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The electrostatic spray deposition (ESD) technique was used for biomedical purposes in order to deposit calcium phosphate (CaP) coatings onto titanium substrates. The relationship between various deposition parameters and the chemical properties of deposited coatings was investigated in order to be able to deposit CaP coatings with tailored chemical characteristics. The results showed that the chemical properties of the coatings were determined by both physical, apparatus-related factors and chemical, solution-related parameters. By varying the processing parameters of the technique, several crystal phases and phase mixtures were obtained, ranging from carbonate-free phases such as meta- and pyrophosphates, monetite and various tricalcium phosphates to carbonate-containing phases such as various carbonate apatites and calcite. On the basis of these results, a chemical mechanism of coating formation was proposed. Essentially, the deposition of the various crystal phases was the result of an acid–base reaction between basic CO 3 2− groups (originating from solvent decomposition reactions) and acidic HPO 4 2− groups from an intermediate monetite (CaHPO 4 ) phase of the CaP precipitate. The amount of carbonate incorporation (ranging from 0 to 15 wt%) determined the crystal and molecular structure of the deposited coatings.

RF magnetron sputtering of calcium phosphate (CaP) coatings is a promising technique to apply thin bioactive films on bulk implant materials. In this paper the properties of the interface between RF sputtered coatings and simulated body fluids (SBFs) are related to the ability to form CaP crystals on the coating surface. Two types of coatings were compared: coatings with a low Ca over P ratio (∼0.8; CaP low ), which remain inert when immersed in SBF 2 (i.e. SBF with twice the Ca and PO 4 concentrations), and coatings with a high Ca over P ratio (1.6; CaP high ), which show the formation of CaP crystals on their surface within 2 h. Low energy ion scattering (LEIS) and radioactive labeling of the SBFs combined with liquid scintillation counting (LSC) allowed us to study very accurately the composition of the adsorbates of both coating groups after 10 min of immersion in SBF 2 . For the adsorbate on CaP high and CaP low coatings coverages were found consistent with ionic adsorption and Ca/P ratios of 1.24 ± 0.02 and 2.17 ± 0.10, respectively. Adsorption was found to be reversible over the studied immersion period. After an induction period of 40 min a CaP precipitate started to form on the CaP high coatings with a Ca/P ratio of 1.30 ± 0.02. Further, no significant desorption of coating species was observed during this induction period.

Contains fulltext : 35974.pdf (Publisher’s version ) (Closed access) DNA-containing biomaterial coatings offer potential beneficial effects for both soft and hard tissue implants because of the structural properties of DNA. In the current study, the aim was to assess the in vitro cyto- and in vivo histocompatibility of multilayered DNA-coatings generated using the electrostatic self-assembly technique, with poly-D-lysine or poly(allylamine hydrochloride) as the cationic counterparts of anionic DNA. Multilayered DNA-coatings were fabricated on titanium substrates. Noncoated titanium substrates served as controls. In vitro experiments with rat primary dermal fibroblasts (RDF) assessing their viability were performed using a Live/Dead assay and an MTT-based assay. The presence of multilayered DNA-coatings did not affect RDF cell viability. On the other hand, an increased proliferation was demonstrated on both types of multilayered DNA-coatings. An in vivo rat model was used to study the soft tissue histocompatibility of subcutaneously inserted implants during implantation periods of 4 and 12 weeks. Light microscopic analysis revealed that all implants were surrounded by a fibrous capsule containing alpha-smooth muscle actin, and that the presence of a multilayered DNA-coating did not induce any adverse effects in terms of inflammation and wound healing. Histomorphometrically, no significant differences in capsule quality or thickness were observed dependent on multilayered DNA-coating or implantation period. The cyto- and histocompatibility of multilayered DNA-coatings demonstrated in this study allows their use and functionalization with appropriate compounds to modulate cell and tissue responses in dental and medical implantology.

Contains fulltext : 50853.pdf (Publisher’s version ) (Closed access) Calcium phosphate (CaP) cements show an excellent biocompatibility and often have a high mechanical strength, but in general degrade relatively slow. To increase degradation rates, macropores can be introduced into the cement, e.g., by the inclusion of biodegradable microspheres into the cement. The aim of this research is to develop an injectable PLGA microsphere/CaP cement with sufficient setting/cohesive properties and good mechanical and physical properties. PLGA microspheres were prepared using a water-in-oil-in-water double-emulsion technique. The CaP-cement used was Calcibon, a commercially available hydroxyapatite-based cement. 10:90 and 20:80 dry wt% PLGA microsphere/CaP cylindrical scaffolds were prepared as well as microporous cement (reference material). Injectability, setting time, cohesive properties and porosity were determined. Also, a 12-week degradation study in PBS (37 degree C) was performed. Results showed that injectability decreased with an increase in PLGA microsphere content. Initial and final setting time of the PLGA/CaP samples was higher than the microporous sample. Porosity of the different formulations was 40.8% (microporous), 60.2% (10:90) and 69.3% (20:80). The degradation study showed distinct mass loss and a pH decrease of the surrounding medium starting from week 6 with the 10:90 and 20:80 formulations, indicating PLGA erosion. Compression strength of the PLGA microsphere/CaP samples decreased siginificantly in time, the microporous sample remained constant. After 12 weeks both PLGA/CaP samples showed a structure of spherical micropores and had a compressive strength of 12.2 MPa (10:90) and 4.3 MPa (20:80). Signs of cement degradation were also found with the 20:80 formulation. In conclusion, all physical parameters were well within workable ranges with both 10:90 and 20:80 PLGA microsphere/CaP cements. After 12 weeks the PLGA was totally degraded and a highly porous, but strong scaffold remained.

Contains fulltext : 50062.pdf (Publisher’s version ) (Closed access) CaP ceramic has been widely used as coating on metals in orthopedics and oral dentistry. Variations in CaP composition can lead to different dissolution/precipitation behavior and may also affect the bone response. In the present study calcium pyrophosphate and hydroxylapatite coatings were successfully prepared by RF magnetron sputtering deposition. The phase composition, morphological properties, and the dissolution in SBF were characterized by using XRD, FTIR, EDS, SEM, and spectrophotometry. The results showed that all the sputtered coatings were amorphous and changed into a crystal structure after IR-radiation. The temperature for the crystallization of the amorphous coatings is lower for the hydroxylapatite coating (550 degrees C), compared to the calcium pyrophosphate coating (650 degrees C). All sputtered amorphous coatings were instable in SBF and dissolved partially within 4 wks of incubation. The heat-treated coatings appeared to be stable after incubation. These results showed that magnetron sputtering of calcium pyrophosphate coating is a promising method for forming a biocompatible ceramic coating.

Contains fulltext : 49052.pdf (Publisher’s version ) (Open Access) The current rapid progression in stem cell research has enhanced our knowledge of dental tissue regeneration. In this study, rat dental pulp cells were isolated and their differentiation ability was evaluated. First, dental pulp cells were obtained from maxillary incisors of male Wistar rats. Immunochemistry by stem cell marker STRO-1 proved the existence of stem cells or progenitors in the isolated cell population. The dissociated cells were then cultured both on smooth surfaces and on three-dimensional (3-D) scaffold materials in medium supplemented with beta-glycerophosphate, dexamethasone, and L-ascorbic acid. Cultures were analyzed by light and scanning electron microscopy and, on proliferation, alkaline phosphatase activity and calcium content were determined and the polymerase chain reaction was performed for dentin sialophosphoprotein, osteocalcin, and collagen type I. These cells showed the ability to differentiate into odontoblast-like cells and produced calcified nodules, which had components similar to dentin. In addition, we found that the "odontogenic" properties of the isolated cells were supported by three-dimensional calcium phosphate and titanium scaffolds equally well.

Contains fulltext : 48042.pdf (Publisher’s version ) (Closed access) The electrostatic spray deposition (ESD) technique offers the possibility of depositing calcium phosphate (CaP) coatings onto various substrate materials with defined chemical and morphological properties. The relationship between physical, apparatus-related deposition parameters, and the chemical characteristics of ESD coatings was investigated by means of X-ray diffraction, Fourier transform infrared spectroscopy, and energy dispersive spectroscopy to be able to deposit CaP coatings with tailored chemical properties. The results showed that the chemical characteristics of CaP coatings, deposited with use of the ESD technique, were strongly dependent on the deposition temperature, the nozzle-to-substrate distance, the liquid flow rate, and the geometry of the spraying nozzle. By investigating the influence of the deposition temperature, information could be obtained on the formation mechanism of CaP coatings-and specifically the biologically interesting carbonate apatite phase-using the ESD technique. CaP coatings were not formed merely because of solvent evaporation; a chemical reaction was needed to synthesize the coatings. This reaction involved thermal decomposition of the organic solvent butyl carbitol into carbonate ions via formation of intermediate oxalate ions. The amount of carbonate incorporation, and consequently, the Ca/P ratios of the deposited coatings, was shown 1) to decrease with increasing nozzle-to-substrate distance, 2) to decrease with increasing liquid flow rate, and 3) to decrease by making use of a novel two-component nozzle geometry.

Item does not contain fulltext We analysed the effect of three portion sizes Optocal Plus (small, medium and large) on swallowing thresholds in subjects with either conventional complete dentures or mandibular implant-retained overdentures (transmandibular and permucosal cylindric implants). Tests were carried out in 52 women and 15 men (mean age 59 years) 4 years after treatment in a randomised controlled clinical trial. The results indicated that the degree of mucosal support for the mandibular denture did not affect the number of chewing strokes, time till swallowing or swallowed particle size. Only the chewing rate differed: subjects wearing mandibular implant-retained overdentures chewed the food at a higher rate than complete-denture wearers. With larger portion sizes, subjects needed significantly more chewing strokes and time until swallowing and they would have swallowed larger particles. Men chewed their food more efficiently than women, as they used the same number of chewing strokes and time, but achieved a greater particle size reduction at the swallowing moment.

Item does not contain fulltext To evaluate the osteoinductive effects of recombinant human bone morphogenetic protein (rhBMP)-2 during the early stages of rat ectopic bone formation, we prepared two distinct carriers. Two carriers, insoluble bone matrix (IBM) and fibrous glass membrane (FGM) were combined with rhBMP-2 and implanted into the backs of rats to evaluate the osteoinductive effects of the two rhBMP-2 carrier systems. Insoluble bone matrix particle size was 320 to 620 microm. Fibrous glass membrane was constructed from unwoven glass fibers 1 microm in diameter. Alkaline phosphatase (ALP) activity and type II collagen were detected in IBM/rhBMP-2 at 5 days postimplantation. Calcium (Ca) was also detected in IBM/rhBMP-2 at 7 and 9 days postimplantation. In contrast, ALP and type II collagen were detected in FGM/rhBMP-2 at 7 days. Calcium was undetected, indicating that the bone formation in IBM/rhBMP-2 proceeded faster than in FGM/rhBMP-2 during the early stage of BMP-induced osteogenesis. In addition, mRNA expression level of KDR, a receptor for vascular endothelial growth factor, was also increased in IBM/rhBMP-2. To investigate the in vivo release profile of rhBMP-2, iodine 125 ((125)I)-labeled BMP-2-incorporating IBM and FGM implants were inserted into the back subcutis of mice. More than 60% of the rhBMP-2 was released from the IBM/rhBMP-2 carrier within 1 day after implantation, whereas 50% of the rhBMP-2 was released from the FGM/rhBMP-2 10 days postimplantation. These results indicated that osteo- and chondrogenesis depends highly upon the geometry of the carrier and the in situ retention of rhBMP-2 during the early stage of rhBMP-2 induced bone formation.

Item does not contain fulltext Calcium phosphate (CaP) coatings are well known for their bioactive nature. CaP coated polymeric materials can be used as implant material. For this, a strong adhesion between the coating and substrate is necessary. Because the chemical structure of the interface plays an important role in the coating adhesion, we studied the interface between CaP and the polymers polyethylene (PE) and polydimethylsiloxane (PDMS/silicone rubber). Both untreated and plasma pretreated polymers were used. On PE, a low Ca/P ratio nearby the interface and a high amount of C-O bonds were found on both untreated and plasma pretreated PE. This is the result of phosphate-like groups that are able to bind to the carbon of the PE. PDMS reacts towards the plasma pretreatment by losing CH(3) side groups. Compared to PE, a low amount of C-O bonds is found nearby the interface. Besides, a low Ca/P ratio is found nearby the interface. This is the result of phosphate groups that connect to Si atoms of the PDMS, thereby replacing the CH(3) side groups. The bombardment by negatively charged oxygen ions that are accelerated from the target during the deposition process makes the chemical interaction between the coating and the substrates possible.

Item does not contain fulltext The aim of this study was to investigate the physicochemical and biological properties of a newly developed calcium phosphate cement (CaP cement) implanted in cortical bone. CaP cement was injected as a paste into tibia cortical bone defects in goats. Polymethylmethacrylate (PMMA) bone cement was used as a control. The animals were killed after 3 days, 2, 8, 16 and 24 weeks. X-ray diffraction and Fourier transform infrared spectroscopy performed at retrieved samples showed that the CaP cement had set as a carbonate apatite and remained stable over time. Light microscopic evaluation showed that after 2 weeks the cement was in tight contact with the bone without any inflammatory reaction or fibrous encapsulation. At later time points, the CaP cement implants were totally covered by a thin layer of bone and osteoclasts, present at the interface, which were clearly resorbing the cement. At locations where CaP cement was resorbed, new bone was deposited. Transmission electron microscopy revealed that indeed a seamless contact existed between CaP cement and bone, as characterized by the occurrence of an electron dense line of 50-60 nm thick that covered the CaP cement. Osteoblasts, in contact with the cement, were depositing new bone. Although the bulk of the material was still in situ after 24 weeks, the progressive osteoclast resorption of the cement followed by new bone formation suggests that all of the material may be replaced eventually. In contrast to the CaP cement, the PMMA reference cement was always surrounded by a thin fibrous capsule. The results indicate that the investigated CaP cement is biocompatible, osteoconductive as well as osteotransductive and is a candidate material for use as a bone substitute.

Item does not contain fulltext The osteogenic activity of calcium phosphate (CaP)-coated and noncoated porous titanium (Ti) fiber mesh loaded with cultured syngeneic osteogenic cells after prolonged in situ culturing was compared in a syngeneic rat ectopic assay model. Rat bone marrow (RBM) cells were loaded onto the CaP-coated and noncoated Ti scaffolds using either a droplet or a suspension loading method. After loading, the RBM cells were cultured for 8 days in vitro. Thereafter, implants were subcutaneously placed in 39 syngeneic rats. The rats were euthanized and the implants retrieved at 2, 4, and 8 weeks postoperatively. Further, in the 8 week group fluorochrome bone markers were injected at 2, 4, and 6 weeks. Histological analysis demonstrated that only the CaP-coated meshes supported bone formation. The amount of newly formed bone varied between single and multiple spheres to filling a significant part of the mesh porosity. In the newly formed bone, osteocytes embedded in a mineralized matrix could be observed clearly. On the other hand, in the noncoated titanium implants, abundant deposition of calcium-containing material was seen. This deposit lacked a bonelike tissue organization. Further analysis revealed that the cell-loading method did not influence the final amount of bone formation. In CaP-coated implants the accumulation sequence of the fluorochrome markers showed that bone formation started on the mesh fibers. In conclusion, our results prove that the combination of a thin CaP coating, Ti-mesh, and RBM cells can indeed generate ectopic bone formation after prolonged in vitro culturing. No effect of the loading method was observed on the final amount of bone.

Item does not contain fulltext In this study, the soft tissue reaction to two newly developed injectable calcium phosphate bone cements (cement D and W) was evaluated after implantation in the back of goats. For one of the cements (cement D) the tissue reaction was also investigated after varying the concentration of accelerator Na(2)HPO(4) in the cement liquid (resulting in cement D1 and D2). Eight healthy mature female Saanen goats were used. The cement was applied 10min after mixing while it was still moldable and plastic. The material was given a standardized cylindrical shape. Thirty-two implants of each cement formulation were inserted and left in place for 1, 2, 4, and 8weeks. At the end of the study, eight specimens of each material and healing period were available for further analysis. Two specimens were used for X-ray diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR) and six specimens were used for light microscopical evaluation. XRD and FTIR showed that the cements did set as microcrystalline carbonate apatite with the disappearance of monetite from the cements during implantation. Histological analysis showed that after 8weeks of implantation around all materials a thin soft-tissue capsule was formed (thickness ranging from 5 to 15 cell layers) with almost complete absence of inflammatory cells. Only in some specimens a slightly higher inflammatory reaction was observed. This was due to cement surface defects and a zone of dispersed particles near the cement-soft tissue interface. There was almost no resorption of the material after 8 weeks of implantation. In a few 4 and 8weeks samples, small areas of calcification were found in the fibrous capsule surrounding the implants. On the basis of our observations, we conclude that the tested cements were biocompatible and can be used next to soft tissue.

Item does not contain fulltext Here we aimed to compare the tissue reaction to smooth and micro-grooved implants, at different implantation sites. We hypothesised that subperiosteally less mobility is to be expected between an implant and the surrounding tissue, which can lead to a more subdued tissue response. In addition, we hypothesised that a similar effect can be reached when substrata are equipped with micro-grooves. Poly-L-lactic acid smooth or micro-grooved surfaces (width 2 or 10 microm, depth 1 microm) were implanted subperiosteally on the frontal bone of the skull, or subcutaneously in the flanks of goats for 2, 4 and 12 weeks. After sacrifice, implants and surrounding tissue were histologically processed. Light microscopical and histomorphometrical evaluation of the histomorphometrical analyses, capsule thickness, capsule quality and implant-tissue interface was performed. In addition, we stained for alpha-smooth muscle actin. collagen and CD-68 expression. All implants were surrounded by a fibrous capsule. Capsules around subperiosteal implants were more matured than around subcutaneous implants. In time, capsule thickness significantly decreased around subperiosteal implants, but increased around subcutaneous implants. Also, nowhere differences were found in the presence of collagen or alpha-smooth muscle actin. The interfacial cells around all implants frequently showed staining for the monocyte-macrophage marker CD-68. We concluded that in this model, decreased mobility of an implant relative to the surrounding tissue did positively influence the peri-implant tissue response, but the applied surface topography did not.

Item does not contain fulltext Titanium (Ti) fiber mesh is a candidate scaffold material for the creation of bone graft substitutes (BGS). Two densities (3.54 x 10(4) cells/cm(2) [LD or low density] and 3.54 x 10(5) cells/cm(2) [HD or high density]) of rat bone marrow stromal cells were seeded on Ti-fiber mesh discs. Cells were cultured for up to 16 days, 7 days of which the cells were in the presence of various concentrations of rhBMP-2 (0, 10, 100, and 1,000 ng/mL) in order to evaluate osteogenic expression. Scanning electron microscopy (SEM), light microscopy (LM), energy dispersive spectroscopy (EDS), DNA and calcium (Ca) content measurements, and x-ray diffraction (XRD) analysis were performed. SEM and EDS evaluation showed that a confluent layer of cells was present on top of the meshes together with collagen bundles and calcified globular accretions. Light microscopical evaluation showed a densely stained layer in the upper part of the mesh. SEM and Ca content measurement showed that calcification starts at 8 days. In addition, it was demonstrated that DNA content peaked at 8 days. LM, SEM, and Ca content evaluation revealed positive effects of increasing the cell seeding density, the rhBMP-2 concentration and the culture time on mineralization. Increasing the cell seeding density also showed a positive effect on DNA content. No effects of rhBMP-2 concentration were seen on DNA content. Finally, XRD revealed that the deposited matrix contained a precipitate of a stable calcium phosphate phase. We conclude that (1) titanium fiber mesh sustains excellent osteogenic expression in vitro, (2) increasing the cell seeding density has a positive effect on osteogenic expression in titanium mesh in vitro, and (3) in high density specimens, rhBMP-2 concentrations of 100 ng/mL and 1,000 ng/mL stimulate extracellular matrix calcification in a dose-responsive manner.

Item does not contain fulltext The osteoinductive properties of porous titanium fiber mesh, with or without a calcium phosphate coating and loaded with recombinant human bone morphogenic protein-2 (rhBMP-2) or rhBMP-2 and native bovine BMP (S-300) were investigated in a rat ectopic assay model. A total of 112 calcium phosphate-coated and 112 noncoated porous titanium implants, either loaded with rhBMP-2 and S-300 or loaded with rhBMP-2 alone, were subcutaneously placed in 56 Wistar-King rats. The rats were killed 5, 10, 20, and 40 days postoperatively, and the implants were retrieved.Histologic analysis demonstrated that all growth factor and carrier combinations induced ectopic cartilage and bone formation at 5 and 10 days, respectively. At 20 days, bone formation increased and was characterized by trabecular bone and bone marrow-like tissue. At 40 days, more lamellar bone and hemopoietic bone marrow-like tissue were present. At both times, more bone had been formed in calcium phosphate-coated implants than in noncoated samples. Further, in rhBMP-2 and S-300-loaded specimens, bone formation was higher than in rhBMP-2 only-loaded specimens. In rhBMP-2 only-loaded specimens, bone formation was mainly localized inside the mesh material, whereas in specimens loaded with both rhBMP-2 and S-300, the bone was localized inside and surrounding the titanium mesh. The histological findings were confirmed by calcium content and alkaline phosphatase activity measurements. In addition, all specimens showed osteocalcin expression as early as 5 days postoperatively.Our results show that the combination of titanium mesh with BMPs can induce ectopic bone formation and that this bone formation seems to be similar to "enchondral" ossification. In addition, a thin calcium phosphate coating can have a beneficial effect on the bone-inducing properties of a scaffold material. Finally, rhBMP-2 and native BMP act synergistically in ectopic bone induction.

Background: Self-directed learning requires accurate self-assessment, but research evidence shows poor validity of self-assessment. Training in self-assessment may improve validity. Purpose: To investigate if repeated personal feedback based on objective knowledge and skill scores enhances self-assessment skills of practicing general practitioners. Method: Participants were general practitioners (n = 60), who received skills training covering 4 clinical skills at3 months (Group A)or 6 months (Group B)after enrollment in the study. Participants were tested at 3-month intervals with a knowledge test (60 items), a performance-based test (4 stations), and a self-assessment questionnaire (22 items), covering the four different clinical skills. They received personal feedback on the results. Results: At 3 months, mean scores on the self-assessment questionnaire and knowledge test had increased significantly more in Group A compared to Group B, but at 6 months no differences in mean scores remained. Correlations...

The basic mechanisms underlying skin-implant interactions were investigated by means of in vitro experiments with fibroblast and epithelial cell cultures. Cells were cultured on various implant materials treated with radio frequency glow discharge. The possible influence of this treatment on the morphological mode of cell attachment, as well as cell behaviour in attachment and growth rate were investigated. The results demonstrate that there are significant behavioural differences between fibroblasts and epithelial cells.

Absolute cross sections for the elastic scattering of electrons by 12 C and 9 Be have been measured with an accuracy of about 1% for momentum transfers ranging from 0.15–0.7 fm −1 . The nuclear radii derived from these data by means of phase-shift calculations are: 12 C: 2.445±0.015 fm (Fermi model) and 2.453±0.008 fm (shell model); 9 Be: 2.519±0.012 fm (shell model, Q = 3.2±1.2 fm 2 ).

The objective of this study was to enlarge the understanding of the basic mechanisms underlying epithelial tissue implant reaction by means of in vitro experiments with epithelial cell cultures. For the experiments, rat palatal epithelial cells were cultured on various implant materials. The implant surfaces were treated by different procedures. The possible influence of these treatments on the attachment percentage and growth rate of the cells was studied. The results of the experiments demonstrate no significant relation between surface treatment and the behaviour of rat palatal epithelial cells cultured on the various kinds of substrates relevant for implants.

Attachment of gingival tissues to the protruding post of an endosseous dental implant is of great importance for the prognosis of its clinical success. Little is known about the requirements an implant material must meet to secure a durable permucosal seal. The objective of this study, therefore, was to gain insight into the morphology of epithelial cell-implant interfaces for a number of well-known or potential implant materials.Guinea pig epithelial cells were cultured on gold, titanium, carbon, hydroxylapatite, carbonate apatite, and modified polystyrene substrates. The metallic and carbon substrates were obtained by vapor-phase deposition of thin films on polystyrene carriers. This technique allowed for the preparation of ultra-thin sections for transmission electron microscopy containing substrate as well as the cells adhering to it. The cultures on apatite were decalcified prior to sectioning.The results revealed that as attachment structures, focal contacts, extracellular matrix contacts, and hemidesmosome-like contacts could be distinguished. Hemidesmosome-like contacts were only observed on apatite and polystyrene and not on the metallic or carbon surfaces.The results of this study suggest the existence of some, as yet unknown, property of the substrate that determines the nature and the structure of the contact site with epithelial cells.

A mixture containing 3 g of boric acid and 300 mg of cinchocaine chloride prescribed due to painful dental protrusion was accidentally ingested by a 12-month-old girl. She developed violent vomiting and coughing. Irritability, tremor, seizures and a delirious reaction. She was treated with diazepam, intubated, sedated and ventilated. Her diuresis was stimulated with furosemide and fluid. Within the first 24 h she was treated with haemodialysis twice on femoral catheters. Her renal function was unaffected. In two days she fully recovered. The maximum measured levels of boric acid and cinchocaine chloride approximately 6 h after ingestion were 26 μg/ml and 71 ng/ml respectively. The plasma half-life of boric acid was 7.0 h and decreased to 3.6 and 4.4 h during the two haemodialyses. The total body clearance of boric acid increased correspondingly from 21 ml/min to 41 and 34 ml/min. The in vitro clearance of boric acid of the dialyser was later determined to be 18 ml/min. It is concluded that haemodialysis is valuable in the treatment of boric acid intoxication because it increases the elimination of the drug even in patients without any sign of renal toxicity.

In contemporary surgical practice, injectable bone cements are increasingly being used to treat a variety of pathological conditions of the spine including osteoporotic vertebral compression fractures, metastatic vertebral body lesions, and traumatic fractures. The principal goal of applying these injectable bone cements is to augment impaired bony structures in order to maintain or improve the strength and stability of the spinal column. The clinical results obtained in the last decades by using polymethyl methacrylate bone cement in vertebroplasty and balloon kyphoplasty procedures have clearly established a demand for biomaterials better adapted to their function as vertebral body bone void filler. Currently, many new injectable bone cements are being designed specifically for application in the vertebral body. This chapter aims to provide the reader with a brief introduction to the history of injectable bone cements for spinal column augmentation and discusses its currently accepted indications. The clinical implications of cement leakage are discussed together with guidelines for bone cement handling to prevent this complication. A quick glance at possible future directions in the field of injectable bone cements for spinal column augmentation concludes this chapter.