Thesis (M.S.)--University of Louisville, 1998. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.S.)--University of Louisville, 1998. / Includes bibliographical references.

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No description available.

A osteoporose é uma doença sistêmica caracterizada pela perda de conteúdo mineral do osso propiciando fraturas críticas. A regeneração óssea guiada e a terapia de fotobiomodulação (PBMT do inglês photobiomodulation therapy) favorecem a regeneração óssea. O objetivo do estudo foi avaliar o efeito da PBMT no reparação óssea guiada de lesões críticas de 36 ratas com osteoporose induzida por ooforectomia. Foram realizadas lesões ósseas estandardizadas nos ossos parietais e então tratadas de acordo com os seguintes grupos experimentais (n=12 lesões por grupo): Controle: sem tratamento adicional; Membrana - Colocação de uma membrana de colágeno suíno comercial (Bio-Gide®) dentro do leito cirúrgico; PBMT1- membrana e aplicação da PBMT1; PBMT2- membrana e aplicação da PBMT2. A PBMT foi realizada com laser de diodo infravermelho no modo contínuo, pontual e em contato (808nm, 40mW, 1,42W/cm2; PBMT1: 3s, 4J/cm2, 0,12J por ponto e PBMT2: 10s, 14J/cm2, 0,4J por ponto) imediatamente, 48 e 96 horas após a cirurgia. Quatro e oito semanas após a cirurgia os animais foram eutanasiados, a calota craniana dissecada, fixada e submetida à análise por microtomografia computadorizada. Foram coletados os seguintes dados: volume ósseo relativo (razão entre o volume ósseo e o volume total), número, espessura e separação de trabéculas, conectividade por densidade e índice de estrutura de modelo (SMI do inglês structure model index). Os dados de cada análise foram comparados pelo teste ANOVA dois critérios/Tukey ou Kruskal Wallis/Dunn e os dados de análises diferentes pelo teste de correlação de Spearman (p<0,05). Diferenças significativas foram observadas em 8 semanas. A PBMT, em especial nos parâmetros de menor energia (0,12J), acelerou o reparo ósseo resultando na obtenção de maior volume ósseo, com grande número de trabéculas, de espessura média, próximas e interconectadas e com valores baixos de SMI. Dentro das limitações deste trabalho in vivo, concluímos que a PBMT acelera a formação e maturação do tecido ósseo neoformado em lesões ósseas críticas de ratas osteoporóticas. / Osteoporosis is a systemic disease characterized by loss of bone mineral content leading to critical fractures. Guided bone regeneration and photobiomodulation therapy (PBMT) favor bone regeneration. The objective of the study was to evaluate the effect of PBMT on the guided bone repair of critical lesions of 36 rats with osteoporosis induced by oophorectomy. Standardized bone lesions were performed on the parietal bones and then treated according to the following experimental groups (n = 12 lesions per group): Control: no additional treatment; Membrane - Placement of a commercial swine collagen membrane (Bio-Gide®) within the surgical bed; PBMT1 membrane and PBMT1 application; PBMT2-membrane and PBMT2 application. PBMT was performed with continuous wave infrared diode lasers in punctual and contact mode (808nm, 40mW, 1.42W / cm2, PBMT1: 3s, 4J / cm2, 0,12J per ponit and PBMT2: 10s, 14J / cm2, 0.4J per point) immediately, 48 and 96 hours after surgery. Four and eight weeks after surgery, the animals were euthanized, the skulls dissected, fixed and submitted to the analysis by computerized microtomography. The following data were collected: bone volume, relative bone volume (ratio of bone volume to total volume), number, thickness and separation of trabeculae, density connectivity and model structure index (SMI). The data from each analysis were compared using the ANOVA two criteria / Tukey or Kruskal Wallis / Dunn test and the different analysis data by the Spearman correlation test (p <0.05). Significant differences were observed at 8 weeks. PBMT, especially in the lower energy parameters (0.12J), accelerated bone repair resulting in higher bone volume, with a large number of trabeculae, medium thickness, close to each other and interconnected, and with low SMI values. Within the limitations of this in vivo study, we concluded that PBMT accelerates the formation and maturation of neoformed bone tissue in critical bone lesions of osteoporotic rats.

Introdução: A doença periimplantar caracteriza-se pela perda óssea progressiva em implantes dentais osseointegrados. Sua origem é bacteriana, e acomete cerca de 20% da população com reabilitações implantossuportadas. O sucesso do tratamento parece depender da desinfecção da superfície dos implantes para resolução da inflamação, e da configuração dos defeitos ósseos para a regeneração dos tecidos. Até o momento, não há protocolos bem estabelecidos para a desinfecção da superfície de implantes osseointegrados. O objetivo deste estudo foi comparar dois métodos de desinfecção da superfície de implantes, e o efeito do uso da regeneração óssea guiada no tratamento da periimplantite induzida em cães. Materiais e Método: Oito cães beagle receberam 8 implantes cada. Após 8 semanas, ligaduras de seda foram posicionadas, e removidas após mais 8 semanas. O tratamento foi realizado após 10 semanas, por meio de desinfecção com a terapia fotodinâmica antimicrobiana ou aplicação tópica tetraciclina 50mg/ml, com ou sem procedimentos de regeneração óssea guiada associados. Durante o tratamento foram coletadas amostras microbiológicas por meio de um swab com microbrush estéril antes do tratamento, e imediatamente após o tratamento. A eutanásia ocorreu 12 semanas após o tratamento para processamento histológico. Os desfechos de tratamento analisados foram: ganho ósseo linear (mm), ganho ósseo (%), reosseointegração (%), redução bacteriana total e proporcional após o tratamento (%). Resultados: Os resultados gerais não demonstraram diferenças significantes entre os grupos quando comparados os métodos de desinfecção, e o uso ou não de procedimentos regenerativos. O uso da regeneração óssea guiada não resultou em melhoras no ganho ósseo, e sítios vestibulares apresentaram piores resultados regenerativos. A exposição precoce ao meio bucal afetou negativamente os resultados do tratamento, independente do grupo. Conclusão: Ambas terapias antiinfecciosas, associadas ou não a procedimentos regenerativos, obtiveram sucesso na resolução da inflamação e desinfecção da superfície dos implantes, com ganho ósseo parcial, sem o uso de antibioticoterapia sistêmica. / Objectives: This study used a dog model to evaluate two anti-infective treatment protocols for the treatment of periimplantitis with or without the use of guided bone regeneration (GBR). Material and Methods: Eight beagle dogs received eight implants each. After 8 weeks, silk ligatures were installed and then removed after 8 weeks, and after the end of 10 weeks the lesions were treated either with antimicrobial photodynamic therapy (aPDT) or topical tetracycline hydrochloride 50mg/ml with and without guided bone regeneration. Microbiological samples were collected with sterile microbrush before, and immediately after treatment. The animals were euthanized 12 weeks after treatment and submitted to histological processing. The outcomes evaluated included: linear bone gain (mm), bone gain (%), re-osseointegration (%), bacteria total counts before and after each treatment, and proportions of microorganisms. The effects of the implant site, early exposure and type of anti-infective treatment on bone regeneration were evaluated. Results: Both treatment presented success on decontamination of implant surface, with no difference between them. The overall results failed to detect significant differences between the anti-infective treatments and the adjunctive use of guided bone regeneration failed provide better re-osseointegration or bone gain in either of the anti-infective treatments. Buccal sites and implant early exposure negatively affect bone regeneration. Conclusion: Both antiinfective therapies successfully decontaminated implant surface. Stand-alone or combined with guided bone regeneration allowed similar and partial bone gain, without the use of systemic antibiotics.

Introdução: A doença periimplantar caracteriza-se pela perda óssea progressiva em implantes dentais osseointegrados. Sua origem é bacteriana, e acomete cerca de 20% da população com reabilitações implantossuportadas. O sucesso do tratamento parece depender da desinfecção da superfície dos implantes para resolução da inflamação, e da configuração dos defeitos ósseos para a regeneração dos tecidos. Até o momento, não há protocolos bem estabelecidos para a desinfecção da superfície de implantes osseointegrados. O objetivo deste estudo foi comparar dois métodos de desinfecção da superfície de implantes, e o efeito do uso da regeneração óssea guiada no tratamento da periimplantite induzida em cães. Materiais e Método: Oito cães beagle receberam 8 implantes cada. Após 8 semanas, ligaduras de seda foram posicionadas, e removidas após mais 8 semanas. O tratamento foi realizado após 10 semanas, por meio de desinfecção com a terapia fotodinâmica antimicrobiana ou aplicação tópica tetraciclina 50mg/ml, com ou sem procedimentos de regeneração óssea guiada associados. Durante o tratamento foram coletadas amostras microbiológicas por meio de um swab com microbrush estéril antes do tratamento, e imediatamente após o tratamento. A eutanásia ocorreu 12 semanas após o tratamento para processamento histológico. Os desfechos de tratamento analisados foram: ganho ósseo linear (mm), ganho ósseo (%), reosseointegração (%), redução bacteriana total e proporcional após o tratamento (%). Resultados: Os resultados gerais não demonstraram diferenças significantes entre os grupos quando comparados os métodos de desinfecção, e o uso ou não de procedimentos regenerativos. O uso da regeneração óssea guiada não resultou em melhoras no ganho ósseo, e sítios vestibulares apresentaram piores resultados regenerativos. A exposição precoce ao meio bucal afetou negativamente os resultados do tratamento, independente do grupo. Conclusão: Ambas terapias antiinfecciosas, associadas ou não a procedimentos regenerativos, obtiveram sucesso na resolução da inflamação e desinfecção da superfície dos implantes, com ganho ósseo parcial, sem o uso de antibioticoterapia sistêmica. / Objectives: This study used a dog model to evaluate two anti-infective treatment protocols for the treatment of periimplantitis with or without the use of guided bone regeneration (GBR). Material and Methods: Eight beagle dogs received eight implants each. After 8 weeks, silk ligatures were installed and then removed after 8 weeks, and after the end of 10 weeks the lesions were treated either with antimicrobial photodynamic therapy (aPDT) or topical tetracycline hydrochloride 50mg/ml with and without guided bone regeneration. Microbiological samples were collected with sterile microbrush before, and immediately after treatment. The animals were euthanized 12 weeks after treatment and submitted to histological processing. The outcomes evaluated included: linear bone gain (mm), bone gain (%), re-osseointegration (%), bacteria total counts before and after each treatment, and proportions of microorganisms. The effects of the implant site, early exposure and type of anti-infective treatment on bone regeneration were evaluated. Results: Both treatment presented success on decontamination of implant surface, with no difference between them. The overall results failed to detect significant differences between the anti-infective treatments and the adjunctive use of guided bone regeneration failed provide better re-osseointegration or bone gain in either of the anti-infective treatments. Buccal sites and implant early exposure negatively affect bone regeneration. Conclusion: Both antiinfective therapies successfully decontaminated implant surface. Stand-alone or combined with guided bone regeneration allowed similar and partial bone gain, without the use of systemic antibiotics.

Orientador: Leila Aparecida Chiavacci / Coorientador: Bruno Leonardo Caetano / Banca: Ana Maria Minarelli Gaspar / Banca: Giancarlo Esposito de Souza Brito / Resumo: Dentre as membranas utilizadas para regeneração óssea guiada as membranas reabsorvíveis se destacam por não necessitarem do segundo ato cirúrgico, fato esse que pode ocasionar lesões no tecido estabelecido além do incomodo que o segundo ato cirúrgico em si proporciona ao paciente. Entretanto, não existe no mercado uma membrana considerada adequada. O objetivo deste trabalho foi desenvolver uma membrana a partir de materiais híbridos ureasil-poliéter para regeneração óssea guiada, capaz de isolar o enxerto ósseo e simultaneamente liberar de forma controlada fármacos ou proteínas, resultando assim em uma membrana capaz de melhorar a resposta fisiológica do tecido ósseo diminuindo o tempo de neoformação óssea. Os materiais utilizados foram sintetizados a partir do método sol-gel utilizando os polímeros Poli Oxido de Etileno (POE) e Poli Oxido de Propileno (POP) de diferentes massas moleculares (400, 1900, 2000 g mol-1). O fármaco utilizado como modelo foi o Acetato de Dexametasona. Os resultados de intumescimento na presença de saliva artificial revelaram que com o aumento na proporção de ureasil-POP2000 e ureasil-POE1900 na mistura ocorre um aumento no ganho de massa, contudo esse aumento é mais expressivo para as misturas com ureasil-POE1900. A evolução das curvas de SAXS durante os experimentos de liberação com saliva artificial revela que a mistura formada por ureasil-POP400/POE1900 leva ao deslocamento do pico de correlação para baixos valores de q e ao aumento na intensidade do pico, por outro lado devido à razão hidrofóbica na mistura ureasil-POP400/POP2000 esse deslocamento para baixos valores de q é invariável. O teste de liberação revelou que é possível controlar a velocidade de liberação do fármaco a partir da variação das misturas ureasil-POP400/POP2000 e ureasil-POP400/POE1900. Resultados da análise... / Abstract: Among the membranes used for guided bone regeneration the resorbable membranes stand out for do not need the second surgery, a fact that can cause tissue damage beyond uncomfortable that the second surgery itself provides the patient.However, there is no on the market a membrane considered appropriate. The objective of this study was to develop a membrane from hybrid materials ureasil polyether for guided bone regeneration, able to isolate the bone graft and simultaneously drug release controlled or protein, resulting in a membrane capable of improving the physiological response of the tissue bone decreasing the bone formation. The materials used were synthesized from solgel method using polymers poly ethylene oxide (POE) and poly propylene oxide (POP) of different molecular weights (400, 1900, 2000 g mol-1).The drug used as model was dexamethasone acetate. The results of swelling in the presence of artificial saliva showed that with the increase in the proportion of ureasilPOP2000 and ureasil POE1900 in the mixture occurred an increasing mass, but this increase is more significant for mixture with the ureasil-POE1900.The evolution of SAXS curves during the release experiment with artificial saliva reveals that the mixture formed by ureasil-POP400/POE1900 leads to displacement of the correlation peak for low values of q and the increase in the intensity of the peak but the reason hydrophobic in the mix ureasilPOP400/POP2000 this displacement for low values of q is invariable. The release test showed that it is possible to control the release rate of the drug from the variation of the mixtures and ureasil-POP400/POP2000 ureasilPOP400/POE1900. Results of the microtomography showed that bone defects containing the ureasil-polyether membranes tested showed bone growth statistically similar to bone defects containing commercial collagen membrane (Bio-Gide, Geistlich Pharma). / Mestre

Bone defects caused by trauma, tumor resection or disease present a significant clinical problem. Failures in 'high risk' fractures and large bone defects have been reported to be as high as 30-50%. The drawbacks associated with current bone grafting procedures have stimulated the search for improved techniques for bone repair. Tissue engineering/regenerative medicine approaches promote tissue repair by providing a combination of physical and biological cues through structural scaffolds and bioactive agents. Though they have demonstrated significant promise for bone regeneration, very little has been translated to clinical practice. The goal of this thesis was to investigate the potential of electrospun nanofiber mesh scaffolds for bone regeneration. Nanofiber meshes were utilized in a three-pronged approach. First, we validated their ability to robustly support osteogenic cell functions, including proliferation and matrix mineralization. We also demonstrated their efficacy as a cell delivery vehicle. Second, we investigated the effects of modulating nanofiber bioactivity and orientation on stem cell programming. Our results indicate that functionalization of nanofiber meshes with a collagen-mimetic peptide enhanced the migration, proliferation and osteogenic differentiation of cells. Fiber alignment improved cell migration along the direction of fiber orientation. Finally, a nanofiber mesh based hybrid system for growth factor delivery was developed for bone repair and tested in a challenging animal model. The delivery of bone morphogenetic protein (BMP) via this system resulted in the functional restoration of limb function, and in fact proved more efficacious than the current clinical standard for BMP delivery. The studies performed in this thesis have suggested novel techniques for improving the repair of clinically challenging bone defects. They indicate that the delivery of BMP via the hybrid system may reduce the dose and side effects of BMP, thereby broadening the use of BMP based bone augmentation procedures. Therefore, this nanofiber mesh based system has the potential to become the standard of care for clinically challenging bone defects, including large bone defects, open tibial fractures, and nonunions.

Modifications of biomaterial surface properties are employed to increase osteoblast differentiation and bone formation. Microtextured metallic surfaces promote osteoblast differentiation and high surface energy- achieved by controlling surface hydrocarbon contamination- increases osteoblast differentiation and peri-implant bone formation. Recombinant human bone morphogenic protein 2 (BMP2) is approved to induce bone formation in a number of applications. It is used clinically in combination with biomaterials to improve peri-implant bone formation and osseointegration. The amount of BMP2 that is required is large and inflammatory (swelling/seroma) and bone-related (ectopic bone/bone resorption) complications have been reported after BMP2 treatment. The aim of this study was to examine potential deleterious effects of BMP2 on the inflammatory environment and apoptosis of osteoblasts. Surface roughness and energy decreased pro-inflammatory interleukins and increased anti-inflammatory interleukins. In contrast, BMP2 abolished the surface effect, increasing pro-inflammatory interleukin (IL) 6, IL8, and IL17 in a surface roughness-dependent fashion and decreasing anti-inflammatory IL10 on rough surfaces. 5Z-7-Oxozeaenol and Dorsomorphin, but not H-8, blocked the effect of BMP2 on IL1A expression. There was an increase in expression of IL6 when treated with BMP2 for the control and H-8 groups, but both 5Z-7-Oxozeaenol and Dorsomorphin blocked the effect. Both 5Z-7-Oxozeaenol and H-8 blocked the effect of BMP2 on IL10 expression. BMP2 treatment had little effect on apoptosis in human mesenchymal stem cells (MSCs). Exogenous BMP2 had no effect on TUNEL. Caspase-3 activity was increased only at 200ng/ml BMP2. BAX/BCL2 decreased in MSCs treated with 50 and 100ng/ml BMP2. In contrast, BMP2 increased caspase-3 activity and TUNEL at all doses in normal human osteoblasts (NHOst). BAX/BCL2 increased in NHOst treated with BMP2 in a dose-dependent manner. Cells treated with 200 ng/ml BMP2 had an 8-fold increase in BAX/BCL2 expression in comparison with untreated cells. Similarly, BMP2 increased DNA fragmentation in NHOst cells. The BMP2-induced increase in DNA fragmentation was eliminated by 5-Z7-Oxozeaenol and Dorsomorphin. The results suggest that while surface features modulate an initial controlled inflammatory response, the addition of BMP2 induces a pro-inflammatory response. The effect of BMP2 on apoptosis depends on cell maturation state, inducing apoptosis in committed osteoblasts. BMP2 together with microtextured orthopaedic and dental implants may increase inflammation and possibly delay bone formation. Dose, location, and delivery strategies are important considerations in BMP2 as a therapeutic and must be optimized to minimize complications.