Suport Curs – Masterat Substituenti Ososi

8/20/2019 Suport Curs – Masterat Substituenti Ososi

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segmental bone defects, honghua heng Ging =ai e a hi. 2 3an(#1$)66-@. +'. /6!1/6; /isch A, Ci 0<, <arment :H., Accuracy of cone beam computed tomography for periodontal defectmeasurements. 3 Heriodontol. 2 3ul(55#5$)121-2. +'. /630!6/@ 9ibeiro .., Barrias .., Barbosa /.A., Hreparation and characterisation of calcium-phosphate porousmicrospheres with a uniform si'e for biomedical applications. 3 /ater <ci /ater /ed. 2 /ay( 15 #6$) 466-27.+'. /6633!36.

10. Schmidhammer R, Zandieh S, Mittermayr R, Pelinka LE, Leixnering M, Hopf R,

roepfl !, Redl H., !""e""ment of #one $nion%non$nion in an experimental model$"ing microcomp$ted technology. & 'ra$ma. (00) &$l*)1+1-1/(0.

PMID: 1683227111. erne E, 2o"etti M, 2ro3arone 4, Moi"e"c$ 4, L$po 5, Spriano S, 4anna" M., 5l$oroapatite gla""/ceramic

coating" on al$mina- "tr$ct$ral, mechanical and #iological characteri"ation. 2iomaterial". (00(

!$g*(6+1)-66/706. PMID: 12099282

12. Yamamoto ', akaasi Y, abata Y#, Enan&ed bone re5eneration at a se5mental bone de*e&t b&ontrolled release o* bone morpo5eneti& protein-2 *rom a biode5radable dro5el# issue En5#2006 'a7/2(!)./10!-//#

PM89- 1)::1)76

Th !"#$r%&'( $) *$' +,*+%!%,%+ Autografts, allografts and bone synthetic substitutes plays an important role in

orthopaedic and reconstructive surgery while the understanding of their biological effects isre"uired for directed applications.

Bone grafting materials are those implants that promotes bone healing by one of thefollowing actions) osteogenesis, osteoinduction and osteoconduction.

>steoconductive materials became more important, especially in bone pathologywhile they are used as bone substitutes. %hese substances have a composition similar to thebone mineral matrix and are biocompatible. %heir main function is of bone tissue support,allowing bone apposition on their surface( thus, they are used mainly for treating the bonedefects. /ore recently, they are used as a vehicle for osteoinductive substances, augmentingbone formation.

=hile initially, only coral hydroxiapatite, calcium phosphate #Hlaster-of-Haris$ and thenbioactive glasses #bioviotroceramics$ were used as bone substitutes, nowadays we are usingosteoconductive ceramic materials and phosphocalcic cements.

&rom the ceramic materials used in medical applications, we mention here thecalcium triphosphate #I-%H$, hydroxyapatite #A$ #8ei*el /!, 'i9il9 200!, :ura /$and calcium biphosphate #or biphasic calcium phosphate or BH or I-%H-A$.

Hhosphocalcic cements #H$ consist in one or more calcium phosphates #aH$soluble in a"ueous solutions. /any experimental and clinical studies have usedphosphocalcic cements #;onstant< /3, 8rankenbur5 /3, 'i9il9 200!$.

%he proposed subect underlines te pra&ti&al appli&ation by a histologic, histo-morphometric and biomechanical investigation between organic bone substitutes #e.g.phosphorilated cellulose$ and import phosphocalcic compounds, whose prices are stillprohibitive, even if they are biocompatible and osteoinductive. %his study will represent alsothe first step for the homologation process for the 9omanian products.

%o reach this goal, we will use *undamental resear& metods, as in vivo researchon animal model followed by a histologic evaluation on calcified and decalcified bone andelectronic methods for biomechanical histomorphometric evaluation.

Dp to now, the phosphocalcic cements were successfully used in maxillofacial surgery,in radius lower extremity fractures or calcaneal fractures, trochanteric fractures, tibialplate fractures, and also as filler for the osteoporosis in vertebrae bone. Anotherapplication is represented by osteosynthesis augmentation by sponge screws orpedicular screws in spine surgery.

+n this domain, our proposed subect shows an important pra&ti&al appli&ation, by

providing useful information in practical orthopaedics for phosphocalcic cement usage inorder to improve screws osteosynthesis for osteoporotic bones





&ig 1. /olecular structure of the human B/H. Hrotein :atabank www.rcsb.org

growth factor supergamily called %8&-I #transforming growth factors$. %he most used B/H-sare B/H- # Yan5 2006, +atel 2006, %&iadini 2000, %in5 2006) and B/H-5 or theosteogenic protein #>H-1$ #siridis 2006$. An important study in the B/H study isrepresented by the vehicle through which these proteins are adminstered locaaly. &irst, apowder deminerali'ed bone matrix was used. %he mainly contains a type + collagenandrepresented the golden standard for the comparison with later synthetised materials #'aeda2004, Kim 2002$. /any other biocompatible materials were evaluated as B/H carriers)

/0xtracellular matrix components) various collaen types, fibrin, fibronectin, hialuronic acid,

glycosaminoglycans/;erami& materials. dro?iapatitis, &al&ium tripospate /<ynthetic polymers)polylactic and polyglycolic acid /Bone grafts) autogenous and allogenous

/#2# e se&ond resear& dire&tion is represented b te dis&o=er, sntesis andusa5e o* te osteo&ondu&ti=e bone subtitutes#>steoconductive materials gain an increased importance in the biomaterial field, especiallyfor bone pathology while serving as bone substitutes. %hese substances has a compositionsimilar to the bone minerali'ed matrix and are also biocompatible. %heir main function is ofbone support, allowing aposition of the new bone on their surface for this reason they areused especially in the treatment of bone defects. 9ecently, they were used as vehicle for theosteoinductive substances, augmenting the bone forming.

1.2.1. Cr&"!( "&%r!&-+ #h$+#h$(&-(!( #r$/,(%+

8n the pa"t >0 year" the calci$m pho"phate" =ere inten"i3ely in3e"tigated and $"ed in #one repair. 'he mo"t important property of the pho"phocalcic comp$nd" +B$h'r

2000 i" the =ater "ol$#ility, "o a" a compo$nd i" more re"or#a#le a" it i" =ater

"ol$#le +e.g. D/'4P =hen a compo$nd i" le"" "ol$#le in =ater and in the #one matrix,

it =ill #e le"" or hard to #e re"or#ed +e.g. H!. 'he mo"t $"ed compo$nd" in the

medical field are repre"ented #y the calci$m tripho"phate" +D/'4P, hydroxiapatiti"

+H! +M!h!- 2006 Oh,r& 1996 and calci$m #ipho"phate +24P or D/'4P/H!./#2#2# +ospo&al&i& &ements (;+;)%hey were discovered by Brown and how in the M;. H are composed by one or

more calcium phosphates #aH$ that are solved and precipitated in an a"ueous solution.:uring precipitation, the calcium phosphate crystals are growing and interweaving so as they

confer mechanical rigidity to the newly formed cement. /any experimental and clinicalstudies have used the phosphocalcic cements #;onstant< /3, 8rankenbur5 /3,



'i9il9 2006$. By difference to the polymetilmetacrilate #H//A$, that is formed by apolymeri'ation reaction, the phosphocalcic cements are formed by a less exothermalreaction while the cement volume remains almost constant during formation 9egardlesstheir type, the phosphocalcic cements shows two big disadvantages by comparison withporous phosphocalcic ceramics)

/%hey are fragile materials, and can be used alone #in low mechanical stress regions$eiter

&ombined >it osteosntesis materials #in loading regions, with high mechanical stress$/%he pore dimension is around 1 micron that makes the bone growth difficult inside thepores

while degradation is proceeding step by step. #outside-in$.

2# $ational resear&+n 9omania, :r. Hopescu-*egreanu and the research group led by Hrof. :r. :. Antonescu inD/& N. :avila Bucharest have reali'ed a biovitroceramic, commercially called HA=1,homologated in 1@@4 and used in many national clinics (ntones&u /). Bioactivity testswere performed by HA=1 implantation, as granules or ad'ed pieces in the rabbit tibia or thedog femur. /icroscopy studies at the bone implant interface showed a goodosteoconductivity and osseointegration for HA=1. 0xperimental results were confirmed bythe good clinical results of the HA= 1 in treatment of the tibial plate fractures, plumbing of thebone defects after benign tumor resection or cyphosis treatment by anterior arthrodesis.HA=1 showed good results in revision osteosynthesis after hip prostesis and was alsocombined with antibiotics to treat osteitis with various locali'ations) humerus, femur, tibia.'he di"ad3antage" of the a$to/, allo/ and xenograft" $"ed in #one "$#"tit$tion fa3ori@ed the

de3elopment of "ynthetic #one "$#"tit$te". 2et=een the"e "$#"tit$te", the #i/ or tripha"ic

pho"phocalcic ceramic" play" themain role". 'he efficiency of the #one "$#"tit$te" characteri@ed #y

the #one material interaction " #o$nd to the main phy"ical propertie" and e"pecially to the material

macroporo"ity +B$% 2002.+5ig.(

5ig. ( Material macroporo"ity and radiologic re"$lt of the material application in the "pine

&or limited indications on small and medium bone defects, if there is a good contact of thereceptor bone and a stable mechanic assembly, the phosphocalcic based and macroporousbone substitut, with or without embedded antibiotic, represents a viable alternative to autoand allografts.#@ote< 2002$

1# &tual dire&tions

8n the pa"t year", the literat$re i" mentioning more and more the g$ided ti""$e regeneration

term. 'hi" treatment method =a" "$cce""f$lly $"ed in "tomatology, maxillofacial "$rgery and

experimental repair of the peripheral ner3e". 8t con"i"t" in #$ilding a phy"ical #arrier aro$nd

the di"ea"ed organ and to i"olate it from the "$rro$nding part", facilitating the healing proce"".

?"ing a t$#$lar mem#rane aro$nd a diaphy"eal #one defect ha" the follo=ing ad3antage"

+B--$%! 2006- 1. 4onfer" a "pace for #one regeneration, (. 2$ild a #ridge o3er the defect 6.

8mpede the loo"e ti""$e" to coloni@e the defect* 7. repre"ent a "caffold for perio"teal

regeneration, . create" an open "pace =ith an increa"ed den"ity of proo"teogenic factor" that

cannot diff$"e in the "$rro$nding ti""$e". ario$" mem#rane type" ha3e #een $"ed-

#iodegrada#le polylactic +B--$%! 2006 S!"&"$r& 2006, #iodegrada#le poly$rethanic +Ch!&



2006, expanded polytetrafl$oroethylenic +ore/'ex, non/#iodegrada#le. !ct$al re"earch i"

directed to=ard the prod$ction of macroporo$" pho"phocalcic cement" in order to increa"e the

o"teocond$cti3ity and #iodegrada#ility =itho$t altering the #iomechanical propertie".4# :bAe&ti=es (trends)Bone defects treatment remains a difficult problem and a challenge for the orthopedicsurgeon. /inor epiphyseal or diaphyseal defects, :efectele minore epifi'o-metafi'are saudiafi'are Li pOnJ la marile pierderi de substanPJ osoasJ, precum cele re'ultate din re'ecPiiletumorale, se QntOlnesc frecvent Qn practica medicalJ. /odalitJPile lor de re'olvare suntmultiple, variate Li relativ complicate. 8ama terapeuticJ se extinde de la clasica autogrefJcapabilJ numai de re'olvJri limitate , la alogrefe legate Li de existenPa unei costisitoare bJncide Pesut osos Li pOnJ la heterogrefe #xenogrefe$, cu dificultJPi de preparare, cu riscul unortransmisii virale sau septice precum Li cu pierderea specificitJPii antigenice. :eLi diferitelecercetJri Li experienPe LtiinPifice din acest domeniu abundJ, martorJ fiind Li bibliografiaconexJ, aceLti Qnlocuitori ai grefelor nu au intrat QncJ, larg, Qn practica curentJ. <cepticismul,parPial QndreptJPit, este Qn raport de tolerabilitatea lor, de posibilitatea de producere a unorrelaPii chimice cu Pesutul osos, de depunere de os sau chiar de a reali'a o osteoinducPie.:acJ pentru tratamentul defectelor osoase mici, situate Qn 'one neportante este suficientJutili'area numai a substituenPilor de os #ceramici sau cimenturi$, pentru tratamentul

defectelor osoase mari mai ales situate Qn 'one portante este necesarJ asocierea uneiosteosinte'e solide.

@iblio5ra*ie sele&ti=9

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Suport Curs – Masterat Substituenti Ososi