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Biointerphases Aug 2019In this systematic review, the authors explored the surface aspects of various titanium (Ti) or Ti alloy medical implants, examining the interface formed between the...
In this systematic review, the authors explored the surface aspects of various titanium (Ti) or Ti alloy medical implants, examining the interface formed between the implant and surrounding nonkeratinized soft tissues (periosteum, muscles, tendons, fat, cicatrix, or dura mater). A comprehensive search undertaken in July 2019 used strict keywords in relevant electronic databases to identify relevant studies. Based on the authors' inclusion criteria (restricted to in vivo studies), 19 of 651 publications qualified, all pertaining to animal models. The syrcle's risk of bias tool for animal studies was applied at study level. Given the broad nature of the reported results and the many different parameters measured, the articles under scrutiny were assigned to five research subgroups according to their surface modification types: mechanical surface modifications, oxidative processes (e.g., acid etching, anodization, microarc oxidation), sol-gel derived titania (TiO) coatings, biofunctionalized surfaces, and a subgroup for other modifications. The primary outcome was a liquid space at the interface (e.g., seroma formation) that was reported in six studies. Machining Ti implants to a roughness between R = 0.5 and 1.0 μm was shown to induce soft-tissue adhesion. Smoother surfaces, with the exception of acid polished and anodized Ti (R = 0.2 μm), prevented soft-tissue adhesion. A fibroblast growth factor 2 apatite composite coating promoted soft-tissue attachment via Sharpey-like fibers. In theory, this implant-soft tissue interface could be nearly perfect.
Topics: Alloys; Coated Materials, Biocompatible; Materials Testing; Prostheses and Implants; Surface Properties; Titanium
PubMed: 31419910
DOI: 10.1116/1.5113607 -
The International Journal of Artificial... Jul 2019To systematically assess the effects of hydroxyapatite bone repair scaffold coated with bone morphogenetic protein-2 on murine calvarial defect models and to determine...
To systematically assess the effects of hydroxyapatite bone repair scaffold coated with bone morphogenetic protein-2 on murine calvarial defect models and to determine the quality of studies according to the Animal Research Reporting in In Vivo Experiments guidelines. Internet search was performed in duplicate using PubMed, MEDLINE, Ovid and Embase databases (without restrictions on publication date). The Animal Research Reporting in In Vivo Experiments guidelines were used to evaluate the quality of selected studies. Following screening, 12 studies were eligible for the review. Studies with average quality coefficients predominated (66.67%), followed by poor (25%) and excellent (8.33%) quality coefficients. Minimum quality scores were assigned to the Animal Research Reporting in In Vivo Experiments guideline items: housing and husbandry (9), allocation (11), outcomes (12), interpretation (18) and generalizability (19). Sprague-Dawley rats were the most frequently used (50%) species, and most studies had a sample size of more than 30 (58.33%). A defect dimension of 5 mm was the most common (33.33%). The biological hydroxyapatite composite scaffold was common (50%), and the bioactive factors were bone morphogenetic protein-2 (50%) and recombinant human bone morphogenetic protein-2 (50%). Histomorphometric results showed that bone morphogenetic protein-2 enhanced the capacity to regenerate bone considerably. In addition, scaffolds with bone morphogenetic protein-2 resulted in a significant increase in the blood vessel in the new bone. The findings suggested that data on animal experiments of hydroxyapatite scaffold coated with bone morphogenetic protein-2 in murine calvarial defect models lack homogeneity. Animal experiment should follow the Animal Research Reporting in In Vivo Experiments guidelines to promote the high quality, integrity and reproducibility. This systematic review suggested that bone morphogenetic protein-2 enhanced the capacity to regenerate bone and the angiogenesis in the new bone.
Topics: Animals; Bone Morphogenetic Protein 2; Bone Regeneration; Durapatite; Humans; Mice; Models, Animal; Rats; Rats, Sprague-Dawley; Recombinant Proteins; Plastic Surgery Procedures; Reproducibility of Results; Skull; Tissue Scaffolds; Transforming Growth Factor beta
PubMed: 30905250
DOI: 10.1177/0391398819834944 -
Survey of Ophthalmology 2007Orbital implants have been used for cosmesis following surgical removal of the eyeball, or enucleation, for over a century. Implant design has progressed significantly... (Review)
Review
Orbital implants have been used for cosmesis following surgical removal of the eyeball, or enucleation, for over a century. Implant design has progressed significantly in recent years with the use of porous devices, with the theoretical advantages of reduced complications and improved cosmesis. However, in some cases the theoretical benefits have not fully translated into clinical results. In this article the use of orbital implants in enucleation, with a particular focus on the newer porous biomaterials that have gained prominence over the last 15 years, is reviewed. Specific factors identified as affecting the performance of porous orbital implants include the material used, pore size, and morphology. Mechanical factors have received little consideration in the past and may form a basis for the use of higher compliance porous materials in the future. Of the porous materials in use, current clinical evidence is not sufficient to suggest either that porous implants are superior to non-porous implants, or that one material is more suited to the application than another. Future developments in this field require randomized controlled clinical trials with extensive follow-up as complications may not become evident until over 5 years post-implantation.
Topics: Aluminum Oxide; Biocompatible Materials; Durapatite; Eye Enucleation; Eye, Artificial; Humans; Orbital Implants; Polyethylene; Porosity; Prosthesis Implantation
PubMed: 17355854
DOI: 10.1016/j.survophthal.2006.12.007 -
European Journal of Oral Implantology 2014An oroantral communication (OAC) is a common complication in alveolar surgery that usually occurs as a result of the extraction of maxillary posterior teeth. To avoid... (Review)
Review
BACKGROUND
An oroantral communication (OAC) is a common complication in alveolar surgery that usually occurs as a result of the extraction of maxillary posterior teeth. To avoid further complications, several closure techniques are used; most of them need a flap elevation. Recently, simpler conservative flapless techniques for OAC closure have been described.
OBJECTIVES
To appraise the effectiveness of different techniques for closure of OACs also in comparison to nothing.
SEARCH METHODS
The following electronic databases were searched for randomised controlled trials regarding techniques for closure of OACs: PubMed; SciVerse Scopus; Latin American and Caribbean Health Sciences; The Scientific Electronic Library Online and The Cochrane Library (from January 1949 to August 2014). Unspecific algorithms were chosen in order to maximise search sensibility. Additional manual searching was performed in PubMed related citations, in five journals and in the references of the selected articles. There were no restrictions with regard to publication language.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing techniques for closing oroantral communications to nothing, or different techniques for closing oroantral communications reporting the success rate with at least two months follow-up.
DATA COLLECTION AND ANALYSIS
The screening of eligible studies, the assessment of methodological quality and data extraction were done by two independent reviewers working in duplicate.
RESULTS
The research individuated 1256 publications. After screening, only five articles were assessed for eligibility. Only two RCTs evaluating the effectiveness of techniques for OAC closure fulfilled the inclusion criteria of the present review. One trial including 30 patients assessed whether flapless techniques (resorbable root analogues and haemostatic gauze) could be as effective as the Rehrmann's buccal flap; all the patients were reported as successfully healed in the three intervention groups. Another RCT with 20 patients compared the effectiveness of the buccal fat pad flap (100% success rate) with a sandwich graft with hydroxyapatite crystals within collagen sheaths (90% success rate). The authors found no significant difference.
CONCLUSIONS
There are no RCTs evaluating whether an oroantral communication should be closed or not. There is weak evidence from two RCTs showing good results with five different techniques for closure of OACs (resorbable root analogues, haemostatic gauze, Rehrmann's buccal flap, buccal fat pad flap, sandwich graft with hydroxyapatite crystals). Until sufficiently high quality RCTs are conducted, elevating or not a flap for closure of OACs will be left to the personal choice of the surgeon.
Topics: Adipose Tissue; Bone Substitutes; Collagen; Durapatite; Humans; Oral Surgical Procedures; Oroantral Fistula; Randomized Controlled Trials as Topic; Surgical Flaps; Treatment Outcome
PubMed: 25422823
DOI: No ID Found -
Journal of Dentistry Jun 2024Assessed the effect of dental products containing nano-hydroxyapatite (nano-HA) + fluoride on the remineralization of white spot lesions (WSL) in vivo or in situ.
OBJECTIVE
Assessed the effect of dental products containing nano-hydroxyapatite (nano-HA) + fluoride on the remineralization of white spot lesions (WSL) in vivo or in situ.
METHODS
Seven databases were explored using a two-pronged approach (intervention/treatment). After screening, full-text assessment, and further exclusion, the qualitative synthesis of five studies (four clinical and one in situ) was performed. Based on the Cochrane collaboration guidelines relevant data of the studies were collected and summarized. The Cochrane risk of bias tool for randomized trials (RoB 2.0) was used to appraise the studies' methodological quality and the GRADE guidelines to assess their level of evidence. The RoB 2.0 domains were rated on their risk of bias (RoB) as low, high, or with some concerns, and an adaptation of the tool was used to the in situ study.
RESULTS
The included studies assessed 151 WSL in anterior permanent teeth, on patients with varying ages. The protocol application, treatment length (7d-12 w), and control groups varied greatly between the studies making the performance of a quantitative analysis unfeasible. The general RoB of the clinical studies was classified as being of low risk (n = 2) or some concerns (n = 2). The in situ study was considered as being of low risk. The level of the evidence was moderate. Most of the studies found moderate evidence regarding the superiority of this association in clinical settings.
CONCLUSION
Even with the nano-HA + fluoride promising results for the remineralization treatment of WSL, due to the restricted number of studies and types of products, its extended use cannot be recommended based on the current systematic review, especially when considering the moderate level of the evidence found.
CLINICAL SIGNIFICANCE
Due to the biocompatibility and higher surface coverage of nano-HA and the remineralization capacity of fluoride formulations, the association of these elements to remineralize WSL has been positively reported. After the collection and qualitative appraise of the data, the clinical evidence of the use of these dental products is promising but limited.
Topics: Humans; Tooth Remineralization; Durapatite; Fluorides; Dental Enamel; Dental Caries; Cariostatic Agents
PubMed: 38556192
DOI: 10.1016/j.jdent.2024.104973 -
Acta Orthopaedica Aug 2011It is unclear whether there is a clinical benefit to adding hydroxyapatite (HA) coatings to total knee implants, especially with the tibial component, where failure of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It is unclear whether there is a clinical benefit to adding hydroxyapatite (HA) coatings to total knee implants, especially with the tibial component, where failure of the implant more often occurs. A systematic review of the literature was undertaken to identify all prospective randomized trials for determining whether the overall clinical results (as a function of durability, function, and adverse events) favored HA-coated tibial components.
METHODS
A comprehensive literature search was performed for the years 1990 to September 16, 2010. We restricted our search to randomized controlled trials involving participants receiving either an HA-coated tibia or other forms of tibial fixation. The primary outcome measures evaluated were durability, function, and acute adverse events.
RESULTS
Data from 926 evaluable primary total knee implants in 14 studies were analyzed. Using an RSA definition for durability, HA-coated tibial components (porous or press-fit) without screw fixation were less likely to be unstable at 2 years than porous and cemented metal-backed tibial components (RR = 0.58, 95% CI: 0.34-0.98; p = 0.04, I(2) = 39%, M-H random effects model). There was no significant difference in durability, as measured from revision and evaluated at 2 and 8-10 years, between groups. Also, functional status using different validated measures showed no significant difference at 2 and 5 years, no matter what measure was used. Lastly, there was no significant difference in adverse events. Limitations included small numbers of evaluable patients (≤ 50) in 7 of the 14 trials identified, and a lack of "hard" evidence of durability with need for replacement (i.e. frank failure, pain, or loss of functionality).
INTERPRETATION
In patients > 65 years of age, an HA-coated tibial implant may provide better durability than other forms of tibial fixation. Larger trials should be undertaken comparing the long-term durability, function, and adverse events of HA-coated implants with those of other porous-coated tibial implants in younger, more active OA patients.
Topics: Arthroplasty, Replacement, Knee; Coated Materials, Biocompatible; Durapatite; Humans; Knee Prosthesis; Outcome Assessment, Health Care; Prosthesis Design; Prosthesis Failure
PubMed: 21657975
DOI: 10.3109/17453674.2011.590762 -
The British Journal of Oral &... Jul 2020Tissue engineering is a promising alternative that may facilitate bony regeneration in small defects in compromised host tissue as well as large mandibular defects. This...
Tissue engineering is a promising alternative that may facilitate bony regeneration in small defects in compromised host tissue as well as large mandibular defects. This scoping systematic review was therefore designed to assess in vivo research on its use in the reconstruction of mandibular defects in animal models. A total of 4524 articles were initially retrieved using the search algorithm. After screening of the titles and abstracts, 269 full texts were retrieved, and a total of 72 studies included. Just two of the included studies employed osteonecrosis as the model of mandibular injury. All the rest involved the creation of a critical defect. Calcium phosphates, especially tricalcium phosphate and hydroxyapatite, were the scaffolds most widely used. All the studies that used a scaffold reported increased formation of bone when compared with negative controls. When combined with scaffolds, mesenchymal stem cells (MSC) increased the formation of new bone and improved healing. Various growth factors have been studied for their potential use in the regeneration of the maxillofacial complex. Bone morphogenic proteins (BMP) were the most popular, and all subtypes promoted significant formation of bone compared with controls. Whilst the studies published to date suggest a promising future, our review has shown that several shortfalls must be addressed before the findings can be translated into clinical practice. A greater understanding of the underlying cellular and molecular mechanisms is required to identify the optimal combination of components that are needed for predictable and feasible reconstruction or regeneration of mandibular bone. In particular, a greater understanding of the biological aspects of the regenerative triad is needed before we can to work towards widespread translation into clinical practice.
Topics: Animals; Bone Regeneration; Durapatite; Mandible; Osteogenesis; Tissue Engineering; Tissue Scaffolds
PubMed: 32247521
DOI: 10.1016/j.bjoms.2020.03.016 -
Archives of Orthopaedic and Trauma... Sep 2009The purpose of this systematic review was to determine the clinical and radiologic benefit of hydroxyapatite coating in uncemented primary total hip arthroplasty. A... (Meta-Analysis)
Meta-Analysis Review
The purpose of this systematic review was to determine the clinical and radiologic benefit of hydroxyapatite coating in uncemented primary total hip arthroplasty. A database of Medline articles published up to September 2007 was compiled and screened. Eight studies involving 857 patients were included in the review. Pooled analysis for Harris hip score as a clinical outcome measure demonstrated no advantage of the hydroxyapatite coating (WMD: 1.49, P = 0.44). Radiologically, both groups showed equal presence of endosteal bone ingrowth (RR: 1.04, P = 0.66) and radioactive lines (RR: 1.02, P = 0.74) in the surface area of the prosthesis. This meta-analysis demonstrates neither clinical nor radiologic benefits on the application of a hydroxyapatite coating on a femoral component in uncemented primary total hip arthroplasty.
Topics: Aged; Arthroplasty, Replacement, Hip; Biocompatible Materials; Cementation; Coated Materials, Biocompatible; Durapatite; Female; Hip Joint; Hip Prosthesis; Humans; Male; Middle Aged; Prosthesis Design; Radiography; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 18815799
DOI: 10.1007/s00402-008-0749-9 -
Annals of Periodontology Dec 2003Bone replacement grafts (BRG) are widely used in the treatment of periodontal osseous defects; however, the clinical benefits of this therapeutic practice require... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Bone replacement grafts (BRG) are widely used in the treatment of periodontal osseous defects; however, the clinical benefits of this therapeutic practice require further clarification through a systematic review of randomized controlled studies.
RATIONALE
The purpose of this systematic review is to access the efficacy of bone replacement grafts in proving demonstrable clinical improvements in periodontal osseous defects compared to surgical debridement alone.
FOCUSED QUESTION
What is the effect of bone replacement grafts compared to other interventions on clinical, radiographic, adverse, and patient-centered outcomes in patients with periodontal osseous defects?
SEARCH PROTOCOL
The computerized bibliographical databases MEDLINE and EMBASE were searched from 1966 and 1974, respectively, to October 2002 for randomized controlled studies in which bone replacement grafts were compared to other surgical interventions in the treatment of periodontal osseous defects. The search strategy included screening of review articles and reference lists of retrieved articles as well as hand searches of selected journals.
INCLUSION CRITERIA
All searches were limited to human studies in English language publications.
EXCLUSION CRITERIA
Non-randomized observational studies (e.g., case reports, case series), publications providing summary statistics without variance estimates or data to permit computation, and studies without BRG intervention alone were excluded.
DATA COLLECTION AND ANALYSIS
The therapeutic endpoints examined included changes in bone level, clinical attachment level, probing depth, gingival recession, and crestal resorption. For purposes of meta-analysis, change in bone level (bone fill) was used as the primary outcome measure, measured upon surgical re-entry or transgingival probing (sounding).
MAIN RESULTS
1. Forty-nine controlled studies met eligibility criteria and provided clinical outcome data on intrabony defects following grafting procedures. 2. Seventeen studies provided clinical outcome data on BRG materials for the treatment of furcation defects.
REVIEWERS' CONCLUSIONS
1. With respect to the treatment of intrabony defects, the results of meta-analysis supported the following conclusions: 1) bone grafts increase bone level, reduce crestal bone loss, increase clinical attachment level, and reduce probing depth compared to open flap debridement (OFD) procedures; 2) No differences in clinical outcome measures emerge between particulate bone allograft and calcium phosphate (hydroxyapatite) ceramic grafts; and 3) bone grafts in combination with barrier membranes increase clinical attachment level and reduce probing depth compared to graft alone. 2. With respect to the treatment of furcation defects, 15 controlled studies provided data on clinical outcomes. Insufficient studies of comparable design were available to submit data to meta-analysis. Nonetheless, outcome data from these studies generally indicated positive clinical benefits with the use of grafts in the treatment of Class II furcations. 3. With respect to histological outcome parameters, 2 randomized controlled studies provide evidence that demineralized freeze-dried bone allograft (DFDBA) supports the formation of a new attachment apparatus in intrabony defects, whereas OFD results in periodontal repair characterized primarily by the formation of a long junctional epithelial attachment. Multiple observational studies provide consistent histological evidence that autogenous and demineralized allogeneic bone grafts support the formation of new attachment. Limited data also suggest that xenogenic bone grafts can support the formation of a new attachment apparatus. In contrast, essentially all available data indicate that alloplastic grafts support periodontal repair rather than regeneration. 4. The results of this systematic review indicate that bone replacement grafts provide demonstrable clinical improvements in periodontal osseous defects compared to surgical debridement alone.
Topics: Alveolar Bone Loss; Bone Regeneration; Bone Substitutes; Bone Transplantation; Calcium Carbonate; Ceramics; Furcation Defects; Guided Tissue Regeneration, Periodontal; Humans; Hydroxyapatites; Polymers; Randomized Controlled Trials as Topic
PubMed: 14971256
DOI: 10.1902/annals.2003.8.1.227 -
Clinical Implant Dentistry and Related... Apr 2019Air abrasion (AA) is one of the decontamination methods that have demonstrated promising results in treating peri-implant diseases.
BACKGROUND
Air abrasion (AA) is one of the decontamination methods that have demonstrated promising results in treating peri-implant diseases.
PURPOSE
This systematic review aimed at evaluating the in vitro effect of AA on surface change, cleaning efficacy, and biocompatibility of titanium surfaces and at comparing it with other decontamination methods.
MATERIALS AND METHODS
A comprehensive search was conducted up to April 2018 using PubMed, Scopus, and Google Scholar databases to identify studies on the decontamination effect of AA. All types of titanium surfaces, abrasive powders, contaminated surfaces, and measuring methods were included.
RESULTS
Overall, 1502 articles were identified. After screening the titles and abstracts, and carefully reading the full-texts, 48 articles published between 1989 and 2018 were selected. AA was considered almost safe, particularly for the nonmodified surfaces. Nevertheless, harder powders such as sodium bicarbonate tended to damage the surface more than glycine. AA resulted in surface change similar to plastic curettes and Er: YAG lasers. Regarding the cleaning efficacy, there was no significant difference between glycine and sodium bicarbonate, but different mixtures of calcium phosphate, hydroxyapatite, and erythritol were superior to glycine. AA was superior or equal to all other decontamination methods in cleaning. Regarding biocompatibility, AA was more successful in preserving biocompatibility for noncontaminated surfaces compared with contaminated surfaces and when used with erythritol and osteoinductive powders.
CONCLUSIONS
AA can efficiently remove contamination without serious damage to the surface. The main drawback of the AA method seems to be its limitation in restoring the biocompatibility of the surface.
Topics: Decontamination; Dental Implants; Durapatite; Surface Properties; Titanium
PubMed: 30838790
DOI: 10.1111/cid.12747