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PubMed2006

Evaluation of tissue response to MTA and Portland cement with iodoform.

OBJECTIVE: The aim of this study was to evaluate the biocompatibility of Portland cement with the addition of iodoform, compared to MTA (ProRoot). STUDY DESIGN: Eighteen Wistar albino rats were divided into 3 groups of 6 animals each. Polyethylene tubes were filled either with freshly mixed MTA or Portland cement mixed with iodoform (20% wt/wt) and implanted subcutaneously. An empty tube served as control. After 7, 30, or 60 days, the implants together with the surrounding tissues were removed in blocks. Sections were evaluated for the presence and thickness of a fibrous capsule, presence of granulation tissue, and the severity of inflammatory response. Data were submitted to nonparametric statistical analysis with individual comparisons between groups at a significance level of P < 0.05. RESULTS: There were no differences between inflammatory responses at 7 and 30 days. After 60 days from surgical removal, there was significantly more tissue reaction to the MTA and Portland cement compared to the control group. CONCLUSION: There were no significant differences regarding inflammatory responses between MTA and Portland cement with iodoform after 7, 30, or 60 days. After 60 days, the fibrous capsule around the Portland cement appeared more organized than tissue surrounding MTA implants. After 60 days, there was still a significantly increased tissue reaction to the 2 cements compared to the empty polyethylene tubes.

Aluminum Compounds↗
PubMed1998

Inhibition by glass-ionomer cements of protein synthesis by human gingival fibroblasts in continuous culture.

The effects of several glass-ionomer cements (Baseline and Chem Fil of De Trey; Ketac Fil and Ketac Bond of ESPE; Vitrebond and Vitremer of 3 M) on the protein synthesis of cultured gingival fibroblasts were studied. The presence of cements in the culture medium inhibited protein synthesis, although the relative effectiveness varied significantly. The cements tested have been ranked in three groups, group A (Chem Fil and Ketac Fil), group B (Ketac Bond and Baseline) and group C (Vitrebond and Vitremer), showing 50, 75 and 100% reduction in protein synthesis, respectively. Incubation of cells with medium previously conditioned by Baseline and Ketac Fil caused only transient inhibition of protein synthesis followed by almost complete recovery. This recovery was not observed when the medium was conditioned with Vitrebond. A characterization of the factors determining the inhibitory effect of one cement in each group was attempted. The cements, irrespective of the type, produced small but reproducible decreases in the pH of the medium but released fluoride ions to a different extent. Both changes in the pH of the medium and in the fluoride concentration inhibited protein synthesis by cultured gingival fibroblasts. The different action of cements can be explained, at least in part, by a differing release of fluoride ions.

Aluminum Silicates↗
PubMed1997

Bactericidal eradication from carious lesions of prepared abutments by an antibacterial temporary cement.

PURPOSE: The aim of this study was to observe the antibacterial potential of polycarboxylate temporary cement containing a mixture of metronidazole, ciprofloxacin, and cefaclor on carious lesions of prepared abutments that were designed to leave caries on the abutments. MATERIAL AND METHODS: Antibacterial efficacy was estimated in vitro and in vivo by measuring bacterial recovery from the lesions. Bacteria counts ranged from 10(4) to 10(7) both in vitro (nine samples) and in vivo (five samples) in time-zero samples, just before the application of the antibacterial cement. RESULTS: No bacteria were recovered from carious lesions in vitro (six samples) or in vivo (four samples) after the lesions were covered by the antibacterial temporary cement. For the remaining samples, some bacteria (5 to 80 counts per sample) were recovered, with one notable exception in which marginal leakage provided a bacteria count of 10(3). Bacteria counts ranging from 10(3) to 10(5) occurred in carious lesions covered by temporary cement without antibacterial agents, which indicated that temporary cement alone was not a potent disinfectant. CONCLUSIONS: The results of this study indicated that the antibacterial temporary cement can be useful for eradicating bacteria from carious lesions of prepared abutments.

Adult↗
PubMed2006

[Early aseptic loosening of cemented cup in metal-on-metal total hip arthroplasties].

PURPOSE OF THE STUDY: The aim of this study was to report cases of acetabular failure of metal-on-metal total hip arthroplasties using cemented cups with a metal-metal bearing. MATERIAL AND METHODS: From 1997 to 1999, 137 patients underwent total hip arthroplasty with a 28-mm head and a metal-metal (Metasul) bearing. At mean follow-up of three years eight months (range 2-6 years), three patients had died and thirteen were lost to follow-up or had less than 2 years follow-up. The analysis thus included 118 patients (122 hips) 67 women and 51 men (mean age 61 years). The same transgluteal approach with two cemented implants (Palacos gentamycine) was used in all patients. The Postel-Merle-d'Aubigné score was used for clinical assessment with search for lucent lines in the Delee and Charnley zones and cup migration on the standard x-rays. Actuarial survival curves were drawn using revision and failure as the end events. RESULTS: In this series, there were no cases of dislocation or infection but there were five revisions for aseptic cup loosening: one at two years, two at four years, and two at five years. Among the remaining 117 implants, outcome was clinically very good in 101, good in 10 and fair in 6. Radiologically, there were no cases of femoral lucent lines, migration or osteolysis. For the cup, a lucent line measuring less than 1 mm and stable was observed in 81 hips. A progressive lucent line was observed in 18 hips with 11 showing signs of probable loosening. The five-year survival using surgical revision as the endpoint was 94%. Using cup failure (revision and progressive line), it was 80%. Revisions and radiographically probable loosenings were statistically more significant in small cups measuring 44 and 46 mm. DISCUSSION: In this series, cemented metal-on-metal bearings showed a rate of failure greater than observed in metal-polyethylene implants and metal-on-metal implants using a press fit cup. Other series using a metal-on-metal bearing with a cemented cup have found the same trend. CONCLUSION: We have discontinued this type of implant and recommend avoiding direct cementing of the polyethylene-metasul cup on the bone for total hip arthroplasty. The metal-on-metal bearing can still be used, but without cementing the cup.

Adult↗
PubMed2002

Micro-tensile bond testing of resin cements to dentin and an indirect resin composite.

OBJECTIVES: Micro-tensile bond strength (microTBS) evaluation and fractographic analysis were used to compare four resin cement systems (AC: All-Bond 2/Choice; RX: Single Bond/RelyX ARC; SB: Super-Bond C & B; and PF: Panavia F) in indirect composite/dentin adhesive joints. METHODS: Flat dentin surfaces were created on extracted human third molars. The resin cements were used according to the manufacturers' instructions for bonding silanized composite overlays to deep coronal dentin. 0.9x0.9 composite-dentin beams prepared from the luted specimens were stressed to failure in tension. Dentin sides of all fractured specimens were examined by scanning electron microscopy (SEM) to examine the failure modes. In group PF, morphologic features that could not be resolved at the SEM level were further validated by transmission electron microscopy (TEM) examination of the SEM specimens. RESULTS: Statistical analyses revealed significant difference (p<0.05) among microTBS and failure modes in the resin cement groups. The two groups (AC and RX) with highest microTBS failed predominantly along the composite overlay/cement interface. Cohesive failure in resin cement was primarily observed in group SB that exhibited intermediate microTBS values. In group PF with the lowest microTBS, failure occurred mostly along the dentin surface. Globular resin agglomerates seen by SEM on PF-treated dentin were distinguished from silica fillers by TEM. SIGNIFICANCE: The bond between the processed composite and the luting resin cement was the weak link in indirect composite restorations cemented with AC or RX. Super-Bond C&B exhibited intermediate tensile strength and Panavia F is less reliable when used in conjunction with a self-etching primer for bonding indirect restorations to dentin.

Analysis of Variance↗
PubMed2003

Dynamic viscoelastic behavior of resin cements measured by torsional resonance.

OBJECTIVE: The purpose of the study was to measure the viscoelastic properties of four dental resin composite cements using a dynamic mechanical analysis technique. METHODS: Dynamic torsional loading was conducted in the frequency range from 1 to 80 Hz. Cement specimens were tested after storage in 37 degrees C water for 24 h. One group was thermal cycled prior to testing. Measurements were taken at 21, 37, and 50 degrees C. Storage modulus, loss tangent and other viscoelastic parameters were determined from the amplitude/frequency curves. RESULTS: Storage moduli of the cements ranged from 2.9 to 4.1 GPa at 37 degrees C. Loss tangents ranged from 0.054 to 0.084. Storage moduli decreased in a regular way with increasing temperature, whereas, loss tangents increased. Thermal cycling caused small decreases in storage moduli. SIGNIFICANCE: Resin cements with higher filler loading were found to have higher storage moduli and lower loss tangents. Since these properties have been associated with better clinical performance in the areas of retention and prevention of fracture of porcelain and resin restorations, the more highly filled cements may be recommended. Temperature variations influenced viscoelastic behavior of the cements. However, within the temperature range studied no sharp drop in modulus was seen, so the materials should function satisfactorily in the oral cavity.

Analysis of Variance↗
PubMed2004

Marginal adaptation in dentin of a self-adhesive universal resin cement compared with well-tried systems.

OBJECTIVES: This study compares the marginal adaptation of a new self-adhesive universal resin cement with only one application step, to the marginal adaptation of established cements and their corresponding adhesive systems. METHODS: All-ceramic crowns were inserted on human molars using a new self-adhesive universal resin cement without and with one pre-treatment step, a resin cement with a smear-layer removing and a compomer cement with a smear-layer dissolving adhesive system. After simulation of five years oral stress, the marginal adaptation was evaluated by dye penetration and scanning electronic microscope analysis using the replica technique. RESULTS: Scanning electron microscopy: all investigated luting agents showed comparable amounts of 'perfect margin' ranging between 88-98% (median). Dye penetration: the self-adhesive system had significantly lower dye penetration (18-25%, median). SIGNIFICANCE: The results indicate that a self-adhesive universal resin cement without pre-treatment can provide a marginal adaptation at dentin which is comparable to established luting agents.

Coloring Agents↗
PubMed2000

Strengthening of glass-ionomer cement by compounding short fibres with CaO-P2O5-SiO2-Al2O3 glass.

The purpose of this study was to determine if short fibres of CaO-P2O5-SiO2-Al2O3 (CPSA) glass possessing a particular aspect ratio (length/diameter) could be used as a reinforcing agent for glass-ionomer cement. The powder of a commercial glass-ionomer cement (not resin modified) was mixed with variously sized CPSA glass short fibres before mixing with the liquid of the glass-ionomer cement. The mixed powders containing 60 mass% CPSA glass short fibres (diameter, 9.7 +/- 2.1 microm, aspect ratio, 5.0 +/- 0.9) obtained maximum values of 18 and 35 MPa for the diametral tensile strength (DTS) and flexural strength (FS) of set cements, respectively, after 24 h. These DTS and FS values were 1.8 and 4.5 times larger, respectively, than those of the set glass-ionomer cement not containing short fibres. Moreover, it was found that the addition of CPSA glass short fibres was remarkably more effective in the strengthening than electric glass (a typical glass fibre) short fibres. The results suggested that the CPSA glass short fibres acted as a reinforcing agent for strengthening the glass-ionomer cement, because of the shape of short fibres and reactivity between the mixing liquid and short fibres.

Dental Cements↗
PubMed2001

Setting characteristics and mechanical behaviour of a calcium phosphate bone cement containing tetracycline.

Calcium phosphate cements are used for bone defect filling and they may also be used as delivery systems for active agents. The physicochemical behaviour of an ionic cement, with a final composition of hydroxyapatite, containing tetracycline hydrochloride was investigated. Chemical characterisation, X-ray diffraction analysis, compressive strength and tensile strength were performed. It is known that the antibiotic can be adsorbed on calcium phosphate compounds and the presence of chloride ions can strongly influence the behaviour of the cement. Adding more than 1% (w/w) of 95% pure tetracycline hydrochloride in the solid phase led to a cement with poor mechanical properties, but which, in addition to hydroxyapatite, contained residual starting reagents. For this reason, experiments were also performed with tetracycline previously treated with a calcium sulphate solution. Using a treated tetracycline, it was possible to introduce at least 7% (w/w) of active ingredient whilst still allowing the reaction to proceed to completion i.e. the formation of hydroxyapatite with good mechanical properties. Therefore, treating the tetracycline HCI with calcium sulphate solution prior to reaction conserved the activity of the antibiotic, limited the influence of the antibiotic on the cement evolution and retained the physical properties of the cement.

Bone Cements↗
PubMed2001

Evaluation of the effect of seven acrylic bone cements on erythrocytes and plasmatic phase of coagulation.

The haemolytic activity and the effect on the plasmatic phase of coagulation of seven bone cements were evaluated (Sulfix-60 from Sulzer Orthopedic Inc., a bone cement at low viscosity from Zimmer, a bone cement dough-type from Zimmer, Palacos R from Merck, CMW1, CMW2 and CMW3 from DePuy International Ltd.). Haemolytic activity was tested by adding the cement extracts in phosphate buffered saline to a suspension of erythrocytes. After 4 h incubation at 37 degrees C, the haemoglobin concentration was determined on the supernatants by colorimetric method. The effect on the plasmatic phase of coagulation was tested by adding the cement extracts in saline to human plasma. After 30 min incubation at room temperature activated partial thromboplastin time (APTT) was determined. All extracts induced non-significant variations of haemoglobin concentration and APTT. It was concluded that the tested cement extracts do not induce haemolysis and do not activate the intrinsic pathway of coagulation, at least in the tests that were performed.

Acrylates↗
PubMed2001

The effect of cross-linking agents on acrylic bone cements containing radiopacifiers.

Poly(methylmethacrylate) PMMA, based cements are the most widely used bone cements in joint replacement surgery. Although, there are some disadvantages in the use of these cements, the clinical success rate is fairly high. Intrinsic radiopacity is difficult to achieve in these cements due to the constituent elements of the PMMA polymer. As radiopacity is an essential requirement, PMMA bone cements have been rendered radiopaque by blending heavy metal ion salts, which tend to adversely affect the mechanical and biological properties of the bone cement. In this study, dimethacrylate cross-linking agents were added to the monomer phase in order to generate a cross-linked matrix, with barium sulphate as a radiopaque agent. The results suggest that the mechanical properties can be improved or retained with the addition of such cross-linking agents.

Acrylates↗
PubMed2002

Effects of bone cement extracts on the cell-mediated immune response.

The aim of the study was to evaluate some aspects of the immunocompatibility of 10 acrylic bone cements. Mononuclear cells harvested from healthy individuals were cultured with cement extracts which were tested to assess their effect on the viability of lymphocytes, unstimulated and phytohaemoagglutinin (PHA)-stimulated, activating resting lymphocytes, and changing the reactivity of PHA-stimulated lymphocytes. After 24 h the extracts did not increase the percentage of dead cells in unstimulated or PHA-stimulated lymphocytes. The early apoptotic events of culture were evaluated after 4 and 24 h in PHA-stimulated lymphocytes: at 4 h three cements, namely Zimmer-dough type, Palacos R and CMW-1, increased significantly the percentage of apoptotic cells, while at 24 h no differences were found. Cement extracts did not activate the resting lymphocytes, whereas the response of the PHA-stimulated cells was significantly modified. All cements decreased the expression of the interleukin 2 receptor (CD25) and the lymphocyte proliferation, whereas only two materials (Zimmer-dough type, CMW 1) affected the expression of early activation antigen (CD69). These findings show that the products released from bone cement are not able, by themselves, to elicit a specific immune response; on the contrary they hamper the function of lymphocytes activated by an exogenous stimulus.

Antigens, CD↗
PubMed2002

Bone cement extracts modulate the osteoprotegerin/osteoprotegerin-ligand expression in MG63 osteoblast-like cells.

The osteoprotegerin-ligand (OPG-L) has been identified as the essential factor required for osteoclastogenesis, and its effects are prevented by the osteoprotegerin (OPG). The OPG-L/OPG balance plays a crucial role in coordinating the sequence of osteoclast and osteoblast differentiation during the bone remodeling. The aim of the study was to investigate if polymethylmethacrylate-based cements are able to modulate the expression of OPG-L/OPG in MG63 cells, which are known to have high levels of OPG and inducible expression of OPG-L. Four radio-opaque cements. namely Sulfix-60, CMW1, CMW2 and CMW3, were polymerized for either 1 h or 7 d. MG63 were incubated for 24 h with culture medium only, cement extracts and 2 microg/ml of human recombinant IL-1beta as positive control. An RT-PCR was performed to detect the OPG and OPG-L expression, and the house-keeping gene, GAPDH, was used as a reference for the semi-quantitative analysis. An increase in the OPG-L band density was observed for all cements, and consequently, the OPG-L/OPG ratio also increased. The ability of bone cements to induce the expression of OPG-L could be a co-factor in the development of osteolysis at the bone-cement interface.

Bone Cements↗
PubMed2002

Release of gentamicin sulphate from a modified commercial bone cement. Effect of (2-hydroxyethyl methacrylate) comonomer and poly(N-vinyl-2-pyrrolidone) additive on release mechanism and kinetics.

The influence of the (2-hydroxyethyl methacrylate) (HEMA) monomer addition as a comonomer to the cement liquid component and of a polymer, poly(N-vinyl-2-pyrrolidone) (PVP) to the solid component of a standard CMW-1 bone cement on gentamicin sulphate (GS) on its drug release properties have been studied. The addition of HEMA modifies the habit of the delivery curves. The incorporation of PVP into the cement matrix, apparently, did not very much modify the shape of the HEMA modified cement release curves, but led to a remarkable increase of the maximum amount of GS released. This effect was proportional to the PVP concentration incorporated. From the matrix composition and SEM data, a model based on the morphology of the matrix has been proposed. The cumulative amount of GS released by each slab Mt is most adequately fitted and represented by the equation Mt = c + at 1/2 + b[1 - exp(-nt)], which corroborates that the release occurs according to the model proposed. by means of three discrete mechanisms, namely: (i) a short-term initial elution due to the imperfections in the poly(methyl methacrylate) covering of the most external GS beads, burst effect by the buffer solution; (ii) followed by a fracture by stress cracking in an active media of the coated GS beads located on the external surface of the matrix where water molecules enter to dissolve GS molecules releasing them into the buffer solution by a diffusion-controlled process; and (iii) a third process in which the buffer solution penetrates into the internal voids and cracks creating a series of channels in a labyrinthic structure, which may facilitate the access of water molecules to the plastic-coated GS beads within the bulk matrix. This third process is enhanced by the incorporation of PVP beads as dissolved molecules within the matrix. This water-soluble additive is leachable, generating a highly porous structure in the cement. This HEMA and PVP modified cement may be used as a drug delivery system to modulate the GS release rate.

Anti-Bacterial Agents↗
PubMed2002

Bone repair in radii and tibias of rabbits with phosphorylated chitosan reinforced calcium phosphate cements.

Biocompatibility of two calcium phosphate cements (CPCs), reinforced with phosphorylated chitosan (P-chitosan), was investigated in rabbits in present study. The two CPCs are monocalcium phosphate monohydrate (MPCM) with calcium oxide (CaO) in 1 M phosphate buffer (i.e. MCPM/CaO/1 M phosphate buffer cement, CPC-I) and dicalcium phosphate dihydrate (DCPD) with calcium hydroxide [Ca(OH)2] in 1 M Na2HPO4 solution (i.e. DCPD/Ca(OH)2/1 M Na2HPO4 cement, CPC-II). Different amount of P-chitosan was added to the liquid phase before the power phase was mixed with the liquid phase. The MCPM/CaO/1 M phosphate buffer/P-chitosan cements (P-CPC-I) with neutral pH were filled into the holey defects of rabbit tibias. While the DCPD/Ca(OH)2/1 M Na2HPO4/P-chitosan cements (P-CPC-II) shaped as prehardened cylinders were implanted into rabbit radial defects. After operation, the two serial groups and CPC-II controls were observed for 1, 4, 12 and 22 weeks, respectively. Histological and histomorphological studies proved that P-chitosan containing cements are biocompatible, bioabsorbable and osteoinductive. The biodegradation rate has a negative relationship with the P-chitosan content. Progressive substitution took place at the interface of implants and host bones. No adverse effects were found in tissues around the bone defects. Thus, they could be used as bone substitutes in clinic.

Animals↗
PubMed2003

Gentamicin release from modified acrylic bone cements with lactose and hydroxypropylmethylcellulose.

Modified polymethylmethacrylate (PMMA) bone cements formulations were prepared by including different proportions of gentamicin and release modulators such as lactose or hydroxypropylmethylcellulose (HPMC). Surface aspect, gentamicin release and porosity of these modified formulations were studied by means of scanning electron microscopy (SEM), a specially designed system for the dissolution studies of the bone cements, and mercury intrusion porosimetry. Lactose modified cements presented an irregular surface with numerous hollows and voids due to the lactose dissolution. HPMC cements presented a characteristic laminated and flaky surface. The drug release of lactose formulations was up to four-fold greater (13%) than the commercial bone cement CMW1 Gentamicin one (3%). The amount of gentamicin eluted at the first withdrawn sample ranged from 30% to 60% of total gentamicin released over the assay. Gentamicin release from lactose formulations increased as lactose percentage was increased which agree with the porosity results. Nevertheless, the use of release modulator HPMC increased porosity, but did not produce an increase in the gentamicin release. HPMC dissolution creates a surrounding sticky and viscous medium similar to a gel that makes the gentamicin release from the cement matrix difficult.

Anti-Bacterial Agents↗
PubMed2003

Long-term radiographic changes in cemented total hip arthroplasty with six designs of femoral components.

Measurements were made from annual follow-up radiographs, obtained over 27.6 years, of 860 cemented total hip arthroplasties implanted by one surgeon. Femoral components were made of stainless steel or titanium alloy, were non-modular, and were all fixed with cement, and acetabular cups were all-polyethylene and were fixed with cement. Radiographic outcome was correlated with the shape and material of the femoral component. Specifically, throughout the follow-up, stems made of titanium alloy were at greater risk of developing bone-cement radiolucent lines than those made of stainless steel, the difference ranging from approximately 10-50 percent at 2-10 years of follow-up. Similarly, titanium alloy stems were at greater risk of developing endosteal scalloping, indicating osteolytic lesions. Among the stainless steel Charnley cobra and straight-narrow Charnley stems, none developed cement fracture, only one became radiographically loose and one developed endosteal scalloping. The differences in the risk of developing radiolucent lines, cement fracture and progressive loosening among these stems were correlated with the relative rigidity of the femoral stems, and were generally consistent with the predictions made heretofore using finite element models, although differences in stem surface finish and femoral ball size and material could have also influenced the results.

Aged↗
PubMed2003

Elimination of barium sulphate from acrylic bone cements. Use of two iodine-containing monomers.

The aim of this work is to present a new approach to joint arthroplasty failure related to bone cement mantle. As barium sulphate is considered one of the main causes of mechanical weakness in the cement, we substituted this inorganic radiopacifier of the solid component for radiopaque monomers in the liquid component. We obtained two different cements, one containing 5 vol% 2-[2',3',5'-triiodobenzoyl] ethyl methacrylate (TIBMA) and the other containing 3,5-diiodine salicylic methacrylate (DISMA). In both cases, the mechanical properties of these new cements were better than those of the barium sulphate-containing cement. The radiopacity obtained was comparable to that of the aforementioned cement and all the samples showed good biocompatibility.

Barium Sulfate↗