Efficacy and Safety of Antibiotic Impregnated Microporous Nanohydroxyapatite Beads for Chronic Osteomyelitis Treatment: A Multicenter, Open-Label, Prospective Cohort Study

Chronic osteomyelitis is still a serious health problem that causes disabling conditions and has an impact on the quality of life. The objective of this study was to determine the clinical efficacy and safety of localized antibiotics delivery via impregnated microporous nanohydroxyapatite (nHA-ATB) beads for chronic osteomyelitis treatment. A total of 62 patients were enrolled in this study. After radical surgical debridement, the bone defect was filled with three types of antibiotics (vancomycin or gentamicin or fosfomycin) impregnated HA beads. The follow-up period was 48 weeks. It was found that the success rate was approximately 98% with a re-infection in only one patient. Quality of life of all patients after treatment improved significantly over time. Systemic exposure to vancomycin and gentamicin after beads implantation was limited and high local antibiotics concentrations were found in wound drainage fluid at 24, 48 and 72 h. Blood biochemistry measurements did not show any nephrotoxic or hepatotoxic effects. 20 adverse events were reported, but 90% of the events were resolved without having to remove the beads and the patients recovered. Satisfactory outcomes were observed in terms of success rate, quality of life and adverse effect. nHA-ATB beads impregnated by vancomycin or gentamicin or fosfomycin could potentially be employed as an alternative product of choice for localized antibiotics delivery in chronic osteomyelitis treatment.

Preparation of Isopropyl Acrylamide Grafted Chitosan and Carbon Bionanocomposites for Adsorption of Lead Ion and Methylene Blue

Wastewater, which is rich with heavy elements, dyes, and pesticides, represents one of the most important environmental pollutants. Thus, it has been significant to fabricate environmentally friendly polymers with high adsorption ability for those pollutants. Herein, crosslinked chitosan (C-Cs) was prepared using isopropyl acrylamide and methylene bisacrylamide. Carbon nanoparticles (C-NPs) were also obtained by the treatment of the agricultural wastes, which was used with C-Cs to prepare C-Cs/C-NPs nanocomposite (C-Cs/C-NC). Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and transmission electron microscope (TEM) were used to investigate the prepared adsorbent. C-Cs, C-NPs, and C-Cs/C-NC were used in water treatment for the adsorption of lead ions (Pb⁺²) and methylene blue (MB). The adsorption process occurred by the prepared samples was investigated under different conditions, including contact time, as well as different doses and concentrations of adsorbents. The findings exhibited that the adsorption of Pb⁺² and MB by C-Cs/C-NC was higher than C-Cs and C-NPs. In addition, the kinetic and isotherm models were studied, where the results showed that the adsorption of Pb⁺² and MB by various adsorbents obeys pseudo-second-order and Langmuir isotherms, respectively.

Cefazolin Loaded Oxidized Regenerated Cellulose/Polycaprolactone Bilayered Composite for Use as Potential Antibacterial Dural Substitute

Oxidized regenerated cellulose/polycaprolactone bilayered composite (ORC/PCL bilayered composite) was investigated for use as an antibacterial dural substitute. Cefazolin at the concentrations of 25, 50, 75 and 100 mg/mL was loaded in the ORC/PCL bilayered composite. Microstructure, density, thickness, tensile properties, cefazolin loading content, cefazolin releasing profile and antibacterial activity against S. aureus were measured. It was seen that the change in concentration of cefazolin loading affected the microstructure of the composite on the rough side, but not on the dense or smooth side. Cefazolin loaded ORC/PCL bilayered composite showed greater densities, but lower thickness, compared to those of drug unloaded composite. Tensile modulus was found to be greater and increased with increasing cefazolin loading, but tensile strength and strain at break were lower compared to the drug unloaded composite. In vitro cefazolin release in artificial cerebrospinal fluid (aCSF) consisted of initial burst release on day 1, followed by a constant small release of cefazolin. The antibacterial activity was observed to last for up to 4 days depending on the cefazolin loading. All these results suggested that ORC/PCL bilayered composite could be modified to serve as an antibiotic carrier for potential use as an antibacterial synthetic dura mater.

Customized 3D printed nanohydroxyapatite bone block grafts for implant sites: a case series

PATIENTS

A case series of 12 patients (mean age, 53.5 years) with horizontal ridge deficiencies had augmentations with customized 3D printed nanohydroxyapatite (3DHA) block grafts prior to implant placement. 3DHA graft materials were fabricated to fit the individual patient defects using DICOMs from CBCT images obtained from each patient. The CBCT images were then converted into the STL file format and 3DHA was reconstructed by 3D printing. Surgical bone augmentation consisted of 3DHA incorporating concentrated growth factors (CGFs) and platelet-rich fibrin (PRF) membrane. At 6 months, a bone biopsy and implantation were performed. The primary outcome was horizontal bone gain after 6 months. The secondary outcomes included information on the clinical outcomes, dimensions, and histomorphometric results.

DISCUSSION

The 3DHA block graft was successful in 10 of 12 patients. Graft adjustment was not required. All 3DHA adapted and fit well at all defect sites. Maximum mean horizontal bone gains were 3.06 ± 1.02 and 3.56 ± 0.23 mm from the DICOMs and STL data sets, respectively. The volume gain was 229.8 ± 82.96 mm³. A low pain score after surgery was reported of 1.41 ± 0.51, while the healing index score increased with a maximum mean of 4.7 ± 0.67. Thirteen implants were placed with good primary stability (ISQ = 65 ± 4.08), without additional guided bone regeneration. Histomorphometric analysis revealed that new bone formation, bone tissue, residual grafts, and connective tissue were 28.6 ± 1.88, 30.48 ± 4.81, 19.82 ± 4.07, and 20.81 ± 4.41%, respectively.

CONCLUSIONS

A customized 3DHA block graft is a viable treatment option for primary implant-site augmentation.

Clinical evaluation of 3D printed nano-porous hydroxyapatite bone graft for alveolar ridge preservation: A randomized controlled trial

Background/purpose

Ridge resorption after tooth extraction may result in inadequate bone volume and unfavorable ridge architecture for ideal implant placement. The use of bone substitutes has been advocated to fill extraction sites and to enhance primary implant stability. This study was made to evaluate the clinical efficacy of novel 3D printed nano-porous hydroxyapatite (3DP HA, test group) in comparison to nano-crystalline bone graft (NanoBone®, control group) in alveolar ridge preservation prior to implant placement.

Materials and methods

Thirty patients were randomized into two groups following tooth extraction. All extracted sockets were filled with 3DP HA or NanoBone® and covered with a non-resorbable membrane. After four months, cone-beam computed tomography (CBCT) and intraoral scanner were used to measure dimensional changes of bone and soft tissue surface. Bone core specimens were harvested for histological analysis during implant osteotomy. Implant stability was assessed using a modified damping capacity analysis.

Results

At four months postoperatively, dimensional changes in soft tissue surface resorption were less in the test group than in the control group; however, alveolar bone resorption was the same in both groups. Histological analysis revealed new bone formation, residual graft and fibrous connective tissue in both groups. The average primary implant stability (IST) value for both groups was approximately 70. There was no statistically significant difference in all parameters between two groups (p > 0.05).

Conclusion

3DP HA could potentially be used as an alternative bone graft material for alveolar ridge preservation.

In Vitro and In Vivo Evaluations of Mesoporous Iron Particles for Iron Bioavailability

Chronic renal failure involving hemodialysis results in blood loss during filtration. Iron deficiency and iron deficiency anemia can result. A compensatory increase in iron dosage has many side effects including discomfort. Elemental iron is a highly-pure iron source, which reduces the frequency of dosages; the solubility decreases with increased particle size or pore size. In this study, synthesized mesoporous iron particles (MIPs) were used to relieve iron deficiency anemia. Their bioavailability was measured in vitro by a Caco-2 cell model and in vivo in iron-deficient rats. In vitro bioavailability of MIPs was examined by measuring ferritin content in the Caco-2 cell model. Iron uptake of MIPs was significantly higher than commercial iron particles, which were less porous. In vivo bioavailability of MIPs was examined by measuring body weight gain and red blood cell-related parameters, compared with the bioavailability of standard drug ferrous sulfate in iron-deficient anemic rats. Finally, average hemoglobin content and hemoglobin regeneration efficiency were significantly higher in anemic rats supplemented with commercial iron particles, compared to anemic controls. In the 28-day oral toxicity test, MIPs were not significantly toxic to rat physiology or tissue histopathology. Thus, MIPs may allow effective recovery of hemoglobin in iron deficiency anemia.

Antibiotic delivery by nanobioceramics

The role of nanotechnology has evinced remarkable interest in the field of drug delivery. Bioceramics are inorganic biomaterials which are frequently used as bone substitutes. They have been explored in drug delivery as carriers for antibiotics, anti-osteoporotic drugs and anticancer drugs. Bioceramic nanoparticles are excellent alternatives to polymers due to their bioactivity, pH and temperature stability, multifunctionality, biocompatibility and tunable biodegradability. The use of bioceramics for local drug delivery in the field of orthopedics offer an efficient, safe mode of drug delivery directly to the surgical site thereby overcoming the limitations of systemic drug delivery. This review focuses on the development and applications of various nanobioceramics employed as drug delivery systems for the treatment of bone infections.

Enhancement of mechanical properties of 3D printed hydroxyapatite by combined low and high molecular weight polycaprolactone sequential infiltration

A new infiltration technique using a combination of low and high molecular weight polycaprolactone (PCL) in sequence was developed as a mean to improve the mechanical properties of three dimensional printed hydroxyapatite (HA). It was observed that using either high (M _n~80,000) or low (M _n~10,000) molecular weight infiltration could only increase the flexural modulus compared to non-infiltrated HA, but did not affect strength, strain at break and energy at break. In contrast, a combination of low and high molecular infiltration in sequence increased the flexural modulus, strength and energy at break compared to those of non-infiltrated HA or infiltrated by high or low molecular weight PCL alone. This overall enhancement was found to be attributed to the densification of low molecular weight PCL and the reinforcement of high molecular PCL concurrently. The combined low and high molecular weight infiltration in sequence also maintained high osteoblast proliferation and differentiation of the composites at the similar level of the HA. Densification was a dominant mechanism for the change in modulus with porosity and density of the infiltrated HA/PCL composites. However, both densification and the reinforcing performance of the infiltration phase were crucial for strength and toughening enhancement of the composites possibly by the defect healing and stress shielding mechanisms. The sequence of using low molecular weight infiltration and followed by high molecular infiltration was seen to provide the greatest flexural properties and highest cells proliferation and differentiation capabilities.