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Jackson ND, Nyska A, Palmanovich E, Nyska M. The biointegration profile of fiber-reinforced plates following tibial implantation in sheep. J Orthop Res 2024; 42:360-372. [PMID: 37593823 DOI: 10.1002/jor.25682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/17/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
Biointegrative, mineral fiber-reinforced bone fixation implants recently introduced in orthopedic surgery have expanded available treatment options for fractures and bone deformities. This new technology aims to address the disadvantages of permanent metallic implants while overcoming inherent concerns of adverse inflammatory reactions when using polymer-based orthopedic implants. The purpose of this double-arm preclinical study was to evaluate the safety, biocompatibility, and biointegration of fiber-reinforced plates, following implantation on the tibias of eight sheep. Left tibias underwent periosteal elevation, allowing for implant attachment directly onto the cortical surface; right tibia plates were implanted over intact periosteum. Microcomputed tomography and histopathology were performed at 13, 26, 52, 78, 104, and 134 weeks postimplantation. All animals were evaluated clinically at each time point, with no evidence of local adverse reactions. Histopathology demonstrated anti-inflammatory M2-like macrophages and multinucleated giant cells corresponding to implant bioabsorption, similar for both groups at each time point, and indicating expected implant biocompatibility. Inflammatory cells (i.e., eosinophils, lymphophyctes, plasma cells, and M1-like macrophages) were absent throughout the study. The bioabsorption process had started at 13 W, with the highest rate at 52-78 W. At 104 W, only residual polymer material was left (∼5% of implant area). Low amounts of mineral fibers were evident at 78 W and were absent (fully remodeled) by 104 W. At 134 W, implants at both sites were fully bioabsorbed. In conclusion, these new fiber-reinforced implants demonstrated bone remodeling and complete biointegration, with no adverse tissue response. Clinical significance: In this double-arm, 2.5-year study, a biointegrative, fiber-reinforced plate implanted on the tibias of sheep was fully absorbed within 134 weeks, with no adverse tissue reaction. Bioabsorption was similar, with or without periosteal elevation, mimicking conditions like those observed in traumatic injuries disrupting the periosteum, open reduction and internal fixation, or minimally invasive surgeries. These results demonstrate the feasibility, versatility, and safety of this new class of biointegrative bone implants. This newly developed technology avoids the complications of the removal of metal implants.
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Jang WY, Pyun JC, Chang JH. Comparative In Vitro Dissolution Assessment of Calcined and Uncalcined Hydroxyapatite Using Differences in Bioresorbability and Biomineralization. Int J Mol Sci 2024; 25:621. [PMID: 38203791 PMCID: PMC10779548 DOI: 10.3390/ijms25010621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
This study reports the effect of the not-calcining process on the bioresorption and biomineralization of hydroxyapatite through in vitro dissolution assessment. The prepared calcined hydroxyapatite (c-HAp) and uncalcined hydroxyapatite (unc-HAp) have a particle size of 2 μm and 13 μm, surface areas of 4.47 m2/g and 108.08 m2/g, and a Ca/P ratio of 1.66 and 1.52, respectively. In vitro dissolution assessments of c-HAp and unc-HAp were performed for 20 days at 37 °C in a citric acid buffer according to ISO 10993-14. During the dissolution, the c-HAp and unc-HAp confirmed an increase in weight, and the calcium and phosphorous ions were rapidly released. The calcium ions released from c-HAp formed rod-shaped particles with a longer and thinner morphology, while in unc-HAp, they appeared thicker and shorter. In the ICP-OES results, the concentrations of calcium elements were initially increased and then decreased by this formation. The rod-shaped particles identified as calcium citrate (Ca-citrate) through the XRD pattern. The calcium content of Ca-citrate particles from unc-HAp was higher than that from c-HAp. The unc-HAp demonstrated non-toxic properties in a cytotoxicity evaluation. Therefore, due to its higher bioresorption and biomineralization, unc-HAp exhibits enhanced biocompatibility compared to c-HAp.
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Affiliation(s)
- Woo Young Jang
- Korea Institute of Ceramic Engineering and Technology, Jinju 28160, Republic of Korea
- Department of Materials Science & Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | - Jae Chul Pyun
- Department of Materials Science & Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | - Jeong Ho Chang
- Korea Institute of Ceramic Engineering and Technology, Jinju 28160, Republic of Korea
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Shin JY, Roh SG, Lee NH. A Rare Case of Metal Exposure After Internal Fixation of Facial Bone Fracture With Autogenous Bone Graft. J Craniofac Surg 2023; 34:e347-e348. [PMID: 36727762 DOI: 10.1097/scs.0000000000009158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 02/03/2023] Open
Abstract
Few studies have reported complications in metal fixation systems, such as infection or device exposure. Here, we report our experience with exposed metal screws after the reduction of facial bone fracture. This will be a useful guide to using a metal fixation system in situations in which metal fixation systems should not be used.
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Affiliation(s)
- Jin Yong Shin
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Si-Gyun Roh
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Nae-Ho Lee
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Moya-Lopez C, González-Fuentes J, Bravo I, Chapron D, Bourson P, Alonso-Moreno C, Hermida-Merino D. Polylactide Perspectives in Biomedicine: From Novel Synthesis to the Application Performance. Pharmaceutics 2022; 14:pharmaceutics14081673. [PMID: 36015299 PMCID: PMC9415503 DOI: 10.3390/pharmaceutics14081673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
The incessant developments in the pharmaceutical and biomedical fields, particularly, customised solutions for specific diseases with targeted therapeutic treatments, require the design of multicomponent materials with multifunctional capabilities. Biodegradable polymers offer a variety of tailored physicochemical properties minimising health adverse side effects at a low price and weight, which are ideal to design matrices for hybrid materials. PLAs emerge as an ideal candidate to develop novel materials as are endowed withcombined ambivalent performance parameters. The state-of-the-art of use of PLA-based materials aimed at pharmaceutical and biomedical applications is reviewed, with an emphasis on the correlation between the synthesis and the processing conditions that define the nanostructure generated, with the final performance studies typically conducted with either therapeutic agents by in vitro and/or in vivo experiments or biomedical devices.
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Affiliation(s)
- Carmen Moya-Lopez
- Laboratoire Matériaux Optiques Photonique et Systèmes (LMOPS), CentraleSupélec, Université de Lorraine, 57000 Metz, France
| | - Joaquín González-Fuentes
- Centro Regional de Investigaciones Biomédicas (CRIB), 02008 Albacete, Spain
- Facultad de Farmacia de Albacete, Universidad de Castilla-La Mancha, 02008 Albacete, Spain
| | - Iván Bravo
- Facultad de Farmacia de Albacete, Universidad de Castilla-La Mancha, 02008 Albacete, Spain
- Unidad NanoCRIB, Centro Regional de Investigaciones Biomédicas, 02008 Albacete, Spain
| | - David Chapron
- Laboratoire Matériaux Optiques Photonique et Systèmes (LMOPS), CentraleSupélec, Université de Lorraine, 57000 Metz, France
| | - Patrice Bourson
- Laboratoire Matériaux Optiques Photonique et Systèmes (LMOPS), CentraleSupélec, Université de Lorraine, 57000 Metz, France
| | - Carlos Alonso-Moreno
- Facultad de Farmacia de Albacete, Universidad de Castilla-La Mancha, 02008 Albacete, Spain
- Unidad NanoCRIB, Centro Regional de Investigaciones Biomédicas, 02008 Albacete, Spain
| | - Daniel Hermida-Merino
- DUBBLE@ESRF BP CS40220, 38043 Grenoble, France
- Departamento de Física Aplicada, CINBIO, Lagoas-Marcosende Campus, Universidade de Vigo, 36310 Vigo, Spain
- Correspondence: ; Tel.: +33-(0)476882375
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Elhattab K, Bhaduri SB, Sikder P. Influence of Fused Deposition Modelling Nozzle Temperature on the Rheology and Mechanical Properties of 3D Printed β-Tricalcium Phosphate (TCP)/Polylactic Acid (PLA) Composite. Polymers (Basel) 2022; 14:polym14061222. [PMID: 35335552 PMCID: PMC8952643 DOI: 10.3390/polym14061222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 12/13/2022] Open
Abstract
The primary goal of this study is to develop and analyze 3D printed structures based on a well-known composite known as β-Tricalcium Phosphate (TCP)– polylactic acid (PLA). There are some interesting aspects of this study. First, we developed 3D printable TCP–PLA composite filaments in-house, with high reproducibility, by a one-step process method using a single screw extruder. Second, we explored the physicochemical properties of the developed TCP–PLA composite filaments. Third, we investigated the effect of an FDM-based nozzle temperature of 190 °C, 200 °C, 210 °C, and 220 °C on the composite’s crystallinity and rheological and mechanical properties. Results confirmed the successful development of constant-diameter TCP–PLA composite filaments with a homogeneous distribution of TCP particles in the PLA matrix. We observed that a higher nozzle temperature in the FDM process increased the crystallinity of the printed PLA and TCP–PLA structures. As a result, it also helped to enhance the mechanical properties of the printed structures. The rheological studies were performed in the same temperature range used in the actual FDM process, and results showed an improvement in rheological properties at higher nozzle temperatures. The bare polymer and the composite polymer-ceramic melts exhibited lower viscosity and less rigidity at higher nozzle temperatures, which resulted in enhancing the polymer melt flowability and interlayer bonding between the printed layers. Overall, our results confirmed that 3D printable TCP–PLA filaments could be made in-house, and optimization of the nozzle temperature is essential to developing 3D printed composite parts with favorable mechanical properties.
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Affiliation(s)
- Karim Elhattab
- Department of Mechanical, Industrial & Manufacturing Engineering, The University of Toledo, Toledo, OH 43606, USA;
- Correspondence:
| | - Sarit B. Bhaduri
- Department of Mechanical, Industrial & Manufacturing Engineering, The University of Toledo, Toledo, OH 43606, USA;
- EEC Division, Directorate of Engineering, The National Science Foundation, Alexandria, VA 22314, USA
| | - Prabaha Sikder
- Department of Mechanical Engineering, Cleveland State University, Cleveland, OH 44115, USA;
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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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Ishizuka S, Dong QN, Ngo HX, Bai Y, Sha J, Toda E, Okui T, Kanno T. Bioactive Regeneration Potential of the Newly Developed Uncalcined/Unsintered Hydroxyapatite and Poly-l-Lactide-Co-Glycolide Biomaterial in Maxillofacial Reconstructive Surgery: An In Vivo Preliminary Study. MATERIALS 2021; 14:ma14092461. [PMID: 34068558 PMCID: PMC8126161 DOI: 10.3390/ma14092461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022]
Abstract
Uncalcined/unsintered hydroxyapatite (HA) and poly-l-lactide-co-glycolide (u-HA/PLLA/PGA) are novel bioresorbable bioactive materials with bone regeneration characteristics and have been used to treat mandibular defects in a rat model. However, the bone regenerative interaction with the periosteum, the inflammatory response, and the degradation of this material have not been examined. In this study, we used a rat mandible model to compare the above features in u-HA/PLLA/PGA and uncalcined/unsintered HA and poly-l-lactic acid (u-HA/PLLA). We divided 11 male Sprague–Dawley rats into 3- and 16-week groups. In each group, we assessed the characteristics of a u-HA/PLLA/PGA sheet covering the right mandibular angle and a u-HA/PLLA sheet covering the left mandibular angle in three rats each, and one rat was used as a sham control. The remaining three rats in the 16-week group were used for a degradation assessment and received both sheets of material as in the material assessment subgroup. At 3 and 16 weeks after surgery, the rats were sacrificed, and mandible specimens were subjected to micro-computed tomography, histological analysis, and immunohistochemical staining. The results indicated that the interaction between the periosteum and u-HA/PLLA/PGA material produced significantly more new bone regeneration with a lower inflammatory response and a faster resorption rate compared to u-HA/PLLA alone. These findings may indicate that this new biomaterial has ideal potential in treating maxillofacial defects of the midface and orbital regions.
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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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Bone Regeneration Capacity of Newly Developed Uncalcined/Unsintered Hydroxyapatite and Poly-l-lactide-co-glycolide Sheet in Maxillofacial Surgery: An In Vivo Study. NANOMATERIALS 2020; 11:nano11010022. [PMID: 33374294 PMCID: PMC7824502 DOI: 10.3390/nano11010022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022]
Abstract
Uncalcined/unsintered hydroxyapatite and poly-l-lactide-co-glycolide (u-HA/PLLA/PGA) is a new bioresorbable nanomaterial with superior characteristics compared with current bioresorbable materials, including appropriate mechanical properties, outstanding bioactive/osteoconductive features, and remarkably shorter resorption time. Nevertheless, the bone regeneration characteristics of this nanomaterial have not been evaluated in maxillofacial reconstructive surgery. In this study, we used a rat mandible model to assess the bone regeneration ability of u-HA/PLLA/PGA material, compared with uncalcined/unsintered hydroxyapatite and poly-l-lactide acid (u-HA/PLLA) material, which has demonstrated excellent bone regenerative ability. A 4-mm-diameter defect was created at the mandibular angle area in 28 Sprague Dawley male rats. The rats were divided into three groups: u-HA/PLLA/PGA (u-HA/PLLA/PGA graft + defect), u-HA/PLLA (u-HA/PLLA graft + defect), and sham control (defect alone). At 1, 3, 8, and 16 weeks after surgeries, the rats were sacrificed and assessed by micro-computed tomography, histological analysis with hematoxylin and eosin staining, and immunohistochemical analyses. The results confirmed that the accelerated bone bioactive/regenerative osteoconduction of u-HA/PLLA/PGA was comparable with that of u-HA/PLLA in the rat mandible model. Furthermore, this new regenerative nanomaterial was able to more rapidly induce bone formation in the early stage and had great potential for further clinical applications in maxillofacial reconstructive surgery.
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Park JKH, Kim SW. Zygomaticomaxillary complex fracture after two-jaw surgery. Arch Craniofac Surg 2020; 21:301-304. [PMID: 33143398 PMCID: PMC7644343 DOI: 10.7181/acfs.2020.00276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/18/2020] [Indexed: 11/11/2022] Open
Abstract
Orthognathic surgeries often utilize rigid fixation for stabilization of the osteotomy site. The longterm fate of rigid fixations is still under investigation, and whether they should be routinely removed is under debate despite their low complication rates. Here, we report a case where a 26-year-old man suffered high-velocity trauma to his face 7 years after a two-jaw surgery. Computed tomography examination revealed a zygomaticomaxillary complex fracture, and open reduction and internal fixation was performed along with anterior maxillary wall reconstruction using absorbable mesh. Intraoperative examination revealed a broken L-shaped titanium plate near the fracture site with multiple bony fragments near each titanium screw. The rigid titanium system may have caused comminution of the fracture pattern, worsening the severity of the fracture.
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Affiliation(s)
- Joseph Kyu-Hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Prognosis of Patient With Resorbable Plates and Screws Under the Incision Site. J Craniofac Surg 2020; 31:e694-e695. [PMID: 32569051 DOI: 10.1097/scs.0000000000006609] [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] Open
Abstract
Various resorbable plates and screws were used for facial bone fractures because of several strengths. However, there are few studies on their clinical course and long-term follow-up concerning their degradation and resorption time. The authors present rare case of long term follow-up of resorbable plates and screws under the incision site.
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