Modification of PMMA Cements for Cranioplasty with Bioactive Glass and Copper Doped Tricalcium Phosphate Particles.

Teresa Russo,Roberto De Santis,Katia Barbaro,Annalisa Altigeri,Inna Fadeeva,Antonio Gloria,Julietta Rau

doi:10.3390/polym12010037

Abstract

Cranioplasty represents the surgical repair of bone defects or deformities in the cranium arising from traumatic skull bone fracture, cranial bone deformities, bone cancer, and infections. The actual gold standard in surgery procedures for cranioplasty involves the use of biocompatible materials, and repair or regeneration of large cranial defects is particularly challenging from both a functional and aesthetic point of view. PMMA-based bone cement are the most widely biomaterials adopted in the field, with at least four different surgical approaches. Modifications for improving biological and mechanical functions of PMMA-based bone cement have been suggested. To this aim, the inclusion of antibiotics to prevent infection has been shown to provide a reduction of mechanical properties in bending. Therefore, the development of novel antibacterial active agents to overcome issues related to mechanical properties and bacterial resistance to antibiotics is still encouraged. In this context, mechanical, biological, and antibacterial feature against P. aeruginosa and S. aureus bacterial strains of surgical PMMA cement modified with BG and recently developed Cu-TCP bioactive particles have been highlighted.

Highlights

Cranioplasty is a common technique for repairing bone defects in the cranium arising from cranial bone deformities, traumatic skull bone fracture, bone cancer, and infections
We investigated mechanical, biological, and antibacterial features of surgical PMMA cement modified with Bioactive glass (BG) and recently developed Cu-TCP
PMMA and PMMA-based composites have shown a mechanical behaviour in bending typical of brittle materials: The stress linearly increases as the strain is increased, and a brittle fracture occurs at strain values of about 3% (Figure 1a)

Summary

Introduction

Cranioplasty is a common technique for repairing bone defects in the cranium arising from cranial bone deformities, traumatic skull bone fracture, bone cancer, and infections. As PMMA for cranioplasty purposes is conceived, at least four surgical approaches can be distinguished: The first and simplest one is the in situ application and polymerization of PMMA, consisting of a single step procedure applied intra-operatively [7,8,9]; the second ex vivo approach uses a plaster impression taken over the cranial defect for realizing a mould into which the PMMA. For the in situ forming approach, PMMA is provided to surgeons in the form of a liquid monomer component in conjunction with a solid powder phase made of PMMA and/or copolymers. After mixing the liquid and powder phases, the reactive malleable paste is placed onto the skull defect and it is shaped for achieving a smooth prosthesis conforming to the normal contours of the patient’s skull [8,18]. The use of cold saline solution irrigation or of a damp gauze in saline solution placed between the setting acrylic resin and dura tissue are suggested for reducing temperature levels due to the heat developed during polymerization [11,21]

Methods

Results

Discussion

Conclusion