Bone Regeneration Related to Calcium Phosphate-Coated Implants in Osteoporotic Animal Models: A Meta-Analysis
1 Department of Biomaterials, Radboud University Nijmegen Medical Center , Nijmegen, The Netherlands . Tissue Engineering Part B Reviews
(Impact Factor: 4.64).
04/2012; 18(5):383-95. DOI: 10.1089/ten.TEB.2012.0130
Background: Osteoporosis is a frequent human metabolic bone disorder. Prospectively, global ageing of populations will lead to a major increase of subjects being diagnosed with osteoporosis and in need for dental rehabilitation. However, as local osteoporosis of the jaws affects bone quantity and quality of edentulous regions, osseointegration of dental implants might be hampered. Consequently, calcium phosphate ceramic-coated implants have been suggested to compensate for low bone quantity/density and for impaired bone healing in osteoporosis. Nonetheless, up to now no meta-analytical assessment of the relevant preclinical literature to quantify such a possible positive effect has been undertaken. Materials and Methods: PubMed search, limited to animal models, to identify a possible positive effect of calcium phosphate-coated implants on bone regeneration, was carried out. Further, the reference lists of related review articles and publications selected for inclusion in this review were systematically screened. The primary outcome variables were bone-to-implant contact percentage as assessed histomorphometrically and mechanical stability testing. Results: The electronic search in the database of the National Library of Medicine resulted in the identification of 2704 titles. These titles were initially screened by the two independent reviewers for possible inclusion, resulting in further consideration of 51 publications. Screening the abstracts led to 22 full-text articles. From these articles, 16 reports were excluded. Finally, six of these original research reports could be selected for evaluation. Additionally, eight publications were identified by manual search. Thus, a total of 14 articles were included for analysis. Conclusions: It was concluded that (1) in osteoporotic animal models calcium phosphate ceramic-coated implants are associated with improved bone-to-implant healing as compared to noncoated implants. Moreover, (2) essentially due to quality characteristics of the analyzed original research articles a negative impact of osteoporosis on bone-to-implant healing could not be confirmed. Besides, (3) the established positive bone-to-implant healing effect of calcium phosphate ceramic coatings does not differ between osteoporotic and nonosteoporotic, healthy animal models.
Available from: Jeroen JJP van den Beucken
- "The local release of these bone anabolic agents at the implant interface is anticipated to improve impaired bone healing in osteoporosis. Various preclinical osteoporotic models are available to study the effect of therapeutic coatings on implant osseointegration and fracture healing . Although an osteoporotic bone condition appears to be a human-specific disease and does not naturally occur in animals, the disease can be induced artificially in an animal model (e.g. "
Drug Discovery Today Disease Models 11/2014; DOI:10.1016/j.ddmod.2014.10.001
Available from: liebertonline.com
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ABSTRACT: Clinical management of orthopedic hardware infections related to ankle fracture fixation may present difficult therapeutic dilemmas. Typically, management includes removal of the hardware, debridement of necrotic tissue, and eventual placement of an alternative method of stabilization, usually, an external fixator or cast. However, problems arise when the fracture cannot be managed adequately with an external method. Such is the case with supination external rotation (SER) fractures, yet maintaining the hardware in the setting of infection typically is not considered an option.
Case report and review of pertinent English-language literature.
The patient was a 47-year-old man with diabetes mellitus who sustained a type IV SER fracture that was treated with plate and screw fixation. Six weeks postoperatively, he presented with infection of the lateral ankle incision and the hardware. This was treated with debridement of the wound and dressing changes while leaving the hardware in place. It was decided to use a free muscle flap in an effort to preserve the ankle for a functional outcome versus the alternative of a below-knee amputation. With a free rectus abdominis flap, the lower extremity was preserved, and after four months, the patient was able to walk. One year postoperatively, the patient was ambulating without difficulty, and the hardware was still in place.
This report examines the dilemma of SER ankle fractures and how management strategies must be tailored to the individual situation. In some cases, the hardware must be considered essential to avoid below-knee amputation.
Surgical Infections 07/2006; 7(3):315-22. DOI:10.1089/sur.2006.7.315 · 1.45 Impact Factor
Available from: online.liebertpub.com
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ABSTRACT: Oral implantology is considered as the treatment of choice for replacing missing teeth in elderly people. However, implant complications may occur in patients with osteoporosis. The pathogenesis underlying osteoporosis is due to an alteration in bone cell response to hormonal, nutritional, and aging factors. For such challenging situations, improved bone regeneration has been shown around dental implants for certain surface modifications. These modifications include coatings of titanium implants with calcium phosphate ceramics. Surface coating developments also allow for the addition of organic biomolecules, like growth factors, into the inorganic coatings that increase the bone formation process at the bone-implant interface. The application of therapeutic-based coatings is becoming a rapidly growing research field of interest. CaP-coated implants have the ability to incorporate anti-osteoporotic drugs, which then can be locally released over time from an implant surface in a controlled manner. Thus, it can be anticipated that non-therapeutic and/or therapeutic coated implants can significantly increase low bone density as well as improve impaired bone regeneration in osteoporosis. This review aims to provide a thorough understanding of the underlying mechanisms for impaired bone regeneration around dental implants in osteoporosis. Secondly, the review will focus on biological interactions and beneficial role of the surface-coated (i.e. non-therapeutics and therapeutics) bone implants in osteoporotic bone tissue.
Tissue Engineering Part B Reviews 10/2012; 19(3). DOI:10.1089/ten.TEB.2012.0400 · 4.64 Impact Factor
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