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Roesner M, Zankovic S, Kovacs A, Benner M, Barkhoff R, Seidenstuecker M. Mechanical Properties and Corrosion Rate of ZnAg3 as a Novel Bioabsorbable Material for Osteosynthesis. J Funct Biomater 2024; 15:28. [PMID: 38391881 PMCID: PMC10890006 DOI: 10.3390/jfb15020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
Osteosynthesis in fracture treatment typically uses hardware that remains in the patient's body, which brings a permanent risk of negative side effects such as foreign body reactions or chronic inflammation. Bioabsorbable materials, however, can degrade and slowly be replaced by autologous bone tissue. A suitable material is requested to offer great biocompatibility alongside excellent mechanical properties and a reasonable corrosion rate. Zinc-silver alloys provide these characteristics, which makes them a promising candidate for research. This study investigated the aptitude as a bioabsorbable implant of a novel zinc-silver alloy containing 3.3 wt% silver (ZnAg3). Here, the tensile strength as well as the corrosion rate in PBS solution (phosphate buffered solution) of ZnAg3 were assessed. Furthermore, shear tests, including fatigue and quasi-static testing, were conducted with ZnAg3 and magnesium pins (MAGNEZIX®, Syntellix AG, Hannover, Germany), which are already in clinical use. The detected corrosion rate of 0.10 mm/year for ZnAg3 was within the proposed range for bioabsorbable implants. With a tensile strength of 237.5 ± 2.12 MPa and a shear strength of 144.8 ± 13.2 N, ZnAg3 satisfied the mechanical requirements for bioabsorbable implants. The fatigue testing did not show any significant difference between ZnAg3 and magnesium pins, whereas both materials withstood the cyclic loading. Thus, the results support the assumption that ZnAg3 is qualified for further investigation.
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Affiliation(s)
- Maria Roesner
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Sergej Zankovic
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Adalbert Kovacs
- Limedion GmbH, Coatings and Surface Analysis, Am Schäferstock 2-4, 68163 Mannheim, Germany
| | - Moritz Benner
- Limedion GmbH, Coatings and Surface Analysis, Am Schäferstock 2-4, 68163 Mannheim, Germany
- Quadralux e.K., Am Schäferstock 2-4, 68163 Mannheim, Germany
| | - Roland Barkhoff
- Quadralux e.K., Am Schäferstock 2-4, 68163 Mannheim, Germany
| | - Michael Seidenstuecker
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
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Slavin BV, Ehlen QT, Costello JP, Nayak VV, Bonfante EA, Benalcázar Jalkh EB, Runyan CM, Witek L, Coelho PG. 3D Printing Applications for Craniomaxillofacial Reconstruction: A Sweeping Review. ACS Biomater Sci Eng 2023; 9:6586-6609. [PMID: 37982644 DOI: 10.1021/acsbiomaterials.3c01171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The field of craniomaxillofacial (CMF) surgery is rich in pathological diversity and broad in the ages that it treats. Moreover, the CMF skeleton is a complex confluence of sensory organs and hard and soft tissue with load-bearing demands that can change within millimeters. Computer-aided design (CAD) and additive manufacturing (AM) create extraordinary opportunities to repair the infinite array of craniomaxillofacial defects that exist because of the aforementioned circumstances. 3D printed scaffolds have the potential to serve as a comparable if not superior alternative to the "gold standard" autologous graft. In vitro and in vivo studies continue to investigate the optimal 3D printed scaffold design and composition to foster bone regeneration that is suited to the unique biological and mechanical environment of each CMF defect. Furthermore, 3D printed fixation devices serve as a patient-specific alternative to those that are available off-the-shelf with an opportunity to reduce operative time and optimize fit. Similar benefits have been found to apply to 3D printed anatomical models and surgical guides for preoperative or intraoperative use. Creation and implementation of these devices requires extensive preclinical and clinical research, novel manufacturing capabilities, and strict regulatory oversight. Researchers, manufacturers, CMF surgeons, and the United States Food and Drug Administration (FDA) are working in tandem to further the development of such technology within their respective domains, all with a mutual goal to deliver safe, effective, cost-efficient, and patient-specific CMF care. This manuscript reviews FDA regulatory status, 3D printing techniques, biomaterials, and sterilization procedures suitable for 3D printed devices of the craniomaxillofacial skeleton. It also seeks to discuss recent clinical applications, economic feasibility, and future directions of this novel technology. By reviewing the current state of 3D printing in CMF surgery, we hope to gain a better understanding of its impact and in turn identify opportunities to further the development of patient-specific surgical care.
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Affiliation(s)
- Blaire V Slavin
- University of Miami Miller School of Medicine, 1011 NW 15th St., Miami, Florida 33136, United States
| | - Quinn T Ehlen
- University of Miami Miller School of Medicine, 1011 NW 15th St., Miami, Florida 33136, United States
| | - Joseph P Costello
- University of Miami Miller School of Medicine, 1011 NW 15th St., Miami, Florida 33136, United States
| | - Vasudev Vivekanand Nayak
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, 1011 NW 15th St., Miami, Florida 33136, United States
| | - Estavam A Bonfante
- Department of Prosthodontics and Periodontology, University of Sao Paulo, Bauru School of Dentistry, Alameda Dr. Octávio Pinheiro Brisolla, Quadra 9 - Jardim Brasil, Bauru São Paulo 17012-901, Brazil
| | - Ernesto B Benalcázar Jalkh
- Department of Prosthodontics and Periodontology, University of Sao Paulo, Bauru School of Dentistry, Alameda Dr. Octávio Pinheiro Brisolla, Quadra 9 - Jardim Brasil, Bauru São Paulo 17012-901, Brazil
| | - Christopher M Runyan
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, 475 Vine St, Winston-Salem, North Carolina 27101, United States
| | - Lukasz Witek
- Biomaterials Division, NYU Dentistry, 345 E. 24th St., New York, New York 10010, United States
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York University, 222 E 41st St., New York, New York 10017, United States
- Department of Biomedical Engineering, NYU Tandon School of Engineering, 6 MetroTech Center, Brooklyn, New York 11201, United States
| | - Paulo G Coelho
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, 1011 NW 15th St., Miami, Florida 33136, United States
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, 1120 NW 14th St., Miami, Florida 33136, United States
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McLeod NM, Saeed NR, Gerber B. Remodelling of mandibular condylar head after fixation of fractures with ultrasound activated resorbable pins: A retrospective case series. J Craniomaxillofac Surg 2023; 51:460-466. [PMID: 37553264 DOI: 10.1016/j.jcms.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/22/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Abstract
The aim of this study was to assess whether the resorption of poly-lactic acid pins, used for condylar head fracture fixation, adversely affect remodelling of the condylar head. A retrospective review of patients was performed that underwent ORIF of CHF with ultrasound activated resorbable poly-lactic acid pins and had CT/CBCT scans of the condyle at least 18 months after surgery, at which point the fixation material was expected to be resorbed. We reviewed the size, shape and position of the condylar head and compared this to the normal side and compared this to the results of conservative management and ORIF with titanium screws in the literature. Most patients had condylar heads normally positioned and shaped, with minimal bone changes. The position of the condyle in the fossa, its shape and bone changes compare favourably with previous studies on CHF managed conservatively or with titanium screw fixation. There was no radiographic evidence of the pins after 18 months. In conclusion, ultrasound activated resorbable pins can provide suitable fixation for ORIF of condylar head fractures, avoiding the need for screw removal, and there was no evidence that the resorption process adversely affected the remodelling of the condylar head.
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Affiliation(s)
- Niall Mh McLeod
- University Hospitals Coventry and Warwickshire NHS Trust, Department of Oral & Maxillofacial Surgery, University Hospital, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Nadeem R Saeed
- Oxford University Hospitals NHS Trust, Department of Oral & Maxillofacial Surgery, The John Radcliffe, Headley Way, Oxford, OX3 9DU, UK
| | - Barbara Gerber
- Oxford University Hospitals NHS Trust, Department of Oral & Maxillofacial Surgery, The John Radcliffe, Headley Way, Oxford, OX3 9DU, UK
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Karanth D, Puleo D, Dawson D, Holliday LS, Sharab L. Characterization of 3D printed biodegradable piezoelectric scaffolds for bone regeneration. Clin Exp Dent Res 2023; 9:398-408. [PMID: 36779270 PMCID: PMC10098282 DOI: 10.1002/cre2.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/17/2022] [Accepted: 01/10/2023] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE The primary objective of this research was to develop a poly(l-lactic acid) (PLLA) scaffold and evaluate critical characteristics essential for its biologic use as a craniofacial implant. MATERIALS AND METHODS PLLA scaffolds were designed and fabricated using fused deposition modeling technology. The surface morphology and microarchitecture were analyzed using scanning electron microscopy (SEM) and microCT, respectively. Crystallography, compressive modulus, and the piezoelectric potential generated upon mechanical distortion were characterized. Hydrolytic degradation was studied. MG63 osteoblast-like cell proliferation and morphology were assessed. RESULTS The porosity of the scaffolds was 73%, with an average pore size of 450 µm and an average scaffold fiber thickness of 130 µm. The average compressive modulus was 244 MPa, and the scaffolds generated an electric potential of 25 mV upon cyclic/repeated loading. The crystallinity reduced from 27.5% to 13.9% during the 3D printing process. The hydrolytic degradation was minimal during a 12-week period. Osteoblast-like cells did not attach to the uncoated scaffold but attached well after coating the scaffold with fibrinogen. They then proliferated to cover the complete scaffold by Day 14. CONCLUSION The PLLA scaffolds were designed and printed, proving the feasibility of 3D printing as a method of fabricating PLLA scaffolds. The elastic modulus was comparable to that of trabecular bone, and the piezoelectric properties of the PLLA were retained after 3D printing. The scaffolds were cytocompatible. These 3D-printed PLLA scaffolds showed promising properties akin to the natural bone, and they warrant further investigation for bone regeneration.
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Affiliation(s)
- Divakar Karanth
- Department of Orthodontics, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - David Puleo
- Department of Biomedical Engineering, University of Mississippi, University Park, Mississippi, USA
| | - Dolph Dawson
- Department of Periodontics, University of Kentucky College of Dentistry, Lexington, Kentucky, USA
| | - L S Holliday
- Department of Orthodontics, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Lina Sharab
- Department of Orthodontics, University of Kentucky College of Dentistry, Lexington, Kentucky, USA
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Xu J, Hadjichristidis N. Heteroatom-containing degradable polymers by ring-opening metathesis polymerization. Prog Polym Sci 2023. [DOI: 10.1016/j.progpolymsci.2023.101656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Gareb B, van Bakelen NB, Driessen L, Buma P, Kuipers J, Grijpma DW, Vissink A, Bos RR, van Minnen B. Biocompatibility and degradation comparisons of four biodegradable copolymeric osteosynthesis systems used in maxillofacial surgery: A goat model with four years follow-up. Bioact Mater 2022; 17:439-456. [PMID: 35386449 PMCID: PMC8961280 DOI: 10.1016/j.bioactmat.2022.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/10/2021] [Accepted: 01/08/2022] [Indexed: 01/15/2023] Open
Abstract
Applying biodegradable osteosyntheses avoids the disadvantages of titanium osteosyntheses. However, foreign-body reactions remain a major concern and evidence of complete resorption is lacking. This study compared the physico-chemical properties, histological response and radiographs of four copolymeric biodegradable osteosynthesis systems in a goat model with 48-months follow-up. The systems were implanted subperiosteally in both tibia and radius of 12 Dutch White goats. The BioSorb FX [poly(70LLA-co-30DLLA)], Inion CPS [poly([70–78.5]LLA-co-[16–24]DLLA-co-4TMC)], SonicWeld Rx [poly(DLLA)], LactoSorb [poly(82LLA-co-18GA)] systems and a negative control were randomly implanted in each extremity. Samples were assessed at 6-, 12-, 18-, 24-, 36-, and 48-month follow-up. Surface topography was performed using scanning electron microscopy (SEM). Differential scanning calorimetry and gel permeation chromatography were performed on initial and explanted samples. Histological sections were systematically assessed by two blinded researchers using (polarized) light microscopy, SEM and energy-dispersive X-ray analysis. The SonicWeld Rx system was amorphous while the others were semi-crystalline. Foreign-body reactions were not observed during the complete follow-up. The SonicWeld Rx and LactoSorb systems reached bone percentages of negative controls after 18 months while the BioSorb Fx and Inion CPS systems reached these levels after 36 months. The SonicWeld Rx system showed the most predictable degradation profile. All the biodegradable systems were safe to use and well-tolerated (i.e., complete implant replacement by bone, no clinical or histological foreign body reactions, no [sterile] abscess formation, no re-interventions needed), but nanoscale residual polymeric fragments were observed at every system's assessment. Foreign-body reactions are a major concern of biodegradable osteosyntheses. Amorphous poly(DLLA) showed the most predictable degradation profile. Nanoscale residual polymeric fragments could still be observed after 4 years.
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Comparison of the Results of Suture and Resorbable Plate-Screw Fixation in Craniosynostosis. Ann Plast Surg 2022; 89:385-390. [PMID: 36149978 DOI: 10.1097/sap.0000000000003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although many fixation methods are used alone or in combination for craniosynostosis, only few studies have compared the effectiveness and long-term results of these methods. METHOD In this study, patients in whom suture or resorbable plate-screw system was used for fixation were evaluated in terms of postoperative results and complications. The data of patients who underwent surgery for craniosynostosis between 2002 and 2019 were retrospectively reviewed and evaluated. RESULTS A total of 70 patients, 41 in the suture group and 29 in the resorbable plate-screw group, were included in the study. Whitaker classification was used for head shape evaluation, and anthropometric head circumference measurements were performed in all patients in the preoperative and postoperative periods. In the postoperative period, all patients were compared in terms of the operation time, transfusion requirement, discharge, follow-up period, and complications according to the chosen fixation method.The mean age, postoperative complication rates, anthropometric head circumference measurements, and Whitaker scores of both groups were found to be statistically similar. Although the resorbable plate-screw group had a longer follow-up period, the operation time was longer in the suture group. Furthermore, the suture group had lower transfusion requirement and earlier discharge from the hospital than the resorbable plate-screw group. CONCLUSIONS If fixation with suture is chosen in suitable patients, in addition to the low patient cost, this method can be safely applied in centers with limited logistical possibilities, because of the results and complication rates being similar to fixation with resorbable plate-screws.
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8
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The Anterolateral Thigh Perforator Flap for Mandibular Reconstruction: A Volumetric and Patient Satisfaction Analysis. J Craniofac Surg 2022; 33:2154-2160. [DOI: 10.1097/scs.0000000000008742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
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Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances. Polymers (Basel) 2022; 14:polym14142782. [PMID: 35890557 PMCID: PMC9316877 DOI: 10.3390/polym14142782] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 02/06/2023] Open
Abstract
Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.
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Zheng Z, Wang R, Lin J, Tian J, Zhou C, Li N, Li L. Liquid Crystal Modified Polylactic Acid Improves Cytocompatibility and M2 Polarization of Macrophages to Promote Osteogenesis. Front Bioeng Biotechnol 2022; 10:887970. [PMID: 35782509 PMCID: PMC9247145 DOI: 10.3389/fbioe.2022.887970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Liquid crystalline phases (LC phases) are widely present in an organism. The well-aligned domain and liquidity of the LC phases are necessary for various biological functions. How to stabilize the floating LC phases and maintain their superior biology is still under study. In addition, it is unclear whether the exogenous LC state can regulate the immune process and improve osteogenesis. In this work, a series of composite films (PLLA/LC) were prepared using cholesteryl oleyl carbonate (COC), cholesteryl pelargonate (CP), and polylactic acid (PLLA) via a controlled facile one-pot approach. The results showed that the thermo-responsive PLLA/LC films exhibited stable LC phases at human body temperature and the cytocompatibility of the composites was improved significantly after modification by the LC. In addition, the M2 polarization of macrophages (RAW264.7) was enhanced in PLLA/LC films, and the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) was improved as co-cultured with macrophages. The in vivo bone regeneration of the materials was verified by calvarial repair, in which the amount of new bone in the PLLA-30% LC group was greater than that in the PLLA group. This work revealed that the liquid crystal-modified PLLA could promote osteogenesis through immunomodulation.
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Affiliation(s)
- Zexiang Zheng
- Department of Materials Science and Engineering, Engineering Research Center of Artificial Organs and Materials, Jinan University, Guangzhou, China
| | - Renqin Wang
- Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, China
| | - Jianjun Lin
- Department of Materials Science and Engineering, Engineering Research Center of Artificial Organs and Materials, Jinan University, Guangzhou, China
| | - Jinhuan Tian
- Department of Materials Science and Engineering, Engineering Research Center of Artificial Organs and Materials, Jinan University, Guangzhou, China
| | - Changren Zhou
- Department of Materials Science and Engineering, Engineering Research Center of Artificial Organs and Materials, Jinan University, Guangzhou, China
| | - Na Li
- Foshan Stomatology Hospital, School of Medicine, Foshan University, Foshan, China
- *Correspondence: Na Li, ; Lihua Li,
| | - Lihua Li
- Department of Materials Science and Engineering, Engineering Research Center of Artificial Organs and Materials, Jinan University, Guangzhou, China
- *Correspondence: Na Li, ; Lihua Li,
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Voss JO, Kasselmann S, Koerdt S, Rendenbach C, Fischer H, Jöhrens K, Czabanka M, Schmidt-Bleek K, Duda GN, Heiland M, Raguse JD. Treatment options for critical size defects - Comparison of different materials in a calvaria split model in sheep. BIOMATERIALS ADVANCES 2022; 136:212788. [PMID: 35929320 DOI: 10.1016/j.bioadv.2022.212788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 06/15/2023]
Abstract
Bone defects of the craniofacial skeleton are often associated with aesthetic and functional impairment as well as loss of protection to intra- and extracranial structures. Solid titanium plates and individually adapted bone cements have been the materials of choice, but may lead to foreign-body reactions and insufficient osseointegration. In contrast, porous scaffolds are thought to exhibit osteoconductive properties to support bone ingrowth. Here, we analyse in critical size defects of the calvaria in sheep whether different bone replacement materials may overcome those remaining challenges. In a critical size defect model, bilateral 20 × 20 × 5-mm craniectomies were performed on either side of the sagittal sinus in 24 adult female blackheaded sheep. Bony defects were randomised to one of five different bone replacement materials (BRMs): titanium scaffold, biodegradable poly(d,l-lactic acid) calcium carbonate scaffold (PDLLA/CC), polyethylene 1 (0.71 mm mean pore size) or 2 (0.515 mm mean pore size) scaffolds and polymethyl methacrylate (PMMA)-based bone cement block. Empty controls (n = 3) served as references. To evaluate bone growth over time, three different fluorochromes were administered at different time points. At 3, 6 and 12 months after surgery, animals were sacrificed and the BRMs and surrounding bone analysed by micro-CT and histomorphometry. The empty control group verified that the calvaria defect in this study was a reliable critical size defect model. Bone formation in vivo was detectable in all BRMs after 12 months by micro-CT and histomorphometric analysis, except for the non-porous PMMA group. A maximum of bone formation was detected in the 12-months group for titanium and PDLLA/CC. Bone formation in PDLLA/CC starts to increase rapidly between 6 and 12 months, as the BRM resorbs over time. Contact between bone and BRM influenced bone formation inside the BRM. Empty controls exhibited bone formation solely at the periphery. Overall, porous BRMs offered bone integration to different extent over 12 months in the tested calvaria defect model. Titanium and PDLLA/CC scaffolds showed remarkable osseointegration properties by micro-CT and histomorphometric analysis. PDLLA/CC scaffolds degraded over time without major residues. Pore size influenced bone ingrowth in polyethylene, emphasising the importance of porous scaffold structure.
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Affiliation(s)
- Jan Oliver Voss
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany.
| | - Svenja Kasselmann
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; Department of Veterinary Medicine, Institute of Veterinary Anatomy, Freie Universität Berlin, Koserstraße 20, 14195 Berlin, Germany.
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Heilwig Fischer
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Korinna Jöhrens
- Institute of Pathology, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307, TU Dresden, Dresden, Germany.
| | - Marcus Czabanka
- Department of Neurosurgery, Universitätsmedizin Frankfurt am Main, Schleusenweg 2-16, 60590 Frankfurt am Main, Germany.
| | - Katharina Schmidt-Bleek
- Julius Wolff Institute and Berlin Institute of Health Centre for Regenerative Therapies, Berlin Institute of Health at Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Georg N Duda
- Julius Wolff Institute and Berlin Institute of Health Centre for Regenerative Therapies, Berlin Institute of Health at Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Jan-Dirk Raguse
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; Fachklinik Hornheide, Department of Oral and Maxillofacial Surgery, Dorbaumstraße 300, 48147 Münster, Germany.
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12
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Making Hardware Removal Unnecessary by Using Resorbable Implants for Osteosynthesis in Children. CHILDREN 2022; 9:children9040471. [PMID: 35455515 PMCID: PMC9031809 DOI: 10.3390/children9040471] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Introduction: Following osteosynthesis, children generally require a second surgery to remove the hardware. This becomes unnecessary, by using resorbable implants. Limiting the number of required surgeries and their associated risks, this technique provides critical aspects of minimally invasive surgery. This review focuses on resorbable implants for osteosynthesis for the treatment of fractures in children and discusses their clinical features. Method: We provide an overview of the two most common technologies used in resorbable osteosynthesis materials: polymer- and magnesium-based alloys. Clinical examples of osteosynthesis are presented using polymer-based ActivaTM products and magnesium-based Magnezix® products. Results: Polymer-based implants demonstrate surgical safety and efficacy. Due to their elasticity, initial placement of polymer-based products may demonstrate technical challenges. However, stability is maintained over the course of healing. While maintaining good biocompatibility, the rate of polymer-resorption may be controlled by varying the composition of polyesters and copolymers. Similarly, magnesium-based implants demonstrate good mechanical stability and resorption rates, while these characteristics may be controlled by varying alloy components. One of the significant shortcomings of magnesium is that metabolism results in the production of hydrogen gas. Both technologies provide equally good results clinically and radiographically, when compared to non-resorbable implants. Conclusion: Resorbable osteosynthesis materials demonstrate similar therapeutic results as conventional materials for osteosynthesis. Resorbable implants may have the potential to improve patient outcomes, by sparing children a second surgery for hardware removal.
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Chen D, Xi Y, Zhang S, Weng L, Dong Z, Chen C, Wu T, Xiao J. Curcumin attenuates inflammation of Macrophage-derived foam cells treated with Poly-L-lactic acid degradation via PPARγ signaling pathway. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:33. [PMID: 35303193 PMCID: PMC8933344 DOI: 10.1007/s10856-022-06654-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/31/2022] [Indexed: 05/12/2023]
Abstract
Poly-L-lactic acid (PLLA) is considered to be a promising candidate material for biodegradable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI). But, PLLA-BVS also faces the challenge of thrombosis (ST) and in-stent restenosis (ISR) caused by in-stent neo-atherosclerosis (ISNA) associated with inflammatory reactions in macrophage-derived foam cells. Our previous studies have confirmed that curcumin alleviates PLLA-induced injury and inflammation in vascular endothelial cells, but it remains unclear whether curcumin can alleviate the effect of inflammatory reactions in macrophage-derived foam cells while treated with degraded product of PLLA. In this study, PLLA-BVS was implanted in the porcine coronary artery to examine increased macrophages and inflammatory cytokines such as NF-κb and TNF-α by histology and immunohistochemistry. In vitro, macrophage-derived foam cells were induced by Ox-LDL and observed by Oil Red Staining. Foam cells were treated with pre-degraded PLLA powder, curcumin and PPARγ inhibitor GW9662, and the expression of IL-6, IL-10, TNF-α, NF-κb, PLA2 and PPARγ were investigated by ELISA or RT-qPCR. This study demonstrated that the macrophages and inflammatory factors increased after PLLA-BVS implantation in vivo, and foam cells derived from macrophages promoted inflammation by products of PLLA degradation in vitro. This present study was found that the inflammation of foam cells at the microenvironment of PLLA degraded products were significantly increased, and curcumin can attenuate the inflammation caused by the PLLA degradation via PPARγ signal pathway. In addition, curcumin should be further studied experimentally in vivo experiments on animal models as a potential therapeutic to reduce ISNA of PLLA-BVS. Graphical abstract.
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Affiliation(s)
- Dongping Chen
- Central Laboratory, The Dongguan Affiliated Hospital of Jinan University, Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Yangbo Xi
- Department of Cardiology, The Dongguan Affiliated Hospital of Jinan University, Binhaiwan Central Hospital of Dongguan, Dongguan, China
- Department of The First Clinical Medical College, Jinan University, Guangzhou, China
| | - Suzhen Zhang
- Central Laboratory, The Dongguan Affiliated Hospital of Jinan University, Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Linsheng Weng
- Department of Cardiology, The Dongguan Affiliated Hospital of Jinan University, Binhaiwan Central Hospital of Dongguan, Dongguan, China
- Intensive Care Unit of Foshan Women and Children Hospital, Foshan, China
| | - Zhihui Dong
- Central Laboratory, The Dongguan Affiliated Hospital of Jinan University, Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Can Chen
- Department of pathology, The Dongguan Affiliated Hospital of Jinan University, Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Tim Wu
- Dongguan TT Medical,Inc, Dongguan, China
- VasoTech, Inc., Lowell, MA, USA
| | - Jianmin Xiao
- Central Laboratory, The Dongguan Affiliated Hospital of Jinan University, Binhaiwan Central Hospital of Dongguan, Dongguan, China.
- Department of Cardiology, The Dongguan Affiliated Hospital of Jinan University, Binhaiwan Central Hospital of Dongguan, Dongguan, China.
- Department of The First Clinical Medical College, Jinan University, Guangzhou, China.
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14
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Bone Union Quality after Fracture Fixation of Mandibular Head with Compression Magnesium Screws. MATERIALS 2022; 15:ma15062230. [PMID: 35329682 PMCID: PMC8950275 DOI: 10.3390/ma15062230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/13/2022] [Accepted: 03/15/2022] [Indexed: 12/22/2022]
Abstract
For some years now, fixation devices created with resorbable magnesium alloys for the mandibular head have been clinically available and are beginning to be used. It is thus valuable to evaluate the quality of unions in these cases. The aim of this study was radiological comparison of magnesium versus titanium open reduction and rigid fixations in the mandible condylar head. Thirty-one patients were treated for fractures of the mandibular head with magnesium WE43 alloy headless compression screws (diameter 2.3 mm) and, as a reference group, 29 patients were included with similar construction titanium screws (diameter 1.8 mm). The 12-month results of the treatment were evaluated by the texture analysis of CT. Near similar treatment results were found with magnesium screws in traditional titanium fixation. Magnesium screws result in a higher density of the bone structure in the mandibular head. Conclusions: The quantitative evaluation of bone union after surgical treatment of mandibular head fracture with magnesium compression headless screws indicates that stable consolidation was achieved. Undoubtedly, the resorption process of the screws was found to be incomplete after 12 months, evidenced by a marked densification of the bone structure at the fracture site.
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15
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Augustin J, Feichtner F, Waselau AC, Julmi S, Klose C, Wriggers P, Maier HJ, Meyer-Lindenberg A. Effect of pore size on tissue ingrowth and osteoconductivity in biodegradable Mg alloy scaffolds. J Appl Biomater Funct Mater 2022; 20:22808000221078168. [PMID: 35189733 DOI: 10.1177/22808000221078168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Magnesium has mechanical properties similar to those of bone and is being considered as a potential bone substitute. In the present study, two different pore sized scaffolds of the Mg alloy LAE442, coated with magnesium fluoride, were compared. The scaffolds had interconnecting pores of either 400 (p400) or 500 µm (p500). ß-TCP served as control. Ten scaffolds per time group (6, 12, 24, 36 weeks) were implanted in the trochanter major of rabbits. Histological analyses, µCT scans, and SEM/EDX were performed. The scaffolds showed slow volume decreases (week 36 p400: 9.9%; p500: 7.5%), which were accompanied by uncritical gas releases. In contrast, ß-TCP showed accelerated resorption (78.5%) and significantly more new bone inside (18.19 ± 1.47 mm3). Bone fragments grew into p400 (0.17 ± 0.19 mm3) and p500 (0.36 ± 0.26 mm3), reaching the centrally located pores within p500 more frequently. In particular, p400 displayed a more uneven and progressively larger surface area (week 36 p400: 253.22 ± 19.44; p500: 219.19 ± 4.76 mm2). A better osseointegration of p500 was indicated by significantly more trabecular contacts and a 200 µm wide bone matrix being in the process of mineralization and in permanent contact with the scaffold. The number of macrophages and foreign body giant cells were at an acceptable level concerning resorbable biomaterials. In terms of ingrown bone and integrative properties, LAE442 scaffolds could not achieve the results of ß-TCP. In this long-term study, p500 appears to be a biocompatible and more osteoconductive pore size for the Mg alloy LAE442.
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Affiliation(s)
- Julia Augustin
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Munich, Germany
| | - Franziska Feichtner
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Munich, Germany
| | - Anja-Christina Waselau
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Munich, Germany
| | - Stefan Julmi
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, Garbsen, Germany
| | - Christian Klose
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, Garbsen, Germany
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz Universität Hannover, Garbsen, Germany
| | - Hans Jürgen Maier
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, Garbsen, Germany
| | - Andrea Meyer-Lindenberg
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Munich, Germany
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16
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New way to obtain the poly(L-lactide-co-D,L-lactide) blend filled with nanohydroxyapatite as biomaterial for 3D-printed bone-reconstruction implants. Eur Polym J 2022. [DOI: 10.1016/j.eurpolymj.2022.110997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Yanagisawa Y, Shimizu Y, Mukai T, Sano Y, Odashima K, Ikeo N, Saito H, Yamauchi K, Takahashi T, Kumamoto H. Biodegradation behaviors of magnesium(Mg)-based alloy nails in autologous bone grafts: In vivo study in rabbit skulls. J Appl Biomater Funct Mater 2022; 20:22808000221095230. [PMID: 35599624 DOI: 10.1177/22808000221095230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE In this study, autologous bone grafts using bone-fixing nails made of magnesium-zinc-calcium ternary alloys were performed using rabbit skulls. MATERIAL AND METHODS Two types of nails for bone fixation were prepared: 2.5 mm width, 3 mm length and 2.5 mm width, 2 mm length. A disk-shaped bone with a diameter of 5 mm was resected from the parietal bone and fixed with a 3 mm long nail. As a control group, a 2 mm long nail was driven into the existing bone. The rabbits were sacrificed at 1, 4, 12, and 24 weeks after surgery. The resected samples were observed with micro X-ray CT, and embedded in methyl methacrylate to prepare non-decalcified specimens. The in vivo localization of elements was examined using energy-dispersive X-ray spectroscopy (EDS). RESULTS Micro X-ray CT images of samples showed volume reduction due to degradation in both the bone graft and control groups. No significant difference in the amount of degradation between the two groups was observed, however characteristic degradation processes were observed in each group. The samples stained with alizarin red S showed amorphous areas around the nails, which were considered as corrosion products and contacted directly with the newly formed bones. EDS analysis showed that corrosion products were mainly composed of magnesium and oxygen at an early stage, while calcium and phosphorus were detected on the surface layer during the long-term observation. CONCLUSIONS The degradation speed of the magnesium alloy nails varied depending on the shapes of the nails and surrounding tissue conditions. A calcium phosphate layer was formed on the surface of magnesium alloy nails, suggesting that the degradation rate of the nail was slow.
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Affiliation(s)
- Yuta Yanagisawa
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan.,Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Yoshinaka Shimizu
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Toshiji Mukai
- Department of Mechanical Engineering, Kobe University, Kobe, Hyogo, Japan
| | - Yuya Sano
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kenji Odashima
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan.,Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Naoko Ikeo
- Department of Mechanical Engineering, Kobe University, Kobe, Hyogo, Japan
| | - Haruka Saito
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Hiroyuki Kumamoto
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
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Agarwal M, Singh A, Muthunagai R, Mehta R, Karpagavalli S, Sharma S, Prasad GA. Experience with resorbable plates for fixation of mandible fracture. A prospective study of 10 cases. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S845-S849. [PMID: 36110805 PMCID: PMC9469250 DOI: 10.4103/jpbs.jpbs_22_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/23/2022] [Indexed: 12/02/2022] Open
Abstract
Aim: This study aims to evaluate the efficacy of resorbable plates for the fixation of mandible fracture. Materials and Methods: 10 cases of fracture mandible were treated with resorbable plates using the Inion CPS system. Patients were evaluated during their entire hospital stay and recalled on 1st, 4th, and 8th postoperative weeks. A thorough evaluation was done at the recall visits for any surgical and postoperative complications such as infection, malocclusion, neural abnormalities, wound or suture dehiscence, segmental mobility, foreign body reaction, and pain on biting. Bite force measurements were taken to evaluate the return of function. Results: Clinical union of the fracture was noted at the 8th week follow-up examination for all cases. There were swelling and pain at the operated site at 8th week follow-up for one patient, which was managed conservatively. The mean bite force was recorded for different regions and it increased over the entire follow-up period progressively. Conclusion: These plates and screws are an essential tool in the treatment of mandibular fractures owing to benefits such as biodegradability, biocompatibility, and the ability to be eliminated via the body's natural processes.
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19
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Sharma S, Basu B. Biomaterials assisted reconstructive urology: The pursuit of an implantable bioengineered neo-urinary bladder. Biomaterials 2021; 281:121331. [PMID: 35016066 DOI: 10.1016/j.biomaterials.2021.121331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 12/27/2022]
Abstract
Urinary bladder is a dynamic organ performing complex physiological activities. Together with ureters and urethra, it forms the lower urinary tract that facilitates urine collection, low-pressure storage, and volitional voiding. However, pathological disorders are often liable to cause irreversible damage and compromise the normal functionality of the bladder, necessitating surgical intervention for a reconstructive procedure. Non-urinary autologous grafts, primarily derived from gastrointestinal tract, have long been the gold standard in clinics to augment or to replace the diseased bladder tissue. Unfortunately, such treatment strategy is commonly associated with several clinical complications. In absence of an optimal autologous therapy, a biomaterial based bioengineered platform is an attractive prospect revolutionizing the modern urology. Predictably, extensive investigative research has been carried out in pursuit of better urological biomaterials, that overcome the limitations of conventional gastrointestinal graft. Against the above backdrop, this review aims to provide a comprehensive and one-stop update on different biomaterial-based strategies that have been proposed and explored over the past 60 years to restore the dynamic function of the otherwise dysfunctional bladder tissue. Broadly, two unique perspectives of bladder tissue engineering and total alloplastic bladder replacement are critically discussed in terms of their status and progress. While the former is pivoted on scaffold mediated regenerative medicine; in contrast, the latter is directed towards the development of a biostable bladder prosthesis. Together, these routes share a common aspiration of designing and creating a functional equivalent of the bladder wall, albeit, using fundamentally different aspects of biocompatibility and clinical needs. Therefore, an attempt has been made to systematically analyze and summarize the evolution of various classes as well as generations of polymeric biomaterials in urology. Considerable emphasis has been laid on explaining the bioengineering methodologies, pre-clinical and clinical outcomes. Some of the unaddressed challenges, including vascularization, innervation, hollow 3D prototype fabrication and urinary encrustation, have been highlighted that currently delay the successful commercial translation. More importantly, the rapidly evolving and expanding concepts of bioelectronic medicine are discussed to inspire future research efforts towards the further advancement of the field. At the closure, crucial insights are provided to forge the biomaterial assisted reconstruction as a long-term therapeutic strategy in urological practice for patients' care.
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Affiliation(s)
- Swati Sharma
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore, 560012, India
| | - Bikramjit Basu
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore, 560012, India; Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, 560012, India.
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20
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Ngo HX, Bai Y, Sha J, Ishizuka S, Toda E, Osako R, Kato A, Morioka R, Ramanathan M, Tatsumi H, Okui T, Kanno T. A Narrative Review of u-HA/PLLA, a Bioactive Resorbable Reconstruction Material: Applications in Oral and Maxillofacial Surgery. MATERIALS 2021; 15:ma15010150. [PMID: 35009297 PMCID: PMC8746248 DOI: 10.3390/ma15010150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022]
Abstract
The advent of bioresorbable materials to overcome limitations and replace traditional bone-reconstruction titanium-plate systems for bone fixation, thus achieving greater efficiency and safety in medical and dental applications, has ushered in a new era in biomaterial development. Because of its bioactive osteoconductive ability and biocompatibility, the forged composite of uncalcined/unsintered hydroxyapatite and poly L-lactic acid (u-HA/PLLA) has attracted considerable interest from researchers in bone tissue engineering, as well as from clinicians, particularly for applications in maxillofacial reconstructive surgery. Thus, various in vitro studies, in vivo studies, and clinical trials have been conducted to investigate the feasibility and weaknesses of this biomaterial in oral and maxillofacial surgery. Various technical improvements have been proposed to optimize its advantages and limit its disadvantages. This narrative review presents an up-to-date, comprehensive review of u-HA/PLLA, a bioactive osteoconductive and bioresorbable bone-reconstruction and -fixation material, in the context of oral and maxillofacial surgery, notably maxillofacial trauma, orthognathic surgery, and maxillofacial reconstruction. It simultaneously introduces new trends in the development of bioresorbable materials that could used in this field. Various studies have shown the superiority of u-HA/PLLA, a third-generation bioresorbable biomaterial with high mechanical strength, biocompatibility, and bioactive osteoconductivity, compared to other bioresorbable materials. Future developments may focus on controlling its bioactivity and biodegradation rate and enhancing its mechanical strength.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Takahiro Kanno
- Correspondence: ; Tel.: +81-(0)853-20-2301; Fax: +81-(0)853-20-2299
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21
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Mei X, Ye D, Zhang F, Di C. Implantable application of polymer‐based biosensors. JOURNAL OF POLYMER SCIENCE 2021. [DOI: 10.1002/pol.20210543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Xiangyuan Mei
- Beijing National Laboratory for Molecular Sciences, CAS Key Laboratory of Organic Solids Institute of Chemistry, Chinese Academy of Sciences Beijing China
- School of Chemical Sciences University of Chinese Academy of Sciences Beijing China
| | - Dekai Ye
- Beijing National Laboratory for Molecular Sciences, CAS Key Laboratory of Organic Solids Institute of Chemistry, Chinese Academy of Sciences Beijing China
| | - Fengjiao Zhang
- School of Chemical Sciences University of Chinese Academy of Sciences Beijing China
| | - Chong‐an Di
- Beijing National Laboratory for Molecular Sciences, CAS Key Laboratory of Organic Solids Institute of Chemistry, Chinese Academy of Sciences Beijing China
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22
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Usami T, Takada N, Sakai H, Endo S, Sekiya I, Ueki Y, Murakami H, Kuroyanagi G. Treatment of patellar fractures using bioresorbable forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide cannulated screws and nonabsorbable sutures. Injury 2021; 52:1587-1591. [PMID: 33386156 DOI: 10.1016/j.injury.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/16/2020] [Accepted: 12/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) implants are widely used in surgeries because they possess high mechanical strength, bioactivity, and radio-opacity. We previously reported that F-u-HA/PLLA implants were useful for treating lateral tibial condylar, lateral humeral condylar, and ankle fractures. The study aim was to investigate the efficacy of F-u-HA/PLLA cannulated screws and FiberLoop® for treating transverse patellar fractures. METHODS From April 2013 to February 2019, 15 patients with transverse patellar fractures were treated with F-u-HA/PLLA cannulated screws and FiberLoop® as follows: Open reduction and internal fixation (ORIF) were performed with two F-u-HA/PLLA cannulated screws and a temporary fixation Kirshner wire (K-wire). Three No. 2 FiberLoops® were inserted into these two screw holes and the K-wire hole for temporary fixation. All patients were allowed to full weight-bearing gaits using a knee brace. Knee range of motion exercise was initiated on postoperative day 1. Knee flexion was restricted to ≤90° for 1 month postoperatively. Radiograph was performed to evaluate fracture healing, screw breakage, reduction loss, and screw radio-opacity. Clinical outcomes and postoperative complications were assessed. RESULTS The average follow-up was 16.0 months. All fractures were successfully united. Screw breakage, reduction loss, osteolysis, and radiolucent zones around the screws were not observed at the final radiographic follow-up. All F-u-HA/PLLA screw shadows were observed during the follow-up. The average range of flexion and extension were 132.0° and -2.7°, respectively. No patients experienced deep infection episodes, late aseptic tissue reactions, or foreign body reactions postoperatively. No patients complained of pain at the final follow-up. All patients returned to their pre-injury work level and activities of daily living. CONCLUSION Our results strongly suggest that ORIF with F-u-HA/PLLA screws and FiberLoop® could be an alternative treatment option for transverse patellar fractures.
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Affiliation(s)
- Takuya Usami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Orthopedic Surgery, Kainan Hospital, Yatomi, Japan
| | - Naoya Takada
- Department of Orthopedic Surgery, Kainan Hospital, Yatomi, Japan
| | - Hiroaki Sakai
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinichiro Endo
- Department of Orthopedic Surgery, Kainan Hospital, Yatomi, Japan; Department of Orthopedic Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Isato Sekiya
- Department of Orthopedic Surgery, Kainan Hospital, Yatomi, Japan
| | - Yoshino Ueki
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Gen Kuroyanagi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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23
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Lee JS, Park TH, Ryu JY, Kim DK, Oh EJ, Kim HM, Shim JH, Yun WS, Huh JB, Moon SH, Kang SS, Chung HY. Osteogenesis of 3D-Printed PCL/TCP/bdECM Scaffold Using Adipose-Derived Stem Cells Aggregates; An Experimental Study in the Canine Mandible. Int J Mol Sci 2021; 22:ijms22115409. [PMID: 34063742 PMCID: PMC8196585 DOI: 10.3390/ijms22115409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/20/2022] Open
Abstract
Three-dimensional (3D) printing is perceived as an innovative tool for change in tissue engineering and regenerative medicine based on research outcomes on the development of artificial organs and tissues. With advances in such technology, research is underway into 3D-printed artificial scaffolds for tissue recovery and regeneration. In this study, we fabricated artificial scaffolds by coating bone demineralized and decellularized extracellular matrix (bdECM) onto existing 3D-printed polycaprolactone/tricalcium phosphate (PCL/TCP) to enhance osteoconductivity and osteoinductivity. After injecting adipose-derived stem cells (ADSCs) in an aggregate form found to be effective in previous studies, we examined the effects of the scaffold on ossification during mandibular reconstruction in beagle dogs. Ten beagles were divided into two groups: group A (PCL/TCP/bdECM + ADSC injection; n = 5) and group B (PCL/TCP/bdECM; n = 5). The results were analyzed four and eight weeks after intervention. Computed tomography (CT) findings showed that group A had more diffuse osteoblast tissue than group B. Evidence of infection or immune rejection was not detected following histological examination. Goldner trichrome (G/T) staining revealed rich ossification in scaffold pores. ColI, Osteocalcin, and Runx2 gene expressions were determined using real-time polymerase chain reaction. Group A showed greater expression of these genes. Through Western blotting, group A showed a greater expression of genes that encode ColI, Osteocalcin, and Runx2 proteins. In conclusion, intervention group A, in which the beagles received the additional ADSC injection together with the 3D-printed PCL/TCP coated with bdECM, showed improved mandibular ossification in and around the pores of the scaffold.
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Affiliation(s)
- Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
| | - Tae Hyun Park
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
| | - Jeong Yeop Ryu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
| | - Dong Kyu Kim
- TINA Aesthetic Surgical Clinic, Daegu 41938, Korea;
| | - Eun Jung Oh
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
- Cell & Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Hyun Mi Kim
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
- Cell & Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Jin-Hyung Shim
- Department of Mechanical Engineering, Korea Polytechnic University, 237 Sangidaehak-Ro, Siheung-si 15073, Gyeonggi-do, Korea; (J.-H.S.); (W.-S.Y.)
- Research Institute, T&R Biofab Co., Ltd. 242 Pangyo-ro, Seongnam-si 13487, Gyeonggi-do, Korea;
| | - Won-Soo Yun
- Department of Mechanical Engineering, Korea Polytechnic University, 237 Sangidaehak-Ro, Siheung-si 15073, Gyeonggi-do, Korea; (J.-H.S.); (W.-S.Y.)
- Research Institute, T&R Biofab Co., Ltd. 242 Pangyo-ro, Seongnam-si 13487, Gyeonggi-do, Korea;
| | - Jung Bo Huh
- Department of Prosthodontics, Dental Research Institute, Institute of Translational Dental Science, School of Dentistry, Pusan National University, Yangsan-si 50612, Korea;
| | - Sung Hwan Moon
- Research Institute, T&R Biofab Co., Ltd. 242 Pangyo-ro, Seongnam-si 13487, Gyeonggi-do, Korea;
| | - Seong Soo Kang
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea;
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (J.S.L.); (T.H.P.); (J.Y.R.); (E.J.O.); (H.M.K.)
- Cell & Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- BK21 FOUR KNU Convergence Educational Program of Biomedical Science for Creative Future Talents, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence: or ; Tel.: +82-53-420-5692; Fax: +82-53-425-3879
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Xing Z, Jiang X, Si Q, Finne-Wistrand A, Liu B, Xue Y, Mustafa K. Endochondral Ossification Induced by Cell Transplantation of Endothelial Cells and Bone Marrow Stromal Cells with Copolymer Scaffold Using a Rat Calvarial Defect Model. Polymers (Basel) 2021; 13:polym13091521. [PMID: 34065081 PMCID: PMC8125936 DOI: 10.3390/polym13091521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
It has been recently reported that, in a rat calvarial defect model, adding endothelial cells (ECs) to a culture of bone marrow stromal cells (BMSCs) significantly enhanced bone formation. The aim of this study is to further investigate the ossification process of newly formed osteoid and host response to the poly(L-lactide-co-1,5-dioxepan-2-one) [poly(LLA-co-DXO)] scaffolds based on previous research. Several different histological methods and a PCR Array were applied to evaluate newly formed osteoid after 8 weeks after implantation. Histological results showed osteoid formed in rat calvarial defects and endochondral ossification-related genes, such as dentin matrix acidic phosphoprotein 1 (Dmp1) and collagen type II, and alpha 1 (Col2a1) exhibited greater expression in the CO (implantation with BMSC/EC/Scaffold constructs) than the BMSC group (implantation with BMSC/Scaffold constructs) as demonstrated by PCR Array. It was important to notice that cartilage-like tissue formed in the pores of the copolymer scaffolds. In addition, multinucleated giant cells (MNGCs) were observed surrounding the scaffold fragments. It was concluded that the mechanism of ossification might be an endochondral ossification process when the copolymer scaffolds loaded with co-cultured ECs/BMSCs were implanted into rat calvarial defects. MNGCs were induced by the poly(LLA-co-DXO) scaffolds after implantation, and more specific in vivo studies are needed to gain a better understanding of host response to copolymer scaffolds.
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Affiliation(s)
- Zhe Xing
- School of Stomatology, Lanzhou University, Lanzhou 730000, China; (Z.X.); (X.J.); (Q.S.)
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, 5009 Bergen, Norway;
| | - Xiaofeng Jiang
- School of Stomatology, Lanzhou University, Lanzhou 730000, China; (Z.X.); (X.J.); (Q.S.)
| | - Qingzong Si
- School of Stomatology, Lanzhou University, Lanzhou 730000, China; (Z.X.); (X.J.); (Q.S.)
| | - Anna Finne-Wistrand
- Department of Fibre and Polymer Technology, KTH Royal Institute of Technology, Teknikringen 56-58, SE 100-44 Stockholm, Sweden;
| | - Bin Liu
- School of Stomatology, Lanzhou University, Lanzhou 730000, China; (Z.X.); (X.J.); (Q.S.)
- Correspondence: (B.L.); (Y.X.); Tel.: +86-9318915051 (B.L.); +47-55586519 (Y.X.)
| | - Ying Xue
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, 5009 Bergen, Norway;
- Correspondence: (B.L.); (Y.X.); Tel.: +86-9318915051 (B.L.); +47-55586519 (Y.X.)
| | - Kamal Mustafa
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, 5009 Bergen, Norway;
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Change in Pull-Out Force during Resorption of Magnesium Compression Screws for Osteosynthesis of Mandibular Condylar Fractures. MATERIALS 2021; 14:ma14020237. [PMID: 33418924 PMCID: PMC7825024 DOI: 10.3390/ma14020237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Magnesium has been used as degradable fixation material for osteosynthesis, but it seems that mechanical strength is still a current issue in these fixations. The aim of this study was to evaluate the axial pull-out force of compression headless screws made of magnesium alloy during their resorption. METHODS The tests included screws made for osteosynthesis of the mandible head: 2.2 mm diameter magnesium alloy MgYREZr (42 screws) and 2.5 mm diameter polylactic-co-glycolic acid (PLGA) (42 pieces, control). The screws were resorbed in Sørensen's buffer for 2, 4, 8, 12, and 16 weeks, and force was measured as the screw was pulled out from the polyurethane block. RESULTS The force needed to pull the screw out was significantly higher for MgYREZr screws than for PLGA ones (p < 0.01). Within eight weeks, the pull-out force for MgYREZr significantly decreased to one third of its initial value (p < 0.01). The dynamics of this decrease were greater than those of the pull-out force for PLGA screws (p < 0.05). After these eight weeks, the values for metal and polymer screws equalized. It seems that the described reduction of force requires taking into account when using magnesium screws. This will provide more stable resorbable metallic osteosynthesis.
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Kosugi K, Zenke Y, Tajima T, Yamanaka Y, Menuki K, Sakai A. Long-term outcomes of metacarpal fractures surgically treated using bioabsorbable plates: a retrospective study. BMC Musculoskelet Disord 2020; 21:817. [PMID: 33287779 PMCID: PMC7722336 DOI: 10.1186/s12891-020-03841-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background Implants made from bioabsorbable unsintered hydroxyapatite and poly-L-lactate composites (u-HA/PLLA) are widely used in the oral, maxillofacial, and orthopedic fields. This study assess the long-term (> 5 years) outcomes of patients with metacarpal fractures who were surgically treated using bioabsorbable plates and screws (Super-Fixsorb MX40 mesh; Teijin Medical Technology, Osaka, Japan). Methods A retrospective analysis of six patients with eight metacarpal fractures treated with bioabsorbable plates was done. All patients were followed for more than 5 years post-surgery. The clinical outcomes were evaluated using Q-DASH scores and the grip strength (GS): opposite side ratio. The resorption status of implants was assessed on plain computed tomography (CT) scans at final follow-up appointments. Results The mean age of the patients at the time of surgery was 29.5 years (16–54), and the median follow-up period was 81.8 months (68–101). All fractures united without displacement after an average of 3.5 months, and there were no implant specific complications associated with the use of absorbable plates. The mean grip strength ratio was 85.1% (56.8–104.5). The mean Q-DASH scores of 11.36 points (0–34.09) was good in all but two patients. We also observed that it took more than 8 years for the plates to be absorbed completely. Conclusions This study demonstrates that the process of bioabsorption in metacarpal fractures might be completed in about 8 years, and the absorption speeds were different inside and outside of the bone. The bioabsorbable plates are more cost-effective than metallic implants. The potential for bioabsorbable plates to be used in various clinical procedures is promising. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03841-x.
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Affiliation(s)
- Kenji Kosugi
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yukichi Zenke
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Takafumi Tajima
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yoshiaki Yamanaka
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Kunitaka Menuki
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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Li R, Wang H, John JV, Song H, Teusink MJ, Xie J. 3D Hybrid Nanofiber Aerogels Combining with Nanoparticles Made of a Biocleavable and Targeting Polycation and MiR-26a for Bone Repair. ADVANCED FUNCTIONAL MATERIALS 2020; 30:2005531. [PMID: 34326714 PMCID: PMC8315031 DOI: 10.1002/adfm.202005531] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 05/24/2023]
Abstract
The healing of large bone defects represents a clinical challenge, often requiring some form of grafting. Three-dimensional (3D) nanofiber aerogels could be a promising bone graft due to their biomimetic morphology and controlled porous structures and composition. miR-26a has been reported to induce the differentiation of bone marrow-derived mesenchymal stem cells (BMSCs) and facilitate bone formation. Introducing miR-26a with a suitable polymeric vector targeting BMSCs could improve and enhance the functions of 3D nanofiber aerogels for bone regeneration. Herein, we first developed the comb-shaped polycation (HA-SS-PGEA) carrying a targeting component, biocleavable groups and short ethanolamine (EA)-decorated poly(glycidyl methacrylate) (PGMA) (abbreviated as PGEA) arms as miR-26a delivery vector. We then assessed the cytotoxicity and transfection efficiency of this polycation and cellular response to miR-26a-incorporated nanoparticles (NPs) in vitro. HA-SS-PGEA exhibited a stronger ability to transport miR-26a and exert its functions than the gold standard polyethyleneimine (PEI) and low-molecular-weight linear PGEA. We finally examined the efficacy of HA-SS-PGEA/miR-26a NPs loaded 3D hybrid nanofiber aerogels showing a positive effect on the cranial bone defect healing. Together, the combination of 3D nanofiber aerogels and functional NPs consisting of a biodegradable and targeting polycation and therapeutic miRNA could be a promising approach for bone regeneration.
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Affiliation(s)
- Ruiquan Li
- Department of Surgery-Transplant and Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68130, United States
| | - Hongjun Wang
- Department of Surgery-Transplant and Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68130, United States
| | - Johnson V John
- Department of Surgery-Transplant and Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68130, United States
| | - Haiqing Song
- Department of Chemical Engineering, University of Illinois at Chicago, Chicago, IL 60607, United States
| | - Matthew J Teusink
- Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Jingwei Xie
- Department of Surgery-Transplant and Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68130, United States
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Comparison of the mechanical properties of biodegradable and titanium osteosynthesis systems used in oral and maxillofacial surgery. Sci Rep 2020; 10:18143. [PMID: 33097757 PMCID: PMC7584639 DOI: 10.1038/s41598-020-75299-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022] Open
Abstract
To guide the selection of osteosynthesis systems, this study compared the mechanical properties of biodegradable and titanium osteosynthesis systems. SonicPins Rx and xG were subjected to pull-out tests. Additionally, 15 biodegradable (Inion CPS 2.0 and 2.5 mm; LactoSorb 2.0 mm; Macropore 2.0 mm; Polymax 2.0 mm; BioSorb FX 2.0 mm; ResorbX 2.1 mm; Osteotrans-MX 2.0 mm with plate thicknesses 1.0 and 1.4 mm; SonicWeld Rxplate/Rxpins, xGplate/Rxpins and xGplate/xGpins 2.1 mm without and with tapping the burr hole) and six titanium (CrossDrive (2006), CrossDrive (2018), MaxDrive; all 1.5 and 2.0 mm) straight, four-hole osteosynthesis systems were evaluated. All systems were subjected to tensile, bending and torsion tests. Pull-out loads of the SonicPins were comparable (P = 0.423). Titanium systems’ tensile loads were higher than biodegradable systems (P < 0.001). CrossDrive (2018) and MaxDrive systems’ tensile and torsional stiffness were lower, accompanied with higher ductility, than corresponding CrossDrive (2006) systems (P < 0.001). Bending stiffness of 1.5 mm titanium systems was comparable to, and of the 2.0 mm systems higher than, all biodegradable systems (P < 0.001). Regarding biodegradable systems, Inion CPS 2.5 mm had highest tensile load and torsional stiffness, SonicWeld 2.1 mm highest tensile stiffness, and BioSorbFX 2.0 mm highest bending stiffness (P < 0.001). On the basis of the results of this study, the CrossDrive (2018) and MaxDrive 1.5 mm titanium systems are recommended for midface fractures (e.g., zygomatic or maxillary fractures) and osteotomies (e.g., Le Fort I osteotomy), and the CrossDrive (2018) and MaxDrive 2.0 mm titanium systems for mandibular fractures and osteotomies when a titanium osteosynthesis system is used. When there is an indication for a biodegradable osteosynthesis system, the SonicWeld 2.1 mm or BioSorbFX 2.0 mm are recommended for midface fractures and osteotomies, and the Inion CPS 2.5 mm biodegradable system for mandibular osteotomies and non-load bearing mandibular fractures, especially when high torsional forces are expected (e.g., mandibular symphysis fractures).
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Nabavi MH, Salehi M, Ehterami A, Bastami F, Semyari H, Tehranchi M, Nabavi MA, Semyari H. A collagen-based hydrogel containing tacrolimus for bone tissue engineering. Drug Deliv Transl Res 2020; 10:108-121. [PMID: 31428941 DOI: 10.1007/s13346-019-00666-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bone tissue engineering aims to develop bone graft structure that can heal bone defects without using autografts or allografts. The current study was conducted to promote bone regeneration using a collagen type I hydrogel containing tacrolimus. For this purpose, different amounts of tacrolimus (10 μg/ml, 100 μg/ml, and 1000 μg/ml) were loaded into the hydrogel. The resulting drug-loaded hydrogels were characterized for their porosity, swelling capacity, weight loss, drug release, blood compatibility, and cell proliferation (MTT). For functional analysis, the developed hydrogel surrounded by a film made of gelatin and polycaprolactone (PCL) was administrated in the calvarias defect of Wistar rats. The results indicated that the hydrogel has a porosity of 89.2 ± 12.5% and an appropriate swelling, drug release, and blood compatibility behavior. The in vitro results indicated that the collagen hydrogel containing 1000 μg tacrolimus was adequate in terms of cell proliferation. Finally, in vivo studies provided some evidence of the potential of the developed hydrogel for bone healing.
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Affiliation(s)
- Mir Hamed Nabavi
- Faculty of Dentistry, Shahed University of Medical Sciences, Tehran, Iran
| | - Majid Salehi
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran.
- Tissue Engineering and Stem Cells Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Arian Ehterami
- Department of Mechanical and Aerospace Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Farshid Bastami
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Oral and Maxillofacial Surgery Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Semyari
- Faculty of Dentistry, Shahed University of Medical Sciences, Tehran, Iran
| | - Maryam Tehranchi
- Faculty of Dentistry, Shahed University of Medical Sciences, Tehran, Iran
| | - Mir Ahmad Nabavi
- Faculty of Dentistry, Shahed University of Medical Sciences, Tehran, Iran
| | - Hossein Semyari
- Faculty of Dentistry, Shahed University of Medical Sciences, Tehran, Iran
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Chai G, Zhang D, Hua W, Yin J, Jin Y, Chen M. Theoretical model of pediatric orbital trapdoor fractures and provisional personalized 3D printing-assisted surgical solution. Bioact Mater 2020; 6:559-567. [PMID: 33005822 PMCID: PMC7501422 DOI: 10.1016/j.bioactmat.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 01/06/2023] Open
Abstract
Pediatric orbital trapdoor fractures are common in children and adolescents and usually require emergency surgical intervention. Herein, a personalized 3D printing-assisted approach to surgical treatment is proposed, serving to accurately and effectively repair pediatric orbital trapdoor fractures. We first investigated stress distribution in external force-induced orbital blowout fractures via numerical simulation, determining that maximum stresses on inferior and medial walls exceed those on superior and lateral walls and thus confer higher probability of fracture. We also examined 36 pediatric patients treated for orbital trapdoor fractures between 2014 and 2019 to verify our theoretical construct. Using 3D printing technique, we then created orbital models based on computed tomography (CT) studies of these patients. Absorbable implants were tailor-made, replicating those of 3D-printed models during surgical repairs of fractured orbital bones. As follow-up, we compared CT images and clinical parameters (extraocular movements, diplopia, enophthalmos) before and 12 months after operative procedures. There were only two patients with diplopia and six with enophthalmos >2 mm at 12 months, attesting to the efficacy of our novel 3D printing-assisted strategy. Numerical simulation is used to theoretically investigate the mechanism of external force-induced orbital blowout fractures. 3D printing--assisted surgical treatment is proposed to effectively repair pediatric orbital trapdoor fractures. Clinical studies are performed by repairing fractured orbital bones via 3D printed customized absorbable implants.
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Affiliation(s)
- Guangrui Chai
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Deming Zhang
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL 32611, USA.,The State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, Zhejiang 310027, China
| | - Weijian Hua
- Department of Mechanical Engineering, University of Nevada Reno, Reno, NV, 89557, USA
| | - Jun Yin
- The State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, Zhejiang 310027, China
| | - Yifei Jin
- Department of Mechanical Engineering, University of Nevada Reno, Reno, NV, 89557, USA
| | - Ming Chen
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
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Ahmadipour M, Mohammadi H, Pang AL, Arjmand M, Ayode Otitoju T, U. Okoye P, Rajitha B. A review: silicate ceramic-polymer composite scaffold for bone tissue engineering. INT J POLYM MATER PO 2020. [DOI: 10.1080/00914037.2020.1817018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mohsen Ahmadipour
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Penang, Malaysia
| | - Hossein Mohammadi
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Penang, Malaysia
| | - Ai Ling Pang
- Faculty of Engineering, School of Chemical and Energy Engineering, UTM-MPRC Institute for Oil and Gas, Universiti Teknologi Malaysia, UTM Johor Bahru, Malaysia
| | - Mohammad Arjmand
- School of Engineering, University of British Columbia, Kelowna, BC, Canada
| | - Tunmise Ayode Otitoju
- School of Materials Science and Engineering, Shenyang University of Technology, Shenyang, China
| | - Patrick U. Okoye
- Laboratorio de Bioenergía, Instituto de Energías Renovables (IER-UNAM), Temixco, Morelos, México
| | - Beerelli Rajitha
- BVIRT Hyderabad College of Engineering for woman, Hyderabad, India
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Biomechanical comparison of polylactide-based versus titanium miniplates in mandible reconstruction in vitro. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:377-382. [DOI: 10.1016/j.jormas.2019.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/01/2019] [Accepted: 12/11/2019] [Indexed: 12/28/2022]
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On SW, Cho SW, Byun SH, Yang BE. Bioabsorbable Osteofixation Materials for Maxillofacial Bone Surgery: A Review on Polymers and Magnesium-Based Materials. Biomedicines 2020; 8:biomedicines8090300. [PMID: 32825692 PMCID: PMC7555479 DOI: 10.3390/biomedicines8090300] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/24/2023] Open
Abstract
Clinical application of osteofixation materials is essential in performing maxillofacial surgeries requiring rigid fixation of bone such as trauma surgery, orthognathic surgery, and skeletal reconstruction. In addition to the use of titanium plates and screws, clinical applications and attempts using bioabsorbable materials for osteofixation surgery are increasing with demands to avoid secondary surgery for the removal of plates and screws. Synthetic polymeric plates and screws were developed, reaching satisfactory physical properties comparable to those made with titanium. Although these polymeric materials are actively used in clinical practice, there remain some limitations to be improved. Due to questionable physical strength and cumbersome molding procedures, interests in resorbable metal materials for osteofixation emerged. Magnesium (Mg) gained attention again in the last decade as a new metallic alternative, and numerous animal studies to evaluate the possibility of clinical application of Mg-based materials are being conducted. Thanks to these researches and studies, vascular application of Mg-based biomaterials was successful; however, further studies are required for the clinical application of Mg-based biomaterials for osteofixation, especially in the facial skeleton. The review provides an overview of bioabsorbable osteofixation materials in maxillofacial bone surgery from polymer to Mg.
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Affiliation(s)
- Sung-Woon On
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea;
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
| | - Seoung-Won Cho
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Korea
| | - Soo-Hwan Byun
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Korea
| | - Byoung-Eun Yang
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Korea
- Correspondence: ; Tel.: +82-380-3870
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Hu X, He J, Yong X, Lu J, Xiao J, Liao Y, Li Q, Xiong C. Biodegradable poly (lactic acid-co-trimethylene carbonate)/chitosan microsphere scaffold with shape-memory effect for bone tissue engineering. Colloids Surf B Biointerfaces 2020; 195:111218. [PMID: 32650218 DOI: 10.1016/j.colsurfb.2020.111218] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
Abstract
Poly (lactic acid) (PLA), although extensively used as biomedical materials, has the distinct disadvantage of producing acidic byproducts which can lead to tissue inflammatory reactions and clinic failure. Here we presented a combination of Poly (lactic acid-co-trimethylene carbonate) and natural polymer chitosan, improving its compression resilience and reducing its acidic byproducts. In this case, we developed 3D scaffolds using solvent/nonsolvent technique sintered PLA-TMC and PLA-TMC/Chitosan microspheres with selected particle size (355-500 μm). By controlling the preparation methods and parameters, the porosity, pore size and mechanical properties of microsphere scaffolds can be designed and controlled. Strikingly, PLA-TMC/15 % Chitosan microsphere scaffolds possess shape-memory effect and rapidly recovered to initial shape when heated to 37℃ within 300 s. The microsphere scaffolds had a 3D porous architecture with pore size ranging from 105.67 ± 12.51 μm to 129.69 ± 11.39 μm. The mechanical and physicochemical properties of microspheres and scaffolds were characterized in details. Moreover, all microsphere scaffolds were qualified as their compressive modulus (120.36 MPa -195.32 MPa) matched the cancellous bone during 16 weeks degradation. Furthermore, CCK8 cell proliferation assay and ALP activity assay verified that the scaffolds were non-toxic and conductive to cell adhesion. The scaffolds are expected to be used in bone regeneration and bone repair field.
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Affiliation(s)
- Xulin Hu
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, Sichuan 610041, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jian He
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, Sichuan 610041, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xin Yong
- State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu 610041, China
| | - Junlin Lu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jianping Xiao
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, Sichuan 610041, China
| | - Yijun Liao
- School of Materials and Environmental Engineering, Chengdu Technology University, Chengdu 610041, China
| | - Qing Li
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, Sichuan 610041, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chengdong Xiong
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, Sichuan 610041, China; University of Chinese Academy of Sciences, Beijing 100049, China.
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Kozakiewicz M. Are Magnesium Screws Proper for Mandibular Condyle Head Osteosynthesis? MATERIALS 2020; 13:ma13112641. [PMID: 32531885 PMCID: PMC7321625 DOI: 10.3390/ma13112641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
Recently, magnesium alloys have gained a significant amount of recognition as potential biomaterials for degradable implants for craniofacial bone screws. Purpose: The aim of this work was to compare screws made specifically for mandibular head osteosynthesis from different materials. Materials and Methods: Screws measuring 14 mm made by one manufacturer specifically for mandibular head osteosynthesis out of the following materials were selected: magnesium (MgYREZr), titanium (Ti6Al7Nb), and polymer (PLGA). The axial pull-out strength and torsional properties were investigated. Results: Each type of screw presented different pull-out forces (Kruskal–Wallis test, p < 0.001). The magnesium screw had the highest pull-out force of 399 N (cracked without the screw out being pulled out), followed by the titanium screw, with a force of 340 N, and the PLGA screw, with a force of 138 N (always cracked at the base of the screw head without the screw being pulled out). ANOVA was performed for the maximal torques before damage to the screw (torsional properties), revealing that the maximal torque of the magnesium screw was 16 N·cm, while that of the titanium screw was 19 N·cm. The magnesium screw was significantly weaker than the titanium screw (p < 0.05). The measured torque and pull-out force were not related to each other (p > 0.05). Conclusion: Among the screws compared, the metal biodegradable magnesium screw seems to be the most suitable material for multiscrew mandibular head osteosynthesis, considering the condition of the fragile screwdriver socket.
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Affiliation(s)
- Marcin Kozakiewicz
- Department of Maxillofacial Surgery, Medical University of Lodz, 1st Gen. J. Haller Pl., 90-647 Lodz, Poland
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36
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Augustin J, Feichtner F, Waselau AC, Julmi S, Klose C, Wriggers P, Maier HJ, Meyer-Lindenberg A. Comparison of two pore sizes of LAE442 scaffolds and their effect on degradation and osseointegration behavior in the rabbit model. J Biomed Mater Res B Appl Biomater 2020; 108:2776-2788. [PMID: 32170913 DOI: 10.1002/jbm.b.34607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/23/2020] [Accepted: 03/02/2020] [Indexed: 11/09/2022]
Abstract
The magnesium alloy LAE442 emerged as a possible bioresorbable bone substitute over a decade ago. In the present study, using the investment casting process, scaffolds of the Magnesium (Mg) alloy LAE442 with two different and defined pore sizes, which had on average a diameter of 400 μm (p400) and 500 μm (p500), were investigated to evaluate degradation and osseointegration in comparison to a ß-TCP control group. Open-pored scaffolds were implanted in both greater trochanter of rabbits. Ten scaffolds per time group (6, 12, 24, and 36 weeks) and type were analyzed by clinical, radiographic and μ-CT examinations (2D and 3D). None of the scaffolds caused adverse reactions. LAE442 p400 and p500 developed moderate gas accumulation due to the Mg associated in vivo corrosion, which decreased from week 20 for both pore sizes. After 36 weeks, p400 and p500 showed volume decreases of 15.9 and 11.1%, respectively, with homogeneous degradation, whereas ß-TCP lost 74.6% of its initial volume. Compared to p400, osseointegration for p500 was significantly better at week 2 postsurgery due to more frequent bone-scaffold contacts, higher number of trabeculae and higher bone volume in the surrounding area. No further significant differences between the two pore sizes became apparent. However, p500 was close to the values of ß-TCP in terms of bone volume and trabecular number in the scaffold environment, suggesting better osseointegration for the larger pore size.
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Affiliation(s)
- Julia Augustin
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Munich, Germany
| | - Franziska Feichtner
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Munich, Germany
| | - Anja-Christina Waselau
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Munich, Germany
| | - Stefan Julmi
- Institut für Werkstoffkunde, Leibniz Universität Hannover, An der Universität 2, Garbsen, Germany
| | - Christian Klose
- Institut für Werkstoffkunde, Leibniz Universität Hannover, An der Universität 2, Garbsen, Germany
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz Universität Hannover, Hannover, Germany
| | - Hans Jürgen Maier
- Institut für Werkstoffkunde, Leibniz Universität Hannover, An der Universität 2, Garbsen, Germany
| | - Andrea Meyer-Lindenberg
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Munich, Germany
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37
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Yanagibayashi S, Nishijima A, Yoshida R, Sasaki K, Yamamoto N, Takikawa M. Intramedullary fixation with bioabsorbable and osteoconductive hydroxyapatite/poly-L-lactide threaded pin in digital replantation. J Plast Surg Hand Surg 2020; 54:177-181. [PMID: 32153234 DOI: 10.1080/2000656x.2020.1738239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In digital replantation, Kirschner wire (K-wire) fixation has commonly been used for osteosynthesis. On the other hand, K-wires are often obtrusive because of protrusion from the replanted digit. We describe a case series treated using hydroxyapatite/poly-L-lactide (HPLLA) threaded pins, which are not only bioabsorbable, but also osteoconductive, for osteosynthesis in crushed amputation or comminuted fracture, including distal phalanx amputation. Using an HPLLA threaded pin, 10 digital replantations were performed between July 2016 and April 2018. The precisely cut pin is manually pushed into the fracture site as an intramedullary nail. The pin is first pushed into the distal site, and then into the proximal site, after drilling with a K-wire of the same diameter as the pin. All amputations were crush type, and levels of amputations were Tamai zone I in three cases, zone II in two and zone III in five. Eight of the 10 digits survived. The two digits that did not survive showed venous insufficiency. Bone union of the eight digits was successfully obtained after 9-19 weeks (median 12 weeks). No adverse events occurred such as distortion of the pin, infection or foreign body reaction. The HPLLA threaded pin may be an adequate device to fix fractures in digital replantation.
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Affiliation(s)
- Satoshi Yanagibayashi
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Japan
| | - Akio Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Japan.,Department of Plastic and Reconstructive Surgery, Institute Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryuichi Yoshida
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Japan
| | - Kaoru Sasaki
- Department of Plastic and Reconstructive Surgery, Institute Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoto Yamamoto
- Department of Plastic and Reconstructive Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Megumi Takikawa
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Japan
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38
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Byun SH, Lim HK, Cheon KH, Lee SM, Kim HE, Lee JH. Biodegradable magnesium alloy (WE43) in bone-fixation plate and screw. J Biomed Mater Res B Appl Biomater 2020; 108:2505-2512. [PMID: 32048809 PMCID: PMC7383574 DOI: 10.1002/jbm.b.34582] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/25/2019] [Accepted: 02/02/2020] [Indexed: 01/07/2023]
Abstract
The purpose of the present study was to evaluate the mechanical strength and the absorption rate of WE43 material and to develop an absorbable metallic plate and screw for craniofacial application. The extruded WE43 plate and screw were evaluated using a LeFort I osteotomy canine model of 10 beagle dogs. Animals were divided into two groups: five dogs in the experimental group and five dogs in the control group. μCT was acquired at 4, 12, and 24 weeks. At 24 weeks after the operation, all animals were sacrificed, and histologic evaluation was performed. Swelling and gas formation were observed in three dogs in the experimental groups at 8 weeks. From 12 weeks, infraorbital fistula and inflammation were observed in three dogs in the experimental group, which gradually decreased and disappeared at 24 weeks. Other two dogs showed less gas formation at 12 weeks. The plates were completely absorbed, and gas formation was not observed at 24 weeks in these two dogs. New bone was well formed around the plates and screws in both groups. Histologic examination showed no specific differences between two groups. The mechanical strength of extruded WE43 was sufficient for mid‐facial application. Plates and screws made with appropriately treated WE43 have the potential to be useful clinically.
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Affiliation(s)
- Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, Hallym University Medical Center, Dongtan Sacred Heart Hospital, Hwaseong, Korea.,Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Ho-Kyung Lim
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea.,Department of Oral and Maxillofacial Surgery, Korea Medical University Medical Center, Guro Hospital, Seoul, Korea
| | - Kwang-Hee Cheon
- Biomedical Implant Convergence Research Center, Advanced Institutes of Convergence Technology, Suwon, Korea.,Department of Material Science and Engineering, Seoul National University, Seoul, Korea
| | - Sung-Mi Lee
- Biomedical Implant Convergence Research Center, Advanced Institutes of Convergence Technology, Suwon, Korea.,Department of Material Science and Engineering, Seoul National University, Seoul, Korea
| | - Hyoun-Ee Kim
- Department of Material Science and Engineering, Seoul National University, Seoul, Korea
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
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39
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Shafaghi R, Rodriguez O, Phull S, Schemitsch EH, Zalzal P, Waldman SD, Papini M, Towler MR. Effect of TiO2 doping on degradation rate, microstructure and strength of borate bioactive glass scaffolds. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 107:110351. [DOI: 10.1016/j.msec.2019.110351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/16/2019] [Accepted: 10/20/2019] [Indexed: 12/15/2022]
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40
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Natural Sources and Applications of Demineralized Bone Matrix in the Field of Bone and Cartilage Tissue Engineering. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1249:3-14. [DOI: 10.1007/978-981-15-3258-0_1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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41
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Zha F, Chen W, Zhang L, Yu D. Electrospun natural polymer and its composite nanofibrous scaffolds for nerve tissue engineering. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2019; 31:519-548. [DOI: 10.1080/09205063.2019.1697170] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Fangwen Zha
- Department of Chemistry, MOE Key Laboratory for Non-Equilibrium Synthesis and Modulation of Condensed Matter, School of Science, State Key Laboratory of Electrical Insulation and Power Equipments, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Wei Chen
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, PR China
| | - Lifeng Zhang
- Department of Nanoengineering, Joint School of Nanoscience and Nanoengineering, NC A&T State University, Greensboro, NC, USA
| | - Demei Yu
- Department of Chemistry, MOE Key Laboratory for Non-Equilibrium Synthesis and Modulation of Condensed Matter, School of Science, State Key Laboratory of Electrical Insulation and Power Equipments, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
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Abstract
BACKGROUND Orbital fractures are one of the most common sequelae of facial trauma. OBJECTIVE The objective of this study was to summarize published data for resorbable implants in orbital reconstruction, including polymer composition, degradation characteristics, osteoconductivity, and complications such as enophthalmos, diplopia, and peri-implant inflammation. A literature search of the National Library of Medicine was performed via PubMed using the keyword resorbable orbital implant. A total of 27 studies were reviewed. Strength of data was assessed according to the Oxford Centre criteria. RESULTS Most commercially available implants provide adequate tensile strength for up to 6 months (with the exception of polydioxanone, which loses strength within 1 month, and poly(D,L-lactide) within 3 months). This is sufficient for the isolated orbital floor or medial wall (tensile strength, ~300 MPa) but insufficient for reconstruction of load-bearing areas (eg, the inferior orbital rim with tensile strength of ~1.2 GPa). Thicker products (>1 mm) have increased risk for delayed inflammation than thinner products. Postoperative complications including delayed inflammation (0%-9%), eyelid malposition (0%-5%), enophthalmos (5%-16%), diplopia (0%-16%), infection (0%-2%), and infraorbital nerve hypesthesia (2%-18%) are variably distributed across implants with several notable exceptions: poly(L-lactide) has an increased risk of delayed inflammation, and polydioxanone has a risk of delayed enophthalmos and hematoma. CONCLUSIONS Resorbable implants are suitable for isolated medial wall or floor fractures with intact bony buttresses and function as a barrier rather than a load-bearing support.
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43
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44
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Retrograde Intramedullary Absorbable Pin Fixation for Intraarticular Fracture of the Metacarpal Head. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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45
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Resorbable Implants for Mandibular Fracture Fixation: A Systematic Review and Meta-Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2384. [PMID: 31592391 PMCID: PMC6756660 DOI: 10.1097/gox.0000000000002384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 12/04/2022]
Abstract
Mandibular fractures in adults commonly require rigid fixation to ensure proper occlusion while minimizing infection risks. Numerous centers have assessed the efficacy of resorbable materials as a potential alternative to metallic plates. The purpose of the current systematic review and meta-analysis is to shed light on overall outcomes for resorbable implants and to compare these results to those for metallic counterparts.
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46
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Vacaras S, Baciut M, Lucaciu O, Dinu C, Baciut G, Crisan L, Hedesiu M, Crisan B, Onisor F, Armencea G, Mitre I, Barbur I, Kretschmer W, Bran S. Understanding the basis of medical use of poly-lactide-based resorbable polymers and composites – a review of the clinical and metabolic impact. Drug Metab Rev 2019; 51:570-588. [DOI: 10.1080/03602532.2019.1642911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Sergiu Vacaras
- Department of Cranio-Maxillofacial Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Mihaela Baciut
- Department of Oral Rehabilitation, Maxillofacial Surgery and Implantology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Ondine Lucaciu
- Department of Oral Rehabilitation, Maxillofacial Surgery and Implantology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Cranio-Maxillofacial Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Grigore Baciut
- Department of Cranio-Maxillofacial Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Liana Crisan
- Department of Cranio-Maxillofacial Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Mihaela Hedesiu
- Department of Cranio-Maxillofacial Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Bogdan Crisan
- Department of Oral Rehabilitation, Maxillofacial Surgery and Implantology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Florin Onisor
- Department of Cranio-Maxillofacial Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Gabriel Armencea
- Department of Cranio-Maxillofacial Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Ileana Mitre
- Department of Oral Rehabilitation, Maxillofacial Surgery and Implantology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Ioan Barbur
- Department of Oral Rehabilitation, Maxillofacial Surgery and Implantology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Winfried Kretschmer
- Department of Oral Rehabilitation, Maxillofacial Surgery and Implantology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Simion Bran
- Department of Oral Rehabilitation, Maxillofacial Surgery and Implantology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
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Wang X, Shao X, Dai T, Xu F, Zhou JG, Qu G, Tian L, Liu B, Liu Y. In vivo study of the efficacy, biosafety, and degradation of a zinc alloy osteosynthesis system. Acta Biomater 2019; 92:351-361. [PMID: 31059834 DOI: 10.1016/j.actbio.2019.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/26/2019] [Accepted: 05/01/2019] [Indexed: 01/11/2023]
Abstract
In this study, a comprehensive analysis of a novel zinc alloy osteosynthesis system in a canine mandibular fracture model is presented. The efficacy of the system was compared for PLLA (poly-l-lactic acid) and titanium materials using X-ray radiography, micro-CT tomography, undecalcified bone histomorphometry, and a three-point bending test. Histology, blood normal, blood biochemical, and serum zinc concentration tests were also performed to assess the biosafety of the zinc alloy osteosynthesis system. The degradability of the zinc alloy was evaluated using a micro-CT and scanning electron microscope during the 24-week post operation period. The results showed that zinc alloy possesses good mechanical properties that support fracture healing. Its uniform and slow corrosion leads to adequate degradation behavior in 24 weeks. Additionally, the zinc alloy proved to be biocompatible, indicating that this novel osteosynthesis system is safe for use in the body. The results of the study demonstrate that this zinc alloy-based osteosynthesis system is a promising candidate for a new generation of osteosynthesis systems, with further improvements required in the future.
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48
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Naujokat H, Ruff CB, Klüter T, Seitz JM, Açil Y, Wiltfang J. Influence of surface modifications on the degradation of standard-sized magnesium plates and healing of mandibular osteotomies in miniature pigs. Int J Oral Maxillofac Surg 2019; 49:272-283. [PMID: 31227276 DOI: 10.1016/j.ijom.2019.03.966] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 01/16/2019] [Accepted: 03/17/2019] [Indexed: 11/28/2022]
Abstract
Biodegradable magnesium alloys are suitable osteosynthesis materials. Despite the alloy composition, surface modifications appear to have an influence on the degradation process and biocompatibility. The aim of this study was to investigate the impact of hydrogenation and fluoridation of the surface in a mandibular osteotomy model. Standard-sized plates and screws were implanted in an osteotomy at the mandibular angle in nine miniature pigs. The plates and screws were harvested together with the adjacent tissues at 8 weeks after surgery and were investigated by micro-computed tomography and histological analysis. The bone healing of the osteotomy was undisturbed, independent of the surface properties. The adjacent bone tissue showed new bone formation at the implant surface; however, formation of some lacunae could be observed. The corrosion was between 9.8% and 11.6% (fluoridated<hydrogenated<non-modified) in histological specimens, while radiologically neither the volume nor the density of the osteosynthesis material was reduced in any treatment group. The soft tissues exhibited full biocompatibility with every surface property. In summary, surface modification by hydrogenation and fluoridation did not significantly influence bone healing, biocompatibility, or corrosion kinetics of the magnesium osteosynthesis at the mandibular angle.
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Affiliation(s)
- H Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany.
| | - C B Ruff
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - T Klüter
- Department of Trauma Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | | | - Y Açil
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - J Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
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49
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Investigation of zinc‑copper alloys as potential materials for craniomaxillofacial osteosynthesis implants. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 103:109826. [PMID: 31349503 DOI: 10.1016/j.msec.2019.109826] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/17/2019] [Accepted: 05/28/2019] [Indexed: 12/22/2022]
Abstract
In this study, zinc‑copper (ZnCu) alloys were investigated regarding their feasibility as absorbable metals for osteosynthesis implants, especially in the craniomaxillofacial area. Mechanical properties and in vitro corrosion behavior of as-rolled Zn-xCu (x = 1, 2 and 4 wt%) alloys were systematically evaluated and screened. The as-rolled Zn4Cu alloy had mechanical properties that were superior to the most absorbable craniomaxillofacial osteosynthesis materials recently reported. The addition of Cu to Zn showed to have no apparent effect on the corrosion rates of the samples. The rolling process on Zn and Zn1Cu resulted in more uniform corrosion than on as-cast counterparts after 28 days immersion. Furthermore, the Zn4Cu alloys exhibited no apparent cytotoxic effect towards L929, TAg or Saos-2 cells. Proliferation rates of TAg and Saos-2 cells were shown to be activated by specific Zn ion concentrations in the as-rolled Zn4Cu alloy extracts. Analysis of in vitro antibacterial properties revealed that the as-rolled Zn4Cu alloy possessed the potential to inhibit biofilm formation of mixed oral bacteria. We conclude that the as-rolled Zn4Cu alloy might be a promising material for fabrication of craniomaxillofacial osteosynthesis implants.
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50
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Kim SY. Application of the three-dimensionally printed biodegradable polycaprolactone (PCL) mesh in repair of orbital wall fractures. J Craniomaxillofac Surg 2019; 47:1065-1071. [PMID: 30935850 DOI: 10.1016/j.jcms.2019.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/25/2019] [Accepted: 03/11/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The present study aims to investigate the surface characteristics and biomechanical properties of 3D-printed polycaprolactone (PCL) mesh and present the clinical outcomes of this implant in the treatment of orbital wall fractures. PATIENTS AND METHOD A retrospective review of patients who underwent surgery for medial, inferior and inferomedial orbital wall fractures using PCL mesh was performed between April 2017 and June 2018. Two clinical outcomes were investigated: functional recovery and anatomical accuracy of reduction detected in image. Furthermore, scanning electron microscopy was used to evaluate the microscopic morphology, surface characteristics, and porosity of the PCL mesh. RESULTS Among a total of 22 patients with a mean age of 41.3 years, the most common cause of injury was assault (54.5%). Fourteen patients (63.6%) had isolated orbital floor fractures. At postoperative 1-week follow-up, three patients (13.6%) exhibited diplopia and a further three patients (13.6%) showed restriction in ocular motility, but these patients had completely recovered by their 6-month postoperative follow-up. Ideal repair of orbital fracture was almost achieved in 21 patients (95.4%) and there were no cases of implant infection, inflammatory response, migration of implant, or hemorrhage. Microscopic imaging of PCL mesh surface revealed fully interconnected micropores with 50% porosity. CONCLUSIONS The repair of orbital wall fracture using PCL mesh offers reliable stabilization of orbital wall defects with a low complication rate, leading to outstanding functional and aesthetic outcomes. Therefore, PCL mesh is a good alternative for bioresorbable implants in the treatment of orbital wall fractures.
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Affiliation(s)
- So Young Kim
- Department of Plastic and Reconstructive Surgery, Inje University Sanggye Paik Hospital, Inje University School of Medicine, Seoul, South Korea.
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