Biodegradable ceramic implants in bone. Electron and light microscopic analysis

Tricalcium Phosphate as a Bone Substitute to Treat Massive Acetabular Bone Defects in Hip Revision Surgery: A Systematic Review and Initial Clinical Experience with 11 Cases

The use of tricalcium phosphate (TCP) as a bone substitute is gaining increasing interest to treat severe acetabular bone defects in revision total hip arthroplasty (rTHA). The aim of this study was to investigate the evidence regarding the efficacy of this material. A systematic review of the literature was performed according to the PRISMA and Cochrane guidelines. The study quality was assessed using the modified Coleman Methodology Score (mCMS) for all studies. A total of eight clinical studies (230 patients) were identified: six on TCP used as biphasic ceramics composed of TCP and hydroxyapatite (HA), and two as pure-phase ceramics consisting of TCP. The literature analysis showed eight retrospective case series, of which only two were comparative studies. The mCMS showed an overall poor methodology (mean score 39.5). While the number of studies and their methodology are still limited, the available evidence suggests safety and overall promising results. A total of 11 cases that underwent rTHA with a pure-phase ceramic presented satisfactory clinical and radiological outcomes at initial short-term follow-up. Further studies at long-term follow-up, involving a larger number of patients, are needed before drawing more definitive conclusions on the potential of TCP for the treatment of patients who undergo rTHA.

β-tricalcium phosphate for bone substitution: Synthesis and properties

β-tricalcium phosphate (β-TCP) is one the most used and potent synthetic bone graft substitute. It is not only osteoconductive, but also osteoinductive. These properties, combined with its cell-mediated resorption, allow full bone defects regeneration. Its clinical outcome is sometimes considered to be "unpredictable", possibly due to a poor understanding of β-TCP physico-chemical properties: β-TCP crystallographic structure is not fully uncovered; recent results suggest that sintered β-TCP is coated with a Ca-rich alkaline phase; β-TCP apatite-forming ability and osteoinductivity may be enhanced by a hydrothermal treatment; β-TCP grain size and porosity are strongly modified by the presence of minute amounts of β-calcium pyrophosphate or hydroxyapatite impurities. The aim of the present article is to provide a critical, but still rather comprehensive review of the current state of knowledge on β-TCP, with a strong focus on its synthesis and physico-chemical properties, and their link to the in vivo response. STATEMENT OF SIGNIFICANCE: The present review documents the richness, breadth, and interest of the research devoted to β-tricalcium phosphate (β-TCP). β-TCP is synthetic, osteoconductive, osteoinductive, and its resorption is cell-mediated, thus making it one of the most potent bone graft substitutes. This comprehensive review reveals that there are a number of aspects, such as surface chemistry, crystallography, or stoichiometry deviations, that are still poorly understood. As such, β-TCP is still an exciting scientific playground despite a 50 year long history and > 200 yearly publications.

Enhanced new bone formation in canine maxilla by a graft of electrically polarized β-tricalcium phosphate

We succeeded in the electrical polarization of β-tricalcium phosphate (β-TCP) granules and performed an unprecedented attempt to implant them into maxillary bone defects in canines to confirm their ability to facilitate new bone formation. Two holes were drilled into each maxilla half of a canine and filled with electrically polarized and nonpolarized β-TCP granules (grouping assignment was decided randomly). The implanted specimens were dissected en bloc and used for microcomputed tomography (μCT) observations and histological analyses 4 and 8 weeks after the operation. New bone ingrowth in the bone hole progressed over time from the superficial layer of the cortex toward the inner cancellous bone. The percentage area of new bone in the bone hole, as measured by μCT in the sagittal plane, was significantly larger after 4 and 8 weeks, and that measured by H&E-stained specimens in the transverse plane after 4 weeks was significantly larger in the polarized group than in the nonpolarized group. In addition to the structural stability and chemical characteristics of the β-TCP granules, electrical stimulation bears influence not indirectly but directly on osteogenic and vessel cells, which might work cooperatively for the early initiation of the bone formation process.

Micro patterning of hydroxyapatite by soft lithography on hydrogels for selective osteoconduction

Mechanically robust hydrogels are promising biomaterials as artificial supportive tissue. These applications require selective and robust bonding of the hydrogels to living tissue. Recently, we achieved strong in vivo bone bonding of a tough double network (DN) hydrogel, a potential material for use as artificial cartilage and tendon, by hybridizing osteoconductive hydroxyapatite (HAp) in the gel surface layer. In this work, we report micro patterning of HAp at the surface of the DN hydrogel for selective osteoconduction. Utilizing the dissolution of HAp in an acidic environment, the soft lithography technique using an acid gel stamp was adopted to form a high-resolution HAp pattern on the gel. The HAp-patterned gel showed well-regulated migration and adhesion of cells in vitro. Moreover, the HAp-patterned gel showed selective and robust bonding to the rabbit bone tissue in vivo. This HAp soft lithography technique allows for simple and quick preparation of tailor-made osteoconductive hydrogels and can be applied to other hydrogels for selective bone bonding. STATEMENT OF SIGNIFICANCE: Hydrogels, preserving large amount of water, have been studied for next-generation artificial soft tissues. However, fixation of hydrogels to living tissue was unsolved issue for clinical application. Recently, we achieved robust bonding of a tough double network gel to bone in vivo by coating of osteoconductive hydroxyapatite in the gel surface layer. For further progress for practical use, we report the micro patterning of HAp at the surface of the DN hydrogel by using soft lithography technique, to perform selective bonding to only objective area without unnecessary coalescence. The HAp lithography technique is simple, quick and non-toxic method to prepare tailor-made osteoconductive hydrogels and has universality of species of hydrogels.

Settable polymer/ceramic composite bone grafts stabilize weight-bearing tibial plateau slot defects and integrate with host bone in an ovine model

Bone fractures at weight-bearing sites are challenging to treat due to the difficulty in maintaining articular congruency. An ideal biomaterial for fracture repair near articulating joints sets rapidly after implantation, stabilizes the fracture with minimal rigid implants, stimulates new bone formation, and remodels at a rate that maintains osseous integrity. Consequently, the design of biomaterials that mechanically stabilize fractures while remodeling to form new bone is an unmet challenge in bone tissue engineering. In this study, we investigated remodeling of resorbable bone cements in a stringent model of mechanically loaded tibial plateau defects in sheep. Nanocrystalline hydroxyapatite-poly(ester urethane) (nHA-PEUR) hybrid polymers were augmented with either ceramic granules (85% β-tricalcium phosphate/15% hydroxyapatite, CG) or a blend of CG and bioactive glass (BG) particles to form a settable bone cement. The initial compressive strength and fatigue properties of the cements were comparable to those of non-resorbable poly(methyl methacrylate) bone cement. In animals that tolerated the initial few weeks of early weight-bearing, CG/nHA-PEUR cements mechanically stabilized the tibial plateau defects and remodeled to form new bone at 16 weeks. In contrast, cements incorporating BG particles resorbed with fibrous tissue filling the defect. Furthermore, CG/nHA-PEUR cements remodeled significantly faster at the full weight-bearing tibial plateau site compared to the mechanically protected femoral condyle site in the same animal. These findings are the first to report a settable bone cement that remodels to form new bone while providing mechanical stability in a stringent large animal model of weight-bearing bone defects near an articulating joint.

Behavior of macrophage and osteoblast cell lines in contact with the β-TCP biomaterial (beta-tricalcium phosphate)

Beta-tricalcium phosphate (β-TCP) is a synthetic ceramic used for filling bone defects. It is a good alternative to autologous grafts since it is biocompatible, resorbable and osteoconductive. Previous in vivo studies have shown that macrophages are one of the first cells coming in contact with the biomaterial followed by osteoclasts and osteoblasts that will elaborate new bone packets. Studies have focused on osteoclast morphology and very few of them have investigated the role of macrophages. The aims of this study were to characterize (i) the biomaterial surface; (ii) the in vitro behavior of macrophages (J774.2 and Raw264.7 cells) using the description of cell morphology by scanning electron microscopy (SEM) at 7 and 14 days; (iii) the behavior of osteoblasts (SaOs-2 and MC3T3-E1 cells) seeded at the surface of the biomaterial 24, 48 and 72hours by SEM and confocal microscopy. Cell proliferation was analyzed by MTT assays. Viability and affinity of the macrophages for β-TCP were found significantly increased after 7 and 14d. MC3T3-E1 cells were anchored and stretched onto the β-TCP surface as early as 24h with a high proliferation rate (+190%) when compared to the surface of a well plate. SaOs-2 exhibited the same morphological profile at 72h. Proliferation became significantly higher compared to the plastic surface at only 72h (+129%). This study emphasises the importance of choice of the cell line used in exploring the osteoconductive and osteoinductive properties of a biomaterial. Additional studies are needed to analyze differentiation of macrophages into giant multinucleated cells and how the biomaterial surface influences osteoblast differentiation.

Calcium Phosphate Bioceramics: A Review of Their History, Structure, Properties, Coating Technologies and Biomedical Applications

Calcium phosphate (CaP) bioceramics are widely used in the field of bone regeneration, both in orthopedics and in dentistry, due to their good biocompatibility, osseointegration and osteoconduction. The aim of this article is to review the history, structure, properties and clinical applications of these materials, whether they are in the form of bone cements, paste, scaffolds, or coatings. Major analytical techniques for characterization of CaPs, in vitro and in vivo tests, and the requirements of the US Food and Drug Administration (FDA) and international standards from CaP coatings on orthopedic and dental endosseous implants, are also summarized, along with the possible effect of sterilization on these materials. CaP coating technologies are summarized, with a focus on electrochemical processes. Theories on the formation of transient precursor phases in biomineralization, the dissolution and reprecipitation as bone of CaPs are discussed. A wide variety of CaPs are presented, from the individual phases to nano-CaP, biphasic and triphasic CaP formulations, composite CaP coatings and cements, functionally graded materials (FGMs), and antibacterial CaPs. We conclude by foreseeing the future of CaPs.

Dissolution and drug release profiles of phosphate glasses doped with high valency oxides

This paper investigates phosphate glasses incorporating vanadium and molybdenum oxides for effective management of dissolution and drug release. These glass formulations are found to reduce the rate of dissolution from the glass surfaces. The drug functional groups of vancomycin molecules loaded by immersion showed stronger hydrogen bonding with Vanadium doped glasses and consequently lower rate of drug release over 2 weeks indicating better surface attachment with the drug molecules and slow drug release profiles. This can be explained by the strong adherence of drug molecules to glass surfaces compared with the molybdenum containing glasses (PM5 and PM10). The strong attachment relates to hydrogen bonding between the amino-functional groups of vancomycin and the hydrated P-O-H groups in the glass network. In conclusion, the rate of dissolution of doped glasses and the rate of drug release can be administered to deliver the drug molecules over weeks.

Precision in harsh environments

Microsystems are increasingly being applied in harsh and/or inaccessible environments, but many markets expect the same level of functionality for long periods of time. Harsh environments cover areas that can be subjected to high temperature, (bio)-chemical and mechanical disturbances, electromagnetic noise, radiation, or high vacuum. In the field of actuators, the devices must maintain stringent accuracy specifications for displacement, force, and response times, among others. These new requirements present additional challenges in the compensation for or elimination of cross-sensitivities. Many state-of-the-art precision devices lose their precision and reliability when exposed to harsh environments. It is also important that advanced sensor and actuator systems maintain maximum autonomy such that the devices can operate independently with low maintenance. The next-generation microsystems will be deployed in remote and/or inaccessible and harsh environments that present many challenges to sensor design, materials, device functionality, and packaging. All of these aspects of integrated sensors and actuator microsystems require a multidisciplinary approach to overcome these challenges. The main areas of importance are in the fields of materials science, micro/nano-fabrication technology, device design, circuitry and systems, (first-level) packaging, and measurement strategy. This study examines the challenges presented by harsh environments and investigates the required approaches. Examples of successful devices are also given.

Biomaterials in periodontal osseous defects

INTRODUCTION

Osseous defects in periodontal diseases require osseous grafts and guided tissue regeneration (GTR) using barrier membranes. The present study was undertaken with the objectives to clinically evaluate the osteogenic potential of hydroxyapatite (HA), cissus quadrangularis (CQ), and oxidized cellulose membrane (OCM) and compare with normal bone healing.

MATERIALS AND METHODS

Twenty subjects with periodontitis in the age group ranging from 20 years to 40 years were selected from our outpatient department on the basis of presence of deep periodontal pockets, clinical probing depth ≥5 mm, vertical osseous defects obvious on radiograph and two- or three-walled involvement seen on surgical exposure. Infrabony defects were randomly divided into four groups on the basis of treatment to be executed, such that each group comprised 5 defects. Group I was control, II received HA, III received CQ and IV received OCM. Probing depth and attachment level were measured at regular months after surgery. Defects were re-exposed using crevicular incisions at 6 months.

RESULTS

There was gradual reduction in the mean probing pocket depth in all groups, but highly significant in the site treated with HA. Gain in attachment level was higher in sites treated with HA, 3.2 mm at 6 months.

CONCLUSION

Hydroxyapatite and OCM showed good reduction in pocket depth, attachment level gain and osseous defect fill. Further study should be conducted by using a combination of HA and OCM in periodontal osseous defects with growth factors and stem cells.

Improvement of Compressive Properties of Porous HA Scaffold by Introducing PCL Secondary Phase

Continuous porous hydroxyapatite (HA) scaffold has been considered to be used in bone tissue engineering. However, the low fracture property of HA scaffold has been a problem to be solved. In the present study, polycaprolactone (PCL) was introduced as a secondary phase into the porous structure of HA scaffold to improve the low fracture property. HA scaffolds were firstly fabricated using the template method. The HA scaffolds were then coated with PCL by changing the solution concentration from 1 to 5 wt%. Compression tests and SEM were done to examine the mechanical properties and the morphology of the two-phase composite scaffolds. It was found that the compression strength and modulus increased with increasing PCL concentration. It is also noted that PCL coating can greatly improve the brittleness of pure HA scaffolds. XRD test was also done to study the phase stability of HA and the two-phase scaffolds. There was no chemical reaction between PCL and HA observed by the XRD results. On the overall, these results indicated that PCL coating can effectively improve the low fracture property of pure HA scaffold and the two-phase scaffold could be a potential candidate for bone regeneration.

A histomorphometric and micro-computed tomography study of bone regeneration in the maxillary sinus comparing biphasic calcium phosphate and deproteinized cancellous bovine bone in a human split-mouth model

OBJECTIVE

The gain of mineralized bone was compared between deproteinized bovine bone allograft (DBA) and biphasic calcium phosphate (BCP) for dental implant placement.

STUDY DESIGN

Five patients with atrophic maxillae underwent bilateral sinus elevation with DBA (Bio-Oss) and BCP (Straumann BoneCeramic). After 3 to 8 months, 32 Camlog implants were placed, and biopsies were retrieved. Bone and graft volume, degree of bone mineralization, and graft degradation gradient were determined using micro-computed tomography, and bone formation and resorption parameters were measured using histomorphometry. Implant functioning and peri-implant mucosa were evaluated up to 4 years.

RESULTS

Patients were prosthetically successfully restored. All but one of the implants survived, and peri-implant mucosa showed healthy appearance and stability. Bone volume, graft volume, degree of bone mineralization, and osteoclast and osteocyte numbers were similar, but BCP-grafted biopsies had relatively more osteoid than DBA-grafted biopsies.

CONCLUSIONS

The BCP and DBA materials showed similar osteoconductive patterns and mineralized bone, although signs of more active bone formation and remodeling were observed in BCP- than in DBA-grafted biopsies.

Evaluation of Apical Microleakage in Open Apex Teeth Using MTA Apical Plug in Different Sessions

Aim. To compare microleakage of apexification using MTA in one or two sessions. Materials and Methods. 88 single rooted teeth were prepared and divided into two groups then received MTA apical plug. In the first group, the teeth were immersed in normal saline for 24 hours and then backfilled with guttapercha and AH26 sealer. In the second group, the teeth were obturated immediately after receiving apical plug. Four positive and four negative controls were selected. All specimens were placed in 1% methylene blue and decalcified in 5% nitric acid and finally were placed in methyl salicylate until getting transparent. All teeth were visualized for assessment of dye penetration under stereo dissecting microscope. Results. 36 and 35 teeth showed dye leakage in the first and second groups. Dye penetration into the entire canal length was confirmed in the positive control group, and in the negative control group no dye penetration was seen. Mean dye penetration in the first and second group was 5813 and 9152  μ m. t-test revealed a significant difference between dye penetrations of two groups (P < 0.05). Conclusion. MTA requires adequate time for setting in the presence of the moisture, and final obturation should be delayed until final setting of MTA.

In vivo performance of microstructured calcium phosphate formulated in novel water-free carriers

Osteoinductive calcium phosphate (CaP) ceramics can be combined with polymeric carriers to make shapeable bone substitutes as an alternative to autologous bone; however, carriers containing water may degrade the ceramic surface microstructure, which is crucial to bone formation. In this study five novel tricalcium phosphate (TCP) formulations were designed from water-free polymeric binders and osteoinductive TCP granules of different particle sizes (500-1000 μm for moldable putty forms, and 150-500 μm for flowable paste forms). The performance of these novel TCP formulations was studied and compared with control TCP granules alone (both 150-500 and 500-1000 μm). In vitro the five TCP formulations were characterized by their carrier dissolution times and TCP mineralization kinetic profiles in simulated body fluid. In vivo the formulations were implanted in the dorsal muscle and a unicortical femoral defect (Ø=5 mm) of dogs for 12 weeks. The TCP formulation based on a xanthan gum-glycerol carrier exhibited fast carrier dissolution (1 h) and TCP mineralization (7 days) in vitro, but induced inflammation and showed little ectopic bone formation. This carrier chemistry was thus found to disrupt the early cellular response related to osteoinduction by microstructured TCP. TCP formulations based on carboxymethyl cellulose-glycerol and Polyoxyl 15-hydroxystearate-Pluronic(®) F127 allowed the in vitro surface mineralization of TCP by day 7 and produced the highest level of orthotopic bone bridging and ectopic bone formation, which was equivalent to the control. These results demonstrate that water-free carriers can preserve the chemistry, microstructure, and performance of osteoinductive CaP ceramics.

Histologic evaluation of human alveolar sockets treated with an artificial bone substitute material

This study involved a histologic, enzyme histologic, immunohistologic, and three-dimensional microstructure evaluating the extent of osteogenesis and repair in the human alveolar extraction socket achievable with an artificial bone substitute. After tooth extraction in 7 patients, extraction sockets were filled with Mastergraft (15% hydroxyapatite, 85% β-tricalcium phosphate complex). Radiomicrographs and histologic examinations were performed on samples obtained during dental implant placement procedure. On micro-computed tomography, new bone was observed in all collected samples, and osteogenesis was observed to have taken place around the artificial bone substitute. Histologically, active osteogenesis was found throughout the region observed. Addition of new bone around the Mastergraft was observed, and osteoblast-like cells were present. Cells that had partially invaded the artificial bone included tartrate-resistant acid phosphate-positive and CD34-positive cells. These findings indicate that the Mastergraft artificial bone induced osteogenesis in the jawbone and seemed effective for repairing bone defects.

How bone forms in large cancellous defects: critical analysis based on experimental work and literature

The behaviour of physiological biomaterials, β-tricalciumphosphate and hydroxyapatite, is analysed based on current literature and our own experimental work. The properties of graft substitutes based on ceramic materials are clearly defined according to their scientific efficiency. The strength of the materials and their biodegradability are still not fully evaluated. Strength and degradability have a direct proportional relationship and are considered the most efficient way to be adapted by their properties to the needs for the treatment of bone defects. New technologies for the manufacturing process are presented that increase those properties and thus open up new indications and easier application of the ceramic materials. The implantation process as well is carefully validated by animal experiments to avoid failures. Based on the experiments, a completely new approach is defined as to how primary bone formation with osteoconductive ceramics can be achieved. The milestones in that approach comprise a synthetically manufactured replica of the bone marrow spaces as osteoconductive ladder, whereas the bead is defined as bone-forming element. As a result, materials are available with high strength if the ceramic is solid or highly porous and possesses a micro-structure. The injection moulding process allows for the combination of high strength of the material with high porosity. Based on the strong capillary forces, micro-chambered beads fulfil most expectations for primary bone formation in cancellous bone defects, including drug delivery, mechanical strengthening if necessary, and stable implantation in situ by coagulation of the blood and bone marrow suctioned in.

Healing of extraction sockets filled with BoneCeramic® prior to implant placement: preliminary histological findings

BACKGROUND

Various grafting materials have been designed to minimize edentulous ridge volume loss following tooth extraction by encouraging new bone formation in healing sockets. BoneCeramic® is a composite of hydroxyapatite and bèta-tricalcium phosphate with pores of 100-500 microns.

PURPOSES

The aim of this study was to evaluate bone regeneration in healing sockets substituted with BoneCeramic® prior to implant procedures.

MATERIALS AND METHODS

Fifteen extraction sockets were substituted with BoneCeramic® and 14 sockets were left to heal naturally in 10 patients (mean age 59.6 years). Biopsies were collected only from the implant recipient sites during surgery after healing periods ranging from 6-74 weeks (mean 22). In total, 24 biopsies were available; 10 from substituted and 14 from naturally healed sites. In one site, the implant was not placed intentionally and, in four substituted sites, implant placement had to be postponed due to inappropriate healing, hence from five sites biopsies were not available. Histological sections were examined by transmitted light microscope.

RESULTS

At the time of implant surgery, bone at substituted sites was softer than in controls, compromising initial implant stability. New bone formation at substituted sites was consistently poorer than in controls, presenting predominantly loose connective tissue and less woven bone.

CONCLUSION

The use of BoneCeramic® as a grafting material in fresh extraction sockets appears to interfere with normal healing processes of the alveolar bone. On the basis of the present preliminary findings, its indication as a material for bone augmentation, when implant placement is considered within 6-38 weeks after extraction, should be revised.

Periodontal regeneration in experimentally-induced alveolar bone dehiscence by an improved porous biphasic calcium phosphate ceramic in beagle dogs

Regeneration of lost periodontium is the focus of periodontal therapy. To achieve the effective regeneration, a number of bone graft substitute materials have been developed. This study aimed to investigate the histological response in alveolar bone dehiscences which were filled with an improved biphasic calcium phosphate (BCP) ceramic with more reasonable pore diameter, pore wall thickness and porosity. Twenty-four alveolar bone dehiscences were made surgically in twelve beagle dogs by reflecting mucoperiosteal flaps on the buccal aspect of bilateral lower second premolars and removing alveolar bone. The left dehiscences were treated with BCP ceramic and the contralaterals were cured with the open flap debridement (OFD) as controls. Three dogs were used at week 4, 12, and 24 respectively. Histological observations were processed through three-dimensional micro-computed tomographic imaging, fluorescence and light microscopy. The histological study indicated that the biphasic ceramic was biocompatible, and regeneration was achieved more effectively through the BCP treatment. There were also arrest of epithelial migration apically and formation of new bone and cementum, as well as proliferation of fibrous connective tissues that became attached to the newly formed cementum at week 24, while there was no significant periodontal regeneration in the OFD group only with epithelial tissue migrating into the dehiscence regions. Clinically speaking, though the surgical location formed a limitation to the application of the improved BCP on the periodontal regeneration, the actual result was positive. It proved that the BCP had biocompatibility and was able to act as a stable scaffold to induce periodontal regeneration effectively.

Electron microscopic study on bone formation and bioresorption after implantation of beta-tricalcium phosphate in rabbit models

BACKGROUND

The role of bone formation and bioresorption in an early stage after implantation of beta-tricalcium phosphate (beta-TCP) was investigated using scanning and transmission electron microscopy (SEM, TEM).

METHODS

The ceramic beta-TCP cylinders were implanted into cavities drilled in the femoral condyles of eight NZW rabbits. Four of the rabbits were sacrificed at 2 weeks and four at 4 weeks after implantation, respectively. The femoral condyles were excised to prepare the specimens for SEM and TEM.

RESULTS

SEM showed giant cells of more than 20 mum in diameter were observed on the surface of beta-TCP at 2 weeks after implantation. TEM demonstrated that collagen fibrils secreted from the monocytic cells invaded beta-TCP micropores at 2 weeks. Multinucleated giant cells (MNGCs) were in contact with the surface of beta-TCP at 2 weeks. Some of them had a ruffled border (RB) at the cell-substrate interface, characteristic of osteoclasts.

CONCLUSIONS

These findings suggest that cell-mediated disintegration by osteoclasts played a role in the bioresorption of beta-TCP at an early stage after implantation. In addition, the micropores of beta-TCP ceramic may provide an environment for collagen formation, leading to the deposition of apatite crystals. Therefore, the micropores facilitate bone ingrowth as well as ceramic resorption.

Upgrading Calcium Phosphate Scaffolds for Tissue Engineering Applications

The research on ceramic scaffolds for bone tissue engineering is, nowadays, one of the newest and most attractive topics in the field of materials for biomedical applications. These scaffolds are aimed to provide supporting or even enhance the reparative capacity of body. Biphasic calcium phosphates (BCPs) and silicon doped BCP are very interesting candidates to be used as materials for scaffolds fabrication in bone tissue engineering. BCPs and silicon doped BCP consist of a mixture of hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) or HA and α-tricalcium phosphate (α-TCP), respectively. For the regenerative purposes BCPs show better performance than HA because of the higher solubility of β-TCP compound, which facilitate the subsequent bone ingrowth in the implant. On the other, silicon doped BCP involve silicon that substituted into the apaptite crystal lattice for phosphorous with the subsequent charge imbalance. HA/α-TCP based bioceramics exhibits an important improvement of the bioactive behaviour with respect to non-substituted apatites. This work reviews the procedures to synthesise and fabricate scaffolds based on HA/β-TCP and silicon stabilised HA/α-TCP. Special attraction has been paid in the different synthesis methods and to the shaping of final scaffolds. By knowing the scaffold features at the crystallinity and macrostuctural level, the biocompatibility and clinical performance can be better understood, which will be also considered in this review.

Histological and histomorphometric investigations on bone integration of rapidly resorbable calcium phosphate ceramics

Resorbable ceramics can promote the bony integration of implants. Their rate of degradation should ideally be synchronized with bone regeneration. We report here the results of a histological study of implants with two resorbable calcium phosphate ceramic coatings: Ca(2)KNa(PO(4))(2)-(GB14) and Ca(10)[K/Na](PO(4))(7)-(602020). The results attained with these ceramic-coated implants show the benefits of these materials with regard to bioactive bone-healing stimulation, compared with uncoated implants. The GB14 ceramic coating exhibited greater bone regeneration and differentiation on its surface than the conventional hydroxyapatite coating and helped bone tissue achieve more extensive contact free of connective tissue. Not until the coating disintegrated did the histological features of GB14- and 602020-coated implants converge-both implant types were integrated into bone. Rapid disintegration of the coating material, as with 602020, supports osteoblast proliferation but has negative effects on bone mineralization. Both resorbable ceramics tested, GB14 and 602020, demonstrated bioactivity; even metal surfaces coated with these materials were populated by mature bone tissue without connective tissue after disintegration of their ceramic coating. The less rapidly degrading material, GB14, achieved better results. Degradable calcium phosphate coatings have the potential to stimulate bone regeneration. From the histological viewpoint, the resorbable ceramics examined here can be recommended as coating materials for clinical use.

Histological and histomorphometrical comparative study of the degradation and osteoconductive characteristics of α- and β-tricalcium phosphate in block grafts

The purpose of the present study was to compare alpha- and beta-tricalcium phosphate (TCP) as bone graft material for augmenting highly resorbed alveolar ridges. The cranial bones of 15 rabbits were used. Three titanium chambers filled with porous blocks of alpha-TCP, beta-TCP, or blood clots were placed in each slit. The two TCP blocks had similar inner/outer structures and purities. Animals were sacrificed after 2, 4, and 8 weeks. Specimens were embedded in polyester resin as nondecalcified specimens, and evaluated both histologically and histomorphometrically. In both TCP groups, blocks had hardly degraded at 2 weeks while in the alpha-TCP group, the block had notably started degrading after 4 weeks. In the beta-TCP group, degradation began at 4 weeks and this degradation had increased just slightly after 8 weeks. The alpha-TCP block degraded significantly more than the beta-TCP block. Residual alpha-TCP particles surrounded by newly formed bone decreased over time, and both particles and newly formed bone were simultaneously absorbed by osteoclast-like cells. These observations suggest that residual alpha-TCP particles surrounded by newly formed bone may disappear progressively from bone and could be incorporated into the bone remodeling cycle in combination with newly formed bone.

Bone Formation on the Apatite-coated Zirconia Porous Scaffolds within a Rabbit Calvarial Defect

Previously, a strong and bioactive ceramic scaffold consisting of a porous zirconia body coated with apatite double layers (fluorapatite (FA) as an inner layer and hydroxyapatite (HA) as an outer layer) was successfully fabricated. In this contribution, the authors investigate the in vivo performance of the engineered bioceramic scaffolds using a rabbit calvarial defect model. In particular, the porosity and pore size of the scaffolds are varied in order to observe the geometrical effects of the scaffolds on their bone formation behaviors. The scaffolds supported on a zirconia framework can be produced with an extremely high porosity (~84—87%), while retaining excellent compressive strength (~7—8 MPa), which has been unachievable in the case of pure apatite scaffolds (~74% porosity with ~2MPa strength).

The experimental groups used in this study include three types of zirconia scaffolds coated with apatite; high porosity (~87%) with large pore size (~500— 700 μm): AZ-HL, high porosity (~84%) with small pore size (~150—200 μm): AZ-HS, and low porosity (~75%) with large pore size (~500—700 μm): AZ-LL, as well as one type of HA porous scaffold: low porosity (~74%) with a large pore size (~500—700 μm) for the purpose of comparison. The scaffolds prepared with dimensions of ~ 10 mm (diameter) × 1.2 mm (thickness) are grafted in rabbit calvaria defects. The histological sections are made at 4 and 12 weeks after surgery and immunohistochemical analyses are performed on the samples.

All of the specimens show a good healing response without adverse tissue reactions. Good healing is shown at 4 weeks post-surgery with the ingrowth of new bone into the macropore-channels of the scaffolds. The newly formed bone amounts to ~19.9—24.2% of the initial defect area, depending on the scaffold type, but there is no statistical significance between the scaffold groups. However, the defects without the scaffolds (control group) show a significantly lower bone formation ratio (~4.3%). At twelve weeks after surgery, the extent of new bone formation is more pronounced in all of the scaffold groups. All of the scaffold groups show significantly higher bone formation ratios (26.7—46.9%) with respect to the control without the graft. In the comparison between the scaffold groups, those with high porosities (AZ-HL and AZ-HS) exhibit significantly higher bone formation as compared to the scaffold with low porosity (AZ-LL).

Based on the present in vivo test performed within a rabbit calvaria defect model, it is concluded that the apatite-coated zirconia scaffolds show good bone forming ability and are considered to be a promising scaffolding material for bone regeneration since they possess a high level of both mechanical and biological properties.

Subacute systemic toxicity assessment of beta-tricalcium phosphate/carboxymethyl-chitin composite implanted in rat femur

The efficacy of a composite of beta-tricalcium phosphate particles and carboxymethyl-chitin (beta-TCP/CM-chitin) for bone repair has already been established in animal experiments. In the present study, subacute systemic toxicity was evaluated to further assess the biological safety of the implanted composite. beta-TCP/CM-chitin (approximately 4 mg/kg and 7 mg/kg in male and female rats, respectively) was implanted for 28 days into penetrating defects (2 mm diameter) made artificially in the shaft of the right femur of rats. Sham operation groups with the defect only were prepared as controls. Haematology, blood chemistry, urinalysis, and the histopathology of 44 organs and tissues were investigated. Body weight measurements and clinical observations were performed daily throughout the study. No subacute systemic toxicity possibly caused by the implantation of beta-TCP/CM-chitin was detected. These findings indicate that beta-TCP/CM-chitin composite is a highly biocompatible bone substitute, at least with an implantation dosage of < 4-7 mg/kg.

Expression of bone morphogenetic protein 2 and fibroblast growth factor 2 during bone regeneration using different implant materials as an onlay bone graft in rabbit mandibles

OBJECTIVES

The purpose of this study was to histologically and immunohistochemically evaluate bone regeneration using 3 different implant materials in rabbit mandibles and to compare the bone regenerative capability of these materials in an animal model.

STUDY DESIGN

Adult male Japanese white rabbits (n = 48; 12-16 wks old; 2.5-3.0 kg) were divided into 4 groups, consisting of 12 animals each. The implant materials were beta-tricalcium phosphate (beta-TCP), autologous bone derived from the radius, and recombinant human bone morphogenetic protein 2 (rhBMP-2) with polylactic acid/polyglycolic acid copolymer and gelatin sponge (PGS) complex. After incising along the inferior border of the mandible, the materials were implanted as only grafts and covered by titanium mesh with screws. No material was implanted into the control group. The rabbits were killed at 2, 4, 8, 12, and 24 wks postoperatively, and formalin-fixed specimens containing titanium mesh were embedded in acrylic resin. The specimens were stained with hematoxylin and eosin. For immunohistochemical analysis, the specimens were treated with BMP-2 and fibroblast growth factor 2 (FGF-2) antibodies. Finally, they were examined microscopically.

RESULTS

The autologous bone induced substantially more new bone formation compared with beta-TCP at 4 wks postoperatively. However, rhBMP-2/PGS induced new bone formation at 8 wks postoperatively. No growth of bony tissue was observed in the control group at any period. In the autologous bone and rhBMP-2/PGS groups, both BMP-2 and FGF-2 were observed later in the beta-TCP group than in other groups.

CONCLUSION

This study suggests that autologous bone as well as rhBMP-2/PGS implants induce expression of both BMP-2 and FGF-2 specifically at the operated sites, even at early stages.

The engineering of craniofacial tissues in the laboratory: a review of biomaterials for scaffolds and implant coatings

Tissue engineering is a rapidly growing interdisciplinary field that focuses on the interactions between cells, growth factors, and scaffolds to produce replacement tissue and organs. Recent developments in tissue engineering technology include refinements in isolation and differentiation of progenitor cells, 3-D printing technology to produce scaffolds, new biomaterials for scaffolds, and growth factor delivery systems. The purpose of this article is to review advances in biomaterials, scaffolds, and implant coatings for craniomaxillofacial (bone) tissue engineering.

Ectopic osteoinduction and early degradation of recombinant human bone morphogenetic protein-2-loaded porous β-tricalcium phosphate in mice

The present study investigated the ectopic osteoinduction and early degradation of recombinant human bone morphogenetic protein-2 (rhBMP-2)-loaded porous beta-tricalcium phosphate (beta-TCP) in mice. The porous beta-TCP with 50 microg of rhBMP-2 (n = 25) and porous beta-TCP (control group, n = 25) were implanted into muscle pouches in the right and left thigh of 28-day-old mice (n = 25), respectively. At every time point (3, 7, 14, 21 and 28 days after implantation), five mice were euthanized and the histological examinations of implantation sites were performed. In addition, the alkaline phosphatase (ALP) activity was also quantitatively analyzed. For the rhBMP-2-loaded group, blood vessel formation and immature cartilage was observed within the porous beta-TCP 3 days after implantation. Mature cartilage was observed 7 days after implantation of rhBMP-2-loaded porous beta-TCP. Newly formed woven bone, lamellar bone as well as marrow were observed 14 and 21 days after implantation of the rhBMP-2-loaded porous beta-TCP. Lamellar bone and marrow were observed 28 days after implantation of the rhBMP-2-loaded porous beta-TCP. For the control group, no bone or cartilage was observed at all time points. However, multinucleated giant cells and fibrous tissues were observed in the control group at 7 and 28 days after implantation, respectively. At 21 and 28 days after implantation, porous beta-TCP was observed to fragment indicating early degradation of the porous beta-TCP in both groups. In addition, ALP was observed to be significantly higher in the rhBMP-2-loaded beta-TCP as compared to the control beta-TCP. It was concluded from this study that the rhBMP-2-loaded porous beta-TCP induced blood vessel and ectopic bone formation.

In vitro cytocompatibility assessment of beta-tricalcium phosphate/carboxymethyl-chitin composite

A novel bioabsorbable bone substitute composed of a beta-tricalcium phosphate (beta-TCP) and a carboxymethyl-chitin (CM-chitin) sodium has been developed. Rabbit tibia defects (4 mm in diameter) were repaired after 4 weeks more effectively by the composite compared with a sham-operation group. To further investigate the biological safety of the components, genotoxicity and carcinogenicity of an extract prepared from the composite were determined using four different in vitro assays. The main extract component was identified as CM-chitin sodium [average molecular weight (Mw) approximately 230 kDa] as determined by Fourier transform infrared spectroscopy and gel permeation chromatography analysis. The concentrations of P and Ca possibly derived from beta-TCP were 17.7 and 37.1 microg/g, respectively, as determined by inductively coupled plasma mass spectroscopy. Both the metabolic activation and nonactivation (-S9) systems of the rat microsome S9 fraction were used to perform a genotoxicity evaluation using the Ames test and chromosome aberration assay on Chinese hamster lung fibroblast cells treated with the extract. In these assays, no genotoxicity was detected with doses < or =5 mg/mL (maximum concentration). The cell transformation assay using BALB/c 3T3 cells and the metabolic cooperation assay with V79 cells both showed negative results for any tumor-promoting activity caused by the extract (approximately 5 mg/mL). These results indicate that the bioabsorbable beta-TCP/CM-chitin composite is a highly biocompatible bone substitute.

Experimental study of bone formation around a titanium rod with beta-tricalcium phosphate and prostaglandin E2 receptor agonists

beta-Tricalcium phosphate (beta-TCP) is an excellent bone-filling material that is completely absorbed by the body and replaced by autologous bone. Unfortunately, its mechanical strength is low, rendering its application at loaded regions difficult. The purpose of this study is to evaluate the histological and mechanical effects of single and combined use of beta-TCP and EP4 agonist on bone formation around a titanium rod. beta-TCP was loaded into the femoral bone marrow from the distal end of the femur, where the titanium implants were inserted, and the animals received twice-daily subcutaneous injections of EP4 agonist. Group I received the rod only and was designated the control group; group II received EP4 agonist only; group III received beta-TCP only; and group IV received both beta-TCP and EP4 agonist. Examination of decalcified specimens revealed favorable bone formation in all treatment groups compared with that in group I, with the most active bone formation seen in group IV. Mechanical evaluation revealed significant differences in maximum pull-out force compared with group I at weeks 4 and 8. There were no differences between groups II and III at either week 4 or 8, but the values seen in group IV at weeks 4 and 8 were significantly higher compared with the other groups. Combined use of beta-TCP and EP4 agonist is expected to compensate for bone defects resulting from revision total joint arthroplasty and to achieve stability at an early stage.

In-Vitro Evaluation of Microleakage of an Orthograde Apical Plug of Mineral Trioxide Aggregate in Permanent Teeth with Simulated Immature Apices

This in vitro study evaluated the seal created by varying depths of mineral trioxide aggregate (MTA) plugs placed in an orthograde fashion in five groups of 10 teeth. One group received a 2 mm thick orthograde apical plug of MTA, the second group a 5 mm apical MTA plug, and the third group a 2 mm apical MTA plug with a second 2 mm increment, 24 h later. The remaining portion of the canal in these groups was left unfilled. Group four received a 2 mm MTA plug that set for 24 h and the canal was then back-filled with gutta-percha and eugenol based sealer. Group five was a positive control without an MTA plug. The apical seal was tested using a bacterial leakage model of Actinomyces viscosus. Results showed a statistically significant difference in only the 5 mm apical plug, which completely prevented bacterial leakage.

Effects on bone formation in ovariectomized rats after implantation of tooth ash and plaster of Paris mixture

PURPOSE

Our goal was to report on tooth ash and plaster of Paris mixture in bone defects in an ovariectomized rat osteoporosis model.

MATERIALS AND METHODS

Sixty rats were randomly assigned to 4 groups and each group was further divided into 3 subgroups: 4, 8, and 16 weeks after implantation. The defect was filled with different grafting conditions as follows: group 1, ovariectomy and nongraft group; group 2, ovariectomy and tooth ash-plaster graft group; group 3, nonovariectomy and nongraft group; and group 4, nonovariectomy and tooth ash-plaster graft group. Histologic sections and histomorphometric analysis of defects were obtained 4, 8, and 16 weeks after surgery.

RESULTS

For the 4-week ovariectomy group, there was significantly greater bone formation in tooth ash-plaster group compared with the nongraft group. In the nonovariectomy group, the tooth ash-plaster group also showed better bone formation than the nongraft group. However, there was no statistical significance. In both the ovariectomy and nonovariectomy groups, a significant increase in bone formation was observed according to the elapse of time. The nonovariectomy group showed increased new bone formation compared with the ovariectomy group, with the tooth ash-plaster group showing statistical significance in each subgroup (P =.048).

CONCLUSIONS

Ovariectomy acts as a negative factor in new bone formation. For a critical size bony defect, the tooth ash-plaster treatment of the osseous defect produces more stable, effective, and rapid new bone formation.

Hydroxyapatite/poly(ε-caprolactone) composite coatings on hydroxyapatite porous bone scaffold for drug delivery

Hydroxyapatite (HA) porous scaffold was coated with HA and polycaprolactone (PCL) composites, and antibiotic drug tetracycline hydrochloride was entrapped within the coating layer. The HA scaffold obtained by a polymeric reticulate method, possessed high porosity ( approximately 87%) and controlled pore size (150-200 microm). Such a well-developed porous structure facilitated usage in a drug delivery system due to its high surface area and blood circulation efficiency. The PCL polymer, as a coating component, was used to improve the brittleness and low strength of the HA scaffold, as well to effectively entrap the drug. To improve the osteoconductivity and bioactivity of the coating layer, HA powder was hybridized with PCL solution to make the HA-PCL composite coating. With alteration in the coating concentration and HA/PCL ratio, the morphology, mechanical properties, and biodegradation behavior were investigated. Increasing the concentration rendered the stems thicker and some pores to be clogged; as well increasing the HA/PCL ratio made the coating surface be rough due to the large amount of HA particles. However, for all concentrations and compositions, uniform coatings were formed, i.e., with the HA particles being dispersed homogeneously in the PCL sheet. With the composite coating, the mechanical properties, such as compressive strength and elastic modulus were improved by several orders of magnitude. These improvements were more significant with thicker coatings, while little difference was observed with the HA/PCL ratio. The in vitro biodegradation of the composite coatings in the phosphate buffered saline solution increased linearly with incubation time and the rate differed with the coating concentration and the HA/PCL ratio; the higher concentration and HA amount caused the increased biodegradation. At short period (<2 h), about 20-30% drug was released especially due to free drug at the coating surface. However, the release rate was sustained for prolonged periods and was highly dependent on the degree of coating dissolution, suggesting the possibility of a controlled drug release in the porous scaffold with HA+PCL coating.

Effect of biphasic calcium phosphates on drug release and biological and mechanical properties of poly(?-caprolactone) composite membranes

Poly(epsilon-caprolactone) (PCL) and biphasic calcium phosphate (CaP) composite membranes were prepared for use in tissue regeneration by a novel solvent casting-pressing method. An antibiotic drug, tetracycline hydrochloride (TCH), was entrapped within the membranes to investigate the efficacy of the material as a drug delivery system. The CaP powders were varied in amount (0-50 wt %) and in powder characteristics by heat treating at different temperatures, and their effects on the mechanical and biological properties and drug release of the membranes were examined. With CaP addition up to 30 wt %, the elastic modulus of the membranes was enhanced much due to the rigidity of CaP. While the tensile strength and elongation rate decreased gradually with CaP addition because the CaP powders acted as a failure source. The osteoblast-like cells cultured on the CaP-PCL composite membranes exhibited significant improvements in proliferation and alkaline phosphatase (ALP) activity compared to pure PCL and culture plastic control, indicating excellent cell viability and functional activity. The TCH drugs were released from the PCL and CaP-PCL membranes in a similar fashion; an initial burst followed by a reduced release rate. The initial burst effect diminished much by the addition of CaP powders. The CaP addition increased the drug release rate after an initial period, and this was attributed to the high water uptake capacity and dissolution of the CaP containing membranes. Compared to the composite membranes containing heat-treated CaP powders, those with as-precipitated ones had higher dissolution and drug releases. These observations on mechanical properties and cellular responses as well as on drug release profiles suggested that the CaP-PCL composite membranes are potentially applicable to tissue regeneration and drug delivery system.

Bone formation and bioresorption after implantation of injectable ?-tricalcium phosphate granules-hyaluronate complex in rabbit bone defects

The objective of this study was to evaluate the effects of a complex of beta-tricalcium phosphate (beta-TCP) granules and 3.5% hyaluronate (beta-TCP granules-HY complex) compared with a beta-TCP block, in terms of osteoconductivity and biodegradability, to determine whether this complex would be a good candidate for bone void filler. Both materials were implanted into cavities drilled in rabbit femoral condyles. New bone formation and mineral apposition rate were evaluated to analyze osteoconductivity, whereas residual beta-TCP within the defects and tartrate-resistant acid phosphatase (TRAP) cellular activity were studied for beta-TCP resorption. The results show that both the beta-TCP block and the beta-TCP granules-HY complex support bone ingrowth; however, bioresorption was rapid for beta-TCP granules-HY but weak for beta-TCP block. This biodegradation mechanism was considered to be a cell-mediated disintegration by numerous TRAP-positive giant cells. The time lag between the peak value of TRAP-positive giant cell population and that of new bone formation rate suggests that a coupling-like phenomenon could be occurring in the beta-TCP-filled bone defects. In addition, beta-TCP granules-HY complex, which is an injectable, pastelike material, has similar osteoconductive properties to beta-TCP block. Thus, this complex may be useful as a bone filler in clinical application.

Hard-tissue-engineered zirconia porous scaffolds with hydroxyapatite sol-gel and slurry coatings

A zirconia (ZrO(2)) porous scaffold was coated with a gradient apatite layer to induce osteoconductivity with the use of a combination of sol-gel and powder slurry methods. The ZrO(2) was used to impart mechanical strength and the apatite layer was coated for functional biocompatibility. The coating layer, from the outside in, was composed of sol-gel hydroxyapatite (HA)/slurry HA/slurry FA. The sol-gel coating powder had a lower crystallinity than the slurry coating powder. The sol-gel HA coating over the HA/FA slurry coating layer made the surface very smooth. The sol-gel coating over the slurry coating layer enhanced the bonding strength up to 33 MPa. The dissolution rate of the sol-gel/slurry coating layer was much higher than that of the slurry coating. Moreover, the rate could be controlled by altering the heat-treatment temperature of the sol-gel HA layer. The MG63 cells cultured on these materials grew and spread in a different manner, depending on the coating layer. However, the proliferation rates of the cells on both coating systems were not much different.

Porous ZrO2 bone scaffold coated with hydroxyapatite with fluorapatite intermediate layer

Highly porous zirconia (ZrO(2)) bone scaffolds, fabricated by a replication technique using polymeric sponge, were coated with hydroxyapatite (HA). To prevent the chemical reactions between ZrO(2) and HA, an intermediate fluorapatite (FA) layer was introduced. The strength of the porous ZrO(2) was higher than that of pure HA by a factor of 7, suggesting the feasibility of ZrO(2) porous scaffolds as load-bearing part applications. The coated HA/FA layer, with a thickness of about 30 microm, was firmly adhered to the ZrO(2) body with a bonding strength of 22MPa. The osteoblast-like cells were attached and spread well on the coating layer throughout the porous scaffolds. The alkaline phosphatase activity of the proliferated cells on the HA/FA coated ZrO(2) was comparable to that on pure HA and higher than that on pure ZrO(2).

Histological examination of beta-tricalcium phosphate graft in human femur

Prominent osteoconductive activity and the biodegradable nature of beta tricalcium phosphate (beta-TCP) for bone grafts in animal experiments has been reported. A new type of beta-TCP has been manufactured at extraordinarily high purity and has been available as potent bone grafting substitute for clinical use. The histological features of grafted beta-TCP in human bone have been analyzed. A 33-year-old female with a bone tumor of the proximal femur underwent curettage and beta-TCP graft under the diagnosis of probable benign fibrous dysplasia. Four weeks later, the proximal femur, including the grafted beta-TCP was resected because of the final diagnosis of the curettaged materials was osteosarcoma. The resected specimen revealed abundant direct new bone apposition on beta-TCP. There was no cartilaginous tissue or enchondral ossification. Bone formation was more prominent in the periphery of the grafted area than in the center. There was a considerable number of osteoclast-like giant cells surrounding the beta-TCP. This case illustrated that highly purified beta-TCP had prominent osteoconductive activity and biodegradable nature in human bone.

Local treatment of Dacron patch graft contaminated with Staphylococcus aureus with antibiotic-releasing porous apatite ceramic: an experimental study in the rabbit

OBJECTIVE

The purpose of this study was to investigate whether or not infection of prosthetic vascular graft could be prevented with the placement of antibiotic-loaded porous apatite ceramic on the graft with bacterial contamination.

METHODS

Teicoplanin as an antibiotic was loaded into a beta-tricalcium phosphate (TCP) block of porous apatite ceramic. The activity of teicoplanin released from teicoplanin-loaded TCP was examined for 40 days at 2-day intervals. In an in vivo study, the graft was patched in the abdominal aorta of a rabbit. Two different doses of Staphylococcus aureus were applied (n = 13). Teicoplanin-loaded TCP was placed around the graft infected with S aureus (n = 6). The graft, the tissue around it, and the arterial blood were collected and cultivated 4 weeks after operation.

RESULTS

The activity of teicoplanin in the replaced saline solution was maintained for at least 40 days. Because graft infection was established in all rabbits with a dose of 2 x 10(7) colony forming units, this dose was used as the dose of S aureus in this study. Fifty-seven percent of the subjects died from the infection. When teicoplanin-loaded TCP was placed around the graft contaminated with S aureus, no rabbits died. Bacterial cultures of the graft and of tissues around it were negative in all rabbits killed 4 weeks after operation. This infection was prevented with teicoplanin-loaded TCP in all rabbits.

CONCLUSION

Teicoplanin-loaded TCP may be useful in avoiding Dacron graft infection with S aureus in rabbits.

Intramedullary anchoring strength of titanium rod with mixed beta-tricalcium phosphate and fibrin adhesive

Histological and biomechanical studies were conducted in Japanese white rabbits to evaluate the effect of mixed beta-tricalcium phosphate (beta-TCP) and fibrin adhesive on bone formation around a titanium rod in femoral bone marrow. The animals received injections of fibrin adhesive with beta-TCP or hydroxyapatite into the femoral bone marrow from the distal end of the femur, where a titanium rod was inserted. Group I received fibrin adhesive only, group II received fibrin adhesive and hydroxyapatite (HA), and group III received fibrin adhesive and beta-TCP. On the examination of nondecalcified specimens, group III showed cross-bridging bone formation between beta-TCP particles at week 8, this being observed earlier than in group II. On mechanical evaluation, group III showed significant differences in maximum pull-out force at week 8, and in modulus of rigidity at week 24, compared with the other groups. On the examination of decalcified specimens, chronic inflammation was clearly identified in group I at week 8, and residual beta-TCP particles were found in group III at week 24. These results suggest that the mixture given to group III filled bone defects around the rod and promoted bone formation at a relatively early stage. Inflammation and delayed absorption of beta-TCP, which appeared to be a reaction of heterologous fibrins, caused delays in bone formation promoted by beta-TCP. Nevertheless, the use of fibrin adhesive appears to be a feasible method for loading powdered beta-TCP.