In vitro interaction between primary bone organ cultures, glass-ionomer cements and hydroxyapatite/tricalcium phosphate ceramics

The role of poly(acrylic acid) in conventional glass polyalkenoate cements

Glass polyalkenoate cements (GPCs) have been used in dentistry for over 40 years. These novel bioactive materials are the result of a reaction between a finely ground glass (base) and a polymer (acid), usually poly(acrylic acid) (PAA), in the presence of water. This article reviews the types of PAA used as reagents (including how they vary by molar mass, molecular weight, concentration, polydispersity and content) and the way that they control the properties of the conventional GPCs (CGPCs) formulated from them. The article also considers the effect of PAA on the clinical performance of CGPCs, including biocompatibility, rheological and mechanical properties, adhesion, ion release, acid erosion and clinical durability. The review has critically evaluated the literature and clarified the role that the polyacid component of CGPCs plays in setting and maturation. This review will lead to an improved understanding of the chemistry and properties of the PAA phase which will lead to further innovation in the glass-based cements field.

Microtomographic evaluation of the bone-cell interactions with a silorane-based composite

The low-shrink Silorane-based composite could bond effectively to bone and showed the potential be used as a bone cement. Bone organ culture maintains the anatomical order, natural cell-to-cell and cell-to-matrix relationship. The purpose of this study was to evaluate the responses of bone cells to a Silorane-based composite which was compared with a representative polymethyl methacrylate (PMMA) bone cement. The critical size defects were created through the parietal bones from one litter of mice. The paired bones were divided into two groups: Silorane-based composite group and PMMA group. The prepared two groups of disks were put into the defects. The cultures were grown in vitro for 38 days and analyzed with microcomputed-tomography, dissecting-microscope, phase- contrast-microscope, scanning-electron-microscopy, and energy- dispersive-X-ray. At the 10th day, the Silorane disk was almost fully covered by a sheet of cells but the cells hardly attached to the disk surface. The edge of the PMMA disk was covered by a sheet of cells and the migrated individual cells attached to the whole surface of the disk. At the 38th day, some cells attached to the exposed disk area of the Silorane disk while the formed tissues covered the whole surface of the PMMA disk. The collagen fibers, globular deposits and bone formation were visible in both groups. The Silorane-based composite showed promise as a potential bone cement when compared with PMMA which is used in clinical orthopedics. However, the cell attachment to PMMA was evidently better than to Silorane-based composite.

In vitro Characteristics of a Glass Ionomer Cement

Glass ionomer cements were first described by Wilson and Kent and have been used in dentistry since 1969. It has been recommended for bridging ossicular chain defects, fixation of ossicular chain prosthesis, anchoring of cochlear implants, mastoid obliteration, and repair of tegmen and posterior canal wall defects. The biocompatability and stability of this material over time is vital to its usefulness in neurotologic surgery. The purpose of this study was to assess the stability of a glass ionomer cement in the presence of bacteria and in different pH environments. We demonstrated that bacteria readily adhere to the surface and their presence is associated with accelerated loss of matrix. We found the cement to be susceptible to low pH and to release a visible cloud of debris upon contact with fluid. Calcium concentration in the solution was elevated at all pH levels. Although we are able to demonstrate these findings in vitro the clinical relevance is unclear. There have been several cases of aseptic meningitis possibly due to intracranial release of components of the cement. Until further studies are done use of the cement in contact with cerebral spinal fluid should be avoided. This cement, or a similar material, would be useful in neurotologic surgery but prior to widespread use further testing should be done to assess safety.

In vitro cellular adhesion and antimicrobial property of SiO2-MgO-Al2O3-K2O-B2O3-F glass ceramic

The aim of the present study was to examine the cellular functionality and antimicrobial properties of SiO(2)-MgO-Al(2)O(3)-K(2)O-B(2)O(3)-F glass ceramics (GC) containing fluorophlogopite as major crystalline phase. The cellular morphology and cell adhesion study using human osteoblast-like Saos-2 cells and mouse fibroblast L929 cells reveals good in vitro cytocompatibility of GC. The potential use of the GC for biomedical application was also assessed by in vitro synthesis of the alkaline phosphatase (ALP) activity of Saos-2 cells. It is proposed that B(2)O(3) actively enhances the cell adhesion and supports osteoconduction process, whereas, fluorine component significantly influences cell viability. The Saos-2 and L929 cells on GC shows extensive multidirectional network of actin cytoskeleton. The in vitro results of this study illustrate how small variation in fluorine and boron in base glass composition influences significantly the biocompatibility and antimicrobial bactericidal property, as evaluated using a range of biochemical assays. Importantly, it shows that the cell viability and osteoconduction can be promoted in glass ceramics with lower fluorine content. The underlying reasons for difference in biological properties are analyzed and reported. It is suggested that oriented crystalline morphology in the lowest fluorine containing glass ceramic enhanced cellular spreading. Overall, the in vitro cell adhesion, cell flattening, cytocompatibility and antimicrobial study of the three different compositions of glass ceramic clearly reveals that microstructure and base glass composition play an important role in enhancing the cellular functionality and antimicrobial property.

Histomorphometric assessment of bone formation in sinus augmentation utilizing a combination of autogenous and hydroxyapatite/biphasic tricalcium phosphate graft materials: at 6 and 9 months in humans

OBJECTIVE

The aim of this study was to examine the efficacy of a new biphasic hydroxyapatite/tricalcium phosphate (HA/TCP) bone substitute in combination with particulate autogenous bone in sinus floor augmentation procedures.

MATERIAL AND METHODS

A simultaneous or a two-stage sinus augmentation and implant placement were conducted in 28 patients. A mixture of HA/TCP and autogenous bone chips in a 1 : 1 ratio was used as the grafting biomaterial. Cylindrical specimen bone retrieval was performed in all patients except one. Specimens were harvested either at 6 (n=14) or 9 (n=13) months post-augmentation. For histologic and histomorphometric evaluations, the non-decalcified tissue processing (Donath's technique) was performed.

RESULTS

Newly formed bone around the grafted particles was found in all samples. The encircling, highly cellular bone followed the outline of the grafted particles in direct contact. Both woven and lamellar types of bone were observed. Morphometrically, the total mean bone area fraction of all sections was 34.8+/-10.3%, increasing from 28.6+/-7.8% at 6 months to 41.6+/-8.3% at 9 months (P<0.001). Mean particle area fraction average was 25.5+/-11.6% and 23.5+/-9.3% at 6 and 9 months, respectively, with a total mean of 24.5+/-10.4%. The increase in bone area fraction was not significantly correlated to the decrease of the grafted particles area fraction.

CONCLUSIONS

The biphasic HA/TCP showed biocompatible and osteoconductive properties. This alloplast as a composite with autogenous bone chips promotes newly formed bone, which increases in its fraction along an extended healing period.

Biocompatibility of glass-ionomer bone cements

Glass-ionomer cements (GIC) have been extensively used in dentistry for over 30 years. Due to their excellent biocompatibility in dental applications GIC have been formulated for medical applications. The past decade has seen some impressive advances in the development of medical GICs, however these advances have been matched by serious critical problems. This review examines the properties of GICs, which can influence their behaviour in a biological environment. The progress made and the problems encountered in the development of these bone cements will also be addressed. The review will conclude with the research currently being employed to optimise the biocompatibility of these important biomaterials. There is little doubt that GICs compare favourably with alternative bone cements for specific applications, based on in vitro and in vivo studies. There is however, a degree of risk inherent in the use of any medical device or biomaterial. GICs must therefore be used carefully and in accordance with the instructions that are based on a significant body of research data.

Osteoblastic differentiation of cultured rat bone marrow cells on hydroxyapatite with different surface topography

Hydroxyapatite (HA) has been used in orthopedic, dental, and maxillofacial surgery as a bone substitute.

OBJECTIVE

The aim of this investigation was to study the effect of surface topography produced by the presence of microporosity on the response of the rat bone marrow cells, evaluating: cell attachment, proliferation, total protein content, alkaline phosphatase (ALP) activity, and bone-like nodule formation.

METHODS

Cells were cultured on HA discs manufactured by a combination of uniaxial powder pressing and different sintering conditions, with different percentage of microporosity (<5%-HA5, 15%-HA15, and 30%-HA30). For attachment evaluation, cells were cultured for 2 h. Proliferation was evaluated after 7 and 14 days. After 14 days, total protein content and ALP activity were measured. For bone-like nodule formation, cells were cultured for 21 days. Data were compared by ANOVA and Duncan's multiple range test when appropriate.

RESULTS

Cell attachment was not affected by surface topography (p=0.37). Proliferation (p=0.001), total protein content (p=0.039), ALP activity (p=0.050), and bone-like nodule formation (p=0.00001) were all significantly decreased by the most irregular surface (HA30). SIGNIFICANCE. These results suggest that initial cell events were not affected by the surface topography of the HA. However, intermediary and final events such as proliferation, protein synthesis, ALP activity, and bone-like nodule formation favored surfaces with a more regular topography, such as that presents in HA with 15% or less of microporosity.

Surface reactivity of calcium phosphate based ceramics in a cell culture system

Surface reactivity of Calcium Phosphate materials--Hydroxyapatite (HA), Tricalcium Phosphate (beta-TCP), Hydroxyapatite-Tricalcium Phosphate (HA-TCP) were elucidated in a cell culture system. MG-63 osteoblast-like cells were seeded onto the ceramic discs to evaluate changes in the cell morphology and functionality with respect to the different substrates. The dissolution and re-precipitation of calcium phosphate phases on the surface of the discs in the culture medium was found to be prominent on beta-TCP when compared with HA. Low calcium (Ca), magnesium (Mg) and alkaline phosphatase (ALP) levels and high phosphorous (P) levels in the medium of beta-TCP were observed. This indicated that P must have leached out into the medium from beta-TCP and Ca in turn deposited from the medium onto beta-TCP resulting in the apatite phase transformation. The low ALP activity in beta-TCP medium is however an indication of low osteoblastic activity. Under the phase contrast microscope, the osteoblast cells around HA material were found to be confluent and viable, while in the vicinity of beta-TCP only cellular debris was observed. In the case of HA-TCP, only a few viable cells surrounded the material amidst the debris. Scanning electron microscopy revealed numerous cells on the surface of HA showing different cell behaviour like anchorage, attachment, adhesion and spreading in the early time period as the surface was only slightly disturbed with re-crystallisation. But with time the entire surface of HA had changed due to precipitation and re-crystallization which did not support cell behaviour while the cells surrounding the material showed normal growth. On the contrary, cells were scarcely observed on the entirely changed surface of beta-TCP and HA-TCP even from the earlier days of the culture and the morphology of cells surrounding the material too started changing. These results establish that HA promoted the activity of osteoblast cells. HA surface remained unaltered for some time, while the surface of beta-TCP underwent dissolution of surface ions and resulted in the re-crystallization of apatite over the surface. The resulting changes in the surrounding milieu of beta-TCP with high phosphate and low Ca levels probably was responsible for the death of the cells.

Experimental studies on a new bioactive material: HAIonomer cements

The lack of exotherm during setting, absence of monomer and improved release of incorporated therapeutic agents has resulted in the development of glass ionomer cements (GICs) for biomedical applications. In order to improve biocompatibility and biomechanically match GICs to bone, hydroxyapatite-ionomer (HAIonomer) hybrid cements were developed. Ultra-fine hydroxyapatite (HA) powders were produced using a new induction spraying technique that utilizes a radio-frequency source to spheriodize an atomized suspension containing HA crystallites. The spheriodized particulates were then held at 800 degrees C for 4 h in a carbolite furnace using a heating and cooling rate of 25 degrees C/min to obtain almost fully crystalline HA powders. The heat-treated particles were characterized and introduced into a commercial glass ionomer cement. 4 (H4), 12 (H12) and 28 (H28) vol% of fluoroalumino silicate were substituted by crystalline HA particles that were dispersed using a high-speed dispersion technique. The HAIonomer cements were subjected to hardness, compressive and diametral tensile strength testing based upon BS6039:1981. The storage time were extended to one week to investigate the effects of cement maturation on mechanical properties. Commercially available capsulated GIC (GC) and GIC at maximum powder:liquid ratio (GM) served as comparisons. Results were analyzed using factorial ANOVA/Scheffe's post-hoc tests and independent samples t-test at significance level 0.05. The effect of time on hardness was material dependent. With the exception of H12, a significant increase in hardness was observed for all materials at one week. A significant increase in compressive strength was, however, observed for H12 over time. At 1 day and 1 week, the hardness of H28 was significantly lower than for GM, H4, and H12. No significant difference in compression and diametral tensile strengths were observed between materials at both time intervals. Results show that HAIonomers is a promising material, which possess good mechanical properties. Potential uses of this new material include bone cements and performed implants for hard tissue replacement in the field of otological, oral-maxillofacial and orthopedic surgery.

Grooves affect primary bone marrow but not osteoblastic MC3T3-E1 cell cultures

To elucidate the influence of microtextures on bone cell performance, primary adult rat bone marrow cells (RBMC) and osteoblastic MC3T3-E1 cells were cultured on tissue culture pretreated plates to which grooves at different density were applied. RBMC cells were found to be significantly affected by grooves in the substratum in contrast to osteoblastic MC3T3-E1 cells, taking culture morphology, total cell number, cell mass, and cell activity (MTT-dehydrogenase), parameter for differentiation of osteoblast progenitor cells into (pre-)osteoblasts (alkalinephosphatase activity, ALP) and tartrate-resistant acid phosphatase (TRAP) activity as indices. TRAP is located in lysosomes and secretory granules mainly although not solely in osteoclasts. By applying grooves to and/or by chemical treatment of unpretreated pure polysterene plates it could be concluded that the effects on RBMC cells were evoked not only by the presence of grooves but also by the surface chemistry of the grooved and ungrooved surface areas.

Osteogenic evaluation of glutaraldehyde crosslinked gelatin composite with fetal rat calvarial culture model

The cytotoxicity of the synthetic bone substitute composed of tricalcium phosphate and glutaraldehyde crosslinked gelatin (GTG) were evaluated by osteoblast cell culture. In a previous study, the GTG composites were soaked in distilled water for 1, 2, 4, 7, 14, 28, and 42 days, and then the solutions (or extracts) were cocultured with osteoblasts to evaluate the cytotoxicity of GTG composites by alive cell counting. In this study, the extracts were cocultured with the osteoblasts; thereafter, the concentration of transforming growth factor-beta (TGF-beta1) and prostaglandin E2 (PGE2) in the medium was analyzed to strictly reflect the biological effects of GTG composites on the growth of osteoblasts. In order to investigate the osteoconductive potential of the GTG composites on new bone formation in a relative short term, a model of neonatal rat calvarial organ culture was designed prior to animal experiments. Three experimental materials of 4, 8, and 12% GTG composites were evaluated by fetal rat calvarial organ culture for their ability for bone regeneration. Deproteinized bovine and porcine cancellous bone matrixes were used as the controlled materials. All the organ culture units were maintained in cultured medium for 5 weeks. Following the culture period, the morphology of tissue was observed under an optical microscope, and the quantitative evaluation of the new generation bone was determined by using a semiautomatic histomorphometeric method. Except in the initial 4 days, the concentration of TGF-beta1 of 4% and 8% GTG composites was higher than that of the blank group for all the other experimental time periods. The PGE2 concentration for 4% and 8% GTG composites was lower than that of the blank group. It revealed that the 4% and 8% GTG composites would not lead to inflammation and would promote osteoblast growth. The morphology and activity of the osteoblasts were not transformed or changed by the 2 GTG composites. For the 12% GTG composite, the performance of the in vitro condition was inferior to the blank group and the other 2 GTG composites. Although the concentration of TGF-beta1 and PGE2 was gradually back to normal after 14 days, the morphology of the osteoblasts was abnormal with features such as contracted cytoplast structures. The osteoblast was damaged perhaps in the initial stage. We suggested that the 4% and 8% GTG composites should be soaked in distilled water at least for 4 days before medical applications. The 12% GTG composite and the composites with a concentration of glutaraldehyde solution higher than 12% were not recommended as a medical prostheses in any condition. The fetal rat calvaria culture also showed the same results with the analysis of TGF-beta1 and PGE2. From the study, we could predict the results of animal experiments in the future.

Proliferation, morphology, and protein expression by osteoblasts cultured on poly(anhydride-co-imides)

In vitro cell biocompatibility models are crucial in the study of any newly synthesized material. Our focus has been on the development of a new class of biocompatible, degradable, high-strength polymeric materials, the poly(anhydride-co-imides), for use in bone regeneration. This study examined osteoblast cell adherence, proliferation, viability, and phenotypic preservation on the surface of the poly(anhydride-co-imide) poly[pyromellitylimidoalanine (PMA-ala):1,6-bis(carboxyphenoxy) hexane (CPH)] over a period of time. Cell proliferation on PMA-ala:CPH degradable matrices over 21 days was examined. Throughout the 21-day period of study, osteoblast proliferation was similar on PMA-ala:CPH and on tissue culture polystyrene controls. Osteoblasts maintained their characteristic morphology as demonstrated by both scanning electron microscopy and immunofluorescence studies. Alkaline phosphatase activity for cells grown on PMA-ala:CPH was confirmed. Retention of the osteoblastic phenotype was demonstrated using immunofluorescence techniques and staining with antibodies against osteocalcin (an extracellular matrix protein of bone) and osteopontin (a marker of cell adhesion). Radioimmunoassay results provided evidence that levels of osteocalcin production by osteoblasts were similar when cells were cultured on PMA-ala:CPH and on tissue culture polystyrene controls. The present study provided evidence of normal osteoblast function on PMA-ala:CPH surfaces. PMA-ala:CPH may therefore be useful as a synthetic material for orthopedic applications.

Repair of a root resorption lesion. A case report

An extensive root surface lesion that presented both supra- and subgingival components was successfully treated with the use of glass ionomer cement to restore the lesion, and facilitate subsequent endodontic therapy and restoration. A coronally-positioned flap covered the repaired/restored lesion, approximately 6 mm x 10 mm in dimension. At 6 months following placement of the restoration, all but 1 mm of the restoration appeared covered, with probing depths <3 mm and no clinical signs of inflammation. Glass ionomer cement appears to be a viable, biocompatible material to restore subgingival root surface lesions.

Combining reconstructive and regenerative therapies

The authors used combined reconstructive and regenerative therapy to treat a patient who had a surgically created osseous defect that also was associated with a perforated root canal. The defect involved a maxillary canine that exhibited 10 millimeters of attachment loss on its mesial surface. Tetracycline root surface conditioning, glass ionomer cement, a decalcified freeze-dried bone allograft and an expanded-polytetrafluorethylene membrane were used to achieve a 7- to 8-mm gain in clinical attachment level two years after the initial surgery. This case illustrates the use of glass ionomer cement, in conjunction with regenerative therapy, to effectively treat a root perforation adjacent to a periodontal osseous defect.

Role of exchanged ions in the integration of ionomeric (glass polyalkenoate) bone substitutes

Ionomeric (glass polyalkenoate) implants are synthetic materials which can be used for repairing bone defects. It has been suggested that ions are leached from these implants during healing and that they influence cellular activity in the surrounding tissues. Morphological, immunohistochemical and microanalytical techniques were used to compare the osteogenic capacity of implants which eluted aluminium ions with implants which did not elute aluminium ions. The extracellular matrix molecules fibronectin and tenascin were located upon the surface of both implanted materials. Thick seams of lamellar bone were apposed to implants containing labile aluminium ions, but the bone was poorly mineralized. At the same time, transient increases were apparent in osteoblast activity on periosteal and endosteal surfaces and in chondrocyte activity in the growth plate and articular cartilages. In contrast, small amounts of mineralized lamellar bone were apposed to substituted implants (without aluminium) and the growth plate and articular cartilages remained normal in thickness and morphology. These results suggest that exchanged ions can influence the amount and quality of bone apposed to the implant. They also suggest that the effect of the ions depends upon their concentration and the state of differentiation of osteogenic cells.

In vitro interaction between tetracalcium phosphate-based cement and calvarial osteogenic cells

Newly-developed tetracalcium phosphate-based cement (4CP cement) and cells derived from neonatal rat calvaria were cocultured to study the in vitro reaction of osteoblastic cells to the biomaterial at light and electron microscopic levels. Three-dimensional nodular structures covered with active osteoblastic cells were formed in the periphery of the test material and they contained a mineralized tissue that exhibited features closely resembling bone formed in vivo. Ultrastructurally, the test material was circumscribed with an electron-dense structure, and was immediately adjacent to elongated cyoplasmic processes with intact morphology or collagen fibrils with periodic structures. Furthermore, the mineralization of the extracellular collagenous matrix occurred directly on the surface of the material. These in vitro findings suggest the ability of 4CP cement to bind directly with newly-formed hard tissues.

The interface between ionomer cement and bone in the porcine cervical spine

The interface between bone and ionomer cement has been studied in twelve young adult pigs 1-6 months after anterior cervical discectomy, removal of adjacent end plates and grafting of the bone defect with ionomer cement. Methods used to study the interface were fluorescence microscopy, scanning electron microscopy, electron microprobe analysis and radiological investigation. The interface in all animals consisted of collagenous tissue. The amount of collagenous fibres was related to the amount of residual movement within the motion segment: animals undergoing anterior plating after reconstruction of the bone defect presented with more or less compactly organized collagenous tissue. Sequential fluorochromic marking of osteoid formation revealed a vital bone bed around the interface but no signs of direct bone apposition to the ionomer cement plug. No signs of toxicity or graft rejection were noted. Ionomer bone cement contrary to experimental and clinical experience induces the formation of a connective tissue layer of different density in the porcine cervical spine.

A transmission electron microscopy examination of the interface between osteoblasts and metal biomaterials

Transmission electron microscopy was used to examine the interface between metal implant materials and bone cells. Specifically, neonatal rat calvaria osteoblasts were cultured on CoCrMo alloy and on 316L stainless steel discs (mechanically polished to a 0.3 micron finish) in Dulbecco's Modified Eagle Medium (supplemented with 10% fetal bovine serum, 50 micrograms/mL ascorbic acid, and 10 mM beta-glycerophosphate) under standard, sterile, cell culture conditions for 14 to 28 days. At the end of the prescribed time periods, the cells were fixed and embedded in resin before removing the metal substrates using an electrolytic dissolution technique and a 7% NaCl solution. Transmission electron microscopic examination of stained, ultrathin sections of the biological samples revealed an intact interface with microscopic details characteristic to the cell line and similar to those reported in the literature for animal and explant studies. The osteoblasts exhibited continuous contact and intimate apposition to both the CoCrMo and stainless steel substrate surfaces and grew in multilayered structures; an electron dense layer (composed of mucopolysaccharides and proteins) was observed at the surface of both substrates; collagen fibrils and mineralized foci were observed in the extracellular matrix interspersed among the multilayered osteoblasts.

An in-vitro evaluation of coralline porous hydroxyapatite as a scaffold for osteoblast growth

The purpose of this study was to determine the potential of coralline calcium phosphate ceramics to support osteoblast growth for a proposed bone-ceramic composite for skeletal tissue repair. The goal was the development of a matrix with both osteogenic and osteoconductive properties, as compared to ceramic alone, which is solely osteoconductive. MC3T3-E1 osteoblast-like cells were seeded onto sintered and non-sintered porous coralline hydroxyapatite (HA), and onto non-porous hydroxyapatite discs. These in-vitro studies demonstrated that coralline HA supported the growth of osteoblast-like cells. Porous discs supported higher numbers of cells than non-porous discs. Sintering encouraged cell growth, with higher numbers of cells adhered to sintered porous HA discs by day seven. The results suggest that HA can provide a support for osteoblast cells as part of a matrix which may prove to be osteogenic in vivo and may, accordingly, enhance the bone repair process.

The response of cultured bone cells to resorbable polyglycolic acid and silicone membranes for use in orbital floor fracture repair

Two membranes intended for use in repairing fractures of the orbital floor--reinforced silicone and biodegradable polyglycolic acid (PGA)--were evaluated in vitro using a rat bone cell culture model. After two weeks in culture, cells had colonised the surface of both materials. Bone cells penetrated the weave of the PGA membrane after three weeks in culture, forming a calcified collagenous bone-like tissue within the weave of the PGA at the same time as there was evidence of resorption of the PGA. In contrast, cells could easily be dislodged from the surface of the reinforced silicone membrane and there was less evidence of mineralised extra cellular matrix production. The production of a bone-like tissue within the weave of the PGA membrane supported previous reports of osteoconductive activity of this material.

In vitro evaluation of dental materials

Biocompatibility has been described as the ability of a material to perform with an appropriate host response in a specific application. Appropriate host response means no (or a tolerable) adverse reaction of a living system to the presence of such a material. An adverse reaction may be due to the toxicity of a dental material. Therefore toxicity may be regarded as one reason for nonbiocompatibility of a dental material. The toxicity of a dental material can be evaluated by in vitro tests, animal experiments and clinical trials. There exists a variety of different in vitro test methods. The most widely used biological systems for toxicity screening of dental materials are cell cultures. Cell cultures for toxicity screening of dental materials are valuable tools for understanding their biological behavior, if the limitations of the methods are taken into consideration, especially concerning the interpretation of the results. Further research should concentrate on better simulations of the in vivo situation in cell cultures. In this review the applications of various cell culture methods to evaluate the cytotoxicity of a wide range of dental materials, e.g. metals, alloys, polymers and cements, are described.

Biological evaluation of an ionomeric bone cement by osteoblast cell culture methods

Periosteal derived bovine osteoblast-like cells migrated in culture onto an ionomeric cement. Cell cultures were maintained for 4 weeks and used to study the in vitro behaviour of cells on the ionomeric bone cement (IC). The cells produced bone matrix proteins (osteocalcin, bone sialoprotein II) and were osteoblast-like. The osteoblast-like cells colonized the substrate in monolayers and produced an extracellular matrix as seen by light and scanning electron microscopy. Morphological comparison between cells growing on the ionomeric bone cement and cortical bone revealed no significant difference in phenotypic expression. Staining for aluminium in osteoblasts growing on the IC showed an uptake and storage of aluminium in the cells. Energy dispersive X-ray microanalysis revealed high concentrations of aluminium and silicon in the periosteal tissue. Despite the known toxic effect of aluminium in vivo and in vitro on osteoblasts, no signs of toxicity were apparent on light and scanning electron microscopy analysis.

Preliminary study of factors affecting the fluoride release from glass-ionomer cements

A study has been made on the release of fluoride from three glass-ionomer cements. The effect of the maturity of cements at the time of immersion and powder/liquid ratio were examined. It was found that fluoride release from immature cements was dependent on cement and powder/liquid ratio and that the effect was permanent. The effect of cement type and powder/liquid ratio lessened as cements were allowed to mature prior to immersion. It appears that fluoride release was dependent on the strength and maturity of the cement matrix and not fluoride content. It was concluded that the rate of fluoride release would depend largely on clinical factors rather than cement type.

Use of polyphosphazenes for skeletal tissue regeneration

The hydrolytically unstable polyphosphazenes, poly [(imidazolyl) (methylphenoxy) phosphazenes] and poly [ethyl glycinato) (methylphenoxy) phosphazenes], were studied as potential polymeric supports for cells in tissue regeneration. For bone repair, their specific function would be to support osteoblast growth, forming a bone-polymer matrix. MC3T3-E1 cells (an osteogenic cell line) were seeded onto polymer matrices and cell adhesion and growth as well as polymer degradation were examined. Both imidazolyl- and ethyl glycinato-substituted polyphosphazenes supported the growth of MC3T3-E1 cells. An increase in the content of the imidazolyl side group resulted in a reduction in cell attachment and growth on the polymer surface and an increase in the rate of degradation of the polymer. In contrast, substitution with the ethyl glycinato group favored increased cell adhesion and growth and also an increase in the rate of degradation of the polymers. Thus, the polyphosphazenes represent a system whereby cell growth and degradation can be modulated by varying the nature of the hydrolytically unstable side chain. This in vitro evaluation suggests that the polyphosphazenes may be suitable candidate biomaterials for the construction of a cell-polymer matrix for tissue regeneration.

In vitro induction of a calcifying matrix by biomaterials constituted of collagen and/or hydroxyapatite: an ultrastructural comparison of three types of biomaterials

The induction of a calcifying matrix was studied in vitro and compared for three biomaterials (collagen sponge, hydroxyapatite material and a mixture of both (Biostite)) cultured with human osteoblast-like cells. The influence of biomaterials on organic matrix synthesis and the calcification process was analysed at the ultrastructural level (transmission electron microscopy and X-ray microanalysis). Biomaterials were well tolerated by bone cells. Whichever biomaterial was used, osteoblasts proliferated and synthesized a new matrix constituted of fibrillar and non-fibrillar elements. This activity appeared earlier and was more intense with Biostite than with collagen sponge alone. A deposition of a mineral substance in this newly formed matrix was observed with the collagen sponge and Biostite, but never with hydroxyapatite alone. The mineral deposits were identified as hydroxyapatite crystals, similar to those observed and analysed in bone tissue. These in vitro observations clearly demonstrated the property of Biostite to produce a calcified collagenous matrix similar to bone tissue. However, in vivo confirmation is required before extending the use of this biomaterial to periodontology.

Reinforced glass-ionomer cements--a review of properties and clinical use

In recent years, two new metal-reinforced Glass-ionomers have been introduced. The aim has been to develop a cement which can be used successfully as a replacement for amalgam. This paper reviews the published literature on the mechanical properties and clinical use of both the cermet and so-called 'Miracle Mix' cements. The published results do not suggest an improvement in strength or adhesion to tooth material; wear resistance is improved, however. One problem encountered in reviewing this literature is the wide variation in test methodology and hence results. In clinical use, the metal-reinforced cement has been successful in Class I and II restorations, particularly using the tunnel technique, and has potential for use in a number of other applications.

Ionomeric bone cement in neuro-otological surgery

The use of a polymaleinate glass ionomer cement in 80 neuro-otology cases is described. It has proved of great value in translabyrinthine acoustic neuroma surgery, reducing the incidence of CSF fistula to nil. It is the method of choice for fixation of the Nucleus cochlear implant, and has many other applications in the field of otology and neuro-otology. It is easy to use and appears to have no side effects.

Initial in-vivo evaluation of glass-ionomer cements for use as alveolar bone substitutes

The response of rat femora to implantation of four glass-ionomer (polyalkenoic) cements (GIC) compared to that seen following implantation of densely sintered hydroxyapatite (Ha) ceramic was evaluated for periods up to 12 weeks. Light and transmission electron microscopic analysis of the GIC/bone interface revealed direct bonding of the GIC G338 and Ketac Cem (both based on fluoro-alumino-silicate) glasses to bone, with a mineralized collagen-containing extra-cellular matrix deposited on the surface of the GIC. AquaCem and the fluoride-free GIC based on MP4 glass showed incomplete osseointegration.