SammanfattningMål Litteraturstudien har som syfte att undersöka om diabetes anses kunna vara en kontraindikation för implantatbehandling, dels på kort och lång sikt. Alla typer av diabetes (typ 1 & typ 2) inkluderas i studien samt alla typer av implantat. Material och metod En sökning i databasen PubMed gjordes 18 April 2012 på bestämda MeSH termer. Sökningen resulterade i 186 artiklar. Artiklarna granskades på titel, abstract och fulltextnivå och dubbletter sorterades bort. Inklusionskriterierna / exklusionskriterierna var: språk engelska eller svenska, alla åldrar, tillgänglig abstract, kliniska studier samt humanstudier. Kvar blev 24 artiklar som ingick i studien. De inkluderade studierna sekundärgranskades enligt ett sekundärgranskningsprotokoll. Resultat Artiklarnas uppföljningstid varierade från 4 månader till 20år, varav de flesta artiklarna hade en uppföljningstid under 6år. Sexton artiklar kom fram till att diabetes inte är en kontraindikation för implantatbehandling, hos dessa varierade uppföljningstiden mellan 6 månader till 9år. Antal installerade implantat varierade mellan 23st till 6946st.Tre artiklar kom fram till att diabetes är en kontraindikation för implantatbehandling, hos dessa varierade uppföljningstiden mellan 4 månader och 20år. Antal installerade implantat varierade mellan 74st till 4680st. Resterande artiklar visade osäkert resultat och kom inte fram till om diabetes är en kontraindikation för implantatbehandling eller inte.Konklusion De flesta artiklarna hade en uppföljningstid som var kortare än fem år. Kriterier för vad som ansågs som ett lyckat implantat varierade. Slutsatsen var att de flesta artiklarna kom fram till att diabetes inte är en kontraindikation för implantatbehandling endast på kort sikt.

Metallic bone implant devices are commonly used to tackle a wide array of bone failures in human patients. The success of such implants relies on the biomechanical and functional bonding between the living bone tissue and implant, a process defined as osseointegration. However, the mechanism of osseointegration is still under debate in the scientific community. One efficient method to help understand this complex process is to characterize the interface between human bones and implant devices after the osseointegration has been established, while another approach is to visualize mineralization in real-time under simulated body conditions. Both of these approaches to understand mineralization have been explored in this thesis. Firstly, due to the inhomogeneous nature of bone and complex topography of implant surfaces, a suitable sample geometry for three-dimensional (3D) characterization was required to fully understand osseointegration. Electron tomography has been proven as an efficient technique to visualize the nanoscale topography of bone-implant interface in 3D. However, resulting from the thickness and shadowing effects of conventional transmission electron microscope (TEM) lamellae at high tilt angles and the limited tilt-range of TEM holders, “missing wedge” artifacts limit the resolution of final reconstructions. In Chapter 3, the exploration of a novel sample geometry to explore osseointegration is reported. Here, on-axis electron tomography based on a needle-shaped sample was applied to solve the problem of the “missing wedge”. This resulted in a near artifact-free 3D visualization of the structure of human bone and laser-modified titanium implant, showing bone growth into the nanotopographies of the implant surface and contributing to the evolution of the definition of osseointegration towards nano-osseointegration. One of the key issues regarding the mechanism of osseointegration that remains is that of the chemical structure at the implant interface, namely distribution of calcium-based and carbon-based components at the interface and their origins. Thus, the second objective of this thesis aimed to push characterization techniques further to four dimensions (4D), by incorporating chemical information as the fourth dimension after the spatial X,Y,Z coordinates. In Chapter 4, correlative 4D characterization techniques including electron energy-loss spectroscopy (EELS) tomography and atom probe tomography (APT) and other spectroscopy techniques were used to probe the nanoscale chemical structure of the bone-implant interface. This work uncovered a transitional biointerphase at the bone-implant interface, consisting of morphological and chemical differences compared to bone away from the interface. Also, a TiN layer between the surface oxide and bulk metal was identified in the laser-modified commercial dental implant. Both findings have implications for the immediate and long-term osseointegration. Since bone formation at the implant interface is a dynamic process, which includes calcium phosphates (CaP) biomineralization as a basis of these reactions, the third objective of this work focused on exploring real-time mineralization processes. Liquid-phase transmission electron microscopy (LP-TEM) is a promising technique to enable real-time imaging with nanoscale spatial resolution and sufficient temporal resolution. In Chapter 5, by using this technique, we present the first real-time imaging of CaP nucleation and growth, which is a direct evidence to demonstrate that CaP mineralization occurs by particle attachment. Overall, this thesis has applied state-of-the-art advanced microscopy techniques to enhance the knowledge and understanding of osseointegration mechanisms by investigating established biointerfaces and real-time mineralization. The developed correlative 4D tomography workflow is transferable to study other interfacial applications in materials science and biological systems, while the LP-TEM work forms a basis for further mineralization research. / Thesis / Doctor of Philosophy (PhD)

No description available.

Die Entwicklung und Erprobung von metallischen Implantatwerkstoffen mit biologischen Beschichtungen für den Einsatz im menschlichen Knochen verlangt, neben der Untersuchung grundlegender zellbiologischer Wechselwirkungen, eine ganzheitliche Betrachtung ihrer Wirkungsweise im lebenden Organismus. Die vorwiegend angewandte Methode zur Quantifizierung des Potentials von Biofunktionalisierungen metallischer Implantate ist dabei die histologische Auswertung. Diese stützt sich aber auf Informationen aus nur wenigen und eher zufälligen Schnittlagen im Probenvolumen, was mit einer hohen Anzahl an Tierexperimenten ausgeglichen wird. Mit der Mikrocomputertomographie steht neben der klassischen Histologie eine zerstörungsfreie Methode zur Verfügung, welche eine detaillierte dreidimensionale Darstellung des neugebildeten Knochengewebes ermöglicht. Die Abbildungsqualität des mineralischen Knochengewebes um Titanimplantate, als Grundlage für eine Vergleichbarkeit von Tomographie und Histologie, wurde anhand von drei Mikrofokus-Computertomographen und einem Synchrotron-Computertomographen am HASYLAB untersucht. Die tomographische Untersuchung von Hartgewebe einschließlich metallischer Implantate zeigte mit Hilfe von Synchrotronstrahlung die beste qualitative Übereinstimmung zur histologischen Bildgebung. Für die Quantifizierung der Knochenneubildung wurden interaktive Analysemodelle erarbeitet, welche eine vereinheitlichte Auswertung von histologischen und tomographischen Informationen erlaubt. Auf Grundlage der entwickelten Analyseprozeduren war es erstmals möglich, die statistische Belastbarkeit der Ergebnisse aus der histologischen und tomographischen Analyse zu untersuchen. Dabei konnte gezeigt werden, dass hinsichtlich der Herausstellung von Unterschieden bei der Osseointegration modifizierter Titanimplantate mit beiden Methoden ähnliche Ergebnistrends gefunden werden. Eine Signifikanz (p < 0,01) der Unterschiede bei der Knochenneubildung konnte jedoch ausschließlich mit der mikrotomographischen Analyse herausgestellt werden. Die Ergebnisse bei der Darstellung und Analyse des mineralischen Gewebes durch die Nutzung der Synchrotrontomographie gehen weit über die Grenzen der histologischen Untersuchungen hinaus. Durch den dreidimensionalen Charakter der Informationen ergeben sich dabei neue Bewertungsmodelle zur Beurteilung der Osseointegration von biofunktionalisierten Implantaten. Die mikrotomographische Analyse führt gegenüber der histologischen Auswertung durch die geringe Irrtumswahrscheinlichkeit der Ergebnisse bei deutlich verminderter Probenanzahl zu einer erheblichen Verringerung von Tierversuchen.

Die Entwicklung und Erprobung von metallischen Implantatwerkstoffen mit biologischen Beschichtungen für den Einsatz im menschlichen Knochen verlangt, neben der Untersuchung grundlegender zellbiologischer Wechselwirkungen, eine ganzheitliche Betrachtung ihrer Wirkungsweise im lebenden Organismus. Die vorwiegend angewandte Methode zur Quantifizierung des Potentials von Biofunktionalisierungen metallischer Implantate ist dabei die histologische Auswertung. Diese stützt sich aber auf Informationen aus nur wenigen und eher zufälligen Schnittlagen im Probenvolumen, was mit einer hohen Anzahl an Tierexperimenten ausgeglichen wird. Mit der Mikrocomputertomographie steht neben der klassischen Histologie eine zerstörungsfreie Methode zur Verfügung, welche eine detaillierte dreidimensionale Darstellung des neugebildeten Knochengewebes ermöglicht. Die Abbildungsqualität des mineralischen Knochengewebes um Titanimplantate, als Grundlage für eine Vergleichbarkeit von Tomographie und Histologie, wurde anhand von drei Mikrofokus-Computertomographen und einem Synchrotron-Computertomographen am HASYLAB untersucht. Die tomographische Untersuchung von Hartgewebe einschließlich metallischer Implantate zeigte mit Hilfe von Synchrotronstrahlung die beste qualitative Übereinstimmung zur histologischen Bildgebung. Für die Quantifizierung der Knochenneubildung wurden interaktive Analysemodelle erarbeitet, welche eine vereinheitlichte Auswertung von histologischen und tomographischen Informationen erlaubt. Auf Grundlage der entwickelten Analyseprozeduren war es erstmals möglich, die statistische Belastbarkeit der Ergebnisse aus der histologischen und tomographischen Analyse zu untersuchen. Dabei konnte gezeigt werden, dass hinsichtlich der Herausstellung von Unterschieden bei der Osseointegration modifizierter Titanimplantate mit beiden Methoden ähnliche Ergebnistrends gefunden werden. Eine Signifikanz (p < 0,01) der Unterschiede bei der Knochenneubildung konnte jedoch ausschließlich mit der mikrotomographischen Analyse herausgestellt werden. Die Ergebnisse bei der Darstellung und Analyse des mineralischen Gewebes durch die Nutzung der Synchrotrontomographie gehen weit über die Grenzen der histologischen Untersuchungen hinaus. Durch den dreidimensionalen Charakter der Informationen ergeben sich dabei neue Bewertungsmodelle zur Beurteilung der Osseointegration von biofunktionalisierten Implantaten. Die mikrotomographische Analyse führt gegenüber der histologischen Auswertung durch die geringe Irrtumswahrscheinlichkeit der Ergebnisse bei deutlich verminderter Probenanzahl zu einer erheblichen Verringerung von Tierversuchen.

Introdução: A mastoidectomia cavidade aberta é considerada por muitos autores o procedimento cirúrgico de escolha para o tratamento da otite média colesteatomatosa, devido à alta incidência de recidiva da doença. Porém, a formação desta cavidade única pode gerar algumas complicações e a obliteração da cavidade mastóidea é uma técnica descrita e estudada para a eliminação desta cavidade. Materiais aloplásticos têm sido estudados em cirurgias de obliteração da cavidade mastóidea, porém estes materiais podem apresentar problemas de biocompatibilidade e de rejeição O cimento de osso alfa -tricálcio-fosfato é um material composto por cálcio e fosfato e apresenta composição bioquímica semelhante à fase mineral do osso. Embora já utilizado em cirurgias há mais de 10 anos, não existem estudos sobre a sua aplicação nas cirurgias de obliteração de cavidade mastóidea na literatura. Objetivo: Estudar a biocompatibilidade do cimento de osso alfatricálcio- fosfato na obliteração da cavidade mastóidea em guinea pigs. Casuística e Métodos: Vinte Cavia porcellus (guinea pig) fêmeas foram submetidos a procedimento cirúrgico na bula timpânica esquerda. Em 10 cobaias (grupo cimento) a bula timpânica foi obliterada com o cimento de osso alfa-tricálcio-fosfato e em 10 cobaias (grupo controle) a cavidade foi deixada sem preenchimento. 60 dias após o procedimento os animais foram sacrificados e avaliados quanto à presença de sinais clínicos de rejeição ao material e outras complicações. Os ossos temporais foram removidos e submetidos à análise histopatológica. Foram avaliados o tipo e o grau de resposta inflamatória e o grau de ossificação. Resultados: A taxa de mortalidade foi igual em ambos os grupos. As mortes foram atribuídas a complicações anestésicas. Entre as cobaias que completaram o estudo não foram observados sinais de complicações em nenhum caso. Oito animais (100%) do grupo cimento em e cinco animais (62,5%) apresentaram resposta inflamatório graus I e II que correspondem histopatologicamente a alterações cicatriciais normais ao procedimento cirúrgico. Não foi observado presença de reação inflamatória crônica tipo corpo estranho em nenhuma amostra de ambos os grupos. Quanto ao grau de ossificação, a média dos escores de ossificação no grupo controle (3,5) foi maior que o observado no grupo cimento (1,0). O grupo controle (3,5 ± 5) apresentou grau de ossificação estatisticamente maior quando comparado com o grupo cimento (1,0 ± 0,0) (p < 0,01). Conclusões: 1) O cimento de osso alfa-tricálciofosfato é biocompatível em osso temporal de cobaia. 2) O cimento de osso alfa-tricálcio-fosfato sofre remodelação óssea, porém não apresenta propriedade de osteocondução / Introduction: Many authors consider open cavity mastoidectomy the surgical procedure of choice for the treatment of otitis media with cholesteatoma, due to the high incidence of recurrence of the disease. However, the formation of this open cavity can generate some complications and mastoid cavity obliteration is one type of technique for the elimination of this cavity. Alloplastic materials have been testes in mastoid cavity obliteration, however such materials can present problems of biocompatibility and rejection. Alphatricalcium phosphate bone cement is a material compose of calcium and phosphate and presents physicochemical characteristics similar to the bone mineral fase. Although it has been used for more than 10 years, there are no studies in the literature on its application in mastoid cavity obliteration. Objective: This study aimed to evaluate the biocompatibility of alphatricalcium phosphate bone cement in the obliteration of the mastoid cavity in guinea pigs. Methods: We studied 20 Cavia porcellus (guinea pig) submitted to surgical manipulation of the left dorsal tympanic bulla. In the study group animals (n = 10), mastoid cavity obliteration was conducted with alphatricalcium phosphate bone cement. In the control group animals (n = 10), the cavity was left unfilled. On postoperative day 60, the animals were sacrificed and studied for signs of rejection of the material and other complications. Temporal bones were removed for histopathological study, in which the type and degree of inflammatory response, as well as the degree of ossification, were analyzed. Results: The mortality rate was the same in both groups. Deaths were attributed to anesthetic complications in the initial postoperative period. In the animals that survived, there were no complications. The histological analysis of the degree and type of inflammatory response shown no signs of foreign body in both groups, 8 (100%) of the samples in cement group and 5 (62,5%) of the samples in control group presenting category I or II inflammatory responses that corresponds histopathologically to an inflammatory response that normally occurs in tissues submitted to surgical trauma. There were no histopathological signs of foreign body reaction in none samples of both groups. As for the study of the degree of ossification, the mean ossification in the control group (3.5) was greater than that shown by the cement group (1.0). The control group showed statistically significant (p < 0.01) higher degrees of ossification (mean 3.5 ± 0.5) when compared to the cement group (1.0 ± 0.0). Conclusion: 1) Alpha-tricalcium phosphate bone cement is biocompatible in the mastoid cavity of guinea pigs 2) Alphatricalcium fosfato bone cement undergoes bone remodeling but it doesn´t present osteoconductive properties

Na presença de fraturas, infecções ou tumores ósseos que ocasionem perda extensa de tecido ósseo, existe a necessidade da utilização de enxerto ósseo autólogo. Apesar deste método ser considerado o padrão-ouro, apresenta algumas desvantagens, como a morbidade da área doadora e limitação do volume a ser obtido. Alternativamente, são considerados como uma importante opção de tratamento, os implantes com biomateriais. Dentre eles, destacam-se as esponjas de colágeno, hidroxiapatita e proteína morfogenética óssea (BMP). A elastina atualmente esta sendo investigada como nova opção para substrato na regeneração tecidual. Assim, o objetivo deste projeto foi avaliar o processo de reparo de defeitos ósseos enxertados com estes biomateriais. Foram estudados 77 animais da seguinte forma: Grupo 1 (G1-C): ratos com defeito crítico induzido no osso femoral direito, sem preenchimento com implante (grupo controle). Grupo 2 (G2-E24/37): animais com defeito produzido no fêmur distal direito, preenchido com membrana de elastina 24h a 37ºC. Grupo 3 (G3-E24/37+HA): animais com defeito produzido no fêmur distal direito, preenchido com membrana de elastina 24h a 37ºC + hidroxiapatita. Grupo 4 (G4-E24/37+BMP): animais com defeito produzido no fêmur distal direito, preenchido com membrana de elastina 24h a 37ºC + BMP. Grupo 5 (G5-C24/25): animais com defeito produzido no fêmur distal direito, preenchido com membrana de colágeno da serosa de intestino porcino 24h a 25ºC. Grupo 6 (G6-C24/25+HA): animais com defeito produzido no fêmur distal direito, preenchido com membrana de colágeno da serosa de intestino porcino 24h a 25ºC + hidroxiapatita. Grupo 7 (G7-C24/25+BMP): animais com defeito produzido no fêmur distal direito, preenchido com membrana de colágeno da serosa de intestino porcino 24h a 25ºC + BMP. As análises demonstraram a biocompatibilidade das membranas devido a ausência de elementos celulares característicos de processo inflamatório. A membrana de elastina isolada ou associada a hidroxiapatita não apresentou resultados superiores ao grupo controle, apenas quando associada à BMP, o resultado foi superior ao controle. A membrana de colágeno isolada ou associada à BMP ou hidroxiapatita apresentaram resultados superiores ao controle. Os biomateriais estudados apresentaram capacidade osteogênica e houve osteointegração na falha óssea induzida experimentalmente. / Bone lesions as fractures, infections or bone tumors can cause extensive bone loss. In this scenario, the use of any type of bone augments is advocated. Although autollogus bone graft is considered the gold standard, some disadvantages are related with this method such as donor area morbidity and limited availability of graft material. Alternatively, implants with biomaterials are considered an important option. Among them, the sponges of collagen, hydroxyapatite and BMP show outstanding results. Elastin is currently being investigated as a new substrate option in tissue regeneration. Thus, the objective of this project was to evaluate the repair process of bone defects grafted with these biomaterials. A total of 77 animals were studied as follows: Group 1 (G1-C): rats with critical defect induced in the right femoral bone, without implant filling (control group). Group 2 (G2-E24/37): animals with defect produced in the right distal femur, filled with elastin membrane. Group 3 (G3-E24/37 + HA): animals with defect produced in the right distal femur, filled with elastin membrane plus hydroxyapatite. Group 4 (G4-E24/37 + BMP): animals with defect produced in the right distal femur, filled with elastin membrane plus BMP. Group 5 (G5-C24/25): animals with defect produced in the right distal femur, filled with porcine intestinal serosa collagen membrane. Group 6 (G6-C24/25 + HA): animals with defect produced in the right distal femur, filled with porcine intestine serous collagen membrane plus hydroxyapatite. Group 7 G7-C24/25 + BMP: animals with defect produced in the right distal femur, filled with porcine intestinal serosa collagen membrane plus BMP. The analyzes demonstrated the biocompatibility of the membranes due to the absence of cellular elements characteristic of inflammatory process. The elastin membrane isolated or associated with hydroxyapatite did not present superior results to the control group. The result was superior to the control only when elastin was associated with BMP. The collagen membrane isolated or associated with BMP or hydroxyapatite presented superior results to control. The studied biomaterials presented osteogenic capacity and osseointegration in experimentally induced bone failure.

Diversas aplicações do plasma de argônio tem sido encontradas na literatura. Na odontologia, suas aplicações se referem a capacidade de limpeza de componentes e aumento da energia de superfície. Os tratamentos para melhorar a energia de superfície são estudados com objetivo de criar um ambiente mais favorável para a adesão celular. Este estudo teve como objetivo avaliar histologicamente as mudanças nos tecidos moles e duros após a inserção de implantes e pilares de titânio limpos e ativados com plasma de argônio. Foram instalados 64 implantes e pilares em 8 cães Beagle, sendo randomizados em dois grupos: tratados com plasma de argônio ou não tratados. Dois tempos experimentais foram realizados: 4 e 8 semanas. Após esse período, os animais foram sacrificados, as mandíbulas foram divididas em blocos individuais e processados para confecção de lâminas para análise histológica. Na análise dos pilares, não houve diferença estatística entre os grupos, apesar de maiores níveis de osso marginal nos locais de teste em comparação com os locais de controle. Em relação aos implantes de titânio, as diferenças entre teste e controle, principalmente no período de 8 semanas, podem sugerir que o uso de plasma de argônio poderia melhorar a integração dos tecidos periimplantares à superficie dos implantes. / Several applications of argon plasma have been found in the literature. In dentistry, its applications refer to the ability to clean components and increase surface energy. Treatments for enhancing surface energy were studied in an effort to create a more favorable environment for cell adhesion. This study aimed to histologically evaluate changes in soft and hard tissues after insertion of implants and titanium abutments cleaned and activated with argon plasma. 64 implants and abutments were installed in 8 Beagle dogs, and were randomized into two groups: treated with argon plasma or untreated. Two experimental times were performed: 4 and 8 weeks. After this period, the animals were sacrificed, the jaws were divided into individual blocks and processed for histological analysis. In the analysis of abutments, there was no statistical difference between groups, despite higher levels of marginal bone in test sites compared to the control sites. Regarding titanium implants, the differences between test and control, especially in the 8-week period, may suggest that the use of argon plasma could improve the integration of peri-implant tissues to the implant surface.

The trend for designing of a titanium implant explored using different chemical compositions and crystallinity materials until people realized that the implant surface character was another important factor affecting the rate and extent of osseointegartion. Titanium received a macroporous titania surface layer by anodization, which contains open pores with average pore diameter around 5μm. An additional mesoporous titania top layer was created that followed the contour of the macropores and having 100–200 nm thickness and a pore diameter of 10 nm. Thus, a coherent laminar titania surface layer was obtained producing a hierarchical macro- and mesoporous surface. The interfacial bonding between the surface layers and the titanium matrix was characterized by a scratch test that confirmed a stable and strong bonding of the laminar titania surface layers upon titanium. The wettability to water and the effects on the osteosarcoma cell line (SaOS-2) proliferation and mineralization of the formed titania surface layers were studied systematically by cell culture and scanning electron microscopy (SEM). A synergistic role of the hierarchical macro- and mesoporosities was revealed in terms of enhancing cell adhesion, proliferation and mineralization, when compared with the titania surface with solo porosity scale topography. For the in vivo results of the evaluation of osseointegration, an argon ion beam polishing technique was applied to prepare the cross sections of implants feasible for the high resolution SEM investigation. The interfacial microstructure between newly formed bone and implants with four modified surfaces including the new hierarchical macro- and mesoporous implant surface retrieved after in vivo tests were characterized. By this approach it has become possible to directly observe early bone formation, the increase of bone density, and the evolution of bone structure. The two bone growth mechanisms, distant osteogenesis and contact osteogenesis, can also be distinguished. These direct observations give, at microscopic level, a better view of osseointegration and explain the functional mechanisms of various implant surfaces for osseointegration. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 3: In press. Paper 4: Manuscript.</p>

Το ερευνητικό πεδίο της παρούσας διδακτορικής διατριβής ήταν η οστεοενσωμάτωση οστικών εμφυτευμάτων. Οι βασικοί στόχοι της έρευνας αφορούσαν την κατανόηση του ρόλου τριών βασικών ρυθμιστικών παραγόντων της διαδικασίας οστεοενσωμάτωσης, δηλαδή της μηχανικής φόρτισης, της επιφανειακής τοπογραφίας και της επιφανειακής (βιο)χημείας, καθώς και τη μελέτη του βασικότερου λόγου αστοχίας των ορθοπεδικών εμφυτευμάτων, της παραγωγής μικροσωματιδίων προϊόντων φθοράς τους. / -