Glass Polyalkenoate Cements Research Articles

Evaluating the physico-chemical properties of water-based and 2% lidocaine hydrochloride-based aluminum-free glass polyalkenoate cements for distal radius fixation.

Lidocaine hydrochloride is used as an anesthetic for clinical applications. This study considers the effects of the substitution of 2% lidocaine hydrochloride for deionized (DI) water on the rheological, mechanical, ion release, pH and injectable properties of two formulations of aluminum-free glass polyalkenoate cements (GPCs) using two distinct poly(acrylic) acids (PAA), E9 and E11, which have different molecular weights (Mw). The substitution of 2% lidocaine hydrochloride demonstrated increased injectability, but did not affect mechanical properties. The mechanical properties increased with time, as expected, and, in general, E9-based GPCs displayed significantly higher strengths over E11-based GPCs. With respect to ion release, which includes calcium (Ca), strontium (Sr), zinc (Zn) and silicon (Si); all ions displayed a steady and consistent increased release over time. Ca and Sr showed similar ion release patterns, whereby the GPC made with E11 PAA and lidocaine hydrochloride released significantly more ions than all other compositions likely due to similar chemical kinetics. However, Zn is also divalent in nature, but displayed only one significant difference across the GPC series at all time points, which was attributed to its higher electronegativity allowing for increased participation in the setting reaction. Finally, an analysis of the pH confirmed an increase in pH with time, suggesting that H+ ions were attacking the glass structure to allow for ion release. After 1 and 7 days, water-based GPCs environments achieved a higher pH than lidocaine hydrochloride-based GPCs, indicating that the lidocaine hydrochloride may be releasing additional protons upon bond formation with PAA.

In vitro assessment of a gallium-doped glass polyalkenoate cement: chemotherapeutic potential, cytotoxicity and osteogenic effects

Metastatic bone lesions are often osteolytic, which causes advanced-stage cancer sufferers to experience severe pain and an increased risk of developing a pathological fracture. Gallium (Ga) ion possesses antineoplastic and anti-bone resorption properties, suggesting the potential for its local administration to impede the growth of metastatic bone lesions. This study investigated the chemotherapeutic potential, cytotoxicity, and osteogenic effects of a Ga-doped glass polyalkenoate cement (GPC) (C-TA2) compared to its non-gallium (C-TA0) counterpart. Ion release profiles revealed a biphasic pattern characterized by an initial burst followed by a gradually declining release of ions. C-TA2 continued to release Ga steadily throughout the experimentation period (7 d) and exhibited prolonged zinc (Zn) release compared to C-TA0. Interestingly, the Zn release from both GPCs appeared to cause a chemotherapeutic effect against H1092 lung cancer cells in vitro, with the prolonged Zn release from C-TA2 extending this effect. Unfortunately, both GPCs enhanced the viability of HCC2218 breast cancer cells, suggesting that the chemotherapeutic effects of Zn could be tied to cellular differences in preferred Zn concentrations. The utilization of SAOS-2 and MC3T3 cell lines as bone cell models yielded conflicting results, with the substantial decline in MC3T3 viability closely associated with silicon (Si) release, indicating cellular variations in Si toxicity. Despite this ambiguity, both GPCs exhibited harmful effects on the osteogenesis of primary rat osteoblasts, raising concerns about excessive burst Zn release. While Ga/Zn-doped GPCs hold promise for treating metastatic bone lesions caused by lung cancers, further optimization is required to mitigate cytotoxicity on healthy bone.

Ytterbium (III) Fluoride in Dental Materials

(1) Background: The compound ytterbium trifluoride is used as a component of several dental materials, and this is reviewed in the current article. (2) Methods: Published articles on this substance were identified initially from PubMed, and then from Science Direct and Google Scholar. The publications identified in this way showed that ytterbium trifluoride has been included in a variety of dental restorative materials, including composite resins, glass polyalkenoate cements, and calcium trisilicate cements. (3) Results: Ytterbium trifluoride is reported to be insoluble in water. Despite this, its presence is associated with fluoride release from dental materials. There is evidence that it reacts with the components of calcium trisilicate cements to form small amounts of a variety of compounds, including ytterbium oxide, Yb2O3, and calcium–ytterbium fluoride, CaYbF5. In nanoparticulate form, it has been shown to reinforce glass polyalkenoates and it also provides high contrast in X-ray images. (4) Conclusions: Ytterbium trifluoride is a useful component of dental materials, though some of the published findings suggest that there are aspects of its chemistry which are poorly understood.

Effect of liquid environment on adhesion strength of bioactive glass-based adhesives to bone

Glass Polyalkenoate Cements (GPCs) are composed of ionomeric glass having setting reaction with aqueous poly(acrylic) acid (PAA). The mechanical properties of GPCs are normally affected by various factors such as the concentration of the acid solution, the molar mass of the polyacid, and the powder:liquid ratio. A previous study using fracture testing of double cantilever beam specimens made with a GPC (GPC A) adhered to bovine bone showed that the mode I energy release rate decreased significantly when the specimens were prepared in a flooded liquid environment, simulating a worst-case surgical sternal closure application. The present study used pull-out and butt strength tests to determine the extent to which the adhesion to bovine bone could be improved in wet environments by using a more viscous adhesive (GPC B). The pull-out samples were prepared in both dry and flooded liquid environments and incubated in both humid and flooded liquid environments at 37 °C for two time periods: one and seven days. Overall, the pull-out strength of GPC B was found to be between 56% and 808% higher than GPC A, indicating that the more viscous formulation could mitigate the effects of the wet environment. The GPC B samples prepared and incubated in a flooded liquid environment (L-LI) had a significantly lower pull-out strength than all three other conditions: (1) when prepared in a dry environment and incubated in either a liquid (D-LI) or (2) humid environment (D-H), and (3) when prepared in a liquid environment and incubated in a humid one (L-H), which were all of similar strength. No significant difference in pull-out strength between the samples tested after 1 and 7 days of incubation was found indicating that robust adhesion strength was obtained rapidly. To further assess the adhesive strength for augmenting sternal closure, GPC B and bovine bone were used to create butt joints which were tested at strain rates typical of breathing and coughing. The tests revealed that GPC B's viscoelastic properties resulted in a higher butt joint strength for coughing loads compared to breathing. Overall, the results of the present study show that when the adhesives are expected to be subjected to a flooded liquid environment while they set, significant gains in adhesive strength can be obtained by using more viscous GPC adhesives.

Tissue response to a novel bone adhesive implanted subcutaneously in rats: A histological and gene expression analysis

AbstractMedian sternotomy provides access to the heart and surrounding valves for cardiothoracic surgery. However, complications arise such as micro‐motion and separation between the two sternal halves. To prevent these complications, the use of a bone adhesive has been proposed to augment the mechanical union of the two sternal halves when combined with wire cerclage. Our group has developed a bone adhesive for sternal fixation, utilizing a glass polyalkenoate cement (GPC) based on a zinc silicate ionomeric glass (mole fraction: SiO2:0.48, ZnO:0.36, CaO:0.12, SrO:0.04). Here we present the first soft‐tissue biological safety assessment of this novel Sr/Zn‐GPC, where we implanted the material subcutaneously in rats for 6 and 12 weeks. Polymethyl‐methacrylate (PMMA) bone cement was used as a baseline control with respect to inflammation and biocompatibility. Histological assessment revealed no adverse tissue reaction nor ectopic bone formation in response to the novel material. Additionally, relative expression of pro‐inflammatory and osteogenic genes (Col1a1, SOX9, Runx2, IL‐1, IL‐6, and TNF‐α) was assessed in the tissue surrounding implants and revealed no significant differences in expression between the Sr/Zn‐GPC and PMMA implants.

A comparative life cycle assessment of dental restorative materials.

Different types of direct-placement dental materials are used for the restoration of structure, function and aesthetics of teeth. The aim of this research investigation is to determine, through a comparative cradle-to-gate life cycle assessment, the environmental impacts of three direct-placement dental restorative materials (DRMs) and their associated packaging. Three direct-placement dental materials; dental amalgam, resin-based composite (RBC) and glass polyalkenoate cements (GIC) are assessed using primary data from a manufacturer (SDI Limited, Australia). The functional unit consisted of 'one dental restoration' of each restorative system under investigation: 1.14g of dental amalgam; 0.25g of RBC (plus the adhesive = 0.10g); and 0.54g of GIC. The system boundary per restoration included the raw materials and their associated packaging materials for each DRM together with the processing steps for both the materials and packaging. The environmental impacts were assessed using an Egalitarian approach under the ReCiPe method using Umberto software and the Ecoinvent database. Nine different impact categories were used to compare the environmental performance of these materials. Dental amalgam had the highest impact across most of the categories, but RBC had the highest Global Warming Potential. The highest sources of the environmental impacts for each restorative material were: Amalgam, derived from material use; RBC, derived from energy use in processing material and packaging material; GIC, derived from material and energy use for packaging. Less intensive energy sources or more sustainable packaging materials can potentially reduce the impacts associated with RBC and GIC thus making them suitable alternatives to dental amalgam.

In vitro immunomodulatory effects of novel strontium and zinc-containing GPCs.

Glass polyalkenoate cements (GPCs) are bio-adhesives which consist of ionomeric glass particles embedded in a poly-salt matrix. These materials have been used in dentistry and orthodontics extensively but are presently being optimized as bone putties for orthopedic applications. This study utilized a patented ionomeric glass (mole fraction: SiO2:0.48, ZnO:0.36, CaO:0.12, SrO:0.04) to formulate two GPCs: GPC A (<45μm particle size glass) and GPC B (45μm-63μm). These formulations were previously assessed for their effect on osteoblast viability and osteogenic function. However, the immunomodulatory effects of GPC A and B have not previously been investigated. Non-toxic concentrations of (a) GPC dissolution products and (b) fragmented GPC particles were tested for their ability to affect the secretion of cytokines (TNF-α, IL-1β, IL-6 and IL-10) by rat peripheral blood mononuclear cells (PBMCs), in the presence or absence of the stimulant liposaccharide (LPS). Additionally, the ionic concentrations of Sr, Zn, Ca, and Si were measured in GPC ionic extracts, and the size, shape and concentration of fragmented GPC particles in deionized water were characterized using an optical microscope-based particle analyzer. The results showed that GPC A ionic products reduced the concentration of TNF-α secreted by stimulated cells compared with cells stimulated in the absence of GPC products. Interestingly, the particles released from GPC A significantly increased the secretion of both TNF-α and IL-6 from unstimulated cells, compared to control cells. Neither GPC B ionic products nor released particles were found to be biologically active with respect to PBMC cytokine secretion.

Conventional glass-ionomer cements: a guide for practitioners

Glass-polyalkenoate cements, also known as glass-ionomer cements (GICs), are one of the most commonly used bio-interactive restorative dental materials, having been available since the 1970s. With the promotion of minimally invasive operative dentistry (MID), and the reduction in the use of dental amalgam worldwide, the popularity of these materials has grown significantly in recent years. This article outlines the basics and clinical importance of GIC material science, and provides an overview of their use in restorative dentistry.CPD/Clinical Relevance: GICs are versatile dental biomaterials that require correct case selection, material handling and placement technique to ensure optimal clinical success.

Comparative Evaluation of Two Glass Polyalkenoate Cements: An In Vivo Pilot Study Using a Sheep Model.

Poly(methyl methacrylate) (PMMA) is used to manage bone loss in revision total knee arthroplasty (rTKA). However, the application of PMMA has been associated with complications such as volumetric shrinkage, necrosis, wear debris, and loosening. Glass polyalkenoate cements (GPCs) have potential bone cementation applications. Unlike PMMA, GPC does not undergo volumetric shrinkage, adheres chemically to bone, and does not undergo an exothermic setting reaction. In this study, two different compositions of GPCs (GPCA and GPCB), based on the patented glass system SiO2-CaO-SrO-P2O5-Ta2O5, were investigated. Working and setting times, pH, ion release, compressive strength, and cytotoxicity of each composition were assessed, and based on the results of these tests, three sets of samples from GPCA were implanted into the distal femur and proximal tibia of three sheep (alongside PMMA as control). Clinical CT scans and micro-CT images obtained at 0, 6, and 12 weeks revealed the varied radiological responses of sheep bone to GPCA. One GPCA sample (implanted in the sheep for 12 weeks) was characterized with no bone resorption. Furthermore, a continuous bone–cement interface was observed in the CT images of this sample. The other implanted GPCA showed a thin radiolucent border at six weeks, indicating some bone resorption occurred. The third sample showed extensive bone resorption at both six and 12 weeks. Possible speculative factors that might be involved in the varied response can be: excessive Zn2+ ion release, low pH, mixing variability, and difficulty in inserting the samples into different parts of the sheep bone.

A Gallium-doped cement for the treatment of bone cancers. The effect of ZnO ↔ Ga2O3 substitution of an ionomeric glass series on the rheological, mechanical, pH and ion-eluting properties of their corresponding glass polyalkenoate cements

The primary treatment for patients suffering from bone cancers is resection of the tumour followed by reconstruction of the damaged bone. Despite the administration of post-operative chemotherapy, tumour recurrence continues to present itself as a severe complication leading to re-operation. Attempts to incorporate chemotherapeutic drugs into bone cements elicits local toxic effects on healthy bone, which could compromise implant fixation. Alternatively, the local administration of gallium (Ga) may prove to be more effective. This report considers the development of a Ga ionomeric glass series (0.48SiO2-0.355ZnO-0.06CaO-0.08SrO-0.02P2O5-0.005Ta2O5, with 0.01–0.05 mol% substitution for ZnO). X-ray Diffraction (XRD) confirmed the amorphous glass structure and Energy Dispersive x-ray Fluorescence (EDXRF) verified the successful addition of Ga into the glass series at the expense of Zinc (Zn). A Ga-GPC series was then formulated by mixing the glass particles with aqueous poly(acrylic) acid (PAA) and trisodium citrate (TSC). Fourier transform infrared (FTIR) spectroscopy demonstrated no structural changes to the GPC matrix with the incorporation of Ga. Measurements of the rheological properties demonstrated an exponential increase in setting time with increasing Ga content. Furthermore, the addition of 3 mol% Ga demonstrated deleterious effects on the GPC’s mechanical properties and an analysis of pH confirmed that it decreased with increasing Ga content, suggesting a reduction in glass reactivity and PAA cross-linking. Finally, inductively coupled plasma—optical emission spectrometry (ICP-OES) demonstrated the controlled release of Ga across the GPC series, which will prove beneficial to future in vitro studies.

In vivo analysis of a proprietary glass-based adhesive for sternal fixation and stabilization using rabbit and sheep models

Wire cerclage remains the standard method of care for sternal fixation, following median sternotomy, despite being beset with complications. An emerging treatment option has been to augment the wires with an adhesive. A patented ionomeric glass (mole fraction: SiO2:0.48, ZnO:0.36, CaO:0.12, SrO:0.04) has been used to formulate GPC+, a glass polyalkenoate cement (GPC), by mixing it with poly(acrylic) acid (PAA) and de-ionized water. In a human cadaver study, this material, when applied with wire cerclage, was able to significantly reduce sternal instability. However, the material has yet to be tested in pertinent animal models. Here, after a series of physical and mechanical tests to confirm suitability of the experimental material for implantation, three samples of GPC+ were implanted in either the tibia or femur of three different rabbits, alongside sham defects, for two different time modalities. A further seven samples of GPC+ and one poly(methyl methacrylate) control (PMMA) were implanted in either the tibia or femur of two different sheep. The sheep containing the PMMA was sacrificed at 8 weeks and the other at 16 weeks, to evaluate time dependent biological response. Upon sacrifice, microCT images were acquired and histology slides prepared for analysis. All three GPC+ samples implanted in the rabbit model, for the two time modalities, were characterized by minimal bone resorption along with a mild inflammatory response. Five of the seven GPC+ materials implanted in the sheep model (all three implanted for 8 weeks and two of those implanted for 16 weeks) were associated with mild to moderate immune response, comparable to that observed with PMMA, as well as mild bone resorption. The remaining two GPC + materials (implanted in the sheep model for 16 weeks) exhibited no bone resorption or inflammatory response and appeared to stimulate increased bone density at the implant site. These results suggest that GPC + can be a viable bone adhesive for use in hard tissue applications such as sternal fixation and stabilization.Experiments performed to synthesize & test Sr-doped glass adhesive for sternal fixation. (1) Sr-doped ionomeric glass fired, ground down and mixed with aqueous polyacrylic acid to produce the adhesive. (2) Adhesive characterized and tested by a suite of laboratory-based tests to ensure suitability for implantation. (3) Adhesive implanted into a rabbit model (distal femur, 12 weeks post implantation) where micro-CT images confirmed an excellent bone/cement interface, no evidence of bone resorption and some bone remodelling. (4) Adhesive subsequently implanted into a sheep model; at 16-weeks, a continuous bone—adhesive interface is seen suggesting no bone resorption. There was an increase in the peri-implant radiodensity, suggesting enhanced mineral content of the bone surrounding the GPC+ implant.

In vitro osteogenic performance of two novel strontium and zinc-containing glass polyalkenoate cements.

Glass polyalkenoate cements (GPCs) are under investigation as potential bone adhesives, as they may provide an alternative to polymethylmethacrylate-based cements. GPCs containing strontium (Sr) and zinc (Zn) in place of aluminium (Al) are of particular interest because these ions are known stimulators of osteoprogenitor differentiation. GPCs have been manufactured from a novel bioactive glass (SiO2 :0.48, ZnO:0.36, CaO:0.12, SrO:0.04) in the past, but, while such materials have been assessed for their influence on viability, their influence on osteogenic function has not been investigated until now. For this study, two GPCs were formulated from the same glass precursor evaluated in previous studies. These GPCs were named GPC A and GPC B, and they differed in glass particle size, polyacrylic acid molecular weight, and their powder: liquid ratios. The effect of these two GPCs on osteogenic differentiation of primary rat osteoblasts were evaluated using three culture systems: culture with dissolution extracts, indirect contact with transwell-inserts and direct contact. Additionally, the degradation characteristics of GPCs were assessed, including their interfacial pH and surrounding pH. The experimental outcomes revealed that collagen deposition, alkaline phosphatase expression, and mineralization were largely dependent on GPC composition as well as the mode of interaction with cells. These markers were found to be significantly elevated in response to GPC A's dissolution products. However, osteogenic differentiation was inhibited when osteoblasts were cultured indirectly and directly with GPCs, with, overall, GPC B significantly outperforming GPC A. These results suggest that GPC degradation products effect osteogenic differentiation in a dose-dependent manner.

Calcium sulfate‐containing glass polyalkenoate cement for revision total knee arthroplasty fixation

Poly(methyl methacrylate) (PMMA) bone cement is used as a minor void filler in revision total knee arthroplasty (rTKA). The application of PMMA is indicated only for peripheral bone defects with less than 5 mm depth and that cover less than 50% of the bone surface. Treating bone defects with PMMA results in complications as a result of volumetric shrinkage, bone necrosis, and aseptic loosening. These concerns have driven the development of alternative bone cements. We report here on novel modified glass polyalkenoate cements (mGPCs) containing 1, 5 and 15 wt% calcium sulfate (CaSO4 ) and how the modified cements' properties compare to those of PMMA used in rTKA. CaSO4 is incorporated into the mGPC to improve both osteoconductivity and bioresorbability. The results confirm that the incorporation of CaSO4 into mGPCs decreases the setting time and increases release of therapeutic ions such as Ca2+ and Zn2+ over 30 days of maturation in deionized (DI) water. Moreover, the compressive strength for 5 and 15 wt% CaSO4 addition increased to over 30 MPa after 30 day maturation. Although the overall initial compressive strength of the mGPC (~ 30 MPa) is less than PMMA (~ 95 MPa), the compressive strength of mGPC is closer to that of cancellous bone (~ 1.2-7.8 MPa). CaSO4 addition did not affect biaxial flexural strength. Fourier transform infrared analysis indicated no cross-linking between CaSO4 and the GPC after 30 days. in vivo tests are required to determine the effects the modified GPCs as alternative on PMMA in rTKA.

Incorporation of cellulose fiber in glass ionomer cement.

This study investigated the effect of discontinuous cellulose microfibers with various loading fractions on selected physical properties of glass polyalkenoate (glass ionomer) cement (GIC). Fiber-reinforced GIC (Exp-GIC) was prepared by adding discontinuous cellulose microfiber (with an average length of 500μm) at various mass ratios (1, 2, 3, 4, and 5 mass%) to the powder of conventional GIC (GC Fuji IX) using a high-speed mixing device. Fracture toughness, work of fracture, and compressive strength were determined for each experimental and control material. The specimens (n=6) were wet stored (37°C for 1d) before testing. A scanning electron microscope equipped with an energy dispersive spectroscope was used to examine the surface of fibers after treatment with cement liquid. Data were analyzed using ANOVA. The Exp-GIC (5 mass%) specimen had statistically significantly higher fracture toughness (0.9MPa.m1/2 ) than unreinforced material (0.4MPa.m1/2 ). On the other hand, Exp-GIC with 1 mass% displayed the highest compressive strength (116MPa) among all tested groups. The use of discontinuous cellulose microfibers with conventional GIC matrix considerably increased the toughening performance compared with the particulate GICs used.

Effects of bioactive additions on the physical properties of glass polyalkenoate cement

Aim Conventional glass ionomer cements are clinically attractive materials and have unique properties that make them useful dental restorative materials. The glass ionomer cements however are slightly brittle materials though they deform a little under load. They display high compressive strengths but slightly weak flexural strengths. Collagen type I and RGD peptides (Arg-Gly-Asp) are the most effective and widely used bioactive molecules to promote cell adhesion on a synthetic surface. This study investigates the effect of chairside addition of bioactive molecules (Collagen type I and RGD) into glass polyalkenoate cement on improving the physical properties. Materials and methods Mechanical properties of the glass polyalkenoate cement (ChemFil Superior, Dentsply De Trey, Konstanz, Germany) were investigated both at baseline and after incorporating bioactive additions made at the time of mixing the material. The properties that are of potential significance for clinical durability were determined namely; compressive strength, diametral compressive strength, three-point flexural strength, diametral compressive fatigue limit, and biaxial flexural strength. Results: Additions of Type I Collagen and RGD to ChemFil Superior improved all physical properties measured except shear bond strength where no detriment was observed. Conclusion Chairside additions of bioactive molecules to conventional glass ionomer restorations have potential clinical applications and represent a new paradigm in dentistry that can be utilized to improve biocompatibility, mechanical properties, and therefore, clinical durability. Improving the mechanical strength of glass ionomer restorations by optimized reinforcement strategy requires further investigation. Clinical significance: the methodology of mixing conventional glass ionomer with bioactive molecules for superior biocompatibility and reinforcement, developed in the present study, should be applicable to chairside dental procedures. The increase in physical properties of the glass polyalkenoate, achieved in the present study, may help extend its dental applications to the restoration of stress-bearing cavities.

Investigating the effect of germanium on the structure of SiO2-ZnO-CaO-SrO-P2O5 glasses and the subsequent influence on glass polyalkenoate cement formation, solubility and bioactivity

A series of germanium (Ge)-containing glasses were synthesized based on a starting glass composition of SiO2-ZnO-CaO-SrO-P2O5. Additions of GeO2 (6 and 12 mol%) were incorporated at the expense of SiO2, which retained the amorphous character, and each glass was processed to present similar particle size and surface area. Glass characterization using x-ray photoelectron spectroscopy (XPS) and magic angle spinning nuclear magnetic resonance (MAS-NMR) determined that the addition of GeO2 increased the fraction of lower Q-speciation and subsequently the concentration of non-bridging oxygens (NBO). Glass Polyalkenoate Cements (GPC) were formulated from each glass with 40, 50 and 60 wt% PAA, and presented time dependent solubility profiles (1, 10, 100, 1000 h) for the release of Si4+ (4–140 mg/l), Ca2+ (1–8 mg/l), Zn2+ (<6 mg/l), Sr2+ (2–37 mg/l), PO43− (2–43 mg/l) and Ge4+ (20–911 mg/l) and attained pH values close to 7.5 after 1000 h. Ge-GPCs containing 40 wt% polyacrylic acid (PAA) presented appropriate working time (Tw) and setting times (Ts), and the corresponding compressive strengths ranged from (14–30 MPa). The Ge-GPCs (40, 50 wt%) presented a linear increase (R2–0.99) with respect to time. Simulated Body Fluid (SBF) testing resulted in the Ge-GPCs encouraging the precipitation of crystalline hydroxyapatite on the GPC surface, more evidently after 100 and 1000 h incubation.

Kyphoplasty of Osteoporotic Fractured Vertebrae: A Finite Element Analysis about Two Types of Cement.

If conservative treatment of osteoporotic vertebral compression fractures fails, vertebro- or kyphoplasty is indicated. Usually, polymethylmethacrylate cement (PMMA) is applied coming along with many disadvantageous features. Aluminum-free glass-polyalkenoate cement (GPC) appears to be a benefit alternative material. This study aimed at comparing the mean stress values in human vertebrae after kyphoplasty with PMMA and GPC (IlluminOss™) at hand of a finite element analysis. Three models were created performing kyphoplasty using PMMA or IlluminOss™, respectively, at two native, human lumbar vertebrae (L4) while one remains intact. Finite element analysis was performed using CT-scans of every vertebra. Moreover the PMMA-treated vertebra was used as a model as analyses were executed using material data of PMMA and of GPC. The unimpaired, spongious bone showed potentials of 0.25 MPa maximally. After augmentation stress levels showed fivefold increase, rising from externally to internally, revealing stress peaks at the ventral border of the spinal canal. At central areas of cement 1 MPa is measured in both types of cement. Around these central areas the von Mises stress decreased about 25-50% (0.5-0.75 MPa). If workload of 500 N was applied, the stress appeared to be more centralized at the IlluminOss™-model, similar to the unimpaired. Considering the endplates the GPC model also closely resembles the unimpaired. Comparing the PMMA-treated vertebral body and the GPC-simulation, there is an obvious difference. While the PMMA-treated model showed a central stress peak of 5 MPa, the GPC-simulation of the same vertebral body presents lower stress of 1.2-2.5 MPa. Finite element analysis showed that IlluminOss™ (GPC), used in kyphoplasty of vertebral bodies, creates lower level stress and strain compared to standardly used PMMA, leading to lower stress concentrations on the cranial and caudal vertebral surface especially. GPC appears to own advantageous biological and clinical relevant features.

Novel adhesives for distal radius fixation: A biomechanical analysis

Wrist fractures can be difficult to treat due to advanced age of the patient, medical co-morbidities, and comminution of the bone. This study examines the effectiveness of two injectable glass polyalkenoate cements (GPCs), derived from two different glasses (A and B), as minimally invasive treatments for distal radius fractures. Twenty-seven fresh cadaveric radial pairs were tested either in compressive fatigue or to quasi-static compressive failure. The radii tested to failure had one pair fixated with a GPC while the other was left intact. The radii tested under fatigue had one pair fixated with a GPC and the other with a volar locking plate. A wedge osteotomy was used to simulate a severely comminuted fracture. When loaded to failure, the radii fixated with a GPC made from glass A or B were found to be, respectively, at least 57% and 62% as strong as their intact biological pair (95% Confidence Interval, Lower). Using a paired t-test, the radii fixated with either adhesive were found to be significantly stiffer than their biological pairs fixated with a volar locking plate for all cycles of fatigue loading. The adhesives under investigation demonstrate promise as treatment for distal radius fractures. In vivo investigations are warranted to determine the effect that the adhesives have on the bone remodelling process.

Incorporating Germanium Oxide into the Glass Phase of Novel Zinc/Magnesium-Based GPCs Designed for Bone Void Filling: Evaluating Their Physical and Mechanical Properties

The structural role of Germanium (Ge), when substituting for Zinc (Zn) up to 8 mol % in the 0.48SiO2–0.12CaO–0.36ZnO–0.04MgO glass series, was investigated with respect to both the glass chemistry and also the properties of glass polyalkenoate cements (GPCs) manufactured from them. The Network connectivity (NC) of the glass was calculated to increase from 1.83 to 2.42 with the addition of GeO2 (0–8 mol %). Differential thermal analysis (DTA) results confirmed an increase in the glass transition temperature (Tg) of the glass series with GeO2 content. X-ray photoelectron spectroscopy (XPS) showed an increase in the ratio of bridging oxygens (BO) to non-bridging oxygens (NBO) with the addition of GeO2, supporting the NC and DTA results. 29Si magic angle spinning nuclear magnetic resonance spectroscopy (29Si MAS-NMR) determined a chemical shift from −80.3 to −83.7 ppm as the GeO2 concentration increased. These ionomeric glasses were subsequently used as the basic components in a series of GPCs by mixing them with aqueous polyacrylic acid (PAA). The handling properties of the GPCs resulting were evaluated with respect to the increasing concentration of GeO2 in the glass phase. It was found that the working times of these GPCs increased from 3 to 15 min, while their setting times increased from 4 to 18 min, facilitating the injectability of the Zn/Mg-GPCs through a 16-gauge needle. These Ge-Zn/Mg-GPCs were found to be injectable up to 96% within 12 min. Zn/Mg-GPCs containing GeO2 show promise as injectable cements for use in bone void filling.

Glass -polyalkenoate cement: An alternative material for kyphoplasty in osteoporotic vertebral compression fractures - An ex vivo study.

Adjacent vertebral body fracture is described as a risk after vertebroplasty and kyphoplasty. It may be true that this phenomenon is caused precisely because of the frequently used polymethylmethacrylate cement (PMMA), which shows a higher level of stiffness than bone material and may ultimately lead to shifting stress levels within the entire spine. The goal of the present study was to evaluate and compare the pressure distribution in the endplate of human vertebrae after kyphoplasty with PMMA and aluminum-free glass-polyalkenoate cement (gpc). For the present study, 8 fresh frozen human cadaveric vertebral bodies from the thoracolumbar junction were used. All vertebrae were augmented transpedicularly on one side with gpc and on the other side with PMMA. A loading of 600 N, 800 N and 1000 N was applied. In the data processing an individual region of interest (roi) was generated for each vertebra. The following parameters were determined for each roi: maximum force [N], maximum pressure [kPa], mean pressure [kPa], roi area [cm2]. We found significantly higher mean pressure values in the areas of the vertebrae augmented with PMMA, compared to the ones after augmentation with gpc (p = 0.012) when applying 1000 N. In the groups with lower forces there were no statistical relevant differences. The pressure distribution shows an advantage for gpc. A material, which does not create load concentration onto the cranial and caudal vertebral surface, could have major advantages concerning the risk of adjacent vertebral fractures. Thus the results of the 1000 N loading protocol suggest gpc being a possible alternative to ordinary PMMA cement, regarding its influence on stiffness in kyphoplasty. These and other general aspects like incorporation should be addressed and elaborated more detailed in further studies.