Antibiotic delivery system using bioactive bone cement consisting of Bis-GMA/TEGDMA resin and bioactive glass ceramics

Studies on the Curing Efficiency and Mechanical Properties of Bis-GMA and TEGDMA Nanocomposites Containing Silver Nanoparticles

Bioactive dimethacrylate composites filled with silver nanoparticles (AgNP) might be used in medical applications, such as dental restorations and bone cements. The composition of bisphenol A glycerolate dimethacrylate (Bis-GMA) and triethylene glycol dimethacrylate (TEGDMA) mixed in a 60/40 wt% ratio was filled from 25 to 5000 ppm of AgNP. An exponential increase in resin viscosity was observed with an increase in AgNP concentration. Curing was performed by way of photopolymerization, room temperature polymerization, and thermal polymerization. The results showed that the polymerization mode determines the degree of conversion (DC), which governs the ultimate mechanical properties of nanocomposites. Thermal polymerization resulted in a higher DC than photo- and room temperature polymerizations. The DC always decreased as AgNP content increased. Flexural strength, flexural modulus, hardness, and impact strength initially increased, as AgNP concentration increased, and then decreased at higher AgNP loadings. This turning point usually occurred when the DC dropped below 65% and moved toward higher AgNP concentrations, according to the following order of polymerization methods: photopolymerization < room temperature polymerization < thermal polymerization. Water sorption (WS) was also determined. Nanocomposites revealed an average decrease of 16% in WS with respect to the neat polymer. AgNP concentration did not significantly affect WS.

Methotrexate-loaded glass ionomer cements for drug release in the skeleton: An examination of composition-property relationships

Chemotherapeutic-loaded bone cement may be an effective method of drug delivery for the management of cancer-related vertebral fractures that require cement injection for pain relief. Recent advancements in the development of aluminum-free glass ionomer cements (GICs) have rendered this class of biomaterials clinically viable for such applications. To expand the therapeutic benefits of these materials, this study examined, for the first time, their drug delivery potential. Through incrementally loading the GIC with methotrexate (MTX) by up to 10-wt%, composition-property relationships were established, correlating MTX loading with working time and setting time, as well as compressive strength, drug release, and cytotoxic effect over 31 days. The most significant finding of this study was that MTX was readily released from the GIC, while maintaining cytotoxic activity. Release correlated linearly with initial loading and appeared to be diffusion mediated, delivering a total of 1-2% of the incorporated drug. MTX loading in this range exerted minimal effects to handling and strength, indicating the clinical utility of the material was not compromised by MTX loading. The MTX-GIC systems examined herein are promising materials for combined structural delivery applications.

Novel injectable biomaterials for bone augmentation based on isosorbide dimethacrylic monomers

Drawbacks with the commonly used PMMA-based bone cements, such as an excessive elastic modulus and potentially toxic residual monomer content, motivate the development of alternative cements. In this work an attempt to prepare an injectable biomaterial based on isosorbide-alicyclic diol derived from renewable resources was presented. Two novel dimethacrylic monomers ISDGMA - 2,5-bis(2-hydroxy-3-methacryloyloxypropoxy)-1,4:3,6-dianhydro-sorbitol and ISETDMA - dimethacrylate of ethoxylated isosorbide were synthesized and used to prepare a series of low-viscosity compositions comprising bioactive nano-sized hydroxyapatite in the form of a two-paste system. Formulations exhibited a non-Newtonian shear-thinning behavior, setting times between 2.6 min and 5.3 min at 37°C and maximum curing temperatures of 65°C. Due to the hydrophilic nature of ISDGMA, cured compositions could absorb up to 13.6% water and as a result the Young's modulus decreased from 1,429 MPa down to 470 MPa. Both, poly(ISDGMA) and poly(ISETDMA) were subjected to a MTT study on mice fibroblasts (BALB/3T3) and gave relative cell viabilities above 70% of control. A selected model bone cement was additionally investigated using human osteosarcoma cells (SaOS-2) in an MTS test, which exhibited concentration-dependent cell viability. The preliminary results, presented in this work reveal the potential of two novel dimethacrylic monomers in the preparation of an injectable biomaterial for bone augmentation, which could overcome some of the drawbacks typical for conventional acrylic bone cement.

Antibiotic loading on bioactive glasses and glass-ceramics: An approach to surface modification

A bioactive glass and its corresponding glass-ceramic have been used to investigate the possibility to load a common antibiotic (carbenicillin) on their surface during the reactivity processes which occur by dipping these materials in a simulated body fluid. The materials bioactivity in the early stage of simulated body fluid treatment has been investigated by means of scanning electron microscopy (SEM-EDS) and X-ray diffraction. The uptake of carbenicillin has been performed by dipping the samples in simulated body fluid solution with a drug concentration of 500 mg/l for 6, 12 and 24 h. Some glass samples underwent a pre-treatment in simulated body fluid, for different time frames, in order to form a silica gel layer before the surface exposition to antibiotic. The carbenicillin release has been measured in water up to 36 h. The amount of incorporated and released antibiotic has been estimated by UV visible spectrophotometer. All samples were able to incorporate a significant amount of antibiotic and it was possible to tailor the drug release by modifying the simulated body fluid pre-treatment.

Nano-hydroxyapatite/chitosan/konjac glucomannan scaffolds loaded with cationic liposomal vancomycin: preparation, in vitro release and activity against Staphylococcus aureus biofilms

The objective of this study was to design a novel artificial bone scaffold for the therapy and prevention of refractory bacterial infections. Porous nano-hydroxyapatite/chitosan/konjac glucomannan (n-HA/CS/KGM) scaffolds were loaded with cationic liposomal vancomycin (CLV) to form a novel complex drug carrier (LLS). The kinetics of CLV release from LLS and the effects of the amount of konjac glucomannan (KGM) and CLV in LLS were examined in vitro. The anti-biofilm activity of LLS was also studied. Electron microscopy indicated that the liposomes were well preserved in the scaffold, and that CLV rather than free vancomycin is released from the scaffold. The weight percentage of KGM or CLV greatly influenced the release behavior of the scaffolds. LLS could provide sustained CLV release and inhibited the formation of Staphylococcus aureus biofilms better than scaffolds without CLV loaded. LLS may be a novel, effective drug-delivery system for the antibiotic treatment of osteomyelitis caused by biofilm infections.

Antibiotic delivery system using nano-hydroxyapatite/chitosan bone cement consisting of berberine

Different concentrations of berberine were mixed with nano-hydroxyapatite/chitosan (n-HA/CS) bone cement to generate an antibiotic drug delivery system for treatment of bone defects. Properties of the system such as setting time, compressive strength, surface morphology, phase compositions, drug release profiles and antimicrobial activity were also characterized. It was shown that the setting time of the cement ranged from 17.03 +/- 0.50 min to 28.47 +/- 0.96 min and the compressive strength changed from 184.00 +/- 7.94 MPa to 120.33 +/- 9.02 MPa with the increase of berberine. The XRD, IR, and SEM analyses suggested that berberine powders were stable in the bone cement in simulated body fluid (SBF). In vitro release of berberine from the bioactive bone cement pellets in SBF could last more than 4 weeks. The release profiles of 1.0 wt % berberine loaded bone cement followed the Higuchi equation at the infusion stage. The drug loaded pellets can inhibit bacterial growth (Staphylococcus aureus) at the standardized berberine minimum inhibitory concentration of 0.02 mg/mL during berberine release from 1 to 28 days. The n-HA/CS bone cement only with 1.0 wt % berberine proved to be an efficient antibiotic drug delivery system.

Macrophage response to methacrylate conversion using a gradient approach

Incomplete conversion, an ongoing challenge facing photopolymerized methacrylate-based polymers, affects leachables as well as the resulting polymer network. As novel polymers and composites are developed, methods to efficiently screen cell response to these materials and their properties, including conversion, are needed. In this study, an in vitro screening methodology was developed to assess cells cultured directly on cross-linked polymer networks. A gradient in methacrylate double bond conversion was used to increase the experimental throughput. A substrate of 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl] propane (BisGMA) and triethylene glycol dimethacrylate (TEGDMA) was prepared with a conversion ranging from 43.0% to 61.2%. Substrates aged for 7 days had no significant differences in surface roughness or hydrophilicity as a function of conversion. Leachables were detectable for at least 7 days using UV absorption, but their global cytotoxicity was insignificant after 5 days of aging. Thus, RAW 264.7 macrophage-like cells were cultured on aged substrates to evaluate the cell response to conversion, with possible contributions from the polymer network and local leachables. Conversions of 45% and 50% decreased viability (via calcein/ethidium staining) and increased apoptosis (via annexin-V staining). No significant changes (p>0.05) in tumor necrosis factor-alpha and interleukin-1beta gene expression, as measured by quantitative, real-time reverse transcription-polymerase chain reaction, were seen as conversion increased. Thus, conversions greater than 50% are recommended for equimolar BisGMA/TEGDMA. The ability to distinguish cell response as a function of conversion is useful as an initial biological screening platform to optimize dental polymers.

Structure and dissolution investigation of calcium-bismuth-borate glasses and vitroceramics containing silver

Quaternary Ag(2)O-CaO-Bi(2)O(3)-B(2)O(3) glasses and glassceramics are investigated with regard to release behaviour and local structure. The dissolution behaviour in water and physiological serum shows that the cations are released rapidly or gradually and points out a multi-step process, generally characterised by higher rates in water than in physiological serum. The structural effect of silver addition to bismuth-borate glasses is observed from infrared spectroscopic data. The antibacterial activity of the investigated samples was tested on six bacterial media.

Effects of nano HAP on biological and structural properties of glass bone cement

A novel type of glass-based nanoscale hydroxyapatite (HAP) bioactive bone cement (designed as GBNHAPC) was synthesized by adding nanoscale hydroxyapatite crystalline (20-40 nm), into the self-setting glass-based bone cement (GBC). The inhibition rate of nanoscale HAP and micron HAP on osteosarcoma U2-OS cells was examined. The effects of nanoscale HAP on the crystal phase, microstructure and compressive strength of GBNHAPC were studied, respectively. It was concluded that nanoscale HAP could inhibit the cell proliferation, whereas micron HAP could not, and that nanoscale HAP could be dispersed in the cement evenly and the morphology did not change significantly after a longer immersion time. XRD and FTIR results show nanoscale HAP did not affect the setting reaction of the cement. Furthermore, GBNHAPC had a higher compressive strength (92.6 +/- 3.8 MPa) than GBC (80.1 +/- 3.0 MPa). It was believed that GBNHAPC might be a desirable biomaterial that could not only fill bone defects but also inhibit cancer cell growth.

Sol–gel synthesis of a multifunctional, hierarchically porous silica/apatite composite

In this study, a degradable, hierarchically porous silica/apatite composite material is developed from a simple low-temperature synthesis. Mesoporosity is induced in the silica portion by the use of supramolecular templating. The template is further removed by calcination. Firstly, hydroxyapatite is synthesized through a sol-gel method at near room temperature conditions. After the mineralization process, the crystal surface is coated with a mesoporous silica matrix using the templates already present in the bulk solution. The material is characterized by XRD, N(2)-sorption, FT-IR, SEM/EDS, and TEM. The coating layer is distributed fairly homogeneously over the apatite surface and the coating thickness is easily adjustable and dependent on the amount of added silica precursor. The hybrid material is shown to efficiently induce calcium phosphate formation under in vitro conditions and simultaneously work as a carrier system for drugs.

PLGA/mesoporous silica hybrid structure for controlled drug release

In this paper, we report a poly(D,L-lactide-co-glycolide) (PLGA)/mesoporous silica hybrid structure (PS hybrid structure), which was synthesized via a novel sol-gel route assisted by single emulsion solvent evaporation. The in intro drug release properties of both the mesoporous silica and the PS hybrid structure were investigated. It was observed that gentamicin-loaded mesoporous silica showed a sharp initial burst during the first day followed by a rather constant and low release over the subsequent period of 3 weeks. In comparison with the mesoporous silica without biodegradable polymer encapsulation, the PS hybrid structure could realize a reduced initial burst, with a plateau stage for nearly 3 weeks of slow release, followed by a sustained release stage lasting for nearly 2 weeks. The whole release period could last as long as 5 weeks. These distinct behaviors make the hybrid structure material promising as a new drug release material for bone filling applications.

In vitro tobramycin elution analysis from a novel ?-tricalcium phosphate-silicate-xerogel biodegradable drug-delivery system

This in vitro research analyzed local tobramycin elution characteristics from a novel, biodegradable drug delivery system, consisting of a beta-TCP bone substitute, VITOSS trade mark, encapsulated with silicate xerogel prepared by the sol-gel process. Tobramycin elution from silicate-xerogel-encapsulated VITOSS was compared directly with non-silicate-xerogel-encapsulated VITOSS to assess whether xerogels are effective in delivering greater tobramycin quantities in a controllable, sustained manner crucial for microbial inhibition. Tobramycin elution characteristics indicate an initial release maximum during the first 24 h that diminishes gradually several days after impregnation. The copious tobramycin quantity eluted from the VITOSS/silicate-xerogel systems is attributed to various factors: the intrinsic ultraporosity and hydrophilicity of VITOSS, the ability of tobramycin to completely dissolve in aqueous media, tobramycin complexation with highly polar SO(4) (2-) salts that further assist dissolution, and ionic exchanges between VITOSS and the environment. Silicate-xerogel-encapsulated VITOSS eluted 60.65 and 61.31% of impregnated tobramycin, whereas non-silicate-xerogel-encapsulated VITOSS eluted approximately one-third less impregnated tobramycin, at 21.53 and 23.60%. These results suggest that silicate xerogel optimizes tobramycin elution because of its apparent biodegradability. This mechanism occurs through xerogel superficial acidic sites undergoing exchanges with various ions present in the leaching buffer. Tobramycin elution kinetics were evaluated, and demonstrate that first-order elution rate constants are considerably less when silicate xerogels are employed, following a more uniform exponential decay-type mechanism, thus bolstering controlled release. Overall, tobramycin elution rates adhere to linear-type Higuchi release profiles. Elution rate constants are initially first order, and taper into zero-order elution kinetics in the latter stages of release. Because VITOSS and silicate xerogel are completely biodegradable, essentially all impregnated tobramycin will be delivered to the surgical site after implantation.

Tobramycin and gentamycin elution analysis between two in situ polymerizable orthopedic composites

This research analyzed Tobramycin and Gentamycin elution characteristics for two antibiotic-impregnated bone composites: PMMA-based Simplex P and the novel, hybrid, bioactive, CORTOSS. Experimental results were correlated with composite hydrophilicity and antibiotic phase partitioning behaviors. The phase partitioning experiment was conducted to understand antibiotic solubility in aqueous environments. By comparing experimental results with calculated data, antibiotic release behavior was predicted. Total Tobramycin elution percentages from CORTOSS and Simplex P were 12.5 and 6.4%, respectively. Total Gentamycin elution percentages from CORTOSS and Simplex P were 6.95 and 10.17%, respectively. Phase partitioning data indicate 100% of Tobramycin remains in aqueous phases, being extremely hydrophilic. This is supported by its calculated theoretical value (log P = - 7.32). Results suggest that Tobramycin elution can be attributed to composite hydrophilicity as well as its high degree of hydrophilicity. Fifteen percent of Gentamycin distributes in hydrophobic phases (log P = - 4.22). Despite a lower Gentamycin hydrophilicity, its release was affected by its complexation with polar salts in the leaching buffer, thereby increasing its elution potential, making it appreciably water soluble. CORTOSS is more hydrophilic; therefore the migration of aqueous liquids into the polymer network of CORTOSS facilitates greater antibiotic elution compared with hydrophobic Simplex P.

Ceramic drug delivery: a perspective

Different ceramic substances are offered in the market as bone substitute materials. These include monophasic calcium phosphate ceramics of tricalciumphosphate (TCP) or hydroxyapatite (HA), biphasic calcium phosphate ceramics and multiphasic bio-glasses synthetic calcium phosphate cements. Ceramics with appropriate three-dimensional geometry are able to bind and concentrate bone morphogenetic proteins in circulation and may become osteoinductive (capable of osteogenesis) and can be effective carriers of bioactive peptide or bone cell seeds and are therefore potentially useful in tissue engineering and drug delivery. An attempt has been made to review various drug delivery applications of ceramics.

Use of antibiotic-impregnated cement in total joint arthroplasty

The use of antibiotic-impregnated cement in revision of total hip arthroplasty procedures is widespread, and a substantial body of evidence demonstrates its efficacy in infection prevention and treatment. However, it is not clear that it is necessary or desirable as a routine means of prophylaxis in primary total joint arthroplasty. In the management of infected implant sites, antibiotic-impregnated cement used in one-stage exchange arthroplasties has lowered reinfection rates. In two-stage procedures, use of beads and either articulating or nonarticulating antibiotic-impregnated cement spacers also has lowered reinfection rates. In addition, spacers reduce "dead space," help stabilize the limb, and facilitate reimplantation. Problems associated with antibiotic-impregnated cement in total joint arthroplasty include weakening of the cement and the generation of antibiotic-resistant bacteria in infected implant sites.

Chemical-Biological Interactions of the resin monomer triethyleneglycol-dimethacrylate (TEGDMA)

Most dental resinous materials contain high quantities of the diluent monomer triethyleneglycol-dimethacrylate (TEGDMA). Due to its 'hydrophilic' nature, significant amounts of this substance leach into an aqueous environment, such as the oral cavity. Therefore, it is hypothesized that TEGDMA frequently interferes with oral and/or systemic tissues. In vitro studies revealed that TEGDMA is considerably cytotoxic in various cell cultures. It has also been observed that TEGDMA can easily penetrate membranes and subsequently may react with intracellular molecules. The formation of glutathione-TEGDMA adducts is of specific interest, since the nearly complete exhaustion of this molecule significantly reduces its cellular detoxifying potency. Large deletions of DNA sequences were caused by TEGDMA, resulting in high mutation frequency. In addition, TEGDMA has been identified as an important resinous sensitizer in patients and professionals. Taken together, available in vitro information, in vivo studies with animals, and clinical data as well indicate that TEGDMA may contribute considerably to local and systemic adverse effects caused by dental resins.