The effect of local controlled release of sodium fluoride on the stimulation of bone growth

Fluoride coatings on orthodontic wire for controlled release of fluorine ion

The purpose of this study was to develop a new method of releasing fluorine in a controlled manner for applications in the field of orthodontic Ti-based wire, namely the coating of fluorides on Ti. Thin films of two fluoride compounds, CaF(2) and MgF(2), were coated on Ti via the electron-beam evaporation method. The fluorine was released rapidly from the as-deposited MgF(2) coating within a short period(,) and then the release rate slowed down. When the MgF(2) coating was heat treated, this initial burst effect was decreased, but a significant amount of cracks were generated. On the other hand, in the case of the as-deposited CaF(2) coating, fluorine was released linearly for the entire period, without an initial burst. In the heat-treated CaF(2) coatings the trend was similarly observed. The linear fluorine release from the CaF(2) coatings, even in the as-deposited state, was attributed to the high degree of crystallinity of the coatings. A preliminary cell test showed favorable cell viability on both the fluoride coatings. Given their sustained and controlled fluorine release, these fluoride coatings, particularly CaF(2), are suggested to be potentially useful in the field of orthodontic Ti-based wire.

The use of glass ionomer cements in both conventional and surgical endodontics

The capacity to bond to dental tissues, especially to dentine, their long-term fluoride release and their biocompatibility make glass ionomer cements (GICs) advantageous for use in endodontics, as well as in restorative dentistry. This review provides information on the basic properties of GICs, such as adhesion, antimicrobial effects and biocompatibility, particularly as they relate to use in endodontics. Indications for the use of GICs in endodontics are orthograde root canal sealing, root-end filling, repair of perforations and root resorption defects, treatment of vertical fractures and maintenance of the coronal seal. The paper includes a review on each of these indications. It is concluded that in spite of the critical handling characteristics and the inconclusive findings regarding sealing ability and antimicrobial activity, there is substantial evidence to confirm their satisfactory clinical performance. Both soft tissue and bone compatibility make them suitable for use during endodontic surgery.

Craniofacial osteoblast responses to polycaprolactone produced using a novel boron polymerisation technique and potassium fluoride post-treatment

There is no ideal material for craniofacial bone repair at present. The aim of this study was to test the biocompatibility of polycaprolactone (PCL) synthesised by a novel method allowing control of molecular weight and degradation rate, with regard to it being used as matrix for a biodegradable composite for craniofacial bone repair. Human primary craniofacial cells were used, isolated from paediatric skull after surgery. Cell responses were analysed using various assays and antibody staining. Cells attached and spread on the PCL in a similar manner to the Thermanox controls as shown by phalloidin staining of F-actin. Cells maintained the osteoblast phenotype as demonstrated by alkaline phosphatase assay and antibody staining throughout the time points studied, up to 28 days. Cells proliferated on the PCL as shown by a DNA assay. Collagen-1 staining showed extensive production of a collagen-1 containing extracellular matrix, which was also shown to be mineralised by alizarin red staining. Short-term (up to 48 h) attachment studies and long-term (up to 28 days) expression of markers of the osteoblast phenotype have been demonstrated on the PCL. This new method of synthesising PCL shows biocompatibility characteristics that give it potential to be used for craniofacial bone repair.

Release of bioactive human growth hormone from a biodegradable material: poly(epsilon-caprolactone)

We have characterized the biodegradable material poly(epsilon-caprolactone) (PCL) as a delivery system for recombinant human growth hormone (hGH). Two contrasting methods for the manufacture of the biomaterial were investigated: namely, solvent casting and solvent casting particulate leaching; the latter yielded porous PCL discs. The degree of porosity, which was assessed by scanning electron microscopy, could be controlled by incorporating selected concentrations of particulate sodium chloride during the manufacturing process. Bioactive hGH released from the PCL preparations was quantified with a highly sensitive and precise bioassay which was based upon hGH activation of rat lymphoma Nb2 cells. Eluates obtained from control discs of PCL which had not been loaded with hGH proved to be nontoxic when tested on these cells. The release of bioactive hGH from hormone-loaded nonporous discs of PCL was found to be a direct function of the initial hormone loading dose. Increased porosity of the discs manufactured by solvent casting particulate leaching increased the delivery of hGH from discs which had been immersion loaded. However, hGH release after surface loading was independent of porosity. Hormone concentrations were also assessed by immunoassay so that the ratios of bio- to immunoactivity (B:I ratio) of the hormone release could be determined. We found that the B:I ratio of the hormone after release from unstored discs was identical to that of the hormone prior to its incorporation into the PCL, demonstrating that the mild incorporation procedures utilized had not adversely affected the structural integrity of the hormone. However, if the hormone-loaded discs were stored at 37 degrees C prior to elution, the B:I ratios of the hGH released decreased indicating that this compromised the bioactive site.

Effects of cyclical mechanical stress on the controlled release of proteins from a biodegradable polymer implant

The availability of osteogenic proteins for orthopedic applications has led to great interest in developing delivery systems for these substances. Standard release rate models are applicable in most biological settings, but orthopedic implants usually bear mechanical loads. To determine whether a release rate model for load bearing applications must consider mechanical stress, the effects of dynamic mechanical stress on the in vitro release kinetics of two model proteins, bovine albumin (BA) and trypsin inhibitor (TI), from a biodegradable film were evaluated. Biodegradable poly(lacticco-glycolic acid) cylindrical implants with embedded proteins were subjected to cyclic three point bending loading of 720 cycles/day at 0.4 Hz for 2 weeks. Protein release into solution, swelling and mass loss changes, molecular weight degradation, and the presence of microstructural stress cracks and pores in the polymer carrier were evaluated. Cumulative BA and TI releases with time were significantly higher when a cyclic bending load was applied and increased with the magnitude of the load. Mass loss was not significantly greater, nor was swelling or molecular weight change of the polymer carrier in this 2-week interval. Pores on the surface of the polymer in the highest stress region were elongated into cracks, compared with pores in the low-stress region of the same implant, which were roughly circular. This implies that the pores probably act as stress risers to initiate cracks, which then expose more surface area, increasing protein release.

Influence of processing conditions on the release of sodium fluoride from oligomeric L-lactic acid matrices

Matrices were prepared in the shape of rods with a diameter of 4 mm and a length of 10 mm. They were composed of oligomers of L-lactic acid (Mw 2550-11730 Daltons) and micronized sodium fluoride particles. Sodium fluoride concentration was kept in the range 5-60%. Matrices were prepared by melting the mixture of L-lactic acid oligomer and sodium fluoride. Two types of products according to the applied cooling rate were prepared and evaluated for release characteristics in vitro. Sink conditions of isotonic phosphate buffer solution pH = 7.4 at 37 degrees C were maintained throughout the experiment. The concentration of dissolved sodium fluoride was determined by ion-selective electrode. It was documented that the release rate of sodium fluoride is strongly dependent on the molecular weight of oligomer. The effects of sodium fluoride concentration and cooling rate of melted mixture were evaluated by ANOVA, separately for each oligomer. The effect of sodium fluoride concentration was significant at each oligomer studied, while the influence of cooling rate was significant with higher molecular weight oligomers. Moreover, this effect is ambiguous and dependent on the capability of oligomers to form crystalline phases and on the form and geometric arrangement of this phase.

Resorbable synthetic polymers as replacements for bone graft

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

Effect of controlled local release of sodium fluoride on bone formation: filling a defect in the proximal femoral cortex

To assess the effect of sodium fluoride (NaF) in the healing of a defect in cortical bone, an experimental model was created by the drilling of 5.0 mm holes in the proximal ends of both femora of 12 adult male New Zealand White rabbits. An interlocking intramedullary implant constructed of poly(d,l-lactic acid) containing NaF was placed in the right femur and an identical implant without NaF (sham), in the left. The implant in the right femur was designed to release NaF in a controlled manner over the duration of the experiment. Ten weeks after implantation, the specimens were removed and were tested in torsion. The mechanical properties were not significantly different between the groups. The femora exposed to NaF had an 18.6% increase in intact cortex near the defect (p = 0.023), however, the deposition of mineralized bone within the defect was not significantly greater. In fact, healing appeared to be impaired by the presence of NaF. There was complete closure of the defect in all but one of the femora with a sham implant, but the tissue had not yet calcified. In contrast, only one femoral defect exposed to NaF had closed. Examination of the material filling the defects of the femora exposed to NaF showed that it was predominantly uncalcified osteogenic mesenchymal tissue.

Effect of controlled local release of sodium fluoride on trabecular bone

Systemic sodium fluoride has been used in the treatment of osteoporosis. Recent studies have shown that it has a positive risk/benefit ratio for use in increasing spinal trabecular bone density. However, thinning of the cortices of the long bones with a resulting increase in fracture incidence has been observed. This study was designed to determine the response of bone to sodium fluoride released from a biodegradable polymer matrix, a technique which could potentially deliver it locally to a site of need in the skeleton which has a positive response to fluoride. In one group of mature New Zealand white rabbits, cylindrical poly(D,L-lactic acid) (PLA) implants, with or without impregnated sodium fluoride, were implanted into the contralateral femoral trochanters and tibial metaphyses. In a second group, similar implants were placed in adjacent vertebrae. Four weeks postimplantation, the femora, tibiae, and vertebrae were removed, sectioned, cleaned of all but mineralized tissue, and the surfaces of the sections stained. The stained surfaces were imaged and analyzed for morphometric properties of the trabeculae. Comparing contralateral vertebrae, those exposed to sodium fluoride had significantly thickened trabeculae, with decreased spacing between them and a greater bone fraction. A similar increase in trabecular width was found in the subchondral bone of the proximal tibiae exposed to local release fluoride. Femoral sections showed no difference, possibly due to the lack of extensive trabecular bone in the region chosen for study.

Response of cortical bone to local controlled release of sodium fluoride: the effect of implant insertion site

In a previous experiment, sodium fluoride in a biodegradable polymer matrix was introduced into the femoral canal of the rabbit and bone formation was compared with contralateral controls. We noted significant bone formation, but only in the distal third of the periosteal surface of the femur. This experiment was performed to distinguish fluoride-induced periosteal bone formation from that due to the reactive osteogenic changes associated with local injury caused by the process of implantation. A proximal approach on the right leg and a distal approach on the left were used for the insertion of the implants in rabbits. Femurs were removed after 30 days and tested for stiffness and load to failure. The cross-sectional area of mineralized bone was determined at proximal, midshaft, and distal locations. Fluorescent bone tissue growth labels were injected at weekly intervals to measure the rate of new periosteal bone formation. The results were compared with a control group that received sham implants. Results showed no difference between measured properties in right and left femurs in the control group or in those exposed to fluoride. A significant increase was found in the fluoride group in load to failure, along with cross-sectional area of mineralized bone, and periosteal growth rates compared with the control group, but no difference was seen in stiffness. No difference was detected between the response proximally and distally in the fluoride group regardless of the location of insertion. There were no detectable changes in serum fluoride level after implantation of the poly L-lactic acid/sodium fluoride matrix. These results show that fluoride exerts its osteogenic effects equally at proximal, midshaft, and distal regions of diaphyseal bone and is uninfluenced by the site of local injury due to insertion of the implant.

The biocompatibility of glass-poly(alkenoate) (Glass-Ionomer) cements: a review

The literature describing the biocompatibility of glass-poly(alkenoate) ('Glass-Ionomer') cements has been reviewed. This literature shows that these materials have generally good biocompatibility for both dental and orthopaedic use, this latter observation being very recent. There have, though, been a few reports showing that in certain circumstances these materials may cause pulpal irritation and the reasons for these particular findings are considered. Following discussion of the biocompatibility of Glass-Ionomer cements, consideration is given to the likely underlying causes of this feature. Three factors are identified as contributing to the biocompatibility of these cements. They are: (i) minimal exotherm on setting; (ii) rapid neutralization following mixing; and (iii) slow release of ions which are generally biologically beneficial or, at least, benign. This last point is considered in some detail. Previous studies of leaching of ions from Glass-Ionomer cements have shown that only inorganic species are released. The biological effects of each of these inorganic ions are described and their influence on biocompatibility discussed.