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PubMed2003

The effect of mixing on gentamicin release from polymethylmethacrylate bone cements.

We compared the release of gentamicin from 6 different commercially available, antibiotic-loaded PMMA bone cements used for vacuum- and hand-mixed cement using a Cemvac vacuum mixing system. We also measured the release of gentamicin after manual addition of the antibiotic to different commercial, unloaded bone cements after hand-mixing. The porosity of cements was reduced in all vacuum-mixed cements, as compared with hand-mixed cements, concurrent with a statistically significant reduction (3 of 6) or increase (1 of 6) in the total amounts of gentamicin released. The total gentamicin release was studied in 3 of the brands after manual addition and mixing of the antibiotics. We found that the release of antibiotics was lower than in samples made from industrial mixing. In conclusion, the manual addition and mixing of gentamicin in PMMA bone cements leads to a lower release of antibiotics than that in corresponding commercially available antibiotic-loaded cements, while vacuum-mixing only leads to a minor reduction in antibiotic release, as compared to hand-mixing.

Anti-Bacterial Agents↗
PubMed1998

White spot formation under orthodontic bands cemented with glass ionomer with or without Fluor Protector.

The purpose of this study was to determine whether an additional application of Fluor Protector before band cementation with glass ionomer cement reduces white spot formation compared with band cementation with glass ionomer cement. In the in vitro study, 80 premolars were divided in half, creating a control and a test group. All specimens were divided into four different groups to simulate different clinical situations and stored in a demineralizing solution to induce white spot formation. In the in vivo investigation, 18 orthodontic patients were incorporated in the study. One lower and one upper first molar band (randomly selected) were coated with Fluor Protector and then cemented with a glass ionomer cement (test group). The other two uncoated first molars were cemented with glass ionomer cement and served as the control group. The application of Fluor Protector in combination with Aquacem did not contribute to a reduction of white spot formation underneath molar bands compared with the use of Aquacem for banding.

Acrylic Resins↗
PubMed1998

Importance of a thin cement mantle. Autopsy studies of eight hips.

The question whether thin cement mantles around cemented femoral components led to an increased frequency of cracks in the cement was asked. Microscopically, multiple cross sections of eight femurs retrieved at autopsy from clinically successful total hip replacements after prolonged in vivo service containing well fixed Harris Design 2 cemented femoral components were studied. None of the components were loose by radiographic criteria. All were fixed solidly when loaded in vitro in simulated stair climbing and gait, as assessed by high resolution micromotion sensors. The specimens were sectioned transversely at 5-mm increments. The cross sections were examined under a dissecting microscope at x 100. A thin mantle arbitrarily was defined as a mantle of less than 1 mm in thickness. The analysis of the contact radiographs showed that the routine anteroposterior and lateral radiographs underestimated the prevalence of thin cement mantles and mantle defects. Although overall on all the cross sections 9% of the aggregated cement mantles was classified as having thin cement, 92 of the 101 cement cracks occurred in areas of the mantles that were less than 1 mm thick.

Activities of Daily Living↗
PubMed1998

Cemented femoral component surface finish mechanics.

A cemented femoral component's surface finish may influence implant function through variations in cement adhesion and abrasion properties. Morphologic characterization of historic and current femoral hip prosthesis surface finishes show greater than x 20 range in implant roughness. Early implants typically had relatively smooth surfaces, whereas many of the more recent implants have rougher surface finishes. Smoother implant surfaces have lower cement-metal interface fixation strength, whereas rougher surfaces have greater fixation strength. With interface motion, the smoother surfaces are less abrasive of bone cement, whereas rougher implant surfaces are more abrasive. Because of enhanced bone cement attachment, rougher implant surfaces may have a lower probability of interface motion, while at the same time, a higher debris generation consequence if motion occurs. In contrast, smoother implant surfaces may have a higher probability of interface motion with a lower debris generating consequence of that motion. The prolonged use of cemented total hip replacement may be approached by either extending the duration of implant function after cement-metal interface loosening with smooth surfaced implants or, in contrast, by extending the duration of cement-metal interface adhesion with rougher surfaced implants.

Arthroplasty, Replacement, Hip↗
PubMed2003

Technical refinements and precautions during ionomeric cement reconstruction of incus erosion during revision stapedectomy.

OBJECTIVE: The study describes the technical precautions and short-term hearing results of fast-setting ionomeric cement (SerenoCem) for managing incus erosion in revision stapedectomy. STUDY DESIGN: Observational and retrospective chart review. METHODS: Consecutive patients undergoing ionomeric cement incus reconstruction during revision stapedectomy had surgery on an ambulatory basis in a tertiary care referral center. Main outcome measures included technical details, precautions, and recommendations for handling this new material and 6-week hearing outcomes comparing preoperative and postoperative air-conduction and bone-conduction thresholds. RESULTS: A small amount of ionomeric cement on the tip of otological picks applied to the incus remnant successfully reconstitutes the original length of the long process of the incus. In revision stapedectomy, a crimp-on prosthesis may be placed on the cement-lengthened incus. Six-week postoperative audiograms demonstrated significant closure of the air-bone gap in operated cases. Our experience in a failed case leads us to recommend that the setting time for the cement be increased to no less than 20 minutes as opposed to the manufacturer's recommendation of 10 minutes. Also, revision stapedectomy was more likely to be successful when the prosthesis was placed to the incus remnant and stabilized with cement, rather than placing the prosthesis on the cement itself. CONCLUSIONS: Ionomeric cement permits direct reconstruction of a pathologically shortened incus in revision stapedectomy. Surgeons must be aware of precaution and limitations of this new material. Preliminary results indicate significant hearing improvement with this technique when appropriate precautions are taken.

Adolescent↗
PubMed1998

Revision of failed pedicle screws using hydroxyapatite cement. A biomechanical analysis.

STUDY DESIGN: The biomechanical influence of in situ setting hydroxyapatite cement was examined for use in pedicle screw revision surgery. Pull-out testing of control and pedicle screws augmented with hydroxyapatite cement was performed in human cadaver vertebrae. OBJECTIVES: To determine the immediate effect of using hydroxyapatite cement to augment revision pedicle screws after failure of the primary pedicle screw fixation. SUMMARY OF BACKGROUND DATA: The potential problems associated with using polymethylmethacrylate to augment revision pedicular instrumentation have prompted the search for other solutions. The introduction of resorbable hydroxyapatite pastes may have provided new biocompatible solutions for pedicle screw revision. METHODS: Ten human cadaver vertebrae were instrumented with 6.0-mm pedicle screws in each pedicle. The screws were loaded to failure in axial tension (pull-out). The failed pedicles then were instrumented with 7.0-mm pedicle screws, either augmented with hydroxyapatite cement or nonaugmented, which also were loaded to failure. Finally, the nonaugmented 7.0-mm screw hole was reinstrumented with a hydroxyapatite cement-augmented, 7.0-mm pedicle screw and loaded to failure. RESULTS: The pull-out strength of the 7.0-mm, hydroxyapatite cement-augmented screws was 325% (P = 2.9 x 10(-5)) of that of the 6.0-mm control screws, whereas the strength of the 7.0-mm nonaugmented screws was only 73% (P = 2.0 x 10(-2)) of that of the 6.0-mm control screws. The 7.0-mm screws augmented with hydroxyapatite cement also were able to salvage 7.0-mm pull-out sites to 384% (P = 6.9E-5) of the pull-out strength of the 7.0-mm nonaugmented screws. CONCLUSIONS: Hydroxyapatite cement may be a mechanically viable alternative to polymethyl methacrylate for augmenting revision pedicular instrumentation and should be considered for future experimental, animal, and clinical testing.

Biomechanical Phenomena↗
PubMed2001

Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty.

STUDY DESIGN: The biomechanical behavior of a single lumbar vertebral body after various surgical treatments with acrylic vertebroplasty was parametrically studied using finite-element analysis. OBJECTIVES: To provide a theoretical framework for understanding and optimizing the biomechanics of vertebroplasty. Specifically, to investigate the effects of volume and distribution of bone cement on stiffness recovery of the vertebral body. SUMMARY OF BACKGROUND DATA: Vertebroplasty is a treatment that stabilizes a fractured vertebra by addition of bone cement. However, there is currently no information available on the optimal volume and distribution of the filler material in terms of stiffness recovery of the damaged vertebral body. METHODS: An experimentally calibrated, anatomically accurate finite-element model of an elderly L1 vertebral body was developed. Damage was simulated in each element based on empirical measurements in response to a uniform compressive load. After virtual vertebroplasty (bone cement filling range of 1-7 cm3) on the damaged model, the resulting compressive stiffness of the vertebral body was computed for various spatial distributions of the filling material and different loading conditions. RESULTS: Vertebral stiffness recovery after vertebroplasty was strongly influenced by the volume fraction of the implanted cement. Only a small amount of bone cement (14% fill or 3.5 cm3) was necessary to restore stiffness of the damaged vertebral body to the predamaged value. Use of a 30% fill increased stiffness by more than 50% compared with the predamaged value. Whereas the unipedicular distributions exhibited a comparative stiffness to the bipedicular or posterolateral cases, it showed a medial-lateral bending motion ("toggle") toward the untreated side when a uniform compressive pressure load was applied. CONCLUSION: Only a small amount of bone cement ( approximately 15% volume fraction) is needed to restore stiffness to predamage levels, and greater filling can result in substantial increase in stiffness well beyond the intact level. Such overfilling also renders the system more sensitive to the placement of the cement because asymmetric distributions with large fills can promote single-sided load transfer and thus toggle. These results suggest that large fill volumes may not be the most biomechanically optimal configuration, and an improvement might be achieved by use of lower cement volume with symmetric placement.

Bone Cements↗
PubMed2003

Bone cements as adjuvant techniques for ossicular chain reconstruction.

HYPOTHESIS: The osseointegrative capacity of medical-grade bone cement can be used to improve fixation and prevent displacement of an ossicular prosthesis in a guinea pig model. BACKGROUND: Successful ossiculoplasty requires a firm connection between the vibrating tympanic membrane and the inner ear. In patients requiring revision ossiculoplasty, half of failures are due to prosthesis displacement. Bone cements have been used as prosthetic material in craniofacial surgery, and their adhesive and osseointegrative properties make them ideal for use in ossicular reconstruction. METHODS: Twenty-four adult male guinea pigs underwent a postauricular surgical approach for access to the middle ear. Hydroxyapatite and Dahllite cements were used in an alternating fashion to fix ossicular bone. Four animals were killed immediately to demonstrate mechanical bonding of the ossicles at the time of application. Nineteen animals were killed 8 weeks postoperatively to assess bonding capacity and histologic inflammation. RESULTS: Both cements mechanically bonded the ossicles at the time of application, but Dahllite cement set faster in the moist environment of the middle ear space. Histologic examination showed bonding of the ossicles with both cements, with little evidence of inflammation or foreign body reaction. CONCLUSIONS: Hydroxyapatite and Dahllite bone cements showed evidence of osseointegration with ossicular bone in the guinea pig model. Further studies are under way to determine the osseointegrative capacity of Dahllite cement between the guinea pig malleus and a partial prosthesis, and any ototoxic effects with use in the middle ear.

Animals↗
PubMed2003

The use of acrylic bone cement for suture anchoring.

Healing of tendon or ligament sutured to bone depends among other parameters on the mechanical stability of the suture fixation in or to the bone. The authors propose a method of anchoring suture material using bone cement as a substitute for conventional suture anchors. Conditions for secure fixation of suture material in bone cement were assessed and the technique of anchoring suture material with acrylic cement in bone was developed. Mechanical testing and microcomputed tomography of the suture-cement-bone compound were done. It was found that the suture always should be knotted before embedding it at least 2 mm deep in the bone cement. The holes drilled into the bone in which the sutures are secured with cement should be at least 3.5 mm in diameter and 10 mm deep; in cortical bone a tapped thread is required. Sutures can be secured safely using cement anchors which provide higher pull-out strength of a factor two to five than conventional metallic suture anchors of comparable size. They also adapt to anatomic situations where conventional anchors cannot be used and are more favorable in osteoporotic bone. Cement anchoring of sutures seems to be a cost-effective and valuable alternative when there is poor bone quality or extraordinarily high mechanical load.

Bone Cements↗
PubMed2005

Repair of the immature and mature craniofacial skeleton with a carbonated calcium phosphate cement: assessment of biocompatibility, osteoconductivity, and remodeling capacity.

BACKGROUND: The apatite compounds used most commonly in craniofacial reconstruction are highly crystalline and biologically inert ceramics. Because their capacity to be replaced by native bone is limited, they have found little application in repair of the growing craniofacial skeleton. Carbonated calcium phosphate cements more closely resemble the mineral phase of bone, thereby offering enhanced bioresorption and osteoconductivity, but their fate in the immature and mature craniofacial skeleton has not been investigated. METHODS: The authors hypothesized that the capacity for cell-mediated remodeling of carbonated calcium phosphate cements is based on (1) their crystallographic and compositional similarity to the mineral phase of bone and (2) the osteogenic capacity of the host. Four noncritical-sized calvarial defects were created in six 3-week-old and six 16-week-old Yorkshire pigs. The defects were repaired with autologous bone, sintered carbonated calcium phosphate cement disks with a higher crystal order, or carbonated calcium phosphate cement (Norian CRS; Synthes Maxillofacial, West Chester, Pa.). The fourth defect was left empty as a control. Specimens were harvested at 30 and 90 days postoperatively. RESULTS: Empty defects healed with dense fibroconnective tissue in all groups. Autologous bone grafts underwent complete remodeling and replacement with woven bone at both time points. Sintered carbonated calcium phosphate disks demonstrated no bony ingrowth or remodeling. In immature animals, carbonated calcium phosphate cement implants were progressively replaced with woven bone through osteoclast-mediated resorption and osteoblast-mediated bone formation. Only minimal remodeling of the carbonated calcium phosphate cement implants was observed in skeletally mature animals. CONCLUSIONS: The results of these experiments suggest that the extent of remodeling of carbonated calcium phosphate cement is dependent on both the composition of the implant itself and the osteogenic capacity of the host and that carbonated calcium phosphate cement may be used successfully for inlay applications in the immature craniofacial skeleton.

Animals↗
PubMed2005

The chemical constitution and biocompatibility of accelerated Portland cement for endodontic use.

AIM: To evaluate the biocompatibility of mineral trioxide aggregate and accelerated Portland cement and their eluants by assessing cell metabolic function and proliferation. METHODOLOGY: The chemical constitution of grey and white Portland cement, grey and white mineral trioxide aggregate (MTA) and accelerated Portland cement produced by excluding gypsum from the manufacturing process (Aalborg White) was determined using both energy dispersive analysis with X-ray and X-ray diffraction analysis. Biocompatibility of the materials was assessed using a direct test method where cell proliferation was measured quantitatively using Alamar Blue dye and an indirect test method where cells were grown on material elutions and cell proliferation was assessed using methyltetrazolium assay as recommended by the International standard guidelines, ISO 10993-Part 5 for in vitro testing. RESULTS: The chemical constitution of all the materials tested was similar. Indirect studies of the eluants showed an increase in cell activity after 24 h compared with the control in culture medium (P<0.05). Direct cell contact with the cements resulted in a fall in cell viability for all time points studied (P<0.001). CONCLUSIONS: Biocompatibility testing of the cement eluants showed the presence of no toxic leachables from the grey or white MTA, and that the addition of bismuth oxide to the accelerated Portland cement did not interfere with biocompatibility. The new accelerated Portland cement showed similar results. Cell growth was poor when seeded in direct contact with the test cements. However, the elution made up of calcium hydroxide produced during the hydration reaction was shown to induce cell proliferation.

Aluminum Compounds↗
PubMed2000

Influence of additional acid etch treatment on resin cement dentin infiltration.

PURPOSE: The purpose of this study was to compare the penetration of a resin cement into dentin surfaces pretreated with self-etching primer with or without conventional acid etch. MATERIALS AND METHODS: Dentin surfaces of 8 unerupted human third molars were treated with self-etch primer (Panavia 21; Kuraray Co, Ltd, Osaka, Japan) with or without conventional acid etch treatment. A resin cement (Panavia 21) was applied according to manufacturer's instructions. Dentin/resin cement interface sections from each tooth were examined with light microscopy and scanning electron microscopy. In the light microscopy sections, exposed protein at the dentin/cement interface was stained a distinct red with Goldner's trichrome. RESULTS: The resin cement did not penetrate the depth of the zone of demineralized dentin when the self-etch primer was used in combination with conventional acid etch treatment. Inadequate resin cement penetration leaves a substantial area of exposed protein at the dentin/cement interface. In contrast, there was complete resin cement diffusion throughout the demineralized dentin when the self-etch primer was used without acid etching. CONCLUSIONS: Combining conventional acid etch treatment with a self-etching primer/resin cement system resulted in incomplete resin cement penetration and exposed protein at the dentin/cement interface.

Acid Etching, Dental↗
PubMed1989

Strength properties of three zinc phosphate cements mixed to two different consistencies.

When hand-mixing is used, clinicians mix zinc phosphate cement to consistencies which allow proper seating of restorations. Slump tests have indicated that the same two preferred consistencies (one for cementing a single unit restoration, the other for cementing a multiple unit restoration) could be obtained at different slab temperatures for three cements by mixing to certain powder-liquid ratios which were different for each cement. Each cement could be repeatedly mixed to the preferred consistency by using the appropriate powder-liquid ratio. The compressive and tensile strengths of the cements varied, although mixed to the same consistency. Selection of a cement for clinical use should be based on its strength properties when mixed to a preferred consistency.

Dental Stress Analysis↗
PubMed1984

A crack model of a bone cement interface.

This paper is concerned with the fracture mechanics of a bone-cement interface that includes a cohesive zone effect on the crack faces. This accounts for the experimentally observed strengthening mechanism due to the mechanical interlock between the crack faces. Edge crack models are developed where the cohesive zone is simulated by a continuous or a discrete distribution of linear or nonlinear springs. It is shown that the solution obtained by assuming a homogeneous material is fairly close to the exact solution for the bimaterial interface edge crack problem. On the basis of that approximation, the analysis is conducted for the problem of two interacting edge cracks, one at the interface, and the other one in the cement. The small crack that was observed to initiate in the cement, close to the bone-cement interface, does not affect much the mode I stress-intensity factor at the tip of the interface crack. However it may grow, leading to a catastrophic breakdown of the cement. The analysis and following discussion point out an interdependency between bone-cement interface strength and cement strength not previously appreciated. The suggested crack models provide a framework for quantifying the fracture mechanisms at the bone-cement interface.

Biomedical Engineering↗
PubMed2000

In vitro testing of ten bone cements after different time intervals from polymerization.

Biological response of cells to implanted bone cement is a fundamental but often neglected issue in successful cemented implants. In this study, ten acrylic bone cements for orthopedics were assayed using two different in vitro testing methods on L929 cells. The cements were mixed as prescribed, cured for either 1 h or 7 days and then extracted in minimum essential medium (MEM) according to the ISO standard for the preparation of samples. For the evaluation of cytotoxicity, the neutral red uptake assay (NRU) and the incorporation of propidium iodide (PI) were used to detect the viability/death of cells. The two methods were shown to be well correlated (p < 0.0001) in the case of both the 1-h and the 7-day extracts. Two cements, i.e. CERIM LT and CMW2, were found to be toxic after 1-h curing through both the spectrophotometric NRU assay and the cytofluorometric assay with PI. After 7-day curing, these two cements, as well as the Zimmer-low viscosity cement, were toxic according to the NRU assay. The toxic effect of all the cements disappeared after dilution of extracts 1:2 with MEM, except in the case of CERIM LT. In the search for the component inducing the toxic effect, the possible contribution of the residual monomer was discarded on the basis of literature data and the influence of various other factors was analyzed, including the contrast medium (barium sulphate or zirconium dioxide) and the concentrations of N,N-dimethyl-paratoluidine and of benzoyl peroxide (< 1% or > or = 1%). Unlike zirconium dioxide, barium sulphate was found to damage the cells at the 1-h endpoint. Benzoyl peroxide at concentration > or = 1% was found to affect cells at the same endpoint, whereas dimethylparatoluidine had no effect regardless of the proportion.

Animals↗
PubMed2001

Characterization of bone cements prepared with functionalized methacrylates and hydroxyapatite.

Bone cements prepared with methyl methacrylate and either methacrylic acid or diethyl amino ethyl methacrylate as comonomers were characterized by infrared spectroscopy, nuclear magnetic resonance, gel permeation chromatography, dynamic mechanical thermal analysis, and mechanical testing. Selected formulations containing these functionalized methacrylates were filled with hydroxyapatite and studied in terms of their properties in tension, compression and bending, and X-ray diffraction. It was found that residual monomer was not greatly affected by the presence of either acid or basic comonomers in the unfilled bone cements. In contrast, molecular weight, curing times, and glass transition temperature were composition dependent. For samples with acidic comonomer, a faster curing time, higher molecular weight, and higher glass transition temperatures were observed with respect to those with the basic comonomer. X-ray diffraction revealed that the crystalline structure was not affected by the nature of comonomer in the bone cement while scanning electron microscopy showed that hydroxyapatite remained as clusters in the bone cement. The mechanical properties of filled bone cements depended mainly on composition and type of testing. Hydroxyapatite-filled bone cements fullfilled the minimum compressive strength (70 MPa) required for bone cement use. However, the minimum tensile strength (30 MPa) was only fullfilled by cements prepared without comonomer and those containing methacrylic acid. The minimum bending strength requirement (50 MPa) was not satisfied by any of the formulations studied.

Biocompatible Materials↗
PubMed2005

Surface and chemical properties of surface-modified UHMWPE powder and mechanical and thermal properties of it impregnated PMMA bone cement, III: effect of various ratios of initiator/inhibitor on the surface modification of UHMWPE powder.

From our previous study, 3 wt% of ultra-high-molecular-weight polyethylene (UHMWPE) powder surface-modified by various ratios of methyl methacrylate (MMA) and poly(methyl methacrylate) (PMMA) solution was impregnated to improve the poor mechanical and thermal properties of conventional PMMA bone cement. In this study, various amounts of benzoyl peroxide (BPO) and hydroquinone were used for the adhesion reinforcement of UHMWPE powder with PMMA polymerized from MMA monomer (polyMMA) by the mixture of BPO and hydroquinone and ultimately to strengthen the poor mechanical and thermal properties of conventional PMMA bone cement. The tensile strengths of 3 wt% of UHMWPE powders surface-precoated with polyMMA prepared by various amounts of BPO- and hydroquinone-impregnated composite PMMA bone cements were similar to that of conventional PMMA bone cement. In particular, 3 wt% of UHMWPE powder surface precoated with polyMMA prepared with 0.75 wt% of BPO and 300 ppm of hydroquinone impregnated composite PMMA bone cement revealed the maximum tensile strength. However, no obvious significant difference was revealed, although the curing temperatures of the composite PMMA bone cements decreased from 103 degrees C to 91-97 degrees C. From these results, it was determined that the mixture of BPO and hydroquinone plays an important role in improving the poor mechanical properties of conventional PMMA bone cement. However, the thermal properties of the composite PMMA bone cements were not remarkably improved. The mechanical, chemical and thermal properties were individually confirmed using a scanning electron microscope (SEM), universal transverse mercator (UTM), Fourier transform infrared-attenuated total reflectance (FT-IR-ATR) and digital thermometer, respectively.

Bone Cements↗
PubMed1991

Physical properties of stainless-steel and silver-reinforced glass-ionomer cements.

The purpose of this study was to compare specific physical properties of an experimental stainless-steel-reinforced glass-ionomer cement with those of two commercially available silver-reinforced cements. Properties evaluated were compressive and diametral tensile strengths (one and 24 h), percent solubility in 0.01 mol/L lactic acid over 23 h, and working and setting times. Cylindrical specimens 6 mm (diameter) x 12 mm were prepared and maintained in distilled water at 37 +/- 2 degrees C and then tested on an MTS mechanical testing machine with a cross-head displacement rate of 0.5 mm/min for the diametral tensile strength test and 1.0 mm/min for the compressive strength test. ANOVA and Tukey's Studentized Multiple Range Test indicated significant differences between the experimental and commercially available cements for both compressive and tensile strengths at one and 24 h (p less than 0.01). The experimental stainless-steel-reinforced cement appeared to be significantly stronger in both tensile and compressive strengths than either of the commercially available cements. Working and setting times--as well as acid solubility of the experimental cement--also compared favorably with those of the commercial cements. Results suggest that the stainless-steel-reinforced glass-ionomer cement possesses strength properties that should lead to a stronger, more fracture-resistant restorative filling material when compared with those presently available.

Analysis of Variance↗