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Evaluation of Blood Titanium Levels and Total Bone Contact Area of Dental Implants. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4121639. [PMID: 30046598 PMCID: PMC6038673 DOI: 10.1155/2018/4121639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/11/2018] [Accepted: 05/02/2018] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to evaluate the effect of total implant-bone surface contact area of dental implants applied on partial or total edentulous patients on the increase in the level of blood titanium level. Changes of the blood titanium levels were evaluated after placement of the dental implants in 30 patients including 15 females and 15 males. Patients were divided into 3 groups as dental implants were applied on only maxilla, only mandible, or both of them. Taking into the consideration anatomic formation and prosthetic indication, dental implant-bone total contact area was calculated and saved for each patient after dental implants placement. Blood samples of the patients taken preoperatively and postoperatively at 12 weeks were analyzed by ICP-MS device. Blood titanium levels of preoperative and postoperative blood samples were analyzed for each patient and results were evaluated statistically. In the evaluation after analyzing blood titanium level changes, while a statistically significant decrease was observed in Group 1 patients, a statistically significant increase was observed in Group 2 and Group 3 patients to blood titanium level. A statistically significant difference was observed between Group 1 and Group 2 and between Group 1 and Group 3 patients of blood titanium levels. The change of the blood titanium level was not related to total implant-bone surface area, number of the implants, and gender. In our study, no correlation was found between change of blood titanium level and total contact area with bone of dental implants. We believe that more accurate results can be obtained with biopsy of tissues and organs on animal studies.
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Wang HT, Chiang PC, Tzeng JJ, Wu TL, Pan YH, Chang WJ, Huang HM. In Vitro Biocompatibility, Radiopacity, and Physical Property Tests of Nano-Fe₃O₄ Incorporated Poly-l-lactide Bone Screws. Polymers (Basel) 2017; 9:polym9060191. [PMID: 30970868 PMCID: PMC6432293 DOI: 10.3390/polym9060191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/20/2017] [Accepted: 05/24/2017] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to fabricate biodegradable poly-l-lactic acid (PLLA) bone screws containing iron oxide (Fe3O4) nanoparticles, which are radiopaque and 3D-printable. The PLLA composites were fabricated by loading 20%, 30%, and 40% Fe3O4 nanoparticles into the PLLA. The physical properties, including elastic modulus, thermal properties, and biocompatibility of the composites were tested. The 20% nano-Fe3O4/PLLA composite was used as the material for fabricating the 3D-printed bone screws. The mechanical performance of the nano-Fe3O4/PLLA bone screws was evaluated by anti-bending and anti-torque strength tests. The tissue response and radiopacity of the nano-Fe3O4/PLLA bone screws were assessed by histologic and CT imaging studies using an animal model. The addition of nano-Fe3O4 increased the crystallization of the PLLA composites. Furthermore, the 20% nano-Fe3O4/PLLA composite exhibited the highest thermal stability compared to the other Fe3O4 proportions. The 3D-printed bone screws using the 20% nano-Fe3O4/PLLA composite provided excellent local tissue response. In addition, the radiopacity of the 20% nano-Fe3O4/PLLA screw was significantly better compared with the neat PLLA screw.
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Affiliation(s)
- Hsin-Ta Wang
- School of Organic and Polymeric, National Taipei University of Technology, Taipei 10608, Taiwan.
| | - Pao-Chang Chiang
- Dental Department, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan.
| | - Jy-Jiunn Tzeng
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
| | - Ting-Lin Wu
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
| | - Yu-Hwa Pan
- Department of General Dentistry, Chang Gung Memorial Hospital, Taipei 10507, Taiwan.
- Chang Gung University, Taoyuan 33371, Taiwan.
| | - Wei-Jen Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan.
- Dental Department, Taipei Medical University Shuang-Ho Hospital, New Taipei City 23561, Taiwan.
| | - Haw-Ming Huang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan.
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei 11031, Taiwan.
- Ph.D Program in Biotechnology Research and Development, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan.
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Chang WJ, Pan YH, Tzeng JJ, Wu TL, Fong TH, Feng SW, Huang HM. Development and Testing of X-Ray Imaging-Enhanced Poly-L-Lactide Bone Screws. PLoS One 2015; 10:e0140354. [PMID: 26466309 PMCID: PMC4605620 DOI: 10.1371/journal.pone.0140354] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/24/2015] [Indexed: 11/19/2022] Open
Abstract
Nanosized iron oxide particles exhibit osteogenic and radiopaque properties. Thus, iron oxide (Fe3O4) nanoparticles were incorporated into a biodegradable polymer (poly-L-lactic acid, PLLA) to fabricate a composite bone screw. This multifunctional, 3D printable bone screw was detectable on X-ray examination. In this study, mechanical tests including three-point bending and ultimate tensile strength were conducted to evaluate the optimal ratio of iron oxide nanoparticles in the PLLA composite. Both injection molding and 3D printing techniques were used to fabricate the PLLA bone screws with and without the iron oxide nanoparticles. The fabricated screws were implanted into the femoral condyles of New Zealand White rabbits. Bone blocks containing the PLLA screws were resected 2 and 4 weeks after surgery. Histologic examination of the surrounding bone and the radiopacity of the iron-oxide-containing PLLA screws were evaluated. Our results indicated that addition of iron oxide nanoparticles at 30% significantly decreased the ultimate tensile stress properties of the PLLA screws. The screws with 20% iron oxide exhibited strong radiopacity compared to the screws fabricated without the iron oxide nanoparticles. Four weeks after surgery, the average bone volume of the iron oxide PLLA composite screws was significantly greater than that of PLLA screws without iron oxide. These findings suggested that biodegradable and X-ray detectable PLLA bone screws can be produced by incorporation of 20% iron oxide nanoparticles. Furthermore, these screws had significantly greater osteogenic capability than the PLLA screws without iron oxide.
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Affiliation(s)
- Wei-Jen Chang
- School of Dentistry, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hwa Pan
- Department of General Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University, Taoyuan, Taiwan
| | - Jy-Jiunn Tzeng
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan
| | - Ting-Lin Wu
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan
| | - Tsorng-Harn Fong
- Department of Anatomy, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Wei Feng
- School of Dentistry, Taipei Medical University, Taipei, Taiwan
| | - Haw-Ming Huang
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Yoo D, Tovar N, Jimbo R, Marin C, Anchieta RB, Machado LS, Montclare J, Guastaldi FPS, Janal MN, Coelho PG. Increased osseointegration effect of bone morphogenetic protein 2 on dental implants: Anin vivostudy. J Biomed Mater Res A 2013; 102:1921-7. [DOI: 10.1002/jbm.a.34862] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/06/2013] [Accepted: 06/13/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Daniel Yoo
- Department of Biomaterials and Biomimetics; New York University College of Dentistry; New York New York
| | - Nick Tovar
- Department of Biomaterials and Biomimetics; New York University College of Dentistry; New York New York
| | - Ryo Jimbo
- Department of Prosthodontics; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Charles Marin
- Department of Dentistry; UNIGRANRIO; Duque de Caxias RJ Brazil
| | - Rodolfo B. Anchieta
- Department of Biomaterials and Biomimetics; New York University College of Dentistry; New York New York
- Sao Paulo State University; Araçatuba Dental School-UNESP; Araçatuba Sao Paulo Brazil
| | - Lucas S. Machado
- Department of Biomaterials and Biomimetics; New York University College of Dentistry; New York New York
- Sao Paulo State University; Araçatuba Dental School-UNESP; Araçatuba Sao Paulo Brazil
| | - Jin Montclare
- Polytechnic Institute of New York University; Brooklyn New York
| | - Fernando P. S. Guastaldi
- Department of Biomaterials and Biomimetics; New York University College of Dentistry; New York New York
- Sao Paulo State University; Araçatuba Dental School-UNESP; Araçatuba Sao Paulo Brazil
| | - Malvin N. Janal
- Department of Epidemiology; New York University College of Dentistry; New York New York
| | - Paulo G. Coelho
- Department of Biomaterials and Biomimetics; New York University College of Dentistry; New York New York
- Department of Periodontology and Implant Dentistry; New York University College of Dentistry; New York New York
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Chen X, Sevilla P, Aparicio C. Surface biofunctionalization by covalent co-immobilization of oligopeptides. Colloids Surf B Biointerfaces 2013; 107:189-97. [PMID: 23500730 DOI: 10.1016/j.colsurfb.2013.02.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/07/2013] [Accepted: 02/11/2013] [Indexed: 02/07/2023]
Abstract
Functionalization of implants with multiple bioactivities is desired to obtain surfaces with improved biological and clinical performance. Our objective was developing a simple and reliable method to obtain stable multifunctional coatings incorporating different oligopeptides. We co-immobilized on titanium surface oligopeptides of known cooperative bioactivities with a simple and reliable method. Appropriately designed oligopeptides containing either RGD or PHSRN bioactive sequences were mixed and covalently bonded on CPTES-silanized surfaces. Coatings made of only one of the two investigated peptides and coatings with physisorbed oligopeptides were produced and tested as control groups. We performed thorough characterization of the obtained surfaces after each step of the coating preparation and after mechanically challenging the obtained coatings. Fluorescence labeling of RGD and PHSRN peptides with fluorescence probes of different colors enabled the direct visualization of the co-immobilization of the oligopeptides. We proved that the coatings were mechanically stable. The surfaces with co-immobilized RGD and PHSRN peptides significantly improved osteoblasts response in comparison with control surfaces, which assessed the effectiveness of our coating method to bio-activate the implant surfaces. This same simple method can be used to obtain other multi-functional surfaces by co-immobilizing oligopeptides with different targeted bioactivities--cell recruitment and differentiation, biomineral nucleation, antimicrobial activity--and thus, further improving the clinical performance of titanium implants.
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Affiliation(s)
- Xi Chen
- Minnesota Dental Research Center for Biomaterials and Biomechanics, Department of Restorative Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
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Liu Y, Lim J, Teoh SH. Review: development of clinically relevant scaffolds for vascularised bone tissue engineering. Biotechnol Adv 2012; 31:688-705. [PMID: 23142624 DOI: 10.1016/j.biotechadv.2012.10.003] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 10/21/2012] [Accepted: 10/26/2012] [Indexed: 12/15/2022]
Abstract
Clinical translation of scaffold-based bone tissue engineering (BTE) therapy still faces many challenges despite intense investigations and advancement over the years. To address these clinical barriers, it is important to analyse the current technical challenges in constructing a clinically relevant scaffold and subsequent clinical issues relating to bone repair. This review highlights the key challenges hampering widespread clinical translation of scaffold-based vascularised BTE, with a focus on the repair of large non-union defects. The main limitations of current scaffolds include the lack of sufficient vascularisation, insufficient mechanical strength as well as issues relating to the osseointegration of the bioresorbable scaffold and bone infection management. Critical insights on the current trends of scaffold technologies and future directions for advancing next-generation BTE scaffolds into the clinical realm are discussed. Considerations concerning regulatory approval and the route towards commercialisation of the scaffolds for widespread clinical utility will also be introduced.
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Affiliation(s)
- Yuchun Liu
- Division of Bioengineering, School of Chemical and Biomedical Engineering, 70 Nanyang Drive, Nanyang Technological University, Singapore 637459, Singapore
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Sasikumar KP, Elavarasu S, Gadagi JS. The application of bone morphogenetic proteins to periodontal and peri-implant tissue regeneration: A literature review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2012; 4:S427-30. [PMID: 23066304 PMCID: PMC3467926 DOI: 10.4103/0975-7406.100320] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 01/02/2012] [Accepted: 01/26/2012] [Indexed: 11/04/2022] Open
Abstract
Progress in understanding the role of bone morphogenetic proteins (BMPs) in craniofacial and tooth development and the demonstration of stem cells in periodontal ligament have set the stage for periodontal regenerative therapy and tissue engineering. Furthermore, recent approval by the Food and Drug Administration of recombinant human BMPs for accelerating bone fusion in slow-healing fractures indicates that this protein family may prove useful in designing regenerative treatments in periodontics. In the near term, these advances are likely to be applied to periodontal surgery; ultimately, they may facilitate approaches to regenerating whole lost periodontal structures.
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Affiliation(s)
- Karuppanan P Sasikumar
- Department of Periodontics, JKK Nattraja Dental College, Komarapalayam, Tamil Nadu, India
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The effect of growth factors for bone augmentation to enable dental implant placement: A systematic review. JAPANESE DENTAL SCIENCE REVIEW 2010. [DOI: 10.1016/j.jdsr.2009.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Impact of rhBMP-2 on regeneration of buccal alveolar defects during the osseointegration of transgingival inserted implants. ACTA ACUST UNITED AC 2009; 108:e3-e12. [DOI: 10.1016/j.tripleo.2009.05.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 05/07/2009] [Accepted: 05/21/2009] [Indexed: 01/20/2023]
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Kao RT, Murakami S, Beirne OR. The use of biologic mediators and tissue engineering in dentistry. Periodontol 2000 2009; 50:127-53. [PMID: 19388957 DOI: 10.1111/j.1600-0757.2008.00287.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Stadlinger B, Pilling E, Huhle M, Mai R, Bierbaum S, Scharnweber D, Kuhlisch E, Loukota R, Eckelt U. Evaluation of osseointegration of dental implants coated with collagen, chondroitin sulphate and BMP-4: an animal study. Int J Oral Maxillofac Surg 2008; 37:54-9. [DOI: 10.1016/j.ijom.2007.05.024] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 04/16/2007] [Accepted: 05/10/2007] [Indexed: 11/25/2022]
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Nishikawa T, Masuno K, Mori M, Tajime Y, Kakudo K, Tanaka A. Calcification at the Interface Between Titanium Implants and Bone: Observation With Confocal Laser Scanning Microscopy. J ORAL IMPLANTOL 2006; 32:211-7. [PMID: 17069165 DOI: 10.1563/799.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
It has not been previously possible to observe bone formation in undecalcified sections with titanium implants at high magnification because of the difficulty in sectioning bone together with implants. A method for examining the bone-implant interface in undecalcified sections is described in which implants are left in situ and confocal laser scanning microscopy (CLSM) is used to examine both the implant surface and adjacent bone. Pulsing of animals at different times with the fluorescent dyes calcein and alizarin red permitted assessment of temporal patterns of bone formation by CLSM. Reflectivity of the polished implant surface permitted accurate assessment of the position of the implant relative to labeled bone. The analysis showed that bone first formed as thin processes towards and across the implant surface, followed by further bone formation behind these processes. The interface between calcified bone tissue and the implant surface was characterized by a 10-μm space. The CLSM technique enabled detailed observations of new bone formation at the titanium implant interface.
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Simon Z, Deporter DA, Pilliar RM, Clokie CM. Heterotopic Bone Formation Around Sintered Porous-Surfaced Ti-6Al-4V Implants Coated with Native Bone Morphogenetic Proteins. IMPLANT DENT 2006; 15:265-74. [PMID: 16966900 DOI: 10.1097/01.id.0000226754.71828.6b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Coating endosseous dental implants with growth factors such as bone morphogenetic proteins (BMPs) may be one way to accelerate and/or enhance the quality of osseointegration. The purpose of this study was to investigate in the murine muscle pouch model whether sintered porous-surfaced titanium alloy implants coated with BMPs would lead to heterotopic bone formation around and within the implant surface geometry. MATERIALS Porous-surfaced dental implants were coated with partially purified native human BMPs, with or without a carrier of Poloxamer 407 (BASF Corp., Parsippany, NJ), placed in gelatin capsules and implanted into the hindquarter muscles of mice. Mice were euthanized after 28 days. Sections of retrieved specimens were subsequently prepared for morphometric analysis of bone formation using backscatter electron microscopic images. RESULTS Human BMPs, either with or without the carrier of Poloxamer 407, led to bone formation within and outside of the sintered porous implant surface. When the sintered implant surface region was subdivided into inner and outer halves, similar levels of bone ingrowth and contact were seen in the 2 halves. Evidence of bone formation to the depth of the solid implant core (i.e., the deepest level possible) also was seen. DISCUSSION AND CONCLUSIONS Sintered porous-surfaced dental implants can be used as substrate for partially purified BMPs in the murine muscle pouch model. With the addition of these osteoinductive factors, the porous implant surface supported bone formation within the surface porosity provided, in some instances, all the way to the solid implant core. The addition of growth factors to a sintered porous surface may be an efficient method for altering locally the healing sequence and quality of bone associated with osseointegration of bone-interfacing implants.
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Affiliation(s)
- Ziv Simon
- School of Dentistry, University of Southern California, Los Angeles, California, USA
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Lan J, Wang Z, Wang Y, Wang J, Cheng X. The Effect of Combination of Recombinant Human Bone Morphogenetic Protein-2 and Basic Fibroblast Growth Factor or Insulin-Like Growth Factor-I on Dental Implant Osseointegration by Confocal Laser Scanning Microscopy. J Periodontol 2006; 77:357-63. [PMID: 16512749 DOI: 10.1902/jop.2006.050016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The healing period of bone-implant osseointegration usually varies from 3 to 6 months or even longer. Failure may occur during this time. This study aimed to investigate whether osseointegration of dental implants can be enhanced by the combination of growth factors. METHODS Sixty-four implants were coated with polylactic acid and divided into four groups. Group I was applied with 1.0 mg recombinant human bone morphogenetic protein-2 (rhBMP-2) and 200 microg recombinant human basic fibroblast growth factor (rhbFGF), group II with 1.0 mg rhBMP-2 and 250 mug recombinant human insulin-like growth factor-I (rhIGF-I), group III with 1.0 mg rhBMP-2, and group IV without growth factors as control. In total, 16 rabbits were used, and two osteotomies were drilled on each side of the femur, in which four different groups were randomly placed. Four weeks after implanting, 20 mg calcein green/kg body weight was administered intravenously, and 8 weeks after implanting, 20 mg alizarin/kg body weight was administered intravenously. Twelve weeks after implanting, the animals were sacrificed. The block of bone with implants was embedded in methylmethacrylate and sectioned, and the percentage of new bone surrounding the implant was analyzed by confocal laser scanning microscopy. RESULTS There was a statistical difference in bone formation between rhBMP-2-applied groups and the non-applied group at 4 or 8 weeks, and no significant difference between groups I and II (although bone formation in group II was greater than that in group I at 4 weeks). The bone formation in group II was greater than that in group III at 4 or 8 weeks. The formed bone in group I was also greater than the one in group III at 8 weeks, but there was no difference at 4 weeks. CONCLUSIONS rhBMP-2 could increase new bone formation, and it acted synergistically with rhbFGF and rhIGF-I to improve bone-implant osseointegration. The combination of rhBMP-2 and rhbFGF (group 1) showed faster growth of new bone than other groups at 8 months.
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Affiliation(s)
- Jing Lan
- Department of Prosthodontics, School of Stomatology, Key Lab for Oral Biomedical Engineering of Ministry of Education, Wuhan University, Wuhan, China
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15
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Fini M, Giavaresi G, Setti S, Martini L, Torricelli P, Giardino R. Current trends in the enhancement of biomaterial osteointegration: biophysical stimulation. Int J Artif Organs 2005; 27:681-90. [PMID: 15478539 DOI: 10.1177/039139880402700806] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To enhance bone implant osteointegration, many strategies for improving biomaterial properties have been developed which include optimization of implant material, implant design, surface morphology and osteogenetic coatings. Other methods that have been attempted to enhance endogenous bone healing around biomaterials are different forms of biophysical stimulations such as pulsed electromagnetic fields (PEMFs) and low intensity pulsed ultrasounds (LIPUS), which were initially developed to accelerate fracture healing. To aid in the use of adjuvant biophysical therapies in the management of bone-implant osteointegration, the present authors reviewed experimental and clinical studies published in the literature over the last 20 years on the combined use of biomaterials and PEMFs or LIPUS, and summarized the methodology, and the possible mechanism of action and effectiveness of the different biophysical stimulations for the enhancement of bone healing processes around bone implanted biomaterials.
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Affiliation(s)
- M Fini
- Department of Experimental Surgery, Research Institute Codivilla-Putti, Rizzoli Orthopedic Institute, Bologna, Italy
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16
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Sykaras N, Iacopino AM, Triplett RG, Marker VA. Effect of recombinant human bone morphogenetic protein-2 on the osseointegration of dental implants: a biomechanics study. Clin Oral Investig 2004; 8:196-205. [PMID: 15583918 DOI: 10.1007/s00784-004-0270-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2003] [Accepted: 05/03/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Bone augmentation procedures in combination with dental implants enhance osseointegration in areas that demonstrate localized bone deficit. Clinical confirmation of a biomechanically stable interface is essential for functional implant loading. PURPOSE The aim of this study was to evaluate biomechanically the effect of recombinant human bone morphogenetic protein (rhBMP)-2 on implant osseointegration and correlate it with periotest and radiographic measurements. MATERIALS AND METHODS Hollow cylinder implants were filled with absorbable collagen sponge soaked with rhBMP-2 or left empty and implanted in dog mandibles. The animals were followed for 4, 8, and 12 weeks, periotest assessment was performed at the end of each time interval, and specimens were collected for pullout biomechanical testing and radiographic evaluation of bone-implant contact levels. RESULTS Periotest assessment did not provide evidence of statistically significant differences between the two groups and correlated well with the radiographic bone-implant contact levels. The pullout test revealed a higher correlation between force/displacement and displacement/energy for the experimental group, suggesting that the addition of rhBMP-2 did influence the rate of osseointegration. CONCLUSION The results from the pullout test support the potential role of rhBMP-2 in clinical applications by promoting a biomechanically mature interface at 12 weeks. However, radiographic and periotest assessment of the bone-implant interface did not provide evidence of the differences observed with biomechanical testing.
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Affiliation(s)
- Nikitas Sykaras
- Department of Fixed Prosthodontics, Dental School, Athens University, Athens, Greece.
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Abu-Serriah MM, McGowan DA, Moos KF, Bagg J. Extra-oral craniofacial endosseous implants and radiotherapy. Int J Oral Maxillofac Surg 2003; 32:585-92. [PMID: 14636607 DOI: 10.1054/ijom.2003.0429] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper discusses the use of extra-oral endosseous craniofacial implant (EOECI) therapy in irradiated bone. The survival rate of EOECIs in irradiated bone is reviewed and the controversy over the optimal time prior to place implants is described. The advantages and disadvantages of pre- and post-implant radiotherapy are addressed. The EOECI rehabilitation and osteoradionecrosis and the evidence of the potential role of hyperbaric oxygen are reviewed. Strategies for improving the clinical outcome of EOECIs are suggested.
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Affiliation(s)
- M M Abu-Serriah
- Oral & Maxillofacial Surgery, Glasgow Dental Hospital and School, UK
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18
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Rungcharassaeng K, Lozada JL, Kan JYK, Kim JS, Campagni WV, Munoz CA. Peri-implant tissue response of immediately loaded, threaded, HA-coated implants: 1-year results. J Prosthet Dent 2002; 87:173-81. [PMID: 11854674 DOI: 10.1067/mpr.2002.121111] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM Although high success rates have been reported with immediately loaded implants, the peri-implant tissue response has not been well documented. PURPOSE This study evaluated implant success and peri-implant tissue response of immediately loaded, threaded, hydroxyapatite (HA)-coated root-form implants supporting mandibular bar overdentures with opposing conventional maxillary complete dentures in humans. MATERIAL AND METHODS Five patients (3 men, 2 women; mean age 61 years) each received 4 HA-coated endosseous root-form implants in the interforaminal region in the mandible. The implants were rigidly splinted with a metal framework within 24 hours. The final EDS clip prosthesis was placed 1 to 2 weeks thereafter. The implants and peri-implant tissues were evaluated clinically and radiographically 0, 1, 3, 6, and 12 months after prosthesis placement. Data were analyzed with a repeated measures 1-way analysis of variance (P<.05). RESULTS All implants were stable at the end of the observation period (mean Periotest value = -5.9 +/- 1.4). No peri-implant radiolucencies were noted, and no implants were lost. The mean marginal bone changes were -0.42 plus minus 0.34, -0.84 +/- 0.55, -1.14 +/- 0.80, and -1.16 +/- 0.89 mm at the 1-, 3-, 6-, and 12-month follow-ups, respectively (P<.001). Significant declines in the rates of marginal bone changes at each time interval were noted (P<.001). In addition, there were significant decreases in probing depth (P<.001) and plaque index (P<.001) but no significant difference in the frequency of bleeding upon probing (P=.64). CONCLUSION Within the limitations of this study, the peri-implant tissue response of immediately loaded, HA-coated implants was favorable and comparable to that of conventional, delayed-loaded implants after 1 year.
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Affiliation(s)
- Kitichai Rungcharassaeng
- Department of Restorative Dentistry, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA.
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Santa-Comba A, Pereira A, Lemos R, Santos D, Amarante J, Pinto M, Tavares P, Bahia F. Evaluation of carboxymethylcellulose, hydroxypropylmethylcellulose, and aluminum hydroxide as potential carriers for rhBMP-2. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2001; 55:396-400. [PMID: 11255193 DOI: 10.1002/1097-4636(20010605)55:3<396::aid-jbm1028>3.0.co;2-q] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Conventional iliac crest nonvascularized corticocancelous bone grafts and bone flaps have been used to treat bony defects. However, these treatments have some limitations, namely, the availability of donor tissue, donor site morbidity, difficulty to shape the bone flap to the defect, and complexity of the surgery. The bone morphogenetic protein (rhBMP-2) is osteoinductive. However, its implantation requires a matrix (carrier) in order to define the shape of the resulting bone and to retain the protein at the site for the time required for induction to occur. When the ideal carrier is found, an unlimited supply of material would be available for all applications where bone is needed. In this in vitro study, we evaluated the suitability of some potential carriers for rhBMP-2 by measuring the alkaline phosphatase (ALP) activity of fibroblast cultures. Either rhBMP-2 or sodium carboxymethylcellulose significantly increased the ALP activity, when used alone. When sodium carboxymethylcellulose was combined with rhBMP-2, there was an increase in the ALP activity, but lower than those obtained when the products were used alone. Hydroxypropylmethylcellulose alone did not affect ALP activity. However, the combination of rhBMP-2 with hydroxypropylmethylcellulose did not increase the ALP activity, despite the presence of rhBMP-2. Aluminium hydroxide proved to be an unsuitable rhBMP-2 adsorbent.
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Affiliation(s)
- A Santa-Comba
- Plastic Surgery Department, Hospital de S. João, Alameda Prof. Hernâni Monteiro, 4202-451 Porto, Portugal.
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Meraw SJ, Reeve CM, Lohse CM, Sioussat TM. Treatment of peri-implant defects with combination growth factor cement. J Periodontol 2000; 71:8-13. [PMID: 10695933 DOI: 10.1902/jop.2000.71.1.8] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The use of growth factor agents in the regeneration of oral tissues is an area of current investigation. Combinations of growth factors have been used synergistically to improve tissue regeneration. The aim of this study was to determine the effects of a combination growth factor cement (GFC) on guided bone regeneration around dental implants. METHODS A combination of bone morphogenetic protein-2 (BMP-2), transforming growth factor-beta (TGF-beta), platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF) was used in a bioabsorbable, non-hydroxyapatite, calcium phosphate cement. Five adult hound dogs were used to compare the effects of GFC, plain cement, and control (no cement). The right and left second, third, and fourth mandibular premolar teeth were extracted; the implant osteotomies were prepared; and a uniform circumferential gap was prepared 1.5 mm beyond the width of the implant in the coronal half of the osteotomy for cement placement. Titanium machine-polished dental implants were placed in the prepared sites, and coronal defects were treated according to previously randomized, assigned modality. A bioabsorbable collagen membrane was secured over the control site, and the flaps were closed primarily. The dogs were maintained on a soft diet to avoid soft tissue trauma. The dogs were sacrificed at 3 months. The specimens were sectioned, mounted, and stained with Stevenel's blue and van Gieson's picric fuchsin. The bone-to-implant contact and bone 1 mm peripheral to the implant surface were recorded with a computerized microscopic digitizer. RESULTS The findings of this study indicate a significant effect of GFC on increased bone-to-implant contact and amount of bone per surface area compared with the other treatment modalities (P <0.0009). Plain cement demonstrated slight but nonsignificant increases compared with the control (P>0.05). CONCLUSIONS GFC increases bone-to-implant contact and bone surface area within peri-implant defects. Further studies may be beneficial to determine the feasibility of its use for other regenerative applications.
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Affiliation(s)
- S J Meraw
- Department of Dental Specialties, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
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Abstract
A review of the literature on the use of growth-regulatory molecules in the oral cavity permits a model in which to consider approaches to oral tissue engineering. These concepts apply to periodontal regeneration and to regeneration of alveolar bone. In either case, the formation of tissues is complex but proceeds in a deliberate and orderly sequence. In these sequence of events resulting in either bone or cementum formation, periodontal ligament and bone can be stimulated at various points. Different signals can apparently be used to stimulate tissue formation including mitogenic signals and differentiation factors. Additionally, both hard and soft tissue stimulatory molecules appear to be permissive. Classic receptor-mediated peptides or extracellular matrix molecules for soft and hard tissues appear to allow stimulation of tissue formation cascades. Importantly, it also appears that the stimulatory event is transitory (that is, short-lived) and leads itself to a sequence of cellular events. These cellular events in turn stimulate a number of subsequent events (such as chemotaxis, proliferation, differentiation or angiogenesis), which lead to further progression of tissue formation. While a solid scientific rationale exists for the use of a variety of growth and attachment factors in regeneration of oral tissues, only a small number are being pursued clinically. Many therapeutic regimens have failed in preclinical testing or have resulted in limited regenerative capacity. The mitogenic polypeptides that stimulate soft tissue growth (such as platelet-derived growth factor) and both hard and soft tissue growth (such as transforming growth factor-beta) appear to have not led to successful enough outcomes to facilitate further work towards regulatory approval. The demonstrated ability of bone morphogenetic proteins to generate substantial quantities of bone suggest many applications in the oral cavity where this is the only tissue desired. Another therapeutic candidate is enamel matrix derivative, a set of matrix proteins. Enamel matrix derivative appears to stimulate first acellular cementum formation, which may allow for functional periodontal ligament formation. It will be of interest in the future to determine whether the protein matrix contains classic mitogenic or differentiation factors as well as the amelogenins. It is also evident that the bone morphogenetic proteins permit periodontal ligament formation. The conditions for stimulating predictable periodontal ligament tissues with bone morphogenetic proteins however are not known. It is clear that the bone morphogenetic proteins are excellent molecules for stimulating oral bone formation. The results of all these studies will determine the future therapeutic potential for these growth molecules such that they may be used to optimally stimulate and direct specific points along tissue formation cascades.
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Affiliation(s)
- D L Cochran
- Department of Periodontics, School of Dentistry, University of Texas Health Science Center, San Antonio, USA
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Cooper LF. Biologic determinants of bone formation for osseointegration: clues for future clinical improvements. J Prosthet Dent 1998; 80:439-49. [PMID: 9791791 DOI: 10.1016/s0022-3913(98)70009-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
STATEMENT OF PROBLEM Further improvement in and expansion of the application of dental implants requires control and improvement of bone mass for implant support. PURPOSE Although osseointegration involves both the formation and the maintenance of bone at implant surfaces, the aim of this article is to identify cellular and molecular determinants of bone formation that may be used in clinical attempts to enhance or expand the application of endosseous implants for dental and craniofacial prosthetics. METHODS A review of bone biology and dental and orthopedic implant literature was performed using Medline and published monographs. RESULTS This spectrum of information indicates that molecular and cellular approaches to creating and maintaining bone mass may be used to expand the application of dental implants and to improve dental implant success in bone-deficient sites.
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Affiliation(s)
- L F Cooper
- Department of Prosthodontics, School of Dentistry, University of North Carolina, Chapel Hill, USA
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Welch RD, Jones AL, Bucholz RW, Reinert CM, Tjia JS, Pierce WA, Wozney JM, Li XJ. Effect of recombinant human bone morphogenetic protein-2 on fracture healing in a goat tibial fracture model. J Bone Miner Res 1998; 13:1483-90. [PMID: 9738522 DOI: 10.1359/jbmr.1998.13.9.1483] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bone morphogenetic proteins (BMPs) are considered to have important regulatory roles in skeletal embryogenesis and bone healing. Recombinant human BMPs (rhBMPs) have been shown to heal critical size defects and promote spinal fusion. We studied the effects of rhBMP-2 in an absorbable collagen sponge (ACS) on bone healing in a large animal tibial fracture model. Bilateral closed tibial fractures were created in 16 skeletally mature goats and reduced and stabilized using external fixation. In each animal, one tibia received the study device (0.86 mg of rhBMP-2/ACS or buffer/ACS), and the contralateral fracture served as control. The device was implanted as a folded onlay or wrapped circumferentially around the fracture. Six weeks following fracture, the animals were sacrificed and the tibiae harvested for torsional testing and histomorphologic evaluation. Radiographs indicated increased callus at 3 weeks in the rhBMP-2/ACS treated tibiae. At 6 weeks, the rhBMP-2/ACS wrapped fractures had superior radiographic healing scores compared with buffer groups and controls. The rhBMP-2/ACS produced a significant increase in torsional toughness (p = 0.02), and trends of increased torsional strength and stiffness (p = 0.09) compared with fracture controls. The device placed in a wrapped fashion around the fracture produced significantly tougher callus (p = 0.02) compared with the onlay application. Total callus new bone volume was significantly increased (p = 0.02) in the rhBMP-2/ACS fractures compared with buffer groups and controls regardless of the method of device application. The rhBMP-2/ACS did not alter the timing of onset of periosteal/endosteal callus formation compared with controls. Neither the mineral apposition rates nor bone formation rates were affected by rhBMP-2/ACS treatment. The increased callus volume associated with rhBMP-2 treatment produced only moderate increases in strength and stiffness.
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Affiliation(s)
- R D Welch
- Department of Research, Texas Scottish Rite Hospital for Children, Dallas 75219, USA
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Abstract
Bone morphogenetic proteins (BMPs) are becoming increasingly recognised as valuable molecular tools for regenerating bone and accelerating fracture healing. New bone growth is the result of BMP-induced differentiation of pluripotent mesenchymal cells along osteoblastic pathways. This phenomenon recapitulates in adults specific aspects of skeletal morphogenesis co-ordinated by BMPs during development. An understanding of the basic scientific research which has led to the characterisation and purification of these remarkable molecules is essential if their full therapeutic potential is to be realised.
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Affiliation(s)
- C A Stone
- Department of Anatomy and Developmental Biology, University College London, UK
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Abstract
For over 30 years now, research has been carried out to isolate and purify bone morphogenetic protein (BMP), a substance which has been shown to induce heterotopic bone formation in various animal species. Recent advances in the fields of developmental biology, molecular biology, genetics and wound healing, have shown that the BMPs are not only responsible for postfetal bone induction (including normal bone remodeling, healing and repair), but are also critical during embryogenesis, not only in regards to the skeletal system, but quite possibly in the morphogenesis and pattern formation of other tissues and organs as well. Therefore, BMPs have the potential as a therapeutic utility in orthopedic and dento-alveolar reconstruction.
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Affiliation(s)
- M B Lee
- Department of Periodontics, Loma Linda University, School of Dentistry, CA 92350, USA
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Abstract
Polypeptide growth factors (GFs) have been shown to modulate the wound healing response in both hard and soft tissues. During the past decade, many investigators have demonstrated the anabolic effects of these wound healing molecules on the promotion of periodontal attachment structures, namely alveolar bone, periodontal ligament and tooth root cementum. The molecular cloning and large scale purification of GFs has allowed expanded in vivo studies on periodontal tissue regeneration. This review will outline specific effects of these factors at both the in vitro and in vivo level on the promotion of periodontal and peri-implant bone wound healing. This paper will conclude with a future perspective of ongoing studies in the human clinical trial arena using growth and osteoinductive factors to promote periodontal tissue regeneration and alveolar bone repair in the oral cavity.
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Affiliation(s)
- W V Giannobile
- Department of Periodontology, Harvard School of Dental Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA
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Arm DM, Tencer AF, Bain SD, Celino D. Effect of controlled release of platelet-derived growth factor from a porous hydroxyapatite implant on bone ingrowth. Biomaterials 1996; 17:703-9. [PMID: 8672632 DOI: 10.1016/0142-9612(96)86740-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Platelet-derived growth factor (PDGF) is one of several osteogenic factors which affect bone growth and fracture healing. This study examined the potential of hydroxyapatite (HA) rods with interconnected pores of mean diameter 200 microns to be used as a matrix for the release of PDGF to enhance bone ingrowth into the implant. In the initial phase of the study the sustained release of PDGF from the HA rods was characterized in vitro for two different PDGF loadings, 10 and 100 micrograms per implant. The second phase of the study examined bone ingrowth in HA implants placed into the medullary canals of rabbit femora. The specimens were dumb-bell shaped, with a reduced central diameter so that bone growth across a gap could also be determined. Bone ingrowth into HA implants was compared with growth into HA implants loaded with 100 micrograms of PDGF. Pushout measurements were made of average shear strength across the bone-implant interface and backscatter scanning electron microscopy of thick sections was used to quantify the amount of bone ingrowth into the implant. Although greater interfacial shear strength and area of ingrowth were observed, especially across gap sites, in specimens loaded with PDGF, no difference was statistically significant.
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Affiliation(s)
- D M Arm
- Department of Orthopedics, University of Washington, Seattle 98125, USA
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Abstract
Bone morphogenetic proteins (BMPs) are differentiative factors whose principal function is to induce transformation of undifferentiated mesenchymal cells into chondroblasts and osteoblasts in a dose-dependent manner. Bone morphogenetic proteins have been isolated postnatally in mammals from bone matrix, periosteal cells, mesenchymal cells of marrow stroma, tooth analagen, and cells of osteosarcoma and chondrosarcoma. Distribution in additional embryonic tissues implies a broader organogenic function. Bone morphogenetic proteins are the only differentiative factors able to singularly induce de novo bone formation in vitro and in vivo. Recombinant DNA technology allows their production in large and highly purified quantities. The BMPs' osteoinductive ability has been shown with a variety of carriers including collagens and polymers at heterotopic and orthotopic sites in a wide range of species. They are presently being readied for clinical use as alternatives to bone grafts. Other potential applications include use as pulp capping agents, promoters of implant osteointegration and soft tissue reunion with bone, treatments for nonadaptive bone disease, and implants for use with mitotically expanded skeletal stem cell populations. Errors in the genetic coding of BMPs may manifest as clinical disease entities.
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Affiliation(s)
- C A Kirker-Head
- Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA
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31
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Abstract
The future of wound healing progress lies in the support of research being performed at this very moment. In basic science and clinical laboratories all across the nation, there are investigative studies underway, which have as their purpose, the ultimate improvement of wound healing capabilities of the human body in both soft and hard tissues.
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Affiliation(s)
- G R Holt
- University of Texas Health Science Center, San Antonio
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