Search

Purpose: To compare the outcome of 2 bioabsorbable screws for tibial interference fixation in anterior cruciate ligament reconstruction with reference to rate of absorption, osteoconductive properties, and clinical outcome., Methods: Patients undergoing primary anterior cruciate ligament reconstruction with hamstring autograft in a single unit were invited to participate in this study. Patients were randomized to receive either the Calaxo screw (Smith & Nephew, Andover, MA) or Milagro screw (DePuy Mitek, Raynham, MA) for tibial fixation. Patients were reviewed with subjective and objective evaluation by use of the International Knee Documentation Committee form, Lysholm score, KT-1000 arthrometry (MEDmetric, San Diego, CA), and clinical examination. Magnetic resonance imaging was performed at 1 year and computed tomography scanning at 1 week and at 6, 12, and 24 months., Results: Sixty patients agreed to participate in the study, with 32 patients randomized to the Calaxo screw and 28 to the Milagro screw for tibial fixation. There was no significant difference in subjective or objective clinical outcome between the 2 groups. At 24 months, 88% of Calaxo screws showed complete screw resorption compared with 0% of Milagro screws (P < .001). Tibial cysts were present in 88% of the Calaxo group and 7% of the Milagro group (P = .001). At 24 months, the mean volume of new bone formation for the Calaxo group was 21% of original screw volume. Ossification of the Milagro screw was unable to be accurately assessed as a result of incomplete screw resorption., Conclusions: Both screws showed similar favorable objective and subjective outcomes at 2 years. The Calaxo screw resorbed completely over a period of 6 months and was associated with a high incidence of intra-tunnel cyst formation. The Milagro screw increased in volume over a period of 6 months, followed by a gradual resorption, which was still ongoing at 2 years. Both screws were associated with tunnel widening, and neither showed evidence of significant tunnel ossification. We conclude that, despite satisfactory clinical outcomes, the addition of "osteoconductive" materials to bioabsorbable screws is not associated with bone formation at the screw site at 2 years., Level of Evidence: Level I, randomized controlled trial., (Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

The present study investigated the effects of fluoride (F) concentration, lesion baseline severity (ΔZ(base)) and mineral distribution on lesion progression. Artificial caries lesions were created using three protocols [methylcellulose acid gel (MeC), hydroxyethylcellulose acid gel (HEC), carboxymethylcellulose acid solution (CMC)] and with low and high ΔZ(base) groups by varying demineralization times within protocols. Subsequently, lesions were immersed in a demineralizing solution for 24 h in the presence of 0, 1, 2 or 5 ppm F. Changes in mineral distribution characteristics of caries lesions were studied using transverse microradiography. At baseline, the protocols yielded lesions with three distinctly different mineral distributions. Secondary demineralization revealed differences in F response between and within lesion types. In general, lowΔZ lesions were more responsive to F than highΔZ lesions. LowΔZ MeC lesions showed the greatest range of response among all lesions, whereas highΔZ HEC lesions were almost unaffected by F. Laminations were observed in the presence of F in all but highΔZ HEC and CMC lesions. Changes in mineral distribution effected by F were most pronounced in MeC lesions, with remineralization/mineral redeposition in the original lesion body at the expense of sound enamel beyond the original lesion in a dose-response manner. Both ΔZ(base) and lesion mineral distribution directly impact the F response and the extent of secondary demineralization of caries lesions. Further studies - in situ and on natural white spot lesions - are required to better mimic in vivo caries under laboratory conditions., (Copyright © 2012 S. Karger AG, Basel.)

Aspartate-serine-serine (DSS) repeats are abundant in naturally occurring proteins that are critical for tooth formation. We recently developed octuplet repeats of aspartate-serine-serine (8DSS) peptides to promote the nucleation of calcium phosphate carbonate from free ions. In this paper, we report a possible role of 8DSS in promoting mineral deposition onto human enamel. Human enamel specimens were demineralized, exposed briefly to 8DSS solution, and then exposed to simulated body fluid that favors mineral deposition. At various stages of treatment, nano-mechanical behaviors, namely, hardness and elastic modulus, were determined by nano-indentation. Nano-indentation results showed that 8DSS treatment effectively improved the mechanical and elastic properties of demineralized enamel. The values of hardness and elastic modulus for the 8DSS-treated enamel were significantly higher than those of surfaces without 8DSS treatment. Furthermore, 8DSS peptides promoted the uniform deposition of nano-crystalline calcium phosphate carbonate over demineralized enamel surfaces and reduced surface roughness of demineralized enamel.

Dental caries is a highly prevalent diet-related disease and is a major public health problem. A goal of modern dentistry is to manage non-cavitated caries lesions non-invasively through remineralization in an attempt to prevent disease progression and improve aesthetics, strength, and function. Remineralization is defined as the process whereby calcium and phosphate ions are supplied from a source external to the tooth to promote ion deposition into crystal voids in demineralized enamel, to produce net mineral gain. Recently, a range of novel calcium-phosphate-based remineralization delivery systems has been developed for clinical application. These delivery systems include crystalline, unstabilized amorphous, or stabilized amorphous formulations of calcium phosphate. These systems are reviewed, and the technology with the most scientific evidence to support its clinical use is the remineralizing system utilizing casein phosphopeptides to stabilize and deliver bioavailable calcium, phosphate, and fluoride ions. The recent clinical evidence for this technology is presented and the mechanism of action discussed. Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization show promise for the non-invasive management of dental caries.

Objectives: To compare resorption of a synthetic biphasic calcium phosphate (BCP) bone-graft substitute with deproteinized bovine bone (DBB) used for human maxillary sinus augmentation., Materials and Methods: Eleven patients underwent bilateral maxillary sinus floor augmentation with DBB in one side and a BCP (40%beta-tricalcium phosphate (beta-TCP) and 60% hydroxyapatite) in the contralateral side. Simultaneously, with the augmentation on each side a microimplant was placed vertically from the top of the alveolar crest penetrating the residual bone and the grafting material. Eight months after initial surgery the microimplants were retrieved with a surrounding bone core. The composition of residual graft material and surrounding bone was analysed by scanning electron microscopy and energy dispersive X-ray spectroscopy., Results: Residual graft material of both types was present as 10-500 mum particles in direct contact with, or completely surrounded by, newly formed bone; smaller particles were also present in non-mineralized tissue. In the case of BCP the bone-graft substitute interface showed evidence of superficial disintegration of particles into individual grains. Median Ca/P ratios (at.%), determined from >200 discreet sites within residual graft particles and adjacent bone, were: DBB: 1.61 (confidence interval [CI] 1.59-1.64); BCP: 1.5 (CI 1.45-1.52); DBB-augmented bone: 1.62 (CI 1.59-1.66); BCP-augmented bone: 1.52 (CI 1.47-1.55); P=0.028 for DBB vs. BCP and DBB- vs. BCP-augmented bone. The reduction in Ca/P ratio for BCP over the healing period is consistent with the dissolution of beta-TCP and reprecipitation on the surface of calcium-deficient hydroxyapatite., Conclusion: The beta-TCP component of BCP may be gradually substituted by calcium-deficient hydroxyapatite over the healing period. This process and superficial degranulation of BCP particles may influence the progress of resorption and healing.

Objectives: Although many nanomaterials are being used in academia, industry and daily life, there is little understanding about the effects of nanoparticles on the reproductive health of vertebral animals, including human beings. An experimental study was therefore performed here to explore the effect of calcium phosphate nanoparticles on both steroid hormone production and apoptosis in human ovarian granulosa cells., Methods: Calcium phosphate nanoparticles uptaking was evaluated by transmission electron microscopy (TEM). The cell cycle was assessed with propidium iodide-stained cells (distribution of cells in G0/G1, S, and G2/M phases) by flow cytometry. The pattern of cell death (necrosis and apoptosis) was analyzed by flow cytometry with annexin V-FITC/PI staining. The expression of mRNAs encoding P450scc, P450arom and StAR were determined by RT-PCR. Progesterone and estradiol levels were measured by radioimmunoassay., Results: TEM results confirmed that calcium phosphate nanoparticles could enter into granulosa cells, and distributed in the membranate compartments, including lysosome and mitochondria and intracellular vesicles. The increased percentage of cells in S phase when cultured with nanoparticles indicated that there was an arrest at the checkpoint from phase S-to-G2/M (from 6.28 +/- 1.55% to 11.18 +/- 1.73%, p < 0.05). The increased ratio of S/(G2/M) implied the inhibition of DNA synthesis and/or impairment in the transition of the S progression stage. The apoptosis rate of normal granulosa cells was 7.83 +/- 2.67%, the apoptotic rate increased to 16.53 +/- 5.56% (P < 0.05) after the cells were treated with 100 microM calcium phosphate nanoparticles for 48 hours. Treatment with calcium phosphate nanoparticles at concentrations of 10-100 microM didn't significantly change either the progesterone or estradiol levels in culture fluid, and the expression levels of mRNAs encoding P450scc, P450arom and StAR after 48 h and 72 h period of treatment., Conclusion: Calcium phosphate nanoparticles interfered with cell cycle of cultured human ovarian granulosa cells thus increasing cell apoptosis. This pilot study suggested that effects of nanoparticles on ovarian function should be extensively investigated.

Three types of ceramic scaffolds with different composition and structure [namely synthetic 100% hydroxyapatite (HA; Engipore), synthetic calcium phosphate multiphase biomaterial containing 67% silicon stabilized tricalcium phosphate (Si-TCP; Skelite) and natural bone mineral derived scaffolds (Bio-oss)] were seeded with mesenchymal stem cells (MSC) and ectopically implanted for 8 and 16 weeks in immunodeficient mice. X-ray synchrotron radiation microtomography was used to derive 3D structural information on the same scaffolds both before and after implantation. Meaningful images and morphometric parameters such as scaffold and bone volume fraction, mean thickness and thickness distribution of the different phases as a function of the implantation time, were obtained. The used imaging algorithms allowed a direct comparison and registration of the 3D structure before and after implantation of the same sub-volume of a given scaffold. In this way it was possible to directly monitor the tissue engineered bone growth and the complete or partial degradation of the scaffold. Further, the detailed kinetics studies on Skelite scaffolds implanted for different length of times from 3 days to 24 weeks, revealed in the X-ray absorption histograms two separate peaks associated to HA and TCP. It was therefore possible to observe that the progressive degradation of the Skelite scaffolds was mainly due to the resorption of TCP. The different saturation times in the tissue engineered bone growth and in the TCP resorption confirmed that the bone growth was not limited the scaffold regions that were resorbed but continued in the inward direction with respect to the pore surface.

The purpose of this study was to determine whether angiogenesis could successfully be induced into bone tissue that was engineered by cultured adipose-derived stem cells with porous beta-tricalcium phosphate and whether its biologic properties could be maintained by flap prefabrication technique.Adipose-derived stem cells with porous beta-tricalcium phosphate were implanted into the superficial inferior epigastric artery flap of the Fisher rats. After prefabrication for 8 weeks, the prefabricated flaps were elevated and the pedicles were clamped for 4 hours. The samples were harvested after 2 weeks for analyses.Angiogenesis was significantly increased in the prefabricated groups (P < 0.05). There was no significant difference between the prefabricated and nonprefabricated groups in terms of the osteogenic capacity (P > 0.5).The promising results obtained with prefabrication in tissue engineered bone grafts encourage the clinical application of this technology. Thus, prefabrication may be a useful technique in any engineered bone tissue transfer.

Objective: The primary objective of this work was to develop a method of quantifying the levels and source of calcium and phosphate deposited on dental hard tissue from a novel calcium phosphosilicate (NovaMin) material using neutron activation analysis (NAA). A second objective was to explore the utility of radiotracing to determine dentin porosity following exposure to calcium phosphosilicate., Methods: Neutron activation was used to create isotopes of Ca and P in the calcium phosphosilicate particles. Gamma radiation emitted from these isotopes was used to identify and measure their uptake (concentration) onto dental hard tissue. Three experiments were conducted to explore calcium and phosphate uptake to dental hard tissue: 1) a dose response to quantify the relative levels of calcium and phosphate deposited on dental hard tissue as a function of calcium phosphosilicate dose; 2) the effect of calcium phosphosilicate particle size on the relative levels of calcium and phosphate uptake; and 3) the permeability of calcium phosphosilicate-treated dentin by employing the radiotracer technetium. For all experiments, extracted bovine incisors were employed as the test substrate., Results: The results indicate there is a strong dose relationship between the wt% and particle size of calcium phosphosilicate in the dentifrice formulation and new Ca and P deposition. At above 5.0 wt% calcium phosphosilicate, there appears to be an exponential increase in the number of counts from the tooth surface. Finer particle size calcium phosphosilicate appears to deposit much higher levels of Ca and P than the larger range of particle sizes. The results from the technetium study show that when treated with the dentifrice slurry containing calcium phosphosilicate, dentin shows only a slight amount of technetium infiltration, indicating a lowering of dentin permeability., Conclusion: This exploratory study has demonstrated that NAA and the use of radio isotopes have utility in monitoring the uptake of Ca and P into both dentin and enamel tooth structure. The data generated from these studies have shown that there is a dose dependence and particle size effect for calcium phosphosilicate on the deposition of calcium and phosphate to dental hard tissue.

Growth factors are essential components of the diamond concept model. The bone morphogenetic proteins (BMPs) are the most potent and promising growth factors and their clinical efficacy is well demonstrated for specific indications. Application of BMPs involves a carrier material to enhance local residual time and pharmacokinetics. On the other hand carrier materials, collagen at this point, also limit the use of BMPs, for example in minimally invasive application methods. In this overview, the pharmacokinetics of BMPs, and various carrier materials (collagen, synthetic polymers, calcium phosphates, hyaluronic acid, CMC, and sodium acetate) are discussed. No other carrier material than collagen has been proven effective in clinical studies. Other formulations are needed to improve the residual time and handling., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Summary: This study was undertaken to investigate the radiologic and clinical outcomes of vertebroplasty with calcium phosphate (CaP) cement in patients with osteoporotic vertebral compression fractures. The morphological changes of injected CaP cement in osteoporotic compressed vertebral bodies were variable and unpredictable. We suggest that the practice of vertebroplasty using CaP should be reconsidered., Introduction: Recently, CaP, an osteoconductive filler material, has been used in the treatment of osteoporotic compression fractures. However, the clinical results of CaP-cement-augmented vertebrae are still not well established. The purpose of this study is to assess the clinical results of vertebroplasty with CaP by evaluating the morphological changes of CaP cement in compressed vertebral bodies., Methods: Fourteen patients have been followed for more than 2 years after vertebroplasty. The following parameters were reviewed: age, sex, T score, compliance with osteoporosis medications, visual analog scale score, compression ratio, subsequent compression fractures, and any morphological changes in the filler material., Results: The morphological changes of injected CaP included reabsorption, condensation, bone formation (osteogenesis), fracture of the CaP solid hump, and heterotopic ossification. Out of 14 patients, 11 (78.6%) developed progression of the compression of the CaP-augmented vertebral bodies after vertebroplasty., Conclusions: The morphological changes of the injected CaP cement in the vertebral bodies were variable and unpredictable. The compression of the CaP-augmented vertebrae progressed continuously for 2 years or more. The findings of this study suggest that vertebroplasty using CaP cement should be reconsidered.

Secondary caries and restoration fracture are common problems in restorative dentistry. The aim of this study was to develop Ca-PO(4) nanocomposite having improved stress-bearing properties and Ca and PO(4) ion release to inhibit caries, and to determine the effects of filler level. Nanoparticles of dicalcium phosphate anhydrous (DCPA), two larger DCPA powders, and reinforcing whiskers were incorporated into a resin. A 6 x 3 design was tested with six filler mass fractions (0, 30, 50, 65, 70, and 75%) and three DCPA particle sizes (112 nm, 0.88 mum, 12.0 mum). The DCPA nanocomposite at 75% fillers had a flexural strength (mean +/- SD; n = 6) of 114 +/- 23 MPa, matching the 112 +/- 22 MPa of a commercial non-releasing, hybrid composite (P > 0.1). This was 2-fold of the 60 +/- 6 MPa of a commercial releasing control. Decreasing the particle size increased the ion release. Increasing the filler level increased the ion release at a rate faster than being linear. The amount of ion release from the nanocomposite matched or exceeded those of previous composites that released supersaturating levels of Ca and PO(4) and remineralized tooth lesions. This suggests that the much stronger nanocomposite may also be effective in remineralizing tooth lesion and inhibiting caries. In summary, combining calcium phosphate nanoparticles with reinforcing co-fillers in the composite provided a way to achieving both caries-inhibiting and stress-bearing capabilities. Filler level and particle size can be tailored to achieve optimal composite properties.

Purpose: To determine the fluoride dose response of experimental NaF dentifrices containing a prospective calcium phosphate technology, along with the corresponding relative enamel and dentin abrasion values., Methods: 3 mm diameter bovine enamel specimens were mounted, ground and polished, and softened in a carbopol-lactic acid solution (pH = 5.0) for 36 hours at 37 degrees C. Specimens were then measured for baseline Vickers microhardness and stratified (N = 18, mean VHN = 33) into eight groups. These groups consisted of a placebo paste, four test dentifrices (A, B, C, D) with three of the four (A, B, C) containing a promising calcium phosphate ingredient, Crest Cavity Protection, MI Paste Plus, and PreviDent Booster 5000. The groups were cycled in a lesion reversal pH cycling model consisting of four 2-minute treatment periods (diluted 1:3 with DI water) and one 4-hour acid challenge (carbopol-lactic acid, pH = 5.0) per day. Between these events, specimens were immersed in artificial saliva (pH = 7.0). After 20 days of cycling, the specimens were microdrilled and analyzed for fluoride content, and also measured for Vickers surface microhardness after 10 and 20 days of cycling and after a 2-hour and 16-hour post-cycle acid challenge (carbopol-lactic acid, pH = 5.0). Separately, relative dentin and enamel abrasion (RDA and REA) were performed using the ADA recommended radiotracer method., Results: A fluoride dose response was observed for the test dentifrices after 10 and 20 days of pH cycling, with test dentifrice C promoting the highest remineralization among the groups while both the MI Paste Plus and PreviDent systems provide the least remineralization (one-way ANOVA, SNK, P < 0.05). With respect to enamel fluoride uptake, the group facilitating the highest incorporation of fluoride into the enamel lesion was test dentifrice C, while the least effective NaF system was the MI Paste Plus (one-way ANOVA, SNK, P < 0.05). In terms of formulation abrasion, the REA scores were similar among the test dentifrices, MI Paste Plus, and PreviDent and compared favorably to the ADA reference material score (one-way ANOVA, SNK, P < 0.05); relative to the ADA reference material RDA score, the data indicate that MI Paste Plus was essentially non-abrasive, while PreviDent was significantly more abrasive to dentin (one-way ANOVA, SNK, P < 0.05). Altogether, these data show the developmental test dentifrices demonstrate a fluoride dose response and show great promise in remineralizing white-spot enamel lesions relative to MI Paste Plus and PreviDent.

Background: Sodium phosphate containing colonoscopy preparations may cause electrolyte disturbances and calcium-phosphate nephropathy. Decreased body weight is an unexplored risk factor for complications with sodium phosphate ingestion., Aim: To perform a pharmacokinetic analysis of a single dose of Fleet Phospho-Soda in smaller and larger individuals., Methods: Seven subjects weighing <55 kg (Group I) and six weighing >100 kg (Group II) consumed 45 mL Fleet Phospho-Soda. Serum electrolytes were measured. Hydration was closely maintained by monitoring weight, fluid intake and total body water., Results: Marked increases in serum phosphate were seen in Group I compared to Group II. For example, mean serum phosphate at 120 min was 7.8 +/- 0.5 mg/dL in Group I and 5.1 +/- 0.8 mg/dL in Group II (P < 0.001). Normalized area under the phosphate vs. time curve for Group I was 1120 +/- 190 mg/dL*min and 685 +/- 136 mg/dL*min for Group II (P < 0.001). Twelve-hour urine calcium was lower in Group I (16.4 +/- 7.6 mg) than in Group II (39.2 +/- 7.8 mg, P < 0.001)., Conclusions: Increased serum phosphate occurs in smaller individuals after ingestion of sodium phosphate preparations, even with strict attention to fluid intake. Smaller body weight poses a potential risk for calcium-phosphate nephropathy.

Purpose: To determine the in vitro remineralization potential of a new calcium phosphate technology in a 1000 ppm F system., Methods: 3 mm diameter bovine enamel specimens were mounted, ground and polished, and softened in a carbopol-lactic acid solution (pH = 5.0) for 36 hours at 37 degrees C. Specimens were then measured for baseline Vickers microhardness and stratified (N = 10, mean VHN = 35) into the following groups: Group A: distilled water (negative control); Group B: MI Paste Plus (900 ppm F); Group C: Theramed SOS (1450 ppm F); Group D: "control" dentifrice (1000 ppm F); and, Group E: "test" dentifrice (1000 ppm F) admixed with a new functionalized calcium phosphate system. The groups were then cycled for 10 days in a pH cycling model consisting of four 2-minute treatment periods (diluted 1:3 with distilled water) and one 4-hour acid challenge (carbopol-lactic acid, pH = 5.0) per day. Between these events, specimens were immersed in artificial saliva (pH = 7.0). After 10 days of cycling, the specimens were measured for Vickers surface microhardness and were subsequently microdrilled, with the powder measured for fluoride content using a calibrated fluoride-sensitive electrode., Results: Significant differences resulted between the distilled water and fluoride-containing groups. Among the fluoride-containing groups, Group B demonstrated statistically low levels of enamel fluoride deposition and deltaVHN, while Group E statistically outperformed Group D. Among the groups with different calcium systems (Groups B, C, and E), Groups C and E were found to be statistically equivalent and superior to Group B with respect to both bioavailable fluoride and deltaVHN. Based on our results, these data demonstrated the combination of a new calcium phosphate technology plus 1000 ppm F, produced significantly greater remineralization relative to both the 1000 ppm F test dentifrice and MI Paste Plus, and was statistically equivalent to Theramed SOS.

Biodegradable and bioactive beta-tricalcium phosphate (beta-TCP) coatings were prepared on magnesium (Mg) in order to improve its biocompatibility by a chemical method. The tensile bonding strength of beta-TCP coating and Mg substrate was measured by the standard adhesion test (ISO 13779-4). And the cytocompatibility of beta-TCP coated Mg was studied by using human osteoblast-like MG63 cells. It was found that the MG63 cells could grow well on the surface of beta-TCP coated Mg and the cell viability on beta-TCP coated Mg was above 80% during the cocultivation of MG63 cells and beta-TCP coated Mg for 10 days, indicating no cytotoxicity. It was concluded that the beta-TCP coated Mg had good cytocompatibility. The degradation of Mg substrate with beta-TCP coating in vitro was studied in detail by XRD, EDX, SEM, and ICP. The results showed that a bone-like apatite continually formed on the surface of the sample with the degradation of both Mg substrate and beta-TCP coating in Hank's solution (a simulated body fluid). The biodegradation mechanism was preliminarily analyzed in the paper.

Clinical orthopaedic use of calcium phosphate cement has been limited due to its slow resorption rate, but a new macroporous alpha-tricalcium phosphate (alpha-TCP) bone cement has been designed to accelerate resorption and to increase bone ingrowth. To assess its clinical potential, the in vivo behaviour of alpha-TCP was evaluated in a critical-size defect drilled in the femoral condyles of 36 adult female New Zealand rabbits. Macroporous or standard cement was injected immediately after preparation of the defect. The foaming agent was albumen, which gave up to 75% porosity. The rabbits were divided into three groups and the lesions examined histopathologically at 1, 4 and 12 weeks. No inflammatory reaction was detected at any time period following implantation with either macroporous or standard cement. At 12 weeks, the area of the implanted macroporous cement was approximately 35% of the initial lesion size. Bone growth and revascularisation was observed inside the central pores of the macroporous cement, not only at the margins, as was found with standard calcium phosphate cement. The results indicated that both cements were osteoconductive, biocompatible and biodegradable but their different physicochemical and biological properties had a marked influence on their post-implant behaviour.

The healing of large bone defects can be improved by osteogenic bone graft substitutes, due to growth factor inclusion. A sustained release of these growth factors provides more efficient bioactivity when compared with burst release and might reduce the dose required for bone regeneration, which is desirable for socioeconomical and safety reasons. In this study, we compared different rhBMP-2 loadings in a sustained release system of CaP cement and PLGA-microparticles and were able to couple kinetic to biological activity data. Fifty-two rats received a critical-size cranial defect, which was left open or filled with the cement composites. The implants consisted of plain, high, and five-fold lower dose rhBMP-2 groups. Implantation time was 4 and 12 weeks. Longitudinal in vivo release was monitored by scintigraphic imaging of (131)I-labeled rhBMP-2. Quantitative analysis of the scintigraphic images revealed a sustained release of (131)I-rhBMP-2 for both doses, with different release profiles between the two loadings. However, around 70% of the initial dose was retained in both implant formulations. Although low amounts of rhBMP-2 were released (2.4 +/- 0.8 mug in 5 weeks), histology showed defect bridging in the high-dose implants. Release out of the low-dose implants was not sufficient to enhance bone formation. Implant degradation was limited in all formulations, but was mainly seen in the high-dose group. Low amounts of sustained released rhBMP-2 were sufficient to bridge critically sized defects. A substantial amount of rhBMP-2 was retained in the implants because of the slow release rate and the limited degradation., ((c) 2008 Wiley Periodicals, Inc. J Biomed Mater Res, 2008.)

Strontium-substituted beta-TCP with the general formula Ca((3-x))Sr(x)(PO(4))(2) (0

Vascular calcification is associated with an increased risk of myocardial infarction; however, the mechanisms linking these 2 processes are unknown. Studies in macrophages have suggested that calcium phosphate crystals induce the release of proinflammatory cytokines; however, no studies have been performed on the effects of calcium phosphate crystals on vascular smooth muscle cell function. In the present study, we found that calcium phosphate crystals induced cell death in human aortic vascular smooth muscle cells with their potency depending on their size and composition. Calcium phosphate crystals of approximately 1 microm or less in diameter caused rapid rises in intracellular calcium concentration, an effect that was inhibited by the lysosomal proton pump inhibitor, bafilomycin A1. Bafilomycin A1 also blocked vascular smooth muscle cell death suggesting that crystal dissolution in lysosomes leads to an increase in intracellular calcium levels and subsequent cell death. These studies give novel insights into the bioactivity of calcified deposits and suggest that small calcium phosphate crystals could destabilize atherosclerotic plaques by initiating inflammation and by causing vascular smooth muscle cell death.

The aim of this research was to study, in vitro by resultant-weight measurement and in vivo by gamma-scintigraphy experiments in humans, the floatation behavior of systems obtained by modules assembled in void configuration. The assembled system technology allowed the manufacturing of a system characterized by the presence of an internal void space that provided an apparent density lower than water. The gastro-retention times of floating assembled systems were determined in comparison with non-floating systems having the same mass and composition. In vitro the floatation of the system started immediately after immersion in water and lasted for more than 5 h. The in vivo studies confirmed that the in vitro floating ability of void configuration was maintained also in the human stomach where the system stayed for periods of time ranging from 2.5 to 5.0 h, depending on the food regimen and the sex of the subject. Reiterate eating and drinking further prolonged the stomach residence time.

We conducted this study to test the hypothesis that acidic solutions undersaturated with respect to enamel and supersaturated with respect to fluorapatite can enhance enamel remineralization by reducing preferential remineralization of the outer lesion and promoting mineral ion penetration. We used quantitative microradiography to assess mineral changes in artificial surface-softened and subsurface lesions in human enamel in vitro, induced by such an acidic solution and by a neutral remineralizing solution. For surface-softened lesions, the extent of remineralization was similar for both solutions, although preferential remineralization of the outer lesion was observed with the neutral solution. For subsurface lesions, preferential remineralization of the outer lesion was not observed with either solution. However, the extent of subsurface lesion remineralization by the acidic solution was significantly greater than that observed with the neutral solution. Results obtained are noted to reflect inherent differences in lesion type and the properties of the solutions studied.

Purpose: The purpose of this study was to evaluate the long-term in vivo degradation of biodegradable interference screws made of poly-L-lactic acid (PLLA) and beta-tricalcium phosphate (beta-TCP)., Methods: Twenty patients undergoing patellar tendon autograft anterior cruciate ligament reconstruction fixed at both the femur and tibia with beta-TCP-PLLA screws at least 44 months earlier were evaluated by physical, radiographic, and computed tomography (CT) evaluations. This study was approved by the institutional review board. Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee scores were also obtained. CT data were measured in Hounsfield units., Results: We evaluated 13 male and 7 female patients at a mean of 50 months after surgery (range, 44 to 56 months). CT scans and radiographs showed the bone plug fused to the tunnel wall with no beta-TCP-PLLA screw remaining. The screws were replaced with clearly calcified non-trabecular material, denser than soft tissue. Osteoconductivity was present in 75% of the tunnels and complete in 10%. No positive pivot-shift tests were found. Lysholm, Tegner, and Cincinnati scores improved from 60.4, 3.7, and 53.3, respectively, preoperatively to 90.8, 5.8, and 86.4, respectively, at follow-up. The mean side-to-side difference determined by use of the KT arthrometer (MEDmetric, San Diego, CA) was 0.4 mm., Conclusions: The beta-TCP-PLLA interference screw (Bilok; ArthroCare, Sunnyvale, CA) completely degraded, and no remnant was present 4 years after insertion. Osteoconductivity was confirmed by CT scans at 75% of the screw sites and completely filled the site in 10%. The addition of beta-TCP to PLLA results in a biocomposite interference screw that is osteoconductive., Level of Evidence: Level IV, therapeutic case series.

Objective: Calcium phosphates are clinically established as bone defect fillers. They have the capability of osseoconduction and are characterized by a slow resorption process. The present study evaluated the suitability of a newly developed calcium phosphate cement modified with collagen type I., Study Design: The modified cement paste was inserted in differently designed defects of 10 minipigs. Further, an alveolar ridge augmentation was performed, applying the cement paste. The cement hardened in situ during the operation, forming a hydroxyapatite collagen composite. Animals were sacrificed after 1, 3, 6, 12, and 18 months. The tissue integration and resorption process was then evaluated using nondecalcified microsections. All animals were evaluated for histology., Results: The implanted material showed osseoconductive characteristics. Resorption started from the edge of the defect zone, and bone substitution followed rapidly. Twelve months after placement of the cement, complete remodeling was observed., Conclusion: It can be concluded that the applied hydroxyapatite-collagen cement composite shows good resorption and bone integration.

Different in vivo studies demonstrated that brushite cements are biocompatible, bioresorbable, and osteoconductive. However, the decay of brushite cements has been scarcely studied even though it may be of great concern for clinical applications in highly blood-perfused regions. This work was elaborated to elucidate factors that determine brushite cement surface disintegration. For that, brushite cements were modified using in their preparation different aqueous solutions of phosphoric, glycolic, tartaric, and citric acids in concentrations that were reported to improve the cement properties. Two-viscosity enhancing polysaccharides, chondroitin-4 sulfate and hyaluronic acid, were also assayed. Thereafter, pre- and set cement samples were immersed in distilled water for 24 h. The cement-solid weight loss, microstructure, liquid phase viscosity, mean size of the released particles, and zeta potential were analyzed using X-ray diffraction, FTIR spectroscopy, light scattering, scanning electron microscopy and optical microscopy. It was found that the particles released from the cement surface were beta-TCP, and their amount depends on the carboxylic acid used in the preparation of the cement. The addition of hyaluronic acid and chondroitin-4 sulfate decreased the amount of released particles from the surface of the set brushite cement made with citric acid. Furthermore, the hyaluronic acid increased significantly the viscosity of the citric acid solution and the cement paste prepared with this liquid phase showed a pronounced step down in particle release. In this study, we showed that the water solubility of calcium carboxylate and the viscosity of mixing liquid may dictate the superficial disintegration of brushite cements., ((c) 2007 Wiley Periodicals, Inc.)

Characterizations of hydroxyapatite (HA), biphasic calcium phosphate (BCP) and beta tricalcium phosphate (beta-TCP) ceramic particles were carried out using X-ray diffusion (XRD), Scanning electron micrograph (SEM), Particle Sizer and Zeta potential analyzer. Competitive adsorption of bovine serum albumin (BSA) and lysozyme (LSZ) on the three calcium phosphates were investigated by polyacrylamide gel electrophoresis (PAGE) method. The results showed that HA, BCP and beta-TCP ceramic particles with irregular shapes and similar size distributions all had negative surface net charges in pH7.4 phosphate buffered saline (PBS) solution and exhibited alike behaviors of BSA and LSZ adsorption. LSZ had higher affinity for calcium phosphate ceramics than BSA and its adsorption on them didn't be almost influenced by the increasing of BSA concentration in the solution. Electrostatic interaction played an important role on the competitive adsorption of BSA and LSZ on the surface of calcium phosphate ceramic particles.

Purpose: The purpose of the present preliminary study is to show that a novel 3-dimensional porous silica-calcium phosphate nanocomposite (SCPC) can provide a controlled release of rhBMP-2 and regenerate bone in a load-bearing segmental defect., Materials and Methods: A bone replica of the rabbit ulna was created from SCPC powder using rapid prototyping technology. The ceramic bone replica was coated with rhBMP-2 and then implanted into a 10-mm segmental defect created in a rabbit ulna and fixated with a 1-mm titanium adaptation plate. Bone healing was evaluated using computed tomography (CT) scan, histomorphometry, and biomechanical techniques. The release kinetics of rhBMP-2 and the dissolution kinetics were also determined in vitro. Statistical analysis was performed to compare the biomechanical strength of the grafted bone with the contralateral unoperated ulna., Results: After 4 weeks, CT scans showed that the critical size defect had been replaced by newly formed bone. Torsional testing of the ulna after 12 weeks showed restoration of maximum torque and angle at failure. Histological evaluation showed that the regenerated bone had the morphological characteristics of mature bone. SCPC provided a sustained release profile of an effective dose of rhBMP-2 for 14 days., Conclusions: The SCPC-rhBMP-2 hybrid enhanced bone regeneration in a load-bearing segmental defect in a rabbit ulna. The regenerated bone acquired morphology and mechanical strength typical for natural bone. The enhanced bone formation correlates well with the surface bioactivity and effective release profile of rhBMP-2. The present preliminary study shows the proof of principles that porous, resorbable, bioactive SCPC-rhBMP-2 tissue engineering hybrid can serve as a substitute for autologous bone in load-bearing applications.

Calcium phosphates (CaPO4) and faster-resorbing calcium sulfate (CaSO4) are successfully employed as synthetic bone grafts for treatment of contained defects. We used a canine critical-sized bone defect model to study an injectable CaSO4/CaPO4 composite graft that incorporated a matrix of CaSO4 and dicalcium phosphate dihydrate into which beta-tricalcium phosphate granules were distributed. The area fraction, ultimate compressive stress, and elastic modulus of restored bone and the relative rates of material resorption were compared between the CaSO4/CaPO4 composite graft and pure CaSO4 pellets and to normal canine bone. The area fraction of bone in stained sections and the ultimate compressive stress of the regenerated bone were greater using the CaSO4/CaPO4 composite graft compared to pure CaSO4 pellets after 13 and 26 weeks and were greater than normal bone. The elastic modulus of restored bone in defects treated with CaSO4/CaPO4 composite graft was greater than in defects treated with CaSO4 pellets after 26 weeks, but similar to specimens of normal bone. A small amount of CaSO4/CaPO4 composite graft and no CaSO4 pellets remained after 13 or 26 weeks. This novel CaSO4/CaPO4 composite holds promise for clinical applications where a strong, injectable, slower-resorbing, and biocompatible bone graft substitute would be advantageous.

Since calcium phosphate cements were proposed, several formulations have been developed, some of them commercialised, and they have proven to be very efficient bone substitutes in different applications. Some of their properties, such as the injectability, or the low-temperature setting, which allows the incorporation of different drugs, make them very attractive candidates as drug carriers. In this article, the performance of calcium phosphate cements as carriers of different types of drugs, such as antibiotics, analgesics, anticancer, anti-inflammatory, as well as growth factors is reviewed.

Bioresorption and biocompatibility of carbonate apatites, both sintered and non-sintered (S-CAP and N-CAP), and of sintered beta-tricalcium phosphate (beta-TCP) were compared by implanting particles of these materials into the back of adult rats. Bioresorption--when evaluated non-destructively with non-decalcified tissues using microfocus X-ray tomography--was essentially the same for N-CAP and beta-TCP, while S-CAP exhibited statistically lower bioresorption at 2, 4, and 12 weeks postoperatively. Biocompatibility--when evaluated by ED1 immunostaining--was in the order of beta-TCP > N-CAP > S-CAP. The intensity of ED1 immunostaining decreased with time, but persisted longer in beta-TCP than in S-CAP and N-CAP, indicating that beta-TCP produced the strongest and most enduring stimulation of macrophages. Although no statistical differences were found in tartrate-resistant acid phosphatase (TRAP) staining among the materials at each implantation period, the degree of TRAP staining for S-CAP was statistically greater at 12 weeks than at 2 and 4 weeks, indicating that osteoclast-like cells were in part responsible for the resorption of the carbonate apatite.

Calcium (Ca)-fortified soymilk has gained popularity in the United States. Tricalcium phosphate (TCP)-fortified soymilk was shown to have a lower Ca bioavailability than cow's milk in men. However, the most popular soymilk in the U.S. is fortified with Ca carbonate (CC) and has not been evaluated. Ca bioavailability from CC-fortified soymilk (CCSM) and TCP-fortified soymilk (TCPSM) was compared with cow's milk in young healthy women using the dual stable isotope technique. In a 3-way crossover design, 20 volunteers (23 +/- 2 y old) consumed 250 mg Ca in cow's milk, CCSM, or TCPSM along with 10 mg 44Ca after an overnight fast. Cow's milk was extrinsically labeled, whereas each fortified soymilk was intrinsically labeled with each chemical salt of 44Ca at the manufacturing facility. Another stable isotope, 43Ca, was injected i.v. 1 h after the complete consumption of cow's milk or soymilk. Fractional Ca absorption was determined from the ratios of 43Ca:42Ca and 44Ca:42Ca by inductively coupled plasma (ICP)-MS in the 24-h urine samples. A mixed linear model (SAS proc mixed) was used to compare the fractional Ca absorption among groups. Fractional Ca absorption in CCSM (0.211 +/- 0.057) did not differ from that of cow's milk (0.217 +/- 0.040), but both were higher (P < 0.05) than that of TCPSM (0.181 +/- 0.039). Our result suggests that calcium absorption is equivalent for CCSM and cow's milk at similar calcium loads.

The objective of this study was to compare the bioavailability of calcium from two fortification systems used in orange juice. The design was randomized crossover, within-subject. The subjects were 25 healthy premenopausal women in an academic health sciences center. Two commercially marketed calcium-fortified orange juices, ingested in an amount providing 500 mg calcium, were taken at breakfast after an overnight fast. The two fortification systems tested were calcium citrate malate and a combination of tricalcium phosphate and calcium lactate (tricalcium phosphate/calcium lactate). The main outcome measure was the area under the curve (AUC) for the increase in serum calcium from 0 to 9 hours after ingesting the test calcium source. Statistical analyses performed were repeated measures analysis of variance, testing source, and sequence. AUC 9 was 48% greater for calcium citrate malate than for tricalcium phosphate/calcium lactate ( P < .001); absorbed calcium calculated from AUC 9 values (mean+/-standard error of the mean) was 148+/-9.0 mg and 100+/-8.9 mg for calcium citrate malate and tricalcium phosphate/calcium lactate, respectively. The results indicate that equivalent calcium contents on a nutritional label do not guarantee equivalent nutritional value. Nutritionists and dietetics professionals should encourage manufacturers of fortified products to provide information on bioavailability.

Calcium phosphate adjuvant is a commercially available vaccine adjuvant that potentiates the immune response to antigens. Although its name suggests that it is Ca3(PO4)2, X-ray diffraction, FTIR spectroscopy, thermal analysis and the Ca/P molar ratio identify commercial calcium phosphate adjuvant as non-stoichiometric hydroxyapatite, Ca10-x (HPO4)x (PO4)6-x (OH)2-x, where x varies from 0 to 2. The surface charge is pH-dependent (point of zero charge = 5.5). Consequently, commercial calcium phosphate adjuvant exhibits a negative surface charge at physiological pH and electrostatically adsorbs positively charged antigens. The presence of hydroxyls allows calcium phosphate adjuvant to adsorb phosphorylated antigens by ligand exchange with surface hydroxyls.

The organic-inorganic hybrid nanoparticles entrapping oligodeoxynucleotide (ODN) or siRNA were prepared through the self-associating phenomenon of the block copolymer, poly(ethylene glycol)-block-poly(aspartic acid) (PEG-PAA), with calcium phosphate. The nanoparticles have diameters in the range of several hundreds of nanometers depending on the PEG-PAA concentration and revealed excellent colloidal stability due to the steric repulsion effect of the PEG layer surrounding the calcium phosphate core. The loading capacities of ODN and siRNA were fairly high, reaching almost 100% under optimal conditions. The flowcytometric analysis and confocal microscopy observation indicated that the hybrid nanoparticles loaded with ODN were taken up by the cells through the endocytosis mechanism. Furthermore, the calcium phosphate core dissociates in the intracellular environment with appreciably lowered calcium ion concentration compared to the exterior, allowing the release of the incorporated ODN and siRNA in a controlled manner. Eventually, effective intracellular delivery and nuclear localization of these nucleic acid-based drugs were evidenced through the observation of laser confocal microscopy using FITC-labeled ODN. This smart ion-sensitive characteristic of hybrid nanoparticles was further demonstrated by the appreciable silencing of reporter gene expression by siRNA incorporated in the nanoparticles., (Copyright 2004 Elsevier B.V.)

Purpose: An inorganic xenograft (inorganic bovine bone [IBB]) and a porous alloplast (beta-tricalcium phosphate [beta-TCP]) material were compared at different healing periods in experimental bone defects in dogs., Materials and Methods: Six round defects, 5 x 4 mm, were made on the lateral bony mandibular angle in 8 dogs at different times. Two defects were randomly filled with IBB, 2 with beta-TCP, and 2 were left to blood clot. A bi-layer collagen membrane covered 1 defect of each type. Four specimens per treatment group were obtained for each treatment group at 3, 6, 12, and 24 months postoperatively. Morphometric analysis of decalcified (Donath technique) histologic slides was conducted using the measured areas of regenerated bone, grafted particles, and remaining concavity., Results: In IBB sites, complete bone healing was evident at 12 and 24 months, but grafted particles dominated the sites. In beta-TCP sites, only particle remnants remained at 12 months. At 24 months, particles had completely resorbed in both membrane-protected (MP) and uncovered (UC) defects. Data were combined for final analysis since there were no statistically significant differences within each graft material group (MP or UC). Mean bone area fraction increased from 3 to 24 months at all sites. In bone area fraction a statistically significant difference was found between 3 and 6 months in the IBB and beta-TCP groups. IBB sites also showed such significance between 6 and 12 months. A statistically significant difference was found between MP ungrafted sites (42.9%) vs IBB (24.7%) and vs the control (24.8%) at 3 months. At 6 months, beta-TCP bone area fraction (68.8%) was significantly greater than IBB (47.9%) and control (37.5%) sites. At 12 months, beta-TCP bone area fraction (79.0%) was significantly greater than the control (42.5%). At 24 months, beta-TCP bone area fraction (86.5%) was significantly greater than IBB (55.6%) sites. Mean particle area fraction of beta-TCP sites decreased gradually until complete resorption at 24 months. IBB sites showed a significant decrease only between 3 (38.7%) and 6 (29.4%) months., Discussion and Conclusion: Complete bone healing was established in all grafted defects. IBB and beta-TCP are both excellent biocompatible materials. However, at 24 months beta-TCP particles were completely resorbed, whereas IBB particles still occupied a remarkable area fraction without significant resorption beyond 6 months. (More than 50 references.)

A calcium phosphate cement containing an antibiotic can be used for filling bone defects and to ensure local antibiotherapy. A calcium phosphate cement (already marketed under the name of Cementek can become injectable thanks to the addition of silicone. For dental applications, the behaviour of this injectable cement with added tetracycline was investigated. The tetracycline hydrochloride does not allow maturation of the cement: the tetracycline has to be treated with a calcium sulphate solution. The treated tetracycline (TTC) allowed maturation of the cement towards hydroxyapatite. But the setting time was longer and the mechanical properties decreased. Study in a continuous flow cell showed that the tetracycline is released in a continuous manner: thus, after 6 days, 60% of the antibiotic was released into the surrounding medium.

In this study we have examined the effect of different calcium salts, Ca gluconate (CaG), Ca lactate (CaL), Ca carbonate (CaC) and Ca phosphate (CaP), on the clearance of radiostrontium (*Sr) administered either intraperitoneally (ip) (*Sr-ip group) or orally (*Sr-oral group) in rats. The influence of these Ca salts was examined in a group of animals administered *Sr ip, while the effect of three Ca salts (CaG, CaL and CaP) was studied in another group of rats given *Sr orally and compared with that of Ca alginate (CaA), normally advised for *Sr decorporation. Rats from both groups were subdivided into control and four experimental subgroups and were housed individually. The experimental subgroups were given the respective Ca salts (elemental Ca = 9 mg/rat/day) 2 h post 85Sr, and thereafter once daily. In the *Sr-ip group, CaG was administered ip while the other Ca salts were given orally. In the *Sr-oral group all Ca salts were administered orally. In addition, the diet of all the experimental subgroups was supplemented with the respective Ca salts to 2% elemental Ca. The whole-body retention (WBR) of *Sr in animals treated with Ca salts was found to be significantly reduced from 50-60% at 24 h to 20-30% at the end of 15 days compared with 70-80% at 24 h to 50-60% at the end of 15 days in the untreated control animals. The results strongly suggest that CaA could be replaced by any of the commonly used Ca salts for curtailing the WBR of *Sr. CaG which was administered ip, in the *Sr-ip group, was found to be more effective in reducing the WBR of *Sr.

Objective: This study examined strength and bioactive (remineralizing) properties of a powder/liquid formulation (Cement I) and a more practical two-paste formulation (Cement II) of a fluoride-releasing resin-based Ca-PO(4) cement., Methods: For the remineralization potential, the dissolution of calcium, total ionic phosphate and fluoride from set cement specimens were determined in buffered saline and saliva-like solution (SLS). Artificial caries lesions were produced on coronal dentin of extracted human molars. On each tooth, two defined areas were coated, one with a composite resin (calcium-free control), the other with either Cement I or II. After incubation in SLS, the mineral loss under the cement was analyzed by digitized microradiography and compared to that under the control., Results: The diametral tensile strength of Cement II of approximately 30 MPa after 24 h and 23 MPa after 4 weeks was 2 to 3 times higher than that of Cement I (ANOVA, t-test, p<0.05). Calculations of the ion-activity products and Gibb's free energy from solution ion concentrations indicated a significant potential for the formation of fluor- and/or hydroxyapatite. Concurrently, both cements caused increases of 47% (Cement I) and 38% (Cement II) in the lesion mineral content over that underneath the corresponding controls., Significance: These in vitro results suggest that the stronger Cement II could serve as a restoration-supporting lining material and could remineralize dentin in areas where complete removal of carious tissue is contra-indicated.

Zinc is an essential trace element that has stimulatory effects on bone formation. Recently, we developed zinc-releasing calcium phosphate ceramics in order to add the pharmacologic effect of zinc to calcium phosphate ceramics. In our previous study, we showed that the optimum zinc content for promoting bone formation was 0.316 wt %. Therefore a zinc composite ceramic of zinc-containing beta-tricalcium phosphate and hydroxyapatite, with a zinc content of 0.316 wt %, was chosen for long-term implantation. Cylindrical rods of the zinc composite ceramic were implanted in rabbit femora for 2 to 60 weeks. Using computer-aided image analysis, a histomorphometric study was carried out to investigate bone formation and resorption around the implants. The control was a composite ceramic of beta-tricalcium phosphate and hydroxyapatite without zinc. The addition of zinc to the implant demonstrated both favorable and unfavorable effects on bone remodeling. The favorable effect was enhanced bone apposition to the implant surface, demonstrated by a significant increase in intramedullary bone apposition rate at 6 weeks and in cortical bone apposition rate at 24 and 60 weeks (p < 0.05). The unfavorable effect was increased bone resorption, demonstrated by a significant increase in medullary cavity area at 60 weeks (p < 0.05). In order to utilize the favorable effect and avoid the unfavorable effect of zinc, either a reduction in zinc content in the zinc composite ceramic or the selection of implantation sites that do not have excessive exposure to bone marrow are required., (Copyright 2003 Wiley Periodicals, Inc. J Biomed Mater Res 65A: 468-474, 2003)

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) nanocomplexes incorporated into sugar-free chewing gum have been shown to remineralize enamel subsurface lesions in situ. The aim of this study was to compare the ability of CPP-ACP, with that of other forms of calcium, to be retained in supragingival plaque and remineralize enamel subsurface lesions in situ when delivered in a mouthrinse or sugar-free gum in randomized, double-blind trials. In the mouthrinse study, only the CPP-ACP-containing mouthrinse significantly increased plaque calcium and inorganic phosphate levels, and the CPP were immunolocalized to the surfaces of bacterial cells as well as the intercellular matrix. In the chewing gum studies, the gum containing the CPP-ACP, although not containing the most calcium per piece of gum, produced the highest level of enamel remineralization independent of gum-chewing frequency and duration. The CPP could be detected in plaque extracts 3 hrs after subjects chewed the CPP-ACP-containing gum. The results showed that CPP-ACP were superior to other forms of calcium in remineralizing enamel subsurface lesions.

In a previous investigation, we demonstrated that when bovine serum albumin (BSA) is biomimetically co-precipitated with Ca(2+) and PO(4)(3-) ions upon titanium-alloy implants, it becomes incorporated into the crystal lattice and is not merely deposited on its surface. Moreover, the protein elicited a change in crystal structure from an octacalcium phosphate type to a carbonated apatite one, which bears a closer resemblance to natural bone mineral. In the present study, we investigated the dissolution rate and mechanical strength of such BSA-containing coatings as a function of protein concentration within the bathing medium (10 ng/ml to 1.0 mg/ml). BSA-containing coatings released Ca(2+) ions more slowly (5 ppm/min) than did non-BSA-containing ones (10 ppm/min), but this rate did not change as a function of protein concentration within the bathing medium. In contrast, the strength of coatings increased almost linearly as a function of protein concentration within the bathing medium, indicating that BSA incorporated into the crystal lattice enhances its mechanical strength in a concentration-dependent manner., (Copyright 2002 Elsevier Science Ltd.)

The present work investigates, in situ, the in vitro bioactivity of partially crystallized 45S5 Bioglass (BG) as a function of immersion time in a simulated body fluid (SBF) using atomic force microscopy (AFM). The results obtained for the crystallized BG were compared to those of hydroxyapatite c- and a-faces. The calcium phosphate layer grows on the crystallized 45S5 B by multiple two-dimensional nucleation and fusion of these two-dimensional islands, which is essentially the same mode as for the hydroxyapatite c-face. The surface of the crystallized 45S5 BG was almost fully covered with a dense and compact calcium phosphate layer after 24 h. The calcium phosphate formation on the crystallized BG arises from a low surface energy of the surface layer and/or an effect of the layer to lower the resistance when the growth units of calcium phosphate incorporate into the growing island. These results indicate that the crystallized 45S5 BG is suitable to be used as a filler for polymeric matrix bioactive composites, as it maintains a high bioactivity associated with a stiffer behavior (as compared to standard BG)., (Copyright 2002 Wiley Periodicals, Inc.)

Three hundred, day-old broiler chicks, with an average initial weight of 41.8 +/- 1.79 g, were used in a 15-day study (10 birds per battery cage) to characterize their performance and fluorine status when dicalcium phosphate (DCP) was replaced by Busumbu rock phosphate (BRP) as the source of phosphorus in the chicks' ration. The treatments comprised a standard ration with BRP replacing 0, 25%, 50%, 75% or 100% of DCP. Replacing DCP with BRP significantly reduced the final weight of the chicks (p < 0.01), feed intake (p < 0.01), weight gains (p < 0.01) and dry matter digestibility (p < 0.05) but increased (p < 0.05) the feed-to-gain ratio. True phosphorus absorption and the percentage of phosphorus in the tibia were not affected by increasing amounts of BRP in the diet. Increasing levels of BRP in the diet linearly reduced (p < 0.01) the percentage bone ash, calcium, Ca:P ratio, ultimate breaking force, bending moment, stress, and modulus of elasticity. Leg stiffness, lameness, reduced feed intake, and a decline in general health were recorded in 10-40% of the chicks on 75% and 100% BRP, respectively. These results suggest that excessive ingestion of fluorine from the BRP caused the reduction in the chicks' performance.

A new biomimetic method for coating metal implants enables the fast formation of dense and homogeneous calcium phosphate coatings. Titanium alloy (Ti6Al4V) disks were coated with a thin, carbonated, amorphous calcium phosphate (ACP) by immersion in a saturated solution of calcium, phosphate, magnesium, and carbonate. The ACP-coated disks then were processed further by incubation in calcium phosphate solutions to produce either crystalline carbonated apatite (CA) or octacalcium phosphate (OCP). The resorption behavior of these three biomimetic coatings was studied using osteoclast-enriched mouse bone-marrow cell cultures for 7 days. Cell-mediated degradation was observed for both carbonated apatite and octacalcium phosphate coatings. Numerous resorption lacunae characteristic of osteoclastic resorption were found on carbonated apatite after cell culture. The results showed that carbonated apatite coatings are resorbed by osteoclasts in a manner consistent with normal osteoclastic resorption. Osteoclasts also degraded the octacalcium phosphate coatings but not by classical pit formation., (Copyright 2001 John Wiley & Sons, Inc. J Biomed Mater Res 56: 208-215, 2001)

Chitosan scaffolds reinforced by beta-tricalcium phosphate (beta-TCP) and calcium phosphate invert glass were fabricated with a low-cost, bioclean freeze-drying technique via thermally induced phase separation. The microstructure, mechanical performance, biodegradation, and bioactivity of the scaffolds were studied. The composite scaffolds were macroporous, and the pore structures of the scaffolds with beta-TCP and the glass appeared very different. Both the compressive modulus and yield strength of the scaffolds were greatly improved, and reinforced microstructures were achieved. The bioactivity tests showed a continuous decrease in both Ca and P concentrations of a simulated body fluid (SBF) after the scaffolds with beta-TCP were immersed in the SBF for more than 20 h, which suggests that an apatite layer might be formed on the scaffolds. However, the same was not observed for the pure chitosan scaffolds or the scaffolds incorporated with the glass. This was further confirmed by micrographs from scanning electron microscopy. This study suggests that the desirable pore structure, biodegradation rate, and bioactivity of the composite scaffolds might be achieved through controlling the ratio of chitosan and calcium phosphates or beta-TCP and the glass., (Copyright 2001 John Wiley & Sons, Inc. J Biomed Mater Res 55: 304-312, 2001)

A new method for the labeling of polysaccharides by using tyrosine derivatives after CNBr activation is presented, along with its use for pharmacokinetic studies of an orally active immunomodulating noncovalent glycoconjugate, which was administered labeled either in the polysaccharide or the protein moiety. The relationship between the obtained results and the mechanism of action are also discussed.

The aim of this work was to develop a calcium phosphate cement (CPC) providing controlled release of the antibiotic gentamicin sulfate (GS) over at least 1 week. The CPC was made of beta-tricalcium phosphate [beta-TCP; beta-Ca(3)(PO(4))(2)], monocalcium phosphate monohydrate [MCPM; Ca(H(2)PO(4))(2). H(2)O] and water. Release of GS was controlled by admixture of poly(acrylic acid) (PAA). The effects on the GS release kinetics of the molecular weight of PAA, of the amount of admixed PAA, and of the pH of the release medium were investigated. A typical cement sample weighed 3.6 g and contained 100 mg of GS and between 0 and 150 mg of PAA. In the following, PAA content is expressed as the weight ratio, lambda, with respect to GS. At a low PAA content in the CPC (lambda < 0.7), GS was released over 1-2 days according to a square-root-of-time kinetics, but not all GS was released. The unreleased GS fraction increased from 0 to 58% with an increase of PAA content (up to lambda = 0.7). At high PAA content (lambda > 0.7), GS was released over a period of up to 8 days according to a combination of a square-root-of-time and a zero-order kinetics. The total GS fraction released increased again from 58 to 100% with an increase of the amount of PAA (up to lambda = 1.5). These observations were explained by molecular interaction between PAA and GS resulting in gel formation. The maximum fraction of GS released from the cement was indeed a function of the solubility of the PAA-GS (coacervate) complex in the release medium. Thus, GS release was controlled by two mechanisms: (1) diffusion of free GS molecules through the porous cement (square-root-of-time kinetics); and (2) dissociation of GS from the PAA-GS complex (zero-order kinetics). The first mechanism was predominant at low lambda, whereas the second mechanism became important at high lambda and later release times. As the solubility of the PAA-GS complex decreased with an increase in PAA molecular weight, the higher molecular weight PAA yielded more prolonged release periods of up to 8 days. Interestingly, the use of 450 kDa PAA at lambda = 1.00 provided an almost constant release profile over a period of 7 days. Gel formation between PAA and GS was explained in terms of hydrogen bonding of PAA carboxyl groups with GS amino groups. The molar ratio between carboxyl groups and amino groups in the gel was estimated to be approximately 1.9. In conclusion, admixture of PAA into calcium phosphate cement appeared to be a very elegant tool to control the release of the antibiotic over a period of 7 to 8 days., (Copyright 2000 Wiley-Liss, Inc. and the American Pharmaceutical Association J Pharm Sci 89:1262-1270, 2000)

Implants to prevent or treat osteomyelitis are described, composed of phosphate/poly(d,l-lactide) blends containing the antibiotic gentamicin. Seven formulations of implants containing 3% gentamicin sulfate (GS) were prepared at 433 MPa and 693 MPa of compression pressure. The blends contained phosphates (25% hydroxyapatite (HAP), 75% tricalcium phosphate (TCP)) and 20% dl-PLA (weight average molecular weight, M(w): 30 kD). To prolong GS release, implants were coated with PLGA (M(w):100 kD) or dl-PLA (M(w): 200 kD). Various durations of GS release from these devices were demonstrated as feasible. Release times of more than 10 weeks were attained with implants coated with dl-PLA (M(w): 200 kD), greatly exceeding the performance of the commercial formulation.

Disks made of hydroxyapatite, beta-tricalcium phosphate, carbonate apatite, tetracalcium phosphate, alpha-tricalcium phosphate, dicalcium phosphate dihydrate, and octacalcium phosphate were incubated in osteoclastic cell cultures for 2 days. The first five salts were sintered and the last two were compressed before incubation. Osteoclasts resorbed only the sintered carbonate apatite disks. However, osteoclasts were able to resorb octacalcium phosphate disks that were preincubated for 1 day in medium without cells, indicating that surface conditioning was important for osteoclastic resorption of this calcium phosphate. Although resorption did not occur, medium calcium and phosphorus changed to an appreciable extent after a 2-day incubation of beta-tricalcium phosphate, tetracalcium phosphate, alpha-tricalcium phosphate, and dicalcium phosphate dihydrate. These changes in the medium calcium and phosphate concentrations could explain why osteoclasts appeared to have lost their activity on these calcium phosphate disks and were not capable of resorbing them. With hydroxyapatite disks no changes were observed in the medium calcium and phosphorus before and after incubation. Moreover, the osteoclasts appeared to be essentially the same as with the sintered carbonate apatite disks and with bone slices used as a control. Nevertheless, no pits or lacunae were observed on the hydroxyapatite disks, indicating that sintered carbonate apatite should be superior to sintered hydroxyapatite as a bioresorbable bone substitute., (Copyright 1999 John Wiley & Sons, Inc.)

This study investigated the in vivo performance of two composite injectable bone substitutes (IBS), each with different calcium-phosphate particles granulometries [40-80 (IBS 40-80) and 200-500 microm (IBS 200-500)]. These biomaterials were obtained by associating a biphasic calcium-phosphate (BCP) ceramic mineral phase with a 3% aqueous solution of a cellulosic polymer (hydroxy-propyl-methyl-cellulose). Both materials were injected for periods of 2, 3, 8, or 12 weeks into bone defects at the distal end of rabbit femurs. Quantitative results on new bone formation, BCP resorption, and staining for tartrate-resistant acid phosphatase (TRAP) activity were studied for statistical purposes. Measurements with scanning electron microscopy and image analysis showed that the final rates of newly formed bone were similar for both tested IBS after 12 weeks of implantation. Bone colonization occurred more extensively during early implantation times for IBS 40-80 than for IBS 200-500. For the latter, BCP degradation occurred regularly throughout the implantation period, whereas it was very intensive during the first 2 weeks for IBS 40-80. Positive TRAP-stained degradation cells were significantly more numerous for IBS 40-80 than for IBS 200-500 regardless of implantation time. With the granulometry of either mineral phase, both tested IBS supported extensive bone colonization, which was greater than that previously reported for an equivalent block of macroporous BCP. The resorption-bone substitution process seemed to occur earlier and faster for IBS 40-80 than for IBS 200-500. Both tested IBS expressed similar biological efficiency, with conserved in vivo bioactivity and bone-filling ability., (Copyright 1999 John Wiley & Sons, Inc.)