In vivo safety and efficacy testing of a thermally triggered injectable hydrogel scaffold for bone regeneration and augmentation in a rat model

Bone loss resulting from degenerative diseases and trauma is a significant clinical burden which is likely to grow exponentially with the aging population. In a number of conditions where pre-formed materials are clinically inappropriate an injectable bone forming hydrogel could be beneficial. The development of an injectable hydrogel to stimulate bone repair and regeneration would have broad clinical impact and economic benefit in a variety of orthopedic clinical applications.

We have previously reported the development of a Laponite^® crosslinked pNIPAM-co-DMAc (L-pNIPAM-co-DMAc) hydrogel delivery system, loaded with hydroxyapatite nanoparticles (HAPna), which was capable of inducing osteogenic differentiation of mesenchymal stem cells (MSCs) without the need for additional growth factors in vitro. However to enable progression towards clinical acceptability, biocompatibility and efficacy of the L-pNIPAM-co-DMAc hydrogel to induce bone repair in vivo must be determined.

Biocompatibility was evaluated by subcutaneous implantation for 6 weeks in rats, and efficacy to augment bone repair was evaluated within a rat femur defect model for 4 weeks. No inflammatory reactions, organ toxicity or systemic toxicity were observed. In young male rats where hydrogel was injected, defect healing was less effective than sham operated controls when rat MSCs were incorporated. Enhanced bone healing was observed however, in aged exbreeder female rats where acellular hydrogel was injected, with increased deposition of collagen type I and Runx2. Integration of the hydrogel with surrounding bone was observed without the need for delivered MSCs; native cell infiltration was also seen and bone formation was observed within all hydrogel systems investigated.

This hydrogel can be delivered directly into the target site, is biocompatible, promotes increased bone formation and facilitates migration of cells to promote integration with surrounding bone, for safe and efficacious bone repair.

3D printed tissue engineered model for bone invasion of oral cancer

Recent advances in three-dimensional printing technology have led to a rapid expansion of its applications in tissue engineering. The present study was designed to develop and characterize an in vitro multi-layered human alveolar bone, based on a 3D printed scaffold, combined with tissue engineered oral mucosal model. The objective was to incorporate oral squamous cell carcinoma (OSCC) cell line spheroids to the 3D model at different anatomical levels to represent different stages of oral cancer. Histological evaluation of the 3D tissue model revealed a tri-layered structure consisting of distinct epithelial, connective tissue, and bone layers; replicating normal oral tissue architecture. The mucosal part showed a well-differentiated stratified oral squamous epithelium similar to that of the native tissue counterpart, as demonstrated by immunohistochemistry for cytokeratin 13 and 14. Histological assessment of the cancerous models demonstrated OSCC spheroids at three depths including supra-epithelial level, sub-epithelial level, and deep in the connective tissue-bone interface. The 3D tissue engineered composite model closely simulated the native oral hard and soft tissues and has the potential to be used as a valuable in vitro model for the investigation of bone invasion of oral cancer and for the evaluation of novel diagnostic or therapeutic approaches to manage OSCC in the future.

Reactive Inkjet Printing of Regenerated Silk Fibroin Films for Use as Dental Barrier Membranes

Current commercially available barrier membranes for oral surgery have yet to achieve a perfect design. Existing materials used are either non-resorbable and require a second surgery for their extraction, or alternatively are resorbable but suffer from poor structural integrity or degrade into acidic by-products. Silk has the potential to overcome these issues and has yet to be made into a commercially available dental barrier membrane. Reactive inkjet printing (RIJ) has recently been demonstrated to be a suitable method for assembling silk in its regenerated silk fibroin (RSF) form into different constructs. This paper will establish the properties of RSF solutions for RIJ and the suitability of RIJ for the construction of RSF barrier membranes. Printed RSF films were characterised by their crystallinity and surface properties, which were shown to be controllable via RIJ. RSF films degraded in either phosphate buffered saline or protease XIV solutions had degradation rates related to RSF crystallinity. RSF films were also printed with the inclusion of nano-hydroxyapatite (nHA). As reactive inkjet printing could control RSF crystallinity and hence its degradation rate, as well as offering the ability to incorporate bioactive nHA inclusions, reactive inkjet printing is deemed a suitable alternative method for RSF processing and the production of dental barrier membranes.

Characterization of Multilayered Tissue-Engineered Human Alveolar Bone and Gingival Mucosa

Advances in tissue engineering have permitted assembly of multilayered composite tissue constructs for potential applications in the treatment of combined hard and soft tissue defects and as an alternative in vitro test model to animal experimental systems. The aim of this study was to develop and characterize a novel three-dimensional combined human alveolar bone and gingival mucosal model based on primary cells isolated from the oral tissues. Bone component of the model was engineered by seeding primary human alveolar osteoblasts into a hydroxyapatite/tricalcium phosphate scaffold and culturing in a spinner bioreactor. The engineered bone was then laminated, using an adhesive tissue sealant, with tissue-engineered gingival mucosa consisting of air/liquid interface-cultured normal human gingival keratinocytes on oral fibroblast-populated collagen gel scaffold. Histological characterization revealed a structure consisting of established epithelial, connective tissue and bone layers closely comparable to normal oral tissue architecture. The mucosal component demonstrated a mature epithelium undergoing terminal differentiation similar to that characteristic of native buccal mucosa, as confirmed using cytokeratin 13 and cytokeratin 14 immunohistochemistry. Ultrastructural analysis confirmed the presence of desmosomes and hemidesmosomes in the epithelial layer, a continuous basement membrane, and newly synthesized collagen in the connective tissue layer. Quantitative polymerase chain reaction (qPCR) assessment of osteogenesis-related gene expression showed a higher expression of genes encoded collagen I (COL1) and osteonectin (ON) compared with osteocalcin (OC), osteopontin (OP), and alkaline phosphatase (ALP). Enzyme-linked immunosorbent assay quantification of COL1, ON, and OC confirmed a pattern of secretion, which paralleled the model's gene expression profile. We demonstrate in this study that, replicating the anatomical setting between oral mucosa and the underlying alveolar bone is feasible and the developed model showed characteristics similar to those of normal tissue counterparts. This trilayered model therefore offers great scope as an advanced and anatomically representative tissue-engineered alternative to animal models.

Development of three-dimensional tissue engineered bone-oral mucosal composite models

Tissue engineering of bone and oral mucosa have been extensively studied independently. The aim of this study was to develop and investigate a novel combination of bone and oral mucosa in a single 3D in vitro composite tissue mimicking the natural structure of alveolar bone with an overlying oral mucosa. Rat osteosarcoma (ROS) cells were seeded into a hydroxyapatite/tri-calcium phosphate scaffold and bone constructs were cultured in a spinner bioreactor for 3 months. An engineered oral mucosa was fabricated by air/liquid interface culture of immortalized OKF6/TERET-2 oral keratinocytes on collagen gel-embedded fibroblasts. EOM was incorporated into the engineered bone using a tissue adhesive and further cultured prior to qualitative and quantitative assessments. Presto Blue assay revealed that ROS cells remained vital throughout the experiment. The histological and scanning electron microscope examinations showed that the cells proliferated and densely populated the scaffold construct. Micro computed tomography (micro-CT) scanning revealed an increase in closed porosity and a decrease in open and total porosity at the end of the culture period. Histological examination of bone-oral mucosa model showed a relatively differentiated parakeratinized epithelium, evenly distributed fibroblasts in the connective tissue layer and widely spread ROS cells within the bone scaffold. The feasibility of fabricating a novel bone-oral mucosa model using cell lines is demonstrated. Generating human 'normal' cell-based models with further characterization is required to optimize the model for in vitro and in vivo applications.

Treatment of the edentulous atrophic maxilla using zygomatic implants: evaluation of survival rates over 5-10 years

The aim of this retrospective observational cohort study was to analyse and report the 5-10-year survival rates of endosseous zygomatic implants used in the rehabilitation of the atrophic maxilla. Forty-three consecutive zygomatic implant placements in 25 patients were evaluated over a 5-10-year period. All zygomatic implant surgery was carried out under general anaesthesia. Nobel Biocare zygomatic machined-surface implants were used, and placement was undertaken using the modified sinus slot method. The main outcome measures and determinants for success were survival of the restored implants and the proportion of originally planned prostheses delivered to patients. Of the 25 patients treated, 12 were male and 13 were female; 19 were non-smokers, and the mean age at time of surgery was 64 years. Patients were treatment-planned for implant-retained bridgework, a removable prosthesis retained by fixed cast gold or milled titanium beams, or magnet-retained removable prostheses. A combination of zygomatic and conventional implants was used in all but one patient. In this study it was shown that the overall success rate for zygomatic implants was 86%, with six of the implants either failing to integrate or requiring removal due to persistent infection associated with the maxillary sinus. All patients received their planned prosthesis, although in six cases the method of retention required modification. This study illustrates that zygomatic implants are a successful and important treatment option when trying to restore the atrophic maxilla, with the potential to avoid additional augmentation/grafting procedures and resulting in a high long-term success rate.

Contour analysis of an implant--soft tissue interface

BACKGROUND AND OBJECTIVE

Studies of peri-implant soft tissue on in vivo models are commonly based on histological sections prepared using undecalcified or 'fracture' techniques. These techniques require the cutting or removal of implant during the specimen preparation process. The aim of this study is to explore a new impression technique that does not require any cutting or removal of implant for contour analysis of soft tissue around four types of titanium (Ti) surface roughness using an in vitro three-dimensional oral mucosal model (3D OMM).

METHODS

The 3D OMM was constructed by co-culturing a keratinocyte cell line TR146 and human oral fibroblasts on to an acellular dermis scaffold. On the fourth day, a Ti disk was placed into the model. Four types of Ti surface topographies, i.e. polished, machined, sandblasted and anodized were tested. After 10 d of culture, the specimens were processed based on undecalcified (ground sectioning), electropolishing and impression techniques for contour analysis of the implant-soft tissue interface.

RESULTS

Under light microscopic examination of the ground and electropolishing sections, it was found that the cell line-based oral mucosa formed a peri-implant-like epithelium attachment on to all four types of Ti surfaces. In contour analysis, the most common contour observed between the cell line-based oral mucosa and Ti surface was at an angle ranging between 45° and 90°.

CONCLUSION

The in vitro cell line-based 3D OMM formed a peri-implant-like epithelium at the implant-soft tissue interface. The contour of the implant-soft tissue interface for the four types of Ti surface was not significantly different.

Determination of relative in vivo osteoconductivity of modified potassium fluorrichterite glass-ceramics compared with 45S5 bioglass

Potassium fluorrichterite (KNaCaMg(5)Si(8)O(22)F(2)) glass-ceramics were modified by either increasing the concentration of calcium (GC5) or by the addition of P(2)O(5) (GP2). Rods (2 × 4 mm) of stoichiometric fluorrichterite (GST), modified compositions (GC5 and GP2) and 45S5 bioglass, which was used as the reference material, were prepared using a conventional lost-wax technique. Osteoconductivity was investigated by implantation into healing defects in the midshaft of rabbit femora. Specimens were harvested at 4 and 12 weeks following implantation and tissue response was investigated using computed microtomography (μCT) and histological analyses. The results showed greatest bone to implant contact in the 45S5 bioglass reference material at 4 and 12 weeks following implantation, however, GST, GC5 and GP2 all showed direct bone tissue contact with evidence of new bone formation and cell proliferation along the implant surface into the medullary space. There was no evidence of bone necrosis or fibrous tissue encapsulation around the test specimens. Of the modified potassium fluorrichterite compositions, GP2 showed the greatest promise as a bone substitute material due to its osteoconductive potential and superior mechanical properties.

The biological seal of the implant-soft tissue interface evaluated in a tissue-engineered oral mucosal model

For dental implants, it is vital that an initial soft tissue seal is achieved as this helps to stabilize and preserve the peri-implant tissues during the restorative stages following placement. The study of the implant-soft tissue interface is usually undertaken in animal models. We have developed an in vitro three-dimensional tissue-engineered oral mucosal model (3D OMM), which lends itself to the study of the implant-soft tissue interface as it has been shown that cells from the three-dimensional OMM attach onto titanium (Ti) surfaces forming a biological seal (BS). This study compares the quality of the BS achieved using the three-dimensional OMM for four types of Ti surfaces: polished, machined, sandblasted and anodized (TiUnite). The BS was evaluated quantitatively by permeability and cell attachment tests. Tritiated water (HTO) was used as the tracing agent for the permeability test. At the end of the permeability test, the Ti discs were removed from the three-dimensional OMM and an Alamar Blue assay was used for the measurement of residual cells attached to the Ti discs. The penetration of the HTO through the BS for the four types of Ti surfaces was not significantly different, and there was no significant difference in the viability of residual cells that attached to the Ti surfaces. The BS of the tissue-engineered oral mucosa around the four types of Ti surface topographies was not significantly different.

Tissue-engineered oral mucosa

Advances in tissue engineering have permitted the three-dimensional (3D) reconstruction of human oral mucosa for various in vivo and in vitro applications. Tissue-engineered oral mucosa have been further optimized in recent years for clinical applications as a suitable graft material for intra-oral and extra-oral repair and treatment of soft-tissue defects. Novel 3D in vitro models of oral diseases such as cancer, Candida, and bacterial invasion have been developed as alternatives to animal models for investigation of disease phenomena, their progression, and treatment, including evaluation of drug delivery systems. The introduction of 3D oral mucosal reconstructs has had a significant impact on the approaches to biocompatibility evaluation of dental materials and oral healthcare products as well as the study of implant-soft tissue interfaces. This review article discusses the recent advances in tissue engineering and applications of tissue-engineered human oral mucosa.

In vitro biocompatibility of modified potassium fluorrichterite and potassium fluorrichterite-fluorapatite glass-ceramics

Potassium fluorrichterite (KNaCaMg(5)Si(8)O(22)F(2)) glass-ceramics were modified by either increasing the concentration of calcium in the glass (GC5), or by the addition of P(2)O(5) to produce potassium fluorrichterite-fluorapatite (GP2). The solubility of the stoichiometric composition (GST), GC5 and GP2 were measured using the standard test described in ISO 6872:1995 (Dental Ceramics). Ion release profiles were determined for Si, Ca, Mg, Na, K and P using inductively coupled plasma mass spectrometry and fluoride ion (F(-)) concentration was measured using an ion-selective electrode. The cytotoxicity of all compositions was assessed using cultured rat osteosarcoma cells (ROS, 17/2.8). Cell response was qualitatively assessed using scanning electron microscopy (SEM) and quantitatively using the Alamar blue assay. GST was the least soluble and also released the lowest concentration of ions following immersion in water. Of the modified compositions, GC5 demonstrated intermediate solubility but the greatest ion release while GP2 exhibited the highest solubility. This was most likely due to GC5 having the greatest proportion of residual glass following crystallisation. The mass loss exhibited by GP2 may have been due in part to the partial disintegration of the surface of specimens during solubility testing. SEM demonstrated that all compositions supported the growth of healthy ROS cells on their surfaces, and this data was further supported by the quantitative Alamar blue assay.

Osteoconductivity of modified fluorcanasite glass-ceramics for bone tissue augmentation and repair

Modified fluorcanasite glasses were fabricated by either altering the molar ratios of Na(2)O and CaO or by adding P(2)O(5) to the parent stoichiometric glass compositions. Glasses were converted to glass-ceramics by a controlled two-stage heat treatment process. Rods (2 mm x 4 mm) were produced using the conventional lost-wax casting technique. Osteoconductive 45S5 bioglass was used as a reference material. Biocompatibility and osteoconductivity were investigated by implantation into healing defects (2 mm) in the midshaft of rabbit femora. Tissue response was investigated using conventional histology and scanning electron microscopy. Histological and histomorphometric evaluation of specimens after 12 weeks implantation showed significantly more bone contact with the surface of 45S5 bioglass implants when compared with other test materials. When the bone contact for each material was compared between experimental time points, the Glass-Ceramic 2 (CaO rich) group showed significant difference (p = 0.027) at 4 weeks, but no direct contact at 12 weeks. Histology and backscattered electron photomicrographs showed that modified fluorcanasite glass-ceramic implants had greater osteoconductivity than the parent stoichiometric composition. Of the new materials, fluorcanasite glass-ceramic implants modified by the addition of P(2)O(5) showed the greatest stimulation of new mineralized bone tissue formation adjacent to the implants after 4 and 12 weeks implantation.

Biologic assessment of antiseptic mouthwashes using a three-dimensional human oral mucosal model

BACKGROUND

The biologic safety profile of oral health care products is often assumed on the basis of simplistic test models such as monolayer cell culture systems. We developed and characterized a tissue-engineered human oral mucosal model, which was proven to represent a potentially more informative and more clinically relevant alternative for the biologic assessment of mouthwashes. The aim of this study was to evaluate the biologic effects of alcohol-containing mouthwashes on an engineered human oral mucosal model.

METHODS

Three-dimensional (3D) models were engineered by the air/liquid interface culture technique using human oral fibroblasts and keratinocytes. The models were exposed to phosphate buffered saline (negative control), triethylene glycol dimethacrylate (positive control), cola, and three types of alcohol-containing mouthwashes. The biologic response was recorded using basic histology; a cell proliferation assay; 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide tissue-viability assay; transmission electron microscopy (TEM) analysis; and the measurement of release of interleukin (IL)-1beta by enzyme-linked immunosorbent assay.

RESULTS

Statistical analysis showed that there was no significant difference in tissue viability among the mouthwashes, cola, and negative control groups. However, exposure to the positive control significantly reduced the tissue viability and caused severe cytotoxic epithelial damage as confirmed by histology and TEM analysis. A significant increase of IL-1beta release was observed with the positive control and, to a lesser extent, with two of the tested mouthrinses.

CONCLUSIONS

The 3D human oral mucosal model can be a suitable model for the biologic testing of mouthwashes. The alcohol-containing mouthwashes tested in this study do not cause significant cytotoxic damage and may slightly stimulate IL-1beta release.

Preliminary investigation of novel bone graft substitutes based on strontium-calcium-zinc-silicate glasses

Bone graft procedures typically require surgeons to harvest bone from a second site on a given patient (Autograft) before repairing a bone defect. However, this results in increased surgical time, excessive blood loss and a significant increase in pain. In this context a synthetic bone graft with excellent histocompatibility, built in antibacterial efficacy and the ability to regenerate healthy tissue in place of diseased tissue would be a significant step forward relative to current state of the art philosophies. We developed a range of calcium-strontium-zinc-silicate glass based bone grafts and characterised their structure and physical properties, then evaluated their in vitro cytotoxicity and in vivo biocompatibility using standardised models from the literature. A graft (designated BT109) of composition 0.28SrO/0.32ZnO/0.40 SiO(2) (mol fraction) was the best performing formulation in vitro shown to induce extremely mild cytopathic effects (cell viability up to 95%) in comparison with the commercially available bone graft Novabone (cell viability of up to 72%). Supplementary to this, the grafts were examined using the standard rat femur healing model on healthy Wister rats. All grafts were shown to be equally well tolerated in bone tissue and new bone was seen in close apposition to implanted particles with no evidence of an inflammatory response within bone. Complimentary to this BT109 was implanted into the femurs of ovariectomized rats to monitor the response of osteoporotic tissue to the bone grafts. The results from this experiment indicate that the novel grafts perform equally well in osteoporotic tissue as in healthy tissue, which is encouraging given that bone response to implants is usually diminished in ovariectomized rats. In conclusion these materials exhibit significant potential as synthetic bone grafts to warrant further investigation and optimisation.

Development, optimization and characterization of a full-thickness tissue engineered human oral mucosal model for biological assessment of dental biomaterials

Restorative dental materials and oral health care products come into direct contact with oral mucosa and can cause adverse reactions. In order to obtain an accurate risk assessment, the in vitro test model must reflect the clinical situation as closely as possible. The aim of this study was to develop and optimize a three-dimensional full-thickness engineered human oral mucosal model, which can be used for biological assessment of dental materials. In this study human oral fibroblasts and keratinocytes were isolated from patients and seeded onto a number of collagen-based and synthetic scaffolds using a variety of cell seeding techniques and grown at the air/liquid interface to construct human oral mucosa equivalents. Suitability of 10 different scaffolds for engineering human oral mucosa was evaluated in terms of biocompatibility, biostability, porosity, and the ability to mimic normal human oral mucosa morphology. Finally an optimized full-thickness engineered human oral mucosa was developed and characterized using transmission electron microscopy and immunostaining. The oral mucosa reconstruct resembled native human oral mucosa and it has the potential to be used as an accurate and reproducible test model in mucotoxicity and biocompatibility evaluation of dental materials.

The effect of investment materials on the surface of cast fluorcanasite glasses and glass-ceramics

Modified fluorcanasite glass-ceramics were produced by controlled two stage heat-treatment of as-cast glasses. Castability was determined using a spiral castability test and the lost-wax method. Specimens were cast into moulds formed from gypsum and phosphate bonded investments to observe their effect on the casting process, surface roughness, surface composition and biocompatibility. Both gypsum and phosphate bonded investments could be successfully used for the lost-wax casting of fluorcanasite glasses. Although the stoichiometric glass composition had the highest castability, all modified compositions showed good relative castability. X-ray diffraction showed similar bulk crystallisation for each glass, irrespective of the investment material. However, differences in surface crystallisation were detected when different investment materials were used. Gypsum bonded investment discs showed slightly improved in vitro biocompatibility than equivalent phosphate bonded investment discs under the conditions used.

Tissue-engineered oral mucosa: a review of the scientific literature

Tissue-engineered oral mucosal equivalents have been developed for clinical applications and also for in vitro studies of biocompatibility, mucosal irritation, disease, and other basic oral biology phenomena. This paper reviews different tissue-engineering strategies used for the production of human oral mucosal equivalents, their relative advantages and drawbacks, and their applications. Techniques used for skin tissue engineering that may possibly be used for in vitro reconstruction of human oral mucosa are also discussed.

In vitro biocompatibility of fluorcanasite glass-ceramics for bone tissue repair

Fluorcanasite glass-ceramics were produced by controlled two stage heat-treatment of as-cast glasses. These glasses were modified from stoichiometric fluorcanasite composition by either adding P(2)O(5) or altering the molar ratios of Na(2)O and CaO. Commercial bioactive 45S5 Bioglass(R) was also prepared in-house to evaluate the relative in vitro biocompatibility of fluorcanasite glass-ceramics. The scanning electron microscopy (SEM) images showed that cells had colonized the surfaces of fluorcanasite glass-ceramics to form a confluent sheet. Quantitative MTT assay results were in good agreement with the qualitative SEM observations. It was concluded that incorporation of excess calcium oxide or P(2)O(5) in stoichiometric glass composition improved in vitro biocompatibility. Controlled heat-treatment further improved the biological response of cultured bone cells to modified fluorcanasite glass-ceramics when compared with their parent glasses. Ion release and pH data suggested a strong correlation between solubility (in particular, Na ion release) and biocompatibility. Reduced solubility, Na ion release, and related pH effects appeared to be the principal mechanisms responsible for improvement in in vitro biocompatibility.

HPLC analysis of components released from dental composites with different resin compositions using different extraction media

Components released from dental composite resins are essential factors in the assessment of biocompatibility of these materials. The effect of different extraction media on monomer release from composite resins based on different monomer types was evaluated. Three types of visible light cured composite resins were formulated based on the following monomers: triethylene glycol dimethacrylate (TEGDMA), bisphenol A glycerolate dimethacrylate (BisGMA), and urethane dimethacrylate (UDMA). Seventy-five composite resin discs were fabricated and light cured for 1 min in the absence of oxygen. Extraction media used were: distilled water, saline solution, artificial saliva, serum-free culture medium, and culture medium with 10% fetal calf serum. The analysis of extracts from the composite resins was carried out by High Performance Liquid Chromatography (HPLC). Quantifiable amounts of TEGDMA were released into the aqueous media. However, BisGMA and UDMA were not detectable in any of the extracts from the composite resins. Statistical analysis by one-way ANOVA followed by Tukey's test showed that there was a significant difference in TEGDMA release between culture media and other media (p < 0.05). From the results of this experiment it can be concluded that TEGDMA-based composite resins can release a high quantity of monomer into aqueous environments. The type of extraction medium may have a significant effect on monomer release from composite resins.

Cytotoxicity of resin monomers on human gingival fibroblasts and HaCaT keratinocytes

OBJECTIVES

The aim of this study was to evaluate and compare the biological effects of three resin monomers on three human gingival fibroblast (HGF) cell lines and immortalised human keratinocytes.

METHODS

Primary HGFs and HaCaT keratinocytes were cultured for 24h and grown to sub-confluent monolayers. Resin monomers were dissolved in dimethyl sulphoxide (DMSO) and diluted with culture medium. Cultures were exposed to different concentrations of monomers (10(-2) to 10mM) for 24h. Cell viability measured by Alamar Blue assay, and cell culture supernatant was examined for the presence of human interlukin-1beta (IL-1beta) using sandwich enzyme-linked immunosorbant assay (ELISA). TC50 values were calculated from fitted dose-response curves.

RESULTS

All monomers showed toxic effects on the HGFs and HaCaT cells and inhibited chemical reduction of Alamar Blue in high concentrations. Statistical analysis of TC50 values by one-way ANOVA followed by Tukey's analysis showed that there is a significant difference in TC50 values between the cell lines (p<0.05), although the rank order of monomer toxicity remained the same for different cell lines. None of these monomers-induced IL-1beta release from HGFs and HaCaT cells.

SIGNIFICANCE

Dental resin monomers are toxic to human gingival fibroblasts and HaCaT keratinocytes. However, they cannot induce IL-1beta release from these cells by themselves. Alamar Blue assay is a sensitive method for the evaluation of cytotoxicity and it can detect different sensitivities of different cell lines to the resin monomers.

Biocompatibility of glass-ionomer bone cements

Glass-ionomer cements (GIC) have been extensively used in dentistry for over 30 years. Due to their excellent biocompatibility in dental applications GIC have been formulated for medical applications. The past decade has seen some impressive advances in the development of medical GICs, however these advances have been matched by serious critical problems. This review examines the properties of GICs, which can influence their behaviour in a biological environment. The progress made and the problems encountered in the development of these bone cements will also be addressed. The review will conclude with the research currently being employed to optimise the biocompatibility of these important biomaterials. There is little doubt that GICs compare favourably with alternative bone cements for specific applications, based on in vitro and in vivo studies. There is however, a degree of risk inherent in the use of any medical device or biomaterial. GICs must therefore be used carefully and in accordance with the instructions that are based on a significant body of research data.

Bone response to a titanium aluminium nitride coating on metallic implants

The design, surface characteristics and strength of metallic implants are dependant on their intended use and clinical application. Surface modifications of materials may enable reduction of the time taken for osseointegration and improve the biological response of bio-mechanically favourable metals and alloys. The influence of a titanium aluminium nitride (TAN) coating on the response of bone to commercially pure titanium and austenitic 18/8 stainless steel wire is reported. TAN coated and plain rods of stainless steel and commercially pure titanium were implanted into the mid-shaft of the femur of Wistar rats. The femurs were harvested at four weeks and processed for scanning electron and light microscopy. All implants exhibited a favourable response in bone with no evidence of fibrous encapsulation. There was no significant difference in the amount of new bone formed around the different rods (osseoconduction), however, there was a greater degree of shrinkage separation of bone from the coated rods than from the plain rods (p = 0.017 stainless steel and p = 0.0085 titanium). TAN coating may result in reduced osseointegration between bone and implant.

Localization of Type VI Collagen in Tissue-Engineered Cartilage on Polymer Scaffolds

Together, the chondrocyte and its pericellular matrix have been collectively termed the chondron. Current opinion is that the pericellular matrix has both protective and signalling functions between chondrocyte and extracellular matrix. Formation of a native chondrocyte pericellular matrix or chondron structure might therefore be advantageous when tissue engineering a functional hyaline cartilage construct. The presence of chondrons has not been previously described in cartilage engineered on a scaffold. In this paper, we describe a modified immunochemical method to detect collagen VI, a key molecular marker for the pericellular matrix, and an investigation of type VI collagen distribution in engineered hyaline cartilage constructs. Cartilage constructs were engineered from adult human or bovine hyaline chondrocytes cultured on sponge or nonwoven fiber based HYAFF 11 scaffolds. Type VI collagen was detected in all constructs, but a distinctive, high-density, chondron-like distribution of collagen VI was present only in constructs exhibiting additional features of hyaline cartilage engineered using nonwoven HYAFF 11. Chondron structures were localized in areas of the extracellular matrix displaying strong collagen II and GAG staining of constructs where type II collagen composed a high percentage (over 65%) of the total collagen.

The effect of calcium fluoride (CaF) on the chemical solubility of an apatite–mullite glass–ceramic material

OBJECTIVE

To assess the effect of varying CaF(2) on the chemical solubility of apatite-mullite glass-ceramic (G-C) materials in both the glassy and crystallized states.

METHODS

Apatite-mullite forming glasses used in this study are ionomer cement derivatives based on the general formula (4.5SiO(2)-3Al(2)O(3)-1.5P(2)O(5)-3CaO-XCaF(2)). Six glass formulations were produced where X=0.5, 1, 1.5, 2, 2.5 and 3, and called HG1-6, respectively. Batches were melted in covered silliminite crucibles in a furnace overnight at 1050 degrees C, then at 1450 degrees C for 2h, before quenching in water. The six glass compositions were analyzed using differential thermal analysis (DTA), X-ray diffraction (XRD) and X-ray fluorescence spectrometry (XRF). Thirty discs (2mm thick and 12 mm diameter) were produced per glass using the lost wax casting technique. Ten were left as cast and 10 heat treated to either apatite or apatite-mullite. Solubility testing was carried out according to International Standard BS EN ISO 6872 1999 and the mass difference in solubility calculated as mug/cm(2). A lithium disilicate G-C system was used as a control material.

RESULTS

All compositions formed glasses and on heat treatment could form apatite and apatite-mullite. The as-cast glass samples were the most soluble followed by the apatite samples. The apatite-mullite G-C was significantly less soluble than the other two phases (p<0.05) for all six compositions. The control material was significantly less soluble than all the HG glass-ceramic compositions for every phase (p<0.05). Decreasing the CaF(2) content (3-0.5 mol%) led to a decrease in solubility, without affecting the ability of the material to form apatite and apatite-mullite phases.

SIGNIFICANCE

Increasing the CaF(2) content increases the chemical solubility for the glass, apatite G-C and apatite-mullite G-C phases. The solubility values obtained show that all the compositions, as cast and heat treated would be suitable for use as core ceramics.

Crystallization modifies osteoconductivity in an apatite-mullite glass-ceramic

The response to implantation of novel apatite glass-ceramics was evaluated using a weight bearing in vivo bone implant model. Five novel glasses with varying calcium to phosphate ratios were cast as short rods and heat-treated to crystallize principally apatite. One glass ceramic had an apatite stoichiometry (Ca : P=1.67); three were phosphate-rich and one calcium-rich. One of the phosphate-rich glasses was also tested in its glassy state to determine the effect of crystallization on the biological response. Rods were implanted into the midshaft of rat femurs and left for 28 days. The femurs were then harvested and processed for scanning electron microscopy, energy dispersive X-ray microanalysis and conventional histology as ground and polished sections. Four of the materials exhibited evidence of osseointegration and osteoconduction. However, there was a marked inflammatory response to one of the phosphate-rich glass-ceramics, and to the non-crystallized glass. Crystallization of the latter significantly improved the bone tissue response. The glass-ceramic with an apatite stoichiometry elicited the most favorable response and merited further study as an osteoconductive bone substitute in maxillofacial and orthopedic surgery.

Sinus augmentation bone grafts for the provision of dental implants: report of clinical outcome

PURPOSE

The aim of this study was to report the outcome of sinus augmentation surgery with autogenous bone grafting in routine dental implant practice.

MATERIALS AND METHODS

Twenty-seven sinus augmentation procedures were undertaken on 18 consecutive patients (mean age 43.7 years). The mandibular symphysis was used as the donor site for 11 patients. The iliac crest was used as a donor site for 7 bilateral cases.

RESULTS

Six patients had implants placed at the time of grafting: the other 13 had a mean bone graft consolidation period of 24.7 weeks (range 9 to 39 weeks) before implants were placed. One patient who had a repeat procedure had both immediate and delayed techniques. A total of 79 Brånemark System Mk II implants were placed in grafted bone (and 2 Mk IV implants were placed in a patient who had to have a repeat procedure) and proceeded to occlusal loading. After a mean follow-up period of 162 weeks (range 76 to 288 weeks), 16 implants failed to integrate in grafted bone, representing an 80.25% survival rate. Fourteen patients proceeded to the planned prosthesis, 3 patients had a compromised treatment plan, and 1 patient was restored conventionally. This represents 94% of patients who were rehabilitated.

DISCUSSION AND CONCLUSION

The sinus augmentation procedure using autogenous bone grafting can Increase bone volume to allow implant placement where there is insufficient bone. The survival of implants in the grafted bone, as measured by integration and successful loading, was reduced compared to implants placed in normal maxillary bone. Infection during the healing of the grafted site reduces the success of subsequent implant osseointegration.

Dental implants and onlay bone grafts in the anterior maxilla: analysis of clinical outcome

PURPOSE

Loss of alveolar bone in the anterior maxilla may preclude implant placement or compromise positioning and thus diminish the final esthetic result of the restoration. Bone augmentation can overcome such difficulties but may affect osseointegration. The aim of this study was to report the outcome of buccal onlay bone grafting in the anterior maxilla in routine dental implant practice.

MATERIALS AND METHODS

Seventeen consecutive patients (12 men and 5 women, mean age 31.4 years) received autogenous bone grafts from the mandibular symphysis to the anterior maxilla. A total of 35 Brånemark System MK II implants were placed in grafted bone.

RESULTS

Fifteen patients had a mean period of graft consolidation of 19.7 weeks (range 13 to 32 weeks). Two patients had simultaneous graft and implant placement; 1 implant failed to Integrate in this group. This represents a survival rate of 97.1% of implants in functional loading after a mean follow-up period of 153.6 weeks from occlusal loading (range 74 to 283 weeks).

DISCUSSION AND CONCLUSION

Mandibular block onlay grafts appear to be a predictable method for augmenting the width of the anterior maxilla prior to implant placement.

In vivo response of strontium and zinc-based ionomeric cement implants in bone

In this study the osteoconductive properties of strontium based ionomeric cements (ICs) named, LG125 and LG119, as well as zinc-based ICs, designated by LG130 and LG132, were compared. Wet ICs were surgically implanted into the femora of weaned Wistar rats for 4 weeks. To assess the percentage osseointegration the perimeter of the implant and the perimeter of bone in contact with the implant were measured using a pointer (the length of bone/implant interfacial contact). Osteoconduction was determined by taking six points at random around the perimeter of each ionomeric rod measuring the thickness of newly formed bone. The degree of osteoconduction was taken as the average thickness of new bone produced on the implant surface. It was found that osteoconduction was greatest in the strontium based IC implant LG125. From these studies it can be concluded that the composition LG125 might provide a useful purpose as a bone cement.

In vitro and in vivo evaluation of e-PTFE and alkali-cellulose membranes for guided bone regeneration

Guided bone regeneration (GBR) is employed to encourage the formation of new bone in osseous defects by restricting the infiltration of soft tissues. While a variety of membranes have been evaluated for this surgical procedure, the non-resorbable material of choice is currently expanded polytetrafluoroethylene (e-PTFE). A new alkali-cellulose membrane produced by a biotechnological process has been developed as an alternative to e-PTFE for GBR. In this study, the biocompatibility of this novel alkali-cellulose membrane and e-PTFE was compared using tissue culture and an in vivo GBR model. In vitro both materials supported the attachment, migration and differentiation of osteoblast-like cells in culture for up to 3 weeks. The in vivo model was based upon full-thickness transcortical bone defects in the mandibular rami of Sprague-Dawley rats. The right rami were used as controls, contralateral defects being covered bucally and lingually with either e-PTFE or alkali-cellulose membranes. Pathological and histomorphometric analysis was undertaken at 4 and 10 weeks post-implantation. Bone regeneration associated with alkali-cellulose membranes was predominantly endochondral in type in contrast to e-PTFE which induced direct bone formation (intramembranous ossification). The amount of new bone formed in defects was similar for both types of membrane, but alkali-cellulose membranes induced significantly greater inflammatory response; characterized by lymphocytes, macrophages and multinucleated giant cells. Degradation and possible exposure of individual cellulose fibres may account for the poor performance of alkali-cellulose membranes in vivo. This animal and in vitro study indicates that when choosing a non-resorbable membrane for GBR, e-PTFE membranes are likely to perform better than those produced from alkali-cellulose.

Glass-ionomer cement: evaluation as an orbital implant

BACKGROUND

To assess the potential of a porous glass-ionomer cement (GIC) as an alternative material for spherical orbital implants, the handling, side effects and rates of fibrovascular ingrowth of this material were compared with those of a synthetic hydroxyapatite (HA) implant.

METHOD

Twenty-one GIC and 8 HA uncovered 14-mm spheres were implanted into the orbits of New Zealand albino rabbits. Postoperative reactions, animal's behaviour, weight increase and socket conditions were monitored. Light and electron microscopy of the exenterated orbits were performed 2, 3 and 6 months after primary insertion.

RESULTS

Implanting of GIC was easier than HA. Postoperatively all animals did well. Three HA and 1 GIC implant caused conjunctival dehiscences, but no implant extrusion was observed. Histologically, both materials caused mild inflammation in the surrounding connective tissue capsule, decreasing with time. GIC implants proved to be not truly porous, with only peripheral pores partly occupied by relatively acellular collagenous connective tissue. Free glass particles were observed in both the connective tissue and giant cells, occupying the partly filled pore spaces. HA implants showed extensive ingrowth of vital host tissue from the beginning.

CONCLUSIONS

Considering the clinical findings and the mild inflammation in the connective tissue capsule surrounding both materials, they would appear to be equally well tolerated at the implant site. The significantly different microstructure and the histological results make GIC, despite better handling, less suitable as an orbital implant.

Dependence of in vitro biocompatibility of ionomeric cements on ion release

The in vitro biocompatibility of a group of ionomeric cements (ICs) was evaluated with respect to their ion release properties. These ICs were made from a defined series of glasses with the general formula 1.5SiO2.0.5P2O5.Al2O3.(1.0-Z)CaO.0.75CaF2 where Z was the mole fraction (ranging from 0-0.1) of an alkali metal oxide, either sodium or potassium or a mixture of both. For these alkali metal ICs, the amount of sodium released was directly related to the sodium content of the constituent glass. Similarly, the amount of potassium released was directly related to the potassium content. There was no correlation between the aluminum content of the glass and the aluminum ion release. Increasing the monovalent cation concentration, however, produced ICs with increased fluoride release. The biocompatibility of the ICs, as assessed by in vitro cell growth and viability measurements, was inversely proportional to aluminum ion release. Fluoride ion release, although important in terms of in vitro biocompatibility, would appear to be less important than aluminum ion release in determining the overall biocompatibility of the ICs studied.

Plasma copolymer surfaces of acrylic acid/1,7 octadiene: surface characterisation and the attachment of ROS 17/2.8 osteoblast-like cells

The purpose of this study was: (a) to examine the effect of plasma-gas composition on plasma polymer oxygen/carbon (O/C) ratio, functional group composition and stability in water, and then (b) to examine cell attachment to surfaces containing different concentrations of O/C and functional groups. Oxygen-functionalised surfaces were deposited by means of the plasma copolymerisation of acrylic acid/1,7-octadiene. The use of a diluent hydrocarbon allowed the deposition of surfaces with a range of O/C concentrations. Plasma copolymer surfaces were characterised by X-ray photoelectron spectroscopy (XPS). Changes in functional group composition with % acrylic acid monomer and the non-dispersive and dispersive parts of the surface energy of these plasma copolymers were measured. The solubility of the plasma copolymers was assessed by means of XPS. The degree of attachment of ROS 17/2.8 osteoblast-like cells to plasma copolymer surfaces deemed to be 'stable' in aqueous medium was measured. Tissue culture polystyrene (TCPS) was included as a control. Attachment was found to be greatest to the plasma copolymer surface with an O/C of 0.11. This surface had a carboxylic acid concentration of ca. 3%. Attachment did not correlate with increased surface wettability (i.e. the non-dispersive component of the surface energy).

Glass-ionomers: bioactive implant materials

Glass-ionomer cements (GICs) originally designed for use as dental materials have a number of advantages over acrylic bone cements. These include lack of exotherm during setting, absence of monomer and improved release of incorporated therapeutic agents; this has resulted in the development of GICs for biomedical applications. Major landmarks in this history are the formulation of defined-composition ionomer glasses and an improved understanding of the biological and material properties of GICs. Following implantation, GICs can form a stable integration with bone, and affect the growth and development of bone, both adjacent to their surface and systemically, through an ion release mechanism. The 'non-inert' nature of this group of materials is also demonstrated by their adverse effects on neural tissue. Successful clinical use of GICs, both as bone cements and as preformed implants for hard tissue replacement, have been reported in the fields of otologic surgery (Cochlear implant fixation, repair of the tympanic chain, eustation tube obliteration and as ear ossicles), and oral and reconstructive surgery. The use of GICs in situations where they will come into contact with nerves or neural tissue is contraindicated.

Bone healing following the use of hydroxyapatite or ionomeric bone substitutes alone or combined with a guided bone regeneration technique: an animal study

The healing of standardized bone defects grafted with either particulate ionomeric or hydroxyapatite bone substitutes was compared in the mandibular ramus of 30 Sprague-Dawley rats. The possible additional response achieved when combining these materials with a guided bone regeneration (GBR) technique was also evaluated. Three groups of 10 animals received either no implant material or ionomeric or hydroxyapatite bone substitute in defects in the right ramus. The left mandibular defects received the same treatment, except that the operation site was covered by a membrane (GBR technique). Half of the animals were sacrificed at 4 and 10 weeks following surgery, and the inflammatory response at the implant site and the amount of new bone formed in the defects were determined histomorphometrically. Defects implanted with ionomeric bone substitute exhibited more bone formation (4 weeks = 3.19 +/- 0.35 mm2, 10 weeks = 5.35 +/- 0.26 mm2) than both defects that received no treatment (4 weeks = 0.88 +/- 0.35 mm2, 10 weeks = 2.1 +/- 0.49 mm2), membrane alone (4 weeks = 1.21 +/- 0.05 mm2) or hydroxyapatite bone substitute (4 weeks = 1.41 +/- 0.46 mm2, 10 weeks = 3.34 +/- 0.41 mm2) at 4 weeks (P < or = .01) and at 10 weeks (P < or = .05). The use of a GBR technique did not increase the amount of bone formed, compared to the use of bone substitutes alone. Hydroxyapatite and ionomeric bone substitutes used alone were more effective in inducing repair of the defects than was GBR membrane alone. The use of hydroxyapatite was associated with a greater inflammatory reaction (P < or = .01) than was ionomer in this model.

Role of exchanged ions in the integration of ionomeric (glass polyalkenoate) bone substitutes

Ionomeric (glass polyalkenoate) implants are synthetic materials which can be used for repairing bone defects. It has been suggested that ions are leached from these implants during healing and that they influence cellular activity in the surrounding tissues. Morphological, immunohistochemical and microanalytical techniques were used to compare the osteogenic capacity of implants which eluted aluminium ions with implants which did not elute aluminium ions. The extracellular matrix molecules fibronectin and tenascin were located upon the surface of both implanted materials. Thick seams of lamellar bone were apposed to implants containing labile aluminium ions, but the bone was poorly mineralized. At the same time, transient increases were apparent in osteoblast activity on periosteal and endosteal surfaces and in chondrocyte activity in the growth plate and articular cartilages. In contrast, small amounts of mineralized lamellar bone were apposed to substituted implants (without aluminium) and the growth plate and articular cartilages remained normal in thickness and morphology. These results suggest that exchanged ions can influence the amount and quality of bone apposed to the implant. They also suggest that the effect of the ions depends upon their concentration and the state of differentiation of osteogenic cells.

Self-reinforced polyglycolic acid membrane: a bioresorbable material for orbital floor repair. Initial clinical report

A self-reinforced polyglycolic acid membrane has been used successfully to repair 15 orbital floor fractures in 12 consecutive patients. As polyglycolic acid is absorbable it does not cause the complications of long-term infection and migration associated with non-absorbable bioinert alloplastic repair materials.

The response of cultured bone cells to resorbable polyglycolic acid and silicone membranes for use in orbital floor fracture repair

Two membranes intended for use in repairing fractures of the orbital floor--reinforced silicone and biodegradable polyglycolic acid (PGA)--were evaluated in vitro using a rat bone cell culture model. After two weeks in culture, cells had colonised the surface of both materials. Bone cells penetrated the weave of the PGA membrane after three weeks in culture, forming a calcified collagenous bone-like tissue within the weave of the PGA at the same time as there was evidence of resorption of the PGA. In contrast, cells could easily be dislodged from the surface of the reinforced silicone membrane and there was less evidence of mineralised extra cellular matrix production. The production of a bone-like tissue within the weave of the PGA membrane supported previous reports of osteoconductive activity of this material.

X-ray microanalytical detection of iron in pigmentation of oral mucosa

A patient was referred to the Charles Clifford Dental Hospital with a grey metallic pigmentation of the hard palate. Conventional histopathological examination was inconclusive, suggesting the presence of either an ephelis (freckle) or pigmentation resulting from a stainless steel upper denture. Material from the pathological specimen was dewaxed and reembedded in Spurr's resin. Examination in the TEM revealed electron dense deposits in the cytoplasm of macrophages. Energy dispersive X-ray microanalysis demonstrated that these inclusions contained iron. The results suggested that the iron was in a form similar to haemosiderin and had arisen from the steel denture.