Biodegradable materials for bone defect repair

Compared with non-degradable materials, biodegradable biomaterials play an increasingly important role in the repairing of severe bone defects, and have attracted extensive attention from researchers. In the treatment of bone defects, scaffolds made of biodegradable materials can provide a crawling bridge for new bone tissue in the gap and a platform for cells and growth factors to play a physiological role, which will eventually be degraded and absorbed in the body and be replaced by the new bone tissue. Traditional biodegradable materials include polymers, ceramics and metals, which have been used in bone defect repairing for many years. Although these materials have more or fewer shortcomings, they are still the cornerstone of our development of a new generation of degradable materials. With the rapid development of modern science and technology, in the twenty-first century, more and more kinds of new biodegradable materials emerge in endlessly, such as new intelligent micro-nano materials and cell-based products. At the same time, there are many new fabrication technologies of improving biodegradable materials, such as modular fabrication, 3D and 4D printing, interface reinforcement and nanotechnology. This review will introduce various kinds of biodegradable materials commonly used in bone defect repairing, especially the newly emerging materials and their fabrication technology in recent years, and look forward to the future research direction, hoping to provide researchers in the field with some inspiration and reference.

The outcome of biphasic calcium phosphate bone substitute in a medial opening wedge high tibial osteotomy

BACKGROUND

Our objective was to assess clinical and radiological findings following a medial opening wedge high tibial osteotomy using a biphasic calcium phosphate (BCP) synthetic bone substitute, designed as a wedge with two differing zones of density. The in-vivo behaviour of this type of bone substitute over time is currently unknown.

HYPOTHESIS

Our hypothesis was that BCP synthetic bone would facilitate bone union and undergo replacement with host bone over the study period.

PATIENTS AND METHODS

Fifteen sequential patients were followed prospectively for minimum 4-years post-operatively. All patients were evaluated clinically using patient reported outcome measures and radiologically to evaluate alignment with maintenance of the osteotomy correction, and bone union with expected BCP dissolution.

RESULTS

All patients had good clinical scores with no reported complications at 4 years. In all cases there were radiographic findings of bone union with consolidation and no loss of correction. However the graft remained densely radiopaque at final follow-up.

DISCUSSIONS

This study demonstrates that a BCP graft in combination with a locking plate for a medial opening wedge HTO allows early weight-bearing, maintains correction and provides good clinical outcomes. Whilst higher densities of BCP are strong, they do not resorb fully, remaining radiographically visible. This may have implications for the performance of a future knee arthroplasty and caution should therefore be taken.

Spinal fusion procedures in the adult and young population: a systematic review on allogenic bone and synthetic grafts when compared to autologous bone

This systematic review aims to compare clinical evidences related to autologous iliac crest bone graft (ICBG) and non-ICBG (local bone) with allografts and synthetic grafts for spinal fusion procedures in adult and young patients. A systematic search was carried out in three databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials) to identify clinical studies in the last 10 years. The initial search retrieved 1085 studies, of which 24 were recognized eligible for the review. Twelve studies (4 RCTs, 5 prospective, 3 retrospective) were focused on lumbar spine, 9 (2 RCTs, 2 prospective, 4 retrospective, 1 case-series) on cervical spine and 3 (1 RCT, 2 retrospective) on spinal fusion procedures in young patients. Calcium phosphate ceramics, allografts, bioglasses, composites and polymers have been clinically investigated as substitutes of autologous bone in spinal fusion procedures. Of the 24 studies included in this review, only 1 RCT on cervical spine was classified with high level of evidence (Class I) and showed low risk of bias. This RCT demonstrated the safety and efficacy of the proposed treatment, a composite bone substitute, that results in similar and on some metrics superior outcomes compared with local autograft bone. Almost all other studies showed moderately or, more often, high incidence of bias (Class III), thus preventing ultimate conclusion on the hypothesized beneficial effects of allografts and synthetic grafts. This review suggests that users of allografts and synthetic grafting should carefully consider the scientific evidence concerning efficacy and safety of these bone substitutes, in order to select the best option for patient undergoing spinal fusion procedures.

Antibacterial Properties of Nanoparticles in Dental Restorative Materials. A Systematic Review and Meta-Analysis

Background and Objectives: Nanotechnology has become a significant area of research focused mainly on increasing the antibacterial and mechanical properties of dental materials. The aim of the present systematic review and meta-analysis was to examine and quantitatively analyze the current evidence for the addition of different nanoparticles into dental restorative materials, to determine whether their incorporation increases the antibacterial/antimicrobial properties of the materials. Materials and Methods: A literature search was performed in the Pubmed, Scopus, and Embase databases, up to December 2018, following PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines for systematic reviews and meta-analyses. Results: A total of 624 papers were identified in the initial search. After screening the texts and applying inclusion criteria, only 11 of these were selected for quantitative analysis. The incorporation of nanoparticles led to a significant increase (p-value <0.01) in the antibacterial capacity of all the dental materials synthesized in comparison with control materials. Conclusions: The incorporation of nanoparticles into dental restorative materials was a favorable option; the antibacterial activity of nanoparticle-modified dental materials was significantly higher compared with the original unmodified materials, TiO₂ nanoparticles providing the greatest benefits. However, the high heterogeneity among the articles reviewed points to the need for further research and the application of standardized research protocols.

Bone Graft Displacement After Maxillary Sinus Floor Augmentation With or Without Covering Barrier Membrane: A Retrospective Computed Tomographic Image Evaluation

PURPOSE

Scientific publications have recently found that bone graft quality and implant survival rates were not influenced by antrostomy membrane coverage during maxillary sinus floor augmentation with a lateral approach. The aim of this study was to evaluate the stability of the bone substitute after a maxillary sinus floor augmentation procedure with or without using a covering membrane.

MATERIALS AND METHODS

This retrospective study evaluated all patients who were enrolled between April 2016 and January 2017. The stability of the bone graft inside the sinus cavity as well at the level of the lateral bone window was assessed through preoperative and postoperative cone beam computed tomography images up to 6-month follow-up. The clinical postoperative morbidity was evaluated following a visual analog scale (VAS) protocol.

RESULTS

Maxillary sinus floor augmentation with a lateral approach was performed in 41 patients. In 17 cases (10 women/7 men, mean age: 55.4 years), a barrier membrane was used to cover the lateral bone window (control group), and in 24 cases (13 women/11 men, mean age: 56.2 years), no membrane was used (test group). The bone graft dislodgement within the buccal mucosa at 6 months postoperative ranged from 0 to 12.2 mm (mean value: 3.8 ± 3.1 [standard deviation] mm) in the test group and from 0 to 2.3 mm (mean value: 0.5 ± 0.4 mm) in the control group. The postoperative pain and swelling complications were significantly more important for the test group (3.3 ± 1.4/4.3 ± 4.5, respectively) than for the control group (2.1 ± 0.9/2.7 ± 0.9).

CONCLUSION

On the basis of this preliminary study, it appears that the use of a barrier membrane to cover the lateral bone window during maxillary sinus floor augmentation surgery with a lateral approach reduces the postoperative dislodgement of the bone graft throughout the sinus antrostomy and prevents the bone substitute particles penetrating within the buccal mucosa, which is related to postoperative morbidity.

In vivo comparative investigation of three synthetic graft materials with varying compositions processed using different methods

PURPOSE

The aim of this study was to compare the osteoconductive potential and bone-healing pattern of biphasic calcium phosphates (BCPs) with varying compositions produced using different processing methods.

MATERIALS AND METHODS

Ten male New Zealand white rabbits were used. Four circular defects with a diameter of 8 mm were made in the rabbit calvarium. Each defect was assigned to one of the following BCP groups: control; BCP1, 70% hydroxyapatite (HA)/30% β-tricalcium phosphate (β-TCP); BCP2, 30% HA/70% β-TCP; and BCP3, 20% HA/80% β-TCP. The rabbits were killed either 2 (n = 5) or 8 weeks (n = 5) before surgery. Histologic and histomorphometric analyses were conducted.

RESULTS

The total amount of augmentation was significantly greater in the BCP groups than in the control group (P < .05). The amount of new bone formation did not differ significantly among the groups at either 2 or 8 weeks. The resorption of BCPs was significantly greater in the BCP3 group than in the BCP1 and BCP2 groups at 2 weeks, but the difference became insignificant compared with the BCP2 group at 8 weeks. The patterns of new bone formation and material resorption varied markedly among the BCP groups. New bone lined the residual particles in the BCP1 group, but filopodia-shaped new bone was observed in the BCP2 group, and collagen fragments were scattered inside the residual particles in the BCP3 group. Multiple cracklike lines were observed on the particles in the BCP3 group.

CONCLUSION

The specific HA-β-TCP ratios in the present study did not significantly influence new bone formation and space maintenance. The observed differences in healing patterns between the groups may be attributable to different physicochemical properties conferred upon the BCPs by the different processing methods used to produce them.

Histological evaluation of an impacted bone graft substitute composed of a combination of mineralized and demineralized allograft in a sheep vertebral bone defect

Demineralized bone matrix (DBMs) preparations are a potential alternative or supplement to autogenous bone graft, but many DBMs have not been adequately tested in clinically relevant animal models. The aim of current study was to compare the efficacy of a new bone graft substitute composed of a combination of mineralized and demineralized allograft, along with hyaluronic acid (AFT Bone Void Filler) with several other bone graft materials in a sheep vertebral bone void model. A drilled defect in the sheep vertebral body was filled with either the new DBM preparation, calcium sulfate (OsteoSet), autologous bone graft, or left empty. The sheep were euthanized after 6 or 12 weeks, and the defects were examined by histology and quantitative histomorphometry. The morphometry data were analyzed by one-way analysis of variance with the post hoc Tukey-Kramer test or the Student's t-test. All of the bone defects in the AFT DBM preparation group showed good new bone formation with variable amounts of residual DBM and mineralized bone graft. The DBM preparation group at 12 weeks contained significantly more new bone than the defects treated with calcium sulfate or left empty (respectively, p < 0.05, p < 0.01). There was no significant difference between the DBM and autograft groups. No adverse inflammatory reactions were associated with any of the three graft materials. The AFT preparation of a mixture of mineralized and demineralized allograft appears to be an effective autograft substitute as tested in this sheep vertebral bone void model.

Comparative performance of three ceramic bone graft substitutes

BACKGROUND CONTEXT

A number of different synthetic calcium-based bone graft substitutes (BGS) are currently available for clinical use. There is, however, a lack of comparative performance data regarding the relative efficacy of these materials when placed in an osseous defect site.

PURPOSE

To compare the rate, quality, and extent of osseous healing in a standard rabbit defect model for three commercially available BGS materials by measuring early bone formation and completion of defect healing and to identify whether rapid scaffold resorption stimulated or impaired bone healing.

STUDY DESIGN

Osteochondral defects, 4.8 mm in diameter and 6 to 7 mm deep, were made through the articular surface into the subchondral bone of the femoral condyle of New Zealand White rabbits and filled with cylindrical pellets of one of three commercially available BGS materials: dense calcium sulfate (DCaS), ultraporous tricalcium phosphate (beta-TCP), and porous silicated calcium phosphate (Si-CaP). The repair response was examined at 1, 3, 6, and 12 weeks after surgery (n=4 per BGS per time point).

METHOD

Qualitative histological and quantitative histomorphometric (% new bone, % bone graft substitute, capillary index, and mineral apposition rates) analysis.

RESULTS

Rapid resorption of D-CaS, primarily through dissolution, elicited a mild inflammatory response that left the defect site empty before significant quantities of new bone were formed. Both beta-TCP and Si-CaP scaffolds supported early bone apposition (<1 week). However, beta-TCP degradation products subsequently provoked an inflammatory response that impaired and reversed bone apposition within the defect site. The Si-CaP scaffolds appeared to be more stable and supported further bone apposition, with the development of an adaptive bone-scaffold composite; cell-mediated resorption of scaffold and new bone were observed in response to local load and contributed to the production of a functional repair within the defect site.

CONCLUSIONS

Rapid BGS resorption impaired the regenerative ability of local bone via three pathways: 1) insufficient persistence of an osteoconductive scaffold to encourage bone apposition, 2) destabilization of early bony apposition through scaffold disintegration, and 3) stimulation of an inflammatory response by elevated levels of particulate degradation products. This had a significant impact on the ultimate rate of healing. D-CaS did not stimulate early bone apposition, but bone repair was more advanced in D-CaS-treated defects at 12 weeks as compared with those treated with beta-TCP, despite the beta-TCP supporting direct bone apposition at 1 week. Si-CaP appeared to provide a more stable osteoconductive scaffold, which supported faster angiogenesis and bone apposition throughout the defect site, with the development of a functionally adaptive trabecular structure through resorption/remodelling of both scaffold and new bone. There was rapid formation of mineralized tissue at week 1 within the center of the defect and complete infiltration with dense, predominantly mature bone by weeks 3 to 6. The progressive remodeling of bone ingrowth and scaffold to reflect the distribution of local host tissue, combined with histological evidence of targeted osteoclastic resorption of both scaffold and bone, suggest that bone adaptation within the scaffold could be in response to Wolff's law. Although this model may not directly translate to a spinal fusion model and the products may vary according to the environment, these results suggest that, in patients in whom bone regeneration may be compromised, the degradation observed with some resorbable bone grafts may contribute to the decoupling of bone regeneration and resorbtion within the graft site, which may ultimately lead to incomplete bone repair.

Confocal laser scanning microscopy using dialkylcarbocyanine dyes for cell tracing in hard and soft biomaterials

The aim of this work was to study, in vitro, cell colonization of two biomaterials currently used for bone and cartilage repair, this step being important to understand the function of engineered tissues. Current methods that use histological approaches are not always suited to tissue-engineering analysis. We, therefore, set up a protocol to assess cell distribution, utilizing noninvasive confocal microscopy and fluorescent labels with a far red emission wavelength to optimize scaffold transparency and minimize light scattering. Hard (ceramic substitute) and soft (collagen sponge) biomaterials were seeded respectively, on one side of the scaffold, with human fibroblasts and bovine chondrocytes labelled with carbocyanine dyes (DiD and DiR). The mean penetration depth for DiR labelled fibroblasts and chondrocytes in the two scaffolds, around 270 m, was greater than for DiD (136-218 microm) labelled cells. These depths were independent of cell origin but were influenced by the nature of the scaffolds. Collagen sponge is transparent in contrast to ceramic substitutes where measurements could only be made in opened macropores. Besides the limits of the equipment, the limits of the supports were diffusion for collagen sponges and transmission for ceramic substitutes. Confocal microscopy techniques could thus be used to address the question of cell colonization of porous biomaterials in a noninvasive manner.

Bone regeneration of porous β-tricalcium phosphate (Conduit™ TCP) and of biphasic calcium phosphate ceramic (Biosel®) in trabecular defects in sheep

In this study bone regeneration between porous beta-tricalcium phosphate (Conduit TCP) and biphasic calcium phosphate ceramic (Biosel), with a hydroxyapatite/beta-TCP ratio of 75/25, was compared. The ceramic particles were implanted in sheep trabecular bone for 3, 12, and 26 weeks. Histomorphometrical analysis revealed that Conduit degraded significantly during time and only 36% of the material was left at 26 weeks implantation time. Biosel, in contrast, remained nearly intact. The degradation of Conduit was due to dissolution as well as cell-mediated. Biosel showed a high cellular intervention, although this material did not degrade. Both materials were osteoconductive. The amount of newly formed bone appeared greater in the Conduit group after 26 weeks (46% +/- 8% as compared to 37% +/- 8% for Biosel), but this difference was not significant. Bone distribution over the defect was homogeneous in Conduit, whereas Biosel showed significantly more bone in the periphery of the defect after 26 weeks in comparison to the center. In conclusion, both ceramics are biocompatible and osteoconductive. Degradation showed a difference in amount and in cellular events, with more degraded Conduit TCP with less cellular intervention as compared to Biosel.

Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up

STUDY DESIGN

Retrospective analysis of 36 cases of degenerative disc disease treated by interbody fusion with polyetheretherketone (PEEK) cages.

OBJECTIVE

To determine the safety and efficiency of PEEK cages for anterior cervical fusion (ACF).

SUMMARY OF BACKGROUND DATA

ACF with autologous bone has been reported since over 50 years ago. The recent development of cages housing materials inducing osteogenesis simplifies the technique of interbody fusion. The main purposes of bone substitutes for ACF are immediate biomechanical support, osteo-integration of the graft, and elimination of local side effects at the donor site. This report shows our results using PEEK cages.

MATERIALS AND METHODS

During an 18-month period, 36 consecutive patients had cervical fusions at 43 levels between C3 and C7. All operations involved one or two disc spaces for degenerative disc disease. We implanted all disc spaces with PEEK cages (Stryker Corporation, Kalamazoo, MI) containing granulated coralline hydroxylapatite (Pro-Osteon 200, Interpore Cross International, Irvine, CA) or deantigenated pig bone in a gel solution (Gen-Os, Tecnoss, Torino, Italy).

RESULTS

About 97% of patients had a good to excellent outcome; the result in one myelopathic patient was fair. The cervical fusion rate was 16.7% at 3 months, 61.1% at 6 months, and 100% at one year.

CONCLUSIONS

PEEK cages appear to be safe and efficient for ACF. In order to confirm our preliminary impressions studies on larger series with long term follow-up are warranted.

In vitro fatigue behaviour of a cemented acetabular reconstruction

In this study, a hemi-pelvis of composite sawbone was implanted with a Charnley cup using a conventional bone cement and the acetabular replacement was tested under constant amplitude cyclic loads, simulating the maximum hip contact force during normal walking. The damage development in the reconstruction was detected and monitored using CT scanning at regular test intervals, verified by microscopy post testing. Three identical experimental results showed that extensive debonding at the bone-cement interface occurred around the dome region after 20 million cycles.

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: bone graft extenders and substitutes

Despite the large volume of animal data regarding the use of synthetic bone graft substitutes or extenders, there are very few data regarding the use of these substances for fusion in lumbar degenerative disease. The best available data indicate that rhBMP-2 is a viable alternative to autograft bone for interbody fusion procedures. This same substance may also be a viable alternative to autograft for PLF; however, definitive medical evidence is not yet available. There is little, if any, medical evidence to support the use of other biological agents at the present time. As promising new compounds are brought to market, well-designed cohort studies and randomized trials will be required to determine the actual usefulness of these compounds in clinical practice. It is important not to generalize the results obtained with one preparation or application to different preparations or applications. The use of synthetic calcium phosphate ceramics as graft extenders appears to be reasonable in certain situations. The medical evidence available regarding their use is limited and of poor quality. Further study will be required to establish their utility for use in spinal fusion.

Extensive H+ release by bone substitutes affects biocompatibilityin vitro testing

Bone substitutes are widespread in orthopedic and trauma surgery to restore critical bony defects and/or promote local bone healing. Cell culture systems have been used for many years to screen biomaterials for their toxicity and biocompatibility. This study applies a human bone marrow cell culture system to evaluate the toxic in vitro effects of soluble components of different bone substitutes, which are already in clinical use. Different specimens of tricalcium phosphates (TCP) (Vitoss, Cerasorb), nondecalcified bovine bone (Lubboc), demineralized human bone matrices (DBM) (Grafton Flex/Putty), and collagen I/III matrix (ACI-Maix) were tested in Dulbecco's modified Eagle's medium (DMEM) and MesenCult culture solution and compared with a biomaterial-free cell culture. Biocompatibility parameters were cell viability evaluated by phase-contrast microscopy and laser flow cytometry, morphology, and the local H(+) release by bone substitutes. There were significant differences (p < 0.05) between the tested biomaterials and culture solutions. Collagen I/III, non-demineralized bovine bone, and TCP materials showed advantages for cell survival over other tested biomaterials (average values of vital cells/mL MesenCult/DMEM: Collagen I/III: 1090/1083; Vitoss: 893/483; Cerasorb: 471/523; Lubboc: 815/410; Grafton Putty: 61/44; Grafton Flex: 149/57). Especially the DBM materials lead to a significant decrease of pH, which is considered to be a major factor for cell death. DMEM culture solution supports cell survival for those bone substitutes that induce an alkaline reaction, whereas MesenCult media promotes cell vitality in biomaterials, which leads to an acidification of culture solution.

Impacted morselized cancellous bone: mechanical effects of defatting and augmentation with fine hydroxyapatite particles

Geotechnical engineering testing techniques were used to study the mechanical properties of morselized cancellous bone (MCB) and the effects of defatting and augmentation with fine hydroxyapatite (HA) particles. Bovine and human cancellous bone was morselized, rinsed, and manually squeezed to remove excess fluid, producing a standard surgical MCB sample that was also used as a control. Some of the MCB was defatted with heat and detergent and mixed with HA particles in ratios ranging from 0% to 100% HA. Compaction tests were used to determine the effects of moisture content and the amount of MCB that can be packed into a confined space. One-dimensional consolidation tests were used to determine the uniaxial strain behavior, confined modulus, and steady-state creep rate. The compaction tests demonstrated that defatting and adding HA particles significantly increased density. The one-dimensional consolidation tests showed that strain was decreased, modulus was increased and the creep rate was decreased by defatting and adding HA.

[Experimental study of the biocompatible and osteoinductive behavior of the hydroxyapatite/ultra-high molecular weight polyethtlene composite]

OBJECTIVE

To compare the biocompatibility and osteoinductive behavior of HA (hydroxyapatite) and HA/UHMWPE (ultra-high molecular weight polyethtlene) composite in orbital implantation.

METHODS

Osteoectomy of the upper orbital rim was perform on 24 adult New Zealand rabbits. The animals were randomly divided into 4 groups with 6 of each. The HA, HA/UHMWPE composite or UHMWPE (10 mm x 10 mm x 3 mm in size) was implanted to the upper orbital defect of the animal in respective group. Animals were sacrificed at 1, 4, 8, 12 weeks. Histopathologic sections of the implants were evaluated and compared with light and transmission electron microscopy study.

RESULTS

During the experimental period of 12 weeks, there was no implant extrusion or displacement. In the groups of HA and HA/UHMWPE composite, vascular ingrowth and fibroblasts were observed shortly and osteocytes were seen at 8 weeks. Calcium deposition of the implants showed a laminar fashion at 12 weeks. In the group of UHMWPE, fibrous membranes were seen around the implant at 1 week. Transmission electron microscopy study showed that in the HA and HA/UHMWPE groups, fibroblasts and vascular ingrowth could be seen, but osteocytes were not observed.

CONCLUSION

HA/UHMWPE composite demonstrated biocompatibility and osteoinductive property. It would be a good substitute for bone, particularly for orbital bone.

Evaluations of bioactivity and mechanical properties of poly (?-caprolactone)/silica nanocomposite following heat treatment

A composite material consisting of poly(epsilon-caprolactone) (PCL) and silica was prepared and evaluated as a bioactive bone substitute. The composite was synthesized by the co-condensation of tetraethyl orthosilicate and PCL and end-capped with triethoxysilane (Si-PCL). The as-prepared specimens were subjected to an initial heat treatment of 2 days at 60 degrees C, followed by further heat-treatments at 100 degrees C, 150 degrees C, and 200 degrees C for 24 h. The tensile mechanical properties of the heat-treated specimens were determined, and additional specimens were exposed to a simulated body fluid (SBF) for different periods of time. The SBF exposure led to the deposition of a layer of apatite crystals on the surface of the composites. It was found that increasing the second heat-treatment temperature produced an increase in tensile strength and Young's modulus of the composite but a decrease in the initial rate of apatite formation. These phenomena are explained in terms of the condensation reaction that takes place between the silanol groups in the silica and Si-PCL as the heat-treatment temperature is increased.

Bioactive glass as bone-graft substitute for posterior spinal fusion in rabbit

Bioactive glass S53P4 and autogenous bone were studied as bone graft materials for spinal fusion in a rabbit model. Sixteen rabbits underwent surgery by a dorsal approach. A bioactive glass, a combination of bioactive glass and autogenous bone (70/30 vol%), and autogenous bone were implanted at two thoracolumbar vertebraes for 4 and 12 weeks. The volume, consolidation to vertebrae, and fusion of the graft material were evaluated with plain-film radiology, computed tomography (CT) and bone-mineral density measurements, and compared with histomorphometrical measurements. Radiological consolidation by CT of bone graft to underlying vertebrae at 12 weeks was observable in all groups. This was histologically confirmed as bone was growing from the vertebrae into the graft material. Radiologic fusion of vertebraes was, at 12 weeks, observable in all groups in 50--75% of the cases. The radiologic fusion seen at the CT scans could, however, not be confirmed by histology in any of the three groups. Significant differences for graft material and observation period with the use of bone-mineral density measurements (Hounsfield units) were also observable, with the highest measured values for the bioactive glass group and the lowest for the autogenous bone group. The results indicate that bioactive glass have potential as bone-graft material in spinal fusion. The reliability of radiologic evaluation methods in spinal surgery using bone substitutes is also questioned and discussed.

A comparison of the shapes of hydroxyapatite implants before and after implantation

Based on helical volume scan computed tomography (HVCT) data, it has been demonstrated previously that real-size models can be prepared with the binder-jet method with extremely high precision of various parts ranging from the outer structure of the cranio-maxillofacial bone to such fine parts as the cranial base and the orbital walls. The application of this method to clinical cases with large cranial bone defects has also been studied. The results showed the usefulness of the binder-jet method, employing starch for fixing, with which a model can be prepared faster and with less deformity caused by the weight of the material itself. Therefore, the binder-jet method is expected to attain greater clinical significance in this field. In this study the comparison between the shapes of implants before and after implantation revealed that the most important aspect of the design of hydroxyapatite (HAP) implants was determining the shapes of edges, especially its angles. That is, an implant needs very little trimming before being implanted to the patient's defective site if the shape of the edges of the implant can be designed and prepared to fix the incised bone surfaces properly. In addition, to obtain optimum results it was also shown that it is necessary to design optimal shapes of implants, taking into account thickness, porosity, and curvature, before processing the shapes of edges. It was found necessary to establish a technology and a method for producing HAP implants that perfectly fit cranial bone defects. For this purpose, it would be useful to make a template of the implants using the mirror-reversion and binder-jet methods.

Lactic acid based PEU/HA and PEU/BCP composites: Dynamic mechanical characterization of hydrolysis

Lactic acid based poly(ester-urethane) (PEU-BDI) and its composites with 20 and 40 vol.% bioceramic filler were characterized prior to their use as biocompatible and bioabsorbable artificial bone materials. Morphological, dynamic mechanical properties, and degradation of these either hydroxyapatite or biphasic calcium phosphate containing composites were determined. Addition of particulate bioactive filler increased the composite stiffness and the glass transition temperature, indicating strong interactions between the filler and matrix. Materials were sterilized by gamma-irradiation, which reduced the average molecular weights by 30-40%. However, dynamic mechanical properties were not significantly affected by irradiation. Specimens were immersed in 0.85 w/v saline at 37 degrees C for 5 weeks, and changes in molecular weights, mass, water absorption, and dynamic mechanical properties were recorded. All the composite materials showed promising dynamic mechanical performance over the 5 weeks of hydrolysis. Average molecular weights of PEU-BDI and its composites did not change substantially during the test period. PEU-BDI retained its modulus values relatively well, and although the moduli of the composite materials were much higher, especially at high filler content, they exhibited faster loss of mechanical integrity.

[Quality assurance of powders for bioceramic applications with image analysis]

Bone substitute materials are very demanding with respect to their quality, in particular, a high toughness and durability are required. In case of producing the composites by sintering of mechanically generated powder mixtures, a high efficiency of mixture is demanded, too. The characterisation of such particle systems is difficult. An effective method is the image analysis supported by statistical evaluation of both the size and the shape distributions of particles and agglomerates. As it is proved by first results, powder mixtures of hydroxyapatite can be described by the geometry of voids in the agglomerate structure using the shape factor weighted by area of the respective image object. As a measure of the efficiency of mixture, the degree of reproducibility was introduced.

[Cellular culture of osteoblasts and fibroblasts on porous calcium-phosphate bone substitutes]

PURPOSE OF THE STUDY

Calcium phosphate ceramics are synthetic bone substitutes able to fill in bone destruction as a support of the bone growth. This work consisted in an in vitro assessment of osteoblasts and fibroblasts cultures on macroporous calcium-phosphate bone substitutes to analyze the interaction between cells and bone substitute.

MATERIALS AND METHODS

The macroporous ceramic was composed of 70% hydroxyapatite and 30% tri-calcium phosphate with known mechanical and physico-chemical properties. Three compounds were processed with different size of macropore and with or without microporosity on their surface. Cells were seeded on discs measuring 10 mm in diameter and 2 mm in thickness. Cellular viability was evaluated by the MTT test for every stage of observation. An histological study to observe the invasion in the depth of discs was performed. Scanning electron microscopy was used to analyze the cellular comportment in contact with the surface of substitutes.

RESULTS

An exponential cellular growth was effective on each substitute with the two cellular types. Cells spread on the surface of the compounds covering macropores and colonized the depth of the discs. A size of macropore of 300 microm or more seemed to support this invasion. 15 microm sized interconnections appeared to be effective to allow cell migration between macropores. The cell proliferation was similar on substitutes with or without microporosity.

CONCLUSION

Biomaterials currently used as bone substitute are more or less osteoconductive but they have no osteoinductive property. A hybrid association of calcium-phosphate ceramic with osteogenic cells should promote the development of a calcium phosphate compound with osteoinductive capacity.

The effect of silica-containing calcium-phosphate particles on human osteoblastsin vitro

There is an ongoing need for more effective and less costly bone substitutes. It has previously been proposed that silica-containing bioactive glass would be more effective as a bone repair material because of its physiochemical properties. Three newly synthesized silica-containing bioactive glass formulations, HA-31 (25%), HA-11 (50%), and HA-13 (75%), were tested as biocompatible substrates for the continued proliferation and phenotype expression of human bone cells in vitro. Two currently available bioactive glasses (BioGlass(R), Hydroxyapatite) served as comparisons. The biocompatibility of these bioglasses, as well as their osteoconductive properties, was assessed by employing primary cultures of human osteoblasts and human synoviocytes for 4 days. The results obtained demonstrated that the three new bioglasses enhanced the proliferative response of osteoblasts compared with osteoblasts cultured alone. Reverse Transcription Polymerase Chain Reaction (RT-PCR) analysis indicated that osteoblasts retained their phenotypic expression by continued expression of collagen type I and alkaline phosphatase. The newly synthesized preparations of silica-containing bioactive glass did not induce stimulation of proinflammatory markers iNOS and IL-1beta in synoviocytes. In conclusion, the newly synthesized silica-containing bioactive glasses are biocompatible substrate for bone-forming osteoblasts. However, the formulations tested did not show significant advantage over the currently available bioactive glasses in vitro.

Behavior of dense and porous hydroxyapatite implants and tissue response in rat femoral defects

Porous and dense hydroxyapatite cylinders (PHA and DHA) were implanted into cavities produced in rat femora and the sites of implantation were examined at different times over a period of 24 weeks by microradiologic and histological techniques. Microradiographs showed the presence of a layer of trabecular bone around the implants, which became more radiopaque and thinner along the experimental time. The microradiologic methodology used was suitable for the evaluation of the interface between hydroxyapatite and newly formed bone in nondecalcified materials. Microscopic observations showed that young bone grew over the surface of both types of implants after 1 and 2 weeks of surgery and that bone also grew inside PHA implants. Progressive bone absorption was observed in both types of implants after the fourth week. A layer of fibrous tissue was formed in the interface between new bone and DHA. Mature bone with haversian systems surrounded DHA implants and filled the pores of PHA implants throughout the experimental period. The pores of PHA implants were smaller than those commonly reported, which should have been a disadvantage, although it was observed that the extra cellular fluid induced disintegration of the ceramic granules, allowing the gradual growth of bone tissue into the spaces among them, without the interposition of fibrous tissue.

Histological characterization of the early stages of bone morphogenetic protein-induced osteogenesis

On the basis of currently available knowledge, we hypothesize that the initial bone formation, as induced by bone morphogenetic protein (BMP), is influenced by the chemical composition and three-dimensional spatial configuration of the used carrier material. Therefore, in the current study, the osteoinductive properties of porous titanium (Ti) fiber mesh with a calcium phosphate (Ca-P) coating (Ti-CaP), insoluble bone matrix (IBM), fibrous glass membrane (FGM), and porous particles of hydroxy apatite (PPHAP) loaded with rhBMP-2 were compared in a rat ectopic assay model at short implantation periods. Twelve Ti-CaP, 12 IBM, 12 FGM, and 12 PPHAP implants, loaded with rhBMP-2, were subcutaneously placed in 16 Wistar King rats. The rats were sacrificed at 3, 5, 7, and 9 days post-operative, and the implants were retrieved. Histological analysis demonstrated that IBM and Ti-CaP had induced ectopic cartilage and bone formation by 5 and 7 days, respectively. However, in PPHAP, bone formation and cartilage formation were seen together at 7 days. At 9 days, in Ti-CaP, IBM, and PPHAP, cartilage was seen together with trabecular bone. At 9 days, in FGM, only cartilage was observed. Quantitative rating of the tissue response, using a scoring system, demonstrated that the observed differences were statistically significant (Wilcoxon rank sum test, p < 0.05). We conclude that IBM, CaP-coated Ti mesh, FGM, and PPHAP provided with rhBMP-2 can indeed induce ectopic bone formation with a cartilaginous phase in a rat model at short implantation periods. Considering the different chemical composition and three-dimensional spatial configuration of the carrier materials used, these findings even suggest that endochondral ossification is present in rhBMP-2-induced osteogenesis, even though the amount of cartilage may differ.

[Tibial valgus osteotomy using a tricalcium phosphate medial wedge: a minimally invasive technique]

PURPOSE OF THE STUDY

We present a minimally invasive technique for tibial valgus osteotomy using a medial wedge composed of tricalcium phosphate.

MATERIAL AND METHODS

The bone substitute is composed of slowly resorbable tricalcium phosphate material shaped to the desired form and having mechanical properties allowing stable osteotomy via a short incision and staple fixation. Intraoperative fluoroscopy enables a reliable and reproducible technique. A lateral fixation staple is required because there is a risk the lateral hinge could break. This technique was used for 58 knees in 55 patients (mean age 47 years). According to the Ahlback classification of femorotibial degeneration, there were 43 grade I knees, 12 grade II, and 3 grade III.

RESULTS

The implant was well tolerated in all cases. Bone healing was achieved in most cases without loss of the osteotomy angle. Complications were: rupture of the lateral hinge in four cases leading to nonunion in one, one low-grade infection. Implant resorption at mid term was significant: among the 22 patients with a follow-up of more than 5 years, the implant was barely visible in 18.

DISCUSSION

This technique provides an easy way to achieve tibial valgus osteotomy without compromising future intervention. The technique can be considered to be minimally invasive because of the size of the incision, the minimal fixation required, and the bone sparing effect of the bone substitute.

Overview of the biology of lumbar spine fusion and principles for selecting a bone graft substitute

STUDY DESIGN

Reviews were conducted.

OBJECTIVES

To review the biology of spine fusion healing, and to outline several fundamental principles required for the selection of a bone graft substitute.

SUMMARY OF BACKGROUND DATA

More than 200,000 spine fusions are performed each year in the United States. The success of this procedure is limited by morbidity from iliac crest bone graft harvest and a nonunion rate that ranges from 10% to 40%. In recent years, there has been an increased understanding of the biology of spine fusion healing. In addition, there has been a focus on finding suitable substitutes for autogenous iliac crest bone graft to promote spine fusion. The selection of a specific bone graft substitute can be a daunting task for the surgeon.

METHODS

The available literature was reviewed and combined with the author's personal experience.

RESULTS

A basic understanding of the biology of healing in different types of spine fusions and the differences between different categories of bone graft substitutes can help surgeons organize the graft selection process.

CONCLUSIONS

In general, purely osteoconductive substitutes are less effective in adult posterolateral spine fusions, but may be suitable in the anterior spine when it is rigidly immobilized. Osteoinductive substitutes are more likely to be successful as extenders, enhancers, or substitutes for posterolateral spine fusion.

Improvement in zirconia osseointegration by means of a biological glass coating: An in vitro and in vivo investigation

The biocompatibility and osseointegration of zirconia (ZrO(2)), either coated with RKKP bioglazeor uncoated, were evaluated in vitro and in vivo. The in vitro test was performed in human osteoblasts, whereas maximal sensitization was performed in 23 Dunkin Hurtley guinea pigs. RKKP bioglaze-coated and uncoated (controls) ZrO(2) cylinders were implanted in the distal femoral epiphyses of 14 Sprague-Dawley rats under general anesthesia, and animals were sacrificed at 30 and 60 days. Lactate dehydrogenase, alkaline phosphatase, and Thiazolyl Blue (MTT) were tested in vitro. A graded score was used for evaluating the results of the sensitization test. Histomorphometry and microhardness testing were performed to quantify the osseointegration rate, as well as bone quality around the implants. Neither in vitro cytotoxicity nor sensitization were observed. Histomorphometry demonstrated that at 30 days, the affinity index was significantly higher in coated implants than in uncoated ones (p < 0.05); at 60 days, the behavior of coated implants was better than that of uncoated ones, but differences were not significant. Significant increases in bone microhardness were found at 1000 microm from the interface area for both uncoated (p < 0.0005) and RKKP bioglaze-coated (p < 0.0005) ZrO(2), and also within 200 microm from the interface (p = 0.014) but only for coated ZrO(2.) These results suggest that RKKP bioglaze-coated ZrO(2) permits biocompatible devices with improved osseointegration properties to be manufactured.

Evaluation of MEMS materials of construction for implantable medical devices

Medical devices based on microelectro-mechanical systems (MEMS) platforms are currently being proposed for a wide variety of implantable applications. However, biocompatibility data for typical MEMS materials of construction and processing, obtained from standard tests currently recognized by regulatory agencies, has not been published. Likewise, the effects of common sterilization techniques on MEMS material properties have not been reported. Medical device regulatory requirements dictate that materials that are biocompatibility tested be processed and sterilized in a manner equivalent to the final production device. Material, processing, and sterilization method can impact the final result. Six candidate materials for implantable MEMS devices, and one encapsulating material, were fabricated using typical MEMS processing techniques and sterilized. All seven materials were evaluated using a baseline battery of ISO 10993 physicochemical and biocompatibility tests. In addition, samples of these materials were evaluated using a scanning electron microscope (SEM) pre- and post-sterilization. While not addressing all facets of ISO 10993 testing, the biocompatibility and SEM data indicate few concerns about use of these materials in implant applications.

Effects on articular cartilage of subchondral replacement with polymethylmethacrylate and calcium phosphate cement

Bone defects were created in rabbit medial femoral condyle in a model where subchondral bone was completely removed or about 2 mm of subchondral bone was maintained. Groups without augmentation and augmented with autogenous bone, polymethylmethacrylate, or calcium phosphate cement were sacrificed at 3, 12, and 24 weeks for evaluation of articular cartilage and observation of bone formation. In the model in which subchondral bone was completely removed, collapse of the subchondral bone together with exfoliation and prolapse of cartilage developed early in all cases. In the model in which 2 mm of subchondral bone was maintained, degeneration of articular cartilage developed at 12 weeks in the group augmented with polymethylmethacrylate, showing a significant difference when compared to the contralateral untreated control group. The group augmented with calcium phosphate cement did not demonstrate any evident difference from the control group. Mechanical properties after subchondral replacement did not differ between the groups augmented with polymethylmethacrylate and calcium phosphate cement, although calcium phosphate cement was considered histologically superior. Calcium phosphate cement was a reliable subchondral replacement material when the bone defect is adjacent to the articular cartilage.

Biomimetic calcium phosphate coatings on Polyactive 1000/70/30

Precalcification of Polyactive 1000/70/30 with a biomimetic calcium phosphate coating is expected to enhance the bioactivity of this biodegradable polymer for the application as bone filler or scaffold of bone tissue engineering. This study presents a 1-day one-step incubation method to obtain either amorphous or bone-like apatitic calcium phosphate coating on Polyactive 1000/70/30. Either dense plates or three-dimensional porous blocks of the polymer were incubated in a simplified but concentrated simulated body fluid-derived solution at 37 degrees C. By bubbling CO2 gas, a solution was prepared with calcium and phosphate ion concentrations five times of that of regular simulated body fluid. With controlled stirring, the CO2 was released out of the solution and exchanged by air. The pH of the solution increased to induce coating formation. Adjusting stirring rate and CO2/air exchange rate controlled the process kinetics. The reaction kinetics had little influence on the crystallographic structure of the final coating mineral for a given solution composition as shown by Fourier transform infrared spectroscopy and X-ray diffraction. However, the interface structure between the coating and substrate was kinetics-dependent. A fast precipitation condition resulted in a uniform but superficial calcification pattern at the surface of polymer. A slow process by selecting either a slow stirring or a slow CO2/air exchange, on the contrary, induced a localized but deep inside calcification pattern. A tensile test showed no statistically significant difference in the mechanical properties among uncoated and coated polymers. The cracking behavior of coatings from different kinetics, however, exhibited different manners, as can be attributed to different interface structures and interfacial strengths.

[Development of artificial bone made from nacre and polylactic acid and property assessment]

OBJECTIVE

To explore a new bone substitute for bone grafting and evaluate its properties.

METHODS

Pressurized molding of nacre, polylactic acid and NaCl that were proportionally mixed was performed to obtain the bone grafting material, and its properties as porosity, pore size and mechanical strength were compared with those of the material prepared by solvent casting.

RESULTS

Compared with that of the material made by solvent casting, the mechanical strength of the new artificial bone material was 10-fold stronger with an average porosity rate of 47.65%, pore size of 218.83 micrometer compressive strength of 16.10 MPa and flexural strength of 60.18 MPa.

CONCLUSION

The new technique adopted in this study can effectively enhance the biomechanics of the artificial bone material, which can be suitable for repairing bone defect.

Three-dimensional motion analysis with Synex. Comparative biomechanical test series with a new vertebral body replacement for the thoracolumbar spine

The authors present a new implant for vertebral body replacement in the thoracic and lumbar spine. Synex is a titanium implant designated for reconstruction of the anterior column in injury, post-traumatic kyphosis or tumour of the thoracolumbar spine and must be supplemented by a stabilizing implant. After positioning, the implant is distracted in situ, thus ensuring best contact with adjacent end-plates and three-dimensional (3D) stability, and minimizing the possibility of secondary dislocation or loss of correction. We compared the effectiveness of the Synex implant with that of the "Harms cage" (MOSS) in combination with two alternative stabilizing instrumentations: the USS and Ventrofix. In a 3D spinal loading simulator, we determined the bisegmental (T12-L2) neutral zone (NZ), elastic zone (EZ), and range of motion (ROM) of 12 human cadaveric spines. After corpectomy of L1, we tested the four possible combinations of stabilizing instrumentation and vertebral replacement implant: USS/Synex, USS/MOSS, Ventrofix/Synex, Ventrofix/MOSS. We analysed the differences between each of the instrumentations as well as differences compared to the intact spine. Comparing the two stabilizing implants, a significantly higher stability was achieved with the USS for flexion, extension, and lateral bending, regardless of whether Synex or MOSS was used as vertebral body replacement. No differences were observed for axial rotation. In addition, no implant combination was able to restore the rotational stability of the intact spine. Comparing the vertebral body replacing implants, significantly higher stability was noted with Synex in combination with USS for extension, lateral bending, and axial rotation. No differences between Synex and MOSS were observed in combination with Ventrofix. Posterior fixation was found to offer superior stability compared to anterior fixation. Synex was at least comparable to MOSS for suspensory replacement of the vertebral body in the thoracolumbar spine. The increased biomechanical stability demonstrated for Synex suggests that a more rigid construction would also be achieved in vivo. When using MOSS in combination with posterior stabilization, the induction of intervertebral compression via the posterior fixator is recommended. This surgical step was not necessary with Synex.

Results of the biocompatible osteoconductive polymer (BOP) as an intersomatic graft in anterior cervical surgery

Eighty-two patients operated on in our Department between 1989 and 1995 with an anterior cervical approach for soft and hard cervical disc herniations and cervical stenosis were included in this study. In 41 cases a heterologous intersomatic bovine graft (Surgibone) was used. Another 41 patients underwent surgery with a biocompatible osteoconductive polymer (BOP) as intervertebral graft. Both groups were retrospectively reviewed and compared with the objectives of evaluating the biodynamic behaviour of the grafts in the intersomatic space, the complications which appeared (specially those related to the grafts), the bone fusion rate achieved and the clinical outcome of the patients. The results of our study show that the BOP group presented a higher tendency to intersomatic space collapse 6 months after discectomy. There were no differences in the general surgical complications between both groups, but those related directly to the graft were significantly higher in the BOP group. The vast majority of the graft complications recorded had no clinical correlation. Without a strict radiological follow-up such complications would never have been discovered. Bone fusion in the BOP group was significantly slower and worse. Finally, the clinical outcome in both groups did not show any significant difference.

Initial stability comparison of modular hip implants in synthetic femurs

Synthetic femurs were used to assess the initial bone-implant interface stability of three total hip systems: Wright Medical Technology's Infinity smooth trochanteric module (S-TM), Infinity porous-coated trochanteric module (PC-TM), and Johnson and Johnson S-ROM with a porous surface. The hips were implanted into synthetic femurs, rigidly fixed, and subjected to internal rotation and cyclic, axial compressive loads. The results showed that all three implants achieved good initial implant stability and would be expected to permit bone ingrowth. The porous-coated implants showed greater initial implant stability with less axial micromotion compared with the smooth implants. This finding suggests that surface texture plays a role in initial stability of uncemented prostheses if the bone behaves similar to the material used in this study.

The prevention of prosthetic infection using a cross-linked albumin coating in a rabbit model

We evaluated the effects of a serum protein coating on prosthetic infection in 29 adult male rabbits divided into three groups: control, albumin-coated and uncoated. We used 34 grit-blasted, commercially pure titanium implants. Eleven were coated with cross-linked albumin. All the implants were exposed to a suspension of Staphylococcus epidermidis before implantation. Our findings showed that albumin-coated implants had a much lower infection rate (27%) than the uncoated implants (62%). This may be a useful method of reducing the infection of prostheses.

Improved fixation of porous-coated versus grit-blasted surface texture of hydroxyapatite-coated implants in dogs

We inserted, in 8 dogs, implants with either porous-coated or grit-blasted titanium surface and coated with hydroxyapatite (HA) into trabecular bone in the proximal humerus, using a 1 mm gap model. After 25 weeks, push-out tests showed that energy absorption for porous-coated implants was twice that of grit-blasted implants, whereas shear stiffness was reduced by one fifth, indicating a stronger fixation of porous-coated implants. Macroscopically, all grit-blasted implants had delamination of the HA coating, whereas porous implants failed mostly at the HA-tissue interface. Porous-coated implants had 47% bone ingrowth and grit-blasted implants 70% (p = 0.02), however, no difference in absolute surface area was found. Part of the HA coating was resorbed during the implantation period as regards volume and thickness. HA coverage was more reduced on porous-coated than on grit-blasted implants (p = 0.01). No foreign-body reaction or osteolysis was seen. An important finding was that one fifth of the surface with complete resorption of HA coating was replaced by newly formed bone.

Metallic wear debris in dual modular hip arthroplasty

Two cementless hip arthroplasty models with a modular neck made titanium alloy were submitted to cyclical loading in air, in physiological solution, and in a solution for accelerated corrosion tests in order to study the damage process of modular couplings. Thereafter, on one of the two models a series of tests were conducted in order to evaluate the quality of debris produced by the couplings. The parameters of testing adopted allow us to estimate the production of metallic debris observable in vivo with this type of prosthetic stem. The results show that the couplings of modular prostheses may be the source of metallic debris. The amount of debris produced depends on the geometry of the coupling and of the entire implant. Good planning and realization of the couplings, however, reduce the phenomenon that is negligible as compared to other potential sources of debris such as the surface of the stem or of the prosthetic head.

Regulatory issues relating to therapies for periodontal regeneration

The Food and Drug Administration (FDA) has regulated medical devices since May 1976, when the Medical Device Amendments were enacted. The clinical trial requirements for the marketing of periodontal regeneration devices have been dependent, in part, on the degree of their similarity to devices marketed prior to the legislative enactment date in terms of materials, indication statements, and labeling claims. Nonresorbable barriers were allowed to be marketed based on their equivalence to devices marketed prior to the enactment date based on biocompatability and clinical trial data under the premarket notification requirements section of the law. Bone filling materials such as hydroxyapatite were first marketed based on the finding of equivalence to predicate devices. Newer technologies such as bioabsorbable barriers have also been reviewed under the premarket notification provisions of the law, but manufacturers have been required to provide more extensive safety and effectiveness data to establish equivalence to pre-Amendments devices. Data to answer questions related to the potential toxicity of breakdown products, period of absorption, and ultimate clinical effectiveness needed to be answered prior to marketing. New devices that incorporate technologies that are not substantially equivalent to predicate devices must proceed through the premarket approval route to marketing. For new devices considered a potential significant risk to the patient population, clinical trials are conducted via the investigational device exemption (IDE) requirements that specify the means by which trials will proceed in order to protect the rights of patients. New devices of organic origin, such as bone morphogenic protein, have followed the premarket approval route with IDE requirements instituted as a condition for their path to the marketplace. Issues associated with immediate and long-term contact including potential toxicity, tumorigenicity, and sensitization need to be addressed with appropriate animal models.

Fabrication of biodegradable polymer scaffolds to engineer trabecular bone

We present a novel method for manufacturing three-dimensional, biodegradable poly(DL-lactic-co-glycolic acid) (PLGA) foam scaffolds for use in bone regeneration. The technique involves the formation of a composite material consisting of gelatin microspheres surrounded by a PLGA matrix. The gelatin microspheres are leached out leaving an open-cell foam with a pore size and morphology defined by the gelatin microspheres. The foam porosity can be controlled by altering the volume fraction of gelatin used to make the composite material. PLGA 50:50 was used as a model degradable polymer to establish the effect of porosity, pore size, and degradation on foam mechanical properties. The yield strengths and moduli in compression of PLGA 50:50 foams were found to decrease with increasing porosity according to power law relationships. These mechanical properties were however, largely unaffected by pore size. Foams with yield strengths up to 3.2 MPa were manufactured. From in vitro degradation studies we established that for PLGA 50:50 foams the mechanical properties declined in parallel with the decrease in molecular weight. Below a weight average molecular weight of 10,000 the foam had very little mechanical strength (0.02 MPa). These results indicate that PLGA 50:50 foams are not suitable for replacement of trabecular bone. However, the dependence of mechanical properties on porosity, pore size, and degree of degradation which we have determined will aid us in designing a biodegradable scaffold suitable for bone regeneration.

Sintered porous DP-bioactive glass and hydroxyapatite as bone substitute

There is extensive experimental and surgical experience with the use of bone tissue to fill defects in the skeleton, to bridge non-union sites, and to pack defects in bone created from cyst curettage. DP-bioactive glass with a chemical composition of Na2O 8.4%, SiO2 39.6%, P2O5 12% and CaO 40% has been reported as an alternative bone substitute of high mechanical strength, good biocompatibility. and which has a tight bond with living tissue. The bonding layer between DP-bioactive glass and bone tissue was considered to be formed by dissolution of calcium and phosphate ions from the DP-bioactive glass into the surrounding body fluids. The biological hydroxyapatite was suspected to deposit directly onto the bonding layer. In order to confirm the interaction between the DP-bioactive glass and bone tissue, the developed bioactive glass was implanted into rabbit femur condyle for 2-32 weeks. The histological evaluation of DP-bioactive glass as a bone substitute was also investigated in the study. Porous hydroxyapatite bioceramic was used in the control group and the results were compared with those of DP-bioactive glass. The interface between the DP-bioactive glass and bone tissue examined with SEM-EPMA showed that the bioactive glass formed a reaction layer on the surface within 2 weeks after operation and formed a direct bond with natural bone. The elements contained in the bioactive glass apparently interdiffuse with the living bone and biological hydroxyapatite deposited onto the diffusion area, which was proved by EPMA and TEM. After implantation for over 8 weeks, the DP-bioactive glass was gradually biodegraded and absorbed by the living bone. Histological examination using the optical microscope showed that osteocytes grow into the inside of the DP-bioactive glass and the bioactive glass would be expected to be a part of bone.

Resorbable synthetic polymers as replacements for bone graft

The potential of resorbable synthetic polymers derived from the poly(alpha-hydroxy acids), poly(lactide) and poly(glycolide), to fulfill a role as bone graft substitutes is reviewed. The various elements of the relationship between the degradation behaviour of resorbable implants and polymer synthesis and chain structure, implant morphology, processing and dimensions have been defined. The production of resorbable polymeric implants has been extensively documented so as to provide a wide basis for selection of an appropriate manufacturing technique. The key requirement of implant dimensional stability over the early stages of bone healing is emphasised so as to provide a stable surface on which osteoblasts and/or their precursor cells may migrate and secrete bone matrix. Minimisation of the content of slow resorbing polymers such as poly(L-lactide) is recommended, consistent with retention of an adequate implant degradation characteristic. The review concludes with a summary of alternative resorbable polymers such as the polyphosphazines which are interesting candidate materials for bone repair and reconstruction.