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Hua L, Qian H, Lei T, Zhang Y, Lei P, Hu Y. 3D-Printed Porous Tantalum Coated with Antitubercular Drugs Achieving Antibacterial Properties and Good Biocompatibility. Macromol Biosci 2021; 22:e2100338. [PMID: 34708567 DOI: 10.1002/mabi.202100338] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/05/2021] [Indexed: 12/17/2022]
Abstract
Treatment of bone and joint tuberculosis remains a challenge. The development of tissue-engineered drug-loaded biomaterials has increased the therapeutic options. However, for the treatment of osteoarticular tuberculosis with severe local infection risks and high weight-bearing requirements, it is still necessary to design materials consistent with bone biomechanics, cytocompatibility, and osteogenesis and to provide more effective antimicrobial functions. The antitubercular drugs isoniazid and rifampicin are loaded with gellan gum, and a 3D-printed porous tantalum surface is treated with polydopamine to increase adhesion. The osteogenic induction and differentiation are tested using alkaline phosphatase, alizarin red staining, sirius red staining, and polymerase chain reaction testing. Bone regeneration in vivo is measured by X-ray, micro-computerized tomography, hard tissue sections, and fluorescence staining. The drug is released slowly in vitro and in vivo, increasing the duration of antibacterial action. The composite bio-scaffolds inhibit Staphylococcus aureus growth, have good biocompatibility, and does not inhibit the induction of osteogenic differentiation of rat bone marrow mesenchymal stem cells. The composite bio-scaffold can simultaneously achieve localized long-term controlled drug release and bone regeneration and is a promising route for bone and joint tuberculosis treatment.
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Affiliation(s)
- Long Hua
- Department of Orthopedics, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University, Changsha, Hunan, P. R. China.,Department of Orthopedics, The First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, P. R. China.,Department of Orthopedics, The Sixth Affiliated Hospital, Xinjiang Medical University, Urumqi, P. R. China
| | - Hu Qian
- Department of Orthopedics, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University, Changsha, Hunan, P. R. China
| | - Ting Lei
- Department of Orthopedics, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University, Changsha, Hunan, P. R. China
| | - Yu Zhang
- Department of Orthopedics, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University, Changsha, Hunan, P. R. China
| | - Pengfei Lei
- Department of Orthopedics, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University, Changsha, Hunan, P. R. China.,Department of Orthopedics, The First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, P. R. China
| | - Yihe Hu
- Department of Orthopedics, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University, Changsha, Hunan, P. R. China.,Department of Orthopedics, The First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, P. R. China
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2
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Cleemann R, Sorensen M, West A, Soballe K, Bechtold JE, Baas J. Augmentation of implant surfaces with BMP-2 in a revision setting : effects of local and systemic bisphosphonate. Bone Joint Res 2021; 10:488-497. [PMID: 34346256 PMCID: PMC8414437 DOI: 10.1302/2046-3758.108.bjr-2020-0280.r1] [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: 11/05/2022] Open
Abstract
AIMS We wanted to evaluate the effects of a bone anabolic agent (bone morphogenetic protein 2 (BMP-2)) on an anti-catabolic background (systemic or local zoledronate) on fixation of allografted revision implants. METHODS An established allografted revision protocol was implemented bilaterally into the stifle joints of 24 canines. At revision surgery, each animal received one BMP-2 (5 µg) functionalized implant, and one raw implant. One group (12 animals) received bone graft impregnated with zoledronate (0.005 mg/ml) before impaction. The other group (12 animals) received untreated bone graft and systemic zoledronate (0.1 mg/kg) ten and 20 days after revision surgery. Animals were observed for an additional four weeks before euthanasia. RESULTS No difference was detected on mechanical implant fixation (load to failure, stiffness, energy) between local or systemic zoledronate. Addition of BMP-2 had no effect on implant fixation. In the histomorphometric evaluation, implants with local zoledronate had more area of new bone on the implant surface (53%, p = 0.025) and higher volume of allograft (65%, p = 0.007), whereas implants in animals with systemic zoledronate had the highest volume of new bone (34%, p = 0.003). Systemic zoledronate with BMP-2 decreased volume of allograft by 47% (p = 0.017). CONCLUSION Local and systemic zoledronate treatment protects bone at different stages of maturity; local zoledronate protects the allograft from resorption and systemic zoledronate protects newly formed bone from resorption. BMP-2 in the dose evaluated with experimental revision implants was not beneficial, since it significantly increased allograft resorption without a significant compensating anabolic effect. Cite this article: Bone Joint Res 2021;10(8):488-497.
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Affiliation(s)
- Rasmus Cleemann
- Orthopedics, Zealand University Hospital Koge, Køge, Denmark.,Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Elective Surgery Center - Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Mette Sorensen
- Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Aalborg University Hospital, Aalborg, Denmark
| | - Andreas West
- Orthopedics, Regionshospitalet Horsens, Horsens, Denmark
| | - Kjeld Soballe
- Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Joan E Bechtold
- Department of Orthopedic Surgery, Hennepin Healthcare Research Institute, Minneapolis Medical Research Foundation, Orthopedic Biomechanics Laboratory, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jorgen Baas
- Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Aarhus University Hospital Skejby, Aarhus, Denmark
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Kiuttu J, Lehenkari P, Leskelä HV, Yrjämä O, Ohtonen P, Valkealahti M. Intra-operative Clodronate Rinsing Improves the Integration of the Femoral Stem in a Prospective, Double-blinded, Randomized, Placebo-controlled Clinical RSA-study. Open Orthop J 2021. [DOI: 10.2174/1874325002115010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Periprosthetic bone loss after Total Hip Arthroplasty (THA), detected as an early migration of the prosthesis may predict later loosening of the implant.
Objective:
We hypothesized that intra-operative bisphosphonate rinsing would reduce bone resorption after THA. It might therefore be possible to achieve better early fixation of the implant.
Methods:
Nineteen patients suffering from arthrosis were recruited in a prospective, double-blinded, randomized, placebo-controlled clinical pilot trial. Patients were operated with an uncemented Bimetric stem using tantalum markers. The femoral proximal intramedullary canal was rinsed with 1mM clodronate in nine patients and with saline in 10 patients. These patients were followed for two years using radiostereometric analysis (RSA), dual energy x-ray absorptiometry (DXA) and the Harris Hip Score (HHS).
Results:
We did not found any significant differences between the study groups with regards to the primary output measures (maximum total point motion, MTPM). However, there was evidence that clodronate could affect periprosthetic bone quality; a beneficial effect in BMD in Gruen zone 3 during the two-year follow-up was observed, BMD decreased less in the clodronate group (p = 0.02). The maximal x-translation of the stem at 3-24 months was significantly two-fold, being higher in the placebo group (p = 0.02). The baseline BMD and the maximal total point motion (MTPM) at 3-24 months showed a positive correlation in the clodronate group and a negative correlation in the placebo group.
Conclusion:
In conclusion, further studies with larger patient groups and longer follow-up periods are needed to estimate the clinical importance of these findings and further to prove if an intraoperative clodronate rinsing prior to application of femoral stem during THA can prevent periprosthetic bone loss.
Clinical Trial Registration No.: NCT03803839
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Abtahi J, Klintström B, Klintström E. Ibandronate Reduces the Surface Bone Resorption of Mandibular Bone Grafts: A Randomized Trial With Internal Controls. JBMR Plus 2021; 5:e10468. [PMID: 33778329 PMCID: PMC7990152 DOI: 10.1002/jbm4.10468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/19/2022] Open
Abstract
Autologous bone grafts are considered the gold standard for reconstruction of the edentulous alveolar ridges. However, this procedure is associated with unpredictable bone loss caused by physiological bone resorption. Bisphosphonates are antiresorptive drugs that act specifically on osteoclasts, thereby maintaining bone density, volume, and strength. It was hypothesized that the resorption of bone grafts treated with an ibandronate solution would be less advanced than bone grafts treated with saline. Ten patients who underwent bilateral sagittal split osteotomy were included in a randomized double‐blind trial with internal controls. Each patient received a bone graft treated with a solution of ibandronate on one side and a graft treated with saline (controls) contralaterally. Radiographs for the measurement of bone volume were obtained at 2 weeks and at 6 months after surgery. The primary endpoint was the difference in the change of bone volume between the control and the ibandronate bone grafts 6 months after surgery. All of the bone grafts healed without complications. One patient was excluded because of reoperation. In eight of the nine patients, the ibandronate bone grafts showed an increase in bone volume compared with baseline, with an average gain of 126 mm3 (40% more than baseline) with a range of +27 to +218 mm3. Only one ibandronate‐treated graft had a decrease in bone volume (8%). In the controls, an average bone volume loss of −146 mm3 (58% of baseline) with a range of −29 to −301 mm3 was seen. In the maxillofacial field, the reconstructions of atrophic alveolar ridges, especially in the esthetical zones, are challenging. These results show that bone grafts locally treated with ibandronate solution increases the remaining bone volume. This might lead to new possibilities for the maxillofacial surgeons in the preservation of bone graft volumes and for dental implant installations. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Jahan Abtahi
- Department of Oral & Maxillofacial Surgery and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden.,Center for Medical Image Science and Visualization (CMIV) Linköping University Linköping Sweden
| | - Benjamin Klintström
- Department of Biomedical Engineering and Health Systems KTH Royal Institute of Technology Stockholm Sweden
| | - Eva Klintström
- Center for Medical Image Science and Visualization (CMIV) Linköping University Linköping Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
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Hua L, Lei T, Qian H, Zhang Y, Hu Y, Lei P. 3D-printed porous tantalum: recent application in various drug delivery systems to repair hard tissue defects. Expert Opin Drug Deliv 2021; 18:625-634. [PMID: 33270470 DOI: 10.1080/17425247.2021.1860015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The treatment of hard tissue defects, especially those of bone and cartilage, induced by infections or tumors remains challenging. Traditional methods, including debridement with systematic chemotherapy, have shortcomings owing to their inability to eliminate infections and high systematic toxicity. AREA COVERED This review comprehensively summarizes and discusses the current applications of 3D-printed porous tantalum (3D-P-p-Ta), a novel drug delivery strategy, in drug delivery systems to repair hard tissue defects, as well as the limitations of existing data and potential future research directions. EXPERT OPINION Drug delivery systems have advanced medical treatments, with the advantages of high local drug concentration, long drug-release period, and minimal systematic toxicity. Due to its excellent biocompatibility, ideal mechanical property, and anti-corrosion ability, porous tantalum is one of the most preferable loading scaffolds. 3D printing allows for freedom of design and facilitates the production of regular porous implants with high repeatability. There are several reports on the application of 3D-P-p-Ta in drug delivery systems for the management of infection- or tumor-associated bone defects, yet, to the best of our knowledge, no reviews have summarized the current research progress.
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Affiliation(s)
- Long Hua
- Department of Orthopedics, Xiangya Hospital Central South University, Changsha Hunan, China.,Department of Orthopedics, No.6 Affiliated Hospital Xinjiang Medical University, Urumqi Xinjiang, China
| | - Ting Lei
- Department of Orthopedics, Xiangya Hospital Central South University, Changsha Hunan, China
| | - Hu Qian
- Department of Orthopedics, Xiangya Hospital Central South University, Changsha Hunan, China
| | - Yu Zhang
- Department of Orthopedics, Xiangya Hospital Central South University, Changsha Hunan, China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital Central South University, Changsha Hunan, China
| | - Pengfei Lei
- Department of Orthopedics, Xiangya Hospital Central South University, Changsha Hunan, China.,Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Changsha, Hunan, China
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6
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Abstract
There is a high prevalence of osteoporosis in patients undergoing total hip arthroplasty. There are several clinically relevant questions related to the management of such cases: the effect of ageing; the initial osseointegration of implants, especially when cementless THA is used; the effect of medical osteoporosis treatment on bone-implant interface; the incidence of intraoperative and late periprosthetic fractures, and the long-term survival of both cemented and cementless total hip arthroplasty performed for proximal femoral fractures and hip osteoarthritis. A critical review of the literature is presented in an attempt to draw practical conclusions.
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Affiliation(s)
- Theofilos S Karachalios
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece).,School of Health Sciences, Faculty of Medicine, University of Thessalia, Biopolis Mezourlo Region, Larissa, Hellenic Republic (Greece)
| | - Antonios A Koutalos
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece)
| | - George A Komnos
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece)
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Kauffmann F, Höhne C, Assaf AT, Vollkommer T, Semmusch J, Reitmeier A, Michel Stein J, Heiland M, Smeets R, Rutkowski R. The Influence of Local Pamidronate Application on Alveolar Dimensional Preservation after Tooth Extraction-An Animal Experimental Study. Int J Mol Sci 2020; 21:ijms21103616. [PMID: 32443867 PMCID: PMC7279330 DOI: 10.3390/ijms21103616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/02/2022] Open
Abstract
The aim of this randomized, controlled animal exploratory trial was to investigate the influence of local application of aminobisphosphonate pamidronate during the socket preservation procedure. Mandibular premolars were extracted in five Göttingen minipigs. Two animals underwent socket preservation using BEGO OSS (n = 8 sockets) and three animals using BEGO OSS + Pamifos (15 mg) (n = 12 sockets). After jaw impression, cast models (baseline, eight weeks postoperative) were digitized using an inLab X5 scanner (Dentsply Sirona) and the generated STL data were superimposed and analyzed with GOM Inspect 2018 (GOM, Braunschweig). After 16 weeks, the lower jaws were prepared and examined using standard histological methods. In the test group (BEGO OSS + pamidronate), buccooral dimensional loss was significantly lower, both vestibulary (−0.80 ± 0.57 mm vs. −1.92 ± 0.63 mm; p = 0.00298) and lingually (−1.36 ± 0.58 mm vs. −2.56 ± 0.65 mm; p = 0.00104) compared with the control group (BEGO OSS). The test group showed a significant difference between vestibular and lingual dimensional loss (p = 0.04036). Histology showed cortical and cancellous bone in the alveolar sockets without signs of local inflammation. Adjuvant application of pamidronate during socket preservation reduces alveolar dimensional loss significantly. Further investigations with regard to dose–response relationships, volume effects, side effects, and a verification of the suitability in combination with other bone substitute materials (BSMs) are necessary.
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Affiliation(s)
- Frederic Kauffmann
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, 79106 Freiburg, Germany;
| | - Christian Höhne
- Department of Prosthodontics, Julius-Maximilians-University, 97070 Würzburg, Germany;
| | - Alexandre Thomas Assaf
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (A.T.A.); (T.V.); (J.S.); (R.S.)
| | - Tobias Vollkommer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (A.T.A.); (T.V.); (J.S.); (R.S.)
| | - Jan Semmusch
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (A.T.A.); (T.V.); (J.S.); (R.S.)
| | - Aline Reitmeier
- Department of Laboratory Animal Science, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Jamal Michel Stein
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital Aachen (RWTH), 52074 Aachen, Germany;
| | - Max Heiland
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, 14197 Berlin, Germany;
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (A.T.A.); (T.V.); (J.S.); (R.S.)
- Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Rico Rutkowski
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (A.T.A.); (T.V.); (J.S.); (R.S.)
- Correspondence: ; Tel.: +49-1522-2887432
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8
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Effects of local application of alendronate on early healing of extraction socket in dogs. Clin Oral Investig 2019; 24:1579-1589. [PMID: 31346723 DOI: 10.1007/s00784-019-03031-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/16/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the present study was to assess the effects of alendronate (ALN) on bone remodeling following tooth extraction in a dog model. MATERIAL AND METHODS For the study, fifteen male Beagles dogs of approximately 12 months of age were used. Mesial roots of four mandibular premolars were endodontically treated, and the distal roots were removed. ALN concentrations of 0.5, 1, and 2 mg/mL were topically applied for 15 min, while a sterile saline was used as a negative control. After the healing period of 1, 2, and 8 weeks, the samples were analyzed by micro-CT and histology. RESULTS Treatment with ALN increased vertical distance between the lingual and the buccal crestal bones. While the ALN-treated sockets had preserved more lingual bone areas, control sockets showed better preservation of the buccal bone areas. ALN treatment resulted in more osteoid formation within the extraction sockets compared with the control. Higher bone volume was found in ALN groups than in the control at 2-week and 8-week healing periods, reaching the significant difference only for the extraction sockets pooled for the ALN treatment. CONCLUSIONS Although ALN treatment could not prevent buccal bone resorption following tooth extraction in dogs, it proved beneficial for the preservation of the lingual bone and formation of new bone within the socket. There was no clear relation between the ALN dosages and the alterations within the extraction sockets. CLINICAL RELEVANCE ALN affects bone remodeling of the extraction socket. The optimal concentration remains to be determined in future studies.
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Bhadada SK, Pal R, Sood A, Dhiman V, Saini UC. Co-administration of Systemic and Intralesional Zoledronic Acid in a Case of Fibrous Dysplasia: A Potentially Novel Therapy. Front Endocrinol (Lausanne) 2019; 10:803. [PMID: 31803145 PMCID: PMC6877477 DOI: 10.3389/fendo.2019.00803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
Fibrous dysplasia (FD) is a benign bone lesion characterized by replacement of normal bone with abnormal fibrous tissue, clinically manifesting as deformities, bone pains, and pathological fractures. The standard medical management for FD includes systemic bisphosphonate therapy. The efficacy of systemic bisphosphonate is however limited with minimal functional improvement and pain relief. Keeping the above lacunae in mind, we have made a solitary attempt at treating FD with locally administered zoledronic acid. A 25-year-old gentleman had presented to our institute with swelling and pain involving the left thigh and left lower leg. He was diagnosed as having polyostotic FD, confirmed on bone histopathology. He was administered 4 mg of zoledronic acid intravenously while 1 mg of the drug was injected locally into the femoral lesion under ultrasound and fluoroscopy guidance. There were no peri-procedural complications. At 6 months follow-up, there was marked improvement in pain scores at the left thigh, while that at the left leg remained unchanged. In addition, repeat bone scintigraphy showed a 20.8% and 25.3% reduction in anterior and posterior uptake values, respectively, at the left femur while that at the left tibia remained unaltered.
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Affiliation(s)
- Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Sanjay Kumar Bhadada
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vandana Dhiman
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Uttam Chand Saini
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Alendronate release from calcium phosphate cement for bone regeneration in osteoporotic conditions. Sci Rep 2018; 8:15398. [PMID: 30337567 PMCID: PMC6194021 DOI: 10.1038/s41598-018-33692-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 10/03/2018] [Indexed: 01/14/2023] Open
Abstract
Osteoporosis represents a major health problem in terms of compromising bone strength and increasing the risk of bone fractures. It can be medically treated with bisphosphonates, which act systemically upon oral or venous administration. Further, bone regenerative treatments in osteoporotic conditions present a challenge. Here, we focused on the development of a synthetic bone substitute material with local diminishing effects on osteoporosis. Composites were created using calcium phosphate cement (CPC; 60 wt%) and polylactic-co-glycolic acid (PLGA; 40 wt%), which were loaded with alendronate (ALN). In vitro results showed that ALN-loaded CPC/PLGA composites presented clinically suitable properties, including setting times, appropriate compressive strength, and controlled release of ALN, the latter being dependent on composite degradation. Using a rat femoral condyle bone defect model in osteoporotic animals, ALN-loaded CPC/PLGA composites demonstrated stimulatory effects on bone formation both within and outside the defect region.
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11
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Cleemann R, Sorensen M, Bechtold JE, Soballe K, Baas J. Healing in peri-implant gap with BMP-2 and systemic bisphosphonate is dependent on BMP-2 dose-A canine study. J Orthop Res 2018; 36:1406-1414. [PMID: 28976594 DOI: 10.1002/jor.23766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/22/2017] [Indexed: 02/04/2023]
Abstract
The bone-implant interface of cementless orthopedic implants can be described as a series of uneven sized gaps with discontinuous areas of direct bone-implant contact. Bridging these voids and crevices by addition of an anabolic stimulus to increase new bone formation can potentially improve osseointegration of implants. Bone morphogenetic protein 2 (BMP-2) stimulates osteoblast formation to increase new bone formation but also indirectly stimulates osteoclast activity. In this experiment, we investigate the hypothesis that osseointegration, defined as mechanical push-out and histomorphometry, depends on the dose of BMP-2 when delivered as an anabolic agent with systemic administration of the anti-resorptive agent zoledronate to curb an increase in osteoclast activity. Four porous coated titanium implants (one with each of three doses of surface-applied BMP-2 (15 µg; 60 µg; 240 µg) and untreated) surrounded by a 0.75 mm empty gap, were inserted into the distal femurs of each of twelve canines. Zoledronate IV (0.1 mg/kg) was administered 10 days into the observation period of 4 weeks. Bone-implant specimens were evaluated by mechanical push-out test and histomorphometry. The 15 µg implants had the best fixation on all mechanical parameters and largest surface area covered with new bone compared to the untreated, 60 and 240 µg implants, as well as the highest volume of new bone in the implant gap compared to 60 and 240 µg implants. The results in a canine implant model demonstrated that a narrow range of BMP-2 doses have opposite effects in bridging an empty peri-implant gap with bone, when combined with systemic zoledronate. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1406-1414, 2018.
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Affiliation(s)
- Rasmus Cleemann
- Orthopaedic Research Laboratory, Aarhus University Hospital, Denmark.,Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Mette Sorensen
- Department of Orthopaedic Surgery, Regional Hospital Viborg, Viborg, Denmark
| | - Joan E Bechtold
- University of Minnesota Department of Orthopaedic Surgery, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Kjeld Soballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jorgen Baas
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Hong C, Quach A, Lin L, Olson J, Kwon T, Bezouglaia O, Tran J, Hoang M, Bui K, Kim RH, Tetradis S. Local vs. systemic administration of bisphosphonates in rat cleft bone graft: A comparative study. PLoS One 2018; 13:e0190901. [PMID: 29304080 PMCID: PMC5755940 DOI: 10.1371/journal.pone.0190901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022] Open
Abstract
A majority of patients with orofacial cleft deformity requires cleft repair through a bone graft. However, elevated amount of bone resorption and subsequent bone graft failure remains a significant clinical challenge. Bisphosphonates (BPs), a class of anti-resorptive drugs, may offer great promise in enhancing the clinical success of bone grafting. In this study, we compared the effects of systemic and local delivery of BPs in an intraoral bone graft model in rats. We randomly divided 34 female 20-week-old Fischer F344 Inbred rats into four groups to repair an intraoral critical-sized defect (CSD): (1) Control: CSD without graft (n = 4); (2) Graft/Saline: bone graft with systemic administration of saline 1 week post-operatively (n = 10); (3) Graft/Systemic: bone graft with systemic administration of zoledronic acid 1 week post-operatively (n = 10); and (4) Graft/Local: bone graft pre-treated with zoledronic acid (n = 10). At 6-weeks post-operatively, microCT volumetric analysis showed a significant increase in bone fraction volume (BV/TV) in the Graft/Systemic (62.99 ±14.31%) and Graft/Local (69.35 ±13.18%) groups compared to the Graft/Saline (39.18±10.18%). Similarly, histological analysis demonstrated a significant increase in bone volume in the Graft/Systemic (78.76 ±18.00%) and Graft/Local (89.95 ±4.93%) groups compared to the Graft/Saline (19.74±18.89%). The local delivery approach resulted in the clinical success of bone grafts, with reduced graft resorption and enhanced osteogenesis and bony integration with defect margins while avoiding the effects of BPs on peripheral osteoclastic function. In addition, local delivery of BPs may be superior to systemic delivery with its ease of procedure as it involves simple soaking of bone graft materials in BP solution prior to graft placement into the defect. This new approach may provide convenient and promising clinical applications towards effectively managing cleft patients.
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Affiliation(s)
- Christine Hong
- Section of Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, California, United States of America
- * E-mail:
| | - Alison Quach
- Section of Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Lawrence Lin
- UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Jeffrey Olson
- UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Taewoo Kwon
- UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Olga Bezouglaia
- Section of Oral and Maxillofacial Radiology, Division of Diagnostic and Surgical Sciences, UCLA, Los Angeles, California, United States of America
| | - Jaime Tran
- UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Michael Hoang
- Section of Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Kimberly Bui
- UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Reuben H. Kim
- Section of Restorative Dentistry, Division of Constitutive and Regenerative Sciences, UCLA, Los Angeles, California, United States of America
| | - Sotirios Tetradis
- Section of Oral and Maxillofacial Radiology, Division of Diagnostic and Surgical Sciences, UCLA, Los Angeles, California, United States of America
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13
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Kwon DH, Lee SJ, Wikesjö UME, Johansson PH, Johansson CB, Sul YT. Bone tissue response following local drug delivery of bisphosphonate through titanium oxide nanotube implants in a rabbit model. J Clin Periodontol 2017; 44:941-949. [PMID: 28703333 DOI: 10.1111/jcpe.12776] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate whether surface chemistry-controlled TiO2 nanotube structures may serve as a local drug delivery system for zoledronic acid improving implant-bone support. METHODS Twenty-four screw-shaped Ti implants with surface chemistry-controlled TiO2 nanotube structures were prepared and divided into a zoledronic acid-formatted test and a native control group. The implants were inserted into contra-lateral femoral condyles in 12 New Zealand White rabbits. Bone support was evaluated using resonance frequency analysis (RFA) and removal torque (RTQ), as well as histometric analysis following a 3-weeks healing interval. RESULTS Zoledronic acid-formatted TiO2 nanotube test implants showed significantly improved implant stability and osseointegration measured using RFA and RTQ compared with control (p < 0.05), and showed significantly enhanced new bone formation within the root of the threads compared with control (p < 0.05). CONCLUSIONS TiO2 nanotube implants may prove to be a significant delivery system for drugs or biologic agents aimed at supporting local bone formation. Additional study of candidate drugs/agents, optimized dosage and release kinetics is needed prior to evaluation in clinical settings.
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Affiliation(s)
- David H Kwon
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Periodontics, 618th Dental Company, Camp Humphreys, Pyeongtaek, Korea
| | - Sang J Lee
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Ulf M E Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Departments of Periodontics and Oral Biology, Augusta University
- Dental College of Georgia, Augusta, GA, USA
| | - Petra H Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carina B Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Young-Taeg Sul
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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15
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Shah NP, Nayee S, Pazianas M, Sproat C. Beyond ONJ – A review of the potential uses of bisphosphonates in dentistry. Br Dent J 2017; 222:727-730. [DOI: 10.1038/sj.bdj.2017.412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 01/06/2023]
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16
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Jakobsen T, Bechtold JE, Søballe K, Jensen T, Vestermark MT, Baas J. Local delivery of zoledronate from a poly (d,l-lactide)-coating increases fixation of hydroxy-coated implants. J Orthop Res 2017; 35:974-979. [PMID: 26925986 PMCID: PMC6338069 DOI: 10.1002/jor.23219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/23/2016] [Indexed: 02/04/2023]
Abstract
Initial secure implant fixation predicts long-term survival. Bisphosphonates are anti-resorptive agents. They have been shown to increase implant fixation. We investigated whether local delivery of zoledronate from a poly-d,l-lactide (PDLLA)-coating could improve fixation and osseointegration of hydroxy-apatite coated implants. Cylindrical hydroxy-apatite coated implants were bilaterally inserted press-fit into the proximal tibiae of 10 dogs. On one side the implant was coated with PDLLA containing zoledronate. The PDLLA coating was applied upon the hydroxy-apatite coating. We used the contralateral implant as control. This implant was not coated with a poly-d,l-lactide. Observation period was 12 weeks. We evaluated implant fixation with histomorphometry and biomechanical push-out test. Zoledronate resulted in an approximately threefold increase in all biomechanical parameters when comparing data with their respective controls. We found that zoledronate increased preservation of old lamellar bone and increased formation of new woven bone. This study indicates that local delivery of zoledronate from a PDDLA coating has the potential to increase implant fixation. Studies investigating different doses of zoledronate and longer follow-up are needed. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:974-979, 2017.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Joan E. Bechtold
- Orthopaedic Biomechanics Laboratory, Minneapolis Medical Research Foundation and University of Minnesota, Minneapolis, Minnesota
| | - Kjeld Søballe
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Thomas Jensen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Marianne T. Vestermark
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Jørgen Baas
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
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17
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Schilcher J, Palm L, Ivarsson I, Aspenberg P. Local bisphosphonate reduces migration and formation of radiolucent lines adjacent to cemented acetabular components. Bone Joint J 2017; 99-B:317-324. [PMID: 28249970 DOI: 10.1302/0301-620x.99b3.bjj-2016-0531.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/06/2016] [Indexed: 12/13/2022]
Abstract
AIMS Post-operative migration of cemented acetabular components as measured by radiostereometric analysis (RSA) has a strong predictive power for late, aseptic loosening. Also, radiolucent lines predict late loosening. Migration has been reduced by systemic bisphosphonate treatment in randomised trials of hip and knee arthroplasty. Used as a local treatment, a higher local dose of bisphosphonate can be achieved without systemic exposure. We wished to see if this principle could be applied usefully in total hip arthroplasty (THA). PATIENTS AND METHODS In this randomised placebo-controlled, double-blinded trial with 60 participants, we compressed gauze soaked in bisphosphonate solution (ibandronate) or saline against the acetabular bone bed immediately before cementing the acetabular component. RSA, classification of radiolucent lines, the Harris Hip Score (HHS) and the Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) were carried out at three-, six-, 12-, and 24-month follow-up. RESULTS Migration of the cemented acetabular component relative to the pelvis was reduced by movement almost half in the ibandronate group, when measured as maximum total point or as movement of the femoral head (p = 0.001 and 0.004, respectively). Radiolucent lines after one year were classified as absent, partial or complete, and correlated with treatment (rho 0.37; p = 0.004). Only three of 30 patients in the ibandronate group had complete lines, compared with 13 of 28 in the placebo group (p = 0.002). There were no significant effects on HHS or WOMAC score. CONCLUSION Considering the power of RSA to predict loosening of cemented acetabular components, and the likelihood that radiolucent lines indicate risk of loosening, these data suggest that local treatment with a bisphosphonate can reduce the risk of late aseptic loosening. Cite this article: Bone Joint J 2017;99-B:317-24.
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Affiliation(s)
| | - L Palm
- Linköping University, Linköping, Sweden
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18
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Bayat M, Garajei A, Afshari Pour E, Hasheminasab M, Ghorbani Y, Kalantar Motamedi MH, Bahrami N. The Effect of Locally Administered Pamidronate on Autogenous Bone Graft in Maxillofacial Reconstruction: A Randomized Clinical Trial. Int J Organ Transplant Med 2017; 8:43-47. [PMID: 28299027 PMCID: PMC5347405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although bone grafts are commonly used in reconstructive surgeries, they are sensitive to local perfusion and are thus prone to severe resorption. Biphosphonates can inactivate osteoclasts and can be used to control the undesirable bone resorption. OBJECTIVE To assess the effect of administration of biphosphonates on bone resorption. METHODS 20 patients with bony defects who were candidates for free autogenous grafts were randomized into "pamidronate" and "control" groups. Bone segments were soaked in either pamidronate solution or normal saline and were inserted into the area of the surgery. Bone densities were measured post-surgery and in 6-month follow-up. Data were obtained via Digora software and analyzed. RESULTS The mean±SD bone density in pamidronate group changed from 93.4±14.6 to 93.6±17.5 (p<0.05); in the control group the density decreased from 89.7±13.2 to 78.9±11.4 (p<0.05). The mean difference of bone density in anterior areas of the jaws showed higher DXA in comparison to posterior regions (p=0.002). CONCLUSION Locally administered pamidronate affects reduction in bone resorption.
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Affiliation(s)
- M. Bayat
- Craniomaxillofacial Research center, Tehran University of Medical Sciences, Tehran, Iran,Oral and Maxillofacial Surgery Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - A. Garajei
- Craniomaxillofacial Research center, Tehran University of Medical Sciences, Tehran, Iran,Oral and Maxillofacial Surgery Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - E. Afshari Pour
- Oral and Maxillofacial Surgery Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - M. Hasheminasab
- Oral and Maxillofacial Surgery Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Y. Ghorbani
- Department of Physiology, Islamic Azad University, Tehran, Iran
| | - M. H. Kalantar Motamedi
- Oral and Maxillofacial Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran,Attending Faculty, Department of Oral and Maxillofacial Surgery, Azad University of Medical Sciences, Dental College, Tehran, Iran
| | - N. Bahrami
- Craniomaxillofacial Research center, Tehran University of Medical Sciences, Tehran, Iran,Oral and Maxillofacial Surgery Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran,Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Dr. Naghmeh Bahrami, Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran, E-mail:
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19
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Gong T, Chen Y, Zhang Y, Zhang Y, Liu X, Troczynski T, Häfeli UO. Osteogenic and anti-osteoporotic effects of risedronate-added calcium phosphate silicate cement. Biomed Mater 2016; 11:045002. [DOI: 10.1088/1748-6041/11/4/045002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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20
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Pura JA, Bobyn JD, Tanzer M. Implant-delivered Alendronate Causes a Dose-dependent Response on Net Bone Formation Around Porous Titanium Implants in Canines. Clin Orthop Relat Res 2016; 474:1224-33. [PMID: 26831478 PMCID: PMC4814409 DOI: 10.1007/s11999-016-4714-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/14/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bony fixation of cementless orthopaedic implants is not always achieved, particularly in challenging scenarios such as revision surgery, trauma, and tumor reconstruction. An adjunct therapy for improving porous implant fixation could improve the reliability and durability of these reconstructive procedures. QUESTIONS/PURPOSES In this study, we asked whether there is a positive and dose-dependent effect of the local release of the bisphosphonate alendronate from (1) alendronate/hydroxyapatite (HA) porous-coated titanium implants compared with bare metal porous controls; and (2) alendronate/HA on porous-coated titanium implants compared with HA-coated porous controls with respect to extent of bone ingrowth, bone apposition, and periimplant bone formation in a canine model? METHODS Three-dimensional printed porous-coated cylindrical implants coated with three different doses (0.02, 0.06, and 0.18 mg/cm(2)) of alendronate were inserted bilaterally in the intramedullary canal of the proximal femora of 15 adult mongrel dogs (age range, 3-9 years; mean, 5 years) weighing between 36 kg and 60 kg (mean, 43 kg). In each dog, an implant coated with HA and one of three different doses of alendronate was inserted on one side while the contralateral femur had a bare metal porous control implant and an identical control implant with a coating of HA. The dose effect of locally released alendronate on the extent of bone ingrowth, bone apposition, and periimplant bone was assessed by backscattered electron microscopy of three pairs of cross-sections taken from each implant at 12 weeks after surgery. A linear mixed model was used to perform the statistical analyses to account for the correlation in the data resulting from the multiple measures performed on each dog. RESULTS Compared with paired bare metal controls, periimplant bone increased by 92% (p = 0.007), and 114% (p < 0.001) in the femora with the alendronate implants with a dose of 0.06 mg/cm(2), or 0.18 mg/cm(2), respectively. At a dose of 0.02 mg/cm(2), there was no difference (46% change; p = 0.184, with the numbers available). The comparison of the alendronate-dosed implants with their HA-coated controls showed that the intermediate dose of 0.06 mg/cm(2) alendronate had the greatest effect on net bone formation. Bone apposition was enhanced with the 0.06-mg/cm(2) alendronate femoral implants (82%; p = 0.008), although there was no change in bone ingrowth (37% change; p = 0.902, with the numbers available). When compared with the HA-coated control implants, the greatest effect of the alendronate-dosed implants was the increased amount of periimplant bone at the intermediate dose of 0.06-mg/cm(2) (108%, p = 0.009). There was no effect of the low (0.02-mg/cm(2)) and high (0.18-mg/cm(2)) alendronate-dosed implants (4%, and 6%, respectively; p = 0.321, p = 0.502). Overall, all three alendronate-dosed implants revealed little to no effect on bone ingrowth compared with the HA-coated control implants. CONCLUSIONS The local release of alendronate from a three-dimensional printed porous-coated implant from the three doses studied showed an overall improvement in bone apposition and periimplant bone at the intermediate dose compared with bare metal or with HA-coated controls, although the effect was more pronounced compared with bare metal. Long-term studies to show the effects of localized alendronate delivery and mechanical fixation would be the next step for future studies. CLINICAL RELEVANCE Local release of alendronate from a three-dimensional printed porous-coated implant may improve the reliability of cementless fixation of currently available porous-coated bare metal implants.
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Affiliation(s)
- Jenny Ann Pura
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, QC, Canada.
- Montreal General Hospital, 1650 Cedar Avenue, Room C9-136, Montreal, QC, H3G1A4, Canada.
| | - J Dennis Bobyn
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, QC, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Michael Tanzer
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, QC, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
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Jakobsen T, Bechtold JE, Søballe K, Jensen T, Greiner S, Vestermark MT, Baas J. Local delivery of zoledronate from a poly (D,L-lactide)-Coating increases fixation of press-fit implants. J Orthop Res 2016; 34:65-71. [PMID: 26177742 PMCID: PMC6326075 DOI: 10.1002/jor.22979] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 07/08/2015] [Indexed: 02/04/2023]
Abstract
Early secure fixation of total joint replacements is crucial for long-term survival. Antiresorptive agents such as bisphosphonates have been shown to increase implant fixation. We investigated whether local delivery of zoledronate from poly-D, L-lactide (PDLLA)-coated implants could improve implant fixation and osseointegration. Experimental titanium implants were bilaterally inserted press-fit into the proximal tibiae of 10 dogs. On one side the implant was coated with PDLLA containing zoledronate. The contralateral implant was uncoated and used as control. Observation period was 12 weeks. Implant fixation was evaluated with histomorphometry and biomechanical push-out test. We found an approximately twofold increase in all biomechanical parameters when comparing data from the zoledronate group with their respective controls. Histomorphometry showed increased amount of preserved bone and increased bone formation around the zoledronate implants. This study indicates that local delivery of zoledronate from a PDDLA coating has the potential to increase implant fixation.
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Affiliation(s)
- Thomas Jakobsen
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Joan E. Bechtold
- Orthopaedic Biomechanics Laboratory, Minneapolis Medical Research Foundation and University of Minnesota, Minneapolis, Minnesota
| | - Kjeld Søballe
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Jensen
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marianne T. Vestermark
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Baas
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
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Karlsson J, Harmankaya N, Allard S, Palmquist A, Halvarsson M, Tengvall P, Andersson M. Ex vivo alendronate localization at the mesoporous titania implant/bone interface. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:5337. [PMID: 25577217 DOI: 10.1007/s10856-014-5337-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/31/2014] [Indexed: 06/04/2023]
Abstract
An attractive approach in implant technology is local drug delivery, and design of efficient, safe and reliable treatments. Our hitherto strategy has been to coat Ti implants with a thin mesoporous TiO2 film that in turn is loaded with an osteoporosis drug, such as Alendronate (ALN) that is known to suppress osteoclastic activity. This system has proven highly successful and results in excellent osseointegration. However, more detailed information about drug-release and distribution at the bone/implant interface is needed. In this study, (14)C-ALN loaded titanium implants were placed up to 8 weeks into rat tibia and the spatial-temporal distribution of the drug was evaluated. Autoradiography data demonstrated a sustained release of (14)C-ALN and the released drug remained bound to bone in close vicinity, within 500 micrometers, of the implants. Liquid scintillation counting experiments confirmed that the distal transport of released (14)C-ALN was extremely low. The results are favorable as they show that ALN stays for a long time in the vicinity of the implant and may therefore improve for a long time the mechanical fixation of bone anchored implants. Moreover, these findings suggest due to the low systemic spreading a minimal risk of Alendronate related systemic side effects.
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Affiliation(s)
- Johan Karlsson
- Department of Chemical and Biological Engineering, Applied Chemistry, Chalmers University of Technology, Kemivägen 10, 412 96, Gothenburg, Sweden,
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Kettenberger U, Ston J, Thein E, Procter P, Pioletti DP. Does locally delivered Zoledronate influence peri-implant bone formation? – Spatio-temporal monitoring of bone remodeling in vivo. Biomaterials 2014; 35:9995-10006. [DOI: 10.1016/j.biomaterials.2014.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/01/2014] [Indexed: 11/27/2022]
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Bioactive coatings for orthopaedic implants-recent trends in development of implant coatings. Int J Mol Sci 2014; 15:11878-921. [PMID: 25000263 PMCID: PMC4139820 DOI: 10.3390/ijms150711878] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/11/2014] [Accepted: 06/16/2014] [Indexed: 01/21/2023] Open
Abstract
Joint replacement is a major orthopaedic procedure used to treat joint osteoarthritis. Aseptic loosening and infection are the two most significant causes of prosthetic implant failure. The ideal implant should be able to promote osteointegration, deter bacterial adhesion and minimize prosthetic infection. Recent developments in material science and cell biology have seen the development of new orthopaedic implant coatings to address these issues. Coatings consisting of bioceramics, extracellular matrix proteins, biological peptides or growth factors impart bioactivity and biocompatibility to the metallic surface of conventional orthopaedic prosthesis that promote bone ingrowth and differentiation of stem cells into osteoblasts leading to enhanced osteointegration of the implant. Furthermore, coatings such as silver, nitric oxide, antibiotics, antiseptics and antimicrobial peptides with anti-microbial properties have also been developed, which show promise in reducing bacterial adhesion and prosthetic infections. This review summarizes some of the recent developments in coatings for orthopaedic implants.
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Raita Y, Komatsu K, Nifuji A, Sato M, Morito M, Hayakawa T. Promotion of Bone Formation around Alendronate-immobilized Screw-Type Titanium Implants after Implantation into Rat Molar Tooth Sockets. J HARD TISSUE BIOL 2014. [DOI: 10.2485/jhtb.23.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Piscitelli P, Iolascon G, Innocenti M, Civinini R, Rubinacci A, Muratore M, D’Arienzo M, Leali PT, Carossino AM, Brandi ML. Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2013; 10:97-110. [PMID: 24133526 PMCID: PMC3797010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from "painful prosthesis", which currently represents a clinical problem. METHODS A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition. RESULTS Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ≥3) persisting for at least 4 months after surgery, or new onset of pain (VAS ≥3) after the first 4 months, lasting ≥2 months. Acute pain reported as VAS score ≥7 in patients who underwent TJA should be always immediately investigated. CONCLUSIONS The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention.
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Affiliation(s)
- Prisco Piscitelli
- University of Florence, Florence, Italy
- Euro Mediterranean Biomedical Scientific Institute, ISBEM, Brindisi, Italy
| | - Giovanni Iolascon
- Euro Mediterranean Biomedical Scientific Institute, ISBEM, Brindisi, Italy
| | | | | | - Alessandro Rubinacci
- Second University of Naples, Naples, Italy S. Raffaele Scientific Institute, Milan, Italy
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Production, quality control and pharmacokinetic studies of 177Lu–zoledronate for bone pain palliation therapy. J Radioanal Nucl Chem 2013. [DOI: 10.1007/s10967-013-2490-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abtahi J, Agholme F, Sandberg O, Aspenberg P. Effect of local vs. systemic bisphosphonate delivery on dental implant fixation in a model of osteonecrosis of the jaw. J Dent Res 2012; 92:279-83. [PMID: 23264610 DOI: 10.1177/0022034512472335] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Locally applied bisphosphonates may improve the fixation of metal implants in bone. However, systemic bisphosphonate treatment is associated with a risk of osteonecrosis of the jaw (ONJ). We hypothesized that local delivery of bisphosphonate from the implant surface improves the fixation of dental implants without complications in a setting where systemic treatment induces ONJ. Forty rats were randomly allocated to 4 groups of 10. All groups received a titanium implant inserted in an extraction socket. Group I received the implants only. Group II received dexamethasone (0.5 mg/kg). Group III received dexamethasone as above plus alendronate (200 µg/kg). Group IV received zoledronate-coated implants and dexamethasone as above. The animals were sacrificed 2 weeks after tooth extraction. All 10 animals with systemic alendronate treatment developed large ONJ-like changes, while all with local treatment were completely healed. Implant removal torque was higher for the bisphosphonate-coated implants compared with the other groups (p < 0.03 for each comparison). Micro-computed tomography of the maxilla showed more bone loss in the systemic alendronate group compared with groups receiving local treatment (p = 0.001). Local bisphosphonate treatment appears to improve implant fixation in a setting where systemic treatment caused ONJ.
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Affiliation(s)
- J Abtahi
- Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Linköping, Sweden.
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Abtahi J, Tengvall P, Aspenberg P. A bisphosphonate-coating improves the fixation of metal implants in human bone. A randomized trial of dental implants. Bone 2012; 50:1148-51. [PMID: 22348981 DOI: 10.1016/j.bone.2012.02.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/23/2012] [Accepted: 02/02/2012] [Indexed: 10/14/2022]
Abstract
Many surgical procedures use metal implants in bone. The clinical results depend on the strength of the bone holding these implants. Our objective was to show that a drug released from the implant surface can improve parameters reflecting the quality or amount of this bone. Sixteen patients received paired dental titanium implants in the maxilla, in a randomized, double-blinded fashion. One implant in each pair was coated with a thin fibrinogen layer containing 2 bisphosphonates. The other implant was untreated. Fixation was evaluated by measurement of resonance frequency (implant stability quotient; ISQ) serving as a proxy for stiffness of the implant-bone construct. Increase in ISQ at 6months of follow-up was the primary variable. None of the patients had any complications. The resonance frequency increased 6.9 ISQ units more for the coated implants (p=0.0001; Cohen's d=1.3). The average difference in increase in ISQ, and the effect size, suggested a clinically relevant improvement. X-ray showed less bone resorption at the margin of the implant both at 2months (p=0.012) and at 6months (p=0.012). In conclusion, a thin, bisphosphonate-eluting fibrinogen coating might improve the fixation of metal implants in human bone. This might lead to new possibilities for orthopedic surgery in osteoporotic bone and for dental implants.
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Affiliation(s)
- Jahan Abtahi
- Department of Oral & Maxillofacial Surgery, Linköping University Hospital, Sweden.
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30
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DUAN KE, HU YOUXIN, LONG KAREN, TOMS ANDREW, BURT HELENM, OXLAND THOMASR, MASRI BASA, DUNCAN CLIVEP, GARBUZ DONALDS, WANG RIZHI. EFFECT OF ALENDRONATE-CONTAINING COATINGS ON OSTEOINTEGRATION INTO POROUS TANTALUM IN A CORTICAL BONE MODEL. ACTA ACUST UNITED AC 2012. [DOI: 10.1142/s1793984411000414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hip replacement is extensively performed in hips with serious damages. The clinical outcomes of hip implants remain to be improved. Local delivery of bisphosphonates may improve implant fixation by positively affecting local bone modeling. In this study, two alendronate-containing coatings were prepared on porous tantalum by electrolytic deposition. Calcium phosphate coating was deposited and adsorbed with alendronate; the resulting coating had a low drug dose and slow release rate. Solid calcium alendronate coating was also deposited on tantalum; the resulting coating had high drug dose and faster release rate. The effects of the two coatings on new bone formation and implant fixation were studied in the rabbit tibial cortex. Four weeks after implantation, the implants with adsorbed alendronate showed the highest total new bone formation and mechanical fixation, whereas the implants with solid drug coating showed slightly lower fixation and total new bone formation than control bare implants. The improvement by the alendronate-adsorbed calcium phosphate coating provides potentials of enhancing early fixation of porous implants. The solid drug coating warranted further studies to exploit its high drug dose for inhibiting future osteolysis.
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Affiliation(s)
- KE DUAN
- Department of Materials Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - YOUXIN HU
- Department of Materials Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - KAREN LONG
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - ANDREW TOMS
- Department of Orthopaedics, University of British Columbia, Vancouver, BC V5Z 4E3, Canada
| | - HELEN M. BURT
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - THOMAS R. OXLAND
- Department of Orthopaedics, University of British Columbia, Vancouver, BC V5Z 4E3, Canada
| | - BAS A. MASRI
- Department of Orthopaedics, University of British Columbia, Vancouver, BC V5Z 4E3, Canada
| | - CLIVE P. DUNCAN
- Department of Orthopaedics, University of British Columbia, Vancouver, BC V5Z 4E3, Canada
| | - DONALD S. GARBUZ
- Department of Orthopaedics, University of British Columbia, Vancouver, BC V5Z 4E3, Canada
| | - RIZHI WANG
- Department of Materials Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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Qi M, Hu J, Li J, Li J, Dong W, Feng X, Yu J. Effect of zoledronate acid treatment on osseointegration and fixation of implants in autologous iliac bone grafts in ovariectomized rabbits. Bone 2012; 50:119-27. [PMID: 22023930 DOI: 10.1016/j.bone.2011.10.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/28/2011] [Accepted: 10/07/2011] [Indexed: 11/15/2022]
Abstract
One main problem associated with alveolar bone augmentation in implant dentistry is resorption of grafted bone, which may be further compromised by systemic skeletal disorders such as osteoporosis. Zoledronate acid (ZOL) is the most potent bisphosphonate to treat osteoporosis and therefore it is hypothesized to be able to invert the negative effect of osteoporosis on osseointegration and fixation of dental implants in autologous bone grafts. In this study, 56 rabbits received bilateral ovariectomy (OVX) (40 rabbits) or sham operation (16 rabbits). Three months later, 8 animals from each group were sacrificed for bone mineral density (BMD) examination. Then the remaining animals underwent bilateral autologous iliac bone grafting with simultaneous implantation of titanium implants in tibiae and were divided into 5 groups (n=8): Sham, OVX, Loc-ZOL (local treatment), Sys-ZOL (systemic treatment) and Loc+Sys-ZOL (local plus systemic) group. At 3 months after implantation, all animals were sacrificed and specimens were harvested for examinations. Both BMD and histological examinations of femurs showed osteoporotic changes after ovariectomy, while systemic treatment with ZOL restored mineralized bone. Micro-CT examination demonstrated that OVX group showed significant decrease of mineralized bone and implant-bone contact when compared with sham control, whereas both systemic and local treatments of ZOL significantly increased mineralized bone and implant-bone contact in ovariectomized animals. However, the best effects were observed in Loc+Sys-ZOL group (combined use of ZOL) and most of bone indices were similar to (IBCR, p>0.05) or higher than (BV/TV, Conn.D and Tb.N) (p<0.01) those of the sham group, except Tb.Th, which was still significantly lower (p<0.01), and Tb.Sp, which was further decreased (p<0.01). The aforementioned effects were also confirmed by histomorphometric analysis of bone indices on implant-bone contact and mineralized bone. In addition, biomechanical testing further supported the beneficial effect of ZOL treatment and maximal removal torque of titanium implants was observed in Loc+Sys-ZOL group. In conclusion, our study suggests that both systemic and local treatments with ZOL can invert negative effect of osteoporosis and promote osseointegration and fixation of dental implants in autologous bone grafts under osteoporotic condition. Combined systemic and local use of ZOL exerts best effects when compared to their single use.
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Affiliation(s)
- Mengchun Qi
- College of Stomatology, Hebei United University, Tangshan City 063000, China.
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