6 min; compressive strength = 25.6 ± 0.3 MPa) released vancomycin over ~25 days in phosphate-buffered saline, during which time the borate glass converted to hydroxyapatite (HA). When implanted in rabbit tibial defects infected with methicillin-resistant Staphylococcus aureus (MRSA)-induced osteomyelitis, the vancomycin-loaded cement converted to HA and supported new bone formation in the defects within 8 weeks. Osteomyelitis was cured in 87 % of the defects implanted with the vancomycin-loaded borate glass cement, compared to 71 % for the defects implanted with vancomycin-loaded calcium sulfate cement. The injectable borate bioactive glass cement developed in this study is a promising treatment for curing osteomyelitis and for regenerating bone in the defects following cure of the infection.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. Strain shielding in trabecular bone at the tibial cement-bone interface

    NARCIS (Netherlands)

    Srinivasan, Priyanka; Miller, Mark A.; Verdonschot, Nico; Mann, Kenneth A.; Janssen, Dennis

    2017-01-01

    Aseptic loosening of the tibial component remains the leading cause for revision surgery in total knee arthroplasty (TKA). Understanding the mechanisms leading to loss of fixation can offer insight into preventative measures to ensure a longer survival rate. In cemented TKA, loosening occurs at the

  1. Bone augmentation as an adjunct to dental implant rehabilitation in patients with diabetes mellitus: A review of literature

    OpenAIRE

    Ladha, Komal; Sharma, Ankit; Tiwari, Bhawana; Bukya, Dwaraka N

    2017-01-01

    The aim of the present article is to review the success of bone augmentation performed as an adjunct to dental implant rehabilitation in patients with diabetes mellitus. A literature review was conducted in PubMed on this topic, which yielded a total of 102 publications. For inclusion, publications had to be human studies, written in English language and should report on the success of bone augmentation as an adjunct to dental implant rehabilitation in diabetic patients. After screening the t...

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

    Science.gov (United States)

    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.

  3. Effect of Combined Calcium Hydroxide and Accelerated Portland Cement on Bone Formation and Soft Tissue Healing in Dog Bone Lesions

    Directory of Open Access Journals (Sweden)

    Khorshidi H

    2015-09-01

    Full Text Available Statement of Problem: Recent literatures show that accelerated Portland cement (APC and calcium hydroxide Ca (OH2 may have the potential to promote the bone regeneration. However, certain clinical studies reveal consistency of Ca (OH2, as one of the practical drawbacks of the material when used alone. To overcome such inconvenience, the combination of the Ca (OH2 with a bone replacement material could offer a convenient solution. Objectives: To evaluate the soft tissue healing and bone regeneration in the periodontal intrabony osseous defects using accelerated Portland cement (APC in combination with calcium hydroxide Ca (OH2, as a filling material. Materials and Methods: Five healthy adult mongrel dogs aged 2-3 years old (approximately 20 kg in weight with intact dentition and healthy periodontium were selected for this study. Two one-wall defects in both mesial and distal aspects of the 3rd premolars of both sides of the mandible were created. Therefore, four defects were prepared in each dog. Three defects in each dog were randomly filled with one of the following materials: APC alone, APC mixed with Ca (OH2, and Ca (OH2 alone. The fourth defect was left empty (control. Upon clinical examination of the sutured sites, the amount of dehiscence from the adjacent tooth was measured after two and eight weeks, using a periodontal probe mesiodistally. For histometric analysis, the degree of new bone formation was estimated at the end of the eighth postoperative week, by a differential point-counting method. The percentage of the defect volume occupied by new osteoid or trabecular bone was recorded. Results: Measurement of wound dehiscence during the second week revealed that all five APCs had an exposure of 1-2 mm and at the end of the study all samples showed 3-4 mm exposure across the surface of the graft material, whereas the Ca (OH2, control, and APC + Ca (OH2 groups did not show any exposure at the end of the eighth week of the study. The most

  4. Bioactivity of Ceftazidime and Fluconazole Included in Polymethyl Methacrylate Bone Cement for Use in Arthroplasty.

    Science.gov (United States)

    Martínez-Moreno, J; Merino, V; Nácher, A; Rodrigo, J L; Bonet Yuste, Blanca B; Merino-Sanjuán, M

    2017-10-01

    The microorganisms that most frequently cause prosthetic joint infection are methicillin-resistant Staphylococcus aureus and gram-negative aerobic bacillus. Studies have documented the efficacy of mixing antibiotics with polymethyl methacrylate, but that of antifungal drugs has not received much attention. The objective of this in vitro study was to characterize the elution profile and bioactivity of ceftazidime and fluconazole when incorporated into bone cement in proportions intended for prophylaxis and treatment of bone infections. Antibiotic-loaded bone cement cylinders in a proportion of 1:40 and 4:40 (ratio of grams of antibiotic to grams of cement) were assayed. Drug delivery was investigated in a flow-through dissolution apparatus (SotaxCE7). To assess bioactivity, antibiotic concentrations were simulated in the joint space of 1000 patients. Antibacterial properties were evaluated by counting colony forming units and the inhibition-halo test. The ratio of released ceftazidime and fluconazole was 453% and 648%, respectively, higher when used for treatment proportions than prophylaxis proportions. A bioactivity simulation exercise showed that the efficacy of ceftazidime/fluconazole determined as the amount of drug is released at the active site in the first 3 days after surgery would depend on the sensitivity of the microorganism and would increase substantially after drain removal. The microbiology study showed that biofilm formation by Pseudomonas aeruginosa could be a problem when ceftazidime was used in treatment or prophylaxis proportions. Our in vitro findings suggest that ceftazidime and fluconazole can be added into polymethyl methacrylate for the prevention/treatment of infections associated to joint surgery. Their efficacy depends on the sensitivity of the microorganism causing the infection. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Changes in microgaps, micromotion, and trabecular strain from interlocked cement-trabecular bone interfaces in total knee replacements with in vivo service

    NARCIS (Netherlands)

    Miller, M.A.; Goodheart, J.R.; Khechen, B.; Janssen, D.W.; Mann, K.A.

    2016-01-01

    The initial fixation of cemented Total Knee Replacements (TKRs) relies on mechanical interlock between cement and bone, but loss of interlock occurs with in vivo service. In this study, cement-trabeculae gap morphology and micromechanics were measured for lab prepared (representing post-operative

  6. Three-Dimensional Assessment of Volumetric Changes in Sinuses Augmented with Two Different Bone Substitutes

    Directory of Open Access Journals (Sweden)

    B. Alper Gultekin

    2016-01-01

    Full Text Available Introduction. The bone volume of the posterior maxilla may not be appropriate for implant placement, due to factors such as pneumatized maxillary sinus. The purpose of this study was to evaluate the percentage of graft volume reduction following sinus floor elevation (SFE, with either slow resorbable bone substitute only or a composite of slow and fast resorbable bone substitutes, using cone beam computed tomography (CBCT. Materials and Methods. In this retrospective study, CBCT scans of SFE procedures were evaluated to determine the volume of grafted sinus with either deproteinized bovine bone (DBB or a 2 : 1 mixture of biphasic calcium sulfate (CS and DBB, as a composite. The volumetric changes of sinus augmentations were measured 2 weeks (V-I and 6 months (V-II after operation. Results. Thirty-three patients were included in this study. The average percentage volume reduction was 9.39±3.01% and 17.65±4.15% for DBB and composite grafts, respectively. A significant graft volume reduction was observed between V-I and V-II for both groups (p<0.01. The DBB group exhibited significantly less volume reduction than the composite group (p<0.01. Conclusions. Augmented sinus volume may change before implant placement. DBB offers greater volume stability during healing than composite grafts.

  7. 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.

  8. 3D-Printed Bioactive Ca3SiO5Bone 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.

  9. 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

  10. Contemporary adjuvant polymethyl methacrylate cementation optimally limits recurrence in primary giant cell tumor of bone patients compared to bone grafting: a systematic review and meta-analysis.

    Science.gov (United States)

    Zuo, Dongqing; Zheng, Longpo; Sun, Wei; Fu, Dong; Hua, Yingqi; Cai, Zhengdong

    2013-07-16

    Reports of recurrence following restructuring of primary giant cell tumor (GCT) defects using polymethyl methacrylate (PMMA) bone cementation or allogeneic bone graft with and without adjuvants for intralesional curettage vary widely. Systematic review and meta-analysis were conducted to investigate efficacy of PMMA bone cementation and allogeneic bone grafting following intralesional curettage for GCT. Medline, EMBASE, Google Scholar, and Cochrane databases were searched for studies reporting GCT of bone treatment with PMMA cementation and/or bone grafting with or without adjuvant therapy following intralesional curettage of primary GCTs. Pooled risk ratios and 95% confidence intervals (CIs) for local recurrence risks were calculated by fixed-effects methods. Of 1,690 relevant titles, 6 eligible studies (1,293 patients) spanning March 2008 to December 2011 were identified in published data. Treatment outcomes of PMMA-only (n = 374), bone graft-only (n = 436), PMMA with or without adjuvant (PMMA + adjuvant; n = 594), and bone graft filling with or without adjuvant (bone graft + adjuvant; n = 699) were compared. Bone graft-only patients exhibited higher recurrence rates than PMMA-treated patients (RR 2.09, 95% CI (1.64, 2.66), Overall effect: Z = 6.00; P <0.001), and bone graft + adjuvant patients exhibited higher recurrence rates than PMMA + adjuvant patients (RR 1.66, 95% CI (1.21, 2.28), Overall effect: Z = 3.15, P = 0.002). Local recurrence was minimal in PMMA cementation patients, suggesting that PMMA is preferable for routine clinical restructuring in eligible GCT patients. Relationships between tumor characteristics, other modern adjuvants, and recurrence require further exploration.

  11. Bone augmentation as an adjunct to dental implant rehabilitation in patients with diabetes mellitus: A review of literature.

    Science.gov (United States)

    Ladha, Komal; Sharma, Ankit; Tiwari, Bhawana; Bukya, Dwaraka N

    2017-01-01

    The aim of the present article is to review the success of bone augmentation performed as an adjunct to dental implant rehabilitation in patients with diabetes mellitus. A literature review was conducted in PubMed on this topic, which yielded a total of 102 publications. For inclusion, publications had to be human studies, written in English language and should report on the success of bone augmentation as an adjunct to dental implant rehabilitation in diabetic patients. After screening the titles and abstracts, 11 full texts publications were obtained, of which seven were included in the review. These studies provided data on various bone augmentation techniques such as sinus floor elevation (SFE), guided bone regeneration (GBR), and onlay bone grafting. Even though the current review revealed that there are not many studies reporting data relevant to the analyzed topic, the data obtained suggests that; (1) staged GBR technique should be considered more feasible and predictable for bone augmentation, (2) clinicians must take meticulous care when planning and conducting SFE, and (3) block bone augmentation technique should be avoided.

  12. Posterior atrophic jaws rehabilitated with prostheses supported by 5 x 5 mm implants with a novel nanostructured calcium-incorporated titanium surface or by longer implants in augmented bone. Preliminary results from a randomised controlled trial.

    Science.gov (United States)

    Felice, Pietro; Pistilli, Roberto; Piattelli, Maurizio; Soardi, Elisa; Corvino, Valeria; Esposito, Marco

    2012-01-01

    To evaluate whether 5 × 5 mm dental implants with a novel nanostructured calcium-incorporated titanium surface could be an alternative to at least 5 × 10 mm-long implants placed in bone augmented with bone substitutes in posterior atrophic jaws. Forty patients with atrophic posterior (premolar and molar areas) mandibles having 5 to 7 mm of bone height above the mandibular canal and 40 patients with atrophic maxillae having 4 to 6 mm below the maxillary sinus, were randomised according to a parallel group design to receive one to three 5 × 5 mm implants or one to three at least 5 × 10 mm-long implants in augmented bone at two centres. Mandibles were vertically augmented with interpositional bovine bone blocks and resorbable barriers and implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cemented metal-ceramic or zirconia prostheses were delivered. Outcome measures were prosthesis and implant failures as well as any complication. Patients were followed to 4 months post-loading with the exception of one patient who underwent mandibular augmentation and had multiple complications at and after grafting, and subsequent graft failure, who did not want to go ahead with the treatment. This case was considered a complete failure. There were no statistically significant differences in prosthesis and implant failures. In mandibles, apart from the complete graft failure, one 5 × 10 mm implant failed at placement of the provisional prosthesis. In maxillae, one 5 × 5 mm implant failed with its provisional crown 3 months after loading. All complications occurred before loading. Significantly more intra- and postoperative complications occurred at both mandibular and maxillary grafted sites

  13. Bone-to-implant contact after maxillary sinus floor augmentation with Bio-Oss and autogenous bone in different ratios in mini pigs

    DEFF Research Database (Denmark)

    Jensen, Thomas; Schou, Søren; Gundersen, Hans Jørgen G

    2012-01-01

    OBJECTIVES: The objective was to test the hypotheses: (i) no differences in bone-to-implant contact formation, and (ii) no differences between the use of autogenous mandibular or iliac bone grafts, when autogenous bone, Bio-Oss mixed with autogenous bone, or Bio-Oss is used as graft for the maxil......OBJECTIVES: The objective was to test the hypotheses: (i) no differences in bone-to-implant contact formation, and (ii) no differences between the use of autogenous mandibular or iliac bone grafts, when autogenous bone, Bio-Oss mixed with autogenous bone, or Bio-Oss is used as graft...... for the maxillary sinus floor augmentation. MATERIAL AND METHODS: Bilateral sinus floor augmentation was performed in 40 mini pigs with: (A) 100% autogenous bone, (B) 75% autogenous bone and 25% Bio-Oss, (C) 50% autogenous bone and 50% Bio-Oss, (D) 25% autogenous bone and 75% Bio-Oss, or (E) 100% Bio......-Oss. Autogenous bone was harvested from the iliac crest or the mandible and the graft composition was selected at random and placed concomitant with the implant placement. The animals were euthanized 12 weeks after surgery. Bone-to-implant contact was estimated by stereological methods and summarized as median...

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

    Directory of Open Access Journals (Sweden)

    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.

  15. L-PRF block for bone augmentation procedure: a proof-of-concept study.

    Science.gov (United States)

    Cortellini, Simone; Castro, Ana B; Temmerman, Andy; Vandessel, Jeroen; Pinto, Nelson; Jacobs, Reinhilde; Quirynen, Marc

    2018-02-08

    The objective of this proof-of-concept study was to investigate the effects of a new GBR technique with a tissue engineering approach. This single cohort observational study evaluated the outcome of the L-PRF block for horizontal bone augmentation in the maxilla. The L-PRF block is prepared by mixing a particulated biomaterial with chopped L-PRF membranes at a 50:50 ratio and adding Liquid Fibrinogen to glue all together. Horizontal augmentation was assessed linearly and volumetrically immediately after surgery and 5-8 months later by matching consecutive CBCTs. Ten patients (mean age of 50,7 years (±17,2)) representing 15 sites with horizontal alveolar deficiencies were included. Superimposition of pre-operative and post-healing CBCT scans showed an average linear horizontal bone gain of 4,6 mm (±2,3), 5,3 mm (±1,2) and 4,4 mm (±2,3), measured at 2, 6 and 10 mm from the alveolar crest, respectively. The volumetric gain was 1,05 cm 3 (±0,7) on average. The resorption rate after 5-8 months was 15,6% (±6,7) on average. L-PRF block may be a suitable technique to augment deficient alveolar ridges. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  16. 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.)

  17. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials

    DEFF Research Database (Denmark)

    Jensen, Simon Storgård; Terheyden, Hendrik

    2009-01-01

    evidence except expert opinions. Any publication written in English and including 10 or more patients with at least 12 months of follow-up after loading of the implants was eligible for this review. The results were categorized according to the presenting defect type: (1) dehiscence and fenestration......-type defects, (2) horizontal ridge augmentations, (3) vertical ridge augmentations, and (4) maxillary sinus floor elevations using the lateral window technique or transalveolar approach. The review focused on: (1) the outcome of the individual grafting protocols and (2) survival rates of implants placed...... in the augmented bone. RESULTS AND CONCLUSION: Based on 2,006 abstracts, 424 full-text articles were evaluated, of which 108 were included. Eleven studies were randomized controlled clinical trials. The majority were prospective or retrospective studies including a limited number of patients and short observation...

  18. 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

  19. 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.

  20. Histological results after maxillary sinus augmentation with Straumann® BoneCeramic, Bio-Oss®, Puros®, and autologous bone. A randomized controlled clinical trial.

    Science.gov (United States)

    Schmitt, Christian Martin; Doering, Hendrik; Schmidt, Thomas; Lutz, Rainer; Neukam, Friedrich Wilhelm; Schlegel, Karl Andreas

    2013-05-01

    This investigation focused on a comparison of clinical and histological characteristics after sinus floor augmentation with biphasic calcium phosphate (BCP, Straumann BoneCeramic(®) ), anorganic bovine bone (ABB, Geistlich Bio-Oss(®) ), mineralized cancellous bone allograft (MCBA, Zimmer Puros(®) ), or autologous bone (AB). Thirty consecutive patients with a posterior edentulous maxillary situation and a vertical bone height less than or equal to 4 mm were included in this study. A two-stage procedure was carried out. After augmentation of the maxillary sinus with ABB, BCP, MCBA, or AB followed by a healing period of 5 months, biopsies were taken with simultaneous implant placement. The samples were analyzed using microradiography and histology. Ninety-four implants were placed in the augmented positions and 53 bone biopsies were taken and evaluated. The bone volume fraction of newly formed bone was measured as 30.28 ± 2.16% for BCP, 24.9 ± 5.67% for ABB, 41.74 ± 2.1% for AB, and 35.41 ± 2.78% for MCBA with significant increases in bone volume of AB vs. BCP and ABB, and MCBA vs. ABB samples. Significantly different residual bone substitute material was measured as 15.8 ± 2.1% in the BCP group and 21.36 ± 4.83% in the ABB group. As it provides the highest rate of de novo bone formation, AB can be considered to remain the gold standard in sinus floor augmentation. All tested control materials showed comparable results and are suitable for maxillary sinus augmentation. © 2012 John Wiley & Sons A/S.

  1. 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.

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

    Science.gov (United States)

    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.

  3. Brushite-Forming Mg-, Zn- and Sr-Substituted Bone Cements for Clinical Applications

    Directory of Open Access Journals (Sweden)

    José M.F. Ferreira

    2010-01-01

    Full Text Available Calcium phosphate cements have been in clinical use for the last 10 years. Their most salient features include good biocompatibility, excellent bioactivity, self-setting characteristics, low setting temperature, adequate stiffness, and easy shaping to accomodate any complicated geometry. They are commonly used in filling bone defects and trauma surgeries as mouldable paste-like bone substitute materials. Substitution of trace elements, such as Mg, Sr and Zn ions, into the structure of calcium phosphates is the subject of widespread investigation nowadays, because of their impending role in the biological process. Subtle differences in composition and structure of these materials may have a profound effect on their in vivo behaviour. Therefore, the main goal of this paper is to provide a simple, but comprehensive overview of the present achievements relating to brushite-forming cements doped with Mg, Zn and Sr, and to identify new developments and trends. In particular, the influence of ionic substitution on the chemical, physical and biological properties of these materials is discussed.

  4. Reconstruction of chest wall using a two-layer prolene mesh and bone cement sandwich.

    Science.gov (United States)

    Aghajanzadeh, Manouchehr; Alavi, Ali; Aghajanzadeh, Gilda; Ebrahimi, Hannan; Jahromi, Sina Khajeh; Massahnia, Sara

    2015-02-01

    Wide surgical resection is the most effective treatment for the vast majority of chest wall tumors. This study evaluated the clinical success of chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich. The records of all patients undergoing chest wall resection and reconstruction were reviewed. Surgical indications, the location and size of the chest wall defect, diaphragm resection, pulmonary performance, postoperative complications, and survival of each patient were recorded. From 1998 to 2008, 43 patients (27 male, 16 female; mean age of 48 years) underwent surgery in our department to treat malignant chest wall tumors: chondrosarcoma (23), osteosarcoma (8), spindle cell sarcoma (6), Ewing's sarcoma (2), and others (4). Nine sternectomies and 34 antero-lateral and postero-lateral chest wall resections were performed. Postoperatively, nine patients experienced respiratory complications, and one patient died because of respiratory failure. The overall 4-year survival rate was 60 %. Chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich is a safe and effective surgical procedure for major chest wall defects.

  5. Preliminary evaluation of the in vitro cytotoxicity of PMMA-co-EHA bone cement

    International Nuclear Information System (INIS)

    Almeida, T.; Leite Ferreira, B.J.M.; Loureiro, J.; Correia, R.N.; Santos, C.

    2011-01-01

    This work reports a preliminary in vitro cytotoxicity assessment of new poly (methyl methacrylate)-co-ethyl hexylacrylate (PMMA-co-EHA) bone cement by evaluating the effect of its leachables on the viability of human osteoblast-like cells (MG63 line) and their progression through the cell cycle. MG63 cells were exposed to 72 h-extract dilutions of PMMA-co-EHA and their viability was tested using the 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay. Also, putative changes in the progression of cells through the cell cycle were monitored using flow cytometry. For that the relative nuclear DNA content and the ratio of cells at G 1 :S:G 2 stages of the cell cycle were measured after three exposure periods (24, 48 and 72 h). The obtained results revealed a dose-dependent influence of the cement extract in MG63 cell metabolism when compared to cells cultivated in a culture medium only. The MTT assay showed that a moderate number of cells died after exposure to the most concentrated extract. The cell cycle analysis revealed that leachables of PMMA-co-EHA led to significant changes in cellular proliferation, with cells exposed for 48 h to the most concentrated extract being arrested in the S phase of the cell cycle. However, despite the initial period of cytotoxicity, the obtained results suggest that after 72 h of exposure, the surviving cells are able to recover from this arresting condition and continue to proliferate. Therefore, this preliminary study indicates that, at the biological level, PMMA-co-EHA may have potential of being used as a bone cement matrix. However, a more detailed research work is needed to fully understand the factors responsible for the initial cytotoxicity observed.

  6. 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

    . RESULTS: Bone and connective tissue fraction in the newly formed tissues inside the sinus cavity averaged 23.4 ± 13.2% and 54.1 ± 23.5%, respectively. Residual biomaterial, empty spaces, and debris averaged 1.9 ± 3.5%, 10.5 ± 6.3%, and 8.4 ± 14.5%, respectively. In the transalveolar osteotomy, bone...... and connective tissue fraction averaged 41.6 ± 14.3% and 46.1 ± 13%, respectively, while the amount of residual biomaterial, empty spaces, and debris was 2.8 ± 5%, 4.7 ± 1.9%, and 3.2 ± 2.6%, respectively. Statistically significant differences between the sinus cavity and the transalveolar osteotomy were found......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...

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Just a drop of cement: a case of cervical spine bone aneurysmal cyst successfully treated by percutaneous injection of a small amount of polymethyl-methacrylate cement.

    Science.gov (United States)

    Fahed, Robert; Clarençon, Frédéric; Riouallon, Guillaume; Cormier, Evelyne; Bonaccorsi, Raphael; Pascal-Mousselard, Hugues; Chiras, Jacques

    2016-01-01

    Aneurysmal bone cyst (ABC) is a benign hemorrhagic tumor, commonly revealed by local pain. The best treatment for this lesion is still controversial. We report the case of a patient with chronic neck pain revealing an ABC of the third cervical vertebra. After percutaneous injection of a small amount of polymethyl-methacrylate bone cement, the patient experienced significant clinical and radiological improvement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. Calcium phosphate cement augmentation after volar locking plating of distal radius fracture significantly increases stability.

    Science.gov (United States)

    Kainz, Hans; Dall'Ara, Enrico; Antoni, Anna; Redl, Heinz; Zysset, Philippe; Weninger, Patrick

    2014-08-01

    Distal radius fractures represent the most common fractures in adults. Volar locking plating to correct unstable fractures has become increasingly popular. Although reasonable primary reduction is possible in most cases, maintenance of reduction until the fracture is healed is often problematic in osteoporotic bone. To our knowledge, no biomechanical studies have compared the effect of enhancement with biomaterial on two different volar fixed-angle plates. Human fresh-frozen cadaver pairs of radii were used to simulate an AO/OTA 23-A3 fracture. In a total of four groups (n = 7 for each group), two volar fixed-angle plates (Aptus 2.5 mm locking fracture plate, Medartis, Switzerland and VA-LCP two-column distal radius plate 2.4, volar, Synthes, Switzerland) with or without an additional injection of a biomaterial (Hydroset Injectable HA Bone Substitute, Stryker, Switzerland) into the dorsal comminution zone were used to fix the distal metaphyseal fragment. Each specimen was tested load-controlled under cyclic loading with a servo-hydraulic material testing machine. Displacement, stiffness, dissipated work and failure mode were recorded. Improved mechanical properties (decreased displacement, increased stiffness, decreased dissipated work) were found in both plates if the biomaterial was additionally injected. Improvement of mechanical parameters after biomaterial injection was more evident in the Synthes plate compared to the Aptus plate. Pushing out of the screws was noticed as a failure mode only in samples lacking supplementary biomaterial. Injection of a biomaterial into the dorsal comminution zone increases stability after volar locking plating of distal radius fractures in vitro.

  10. Synthetic bone substitute engineered with amniotic epithelial cells enhances bone regeneration after maxillary sinus augmentation.

    Directory of Open Access Journals (Sweden)

    Barbara Barboni

    Full Text Available BACKGROUND: Evidence has been provided that a cell-based therapy combined with the use of bioactive materials may significantly improve bone regeneration prior to dental implant, although the identification of an ideal source of progenitor/stem cells remains to be determined. AIM: In the present research, the bone regenerative property of an emerging source of progenitor cells, the amniotic epithelial cells (AEC, loaded on a calcium-phosphate synthetic bone substitute, made by direct rapid prototyping (rPT technique, was evaluated in an animal study. MATERIAL AND METHODS: Two blocks of synthetic bone substitute (∼0.14 cm(3, alone or engineered with 1×10(6 ovine AEC (oAEC, were grafted bilaterally into maxillary sinuses of six adult sheep, an animal model chosen for its high translational value in dentistry. The sheep were then randomly divided into two groups and sacrificed at 45 and 90 days post implantation (p.i.. Tissue regeneration was evaluated in the sinus explants by micro-computer tomography (micro-CT, morphological, morphometric and biochemical analyses. RESULTS AND CONCLUSIONS: The obtained data suggest that scaffold integration and bone deposition are positively influenced by allotransplantated oAEC. Sinus explants derived from sheep grafted with oAEC engineered scaffolds displayed a reduced fibrotic reaction, a limited inflammatory response and an accelerated process of angiogenesis. In addition, the presence of oAEC significantly stimulated osteogenesis either by enhancing bone deposition or making more extent the foci of bone nucleation. Besides the modulatory role played by oAEC in the crucial events successfully guiding tissue regeneration (angiogenesis, vascular endothelial growth factor expression and inflammation, data provided herein show that oAEC were also able to directly participate in the process of bone deposition, as suggested by the presence of oAEC entrapped within the newly deposited osteoid matrix and by their

  11. Graphene oxide versus functionalized carbon nanotubes as a reinforcing agent in a PMMA/HA bone cement.

    Science.gov (United States)

    Gonçalves, Gil; Cruz, Sandra M A; Ramalho, A; Grácio, José; Marques, Paula A A P

    2012-04-28

    Graphene oxide (GO) and functionalized carbon nanotubes (f-CNTs) (each in the concentration range of 0.01-1.00 wt/wt%) were investigated as the reinforcing agent in a poly(methyl methacrylate) (PMMA)/hydroxyapatite (HA) bone cement. Mixed results were obtained for the changes in the mechanical properties determined (storage modulus, bending strength, and elastic modulus) for the reinforced cement relative to the unreinforced counterpart; that is, some property changes were increased while others were decreased. We postulate that this outcome is a consequence of the fact that each of the nanofillers hampered the polymerization process in the cement; specifically, the nanofiller acts as a scavenger of the radicals produced during polymerization reaction due to the delocalized π-bonds. Results obtained from the chemical structure and polymer chain size distribution determined, respectively, by nuclear magnetic resonance and size exclusion chromatography analysis, on the polymer extracted from the specimens support the postulated mechanism. Furthermore, in the case of the 0.5 wt/wt% GO-reinforced cement, we showed that when the concentration of the radical species in the PMMA bone cement was doubled, mechanical properties markedly improved (relative to the value in the unreinforced cement), suggesting suppression of the aforementioned scavenger activity. This journal is © The Royal Society of Chemistry 2012

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Tooth Movement out of the Bony Wall Using Augmented Corticotomy with Nonautogenous Graft Materials for Bone Regeneration

    Directory of Open Access Journals (Sweden)

    Kye-Bok Lee

    2014-01-01

    Full Text Available This prospective randomized split-mouth study was performed to compare the effects of augmented corticotomy with those of different nonautogenous bone graft materials combined with orthodontic tooth movement in dogs. Decortication was performed on the buccal bone surface of 6 male beagle dogs that were randomly assigned to receive grafts of deproteinized bovine bone mineral, irradiated cortical bone, or synthetic bone. Immediate orthodontic force was applied to the second and third premolars for buccal tipping for 6 weeks. The pocket depth and width of keratinized tissue (WKT were measured. Histologic and histomorphometric analyses were performed. The probing depth, WKT, and ratio of the area of new bone to that of total bone on the buccal side were not significantly different between groups. All groups had considerable new bone formation on the pressure side. New bone formation on the buccal side and buccal plate formation in the coronal direction along the root surfaces were induced by the bone-derived and PDL-derived mesenchymal matrix, respectively. The angular change between groups was significantly different (P < 0.001. Augmented corticotomy using nonautogenous graft materials facilitated tooth movement without fenestrations and accelerated new bone formation on the pressure side.

  15. Hydroxyapatite Microspheres as an Additive to Enhance Radiopacity, Biocompatibility, and Osteoconductivity of Poly(methyl methacrylate Bone Cement

    Directory of Open Access Journals (Sweden)

    In-Gu Kang

    2018-02-01

    Full Text Available This study demonstrates the utility of hydroxyapatite (HA microspheres as an additive to enhance the radiopaque properties, biocompatibility, and osteoconductivity of poly(methyl methacrylate (PMMA-based bone cements. HA microspheres were synthesized using spray drying. They had well-defined spherical shapes, thus allowing for the production of PMMA/HA composites with a very high HA content (20 vol % and 40 vol %. The uniform distribution of these HA microspheres in the PMMA matrix resulted in a remarkable increase in compressive modulus (p < 0.05, while preserving a reasonably high compressive strength. The PMMA/HA bone cements showed much higher radiopacity than PMMA containing BaSO4 as the additive. This was attributed to the high HA content up to 40 vol %. In addition, the biocompatibility and osteoconductivity of PMMA/HA bone cements were significantly enhanced compared to those of PMMA bone cements containing BaSO4, which were assessed using in vitro tests and in vivo animal experiments.

  16. 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

  17. 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.

    2011-01-01

    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

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  20. 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

  1. Release of zirconia nanoparticles at the metal stem-bone cement interface in implant loosening of total hip replacements.

    Science.gov (United States)

    Schunck, Antje; Kronz, Andreas; Fischer, Cornelius; Buchhorn, Gottfried Hans

    2016-02-01

    In a previous failure analysis performed on femoral components of cemented total hip replacements, we determined high volumes of abraded bone cement. Here, we describe the topography of the polished surface of polymethyl methacrylate (PMMA) bone cement containing zirconia radiopacifier, analyzed by scanning electron microscopy and vertical scanning interferometry. Zirconia spikes protruded about 300nm from the PMMA matrix, with pits of former crystal deposition measuring about 400nm in depth. We deduced that the characteristically mulberry-shaped agglomerates of zirconia crystals are ground and truncated into flat surfaces and finally torn out of the PMMA matrix. Additionally, evaluation of in vitro PMMA-on-PMMA articulation confirmed that crystal agglomerations of zirconia were exposed to grain pullout, fatigue, and abrasion. In great quantities, micron-sized PMMA wear and zirconia nanoparticles accumulate in the cement-bone interface and capsular tissues, thereby contributing to osteolysis. Dissemination of nanoparticles to distant lymph nodes and organs of storage has been reported. As sufficient information is lacking, foreign body reactions to accumulated nanosized zirconia in places of long-term storage should be investigated. The production of wear particles of PMMA bone cement in the interface to joint replacement devices, presents a local challenge. The presence of zirconia particles results in frustrated digestion attempts by macrophages, liberation of inflammatory mediators, and necrosis leading to aseptic inflammation and osteolyses. Attempts to minimize wear of articulating joints reduced the attention to the deterioration of cement cuffs. We therefore investigated polished surfaces of retrieved cuffs to demonstrate their morphology and to measure surface roughness. Industrially admixed agglomerates of the radiopacifier are abraded to micron and nano-meter sized particles. The dissemination of zirconia particles in the reticulo-endothelial system to

  2. Vertical Bone Augmentation Using Deproteinized Bovine Bone Mineral, Absorbable Collagen Sponge, and Recombinant Human Bone Morphogenetic Protein-2: An In Vivo Study in Rabbits.

    Science.gov (United States)

    Kim, Yeon Jung; de Molon, Rafael Rafael; Horiguti, Fausto Rioiti; Contador, Guilherme Piragine; Coelho, Marco Antonio; Mascarenhas, Vinicius Ibiapina; de Souza Faloni, Ana Paula; Cirelli, Joni Augusto; Sendyk, Wilson Roberto

    2018-03-15

    The objective of this investigation was to assess vertical bone augmentation using deproteinized bovine bone mineral (DBBM) infused or not with recombinant human bone morphogenetic protein (rhBMP-2) in rabbit tibiae. A total of 18 female rabbits (New Zealand) received two blocks of DBBM in each tibia. The DBBM blocks were randomly assigned into four experimental groups: DBBM (only the bone graft); DBBM associated with absorbable collagen sponge (ACS); DBBM plus rhBMP-2 (1.5 mg/mL); and DBBM infused with rhBMP-2 (1.5 mg/mL) in an ACS carrier. Animals were sacrificed after 12 weeks, and the tibiae containing the DBBM blocks were dissected and analyzed radiographically (microcomputed tomography [micro-CT]), histologically, and immunohistochemically. Micro-CT analysis showed a considerable increase in bone volume (BV) and BV/tissue volume in the rhBMP-2/ACS group compared with all the others. Trabeculae thickness also increased in the rhBMP-2/ACS group compared with the DBBM/ACS group. Trabecular number, separation, and bone mineral density were not different among groups. Histomorphometric evaluation showed increased newly formed bone in the rhBMP-2/ACS group compared with the DBBM and DBBM/ACS groups. The amount of residual bone graft was statistically higher in the rhBMP-2 groups compared with the DBBM/ACS group. Immunohistochemical analysis showed that the vascular endothelial growth factor (VEGF) expression was more intense in the rhBMP-2/ACS group compared with the DBBM/ACS group. The immunopositivity for type 1 collagen tended to be higher in the two groups with rhBMP-2. Collectively, the results of this study suggest that the addition of rhBMP-2 in an ACS carrier placed on top of the DBBM graft enhanced bone formation in this animal model.

  3. Comparative study of the osseous healing process following three different techniques of bone augmentation in the mandible: an experimental study.

    Science.gov (United States)

    Benlidayi, M E; Gaggl, A; Buerger, H; Kahraman, O E; Sencar, L; Brandtner, C; Kurkcu, M; Polat, S; Borumandi, F

    2014-11-01

    The aim of this study was to evaluate the osseointegration of three different bone grafting techniques. Forty-eight mature New Zealand rabbits were divided randomly into three groups of 16 each. Horizontal augmentation was performed on the corpus of the mandible using three different techniques: free bone graft (FBG), free periosteal bone graft (PBG), pedicled bone flap (BF). The animals were sacrificed at postoperative weeks 1, 3, or 8. Specimens were decalcified for histological examination, and histomorphometric measurements were performed. The histological evaluation demonstrated bony fusion between the grafts and the augmented mandibular bone after 8 weeks in all groups. At week 8, the bone volume was significantly greater in the BF group than in the FBG (PPBG (P=0.001) groups, and also the trabecular thickness was significantly greater than in the FBG (P=0.015) and PBG (P=0.015) groups. Trabecular separation was significantly lower in the BF group than in the FBG group at week 8 (P=0.015). BF demonstrated greater osseous healing capacity compared to FBG and PBG. The preserved vascularization in BF improves the bone quality in mandibular bone augmentations. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. ZP2307, a novel, cyclic PTH(1-17) analog that augments bone mass in ovariectomized rats

    DEFF Research Database (Denmark)

    Neerup, Trine Skovlund Ryge; Stahlhut, Martin; Petersen, Jørgen S

    2011-01-01

    Daily injections of human parathyroid hormone (1-34), hPTH(1-34), provide a highly effective treatment option for severe osteoporosis. However, PTH analogs shorter than 28 amino acids do not retain any bone augmenting potential. Here, we present ZP2307 ([Ac₅c¹, Aib³, Leu⁸, Gln¹⁰, Har¹¹, Ala¹², Trp......¹⁴, Asp¹⁷]PTH(1-17)-NH₂), a novel, chemically modified and cyclized hPTH(1-17) analog, that augments bone mass in ovariectomized, osteopenic rats. Subcutaneous administration of this structurally constrained, K¹³-D¹⁷ side-chain-to-side-chain cyclized peptide reversed bone loss and increased bone...... calcium levels in the ovariectomized rats. To our knowledge ZP2307 is the smallest PTH peptide analog known to exert augmentation of bone. Our findings suggest that ZP2307 has the potential to effectively augment bone mass over a broad dose range without a concomitant increase in the serum concentration...

  5. The density of collagen fiber in alveolus mandibular bone of rabbit after augmentation with powder demineralized bone matrix post incisivus extraction

    Directory of Open Access Journals (Sweden)

    Regina TC. Tandelilin

    2006-06-01

    Full Text Available The bone defect due to tooth extraction contributes the most cases reported in the aspects of oral surgery. The defect can be preventively managed by adding powder bone matrix intended for augmentation which eventually induces the formation of new bones. This hard tissue wound healing is preceded by the presence of collagen fibers. The aim of this study was to determine the density of collagen fiber in the alveolus mandibular bone of rabbit which was augmented using powder demineralized bone matrix (DBM post incisivus extraction. Twenty four male rabbits aged 2.5–3 months weighed 900–1,100 grams were randomly divided into two groups. The treated rabbits were augmented with DBM after the incisivus extraction on mandible. The mucosa was then sutured. On the other hand, the controlled rabbits received similar treatments with those of the treated rabbits except there was no augmentation of DBM. Decapitation of treated and controlled rabbits was made on day 5, 7, 10, and 14 days post surgery, each with three rabbits. Mandibles were cut, decalcified, and imbedded in paraffin block. The staining was done using Mallory. Significant differences in the density of collagen were noted on day 10 and 14 post surgery, indicating that powder demineralized bone matrix successfully induced the stimulation of collagen.

  6. The Mechanical Properties of Biocompatible Apatite Bone Cement Reinforced with Chemically Activated Carbon Fibers

    Directory of Open Access Journals (Sweden)

    Anne V. Boehm

    2018-01-01

    Full Text Available Calcium phosphate cement (CPC is a well-established bone replacement material in dentistry and orthopedics. CPC mimics the physicochemical properties of natural bone and therefore shows excellent in vivo behavior. However, due to their brittleness, the application of CPC implants is limited to non-load bearing areas. Generally, the fiber-reinforcement of ceramic materials enhances fracture resistance, but simultaneously reduces the strength of the composite. Combining strong C-fiber reinforcement with a hydroxyapatite to form a CPC with a chemical modification of the fiber surface allowed us to adjust the fiber–matrix interface and consequently the fracture behavior. Thus, we could demonstrate enhanced mechanical properties of CPC in terms of bending strength and work of fracture to a strain of 5% (WOF5. Hereby, the strength increased by a factor of four from 9.2 ± 1.7 to 38.4 ± 1.7 MPa. Simultaneously, the WOF5 increased from 0.02 ± 0.004 to 2.0 ± 0.6 kJ∙m−2, when utilizing an aqua regia/CaCl2 pretreatment. The cell proliferation and activity of MG63 osteoblast-like cells as biocompatibility markers were not affected by fiber addition nor by fiber treatment. CPC reinforced with chemically activated C-fibers is a promising bone replacement material for load-bearing applications.

  7. Bi-layered calcium phosphate cement-based composite scaffold mimicking natural bone structure.

    Science.gov (United States)

    He, Fupo; Ye, Jiandong

    2013-08-01

    In this study, a core/shell bi-layered calcium phosphate cement (CPC)-based composite scaffold with adjustable compressive strength, which mimicked the structure of natural cortical/cancellous bone, was fabricated. The dense tubular CPC shell was prepared by isostatic pressing CPC powder with a specially designed mould. A porous CPC core with unidirectional lamellar pore structure was fabricated inside the cavity of dense tubular CPC shell by unidirectional freeze casting, followed by infiltration of poly(lactic-co-glycolic acid) and immobilization of collagen. The compressive strength of bi-layered CPC-based composite scaffold can be controlled by varying thickness ratio of dense layer to porous layer. Compared to the scaffold without dense shell, the pore interconnection of bi-layered scaffold was not obviously compromised because of its high unidirectional interconnectivity but poor three dimensional interconnectivity. The in vitro results showed that the rat bone marrow stromal cells attached and proliferated well on the bi-layered CPC-based composite scaffold. This novel bi-layered CPC-based composite scaffold is promising for bone repair.

  8. Increase of homogenous new bone formation using osteoinductive factor rhGDF-5 during sinus floor augmentation in Goettingen Minipigs.

    Science.gov (United States)

    Brockmeyer, Phillipp; Lange, Katharina; Hahn, Wolfram; Schliephake, Henning; Matthias Gruber, Rudolf

    2015-11-01

    The aim of this study was to test the hypothesis that recombinant human growth and differentiation factor-5 (rhGDF-5) induces an increased and homogenous distribution of new bone formation across the entire volume of sinus floor augmentation in 12 Goettingen Minipigs. In a randomized split-mouth design, one maxillary sinus was augmented with the bone substitute β-TCP, whereas a combination of β-TCP and the osteoinductive growth factor rhGDF-5 was used on the contralateral side. To evaluate the influence of dose and time on the effectiveness of the factor, two different concentrations of rhGDF-5 (400 μg and 800 μg) and healing periods (4 and 12 weeks) were each analysed. After 4 weeks, a homogenous gradient of bone formation could be observed for all dosage groups, with decreasing bone density from the local bone towards the sinus membrane. Both test groups, however, achieved a higher total level of bone formation compared with the control group, which was only significant in the low-dose group (P = 0.0184). After 12 weeks, the influence of the growth factor significantly depends on the region (P = 0.023). In the low-dose group, the new bone formation did not differ significantly within the examined regions of the graft (P = 0.1118), suggesting a homogeneous bone formation over the entire augmentation. The gradient of the high-dose group was similar to the control group with a decrease of local bone development. rhGDF-5 delivered on a β-TCP scaffold material leads to an increase in homogeneous new bone formation across the entire volume of the sinus floor augmentation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Intracardiac bone cement embolism as a complication of vertebroplasty: management strategy.

    Science.gov (United States)

    Hatzantonis, Catherine; Czyz, Marcin; Pyzik, Renata; Boszczyk, Bronek M

    2017-12-01

    Vertebroplasty carries multiple complications due to the leakage of polymethylmethacrylate (PMMA) into the venous system through the iliolumbar or epidural veins. The rate of venous cement complications may vary from 1 to 10 %, with cement extravasation into the venous system in 24 % of patients. Emboli may further migrate into the right heart chambers and pulmonary arteries. Patients may vary in presentation from asymptomatic or symptoms such as syncope to life-threatening complications. We present a case of a 57-year-old lady diagnosed with osteoporosis who underwent a staged antero-posterior fixation with PMMA vertebroplasty of progressive thoraco-lumbar kyphosis caused by osteoporotic fractures to T12, L1 and L2 vertebral bodies. Four weeks after the operation, the patient developed symptoms of left-sided chest pain, tachycardia and tachypnea. CT pulmonary angiogram (CTPA) found a high-density material within the right atrium, whilst ECHO demonstrated normal systolic function. The patient was commenced on enoxaparin at therapeutic dose of 1.5 mg/kg for 3 months and remained asymptomatic. Follow-up ECHO found no change to the heart function and no blood clot on the PMMA embolus. Factors influencing the decision about conservative treatment included symptoms, localisation of the embolus, as well as time lapse between vertebroplasty and clinical manifestation. Patients that are commonly asymptomatic can be treated conservatively. The management of choice is anticoagulation with low-molecular-weight heparin or warfarin until the foreign body epithelialises and ceases in becoming potentially thrombogenic. Symptomatic patients with thrombi in the right atrium are commonly managed via percutaneous retrieval, whilst those with RV involvement or perforation are commonly managed with surgical retrieval. Management of individual patients should be based on individual clinical circumstances. Patients presenting with intracardiac bone cement embolism related to spinal

  10. Treating osteoporotic vertebral compression fractures with intraosseous vacuum phenomena using high-viscosity bone cement via bilateral percutaneous vertebroplasty.

    Science.gov (United States)

    Guo, Dan; Cai, Jun; Zhang, Shengfei; Zhang, Liang; Feng, Xinmin

    2017-04-01

    Osteoporotic vertebral compression fractures with intraosseous vacuum phenomena could cause persistent back pains in patients, even after receiving conservative treatment. The aim of this study was to evaluate the efficacy of using high-viscosity bone cement via bilateral percutaneous vertebroplasty in treating patients who have osteoporotic vertebral compression fractures with intraosseous vacuum phenomena.Twenty osteoporotic vertebral compression fracture patients with intraosseous vacuum phenomena, who received at least 2 months of conservative treatment, were further treated by injecting high-viscosity bone cement via bilateral percutaneous vertebroplasty due to failure of conservative treatment. Treatment efficacy was evaluated by determining the anterior vertebral compression rates, visual analog scale (VAS) scores, and Oswestry disability index (ODI) scores at 1 day before the operation, on the first day of postoperation, at 1-month postoperation, and at 1-year postoperation.Three of 20 patients had asymptomatic bone cement leakage when treated via percutaneous vertebroplasty; however, no serious complications related to these treatments were observed during the 1-year follow-up period. A statistically significant improvement on the anterior vertebral compression rates, VAS scores, and ODI scores were achieved after percutaneous vertebroplasty. However, differences in the anterior vertebral compression rate, VAS score, and ODI score in the different time points during the 1-year follow-up period was not statistically significant (P > 0.05).Within the limitations of this study, the injection of high-viscosity bone cement via bilateral percutaneous vertebroplasty for patients who have osteoporotic vertebral compression fractures with intraosseous vacuum phenomena significantly relieved their back pains and improved their daily life activities shortly after the operation, thereby improving their life quality. In this study, the use of high-viscosity bone

  11. Effect of storage temperature and equilibration time on polymethyl methacrylate (PMMA) bone cement polymerization in joint replacement surgery.

    Science.gov (United States)

    Koh, Bryan T H; Tan, J H; Ramruttun, Amit Kumarsing; Wang, Wilson

    2015-11-17

    In cemented joint arthroplasty, the handling characteristics (doughing, working, and setting times) of polymethyl methacrylate (PMMA) bone cement is important as it determines the amount of time surgeons have to optimally position an implant. Storage conditions (temperature and humidity) and the time given for PMMA cement to equilibrate to ambient operating theater (OT) temperatures are often unregulated and may lead to inconsistencies in its handling characteristics. This has not been previously studied. Hence, the purpose of this study was to investigate the effect of storage temperatures on the handling characteristics of PMMA cement and the duration of equilibration time needed at each storage temperature to produce consistent and reproducible doughing, setting, and working times. SmartSet® HV cement was stored at three different controlled temperatures: 20 °C (control), 24 °C, and 28 °C for at least 24 h prior to mixing. The cement components were then brought into a room kept at 20 °C and 50 % humidity. Samples were allowed to equilibrate to ambient conditions for 15, 30, 45, and 60 min. The cement components were mixed and the dough time, temperature-versus-time curve (Lutron TM-947SD, Lutron Electronics, Inc., Coopersburg, PA), and setting time were recorded. Analysis was performed using the two-way ANOVA test (IBM SPSS Statistics V.22). At 20 °C (control) storage temperature, the mean setting time was 534 ± 17 s. At 24 °C storage temperature, the mean setting time was 414 ± 6 s (p  0.05) with 60 min of equilibration. At 28 °C storage temperature, the mean setting time was 381 ± 8 s (p  0.05) with 60 min of equilibration. This study reflects the extent to which storage temperatures and equilibration times can potentially affect the handling characteristics of PMMA cement. We recommend institutions to have a well-regulated temperature and humidity-controlled facility for storage of bone cements and a protocol to

  12. Sinus floor augmentation surgery using autologous bone grafts from various donor sites: a meta-analysis of the total bone volume.

    Science.gov (United States)

    Klijn, Reinoud J; Meijer, Gert J; Bronkhorst, Ewald M; Jansen, John A

    2010-06-01

    To date, no studies have been published that evaluated histomorphometric data from a large number of patients while comparing different sites and methods of autologous bone grafting in sinus floor augmentation procedures. A meta-analysis of the English literature from January 1995 till April 2009 was carried out. PubMed search engine and the following journals were explored: Clinical Oral Implant Research, International Journal of Oral and Maxillofacial Implants, International Journal of Periodontics and Restorative Dentistry, and the Journal of Periodontology. Out of 147 titles, according to our criteria, 25 articles were left for analysis. The majority were prospective controlled studies (21) and 2 randomized clinical trials, 1 pilot study and 1 case series. A reference value of 47% for total bone volume (TBV) was found while using iliac bone grafting as a standard. Use of intraoral bone grafts increases the TBV, with 11% for chin bone and 14% for bone grafted from other intraoral sites. Particulation of the bone graft has a negative effect on the TBV of 18%. Surprisingly, no correlation between TBV and the time of graft healing was found. Histological section thickness seemed to be a significant variable, as every micron increase of section thickness leads to an increase of 0.4% of TBV. Bone grafting from the iliac crest resulted in a significantly lower TBV compared with intraoral bone grafting. However, due to the limited availability of intraoral bone to be harvested, iliac grafts still have to be considered the gold standard in augmenting the severely atrophic maxilla.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Fabrication and characterization of a novel carbon fiber-reinforced calcium phosphate silicate bone cement with potential osteo-inductivity

    International Nuclear Information System (INIS)

    Zheng, Jiangjiang; Xiao, Yu; Bao, Chongyun; Gong, Tianxing; Zhou, Shuxin; Troczynski, Tom; Yang, Quanzu; Xu, Xiaoming

    2016-01-01

    The repair of bone defects is still a pressing challenge in clinics. Injectable bone cement is regarded as a promising material to solve this problem because of its special self-setting property. Unfortunately, its poor mechanical conformability, unfavorable osteo-genesis ability and insufficient osteo-inductivity seriously limit its clinical application. In this study, novel experimental calcium phosphate silicate bone cement reinforced by carbon fibers (CCPSC) was fabricated and characterized. First, a compressive strength test and cell culture study were carried out. Then, the material was implanted into the femoral epiphysis of beagle dogs to further assess its osteo-conductivity using a micro-computed tomography scan and histological analysis. In addition, we implanted CCPSC into the beagles’ intramuscular pouches to perform an elementary investigation of its osteo-inductivity. The results showed that incorporation of carbon fibers significantly improved its mechanical properties. Meanwhile, CCPSC had better biocompatibility to activate cell adhesion as well as proliferation than poly-methyl methacrylate bone cement based on the cell culture study. Moreover, pronounced biodegradability and improved osteo-conductivity of CCPSC could be observed through the in vivo animal study. Finally, a small amount of osteoid was found at the heterotopic site one month after implantation which indicated potential osteo-inductivity of CCPSC. In conclusion, the novel CCPSC shows promise as a bioactive bone substitute in certain load-bearing circumstances. (paper)

  15. Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients.

    Science.gov (United States)

    Wu, Zi-xiang; Gao, Ming-xuan; Sang, Hong-xun; Ma, Zhen-sheng; Cui, Geng; Zhang, Yang; Lei, Wei

    2012-03-01

    The incidence of screw loosening increases significantly in elderly patients with severe osteoporosis. Open vertebral cement augmentation of expandable pedicle screw fixation may improve fixation strength in the osteoporotic vertebrae. Twenty cadaveric vertebrae (L1-L5) were harvested from six osteoporotic lumbar spines. Axial pullout tests were performed to compare the maximum pullout strength (Fmax) of four methods: 1. Conventional pedicle screws (CPS), 2. Expandable pedicle screws (EPS), 3. Cement augmentation of CPS (cemented-CPS), 4. Cement augmentation of EPS (cemented-EPS). Thirty-six consecutive patients with single-vertebral osteoporotic compressive fractures received posterior decompression and spinal fusion with cemented-CPS (16 cases) or cemented-EPS (20 cases). Plain film and/or CT scan were conducted to evaluate the spinal fusion and fixation effectiveness. The Fmax and energy absorption of cemented-EPS were significantly greater than three control groups. The mean BMD in the severe osteoporosis group was significantly lower than that in the osteoporosis group (t = 2.04, P = 0.036). In the osteoporosis group, cemented-EPS improved the Fmax by 43% and 21% over CPS and cemented-CPS group. In the severe osteoporosis group, cemented-EPS increased the Fmax by 59%, 22%, and 26% over CPS, EPS, and cemented-CPS, respectively. The clinical results showed that all patients suffered from severe osteoporosis. Six months after operation, the JOA and VAS scores in cemented-EPS group improved from 11.4 ± 2.6 and 7.0 ± 1.4 mm to 24.9 ± 1.6 and 2.1 ± 1.3 mm, respectively. No screw loosening occurred in the cemented-EPS group and spinal fusion was achieved. In the cemented-CPS group, four screws loosened (4.2%) according to the radiolucency. Six months after operation, the JOA and VAS scores improved from 13.1 ± 1.9 and 7.6 ± 1.5 mm to 22.8 ± 2.2 and 2.5 ± 1.6 mm, respectively. No cement leaked into the spinal canal in both groups. Cemented-EPS could increase

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    Pikos, Michael A.; Chan, Hsun-Liang; Suarez, Fernando; Gargallo-Albiol, Jordi; Hernández-Alfaro, Federico; Galindo-Moreno, Pablo; Wang, Hom-Lay

    2014-01-01

    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. PMID:25535616

  18. Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model.

    Science.gov (United States)

    Grüneweller, Niklas; Raschke, Michael J; Zderic, Ivan; Widmer, Daniel; Wähnert, Dirk; Gueorguiev, Boyko; Richards, Robert Geoff; Fuchs, Thomas; Windolf, Markus

    2017-07-01

    Operative treatment of sacral insufficiency fractures is frequently being complicated by osteopenic bone properties. Cement augmentation of implanted sacroiliac screws may lead to superior construct stability and prevent mechanical complications. A novel hemi-pelvis test model with dissected symphysis was developed. Five fresh-frozen cadaveric pelvises were vertically osteotomized at the sacrum on both sides and fixed with sacroiliac screws in both corridors of the first sacral vertebral body. One side was randomly augmented with bone cement. Cyclic testing consisting of torsional loading (±2.5 Nm) combined with progressively increasing axial loading (+50 N compression, -10 N traction, ±0,01 N/cycle) was performed until failure; simulated physiological loads derived from inverse dynamic calculations. The fixation was analyzed fluoroscopically quantifying screw migrations and assessing failure mechanisms. Failure modes were cut-out, pull-out, screw-out, and washer penetration. Motion at fracture site was analyzed via optical motion tracking. Unscrewing was provoked four times with non-augmented and twice with augmented screws. When focusing on the sacral region only, cement augmentation significantly improved screw fixation in terms of increased number of cycles to failure (p = 0.043). However, when considering overall construct stability, there was no significant difference between augmented and non-augmented state due to washer penetration at the iliac bone. The generated hemi-pelvis model was found to be valid due to the reproduction of the clinically observed failure mode (unscrewing). Unscrewing was not fully prevented by cement augmentation. Augmentation effects stability at the screw tip, but particularly in porotic bone, failure may shift to the next weak point. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1485-1493, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  19. 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),

  20. Applicability of equine hydroxyapatite collagen (eHAC) bone blocks for lateral augmentation of the alveolar crest. A histological and histomorphometric analysis in rats

    NARCIS (Netherlands)

    Zecha, P. J.; Schortinghuis, J.; van der Wal, J. E.; Nagursky, H.; van den Broek, K. C.; Sauerbier, S.; Vissink, A.; Raghoebar, G. M.

    This study assessed the mechanical characteristics, biocompatibility and osteoconductive properties of an equine hydroxyapatite collagen (eHAC) bone block when applied as a bone substitute for lateral augmentation of rat mandible. 96 rats underwent lateral augmentation of the mandible, using two

  1. Bone augmentation at peri-implant dehiscence defects comparing a synthetic polyethylene glycol hydrogel matrix vs. standard guided bone regeneration techniques.

    Science.gov (United States)

    Thoma, Daniel S; Jung, Ui-Won; Park, Jin-Young; Bienz, Stefan P; Hüsler, Jürg; Jung, Ronald E

    2017-07-01

    The aim of the study was to test whether or not the use of a polyethylene glycol (PEG) hydrogel with or without the addition of an arginylglycylaspartic acid (RGD) sequence applied as a matrix in combination with hydroxyapatite/tricalciumphosphate (HA/TCP) results in similar peri-implant bone regeneration as traditional guided bone regeneration procedures. In 12 beagle dogs, implant placement and peri-implant bone regeneration were performed 2 months after tooth extraction in the maxilla. Two standardized box-shaped defects were bilaterally created, and dental implants were placed in the center of the defects with a dehiscence of 4 mm. Four treatment modalities were randomly applied: i)HA/TCP mixed with a synthetic PEG hydrogel, ii)HA/TCP mixed with a synthetic PEG hydrogel supplemented with an RGD sequence, iii)HA/TCP covered with a native collagen membrane (CM), iv)and no bone augmentation (empty). After a healing period of 8 or 16 weeks, micro-CT and histological analyses were performed. Histomorphometric analysis revealed a greater relative augmented area for groups with bone augmentation (43.3%-53.9% at 8 weeks, 31.2%-42.8% at 16 weeks) compared to empty controls (22.9% at 8 weeks, 1.1% at 16 weeks). The median amount of newly formed bone was greatest in group CM at both time-points. Regarding the first bone-to-implant contact, CM was statistically significantly superior to all other groups at 8 weeks. Bone can partially be regenerated at peri-implant buccal dehiscence defects using traditional guided bone regeneration techniques. The use of a PEG hydrogel applied as a matrix mixed with a synthetic bone substitute material might lack a sufficient stability over time for this kind of defect. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. 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.

  3. Cement embolism into the venous system after pedicle screw fixation: case report, literature review, and prevention tips

    Directory of Open Access Journals (Sweden)

    Ghassan Kerry

    2013-09-01

    Full Text Available The strength of pedicle screws attachment to the vertebrae is an important factor affecting their motion resistance and long term performance. Low bone quality, e.g. in osteopenic patients, keeps the screw bone interface at risk for subsidence and dislocation. In such cases, bone cement could be used to augment pedicle screw fixation. But its use is not free of risk. Therefore, clinicians, especially spine surgeons, radiologists, and internists should become increasingly aware of cement migration and embolism as possible complications. Here, we present an instructive case of cement embolism into the venous system after augmented screw fixation with fortunately asymptomatic clinical course. In addition we discuss pathophysiology and prevention methods as well as therapeutic management of this potentially life-threatening complication in a comprehensive review of the literature. However, only a few case reports of cement embolism into the venous system were published after augmented screw fixation.

  4. A novel test method for evaluation of the abrasive wear behaviour of total hip stems at the interface between implant surface and bone cement.

    Science.gov (United States)

    Bader, R; Steinhauser, E; Holzwarth, U; Schmitt, M; Mittelmeier, W

    2004-01-01

    After total hip replacement, some cemented titanium stems show above-average early loosening rates. Increased release of wear particles and resulting reaction of the peri-prosthetic tissue were considered responsible. The objective was to develop a test method for analysing the abrasive wear behaviour of cemented stems and for generating wear particles at the interface with the bone cement. By means of the novel test device, cemented hip stems with different designs, surface topographies and material compositions using various bone cements could be investigated. Before testing, the cemented stems were disconnected from the cement mantle to simulate the situation of stem loosening (debonding). Subsequently, constant radial contact pressures were applied on to the stem surface by a force-controlled hydraulic cylinder. Oscillating micromotions of the stem (+/- 250 microm; 3 x 10(6)cycles; 5 Hz) were carried out at the cement interface initiating the wear process. The usability of the method was demonstrated by testing geometrically identical Ti-6A1-7Nb and Co-28Cr-6Mo hip stems (n= 12) with definite rough and smooth surfaces, combined with commercially available bone cement containing zirconium oxide particles. Under identical frictional conditions with the rough shot-blasted stems, clearly more wear particles were generated than with the smooth stems, whereas the material composition of the hip stems had less impact on the wear behaviour.

  5. The GDF5 mutant BB-1 enhances the bone formation induced by an injectable, poly(l-lactide-co-glycolide) acid (PLGA) fiber-reinforced, brushite-forming cement in a sheep defect model of lumbar osteopenia.

    Science.gov (United States)

    Gunnella, Francesca; Kunisch, Elke; Maenz, Stefan; Horbert, Victoria; Xin, Long; Mika, Joerg; Borowski, Juliane; Bischoff, Sabine; Schubert, Harald; Sachse, Andre; Illerhaus, Bernhard; Günster, Jens; Bossert, Jörg; Jandt, Klaus D; Plöger, Frank; Kinne, Raimund W; Brinkmann, Olaf; Bungartz, Matthias

    2018-02-01

    Targeted delivery of osteoinductive bone morphogenetic proteins (eg, GDF5) in bioresorbable calcium phosphate cement (CPC), potentially suitable for vertebroplasty and kyphoplasty of osteoporotic vertebral fractures, may be required to counteract augmented local bone catabolism and to support complete bone regeneration. The biologically optimized GDF5 mutant BB-1 may represent an attractive drug candidate for this purpose. The aim of the current study was to test an injectable, poly(l-lactide-co-glycolide) acid (PLGA) fiber-reinforced, brushite-forming CPC containing low-dose BB-1 in a sheep lumbar osteopenia model. This is a prospective experimental animal study. Bone defects (diameter 5 mm) were generated in aged, osteopenic female sheep and were filled with fiber-reinforced CPC alone (L4; CPC+fibers) or with CPC containing different dosages of BB-1 (L5; CPC+fibers+BB-1; 5, 100, and 500 µg BB-1; n=6 each). The results were compared with those of untouched controls (L1). Three and 9 months after the operation, structural and functional effects of the CPC (±BB-1) were analyzed ex vivo by measuring (1) bone mineral density (BMD); (2) bone structure, that is, bone volume/total volume (BV/TV) (assessed by micro-CT and histomorphometry), trabecular thickness (Tb.Th), and trabecular number (Tb.N); (3) bone formation, that is, osteoid volume/bone volume (OV/BV), osteoid surface/bone surface (OS/BS), osteoid thickness, mineralizing surface/bone surface (MS/BS), mineral apposition rate, and bone formation rate/bone surface; (4) bone resorption, that is, eroded surface/bone surface; and (5) compressive strength. Compared with untouched controls (L1), CPC+fibers (L4) and/or CPC+fibers+BB-1 (L5) significantly improved all parameters of bone formation, bone resorption, and bone structure. These effects were observed at 3 and 9 months, but were less pronounced for some parameters at 9 months. Compared with CPC without BB-1, additional significant effects of BB-1 were

  6. 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)

  7. 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

  8. Proximal Tibia Chondroblastoma Treated With Curettage and Bone Graft and Cement Use.

    Science.gov (United States)

    Cho, Hwan Seong; Park, Yeong Kyoon; Oh, Joo Han; Lee, Jung Hyun; Han, Ilkyu; Kim, Han-Soo

    2016-01-01

    Chondroblastoma has a predilection for the epiphyses or apophyses of long tubular bones. Management of lesions in the proximal tibia is challenging because it is difficult to gain access to intraepiphyseal lesions for completion of curettage. From October 2007 to December 2011, 9 patients with de novo chondroblastoma of the proximal tibia underwent surgery at the authors' institution. All patients initially presented with pain, and 5 patients had limitation of range of motion of the ipsilateral knee. Four lesions abutted the tibial attachment sites of the cruciate ligaments. Surgical procedures included intralesional tumor curettage, additional burring, and packing of the defect with bone graft and/or bone cement. The extra-articular approach was used according to tumor location. The medial or lateral parapatellar approach was used when the tumor was located in the anterior two-thirds of the horizontal plane. When a lesion was located in the posterior third, the posteromedial or posterolateral approach was used as the lesion was cornered. Mean duration of follow-up was 47.2 months (range, 27-80 months). No local recurrence or pulmonary metastasis was noted at latest follow-up. Mean functional score was 29.3 points (range, 28-30 points). All patients fully recovered range of motion in the affected knee. No avulsion fracture or anteroposterior instability of the knee joint was detected. Results of the current study suggest that intralesion curettage followed by additional burring with an extra-articular approach is a successful treatment option for chondroblastoma of the proximal tibia. Copyright 2016, SLACK Incorporated.

  9. 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.

  10. 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.

  11. Maxillary Sinus Floor Augmentation Surgery with Autogenous Bone Grafts as Ceiling : A Pilot Study and Test of Principle

    NARCIS (Netherlands)

    Raghoebar, Gerry M.; Meijer, Henny J. A.; Telleman, Gerdien; Vissink, Arjan

    Background: Studies have pointed out that the mere elevation of the maxillary sinus membrane might suffice to allow for bone formation indicating the additional use of augmentation materials to be redundant. Purpose: The purpose of this study was to assess whether elevation of the sinus mucosal

  12. Does platelet-rich plasma promote remodeling of autologous bone grafts used for augmentation of the maxillary sinus floor?

    NARCIS (Netherlands)

    Raghoebar, GM; Schortinghuis, J; Liem, RSB; Ruben, JL; van der Wal, JE; Vissink, A

    The aim of this study was to evaluate the effect of platelet-rich plasma (PRP) on remodeling of autologous bone grafts used for augmentation of the floor of the maxillary sinus. In five edentulous patients suffering from insufficient retention of their upper denture related to a severely resorbed

  13. Bone cement distribution in the vertebral body affects chances of recompression after percutaneous vertebroplasty treatment in elderly patients with osteoporotic vertebral compression fractures

    Directory of Open Access Journals (Sweden)

    Zhang L

    2017-02-01

    Full Text Available Liang Zhang, Qiang Wang, Lin Wang, Jian Shen, Qiwei Zhang, Changtai Sun Department of Orthopedics, Beijing Hospital, National Center of Gerontology, People’s Republic of China Objective: Percutaneous vertebroplasty (PVP is a surgical procedure that has been widely used to treat patients suffering from osteoporotic vertebral compression fractures (OVCFs. The procedure involves injection of bone cement into a fractured vertebra. In this study, we investigated whether the distribution of the cement in the vertebral body is related to the occurrence of recompression after surgery. Patients and methods: A total of 172 patients diagnosed with OVCF, from January 2008 to June 2013, were retrospectively reviewed. Fifty of these patients experienced recompression after surgery during the follow-up period (recompression group, and 122 patients had no recompression observed during the follow-up period (control group. Statistical analysis was performed to compare clinical and operative parameters between these two groups. Results: Differences were found in bone cement distribution between the recompression group and control group (P=0.001. Patients with bone cement distributed around both upper and lower endplates had a significantly less incidence of recompression (4/50 patients, when compared to other patterns of cement distribution (eg, below upper endplate, above lower endplate, and in the middle of vertebral body. The logistic multiple regression analysis also indicated that patients with bone cement distributed around both the upper and lower endplates had a lower risk of recompression when compared to patients with bone cement distributed in the middle of vertebral body (odds ratio =0.223, P=0.003. Conclusion: We herein suggest that the control of bone cement distribution during surgery provides beneficial effects on reducing the risks of recompression after PVP treatment in patients with OVCF. Keywords: elderly, OVCF, PVP, bone cement

  14. Sinus floor augmentation surgery using autologous bone grafts from various donor sites: a meta-analysis of the total bone volume.

    NARCIS (Netherlands)

    Klijn, R.J.; Meijer, G.J.; Bronkhorst, E.M.; Jansen, J.A.

    2010-01-01

    BACKGROUND: To date, no studies have been published that evaluated histomorphometric data from a large number of patients while comparing different sites and methods of autologous bone grafting in sinus floor augmentation procedures. A meta-analysis of the English literature from January 1995 till

  15. Tooth Movement out of the Bony Wall Using Augmented Corticotomy with Nonautogenous Graft Materials for Bone Regeneration

    Science.gov (United States)

    Kim, Seong-Hun; Kim, Eun-Cheol

    2014-01-01

    This prospective randomized split-mouth study was performed to compare the effects of augmented corticotomy with those of different nonautogenous bone graft materials combined with orthodontic tooth movement in dogs. Decortication was performed on the buccal bone surface of 6 male beagle dogs that were randomly assigned to receive grafts of deproteinized bovine bone mineral, irradiated cortical bone, or synthetic bone. Immediate orthodontic force was applied to the second and third premolars for buccal tipping for 6 weeks. The pocket depth and width of keratinized tissue (WKT) were measured. Histologic and histomorphometric analyses were performed. The probing depth, WKT, and ratio of the area of new bone to that of total bone on the buccal side were not significantly different between groups. All groups had considerable new bone formation on the pressure side. New bone formation on the buccal side and buccal plate formation in the coronal direction along the root surfaces were induced by the bone-derived and PDL-derived mesenchymal matrix, respectively. The angular change between groups was significantly different (P accelerated new bone formation on the pressure side. PMID:25247172

  16. Vertical Bone Augmentation with an Autogenous Block or Particles in Combination with Guided Bone Regeneration: A Clinical and Histological Preliminary Study in Humans.

    Science.gov (United States)

    Rocchietta, Isabella; Simion, Massimo; Hoffmann, Maria; Trisciuoglio, Davide; Benigni, Marco; Dahlin, Christer

    2016-02-01

    Vertical ridge augmentation with the use of solid bone blocks or particulate bone autograft, exposed or covered by a nonresorbable expanded polytetrafluoroethylene (ePTFE) membrane, are well known in the literature and have been shown to be effective in treating bone atrophy. The aim of our study was to assess the two techniques in respect to biological properties of transplanted bone in graft revascularization and bone remodeling in conjunction with dental implants. Ten patients were treated within the study, with a total of 12 sites with posterior mandibular edentulous ridges with insufficient bone to allow implant placement. Bone regeneration was performed using autogenous intraoral block graft or autogenous particulate graft with an ePTFE barrier membrane. At 6-10 months, reentry surgery was performed; bone biopsies, including microscrews, were harvested; and implants were placed. Eleven sites out of 12 healed uneventfully. A mean height gain of 5.03 mm was achieved. Mean bone-to-implant contact and bone fill were assessed by means of histomorphometric analysis. The block specimens revealed a bone-to-implant contact of 42.34%, and the particulate grafts had a bone-to-implant contact of 26.62% (p Bone fill values reported were 68.32% and 48.28% (p bone remodeling, of the two techniques differed significantly. The block grafts outperformed the particulate grafts in terms of bone-to-implant contact and bone fill values; however, the morbidity associated with the donor site of the block must be considered. © 2015 Wiley Periodicals, Inc.

  17. Lateral Ridge Augmentation Using Autogenous Block Grafts and Guided Bone Regeneration: A 10-Year Prospective Case Series Study.

    Science.gov (United States)

    Chappuis, Vivianne; Cavusoglu, Yeliz; Buser, Daniel; von Arx, Thomas

    2017-02-01

    The use of autogenous block grafts harvested from intraoral donor sites has proven to be effective for the reconstruction of horizontal bone defects. The objective of this study was to analyze implant success and the rate of block graft resorption 10 years after ridge augmentation to elucidate contributing factors influencing graft maintenance. A staged horizontal block graft augmentation was performed in 52 implant sites exhibiting severe horizontal bone atrophy using autogenous block grafts protected by DBBM and collagen membranes. The crest width was assessed intraoperatively at surgery and at re-entry after 6 months. At the 10 year reexamination clinical and radiographic parameters were assessed using cone beam computed tomography. The 10-year implant success rate amounted to 98.1%, with minimal peri-implant bone loss (-0.17 mm for the maxilla, -0.09 mm for the mandible). The surface resorption rate after 10 years was 7.7% (0.38 mm). Grafts originating from the chin demonstrated significantly better graft maintenance at 10 years compared to retromolar grafts. Recipient site and age had no significant impact on graft resorption, whereas females showed more bone loss at the 10-year examination. Lateral ridge augmentation using autogenous block grafts and guided bone regeneration demonstrated a favorable success rate of 98.1% with minimal block graft resorption of 7.7% after 10 years. Modulating factors were origin of the graft and gender. © 2016 Wiley Periodicals, Inc.

  18. Stability of pedicle screws after kyphoplasty augmentation: an experimental study to compare transpedicular screw fixation in soft and cured kyphoplasty cement.

    Science.gov (United States)

    Linhardt, Oliver; Lüring, Christian; Matussek, Jan; Hamberger, Corinna; Plitz, Wolfgang; Grifka, Joachim

    2006-04-01

    The goal of this cadaver study was to compare the stability of pedicle screws after implantation in soft or cured kyphoplasty cement. Pedicle screws were inserted in a total of 30 thoracolumbar vertebrae of 10 different human specimens: 10 screws were implanted in nonaugmented vertebrae (group 1), each 10 screws were placed in soft (group 2) and cured (group 3) cement. Pedicle screws were than evaluated for biomechanical axial pullout resistance. Mean axial pullout strength was 232 N (range 60-600 N) in group 1, 452 N (range 60-1125 N) in group 2 and 367 N (range 112-840 N) in group 3. The paired Student t-test demonstrated a significant difference between pullout strength of groups 1 and 2 (P = 0.0300). Between pullout strength of groups 1 and 3 and between groups 2 and 3 no significant difference was seen. We achieved a 1.9 times higher pullout strength with kyphoplasty augmentation of osteoporotic vertebrae compared with the pullout strength of nonaugmented vertebrae. Implantation of pedicle screws in cured cement is a sufficient method. With this method we found a 1.6 times higher pullout strength then in nonaugmented vertebrae.

  19. Current trends in mesenchymal stem cell application in bone augmentation: a review of the literature.

    Science.gov (United States)

    Khojasteh, Arash; Behnia, Hossein; Dashti, Seyedeh Ghazaleh; Stevens, Mark

    2012-04-01

    The literature regarding mesenchymal stem cell (MSC)-based bone reconstruction techniques are sparse and no comprehensive review of current methods has been performed. The aim of this article was to provide a discussion of clinical and experimental reports of MSC application in the reconstruction of bony defects in live models. This search was executed using the PubMed database with various combinations of related keywords. Currently published English-language studies that had applied MSCs as a part of their treatment protocol for reconstruction of bony defects in rat, rabbit, dog, and human models were reviewed. The included studies had reported substantiation that the applied cells were of MSC origin as a part of the study design. Publications inclusive to February 1, 2010 were evaluated. Of review of 187 found abstracts and full texts, 25 articles met the inclusion criteria. Based on this review, tremendous differences exist among investigators for the application of MSCs in bone augmentation procedures. These differences include not only species uniqueness but also a plethora of other variances, such as stem cell source, defect sites and sizes, carriers and constructs, use of additional growth factors, measured parameters, and methods of data collection. Because of the multitude of protocols, range of parameters, and data in the current English-language literature, this review did not reach any significant conclusion as to the "most predictable" model in stem cell reconstruction. However, it does "shed light" on the need for additional collaborated studies using similar homogenous designs and data analysis in advancing the science of bone reconstruction using MSCs. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Bone Repair and Military Readiness

    Science.gov (United States)

    2015-10-01

    and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation...osseointegration/osseoinduction, this material has potential to be used for screw augmentation, total hip/knee joint replacement, and other orthopedic and dental ...silorane bone cement with commercial cement in a swine femoral implant model Kathleen V Kilway, Donna Pacicca, Rachel A Weiler, Elizabeth M. Menuey

  1. Influence of Alveolar Bone Loss and Cement Layer Thickness on the Biomechanical Behavior of Endodontically Treated Maxillary Incisors: A 3-dimensional Finite Element Analysis.

    Science.gov (United States)

    Dal Piva, Amanda Maria de Oliveira; Tribst, João Paulo Mendes; Souza, Rodrigo Othávio de Assunção E; Borges, Alexandre Luiz Souto

    2017-05-01

    In order to understand the mechanical behavior of a weakened incisor, this study aimed to evaluate the stress distribution caused by different alveolar bone heights and cement layer thickness. A finite element analysis was conducted for this investigation. An intact maxillary central incisor was initially modeled, and the bone of the models was modified in order to simulate 4 levels of bone height: BL0 (no bone loss), BL1 (1/3 bone loss), BL2 (1/2 bone loss), and BL3 (2/3 bone loss). These teeth models were remodeled with a fiber post at 2 different cement thicknesses and restored with a ceramic crown; "A" refers to the well-adapted fiber post (0.3 mm) and "B" to the nonadapted fiber post (1 mm), resulting in 12 models. RelyX ARC (3M ESPE, St Paul, MN) cement was simulated for the cementation of the crowns and fiber posts for all groups. Numeric models received a load of 100 N on the lingual surface. All materials and structures were considered linear elastic, homogeneous, and isotropic. Numeric models were plotted and meshed with isoparametric elements, and results were expressed in maximum principal stress. For fiberglass posts, cement, and dentin, the highest stress concentration occurred in the groups with increased bone loss. For cortical bone, the highest values were for the groups with 1/3 bone loss. A greater thickness of cement layer concentrates more stress. More bone loss and greater CLT were the influential factors in concentrating the stress. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  2. 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.

  3. Posterior atrophic jaws rehabilitated with prostheses supported by 5 x 5 mm implants with a novel nanostructured calcium-incorporated titanium surface or by longer implants in augmented bone. One-year results from a randomised controlled trial.

    Science.gov (United States)

    Pistilli, Roberto; Felice, Pietro; Piattelli, Maurizio; Gessaroli, Manlio; Soardi, Elisa; Barausse, Carlo; Buti, Jacopo; Corvino, Valeria

    2013-01-01

    To evaluate whether 5 × 5 mm dental implants with a novel nanostructured calciumincorporated titanium surface could be an alternative to implants at least 10 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. A total of 40 patients with atrophic posterior (premolar and molar areas) mandibles having 5 to 7 mm of bone height above the mandibular canal and 40 patients with atrophic maxillae having 4 to 6 mm below the maxillary sinus, were randomised according to a parallel group design to receive one to three 5 mm implants or one to three at least 10 mm-long implants in augmented bone at two centres. All implants had a diameter of 5 mm. Mandibles were vertically augmented with interpositional bovine bone blocks and resorbable barriers. Implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cemented metal-ceramic or zirconia prostheses were delivered. Patients were followed up to 1 year post-loading and the outcome measures were prosthesis and implant failures, any complications and peri-implant marginal bone level changes. One maxillary grafted patient dropped out before the 1-year evaluation. In mandibles, 1 grafted patient did not want to go ahead with the treatment because of multiple complications and graft failure, and another grafted patient did not receive his prostheses due the loss of 2 implants. In maxillae, one 5 × 5 mm implant failed with its provisional crown 3 months post-loading. There were no statistically significant differences in prostheses and implant failures. Significantly more complications occurred at both mandibular and maxillary grafted sites: 17 augmented patients were affected by complications versus 8 patients treated with

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

    Directory of Open Access Journals (Sweden)

    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

  5. Osteoclastic differentiation and resorption is modulated by bioactive metal ions Co2+, Cu2+ and Cr3+ incorporated into calcium phosphate bone cements

    Science.gov (United States)

    Bernhardt, Anne; Schamel, Martha; Gbureck, Uwe; Gelinsky, Michael

    2017-01-01

    Biologically active metal ions in low doses have the potential to accelerate bone defect healing. For successful remodelling the interaction of bone graft materials with both bone-forming osteoblasts and bone resorbing osteoclasts is crucial. In the present study brushite forming calcium phosphate cements (CPC) were doped with Co2+, Cu2+ and Cr3+ and the influence of these materials on osteoclast differentiation and activity was examined. Human osteoclasts were differentiated from human peripheral blood mononuclear cells (PBMC) both on the surface and in indirect contact to the materials on dentin discs. Release of calcium, phosphate and bioactive metal ions was determined using ICP-MS both in the presence and absence of the cells. While Co2+ and Cu2+ showed a burst release, Cr3+ was released steadily at very low concentrations (below 1 μM) and both calcium and phosphate release of the cements was considerably changed in the Cr3+ modified samples. Direct cultivation of PBMC/osteoclasts on Co2+ cements showed lower attached cell number compared to the reference but high activity of osteoclast specific enzymes tartrate resistant acid phosphatase (TRAP), carbonic anhydrase II (CAII) and cathepsin K (CTSK) and significantly increased gene expression of vitronectin receptor. Indirect cultivation with diluted Co2+ cement extracts revealed highest resorbed area compared to all other modifications and the reference. Cu2+ cements had cytotoxic effect on PBMC/osteoclasts during direct cultivation, while indirect cultivation with diluted extracts from Cu2+ cements did not provoke cytotoxic effects but a strictly inhibited resorption. Cr3+ doped cements did not show cytotoxic effects at all. Gene expression and enzyme activity of CTSK was significantly increased in direct culture. Indirect cultivation with Cr3+ doped cements revealed significantly higher resorbed area compared to the reference. In conclusion Cr3+ doped calcium phosphate cements are an innovative cement

  6. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  7. Cyst-Like Osteolytic Formations in Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) Augmented Sheep Spinal Fusion.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  9. 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.

  10. 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.

  11. Particle size of bone graft and method of impaction affect initial stability of cemented cups: human cadaveric and synthetic pelvic specimen studies.

    NARCIS (Netherlands)

    Bolder, S.B.T.; Schreurs, B.W.; Verdonschot, N.J.J.; Unen, J. van; Gardeniers, J.W.M.; Slooff, T.J.J.H.

    2003-01-01

    We determined the effect of bone graft particle size and impaction technique on the initial stability of cemented acetabular cups. First, acetabular reconstructions were performed in human cadaveric pelvic bones in which type 2 AAOS cavitary defects were created. Reconstructions were made with small

  12. Radiographic follow-up evaluation of sinus augmentation with deproteinized bovine bone and implant installation after loading

    Directory of Open Access Journals (Sweden)

    Park Jun-Beom

    2010-01-01

    Full Text Available Computed tomography (CT has been used in diagnosis and implant treatment, and CT can be used to assess the dimensional stability of graft materials after maxillary sinus augmentation. A 50-year-old male patient was treated for the simultaneous placement of implants with sinus augmentation and two post-operative CT scans were performed after the delivery of the prosthesis at 9 months and 15 months after the operation. There were no significant changes in alveolar bone height and the buccal window seemed to show remodeling over time. The continuity of the defect and the cortication were apparent in the 15-month post-operative CT scan. Implants installed simultaneously with sinus augmentation were well in function and the graft material seemed to be stable in maintaining tissue dimensions after the loading of the implants. The presented results need to be validated in further large case series or case-controlled studies.

  13. 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.

  14. 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.

  15. Three-year results from a randomised controlled trial comparing prostheses supported by 5-mm long implants or by longer implants in augmented bone in posterior atrophic edentulous jaws.

    Science.gov (United States)

    Esposito, Marco; Pistilli, Roberto; Barausse, Carlo; Felice, Pietro

    2014-01-01

    To evaluate whether 5-mm short dental implants could be an alternative to augmentation with anorganic bovine bone and placement of at least 10-mm long implants in posterior atrophic jaws. Fifteen patients with bilateral atrophic mandibles (5 mm to 7 mm bone height above the mandibular canal) and 15 patients with bilateral atrophic maxillae (4 mm to 6 mm bone height below the maxillary sinus), and bone thickness of at least 8 mm, were randomised according to a split-mouth design to receive one to three 5-mm short implants or at least 10-mm long implants in augmented bone. Mandibles were vertically augmented with interpositional bone blocks and maxillary sinuses with particulated bone via a lateral window. Implants were placed after 4 months, submerged and loaded, after another 4 months, with provisional prostheses. Four months later, definitive provisionally cemented prostheses were delivered. Outcome measures were: prosthesis and implant failures; any complication and peri-implant marginal bone level changes. In five augmented mandibles, the planned 10-mm long implants could not be placed and shorter implants (7 mm and 8.5 mm) had to be used instead. Three years after loading, two patients, one treated in the mandible and one in the maxilla, dropped out. Three prostheses (1 mandibular and 2 maxillary) failed in the short implant group versus none in the long implant group. In mandibles, one long implant failed versus two short implants in 1 patient. In maxillae, one long implant failed versus three short implants in 2 patients. There were no statistically significant differences in the failures. Eight patients had 13 complications at short implants (1 patient accounted for 6 complications) and 11 patients had 13 complications at long implants. There were no statistically significant differences in complications (P = 0.63, difference = 0.10, 95% CI from -0.22 to 0.42). Three years after loading, patients with mandibular implants lost on average 1.44 mm at short

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

    Directory of Open Access Journals (Sweden)

    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

  17. Modification of Baksi sloppy hinge elbow to minimize the stresses at the humeral bone cement interface- An early experience

    Directory of Open Access Journals (Sweden)

    Baksi D

    2005-01-01

    Full Text Available Background : Baksi sloppy hinge elbow is an all metal prosthesis having 7 0 - 10 0 varus - valgus inherent laxity at the hinge section with minimal motion bearing contact area. Due to the presence of laxity at it′s hinge section, any strain on the prosthesis dissipates primarily to the surrounding soft tissues thus protecting the cement bone interfaces. However, from our long term clinical experiences on the use of our sloppy hinge design since 1984 and the knowledge of literature review of the results of using other semi-constrained (sloppy or unconstrained designs, it was observed that radiolucency or loosening at the bone-cement interface occurred mainly around the humeral stem in the long run due to the continued effect of rotational torque of forearm and hand. Hence, an attempt in the improvement of the design concept is being made. Methods : In this respect one flange each of one cm height and breadth and three mm thickness has been incorporated on either sides of the shank of humeral stem of the sloppy hinge at medio-lateral (coronal plane which will be seated in the corresponding longitudinal groove cut on either side of humeral shaft extending from its transverse cut end to become single assembly during the rotation of humerus. Results : The preliminary results of clinical application of the modified sloppy hinge elbow in ten cases are found satisfactory. Conclusion : The cyclical compression and distraction forces during flexion and extension of the elbow will be distributed over the larger bony area of lower end of humerus where flanges of the humeral shank being seated. The rotational torque effect of forearm and hand particularly with the arm in abduction will be minimised at the humeral bone cement interface as the humerus and the prosthetic stem act as a single assembly by the snugly fitting of the prosthetic flange in the humural shaft

  18. 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.

  19. Evaluation of zinc-doped mesoporous hydroxyapatite microspheres for the construction of a novel biomimetic scaffold optimized for bone augmentation.

    Science.gov (United States)

    Yu, Weilin; Sun, Tuan-Wei; Qi, Chao; Ding, Zhenyu; Zhao, Huakun; Zhao, Shichang; Shi, Zhongmin; Zhu, Ying-Jie; Chen, Daoyun; He, Yaohua

    2017-01-01

    Biomaterials with high osteogenic activity are desirable for sufficient healing of bone defects resulting from trauma, tumor, infection, and congenital abnormalities. Synthetic materials mimicking the structure and composition of human trabecular bone are of considerable potential in bone augmentation. In the present study, a zinc (Zn)-doped mesoporous hydroxyapatite microspheres (Zn-MHMs)/collagen scaffold (Zn-MHMs/Coll) was developed through a lyophilization fabrication process and designed to mimic the trabecular bone. The Zn-MHMs were synthesized through a microwave-hydrothermal method by using creatine phosphate as an organic phosphorus source. Zn-MHMs that consist of hydroxyapatite nanosheets showed relatively uniform spherical morphology, mesoporous hollow structure, high specific surface area, and homogeneous Zn distribution. They were additionally investigated as a drug nanocarrier, which was efficient in drug delivery and presented a pH-responsive drug release behavior. Furthermore, they were incorporated into the collagen matrix to construct a biomimetic scaffold optimized for bone tissue regeneration. The Zn-MHMs/Coll scaffolds showed an interconnected pore structure in the range of 100-300 μm and a sustained release of Zn ions. More importantly, the Zn-MHMs/Coll scaffolds could enhance the osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells. Finally, the bone defect repair results of critical-sized femoral condyle defect rat model demonstrated that the Zn-MHMs/Coll scaffolds could enhance bone regeneration compared with the Coll or MHMs/Coll scaffolds. The results suggest that the biomimetic Zn-MHMs/Coll scaffolds may be of enormous potential in bone repair and regeneration.

  20. Short implants (6mm) vs. vertical bone augmentation and standard-length implants (≥9mm) in atrophic posterior mandibles: a 5-year retrospective study.

    Science.gov (United States)

    Pieri, F; Forlivesi, C; Caselli, E; Corinaldesi, G

    2017-12-01

    This retrospective study compared the 5-year clinical and radiographic outcomes of short implants (6 mm) (short group), and standard-length implants (≥9mm) placed after a vertical augmentation with autologous bone blocks (augmentation group), supporting partial fixed prostheses in the posterior mandible. Forty-five partially edentulous patients were enrolled in the study and evaluated after 5 years: 22 (51 implants) in the augmentation group and 23 (46 implants) in the short group. Eight surgical complications occurred in the augmentation group versus none in the short group (P=0.003). One short implant failed before loading and one standard-length implant failed after 4 years because of peri-implantitis (P=1.0). Eight biological and two prosthetic complications occurred in the augmentation group vs. three biological and three prosthetic complications in the short group (P=0.09 and P=1.0, respectively). A mean marginal bone loss of 1.61±1.12mm in the augmentation group and 0.68±0.68mm in the short group was found (P=0.002). Within the limitations of this study, both techniques resulted in successful clinical results after 5 years, but short implants exhibited less surgical complications and marginal bone loss than standard-length implants placed in augmented bone. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Using calcium silicate to regulate the physicochemical and biological properties when using β-tricalcium phosphate as bone cement.

    Science.gov (United States)

    Kao, Chia-Tze; Huang, Tsui-Hsien; Chen, Yi-Jyun; Hung, Chi-Jr; Lin, Chi-Chang; Shie, Ming-You

    2014-10-01

    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. Regarding the formation of bone-like apatite, the diametral tensile strength as well as the ion release and weight loss of composites were compared both before and after immersions in simulated body fluid (SBF). In addition, we also examined the behavior of human dental pulp cells (hDPCs) cultured on β-TCP/CS composites. The results show that the apatite deposition ability of the β-TCP/CS composites improves as the CS content is increased. For composites with more than a 60% CS content, the samples become completely covered by a dense bone-like apatite layer. At the end of the immersion period, weight losses of 24%, 32%, 34%, 38%, 41%, and 45% were observed for the composites containing 0%, 20%, 40%, 80%, 80% and 100% β-TCP cements, respectively. In addition, the antibacterial activity of CS/β-TCP composite improves as the CS-content is increased. 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 60%, the quantity of cells and osteogenesis protein of hDPCs is stimulated by Si released from the β-TCP/CS composites. The degradation of β-TCP and the osteogenesis of CS give strong reason to believe that these calcium-based composite cements will prove to be effective bone repair materials. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Long-term Evaluation of Peri-implant Bone Level after Reconstruction of Severely Atrophic Edentulous Maxilla via Vertical and Horizontal Guided Bone Regeneration in Combination with Sinus Augmentation: A Case Series with 1 to 15 Years of Loading.

    Science.gov (United States)

    Urban, Istvan A; Monje, Alberto; Lozada, Jaime L; Wang, Hom-Lay

    2017-02-01

    To the best of the authors' knowledge, there is very limited clinical data on the outcomes of simultaneous guided bone regeneration (GBR) for horizontal and/or vertical bone gain for the reconstruction of severely atrophic edentulous maxilla. Therefore, the purpose of the clinical series presented herein was to clinically evaluate long-term horizontal and vertical bone gain, as well as implant survival rate after reconstruction of severely atrophic edentulous maxillary ridges. Sixteen patients (mean age: 64.6 ± 14.6 years of age) were consecutively treated for vertical and/or horizontal bone augmentation via GBR in combination with bilateral sinus augmentation utilizing a mixture of autologous and anorganic bovine bone. Implant survival, bone gain, intraoperative/postoperative complications and peri-implant bone loss were calculated up to the last follow-up exam. Overall, 122 dental implants were placed into augmented sites and have been followed from 12 to 180 months (mean: 76.5 months). Implant survival was 100% (satisfactory survival rate of 97.5%). Mean bone gain was 5.6 mm (max: 9 mm; min: 3 mm) While vertical bone gain was 5.1 ± 1.8 mm; horizontal bone gain was 7.0 ± 1.5 mm. No intraoperative/postoperative complications were noted. Mean peri-implant bone loss values were consistent within the standards for implant success (1.4 ± 1.0 mm). At patient-level, only one patient who had three implants presented with severe peri-implant bone loss. Complete reconstruction of an atrophied maxilla can be successfully achieved by means of guided bone regeneration for horizontal and/or vertical bone gain including bilateral sinus augmentation using a mixture of anorganic bovine bone and autologous bone. © 2016 Wiley Periodicals, Inc.

  3. 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

  4. Application of Platelet-Rich Fibrin and Injectable Platelet-Rich Fibrin in Combination of Bone Substitute Material for Alveolar Ridge Augmentation - a Case Report

    Directory of Open Access Journals (Sweden)

    Chenchev Ivan L.

    2017-09-01

    Full Text Available Background: Different barrier membranes and augmentation techniques are used in oral surgery to recover lost bone structures with varied success. Recently, a combination between bone graft materials and Platelet-Rich-Fibrin (PRF is implemented in the periodontology and implantology.

  5. Characterization of augmented bone structures with μ-computed tomography and Raman spectroscopy

    International Nuclear Information System (INIS)

    Charwat-Pessler, Johann; Entacher, Karl; Petutschnigg, Alexander; Musso, Maurizio; Plank, Bernhard; Schuller- Götzburg, Peter; Tangl, Stefan

    2013-01-01

    Full text: In the recent past bone graft substitutes are increasingly used in the medical field in order replace missing bone or promote new bone formation. Computed tomography methods provide density information of biomaterials, however, the question how far information on the chemical structure is accessible has not been intensively investigated yet. In the present study a bone sample consisting of autogenous bone derived cells and bovine bone mineral was investigated by computed microtomography imaging and by Raman spectroscopic imaging, and comparing the image data by means of regression analysis and digital image processing methods. (author)

  6. 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...... compared with what achieved after SFA with DBBM + AB alone. MATERIAL AND METHODS: Twenty patients with remaining posterior maxillary alveolar crest height of less than 3 mm received SFA after randomization either with an DBBM and AB composite in a 1 : 1 ratio or with DBBM + AB supplemented with autogenous...... 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...

  7. Influence of platelet-rich plasma on a bioglass and autogenous bone in sinus augmentation. An explorative study.

    Science.gov (United States)

    Klongnoi, Boworn; Rupprecht, Stephan; Kessler, Peter; Thorwarth, Michael; Wiltfang, Joerg; Schlegel, Karl Andreas

    2006-06-01

    Platelet-rich plasma (PRP) has been introduced to the field of oral and maxillofacial surgery for a decade, but its beneficial effects on maxillary sinus augmentation remain unclear. The aim of this study was to evaluate the short- and long-term effects of PRP on osseointegration following single-stage sinus augmentation in a randomized prospective animal study. The maxillary premolars of 24 minipigs were extracted bilaterally and allowed to heal for 2 months. Consecutively all animals underwent bilateral sinus floor elevation using autogenous bone, Biogran as well as a combination of the materials with PRP. Three dental implants (Ankylos, Dentsply Co., Mannheim, Germany) were installed in each sinus simultaneously. Four animals were sacrificed at each period of observation (1, 2, 8 and 12 months). Microradiographic images of the specimens were made for quantitative evaluation of the bone-implant contact (BIC) and light microscopic images were made for qualitative analysis. An increment of the BIC during the observation time could be seen over the observation time in all groups. Autogenous bone exhibited a level of BIC from 25.1 +/- 9.96% at 1 month to 55.1 +/- 13.10% at 12 months; on adding PRP, the BIC ranged from 28.4 +/- 4.64% to 52.5 +/- 17.06%. Biogran with and without PRP led to BIC levels from 16.3 +/- 4.64% to 37.6 +/- 16.40% and 21.7 +/- 4.33% to 46.6 +/- 19.37%, respectively. The results of this study did not show a significantly positive effect of PRP on the BIC following sinus augmentation in both groups.

  8. [Augmentative locking compression plate (LCP) combined with bone graft for the treatment of aseptic femoral shaft nonunion after intramedullary nailing].

    Science.gov (United States)

    Wang, Fei-da; Gao, Yao-zu; Yuan, Wei; Du, Jin-qiang; Wei, Xiao-chun

    2014-10-01

    To investigate the effect of augmentative locking compression plate combined with bone graft in treating aseptic femoral shaft nonunion after intramedullary nailing. Twenty-one cases with aseptic femoral shaft nonunion after intramedullary nailing from January 2007 to January 2013 were treated,including 18 males and 3 females with a mean age of 37.7 years (ranged from 23 to 64 years). The mean period of nonunion after surgery was 23.9 months (ranged from 9 to 62 months). According to Weber-Cech classification,10 of those 21 cases were hypertrophic nonunion,7 were atrophic, and 4 had oligotrophic fracture nonunion. All patients retained the original intramedullary nail, and applied with augmentation plating of 6 to 8 holes locking compression plate, unicortical fixation with 2 to 3 locking screws in the proximal or distal end, with simultaneous autologous iliac bone grafting. After treatment,all patients were allowed to partial weight-bearing until full weight-bearing according to the radiological results. All patients were followed up and were evaluated with clinical and imaging results. All patients were followed up from 8 to 24 months, averaged (13.5±3.5) months,which showed clinical union at 4 to 8 months, averaged (6.0±1.0) months and radiological solid union at 7 to 12 months, averaged (9.1±1.5) months. No such complications as infection,hardware loosening or breaking were found. Augmentative locking compression plate(LCP) combined with bone graft for aseptic femoral shaft nonunion after intramedullary nail has a satisfied clinical efficacy. It's an useful and simple method.

  9. In vitro and in vivo investigation of bisphosphonate-loaded hydroxyapatite particles for peri-implant bone augmentation.

    Science.gov (United States)

    Kettenberger, Ulrike; Luginbuehl, Vera; Procter, Philip; Pioletti, Dominique P

    2017-07-01

    Locally applied bisphosphonates, such as zoledronate, have been shown in several studies to inhibit peri-implant bone resorption and recently to enhance peri-implant bone formation. Studies have also demonstrated positive effects of hydroxyapatite (HA) particles on peri-implant bone regeneration and an enhancement of the anti-resorptive effect of bisphosphonates in the presence of calcium. In the present study, both hydroxyapatite nanoparticles (nHA) and zoledronate were combined to achieve a strong reinforcing effect on peri-implant bone. The nHA-zoledronate combination was first investigated in vitro with a pre-osteoclastic cell assay (RAW 264.7) and then in vivo in a rat model of postmenopausal osteoporosis. The in vitro study confirmed that the inhibitory effect of zoledronate on murine osteoclast precursor cells was enhanced by loading the drug on nHA. For the in vivo investigation, either zoledronate-loaded or pure nHA were integrated in hyaluronic acid hydrogel. The gels were injected in screw holes that had been predrilled in rat femoral condyles before the insertion of miniature screws. Micro-CT-based dynamic histomorphometry and histology revealed an unexpected rapid mineralization of the hydrogel in vivo through formation of granules, which served as scaffold for new bone formation. The delivery of zoledronate-loaded nHA further inhibited a degradation of the mineralized hydrogel as well as a resorption of the peri-implant bone as effectively as unbound zoledronate. Hyaluronic acid with zoledronate-loaded nHA, thanks to its dual effect on inducing a rapid mineralization and preventing resorption, is a promising versatile material for bone repair and augmentation. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  10. The effect of phosphoric and phosphonic acid primers on bone cement bond strength to total hip stem alloys.

    Science.gov (United States)

    Jakubowitz, Eike; Liehn, Louisa; Jahnke, Alexander; Wöstmann, Bernd; Rickert, Markus; Niem, Thomas

    2017-05-01

    Aseptic loosening at alloy-cement interfaces constitutes a main failure mechanism of cemented total hip replacements (THR). As a potential solution we investigated the effect of metal primers containing phosphoric and phosphonic acid on shear bond strength (SBS) of bone cement to THR alloys (CoCrMo, TiAlNb) and pure tin (Sn) substrates (20×8×3 mm). Metal surfaces were modified by polishing or Al 2 O 3 blasting and primer application. Substrates without primer treatment served as references. Cylindrical cement pins (Ø 5mm) were polymerised onto substrate surfaces and aging (1, 5, 14 and 150 days) was simulated in aqueous NaCl solution (0.9%) before SBS determination and failure mode evaluation. Regardless of surface roughness and aging time, SBS for THR alloys and Sn was always significantly higher with primer treatment. Compared to untreated reference specimens (≤0.2MPa) SBS values increased even up to 350 fold (TiAlNb, 14 days) or 400 fold (CoCrMo, 5 days). In general, the phosphoric acid containing primer revealed significant higher SBS values on THR alloys compared to the phosphonic acid containing one. Al 2 O 3 blasted specimens showed generally higher SBS values than polished ones with the exception of Sn which showed high SBS values in general. With primer treatment on polished Sn a significant reduction of SBS could not be detected even up to 150 days, whereas THR alloys showed only an SBS improvement in the short term (≤14 days). A NaCl-pitting corrosion probably led to an increasing and durable SBS on polished Sn surfaces over time. Compared to modern THR in clinical practice that shows survival rates of 10, 15, 20 or more years, the receivable bond strength enhancements described in this study appeared to be very short. The improved SBS on THR alloys lasted only a few days before it was lost again. In contrast, the phosphoric acid primer treatment of polished Sn appeared to be very promising and may play a key role in further investigations dealing

  11. Antibiotic bone cement's effect on infection rates in primary and revision total knee arthroplasties.

    Science.gov (United States)

    Kleppel, Donald; Stirton, Jacob; Liu, Jiayong; Ebraheim, Nabil A

    2017-12-18

    To compare infection rates in primary and revision total knee arthroplasty (TKA) procedures using antibiotic impregnated bone cement (AIBC) to those rates in procedures not using AIBC. A systematic review and meta-analysis was conducted in search for randomized controlled trials/studies (RCTs) pertaining to the field of antibiotic AIBC vs non-AIBC groups in both primary and revision TKA procedures. The primary literature search performed was to identify all RCTs that assessed AIBC in primary and revision TKA procedures. This search was done strictly through the PubMed database using the article "filters" setting that identified and separated all RCTs from the overall search. The original search was "Primary/revision total knee arthroplasty using AIBC". Other key terms and phrases were included in the search as well. Eligible articles that were used in the "results" of this review met the following criteria: (1) Involved primary or revision TKA procedures (for any reason); (2) included TKA outcome infection rate information; (3) analyzed an AIBC group vs a non-AIBC control group; (4) were found through the RCT filter or hand search in PubMed; and (5) published 1985-2017. Exclusion criteria was as follows: (1) Patients that were not undergoing primary or revision TKA procedures; (2) articles that did not separate total hip arthroplasity (THA) vs TKA results if both hip and knee revisions were evaluated; (3) papers that did not follow up on clinical outcomes of the procedure; (4) extrapolation of data was not possible given published results; (5) knee revisions not done on human patients; (6) studies that were strictly done on THAs; (7) articles that were not found through the RCT filter or through hand search in PubMed; (8) articles that did not evaluate AIBC used in a prosthesis or a spacer during revision; (9) articles that did not compare an AIBC group vs a non-AIBC control group; and (10) articles that were published before 1985. In total, 11 articles were deemed

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  13. Vertical augmentation with interpositional blocks of anorganic bovine bone vs. 7-mm-long implants in posterior mandibles: 1-year results of a randomized clinical trial.

    Science.gov (United States)

    Felice, Pietro; Pellegrino, Gerardo; Checchi, Luigi; Pistilli, Roberto; Esposito, Marco

    2010-12-01

    To evaluate whether 7-mm-long implants could be an alternative to longer implants placed in vertically augmented posterior mandibles. Sixty patients with posterior mandibular edentulism with 7-8 mm bone height above the mandibular canal were randomized to either vertical augmentation with anorganic bovine bone blocks and delayed 5-month placement of ≥10 mm implants or to receive 7-mm-long implants. Four months after implant placement, provisional prostheses were delivered, replaced after 4 months, by definitive prostheses. The outcome measures were prosthesis and implant failures, any complications and peri-implant marginal bone levels. All patients were followed to 1 year after loading. One patient dropped out from the short implant group. In two augmented mandibles, there was not sufficient bone to place 10-mm-long implants possibly because the blocks had broken apart during insertion. One prosthesis could not be placed when planned in the 7 mm group vs. three prostheses in the augmented group, because of early failure of one implant in each patient. Four complications (wound dehiscence) occurred during graft healing in the augmented group vs. none in the 7 mm group. No complications occurred after implant placement. These differences were not statistically significant. One year after loading, patients of both groups lost an average of 1 mm of peri-implant bone. There no statistically significant differences in bone loss between groups. When residual bone height over the mandibular canal is between 7 and 8 mm, 7 mm short implants might be a preferable choice than vertical augmentation, reducing the chair time, expenses and morbidity. These 1-year preliminary results need to be confirmed by follow-up of at least 5 years. © 2010 John Wiley & Sons A/S.

  14. Evaluation of zinc-doped mesoporous hydroxyapatite microspheres for the construction of a novel biomimetic scaffold optimized for bone augmentation

    Directory of Open Access Journals (Sweden)

    Yu W

    2017-03-01

    Full Text Available Weilin Yu,1,* Tuan-Wei Sun,2,3,* Chao Qi,2,3 Zhenyu Ding,1 Huakun Zhao,1 Shichang Zhao,1 Zhongmin Shi,1 Ying-Jie Zhu,2,3 Daoyun Chen,1 Yaohua He1,4 1Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 2State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 3University of Chinese Academy of Sciences, Beijing, 4School of Biomedical Engineering, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China *These authors contributed equally to this work Abstract: Biomaterials with high osteogenic activity are desirable for sufficient healing of bone defects resulting from trauma, tumor, infection, and congenital abnormalities. Synthetic materials mimicking the structure and composition of human trabecular bone are of considerable potential in bone augmentation. In the present study, a zinc (Zn-doped mesoporous hydroxyapatite microspheres (Zn-MHMs/collagen scaffold (Zn-MHMs/Coll was developed through a lyophilization fabrication process and designed to mimic the trabecular bone. The Zn-MHMs were synthesized through a microwave-hydrothermal method by using creatine phosphate as an organic phosphorus source. Zn-MHMs that consist of hydroxyapatite nanosheets showed relatively uniform spherical morphology, mesoporous hollow structure, high specific surface area, and homogeneous Zn distribution. They were additionally investigated as a drug nanocarrier, which was efficient in drug delivery and presented a pH-responsive drug release behavior. Furthermore, they were incorporated into the collagen matrix to construct a biomimetic scaffold optimized for bone tissue regeneration. The Zn-MHMs/Coll scaffolds showed an interconnected pore structure in the range of 100–300 µm and a sustained release of Zn ions. More importantly, the Zn-MHMs/Coll scaffolds could enhance the osteogenic differentiation

  15. Mechanical and biological properties of two types of bioactive bone cements containing MgO-CaO-SiO2-P2O5-CaF2 glass and glass-ceramic powder.

    Science.gov (United States)

    Tamura, J; Kawanabe, K; Kobayashi, M; Nakamura, T; Kokubo, T; Yoshihara, S; Shibuya, T

    1996-01-01

    In this study two types of bioactive bone cement containing either MgO-CaO-SiO2-P2O5-CaF2 glass (type A) or glass-ceramic powder (type B) were made to evaluate the effect of the crystalline phases on their mechanical and biological properties. Type A bone cement was produced from glass powder and bisphenol-a-glycidyl methacrylate (BIS-GMA) resin, and type B from glass-ceramic powder containing apatite and wollastonite crystals and BIS-GMA resin. Glass or glass-ceramic powder (30, 50, 70, and 80 by wt %) was added to the cement. The compressive strength of type A (153-180 MPa) and B (167-194 MPa) cement were more than twice that of conventional polymethylmethacrylate (PMMA) cement (68 MPa). Histological examination of rat tibiae showed that all the bioactive cements formed direct contact with the bone. A reactive layer was seen at the bone-cement interface. In specimens with type A cement the reactive layer consisted of two layers, a radiopaque outer layer (Ca-P-rich layer) and a relatively radiolucent inner layer (low-calcium-level layer). With type B cement, although the Ca-P-rich layer was seen, the radiolucent inner layer was absent. Up to 26 weeks there was progressive bone formation around each cement (70 wt %) and no evidence of biodegradation. The mechanical and biological properties of the cements were compared with those of a previously reported bone cement containing MgO-free CaO-SiO2-P2O5-CaF2 glass powder (designated type C).

  16. Lack of beneficial effects of platelet-rich plasma on sinus augmentation using a fluorohydroxyapatite or autogenous bone: an explorative study.

    Science.gov (United States)

    Klongnoi, Boworn; Rupprecht, Stephan; Kessler, Peter; Zimmermann, Robert; Thorwarth, Michael; Pongsiri, Sumitra; Neukam, Friedrich-Wilhelm; Wiltfang, Joerg; Schlegel, Karl Andreas

    2006-07-01

    Maxillary sinus augmentation is frequently necessary before placement of dental implants in the posterior maxilla. Besides autogenous bone graft, various bone substitutes have been used, with favourable results. Although platelet-rich plasma (PRP) has been used in the field of oral and maxillofacial surgery for years, its beneficial effects on osseous regeneration still remain unclear. The aim of this study was to evaluate the short and long time effects of PRP on single-stage sinus augmentation using autogenous bone or a fluorohydroxyapatite (Algipore) in a randomized prospective animal study. After extraction of maxillary premolars of sixteen minipigs, the wounds were allowed to heal for 2 months. Then, sinus augmentations were performed bilaterally using one of the following grafting materials: autogenous bone and Algipore with or without PRP. Three dental implants (Ankylos) were installed in each sinus simultaneously. Four animals were euthanized at each period of observation (1, 2, 8 and 12 months). Implant-bearing specimens were sectioned bucco-lingually along the long axis of implants and undecalcified ground specimens were prepared. The bone-implant-contact (BIC) was measured by means of microradiographic examination. For histological evaluation, the specimens were stained with toluidin blue, and the percentage of the newly formed bone and the remaining bone substitute were evaluated. The grafting materials chosen showed increasing levels of BIC and newly formed bone throughout the period of observation in both PRP and non-PRP groups. Adding PRP resulted in lower BIC and newly formed bone compared with autogenous bone grafts or Algipore alone. However, a statistical significance was not found. The percentages of the remaining bone substitute in both the PRP and non-PRP groups were closely comparable in all observation periods. The application of PRP could not reveal significant beneficial effects on the BIC, the percentage of the newly formed bone and the

  17. Facial symmetry in unilateral cleft lip and palate following alar base augmentation with bone graft: a three-dimensional assessment.

    Science.gov (United States)

    Devlin, Mark F; Ray, Arup; Raine, Peter; Bowman, Adrian; Ayoub, Ashraf F

    2007-07-01

    The aim of this study was to assess the outcome of bone grafting using a corticocancellous block of iliac crest to reconstruct the support for the deformed, volume-deficient alar base in treated patients with unilateral cleft lip and palate (UCLP). The main outcome being measured was nasal symmetry. This was a prospective study using a noninvasive three-dimensional stereophotogrammetry system (C3D) to assess the position of the alar base. Images were captured immediately preoperatively and at 6 months following the augmentation of the alar base with a block of bone graft. These images were used to calculate facial symmetry scores and were compared using a two sample Student's t test to assess the efficacy of the surgical method in reducing facial/nasal asymmetry. This investigation was conducted on 18 patients with one patient failing to attend for follow-up. The results for 17 patients are presented. Facial symmetry scores improved significantly following the insertion of the bone graft at the deficient alar base (p=0.005). 3D stereophotogrammetry is a noninvasive, accurate, and archiveable method of assessing facial form and surgical change. Nasal symmetry can be quantified and measured reliably with this tool. Bone grafting to the alar base region of treated UCLP patients with volume deficiency produces improvement in nasal symmetry.

  18. Effects of rhBMP-2 Loaded Titanium Reinforced Collagen Membranes on Horizontal Bone Augmentation in Dogs

    Directory of Open Access Journals (Sweden)

    Ki-Sun Lee

    2017-01-01

    Full Text Available The aim of this study was to evaluate the efficacy of growth factor loaded collagen membranes on new bone formation during horizontal bone augmentation. Mandibular defects (4 × 4 × 4 mm were surgically prepared in six male beagle dogs, which were then protected with one of three types of membranes: (1 titanium mesh, (2 titanium reinforced collagen, or (3 rhBMP-2 loaded titanium reinforced collagen. Animals were euthanized 8 and 16 weeks after surgery, and nondecalcified specimens were prepared and histomorphologically investigated to determine the degree of osteogenesis. Data were analyzed with Friedman test. With respect to the degree of osteogenesis at earlier stage (8 weeks after surgery, there was significantly higher new bone ratio in rhBMP-2 loaded membrane group (p>0.05. However, with respect to the long-term results (16 weeks after surgery, there were no significant differences among the three membranes (p>0.05. Based on histomorphometric analysis, there were no significant differences in horizontal bone gaining ratio (p>0.05.

  19. Autologous Periosteum-Derived Micrografts and PLGA/HA Enhance the Bone Formation in Sinus Lift Augmentation

    Science.gov (United States)

    Rodriguez y Baena, Ruggero; D'Aquino, Riccardo; Graziano, Antonio; Trovato, Letizia; Aloise, Antonio C.; Ceccarelli, Gabriele; Cusella, Gabriella; Pelegrine, André A.; Lupi, Saturnino M.

    2017-01-01

    Sinus lift augmentation is a procedure required for the placement of a dental implant, whose success can be limited by the quantity or quality of available bone. To this purpose, the first aim of the current study was to evaluate the ability of autologous periosteum-derived micrografts and Poly(lactic-co-glycolic acid) (PLGA) supplemented with hydroxyl apatite (HA) to induce bone augmentation in the sinus lift procedure. Secondly, we compared the micrograft's behavior with respect to biomaterial alone, including Bio-Oss® and PLGA/HA, commercially named Alos. Sinus lift procedure was performed on 24 patients who required dental implants and who, according to the study design and procedure performed, were divided into three groups: group A (Alos + periosteum-derived micrografts); group B (Alos alone); and group C (Bio-Oss® alone). Briefly, in group A, a small piece of periosteum was collected from each patient and mechanically disaggregated by Rigenera® protocol using the Rigeneracons medical device. This protocol allowed for the obtainment of autologous micrografts, which in turn were used to soak the Alos scaffold. At 6 months after the sinus lift procedure and before the installation of dental implants, histological and radiographic evaluations in all three groups were performed. In group A, where sinus lift augmentation was performed using periosteum-derived micrografts and Alos, the bone regeneration was much faster than in the control groups where it was performed with Alos or Bio-Oss® alone (groups B and C, respectively). In addition, the radiographic evaluation in the patients of group A showed a radio-opacity after 4 months, while after 6 months, the prosthetic rehabilitation was improved and was maintained after 2 years post-surgery. In summary, we report on the efficacy of periosteum-derived micrografts and Alos to augment sinus lift in patients requiring dental implants. This efficacy is supported by an increased percentage of vital mineralized

  20. Autologous Periosteum-Derived Micrografts and PLGA/HA Enhance the Bone Formation in Sinus Lift Augmentation

    Directory of Open Access Journals (Sweden)

    Ruggero Rodriguez y Baena

    2017-09-01

    Full Text Available Sinus lift augmentation is a procedure required for the placement of a dental implant, whose success can be limited by the quantity or quality of available bone. To this purpose, the first aim of the current study was to evaluate the ability of autologous periosteum-derived micrografts and Poly(lactic-co-glycolic acid (PLGA supplemented with hydroxyl apatite (HA to induce bone augmentation in the sinus lift procedure. Secondly, we compared the micrograft's behavior with respect to biomaterial alone, including Bio-Oss® and PLGA/HA, commercially named Alos. Sinus lift procedure was performed on 24 patients who required dental implants and who, according to the study design and procedure performed, were divided into three groups: group A (Alos + periosteum-derived micrografts; group B (Alos alone; and group C (Bio-Oss® alone. Briefly, in group A, a small piece of periosteum was collected from each patient and mechanically disaggregated by Rigenera® protocol using the Rigeneracons medical device. This protocol allowed for the obtainment of autologous micrografts, which in turn were used to soak the Alos scaffold. At 6 months after the sinus lift procedure and before the installation of dental implants, histological and radiographic evaluations in all three groups were performed. In group A, where sinus lift augmentation was performed using periosteum-derived micrografts and Alos, the bone regeneration was much faster than in the control groups where it was performed with Alos or Bio-Oss® alone (groups B and C, respectively. In addition, the radiographic evaluation in the patients of group A showed a radio-opacity after 4 months, while after 6 months, the prosthetic rehabilitation was improved and was maintained after 2 years post-surgery. In summary, we report on the efficacy of periosteum-derived micrografts and Alos to augment sinus lift in patients requiring dental implants. This efficacy is supported by an increased percentage of vital

  1. Simulation of the mechanical behavior of a HIP implant. Implant fixed to bone by cementation under arbitrary load

    Science.gov (United States)

    Oldani, C. R.; Dominguez, A. A.

    2007-11-01

    In a previous work a finite elements model was constructed to simulate a fatigue assay according to the norm IRAM 9422-3. Three materials were studied, two of them are the most used in this type of implant (Stainless steel 3161 and alloy T16A14V) and the third was a new developed titanium alloy (Ti35Nb7Zr5Ta). Static loads were applied to the model according to the highest requirements of the norm and the stress - strain distribution were determined. In this study a simplified analysis of the material's fatigue was done according to the previous work. The best behavior of the titanium alloys vs. the stainless steel was evident. With the objective of studying the behavior of both: the implant and the femur bone, new finite elements models were realized, in which the presence of the bone was considered. Inside the bone, the femoral component of the implant was placed in a similar way of a cemented prosthesis in a total hip arthroplasty. The advantage of the titanium implant related to the stainless steel one, was very clear.

  2. Simulation of the mechanical behavior of a HIP implant. Implant fixed to bone by cementation under arbitrary load

    Energy Technology Data Exchange (ETDEWEB)

    Oldani, C R [Materials Department - FCEFyN - Universidad Nacional de Cordoba, Av.Velez Sarsfield 1611 (5016) Cordoba (Argentina); Dominguez, A A [INTI Cordoba, Av. Velez Sarsfield 1561 (5016) Cordoba (Argentina)

    2007-11-15

    In a previous work a finite elements model was constructed to simulate a fatigue assay according to the norm IRAM 9422-3. Three materials were studied, two of them are the most used in this type of implant (Stainless steel 3161 and alloy T16A14V) and the third was a new developed titanium alloy (Ti35Nb7Zr5Ta). Static loads were applied to the model according to the highest requirements of the norm and the stress - strain distribution were determined. In this study a simplified analysis of the material's fatigue was done according to the previous work. The best behavior of the titanium alloys vs. the stainless steel was evident. With the objective of studying the behavior of both: the implant and the femur bone, new finite elements models were realized, in which the presence of the bone was considered. Inside the bone, the femoral component of the implant was placed in a similar way of a cemented prosthesis in a total hip arthroplasty. The advantage of the titanium implant related to the stainless steel one, was very clear.

  3. [Influence of the physiological medium on the mechanical properties of bone cement: can current studies be extrapolated?].

    Science.gov (United States)

    Sanz-Ruiz, P; Paz, E; Abenojar, J; Del Real, J C; Forriol, F; Vaquero, J

    2014-01-01

    The use of bone cement is widespread in orthopaedic surgery. Most of the mechanical tests are performed in dry medium, making it difficult to extrapolate the results. The objective of this study is to assess if the mechanical properties of polymethylmethacrylate (PMMA), obtained in previous reports, are still present in a liquid medium. An experimental study was designed with antibiotic (vancomycin) loaded PMMA. Four groups were defined according to the medium (dry or liquid) and the pre-conditioning in liquid medium (one week or one month). Wear and flexural strength tests were performed according to ASTM and ISO standards. Volumetric wear, friction coefficient, tensile strength, and Young's modulus were analyzed. All samples were examined by scanning electron microscopy. The samples tested in liquid medium showed lower wear and flexural strength values (P<.05). The kind of wear was modified from abrasive to adhesive in those samples studied in liquid medium. The samples with a pre-conditioning time showed lower values of wear (P<.05). Caution is recommended when extrapolating the results of previous PMMA results. The different mechanical strength of the cement in a liquid medium, observed in saline medium, is much closer to the clinical situation. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  4. Sliding malar bone augmentation technique with a high le fort I ...

    African Journals Online (AJOL)

    Records were taken before and 6 months after surgery for comparison, including intra and extra oral photographs and three-dimensional cone-beam computed tomography (CBCT) images. The bone malar width and bone malar depth changings in malar region were evaluated. Preoperative and postoperative CBCT ...

  5. 3D-Printed Scaffolds and Biomaterials: Review of Alveolar Bone Augmentation and Periodontal Regeneration Applications

    Directory of Open Access Journals (Sweden)

    Farah Asa’ad

    2016-01-01

    Full Text Available To ensure a successful dental implant therapy, the presence of adequate vertical and horizontal alveolar bone is fundamental. However, an insufficient amount of alveolar ridge in both dimensions is often encountered in dental practice due to the consequences of oral diseases and tooth loss. Although postextraction socket preservation has been adopted to lessen the need for such invasive approaches, it utilizes bone grafting materials, which have limitations that could negatively affect the quality of bone formation. To overcome the drawbacks of routinely employed grafting materials, bone graft substitutes such as 3D scaffolds have been recently investigated in the dental field. In this review, we highlight different biomaterials suitable for 3D scaffold fabrication, with a focus on “3D-printed” ones as bone graft substitutes that might be convenient for various applications related to implant therapy. We also briefly discuss their possible adoption for periodontal regeneration.

  6. 3D-Printed Scaffolds and Biomaterials: Review of Alveolar Bone Augmentation and Periodontal Regeneration Applications

    Science.gov (United States)

    Asa'ad, Farah; Giannì, Aldo Bruno; Giannobile, William V.; Rasperini, Giulio

    2016-01-01

    To ensure a successful dental implant therapy, the presence of adequate vertical and horizontal alveolar bone is fundamental. However, an insufficient amount of alveolar ridge in both dimensions is often encountered in dental practice due to the consequences of oral diseases and tooth loss. Although postextraction socket preservation has been adopted to lessen the need for such invasive approaches, it utilizes bone grafting materials, which have limitations that could negatively affect the quality of bone formation. To overcome the drawbacks of routinely employed grafting materials, bone graft substitutes such as 3D scaffolds have been recently investigated in the dental field. In this review, we highlight different biomaterials suitable for 3D scaffold fabrication, with a focus on “3D-printed” ones as bone graft substitutes that might be convenient for various applications related to implant therapy. We also briefly discuss their possible adoption for periodontal regeneration. PMID:27366149

  7. Horizontal alveolar ridge augmentation using autologous press fit bone cylinders and micro-lag-screw fixation: technical note and initial experience.

    Science.gov (United States)

    Streckbein, Philipp; Kähling, Christopher; Wilbrand, Jan-Falco; Malik, Christoph-Yves; Schaaf, Heidrun; Howaldt, Hans-Peter; Streckbein, Roland

    2014-07-01

    The use of autologous block bone grafts for horizontal alveolar ridge augmentation in dental implantology is a common surgical procedure. Typically, bone grafts are individually moulded. The aim of this paper is to introduce an innovative procedure in lateral bone augmentation, where the recipient side is adjusted to the graft, not vice versa as in common procedures. Our initial clinical experience of twenty-five consecutive cases is presented. Adjusted trephine drills were used to harvest partly cylindrical grafts from the retromolar region of the mandible. After preparing the recipient site with accurately fitting grinding drills, the bone grafts were transplanted. The horizontally compromised alveolar ridges were successfully augmented and treated with dental implants. No major complication occurred during transplantation, the healing period, and subsequent implant therapy in our experimental setting with 25 patients and 38 augmentation procedures. One out of twenty-five patients presented with temporary dysaesthesia of the inferior alveolar nerve. The new method presented is an effective treatment option for horizontal alveolar ridge augmentation prior to single implant installation. Further studies should evaluate the donor site morbidity and long-term outcome on a larger population. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  8. A Novel Injectable Magnesium/Calcium Sulfate Hemihydrate Composite Cement for Bone Regeneration

    Directory of Open Access Journals (Sweden)

    Shanchuan Zhang

    2015-01-01

    Full Text Available Objective. A novel injectable magnesium/calcium sulfate hemihydrate (Mg/CSH composite with improved properties was reported here. Methods. Composition, setting time, injectability, compressive strength, and bioactivity in simulated body fluid (SBF of the Mg/CSH composite were evaluated. Furthermore, the cellular responses of canine bone marrow stromal cells (cBMSCs and bone formation capacity after the implantation of Mg/CSH in tibia defects of canine were investigated. Results. Mg/CSH possessed a prolonged setting time and markedly improved injectability and mechanical property p<0.05. Mg/CSH samples showed better degradability than CSH in SBF after 21 days of soaking p<0.05. Moreover, the degrees of cell attachment, proliferation, and capability of osteogenic differentiation on the Mg/CSH specimens were higher than those on CSH, without significant cytotoxicity and with the increased proliferation index, ALP activity, and expression levels of integrin β1 and Coll I in cBMSCs p<0.05. Mg/CSH enhanced the efficiency of new bone formation at the tibia defect area, including the significantly elevated bone mineral density, bone area fraction, and Coll I expression level p<0.05. Conclusions. The results implied that this new injectable bone scaffold exhibited promising prospects for bone repair and had a great potential in bone tissue engineering.

  9. Impacted bone and calcium phosphate cement for repair of femoral head defects: a pilot study.

    NARCIS (Netherlands)

    Rijnen, W.H.C.; Gardeniers, J.W.M.; Schreurs, B.W.; Buma, P.

    2007-01-01

    Bone impaction grafting has been advocated for reconstruction of femoral head osteonecrosis. However, bone grafts do not prevent the progression of collapse and subsequent disabling osteoarthritis in late-stage osteonecrosis. We hypothesized reconstruction of large subchondral defects with a mix of

  10. Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft in animals: a systematic review

    DEFF Research Database (Denmark)

    Jensen, Thomas; Schou, S; Stavropoulos, A

    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...

  11. Using calcium silicate to regulate the physicochemical and biological properties when using β-tricalcium phosphate as bone cement

    International Nuclear Information System (INIS)

    Kao, Chia-Tze; Huang, Tsui-Hsien; Chen, Yi-Jyun; Hung, Chi-Jr; Lin, Chi-Chang; 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. Regarding the formation of bone-like apatite, the diametral tensile strength as well as the ion release and weight loss of composites were compared both before and after immersions in simulated body fluid (SBF). In addition, we also examined the behavior of human dental pulp cells (hDPCs) cultured on β-TCP/CS composites. The results show that the apatite deposition ability of the β-TCP/CS composites improves as the CS content is increased. For composites with more than a 60% CS content, the samples become completely covered by a dense bone-like apatite layer. At the end of the immersion period, weight losses of 24%, 32%, 34%, 38%, 41%, and 45% were observed for the composites containing 0%, 20%, 40%, 80%, 80% and 100% β-TCP cements, respectively. In addition, the antibacterial activity of CS/β-TCP composite improves as the CS-content is increased. 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 60%, the quantity of cells and osteogenesis protein of hDPCs is stimulated by Si released from the β-TCP/CS composites. The degradation of β-TCP and the osteogenesis of CS give strong reason to believe that these calcium-based composite cements will prove to be effective bone repair materials. - Highlights: • CS improved the physicochemical properties and osteogenic activity of β-TCP. • Higher CS in the composite, the shorter setting time and the higher DTS was found. • With a CS more than 40%, the osteogenesis and angiogenesis proteins were promoted by

  12. Using calcium silicate to regulate the physicochemical and biological properties when using β-tricalcium phosphate as bone cement

    Energy Technology Data Exchange (ETDEWEB)

    Kao, Chia-Tze; Huang, Tsui-Hsien [School of Dentistry, Chung Shan Medical University, Taichung, Taiwan (China); Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Chen, Yi-Jyun [School of Dentistry, Chung Shan Medical University, Taichung, Taiwan (China); Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Dental Department, Taichung Hospital, Ministry of Health and Welfare, Taichung City, Taiwan (China); Hung, Chi-Jr [School of Dentistry, Chung Shan Medical University, Taichung, Taiwan (China); Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Lin, Chi-Chang, E-mail: chichang31@gmail.com [Department of Chemical and Materials Engineering, Tunghai University, Taichung, Taiwan (China); Shie, Ming-You, E-mail: eviltacasi@gmail.com [Department of Chemical and Materials Engineering, Tunghai University, Taichung, Taiwan (China)

    2014-10-01

    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. Regarding the formation of bone-like apatite, the diametral tensile strength as well as the ion release and weight loss of composites were compared both before and after immersions in simulated body fluid (SBF). In addition, we also examined the behavior of human dental pulp cells (hDPCs) cultured on β-TCP/CS composites. The results show that the apatite deposition ability of the β-TCP/CS composites improves as the CS content is increased. For composites with more than a 60% CS content, the samples become completely covered by a dense bone-like apatite layer. At the end of the immersion period, weight losses of 24%, 32%, 34%, 38%, 41%, and 45% were observed for the composites containing 0%, 20%, 40%, 80%, 80% and 100% β-TCP cements, respectively. In addition, the antibacterial activity of CS/β-TCP composite improves as the CS-content is increased. 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 60%, the quantity of cells and osteogenesis protein of hDPCs is stimulated by Si released from the β-TCP/CS composites. The degradation of β-TCP and the osteogenesis of CS give strong reason to believe that these calcium-based composite cements will prove to be effective bone repair materials. - Highlights: • CS improved the physicochemical properties and osteogenic activity of β-TCP. • Higher CS in the composite, the shorter setting time and the higher DTS was found. • With a CS more than 40%, the osteogenesis and angiogenesis proteins were promoted by

  13. Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft: a systematic review

    DEFF Research Database (Denmark)

    Jensen, Thomas; Schou, Søren; Stavropoulos, Andreas

    2012-01-01

    Aims: The objective of the present systematic review was to test the hypothesis of no differences in the implant treatment outcome when Bio-Oss or Bio-Oss mixed with autogenous bone is used as graft for the maxillary sinus floor augmentation (MSFA) applying the lateral window technique. Material ......, Holmstrup P. Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft: a systematic review. Clin. Oral Impl. Res. xx, 2011; 000-000 doi: 10.1111/j.1600-0501.2011.02168.x....

  14. A 3-year post-loading report of a randomised controlled trial on the rehabilitation of posterior atrophic mandibles: short implants or longer implants in vertically augmented bone?

    Science.gov (United States)

    Esposito, Marco; Cannizarro, Gioacchino; Soardi, Elisa; Pellegrino, Gerardo; Pistilli, Roberto; Felice, Pietro

    2011-01-01

    To evaluate whether 6.3 mm-long implants could be a suitable alternative to longer implants placed in vertically augmented atrophic posterior mandibles. Sixty partially edentulous patients having 7 to 8 mm of residual crestal height and at least 5.5 mm thickness measured on CT scans above the mandibular canal were randomised according to a parallel group design either to receive 1 to 3 submerged 6.3 mm-long implants or 9.3 mm or longer implants (30 patients per group) placed in vertically augmented bone. Bone was augmented with interpositional an organic bovine bone blocks covered by resorbable barriers. Grafts were left to heal for 5 months before implant placement. Four months later, provisional acrylic prostheses were delivered, and were then replaced after another 4 months by definitive metal-ceramic prostheses. Outcome measures were prosthesis and implant failures, complications, and radiographic peri-implant marginal bone level changes. All patients were followed up to 3 years after loading. Four patients dropped out, two from each group. The augmentation procedure failed in two patients and only 6.3 mm-long implants could be inserted. There were no statistically significant differences for prosthesis and implant failures. Three prostheses could not be placed or had to be remade in the short implant group versus 4 prostheses in the augmented group. Two short implants failed versus 3 long implants, all in different patients. There were statistically significantly more complications in augmented patients (22 complications in 20 augmented patients versus 5 complications in 5 patients of the short implant group). Both groups gradually lost peri-implant bone in a statistically significant way at 4 months, and 1 and 3 years after loading. Three years after loading, patients of the short implant group lost an average of 1.24 mm of peri-implant bone compared with 1.76 mm in the long implant group. Short implants experienced statistically significantly less bone loss

  15. Umbilical cord stem cells released from alginate-fibrin microbeads inside macroporous and biofunctionalized calcium phosphate cement for bone regeneration

    Science.gov (United States)

    Chen, Wenchuan; Zhou, Hongzhi; Weir, Michael D.; Bao, Chongyun; Xu, Hockin H.K.

    2012-01-01

    The need for bone repair has increased as the population ages. The objectives of this study were to (1) develop a novel biofunctionalized and macroporous calcium phosphate cement (CPC) containing alginate-fibrin microbeads encapsulating human umbilical cord mesenchymal stem cells (hUCMSCs); and (2) investigate hUCMSC proliferation and osteogenic differentiation inside CPC for the first time. Macroporous CPC was developed using calcium phosphate powders, chitosan, and gas-foaming porogen. Five types of CPCs were fabricated: CPC control, CPC + 0.05% fibronectin (Fn), CPC + 0.1% Fn, CPC + 0.1% Arg-Gly-Asp (RGD), and CPC + 0.1% Fn + 0.1% RGD. Alginate-fibrin microbeads containing 106 hUCMSCs/mL were encapsulated in the CPC paste. After CPC had set, the degradable microbeads released hUCMSCs inside CPC. hUCMScs proliferated inside CPC, with cell density at 21 d being 4-fold that at 1 d. CPC + 0.1% RGD had the highest cell density, which was 4-fold that of CPC control. The released cells differentiated into the osteogenic lineage and synthesized bone minerals. hUCMSCs inside the CPC + 0.1% RGD construct had gene expressions of alkaline phosphatase (ALP), osteocalcin (OC) and collagen I, which were twice those of CPC control. Mineral synthesis by hUCMSCs inside the CPC + 0.1% RGD construct was 2-fold that in CPC control. RGD and Fn incorporation in CPC did not compromise the strength of CPC, which matched the reported strength of cancellous bone. In conclusion, degradable microbeads released the hUCMSCs which proliferated, differentiated and synthesized minerals inside the macroporous CPC for the first time. CPC with RGD greatly enhanced cell functions. The novel biofunctionalized and macroporous CPC-microbead-hUCMSC construct is promising for bone tissue engineering applications. PMID:22391411

  16. Meta-analysis of Randomized Controlled Trials Comparing Clinical Outcomes Between Short Implants and Long Implants with Bone Augmentation Procedure.

    Science.gov (United States)

    Tong, Qingchun; Zhang, Xingwen; Yu, Liming

    The purpose of this meta-analysis was to assess and compare clinical outcomes of short implants versus long implants placed in conjunction with a bone augmentation procedure. The eligible studies were searched from PubMed, Embase, Springer link, and the Cochrane library databases up to 23 January 2015. Prosthesis failures, implant failures, complications, and marginal bone loss were the clinical outcomes measured. The pooled weighted mean difference (WMD) or risk ratios (RRs) and their 95% confidence intervals (CIs) were used to measure the effect size of continuous variables and dichotomous variables, respectively. A random-effects model was performed to assess the effect size. Nine eligible studies including 480 short implants (≤ 8 mm) and 503 long implants (≥ 9.3 mm) were selected for this meta-analysis. Compared with the long-implant group, a notable decrease in the short-implant group was found for complications at the 5-year follow-up (RR = 0.34, 95% CI: 0.15 to 0.79, P short-implant and long-implant groups for other variables (P > .05). Moreover, the results were not obviously changed when stratified by implants placed in the mandible and maxilla. Implants ≤ 8 mm in length are considered to be a suitable alternative treatment when bone height is not adequate for standard implants.

  17. Subsidence of titanium straight stems in combination with highly viscous bone cement

    OpenAIRE

    Hendrich, Christian; Sauer, Ulf; Albrecht, Tobias; Rader, Christof P.

    2005-01-01

    Varying results and a high rate of subsidence have been reported for the straight femoral stem (M.E. Müller) made of titanium alloy. We examined subsidence in 135 titanium-alloy straight stems implanted with high viscosity cement after 68.8±11.5 months using a digital high-precision method (EBRA-FCA). One revised implant showed a subsidence of 14.6 mm and another 2.5 mm over 5 years. A third implant without migration was found to be loose. The 122 implants without loosening showed a mean subs...

  18. 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...

  19. 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...

  20. Human histologic evaluation of anorganic bovine bone mineral combined with recombinant human platelet-derived growth factor BB in maxillary sinus augmentation: case series study.

    Science.gov (United States)

    Nevins, Myron; Garber, David; Hanratty, James J; McAllister, Bradley S; Nevins, Marc L; Salama, Maurice; Schupbach, Peter; Wallace, Steven; Bernstein, Simon M; Kim, David M

    2009-12-01

    The objective of this proof-of-principle study was to examine the potential for improved bone regenerative outcomes in maxillary sinus augmentation procedures when recombinant human platelet-derived growth factor BB (0.3 mg/mL) is combined with particulate anorganic bovine bone mineral. The surgical outcomes in all treated sites were uneventful at 6 to 8 months, with sufficient regenerated bone present to allow successful placement of maxillary posterior implants. Large areas of dense, well-formed lamellar bone were seen throughout the intact core specimens in more than half of the grafted sites. Abundant numbers of osteoblasts were noted in concert with significant osteoid in all sites, indicating ongoing osteogenesis. A number of cores demonstrated efficient replacement of the normally slowly resorbing anorganic bovine bone mineral matrix particles with newly formed bone when the matrix was saturated with recombinant human platelet-derived growth factor BB.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Human embryonic stem cell-encapsulation in alginate microbeads in macroporous calcium phosphate cement for bone tissue engineering

    Science.gov (United States)

    Tang, Minghui; Chen, Wenchuan; Weir, Michael D.; Thein-Han, Wahwah; Xu, Hockin H. K.

    2012-01-01

    Human embryonic stem cells (hESCs) are exciting for regenerative medicine applications because of their strong proliferative ability and multilineage differentiation capability. To date there has been no report on hESC seeding with calcium phosphate cement (CPC). The objective of this study was to investigate hESC-derived mesenchymal stem cell (hESCd-MSC) encapsulation in hydrogel microbeads in macroporous CPC for bone tissue engineering. hESCs were cultured to form embryoid bodies (EBs), and the MSCs were then migrated out of the EBs. hESCd-MSCs had surface markers characteristic of MSCs, with positive alkaline phosphatase (ALP) staining when cultured in osteogenic medium. hESCd-MSCs were encapsulated in alginate at a density of 1 million cells/mL, with an average microbead size of 207 µm. CPC contained mannitol porogen to create a porosity of 64% and macropores with size of 218 µm, with 20% absorbable fibers for additional porosity when the fibers degrade. hESCd-MSCs encapsulated in microbeads in CPC had good viability from 1 to 21 d. ALP gene expression at 21 d was 25-fold that at 1 d. Osteocalcin (OC) at 21 d was two orders of magnitude of that at 1 d. ALP activity in colorimetric p-nitrophenyl phosphate assay at 21 d was 5-fold that at 1 d. Mineral synthesis by the encapsulated hESCd-MSCs at 21 d was 7-fold that at 1 d. Potential benefits of the CPC-stem cell paste include injectability, intimate adaptation to complex-shaped bone defects, ease in contouring to achieve esthetics in maxillofacial repairs, and in situ setting ability. In conclusion, hESCd-MSCs were encapsulated in alginate microbeads in macroporous CPC showing good cell viability, osteogenic differentiation and mineral synthesis for the first time. The hESCd-MSC-encapsulating macroporous CPC construct is promising for bone regeneration in a wide range of orthopedic and maxillofacial applications. PMID:22633970

  3. Clinical and Radiological Regeneration of Large and Deep Osteochondral Defects of the Knee by Bone Augmentation Combined With Matrix-Guided Autologous Chondrocyte Transplantation.

    Science.gov (United States)

    Zellner, Johannes; Grechenig, Stephan; Pfeifer, Christian G; Krutsch, Werner; Koch, Matthias; Welsch, Goetz; Scherl, Madeleine; Seitz, Johannes; Zeman, Florian; Nerlich, Michael; Angele, Peter

    2017-11-01

    Large osteochondral defects of the knee are a challenge for regenerative treatment. While matrix-guided autologous chondrocyte transplantation (MACT) represents a successful treatment for chondral defects, the treatment potential in combination with bone grafting by cancellous bone or bone block augmentation for large and deep osteochondral defects has not been evaluated. To evaluate 1- to 3-year clinical outcomes and radiological results on magnetic resonance imaging (MRI) after the treatment of large osteochondral defects of the knee with bone augmentation and MACT. Special emphasis is placed on different methods of bone grafting (cancellous bone grafting or bone block augmentation). Case series; Level of evidence, 4. Fifty-one patients were included. Five patients were lost to follow-up. This left 46 patients (mean age, 28.2 years) with a median follow-up time of 2 years. The 46 patients had 47 deep, large osteochondral defects of the knee joint (1 patient with bilateral defects; mean defect size, 6.7 cm 2 ). The origin of the osteochondral defects was osteochondritis dissecans (n = 34), osteonecrosis (n = 8), or subchondral cysts (n = 5). Depending on the depth, all defects were treated by cancellous bone grafting (defect depth ≤10 mm; n = 16) or bone block augmentation (defect depth >10 mm; n = 31) combined with MACT. Clinical outcomes were followed at 3 months, 6 months, 1 year, 2 years, and 3 years and evaluated using the International Knee Documentation Committee (IKDC) score and Cincinnati score. A magnetic resonance imaging (MRI) evaluation was performed at 1 and 2 years, and the magnetic resonance observation of cartilage repair tissue (MOCART) score with additional specific subchondral bone parameters (bone regeneration, bone signal quality, osteophytes, sclerotic areas, and edema) was analyzed. The clinical outcome scores revealed a significant increase at follow-up (6 months to 3 years) compared with the preclinical results. The median IKDC score

  4. 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

  5. Effects of loading concentration, blood and synovial fluid on antibiotic release and anti-biofilm activity of bone cement beads.

    Science.gov (United States)

    Dusane, Devendra H; Diamond, Scott M; Knecht, Cory S; Farrar, Nicholas R; Peters, Casey W; Howlin, Robert P; Swearingen, Matthew C; Calhoun, Jason H; Plaut, Roger D; Nocera, Tanya M; Granger, Jeffrey F; Stoodley, Paul

    2017-02-28

    Antibiotic loaded cement beads are commonly used for the treatment of biofilm related orthopaedic periprosthetic infections; however the effects of antibiotic loading and exposure of beads to body fluids on release kinetics are unclear. The purpose of this study was to determine the effects of (i) antibiotic loading density (ii) loading amount (iii) material type and (iv) exposure to body fluids (blood or synovial fluid) on release kinetics and efficacy of antibiotics against planktonic and lawn biofilm bacteria. Short-term release into an agar gel was evaluated using a fluorescent tracer (fluorescein) incorporated in the carrier materials calcium sulfate (CaSO 4 ) and poly methyl methacrylate (PMMA). Different fluorescein concentrations in CaSO 4 beads were evaluated. Mechanical properties of fluorescein-incorporated beads were analyzed. Efficacy of the antibiotics vancomycin (VAN) or tobramycin (TOB) alone and in combination was evaluated against lawn biofilms of bioluminescent strains of Staphylococcus aureus and Pseudomonas aeruginosa. Zones of inhibition of cultures (ZOI) were measured visually and using an in-vivo imaging system (IVIS). The influence of body fluids on release was assessed using CaSO 4 beads that contained fluorescein or antibiotics and were pre-coated with human blood or synovial fluid. The spread from the beads followed a square root of time relationship in all cases. The loading concentration had no influence on short-term fluorescein release and pre-coating of beads with body fluids did not affect short-term release or antibacterial activity. Compared to PMMA, CaSO 4 had a more rapid short term rate of elution and activity against planktonic and lawn biofilms. This study highlights the importance of considering antibiotic loading and packing density when investigating the clinical application of bone cements for infection management. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  6. A clinical study of 406 sinus augmentations with 100% anorganic bovine bone.

    Science.gov (United States)

    Ferreira, Carlos E A; Novaes, Arthur B; Haraszthy, Violet I; Bittencourt, Márcio; Martinelli, Carolina B; Luczyszyn, Sonia M

    2009-12-01

    The aim of the present study is to evaluate the use of anorganic bovine bone (ABB) associated with a collagen membrane (CM) for a sinus graft by means of clinical, histologic, and radiographic parameters in cases with bone availability 406 sinuses) participated in this study. A total of 1,025 implants were placed in the grafted sinuses. A total of 118 implants were placed simultaneously with the sinus graft (one stage), and 907 implants were placed in a subsequent surgery (two stages), 6 to 12 months after the graft was performed. In seven cases, a biopsy was harvested for histomorphometric analysis. Recall appointments were scheduled every 6 months, and panoramic and periapical x-rays were required every year for 3 years. Among 1,025 implants, 19 were lost (survival rate: 98.1%). The difference in survival rates for implants placed in native bone 3 to 5 to < or =7 mm (97.0%) was not statistically significant (P = 0.3408). The survival rates for implants with rough and machined surfaces (98.6% and 97.0%, respectively) were not statistically significant (P = 0.0840). The histomorphometric analysis showed new bone formation (39.0% +/- 12%), marrow space (52.9% +/- 9.3%), and residual ABB (8% +/- 2.7%). Our results indicated that 1,025 implants placed in sinuses grafted exclusively with ABB combined with CM led to an excellent and predictable survival rate of 98.1%.

  7. Evaluation of novel resorbable membranes for bone augmentation in a rat model

    NARCIS (Netherlands)

    Zeng, N.; van Leeuwen, A.C.; Yuan, Huipin; Bos, R.R.M.; Grijpma, Dirk W.; Kuijer, R.

    2016-01-01

    Objectives Our study compared two novel, biodegradable poly(trimethylene carbonate) (PTMC) barrier membranes to clinically applied barrier membranes in maintaining volume of block autologous bone grafts in a rat mandible model. Material and methods Two hundred and forty rats were included in this

  8. Evaluation of novel resorbable membranes for bone augmentation in a rat model

    NARCIS (Netherlands)

    Zeng, Ni; van Leeuwen, Anne; Yuan, Huipin; Bos, Ruud R M; Grijpma, Dirk W; Kuijer, Roelof

    ObjectivesOur study compared two novel, biodegradable poly(trimethylene carbonate) (PTMC) barrier membranes to clinically applied barrier membranes in maintaining volume of block autologous bone grafts in a rat mandible model. Material and methodsTwo hundred and forty rats were included in this

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    2012-04-01

    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 resorption process. In 20 patients, three-dimensional analysis of alveolar ridge dimensions and bone graft volume change in the atrophic posterior maxilla was performed by Cone-Beam Computerized Tomography imaging. Ridge dimensions were assessed before maxillary sinus augmentation surgery. Bone graft volumes were compared after maxillary sinus floor augmentation surgery and a graft healing interval of several months. To analyze the relation between bone volume changes with the independent variables, patients' gender, age, alveolar crest height and width, and graft healing time interval, a multi-level extension of linear regression was applied. A residual bone height of 6.0 mm (SD = 3.6 mm) and 6.2 mm (SD = 3.6 mm) was found at the left and right sides, respectively. Moreover, alveolar bone widths of 6.5 mm (SD = 2.2 mm) and 7.0 mm (SD = 2.3 mm) at the premolars, and 8.8 mm (SD = 2.2 mm) and 8.9 mm (SD = 2.5 mm) at the molars regions were found at the left and right site, respectively. Bone graft volume decreased by 25.0% (SD = 21.0%) after 4.7 months (SD = 2.7, median = 4.0 months) of healing time. The variables "age" (P = 0.009) and mean alveolar crest "bone height" (P = 0.043), showed a significant influence on bone graft resorption. A decrease of 1.0% (SE = 0.3%) of bone graft resorption was found for each year the patient grew older, and an increase in bone graft resorption of 1.8% (SE = 0.8%) was found for each mm of original bone height before sinus floor augmentation. Graft resorption occurs when using autologous bone grafts for maxillary sinus augmentation. Alveolar crest bone height and patient age have a significant effect on graft

  11. Evaluation of an accelerated aging medium for acrylic bone cement based on analysis of nanoindentation measurements on laboratory-prepared and retrieved specimens.

    Science.gov (United States)

    Lewis, Gladius; Xu, Jie; Dunne, Nicholas; Daly, Catherine; Orr, John

    2007-05-01

    The thrust of the study was a critical evaluation of the efficacy of a medium (30% v/v H(2)O(2), at 60 degrees C) that has been suggested in a literature report as being suitable for simulating the oxidative aging process, seen in vivo, in the acrylic bone cement mantles of total hip and knee joint replacements. For this purpose, quasi-static and dynamic nanoindentation measurements were used to obtain material properties--elastic modulus, E; hardness, H; and the variation of the storage and loss moduli with the frequency of the applied indenting force--of PalacosR acrylic bone cement specimens after various periods of immersion (7, 14, 21, and 28 days) in the aging solution, and of specimens prepared from cement mantles retrieved from cemented total hip joint replacements after various times in vivo (0.92-21 years). Also, best-fit relationships were obtained between E and time in the H(2)O(2) solution (t), H and t, E and in vivo time (T), and H and T. This body of results points to the possibility that the aging solution is effective, although the evidence is not conclusive.

  12. 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.

  13. Periodontal regeneration using an injectable bone cement combined with BMP-2 or FGF-2

    NARCIS (Netherlands)

    Oortgiesen, D.A.W.; Walboomers, X.F.; Bronckers, A.L.J.J.; Meijer, G.J.; Jansen, J.A.

    2014-01-01

    Periodontitis is a frequently diagnosed oral disease characterized by bone resorption and soft tissue loss around teeth. Unfortunately, currently available therapies only slow or arrest progress of the disease. Ideally, treatment of periodontal defects should be focused on complete regeneration of

  14. [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.

  15. [Aseptic loosening of total ankle replacement : Two-stage revision with bone augmentation of osseous defects and secondary prosthesis implantation].

    Science.gov (United States)

    Barg, A; Wiewiorski, M; Valderrabano, V

    2017-06-01

    To remove loosened ankle prosthesis components, perform osseous defect augmentation, and reimplant definitive prosthesis components to preserve ankle range of motion. Aseptic loosening of the tibial and/or talar ankle prosthesis components with substantial bone defect. General surgical/anesthesiological risks, infections, critical soft tissue conditions, nonmanageable hindfoot instability, neurovascular impairment of the lower extremity, neuroarthropathy, substantial nonreconstructable osseous defects with or without cysts on the tibial and/or talar side, noncompliance, primary total ankle replacement (TAR) using intramedullary fixation (stem fixation), severely reduced bone quality, insulin-dependent diabetes mellitus, smoking, unrealistic patients' expectations, high activity in sports. Exposure of the ankle joint using the previous incision. Mobilization and removal of loosened prosthesis components. Debridement of bone stock. Assessment and measurement of osseous defects. Harvesting of iliac crest autograft. Screw fixation of iliac crest autograft. Placement of polyethylene inlay as a spacer. Wound closure in layers at the ankle and the iliac crest. Implantation of definitive prosthesis components. A soft wound dressing. Thromboprophylaxis recommended. Mobilization on postoperative day 1 using a stabilizing walking boot/cast for 6 weeks (sole contact but no weight bearing). Clinical and radiographic follow-up 3 months postoperatively including computed tomography to assess osseous consolidation. After the second surgery, patient mobilization on postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot/cast for 6 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually. From January 2007 to December 2012, a two-stage revision TAR was performed in 5 patients (46.8 and 71.4 years). The time between the initial TAR and revision was 2.4-11.5 years. No intra

  16. Vertical bone augmentation versus 7-mm-long implants in posterior atrophic mandibles. Results of a randomised controlled clinical trial of up to 4 months after loading.

    Science.gov (United States)

    Felice, Pietro; Cannizzaro, Gioacchino; Checchi, Vittorio; Marchetti, Claudio; Pellegrino, Gerardo; Censi, Paolo; Esposito, Marco

    2009-01-01

    To evaluate whether 7-mm-long implants could be a suitable alternative to longer implants placed in vertically augmented bone for the treatment of atrophic posterior mandibles. Sixty partially edentulous patients having 7 to 8 mm of residual crestal height and at least 5.5 mm thickness measured on a computed tomography scan above the mandibular canal were randomised to receive either two to three submerged 7-mm-long NanoTite External Hex implants (Biomet 3i) or 10-mm or longer implants (30 patients per group) placed in vertically augmented bone. Bone was augmented with anorganic bovine bone blocks (Bio-Oss) using a sandwich technique and resorbable barriers. The grafts were left healing for 5 months before placing the implants, which were submerged. Four months after implant placement, provisional acrylic prostheses were delivered. Definitive screw-retained metal-ceramic prostheses were delivered 4 months later. Outcome measures were: prosthesis and implant failures, any complications, and time needed to fully recover mental nerve sensitivity. All patients were followed up to the delivery of the final restorations (4 months after loading). No patient dropped out. In two patients of the augmented group, there was not enough space to place 10-mm or longer implants as planned and 7-mm-long implants were used instead. The most likely reason for this is that the Bio-Oss blocks fractured in many pieces at placement. One prosthesis could not be placed when planned in the 7-mm group versus three prostheses in the augmented group, because of failure of one implant in each patient. The difference was not statistically significant. All implants were successfully replaced and final prostheses delivered. Four complications (wound dehiscence) occurred during graft healing in the augmented group (one possibly associated with the failure of one implant) versus none in the 7-mm-long implant group. The difference was not statistically significant. No patient suffered from permanent

  17. Biomechanical study of pedicle screw fixation in severely osteoporotic bone.

    Science.gov (United States)

    Cook, Stephen D; Salkeld, Samantha L; Stanley, Tom; Faciane, Albert; Miller, Scot D

    2004-01-01

    Obtaining adequate purchase with standard pedicle screw techniques remains a challenge in poor quality bone. The development of alternate insertion techniques and screw designs was prompted by recognition of potential fixation complications. An expandable pedicle screw design has been shown to significantly improve fixation compared to a conventional screw in poor quality bone. The purpose of this study was to determine if polymethylmethacrylate (PMMA) bone cement augmentation of an expandable pedicle screw can further improve fixation strength compared to the expandable screw alone in severely osteoporotic bone. A technique for cement insertion into the pedicle by means of the cannulated central portion of the expandable screw is also described. The axial pullout strength, stiffness and energy absorbed of cemented and noncemented expandable pedicle screws was determined in cadaveric vertebrae. Twenty-one fresh unembalmed vertebrae from the thoracolumbar spine were used. Radiographs and bone mineral density measurements (BMD) were used to characterize bone quality. Paired cemented and noncemented pedicle screw axial pullout strength was determined through mechanical testing. Mechanical pullout strength, stiffness and energy to failure was correlated with BMD. Overall, there was a 250% increase in mean pullout strength with the cemented expandable screw compared with a noncemented expandable screw including a greater than twofold increase in pullout strength in the most severely osteoporotic bone. The mean stiffness and energy absorbed to failure was also significantly increased. A cemented conventional screw achieved a pullout strength similar to the noncemented expandable screw. PMMA cement augmentation of the expandable pedicle screw may be a viable clinical option for achieving fixation in severely osteoporotic bone.

  18. A meta-analysis of histomorphometric results and graft healing time of various biomaterials compared to autologous bone used as sinus floor augmentation material in humans.

    Science.gov (United States)

    Klijn, Reinoud J; Meijer, Gert J; Bronkhorst, Ewald M; Jansen, John A

    2010-10-01

    To date, no studies have been published in which histomorphometric data from a large group of patients comparing various biomaterials for sinus floor augmentation procedures were evaluated. A meta-analysis of the English literature from January 1993 till April 2009 was carried out. Out of 147 titles, according to our criteria, 64 articles were selected for analysis describing the use of autologous bone and their alternatives, such as allogenic, xenogenic, and alloplastic materials. On the basis of autologous bone grafting, a reference value for total bone volume (TBV) of 63% was found. Particulation of the bone graft resulted in a general reduction of −18% in TBV. Delayed implant placement reduced the TBV with −7%. Overall TBV was 8% or 6% higher if a biopsy was, respectively, taken before 4.5 months or after 9.0 months after initial sinus augmentation surgery. Allogenic, xenogenic, alloplastic, or combinations of graft materials all resulted in a significant lower amount of TBV compared to autologous bone grafting ranging from −7% to −26%. Inventorying the effect of "biopsy time" for autologous bone, the TBV was significantly higher before 4.5 and after 9.0 months of healing time compared to period in between. Surprisingly, no significant differences in TBV with respect to "biopsy time" for bone substitutes were found. On the basis of the aspect of TBV autologous bone still has to be considered to be the gold standard in sinus augmentation surgery. However, the consequence of the TBV for implant survival is still unraveled yet.

  19. The effects of excess calcium on the handling and mechanical properties of hydrothermal derived calcium phosphate bone cement

    Science.gov (United States)

    Razali, N. N.; Sukardi, M. A.; Sopyan, I.; Mel, M.; Salleh, H. M.; Rahman, M. M.

    2018-01-01

    The objective of this study is to determine the effects of excess calcium on the handling and mechanical properties of hydrothermal derived calcium phosphate cement (CPC) for bone filling applications. Hydroxyapatite powder was synthesized via hydrothermal method using calcium oxide, CaO and ammonium dihydrogen phosphate, NH4H2PO4 as the calcium and phosphorus precursors respectively. The effects of calcium excess were evaluated by varying the CaO content at 0, 5 and 15 mole %. The precursors were then refluxed in distilled water at 90-100°C and dried overnight until the calcium phosphate powder was formed. CPC was then produced by mixing the synthesized powder with distilled water at the powder-to-liquid (P/L) ratio of 1.5. The result from the morphological properties of CPC shows the increase in agglomeration and particles size with 5 mole % of calcium excess but decreased with 15 mole % of calcium excess in CPC. This result was in agreement with the compressive strength result where the CPC increased its strength with 5 mole % of calcium excess but reduced with 15 mole % of calcium excess. The excess in calcium precursor also significantly improved the setting time but reduced the injectability of CPC.

  20. Augmentation of residual alveolar bone height with tissue engineering for dental implant placement

    Directory of Open Access Journals (Sweden)

    S M Balaji

    2014-01-01

    Full Text Available The challenge of correcting deficient vertical alveolar height for dental implant placement has been there since dental implants came in to regular clinical placement. The ability of various methods to increase the residual alveolar height has met with varying results. The primary reason is that the techniques were not quite successful in maintaining the required residual alveolar height. Use of Bone Morphogentic Protein, especially rhBMP-2 has been met with high degree of success in deficient vertical alveolar height in a mandibular ridge. The demonstration of this using a case has been presented here.

  1. Modifications to a 3D-printed temporal bone model for augmented stapes fixation surgery teaching.

    Science.gov (United States)

    Nguyen, Yann; Mamelle, Elisabeth; De Seta, Daniele; Sterkers, Olivier; Bernardeschi, Daniele; Torres, Renato

    2017-07-01

    Functional outcomes and complications in otosclerosis surgery are governed by the surgeon's experience. Thus, teaching the procedure to residents to guide them through the learning process as quickly as possible is challenging. Artificial 3D-printed temporal bones are replacing cadaver specimens in many institutions to learn mastoidectomy, but these are not suitable for middle ear surgery training. The goal of this work was to adapt such an artificial temporal bone to aid the teaching of otosclerosis surgery and to evaluate this tool. We have modified a commercially available 3D-printed temporal bone by replacing the incus and stapes of the model with in-house 3D-printed ossicles. The incus could be attached to a 6-axis force sensor. The stapes footplate was fenestrated and attached to a 1-axis force sensor. Six junior surgeons (residents) and seven senior surgeons (fellows or consultants) were enrolled to perform piston prosthesis placement and crimping as performed during otosclerosis surgery. The time required to perform the tasks and the forces applied to the incus and stapes were collected and analyzed. No statistically significant differences were observed between the junior and senior groups for time taken to perform the tasks and the forces applied to the incus during crimping and placement of the prosthesis. However, significantly lower forces were applied to the stapes by the senior surgeons in comparison with the junior surgeons during prosthesis placement (junior vs senior group, 328 ± 202.9 vs 80 ± 99.6 mN, p = 0.008) and during prosthesis crimping (junior vs senior group, 565 ± 233 vs 66 ± 48.6 mN, p = 0.02). We have described a new teaching tool for otosclerosis surgery based on the modification of a 3D-printed temporal bone to implement force sensors on the incus and stapes. This tool could be used as a training tool to help the residents to self-evaluate their progress with recording of objective measurements.

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

    Science.gov (United States)

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

    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), Cochrane Central, Web of Science and PubMed (as supplied by the publisher) were searched. There were no restrictions regarding language or publication date. Randomised controlled trials that reported membranes in bone augmentation procedures with a minimum follow-up period of 6 months after implant loading or that described geometrical changes of the bone graft at re-entry were included. Membrane placement had to be the only variable in the procedure. Outcomes were implant failure, complications, horizontal bone gain and resorption, graft resorption, defect height reduction, marginal bone loss around implants, aesthetic results and patient satisfaction. The results were pooled using fixed-effect models with mean differences (MDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. After screening the titles and abstracts of 1843 papers, 32 potentially eligible articles were selected. Seventeen articles involving 10 trials were included in this review. These studies presented outcome data for 355 patients. Seven trials were considered to be at a high risk of bias, two at a low risk of bias and one at an unclear risk of bias. Insufficient evidence was found to determine whether there were differences in implant failure rates, marginal bone level changes, aesthetic results or patient satisfaction. For one-stage ridge augmentation (two trials; n = 52), there was evidence of more horizontal bone gain (MD: 0.84 mm, 95% CI: 0.46 to 1.21, P trials), defect height reduction (MD: 18.36%, 95% CI: 10.23 to 26.50, P trials), and prevention of graft resorption (P = 0.004; one trial) in favour of the membrane-covered group, although substantial

  3. Sinus Floor Augmentation Comparing an In Situ Hardening Biphasic Calcium Phosphate (Hydroxyapatite/β-Tricalcium Phosphate) Bone Graft Substitute with a Particulate Biphasic Calcium Phosphate (Hydroxyapatite/β-Tricalcium Phosphate) Bone Graft Substitute: An Experimental Study in Sheep.

    Science.gov (United States)

    Wildburger, Angelika; Bubalo, Vladimir; Magyar, Marton; Nagursky, Heiner; Jakse, Norbert; Schmelzeisen, Rainer; Sauerbier, Sebastian

    2017-07-01

    The aim of the present split-mouth study in sheep was to assess the influence of in situ hardening properties of a biphasic calcium phosphate (BCP) bone graft substitute (BGS) (ratio hydroxyapatite/β-tricalcium phosphate = 60/40) compared with a particulate BGS with the same biphasic core-granule composition without in situ hardening properties on sinus floor augmentation. Therefore, bilateral sinus floor augmentation was performed in eight sheep. Poly(lactide-co-glycolide) (PLGA)-coated, in situ hardening biphasic BGS (PLGA-NMP [N-Methyl-2-pyrrolidone]-BCP) was placed at the test site, and a particulate biphasic BGS without PLGA coating (BCP) was used for the contralateral site as a control. Animals were sacrificed after 21 weeks. Sinus augmentation sites were analyzed histologically. The volume was analyzed by computed tomography. Histomorphometric parameters were assessed for the 12 and 21 weeks' time points. Slopes of new bone formation over time were compared with a linear growth regression model. Bone formation after 12 and 21 weeks of healing was 8.94% (±3.74) and 19.82% (±6.29) for PLGA-NMP-BCP and 7.00% (±2.58) and 14.38% (±4.51) for BCP, respectively. The bone growth rate for PLGA-NMP-BCP was higher than the growth rate for BCP (probability 97.5%). The total fraction of calcified hard tissue (% bone fraction + % biomaterial) was around 46% for both tested biomaterials, 21 weeks after sinus floor augmentation. The in situ hardening BGS (PLGA-NMP-BCP) performed better than the particulate material (BCP) in terms of bone formation rate. The in situ hardening properties of the PLGA-NMP-BCP material mediated by the PLGA coating and NMP solution as plasticizer had no negative influence on the bone formation.

  4. Evaluation study of the sinus lift technique in combination with autologous bone augmentation in dogs' frontal sinus. Limited cone beam CT image and histopathological analyses

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Tatsuo [Tokyo Women' s Medical Coll. (Japan). School of Medicine

    2002-08-01

    The posterior area of the maxilla has often been considered inadequate for the insertion of dental implants due to insufficient height of the alveolar bone by atrophic reduction and the maxillary sinus expansion. This anatomic problem may be resolved with augmentation of the floor of the maxillary sinus. The purpose of this study is to evaluate the effectiveness of sinus lift and grafting with the iliac crest bone performed in the dog frontal sinus as a model of the human maxillary sinus. Time course evaluations of bone volume after insertion of implants were performed by the limited cone beam CT (Ortho-CT), histopathological study and NIH-image digital analysis. New bone formation was identified as early as 2 weeks after the implant insertion. The bone volume was increased continuously until 13th week. High-density bone was found in the cervix of the implant after 26 weeks. However, the bone was lost at apex area of the implant and air cavity of the frontal sinus expanded. Ortho-CT findings showed good correlation with histopathological course of the lesion and bone volume identified by the NIH image analysis. The results revealed first time whole course of the bone remodeling after implant insertion into the frontal sinus of a dog. The data also provide an appropriate timing of the implant prosthesis and promise usefulness of the Ortho-CT in planning efficient implant treatment. (author)

  5. Comparison of Cemented and Bone Ingrowth Fixation Methods in Hip Resurfacing for Osteonecrosis.

    Science.gov (United States)

    O'Leary, Ryan J; Gaillard, Melissa D; Gross, Thomas P

    2017-02-01

    The optimal surgical treatment for osteonecrosis of the femoral head has yet to be elucidated. To evaluate the role of femoral fixation techniques in hip resurfacing, we present a comparison of the results for 2 consecutive groups: group 1 (75 hips) received hybrid hip resurfacing implants with a cemented femoral component; group 2 (103 hips) received uncemented femoral components. Both groups received uncemented acetabular components. We retrospectively analyzed our clinical database to compare failures, reoperations, complications, clinical results, metal ion test results, and X-ray measurements. Using consecutive groups caused time interval bias, so we required all group 2 patients to be at least 2 years out from surgery; we compared results from 2 years and final follow-up. Patient groups matched similarly in age, body mass index, and percent female. Despite similar demographics, the uncemented, group 2 cases showed a lower raw failure rate (0% vs 16%; P < .0001), a lower 2-year failure rate (0% vs 7%; P = .04), and a superior 8-year implant survivorship (100% vs 91%; log-rank P = .0028; Wilcoxon P = .0026). In cases that did not fail, patient clinical (P = .05), activity (P = .02), and pain scores (P = .03), as well as acetabular component position (P < .0001), all improved in group 2, suggesting advancements in surgical management. There were no cases of adverse wear-related failure in either group. This study demonstrates a superior outcome for cases of osteonecrosis with uncemented hip resurfacings compared to cases employing hybrid devices. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

  6. Evaluation of Biocompatibility and Osteogenic Potential of Tricalcium Silicate-based Cements Using Human Bone Marrow-derived Mesenchymal Stem Cells.

    Science.gov (United States)

    Sultana, Neha; Singh, Manisha; Nawal, Ruchika Roongta; Chaudhry, Sarika; Yadav, Seema; Mohanty, Sujata; Talwar, Sangeeta

    2018-03-01

    The success of endodontic regeneration lies in the appropriate combination of stem cells and bioactive materials. Several novel dental materials are available on the market in this regard. Hence, the current study aimed to evaluate the proliferation, differentiation, and osteogenic potential of human bone marrow-derived mesenchymal stem cells (hBMSCs) onto biomaterials like ProRoot MTA (MTA; Dentsply Tulsa Dental, Tulsa, OK), Biodentine (BD; Septodont, Saint Maur de Fosses, France), and EndoSequence Root Repair Material (ERRM; Brasseler USA, Savannah, GA). Dental cements were formulated into discs and assessed for their biocompatibility. hBMSCs were used to study biocompatitibility and the proliferative and osteogenic potential of these dental cements. A live dead assay was performed using confocal microscopy to study the biocompatibility, proliferation, and cell attachment property of the cements. An 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was also performed on days 1, 3, 5, and 7 to study growth kinetics. The osteogenic potential of these cements was studied by inducing hBMSCs over them using osteogenic differentiation medium (assessed by alkaline phosphatase assay). ERRM and MTA have shown the best biocompatibility among the tricalcium silicate materials used with no significant difference between them. Both have shown significantly higher osteogenic bioactivity than BD. All 3 tricalcium silicate cements support good adherence of hBMSCs. All of the dental cements used in this study are biocompatible with the potential to induce proliferation and osteogenic differentiation of hBMSCs. Therefore, the newly introduced ERRM can be the material of choice in various endodontic applications. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  7. Nanostructured gellan and xanthan hydrogel depot integrated within a baghdadite scaffold augments bone regeneration.

    Science.gov (United States)

    Sehgal, Rekha R; Roohani-Esfahani, S I; Zreiqat, Hala; Banerjee, Rinti

    2017-04-01

    Controlled delivery of biological cues through synthetic scaffolds to enhance the healing capacity of bone defects is yet to be realized clinically. The purpose of this study was development of a bioactive tissue-engineered scaffold providing the sustained delivery of an osteoinductive drug, dexamethasone disodium phosphate (DXP), encapsulated within chitosan nanoparticles (CN). Porous baghdadite (BD; Ca 3 ZrSi 2 O 9 ) scaffolds, a zirconia-modified calcium silicate ceramic, was coated with DXP-encapsulated CN nanoparticles (DXP-CN) using nanostructured gellan and xanthan hydrogel (GX). Crosslinker and GX polymer concentrations were optimized to achieve a homogeneous distribution of hydrogel coating within BD scaffolds. Dynamic laser scattering indicated an average size of 521 ± 21 nm for the DXP-CN nanoparticles. In vitro drug-release studies demonstrated that the developed DXP-CN-GX hydrogel-coated BD scaffolds (DXP-CN-GX-BD) resulted in a sustained delivery of DXP over the 5 days (78 ± 6% of drug release) compared with burst release over 1 h, seen from free DXP loaded in uncoated BD scaffolds (92 ± 8% release in 1 h). To estimate the influence of controlled delivery of DXP from the developed scaffolds, the effect on MG 63 cells was evaluated using various bone differentiation assays. Cell culture within DXP-CN-GX-BD scaffolds demonstrated a significant increase in the expression of early and late osteogenic markers of alkaline phosphatase activity, collagen type 1 and osteocalcin, compared to the uncoated BD scaffold. The results suggest that the DXP-releasing nanostructured hydrogel integrated within the BD scaffold caused sustained release of DXP, improving the potential for osteogenic differentiation. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  8. Nano‑calcium phosphate bone cement based on Si-stabilized α-tricalcium phosphate with improved mechanical properties.

    Science.gov (United States)

    Roozbahani, M; Alehosseini, M; Kharaziha, M; Emadi, R

    2017-12-01

    This study aimed to develop nano‑calcium phosphate cement (nCPC) and evaluate the effect of nanosized precursors on mechanical, physical and handling properties (injectability and setting time) as well as conversion rate of nano-reactants into nano-hydroxyapatite (nHA). In this study, while alpha tricalcium phosphate (α-TCP, 98wt%) and HA (2wt%) were applied as the powder phase, 2.5wt% NaH 2 PO 4 solution was used as liquid phase of cement. Before nano-CPC preparation, Si-stabilized α-TCP nanopowder with particle size of 10±3.6nm was firstly synthesized in a two-step process of sol-gel followed by mechanical alloying. Moreover, HA nanopowder with particle size of 32±3.6nm was synthesized using sol-gel process. Our results revealed that after 3days of immersion in ringer's solution, reactants almost completely converted to nHA. Moreover, the initial and final setting time of nano-CPC was obtained 6.3±2.1min and 14.3±4.0min, respectively. Furthermore, injectability of this formulation was reached 87.90±2.60%. In addition, our results confirmed that the compressive strength and modulus of nano-CPC enhanced with increasing immersion time in ringer's solution from 9.50±1.27MPa and 0.38±0.07GPa (at 1day) to 18.70±2.23MPa and 0.57±0.15GPa (at 5days), respectively. Finally, in order to evaluate cellular responses to nano-CPC, MG63 cells were cultured on it and cell morphology and cytotoxicity were evaluated. Results revealed that nano-CPC enhanced proliferation and spreading of osteoblast like cells compared to control (tissue culture plate) which could be due to both appropriate physical and chemical properties of nano-CPC which stimulate cell proliferation. Our findings suggest the formation of an injectable nano-CPC with appropriate mechanical, physical and degradation rate which can potentially utilized for filling bone defects. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Treatment of the atrophic edentulous maxilla: short implants versus bone augmentation for placing longer implants. Five-month post-loading results of a pilot randomised controlled trial.

    Science.gov (United States)

    Felice, Pietro; Soardi, Elisa; Pellegrino, Gerardo; Pistilli, Roberto; Marchetti, Claudio; Gessaroli, Manlio; Esposito, Marco

    2011-01-01

    To evaluate whether short (5 to 8.5 mm) dental implants could be a suitable alternative to longer (>11.5 mm) implants placed in atrophic maxillae augmented with autogenous bone for supporting dental prostheses. Twenty-eight patients with fully edentulous atrophic maxillae having 5 to 9 mm of residual crestal bone height at least 5 mm thick, as measured on computerised tomography scans, were randomised into two groups either to receive 4 to 8 short (5 to 8.5 mm) implants (15 patients) or autogenous bone from the iliac crest to allow the placement of at least 11.5 mmlong implants (13 patients). Bone blocks and the windows at maxillary sinuses were covered with rigid resorbable barriers. Grafts were left to heal for 4 months before placing implants, which were submerged. After 4 months, provisional reinforced acrylic prostheses or bar-retained overdentures were delivered. Provisional prostheses were replaced, after 4 months, by definitive screw-retained metal-resin cross-arch fixed dental prostheses. Outcome measures were: prosthesis and implant failures, any complications (including prolonged postoperative pain) and patient satisfaction. All patients were followed for 5 months after loading. All patients could be rehabilitated with implant-supported prostheses and none dropped out. One bilateral sinus lift procedure failed due to infection, though short implants could be placed. One implant failed in the augmented group versus 2 short implants in 2 patients. All failures occurred before loading. Significantly more complications occurred in augmented patients: 8 complications occurred in 5 augmented patients (all complained of pain 1 month after bone harvesting from the iliac crest). No complications occurred in the short implant group. All patients were fully satisfied with the treatment and would do it again. This pilot study suggests that short implants may be a suitable, cheaper and faster alternative to longer implants placed in bone augmented with autogenous

  10. Characteristics of Bone Tissue and Composite Materials on the Basis of Natural Hydroxyapatite and Endodontic Cement for Replacement of the Tissue

    Science.gov (United States)

    Filipenkov, V. V.; Rupeks, L. E.; Vitins, V. M.; Knets, I. V.; Kasyanov, V. A.

    2017-07-01

    New biocomposites and the cattle bone tissue were investigated. The composites were made from an endodontic cement (EC) and natural hydroxyapatite (NHAp.) The results of experiments performed by the method of infrared spectroscopy showed that protein was removed from the heat-treated specimens of bone tissue practically completely. The structure of bone tissue before and after deproteinization and the structure of the composite materials based on NHAp and EC (with different percentage) were investigated by the method of optical microscopy. The characteristics of mechanical properties (the initial elastic modulus, breaking tensile and compressive stresses, and breaking strain) and the density and porosity of these materials were determined. The new composite materials were implanted in the live tissue of rat. Biocompatibility between the live tissue and the new biocomposites was estimated.

  11. 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.

  12. 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

  13. Primary implant stability in augmented sinuslift-sites after completed bone regeneration: a randomized controlled clinical study comparing four subantrally inserted biomaterials

    OpenAIRE

    Angelo Troedhan; Izabela Schlichting; Andreas Kurrek; Marcel Wainwright

    2014-01-01

    Implant-Insertion-Torque-Value (ITV) proved to be a significant clinical parameter to predict long term implant success-rates and to decide upon immediate loading. The study evaluated ITVs, when four different and commonly used biomaterials were used in sinuslift-procedures compared to natural subantral bone in two-stage-implant-procedures. The tHUCSL-INTRALIFT-method was chosen for sinuslifting in 155 sinuslift-sites for its minimal invasive transcrestal approach and scalable augmentation vo...

  14. Cement composite delivery system.

    Science.gov (United States)

    Convery, F R; Devine, S D; Hollis, J M; Woo, S L

    1986-09-01

    Several new and innovative techniques have recently been introduced that purport to increase the strength of polymethyl methacrylate bone cement. One of these concepts is the use of carbon and polymer fibers to form a cement composite. Bone cement composites usually 1% fiber, are very difficult to use clinically. The composite is very sticky and viscous, which precludes effective hand packing or the use of conventional delivery systems. A new delivery system for very viscous materials is presented and examples of in vitro application are shown.

  15. Short implants versus bone augmentation for placing longer implants in atrophic maxillae: One-year post-loading results of a pilot randomised controlled trial.

    Science.gov (United States)

    Esposito, Marco; Barausse, Carlo; Pistilli, Roberto; Sammartino, Gilberto; Grandi, Giovanni; Felice, Pietro

    2015-01-01

    To evaluate whether short (5.0 to 8.5 mm) dental implants could be a suitable alternative to longer (at least 11.5 mm-long) implants placed in atrophic maxillae augmented with autogenous bone for supporting dental prostheses. Twenty-eight patients with fully edentulous atrophic maxillae, whom had 5 to 9 mm of residual crestal bone height which was at least 5 mm thick, measured using computerised tomography (CT) scans, were randomised into two groups either to receive 4 to 8 short (5.0 to 8.5 mm) implants (15 patients) or autogenous bone from the iliac crest to allow the placement of at least 11.5 mm-long implants (13 patients). Bone blocks and the windows at the maxillary sinuses were covered with rigid resorbable barriers. Grafts were left to heal for 4 months before placing implants which were submerged. After 4 months, provisional reinforced acrylic prostheses or bar retained overdentures were delivered. Provisional prostheses were replaced, after 4 months, by definitive screw-retained metal-resin cross-arch restorations. Outcome measures were prosthesis and implant failures, any complications, peri-implant marginal bone level changes and patient satisfaction. Patients were followed up to 1 year after loading. All patients were rehabilitated with implant-supported prostheses but two patients dropped out from the augmented group. One bilateral sinus lift procedure failed for infection, although short implants could be placed. One implant failed in the augmented group versus two short implants in two patients (Fishers exact test P = 1.00; difference in proportions = 0.06; 95% CI -0.28 to 0.17). All failures occurred before loading. Significantly more complications occurred in augmented patients: eight complications occurred in 5 augmented patients (all of them complained of pain 1 month after bone harvesting from the iliac crest) versus no complications in the short implant (Fisher's exact test P = 0.013; difference in proportions = 0.38; 95% CI 0.11 to 0

  16. 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...

  17. Histological Analysis of the Effect of Accelerated Portland Cement as a Bone Graft Substitute on Experimentally-Created Three-Walled Intrabony Defects in Dogs

    Directory of Open Access Journals (Sweden)

    Mohamad Javad Ashraf

    2007-12-01

    Full Text Available

    Background and aims. Recent literature shows that accelerated Portland cement (APC is a non-toxic material that may have potential to promote bone healing. The objective of this study was to histologically evaluate periodontal healing focusing on new bone regeneration following implantation of APC into intra-bony defects in dogs.

    Materials and methods. Three-wall intra-bony periodontal defects were surgically created at the mesial aspect of the first molar in both sides of mandible in six dogs. One side was randomly filled with the material and other received a flap operation only. The animals were euthanized eight weeks post-surgery when block sections of the defect sites were collected and prepared for qualitative histological analysis.

    Results. Compared to control group, stimulation of growth of new bone tissue in the cavity containing APC was significantly prominent in three of six cases, showing osteoid formation with osteoblastic rimming and new bone trabeculla. New bone formation was observed just close to cavity containing APC. Connective tissue proliferation and downgrowth of epithelium were significantly less than those of control group.

    Conclusion. Our results are encouraging for the use of APC as a bone substitute, but more comprehensive study are necessary before warranting clinical use.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  20. A prospective controlled trial comparing xenograft/autogenous bone and collagen-stabilized xenograft for maxillary sinus augmentation-Complications, patient-reported outcomes and volumetric analysis.

    Science.gov (United States)

    Alayan, Jamil; Ivanovski, Saso

    2018-02-01

    Compare maxillary sinus augmentation (MSA) using two different materials-anorganic bovine bone mineral (ABBM) + autogenous bone (AB) (control group) vs. collagen-stabilized ABBM (test group) in terms of complications, patient-reported outcome measures (PROMs) and volumetric analysis. Sixty patients underwent sinus augmentation (30 control + 30 test group). Intra- and postoperative complications were recorded. PROMs measured the impact of grafting on daily activities, pain and morbidity. CT scans were used to measure graft volume, ridge height, material selection and degree of contact of graft-to-surrounding sinus walls. Dental implant placement parameters were also recorded. All complications were minor and did not prevent completion of the augmentation or subsequent implant placement. Schneiderian membrane perforation was the most frequently encountered complication. Both treatment groups reported moderate limitation in the 1st 48 hr post-surgery but little or none by day 3 or 4. Jaw opening, chewing and bruising were significantly higher in the control group. The impact on work and social life was moderate initially but reduced to little or none by the 2nd day. Mild to moderate pain and interference to daily activities were reported for the first 3 days requiring the use of NSAIDs only. A mean graft volume of 1.46 cm 3 (±0.77) was calculated in the control group and 1.27 cm 3 (±0.65) in the test group. Extent of contact between graft and surrounding sinus walls had a significant impact on bone volume. Shorter (8 mm) implants were utilized more frequently in the test group, which was also more likely to require additional vertical augmentation, but this was not statistically significant. MSA using a lateral wall approach is safe and associated with mild to moderate pain and restrictions to daily activities for 48-72 hr. Patients' reports of morbidity were greater with autogenous bone harvesting. Collagen-stabilized ABBM provides comparable bone volume to

  1. [Preparation and ectopic osteoinduction study of macroporous bone substitute with calcium phosphate cements and rhBMP-2 loaded gelatin microspheres].

    Science.gov (United States)

    Li, Meng; Liu, Xu-dong; Liu, Xing-yan; Ge, Bao-feng

    2011-05-01

    To prepare macroporous bone substitute composed of calcium phosphate cements and rhBMP-2 loaded gelatin microspheres, and to investigate ectopic osteoinduction of the composite. After being prepared by improved emulsified cold-condensation method and crosslinked by 5% genipin solution,gelatin microspheres (GMs) were observed by scanning electron microscope (SEM) and loaded with rhBMP-2 by adsorption. Macroporous bone substitute was developed by mixing calcium phosphate cement (CPC) with 2.5% GMs, being as the experimental group,and CPC with rhBMP-2 was the control group. After the both composites had been soaked in the sodium chloride for 1 week or 3 weeks, compressive strength of the composites were tested, and the cross-sections were observed by SEM. Concentrations of rhBMP-2 in the solutions at different time by ELISA method and the cumulative drug release amount was calculated. The composites had been implanted in the muscle bags of the mouses for 3 weeks. Then the tissues around the materials were collected, stained by hematoxylin and eosin, and Ca and ALP in the tissues were also measured. Gelatin microspheres were spherical with diameters of (62 +/- 18) microm. Macropores appeared in the experimental materials 1 week and 3 weeks after being soaked,and total porosity, macroporosity, cumulative release amount of rhBMP-2 in the experimental group were higher than that in the control. But compressive strength of the experimental group was lower than that of the control group 3 weeks after being soaked. Results of HE stain showed chondral formation in both groups, but there were more chondral tissues in the experiment group, and so were the concentrations of Ca and ALP. Macroporous calcium phosphate cement can be prepared by using rhBMP-2 loaded gelatin microspheres, and it is an excellent bone substitute due to it's proterty of promoting rhBMP release and powerful ectopic osteoinduction.

  2. Localized ridge augmentation in the anterior maxilla using titanium mesh, an alloplast, and a nano-bone graft: a case report.

    Science.gov (United States)

    Alagl, Adel S; Madi, Marwa

    2018-01-01

    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.

  3. A lateral ridge augmentation study to evaluate a synthetic membrane for guided bone regeneration: an experiment in the canine mandible.

    Science.gov (United States)

    Vierra, Matthew; Mau, Lian Ping; Huynh-Ba, Guy; Schoolfield, John; Cochran, David L

    2016-01-01

    To evaluate guided bone regeneration outcomes in defects protected with an in situ formed polyethylene glycol (PEG) hydrogel membrane as compared to a non-cross-linked collagen membrane (CM). Four mandibular alveolar ridge defects were created in eight hound dogs. Regenerative procedures were randomly allocated to one of four groups consisting of freeze-dried bone allograft, which is referred to in this study as freeze-dried bone xenograft (FDBX) + PEG, autogenous bone (AB) + PEG, AB + CM, and AB alone. After 8 weeks, titanium dental implants were placed into augmented sites. After 8 weeks of allowed time for osseointegration, the animals were sacrificed to harvest block specimens for bone-to-implant contact (BIC) and ridge width histomorphometric analysis. Polyethylene glycol membranes had an exposure rate of 50% as compared to 12.5% for sites grafted with CM. Regenerative outcomes with respect to implant placement were least favorable for FDBX + PEG which had implants placed in 37.5% of augmented sites compared to 100% implant placement for all other groups. No statistically significant differences were noted between groups for ridge width measurements in implant and non-implant histologic sections (P > 0.05). Buccal BIC (%) values between treatment groups also failed to reach statistical significant difference (FDBX + PEG [60.2 ± 9.4]; AB + PEG [58.8 ± 8.5]; AB + CM [57.9 ± 12.8]; AB [61.0 ± 10.2]). When used in conjunction with FDBX, PEG had unpredictable bone formation and in most cases negatively impacted future implant placement. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Bone Marrow Concentrate and Bovine Bone Mineral for Sinus Floor Augmentation : A Controlled, Randomized, Single-Blinded Clinical and Histological Trial-Per-Protocol Analysis

    NARCIS (Netherlands)

    Sauerbier, Sebastian; Rickert, Daniela; Gutwald, Ralf; Nagursky, Heiner; Oshima, Toshiyuki; Xavier, Samuel P.; Christmann, Johannes; Kurz, Patrick; Menne, Dieter; Vissink, Arjan; Raghoebar, Gerry; Schmelzeisen, Rainer; Wagner, Wilfried; Koch, Felix P.

    Purpose: The purpose of this work was to evaluate the potential of substituting autogenous bone (AB) by bone marrow aspirate concentrate (BMAC). Both AB and BMAC were tested in combination with a bovine bone mineral (BBM) for their ability of new bone formation (NBF) in a multicentric, randomized,

  5. Self-setting properties and in vitro bioactivity of Ca2SiO4/CaSO4.1/2H2O composite bone cement.

    Science.gov (United States)

    Huan, Zhiguang; Chang, Jiang; Huang, Xiang-Hui

    2008-11-01

    In this study, a biphasic injectable bone substitute based on beta-dicalcium silicate (Ca(2)SiO(4)) and plaster of Paris (CaSO(4).1/2H(2)O) is presented, and its behavior as cement was studied and compared to that of pure Ca(2)SiO(4) paste. The results demonstrated that the setting time of the workable Ca(2)SiO(4)/CaSO(4).1/2H(2)O pastes was only 15 min, which was significantly reduced as compared to that of the Ca(2)SiO(4) paste (100 min), and the composite showed higher short- and long-term mechanical strength (3.25 and 37.2 MPa, respectively) than those of the Ca(2)SiO(4) paste (0.2 and 24.6 MPa). Similar to the pure Ca(2)SiO(4) paste, the composite paste could induce apatite formation in simulated body fluid within a short period and degrade in Ringer's solution. Moreover, the degradation rate could be adjusted by modifying the content of the plaster within the composite cement. These results suggested that the addition of the plaster significantly improved the self-setting properties of the Ca(2)SiO(4) paste, and the bioactive composite cement could be a prospective candidate for further investigation as self-setting tissue-repairing substitute.

  6. Four-year follow-up of a polymethyl methacrylate-based bone cement graft for optimizing esthetics in maxillary anterior implants: a case report.

    Science.gov (United States)

    Torres, Érica Miranda De; Naldi, Luis Fernando; Bernades, Karina Oliveira; Carvalho, Alexandre Leite

    2017-01-01

    Tooth loss promotes bone and gingival tissue remodeling, thus breaking the harmony between the residual ridge and natural teeth. This is critical in the anterior region of the mouth, and the integration of several dental specialties is often essential to successful rehabilitation with implants. This article describes a multidisciplinary approach to implant-supported oral rehabilitation in the maxillary anterior region, presenting a new technique for optimizing esthetics in implants. A 19-year-old woman was missing her central and lateral incisors and had 2 dental implants in the lateral incisor sites. The patient exhibited deficient thickness of the alveolar edge, loss of lip support, and absence of gingival architecture, and the implants were improperly placed. A multidisciplinary team created a correct emergence profile through a polymethyl methacrylate-based bone cement graft along with connective tissue grafts. This technique may be a useful therapeutic adjunct in dental implantology, showing good predictability and regular healing procedures.

  7. Four mm-long versus longer implants in augmented bone in atrophic posterior jaws: 4-month post-loading results from a multicentre randomised controlled trial.

    Science.gov (United States)

    Esposito, Marco; Zucchelli, Giovanni; Barausse, Carlo; Pistilli, Roberto; Trullenque-Eriksson, Anna; Felice, Pietro

    To evaluate whether 4-mm long dental implants could be an alternative to augmentation with equine bone blocks and the placement of at least 10-mm long implants in atrophic posterior jaws. Forty patients with atrophic posterior (premolar and molar areas) mandibles having 5 to 6 mm bone height above the mandibular canal and 40 patients with atrophic maxillae having 4 to 5 mm below the maxillary sinus, were randomised according to a parallel group design to receive one to three 4.0 mm-long implants or one to three implants, which were at least 10 mm long, in augmented bone at two centres. All implants had a diameter of 4.0 or 4.5 mm. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers. Implants were placed 4 months after interpositional grafting. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers, and implants were placed simultaneously. Implants were not submerged and were loaded after 4 months with provisional prostheses. Four months later, screw-retained reinforced acrylic restorations were delivered, and then replaced after 4 months by definitive screw-retained metal-composite prostheses. Patients were followed up to 4-months post-loading. Outcome measures included prosthesis and implant failures, any complication and peri-implant marginal bone level changes. No patient dropped out. In six augmented mandibles (30%), it was not possible to place implants which were at least 10.0-mm long, therefore shorter implants had to be placed instead. In particular, one mandible fractured and the patient did not want to go ahead with the treatment. One implant of the patient with the mandible fracture from the augmented group failed versus two 4.0 mm implants in two patients from the short implant group. In the maxillae, three short implants failed in two patients versus five long implants in three patients (two long implants and one short implant

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

    Science.gov (United States)

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

    2014-04-01

    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. Copyright © 2014. Published by Elsevier B.V.

  9. Preparation, characterization and investigation of in vitro and in vivo biological properties of strontium-modified calcium phosphate cement for bone defect repair

    Directory of Open Access Journals (Sweden)

    Reza Masaeli

    2015-12-01

    Full Text Available Background and Aims: The aim of this study was to evaluate the invitro and invivo performance of a 3 wt% of strontium additive hydroxyapatite calcium phosphate cements (CPC. Materials and Methods: The prepared calcium phosphate cement was characterized with XRD, FTIR, setting time, STA and in vitro and in vivo biological analyses. The MTT assay ALP activities as in vitro study and radiological and histological examinations as in vivo study between the three groups of 3 wt% Sr-HA/CPC, CPC and control were performed and compared. Data were analyzed using T-test and One-way ANOVA. Results: XRD analysis demonstrated that by increasing the ratio of Powder/Liquid (P/L, the crystallinity of the prepared cement increased. The substitution of strontium instead of calcium in CPC could also alter the crystal structure, including some structural disorder. However, in the CPC with no strontium hydroxyapatite (Sr-HA, no significant increase in the crystallinity was observed. SEM observations revealed CPC with increasing P/L ratio, the formation of hydroxyapatite crystals arising from the interaction of solid and liquid phase of cement was decreased. Also, the addition of Sr within Ca site culminated in a dramatic increase in crystallinity of hydroxyapatite. In vitro biological properties ascertained that addition of 3 wt. % Sr-HA into CPC enhanced MTT assay and ALP activity, which could be due to the presence of strontium ions. The histological study showed that greater remodeling was seen at 4 weeks after implantation when the 3 wt% Sr-HA/CPC was used. Conclusion: The obtained results cleared that CPC can be a potential candidate as a carrier with strontium additives for bone remodeling and regeneration.

  10. Acceleration of bone regeneration by activating Wnt/β-catenin signalling pathway via lithium released from lithium chloride/calcium phosphate cement in osteoporosis

    Science.gov (United States)

    Li, Li; Peng, Xiaozhong; Qin, Yongbao; Wang, Renchong; Tang, Jingli; Cui, Xu; Wang, Ting; Liu, Wenlong; Pan, Haobo; Li, Bing

    2017-03-01

    By virtue of its excellent bioactivity and osteoconductivity, calcium phosphate cement (CPC) has been applied extensively in bone engineering. Doping a trace element into CPC can change physical characteristics and enhance osteogenesis. The trace element lithium has been demonstrated to stimulate the proliferation and differentiation of osteoblasts. We investigated the fracture-healing effect of osteoporotic defects with lithium-doped calcium phosphate cement (Li/CPC) and the underlying mechanism. Li/CPC bodies immersed in simulated body fluid converted gradually to hydroxyapatite. Li/CPC extracts stimulated the proliferation and differentiation of osteoblasts upon release of lithium ions (Li+) at 25.35 ± 0.12 to 50.74 ± 0.13 mg/l through activation of the Wnt/β-catenin pathway in vitro. We also examined the effect of locally administered Li+ on defects in rat tibia between CPC and Li/CPC in vivo. Micro-computed tomography and histological staining showed that Li/CPC had better osteogenesis by increasing bone mass and promoting repair in defects compared with CPC (P osteoporosis.

  11. Augmented reality visualization using image overlay technology for MR-guided interventions: cadaveric bone biopsy at 1.5 T.

    Science.gov (United States)

    Fritz, Jan; U-Thainual, Paweena; Ungi, Tamas; Flammang, Aaron J; McCarthy, Edward F; Fichtinger, Gabor; Iordachita, Iulian I; Carrino, John A

    2013-06-01

    The purpose of this study was to prospectively test the hypothesis that image overlay technology facilitates accurate navigation for magnetic resonance (MR)-guided osseous biopsy. A prototype augmented reality image overlay system was used in conjunction with a clinical 1.5-T MR imaging system. Osseous biopsy of a total of 16 lesions was planned in 4 human cadavers with osseous metastases. A loadable module of 3D Slicer open-source medical image analysis and visualization software was developed and used for display of MR images, lesion identification, planning of virtual biopsy paths, and navigation of drill placement. The osseous drill biopsy was performed by maneuvering the drill along the displayed MR image containing the virtual biopsy path into the target. The drill placement and the final drill position were monitored by intermittent MR imaging. Outcome variables included successful drill placement, number of intermittent MR imaging control steps, target error, number of performed passes and tissue sampling, time requirements, and pathological analysis of the obtained osseous core specimens including adequacy of specimens, presence of tumor cells, and degree of necrosis. A total of 16 osseous lesions were sampled with percutaneous osseous drill biopsy. Eight lesions were located in the osseous pelvis (8/16, 50%) and 8 (8/16, 50%) lesions were located in the thoracic and lumbar spine. Lesion size was 2.2 cm (1.1-3.5 cm). Four (2-8) MR imaging control steps were required. MR imaging demonstrated successful drill placement inside 16 of the 16 target lesions (100%). One needle pass was sufficient for accurate targeting of all lesions. One tissue sample was obtained in 8 of the 16 lesions (50%); 2, in 6 of the 16 lesions (38%); and 3, in 2 of the 16 lesions (12%). The target error was 4.3 mm (0.8-6.8 mm). Length of time required for biopsy of a single lesion was 38 minutes (20-55 minutes). Specimens of 15 of the 16 lesions (94%) were sufficient for pathological

  12. Arthroscopic Bankart repair associated with subscapularis augmentation (ASA) versus open Latarjet to treat recurrent anterior shoulder instability with moderate glenoid bone loss: clinical comparison of two series.

    Science.gov (United States)

    Russo, R; Della Rotonda, G; Cautiero, F; Ciccarelli, M; Maiotti, M; Massoni, C; Di Pietto, F; Zappia, M

    2017-04-01

    The treatment of chronic anterior shoulder instability with glenoid bone loss is still debated. The purpose of this study is to compare short-term results of two techniques treating chronic shoulder instability with moderate glenoid bone loss: bone block according to open Latarjet-Patte procedure and arthroscopic Bankart repair in association with subscapularis augmentation. Ninety-one patients with moderate anterior glenoid bone loss underwent from 2011 to 2015. From these patients, two groups of 20 individuals each have been selected. The groups were homogeneous in terms of age, gender, dominance and glenoid bone loss. In group A, an open Latarjet procedure has been performed, and in group B, an arthroscopic Bankart repair associated with subscapularis augmentation has been performed. The mean follow-up in group A was 21 months (20-39 months), while in group B was 20 months (15-36 months). QuickDash score, Constant and Rowe shoulder scores, were used for evaluations of results. The mean preoperative rate of QuickDash score was 3.6 for group A and 4.0 for group B; Rowe Score was 50.0 for group A and 50.0 for group B. Preoperative mean Constant score was 56.2 for Latarjet-Patte and 55.2 for Bankart plus ASA. Postoperative mean QuickDash score was in group A 1.8 and 1.7 in group B; Rowe Score was 89.8 and 91.6; Constant Score was 93.3 and 93.8. No complications related to surgery have been observed for both procedures. Not statistically significant difference was reported between the two groups (p > .05). Postoperatively, the mean deficit of external rotation in ER1 was -9° in group A and -8 in group B; In ER2, the mean deficit was -5° in both groups (p = .0942). Arthroscopic subscapularis augmentation of Bankart repair is an effective procedure for the treatment of recurrent anterior shoulder instability with glenoid bone loss without any significant difference in comparison with the well-known open Latarjet procedure.

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

    Energy Technology Data Exchange (ETDEWEB)

    Su, Ching-Chuan [Antai Medical Care Cooperation Antai Tian-Sheng Memorial Hospital, Pingtung, Taiwan (China); Kao, Chia-Tze; Hung, Chi-Jr [School of Dentistry, Chung Shan Medical University, Taichung, Taiwan (China); Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Chen, Yi-Jyun [School of Dentistry, Chung Shan Medical University, Taichung, Taiwan (China); Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Dental Department, Taichung Hospital, Ministry of Health and Welfare, Taichung City, Taiwan (China); Huang, Tsui-Hsien, E-mail: thh@csmu.edu.tw [School of Dentistry, Chung Shan Medical University, Taichung, Taiwan (China); Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Shie, Ming-You, E-mail: eviltacasi@gmail.com [Institute of Oral Science, Chung Shan Medical University, Taichung, Taiwan (China)

    2014-04-01

    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

  14. 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

  15. Enhancing pedicle screw fixation in the lumbar spine using allograft bone plug interference fixation.

    Science.gov (United States)

    Chrea, Bopha; Malempati, Harsha; Campbell, Jeffrey R; Khan, Sonja; Ching, Randal P; Lee, Michael J

    2014-05-01

    A within-subjects controlled laboratory study. To examine a biological alternative to cement augmentation for pedicle screw fixation comparing bilateral axial pullout tests of augmented and nonaugmented (controls) pedicle screws. Fixation in the osteoporotic spine remains a difficult challenge with failure by loosening or backout. Pedicle screw augmentation has been attempted using polymethylmethacrylate and bioabsorbable calcium cements; however, the potential for extravasation and embolization of cement are becoming increasingly concerning and merit the search for alternative methods to improve screw-anchoring strength. Twenty-four (24) fresh human lumbar vertebrae were tested to compare the pullout strength of augmented and nonaugmented pedicle screws. Two different augmentation strategies were employed using allograft bone plugs (ABPs) and evaluated using 12 specimens per group. Bone mineral density of each specimen was obtained using dual-energy x-ray absorptiometry. The augmented versus nonaugmented pedicle was randomized for each vertebra, and bilateral testing enabled paired statistical analyses. Axial pullout tests were performed using an materials testing system servohydraulic test system, and peak force, failure displacement, and stiffness was obtained for each test and correlated with bone mineral density. Augmentation using 6-mm-diameter ABPs with 6.25-mm-diameter pedicle screws resulted in statistically weaker average pullout strength (775±455 N) than the nonaugmented controls (1233±826 N). When using smaller (5 mm diameter) AGPs with the same diameter screws, there was no statistical difference between average pullout strength for the augmented pedicle screws (1772±652 N) and the nonaugmented screws (1780±575 N). Preliminary study of pedicle screw augmentation using cannulated ABPs showed no improvement of fixation with pedicles in the spine. This was even true in osteoporotic specimens, where augmentation would seem to be of considerable benefit.

  16. Pullout strength of pedicle screws augmented with particulate calcium phosphate: an experimental study.

    Science.gov (United States)

    Hashemi, Ata; Bednar, Drew; Ziada, Samir

    2009-05-01

    Pressure-injected and in situ curing bone cements have been studied as alternatives in augmenting lumbar pedicle screw fixation but are frequently found to leak outside the confines of the target vertebra. The objective is set to determine the mechanical efficacy of a porous granular/particulate calcium phosphate (CP) bone augmentation product (Skelite) applied manually without pressurized injection in this application. The biomechanical analysis compared the axial pullout strength and insertional torque of augmented and nonaugmented pedicle screws in cellular polyurethane foams. The insertion torque and pullout strength of 6.5-mm pedicle screws inserted (via 3.5-mm pilot holes) into polyurethane blocks mimicking the porosity of cancellous bone were measured. New pilot holes were then packed with granular particles of Skelite and retested. Last, those blocks initially tested to failure without augmentation were packed with Skelite and retested. Measurements were performed for polyurethane densities of 0.16 and 0.32 g/cc (corresponding to the porosity of osteoporotic and normal bone) and strain rates of 0.5 and 5mm/min. Peak pullout force averaged 2132.5+/-119.3 N and 1840.1+/-216.7 N in high density samples without and with augmentation and 688.2+/-91.4 N and 861.6+/-74.5 N in low density samples without and with augmentation. After failure, approximately 50% and 77% of the peak pullout force of original high and low density samples was regained by augmentation. Statistical analysis revealed significant (ppullout resistance, and insertion torque. Granular CP augmentation improved the pullout strength in both failed (pulledout) samples and low density (porosity of osteoporotic cancellous bone) polyurethane blocks.

  17. Sinus floor augmentation using large (1-2 mm) or small (0.25-1 mm) bovine bone mineral particles: a prospective, intra-individual controlled clinical, micro-computerized tomography and histomorphometric study.

    Science.gov (United States)

    Chackartchi, Tali; Iezzi, Giovana; Goldstein, Moshe; Klinger, Avigdor; Soskolne, Aubrey; Piattelli, Adriano; Shapira, Lior

    2011-05-01

    To compare the amount of newly formed bone after sinus floor augmentation with two different particle sizes of bovine bone mineral (BBM) using clinical, micro-computerized tomography (CT) and histological techniques. Bilateral sinus floor augmentations were performed in 10 patients. Six to 9 months later, bone samples were retrieved and analyzed. Results: Both groups were not different in vertical bone height achieved after augmentation, post-operative complications and maximal torque for the insertion of implants. Micro-CT measurements could not detect a statistically significant difference in bone volume between the groups (with a tendency for new more bone in the small granules group). Histomorphometric analysis revealed that both granule sizes produced the same pattern of bone formation, surrounding the graft granules, and producing a shape of a network, "bridging" between the BBM particles. Multi-nucleated giant cells, probably osteoclasts, were observed directly on the BBM particle surface in both groups. The osteoclast-like cells preferred the small-size BBM particles and not the large particles both in the small-size and the large-size granules group. Both sizes of BBM granules preformed equally and achieved the aim of the sinus floor augmentation procedure clinically and histologically. © 2010 John Wiley & Sons A/S.

  18. Maxillary Sinus Augmentation Combining Bio-Oss with the Bone Marrow Aspirate Concentrate: A Histomorphometric Study in Humans

    Directory of Open Access Journals (Sweden)

    Paulo José Pasquali

    2015-01-01

    Full Text Available Purpose. To investigate the regenerative results obtained with the association of bone marrow aspirate concentrate using the Bone Marrow Aspirate Concentrate (BMAC method to a xenogeneic bone graft (Bio-Oss in sinus floor elevation. Materials and Methods. Using a randomized controlled study design in eight consecutive patients (age of 55.4 ± 9.2 years, 16 sinus floor lift procedures were performed with Bio-Oss alone (control group, CG, n=8 or combined with bone marrow aspirate concentrate obtained via the BMAC method (test group, TG, n=8. Six months after the grafting procedures, bone biopsies were harvested during implant placement and were analyzed by histomorphometry. Results. Histomorphometric analysis revealed a significantly higher amount (p0.05 of nonmineralized tissue (38.53 ± 13.08% and 49.90 ± 7.64%, resp.. Conclusion. The use of bone marrow concentrate obtained by BMAC method increased bone formation in sinus lift procedures.

  19. Sandcastle Worm-Inspired Blood-Resistant Bone Graft Binder Using a Sticky Mussel Protein for Augmented In Vivo Bone Regeneration.

    Science.gov (United States)

    Kim, Hyo Jeong; Choi, Bong-Hyuk; Jun, Sang Ho; Cha, Hyung Joon

    2016-12-01

    Xenogenic bone substitutes are commonly used during orthopedic reconstructive procedures to assist bone regeneration. However, huge amounts of blood accompanied with massive bone loss usually increase the difficulty of placing the xenograft into the bony defect. Additionally, the lack of an organic matrix leads to a decrease in the mechanical strength of the bone-grafted site. For effective bone grafting, this study aims at developing a mussel adhesion-employed bone graft binder with great blood-resistance and enhanced mechanical properties. The distinguishing water (or blood) resistance of the binder originates from sandcastle worm-inspired complex coacervation using negatively charged hyaluronic acid (HA) and a positively charged recombinant mussel adhesive protein (rMAP) containing tyrosine residues. The rMAP/HA coacervate stabilizes the agglomerated bone graft in the presence of blood. Moreover, the rMAP/HA composite binder enhances the mechanical and hemostatic properties of the bone graft agglomerate. These outstanding features improve the osteoconductivity of the agglomerate and subsequently promote in vivo bone regeneration. Thus, the blood-resistant coacervated mussel protein glue is a promising binding material for effective bone grafting and can be successfully expanded to general bone tissue engineering. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  20. Inkjet-based biopatterning of SDF-1β augments BMP-2-induced repair of critical size calvarial bone defects in mice.

    Science.gov (United States)

    Herberg, Samuel; Kondrikova, Galina; Periyasamy-Thandavan, Sudharsan; Howie, R Nicole; Elsalanty, Mohammed E; Weiss, Lee; Campbell, Phil; Hill, William D; Cray, James J

    2014-10-01

    A major problem in craniofacial surgery is non-healing bone defects. Autologous reconstruction remains the standard of care for these cases. Bone morphogenetic protein-2 (BMP-2) therapy has proven its clinical utility, although non-targeted adverse events occur due to the high milligram-level doses used. Ongoing efforts explore the use of different growth factors, cytokines, or chemokines, as well as co-therapy to augment healing. Here we utilize inkjet-based biopatterning to load acellular DermaMatrix delivery matrices with nanogram-level doses of BMP-2, stromal cell-derived factor-1β (SDF-1β), transforming growth factor-β1 (TGF-β1), or co-therapies thereof. We tested the hypothesis that bioprinted SDF-1β co-delivery enhances BMP-2 and TGF-β1-driven osteogenesis both in-vitro and in-vivo using a mouse calvarial critical size defect (CSD) model. Our data showed that BMP-2 bioprinted in low-doses induced significant new bone formation by four weeks post-operation. TGF-β1 was less effective compared to BMP-2, and SDF-1β therapy did not enhance osteogenesis above control levels. However, co-delivery of BMP-2+SDF-1β was shown to augment BMP-2-induced bone formation compared to BMP-2 alone. In contrast, co-delivery of TGF-β1+SDF-1β decreased bone healing compared to TGF-β1 alone. This was further confirmed in vitro by osteogenic differentiation studies using MC3T3-E1 pre-osteoblasts. Our data indicates that sustained release delivery of a low-dose growth factor therapy using biopatterning technology can aid in healing CSD injuries. SDF-1β augments the ability for BMP-2 to drive healing, a result confirmed in vivo and in vitro; however, because SDF-1β is detrimental to TGF-β1-driven osteogenesis, its effect on osteogenesis is not universal. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Primary implant stability in augmented sinuslift-sites after completed bone regeneration: a randomized controlled clinical study comparing four subantrally inserted biomaterials.

    Science.gov (United States)

    Troedhan, Angelo; Schlichting, Izabela; Kurrek, Andreas; Wainwright, Marcel

    2014-07-30

    Implant-Insertion-Torque-Value (ITV) proved to be a significant clinical parameter to predict long term implant success-rates and to decide upon immediate loading. The study evaluated ITVs, when four different and commonly used biomaterials were used in sinuslift-procedures compared to natural subantral bone in two-stage-implant-procedures. The tHUCSL-INTRALIFT-method was chosen for sinuslifting in 155 sinuslift-sites for its minimal invasive transcrestal approach and scalable augmentation volume. Four different biomaterials were inserted randomly (easy-graft CRYSTAL n = 38, easy-graft CLASSIC n = 41, NanoBone n = 42, BioOss n = 34), 2 ccm in each case. After a mean healing period of 8,92 months uniform tapered screw Q2-implants were inserted and Drill-Torque-Values (DTV) and ITV were recorded and compared to a group of 36 subantral sites without need of sinuslifting. DTV/ITV were processed for statistics by ANOVA-tests. Mean DTV/ITV obtained in Ncm were: Control Group 10,2/22,2, Bio-Oss 12,7/26,2, NanoBone 17,5/33,3, easy-graft CLASSIC 20,3/45,9, easy-graft CRYSTAL 23,8/56,6 Ncm, significance-level of differences throughout p < 0,05. Within the limits of this study the results suggest self-hardening solid-block-like bone-graft-materials to achieve significantly better DTV/ITV than loose granulate biomaterials for its suspected improvement of vascularization and mineralization of the subantral scaffold by full immobilization of the augmentation site towards pressure changes in the human sinus at normal breathing.

  2. The inlay osteotome sinus augmentation technique for placing short implants simultaneously with reduced crestal bone height. A short-term follow-up.

    Science.gov (United States)

    Teng, Minhua; Liang, Xing; Yuan, Quan; Nie, Jing; Ye, Jun; Cheng, Qian; Zhai, Junjiang; Liao, Jian; Sun, Xu; Wen, Cai; Mo, Anchun

    2013-12-01

    To display an inlay technique of osteotome sinus floor elevation using a trephine combined with simultaneous short implant placement where the residual bone height (RBH) is less than 5 mm, as well as to evaluate the clinical effect in a prospective study. Fifty short implants were installed in 32 patients in the severely atrophic posterior maxilla immediately after sinus floor elevation between January 2010 and October 2012. An inlay osteotome sinus augmentation technique using a trephine was applied in the operation. The mean residual bone height adjacent to or beneath the sinus was 3.34 mm, ranging from 0.96 mm to 4.96 mm. It was rarely necessary to add graft material from bovine sources in this therapy. With the purpose of bite training and soft tissue reforming, the temporary crowns were fixed after 6 months. The final prostheses were restored 3 months later. The stability and osseointegration of the implants were clinically evaluated, also the bone height gain around the implants was measured. The survival rate was 100% during the study period with this procedure. Each of the implants, loaded without pain or any subjective sensation, was clinically stable. No implants had detectable sinus membrane perforation during operation. The radiographic results demonstrated that the bone height gain was 5.38 mm after the surgery. Based on the results and within the limits of the present study, it can be suggested that short implant placement in conjunction with this inlay osteotome sinus augmentation technique could yield predictable clinical results for edentulous posterior maxillary region with RBH less than 5 mm. Besides, from the clinical point of view, these techniques may reduce the indication for complex invasive procedures and simplify treatment in the posterior. © 2013 Wiley Periodicals, Inc.

  3. The effect of plaster (CaSO4 ·1/2H2O) on the compressive strength, self-setting property, and in vitro bioactivity of silicate-based bone cement.

    Science.gov (United States)

    Liu, Wenjuan; Wu, Chengtie; Liu, Weining; Zhai, Wanyin; Chang, Jiang

    2013-02-01

    Bone cements have been widely used for orthopedic applications. Previous studies have shown that calcium silicon-based bone cements (CSC) were injectable, bioactive, biodegradable, and mechanically strong in the long term, while their short-term compressive strength was low and setting time was too long. On the other hand, plaster (CaSO(4)·1/2H(2)O, POP) sets quickly upon contact with water and has excellent short-term compressive strength. The aim of this study is to prepare CSC/POP composite cements and investigate the effect of POP on the compressive strength, setting time, injectability, degradation, and in vitro bioactivity of the composite cements. The results have shown that POP content plays an important role to modulate the physicochemical property of CSC. The addition of POP into CSC significantly decreased the initial and final setting time and enhanced the short-term compressive strength and degradation rate. The obtained composite cement with 30% POP has been found to possess optimal setting time and short-term compressive strength. In addition, the prepared composite cements still maintain apatite-mineralization ability in simulated body fluids and their ionic extracts have no significant cytotoxicity to L929 cells. The results suggested that the addition of POP into CSC is a viable method to improve their setting properties and short-term compressive strength. The obtained composite cements with the optimized composition of 70% CSC and 30% POP could be potentially used for bone repair application. Copyright © 2012 Wiley Periodicals, Inc.

  4. Femoral Component Revision with Use of Impaction Bone-Grafting and a Cemented Polished Stem: A Concise Follow-up, at Fifteen to Twenty Years, of a Previous Report*

    NARCIS (Netherlands)

    Te Stroet, M.A.; Gardeniers, J.W.M.; Verdonschot, N.J.; Rijnen, W.H.C.; Slooff, T.J.J.H.; Schreurs, B.W.

    2012-01-01

    We previously reported our results for thirty-three consecutive femoral component revisions with impaction bone-grafting, performed with the X-change femoral revision system and a cemented polished Exeter stem, at a minimum of eight years of follow-up. The present updated study shows the results

  5. In situ synchrotron X-ray powder diffraction study of the early hydration of α-tricalcium phosphate/tricalcium silicate composite bone cement

    Energy Technology Data Exchange (ETDEWEB)

    Morejon-Alonso, Loreley; Correa, Jose Raul, E-mail: lmorejon@fq.uh.cu [Departamento de Quimica General, Facultad de Quimica, Universidad de La Habana, UH (Cuba); Motisuke, Mariana [Universidade Federal de Sao Paulo (UNIFESP), Sao Jose dos Campos, SP (Brazil); Carrodeguas, Raul Garcia [Universidade Federal de Campina Grande (UFCG), Campina Grande, PB (Brazil). Laboratorio de Avaliacao e Desenvolvimento de Biomateriais do Nordeste; Santos, Luis Alberto dos [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS (Brazil). Escola de Engenharia. Departamento de Materiais

    2015-01-15

    Bioactivity, osteogenicity and mechanical properties of α-tricalcium phosphate (α-TCP) based phosphates cements can be improved by adding tricalcium silicate (C{sub 3}S); however, the addition of C{sub 3}S delays the precipitation and growth of calcium deficient hydroxyapatite (CDHA). Thus, the aim of this work was the study of in situ setting reaction of α-TCP/C{sub 3}S composite bone cement under high energy X-ray generated by a synchrotron source within the first 72h. The results showed that the addition of C{sub 3}S induces the precipitation of nanosized CDHA at early times depending on the added content. Calculated crystallite sizes showed that the higher the content of C{sub 3}S, the smaller the crystal size at the beginning of the precipitation. These results are different from those obtained by conventional XRD method, suggesting that the proposed technique is a powerful tool in determining the composition and extent of reaction of CPCs surfaces in real time. (author)

  6. Effects of loading concentration, blood and synovial fluid on antibiotic release and anti-biofilm activity of bone cement beads

    OpenAIRE

    Dusane, Devendra H.; Diamond, Scott M.; Knecht, Cory S.; Farrar, Nicholas R.; Peters, Casey W.; Howlin, Robert P.; Swearingen, Matthew C.; Calhoun, Jason H.; Plaut, Roger D.; Nocera, Tanya M.; Granger, Jeffrey F.; Stoodley, Paul

    2017-01-01

    Antibiotic loaded cement beads are commonly used for the treatment of biofilm related orthopaedic periprosthetic infections; however the effects of antibiotic loading and exposure of beads to body fluids on release kinetics are unclear. The purpose of this study was to determine the effects of (i) antibiotic loading density (ii) loading amount (iii) material type and (iv) exposure to body fluids (blood or synovial fluid) on release kinetics and efficacy of antibiotics against planktonic and l...

  7. Mandibular atrophy and metabolic bone loss. Mandibular ridge augmentation by combined sandwich-visor osteotomy and resorption related to metabolic bone state

    NARCIS (Netherlands)

    Bras, J.; van Ooij, C. P.; van den Akker, H. P.

    1985-01-01

    22 edentulous women, 11 with and 11 without signs of metabolic bone loss were treated by a combined sandwich-visor osteotomy. Longitudinal studies showed a higher rate of resorption in women with radiographic signs of metabolic bone loss. The analysis was based upon lateral cephalometry

  8. Mandibular atrophy and metabolic bone loss. Mandibular ridge augmentation by combined sandwich-visor osteotomy and resorption related to metabolic bone state. A 5-year follow-up

    NARCIS (Netherlands)

    Habets, L. L.; Bras, J.; van den Akker, H. P.; Borgmeyer-Hoelen, A. M.; van Ooij, C. P.

    1987-01-01

    92 patients, 31 with and 61 without signs of metabolic bone loss, were treated with a combined sandwich-visor osteotomy. A 5-year follow-up showed a significantly higher rate of resorption in patients with radiographic signs of metabolic bone loss. The analysis was based upon lateral cephalometry

  9. Sinus Floor Augmentation Using Straumann® BoneCeramic™ and Bio-Oss® in a Split Mouth Design and Later Placement of Implants: A 5-Year Report from a Longitudinal Study.

    Science.gov (United States)

    Mordenfeld, Arne; Lindgren, Christer; Hallman, Mats

    2016-10-01

    Straumann® BoneCeramic™ is a synthetic biphasic calcium phosphate (BCP) aimed for sinus floor augmentation. Long-term follow-up of implants placed in BCP after sinus augmentation is still missing. The primary aim of the study was to compare survival rates and marginal bone loss of Straumann SLActive implants placed in either BCP (test) or Bio-Oss® (DBB) (control) after sinus floor augmentation. The secondary aim was to calculate graft sinus height at different time points. Bilateral sinus floor augmentation was performed in a split mouth model. Eleven patients (mean age 67 years) received 100% BCP on one side and 100% DBB on the contralateral side. After 8 months of graft healing, 62 Straumann SLActive implants were placed. After 5 years of functional loading (6 years after augmentation) of implants, marginal bone levels and grafted sinus height were measured, and implant survival and success rates were calculated. After 5 years of loading, all prosthetic constructions were in function although two implants were lost in each grafting material. The overall implant survival rate was 93.5% (91.7% for BCP, 91.3% for DBB, and 100% for residual bone). The success rates were 83.3% and 91.3% for BCP and DBB, respectively. There was no statistically significant difference in mean marginal bone level after 5 years between BCP (1.4 ± 1.2 mm) and DBB (1.0 ± 0.7 mm). Graft height reduction (GHR) after 6 years was limited to 6.6% for BCP and 5.8% for DBB. In this limited RCT study, the choice of biomaterial used for sinus floor augmentation did not seem to have any impact on survival rates and marginal bone level of the placed implants after 5 years of functional loading and GHR was minimal. © 2015 Wiley Periodicals, Inc.

  10. Cemented femoral stems in patients with DDH.

    Science.gov (United States)

    Garcia-Cimbrelo, E

    2007-01-01

    Total hip arthroplasty is the procedure of choice for most adult patients with symptomatic arthrosis secondary to developmental dysplasia (DDH), but it requires complex reconstructive techniques, is usually performed in young patients, and has an increased risk of complications. THA is indicated in presence of severe pain and when osteotomy is contraindicated. The complexity of surgery is related to the degree of dysplasia. Anatomic abnormalities in the acetabulum and femur are the cause of the complexity and complications of this procedure. Acetabular bone deficiency requires reconstructive techniques before implanting the cup at the anatomic acetabular location, such as bone autograft augmentation, implanting the cup at higher level of the hip center and cup medialization. Femoral shortening and special cemented or uncemented stems are currently used to avoid intraoperative complications. While a cemented stem needs metaphyseal femoral shortening, subtrochanteric shortening requires a cementless stem. Because of these patients' age, alternative bearing surfaces, such as alumina-on-alumina couples are recommended when possible. Although the long-term results of total hip arthroplasty in DDH are inferior to those in a general population, the results show a high level of pain relief and functional improvement.

  11. Influence of screw augmentation in posterior dynamic and rigid stabilization systems in osteoporotic lumbar vertebrae: a biomechanical cadaveric study.

    Science.gov (United States)

    Hoppe, Sven; Sven, Hoppe; Loosli, Yannick; Yannick, Loosli; Baumgartner, Daniel; Daniel, Baumgartner; Heini, Paul; Paul, Heini; Benneker, Lorin; Lorin, Benneker

    2014-03-15

    Biomechanical cadaveric study. To determine whether augmentation positively influence screw stability or not. Implantation of pedicle screws is a common procedure in spine surgery to provide an anchorage of posterior internal fixation into vertebrae. Screw performance is highly correlated to bone quality. Therefore, polymeric cement is often injected through specifically designed perforated pedicle screws into osteoporotic bone to potentially enhance screw stability. Caudocephalic dynamic loading was applied as quasi-physiological alternative to classical pull-out tests on 16 screws implanted in osteoporotic lumbar vertebrae and 20 screws in nonosteoporotic specimen. Load was applied using 2 different configurations simulating standard and dynamic posterior stabilization devices. Screw performance was quantified by measurement of screwhead displacement during the loading cycles. To reduce the impact of bone quality and morphology, screw performance was compared for each vertebra and averaged afterward. All screws (with or without cement) implanted in osteoporotic vertebrae showed lower performances than the ones implanted into nonosteoporotic specimen. Augmentation was negligible for screws implanted into nonosteoporotic specimen, whereas in osteoporotic vertebrae pedicle screw stability was significantly increased. For dynamic posterior stabilization system an increase of screwhead displacement was observed in comparison with standard fixation devices in both setups. Augmentation enhances screw performance in patients with poor bone stock, whereas no difference is observed for patients without osteoporosis. Furthermore, dynamic stabilization systems have the possibility to fail when implanted in osteoporotic bone.

  12. 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.

    Science.gov (United States)

    Viljakainen, Heli T; Natri, Anna-Mari; Kärkkäinen, Merja; Huttunen, Minna M; Palssa, Anette; Jakobsen, Jette; Cashman, Kevin D; Mølgaard, Christian; Lamberg-Allardt, Christel

    2006-06-01

    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 in a dose-responsive manner. Supplementation decreased the urinary excretion of resorption markers, but had no impact on formation markers. Adequate vitamin D intake protects the elderly against osteoporosis, but there exists no indisputable evidence that vitamin D supplementation would benefit bone mineral augmentation. The aim of this 1-year study was to determine in a randomized double-blinded trial the effect of 5 and 10 microg vitamin D3 supplementation on bone mineral augmentation in adolescent girls with adequate dietary calcium intake. Altogether, 228 girls (mean age, 11.4 +/- 0.4 years) participated. Their BMC was measured by DXA from the femur and lumbar spine. Serum 25-hydroxyvitamin D [S-25(OH)D], intact PTH (S-iPTH), osteocalcin (S-OC), and urinary pyridinoline (U-Pyr) and deoxypyridinoline (U-Dpyr) were measured. Statistical analysis was performed both with the intention-to-treat (IT) and compliance-based (CB) method. In the CB analysis, vitamin D supplementation increased femoral BMC augmentation by 14.3% with 5 microg and by 17.2% with 10 microg compared with the placebo group (ANCOVA, p = 0.012). A dose-response effect was observed in the vertebrae (ANCOVA, p = 0.039), although only with the highest dose. The mean concentration of S-25(OH)D increased (p < 0.001) in the 5-microg group by 5.7 +/- 15.7 nM and in the 10-microg group by 12.4 +/- 13.7 nM, whereas it decreased by 6.7 +/- 11.3 nM in the placebo group. Supplementation had no effect on S-iPTH or S-OC, but it decreased U-DPyr (p = 0.042). Bone mineral augmentation in the femur was 14.3% and 17.2% higher in the groups receiving 5 and 10 microg of vitamin D, respectively, compared with the placebo group

  13. Biomechanical Stability of Dental Implants in Augmented Maxillary Sites: Results of a Randomized Clinical Study with Four Different Biomaterials and PRF and a Biological View on Guided Bone Regeneration

    Science.gov (United States)

    Angelo, Troedhan; Marcel, Wainwright; Andreas, Kurrek; Izabela, Schlichting

    2015-01-01

    Introduction. Bone regenerates mainly by periosteal and endosteal humoral and cellular activity, which is given only little concern in surgical techniques and choice of bone grafts for guided bone regeneration. This study investigates on a clinical level the biomechanical stability of augmented sites in maxillary bone when a new class of moldable, self-hardening calcium-phosphate biomaterials (SHB) is used with and without the addition of Platelet Rich Fibrin (aPRF) in the Piezotome-enhanced subperiosteal tunnel-technique (PeSPTT). Material and Methods. 82 patients with horizontal atrophy of anterior maxillary crest were treated with PeSPTT and randomly assigned biphasic (60% HA/40% bTCP) or monophasic (100% bTCP) SHB without or with addition of aPRF. 109 implants were inserted into the augmented sites after 8.3 months and the insertion-torque-value (ITV) measured as clinical expression of the (bio)mechanical stability of the augmented bone and compared to ITVs of a prior study in sinus lifting. Results. Significant better results of (bio)mechanical stability almost by two-fold, expressed by higher ITVs compared to native bone, were achieved with the used biomaterials and more constant results with the addition of aPRF. Conclusion. The use of SHB alone or combined with aPRF seems to be favourable to achieve a superior (bio)mechanical stable restored alveolar bone. PMID:25954758

  14. Biomechanical Stability of Dental Implants in Augmented Maxillary Sites: Results of a Randomized Clinical Study with Four Different Biomaterials and PRF and a Biological View on Guided Bone Regeneration

    Directory of Open Access Journals (Sweden)

    Troedhan Angelo

    2015-01-01

    Full Text Available Introduction. Bone regenerates mainly by periosteal and endosteal humoral and cellular activity, which is given only little concern in surgical techniques and choice of bone grafts for guided bone regeneration. This study investigates on a clinical level the biomechanical stability of augmented sites in maxillary bone when a new class of moldable, self-hardening calcium-phosphate biomaterials (SHB is used with and without the addition of Platelet Rich Fibrin (aPRF in the Piezotome-enhanced subperiosteal tunnel-technique (PeSPTT. Material and Methods. 82 patients with horizontal atrophy of anterior maxillary crest were treated with PeSPTT and randomly assigned biphasic (60% HA/40% bTCP or monophasic (100% bTCP SHB without or with addition of aPRF. 109 implants were inserted into the augmented sites after 8.3 months and the insertion-torque-value (ITV measured as clinical expression of the (biomechanical stability of the augmented bone and compared to ITVs of a prior study in sinus lifting. Results. Significant better results of (biomechanical stability almost by two-fold, expressed by higher ITVs compared to native bone, were achieved with the used biomaterials and more constant results with the addition of aPRF. Conclusion. The use of SHB alone or combined with aPRF seems to be favourable to achieve a superior (biomechanical stable restored alveolar bone.

  15. Novel Wnt Regulator NEL-Like Molecule-1 Antagonizes Adipogenesis and Augments Osteogenesis Induced by Bone Morphogenetic Protein 2

    Science.gov (United States)

    Shen, Jia; James, Aaron W.; Zhang, Xinli; Pang, Shen; Zara, Janette N.; Asatrian, Greg; Chiang, Michael; Lee, Min; Khadarian, Kevork; Nguyen, Alan; Lee, Kevin S.; Siu, Ronald K.; Tetradis, Sotirios; Ting, Kang; Soo, Chia

    2017-01-01

    The differentiation factor NEL-like molecule-1 (NELL-1) has been reported as osteoinductive in multiple in vivo preclinical models. Bone morphogenetic protein (BMP)-2 is used clinically for skeletal repair, but in vivo administration can induce abnormal, adipose-filled, poor-quality bone. We demonstrate that NELL-1 combined with BMP2 significantly optimizes osteogenesis in a rodent femoral segmental defect model by minimizing the formation of BMP2-induced adipose-filled cystlike bone. In vitro studies using the mouse bone marrow stromal cell line M2-10B4 and human primary bone marrow stromal cells have confirmed that NELL-1 enhances BMP2-induced osteogenesis and inhibits BMP2-induced adipogenesis. Importantly, the ability of NELL-1 to direct BMP2-treated cells toward osteogenesis and away from adipogenesis requires intact canonical Wnt signaling. Overall, these studies establish the feasibility of combining NELL-1 with BMP2 to improve clinical bone regeneration and provide mechanistic insight into canonical Wnt pathway activity during NELL-1 and BMP2 osteogenesis. The novel abilities of NELL-1 to stimulate Wnt signaling and to repress adipogenesis may highlight new treatment approaches for bone loss in osteoporosis. PMID:26772960