Fracture resistance and microleakage of endocrowns utilizing three CAD-CAM blocks

This study assessed marginal leakage and fracture resistance of computer-aided design/computer-aided manufacturing (CAD/CAM) fabricated ceramic crowns with intracoronal extensions into the pulp chambers of endodontically treated teeth (endocrowns) using either feldspathic porcelain (CEREC Blocks [CB], Sirona Dental Systems GmbH, Bensheim, Germany), lithium disilicate (e.max [EX], Ivoclar Vivadent, Schaan, Liechtenstein), or resin nanoceramic (Lava Ultimate [LU], 3M ESPE, St Paul, MN, USA).). Thirty extracted human permanent maxillary molars were endodontically treated. Standardized preparations were done with 2-mm intracoronal extensions of the endocrowns into the pulp chamber. Teeth were divided into three groups (n=10); each group was restored with standardized CAD/CAM fabricated endocrowns using one of the three tested materials. After cementation with resin cement, specimens were stored in distilled water at 37°C for one week, subjected to thermocycling, and immersed in a 5% methylene-blue dye solution for 24 hours. A compressive load was applied at 35 degrees to long axis of the teeth using a universal testing machine until failure. Failure load was recorded, and specimens were examined under a stereomicroscope for modes of failure and microleakage. Results were analyzed using one-way analysis of variance and Bonferroni post hoc multiple comparison tests (α=0.05). LU showed significantly (p<0.05) higher fracture resistance and more favorable fracture mode (ie, fracture of the endocrown without fracture of tooth) as well as higher dye penetration than CB and EX. In conclusion, although using resin nanoceramic blocks for fabrication of endocrowns may result in better fracture resistance and a more favorable fracture mode than other investigated ceramic blocks, more microleakage may be expected with this material.

Digital workflow for virtually designing and milling ceramic lithium disilicate veneers: a clinical report

Laminate veneers have been routinely used to restore and enhance the appearance of natural dentition. The traditional pathway for fabricating veneers consisted of making conventional polyvinyl siloxane impressions, producing stone casts, and fabricating final porcelain prostheses on stone dies. Pressed ceramics have successfully been used for laminate veneer fabrication for several years. Recently, digital computer-aided design/computer-aided manufacturing scanning has become commercially available to make a digital impression that is sent electronically to a dental laboratory or a chairside milling machine. However, technology has been developed to allow digital data acquisition in conjunction with electronically transmitted data that enables virtual design of restorations and milling at a remote production center. Following the aforementioned workflow will provide the opportunity to fabricate a physical cast-free restoration. This new technique has been reported recently for all-ceramic IPS e.max full-coverage pressed-ceramic restorations. However, laminate veneers are very delicate and technique-sensitive restorations when compared with all-ceramic full-coverage ones made from the same material. Complete digital design and fabrication of multiple consecutive laminate veneers seems to be very challenging. This clinical report presents the digital workflow for the virtual design and fabrication of multiple laminate veneers in a patient for enhancing the esthetics of his maxillary anterior teeth. A step-by-step process is presented with a discussion of the advantages and disadvantages of this novel technique. Additionally, the use of lithium disilicate ceramic as the material of choice and the rationale for such a decision is discussed.

Inlays made from a hybrid material: adaptation and bond strengths

The aim of this study was to evaluate the internal fit, marginal adaptation, and bond strengths of inlays made of computer-aided design/computer-aided manufacturing feldspathic ceramic and polymer-infiltrated ceramic. Twenty molars were randomly selected and prepared to receive inlays that were milled from both materials. Before cementation, internal fit was achieved using the replica technique by molding the internal surface with addition silicone and measuring the cement thicknesses of the pulpal and axial walls. Marginal adaptation was measured on the occlusal and proximal margins of the replica. The inlays were then cemented using resin cement (Panavia F2.0) and subjected to two million thermomechanical cycles in water (200 N load and 3.8-Hz frequency). The restored teeth were then cut into beams, using a lathe, for microtensile testing. The contact angles, marginal integrity, and surface patterns after etching were also observed. Statistical analysis was performed using two-way repeated measures analysis of variance (p<0.05), the Tukey test for internal fit and marginal adaptation, and the Student t-test for bond strength. The failure types (adhesive or cohesive) were classified on each fractured beam. The results showed that the misfit of the pulpal walls (p=0.0002) and the marginal adaptation (p=0.0001) of the feldspathic ceramic were significantly higher when compared to those of the polymer-infiltrated ceramic, while the bond strength values of the former were higher when compared to those of the latter. The contact angle of the polymer-infiltrated ceramic was also higher. In the present study, the hybrid ceramic presented improved internal and marginal adaptation, but the bond strengths were higher for the feldspathic ceramic.

Bone substitutes in orthopaedic surgery: from basic science to clinical practice

Bone substitutes are being increasingly used in surgery as over two millions bone grafting procedures are performed worldwide per year. Autografts still represent the gold standard for bone substitution, though the morbidity and the inherent limited availability are the main limitations. Allografts, i.e. banked bone, are osteoconductive and weakly osteoinductive, though there are still concerns about the residual infective risks, costs and donor availability issues. As an alternative, xenograft substitutes are cheap, but their use provided contrasting results, so far. Ceramic-based synthetic bone substitutes are alternatively based on hydroxyapatite (HA) and tricalcium phosphates, and are widely used in the clinical practice. Indeed, despite being completely resorbable and weaker than cortical bone, they have exhaustively proved to be effective. Biomimetic HAs are the evolution of traditional HA and contains ions (carbonates, Si, Sr, Fl, Mg) that mimic natural HA (biomimetic HA). Injectable cements represent another evolution, enabling mininvasive techniques. Bone morphogenetic proteins (namely BMP2 and 7) are the only bone inducing growth factors approved for human use in spine surgery and for the treatment of tibial nonunion. Demineralized bone matrix and platelet rich plasma did not prove to be effective and their use as bone substitutes remains controversial. Experimental cell-based approaches are considered the best suitable emerging strategies in several regenerative medicine application, including bone regeneration. In some cases, cells have been used as bioactive vehicles delivering osteoinductive genes locally to achieve bone regeneration. In particular, mesenchymal stem cells have been widely exploited for this purpose, being multipotent cells capable of efficient osteogenic potential. Here we intend to review and update the alternative available techniques used for bone fusion, along with some hints on the advancements achieved through the experimental research in this field.

Ceramic water filters impregnated with silver nanoparticles as a point-of-use water-treatment intervention for HIV-positive individuals in Limpopo Province, South Africa: a pilot study of technological performance and human health benefits

Waterborne pathogens present a significant threat to people living with the human immunodeficiency virus (PLWH). This study presents a randomized, controlled trial that evaluates whether a household-level ceramic water filter (CWF) intervention can improve drinking water quality and decrease days of diarrhea in PLWH in rural South Africa. Seventy-four participants were randomized in an intervention group with CWFs and a control group without filters. Participants in the CWF arm received CWFs impregnated with silver nanoparticles and associated safe-storage containers. Water and stool samples were collected at baseline and 12 months. Diarrhea incidence was self-reported weekly for 12 months. The average diarrhea rate in the control group was 0.064 days/week compared to 0.015 days/week in the intervention group (p < 0.001, Mann-Whitney). Median reduction of total coliform bacteria was 100% at enrollment and final collection. CWFs are an acceptable technology that can significantly improve the quality of household water and decrease days of diarrhea for PLWH in rural South Africa.

Biosmart materials: breaking new ground in dentistry

By definition and general agreement, smart materials are materials that have properties which may be altered in a controlled fashion by stimuli, such as stress, temperature, moisture, pH, and electric or magnetic fields. There are numerous types of smart materials, some of which are already common. Examples include piezoelectric materials, which produce a voltage when stress is applied or vice versa, shape memory alloys or shape memory polymers which are thermoresponsive, and pH sensitive polymers which swell or shrink as a response to change in pH. Thus, smart materials respond to stimuli by altering one or more of their properties. Smart behaviour occurs when a material can sense some stimulus from its environment and react to it in a useful, reliable, reproducible, and usually reversible manner. These properties have a beneficial application in various fields including dentistry. Shape memory alloys, zirconia, and smartseal are examples of materials exhibiting a smart behavior in dentistry. There is a strong trend in material science to develop and apply these intelligent materials. These materials would potentially allow new and groundbreaking dental therapies with a significantly enhanced clinical outcome of treatments.

Thermoseeds for interstitial magnetic hyperthermia: from bioceramics to nanoparticles

The development of magnetic materials for interstitial hyperthermia treatment of cancer is an ever evolving research field which provides new alternatives to antitumoral therapies. The development of biocompatible magnetic materials has resulted in new biomaterials with multifunctional properties, which are able to adapt to the complex scenario of tumoral processes. Once implanted or injected in the body, magnetic materials can behave as thermoseeds under the effect of AC magnetic fields. Magnetic bioceramics aimed to treat bone tumors and magnetic nanoparticles are among the most studied thermoseeds, and supply different solutions for the different scenarios in cancerous processes. This paper reviews some of the biomaterials used for bone cancer treatment and skeletal reinforcing, as well as the more complex topic of magnetic nanoparticles for intracellular targeting and hyperthermia.

Effectiveness of probiotic Phaeobacter bacteria grown in biofilters against Vibrio anguillarum infections in the rearing of Turbot (Psetta maxima) larvae

The rearing environment of first-feeding turbot larvae, usually with high larvae densities and organic matter concentrations, may promote the growth of opportunistic pathogenic Vibrionaceae bacteria, compromising the survival of the larvae. The aim of this study was to assess the effectiveness of the biofilm-forming probiotic Phaeobacter 27-4 strain grown on a ceramic biofilter (probiofilter) in preventing Vibrio anguillarum infections in turbot larvae. In seawater with added microalgae and maintained under turbot larvae rearing conditions, the probiofilter reduced the total Vibrionaceae count and the concentration of V. anguillarum, which was undetectable after 144 h by real-time PCR. The probiofilter also improved the survival of larvae challenged with V. anguillarum, showing an accumulated mortality similar to that of uninfected larvae (35-40 %) and significantly (p < 0.05) lower than that of infected larvae with no probiofilter (76 %) due to a decrease in the pathogen concentration and in total Vibrionaceae. Furthermore, the probiofilter improved seawater quality by decreasing turbidity. Phaeobacter 27-4 released from the probiofilters was able to survive in the seawater for at least 11 days. The bacterial diversity in the larvae, analysed by denaturing gradient gel electrophoresis, was low, as in the live prey (rotifers), and remained unchanged in the presence of V. anguillarum or the probiofilter; however, the probiofilter reduced the bacterial carrying capacity of the seawater in the tanks. Phaeobacter-grown biofilters can constantly inoculate probiotics into rearing tanks and are therefore potentially useful for bacterial control in both open and recirculating industrial units.

Ceramic head fracture in ceramic-on-polyethylene total hip arthroplasty

Revision rates of total hip arthroplasty have decreased after introducing total hip arthroplasty (THA) using ceramic component, since ceramic components could reduce components wear and osteolysis. The fracture of a ceramic component is a rare but potentially serious event. Thus, ceramic on polyethylene articulation is gradually spotlighted to reduce ceramic component fracture. There are a few recent reports of ceramic head fracture with polyethylene liner. Herein, we describe a case of a ceramic head component fracture with polyethylene liner. The fractured ceramic head was 28 mm short neck with conventional polyethylene liner. We treated the patient by total revision arthroplasty using 4th generation ceramic on ceramic components.

[Examination of influence of microstructure of grafts on TiO2 base on the process of bone tissue forming]

AIM OF THE STUDY

Evaluation of the influence of the introduced structure modification in porous ceramic grafts on TiO2 base on overgrowing with bone tissue, in examinations with use of scanning microscopy and X-rays was the subject of the examinations.

MATERIAL AND METHOD

New ceramic materials based on TiO2 with high values of mechanical resistance, large sintering degree and biocompatibility in in vitro conditions were prepared. Those properties cause that they are worth interest as potential osteosubstitutive materials. Two kinds of grafts were created from ceramics based on TiO2: with compact and porous structure. The introduced structure modification - macroporosity - had the purpose to give osteoconductive properties to the grafts, to evoke processes favorable for bone tissue forming. In examinations of the local reaction of bone tissue after implantation of the formed porous grafts, degree of their osteointegration, the essential issue is the evaluation of the settling of the inner spaces with supporting tissues. Samples of the tested compact and porous materials in the form of cylinders were implanted in femoral bones of rabbits for a period till 6 months. The surfaces of grafts and the degree of their settling with supporting tissues were evaluated in cross-sections of the implants with light and scanning microscopic methods and they were confirmed in X-ray tests.

RESULTS

Analysis of the obtained data showed that, the surface of solid ceramic on TiO2 base was covered mainly with increasing with a time of observation quantities of extracellular substance and lamellas of bone. The macrporous structure of porous ceramic on TiO2 base enabled settling of the inner spaces of graft with supporting tissue cells, partly in the 1st month, more intensively in the 3rd and it was not completed in the 6th month after implantation.

CONCLUSIONS

Porous grafts in the form of ceramic foam on TiO2 base showed osteoconductive properties, though process of colonization after 6th month observation was not completed and the condition of the cells inside of the implant was reduced.

Therapeutic effects of novel resin bonding systems containing bioactive glasses on mineral-depleted areas within the bonded-dentine interface

This study aimed in evaluating the effects of two experimental resin bonding systems containing conventional Bioglass 45S5 (BAG) or Zinc-polycarboxylated bioactive glass (BAG-Zn) micro-fillers on the resin-bonded dentine interface after storage in a simulated body fluid solution (SBFS). Three resin bonding systems were formulated: Resin-A: (BAG containing); Resin-B; (BAG-Zn containing); Resin-C (no filler). The ability of the experimental resins to evoke apatite formation was evaluated using confocal Raman spectroscopy. Acid-etched dentine specimens were bonded, and prepared for AFM/nano-indentation analysis in a fully-hydrated status to evaluate the modulus of elasticity (Ei) and hardness (Hi) across the interface at different SBFS storage periods. Further resin-dentine specimens were tested for microtensile bond strength after 24 h or 3 months of SBFS storage. SEM examination was performed after de-bonding and confocal laser microscopy was used to evaluate the ultramorphology of the interfaces and micropermeability. The resin A and B showed a consistent presence of apatite (967 cm(-1)), reduced micropermeability within the resin-dentine interface and a significant increase of the Ei and Hi along the bonded-dentine interface after prolonged SBFS storage. Bond strength values were affected by the resin system (P < 0.0001) and by storage time (P < 0.0001) both after 24 h and 3 months of SBFS storage. In conclusion, resin bonding systems containing bioactive fillers may a have therapeutic effect on the nano-mechanical properties and sealing ability of mineral-depleted resin-dentine interface.

Complications of bioabsorbable suture anchors in the shoulder

The development of the suture anchor has played a pivotal role in the transition from open to arthroscopic techniques of the shoulder. Various suture anchors have been manufactured that help facilitate the ability to create a soft tissue to bone repair. Because of reported complications of loosening, migration, and chondral injury with metallic anchors, bioabsorbable anchors have become increasingly used among orthopaedic surgeons. In this review, the authors sought to evaluate complications associated with bioabsorbable anchors in or about the shoulder and understand these in the context of the total number of bioabsorbable anchors placed. In 2008, 10 bioabsorbable anchor-related complications were reported to the US Food and Drug Administration. The reported literature complications of bioabsorbable anchors implanted about the shoulder include glenoid osteolysis, synovitis, and chondrolysis. These potential complications should be kept in mind when forming a differential diagnosis in a patient in whom a bioabsorbable anchor has been previously used. These literature reports, which amount to but a fraction of the total bioabsorbable anchors implanted in the shoulder on a yearly basis, underscore the relative safety and successful clinical results with use of bioabsorbable suture anchors. Product development continues with newer composites such as PEEK (polyetheretherketone) and calcium ceramics (tricalcium phosphate) in an effort to hypothetically create a mechanically stable construct with and improve biocompatibility of the implant. Bioabsorbable anchors remain a safe, reproducible, and consistent implant to secure soft tissue to bone in and about the shoulder. Meticulous insertion technique must be followed in using bioabsorbable anchors and may obviate many of the reported complications found in the literature. The purpose of this review is to provide an overview of the existing literature as it relates to the rare complications seen with use of bioabsorbable suture anchors in the shoulder.

The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head

PURPOSE

The purpose of our study is to describe the rationale, the surgical technique and the early clinical and radiographic results of the treatment of patients with early stage osteonecrosis of the femoral head (ONFH) by performing: core decompression, injection of autologous bone marrow concentrate and the use of a new composite injectable bone substitute (PRO-DENSE(®)), as a mechanical supplementation associated with decompression.

METHODS

The study included 37 hips (31 patients, 14 females, 17 males; mean age 43.9 years, range 24-56 years) with stages IC-IIIA ONFH. The outcome was determined by the changes in the Harris hip score (HHS), by progression in radiographic stages and by the need for hip replacement. The mean follow-up was 20.6 months (range 12-32 months).

RESULTS

At final follow-up the mean HHS increased from 68 points pre-operatively to 86 points post-operatively. The radiological results showed that 29 hips (78.4 %) improved or had no further collapse. The overall clinical success rate of the procedure was 86.5 %, with three conversions to THA, and a failure rate of only 3.3 % in the pre-collapse group.

CONCLUSIONS

We are encouraged by these early results using core decompression, injection of the autologous bone marrow concentrate and backfilling the defect with an injectable bioceramic for the treatment of early stages of ONFH; as far as a conclusion can be drawn from the current data, this treatment seems to relieve hip pain and prevent the progression of ONFH in the majority of the cases.

OIC-A006-loaded true bone ceramic heals rabbit critical-sized segmental radial defect

It has been reported that OIC-A006, an osteogenically inducible compound, is able to promote osteogenesis in vitro and in vivo. In this study, we used a rabbit critical-sized segmental radial defect model (CSD) (15 mm) to analyse the osteogenic activity of OIC-A006 in non-cell-seeded tissue engineering bone substitutes. The scaffold carrier was bovine sintered bone "true bone ceramic (TBC)". OIC-A006 was delivered by PLGA (D,L-lactide-co-glycolide acid) microspheres. Drug-free PLGA microspheres and rhBMP-2-loaded PLGA microspheres were used as negative and positive control groups, respectively. Three kinds of composite were fabricated by coupling TBC, type-I collagen and the corresponding microspheres. The animals were randomly divided into 4 groups: (1) Group A: defect only, (2) group B:TBC/Collagen/drug-free-microspheres, (3) group C:TBC/Collagen/ OIC-A006-microspheres, (4) group D: TBC/Collagen/rhBMP-2-microspheres. The samples were analysed by histology, X-ray,microcomputed tomography (micro-CT), and biomechanical analyses. The results showed that OIC-A006 promoted bone regeneration to a remarkable extent. It is suggested that the application of OIC-A006 might be a valuable method in bone tissue engineering for healing large segmental defects of long bones. However, the biomechanical strength was a little inferior to that of BMPs.

Allograft bone matrix versus synthetic bone graft substitutes

Autologous bone is used very often in the treatment of fresh fractures, delayed unions and non-unions. Alternatives have included allografts and in recent years also demineralized bone matrix. The growing availability of good synthetic bone grafts and their advantages in safety and avoiding donor-site morbidity are the reasons that these products are being used more and more. There are on the market a wide variety of substitutes with different capabilities. Nevertheless autologous bone graft is still considered as the gold standard and will be discussed here in that context. Osteoconductive, osteogenic and osteoinductive products will also be classified and their advantages and disadvantages described.

[Effects of bio-glass in subgingival scaling and root planing]

OBJECTIVE

To evaluate the effect of locally applied bio-glass on the teeth hypersentivity and periodontal recovery after subgingival scaling and root planing.

METHODS

In this double blind study, 60 patients with chronic periodontitis were included and were randomly divided into four groups of 15 patients: bio-glass powder and bio-glass paste group (Po+Pa), bio-glass powder group (Po), bio-glass paste group (Pa) and control group. Powder was applied in pockets after subgingival scaling and root planning (SRP) and paste was used as toothpaste for 6 weeks. Periodontal indices and the severity of tooth hypersensitivity were recorded.

RESULTS

Obvious mitigation of tooth hypersensitivity was observed in bio-glass powder or paste applied patients within the fist three weeks after SRP. Only few patients presented teeth hypersensitivity in the 6th week after SRP. In the 6th week after SRP, bleeding index significantly decreased in bio-glass powder or paste applied patients. More pocket depth and clinical attachment level reduction was found in bio-glass powder applied patients. Application of bio-glass powder or paste improved clinical attachment level in the 3rd month after SRP.

CONCLUSION

The hypersensitivity after subgingival scaling could be relieved without any treatment in 6 weeks, while the bio-glass powder and the 7% bio-glass paste could reduce the prevalence and the severity of it. Further more, bio-glass also improved the clinical outcomes of subgingival scaling via its bacteriostatic action.

[Usefulness of HA+beta-TCP in bone defects repair during revision hip and knee arthroplasty]

BACKGROUND

Bone deficiency can present a surgical challenge during revision total hip and knee arthroplasty. The amount of bone grafts available for surgical purposes is insufficient. Synthetic bone substitutes can eliminate the risk of infection transmission. The purpose of the present study was to evaluate the clinical and radiographic outcomes of revision hip and knee arthroplasty with use of an impaction bone-grafting with HA+beta-TCP in reconstruction of bone defects.

MATERIALS AND METHODS

20 total hip revision (THR) and 10 total knee revision (TKR) were performed in 30 patients where impaction bone-grafting technique with HA+beta-TCP was used. Clinical, radiographic and CT results were assessed. Mean follow-up was 21 (11-48) months for THR and 22 (10-46) months.

RESULTS

Loosening was seen in 2 cups. In one case the reoperation was performed. In the second due to massive bone loss the prosthesis was removed. No another acetabular and stem components required revision surgery. There were no knee implant migration or loosening observed. The mean total HSS score was 45.3 preoperatively and 71.5 postoperatively. The mean CRS score was 35.7 preoperatively and 73.4 postoperatively.

CONCLUSIONS

The use of HA+beta-TCP with bone grafts impaction is a good method of bone defect reconstruction and can provide good short-term clinical results in revision hip and knee arthroplasty.

Orthopaedic applications of bone graft & graft substitutes: a review

Treatment of delayed union, malunion, and nonunion is a challenge to the orthopaedic surgeons in veterinary and human fields. Apart from restoration of alignment and stable fixation, in many cases adjunctive measures such as bone-grafting or use of bone-graft substitutes are of paramount importance. Bone-graft materials usually have one or more components: an osteoconductive matrix, which acts as scaffold to new bone growth; osteoinductive proteins, which support mitogenesis of undifferentiated cells; and osteogenic cells, which are capable of forming bone in the appropriate environment. Autologous bone remains the "gold standard" for stimulating bone repair and regeneration, but its availability may be limited and the procedure to harvest the material is associated with complications. Bone-graft substitutes can either substitute autologous bone graft or expand an existing amount of autologous bone graft. We review the currently available bone graft and graft substitutes for the novel therapeutic approaches in clinical setting of orthopaedic surgery.

Low level laser therapy does not modulate the outcomes of a highly bioactive glass-ceramic (Biosilicate) on bone consolidation in rats

The main purpose of the present work was to evaluate if low level laser therapy (LLLT) can improve the effects of novel fully-crystallized glass-ceramic (Biosilicate) on bone consolidation in tibial defects of rats. Forty male Wistar rats with tibial bone defects were used. Animals were divided into four groups: group bone defect control (CG); group bone defect filled with Biosilicate (BG); group bone defect filled with Biosilicate, irradiated with LLLT, at 60 J cm(-2) (BG 60) and group bone defect filled with Biosilicate, irradiated with LLLT, at 120 J cm(-2) (BG 120). A low-energy GaAlAs 830 nm, CW, 0.6 mm beam diameter, 100 W cm(-2), 60 and 120 J cm(-2) was used in this study. Laser irradiation was initiated immediately after the surgery procedure and it was performed every 48 h for 14 days. Fourteen days post-surgery, the three-point bending test revealed that the structural stiffness of the groups CG and BG was higher than the values of the groups BG60 and BG120. Morphometric analysis revealed no differences between the control group and the Biosilcate group. Interestingly, the groups treated with Biosilicate and laser (BG 60 and BG120) showed statistically significant lower values of newly formed bone in the area of the defect when compared to negative control (CG) and bone defect group filled with Biosilicate (CB). Our findings suggest that although Biosilicate exerts some osteogenic activity during bone repair, laser therapy is not able to modulate this process.

Histological comparison of autograft, allograft-DBM, xenograft, and synthetic grafts in a trabecular bone defect: an experimental study in rabbits

BACKGROUND

Different types of bone-graft substitutes have been developed and are on the market worldwide to eliminate the drawbacks of autogenous grafting. This experimental animal study was undertaken to evaluate the different histological properties of various bone graft substitutes utilized in this hospital.

MATERIAL/METHODS

Ninety New Zealand white rabbits were divided into six groups of 15 animals. Under general anesthesia, a 4.5 mm-wide hole was drilled into both the lateral femoral condyles of each rabbit, for a total of 180 condyles for analysis. The bone defects were filled with various grafts, these being 1) autograft, 2) DBM crunch allograft (Grafton), 3) bovine cancellous bone xenograft (Lubboc), 4) calcium phosphate hydroxyapatite substitute (Ceraform), 5) calcium sulfate substitute (Osteoset), and 6) no filling (control). The animals were sacrificed at 1, 3, and 6 months after implantation and tissue samples from the implanted areas were processed for histological evaluation. A histological grading scale was designed to determine the different histological parameters of bone healing.

RESULTS

The highest histological grades were achieved with the use of cancellous bone autograft. Bovine xenograft (Lubboc) was the second best in the histological scale grading. The other substitutes (Grafton, Ceraform, Osteoset) had similar scores but were inferior to both allograft and xenograft.

CONCLUSIONS

Bovine xenograft showed better biological response than the other bone graft substitutes; however, more clinical studies are necessary to determine its overall effectiveness.

The effect of phosphate content on the bioactivity of soda-lime-phosphosilicate glasses

We report on the bioactivity of two series of glasses in the SiO(2)-Na(2)O-CaO-P(2)O(5) system after immersion in simulated body fluid (SBF) after 21 days. The effect of P(2)O(5) content was examined for compositions containing 0-9.25 mol.% phosphate. Both series of glasses degraded to basic pH, but the solutions tended towards to neutrality with increasing phosphate content; a result of the acidic phosphate buffering the effect of the alkali metal and alkaline earth ions on degradation. Bioactivity was assessed by the appearance of features in the X-ray diffraction (XRD) traces and Fourier transform infrared (FTIR) spectra consistent with crystalline hydroxyl-carbonate-apatite (HCAp): such as the appearance of the (002) Bragg reflection in XRD and splitting of the P-O stretching vibration around 550 cm(-1) in the FTIR respectively. All glasses formed HCAp in SBF over the time periods studied and the time for formation of this crystalline phase occurred more rapidly in both series as the phosphate contents were increased. For P(2)O(5) content >3 mol.% both series exhibited highly crystalline apatite by 16 h immersion in SBF. This indicates that in the compositions studied, phosphate content is more important for bioactivity than network connectivity (NC) of the silicate phase and compositions showing rapid apatite formation are presented, superior to 45S5 Bioglass which was tested under identical conditions for comparison.

Anterior cervical fusion with a bio-resorbable composite cage (beta TCP-PLLA): clinical and radiological results from a prospective study on 20 patients

A resorbable composite material (40% PLLA and 60% beta TCP) with a high breaking strength and capacity to withstand plastic and elastic strain has been developed for cervical interbody fusion. This is a prospective study to evaluate clinical and radiological results of 20 patients implanted with 27 cages (mean follow-up, 27 months). Clinical (neck disability index, VAS, neurological evaluation) and radiological (anteroposterior, lateral, bending X-rays) data were assessed before and after surgery. At the end of the study, CT scan was performed to evaluate fusion, resorption of the cage and density of the new tissue substituting the cage. The mean patient age was 50.3 years (range, 18-79 years). The average improvement was 55% for neck pain, 83% for arm pain and 65% for NDI, with 85% good or excellent results at final outcomes. Radiologically, lordosis was significantly improved (mean gain of 5.4 degrees and 3.7 degrees for overall and segmental lordosis, respectively). This correction was conserved in 95% of cases. Fusion was obtained in 96% (CT evaluation). Resorption was started in all cases and completed in an average of 36 months after surgery. The mean density of tissue substituting the cage was 659 UH with a range, of 455-911 UH (compatible with bone nature). Over time, the amount of bony tissue increased and the graft remodelled with an increase in density value. This demonstrates a biological activity and changing bone mineral content of this tissue. The new composite cage under investigation provides long-term fusion without loss of correction or inflammatory reaction. The ceramic block guarantees the maintenance of the disc height and its slow resorption allows long-term fusion and stability with good and reliable clinical and radiological outcomes.

Posterolateral spinal fusion in a rabbit model using a collagen-mineral composite bone graft substitute

Choosing the appropriate graft material to participate in the healing process in posterolateral spinal fusion continues to be a challenge. Combining synthetic graft materials with bone marrow aspirate (BMA) and autograft is a reasonable treatment option for surgeons to potentially reduce or replace the need for autograft. FormaGraft, a bone graft material comprising 12% bovine-derived collagen and 88% ceramic in the form of hydroxyapatite (HAp) and beta tricalcium phosphate (beta-TCP) was evaluated in three possible treatment modalities for posterior spinal fusion in a standard rabbit model. These three treatment groups were FormaGraft alone, FormaGraft soaked in autogenous BMA, and FormaGraft with BMA and iliac crest autograft. No statistically demonstrable benefits or adverse effects of the addition of BMA were found in the current study based on macroscopic, radiology or mechanical data. This may reflect, in part, the good to excellent results of the collagen HA/TCP composite material alone in a well healing bony bed. Histology did, however, reveal a benefit with the use of BMA. Combining FormaGraft with autograft and BMA achieved results equivalent to autograft alone. The mineral and organic nature of the material provided a material that facilitated fusion between the transverse processes in a standard preclinical posterolateral fusion model.