Ultrastructure of durapatite-periodontal tissue interface in human intrabony defects

Elucidating osseointegration in vivo in 3D printed scaffolds eliciting different foreign body responses

Osseointegration between biomaterial and bone is critical for the clinical success of many orthopaedic and dental implants. However, the mechanisms of in vivo interfacial bonding formation and the role of immune cells in this process remain unclear. In this study, we investigated the bone-scaffold material interfaces in two different 3D printed porous scaffolds (polymer/hydroxyapatite and sintered hydroxyapatite) that elicited different levels of foreign body response (FBR). The polymer/hydroxyapatite composite scaffolds elicited more intensive FBR, which was evidenced by more FBR components, such as macrophages/foreign body giant cells and fibrous tissue, surrounding the material surface. Sintered hydroxyapatite scaffolds showed less intensive FBR compared to the composite scaffolds. The interfacial bonding appeared to form via new bone first forming within the pores of the scaffolds followed by growing towards strut surfaces. In contrast, it was previously thought that bone regeneration starts at biomaterial surfaces via osteogenic stem/progenitor cells first attaching to them. The material-bone interface of the less immunogenic hydroxyapatite scaffolds was heterogenous across all samples, evidenced by the coexistence of osseointegration and FBR components. The presence of FBR components appeared to inhibit osseointegration. Where FBR components were present there was no osseointegration. Our results offer new insight on the in vivo formation of bone-material interface, which highlights the importance of minimizing FBR to facilitate osseointegration for the development of better orthopaedic and dental biomaterials.

A clinical investigation to assess the regenerative potential of Biostite® (hydroxyapatite, type-I collagen and chondroitin-sulphate) with or without Paroguide® type-I collagen and chondroitin sulphate) membrane in the treatment of periodontal intrabony defects appraised with surgical re-entry and computer-assisted densitometric image analysis

Background

The traditional treatment procedures which aimed at treating periodontal disease did not result in true periodontal regeneration. Unpredictability about osseous defect fill after periodontal flap surgery has stemmed in the research of a variety of regenerative materials. This randomized clinical trial was conducted to compare regenerative potential of Biostite® bone graft material with and without Paroguide® a bioresorbable membrane in the treatment of periodontal osseous defects.

Materials and Methods

Twenty sites from a total of from ten patients were chosen for the study. Those sites were divided into experimental site A (Biostite®) and experimental site B (Biostite® with Paroguide®) at random. Plaque index and gingival index (GI) were the clinical parameters noted at baseline, 3rd, 6th and 9th months, whereas the probing pocket depth, clinical attachment level and gingival recession were noted at baseline, 6th and 9th months. Radiographic evaluation was made by using computer-assisted densitometric analysis. Intrasurgical measurements were done at baseline and 9 months. Statistical analysis was done using paired t-test and un-paired t-test.

Results

Both experimental site A and B showed a significant reduction in plaque and GI. All clinical parameters as well as radiographic image analysis showed highly significant improvement from baseline to 9 months for both sites. Inter-group comparison does not show statistically significant improvement.

Conclusion

The results of this study suggested that both Biostite® bone graft and Paroguide® membrane have promised encouraging results in the management of periodontal intrabony defects, however, the groups did differed to each other statistically.

Enamel Matrix Derivative (EMD) as an Adjunct to Non-surgical Periodontal Therapy: A Systematic Review

If left untreated, periodontitis is a chronic, irreversible disease that can contribute to tooth loss. The primary objective of periodontal treatment is to arrest the progression of the disease and restore the supporting structures of the tooth. Scaling and root planing (SRP) is a common non-surgical periodontal therapy (NSPT) used to reduce inflammation, pocket depth, and clinical attachment loss. However, NSPT has limitations, notably in difficult-to-access deep pockets and molar furcations. Deep pockets (greater than 4 mm) frequently retain calculus following NSPT. To attain direct access, surgical periodontal therapy (SPT) is recommended, particularly for pockets deeper than 5 mm. Enamel matrix derivative (EMD) has emerged in recent years as a tool for periodontal regeneration when used in conjunction with NSP for infrabony defects. EMD may also have advantageous effects when combined with NSPT. The purpose of this review is to provide a thorough understanding of the effects of EMD as an adjunct to NSPT. The databases Scopus, PubMed/MEDLINE, Google Scholar, Cochrane, and Embase were systematically searched to identify relevant studies on the benefits of EMD and its use as an adjunct to NSPT. Incorporating EMD into NSPT reduces chair time, and 60% of studies demonstrated considerable benefits compared to SRP alone, according to the findings. On the basis of research, it can be concluded that EMD can be used as an adjunct to NSPT, thereby reducing the amount of time spent in the operating chair. In some cases, it can, therefore, be regarded as an alternative to surgical treatment.

In Vivo Degradation Behavior of Magnesium Alloy for Bone Implants with Improving Biological Activity, Mechanical Properties, and Corrosion Resistance

This study aimed to establish a surface modification technology for ZK60 magnesium alloy implants that can degrade uniformly over time and promote bone healing. It proposes a special micro-arc oxidation (MAO) treatment on ZK60 alloy that enables the composite electrolytes to create a coating with better corrosion resistance and solve the problems of uneven and excessive degradation. A magnesium alloy bone screw made in this way was able to promote the bone healing reaction after implantation in rabbits. Additionally, it was found that the MAO-treated samples could be sustained in simulated body-fluid solution, exhibiting excellent corrosion resistance and electrochemical stability. The Ca ions deposited in the MAO coating were not cytotoxic and were beneficial in enhancing bone healing after implantation.

Bioactive Surface Modifications through Thermally Sprayed Hydroxyapatite Composite Coatings: A Review over Selective Reinforcements

Hydroxyapatite (HA) has been an excellent replacement for the natural bone in orthopedic applications, owing to its close resemblance; however, it is brittle and has low strength. Surface modification techniques...

Comparative assessment of the interfacial soft and hard tissues investing implants and natural teeth in the macaque mandible

OBJECTIVES

The aim of this study was to conduct a comparative qualitative and quantitative assessment of the interfacial soft and hard tissues investing implants and natural teeth.

MATERIALS AND METHODS

The test sample consisted of six adult healthy male Macaca fascicularis with three-unit splinted crowns, each crown supported by an Ankylos screw-shaped titanium implant. These implants were placed in the mandibular premolar-second molar region, one side by an immediate-loading (IL) and the other by delayed-loading (DL) protocol. The animals were sacrificed after 3 months of functional loading. Another two monkeys with natural dentition served as controls. Nondecalcified sections were prepared for assessment of optical intensities (OI) under a confocal laser scanning microscope.

RESULTS

In both the test (IL and DL) and control, the soft tissue complexes demonstrated a highly fluorescent keratinized layer and diminished cytoplasmic and enhanced membranous fluorescence in the remaining epithelium. Peri-implant mucosa was further characterized by an intense fluorescence at the junctional epithelium-implant interface and in the stromal mononuclear infiltrate. Connective tissue contact and periodontal ligament were weakly fluorescent. In hard tissues, a high fluorescence was observed in peri-implant woven bone and along the implant-bone interface. Mean OI was significantly higher in peri-implant woven bone than around teeth (P < 0.05). In the remaining soft and hard tissue complexes, no significant differences in mean OI between the test and control were observed (P > 0.05).

CONCLUSIONS

Present findings suggest that peri-implant woven bone is highly mineralized, while the peri-implant and gingival mucosa share structural similarities.

CLINICAL RELEVANCE

Optical intensities of interfacial tissues investing implants and teeth are related to their biological properties.

Comparison of Nano-Sized Hydroxyapatite and β-Tricalcium Phosphate in the Treatment of Human Periodontal Intrabony Defects

BACKGROUND

Since the advent of nanotechnology, various materials have been introduced for the treatment of the bone defects which have shown promising results.

AIM

The purpose of this study was to compare the effect of nano-sized Hydroxyapatite (NHA) and β-Tricalcium Phosphate (β-TCP) in the treatment of human periodontal defects.

MATERIALS AND METHODS

Tweleve patients with a total of 24 sites which were almost identical as determined clinically and radiographically were selected for the study. The selected sites were treated with access flap surgery were divided into two groups: Group I was treated with NHA and Group II treated with β-TCP. Following clinical and radiographic parameters were recorded at baseline, 3 months and 6 months post operatively: 1) Probing pocket depth (PPD); 2)Clinical attachment level (CAL); 3) Gingival recession (GR); 4) Radiographic Defect Depth.

RESULTS

Groups showed statistically significant improvements in soft and hard tissue parameters after 3 months and 6 months. Greater reduction in PPD, gain in CAL and Radiographic Defect Fill (RDF) was seen in Group I after three months whereas after six months were no statistically significant difference was seen with regard to soft and hard tissue measurements.

CONCLUSION

Within limits of the study, both NHA and β-TCP have proved to be beneficial in the management of periodontal defects. Treatment of intrabony periodontal defects with NHA leads to significant improvement in early clinical and radiographic outcomes as compared to β-TCP.

Ultrastructure of the Mineralized Tissue/Calcium Phosphate Interface in Vitro

An in vitro rat bone marrow cell (RBMC) system was used to examine the structure of the interface established between calcium phosphates (Ca-P) and mineralized tissue. The Ca-P used, varied either in chemical structure or crystallinity. Therefore, not only the influence of chemical composition, but also the effect of degradation of Ca-P ceramics could be studied. The interfaces were examined with scanning and transmission electron microscopy (SEM and TEM).

SEM showed that deposition of mineralized extracellular matrix on the different materials examined varied both in time and morphology. Mineralization started with the formation of afibrillar globules with which collagen fibres became integrated. With TEM, three distinctly different interfacial structural arrangements were observed which were dependent on the presence or absence of an electron dense layer and/or an amorphous zone. The former was considered to be at least partially caused by protein adsorption, which would precede biological mineralization events, whereas the latter was considered to represent partial degradation of the ceramic surfaces.

The results of this study showed that interfacial reactions were not only influenced by the chemical structure, but also by the crystallinity of Ca-P ceramics. Thus, characterisation of Ca-P implant materials is of critical importance in achieving a better understanding of the phenomena that occur at the bone-biomaterial interface.

Brushite-Forming Mg-, Zn- and Sr-Substituted Bone Cements for Clinical Applications

Calcium phosphate cements have been in clinical use for the last 10 years. Their most salient features include good biocompatibility, excellent bioactivity, self-setting characteristics, low setting temperature, adequate stiffness, and easy shaping to accomodate any complicated geometry. They are commonly used in filling bone defects and trauma surgeries as mouldable paste-like bone substitute materials. Substitution of trace elements, such as Mg, Sr and Zn ions, into the structure of calcium phosphates is the subject of widespread investigation nowadays, because of their impending role in the biological process. Subtle differences in composition and structure of these materials may have a profound effect on their in vivo behaviour. Therefore, the main goal of this paper is to provide a simple, but comprehensive overview of the present achievements relating to brushite-forming cements doped with Mg, Zn and Sr, and to identify new developments and trends. In particular, the influence of ionic substitution on the chemical, physical and biological properties of these materials is discussed.

Comparison of injectable calcium phosphate bone cement grafting and open flap debridement in periodontal intrabony defects: a randomized clinical trial

BACKGROUND

Regeneration of lost periodontium is the ultimate goal of periodontal therapy. Bone grafts, guided tissue regeneration, and application of growth factors are used for periodontal regeneration. This study aimed to evaluate the clinical efficacy of a new, injectable calcium phosphate bone cement (CPC) in human periodontal intrabony defects.

METHODS

Thirty subjects (mean age, 53.4 +/- 9.1 years) with periodontitis and narrow intrabony defects were enrolled in the study. Subjects were classified randomly into the CPC graft group (N = 15) or the open flap debridement (OFD) alone group (N = 15). Clinical measurements were performed at baseline and at 3, 6, 9, and 12 months; radiographs were taken at baseline, 2 weeks, and 6 and 12 months after surgery. The Student t test was used for statistical analysis.

RESULTS

In the CPC group, six cases showed exposure or loss of the CPC within 12 months, whereas the remaining nine cases (CPC-R group) showed no adverse reaction, including infection or suppuration. Overall, CPC-R and OFD treatment groups exhibited a significant reduction in probing depth and a significant gain in clinical attachment level at 3, 6, 9, and 12 months compared to baseline values. However, there were no significant differences in any of the clinical parameters between the groups. In the CPC-R group, radiographic bone level gain appeared to be greater than in the OFD group.

CONCLUSIONS

The present study failed to demonstrate any superior clinical outcomes for the CPC group compared to the OFD group; however, radiographs revealed more favorable results in the CPC-R group. The filling volume and stiffness of CPC may compromise the clinical outcomes for periodontal intrabony defects.

Favorable Periodontal Healing of 1-Wall Infrabony Defects After Application of Calcium Phosphate Cement Wall Alone or in Combination With Enamel Matrix Derivative: A Pilot Study With Canine Mandibles

BACKGROUND

Although various periodontal regenerative therapies are used, their effects on non-contained infrabony defects are unpredictable. Our previous studies showed that injectable, moldable, fast-setting calcium phosphate cement (CPC) promoted histocompatible periodontal healing in 3-wall intrabony defects. The present study evaluated healing patterns after surgical application of CPC walls with and without an enamel matrix derivative (EMD) in 1-wall infrabony defects in dogs.

METHODS

One-wall infrabony defects (5 x 5 x 4 mm) were created surgically on the mesial and distal sides of bilateral mandibular fourth premolars in four beagle dogs. After elevating a full-thickness flap, exposed root surfaces were planed thoroughly. The 16 defects were assigned randomly to one of the following experimental conditions: CPC, CPC+EMD, EMD, and open flap debridement (OFD). Ten weeks post-surgery, the animals were sacrificed, and histologic specimens were prepared for histomorphometric evaluation.

RESULTS

Defect sites treated with EMD only exhibited varying degrees of new cementum and new bone formation, whereas the OFD group presented only limited new cementum and bone formation. Defect sites where a CPC wall was implanted (CPC and CPC+EMD groups) revealed significantly greater regeneration of new bone and new cementum than in the EMD and OFD groups. No significant differences were observed between the CPC and CPC+EMD groups.

CONCLUSIONS

CPC walls with and without EMD promoted regeneration of alveolar bone and cementum in 1-wall infrabony defects. Space and stable wound healing are believed to be crucial for periodontal regeneration in non-contained infrabony defects.

Bioactivity in in situ hydroxyapatite-polycaprolactone composites

In our previous work, hydroxyapatite (HAP) was synthesized under two conditions: one in the presence of polyacrylic acid (in situ HAP) and the other in the absence of polyacrylic acid (ex situ HAP). Composites of both HAPs with polycaprolactone (PCL) were investigated for their applicability as scaffolds for bone tissue engineering. In the current work, bioactivity of these composites has been investigated by soaking them in simulated body fluid for different intervals of time. Nucleation and growth mechanism of apatite on these composites has also been investigated. Fourier transform infrared spectroscopy study suggests that although apatite growth starts with an intermediate phase, it completely transforms to HAP after 4 days of soaking. Nanoindentation results suggest that the apatite growing on in situ HAP/PCL composites has much higher hardness and elastic modulus as compared to the apatite growing on ex situ HAP/PCL composites. The apatite grown on the ex situ composites has a net-like interconnected structure. The observed differences in mechanical properties and morphology of apatite have been described on the basis of nucleation mechanisms. The nucleation of apatite on the in situ HAP/PCL composites proceeds through the formation of a complex between Ca2+ and COO- groups; on the other hand, nucleation occurs because of dissolution reaction of apatite in ex situ HAP/PCL composites.

Injectable Calcium Phosphate Bone Cement Provides Favorable Space and a Scaffold for Periodontal Regeneration in Dogs

BACKGROUND

An earlier study showed that an injectable calcium phosphate cement (CPC) served as a stable scaffold for bone formation and promoted histocompatible healing of periodontal tissue in dogs. In this study, we evaluated the influence of CPC on regeneration of periodontal defects with experimental periodontitis in dogs.

METHODS

Experimental periodontitis was induced by placing stainless-steel mesh on the mesial side of maxillary canines in six adult, healthy beagle dogs. Subsequently, intrabony defects were resized so as to be standard, and CPC was injected in the experimental bone defects. Non-grafted defects on the contralateral side served as controls. Twelve weeks after surgery, the animals were sacrificed and histologic specimens were prepared. Periodontal tissue healing was evaluated histologically and histometrically.

RESULTS

Healing of periodontal tissues, in terms of bone and cementum formation, was consistently observed in the CPC-applied sites. CPC was partly replaced by new bone. New cementum and periodontal ligament-like tissue were observed between CPC and the root surface. New bone (P <0.05), new cementum (P <0.01), and new connective tissue attachment and adhesion (P <0.05) were significantly enhanced in the experimental sites.

CONCLUSION

Calcium phosphate cement provides stable wound healing and enhanced periodontal regeneration in periodontal defects in dogs with experimental periodontitis.

Maxillary sinus augmentation with Bio-Oss particles: a light, scanning, and transmission electron microscopy study in man

Biological interactions occurring at the bone-biomaterial interface are critical for long-term clinical success. Bio-Oss is a deproteinized, sterilized bovine bone that has been extensively used in bone regeneration procedures. The aim of the present study was a comparative light, scanning, and electron microscopy evaluation of the interface between Bio-Oss and bone in specimens retrieved after sinus augmentation procedures. Under light microscopy, most of the particles were surrounded by newly formed bone, while in a few cases, at the interface of some particles it was possible to observe marrow spaces and biological fluids. Under scanning electron microscopy, in most cases, the particle perimeter appeared lined by bone that was tightly adherent to the biomaterial surface. Transmission electron microscopy showed that the bone tissue around the biomaterial showed all the phases of the bone healing process. In some areas, randomly organized collagen fibers were present, while in other areas, newly formed compact bone was present. In the first bone lamella collagen fibers contacting the Bio-Oss surface were oriented at 243.73 +/- 7.12 degrees (mean +/- SD), while in the rest of the lamella they were oriented at 288.05 +/- 4.86 degrees (mean +/- SD) with a statistically significant difference of 44.32 degrees (p < 0.001). In the same areas the intensity of gray value was 172.56 +/- 18.15 (mean +/- SD) near the biomaterial surface and 158.71 +/- 21.95 (mean +/- SD) in the other part of the lamella with an unstatistically significant difference of 13.79 (p = 0.071). At the bone-biomaterial interface there was also an electron-dense layer similar to cement lines. This layer had a variable morphology being, in some areas, a thin line, and in other areas, a thick irregular band. The analyses showed that Bio-Oss particles do not interfere with the normal osseous healing process after sinus lift procedures and promote new bone formation. In conclusion, this study serves as a better understanding of the morphologic characteristics of Bio-Oss and its interaction with the surrounding tissues.

Strengthening mechanisms of bone bonding to crystalline hydroxyapatite in vivo

The formation and strengthening mechanisms of bone bonding of crystalline hydroxyapatite (HA) has been investigated using high-resolution transmission electron microscope (HRTEM) and energy-dispersive X-ray (EDX) analysis. A series of results were obtained: (i) a layer of amorphous HA, which has almost the same chemistry as the implanted HA, was formed on the surface of crystalline HA particles prior to dissolution; (ii) at 3 months a bone-like tissue formed a bonding zone between mature bone and the HA implant, composed of nanocrystalline and amorphous apatite; and (iii) at 6 months, mature bone was in direct contact with HA particles, and collagen fibres were perpendicularly inserted into the surface layer of implanted HA crystals. Findings (i) and (ii) indicated the following dissolution-precipitation process. (i) The crystalline HA transforms into amorphous HA; (ii) the amorphous HA dissolves into the surrounding solution, resulting in over-saturation; and (iii) the nanocrystallites are precipitated from the over-saturated solution in the presence of collagen fibres. A preliminary analysis indicated several conclusions: (i) the transition from crystalline to amorphous HA might be the controlling step in the bone bonding of crystalline HA; (ii) biological interdigitation (or incorporation) of collagen fibres with HA and chemical bonding of a apatite layer were both necessary to strengthen and toughen a bone bond, not only for the bonding between bone and HA at 6 months, but also for the bonding zone at 3 months, which would otherwise be very fragile due to the inherited brittleness of polycrystalline ceramics; and (iii) perpendicular interdigitation is an effective way for collagen fibres to impart their unique combination of flexibility and strength to the interface which they are keying.

A stereomorphologic study of bone matrix apposition in HA-implanted cavities observed with SEM, being prepared by a microvascular cast and freeze-fracture method

In order to obtain further understanding of the relationship between hydroxyapatite (HA) with regard to its properties as an implantation bed, dense HA particles were implanted into the tibiae of dogs. Following the healing periods of 2 weeks, 1 month, 2 months, 3 months and 6 months, the specimens were prepared with a combination of a microvascular cast method and a freeze-fracture technique, allowing observations to be made with a scanning electron microscope (SEM). Under SEM, osteogenesis among the HA particles developed in a programmed sequence. The unfolding sequence revealed that the sinusoidal capillaries provided the initial evidence of vascularization preceding new bone formation, with microvessels creeping along the interparticular space among the HA particles. Having established an intimate contact existing between the microvessels, collagen fibres and the HA surface, the HA particles served as a supporting scaffold for the vessels to creep over and to connect with each other to form a vascular network. The way that the collagen fibres attached to the HA particles was either through globular depositions or via directly abutting themselves on to the HA surface. On closer inspection the osteoblasts with extracellular collagen fibrils were observed over the HA surface. By appositional growth, osteoblasts laid down a bone matrix in successive layers, forming a woven bone around the HA particles. As the implantation time increased, bony tissues gradually transformed into mature bone occupying all of the interparticular space. This study successfully revealed the spatial relationship between bone cells, collagen fibres and blood vessels in an osteogenetic sequence among HA particles, as revealed by a microvascular cast and the freeze-fracture method.

Histocompatible Healing of Periodontal Defects After Application of an Injectable Calcium Phosphate Bone Cement. A Preliminary Study in Dogs

BACKGROUND

A novel injectable, fast setting calcium phosphate cement (CPC) is currently used in orthopedic therapy for bone fractures. This study evaluated the possibility of applying this cement to healing periodontal defects.

METHODS

Fenestrations and 3-walled periodontal defects were surgically created on bilateral first molars and canines in 5 beagle dogs. CPC was applied to the defects on one side of the mandible. Untreated defects on the contralateral side served as controls. CPC was applied to all defects in the maxilla. Twelve weeks after surgery, the animals were sacrificed and decalcified and undecalcified specimens were prepared. Periodontal tissue healing was evaluated histologically and histometrically under a light microscope.

RESULTS

Healing of periodontal tissues in terms of bone and cementum formation was consistently observed in the CPC-applied sites. CPC was partly replaced by new bone. The residual CPC appeared detached from the denuded root surface. New cementum and periodontal ligament-like tissue were observed between the detached CPC and root surface. No unfavorable reaction was noted in the CPC-applied sites. No statistically significant difference was noted in the experimental or control sites under histometric analysis.

CONCLUSIONS

Although there were no statistically significant differences between the 2 treatment groups, histological observation indicated that CPC seemed to act as a scaffold for bone formation and provided histocompatible healing of periodontal tissues in this study. This cement might be applicable to periodontal therapy; however, further investigations are required.

Properties of osteoconductive biomaterials: calcium phosphates

Bone is formed by a series of complex events involving the mineralization of extracellular matrix proteins rigidly orchestrated by cells with specific functions of maintaining the integrity of the bone. Bone, similar to other calcified tissues, is an intimate composite of the organic (collagen and noncollagenous proteins) and inorganic or mineral phases. The bone mineral idealized as calcium hydroxyapatite, Ca10 (PO4)(6)(OH)2, is a carbonatehydroxyapatite, approximated by the formula: (Ca,X)(10)(PO4,HPO4,CO3)(6)(OH,Y)2, where X are cations (magnesium, sodium, strontium ions) that can substitute for the calcium ions, and Y are anions (chloride or fluoride ions) that can substitute for the hydroxyl group. The current author presents a brief review of CaP biomaterials that now are used as grafts for bone repair, augmentation, or substitution. Commercially-available CaP biomaterials differ in origin (natural or synthetic), composition (hydroxyapatite, beta-tricalcium phosphate, and biphasic CaP), or physical forms (particulates, blocks, cements, coatings on metal implants, composites with polymers), and in physicochemical properties. CaP biomaterials have outstanding properties: similarity in composition to bone mineral; bioactivity (ability to form bone apatitelike material or carbonate hydroxyapatite on their surfaces), ability to promote cellular function and expression leading to formation of a uniquely strong bone-CaP biomaterial interface; and osteoconductivity (ability to provide the appropriate scaffold or template for bone formation). In addition, CaP biomaterials with appropriate three-dimensional geometry are able to bind and concentrate endogenous bone morphogenetic proteins in circulation, and may become osteoinductive (capable of osteogenesis), and can be effective carriers of bone cell seeds. Therefore, CaP biomaterials potentially are useful in tissue engineering for regeneration of hard tissues.

Cancellous bone repair using bovine trabecular bone matrix particulates

At 5 and 15 weeks post-surgery, biomechanical and histological analyses of cancellous bone defects filled with the bovine trabecular bone matrix (BBM) and hydroxyapatite (Hap) particulates of dimensions 106-150 microm were investigated. It was observed that at 5 weeks post-surgery the stiffness properties of the BBM filled defects were significantly higher than those observed in the Hap filled defects (p < 0.01) but comparable to those recorded in intact cancellous bone from the same anatomical position. Histologically, no significant differences were observed in the percentage of new bone contact with the particles. The biomechanical properties of the Hap filled defects mirrored those in intact cancellous bone only at 15 weeks post-surgery. BBM particles thus appeared to accelerate the early healing of osteotomies. It is therefore suggested that particles of this bioceramic be the subject of intense research for more usage in both periodontal osseous defects and orthopaedic fractures.

Cartilage formation by fetal rat chondrocytes cultured in alginate beads: a proposed model for investigating tissue-biomaterial interactions

Chondrocytes from 21-day-old rat fetal nasal cartilage were cultured in alginate beads for up to 20 days. It was found that chondrocytes retained their spherical shape and typical chondrocytic appearance. During the culture time, chondrocytes underwent differentiation, as demonstrated by the alkaline phosphatase-specific activity and rate of proteoglycan synthesis. Morphological data confirmed chondrocyte differentiation with the appearance of hypertrophic chondrocytes scattered in the alginate gel and a dense extracellular matrix containing filamentous structures and matrix vesicles. In addition, Northern blot analysis performed on day 8 of culture showed that chondrocytes cultured in alginate beads expressed type II collagen mRNA. The alginate bead method also appeared to be suitable for testing biomaterials, and the ready dissolution of the alginate beads by chelating agents provided a simple means for the rapid recovery of encapsulated chondrocytes. Powdered glass-ceramic particles entrapped in the alginate gel were colonized by chondrocytes, which then proliferated and formed a tissue similar to a true calcified cartilaginous structure. These results indicate that the alginate system represents a relevant model for studies of chondrogenesis and endochondral ossification. Furthermore, the encapsulation method could prove useful for studies of tissue-biomaterial interactions in an in vitro environment which more closely mirrors the cartilage matrix than other culture methods.

An in vitro system for studying osteointegration of dental implants utilizing cells grown on dense hydroxyapatite disks

A proposed in vitro system is described where chick osteoblasts are cultured on the flat surfaces of dense, nonporous HA disks to facilitate the study of bone formation at the cell-HA interface. During early bone formation cell-coated HA disks were retrieved, fixed with buffered 2% glutaraldehyde, and embedded in epon/araldite. The underlying HA disks were demineralized in diluted acid, and the intact cell-HA interfaces were re-embedded and thin sectioned for routine transmission electron microscopy. Morphologic studies indicated that osteoblasts proliferated and formed nodules of cells on the surfaces of HA disks. With increasing time in culture, they deposited orthogonally packed collagen fibrils between the cell layers that were enveloped by electron-dense mineralized globules. Eventually, small spicules of mineralized HA formed along collagen fibrils. An electron-dense layer about 50 nm thick was observed on the surface of the HA disks. Biochemical studies indicated that cell proliferation, as judged by 3H-thymidine uptake, increased rapidly during the first 3 days, reached a maximum around 6 days, and then declined by 12 days in culture. AP activity and collagen synthesis, as determined by 3H-hydroxyproline formation, increased as cellular proliferation declined. Mineralization, as judged by 45Ca uptake and spicule formation, occurred, as expected, following the increase in AP activity and deposition of densely packed collagen fibrils. Thus, all morphological and biochemical parameters studied indicate that the proposed in vitro system is reproducible and can facilitate the study of the osteointegration of HA-coated implants.

Adaptive crystal formation in normal and pathological calcifications in synthetic calcium phosphate and related biomaterials

Mineralization and crystal deposition are natural phenomena widely distributed in biological systems from protozoa to mammals. In mammals, normal and pathological calcifications are observed in bones, teeth, and soft tissues or cartilage. We review studies on the adaptive apatite crystal formation in enamel compared with those in other calcified tissues (e.g., dentin, bone, and fish enameloids) and in pathological calcifications, demonstrating the adaptation of these crystals (in terms of crystallinity and orientation) to specific tissues that vary in functions or vary in normal or diseased conditions. The roles of minor elements, such as carbonate, magnesium, fluoride, hydrogen phosphate, pyrophosphate, and strontium ions, on the formation and transformation of biologically relevant calcium phosphates are summarized. Another adaptative process of crystals in biology concerns the recent development of calcium phosphate ceramics and other related biomaterials for bone graft. Bone graft materials are available as alternatives to autogeneous bone for repair, substitution, or augmentation. This paper discusses the adaptive crystal formation in mineralized tissues induced by calcium phosphate and related bone graft biomaterials during bone repair.

Colonization of a calcium phosphate/elastin-solubilized peptide-collagen composite material by human osteoblasts

The evaluation of the suitability of a new biomaterial as a possible substitute for bone tissue is described here. This biomaterial is based on calcium phosphate particles linked to an artificial connective matrix, the elastin-solubilized peptides (ESP) associated with type I and III collagens. This work demonstrates the feasibility of shaping this composite material into discs, describes its microstructural characteristics, and evaluates its capacity as a substrate for the proliferation of human osteoblasts without loss of their phenotypic expression.

Polyactive as a bone-filler in a beagle dog model

Calcification is a crucial step in the bone-bonding mechanism of PEO/PBT hydrogel copolymers (Polyactive, a new generation of bone-fillers. A beagle dog study was conducted to determine whether the preoperative presence of a calcium phosphate layer (precalcification) on a PEO/PBT 80/20 copolymer would further increase the bone-bonding rate. Standard bone cavities were filled with either precalcified or nonprecalcified porous cylindric PEO/PBT 80/20 implants, or hydroxyapatite granules held together with PEO/PBT 70/30, or were left unfilled. A significantly higher percentage of mineralized component was present in the cavities filled with the precalcified PEO/PBT 80/20 copolymer than in the control defects. As a result of swelling by fluid-uptake, the press-fit inserted copolymer implants showed a significant reduction in pore size, thus preventing optimal bone ingrowth. Both precalcification of the copolymer and underfilling of the defect, to create space for the copolymer to increase in diameter, stimulate postoperative calcification and bone ingrowth in PEO/PBT 80/20 copolymers.

Application of porous PEO/PBT copolymers for bone replacement

A range of polyethylene oxide/polybutylene terephthalate (PEO/PBT) copolymers (70-30% PEO) was investigated for nonloadbearing bone replacement application. Porous PEO/PBT cylinders (d = 5 mm, h = 7 mm) were implanted transcortically in the diaphyseal femur of 10 goats, and the animals were sacrificed at 3, 6, 9, 12, and 26 weeks. Qualitative evaluation was performed using light and fluorescence microscopy, scanning electron microscopy, and back-scatter electron imaging with an attached X-ray microanalysis system. The percentage of bone ingrowth and the percentage of bone contact in the pore region were quantitatively assessed using undecalcified histological sections. The hydrogel properties of the PEO/PBT copolymers provided a rapid closure of the defect upon press-fit implantation, due to postoperative water uptake and subsequent swelling behavior of the materials. Bridging of the defect by bone and the occurrence of bone bonding were observed 6 weeks postoperatively for the material with the highest PEO content (70/30). For the 60/40 and 55/45 PEO/PBT proportions, union of the defect and bone bonding were observed at 9 and 12 weeks, respectively. The stiffer 40/60 and 30/70 PEO/PBT implants showed bridging of the 5-mm gap after 12 weeks, but did not reveal bone bonding up to 26 weeks. Peripheral fragmentation, mainly in the marrow cavity, was found for the 70/30 material at 12 weeks and had increased at 26 weeks. Degradation was not seen for the other materials. The histomorphometrical data confirmed the microscopical observations and demonstrated a direct relation between PEO content in the PEO/PBT co-polymers, the rate of bone ingrowth, and the amount of bone contact. Porous PEO/PBT copolymers are degradable, bone-bonding elastomeric substrates with favorable handling properties and a high percentage of bone ingrowth (69-78 at 26 weeks). It was therefore concluded that PEO/ PBT copolymers are highly promising materials for bone-replacement surgery.

Transmission electron microscopy observations at the interface of bone and four types of calcium phosphate ceramics with different calcium/phosphorus molar ratios

Four kinds of calcium phosphate ceramics, beta-calcium pyrophosphate (Ca2P2O7), beta-tricalcium phosphate (Ca3(PO4)2), hydroxyapatite (Ca10(PO4)6(OH)2) and tetracalcium phosphate (Ca4(PO4)2O), were prepared. The calcium/phosphorus molar ratios were 1, 1.5, 1.66 and 2, respectively. Particles (150-300 microns) of these ceramics were packed into holes (diameter 2.5 mm) made in the tibial metaphysis of mature male rats. At 2 weeks, 4 weeks, 8 weeks and 6 months after the operation, undecalcified specimens were prepared. Transmission electron microscopy showed that the bone-bonding behaviour of calcium phosphate ceramics at the interface with bone did not vary with the calcium/phosphate molar ratio. Amorphous substances or needle-like microcrystals were observed on the surface of the ceramics at 2 weeks after implantation. The ceramics showed direct continuity with small crystallites of bone tissue at 4 weeks, 8 weeks and 6 months after implantation. The ceramics appeared to be getting smaller with time. Collagen fibres were not observed at the bone/ceramic interface. Neither chemical bonding nor mechanical bonding by interlocking between bone and ceramics was described by morphological observation using transmission electron microscopy.

Bone-bonding behaviour of poly(ethylene oxide)-polybutylene terephthalate copolymer coatings and bulk implants: a comparative study

A range of poly(ethylene oxide)-polybutylene terephthalate (PEO-PBT) copolymers (70-30% PEO), both as coating on titanium alloy as well as bulk cylinders, was press-fit implanted in the diaphyseal femur of 16 goats. At early survival times (4 wk), a high degree of cortical bone contact was observed for bulk implants using light microscopy and this was confirmed by backscatter electron microscopy. This was attributed to the swelling behaviour of PEO-PBT copolymers. At this stage, bone contact was also revealed for coated implants, but to a lesser extent. At a later stage (12 wk), bone bonding was demonstrated both morphologically and by X-ray microanalysis, at the interface of 70:30 PEO-PBT bulk as well as 70:30 PEO-PBT-coated implants. Bone bonding increased with time (26 and 52 wk) for this PEO-PBT proportion and was also observed for 60:40 and 55:45 implants, although less frequently. For 40:60 and 30:70 PEO-PBT proportions, bone bonding was not shown. Based on these qualitative data, it was not possible to differentiate between coated and bulk implants with respect to bone bonding. This study demonstrated that the application of PEO-PBT elastomers as coatings does not alter the bone-bonding properties. It was therefore concluded that PEO-PBT coatings are beneficial over the bone-bonding but brittle ceramic coatings, due to their flexibility. In addition, the bone-bonding capacities of these PEO-PBT coatings surpass the non-bonding behaviour of currently available flexible coatings.

Long-term histological evaluation of hydroxyapatite ceramics in humans

We have investigated the interface between bone and hydroxyapatite (HA) chronically implanted in man. By light microscopy, HA appeared to bind directly to bone without intervening fibrous tissue. By transmission electron microscopy, two patterns were noted: (1) HA either bound directly to bone; or (2) electron-dense material intervened between HA and bone. The orientation of bone collagen fibres likewise showed two patterns: (1) collagen fibres were oriented parallel to the HA; or (2) the fibres were aligned perpendicularly. We have observed similar binding properties of HA to the jaw bone of humans in vivo and in vitro.

Initial bone matrix formation at the hydroxyapatite interface in vivo

Dense, sintered, slip-cast hydroxyapatite rods were implanted transfemorally in young adult rats. The femora were excised after 2 and 4 weeks and, following fixation, either embedded in methyl methacrylate for light microscopy, decalcified and prepared for transmission electron microscopy, or freeze fractured in liquid nitrogen for scanning electron microscopic analysis. The latter was performed on the two tissue fragments that remained after freeze fracturing, from which the first contained the implants and the second comprised tissue that had been immediately adjacent to the hydroxyapatite rods. Undecalcified light microscopic sections revealed extensive bone tissue formation around and in contact with the hydroxyapatite rods. The initial bone matrix apposed to the implant surface, as demonstrated with scanning electron microscopy, was either composed of globular deposits or an organized network of collagen fibers. The deposits, which ranged in size from 0.1-1.1 microns, fused to form a cement-like matrix to which collagen fibers were attached. Degradation of the hydroxyapatite surface resulted in the presence of unidirectionally aligned crystallites, with which the newly formed bone matrix was closely associated. Ultrastructural analysis of the bone-hydroxyapatite interface with transmission electron microscopy revealed a 50-600-nm-wide collagen-free granular zone, comprising one or more 40-100-nm-thick electron-dense layer(s). These structural arrangements most probably partially represent the globular deposits and proteinaceous material adsorbed onto and partially in the degrading hydroxyapatite surface. Although the latter change in surface topography may have enhanced bonding of the cement-like matrix to the hydroxyapatite, the cause for this change in topography and the type of bond formed are, at present, unknown.

Interface reactions to PEO/PBT copolymers (Polyactive) after implantation in cortical bone

The bone reaction at the interface of a range of PEO/PBT copolymers (Polyactive) after press-fit implantation in the diaphyseal femur of 20 goats was investigated. The animals were sacrificed at 1, 4, 12, 26, and 52 weeks. Undecalcified histologic sections were prepared, evaluated qualitatively, and quantified with the aid of an image analysis system. The percentage of bone contact was determined morphometrically for all PEO/PBT proportions; for the 70/30 ratio, the percentage of calcification of the material surface and of bone-bonding (defined as a continuum at the light microscopic level between calcification within the material surface and bone tissue) were also assessed. PEO/PBT copolymers possess hydrogelic properties, and a direct relation has been established between water-uptake and PEO content. The swelling behavior of all PEO/PBT substrates resulted in a high degree of bone contact (over 95%) at early stages. From the 12-week survival time onward the 70/30 revealed higher percentages of bone contact (over 80%) when compared with the other ratios (60/40, 55/45, 40/60, and 30/70). This difference was statistically confirmed 1 year postoperatively. The materials with the higher PEO contents showed the highest amounts of calcification, which is reflected by the rate of bone-bonding (70% of bone-bonding for the 70/30 at 52 weeks). Calcification and bone-bonding were not observed for 40/60 and 30/70 proportions. The quantitative results confirmed the relation between PEO content, water-uptake, calcification, and bone-bonding. It was furthermore demonstrated that PEO/PBT copolymers initially establish a high degree of bone contact, whereas the bone-bonding properties, especially of the 70/30, accomplish a long-term implant fixation.

Biodegradation and bioresorption of calcium phosphate ceramics

The use of several calcium phosphate (Ca-P) materials for bone repair, augmentation, substitution and as coatings on metal implants has gained clinical acceptance in many dental and medical applications. These Ca-P materials may be of synthetic or natural origin, available in different physical forms (dense or macroporous, particles or blocks) and are used in bulk as coatings for metallic and non-metallic substrates or as components in composites, cements and bioactive glasses. Biodegradation or bioresorption of calcium phosphate materials implies cell-mediated degradation in vitro or in vivo. Cellular activity during biodegradation or bioresorption occurs in acid media; thus the factors affecting the solubility or the extent of dissolution (which in turn depends on the physico-chemical properties) of the Ca-P materials are important. Enrichment of the microenvironment due to the release of calcium and phosphate ions from the dissolving Ca-P materials affects the proliferation and activities of the cells. The increase in the concentrations of the calcium and phosphate ions promotes the formation of carbonate apatite which are similar to the bone apatite. The purpose of this invited paper is to discuss the processes of biodegradation or bioresorption of Ca-P materials in terms of the physico-chemical properties of these materials and the phenomena involved including the formation of carbonate apatite on the surfaces and in the vicinity of these materials. This phenomenon appears to be related to the bioactivity of the material and the ability of such materials to directly attach to bone and to form a uniquely strong material-bone interface.

A comparative study of ultrastructures of the interfaces between four kinds of surface-active ceramic and bone

The interfaces between four kinds of surface-active ceramic and bone were studied by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) using undecalcified specimens. The materials were Bioglass-type glass (Bioglass), Ceravital-type glass-ceramic (KGS), apatite- and wollastonite-containing glass-ceramic (A-W.GC) and hydroxyapatite (HA). Particles of these materials, ranging between about 100 and 300 microns in diameter, were implanted into rat tibiae, and specimens were prepared for observation at 8 weeks after implantation. All materials were observed to bond to bone through a collagen-free layer consisting of fine apatite crystals distinct from those in bone. The crystals of this apatite layer and those of bone were intermingled at their interface, suggesting chemical bonding. In Bioglass, which had only a glassy phase, several tens of microns of the material surface had changed to such an apatite layer. In KGS and A-W.GC, which had macrocrystals in the glassy phase, an intervening apatite layer about 0.5 micron thick was observed between the materials and bone. Furthermore, fine apatite crystals were also observed among the macrocrystals near the surface of the materials. In HA, which had no glassy phase, an intervening apatite layer was much less distinct and sometimes absent. These differences were considered to be attributable to the differences in chemical composition, crystallization, and solubility of the materials.

The ultrastructure of the bone-hydroxyapatite interface in vitro

Rat bone marrow cells were cultured on plasma-sprayed hydroxyapatite (HA). The cells formed a mineralized extracellular matrix (ECM) that exhibited several characteristics of bone tissue. The interface between this mineralized ECM and the HA was studied at the ultrastructural level with scanning and transmission electron microscopy and x-ray microanalysis. Initially, the deposition of a globular, afibrillar matrix was observed on HA. This was followed by the integration of collagen fibers in this matrix and their subsequent mineralization. At the bone-HA interface two distinctly different interfacial structures were observed. An electron-dense layer with a thickness of 20-60 nm was regularly present, which contained both organic and inorganic material and was rich in glycosaminoglycans. The interfaces differed however, in the presence or absence of an amorphous zone which was free of collagen fibers and had an average thickness of 0.7-0.8 microns. It was frequently seen interposed between the electron-dense layer and the hydroxyapatite. Similar interfacial structures have also been described in the in vivo environment, where they were referred to as lamina limitans-like or cement linelike. From the results of this study, it can be concluded that the described in vitro system is a suitable model to study bone-biomaterial interactions.

Mineralization and bone formation on microcarrier beads with isolated rat calvaria cell population

Using enzymatically isolated rat bone cells in the presence of cytodex microcarrier beads, osteoblastic cell differentiation and bone nodule formation were studied at the optical and electron microscopic level. Cytochemical method showed an intense alkaline phosphatase activity mainly around the microcarriers where the cells have formed multilayers on day 4 of cultures. On day 7 of experiment cultures, Von Kossa method stained positively only the cytodex microcarriers. During the following days, bone nodule formation was closely associated with cytodex microcarriers. In contrast, in control cultures with negatively charged glass beads, cells failed to pile up around the glass beads, and bone nodule formation occurred randomly in the culture dishes with 24 hour delay. Light microscopy observations of experiment cultures revealed the formation of nodular structures, with active osteoblastic cells forming a mineralized matrix in which osteocytes were present. Transmission electron microscopy revealed first, a mineralization process of the surface of the cytodex microcarriers which appeared like a granular electron-dense, collagen-free layer followed by the deposit of a collagenous matrix. These results indicated that cytodex microcarriers provided an excellent matrix for bone cell differentiation and mineralization.

Ultrastructural and ultracytochemical characteristics of multinucleated cells after hydroxyapatite implantation into rat periodontal tissue

Multinucleated cells (MNCs) that appeared after hydroxyapatite (HAP) implantation into experimentally-produced bone defects in rat periodontal tissues were investigated both ultrastructurally and ultracytochemically. At day 5 after implantation, MNCs first appeared along the HAP surface. They had no features of typical osteoclasts such as ruffled border and clear zone. By d 14, these cells acquired features similar to osteoclasts, including ruffled border and clear zone. With the appearance of ruffled borders in MNCs, new bone deposited around the implanted HAP. MNCs appeared to excavate both newly-formed bone and implanted HAP simultaneously. Ingested HAP particles were observed not only in MNCs but also in macrophages. MNCs contained both tartrate-resistant acid phosphatase (ACPase) and carbonic anhydrase (CAase). ACPase activity was detected along all the biosynthesizing pathways in MNCs. Extracellular ACPase activity around the ruffled border region was also demonstrable. CAase activity could be detected only in the cytosol, vesicles and mitochondrial cristae of the MNCs. These cytochemical characteristics were almost the same regardless of the time elapsed after implantation.

Surface-reactive biomaterials in osteoblast cultures: an ultrastructural study

The tissue/biomaterial interface reactions of three biomaterials selected as candidates for hard tissue replacement were studied at the electron microscopical level after incubation with enzymatically isolated rat bone cells. An electron-dense layer was routinely observed between hydroxyapatite, coral, cytodex polymer and the neighbouring cells. This layer was visible before bone formation occurred, and was collagen free. The ultrastructural features revealed a needle-shaped filamentous layer continuous with coral material, whereas hydroxyapatite or cytodex/tissue interface was granular in appearance. These different structures may indicate reactive surfaces, depending on the composition of the substrate.

Ultrastructural demonstration of the importance of crystal size of bioceramic powders implanted into human periodontal lesions

Stages in bone formation were studied ultrastructurally after the implantation of the following 3 bioceramic powders into human periodontal lesions: (1) beta-tricalcium phosphate whitlockite (Synthograft) consisting of particles with a mean length of 229 +/- 87 microns in SEM and appearing in TEM as crystals with a mean diameter 488 +/- 192 nm; (2) an hydroxyapatite (Bioapatite) which consisted of particles with a mean length of 283 +/- 87 microns in SEM and of crystals with a mean diameter of 146 +/- 47 nm in TEM; and finally (3), a microsized hydroxyapatite consisting of elongated platelets with a mean length of 32 +/- 4 microns in SEM, composed of small crystals with a mean diameter of 38 +/- 16 nm in TEM. In a preliminary experiment in rats, it appeared that the microsized hydroxyapatite implanted into the alveolar region after first molar extraction exhibited biocompatibility. In 6- and 12-month biopsies, it appeared that bone formation in association with the 3 bioceramics tested in human periodontal lesions occurred through similar mechanisms at the ultrastructural level. After the appearance of peripheral fibroblast-like or osteoblast-like cells with an interposed layer reminiscent of an osteoid tissue, collagen fibrils were observed in the intercrystalline spaces. These spaces subsequently underwent mineralization, with deposition of bone apatite crystals followed by the peripheral deposition of a thin inner bone layer with a granular appearance and an outer normal bone layer of either woven bone, lamellar bone or bone with parallel calcified collagen fibrils. These bone nodules, however, formed around the bioceramic particles at highly variable time intervals. Bone formation was observed around Synthograft and Bioapatite implants only in 12-month biopsies, and thicker layers of peripheral bone were observed with the latter hydroxyapatite implant. With microsized hydroxyapatite, a significant amount of peripheral bone formation had already occurred by 6 months, strongly suggesting an important effect of crystal size on bone formation.

Reactions of cells at implant surfaces

The surface of implants is an important parameter in host-implant integration. Several strategies can be used to obtain integration, such as the application of grooves or pores at the implant surface. Most of these surface alterations, however, will lead to an increase of total implant surface area which might influence the inflammatory response to an implant. As far as integration with bone is concerned several biomaterials have been successful in mimicking this material, by having similar crystals at their surface (calcium phosphate ceramics) or by containing a certain amount of calcium and phosphorus. Polyactive, a poly(ethylene oxide)-poly(butylene terephthalate) segmented copolymer, also possesses favourable integration properties with bone, but initially lacks calcium and phosphorus. It is proposed that the application of hydrogels as biomaterial may add a new dimension to integration capacity.

Biocompatibility of a polyether urethane, polypropylene oxide, and a polyether polyester copolymer. A qualitative and quantitative study of three alloplastic tympanic membrane materials in the rat middle ear

The biocompatibility of porous implants made of Estane 5714 F1 polyether urethane, polypropylene oxide, and a poly(ethylene oxide hydantoin) and poly(tetramethylene terephthalate) segmented polyether polyester copolymer (HPOE/PBT copolymer), which were selected as candidates for an alloplastic tympanic membrane, was assessed after implantation in rat middle ears for periods of up to 1 year. Implantation of the materials led to tissue reactions initially associated with the wound-healing process, whereas after 1 month not only the presence of macrophages and foreign-body giant cells surrounding the implant materials but also implant degradation were characteristic for a foreign-body reaction. Macrophages and foreign-body giant cells dominated the picture of the tissue surrounding polypropylene oxide. The altered morphology of these cells, the persistent infiltration of the implantation sites by exudate cells, and the premature death of five rats in the 1-year group suggest that polypropylene oxide degradation was accompanied by the release of toxic substances. Estane and copolymer degradation did not induce tissue responses reflecting implant toxicity, and tympanic membranes given these alloplasts showed a normal healing pattern. Inclusions in the cytoplasm of macrophages associated with degradation and phagocytosis of all of the polymers under study were found to contain iron, silicon, titanium, and aluminum. Growth of fibrous tissue and bone, the latter into Estane and HPOE/PBT copolymer implants, indicated appropriate implant fixation by tissue, although macrophages and foreign-body giant cells were present as well. Especially the fixation of copolymer by ingrowth of bone seems promising in terms of the amount of bone in the pores and the electron-dense bone/copolymer interface. The latter is indicative for bonding osteogenesis. The HPOE/PBT copolymer is a better candidate for alloplastic tympanic membrane than Estane, and the use of polypropylene oxide cannot be recommended.

Tissue/biomaterial interface characteristics of four elastomers. A transmission electron microscopical study

The tissue/biomaterial interface reactions of four elastomers--selected as candidates for scaffolding for tympanic membrane tissue in a total alloplastic middle ear prosthesis--were studied at the electron microscopical level after implantation in the rat middle ear. Time-dependent changes in the phagocyte/polymer interface suggested degradation of porous implants made of Estane polyether urethane, polypropylene oxide, and a poly(ethylene oxide hydantoin) and poly(tetramethylene terephthalate) segmented polyether polyester copolymer (HPOE/PBT copolymer), but not of dense Silastic silicone rubber implants. Silastic was always encapsulated in fibrous tissue. Contact between fibrous tissue and HPOE/PBT copolymer or Estane was established in the third month, but fibrous tissue was never seen close to polypropylene oxide. Bone made contact only with Estane and HPOE/PBT copolymer implants. The bone/copolymer interface showed an electron-dense layer morphologically similar to that seen between bone and hydroxyapatite ceramic, suggesting that with respect to bone HPOE/PBT copolymer behaves like a bioactive implant material. The electron-dense layer was absnet at the bone/Estane interface. Estane and especially HPOE/PBT copolymer seem to be suitable as alloplastic tympanic membrane because of their interface behavior with respect to fibrous tissue and bone.

Formation of carbonate-apatite crystals after implantation of calcium phosphate ceramics

The aims of this study were (1) to determine at the crystal level, the nonspecific biological fate of different types of calcium phosphate (Ca-P) ceramics after implantation in various sites (osseous and nonosseous) in animals and (2) to investigate the crystallographic association of newly formed apatitic crystals with the Ca-P ceramics. Noncommercial Ca-P ceramics identified by X-ray diffraction as calcium hydroxylapatite (HA), beta-tricalcium phosphate (beta-TCP), and biphasic calcium phosphates (BCP) (consisting of beta-TCP/HA = 40/60) were implanted under the skin in connective tissue, in femoral lamellar cortical bone, articular spine bone, and cortical mandibular and mastoidal bones of animals (mice, rabbits, beagle dogs) for 3 weeks to 11 months. In humans, HA or beta-TCP granules were used to fill periodontal pockets, and biopsies of the implanted materials were recovered after 2 and 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Histological investigation of the tissue response to hydroxyapatite used as an implant material in periodontal treatment

Patients with severe periodontitis and who had one or more teeth with infrabony pockets were treated by periodontal surgery with implantation of hydroxyapatite particles into the bone defects at the time of surgery. Subsequently, in three patients it was found necessary to extract a tooth for reasons not related to the previous periodontal treatment. Specimens that included the local soft tissues and crestal bone attached to the teeth were obtained at 22, 40 and 80 weeks after placement of the implant. They were decalcified and stained with haematoxylin and eosin and examined under light microscopy. The healing response was found to vary between specimens, and between sites within the same specimen. The early stage of healing showed the implant particles surrounded by collagen. Subsequently, varying degrees of resorption of the periphery of the particles was seen, and at some sites bone deposition was observed. These different healing responses were found to be progressing concurrently at sites in close proximity. Further work is needed to confirm the histological findings described in the paper.

Crystal dissolution of biological and ceramic apatites

High resolution transmission electron microscopy (Hr TEM) studies on biological and synthetic calcium phosphate have provided information on the dissolution process at the crystal level. The purpose of this study was to investigate the dissolution of ceramic hydroxyapatite (HA) after implantation using Hr TEM. Recovered HA ceramic implanted in bony and nonbony sites in animals and in periodontal pockets in humans were used for the study. For comparison, sections of human fluorotic enamel with caries and sections of shark enameloid previously exposed to 0.1 HCl were similarly investigated. Hr TEM studies demonstrated that in both the biological and ceramic apatites, the lattice and atomic defects were the starting points in the dissolution process. However, significant differences in the process of dissolution were observed: (1) biological apatite crystals showed preferential core dissolution whereas ceramic apatite crystals showed nonspecific dissolution at the cores and at the surfaces; (2) the dissolution of biological apatites appeared to consistently extend along the crystal's c-axis whereas dissolution of the ceramic HA did not appear to be correlated with the crystal's c-axis. The observed differences in crystal dissolution between biological and ceramic apatites may be attributed to the following: (1) the unique crystal/protein interaction present with biological apatites but absent in ceramic HA; (2) differences in defect distribution between biological and ceramic apatites which are due to the differences in the original of these defects; and (3) the longer morphological c-axis of biological apatites compared with that of ceramic apatites.(ABSTRACT TRUNCATED AT 250 WORDS)

Porous hydroxyapatite grafts in chronic subcrestal periodontal defects in rhesus monkeys: a histological investigation

The purpose of this investigation was to evaluate the histologic response to replamineform (porous) hydroxyapatite grafts in chronically inflamed, surgically created, periodontal pockets in Rhesus monkeys. Forty-eight subcrestal defects were surgically created in 8 Rhesus monkeys. Orthodontic wires were adapted to the base of the defects and left in place for 8 weeks. The defects were randomly assigned a treatment modality so that 8 granular porous and 8 block porous hydroxyapatite grafts were done. Eight sites were left as unoperated controls. Twenty-four contralateral sham-operated sites were treated by open curettage. Histometric measurements of the length of regenerated connective tissue attachment were recorded. Block hydroxyapatite, granular hydroxyapatite, and sham-operated sites exhibited similar amounts of regenerated connective tissue attachment, which was significantly greater than that which occurred in unoperated controls. Newly formed bone was observed within the porous channels of the hydroxyapatite grafts as well as in direct apposition on the surface of implant particles. New bone, cementum, and periodontal ligament was observed in grafted sites and in defects treated by open curettage. In some instances healing occurred by means of a long junctional epithelium. Histology confirmed that unoperated defects remained as unhealed, inflamed periodontal pockets. The results of this study suggest that porous hydroxyapatite grafts have the potential to regenerate the attachment apparatus in primates.