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Biomaterials Apr 2013Implants are widely used for orthopaedic applications such as fixing fractures, repairing non-unions, obtaining a joint arthrodesis, total joint arthroplasty, spinal... (Review)
Review
Implants are widely used for orthopaedic applications such as fixing fractures, repairing non-unions, obtaining a joint arthrodesis, total joint arthroplasty, spinal reconstruction, and soft tissue anchorage. Previously, orthopaedic implants were designed simply as mechanical devices; the biological aspects of the implant were a byproduct of stable internal/external fixation of the device to the surrounding bone or soft tissue. More recently, biologic coatings have been incorporated into orthopaedic implants in order to modulate the surrounding biological environment. This opinion article reviews current and potential future use of biologic coatings for orthopaedic implants to facilitate osseointegration and mitigate possible adverse tissue responses including the foreign body reaction and implant infection. While many of these coatings are still in the preclinical testing stage, bioengineers, material scientists and surgeons continue to explore surface coatings as a means of improving clinical outcome of patients undergoing orthopaedic surgery.
Topics: Coated Materials, Biocompatible; Foreign-Body Reaction; Humans; Orthopedics; Osseointegration; Prostheses and Implants; Prosthesis-Related Infections
PubMed: 23391496
DOI: 10.1016/j.biomaterials.2013.01.074 -
Scientific Reports Jul 2021Dental implants are commonly used to repair missing teeth. The implant surface plays a critical role in promoting osseointegration and implant success. However, little... (Meta-Analysis)
Meta-Analysis
Dental implants are commonly used to repair missing teeth. The implant surface plays a critical role in promoting osseointegration and implant success. However, little information is available about which implant surface treatment technology best promotes osseointegration and implant stability. The aim of this network meta-analysis was to evaluate the osseointegration and stability of four commonly used dental implants (SLA, SLActive, TiUnite, and Osseotite). The protocol of the current meta-analysis is registered in PROSPERO (International Prospective Register of Systematic Reviews) under the code CRD42020190907 ( https://www.crd.york.ac.uk ). We conducted a systematic review following PRISMA and Cochrane Recommendations. Medline (PubMed), Cochrane Library, Embase, and the Web of Science databases were searched. Only randomized controlled trials were considered. Twelve studies were included in the current network meta-analysis, eleven studies were included concerning the osseointegration effect and five studies were included for stability analysis (four studies were used to assess both stability and osseointegration). Rank possibility shows that the SLActive surface best promoted bone formation at an early healing stage and TiUnite seemed to be the best surface for overall osseointegration. For stability, TiUnite seemed to be the best surface. The present network meta-analysis showed that the SLActive surface has the potential to promote osseointegration at an early stage. The TiUnite surface had the best effect on osseointegration regarding the overall healing period. The TiUnite surface also had the best effect in stability.
Topics: Animals; Bone Density; Bone Development; Bone and Bones; Dental Implants; Humans; Network Meta-Analysis; Osseointegration; Surface Properties; Titanium; Torque
PubMed: 34226607
DOI: 10.1038/s41598-021-93307-4 -
Dental Materials : Official Publication... Apr 2015The focus of this review is to summarize recent advances on regenerative technologies (scaffolding matrices, cell/gene therapy and biologic drug delivery) to promote... (Review)
Review
OBJECTIVE
The focus of this review is to summarize recent advances on regenerative technologies (scaffolding matrices, cell/gene therapy and biologic drug delivery) to promote reconstruction of tooth and dental implant-associated bone defects.
METHODS
An overview of scaffolds developed for application in bone regeneration is presented with an emphasis on identifying the primary criteria required for optimized scaffold design for the purpose of regenerating physiologically functional osseous tissues. Growth factors and other biologics with clinical potential for osteogenesis are examined, with a comprehensive assessment of pre-clinical and clinical studies. Potential novel improvements to current matrix-based delivery platforms for increased control of growth factor spatiotemporal release kinetics are highlighting including recent advancements in stem cell and gene therapy.
RESULTS
An analysis of existing scaffold materials, their strategic design for tissue regeneration, and use of growth factors for improved bone formation in oral regenerative therapies results in the identification of current limitations and required improvements to continue moving the field of bone tissue engineering forward into the clinical arena.
SIGNIFICANCE
Development of optimized scaffolding matrices for the predictable regeneration of structurally and physiologically functional osseous tissues is still an elusive goal. The introduction of growth factor biologics and cells has the potential to improve the biomimetic properties and regenerative potential of scaffold-based delivery platforms for next-generation patient-specific treatments with greater clinical outcome predictability.
Topics: Bone Regeneration; Humans; Mouth; Osseointegration; Tissue Engineering
PubMed: 25701146
DOI: 10.1016/j.dental.2015.01.006 -
International Journal of Molecular... Aug 2021Titanium surface is an important factor in achieving osseointegration during the early wound healing of dental implants in alveolar bone. The purpose of this study was...
Titanium surface is an important factor in achieving osseointegration during the early wound healing of dental implants in alveolar bone. The purpose of this study was to evaluate sandblasted-etched surface implants to investigate the osseointegration. In the present study, we used two different types of sandblasted-etched surface implants, an SLA™ surface and a Nanoblast Plus™ surface. Roughness and chemical composition were evaluated by a white light interferometer microscope and X-ray photoelectron spectroscopy, respectively. The SLA™ surface exhibited the higher values (Ra 3.05 μm) of rugosity compared to the Nanoblast Plus™ surface (Ra 1.78 μm). Both types of implants were inserted in the femoral condyles of ten New Zealand white rabbits. After 12 weeks, histological and histomorphometric analysis was performed. All the implants were osseointegrated and no signs of infection were observed. Histomorphometric analysis revealed that the bone-implant contact % (BIC) ratio was similar around the SLA™ implants (63.74 ± 13.61) than around the Nanoblast Plus™ implants (62.83 ± 9.91). Both implant surfaces demonstrated a favorable bone response, confirming the relevance of the sandblasted-etched surface on implant osseointegration.
Topics: Animals; Femur; Implants, Experimental; Osseointegration; Rabbits; Surface Properties; Titanium
PubMed: 34445213
DOI: 10.3390/ijms22168507 -
International Journal of Oral Science Dec 2012Micromotion and fretting damages at the dental implant/bone interface are neglected for the limitation of check methods, but it is particularly important for the initial... (Review)
Review
Micromotion and fretting damages at the dental implant/bone interface are neglected for the limitation of check methods, but it is particularly important for the initial success of osseointegration and the life time of dental implant. This review article describes the scientific documentation of micromotion and fretting damages on the dental implant/bone interface. The fretting amplitude is less than 30 µm in vitro and the damage in the interface is acceptable. While in vivo, the micromotion's effect is the combination of damage in tissue level and the real biological reaction.
Topics: Biomechanical Phenomena; Bone and Bones; Dental Implants; Humans; Mechanical Phenomena; Movement; Osseointegration; Stress, Mechanical; Surface Properties
PubMed: 23258381
DOI: 10.1038/ijos.2012.68 -
The Journal of International Medical... Jun 2018Hip osteoarthritis is the most common joint disorder, and is represented by a degenerative process, resulting in pain and functional impairment. If conservative... (Review)
Review
Hip osteoarthritis is the most common joint disorder, and is represented by a degenerative process, resulting in pain and functional impairment. If conservative treatment for hip osteoarthritis fails, the only remaining option is hip arthroplasty. Despite good survival of implants, loosening of components is the most common complication. This leads to revision surgeries, which are technically demanding, expensive, and result in a low satisfaction rate. Uncemented hip replacements require proper osseointegration for increased survival. Physical characteristics of implants include biocompatibility, Young's modulus of elasticity, strength, and corrosion resistance, and each influence fixation of implants. Moreover, implant surface treatments, pore size, pore density, and femoral stem design should be appropriately selected. Patients' optimization of obesity, osteoporosis, cardiovascular disease, psychotic disorders, and smoking cessation are associated with a higher survival of implants. Surgical factors, such as approach, drilling and rasping, acetabular bone coverage, acetabular cup positioning, and implant size, also affect survival of implants. Avoiding drugs, which may impair osseointegration of implants, and having an appropriate rehabilitation protocol are important. Future directions include anabolic and anti-catabolic bone-acting drugs to enhance osseointegration of implants. Comprehensive knowledge of the factors mentioned above is important for preventing aseptic loosening, with important socioeconomic consequences.
Topics: Arthroplasty, Replacement, Hip; Biocompatible Materials; Bone Cements; Cementation; Hip Prosthesis; Humans; Osseointegration; Osteoarthritis, Hip; Prosthesis Design; Prosthesis Failure; Titanium
PubMed: 29098919
DOI: 10.1177/0300060517732697 -
Australian Dental Journal Jun 2008The current and future application of implants to support intra- and extra-oral prostheses is a function not primarily of a current or eventual future, e.g., implant... (Review)
Review
The current and future application of implants to support intra- and extra-oral prostheses is a function not primarily of a current or eventual future, e.g., implant surface configuration, treatment procedure or loading protocol. In contrast, it must be understood by a more complex conceptualization of the practical application of the osseointegration phenomenon. This review will attempt to address the future use of oral implants based on current cutting edge research within the fundamentals that constitute the practical applications of the osseointegration concept.
Topics: Dental Implants; Dental Prosthesis Design; Forecasting; Humans; Osseointegration; Treatment Outcome
PubMed: 18498590
DOI: 10.1111/j.1834-7819.2008.00046.x -
European Cells & Materials Nov 2008Mechanical loading is one of the key factors that influence bone mass and the osseointegration of bone-anchored implants. From a clinical point of view, mechanical... (Review)
Review
Mechanical loading is one of the key factors that influence bone mass and the osseointegration of bone-anchored implants. From a clinical point of view, mechanical stimulation may be used to enhance bone strength and implant osseointegration. Among the many loading parameters that influence the response to mechanical loading, the effects of loading frequency and rate have been investigated in many studies. In this paper the most relevant animal studies that have addressed the effect of loading frequency, rate, and vibration on either bone adaptation or implant osseointegration are systematically reviewed. Apparently contradictory results are discussed and interpreted within the context of mechanotransduction and mechanoregulation of bone. A combined experimental and computational approach is suggested to address some of the remaining research questions.
Topics: Animals; Bone Density; Bone Remodeling; Bone and Bones; Humans; Osseointegration; Prostheses and Implants
PubMed: 19040192
DOI: No ID Found -
JAMA Network Open Oct 2022Transcutaneous osseointegration post amputation (TOPA) creates a direct linkage between residual bone and an external prosthetic limb, providing superior mobility and... (Observational Study)
Observational Study
IMPORTANCE
Transcutaneous osseointegration post amputation (TOPA) creates a direct linkage between residual bone and an external prosthetic limb, providing superior mobility and quality of life compared with a socket prosthesis. The causes and potential risks of mortality after TOPA have not been investigated.
OBJECTIVE
To investigate the association between TOPA and mortality and assess the potential risk factors.
DESIGN, SETTING, AND PARTICIPANTS
This observational cohort study included all patients with amputation of a lower extremity who underwent TOPA between November 1, 2010, and October 31, 2021, at a specialty orthopedic practice and tertiary referral hospital in a major urban center. Patients lived on several continents and were followed up as long as 10 years.
EXPOSURES
Transcutaneous osseointegration post amputation, consisting of a permanent intramedullary implant passed transcutaneously through a stoma and connected to an external prosthetic limb.
MAIN OUTCOMES AND MEASURES
Death due to any cause. The hypotheses tested-that patient variables (sex, age, level of amputation, postosseointegration infection, and amputation etiology) may be associated with subsequent mortality-were formulated after initial data collection identifying which patients had died.
RESULTS
A total of 485 patients were included in the analysis (345 men [71.1%] and 140 women [28.9%]), with a mean (SD) age at osseointegration of 49.1 (14.6) years among living patients or 61.2 (12.4) years among patients who had died. Nineteen patients (3.9%) died a mean (SD) of 2.2 (1.7) years (range, 58 days to 5 years) after osseointegration, including 17 (3.5%) who died of causes unrelated to osseointegration (most commonly cardiac issues) and 2 (0.4%) who died of direct osseointegration-related complications (infectious complications), of which 1 (0.2%) was coclassified as a preexisting health problem exacerbated by osseointegration (myocardial infarction after subsequent surgery to manage infection). No deaths occurred intraoperatively or during inpatient recuperation or acute recovery after index osseointegration (eg, cardiopulmonary events). Kaplan-Meier survival analysis with log-rank comparison and Cox proportional hazards regression modeling identified increased age (hazard ratio, 1.06 [95% CI, 1.02-1.09]) and vascular (odds ratio [OR], 4.73 [95% CI, 1.35-16.56]) or infectious (OR, 3.87 [95% CI, 1.31-11.40]) amputation etiology as risk factors. Notable factors not associated with mortality risk included postosseointegration infection and male sex.
CONCLUSIONS AND RELEVANCE
These findings suggest that patients who have undergone TOPA rarely die of problems associated with the procedure but instead usually die of unrelated causes.
Topics: Adult; Amputation, Surgical; Artificial Limbs; Female; Humans; Lower Extremity; Male; Middle Aged; Osseointegration; Quality of Life
PubMed: 36227599
DOI: 10.1001/jamanetworkopen.2022.35074 -
The Journal of Bone and Joint Surgery.... Oct 2022Bisphosphonates limit resorption by inhibiting osteoclast formation and activation. They are removed during preparation of demineralized bone matrix (DBM) particles, but...
BACKGROUND
Bisphosphonates limit resorption by inhibiting osteoclast formation and activation. They are removed during preparation of demineralized bone matrix (DBM) particles, but it is not known if osteogenesis and incorporation of mineralized bone allografts from patients treated with oral bisphosphonates are affected in vivo.
METHODS
Human block allografts from 3 bisphosphonate-treated donors and 3 age and sex-matched control donors who had not received bisphosphonates were obtained (Musculoskeletal Transplant Foundation); one-half from each donor was demineralized. In the first study, 3 × 2-mm mineralized and demineralized cylindrical grafts were implanted bilaterally in the femoral metaphysis of 56 rats. In the second study, samples from each group were pooled, prepared as particles, and implanted bilaterally in the femoral marrow canal of 24 rats. Osseointegration, defined as native bone in contact with allograft, was assessed at 10 weeks by micro-computed tomography (CT) and histomorphometry.
RESULTS
Micro-CT showed greater bone volume in sites treated with demineralized samples compared with the control mineralized and bisphosphonate-exposed mineralized samples. More new bone was generated along the cortical-endosteal interface compared with mineralized samples. Histology showed significantly less new bone in contact with the mineralized bisphosphonate-exposed allograft (10.4%) compared with mineralized samples that did not receive bisphosphonates (22.8%) and demineralized samples (31.7% and 42.8%). A gap was observed between native bone and allograft in the bisphosphonate-exposed mineralized samples (0.50 mm 2 ). The gap area was significantly greater compared with mineralized samples that did not receive bisphosphonates (0.16 mm 2 ) and demineralized samples (0.10 and 0.03 mm 2 ).
CONCLUSIONS
Mineralized allografts were osseointegrated, but not remodeled or replaced by living bone, preventing full regeneration of the bone defect. Prior treatment of the donor with bisphosphonates affected osteogenesis, preventing osteointegration and remodeling of the allograft into the regenerating bone.
CLINICAL RELEVANCE
Clinical use of mineralized allografts from patients who had received bisphosphonate therapy needs to be evaluated; in this animal model, such grafts were not integrated into the host bone or remodeled, and full regeneration of the bone defects was prevented.
Topics: Animals; Bone Transplantation; Diphosphonates; Humans; Osseointegration; Osteogenesis; Rats; X-Ray Microtomography
PubMed: 35983995
DOI: 10.2106/JBJS.21.01489