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Emonde CK, Eggers ME, Wichmann M, Hurschler C, Ettinger M, Denkena B. Radiopacity Enhancements in Polymeric Implant Biomaterials: A Comprehensive Literature Review. ACS Biomater Sci Eng 2024; 10:1323-1334. [PMID: 38330191 PMCID: PMC10934286 DOI: 10.1021/acsbiomaterials.3c01667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/10/2024]
Abstract
Polymers as biomaterials possess favorable properties, which include corrosion resistance, light weight, biocompatibility, ease of processing, low cost, and an ability to be easily tailored to meet specific applications. However, their inherent low X-ray attenuation, resulting from the low atomic numbers of their constituent elements, i.e., hydrogen (1), carbon (6), nitrogen (7), and oxygen (8), makes them difficult to visualize radiographically. Imparting radiopacity to radiolucent polymeric implants is necessary to enable noninvasive evaluation of implantable medical devices using conventional imaging methods. Numerous studies have undertaken this by blending various polymers with contrast agents consisting of heavy elements. The selection of an appropriate contrast agent is important, primarily to ensure that it does not cause detrimental effects to the relevant mechanical and physical properties of the polymer depending upon the intended application. Furthermore, its biocompatibility with adjacent tissues and its excretion from the body require thorough evaluation. We aimed to summarize the current knowledge on contrast agents incorporated into synthetic polymers in the context of implantable medical devices. While a single review was found that discussed radiopacity in polymeric biomaterials, the publication is outdated and does not address contemporary polymers employed in implant applications. Our review provides an up-to-date overview of contrast agents incorporated into synthetic medical polymers, encompassing both temporary and permanent implants. We expect that our results will significantly inform and guide the strategic selection of contrast agents, considering the specific requirements of implantable polymeric medical devices.
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Affiliation(s)
- Crystal Kayaro Emonde
- Laboratory
for Biomechanics and Biomaterials (LBB), Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hannover, Germany
| | - Max-Enno Eggers
- Institute
of Production Engineering and Machine Tools, Leibniz University Hannover, An der Universität 2, 30823 Garbsen, Hannover, Germany
| | - Marcel Wichmann
- Institute
of Production Engineering and Machine Tools, Leibniz University Hannover, An der Universität 2, 30823 Garbsen, Hannover, Germany
| | - Christof Hurschler
- Laboratory
for Biomechanics and Biomaterials (LBB), Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hannover, Germany
| | - Max Ettinger
- Department
of Orthopedic Surgery − DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hannover, Germany
| | - Berend Denkena
- Institute
of Production Engineering and Machine Tools, Leibniz University Hannover, An der Universität 2, 30823 Garbsen, Hannover, Germany
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Jain T, Tantisuwanno C, Paul A, Takmakov P, Joy A, Isayeva I, Simon DD. Accelerated in vitro oxidative degradation testing of polypropylene surgical mesh. J Biomed Mater Res B Appl Biomater 2023; 111:2064-2076. [PMID: 37596906 DOI: 10.1002/jbm.b.35308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/14/2023] [Accepted: 08/01/2023] [Indexed: 08/21/2023]
Abstract
Polypropylene (PP) surgical mesh had reasonable success in repair of hernia and treatment of stress urinary incontinence (SUI); however, their use for the repair of pelvic organ prolapse (POP) resulted in highly variable results with lifelong complications in some patients. One of several factors that could be associated with mesh-related POP complications is changes in the properties of the implanted surgical mesh due to oxidative degradation of PP in vivo. Currently, there are no standardized in vitro bench testing methods available for assessing the susceptibility to oxidative degradation and estimating long-term in vivo stability of surgical mesh. In this work, we adapted a previously reported automated reactive accelerated aging (aRAA) system, which uses elevated temperatures and high concentrations of hydrogen peroxide (H2 O2 ), for accelerated bench-top oxidative degradation testing of PP surgical mesh. Since H2 O2 is highly unstable at elevated temperatures and for prolonged periods, the aRAA system involves a feedback loop based on electrochemical detection methods to maintain consistent H2 O2 concentration in test solutions. Four PP mesh samples with varying mesh knit designs, filament diameter, weight, and % porosity, were selected for testing using aRAA up to 4 weeks and characterized using thermal analysis, Fourier-transform infrared spectroscopy-attenuated total reflectance (FTIR-ATR) and scanning electron microscopy (SEM). Additionally, the oxidation index (OI) values were calculated based on the FTIR-ATR spectra to estimate the oxidative degradation and oxidation reaction kinetics of PP surgical mesh. The OI values and surface damage in the form of surface flaking, peeling, and formation of transverse cracks increased with aRAA aging time. The aRAA test method introduced here could be used to standardize the assessment of long-term stability of surgical mesh and may also be adopted for accelerated oxidative degradation testing of other polymer-based medical devices.
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Affiliation(s)
- Tanmay Jain
- Division of Biology, Chemistry and Materials Science, U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland, USA
| | | | - Arindam Paul
- Division of Biology, Chemistry and Materials Science, U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland, USA
| | - Pavel Takmakov
- Division of Biology, Chemistry and Materials Science, U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland, USA
| | - Abraham Joy
- Department of Polymer Science, The University of Akron, Akron, Ohio, USA
| | - Irada Isayeva
- Division of Biology, Chemistry and Materials Science, U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland, USA
| | - David D Simon
- Division of Biology, Chemistry and Materials Science, U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland, USA
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Sarfraz S, Tamminen AM, Leikola J, Salmi S, Kaakinen M, Sorsa T, Suojanen J, Reunanen J. High Adherence of Oral Streptococcus to Polylactic Acid Might Explain Implant Infections Associated with PLA Mesh Implantation. Int J Mol Sci 2023; 24:ijms24119504. [PMID: 37298455 DOI: 10.3390/ijms24119504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this study was to evaluate and compare the biofilm formation properties of common pathogens associated with implant-related infections on two different implant material types. Bacterial strains tested in this study were Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis, and Escherichia coli. Implant materials tested and compared were PLA Resorb × polymer of Poly DL-lactide (PDLLA) comprising 50% poly-L-lactic acid and 50% poly-D-lactic acid) and Ti grade 2 (tooled with a Planmeca CAD-CAM milling device). Biofilm assays were done with and without saliva treatment to evaluate the effect of saliva on bacterial adhesion and to mimic the intraoral and extraoral surgical routes of implant placement, respectively. Five specimens of each implant type were tested for each bacterial strain. Autoclaved material specimens were first treated with 1:1 saliva-PBS solution for 30 min, followed by washing of specimens and the addition of bacterial suspension. Specimens with bacterial suspension were incubated for 24 h at 37 °C for biofilm formation. After 24 h, non-adhered bacteria were removed, and specimens were washed, followed by removal and calculation of adhered bacterial biofilm. S. aureus and E. faecalis showed more attachment to Ti grade 2, whereas S. mutans showed higher adherence to PLA in a statistically significant manner. The salivary coating of specimens enhanced the bacterial attachment by all the bacterial strains tested. In conclusion, both implant materials showed significant levels of bacterial adhesion, but saliva treatment played a vital role in bacterial attachment, therefore, saliva contamination of the implant materials should be minimized and considered when placing implant materials inside the body.
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Affiliation(s)
- Sonia Sarfraz
- Biocenter Oulu, Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
| | - Anni-Maria Tamminen
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, 15850 Lahti, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Sonja Salmi
- Biocenter Oulu, Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
| | - Mika Kaakinen
- Biocenter Oulu, Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
- Oulu Centre for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, University of Oulu, 90220 Oulu, Finland
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, 00014 Helsinki, Finland
| | - Juho Suojanen
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, 15850 Lahti, Finland
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, 00029 Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Justus Reunanen
- Biocenter Oulu, Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
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Ju GS, Son KM, Choi WY, Cheon JS. Clinical usefulness of fixation of absorbable implants with cyanoacrylate in comminuted fractures of the maxilla. Arch Craniofac Surg 2019; 20:233-238. [PMID: 31462014 PMCID: PMC6715555 DOI: 10.7181/acfs.2019.00325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background The open reduction of craniofacial bone fractures requires internal fixation using metal plates and screws, which have been considered the gold standard. However, metal implants pose a risk of palpation, protrusion, and foreign body reaction, and they may require an additional operation for removal. Recently, good results have been reported for absorbable implants which complement the disadvantages of metal implants. This study presents the results of using absorbable mesh, plates, and screws with cyanoacrylate for more accurate and firmer fixation of comminuted fractures of the maxilla. Methods In total, 235 patients underwent operations for comminuted fractures of the maxilla. From January 2012 to December 2014, absorbable mesh and screws were used in 114 patients, while from January 2015 to December 2017, absorbable mesh, plates, and screws with cyanoacrylate were used in 121 patients. Open reduction of the bone fragments was performed, after which absorbable implants were accurately molded and fixed by screws. Results All patients underwent postoperative computed tomography scans, which showed highly accurate reduction and firm fixation in the patients who underwent procedures using absorbable implants, screws, and cyanoacrylate. There were no postoperative complications or cases of abnormal facial contour. Conclusion When absorbable implants and screws are used for maxillary fractures, no additional surgery to remove the metal plate is required. In addition, the use of cyanoacrylate enables accurate and firm fixation of the tiny bone fragments that cannot be fixed with screws.
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Affiliation(s)
- Gang San Ju
- Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Kyung Min Son
- Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Woo Young Choi
- Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Ji Seon Cheon
- Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju, Korea
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Kim YH. Delayed reconstruction of posttraumatic facial deformities. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.12.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yong Ha Kim
- Department of Plastic & Reconstructive Surgery, Yeungnam University Hospital, Daegu, Korea
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