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The aim of this study was to develop a third-generation modular mandible endoprosthesis that would experience less stress concentration at its stems compared to earlier generations, thereby minimizing micromotion and achieving long-term stability. In this three-piece modular design, different degrees of movement were incorporated between the endoprosthesis module interfaces. It was hypothesized that this unique feature would minimize stress concentration at the stems and hence promote osseointegration during the early phase of implantation. The endoprosthesis system was made of commercially pure grade 4 titanium, machined and surface-treated, then sterilized and implanted in segmental mandible defects of nine Macaca fascicularis. Clinical, radiological, histological, and histomorphometric evaluations were performed 4 months post-implantation. The endoprosthesis systems with a degree of movement incorporated, exhibited superior performance compared to the rigid system: 30.9-34.8 times higher percentage bone-implant contact (P0.0001) and 3.4-4.1 times higher percentage bone area (P0.0001), with osseointegration noted at the posterior stems. However, fibrous tissue encapsulation was noted around the majority of the anterior stems in all groups. Although the degree of movement was favourable for improving bone healing and stability of the endoprosthesis system, more work needs to be done to investigate other strategies to further reduce loading on the endoprosthesis to achieve predictable osseointegration at the stems.

Item does not contain fulltext The aim of this study was to evaluate the effect of carboxymethylcellulose (CMC) as a pore generator and hydroxyapatite (HA) as an osteoconductive agent on the physicochemical properties and in-vitro mineralization ability of porous polymethylmethacrylate (PMMA) cement. To this end, various compositions of PMMA cements, which differed in amount of millimeter-sized hydroxyapatite (HA) particles and CMC hydrogel, were prepared and immersed into simulated body fluid (SBF) for 0, 7, 14, 21 and 28days. It was demonstrated that the incorporation of CMC hydrogel decreased the maximum temperature of cement to the normal body temperature and prolonged the handling time during polymerization. Further, the amount of CMC was responsible for the creation of porosity and interconnectivity, which in turn determined the final mechanical properties of cements. The loaded HA particles enhanced the potential bioactivity of cement for bone ingrowth. Albeit different amount of HA particles influenced their final exposures on the surface of cured cement, all of the three amounts of HA did not weaken the final mechanical properties of cements. The data here suggests that the HA particle loaded porous PMMA cement can serve as the promising candidate for bone reconstruction.

Contains fulltext : 172532.pdf (Publisher’s version ) (Closed access) The objectives of the current review were (1) to systematically appraise, and (2) to evaluate long-term success data of calcium phosphate (CaP) plasma-spray-coated dental implants in clinical trials with at least 5 years of follow-up. To describe the long-term efficacy of functional implants, the outcome variables were (a) percentage annual complication rate (ACR) and (b) cumulative success rate (CSR), as presented in the selected articles. The electronic search yielded 645 titles. On the basis of the inclusion criteria, 8 studies were finally included. The percentage of implants in function after the first year was estimated to be 98.4 % in the maxilla and 99.2 % in the mandible. The estimates of the weighted mean ACR-percentage increased over the years up to 2.6 (SE 0.7) during the fifth year of function for the maxilla and to 9.4 (SE 8.4) for the mandible in the tenth year of function. After 10 years, the mean percentage of successful implants was estimated to be 71.1 % in the maxilla and 72.2 % in the mandible. The estimates seem to confirm the proposed, long-term progressive bone loss pattern of CaP-ceramic-coated dental implants. Within the limits of this meta-analytic approach to the literature, we conclude that: (1) published long-term success data for calcium phosphate plasma-spray-coated dental implants are limited, (2) comparison of the data is difficult due to differences in success criteria among the studies, and (3) long-term CSRs demonstrate very weak evidence for progressive complications around calcium phosphate plasma-spray-coated dental implants.

Objective The therapeutic potential of periodontal ligament cells for periodontal regeneration gradually decreases when cultured as a monolayer in vitro. Three-dimensional cell culture models provide an alternative to traditional monolayer cell culture. This study aimed to comparatively evaluate the influence of spheroid culture on periodontal ligament cells. Materials and methods Chitosan films were used to culture three-dimensional periodontal ligament cell spheroids. The proliferation, self-renewal, and osteogenic capacity of periodontal ligament cells derived from spheroids were evaluated and compared with cells cultured on a monolayer. Results Viable spheroids of periodontal ligament cells were formed on chitosan films. Compared to monolayer cell culture, periodontal ligament cells exhibited decreased proliferation upon spheroid formation. In contrast, their expression of genes related to self-renewal was significantly higher comparison with cells cultured in a monolayer. Moreover, the formation of periodontal ligament cell spheroids increased their colony-forming unit ability and osteogenic differentiation capacity. Conclusion The results demonstrate the successful use of chitosan films for the culture of periodontal ligament cell spheroids. Compared to cells cultured in monolayer, periodontal ligament cells in spheroids did not proliferate, but exhibited higher self-renewal gene expression, colony-forming unit and osteogenic capacity.

Supplemental material, DS_10.1177_0022034518810213 for A Novel Thermoresponsive Gel as a Potential Delivery System for Lipoxin by B. Wang, J. Shao, J.A. Jansen, X.F. Walboomers and F. Yang in Journal of Dental Research

AIMS: To study the pharmacokinetic characteristics of the hypoxic radiosensitiser nimorazole in patients with head and neck squamous cell carcinoma.MATERIALS AND METHODS: The pharmacokinetics of the hypoxic radiosensitiser nimorazole were studied in 63 patients treated in the DAHANCA-5 trial. After the first day of treatment, serial venous blood samples were taken and plasma concentrations of nimorazole measured by high pressure liquid chromatography (HPLC). Plasma concentration profiles were subjected to non-compartmental pharmacokinetic analysis using validated PC-based software. The different pharmacokinetic parameters were calculated and correlated with the different patient- and treatment-related variables.RESULTS: HPLC measurements showed a linear relationship between peak plasma concentration and administered dose. The mean peak concentration adjusted for dose (in g/m(2)) was 32.2 ± 0.9 μg/ml. The time of peak concentration ranged between 30 and 180 min (median 60 min). Plasma elimination occurred with a mean half-life of 3.35 ± 0.09 h and was not significantly altered as a function of dose. There was a well-established linear-linear relationship between area under the concentration-time curve (AUC; mean 191 ± 6 μg·h/ml) and administered dose, especially when expressed as g/m(2). The mean apparent volume of distribution was 0.77 ± 0.02 l/kg. A statistically significant longer elimination half-life in men relative to women (mean difference 0.40 h; 95% confidence interval 0.77-0.03; P 0.03) was detected. Nimorazole was well tolerated; with 67% of patients reporting no toxicity; nausea/vomiting was the most reported toxicity in the remaining patients.CONCLUSION: The study supports the current nimorazole dose scheduling in patients.

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 on the history of injectable bone cements for spinal column augmentation and will discuss its currently accepted indications. The clinical implications of cement leakage will be 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 will conclude this chapter.

The ultimate goal for surface modifications in bone implants is to achieve biologically active surface able to control and trigger specific tissue response. In this study was evaluated the effects of organic compound, derived from extracellular matrix, involved in tissue mineralization. Alkaline phosphatase (ALP) plays a fundamental role in bone mineralization concurrently with collagen, the main organic components of bones. Electrospray deposition (ESD) was used to coat titanium disks with ALP and collagen at room temperature. To verify the synergistic role of ALP and collagen different conformations of coatings (mixed and layered) were obtained and their mineralization capacity was tested in vitro. The mineralization tests indicated the fundamental role of collagen to increase ALP coating retention. Analyses indicated that the coating conformation has a role; in fact the mixed group showed improved ALP retention, enzymatic activity and unique mineralized surface morphology. ESD demonstrated to be a successful method to deposit organic molecules preserving their properties as indicated by the in vitro results. These findings proved the synergistic effect of ALP and collagen in inducing mineralization offering an intriguing coating constituent for medical device that aim to trigger surface mineralization such as bone implants.

In the context of skeletal tissue development and repair, endochondral ossification has inspired a new approach to regenerate bone tissue in vivo using a cartilage intermediate as an osteoinductive template. The aim of this study was to investigate the behavior of mesenchymal stem cells (MSCs) in regard to in vitro cartilage formation and in vivo bone regeneration when combined with different threedimensional (3D) scaffold materials, i.e., hydroxyapatite/ tricalcium phosphate (HA/TCP) composite block, polyurethane (PU) foam, poly(lactic-co-glycolic acid)/ poly(ε-caprolactone) electrospun fibers (PLGA/PCL) and collagen I gel. To this end, rat MSCs were seeded on these scaffolds and chondrogenically differentiated in vitro for 4 weeks followed by in vivo subcutaneous implantation for 8 weeks. After in vitro chondrogenic priming, comparable cell amounts and cartilage formation were observed in all types of scaffolds. Nonetheless, the quality and maturity of in vivo ectopic bone formation appeared to be scaffold/ material-dependent. Eight weeks of implantation was not sufficient to ossify the entire PLGA/PCL constructs, albeit a comprehensive remodeling of the cartilage had occurred. For HA/TCP, PU and collagen I scaffolds, more mature bone formation with rich vascularity and marrow stroma development could be observed. These data suggest that chondrogenic priming of MSCs in the presence of different scaffold materials allows the establishment of reliable templates for generating functional endochondral bone tissue in vivo without using osteoinductive growth factors. The morphology and maturity of bone formation can be dictated by the scaffold properties.

In this chapter, we describe the function and structure of bone as well as the interaction between its main constituents with a specific focus on the mechanisms of bone mineralization. From a clinical perspective, we summarize the most common bone diseases caused by bone mineralization disorders. Finally, we review the main bio-inspired strategies to mineralize synthetic bone-substituting biomaterials. However, the precise mechanism of bone mineralization requires interdisciplinary knowledge, deeper understanding of bone biology, and extensive research in the future.

Item does not contain fulltext Calcium phosphate cements (CPCs) are significant alternatives to autologous bone grafting. CPCs can be composed of biphasic or multiphase calcium phosphate (CaP) compounds. A common way to process CPCs is by ball milling. Ball milling can be used for grinding or mechanosynthesis. The aim of this study was to determine the effect of well-defined ball milling grinding parameters, applied via different milling pathways, on the properties of CPCs. Starting CaP compounds used included alpha-tricalcium phosphate, dicalcium phosphate anhydrous and precipitated hydroxyapatite. Scanning electron microscopy showed changes in the powder morphology, which were related to the behavior of the starting CaP materials. Specific surface area (SSA) and particle size (PS) measurements exposed the effect of ball milling on the CaP compounds and CPC powders. X-ray diffraction revealed no effect of ball milling pathways or milling time on the composition of CPCs or the starting materials, but affected their crystallographic properties. No contamination of the milling media or transformation into an amorphous calcium phosphate compound was found. The milling pathways affected setting and cohesion. Fourier transform infrared spectroscopy (FTIR) revealed differences on the CPC v-PO(3) bands according to the interaction, created between the CaP compounds by the milling pathways. FTIR confirmed that the milling pathways changed the crystallographic properties. This study demonstrates that the pathways used for milling grinding modify the PS, SSA, and crystallographic properties of the powders, without affecting their composition. These modifications affected the bulk and reactivity properties of the CPCs by creating different setting and cohesion behaviors.

BACKGROUND: A new microplasma spraying equipment (MSE) to deposit calcium phosphate (CaP) ceramic coatings onto titanium substrates has been developed. With this system, it is possible to spray fine particles and to apply textured hydroxylapatite coatings onto titanium surfaces. Moreover, due to the low heat power of the microplasma jet, overheating of the powder particles as well as excessive local overheating of the substrate are diminished. Furthermore, because of the small laminar plasma jet, it is possible to achieve high spray efficiency in the case of spraying for dental implants. Also, the low level of noise (25-50 dB) and hardly any dust makes it possible to operate MSE under conditions of normal workrooms. OBJECTIVE: The aim was to investigate, in a mandibular dog model, the effect of functional load on soft-tissue adaptation as well as crestal bone-level changes around titanium implants provided with newly developed microplasma-sprayed CaP coatings. MATERIAL AND METHODS: For histomorphometrical evaluation, 56 screw-type titanium implants were inserted into the mandibles of seven adult Beagle dogs. The implants were either acid etched without an additional coating, coated with a conventionally plasma-sprayed CaP ceramic (PS), coated with a microplasma-sprayed CaP ceramic (MPS) or with a microplasma-sprayed coating at only the apical part (aMPS). To assess the effect of occlusal loading, a split-mouth design was used. Six weeks after implantation, the implants in one half of the mandible of each dog were functionally loaded whereas the contra lateral implants served as control. One year after loading, the animals were sacrificed. Soft-tissue dimension as well as marginal bone level were histologically assessed. Results : Histometric analysis of undecalcified histologic sections included the evaluation of the sulcus depth, the dimension of the junctional epithelium and the connective tissue as well as the first bone-to-implant contact. For MPS-surfaced implants, functional loading was associated with--compared with the non-loaded state--unchanged soft-tissue dimension. Furthermore, the soft-tissue dimension did not differ from the dimensions around non-coated, PS and aMPS implants. Moreover, the first bone-to-implant contact was not significantly altered by functional loading and comparable non-coated, PS and aMPS implants. Conclusion: Within the limits of the experiment, we conclude that, in comparison, functional loading does not affect the marginal soft-tissue response to MPS CaP-coated implants. However, in comparison, functional loading might affect marginal bone response to MPS CaP-coated implants.

Background: A new microplasma spraying equipment (MSE) to deposit calcium phosphate ceramic (CaP) coatings onto titanium substrates has been developed. With this system, it is possible to spray fine particles and to apply textured hydroxylapatite coatings onto titanium surfaces. Moreover, due to the low heat power of the microplasma jet, overheating of the powder particles as well as excessive local overheating of the substrate is diminished. Furthermore, because of the small laminar plasma jet, it is possible to achieve high spray efficiency in the case of spraying for dental implants. Also, the low level of noise (25–50 dB) and hardly any dust makes it possible to operate MSE under conditions of normal workrooms. Objective: The aim was to investigate, in a mandibular dog model, bone biological properties and the occlusal loading effects of titanium implants provided with newly developed microplasma-sprayed CaP coatings. Material and methods: For histomorphometrical evaluation, 48 screw-type titanium implants were inserted into the mandibles of six adult beagle dogs. The implants were either acid etched without additional coating, coated with a conventionally plasma-sprayed CaP ceramic, coated with a microplasma-sprayed CaP ceramic or with a microplasma-sprayed coating at the apical part only. To assess the effect of occlusal loading, a split-mouth design was used. Six weeks after implantation, the implants in one half of the mandible of each dog were functionally loaded, while the contra lateral implants served as control. Six weeks after loading, the animals were sacrificed and bone-to-implant contact as well as the amount of bone around the implants were assessed. Results: Irrespective of surface and functional load, no statistically significant differences (P>0.05) were found either for bone-to-implant contact or for the amount of bone between the various implant surfaces. On the other hand, functional loading of the non-coated implants was associated with a tendency towards crestal bone loss. Conclusion: Within the limits of the experiment, we conclude that functional loading of MPS CaP coatings induces a favorable bone response, and furthermore, that the bone response, irrespective of the loading condition, does not differ from conventional plasma-sprayed CaP coatings. To cite this article: Junker R, Manders PJD, Wolke J, Borisov Y, Jansen JA. Bone reaction adjacent to microplasma-sprayed CaP-coated oral implants subjected to occlusal load, an experimental study in the dog. Part I: Short-term results. Clin. Oral Impl. Res. 21, 2010; 1251–1263. doi: 10.1111/j.1600-0501.2010.01940.x

Contains fulltext : 88942.pdf (Publisher’s version ) (Open Access) It is envisioned that for the regeneration of highly organized structures, like tendon and ligaments, only aligned fibrous scaffolds can provide adequate topographic guidance to cells. In this study, a novel method to electrospin an aligned scaffold is presented. Electrospun fibres were deposited into a water bath and then the fibres were drawn to a rotating mandrel in a controlled manner. In this way, parallel and cross-aligned fibrous poly (lactide-co-glycolide) (PLGA) scaffolds were fabricated, which were subsequently used to study their effect on the growth behaviour of rat periodontal ligament (PDL) cells. First, the scaffolds were characterized regarding mechanical properties, scaffold stability and degradation in vitro. Then, rat PDL cells were seeded and cultured on these scaffolds for up to 7 days. Randomly oriented PLGA and solvent cast plain PLGA films served as controls. Results showed that the alignment of fibres resulted in a higher tensile stress and Young's modulus. Aligned scaffolds maintained their structural stability better compared to the controls after incubation in phosphate-buffered saline for 6 weeks. Further, cells were observed to elongate along the fibre after 3 days of culture. Proliferation and migration of PDL cells was significantly more prevalent on the aligned fibres compared to the controls. It was concluded that aligned scaffolds seem to be able to promote the organized regeneration of periodontal tissue.

Contains fulltext : 80804.pdf (Publisher’s version ) (Closed access) OBJECTIVES: Despite the high success rates in implantology, the desire to use oral implants in more challenging clinical situations drives the need for continuing refinements in implant design and surface properties. In the present study, the effect of implant geometry on implant bone response was evaluated using two geometrically different implant types, i.e. screw type (St) and push-in type(Pi). Furthermore, the potential beneficial effect of an electrosprayed calcium phosphate (CaP) coating, either or not enriched with the osteoinductive growth factor TGF-beta1, on the osteogenic response was examined. MATERIAL AND METHODS: A total of 54 implants, divided into six groups (n=9), were inserted into the femoral condyles of nine goats. After an implantation period of 12 weeks, retrieved specimens were evaluated histologically and histomorphometrically. Measurements were statistically evaluated using SPSS 14.0 and analyzed using a linear regression model. RESULTS: With respect to implant design, St-implants showed an overall superior biological healing response compared with Pi-implants. Considering surface properties, the deposition of an electrosprayed CaP (2-3 microm) coating onto implants significantly increased the amount of bone-implant contact for both implant types. Additional enrichment of the CaP coating with the osteoinductive growth factor TGF-beta1 did not significantly affect peri-implant bone response. CONCLUSIONS: The results of this study indicate that a substantial improvement of the osteogenic response to titanium implants can be achieved by the deposition of an electrosprayed CaP coating. The enrichment of the coating with 1 microg TGF-beta1 has only a marginal effect.

Contains fulltext : 34523.pdf (Publisher’s version ) (Closed access) A pivotal factor to consider in the development of biomaterials and biomaterial coatings is the inflammatory response to these materials. The insertion of implants is followed by protein adsorption and subsequent interactions with cellular components of the biological surroundings, in which macrophages play a dominant role through the production of a myriad of signaling molecules. In view of this, the aims of the present study were to evaluate (i) gross protein adsorption to, and (ii) in vitro behavior of macrophages on novel biomaterial coatings, composed of poly-D-lysine (PDL) or poly(allylamine hydrochloride) (PAH) and DNA, and to compare these coatings with negative (noncoated glass) and positive controls (noncoated glass + LPS-stimulation). The results demonstrate that multilayered DNA-coatings do not affect gross protein adsorption compared to noncoated controls. Cell culture experiments showed that the attachment to, and viability and morphology of two types of macrophages cultured on multilayered DNA-coatings is comparable to noncoated controls. Still, macrophages repeatedly showed decreased secretion levels of the proinflammatory cytokine TNF-alpha on multilayered DNA-coatings, whereas no differences were observed in the secretion of IL-1beta, IL-10, and TGF-beta1. Appropriate animal studies are required to elucidate if these in vitro indications have clinical effects on the inflammatory and wound healing processes around implants.

Contains fulltext : 36257.pdf (Publisher’s version ) (Closed access) This study describes the effect of multilayered DNA coatings on (i) the formation of mineralized depositions from simulated body fluids (SBF); and (ii) osteoblast-like cell behavior with and without pretreatment in SBF. DNA coatings were generated using electrostatic self-assembly, with poly-d-lysine or poly(allylamine hydrochloride) as cationic polyelectrolytes, on titanium substrates. Coated substrates and non-coated controls were immersed in SBF with various compositions. The deposition of calcium phosphate was enhanced on multilayered DNA coatings as compared with non-coated controls, and was dependent on the type of cationic polyelectrolyte used in the build-up of the DNA coatings. Further analysis showed that the depositions consisted of carbonated apatite. Non-pretreated DNA coatings were found to have no effect on osteoblast-like cell behavior compared with titanium controls. On the other hand, SBF-pretreatment of DNA coatings affected the differentiation of osteoblast-like cells through an increased deposition of osteocalcin. The results of this study are indicative of the bone-bonding capacities of DNA coatings. Nevertheless, future animal experiments are required to provide conclusive evidence for the bioactivity of DNA coatings.

Contains fulltext : 50995.pdf (Publisher’s version ) (Closed access) BACKGROUND AND OBJECTIVE: The major extracellular matrix (ECM) proteins in developing enamel can induce and maintain the formation and mineralization of other skeletal hard tissue, such as bone. Therefore, dental matrix proteins are ideal therapeutic agents when direct formation of functional bone is required for a successful clinical outcome. Emdogain (EMD) consists of enamel matrix proteins which are known to stimulate bone formation. However, only a few studies in the literature have reported the effect of EMD on osteoblast-like cells in vitro. MATERIAL AND METHODS: In this study, rat bone marrow cells, obtained from the femora of Wistar rats, were precultured for 7 d in osteogenic medium. Then, the cells were harvested and seeded in 24-well plates at a concentration of 20,000 cells/well. The wells were either precoated with 100 microg/ml EMD, or left uncoated. The seeded cells were cultured in osteogenic medium for 32 d and analysed for cell attachment (by using the Live and Dead assay), cell growth (by determining DNA content) and cell differentiation (by measuring alkaline phosphatase activity and calcium content, and by using scanning electron microscopy and the reverse transcription-polymerase chain reaction). RESULTS: The results showed that at the 4-h time point of the experiment, more cells were attached to EMD-negative wells, but this effect was no longer apparent at 24 h. DNA analysis revealed that both groups showed a similar linear trend of cell growth. No differences in alkaline phosphatase activity or calcium content were observed, and no differences in gene expression (osteocalcin, alkaline phosphatase and collagen type I) were found between the groups. CONCLUSION: Based on our results, we conclude that EMD had no significant effect on the cell growth and differentiation of rat bone marrow cells.

The aim of this study was to evaluate the osteogenic properties of magnetron sputtered dicalcium pyrophaosphate (DCPP) and hydroxylapatite (HA) coatings. Therefore, DCPP and HA coatings were deposited on grit-blasted titanium discs. The substrates were used as-prepared or received an additional heat treatment which changed the amorphous coating structure to a crystalline structure. Subsequently, rat bone marrow stromal cells were cultured for 1-24 days on the various substrates. DNA and alkaline phosphatase activity was determined after 1, 3, 5, 8, and 12 days of incubation. Osteocalcin expression was evaluated after 8, 12, 16, and 24 days of incubation. Scanning electron microscopical analysis of cell morphology and coating characteristics was done after 8 and 16 days of incubation. All assays were done in duplicate and in each assay all specimens were present in fourfold. Results demonstrated that the cells did not proliferate and differentiate on all amorphous coatings. SEM revealed that the amorphous coatings showed significant dissolution. On the crystalline DCPP and HA coatings an increase in DNA and alkaline phosphatase activity was seen starting at day 8 of incubation. Osteocalcin expression on the crystalline coatings started to increase at day 16 of incubation. SEM showed that the growth and differentiation of the cells was associated with extensive collagen fiber formation and surface mineralization in the form of globular accretions. Further, statistical testing revealed that proliferation and differentiation of the rat bone marrow stromal cells started significantly earlier on the crystalline HA coatings than that on the crystalline DCPP coatings. These results demonstrate that the rat bone marrow stromal cells proliferated and differentiated only on crystalline magnetron sputtered DCPP as well as HA coatings, which warrants the further in vivo analysis of the bone healing supporting properties of these coatings.

Contains fulltext : 50448.pdf (Publisher’s version ) (Closed access) The in vivo behavior of infrared-heated, RF magnetron-sputtered hydroxylapatite (HA) and calcium pyrophosphate (DCPP) coated titanium discs was investigated. The discs were implanted subcutaneously in the back of six goats for 2, 4, 8 and 12 weeks. At the end of the study, coated discs were removed and examined on their physicochemical properties by X-ray diffraction (XRD) and scanning electron microscopy (SEM), including energy dispersive spectroscopy (EDS). Also, implants were prepared for light microscopical evaluation of the tissue response. The results showed that heat-treated HA coatings showed a stable behavior, i.e. no changes in the XRD pattern occurred during implantation. Also, no dissolution of the coating was observed by SEM. EDS revealed that the Ca/P ratio of the HA coatings remained stable during implantation. In contrast, heat-treated DCPP coatings showed a compositional change into apatite and tricalcium phosphate (TCP) during implantation. This was confirmed by the SEM and EDS analysis. The Ca/P ratio of the DCPP coatings changed from 0.8 to 1.52 during implantation. Finally, histology showed that both heat-treated HA and DCPP coatings showed no adverse tissue response, as characterized by the presence of thin, dense fibrous tissue capsule. Consequently, it can be concluded that 2 mum thick heat-treated, RF magnetron-sputtered HA and DCPP coatings are of sufficient thickness to withstand dissolution during 12 weeks of implantation in a subcutaneous location in goats. In addition, both coatings showed a biocompatible tissue behavior. Further, heat-treated DCPP coatings revealed a gradual compositional change into apatite and TCP.

Contains fulltext : 48039.pdf (Publisher’s version ) (Open Access) Little is known about the ability of peptide-coated surfaces to influence cell responses in vivo. Many studies have demonstrated that peptide-modified surfaces influence cell responses in vitro. Integrins, which bind specifically short peptide sequences, are responsible for these cell responses. In this way, information can be transmitted to the nucleus through several cytoplasmic signaling pathways. The peptide sequence Arg-Gly-Asp (RGD peptide) plays an important role in osteoblast adhesion. The present study was designed to investigate new bone formation in a porous titanium (Ti) fiber mesh implant, which was coated with cyclic RGD peptide. The RGD-Ti implants were inserted into the cranium of a rabbit and were compared with porous titanium fiber mesh disks without RGD sequence (Ti) and with an open control defect. Histologic and histomorphometric examinations were performed 2, 4, and 8 weeks postoperatively. A significant increase in bone formation, or bone ingrowth, was seen in the RGD-Ti group compared with the Ti group after 4 and 8 weeks. All control defects stayed open in all three periods. It was concluded that the use of cyclic RGD peptide in combination with titanium fiber mesh has a positive effect on bone formation in vivo in a rabbit animal model.

Radio frequency (rf) magnetron sputtering of calcium phosphate (CaP) is a promising technique to apply thin bioactive films on bulk implant materials. In this paper the interaction is studied of thin (∼100 nm) CaP films with Ca/P ratios ranging from 0.6 to 4.7, with simulated body fluids (SBFs) of different Ca and PO4 concentrations. Analysis of the thickness and composition of the coatings was done with ion beam analysis. Amorphous coatings of all compositions were found to dissolve in all meta-stable SBFs. For coatings with a Ca/P ratio of 1.6, dissolution was linear and congruent. By heat-treating the coatings for 30 min at 650 °C, coatings were crystallized. Crystallized coatings with a Ca/P ratio of 1.6 remain inert when immersed in SBF for days. When immersed in doubly concentrated SBF, after an induction period of 40–60 min where virtually no apposition of material is observed, a CaP precipitate is formed. After formation of these CaP crystals, continuous growth can proceed in SBFs with lower Ca and PO4 concentrations. During the induction period, CaP sediments were found on the coating surface. Their role remains unclear, but their presence seems to be correlated with the ability to grow a precipitate layer from the solution. Completion of the induction period is essential for growth of the precipitate.

Contains fulltext : 48536.pdf (Publisher’s version ) (Closed access) The adhesion of osteoblasts to substrates is mediated through proteins that have adsorbed to the substrate, providing integrins on the cell membrane with ligands to connect to. The integrins regulate cell behavior through bi-directional signaling pathways. This critical review has the purpose to consider the research that has been performed with osteoblasts, integrins, and bone replacing materials. Until now, most research has been done to investigate the integrin expression of osteoblasts in culture during cellular adhesion. However, it remains difficult to draw general conclusions from this research. Nevertheless, it can be concluded that the used substrates and protein or peptide coatings can influence the integrin expression and cellular behavior. Additional research has to be done to fully understand all the parameters involved in integrin expression, the adhesion of cells to substrates, and the subsequent cellular behavior. For this purpose, model substrates are under development. The signaling pathway is receiving more and more attention, but for biomaterial purposes, too little consideration is paid to the translation of the in vitro results to the in vivo situation, and to practical applications.

Cyclic stretching experiments on osteoblast-like cells have proven to be a useful tool in understanding the underlying mechanisms of load transduction at the bone-implant surface. However, most experimental setups use silicone rubber substrates, which are atypical for orthopedic and dental implant materials. Therefore, we investigated the responses of osteoblast-like cells to loading on titanium (Ti)-coated versus plain silicone substrates. Ti-coated substrates were made by a radio-frequency magnetron sputtering process, and characterized using Rutherford backscattering spectrometry, X-ray photoelectron spectroscopy, and contact-angle measurements. Osteoblast-like cells cultured from rat bone marrow were seeded on both types of substrates and stretched for 1 h continuously. Subsequently, cell proliferation, alkaline phosphatase activity, and calcium content were measured for up to 24 days after seeding. In addition light-, scanning electron-, and confocal laser scanning micrographs were made. The results showed that our Ti coating had a thickness of 50 nm and contained Ti/oxygen as 1:1. However, further characterization proved that the silicone material had a tendency to resurface through the coating. Osteoblast-like cells proliferated faster on the Ti-coated substrates, but differentiation was slower compared with the silicone substrates. It was concluded that that there was a definitive influence of the substrate material in mechanical stress models. Therefore, extrapolation of results obtained using silicone substrates cannot be translated directly toward the situation of metallic implant materials.

We conducted an in vivo experiment to evaluate the resorption rate of a calcium phosphate cement (CPC) with macropores larger than 100 microm, using the CPC called Biocement D (Merck Biomaterial, Darmstadt, Germany), which after setting only shows pores smaller than 1 microm. The gas bubble method used during the setting process created macroporosity. Preset nonporous and porous cement implants were inserted into the trabecular bone of the tibial metaphysis of goats. The size of the preset implants was 6 mm and the diameter of the drill hole was 6.3 mm, leaving a gap of 0.3 mm between implant surface and drill wall. After 2 and 10 weeks, the animals were euthanized and cement implants with surrounding bone were retrieved for histologic evaluation. Light microscopy at 2 weeks revealed that the nonporous implants were surrounded by connective tissue. On the cement surface, we observed a monolayer of multinucleated cells. Ten weeks after implantation, the nonporous implants were still surrounded by connective tissue. However, a thin layer of bone now covered the implant surface. No sign of cement resorption was observed. In contrast, the porous cement evoked a completely different bone response. At 2 weeks, bone formation had already occurred inside the implant porosity. Bone formation even appeared to occur as a result of osteoinduction. Also, at their outer surface, the porous implants were completely surrounded by bone. At 2 weeks, about 31% of the initial cement was resorbed. After 10 weeks, 81% of the initial phosphate cement was resorbed and new bone was deposited. On the basis of these observations, we conclude that the creation of macropores can significantly improve the resorption rate of CPC. This increased degradation is associated with almost complete bone replacement.

Item does not contain fulltext Initial interactions of rat bone marrow (RBM) cells with smooth titanium, rough titanium or calcium phosphate coated substrates were tested. Cells were seeded onto the substrates, and attachment, integrin expression and spreading and morphology were studied. We found no difference in attachment of RBM cells to the different materials. We did find differences in the percentage of attached cells within a certain time between replicate runs of the experiments. RBM cells on all materials express alpha1, alpha3, alpha5, alpha6 and beta1 subunits. Again there was a large difference in expression patterns on RBM cells in different runs. No difference was found in expression on the various materials. For alpha1, alpha5, alpha6 and beta1, no difference was found in expression between attached and unattached cells. Expression of alpha3 was similar on attached and unattached cells during early culture. At the end of culture, alpha3 expression was downregulated for attached cells and not for unattached cells. This resulted in a higher expression of alpha3 for unattached cells compared to attached cells. Cells did spread on all materials, and reached a larger cell size on smooth titanium than on the rough materials. Morphology of the cells on the materials differed. On smooth titanium, cells usually showed a compact cell body with short cellular extensions. On the rough materials, cells often showed elongated shapes, with many thin cellular extensions. From this we conclude that the substrate surface characteristics of the materials we used do not influence attachment or integrin expression during the initial cell-material interactions. On the other hand, spreading behavior and cell morphology do depend on substrate surface characteristics.

Item does not contain fulltext The aim of our study was to investigate the osteogenic potential of subcultured rat bone marrow cells. Rat bone marrow (RBM) cells were cultured with or without dexamethasone. Subsequently, osteogenic differentiation and expression was studied. When cells were cultured continuously in the presence of dexamethasone, cultures initially showed high alkaline phosphatase expression and abundant mineralization. Expression of differentiation markers decreased with passaging. After cells were passaged three times, no alkaline phosphatase activity and calcification were found. Primary cells cultured without dexamethasone showed low alkaline phosphatase and no calcification, and remained fibroblast-like. When these cells were subcultured in the presence of dexamethasone, the cells did show osteogenic differentiation. Nevertheless, this occurred at a significant lower level than with cells continuously cultured with dexamethasone. In addition, no differentiation was found after second passage. Our results indicate that subcultured undifferentiated RBM cells show osteogenic differentiation after addition of dexamethasone. Expression of alkaline phosphatase and mineralization is higher in cells continuously supplemented with dexamethasone. Still, even when dexamethasone is added continuously, RBM cells loose their osteogenic potential after several passages. Therefore, we conclude that subculture of undifferentiated rat bone marrow cells results in the loss of osteogenic potential of these cells.

The osteoconductive properties of porous titanium (Ti) fiber mesh with or without a calcium phosphate (Ca-P) coating and osteoinductive properties of noncoated Ti fiber mesh loaded with recombinant human Transforming Growth Factor beta-1 (rhTGF-beta1) were investigated in a rabbit non-critical size cranial defect model. Nine Ca-P-coated and 18 non-coated porous titanium implants, half of them loaded with rhTGF-beta1, were bilaterally placed in the cranium of 18 New Zealand White rabbits. At 8 weeks postoperative, the rabbits were sacrificed and the skulls with the implants were retrieved. Histological analysis demonstrated that in the TGF-beta1-loaded implants, bone had been formed throughout the implant, up to its center, whereas in the non-loaded implants only partial ingrowth of bone was observed. Bone formation had a trabecular appearance together with bone marrow-like tissue. No difference in ingrowth could be observed between the non-TGF-beta1-loaded non-coated implants and the Ca-P-coated ones. All histological findings were confirmed by image analysis: 97% ingrowth was seen in the rhTGF-beta1-loaded implants, while only 57% and 54% ingrowth was observed in the non-loaded Ca-P-coated and non-coated implants, respectively. Bone surface area and bone fill were significantly higher in the rhTGF-beta1-loaded implants (1.37 mm2 and 36%, respectively) than in the non-loaded implants (0.57 mm2 and 26%). No statistical difference was found for any parameter between the Ca-P-coated and noncoated implants. Quadruple fluorochrome labeling showed that in the Ti and Ti-CaP implants mainly bone guidance had occurred from the former defect edge, while in the Ti-TGF-beta1 implants bone formation had mainly started in the center of a pore and proceeded in a centrifugal manner. Our results show that: (1) the combination of Timesh with TGF-beta1 can induce orthotopic bone formation; (2) Ti-fiber mesh has good osteoconductive properties; (3) a thin Ca-P coating, as applied in this study, does not seem to further enhance the bone-conducting properties of a titanium scaffold material.

Item does not contain fulltext Mimicking the nanostructure of bone and understanding the interactions between the nanoscale inorganic and organic components of the extracellular bone matrix are crucial for the design of biomaterials with structural properties and a functionality similar to the natural bone tissue. Generally, these interactions involve anionic and/or cationic functional groups as present in the organic matrix, which exhibit a strong affinity for either calcium or phosphate ions from the mineral phase of bone. This study reviews the interactions between the mineral and organic extracellular matrix components in bone tissue as a source of inspiration for the design of novel nanocomposites. After providing a brief description of the various structural levels of bone and its main constituents, a concise overview is presented on the process of bone mineralization as well as the interactions between calcium phosphate (CaP) nanocrystals and the organic matrix of bone tissue. Bioinspired synthetic approaches for obtaining nanocomposites are subsequently addressed, with specific focus on chemical groups that have affinity for CaPs or are involved in stimulating and controlling mineral formation, that is, anionic functional groups, including carboxyl, phosphate, sulfate, hydroxyl, and catechol groups.

Item does not contain fulltext The current study focused on the development of a rapid, straightforward quantification method based on the use of enzymatic decomposition of urea using urease to assess the mineralization capacity of a wide range of biomaterials for bone regeneration. Urea-containing mineralizing solutions (MSs) (containing: Na2HPO4, CaCl2, and NaCl at 37 degrees C and pH 6.0) were used in the mineralization experiments. Urease was added to these solutions to induce enzymatic decomposition of urea resulting in increased pH and deposition of calcium phosphate. By optimizing the ionic and urease concentrations in these MSs, it was shown that the proposed system could mineralize titanium substrates with six different pretreatments, as opposed to normal simulated body fluid that mineralized only two of them. It was possible to rank the mineralization capacity of these substrates by measuring the amount of calcium deposited. Furthermore, the ranking of (i) various polymeric substrates and (ii) hydrogels with and without functionalization with calcium-binding bisphosphonate groups was also possible. These results confirm that the proposed testing system has a broad applicability in the field of biomaterials due to its inherent versatility and discriminative power.

It has been suggested that the provision of dental implants can improve the oral function of subjects with severely resorbed mandibles, possibly restoring function to the level experienced by satisfied wearers of conventional complete dentures. Nevertheless, a quantitative comparison has never been made and can be drawn from the literature only with difficulty, since studies differ greatly in methodology. To make such a comparison, we measured bite force and chewing efficiency by using identical methods in subjects with overdentures, complete full dentures, and natural dentitions. Our results indicated that bite forces achieved with overdentures on dental implants were between those achieved with artificial and natural dentitions. Chewing efficiency was significantly greater than that of subjects with full dentures (low mandible), but was still lower than that of subjects with full dentures (high mandible) and overdentures on bare roots. Differences in the height of the mandible revealed significant differences in chewing efficiency between the two full-denture groups. Furthermore, subjects with a shortened dental arch exerted bite forces similar to those of subjects with a complete-natural dentition, but their chewing efficiency was limited due to the reduced occlusal area. For all groups combined, a significant correlation was found between maximum bite force and chewing efficiency. Nearly half of the variation in chewing efficiency was explained by bite force alone.

The purpose of the present in vitro study was to examine the effect of surface roughness on the behaviour of osteoblast-like cells. Rat bone marrow RBM cells were cultured on commercially pure titanium discs. The discs were used as machined (TiM) or ground with 4000 (Ti 4000) or 320 (Ti 320) grit paper. Proliferation rate and alkaline phosphatase activity were determined, and morphology of the cells was studied with scanning electron microscopy (SEM). Besides. fluorescent markers, energy dispersive spectroscopy (EDS), X-ray diffraction (XRD) and Fourier transform infrared (FTIR) were used to obtain quantitative and compositional information about the produced calcitied extracellular matrix (ECM). Results demonstrated after 2 days of incubation no significant difference in the percentage of attached cells to all substrates. At 5 days, Ti 320 surfaces showed significantly lower (P≤0.05) cell attachment Percentages compared with Ti M and Ti 4000 surfaces. At 8 days, Ti 320 surfaces showed significantly more (P≤0.05) cell attachment than the other surfaces. The Ti 4000 surfaces showed after 8 days significantly (P≤0.05) higher alkaline phosphatase activity compared to both other surfaces. At 15 days of incubation, the alkaline phosphatase activity on Ti 4000 substrates was significantly lower (P≤0.05) than on the other substrates. No significant difference in mineralized ECM formation was observed on the ground substrate compared to the machined substrates. Physicochemical analysis confirmed the apatite-like nature of the deposited ECM on all substrates. On the basis of these findings, we concluded that our in vitro study could not clearly confirm the effect of surface roughness on the proliferation, differentiation and calcification of rat bone marrow cells.

The stability of radiofrequency (RF) magnetron sputtered calcium phosphate was studied under cyclically loaded conditions. The coatings were deposited on titanium bars and tested in either dry or wet conditions X-ray diffraction (XRD), scanning electron microscopy (SEM), energy dispersive X-ray (EDX) analysis and Fourier transform infrared (FTIR) spectroscopy were used to characterize the as-sputtered and tested coatings. XRD demonstrated that the amorphous structure after annealing at 650 C changed into a crystalline apatite structure. The residual stresses were determined by the XRD cos 2 i/i method. These residual film stresses were influenced by the coating conditions and the crystalline sputtered coating showed the presence of compressive stresses. SEM demonstrated that, after cyclic loading conditions in air, the crystalline sputter-coated Ti-6A1-4V bars showed a partial coating loss. Furthermore, in wet conditions (simulated body fluid) only the heat-treated sputter-coated bars appeared to be stable. On the other hand, the amorphous coating only showed signs of delamination in the more highly stressed regions, while in the less stressed regions a Ca-P precipitate was formed. On the basis of these results we conclude that calcium phosphate coatings subjected to cyclic loading conditions show an important difference in fatigue behaviour when tested in either dry or wet conditions.

Item does not contain fulltext Calcium phosphate cements (CPCs) have been widely used as an alternative to biological grafts due to their excellent osteoconductive properties. Although degradation has been improved by using poly(D,L-lactic-co-glycolic) acid (PLGA) microspheres as porogens, the biological performance of CPC/PLGA composites is insufficient to stimulate bone healing in large bone defects. In this context, the aim of this study was to investigate the effect of incorporating osteopromotive bioactive glass (BG; up to 50 wt %) on setting properties, in vitro degradation behavior and morphological characteristics of CPC/BG and CPC/PLGA/BG. The results revealed that the initial and final setting time of the composites increased with increasing amounts of incorporated BG. The degradation test showed a BG-dependent increasing effect on pH of CPC/BG and CPC/PLGA/BG pre-set scaffolds immersed in PBS compared to CPC and CPC/PLGA equivalents. Whereas no effects on mass loss were observed for CPC and CPC/BG pre-set scaffolds, CPC/PLGA/BG pre-set scaffolds showed an accelerated mass loss compared with CPC/PLGA equivalents. Morphologically, no changes were observed for CPC and CPC/BG pre-set scaffolds. In contrast, CPC/PLGA and CPC/PLGA/BG showed apparent degradation of PLGA microspheres and faster loss of integrity for CPC/PLGA/BG pre-set scaffolds compared with CPC/PLGA equivalents. Based on the present in vitro results, it can be concluded that BG can be successfully introduced into CPC and CPC/PLGA without exceeding the setting time beyond clinically acceptable values. All injectable composites containing BG had suitable handling properties and specifically CPC/PLGA/BG showed an increased rate of mass loss. Future investigations should focus on translating these findings to in vivo applications. (c) 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2013.

Dacron® velour is often used to anchor a percutaneous device, like the catheter used in peritoneal dialysis. However, exit-site infections complicate this method of dialysis and are supposed to be related to the design of the catheter. In animal experiments, a percutaneous device provided with a titanium fibre mesh to anchor the implant was not affected by infectious complications. The purpose of this study was to compare the differences in soft tissue reaction to Dacron velour and titanium fibre mesh under the same experimental conditions. Therefore, we placed implants, provided with either Dacron or titanium mesh, subcutaneously in the dorsum of goats. The implants were left in situ for 4 months. Histological and histomorphological evaluations were performed. It was found that the soft tissue response inside the Dacron was mainly inflammatory, while the titanium mesh evoked good biocompatible behaviour. We concluded that the limited fibrous tissue ingrowth into the Dacron cuff has to be the reason for the observed high failure incidence of a percutaneous device.

The ultimate goal of this work was to develop a biocompatible and biomimetic in situ crosslinkable hydrogel scaffold with an instructive capacity for bone regenerative treatment. To this end, synthetic hydrogels were functionalized with two key components of the extracellular matrix of native bone tissue, i.e. the three-amino acid peptide sequence RGD (which is the principal integrin-binding domain responsible for cell adhesion and survival of anchorage-dependent cells) and calcium phosphate (CaP) nanoparticles in the form of hydroxyapatite (which are similar to the inorganic phase of bone tissue). Rat bone marrow osteoblast-like cells (OBLCs) were encapsulated in four different biomaterials (plain oligo(poly(ethylene glycol) fumarate) (OPF), RGD-modified OPF, OPF enriched with CaP nanoparticles and RGD-modified OPF enriched with CaP nanoparticles) and cell survival, cell spreading, proliferation and mineralized matrix formation were determined via cell viability assay, histology and biochemical analysis for alkaline phosphatase activity and calcium. This study showed that RGD peptide sequences promoted cell spreading in OPF hydrogels and hence play a crucial role in cell survival during the early stage of culture, whereas CaP nanoparticles significantly enhanced cell-mediated hydrogel mineralization. Although cell spreading and proliferation activity were inhibited, the combined effect of RGD peptide sequences and CaP nanoparticles within OPF hydrogel systems elicited a better biological response than that of the individual components. Specifically, both a sustained cell viability and mineralized matrix production mediated by encapsulated OBLCs were observed within these novel biomimetic composite systems.

Item does not contain fulltext Calcium phosphate cements (CPCs) are frequently used as bone substitute material. Despite their superior clinical handling and excellent biocompatibility, they exhibit poor degradability, which limits bone ingrowth into the implant. Microspheres were prepared from poly(d,l-lactic-co-glycolic acid) (PLGA) and included in injectable CPCs as porogens in order to enhance its macroporosity after the polymeric microspheres had degraded. Upon degradation of the PLGA microspheres, acid is produced that enhances the dissolution rate of the CPC. However, the effect of the characteristics of PLGA microspheres on the degradation rate of CPCs has never been studied before. Therefore, the purpose of the current study was to investigate the dependence of CPC degradation on the chemical and morphological characteristics of incorporated PLGA microspheres. With respect to the chemical characteristics of the PLGA microspheres, the effects of both PLGA molecular weight (5, 17 and 44kDa) and end-group functionalization (acid-terminated or end-capped) were studied. In addition, two types of PLGA microspheres, differing in morphology (hollow vs. dense), were tested. The results revealed that, although both chemical parameters clearly affected the polymer degradation rate when embedded as hollow microspheres in CPC, the PLGA and CPC degradation rates were mainly dependent on the end-group functionalization. Moreover, it was concluded that dense microspheres were more efficient porogens than hollow ones by increasing the CPC macroporosity during in vitro incubation. By combining all test parameters, it was concluded that dense PLGA microspheres consisting of acid-terminated PLGA of 17kDa exhibited the highest and fastest acid-producing capacity and correspondingly the highest and fastest amount of porosity. In conclusion, the data presented here indicate that the combination of dense, acid-terminated PLGA microspheres with CPC emerges as a successful combination to achieve enhanced apatitic CPC degradation.

Contains fulltext : 87708.pdf (Publisher’s version ) (Closed access) OBJECTIVES: Despite the availability of numerous animal models for testing the biological performance of dental and orthopedic implants, the selection of a suitable model is complex. This paper presents a new model for objective and standardized evaluation of bone responses to implants using the iliac crest in goats. MATERIAL AND METHODS: The feasibility of the iliac crest model regarding anatomy and implant positioning was determined using two cadaveric specimens and the bone structure was evaluated and compared with that of the goat femoral condyle. Additionally, the validity of the model was tested by performing an in vivo study. RESULTS: By means of a rather simple, safe, fast and reproducible surgical procedure, the iliac crest in goats could be approached and allowed the implantation of maximally five dental implants per iliac crest. Because of the bilateral implantation possibility, statistical comparisons between groups on either side of the goat could be performed, resulting in a high statistical power, and hence a reduction in the number of animals required to obtain significant data. CONCLUSIONS: In terms of surgical approach, anatomy and implant positioning, the iliac crest is the preferred model over the femoral condyle model. The iliac crest implantation model is suitable for evaluation of the osteogenic response to bone implant materials and represents a justified and deliberate alternative to the already existing animal models.

Contains fulltext : 80523.pdf (Publisher’s version ) (Closed access) SUMMARY: In reconstructive surgery defects are closed using pedicled or free flaps. By raising these flaps the reconstructive surgeon creates new defects, which in turn are closed primarily or with the use of skin grafts. Inevitably, this results in extra scars that may be visible and may also lead to diminished function. In an attempt to avoid full-thickness donor site skin defects in reconstructive surgery, the principle of prefabrication has been modified to produce capsular flaps. In a rat model, we created prefabricated and prelaminated pedicled capsular flaps to fill a full-thickness skin defect. Both femoral vascular bundles in 10 Wistar rats were sandwiched between two silicone sheets. The capsule formed between the two sheets received its main blood supply from this vascular pedicle, and was used as carrier for a skin graft. After ligation of the distal femoral vessels a pedicled prelaminated capsular flap was raised on the proximal femoral vessels. The flap was brought to the surface for closure of an experimentally created abdominal skin defect. All 20 flaps survived, and there were no surgery-related complications. Comparison with controls indicated that flap survival was attributable to the blood supply from the vascular axis. Pedicled prelaminated capsular flaps can be created reliably and reproducibly, confirming the results of earlier studies, and are of value in reconstructive surgery.

Contains fulltext : 80731.pdf (Publisher’s version ) (Closed access) To explore the reported contradictory osteogenic capacity of platelet-rich plasma (PRP), the aim of the study was to examine and compare the bone regenerative effect of: PRPs of different species (rat, goat, human); human bone graft (HB) vs. HB combined with human PRP (HB+hPRP); and HB+hPRP vs. synthetic hydroxyapatite-tricalcium phosphate bone substitute combined with hPRP (HA/TCP+hPRP). For this purpose, 72 implants, divided into 6 groups (n=6) were inserted in critical-sized defects of immunodeficient rats. After 2 and 4 weeks, descriptive and quantitative histological, and micro-CT analyses were performed on the specimens. Rat and goat PRP combined with HA/TCP did not enhance bone regeneration compared with HA/TCP. In contrast, human PRP combined with HA/TCP resulted in significantly increased bone fill compared to HA/TCP. The addition of human PRP to human bone graft increased significantly the amount of newly formed bone after 2 weeks. HB+hPRP demonstrated enhanced bone healing compared to HA/TCP+hPRP. In conclusion, rat and goat PRP had no effect on bone formation. Human PRP improved the initial osteogenic response of human bone graft. Human PRP combined with human bone graft had better osteogenic capacity than human PRP combined with synthetic bone substitute.

The aim of this study was to evaluate potential effects of DNA-coatings on calcium phosphate (CaP) nucleation from simulated body fluids (SBF) and subsequently the effects of DNA-coatings and SBF-immersed DNA coatings on the behavior of osteoblast-like cells. DNAcoatings demonstrated to enhance the nucleation and deposition of CaP from SBF compared to titanium controls. The behavior of osteoblast-like cells was affected on SBF-immersed DNAcoatings, showing an increased deposition of the extracellular matrix protein osteocalcin compared to titanium controls. These results indicate bone-bonding capacity of DNA-coatings, which needs to be confirmed using future animal experiments.

Contains fulltext : 70781.pdf (Publisher’s version ) (Closed access) BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the bone-regenerative properties of Emdogain in osseous and nonosseous sites. MATERIAL AND METHODS: For the orthotopic study, unloaded poly(D,L-lactic-coglycolic acid)/calcium phosphate implants, and poly(D,L-lactic-coglycolic acid)/calcium phosphate implants loaded with different concentrations (0.25, 0.50 or 0.80 mg per implant) of enamel matrix derivative (EMD), were inserted into cranial defects of 24 rats. The implantation time was 4 wk. For the ectopic study, 32 implants were placed subcutaneously. The same study period and groups as in the orthotopic study were used. Methods of evaluation consisted of descriptive histology, histomorphometry and an in vitro EMD-release study. RESULTS: In the orthotopic study, new bone formation was most abundant in unloaded implants followed by 0.50-mg EMD composites. Histomorphometric measurements showed 54 +/- 15.0% bone ingrowth for unloaded implants, 19 +/- 22.5% bone ingrowth for 0.25-mg EMD composites, 40 +/- 23.6% bone ingrowth for 0.50-mg EMD composites and 26 +/- 17.6% bone ingrowth for 0.80-mg EMD composites. Light microscopic analysis of the subcutaneous sections from the ectopic study revealed no bone formation in any group after 4 wk. The in vitro release study showed 60% cumulative EMD release after 4 wk. CONCLUSION: Emdogain is not osteoinductive and is not able to enhance bone healing in combination with an osteoconductive material, such as poly(D,L-lactic-coglycolic acid)/calcium phosphate cement.

A novel porous composite material composed of hydroxyapatite, poly(vinyl alcohol) (PVA), and gelatin (Gel) was fabricated by emulsification. Scanning electron microscopy showed that the material had a well-interconnected porous structure including many macropores (100-500 microm) and micropores (less than 20 microm) on their walls. The composite had a porosity of 78% and showed high water absorption up to 312.7% indicating a good water-swellable behavior that is a characteristic of hydrogel materials. When immersed in water, the scaffold's weight continuously decreased. After immersion in simulated body fluid, the weight continuously increased because Ca(2+) and PO(3-) (4) ions deposited on the surface and the internal surfaces of the material pores. The deposit was proved to be carbonated hydroxyapatite by thin-film X-ray diffraction, Fourier transform infrared spectroscopy and energy dispersive X-ray analysis. The composite was detected to be non-cytotoxicity by MTT assay. The HA/PVA/Gel material was also implanted subcutaneously in the dorsal region of adult female rats. After 12 weeks of implantation, the porous material adhered tightly with the surrounding tissue, and the ingrowth of fibrous tissue as well as the material's partial degradation was observed, which partly indicated that the composite was biocompatible in vivo. In conclusion, the porous HA/PVA/Gel composite is a promising scaffold for cartilage tissue engineering with more studies.

The objective of this study was to characterize the physicochemical, dissolution, and osteogenic properties of radio frequency magnetron sputtered dicalcium pyrophosphate/tricalciumphosphate (Pyro/TCP) and hydroxylapatite (HA) coatings. Therefore Pyro/TCP and HA coatings were deposited on grit-blasted titanium discs. The results showed that the deposited coatings were amorphous and changed into a crystalline structure after IR heat-treatment of 550 degrees C for HA and 650 degrees C for Pyro/TCP. Heat-treated HA coatings appeared to be stable during immersion in simulated body fluid (SBF), that is no changes in the XRD pattern were observed. Also, no dissolution of the coating was observed by scanning electron microscopy (SEM). Energy dispersive spectroscopy (EDS) revealed that the Ca/P ratio of the HA coatings remained constant during SBF immersion. On the other hand, the heat-treated Pyro/TCP coatings showed a surface reaction of calcium pyrophosphate into a beta-tricalcium phosphate phase during SBF immersion. This was confirmed by EDS analysis. Rat bone marrow-derived osteoblast-like cells cultured on the heat-treated substrates showed that cell proliferation and differentiation occurred on both types of bioceramic coatings. No significant differences for proliferation and early differentiation were observed between cells cultured on heat-treated Pyro/TCP and HA at individual time points. However, osteocalcin expression, a late marker for osteoblast-like cell differentiation, was significantly increased after 12 days of culture on HA-coatings. These results were confirmed by SEM observations and suggest increased osteogenic properties for HA-coatings over Pyro/TCP-coatings. Additional research is necessary to obtain conclusive evidence on the in vivo osteogenic capacity of Pyro/TCP coatings.

Contains fulltext : 35076.pdf (Publisher’s version ) (Closed access) This study was performed to evaluate the basic biological response to deoxyribonucleic acid (DNA)-based coatings for soft tissue implants. To that end, in vitro experiments were used to study their cytocompatibility, and in vivo subcutaneous implantation studies with transponders in a rat model were performed to evaluate their histocompatibility. The DNA-based coatings were fabricated using the electrostatic self-assembly technique using cationic poly-D-lysine or poly-allylamine hydrochloride and anionic DNA. Noncoated substrates served as controls. In vitro, the behavior of primary rat dermal fibroblasts was assessed in terms of cell proliferation and morphology. Both types of multilayered DNA-coatings significantly increased rat dermal fibroblast proliferation without altering the morphological appearance of the cells. The tissue response to multilayered DNA-coatings was assessed using an in vivo rat model, in which transponders were inserted subcutaneously for 4 and 12 weeks. No macroscopic signs of inflammation or adverse tissue reactions were observed at implant retrieval. Histological analyses demonstrated a uniform tissue response to all types of implants. All implants were encapsulated in a fibrous tissue capsule without intervening inflammatory cells at the implant surface. Histomorphometrically, multilayered DNA-coatings induced fibrous tissue capsules with similar quality and thickness compared to noncoated controls. In addition, all fibrous tissue capsules showed similar expression of alpha-smooth muscle actin. This study demonstrates that multilayered DNA-coatings are cytocompatible and histocompatible, and justifies further research on their functionalization with biologically active compounds to modulate tissue responses.