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Marschall JS, Davis SS, Jones L, Kushner GM. Are Cellular Bone Matrix Allografts a Viable Option for Mandibular Tissue Engineering and Reconstruction? J Oral Maxillofac Surg 2024:S0278-2391(24)00365-3. [PMID: 38909627 DOI: 10.1016/j.joms.2024.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Traditional mandibular reconstruction has relied on the use of vascularized and non-vascularized autografts. The use of allografts and tissue engineering modalities has risen as an alternative. PURPOSE The purpose of this study was to determine the success of a cellular bone matrix (CBM) allograft composed of lineage committed bone forming cells for mandibular tissue engineering and reconstruction. STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was implemented using data from subjects treated with a CBM at the University of Louisville from 2019 to 2023. Subjects were excluded if they were not treated with a CBM, data were not complete, or postoperative follow-up time was less than 3 months. PREDICTOR VARIABLES The predictor variables were composed of heterogenous variables grouped into the following categories: demographics (age, sex), medical history (history of penicillin [PCN] allergy, history of diabetes mellitus [DM] and tobacco use), etiology (benign tumor, ballistic trauma, nonballistic trauma, odontogenic cyst, osteomyelitis/ medication-related osteonecrosis of the jaw), mandibular resection length (cm) and type (marginal, segmental), delayed versus immediate reconstruction, and whether an autograft (proximal tibia) with platelet-rich fibrin was used in combination with the CBM. MAIN OUTCOME VARIABLE The primary outcome variable was graft success (yes or no). Success was defined as bony union and defect fill (demonstrated on panoramic radiograph) and mandibular stability (based on postoperative clinical examination at 3 months). COVARIATES Not applicable. ANALYSES Descriptive statistics were calculated for each variable. To measure the associations between the risk factors and graft success, Fisher's exact test for categorical variables and the Wilcoxon rank sum test for numeric data were used. A P value of <.05 was considered significant. RESULTS The sample included 38 subjects. The median age of all subjects was 46 (interquartile range 32.6) years. Overall, 28 (73.7%) cases were successful. Subjects with a reported PCN allergy or a history of DM had significantly lower success (2, 7.1% with PCN allergy or DM) compared to those who did not (P = .008, PCN allergy; P = .03, DM). CONCLUSIONS AND RELEVANCE This is the largest case series of CBM based mandibular reconstruction relative to the available maxillofacial surgery literature. The clinician should consider confirmation of PCN allergy so PCN-type antibiotics can be used. CBMs may be an alternative to autografts.
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Affiliation(s)
- Jeffrey S Marschall
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Iowa Hospital and Clinics, Iowa City, IA.
| | - Stephen S Davis
- Resident, Department of Oral and Maxillofacial Surgery, University of Louisville, Louisville, KY
| | | | - George M Kushner
- Professor and Chairman, Department of Oral and Maxillofacial Surgery, University of Louisville, Louisville, KY
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Manzano-Moreno FJ, Gónzalez-Acedo A, de Luna-Bertos E, García-Recio E, Ruiz C, Reyes-Botella C. Effect of amoxicillin and clindamycin on the gene expression of markers involved in osteoblast physiology. J Dent Sci 2024; 19:990-997. [PMID: 38618075 PMCID: PMC11010622 DOI: 10.1016/j.jds.2023.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/10/2023] [Indexed: 04/16/2024] Open
Abstract
Background/purpose Amoxicillin and clindamycin are the most effective decontaminants for intraoral bone grafts before their application in bone regeneration without cytotoxic effects on osteoblasts, but their effects on the gene expression of markers involved in osteoblast growth and differentiation remain unclear. The study objective was to determine the effects of amoxicillin and clindamycin on the gene expression of markers involved in osteoblast growth and differentiation. Materials and methods Real-time polymerase chain reaction (RT-PCR) was performed to explore the effect of 150 μg/mL clindamycin or 400 μg/mL amoxicillin on the gene expression by primary human osteoblasts (HOBs) of runt-related transcription factor 2 (Runx-2), osterix (OSX), alkaline phosphatase (ALP), osteocalcin (OSC), osteoprotegerin (OPG), receptor activator for nuclear factor κ B ligand (RANKL), type I collagen (Col-I), bone morphogenetic proteins 2 and 7 (BMP-2 and BMP-7), TGF-β1 and TGF-β receptors (TGF-βR1, TGF-βR2, and TGF-βR3), and vascular endothelial growth factor (VEGF). Results Treatment with 150 μg/mL clindamycin significantly increased the gene expression of TFG-β1, TGF-βR1, TGF-βR2, TGF-βR3, RUNX-2, Col-1, OSX, OSC, BMP-2, BMP-7, ALP, VEGF, and RANKL by HOBs. Treatment with 400 μg/mL amoxicillin significantly increased the gene expression of TGF-β R1, Col-I, OSC, RANKL, and OPG alone. Conclusion These findings suggest that 150 μg/mL clindamycin is the decontaminant of choice to treat intraoral bone grafts before their application in bone regeneration. The osteogenic and antibacterial properties of clindamycin can favor and accelerate the integration of bone grafts in the oral cavity.
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Affiliation(s)
- Francisco Javier Manzano-Moreno
- Biomedical Group (BIO277), Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
- Instituto Investigación Biosanitaria, ibs.Granada, Spain
| | - Anabel Gónzalez-Acedo
- Instituto Investigación Biosanitaria, ibs.Granada, Spain
- Biomedical Group (BIO277), Department of Nursing, Faculty of Hearth Science, University of Granada, Melilla, Spain
| | - Elvira de Luna-Bertos
- Instituto Investigación Biosanitaria, ibs.Granada, Spain
- Biomedical Group (BIO277), Department of Nursing, Faculty of Hearth Science, University of Granada, Granada, Spain
| | - Enrique García-Recio
- Instituto Investigación Biosanitaria, ibs.Granada, Spain
- Biomedical Group (BIO277), Department of Nursing, Faculty of Hearth Science, University of Granada, Melilla, Spain
| | - Concepción Ruiz
- Instituto Investigación Biosanitaria, ibs.Granada, Spain
- Biomedical Group (BIO277), Department of Nursing, Faculty of Hearth Science, University of Granada, Granada, Spain
- Institute of Neuroscience, University of Granada, Granada, Spain
| | - Candela Reyes-Botella
- Biomedical Group (BIO277), Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
- Instituto Investigación Biosanitaria, ibs.Granada, Spain
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Hofmann J, Bewersdorf TN, Sommer U, Lingner T, Findeisen S, Schamberger C, Schmidmaier G, Großner T. Impact of Antibiotic-Loaded PMMA Spacers on the Osteogenic Potential of hMSCs. Antibiotics (Basel) 2024; 13:44. [PMID: 38247603 PMCID: PMC10812455 DOI: 10.3390/antibiotics13010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Antibiotic-loaded PMMA bone cement is frequently used in modern trauma and orthopedic surgery. Although many of the antibiotics routinely applied are described to have cytotoxic effects in the literature, clinical experience shows no adverse effects for bone healing. To determine the effects of antibiotic-loaded PMMA spacers on osteogenesis in vitro, we cultivated human bone marrow mesenchymal stem cells (BM-hMSCs) in the presence of PMMA spacers containing Gentamicin, Vancomycin, Gentamicin + Clindamycin as well as Gentamicin + Vancomycin in addition to a blank control (agarose) and PMMA containing no antibiotics. The cell number was assessed with DAPI staining, and the osteogenic potential was evaluated by directly measuring the amount of hydroxyapatite synthesized using radioactive 99mTc-HDP labelling as well as measuring the concentration of calcium and phosphate in the cell culture medium supernatant. The results showed that Gentamicin and Vancomycin as well as their combination show a certain amount of cytotoxicity but no negative effect on osteogenic potential. The combination of Gentamicin and Clindamycin, on the other hand, led to a drastic reduction in both the cell count and the osteogenic potential.
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Affiliation(s)
- Jakob Hofmann
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Tim Niklas Bewersdorf
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Ulrike Sommer
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Thomas Lingner
- Genevention GmbH, Rudolf-Wissell-Str. 28A, 37079 Goettingen, Germany
| | - Sebastian Findeisen
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Christian Schamberger
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Gerhard Schmidmaier
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Tobias Großner
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
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Mayr HO, Regenbrecht N, Mayr MF, Riedel B, Hart ML, Schmal H, Seidenstuecker M. Effect of Vancomycin, Gentamicin and Clindamycin on Cartilage Cells In Vitro. Biomedicines 2023; 11:3143. [PMID: 38137364 PMCID: PMC10740484 DOI: 10.3390/biomedicines11123143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The treatment of grafts with vancomycin for ligament reconstruction in knee surgery is the current standard. However, high antibiotic concentrations have chondrotoxic effects. PURPOSE To test the chondrotoxicity of clindamycin, gentamicin and vancomycin in comparable concentrations. In vitro and in vivo effective concentrations hugely vary from drug to drug. To allow for comparisons between these three commonly used antibiotics, the concentration ranges frequently used in orthopedic surgical settings were tested. STUDY DESIGN Controlled laboratory study. METHODS Human cartilage from 10 specimens was used to isolate chondrocytes. The chondrocytes were treated with clindamycin (1 mg/mL and 0.5 mg/mL), gentamicin (10 mg/mL and 5 mg/mL) or vancomycin (10 mg/mL and 5 mg/mL), at concentrations used for preoperative infection prophylaxis in ligament surgery. Observations were taken over a period of 7 days. A control of untreated chondrocytes was included. To test the chondrotoxicity, a lactate dehydrogenase (LDH) test and a water-soluble tetrazolium salt (WST-1) assay were performed on days 1, 3 and 7. In addition, microscopic examinations were performed after fluorescence staining of the cells at the same time intervals. RESULTS All samples showed a reasonable vitality of the cartilage cells after 72 h. However, clindamycin and gentamicin both showed higher chondrotoxicity in all investigations compared to vancomycin. After a period of 7 days, only chondrocytes treated with vancomycin showed reasonable vitality. CONCLUSIONS The preoperative treatment of ligament grafts with vancomycin is the most reasonable method for infection prophylaxis, in accordance with the current study results regarding chondrotoxicity; however, clindamycin and gentamicin cover a wider anti-bacterial spectrum. CLINICAL RELEVANCE The prophylactic antibiotic treatment of ligament grafts at concentrations of 5 mg/mL or 10 mg/mL vancomycin is justifiable and reasonable. In specific cases, even the use of gentamicin and clindamycin is appropriate.
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Affiliation(s)
- Hermann O. Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (H.O.M.); (M.F.M.); (H.S.)
| | - Nina Regenbrecht
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (N.R.); (B.R.); (M.L.H.)
| | - Moritz Florian Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (H.O.M.); (M.F.M.); (H.S.)
| | - Bianca Riedel
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (N.R.); (B.R.); (M.L.H.)
| | - Melanie L. Hart
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (N.R.); (B.R.); (M.L.H.)
| | - Hagen Schmal
- Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (H.O.M.); (M.F.M.); (H.S.)
| | - Michael Seidenstuecker
- Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (H.O.M.); (M.F.M.); (H.S.)
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (N.R.); (B.R.); (M.L.H.)
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Zipperer A, Scheurer J, Kretschmer D. Cytotoxicity Assays as Predictors of the Safety and Efficacy of Antimicrobial Agents. Methods Mol Biol 2023; 2601:153-167. [PMID: 36445583 DOI: 10.1007/978-1-0716-2855-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The development of safe antimicrobial agents is important for the effective treatment of pathogens. From a multitude of discovered inhibitory compounds, only a few antimicrobial agents are able to enter the market. Many antimicrobials are, on the one hand, quite effective in killing pathogens but, on the other hand, cytotoxic to eukaryotic cells. Cell health can be monitored by various methods. Plasma membrane integrity, DNA synthesis, enzyme activity, and reducing conditions within the cell are known indicators of cell viability and cell death. For a comprehensive overview, methods to analyze cytotoxic and hemolytic effects, e.g., lactate dehydrogenase release, cell proliferation analysis, cell viability analysis based on the activity of different intracellular enzymes, and hemolysis assay of antimicrobial compounds on human cells, are described in this updated chapter.
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Affiliation(s)
- Alexander Zipperer
- Infection Biology, Interfaculty Institute for Microbiology and Infection Medicine Tübingen (IMIT), University of Tübingen, Tübingen, Germany
| | - Jasmin Scheurer
- Department of Dermatology, Division of Dermatooncology, University of Tübingen, Tübingen, Germany
| | - Dorothee Kretschmer
- Infection Biology, Interfaculty Institute for Microbiology and Infection Medicine Tübingen (IMIT), University of Tübingen, Tübingen, Germany.
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Machowska A, Klara J, Ledwójcik G, Wójcik K, Dulińska-Litewka J, Karewicz A. Clindamycin-Loaded Halloysite Nanotubes as the Antibacterial Component of Composite Hydrogel for Bone Repair. Polymers (Basel) 2022; 14:polym14235151. [PMID: 36501546 PMCID: PMC9739121 DOI: 10.3390/polym14235151] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
A new drug delivery system consisting of clindamycin phosphate entrapped in acid-etched halloysite nanotubes was successfully prepared and characterized. It was then used as an antibacterial component of the multicomponent hydrogel designed as a material for bone regeneration. First, halloysite (HNT) was etched and clindamycin phosphate (CP) was entrapped in both raw and modified nanotubes, resulting in HNT-CP and EHNT-CP systems. They were characterized using SEM, TEM, TGA and FTIR; the entrapment efficiency and release of CP from both systems were also studied. EHNT-CP was then used as an antibacterial component of the two hydrogels composed of alginate, collagen and β-TCP. The hydrogels were prepared using different crosslinking procedures but had the same composition. The morphology, porosity, degradation rate, CP release profile, cytocompatibility, antibacterial activity and ability to induce biomineralization were studied for both materials. The hydrogel obtained by a chemical crosslinking with EDC followed by the physical crosslinking with calcium ions had better properties and was shown to have potential as a bone repair material.
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Affiliation(s)
- Adrianna Machowska
- Department of Chemistry, Jagiellonian University, 2 Gronostajowa St., 30-387 Kraków, Poland
| | - Joanna Klara
- Department of Chemistry, Jagiellonian University, 2 Gronostajowa St., 30-387 Kraków, Poland
| | - Gabriela Ledwójcik
- Department of Chemistry, Jagiellonian University, 2 Gronostajowa St., 30-387 Kraków, Poland
| | - Kinga Wójcik
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387 Kraków, Poland
| | - Joanna Dulińska-Litewka
- Chair of Medical Biochemistry, Faculty of Medicine, Medical College, Jagiellonian University, 31-034 Kraków, Poland
| | - Anna Karewicz
- Department of Chemistry, Jagiellonian University, 2 Gronostajowa St., 30-387 Kraków, Poland
- Correspondence: ; Tel.: +48-12-686-25-33
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Liodakis E, Giannoudis VP, Sehmisch S, Jha A, Giannoudis PV. Bone defect treatment: does the type and properties of the spacer affect the induction of Masquelet membrane? Evidence today. Eur J Trauma Emerg Surg 2022; 48:4403-4424. [PMID: 35726029 DOI: 10.1007/s00068-022-02005-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE High clinical success rates have been reported with the Masquelet technique in the treatment of traumatic bone loss. An increasing number of studies suggest that various factors can influence the properties of induced membranes. Goal of this systematic review is to answer the following questions: (1) which are the ideal spacer properties (material, surface topography, antibiotic supplementation) to booster the quality and osteogenic potential of induced membranes? (2) what is the ideal time to perform the second-stage operation? METHODS A systematic search using the keywords "((Masquelet) OR (Induced Periosteum)) AND ((Spacer) OR (Time))" was performed in PubMed, Embase and Cochrane Library according to PRISMA guidelines. Studies published up to the 23rd of February 2022 were included and assessed independently by two reviewers. RESULTS Thirteen animal and 1 clinical studies were identified to address the above questions. Spacer materials used were PMMA, silicone, titanium, polypropylene, PVA, PCL and calcium sulfate. With the exception of PVA sponges, all solid materials could induce membranes. Low union rates have been reported with titanium and rough surfaced spacers. Scraping of the inner surface of the IM also increased bony union rates. In terms of the ideal timing to perform the second-stage evidence suggests that membranes older than 8 weeks continue to have regenerative capacities similar to younger ones. CONCLUSION Membranes induced by smooth PMMA spacers loaded with low concentrations of antibiotics showed powerful osteogenic properties. Other materials such as Polypropylene or Calcium sulfate can also be used with good results. Despite current recommendation to perform the second stage operation in 4-8 weeks, membranes older than 8 weeks seem to have similar regenerative capacities to younger ones.
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Affiliation(s)
- Emmanouil Liodakis
- Trauma Department, Hannover Medical School (MHH), Carl-Neubergstr. 1, 30625, Hannover, Germany. .,Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, University of Leeds, Leeds, UK.
| | - Vassilis P Giannoudis
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, University of Leeds, Leeds, UK
| | - Stephan Sehmisch
- Trauma Department, Hannover Medical School (MHH), Carl-Neubergstr. 1, 30625, Hannover, Germany
| | - Animesh Jha
- School of Chemical and Process Engineering, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, University of Leeds, Leeds, UK
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Kuehling T, Schilling P, Bernstein A, Mayr HO, Serr A, Wittmer A, Bohner M, Seidenstuecker M. A human bone infection organ model for biomaterial research. Acta Biomater 2022; 144:230-241. [PMID: 35304323 DOI: 10.1016/j.actbio.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
Abstract
The aim of this work was to establish an organ model for staphylococcal infection of human bone samples and to investigate the influence and efficacy of a microporous β-tricalcium phosphate ceramic (β-TCP, RMS Foundation) loaded with hydrogels (alginate, alginate-di-aldehyde (ADA)-gelatin) and clindamycin on infected human bone tissue over a period of 28 days. For this purpose, human tibia plateaus, collected during total knee replacement surgery, were used as a source of bone material. Samples were infected with S. aureus ATCC29213 and treated with differently loaded β-TCP composites (alginate +/- clindamycin, ADA-gelatin +/- clindamycin, unloaded). The loading of the composites was carried out by means of a flow chamber. The infection was observed for 28 days, quantifying bacteria in the medium and the osseus material on day 1, 7, 14, 21 and 28. All samples were histologically processed for bone vitality evaluation. Bone infection could be consistently performed within the organ model. In addition, a strong reduction in bacterial counts was recorded in the groups treated with ADA-gelatin + clindamycin and alginate + clindamycin, while the bacterial count in the control groups remained constant. No significant differences between groups could be observed in the number of lacunae filled with osteocytes suggesting no differences in bone vitality among groups. In an ex-vivo human bone infection model, over a period of 28 days bacterial growth could be reduced by treatment with ADA-Gel + CLI and ALG + CLI -releasing β-TCP composites. This could be relevant for its clinical use. Further work will be necessary to improve the loading of β-TCP and the bone infection organ model itself. STATEMENT OF SIGNIFICANCE: The common treatment of bone infections is debridement and systemic administration of antibiotics. In some cases, antibiotic-containing carriers are already used, but these must be removed again. Our work is intended to show another treatment option. The scaffold we have developed, made of a calcium phosphate ceramic and a hydrogel as the active substance carrier, can, in addition to releasing the active substance, also assume a load-bearing function of the bone and is biodegradable. In addition, the model we developed can also be used for the analysis and treatment of bone infections other than those of the musculoskeletal system. More importantly, it can also serve as a substitute for previously used animal experiments.
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Zahra B, Nicholas B, Geoffrey R, Dina Z, Janal MN, Stuart F. Dental implant failure rates in patients with self-reported allergy to penicillin. Clin Implant Dent Relat Res 2022; 24:301-306. [PMID: 35313065 DOI: 10.1111/cid.13082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/21/2022] [Accepted: 03/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND In a number of previous studies, patients with reported penicillin allergies have been documented to experience higher rates of dental implant failure than those who had not reported this allergy. The authors of this study aimed to determine whether an increased risk of implant failure is associated with patient-reported penicillin allergy and which antibiotic was administered. METHODS AND MATERIALS A retrospective study was conducted through chart review of patients who received dental implants at the New York University College of Dentistry. Participants were eligible if they received one or more dental implants at the College and provided at least 1 year of follow-up data. RESULTS The overall implant failure rate was 12.9%. The failure rate in patients who reported no allergy to penicillin and took amoxicillin was 8.4%, while the failure rate in the allergy-reporting group was 17.1% (adjusted OR = 2.22, 95% CI = 1.44-3.44). The failure rate in allergy-reporting patients who took Clindamycin was also higher than in those who took amoxicillin (19.9%; adjusted OR = 2.9, 95% CI = 1.77-4.47) or any antibiotic other than amoxicillin (20.9%; adjusted OR = 2.77, 95% CI = 1.77-4.32). CONCLUSIONS Significant findings included a lower implant failure rate in patients taking amoxicillin than in patients taking other antibiotics. There was a significant increase in early implant failure in allergy reporting patients.
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Affiliation(s)
- Bagheri Zahra
- Ashman Department of Periodontology and Implant Dentistry, PI New York University College of Dentistry, New York, New York, USA
| | - Barrese Nicholas
- Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Rubinshtein Geoffrey
- Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Zahedi Dina
- Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Malvin N Janal
- Epidemiology and Health Promotion, New York University College of Dentistry, New York, New York, USA
| | - Froum Stuart
- Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
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TANRIVERDİ B, KALECİ B, KOLUMAN AC, TANRIVERDİ G. Sefazolinin değişen dozlarının in vitro 3T3-Fare fibroblast kültürü üzerine etkisi. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1086142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Salgado-Peralvo AO, Peña-Cardelles JF, Kewalramani N, Ortiz-García I, Jiménez-Guerra Á, Uribarri A, Velasco-Ortega E, Moreno-Muñoz J, Núñez-Márquez E, Monsalve-Guil L. Is Penicillin Allergy a Risk Factor for Early Dental Implant Failure? A Systematic Review. Antibiotics (Basel) 2021; 10:antibiotics10101227. [PMID: 34680808 PMCID: PMC8532851 DOI: 10.3390/antibiotics10101227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 12/29/2022] Open
Abstract
The prescription of preventive antibiotics in dental implant treatments reduces the incidence of early failures. This study has focused mainly on the influence of amoxicillin, which is contraindicated in penicillin-allergic patients. The present systematic review aimed to determine whether penicillin-allergic patients have a higher risk of implant failure compared to non-allergic patients. An electronic search was performed on Medline and Web of Science using the following MeSH terms: (penicillin allergy OR clindamycin OR erythromycin OR azithromycin OR metronidazole) AND (dental implant OR dental implant failure OR dental implant complications). The criteria employed were those described in the PRISMA® Declaration. Only five articles were included that analyzed the failure rates of implants placed in penicillin-allergic patients who were prescribed clindamycin compared to non-allergic patients who were prescribed amoxicillin. With the limitations of this study, it is not possible to state that penicillin allergy per se constitutes a risk factor for early dental implant failure as most of the studies included self-reported allergic patients. Clindamycin has been associated with a significantly elevated risk of failure and an up to six times increased risk of infection. Immediate implants also have a 5.7 to 10 times higher risk of failure.
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Affiliation(s)
- Angel-Orión Salgado-Peralvo
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (I.O.-G.); (Á.J.-G.); (E.V.-O.); (J.M.-M.); (E.N.-M.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain; (J.-F.P.-C.); (N.K.)
- Correspondence:
| | - Juan-Francisco Peña-Cardelles
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain; (J.-F.P.-C.); (N.K.)
- Department of Basic Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Naresh Kewalramani
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain; (J.-F.P.-C.); (N.K.)
- Department of Nursery and Stomatology, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Iván Ortiz-García
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (I.O.-G.); (Á.J.-G.); (E.V.-O.); (J.M.-M.); (E.N.-M.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain; (J.-F.P.-C.); (N.K.)
| | - Álvaro Jiménez-Guerra
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (I.O.-G.); (Á.J.-G.); (E.V.-O.); (J.M.-M.); (E.N.-M.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain; (J.-F.P.-C.); (N.K.)
| | - Andrea Uribarri
- Department of Basic Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Eugenio Velasco-Ortega
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (I.O.-G.); (Á.J.-G.); (E.V.-O.); (J.M.-M.); (E.N.-M.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain; (J.-F.P.-C.); (N.K.)
| | - Jesús Moreno-Muñoz
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (I.O.-G.); (Á.J.-G.); (E.V.-O.); (J.M.-M.); (E.N.-M.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain; (J.-F.P.-C.); (N.K.)
| | - Enrique Núñez-Márquez
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (I.O.-G.); (Á.J.-G.); (E.V.-O.); (J.M.-M.); (E.N.-M.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain; (J.-F.P.-C.); (N.K.)
| | - Loreto Monsalve-Guil
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (I.O.-G.); (Á.J.-G.); (E.V.-O.); (J.M.-M.); (E.N.-M.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain; (J.-F.P.-C.); (N.K.)
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12
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Palma LF, Marcucci M, Remondes CM, Chambrone L. Antibiotic therapy for the prevention of osteoradionecrosis following tooth extraction in head-and-neck cancer patients postradiotherapy: An 11-year retrospective study. Natl J Maxillofac Surg 2021; 12:333-338. [PMID: 35153427 PMCID: PMC8820304 DOI: 10.4103/njms.njms_413_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/15/2021] [Accepted: 08/26/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction: One of the most important complications of radiotherapy (RT) for head-and-neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, which mostly arises from tooth extractions. The ORN treatment still represents a great challenge; therefore, the prevention is of paramount importance. Thus, the present study aimed to evaluate retrospectively a perioperative systemic antibiotic therapy protocol for the prevention of ORN following tooth extraction in head-and-neck patients post-3D conformal RT. Materials and Methods: A retrospective medical record review was performed considering HNC patients submitted to RT in the period between 2008 and 2019. They necessarily received oral antibiotic therapy with Clindamycin 300 mg every 8 h for 10 days, with the first dose 3 days before the tooth extraction. Results: Forty-nine patients met the study criteria, with a total of 107 teeth extracted. Regarding the 47 patients who did not develop ORN, 103 tooth extractions were identified (96.3%). Only two patients developed ORN at two adjacent teeth sites (3.7%). Conclusion: The proposed perioperative systemic antibiotic therapy protocol seems to be efficient to prevent ORN following tooth extraction in postirradiated HNC patients.
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Affiliation(s)
- Luiz Felipe Palma
- Graduate Dentistry Program, Ibirapuera University, São Paulo, Brazil
| | - Marcelo Marcucci
- Stomatology and Oral and Maxilofacial Surgery Center, Hospital Heliópolis, São Paulo, São Paulo, Brazil
| | - Cíntia Maria Remondes
- Stomatology and Oral and Maxilofacial Surgery Center, Hospital Heliópolis, São Paulo, São Paulo, Brazil
| | - Leandro Chambrone
- Graduate Dentistry Program, Ibirapuera University, São Paulo, Brazil.,Evidence-Based Hub - CiiEM, Egas Moniz - Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Unit of Basic Oral Investigation (UIBO), Faculty of Dentistry, Universidade El Bosque, Bogota, Colombia
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13
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Kubo H, Czerwinski S, Schrumpf H, Buhren B, Prodinger P, Krauspe R, Pilge H. Rifampicin has - Compared to clindamycin - A dose and time dependent effect on hMSCs during osteogenic differentiation in vitro. J Orthop 2021; 26:49-53. [PMID: 34305347 DOI: 10.1016/j.jor.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background The effects of rifampicin and clindamycin on human mesenchymal stromal cell (hMSC) were examined. Methods hMSC were cultured with rifampicin and clindamycin (0.5 μg/ml, 5 μg/ml, 50 μg/ml) and examinations of proliferation (Bromodeoxyuridine), calcification (Alizarin red) and mineralization (alkaline phosphatase) were performed after 7th, 14th and 21st days. Results With rifampicin (50 μg/ml) cultured hMSC showed a significant negative effect during proliferation, mineralization (7, 14 and 21 days) and calcification (21 days). Clindamycin seems to have no effect. Conclusions Rifampicin in a dosage of 50 μg/ml showed a negative impact on proliferation, mineralization and calcification of hMSC after 21 days.
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Affiliation(s)
- Hannes Kubo
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics and Trauma Surgery, Clinic Director: Prof. Joachim Windolf, Moorenstr. 5, D-40225, Duesseldorf, Germany
| | - Sarah Czerwinski
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics and Trauma Surgery, Clinic Director: Prof. Joachim Windolf, Moorenstr. 5, D-40225, Duesseldorf, Germany
| | - Holger Schrumpf
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics and Trauma Surgery, Clinic Director: Prof. Joachim Windolf, Moorenstr. 5, D-40225, Duesseldorf, Germany
| | - Bettina Buhren
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics and Trauma Surgery, Clinic Director: Prof. Joachim Windolf, Moorenstr. 5, D-40225, Duesseldorf, Germany
| | - Peter Prodinger
- Krankenhaus Agatharied, Abteilung für Unfallchirurgie und Orthopädie, Norbert Kerkel Platz, D-83734, Hausham, Germany
| | - Ruediger Krauspe
- Professor Emeritus of the Orthopedic Department, University Duesseldorf, Germany
| | - Hakan Pilge
- Orthopaedicum Munich, Charles-de-Gaulle-Str. 4, 81737, Munich, Germany
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14
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Wiesli MG, Kaiser JP, Gautier E, Wick P, Maniura-Weber K, Rottmar M, Wahl P. Influence of ceftriaxone on human bone cell viability and in vitro mineralization potential is concentration- and time-dependent. Bone Joint Res 2021; 10:218-225. [PMID: 33739124 PMCID: PMC7998344 DOI: 10.1302/2046-3758.103.bjr-2020-0412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims In orthopaedic and trauma surgery, implant-associated infections are increasingly treated with local application of antibiotics, which allows a high local drug concentration to be reached without eliciting systematic adverse effects. While ceftriaxone is a widely used antibiotic agent that has been shown to be effective against musculoskeletal infections, high local concentrations may harm the surrounding tissue. This study investigates the acute and subacute cytotoxicity of increasing ceftriaxone concentrations as well as their influence on the osteogenic differentiation of human bone progenitor cells. Methods Human preosteoblasts were cultured in presence of different concentrations of ceftriaxone for up to 28 days and potential cytotoxic effects, cell death, metabolic activity, cell proliferation, and osteogenic differentiation were studied. Results Ceftriaxone showed a cytotoxic effect on human bone progenitor cells at 24 h and 48 h at concentrations above 15,000 mg/l. With a longer incubation time of ten days, subtoxic effects could be observed at concentrations above 500 mg/l. Gene and protein expression of collagen, as well as mineralization levels of human bone progenitor cells, showed a continuous decrease with increasing ceftriaxone concentrations by days 14 and 28, respectively. Notably, mineralization was negatively affected already at concentrations above 250 mg/l. Conclusion This study demonstrates a concentration-dependent influence of ceftriaxone on the viability and mineralization potential of primary human bone progenitor cells. While local application of ceftriaxone is highly established in orthopaedic and trauma surgery, a therapeutic threshold of 250 mg/l or lower should diminish the risk of reduced osseointegration of prosthetic implants. Cite this article: Bone Joint Res 2021;10(3):218–225.
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Affiliation(s)
- Matthias Guido Wiesli
- Laboratory for Biointerfaces, Empa - Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Jean-Pierre Kaiser
- Laboratory for Particles-Biology Interactions, Empa - Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Emanuel Gautier
- Department of Orthopaedics, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Peter Wick
- Laboratory for Particles-Biology Interactions, Empa - Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Katharina Maniura-Weber
- Laboratory for Biointerfaces, Empa - Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Markus Rottmar
- Laboratory for Biointerfaces, Empa - Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
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15
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Palma LF, Marcucci M, Remondes CM, Chambrone L. Leukocyte- and platelet-rich fibrin does not provide any additional benefit for tooth extraction in head and neck cancer patients post-radiotherapy: a randomized clinical trial. Med Oral Patol Oral Cir Bucal 2020; 25:e799-e804. [PMID: 32701929 PMCID: PMC7648915 DOI: 10.4317/medoral.23804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background One of the most important complications of radiotherapy (RT) for head and neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, arising mainly from tooth extractions. Thus, the present study aimed to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in preventing ORN following tooth extraction in post-irradiated HNC patients, as well as other postoperative complications.
Material and Methods 23 patients previously submitted to conventionally fractionated 3D-conformational RT for HNC underwent atraumatic tooth extractions with perioperative antibiotic therapy. Besides, they were randomly assigned to receive L-PRF clots to fill and cover the extraction sockets (n=11, Test Group) or not (n=12, Control Group). A visual analog scale was used to quantify postoperative pain on the 3rd and 7th days. For ORN diagnosis, patients were clinically assessed for up to 180 days. Other postoperative complications (edema, alveolitis, suture dehiscence, continuous bleeding, and oroantral communication) were also evaluated within this period.
Results No case of ORN or another surgical complication was observed and there were no differences in the postoperative pain scores between the groups on the 3rd and 7th days.
Conclusions L-PRF did not seem to provide any additional benefits than those achieved by the combination of the surgical and drug protocols used for tooth extractions in the post-irradiated HNC patients. Key words:Radiotherapy, osteoradionecrosis, tooth extraction, head and neck cancer.
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Affiliation(s)
- L-F Palma
- Rua da Moóca, 2518 cj13. 03104-002 São Paulo, SP, Brazil
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16
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Mohajerani H, Irajian G, Latifi F, Masjedian F, Tabrizi R. Efficacy of low-dose local clindamycin in different times for microbial decontamination of autogenous particulate bone graft. Int J Implant Dent 2020; 6:70. [PMID: 33123799 PMCID: PMC7596129 DOI: 10.1186/s40729-020-00263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 09/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clindamycin in low concentration (20 μg/mL) is safe for vitality and osteogenic potential of bone cells. The aim of this study was to evaluate the efficacy of local clindamycin (20 μg/mL) in two different exposure times, for microbial decontamination of particulate bone graft, collected during implant site preparation. This non-randomized parallel-group study was conducted on samples from 17 patients. The particulate bone collected during implant site preparation was divided into three portions by weight: in group S1, the particulate bone was immersed in thioglycolate broth without any antibiotic treatment; in group S2, the collected particulate bone was irrigated with 100 mL clindamycin solution (20 μg/mL); and in group S3, the collected particulate bone was soaked in one ml clindamycin solution (20 μg/mL) for 3 min. Samples in the three groups were cultured in aerobic and anaerobic media and species and CFU count of isolated bacteria were determined. RESULTS Analysis of the data demonstrated a significant difference among the three groups in the mean count of total microorganisms (P = 0.001). The difference in the mean count of anaerobic and aerobic microorganisms in the three groups was statistically significant as well (P = 0.001). Pseudomonas aeruginosa was the only microorganism that was not affected with the mentioned antibiotic. CONCLUSIONS Local use of low-dose clindamycin (20 μg/mL)-irrigation or 3 min immersing-is effective for the decontamination of particulate bone grafts.
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Affiliation(s)
- Hassan Mohajerani
- Department of Oral and Maxillofacial Surgery, Shahid Beheshti University of Medical Sciences, Velenjak, Tehran, Iran
| | - Gholamreza Irajian
- Department of Microbiology, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Latifi
- Department of Oral and Maxillofacial Surgery, Shahid Beheshti University of Medical Sciences, Velenjak, Tehran, Iran.
| | - Faramarz Masjedian
- Department of Microbiology, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, Shahid Beheshti University of Medical Sciences, Velenjak, Tehran, Iran
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17
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Klein C, Monet M, Barbier V, Vanlaeys A, Masquelet AC, Gouron R, Mentaverri R. The Masquelet technique: Current concepts, animal models, and perspectives. J Tissue Eng Regen Med 2020; 14:1349-1359. [PMID: 32621637 DOI: 10.1002/term.3097] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022]
Abstract
Bone reconstruction within a critical-sized defect remains a real challenge in orthopedic surgery. The Masquelet technique is an innovative, two-step therapeutic approach for bone reconstruction in which the placement of a poly (methylmethacrylate) spacer into the bone defect induces the neo-formation of a tissue called "induced membrane." This surgical technique has many advantages and is often preferred to a vascularized bone flap or Ilizarov's technique. Although the Masquelet technique has achieved high clinical success rates since its development by Alain-Charles Masquelet in the early 2000s, very little is known about how the process works, and few animal models of membrane induction have been developed. Our successful use of this technique in the clinic and our interest in the mechanisms of tissue regeneration (notably bone regeneration) prompted us to develop a surgical model of the Masquelet technique in rats. Here, we provide a comprehensive review of the literature on animal models of membrane induction, encompassing the defect site, the surgical procedure, and the histologic and osteogenic properties of the induced membrane. We also discuss the advantages and disadvantages of those models to facilitate efforts in characterizing the complex biological mechanisms that underlie membrane induction.
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Affiliation(s)
- Céline Klein
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France.,MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - Michael Monet
- MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - Vincent Barbier
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France.,MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - Alison Vanlaeys
- MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - Alain-Charles Masquelet
- Service de Chirurgie Orthopédique, Traumatologie et Chirurgie de la Main, Saint-Antoine Hospital, Paris, France
| | - Richard Gouron
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France.,MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - Romuald Mentaverri
- MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France.,Department of Biochemistry and Endocrine Biology, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France
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18
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da Silva TMV, Melo TS, de Alencar RC, Pereira JRD, Leão JC, Silva IHM, Gueiros LA. Photobiomodulation for mucosal repair in patients submitted to dental extraction after head and neck radiation therapy: a double-blind randomized pilot study. Support Care Cancer 2020; 29:1347-1354. [PMID: 32642953 DOI: 10.1007/s00520-020-05608-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of photobiomodulation therapy (PBMT) on the mucosal healing of patients submitted to simple dental extractions after head and neck radiation therapy (HNRT). METHODS Forty surgical procedures were randomly assigned into two groups: G1: dental extraction + PBMT (n = 19) and G2: dental extraction + sham-PBMT (n = 21). All patients received antibiotic therapy and the surgical alveolotomy to promote primary closure of the surgical site. Group 1 was submitted to PMBT according to the following parameters: 808 nm, 40 mW, 100 J/cm2, 70 s, 2.8 J/point, 14 J/session, and area of 0.028cm2. The primary outcome was complete mucosal lining at 14 days, and the secondary outcomes were the presence of infection, postoperative pain, and analgesics intake at 7 days. The patients were evaluated every 7 days until 28 days. RESULTS Alveolar mucosal lining was faster in G1, and at 14 postoperative days, 94.7% patients evolved with complete alveolar mucosal lining compared to no patient from G2 (p < 0.001). Patients from G1 reported postoperative pain less frequently (G1 = 4, 21.1% × G2 = 14, 66.7%, p = 0.005), and also reported lower intake of analgesic pills at D7 (21.1% × 66.7%, p = 0.005%). PBMT had a significant positive impact on both postoperative pain (NNT = 2.192, CI95% = 1.372-5.445) and mucosal healing (NNT = 1.056, CI95% = 0.954-1.181). CONCLUSIONS This preliminary study strongly supports the use of PMBT to promote surgical alveolar mucosal lining in a shorter time and with less postoperative pain.
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Affiliation(s)
- Thyago Morais Vicente da Silva
- Oral Medicine Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, CDU, Recife, PE, 50670-901, Brazil.,Graduate Program in Dentistry, Universidade Federal de Pernambuco, Recife, Brazil
| | - Thayanara Silva Melo
- Graduate Program in Dentistry, Universidade Federal de Pernambuco, Recife, Brazil
| | - Romulo Cesar de Alencar
- Oral Medicine Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, CDU, Recife, PE, 50670-901, Brazil
| | - José Ricardo Dias Pereira
- Oral Medicine Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, CDU, Recife, PE, 50670-901, Brazil
| | - Jair Carneiro Leão
- Oral Medicine Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, CDU, Recife, PE, 50670-901, Brazil.,Graduate Program in Dentistry, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Luiz Alcino Gueiros
- Oral Medicine Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, CDU, Recife, PE, 50670-901, Brazil. .,Graduate Program in Dentistry, Universidade Federal de Pernambuco, Recife, Brazil.
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19
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Olvera-Huertas AJ, Linares-Recatalá M, Herrera-Briones FJ, Vallecillo-Capilla MF, Manzano-Moreno FJ, Reyes-Botella C. Microbiological analysis of autologous bone particles obtained by low-speed drilling and treated with different decontamination agents. Int J Oral Maxillofac Surg 2020; 50:104-108. [PMID: 32451234 DOI: 10.1016/j.ijom.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/27/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023]
Abstract
The aim of this study was to compare the effectiveness of three agents - two antibiotics (amoxicillin and clindamycin) and an antiseptic (chlorhexidine) - to decontaminate bone grafts obtained by low-speed drilling. The study included 248 bone tissue samples harvested from 62 patients by low-speed drilling before dental implant placement. Each of four samples obtained from every patient was dropped, using a sterile instrument, into a sterile tube containing a 500-μl solution of 400μg/mL amoxicillin, 150μg/mL clindamycin, 0.12% chlorhexidine, or physiological saline for 1min. The number of colony-forming units (CFU) was determined at 48h of culture. The use of clindamycin, amoxicillin, or chlorhexidine as decontaminant for 1min significantly reduced the CFU count when compared to physiological saline (control agent). In both anaerobic and CO2-rich atmospheres, significant differences in CFU/mL were found between the control and chlorhexidine groups (P<0.001), control and amoxicillin groups (P<0.001), control and clindamycin groups (P<0.001), chlorhexidine and amoxicillin groups (P<0.0001), and chlorhexidine and clindamycin groups (P<0.0001). In conclusion, clindamycin had the highest decontaminating effect on bone particles obtained by low-speed drilling, followed by chlorhexidine and amoxicillin. Clindamycin may therefore be a valid alternative option for the routine decontamination of intraoral bone grafts.
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Affiliation(s)
- A J Olvera-Huertas
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - M Linares-Recatalá
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - F J Herrera-Briones
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain; Biomedical Group (BIO277), University of Granada, Granada, Spain
| | - M F Vallecillo-Capilla
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain; Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
| | - F J Manzano-Moreno
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain; Biomedical Group (BIO277), University of Granada, Granada, Spain; Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain; Instituto Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.
| | - C Reyes-Botella
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain; Biomedical Group (BIO277), University of Granada, Granada, Spain; Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain; Instituto Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
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20
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Abstract
Fracture-related infection (FRI) remains a challenging complication that imposes a heavy burden on orthopaedic trauma patients. The surgical management eradicates the local infectious focus and if necessary facilitates bone healing. Treatment success is associated with debridement of all dead and poorly vascularized tissue. However, debridement is often associated with the formation of a dead space, which provides an ideal environment for bacteria and is a potential site for recurrent infection. Dead space management is therefore of critical importance. For this reason, the use of locally delivered antimicrobials has gained attention not only for local antimicrobial activity but also for dead space management. Local antimicrobial therapy has been widely studied in periprosthetic joint infection, without addressing the specific problems of FRI. Furthermore, the literature presents a wide array of methods and guidelines with respect to the use of local antimicrobials. The present review describes the scientific evidence related to dead space management with a focus on the currently available local antimicrobial strategies in the management of FRI. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Peeters A, Putzeys G, Thorrez L. Current Insights in the Application of Bone Grafts for Local Antibiotic Delivery in Bone Reconstruction Surgery. J Bone Jt Infect 2019; 4:245-253. [PMID: 31700774 PMCID: PMC6831806 DOI: 10.7150/jbji.38373] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/27/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction: Bone implant related infection is still one of the biggest challenges in bone and joint surgery. Antibiotic impregnated bone grafts seem to be promising in both treatment and prevention of these infections. However, great variance in methodology predominates this field of research. This paper gives an overview of the published literature. Methods: The PRISMA-flowchart was used as protocol for article selection. Medline was searched and articles were selected in accordance with predetermined exclusion criteria. Results: Forty-eight articles were included in the synthesis. Topics including bone graft type, manipulations of the graft, elution profile, bacterial inhibition, osteotoxicity, incorporation, special impregnation methods, clinical use and storage were investigated. Therapeutically, high initial levels seem appropriate for biofilm eradication. A single stage procedure in the treatment of bone implant related infection seems feasible. Prophylactically, the literature indicates a reduction of postoperative infections when using antibiotic impregnated bone grafts. Conclusion: Bone grafts are a suitable carrier for local antibiotic application both therapeutically and prophylactically.
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Affiliation(s)
| | - Guy Putzeys
- Orthopedic Centre, AZ Groeninge, Kortrijk, Belgium
| | - Lieven Thorrez
- Department of Development and Regeneration, KU Leuven, Kortrijk, Belgium
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Dubey N, Xu J, Zhang Z, Nör JE, Bottino MC. Comparative Evaluation of the Cytotoxic and Angiogenic Effects of Minocycline and Clindamycin: An In Vitro Study. J Endod 2019; 45:882-889. [PMID: 31133343 PMCID: PMC6612592 DOI: 10.1016/j.joen.2019.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This study aimed to compare the cytocompatibility and angiogenic potential of 2 antibiotics (clindamycin [CLIN] and minocycline [MINO]) at distinct concentrations on dental pulp stem cells (DPSCs) and human umbilical vein endothelial cells (HUVECs). METHODS DPSCs and HUVECs were exposed to cell culture media modified with CLIN or MINO at concentrations ranging from 30 μg/mL-1000 μg/mL. Cell toxicity and proliferation were investigated using the lactate dehydrogenase and tetrazolium reduction assays, respectively. A capillarylike tube formation in vitro assay was conducted to determine the angiogenic potential associated with each antibiotic. Additionally, selected morphometric angiogenesis parameters were determined using dedicated software (WimTube; Onimagin Technologies SCA, Córdoba, Spain). All statistical analyses were performed using 1-way analysis of variance and the Tukey post hoc test (α= .05). RESULTS The collected data showed that compared with the control (cell culture media, alpha-minimum essential medium Eagle) increasing the antibiotic concentration significantly decreased cell viability and proliferation of both DPSCs and HUVECs. In terms of angiogenic potential, when tested at 30 μg/mL and 50 μg/mL, CLIN significantly amplified tube formation when compared with MINO with angiogenesis parameters (ie, tube length and tube number) similar to the effect promoted by exogenous vascular endothelial growth factor (50 ng/mL). CONCLUSIONS CLIN was less cytotoxic when compared with MINO at higher concentrations. Of note, CLIN did not hinder the proangiogenic activity induced by vascular endothelial growth factor to the same extent as MINO, suggesting that the replacement of MINO by CLIN might translate into positive implications in the overall regenerative outcome.
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Affiliation(s)
- Nileshkumar Dubey
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Jinping Xu
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Zhaocheng Zhang
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Jacques E Nör
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan.
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Wahl P, Rönn K, Bohner M, Decosterd LA, Meier C, Schläppi M, Festa S, Gautier E. In vitro study of new combinations for local antibiotic therapy with calcium sulphate - Near constant release of ceftriaxone offers new treatment options. J Bone Jt Infect 2018; 3:212-221. [PMID: 30416946 PMCID: PMC6215989 DOI: 10.7150/jbji.26218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/17/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Local application of antibiotics provides high concentrations at the site of interest, with minimal systemic toxicity. Carrier materials might help manage dead space. Calcium sulphate (CaSO4) has a dissolution time that only slightly exceeds the usually recommended duration of systemic antibiotic treatments. This in vitro study evaluates compatibility, release kinetics and antibacterial activity of new combinations of antibiotics with CaSO4 as carrier material. METHODS CaSO4 pellets added with 8% w/w antibiotic powder were exposed once in phosphate-buffered saline (PBS) solution and once in bovine plasma, in an elution experiment run over 6 weeks at 37 °C. Antibiotic elution was examined at various time points. Concentration was measured by liquid chromatography with tandem mass spectrometry. Antimicrobial activity was checked with an agar diffusion test. RESULTS Piperacillin-tazobactam, ceftazidime, cefepime, and meropenem showed fast reduction of concentration and activity. Flucloxacillin and cefuroxime remained present in relevant concentrations for 4 weeks. Ciprofloxacin, levofloxacin and clindamycin lasted for 6 weeks, but also at cell toxic concentrations. Ceftriaxone showed a near-constant release with only a small reduction of concentration from 130 to 75 mg/l. Elution profiles from PBS and plasma were comparable. CONCLUSION CaSO4 provides new possibilities in the local treatment of bone and joint infections. Ceftriaxone appears to be of particular interest in combination with CaSO4. Release persists at clinically promising concentrations, and appears to have a depot-like slow release from CaSO4, with only a small reduction in activity and concentration over 6 weeks. To the best of our knowledge, such a particular persistent release never was described before, for any antibiotic in combination with a carrier material for local application.
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Affiliation(s)
- Peter Wahl
- Department of Orthopaedic Surgery, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland.,Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Karolin Rönn
- Department of Orthopaedic Surgery, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland.,Schulthess Clinic, Zürich, Switzerland
| | | | - Laurent A Decosterd
- Division of Clinical Pharmacology, University Hospital Centre CHUV, Lausanne, Switzerland
| | - Christoph Meier
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Michel Schläppi
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Sandrine Festa
- Department of Orthopaedic Surgery, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Emanuel Gautier
- Department of Orthopaedic Surgery, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
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Seidenstuecker M, Ruehe J, Suedkamp NP, Serr A, Wittmer A, Bohner M, Bernstein A, Mayr HO. Composite material consisting of microporous β-TCP ceramic and alginate for delayed release of antibiotics. Acta Biomater 2017; 51:433-446. [PMID: 28104468 DOI: 10.1016/j.actbio.2017.01.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/13/2017] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to produce a novel composite of microporous β-TCP filled with alginate and Vancomycin (VAN) to prolong the release behavior of the antibiotic for up to 28days. MATERIAL AND METHODS Using the flow chamber developed by the group, porous ceramics in a directional flow were filled with alginates of different composition containing 50mg/mL of antibiotics. After cross-linking the alginate with calcium ions, incubation took place in 10mL double-distilled water for 4weeks at 37°C. At defined times (1, 2, 3, 6, 9, 14, 20 and 28days), the liquid was completely exchanged and analyzed by capillary zone electrophoresis and microtiter trials. For statistical purposes, the mean and standard deviation were calculated and analyzed by ANOVA. RESULTS The release of VAN from alginate was carried out via an external calcium source over the entire period with concentrations above the minimal inhibitory concentration (MIC). The burst release measured 35.2±1.5%. The release of VAN from alginate with an internal calcium source could only be observed over 14days. The burst release here was 61.9±4.3%. The native alginate's burst release was 54.1±7.8%; that of the sterile alginate 40.5±6.4%. The microtiter experiments revealed efficacy over the entire study period for VAN. The MIC value was determined in the release experiments as well in a range of 0.5-2.0μg/mL against Staphylococcus aureus. STATEMENT OF SIGNIFICANCE Drug release systems based on β-TCP and hydrogels are well documented in literature. However, in all described systems the ceramic, as granule or powder, is inserted into a hydrogel. In our work, we do the opposite, a hydrogel which acts as reservoir for antibiotics is placed into a porous biodegradable ceramic. Eventually, this system should be applied as treatment of bone infections. Contrary to the "granule in hydrogel" composites it has the advantage of mechanical stability. Thus, it can take over functions of the bone during the healing process. For a quicker translation from our scientific research into clinical use, only FDA approved materials were used in this work.
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Zipperer A, Kretschmer D. Cytotoxicity Assays as Predictors of the Safety and Efficacy of Antimicrobial Agents. Methods Mol Biol 2017; 1520:107-118. [PMID: 27873248 DOI: 10.1007/978-1-4939-6634-9_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The development of safe antimicrobial agents is important for the effective treatment of pathogens. From a multitude of discovered inhibitory compounds only few antimicrobial agents are able to enter the market. Many antimicrobials are, on the one hand, quite effective in killing pathogens but, on the other hand, cytotoxic to eukaryotic cells. Cell health can be monitored by various methods. Plasma membrane integrity, DNA synthesis, enzyme activity, and reducing conditions within the cell are known indicators of cell viability and cell death. For a comprehensive overview, methods to analyze cytotoxic and hemolytic effects, e.g., lactate dehydrogenase release, cell proliferation analysis, cell viability analysis, and hemolysis assay of antimicrobial compounds on human cells, are described in this chapter.
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Affiliation(s)
- Alexander Zipperer
- Department of Infection Biology, Interfaculty Institute for Microbiology and Infection Medicine Tübingen(IMIT), University of Tübingen, Auf der Morgenstelle 28, 72076, Tübingen, Germany
| | - Dorothee Kretschmer
- Department of Infection Biology, Interfaculty Institute for Microbiology and Infection Medicine Tübingen(IMIT), University of Tübingen, Auf der Morgenstelle 28, 72076, Tübingen, Germany.
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Cheng Y, Gao B, Liu X, Zhao X, Sun W, Ren H, Wu J. In vivo evaluation of an antibacterial coating containing halogenated furanone compound-loaded poly(l-lactic acid) nanoparticles on microarc-oxidized titanium implants. Int J Nanomedicine 2016; 11:1337-47. [PMID: 27099494 PMCID: PMC4821396 DOI: 10.2147/ijn.s100763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To prevent peri-implant infection, a new antibacterial coating containing a halogenated furanone compound, (Z-)-4-bromo-5-(bromomethylene)-2(5H)-furanone-loaded poly(l-lactic acid) nanoparticles, has been fabricated. The current study was designed to evaluate the preventive effect of the antibacterial coating under a simulated environment of peri-implant infection in vivo. Microarc-oxidized titanium implants treated with minocycline hydrochloride ointment were used as positive control group, and microarc-oxidized titanium implants without any treatment were used as blank control group. Three kinds of implants were implanted in dogs’ mandibles, and the peri-implant infection was simulated by silk ligation and feeding high sugar diet. After 2-month implantation, the results showed that no significant differences were detected between the experimental and positive control groups (P>0.05), but the data of clinical measurements of the blank control group were significantly higher than those of the other two groups (P<0.05), and the bone–implant contact rate and ultimate interfacial strength were significantly lower than those of the other two groups (P<0.05). Scanning electron microscope observation and histological examination showed that more new bone was formed on the surface of the experimental and positive control groups. It can be concluded that the antibacterial coating fabricated on implants has remarkable preventive effect on peri-implant infection at the early stage.
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Affiliation(s)
- Yicheng Cheng
- Department of Prosthodontics, State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, People's Republic of China; Department of Stomatology, Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China; Department of Prosthodontics, Shaanxi Key Laboratory of Stomatology, Xi'an, People's Republic of China
| | - Bo Gao
- Department of Prosthodontics, State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, People's Republic of China; Department of Prosthodontics, Shaanxi Key Laboratory of Stomatology, Xi'an, People's Republic of China
| | - Xianghui Liu
- Department of Stomatology, Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Xianghui Zhao
- Institute of Neuroscience, School of Basical Medical Science, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Weige Sun
- Department of Stomatology, Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Huifang Ren
- Department of Prosthodontics, State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, People's Republic of China; Department of Prosthodontics, Shaanxi Key Laboratory of Stomatology, Xi'an, People's Republic of China
| | - Jiang Wu
- Department of Prosthodontics, State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, People's Republic of China; Department of Prosthodontics, Shaanxi Key Laboratory of Stomatology, Xi'an, People's Republic of China
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Cefazolin Irreversibly Inhibits Proliferation and Migration of Human Mesenchymal Stromal Cells. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2042687. [PMID: 27069918 PMCID: PMC4812192 DOI: 10.1155/2016/2042687] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 01/08/2023]
Abstract
Drugs may have a significant effect on postoperative bone healing by reducing the function of human mesenchymal stromal cells (hMSC) or mature osteoblasts. Although cefazolin is one of the most commonly used antibiotic drugs in arthroplasty to prevent infection worldwide, there is a lack of information regarding how cefazolin affects hMSC and therefore may have an effect on early bone healing. We studied the proliferation and migration capacity of primary hMSC during cefazolin treatment at various doses for up to 3 days, as well as the reversibility of the effects during the subsequent 3 days of culture without the drug. We found a time- and dose-dependent reduction of the proliferation rate and the migratory potential. Tests of whether these effects were reversible revealed that doses ≥250 μg/mL or treatments longer than 24 h irreversibly affected the cells. We are the first to show that application of cefazolin irreversibly inhibits the potential of hMSC for migration to the trauma site and local proliferation. Cefazolin should be administered only at the required dosage and time to prevent periprosthetic infection. If long-term administration is required and delayed bone healing is present, cefazolin application must be considered as a cause of delayed bone healing.
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Nau C, Seebach C, Trumm A, Schaible A, Kontradowitz K, Meier S, Buechner H, Marzi I, Henrich D. Alteration of Masquelet's induced membrane characteristics by different kinds of antibiotic enriched bone cement in a critical size defect model in the rat's femur. Injury 2016; 47:325-34. [PMID: 26652225 DOI: 10.1016/j.injury.2015.10.079] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 10/30/2015] [Indexed: 02/02/2023]
Abstract
The Masquelet technique for the treatment of large bone defects consists of a 2-stage procedure. In the first stage, a polymethylmethacrylate (PMMA) cement spacer is inserted into the bony defect of a rat's femur and over a period of 2-4 weeks a membrane forms that encapsulates the defect/spacer. In a second operation the membrane is opened, the PMMA spacer is removed and the resulting cavity is filled with autologous bone. Different kinds of bone cements are available, with or without supplemental antibiotics. Both might influence the development and the characteristics of the induced membrane which might affect the bone healing response. Hence, this comparative study was performed to elucidate the effect of different bone cements with or without supplemental antibiotics on the development of an induced membrane in a critical size femur defect model in rats. A total of 72 male SD rats received a 10mm critical size defect of the femur which was stabilised by a plate osteosynthesis and filled with either Palacos+Gentamycin, Copal Gentamycin+Vancomycin, Copal+Gentamycin+Clindamycin or Copal Spacem. The induced membranes were analysed after two, four and six weeks (wks) after insertion of the cement spacers (n=6/group). Paraffin embedded histological sections of the membrane were microscopically analysed for membrane thickness, elastic fibres, vascularisation and proliferation by an independent observer blinded to the group setup. The thickness of the induced membrane increased significantly from 2 wks (553 μm) to 6 wks (774 μm) in group Palacos+Gentamycin whereas membrane thickness decreased significantly in groups Copal+Gentamycin+Clindamycin (682-329 μm) and Copal Spacem (916 μm to 371 μm). The comparison between the groups revealed significantly increased membrane thickness in group Palacos+Gentamycin and Copal Gentamycin+Vancomycin in comparison to group Copal+Gentamycin+Clindamycin six weeks after induction. However, the fraction of elastic fibres was significantly increased in groups Copal+Gentamycin+Clindamycin (71%, 80%) and Copal Spacem (82%, 81%) after 2 and 4 weeks in comparison to the groups Palacos+Gentamycin (56%, 57%) and Copal Gentamycin+Vancomycin (63%, 69%). Those differences however were partly diminished after 6 wks. The ratio of immature (vWF+) to more mature (CD31+) blood vessels increased significantly in groups Palacos+Gentamycin and Copal Gentamycin+Vancomycin whereas no significant alterations were noted in groups Copal+Gentamycin+Clindamycin and Copal Spacem. For the first time we demonstrated that thickness and proportion of elastic fibres in induced membranes were influenced by the type of cement and the kind of supplemental antibiotics being used. Whether these alterations of the induced membrane have an effect on bone healing remains to be proven in future studies.
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Affiliation(s)
- Christoph Nau
- Department of Trauma-, Hand- and Reconstructive Surgery, Hospital of the Goethe- University, Frankfurt/Main, Germany.
| | - Caroline Seebach
- Department of Trauma-, Hand- and Reconstructive Surgery, Hospital of the Goethe- University, Frankfurt/Main, Germany.
| | - Alexander Trumm
- Department of Trauma-, Hand- and Reconstructive Surgery, Hospital of the Goethe- University, Frankfurt/Main, Germany.
| | - Alexander Schaible
- Department of Trauma-, Hand- and Reconstructive Surgery, Hospital of the Goethe- University, Frankfurt/Main, Germany.
| | - Kerstin Kontradowitz
- Department of Trauma-, Hand- and Reconstructive Surgery, Hospital of the Goethe- University, Frankfurt/Main, Germany.
| | - Simon Meier
- Department of Trauma-, Hand- and Reconstructive Surgery, Hospital of the Goethe- University, Frankfurt/Main, Germany.
| | | | - Ingo Marzi
- Department of Trauma-, Hand- and Reconstructive Surgery, Hospital of the Goethe- University, Frankfurt/Main, Germany.
| | - Dirk Henrich
- Department of Trauma-, Hand- and Reconstructive Surgery, Hospital of the Goethe- University, Frankfurt/Main, Germany.
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Pääkkönen M, Kallio MJT, Kallio PE, Peltola H. Repeated serum alkaline phosphatase measurements in the treatment of childhood acute bone and joint infections with high doses of antibiotics. Ann Lab Med 2013; 33:375-8. [PMID: 24003432 PMCID: PMC3756246 DOI: 10.3343/alm.2013.33.5.375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/20/2013] [Accepted: 06/03/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Markus Pääkkönen
- Division of Diseases of the Musculoskeletal System, Turku University Hospital and University of Turku, Turku, Finland.
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Uskoković V, Hoover C, Vukomanović M, Uskoković DP, Desai TA. Osteogenic and antimicrobial nanoparticulate calcium phosphate and poly-(D,L-lactide-co-glycolide) powders for the treatment of osteomyelitis. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2013; 33:3362-73. [PMID: 23706222 PMCID: PMC3672472 DOI: 10.1016/j.msec.2013.04.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 01/31/2013] [Accepted: 04/08/2013] [Indexed: 01/31/2023]
Abstract
Development of a material for simultaneous sustained and localized delivery of antibiotics and induction of spontaneous regeneration of hard tissues affected by osteomyelitis stands for an important clinical need. In this work, a comparative analysis of the bacterial and osteoblastic cell response to two different nanoparticulate carriers of clindamycin, an antibiotic commonly prescribed in the treatment of bone infection, one composed of calcium phosphate and the other comprising poly-(D,L-lactide-co-glycolide)-coated calcium phosphate, was carried out. Three different non-cytotoxic phases of calcium phosphate, exhibiting dissolution and drug release profiles in the range of one week to two months to one year, respectively, were included in the analysis: monetite, amorphous calcium phosphate and hydroxyapatite. Spherical morphologies and narrow size distribution of both types of nanopowders were confirmed in transmission and scanning electron microscopic analyses. The antibiotic-containing powders exhibited sustained drug release contingent upon the degradation rate of the carrier. Assessment of the antibacterial performance of the antibiotic-encapsulated powders against Staphylococcus aureus, the most common pathogen isolated from infected bone, yielded satisfactory results both in broths and on blood agar plates for all the analyzed powders. In contrast, no cytotoxic behavior was detected upon the incubation of the antibiotic powders with the osteoblastic MC3T3-E1 cell line for up to three weeks. The cells were shown to engage in a close contact with the antibiotic-containing particles, irrespective of their internal or surface phase composition, polymeric or mineral. At the same time, both types of particles upregulated the expression of osteogenic markers osteocalcin, osteopontin, Runx2 and protocollagen type I, suggesting their ability to promote osteogenesis and enhance remineralization of the infected site in addition to eliminating the bacterial source of infection.
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Affiliation(s)
- Vuk Uskoković
- Therapeutic Micro and Nanotechnology Laboratory, Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.
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de Menezes B, de Souza Noronha V, Carvalho A, da Silva Freire A, Jham B. Incidence of osteoradionecrosis following oral and maxillofacial surgery in irradiated head and neck cancer patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/ors.12054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | | | | | | | - B.C. Jham
- College of Dental Medicine - Illinois; Midwestern University; Downers Grove IL USA
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Chen X, Li Y, Aparicio C. Biofunctional Coatings for Dental Implants. THIN FILMS AND COATINGS IN BIOLOGY 2013. [DOI: 10.1007/978-94-007-2592-8_4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Uskoković V, Desai TA. Phase composition control of calcium phosphate nanoparticles for tunable drug delivery kinetics and treatment of osteomyelitis. II. Antibacterial and osteoblastic response. J Biomed Mater Res A 2012; 101:1427-36. [PMID: 23115128 DOI: 10.1002/jbm.a.34437] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 08/20/2012] [Indexed: 12/24/2022]
Abstract
Osteomyelitis has been traditionally treated by the combination of long-term antibiotic therapies and surgical removal of diseased tissue. The multifunctional material was developed in this study with the aim to improve this therapeutic approach by: (a) enabling locally delivered and sustained release of antibiotics at a tunable rate, so as to eliminate the need for repetitive administration of systemically distributed antibiotics; and (b) controllably dissolving itself, so as to promote natural remineralization of the portion of bone lost to disease. We report hereby on the effect of previously synthesized calcium phosphates (CAPs) with tunable solubilities and drug release timescales on bacterial and osteoblastic cell cultures. All CAP powders exhibited satisfying antibacterial performance against Staphylococcus aureus, the main causative agent of osteomyelitis. Still, owing to its highest drug adsorption efficiency, the most bacteriostatically effective phase was amorphous CAP with the minimal inhibitory concentration of less than 1 mg/mL. At the same time, the positive cell response and osteogenic effect of the antibiotic-loaded CAP particles was confirmed in vitro for all the sparsely soluble CAP phases. Adsorption of the antibiotic onto CAP particles reversed the deleterious effect that the pure antibiotic exerted on the osteogenic activity of the osteoblastic cells. The simultaneous osteogenic and antimicrobial performance of the material developed in this study, altogether with its ability to exhibit sustained drug release, may favor its consideration as a material base for alternative therapeutic approaches to prolonged antibiotic administration and surgical debridement typically prescribed in the treatment of osteomyelitis.
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Affiliation(s)
- Vuk Uskoković
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California 94158-2330, USA.
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Kallala R, Graham SM, Nikkhah D, Kyrkos M, Heliotis M, Mantalaris A, Tsiridis E. In vitroandin vivoeffects of antibiotics on bone cell metabolism and fracture healing. Expert Opin Drug Saf 2011; 11:15-32. [DOI: 10.1517/14740338.2012.643867] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Autogenous cancellous bone graft provides an osteoconductive, osteoinductive, and osteogenic substrate for filling bone voids and augmenting fracture-healing.The iliac crest remains the most frequently used site for bone-graft harvest, but the proximal part of the tibia, distal end of the radius, distal aspect of the tibia, and greater trochanter are alternative donor sites that are particularly useful for bone-grafting in the ipsilateral extremity.The most common complication associated with the harvest of autogenous bone graft is pain at the donor site, with less frequent complications including nerve injury, hematoma, infection, and fracture at the donor site.Induced membranes is a method that uses a temporary polymethylmethacrylate cement spacer to create a bone-graft-friendly environment to facilitate graft incorporation, even in large segmental defects.
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Affiliation(s)
- Chad Myeroff
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Minneapolis, MN 55454, USA.
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Pountos I, Georgouli T, Bird H, Kontakis G, Giannoudis PV. The effect of antibiotics on bone healing: current evidence. Expert Opin Drug Saf 2011; 10:935-45. [DOI: 10.1517/14740338.2011.589833] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Aykut S, Öztürk A, Özkan Y, Yanik K, İlman AA, Özdemir RM. Evaluation and comparison of the antimicrobial efficacy of teicoplanin- and clindamycin-coated titanium implants. ACTA ACUST UNITED AC 2010; 92:159-63. [DOI: 10.1302/0301-620x.92b1.22134] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied the effects of coating titanium implants with teicoplanin and clindamycin in 30 New Zealand White rabbits which were randomly assigned to three groups. The intramedullary canal of the left tibia of each rabbit was inoculated with 500 colony forming units of Staphylococcus aureus. Teicoplanin-coated implants were implanted into rabbits in group 1, clindamycin-coated implants into rabbits in group 2, and uncoated implants into those in group 3. All the rabbits were killed one week later. The implants were removed and cultured together with pieces of tibial bone and wound swabs. The rate of colonisation of the organisms in the three groups was compared. Organisms were cultured from no rabbits in group 1, one in group 2 but from all in group 3. There was no significant difference between groups 1 and 2 (p = 1.000). There were significant differences between groups 1 and 3 and groups 2 and 3 (p < 0.001). Significant protection against bacterial colonisation and infection was found with teicoplanin- and clindamycin-coated implants in this experimental model.
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Affiliation(s)
- S. Aykut
- Clinic of Orthopaedics and Traumatology Bursa High Specialty Research and Training Hospital, Yildrim 16630, Bursa, Turkey
| | - A. Öztürk
- Clinic of Orthopaedics and Traumatology Bursa High Specialty Research and Training Hospital, Yildrim 16630, Bursa, Turkey
| | - Y. Özkan
- Clinic of Orthopaedics and Traumatology Bursa High Specialty Research and Training Hospital, Yildrim 16630, Bursa, Turkey
| | - K. Yanik
- Department of Surgery, Veterinary Faculty Uludag University, Görükle, 16059 Nilüfer, Bursa, Turkey
| | - A. A. İlman
- Dogal Yasami Koruma Merkezi, 16059 Nilüfer, Bursa, Turkey
| | - R. M. Özdemir
- Clinic of Orthopaedics and Traumatology Bursa High Specialty Research and Training Hospital, Yildrim 16630, Bursa, Turkey
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Zhao L, Chu PK, Zhang Y, Wu Z. Antibacterial coatings on titanium implants. J Biomed Mater Res B Appl Biomater 2009; 91:470-80. [DOI: 10.1002/jbm.b.31463] [Citation(s) in RCA: 645] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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García-Lechuz J, Bouza E. Treatment recommendations and strategies for the management of bone and joint infections. Expert Opin Pharmacother 2009; 10:35-55. [PMID: 19236181 DOI: 10.1517/14656560802611766] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Bone and joint infections are a cause of rising concern, mainly owing to the increasing number of traumatic accidents, the appearance of new groups of patients at risk, the widespread use of prosthetic devices and the emergence of new patterns of antimicrobial resistance. Treatment guidelines and particular strategies for the management of such infections are reviewed. Decisions regarding the best therapeutic modality can be challenging and take into account the factors involved in infection staging, along with a better knowledge of the bacterial biofilm status. Surgery and antibiotic therapy are the keystones of the management, but overall the timing and length of treatment and follow-up should be posed to obtain the best quality of life for the patient. These infections are characteristically intriguing and sometimes need multiple surgical interventions and several courses of therapy. A multi-disciplinary approach is worthwhile in each institution. The collaboration of a specialized team composed by surgeons, pathologists, microbiologists and clinicians will permit diagnostic and therapeutic protocol-guided decisions.
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Affiliation(s)
- Juan García-Lechuz
- Hospital General Universitario Gregorio Marañón, Department of Clinical Microbiology and Infectious Diseases, Dr Esquerdo 46, 28009, Madrid, Spain.
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How to store autologous bone graft perioperatively: an in vitro study. Arch Orthop Trauma Surg 2008; 128:1007-11. [PMID: 18389265 DOI: 10.1007/s00402-008-0616-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Autologous bone graft is the golden standard for bone grafting, but little is known about the influence of various preservation techniques used during surgery immediately following harvest on the osseous structures and graft vitality. Several studies focussed on the optimal treatment of the bone during harvest and implantation, but only few examined the intraoperative storage conditions on the back table. The aim of our study was to examine the influence of various intraoperative preservation techniques on human cancellous bone at different points to optimize the storage during surgery. MATERIALS AND METHODS Cancellous bone was harvested during hip arthroplasty and stored for 2 and 4 h under dry conditions, inside a swab moistened with saline solution or in saline solution, 5% glucose solution or culture medium. After the storage period, the bone was cultured and examined 7 days after the first cells grew out in one of these groups. Following the identification of the cells as osteoblast-like cells, the cultures were analysed by fluorescence staining, cell count and the XTT-test. RESULTS Fluorescence staining revealed no avital cells in all groups. Dry storage of the bone led to significantly lower cell metabolism after 2 h compared to saline solution and 5% glucose solution. The same was true after 4 h dry storage compared to the moistened swab, and glucose and culture medium. Cell count was significantly lower after 2 h of dry storage compared to saline solution and culture medium. CONCLUSIONS Perioperative storage of cancellous bone under dry conditions should be avoided. The bone graft should be stored in saline or 5% glucose solution or a moistened swab.
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