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Mi L, Li F, Xu D, Liu J, Li J, Zhong L, Liu Y, Bai N. Performance of 3D printed porous polyetheretherketone composite scaffolds combined with nano-hydroxyapatite/carbon fiber in bone tissue engineering: a biological evaluation. Front Bioeng Biotechnol 2024; 12:1343294. [PMID: 38333080 PMCID: PMC10850574 DOI: 10.3389/fbioe.2024.1343294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Polyetheretherketone (PEEK) has been one of the most promising materials in bone tissue engineering in recent years, with characteristics such as biosafety, corrosion resistance, and wear resistance. However, the weak bioactivity of PEEK leads to its poor integration with bone tissues, restricting its application in biomedical fields. This research effectively fabricated composite porous scaffolds using a combination of PEEK, nano-hydroxyapatite (nHA), and carbon fiber (CF) by the process of fused deposition molding (FDM). The experimental study aimed to assess the impact of varying concentrations of nHA and CF on the biological performance of scaffolds. The incorporation of 10% CF has been shown to enhance the overall mechanical characteristics of composite PEEK scaffolds, including increased tensile strength and improved mechanical strength. Additionally, the addition of 20% nHA resulted in a significant increase in the surface roughness of the scaffolds. The high hydrophilicity of the PEEK composite scaffolds facilitated the in vitro inoculation of MC3T3-E1 cells. The findings of the study demonstrated that the inclusion of 20% nHA and 10% CF in the scaffolds resulted in improved cell attachment and proliferation compared to other scaffolds. This suggests that the incorporation of 20% nHA and 10% CF positively influenced the properties of the scaffolds, potentially facilitating bone regeneration. In vitro biocompatibility experiments showed that PEEK composite scaffolds have good biosafety. The investigation on osteoblast differentiation revealed that the intensity of calcium nodule staining intensified, along with an increase in the expression of osteoblast transcription factors and alkaline phosphatase activities. These findings suggest that scaffolds containing 20% nHA and 10% CF have favorable properties for bone induction. Hence, the integration of porous PEEK composite scaffolds with nHA and CF presents a promising avenue for the restoration of bone defects using materials in the field of bone tissue engineering.
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Affiliation(s)
- Lian Mi
- Department of Oral Prosthodontics, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Feng Li
- Department of Oral Prosthodontics, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Dian Xu
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi’an, China
| | - Jian Liu
- Department of Oral Prosthodontics, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Jian Li
- Department of Oral Prosthodontics, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Lingmei Zhong
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanshan Liu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
| | - Na Bai
- Department of Oral Prosthodontics, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
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Faverani LP, Rios BR, Santos AMDS, Mendes BC, Santiago-Júnior JF, Sukotjo C, Callahan N, Miloro M. Predictability of single versus double-barrel vascularized fibula flaps and dental implants in mandibular reconstructions: A systematic review and meta-analysis of prospective studies. J Prosthet Dent 2023:S0022-3913(23)00686-8. [PMID: 37978003 DOI: 10.1016/j.prosdent.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
STATEMENT OF PROBLEM Patients with vascularized bone flaps from the fibula have reduced bone height, in which case a higher prosthetic abutment is needed for their implant-supported prosthesis. Although the double-flap technique seems promising, systematic reviews and meta-analyses of prospective studies are lacking. PURPOSE The purpose of this systematic review and meta-analysis was to evaluate the grafted areas of single barrel fibular flaps (SBFF) and double-barrel fibular flaps (DBFF) by considering failure rates, dental implant complications, and bone union at the osteotomy sites. MATERIAL AND METHODS A systematic review and meta-analysis was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, population, intervention, control, and outcomes (PICO) question, and the National Health and Medical Research Council scales. The event rate of complications and failures was calculated with a confidence interval (CI) of 95%. RESULTS A total of 13 prospective studies with 441 participants and 330 graft sites were identified. A total of 235 participants had SBFF with 445 implants, and 95 had DBFF with 164 implants. The overall combined graft failure rates were 4.2% for SBFF and 3.2% for DBFF. The complication rate was 10% for SBFF and 1.9% for DBFF. Implant failure was at 4.7% in the SBFF group and 3.4% in the DBFF group. CONCLUSIONS Complication rates and implant failures were similar for SBFF and DBFF. Therefore, for long-term oral rehabilitation, both SBFF and DBFF are suitable procedures for mandibular reconstruction.
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Affiliation(s)
- Leonardo P Faverani
- Associate Professor, Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery and Implantology, São Paulo State University (UNESP), Araçatuba, SP, Brazil.
| | - Barbara R Rios
- PhD student, Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Anderson Maikon de Souza Santos
- PhD student, Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Bruno C Mendes
- PhD student, Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Joel F Santiago-Júnior
- Assistant Professor, Department of Health Sciences, Sacred Heart University, Bauru, SP, Brazil
| | - Cortino Sukotjo
- Associate Professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Ill
| | - Nicholas Callahan
- Assistant Professor, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Illinois at Chicago, Chicago, Ill
| | - Michael Miloro
- Professor and Head of Department, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Illinois at Chicago, Chicago, Ill
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Martinez DC, Dobkowska A, Marek R, Ćwieka H, Jaroszewicz J, Płociński T, Donik Č, Helmholz H, Luthringer-Feyerabend B, Zeller-Plumhoff B, Willumeit-Römer R, Święszkowski W. In vitro and in vivo degradation behavior of Mg-0.45Zn-0.45Ca (ZX00) screws for orthopedic applications. Bioact Mater 2023; 28:132-154. [PMID: 37250863 PMCID: PMC10209338 DOI: 10.1016/j.bioactmat.2023.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
Magnesium (Mg) alloys have become a potential material for orthopedic implants due to their unnecessary implant removal, biocompatibility, and mechanical integrity until fracture healing. This study examined the in vitro and in vivo degradation of an Mg fixation screw composed of Mg-0.45Zn-0.45Ca (ZX00, in wt.%). With ZX00 human-sized implants, in vitro immersion tests up to 28 days under physiological conditions, along with electrochemical measurements were performed for the first time. In addition, ZX00 screws were implanted in the diaphysis of sheep for 6, 12, and 24 weeks to assess the degradation and biocompatibility of the screws in vivo. Using scanning electron microscopy (SEM) coupled with energy dispersive X-ray spectroscopy (EDX), micro-computed tomography (μCT), X-ray photoelectron spectroscopy (XPS), and histology, the surface and cross-sectional morphologies of the corrosion layers formed, as well as the bone-corrosion-layer-implant interfaces, were analyzed. Our findings from in vivo testing demonstrated that ZX00 alloy promotes bone healing and the formation of new bone in direct contact with the corrosion products. In addition, the same elemental composition of corrosion products was observed for in vitro and in vivo experiments; however, their elemental distribution and thicknesses differ depending on the implant location. Our findings suggest that the corrosion resistance was microstructure-dependent. The head zone was the least corrosion-resistant, indicating that the production procedure could impact the corrosion performance of the implant. In spite of this, the formation of new bone and no adverse effects on the surrounding tissues demonstrated that the ZX00 is a suitable Mg-based alloy for temporary bone implants.
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Affiliation(s)
- Diana C. Martinez
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507, Warsaw, Poland
| | - Anna Dobkowska
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507, Warsaw, Poland
| | - Romy Marek
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Hanna Ćwieka
- Institute of Metallic Biomaterials, Helmholtz-Zentrum Hereon GmbH, 21502, Geesthacht, Germany
| | - Jakub Jaroszewicz
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507, Warsaw, Poland
| | - Tomasz Płociński
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507, Warsaw, Poland
| | - Črtomir Donik
- Department of Physics and Chemistry of Materials, Institute of Metals and Technology, University of Ljubljana, Lepi Pot 11, SI-1000, Ljubljana, Slovenia
| | - Heike Helmholz
- Institute of Metallic Biomaterials, Helmholtz-Zentrum Hereon GmbH, 21502, Geesthacht, Germany
| | | | - Berit Zeller-Plumhoff
- Institute of Metallic Biomaterials, Helmholtz-Zentrum Hereon GmbH, 21502, Geesthacht, Germany
| | - Regine Willumeit-Römer
- Institute of Metallic Biomaterials, Helmholtz-Zentrum Hereon GmbH, 21502, Geesthacht, Germany
| | - Wojciech Święszkowski
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507, Warsaw, Poland
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Chappuis-Chocano AP, Venante HS, da Costa RMB, Pordeus MD, Marcillo-Toala OO, Santiago JF, Porto VC. A systematic review and meta-analysis of the clinical performance of implant-supported overdentures retained by CAD-CAM bars. J Appl Oral Sci 2023; 31:e20230054. [PMID: 37646715 PMCID: PMC10501751 DOI: 10.1590/1678-7757-2023-0054] [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: 02/24/2023] [Revised: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Abstract
Currently, there is no consensus on the indications and clinical performance of implant-supported overdentures (IODs) involving computer-aided design and manufacturing (CAD-CAM) bars. OBJECTIVE To evaluate the performance of IODs involving CAD-CAM bars. METHODOLOGY A comprehensive search of studies published until May 2023 was conducted in many databases, including PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The population, intervention, comparison, outcome (PICO) question was: "How do IODs retained by bars fabricated by CAD-CAM technology perform in daily clinical practice?" The meta-analysis included clinical studies based on effect size and a two-tailed null test with a 95% confidence interval (CI). RESULTS Ten studies were included in the meta-analysis. Among them, nine reported a 100% implant survival rate for all CAD-CAM milled bars. Complications were reported in two studies with CAD/CAM-milled titanium bars, and one study reported more fractures in soldered gold bars used in maxillary rehabilitation. However, no fractures were observed in IODs retained by PEEK and zirconia bars. According to six studies, biological complications, including peri-implantitis, were minimal in the BioHPP and PEEK bar groups, while no cases were reported in the titanium or zirconia bar groups. CAD-CAM-milled zirconia bars had higher plaque and bleeding indices compared with titanium bars, as evidenced by findings from five studies. All four studies that evaluated Oral Health Impact Profile (OHIP) scores showed a positive effect of IODs retained by CAD-CAM milled titanium bars on quality of life. Patient satisfaction and acceptance by prosthodontists were significantly high, according to the results of five studies. CONCLUSION Overdentures retained with CAD-CAM milled titanium bars show great potential for use in daily clinical practice. Moreover, patient and practitioner satisfaction was very high when this method was used.
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Affiliation(s)
- Ana Paula Chappuis-Chocano
- Universidade de São PauloFaculdade de Odontologia de BauruBauruSão PauloBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil.
| | - Helena Sandrini Venante
- Universidade de São PauloFaculdade de Odontologia de BauruBauruSão PauloBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil.
| | - Rodrigo Moreira Bringel da Costa
- Universidade de São PauloFaculdade de Odontologia de BauruBauruSão PauloBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil.
| | - Mariana Domingues Pordeus
- Universidade de São PauloFaculdade de Odontologia de BauruBauruSão PauloBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil.
| | - Oscar Oswaldo Marcillo-Toala
- Universidad de Especialidades Espíritu SantoSamborondónEcuadorUniversidad de Especialidades Espíritu Santo (UEES), Samborondón, Ecuador.
| | - Joel Ferreira Santiago
- Universidade de São PauloFaculdade de Odontologia de BauruBauruSão PauloBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil.
| | - Vinícius Carvalho Porto
- Universidade de São PauloFaculdade de Odontologia de BauruBauruSão PauloBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil.
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Ercetin A, Aslantaş K, Özgün Ö, Perçin M, Chandrashekarappa MPG. Optimization of Machining Parameters to Minimize Cutting Forces and Surface Roughness in Micro-Milling of Mg13Sn Alloy. MICROMACHINES 2023; 14:1590. [PMID: 37630126 PMCID: PMC10456406 DOI: 10.3390/mi14081590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
This comprehensive study investigates the micro-milling of a Mg13Sn alloy, a material of considerable interest in various high-precision applications, such as biomedical implants. The main objective of the study was to explore the optimizations of variable feed per tooth (fz), cutting speed (Vc), and depth of cut (ap) parameters on the key outcomes of the micro-milling process. A unique experimental setup was employed, employing a spindle capable of achieving up to 60,000 revolutions per minute. Additionally, the study leveraged linear slides backed by micro-step motors to facilitate precise axis movements, thereby maintaining a resolution accuracy of 0.1 μm. Cutting forces were accurately captured by a mini dynamometer and subsequently evaluated based on the peak to valley values for Fx (tangential force) and Fy (feed force). The study results revealed a clear and complex interplay between the varied cutting parameters and their subsequent impacts on the cutting forces and surface roughness. An increase in feed rate and depth of cut significantly increased the cutting forces. However, the cutting forces were found to decrease noticeably with the elevation of cutting speed. Intriguingly, the tangential force (Fx) was consistently higher than the feed force (Fy). Simultaneously, the study determined that the surface roughness, denoted by Sa values, increased in direct proportion to the feed rate. It was also found that the Sa surface roughness values decreased with the increase in cutting speed. This study recommends a parameter combination of fz = 5 µm/tooth feed rate, Vc = 62.8 m/min cutting speed, and ap = 400 µm depth of cut to maintain a Sa surface roughness value of less than 1 µm while ensuring an optimal material removal rate and machining time. The results derived from this study offer vital insights into the micro-milling of Mg13Sn alloys and contribute to the current body of knowledge on the topic.
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Affiliation(s)
- Ali Ercetin
- Department of Naval Architecture and Marine Engineering, Maritime Faculty, Bandırma Onyedi Eylul University, Bandırma 10200, Turkey
| | - Kubilay Aslantaş
- Department of Mechanical Engineering, Faculty of Technology, Afyon Kocatepe University, Afyonkarahisar 03200, Turkey;
| | - Özgür Özgün
- Department of Occupational Health and Safety, Faculty of Health Sciences, Bingöl University, Bingöl 12000, Turkey;
| | - Mustafa Perçin
- Department of Machine and Metal Technologies, Vocational School of Technical Sciences, Bursa Uludag University, Bursa 16059, Turkey;
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Ben Amara H, Martinez DC, Shah FA, Loo AJ, Emanuelsson L, Norlindh B, Willumeit-Römer R, Plocinski T, Swieszkowski W, Palmquist A, Omar O, Thomsen P. Magnesium implant degradation provides immunomodulatory and proangiogenic effects and attenuates peri-implant fibrosis in soft tissues. Bioact Mater 2023; 26:353-369. [PMID: 36942009 PMCID: PMC10024189 DOI: 10.1016/j.bioactmat.2023.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 03/17/2023] Open
Abstract
Implants made of magnesium (Mg) are increasingly employed in patients to achieve osteosynthesis while degrading in situ. Since Mg implants and Mg2+ have been suggested to possess anti-inflammatory properties, the clinically observed soft tissue inflammation around Mg implants is enigmatic. Here, using a rat soft tissue model and a 1-28 d observation period, we determined the temporo-spatial cell distribution and behavior in relation to sequential changes of pure Mg implant surface properties and Mg2+ release. Compared to nondegradable titanium (Ti) implants, Mg degradation exacerbated initial inflammation. Release of Mg degradation products at the tissue-implant interface, culminating at 3 d, actively initiated chemotaxis and upregulated mRNA and protein immunomodulatory markers, particularly inducible nitric oxide synthase and toll-like receptor-4 up to 6 d, yet without a cytotoxic effect. Increased vascularization was demonstrated morphologically, preceded by high expression of vascular endothelial growth factor. The transition to appropriate tissue repair coincided with implant surface enrichment of Ca and P and reduced peri-implant Mg2+ concentration. Mg implants revealed a thinner fibrous encapsulation compared with Ti. The detailed understanding of the relationship between Mg material properties and the spatial and time-resolved cellular processes provides a basis for the interpretation of clinical observations and future tailoring of Mg implants.
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Affiliation(s)
- Heithem Ben Amara
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Diana C. Martinez
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Furqan A. Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Johansson Loo
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Emanuelsson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgitta Norlindh
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tomasz Plocinski
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Wojciech Swieszkowski
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Corresponding author. Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg Box 412, SE-405 30, Gothenburg, Sweden.
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Prasad S, Faverani LP, Santiago Junior JF, Sukotjo C, Yuan JCC. Attachment systems for mandibular implant-supported overdentures: A systematic review and meta-analysis of randomized controlled trials. J Prosthet Dent 2022:S0022-3913(22)00485-1. [PMID: 36115712 DOI: 10.1016/j.prosdent.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 10/14/2022]
Abstract
STATEMENT OF PROBLEM Although mandibular implant-supported overdentures have been highly recommended as a treatment option, a consensus on the type of attachment systems that can be used to increase implant and prostheses survivability is lacking. PURPOSE The purpose of this systematic review and meta-analysis was to compare different types of attachments for retention by investigating outcome measures such as implant and prosthesis survival rates and biological and prosthesis complications in participants with a mandibular implant-supported overdenture. MATERIAL AND METHODS The search was performed in the PubMed, Cochrane, Embase, and Scopus databases by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and registered with the International Prospective Register of Systematic Reviews (CRD42021253566). An analysis of association was conducted between different attachment systems and implant and overdenture survival rates in randomized controlled clinical trials. RESULTS The initial search indicated 477 studies, of which 25 randomized controlled trials (RCTs) were included for analysis. A total of 2154 implants and 737 overdentures were analyzed in the meta-analysis. The main results indicated the failure rate for dental implants to be 2.0% (95% confidence interval [CI], 1.3 to 3.2) and overdentures 4.2% (95% CI, 1.6 to 10.5), respectively. With regard to different attachment systems, a similar failure rate was identified with bar-type retention (7.7% to 95% CI, 3.0 to 18.1), magnetic retention systems (7.6% to 95% CI, 2.2 to 22.7), and ball-type retention (6.8% to 95% CI, 3.0 to 14.3). No significant difference was found in biological complications for splinted and unsplinted implant overdentures (P=.902). Regarding prosthetic complications, the most favorable groups were LOCATOR attachments followed by telescopic and Conus, bar, and ball attachments. Magnet attachments had higher prosthetic complications (7.4 times) than the other attachments. CONCLUSIONS Implants and implant-supported mandibular overdentures showed a high survival rate irrespective of the attachment system used. Splinting implants did not significantly affect the rate of biological complications. Prosthetic complications were most common for magnet and least common for LOCATOR attachments.
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Affiliation(s)
- Soni Prasad
- Associate Professor and Director, Pre-Doctoral Implant Program, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wisc
| | - Leonardo P Faverani
- Assistant Professor, Division of Oral and Maxillofacial Surgery and Implantology, Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University - UNESP, Araçatuba, Sao Paulo, Brazil
| | - Joel Ferreira Santiago Junior
- Assistant Professor, Department of Health Sciences, Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, Sao Paulo, Brazil; Assistant Professor, Department of Prosthesis and Periodontics, Bauru School of Dentistry - University of São Paulo (FOB-USP), Bauru, Sao Paulo, Brazil
| | - Cortino Sukotjo
- Professor and Director Pre-Doctoral Implant Program, Department of Restorative Dentistry, University of Illinois Chicago College of Dentistry, Chicago, Ill
| | - Judy Chia-Chun Yuan
- Associate Professor and Managing Partner, Department of Restorative Dentistry, University of Illinois Chicago College of Dentistry, Chicago, Ill.
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Vujović S, Desnica J, Stanišić D, Ognjanović I, Stevanovic M, Rosic G. Applications of Biodegradable Magnesium-Based Materials in Reconstructive Oral and Maxillofacial Surgery: A Review. Molecules 2022; 27:molecules27175529. [PMID: 36080296 PMCID: PMC9457564 DOI: 10.3390/molecules27175529] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Reconstruction of defects in the maxillofacial region following traumatic injuries, craniofacial deformities, defects from tumor removal, or infections in the maxillofacial area represents a major challenge for surgeons. Various materials have been studied for the reconstruction of defects in the maxillofacial area. Biodegradable metals have been widely researched due to their excellent biological properties. Magnesium (Mg) and Mg-based materials have been extensively studied for tissue regeneration procedures due to biodegradability, mechanical characteristics, osteogenic capacity, biocompatibility, and antibacterial properties. The aim of this review was to analyze and discuss the applications of Mg and Mg-based materials in reconstructive oral and maxillofacial surgery in the fields of guided bone regeneration, dental implantology, fixation of facial bone fractures and soft tissue regeneration.
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Affiliation(s)
- Sanja Vujović
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia
| | - Jana Desnica
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia
| | - Dragana Stanišić
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia
| | - Irena Ognjanović
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia
| | - Momir Stevanovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia
- Correspondence: (M.S.); (G.R.); Tel.: +381-641-327752 (M.S.); +381-633-92812 (G.R.)
| | - Gvozden Rosic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia
- Correspondence: (M.S.); (G.R.); Tel.: +381-641-327752 (M.S.); +381-633-92812 (G.R.)
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Martin V, Garcia M, Montemor MDF, Fernandes JCS, Gomes PS, Fernandes MH. Simulating In Vitro the Bone Healing Potential of a Degradable and Tailored Multifunctional Mg-Based Alloy Platform. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9060255. [PMID: 35735498 PMCID: PMC9219794 DOI: 10.3390/bioengineering9060255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023]
Abstract
This work intended to elucidate, in an in vitro approach, the cellular and molecular mechanisms occurring during the bone healing process, upon implantation of a tailored degradable multifunctional Mg-based alloy. This was prepared by a conjoining anodization of the bare alloy (AZ31) followed by the deposition of a polymeric coating functionalized with hydroxyapatite. Human endothelial cells and osteoblastic and osteoclastic differentiating cells were exposed to the extracts from the multifunctional platform (having a low degradation rate), as well as the underlying anodized and original AZ31 alloy (with higher degradation rates). Extracts from the multifunctional coated alloy did not affect cellular behavior, although a small inductive effect was observed in the proliferation and gene expression of endothelial and osteoblastic cells. Extracts from the higher degradable anodized and original alloys induced the expression of some endothelial genes and, also, ALP and TRAP activities, further increasing the expression of some early differentiation osteoblastic and osteoclastic genes. The integration of these results in a translational approach suggests that, following the implantation of a tailored degradable Mg-based material, the absence of initial deleterious effects would favor the early stages of bone repair and, subsequently, the on-going degradation of the coating and the subjacent alloy would increase bone metabolism dynamics favoring a faster bone formation and remodeling process and enhancing bone healing.
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Affiliation(s)
- Victor Martin
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal; (V.M.); (M.G.); (P.S.G.)
- LAQV/REQUIMTE, University of Porto, 4100-007 Porto, Portugal
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, 1649-003 Lisboa, Portugal
- CQE, IMS, Departamento de Engenharia Química, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisboa, Portugal; (M.d.F.M.); (J.C.S.F.)
- EST Setúbal, CDP2T, Instituto Politécnico de Setúbal, 2910-761 Setúbal, Portugal
| | - Mónica Garcia
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal; (V.M.); (M.G.); (P.S.G.)
| | - Maria de Fátima Montemor
- CQE, IMS, Departamento de Engenharia Química, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisboa, Portugal; (M.d.F.M.); (J.C.S.F.)
| | - João Carlos Salvador Fernandes
- CQE, IMS, Departamento de Engenharia Química, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisboa, Portugal; (M.d.F.M.); (J.C.S.F.)
| | - Pedro Sousa Gomes
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal; (V.M.); (M.G.); (P.S.G.)
- LAQV/REQUIMTE, University of Porto, 4100-007 Porto, Portugal
| | - Maria Helena Fernandes
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal; (V.M.); (M.G.); (P.S.G.)
- LAQV/REQUIMTE, University of Porto, 4100-007 Porto, Portugal
- Correspondence:
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Suljevic O, Fischerauer SF, Weinberg AM, Sommer NG. Immunological reaction to magnesium-based implants for orthopedic applications. What do we know so far? A systematic review on in vivo studies. Mater Today Bio 2022; 15:100315. [PMID: 35757033 PMCID: PMC9214802 DOI: 10.1016/j.mtbio.2022.100315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/15/2022] [Accepted: 06/02/2022] [Indexed: 12/09/2022]
Abstract
Magnesium-based implants (Mg) became an attractive candidate in orthopedic surgery due to their valuable properties, such as osteoconductivity, biodegradability, elasticity and mechanical strength. However, previous studies on biodegradable and non-biodegradable metal implants showed that these materials are not inert when placed in vivo as they interact with host defensive mechanisms. The aim of this study was to systematically review available in vivo studies with Mg-based implants that investigated immunological reactions to these implants. The following questions were raised: Do different types of Mg-based implants in terms of shape, size and alloying system cause different extent of immune response? and; Are there missing links to properly understand immunological reactions upon implantation and degradation of Mg-based implants? The database used for the literature research was PubMed (U.S. National Library of Medicine) and it was undertaken in the end of 2021. The inclusion criteria comprised (i) in vivo studies with bony implantation of Mg-based implants and (ii) analysis of the presence of local immune cells or systemic inflammatory parameters. We further excluded any studies involving coated Mg-implants, in vitro studies, and studies in which the implants had no bone contact. The systematic search process was conducted according to PRISMA guidelines. Initially, the search yielded 225 original articles. After reading each article, and based on the inclusion and exclusion criteria, 16 articles were included in the systematic review. In the available studies, Mg-based implants were not found to cause any severe inflammatory reaction, and only a mild to moderate inflammatory potential was attributed to the material. The timeline of foreign body giant cell formation showed to be different between the reviewed studies. The variety of degradation kinetics of different tested implants and discrepancies in studies regarding the time points of immunological investigations impair the conclusion of immunological reactions. This may be induced by different physical properties of an implant such as size, shape and alloying system. Further research is essential to elucidate the underlying mechanisms by which implant degradation affects the immune system. Also, better understanding will facilitate the decision of patients whether to undergo surgery with new device implantation.
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Affiliation(s)
- Omer Suljevic
- Department of Orthopedics and Traumatology, Medical University of Graz, Graz, Austria
| | - Stefan F Fischerauer
- Department of Orthopedics and Traumatology, Medical University of Graz, Graz, Austria
| | - Annelie M Weinberg
- Department of Orthopedics and Traumatology, Medical University of Graz, Graz, Austria
| | - Nicole G Sommer
- Department of Orthopedics and Traumatology, Medical University of Graz, Graz, Austria
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A Systematic Review and Network Meta-Analysis of Biomedical Mg Alloy and Surface Coatings in Orthopedic Application. Bioinorg Chem Appl 2022; 2022:4529520. [PMID: 35399618 PMCID: PMC8991394 DOI: 10.1155/2022/4529520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/19/2022] [Indexed: 12/15/2022] Open
Abstract
Magnesium alloys have great application prospects as ideal bone implant materials. However, their poor corrosion resistance limits their clinical orthopedic application. Surface modification promotes the corrosion resistance of magnesium. Conversion coatings, such as calcium phosphate (Ca-P) coating, microarc oxidation (MAO) treatment, and fluoride (FLU) treatment, have been extensively investigated in in vivo studies. This systematic review and network meta-analysis compared the influence of different conversion coatings on bone repair, material properties, and systemic host response in orthopedic applications. Using the PICOS model, the inclusion criteria for biodegradable magnesium and its alloys were determined for in vivo studies. Four databases were used. The standard and weight mean differences with 95% confidence intervals were used to analyze new bone formation and degradation rate. Network structure and forest plots were created, and ranking probabilities were estimated. The risk of bias and quality of evidence were assessed using SYRCLE, CERQual, and GRADE tools. In the qualitative analysis, 43 studies were selected, and the evaluation of each outcome indicator was not entirely consistent from article to article. In the quantitative analysis, 21 articles were subjected to network meta-analysis, with 16 articles on implant degradation and 8 articles for new bone formation. Additionally, SUCRA indicated that Ca-P coating exhibited the highest corrosion resistance, followed by FLU treatment. MAO demonstrated the best capability for new bone formation, followed by Ca-P coating. Ca-P coating exhibited the highest overall performance. To conclude, coated Mg can promote better new bone formation than bare Mg and has considerable biocompatibility. Ca-P-coated Mg and MAO-coated Mg have the greatest potential to significantly promote corrosion resistance and bone regeneration, respectively. The findings of this study will provide a theoretical basis for the investigation of composite coatings and guidance for the orthopedic application of Mg bone implants.
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Herber V, Labmayr V, Sommer NG, Marek R, Wittig U, Leithner A, Seibert F, Holweg P. Can Hardware Removal be Avoided Using Bioresorbable Mg-Zn-Ca Screws After Medial Malleolar Fracture Fixation? Mid-Term Results of a First-In-Human Study. Injury 2022; 53:1283-1288. [PMID: 34758916 DOI: 10.1016/j.injury.2021.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
UNLABELLED Ankle is the most common site of hardware removal, mainly performed within 12 months of the primary surgery. The prominence of the metallic hardware is a frequent cause of pain after fracture fixation. Over the last decade, the development of bioresorbable materials based on magnesium (Mg) has increased. Bioresorbable metals aim to avoid a second surgery for hardware removal. METHODS Twenty patients with isolated, bimalleolar, or trimalleolar ankle fractures were treated with bioresorbable screws made of Mg, 0.45wt% calcium (Ca) and 0.45wt% zinc (Zn) (ZX00). Patient-reported outcome measures (PROMs) including visual analogue scale (VAS) for pain, the presence of complications 6 and 12 months after surgery and the AOFAS scale after 12 months were reported. The functional outcomes were analysed through the range of motion (ROM) of the ankle joint with a standard goniometer. Degradation products and the bioresorbability of the screws were evaluated using plane radiographs. RESULTS One patient was lost to follow-up. All patients were free of pain, no complications, shoe conflict or misalignement were reported after 12 months of follow-up. No Mg screws were surgically removed. An additional fixation of the distal fibula or the dorsal tibial fragment with conventional titanium implants (Ti) was performed in 17 patients. Within 12 months after primary refixation, 12 of these patients (71%) underwent a second surgery for Ti hardware removal. The mean AOFAS score was 89.8±7.1 and the difference between the treated and the non-treated site in the ROM of the talocrural joint was 2°±11° after 12 months. Radiolucent areas around the screws were attributed to degradation and did not affect clinical or functional outcomes. After one year, the Mg screw heads could not be detected in the plane radiographs of 17 patients which suggests that the majority of the screw head is degraded without introducing adverse reactions. CONCLUSIONS At 6 and 12 months, the bioresorbable Mg screws show excellent PROMs without complications or need for screw removal. The resorbability of the screw heads in most of the patients after one year could also provide an advantage over conventional bio-inert implants by avoiding related skin irritation due for instance to shoe conflict.
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Affiliation(s)
- Valentin Herber
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6 8036 Graz, Austria; Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria..
| | - Viktor Labmayr
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6 8036 Graz, Austria
| | - Nicole G Sommer
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6 8036 Graz, Austria
| | - Romy Marek
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6 8036 Graz, Austria
| | - Ulrike Wittig
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6 8036 Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6 8036 Graz, Austria
| | - Franz Seibert
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6 8036 Graz, Austria
| | - Patrick Holweg
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6 8036 Graz, Austria
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Special Issue "Absorbable Metals for Biomedical Applications". MATERIALS 2021; 14:ma14143835. [PMID: 34300754 PMCID: PMC8306265 DOI: 10.3390/ma14143835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022]
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Herber V, Okutan B, Antonoglou G, Sommer NG, Payer M. Bioresorbable Magnesium-Based Alloys as Novel Biomaterials in Oral Bone Regeneration: General Review and Clinical Perspectives. J Clin Med 2021; 10:jcm10091842. [PMID: 33922759 PMCID: PMC8123017 DOI: 10.3390/jcm10091842] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
Bone preservation and primary regeneration is a daily challenge in the field of dental medicine. In recent years, bioresorbable metals based on magnesium (Mg) have been widely investigated due to their bone-like modulus of elasticity, their high biocompatibility, antimicrobial, and osteoconductive properties. Synthetic Mg-based biomaterials are promising candidates for bone regeneration in comparison with other currently available pure synthetic materials. Different alloys based on Mg were developed to fit clinical requirements. In parallel, advances in additive manufacturing offer the possibility to fabricate experimentally bioresorbable metallic porous scaffolds. This review describes the promising clinical results of resorbable Mg-based biomaterials for bone repair in osteosynthetic application and discusses the perspectives of use in oral bone regeneration.
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Affiliation(s)
- Valentin Herber
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
- Correspondence:
| | - Begüm Okutan
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
| | - Georgios Antonoglou
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
| | - Nicole G. Sommer
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
| | - Michael Payer
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
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Abstract
Multifunctional materials based on a combination of permanent and degradable metals open new perspectives for medical implants combining osseoconductivity and drug-delivery functions which can significantly decrease the number of implants’ revision. In this work, hybrid magnesium-titanium materials were produced via sintering, and the properties of the permanent titanium component before and after the degradation of the temporary magnesium part were evaluated. The changes of chemical composition and mechanical parameters were determined. Loading of hydrogen into the titanium part at room temperature was observed, which deteriorated the mechanical characteristics but could also simultaneously improve the biocompatibility of the permanent titanium implant. The control of degradation of the magnesium part and the modification of the titanium part are required for the development of partly degradable hybrid implants.
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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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