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References
Cranial defect reconstruction in an experimental model using different mixtures of bioglass and autologous bone.Conejero JA, Lee JA, Ascherman JA. From the Department of Surgery, Division of Plastic Surgery, at the Columbia University Medical Center, New York, New York. The purpose of this study was to investigate bone healing in a rabbit cranial defect model using different mixtures of bioglass (NovaBone C/M; Porex Surgical, Inc., Newnan, GA) and autologous bone with and without an overlying absorbable plate (Lactosorb; Walter Lorenz Surgical, Jacksonville, FL). Twelve rabbits were divided into three groups, and a 2 cm diameter cranial defect was created in each rabbit. Group I defects were filled with 80% bioglass and 20% autologous bone, group II with 60% bioglass and 40% autologous bone, and group III with 60% bioglass and 40% autologous bone with the addition of an absorbable plate placed directly over the reconstructed defect to help separate it from the overlying soft tissues. Rabbits were euthanized 6 months postoperatively. Histologic examination was then performed. The size of the remaining bone gap, area of reossification within the defect, and percentage of fibrous tissue within the defect were measured. Histologic analyses revealed that group II animals had an increased cross-sectional area of bone formation and decreased bone gap when compared with group I and III animals (P < 0.05). There were no statistical differences between groups I and III with regard to bone formation. This study suggests that when combining bioactive glass and autologous bone for repairing cranial defects, a combination of 60% bioactive glass and 40% bone graft yields superior results to a combination of 80% bioactive glass and 20% bone graft. Placing an absorbable plate over a defect filled with 60% bioactive glass and 40% bone graft inhibits rather than promotes reossification.
Bioactive glass-derived hydroxyapatite-coating promotes granulation tissue growth in subcutaneous cellulose implants in rats.Tommila M, Jokinen J, Wilson T, Forsback AP, Departments of Medical Biochemistry and Molecular Biology, University of Turku, Kiinamyllynkatu 10, FIN-20520 Turku, Finland. Granulation tissue was induced in hydroxyapatite-coated cellulose sponges with subcutaneous implantation in rats. A massive inflammatory reaction with an intense foreign body reaction and an increased invasion of fibrovascular tissue was observed by days 1-3 post-operation, whereas tissue growth into the uncoated control implants was much slower and took place mainly on their surfaces. The foreign body reaction in apatite-coated sponges declined after post-operative day 14, and no obvious differences were seen between the two cellulose sponges from 1 month up to 1 year after implantation. The apatite-coated implants attracted macrophages and fibroblasts, and favored angiogenesis. The excessive connective tissue formation was histologically normal, synthesized the major extracellular matrix molecules in a normal ratio and did not seem to disturb the animals in any way. These results warrant further investigations on clinical applicability of hydroxyapatite-coated cellulose sponges, when fast proliferation of connective tissue is desirable.
Use of bioglass for orbital volume augmentation in enophthalmos: a rabbit model (oryctolagus cuniculus).Amato MM, Blaydon SM, Scribbick FW Jr, Belden CJ, Texas Oculoplastic Consultants, Austin, Texas, USA. malena_amato@hotmail.com PURPOSE: To investigate the clinical and histologic response of NovaBone-C/M as an osteoproductive alloplastic implant for volume augmentation in the orbit in the treatment of enophthalmos and to compare its outcome alone versus its use in combination with autogenous bone or Medpor granules. METHODS: Novabone-C/M, a bioactive silicone glass material, was implanted in the subperiosteal space of the left orbit of 12 New Zealand White rabbits. The animals were divided into 3 groups, each with 4 animals, based on the material implanted in the orbit: group 1, Novabone alone; group 2, Novabone plus Medpor granules; and group 3, NovaBone plus autogenous bone fragments. All rabbits were studied clinically, radiographically, and histologically at 1-, 3-, and 6-month intervals. Animals underwent preoperative and postoperative computed tomography (CT) with 3-dimensional reconstruction, proptosis measurements, and volumetric analysis. Orbit specimens were studied histologically with mineralized bone stain (MIBS) to look for bone formation, reactivity, infection, implant resorption, and migration. RESULTS: There were no signs of significant inflammation or infection. Subcutaneous migration of the implant was seen radiographically but not clinically in groups 1 and 3. Induced proptosis averaged 2.5 mm (at 1 month) and showed regression in all groups over a 6-month period but was not statistically significant. Implant volume was markedly reduced in all groups, averaging 69% in group 1, 37% in group 2, and 59% in group 3 at 6 months. New bone formation and bone remodeling was present in all 3 groups at 3 months and only in group 2 at 6 months. The rate and amount of implant remodeling and bone formation was greatest in the Novabone/Medpor group (group 2). CONCLUSIONS: Bioglass particulate is biocompatible, easy to use in the orbit, and stimulates bone growth. Bioglass is associated with volume loss and migration over 6 months and may not provide adequate volume augmentation in the orbit when used alone for the treatment of enophthalmos. The duration and amount of bone formation may be enhanced when NovaBone is used in conjunction with Medpor.
Bioactive glass ceramic particles as an alternative for mastoid obliteration: results in an animal model.Leatherman BD, Dornhoffer JL. Department of Otolaryngology/Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock 72205, USA. leathermanbryand@exchange.uams.edu HYPOTHESIS: This study was conducted to evaluate the use of the bioactive glass ceramic particulate NovaBone Bioglass as a graft material for mastoid cavity obliteration in an animal model. BACKGROUND: Canal wall down procedures in otologic surgery may result in a problematic mastoid cavity. Mastoid cavity obliteration can potentially prevent or correct this problem. Many techniques and implant materials have been used for mastoid obliteration, but no single graft material has proved to be ideal. METHODS: Mongolian gerbils received tympanic bulla obliteration using the NovaBone Bioglass particulate. Nine weeks after implantation, the animals were killed, and histologic sections were prepared. Histologic evaluation was performed to evaluate new bone formation within the implant. RESULTS: Wound healing occurred without complication. Mature trabecular bone was observed throughout the entire thickness of the implant material. Extensive neovascularity was observed within the graft material. There was no histologic evidence of inflammatory reaction or short-term resorption. CONCLUSIONS: The extensive new bone formation obtained with bioactive glass ceramic particles in this study makes this material a potential alternative resource as a graft material for mastoid obliteration.
Bone healing in osteoporotic female rats following intra-alveolar grafting of bioactive glass.Teófilo JM, Brentegani LG, Lamano-Carvalho TL. Departamento de Morfologia, Estomatologia e Fisiologia, Faculdade de Odontologia de Ribeirão Preto-USP, Av. do Café s/n, SP, CEP 14090-904, Brazil. We have investigated the effect of ovariectomy combined with a low Ca diet on bone healing following the implantation of bioactive glass into extraction sockets, in rats. Ovariectomized rats received a low Ca diet from the day of surgery until sacrifice while sham-operated animals were fed a standard laboratory chow. Two weeks after surgery the upper incisors were extracted and the alveolar sockets in both groups were partially filled with a particulate bioglass (PerioGlas). The animals were killed 1, 2, 3 and 9 weeks after tooth extraction and the relative volume fraction of the healing components (bone trabeculae, connective tissue and coagulum remnants) was estimated in histological paraffin sections by a histometric differential point-counting method. The bioglass particles persisted inside the socket for all the experimental periods and, as bone repair proceeded, they were progressively enclosed in newly formed bone trabeculae which in some cases established a close contact with their surface. The volume fraction of neoformed bone trabeculae relative to the volume fraction of connective tissue and coagulum remnants was greater in the sockets of ovariectomized animals implanted with bioglass than in those of the overiectomized non-implanted groups.
References
Bioactive glass as a bone substitute for spinal fusion in adolescent idiopathic scoliosis: a comparative study with iliac crest autograft.Ilharreborde B, Morel E, Fitoussi F, Presedo A, Souchet P, Penneçot GF, Mazda K. From the Department of Pediatric Orthopedics, Robert Debré Hospital, Paris, France. BACKGROUND:: Iliac crest autograft is currently the gold standard material for spinal fusion. However, its use is limited by additional operative time, increased blood loss, and morbidity. Recently, a synthetic osteoconductive bone graft material composed of bioactive glass has been described, with high effectiveness in animal models. Its ability to achieve spinal fusion in human has never been reported. The aim of this study was to compare bioactive glass and iliac crest autograft as bone substitutes in the treatment thoracic adolescent idiopathic scoliosis (AIS). METHODS:: Eighty-eight consecutive patients underwent posterior spinal fusion for progressive thoracic AIS. There were 2 study groups based on the type of bone graft used: iliac crest autograft (n = 40) or bioglass (n = 48). A minimum 2-year follow-up was required. Medical data and radiographs were retrospectively analyzed and compared using unpaired t test and Mann-Whitney U test. RESULTS:: Mean follow-up was 40 months in the autograft group and 38 months in the bioglass group. In the autograft group, there were 2 infections (5%) and 3 mechanical failures (7.5%). One infection (2%) and 1 early mechanical failure (2%) occurred in the bioglass group. Loss of correction of the main thoracic curve between immediate postoperative and latest follow-up averaged 15.5% for autograft group and 11% for the bioglass group (P = 0.025).The mean (+/-SD) gain of frontal balance between immediate postoperative latest follow-up was 0.8 (+/-9.3) mm in the autograft group and 8.1 (+/-12) mm for the bioglass group (P = 0.005). CONCLUSIONS:: Results of this retrospective study suggest that bioglass is as effective as iliac crest graft to achieve fusion and maintain correction in AIS. Less complications were seen in the bioactive glass group, but the difference did not reach statistical significance. Bioactive glass can be proposed in the treatment of AIS, avoiding the morbidity of iliac crest harvesting. However, clinical and radiological outcomes need to be confirmed at long-term follow-up. LEVEL OF EVIDENCE:: Level III.
Bioactive glass hydroxyapatite in fronto-orbital defect reconstruction.
Clinical and histologic comparison of two different composite grafts for sinus augmentation: a pilot clinical trial.Galindo-Moreno P, Avila G, Fernández-Barbero JE, Mesa F, O'Valle-Ravassa F, Wang HL. Oral Surgery Department, School of Dentistry, University of Granada, Granada, Spain. Background and objectives: Sinus augmentation is a procedure used for augmenting insufficient bone height that is often observed in the maxillary posterior areas. Many different techniques as well as bone graft regimens have been suggested for performing this procedure. It was the goal of this study to compare, clinically and histologically, two different composite grafting regimens used for sinus augmentation. Material and methods: Five patients, needing a bilateral sinus augmentation to allow implant placement, were recruited for this study. Right sinuses were grafted with cortical bone (collected from overlying the sinus membrane) and bovine hydroxyapatite (HA), while the left side sinuses were grafted with overlying autologous bone plus a bioglass (BG) material. Bone core biopsies were taken at 6 months after sinus graft or at the time of implant insertion. A waiting period of 6 additional months was granted to allow healing, before prosthetic restoration and functional loading. The level of peri-implant bone was evaluated 12 months after loading. A comparative histomorphometric analysis was conducted and a statistical analysis was performed. Results: All implants in both groups were functional after a 12-month loading period. No bone loss was observed radiographically or clinically in both groups. Histologic analysis revealed that both composite grafts had a high biocompatibility. In the bovine HA-containing group, minimal xenogenic graft absorption was noted. In contrast, BG group samples presented a high absorption rate with some remaining particles imbedded in new normal bone. Conclusions: Sinus augmentation using a combination of autogenous bone plus either bovine HA or BG is a predictable technique.
Effect of soft laser and bioactive glass on bone regeneration in the treatment of infra-bony defects (a clinical study).Aboelsaad NS, Soory M, Gadalla LM, Ragab LI, Dunne S, Zalata KR, Louca C. Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt. This study aimed to investigate the influence of low-power 830 nm gallium-aluminium-arsenide (GaAlAs) laser [continuous wave (CW) 40 mW and fluence 4 J/cm(2), with total energy density of 16 J/cm(2)] on the healing of human infra-bony defects treated with bioactive glass graft material. Twenty patients with chronic periodontitis and bilateral infra-bony defects were included. Using a split mouth design, we treated 20 defects with bioactive glass plus laser irradiation during surgical procedures and on days 3, 5, 7 postoperatively; 20 contra-lateral defects were treated with bioactive glass only. Clinical probing pocket depths, clinical attachment levels and standardized periapical radiographs were recorded at baseline and at 3 months and 6 months postoperatively. At 3 months there was a statistically significant difference between the laser and non-laser sites in the parameters investigated. However, at 6 months, no difference was observed. Our results have confirmed the positive effect of soft laser in accelerating periodontal wound healing.
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