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Injury Nov 2022Since ancient times, reduction and internal fixation has been applied to restore skeletal integrity. Despite advances in the understanding of fracture healing, the risk... (Review)
Review
Since ancient times, reduction and internal fixation has been applied to restore skeletal integrity. Despite advances in the understanding of fracture healing, the risk of complication such as implant loosening or implant-related infection still depicts a challenging complication. Nowadays, a great deal of research is devoted to unreveal the impact of implant surface modifications on osteogenic processes to enhance bone consolidation and osseointegration. This narrative review is aimed to (1) show the evolution and already achieved milestones of implant optimization, and (2) to outline the key factors that contribute to an enhanced osseointegration. Different physical and chemical roughening techniques are currently applied in various studies. Surface patterning on the nanoscale has been found to be an essential factor for the biological response, achievable by e.g. anodisation or laser texturing. Besides surface roughening, also different coating methods are vastly investigated. Next to metal or inorganic compounds as coating material, a variety of biomolecules is currently studied for their osteosupportive capacities. Osseointegration can be improved by surface modification on the micro and nanoscale. Bioactive agents can further improve the osseointegration potential. Used agents at the moment are e.g. inorganic compounds, growth factors (BMPs and non-BMPs) and antiresorptive drugs. The advancement in research on new implant generations therefore aims at actively supporting osseointegration processing.
Topics: Bone Density Conservation Agents; Coated Materials, Biocompatible; Humans; Osseointegration; Osteogenesis; Prostheses and Implants; Surface Properties; Titanium
PubMed: 35948509
DOI: 10.1016/j.injury.2022.05.057 -
JBJS Reviews Oct 2017Traditional socket prostheses are not a viable option for all lower-limb prosthetic users. Discomfort, pain in the residual limb, and problems related to the fit of the... (Review)
Review
BACKGROUND
Traditional socket prostheses are not a viable option for all lower-limb prosthetic users. Discomfort, pain in the residual limb, and problems related to the fit of the socket are common and have been shown to negatively impact quality of life and mobility. Osseointegrated or bone-anchored prosthetic implants have evolved over the past 2 decades as a promising alternative for patients who are experiencing substantial issues with socket prostheses.
METHODS
A review of the literature was performed to identify studies focusing on the evolution, clinical outcomes, success rates, and complications of osseointegrated lower-limb prostheses. Articles were summarized according to the implant type, amputation level, and study characteristics, with rating of the Level of Evidence. Information on patient selection criteria, outcomes, and complications was extracted.
RESULTS
Fourteen articles (with Level-II, III, or IV evidence) met the inclusion criteria. Infection and soft-tissue irritation at the stoma were the most common complications. It is evident that, over the years, changes in implant design, surgical technique, perioperative and postoperative care, and rehabilitation protocols have resulted in improvements in functional outcomes and health-related quality of life, and reduction in rates of complications.
CONCLUSIONS
Osseointegration for limb amputation has become an established clinical treatment option for persons with lower-limb amputation not tolerating traditional socket prostheses. Osseointegration could provide substantial benefits regarding function and quality of life for appropriately selected patients who accept the documented risks.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Amputation, Surgical; Amputees; Artificial Limbs; Evidence-Based Medicine; Humans; Lower Extremity; Osseointegration; Prosthesis Implantation; Quality of Life; Treatment Outcome
PubMed: 29087966
DOI: 10.2106/JBJS.RVW.17.00037 -
Plastic and Reconstructive Surgery Mar 1994This review summarizes some aspects of osseointegration. The principles, implant type and design, surgical technique, and results are reviewed. A large number of... (Review)
Review
This review summarizes some aspects of osseointegration. The principles, implant type and design, surgical technique, and results are reviewed. A large number of patients have been followed after intraoral reconstruction using osseointegrated implants. The success rates are 95 percent in the maxilla and 99 percent in the mandible. In craniofacial reconstruction, results vary from 98 percent success in the temporal area to as low as 48 percent in the radiated orbit. Some early experience with finger joint reconstruction, bone-anchored finger prostheses, and major amputations are reviewed.
Topics: Equipment Design; Humans; Osseointegration; Prostheses and Implants; Prosthesis Design; Surgery, Plastic
PubMed: 8115525
DOI: No ID Found -
Journal of Materials Science. Materials... May 2018Osseointegrated implants are frequently used in reconstructive surgery, both in the dental and orthopedic field, restoring physical function and improving the quality of... (Review)
Review
Osseointegrated implants are frequently used in reconstructive surgery, both in the dental and orthopedic field, restoring physical function and improving the quality of life for the patients. The bone anchorage is typically evaluated at micrometer resolution, while bone tissue is a dynamic composite material composed of nanoscale collagen fibrils and apatite crystals, with defined hierarchical levels at different length scales. In order to understand the bone formation and the ultrastructure of the interfacial tissue, analytical strategies needs to be implemented enabling multiscale and multimodal analyses of the intact interface. This paper describes a sample preparation route for successive analyses allowing assessment of the different hierarchical levels of interest, going from macro to nano scale and could be implemented on single samples. Examples of resulting analyses of different techniques on one type of implant surface is given, with emphasis on correlating the length scale between the different techniques. The bone-implant interface shows an intimate contact between mineralized collagen bundles and the outermost surface of the oxide layer, while bone mineral is found in the nanoscale surface features creating a functionally graded interface. Osteocytes exhibit a direct contact with the implant surface via canaliculi that house their dendritic processes. Blood vessels are frequently found in close proximity to the implant surface either within the mineralized bone matrix or at regions of remodeling.
Topics: Animals; Bone and Bones; Bone-Implant Interface; Calcification, Physiologic; Dental Implantation, Endosseous; Dental Implants; Humans; Materials Testing; Osseointegration; Surface Properties
PubMed: 29736606
DOI: 10.1007/s10856-018-6068-y -
Acta Biomaterialia Jan 2021Clinical performance of osseointegrated implants could be compromised by the medications taken by patients. The effect of a specific medication on osseointegration can...
Clinical performance of osseointegrated implants could be compromised by the medications taken by patients. The effect of a specific medication on osseointegration can be easily investigated using traditional systematic reviews. However, assessment of all known medications requires the use of evidence mapping methods. These methods allow assessment of complex questions, but they are very resource intensive when done manually. The objective of this study was to develop a machine learning algorithm to automatically map the literature assessing the effect of medications on osseointegration. Datasets of articles classified manually were used to train a machine-learning algorithm based on Support Vector Machines. The algorithm was then validated and used to screen 599,604 articles identified with an extremely sensitive search strategy. The algorithm included 281 relevant articles that described the effect of 31 different drugs on osseointegration. This approach achieved an accuracy of 95%, and compared to manual screening, it reduced the workload by 93%. The systematic mapping revealed that the treatment outcomes of osseointegrated medical devices could be influenced by drugs affecting homeostasis, inflammation, cell proliferation and bone remodeling. The effect of all known medications on the performance of osseointegrated medical devices can be assessed using evidence mappings executed with highly accurate machine learning algorithms.
Topics: Algorithms; Artificial Intelligence; Dental Implants; Humans; Machine Learning; Osseointegration; Treatment Outcome
PubMed: 33181361
DOI: 10.1016/j.actbio.2020.11.011 -
Der Unfallchirurg Apr 2017Intramedullary, bone-anchored (osseointegrated), transcutaneous docking of artificial limbs has been in clinical use for more than 25 years. This system of prosthetic... (Review)
Review
Intramedullary, bone-anchored (osseointegrated), transcutaneous docking of artificial limbs has been in clinical use for more than 25 years. This system of prosthetic limb attachment is a valuable treatment option in the rehabilitation of patients after limb amputation. Only a few centers are systematically investigating this topic worldwide so that current knowledge on this special treatment option is still limited; however, mainstream medical opinion still regards percutaneous skeletal prosthetic docking with some skepticism. Concerns remain about possible ascending infections along the skin perforating device and this has indeed been a limiting factor in the widespread implementation of this technology and has also been rejected by many orthopedic surgeons. There are also reservations among institutions responsible for exoprosthetic treatment. Ultimately, the advantages and disadvantages of this treatment procedure must be explained in detail to the patients themselves in order to reduce fears and concerns and to be able to bring the overstretched expectations back to reality.
Topics: Amputation, Surgical; Amputation Stumps; Artificial Limbs; Evidence-Based Medicine; Exoskeleton Device; Humans; Osseointegration; Prosthesis Design; Prosthesis Implantation; Treatment Outcome
PubMed: 28235982
DOI: 10.1007/s00113-017-0329-y -
Drug Metabolism Reviews Aug 2019Proton pump inhibitors (PPIs) have become known for the treatment of gastric-acid related disorders. Similar to any other drugs, PPIs have possible adverse reactions,... (Review)
Review
Proton pump inhibitors (PPIs) have become known for the treatment of gastric-acid related disorders. Similar to any other drugs, PPIs have possible adverse reactions, being associated with bone fractures, infections, kidney disease, mineral deficiency, dementia, and pneumonia. Multiple analyses have stated that PPIs therapy may affect bone regeneration and osseointegration process, causing an increased risk of bone fracture, deterioration of bone metabolism and impaired bone healing. In this review, we emphasized the current literature regarding the influence of proton pump inhibitors in the bone regeneration process. Results from the studies suggest a link between PPIs intake and bone regeneration, but several concerns are raised regarding inadequate recipient bone, surgical trauma, limitations on the titanium surface, comorbidities or interference with other pharmacological agents. Further studies are needed to determine whether the impaired bone regeneration process is due to PPI or coexisting factors.
Topics: Animals; Bone Regeneration; Humans; Osseointegration; Prostheses and Implants; Proton Pump Inhibitors
PubMed: 31055956
DOI: 10.1080/03602532.2019.1610767 -
Journal of Periodontology Apr 2010Bisphosphonates (BPs) are an important group of drugs used for the treatment of metabolic and oncologic pathologies involving the skeletal system. Osteonecrosis of the... (Review)
Review
BACKGROUND
Bisphosphonates (BPs) are an important group of drugs used for the treatment of metabolic and oncologic pathologies involving the skeletal system. Osteonecrosis of the jaw (ONJ) is a complication observed in patients using oral or intravenous (IV) BPs. It was suggested that all patients undergoing BP therapy who are expected to receive dental implants should be informed of the possible risks of development of ONJ. The aim of this literature review is to assess the osseointegration of dental implants in patients undergoing BP therapy.
METHODS
The MEDLINE-PubMed databases of The National Library of Medicine, National Institutes of Health, Bethesda, Maryland, were searched for articles addressing the focused question: Can dental implants osseointegrate and remain functionally stable in patients undergoing oral and IV BP therapy? Databases were searched from 1995 up to and including February 2010 using the following terms in different combinations: bisphosphonate, dental implant, immediate-loading, implant survival rate, intravenous, oral, osseointegration, and osteonecrosis.
RESULTS
The initial search yielded 89 articles. Scrutiny of the titles and abstracts reduced the number of articles to 12 (seven case reports and five retrospective studies). In 10 studies, the patients were using oral BPs, and in two studies, patients were using IV BPs. Six case reports showed that the placement of implants in patients using BPs could yield a successful osseointegration and function. Four retrospective studies demonstrated that BPs did not have a negative influence on implant success. Two studies showed a negative impact of BPs on implant success.
CONCLUSION
Dental implants can osseointegrate and remain functionally stable in patients using BPs.
Topics: Bone Density Conservation Agents; Case-Control Studies; Dental Implantation, Endosseous; Dental Implants; Dental Restoration Failure; Diphosphonates; Humans; Osseointegration
PubMed: 20367090
DOI: 10.1902/jop.2009.090587 -
The Journal of Oral Implantology Aug 2013Bisphosphonate (BP) drugs are a commonly prescribed group of medications used in the treatment of metabolic and oncologic bone disorders. The aim of this study was to... (Review)
Review
Bisphosphonate (BP) drugs are a commonly prescribed group of medications used in the treatment of metabolic and oncologic bone disorders. The aim of this study was to conduct a systematic review in order to evaluate whether patients on BP therapy are appropriate candidates for dental implants as compared to patients not taking BP drugs with respect to successful implant osseointegration and the risk of developing bisphosphonate-related osteonecrosis of the jaw. Based on the current literature, a history of oral or intravenous BP use is not an absolute contraindication for dental implant placement, and dental implants can osseointegrate successfully in this patient population. Importantly, the studies currently available on this topic are of moderate to weak strength of evidence with inherent bias and limitations, and hence results must be interpreted in this context. Well-controlled studies with higher strength of evidence and larger population sizes are required to address this topic more accurately in the future.
Topics: Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Dental Implantation, Endosseous; Diphosphonates; Humans; Osseointegration; Risk Assessment
PubMed: 23964780
DOI: 10.1563/AAID-JOI-D-11-00234 -
Effect of Growth Hormone Supplementation on Osseointegration: A Systematic Review and Meta-analyses.Implant Dentistry Aug 2017The aim of this study was to assess whether growth hormone (GH) replacement therapy can enhance implant osseointegration. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aim of this study was to assess whether growth hormone (GH) replacement therapy can enhance implant osseointegration.
MATERIALS AND METHODS
A systematic literature search was conducted from 1982 to March 2016. A structured search using the keywords "growth hormone," "implants," and "osseointegration" was performed to identify preclinical and clinical in vivo controlled studies and was followed by a 2-phase search strategy. Initially, 31 potentially relevant articles were identified. After removal of duplicates and screening by title and abstract, 10 potential studies were included. Studies were assessed for bias and data were synthesized using a random-effects meta-analysis model.
RESULTS
All studies were preclinical animal trials, and the follow-up period ranged from 2 to 16 weeks. Seventy percent of the included studies reported an increase in bone-to-implant contact in animals receiving GH compared with controls. Meta-analysis showed a significant mean difference for bone to implant between GH groups versus controls (no GH supplementation) of 10.60% (95% confidence interval: 3.79%-17.41%) favoring GH administration.
CONCLUSION
GH treatment seems to promote osseointegration around implants in preclinical studies; however, these findings must be assessed in highly controlled human clinical trials as a number of confounding factors may have influenced the outcomes of the included studies.
Topics: Animals; Dental Implantation, Endosseous; Dental Implants; Growth Hormone; Humans; Osseointegration
PubMed: 28574857
DOI: 10.1097/ID.0000000000000616