Hydroxyapatite Sheet Research Articles

Novel Bioengineered Collagen with Manuka Honey and Hydroxyapatite Sheet for the Treatment of Lower Extremity Chronic Wounds in an Urban Hospital Wound Care Setting

Introduction. A novel BCMH sheet has been shown to achieve improved wound closure rates in chronic and acute wounds when compared with SOC. Objective. This retrospective evaluation assessed chronic wound closure rates with SOC or treatment with the BCMH sheet in an urban hospital wound clinic. Methods. Forty-seven chronic wounds were treated with SOC or the BCMH sheet. The primary endpoint was time to closure. For wounds that did not close, investigations were conducted to determine the reason. Results. Twenty wounds were treated with SOC, which varied in usage of multiple products and/or therapies, and 27 wounds were treated with the BCMH sheet. The average initial wound size was not statistically different between the groups. In both groups, most wounds that were treated did not close. For wounds that did close, the average time to closure was 2× faster in the BCMH group compared with the SOC group (7.4 weeks and 14.8 weeks, respectively; P < .05). Conclusions. This retrospective evaluation showed average time to wound closure to be significantly faster with BCMH compared with SOC in patients who maintained adherence with regular visits.

A Preliminary Direct Comparison of the Inflammatory Reduction and Growth Factor Production Capabilities of Three Commercially Available Wound Products: Collagen Sheet, Manuka Honey Sheet, and a Novel Bioengineered Collagen Derivative + Manuka Honey + Hydroxyapatite Sheet.

Many commercially available wound products focus on improving one stage of the wound healing cascade. While this targeted approach works for specific wounds, there is a need for products that can reliably and comprehensively progress a wound through multiple stages. This preliminary in vitro study was performed to directly compare the inflammatory reduction and growth factor production effects of three commercially available wound care products: a collagen sheet (COL), a Manuka Honey Calcium Alginate sheet (MH), and a novel bioengineered sheet comprised of a collagen derivative (gelatin), Manuka honey, and hydroxyapatite (BCMH). Macrophages and human dermal fibroblasts were directly seeded on all three commercial products, and supernatants were analyzed for inflammatory markers and growth factors, respectively. Comparing the MMP-9/TIMP-1 ratio, BCMH resulted in 11× lower levels of this inflammation biomarker compared to COL, and 3× lower levels compared to MH. Both the COL and BCMH products created an environment conducive to expression and release of relevant growth factors, while the MH product showed the lowest levels of growth factor expression of all three commercially available products tested. The favorable 11× lower MMP-9/TIMP-1 ratio observed with the BCMH product compared to the COL product suggests that the BCMH products provided a superior comprehensive approach to healthy progression of the wounds by providing an additional benefit of reducing the inflammatory response in vitro.

Improved Healing by Adjuvant Osteoconductive Therapy Using a Novel Cotton-Like Hydroxyapatite Sheet After Median Sternotomy

The union rate of wire fixation after median sternotomy remains unsatisfactory. We developed a novel osteoconductive sheet composed of hydrophilized hydroxyapatite and evaluated its osteogenetic effect when interposed between sternal halves in a canine model. Eighteen canines were divided equally into groups based on the hemostatic agent used: osteoconductive sheet (S), none (C), and bone wax (BW). After median sternotomy, the sternal halves were closed by wire fixation. In each group, 3 canines were euthanized at 1 month, while 3 were euthanized at 2 months. Resected sternums were mechanically assessed by the 3-point bending test, radiographically assessed by micro-CT, and pathologically assessed to quantify the osteogenesis between sternal halves. Compared with the BW group, the S group had a greater maximum stress at 1 month (S: 322.9 ± 107.7 N, C: 233.0 ± 62.7 N, BW: 124.9 ± 88.4 N; P = 0.025), and greater maximum shear force at 1 month (S: 1.92 ± 0.67 N/m2; C: 1.23 ± 0.28 N/m2; BW: 0.68 ± 0.41 N/m2; P = 0.025). Micro-CT revealed that the S group had more osteogenesis than the BW group at 1 month (25.7% ± 9.8% vs 6.9% ± 9.2%), and 2 months (34.0% ± 15.1% vs 14.8% ± 9.4%); the respective values in the C group were 17.1% ± 7.2% and 29.7% ± 9.3%. Pathologic examination revealed that the S group had the greatest osteogenetic area at 2 months (S: 38.8% ± 18.8%; C: 24.5% ± 6.9%; BW: 24.7% ± 18.6%). Adjuvant osteoconductive therapy using a cotton-like hydroxyapatite sheet in addition to wire fixation significantly improved sternal healing compared with BW. This new material also showed relatively better outcome than the C group.

Development of Ultra-Thin Opaque White Hydroxyapatite Sheet for Restoration of Enamel and Aesthetic Treatments of Teeth

In cosmetic dentistry, bleaching and laminate veneer methods are common treatments to improve the appearance of teeth. However, there are limitations to these treatments, as they damage the enamel which are not capable of recovering naturally. In this study, novel hydroxyapatite (HAp) sheets, which enable both enamel restoration and aesthetic treatments, were developed. Results indicated that the lower range of the sintering temperatures, of the pulsed laser deposition targets, produced lighter shades of amorphous Calcium phosphate (ACP) sheets. Subsequently, the post-annealing process of the sheets induced crystallization processes of the ACP sheets, to form HAp sheets, and improved the shade rank of the sheet. The shade rank of the developed sheet (6.8 ± 0.2) was almost comparable to the average shade rank of the teeth of Japanese people, within a range of 6.5 to 7.0.

Preparation and Application of a Potassium-Substituted Calcium Phosphate Sheet as a Dental Material for Treating Dentin Hypersensitivity

Potassium-substituted calcium phosphate free standing sheet for the treatment of dentin hypersensitivity was prepared and evaluated. The appropriate annealing condition for the target of pulsed laser deposition to prepare the potassium-substituted amorphous calcium phosphate (PS-ACP) sheet was investigated. The target annealed at 1000 °C was used to deposit the PS-ACP sheet. The annealing condition for the potassium-substituted hydroxyapatite (PS-HAp) sheet was evaluated by XRD and EDX. The potassium release rate from PS-ACP sheet in PBS, evaluated by ICP-MS, was 2.5 times larger than that of PS-HAp sheet. The robustness of the PS-ACP sheet was proved by the brushing test of the PS-ACP sheet affixed on a bovine dentin. The dentin tubules on the dentin surface was occluded by the PS-ACP sheet and which confirmed by SEM observations.

Optimal Conditions for Aqueous Tape Casting of Hydroxyapatite

An aqueous tape casting process was employed to produce hydroxyapatite (HA) sheets. The effects of viscosity of slurry, blade height and speed on flexural strength and density of the sintered HA sheets were studied using central composite design (CCD). The flexural strength and the density were measured using a three-point bending test and Archimedes method, respectively. Results suggested that all parameters and the interaction between viscosity and speed had significant effects on both flexural strength and density. Under the conditions studied, the optimal conditions for the maximum flexural strength and density of the sintered HA sheet were obtained with the viscosity of 1532 mPa.s, the blade height of 3.34 mm and the speed of 6.27 mm/s.

Control of Crystallinity of Hydroxyapatite Sheet

A technique to control the crystallinity of hydroxyapatite (HA) was investigated for applications such as dentistry, regenerative medicine, cell culture scaffolding, and bio-sensors. An amorphous HA film was first produced by pulsed laser deposition. After deposition, it was separated from a substrate as a free-standing sheet. Annealing was then performed to control the crystallinity of the sheet. It was found that conventional annealing in an electric oven was not suitable for HA sheets, because it led to curling and cracking. Since such problems were assumed to be caused by thermal stress, annealing was next carried out with the HA sheet enclosed in HA powder in the center of a metal capsule. This method allowed annealing to be successfully carried out without causing any curling or cracking. Uniform pieces with dimensions of 10 mm × 10 mm cut from a large HA sheet were annealed at temperatures of 200 to 800 ºC and then examined using X-ray diffraction. It was found that the intensity of the diffraction peaks associated with crystalline HA changed with annealing temperature, and that the strongest peaks were observed for the sample annealed at 500 ºC. These results indicate that the crystallinity of the HA sheet can be controlled using the proposed method.

Restoration of Tooth Enamel Using a Flexible Hydroxyapatite Sheet Coated with Tricalcium Phosphate

Restoration and protection of tooth enamel are of great importance in operative and conservative dentistry. Using a Pulsed Laser Deposition (PLD) method, we have successfully created a freestanding flexible double-layered sheet composed of a Hydroxyapatite (HAp) layer (4 m in thickness) coated with a Tricalcium Phosphate (TCP) layer (500 nm). In order to apply the newly developed HAp/TCP sheet to the restoration and protection of tooth enamel, the adhesive characteristics of the HAp/TCP sheet on the enamel were evaluated mechanically and microstructurally in the present study. The adhesive strength (5.7 MPa) between the HAp/TCP sheet and enamel was markedly higher than that (1.9 MPa) between the mono-layered HAp sheet and enamel. The electron microscopic observation revealed that HAp/TCP sheet was widely fused with the enamel. Therefore, the double-layered HAp/TCP sheet can be used as a material to promote the repair of tooth eruption and to maintain healthy dentine.

Adhesive Strength between Flexible Hydroxyapatite Sheet and Tooth Enamel

Tooth enamel cannot be reconstructed once it is destroyed immoderately. Hydroxyapatite (HAp) thin sheet can potentially be used for a novel dental biomaterial to repair the enamel. Using a pulsed laser deposition (PLD) method, we have successfully created a flexible HAp sheet of less than a few micrometers in thickness. Due to its flexibility, the HAp sheet is tightly adhered on curved surfaces at the target site. In the present study, we newly developed double-layered sheets composed of HAp film coated with tricalcium phosphate (TCP) thin layer. The HAp/TCP sheet was adhered to the extracted human teeth using a calcium phosphate solution for 3 days. The adhesive strength between the HAp/TCP sheet and tooth enamel was evaluated by quasi-static tensile tests. Moreover, the interface structure between them was observed by a scanning electron microscopy. As a result of the mechanical evaluation, the adhesive strength was greater than approximately 2.5 MPa. The electron microscopic observation revealed that the sheet was partially fused with the enamel. These findings suggest the possibility that enamel defects are repaired using the HAp/TCP sheet for a short duration.

Evaluation of the navigation system for orbital wall reconstruction in unilateral orbital fractures

To evaluate the efficiency of navigation system for orbital wall reconstruction in unilateral orbital fractures. Fifteen patients (7 male and 8 female) with unilateral orbital fracture underwent orbital reconstruction with the help of intraoperative navigation system. The average age was 34.3 ± 9.5 years. All patients underwent spiral CT scanning preoperatively, and the CT data was imported to the BrainLab navigation system (Germany, BrainLab company). The orbit of the intact side was mirrored to the opposite side as the reference for pre-operative planning. The titanium mesh was mounted on the resin template made by rapid prototyping machine based on the mirrored CT data. When the injury was limited, the hydroxyapatite sheet was used for the orbital wall reconstruction. During the operation, the real-time navigation helped to ensure precise placement. The re-establishing result was assessed based on the postoperative CT data with the following four variables: the volumetric difference between the bilateral orbit, the volume of the herniated soft tissue, the global projection and the discrepancy between the simulated and the achieved position of the reconstructed orbital wall. The reconstructive discrepancy was measured only in the titanium plate grafting cases. There were no serious complications such as infection, graft rejection and optic nerve injury in any case. Preoperatively, the average degree of enophthalmos was (3.5 ± 1.6) mm, the average volumetric difference between the injured and the unaffected orbit was (4.5 ± 1.8) ml, and the average volume of the herniated orbital soft tissue was (2.1 ± 0.7) ml. Postoperatively, the three values were respectively reduced to (1.3 ± 0.6) mm, (1.8 ± 0.9) ml and (0.7 ± 0.3) ml. The discrepancy of the medial and inferior wall were (2.5 ± 0.6) mm and (2.1 ± 0.4) mm. The intraoperative use of navigation system for the orbital wall reconstruction in unilateral orbital fractures can provide reliable accuracy and achieve satisfactory results.

Regeneration of Tooth Enamel by Flexible Hydroxyapatite Sheet

Before a tooth erupts, the ameloblasts are lost, which means that the tooth enamel does not regenerate itself after tooth eruption. In the present study, we attempt to regenerate the tooth enamel artificially using a flexible hydroxyapatite (HAp) sheet. First, a HAp film was deposited on a soluble substrate by pulsed laser deposition (PLD) using an ArF excimer laser. Next, the HAp film was collected as a freestanding sheet by dissolving the substrate using a solvent. The HAp sheet was adhered to the extracted human teeth using a calcium phosphate solution. The variation of the crystal structure of the HAp sheet with time was investigated by X-ray diffraction analysis. Furthermore, the variation in the mechanical characteristics with time between the HAp sheet and dental enamel were evaluated using tensile and scratch tests. The results suggest that the HAp sheet became fused to the tooth enamel within approximately one week.

Microstructure and Toughness Mechanism of Shank Bone

Scanning electron microscope (SEM) observation was performed and showed that shank bone is a kind of bioceramic composite consisting of laminated hydroxyapatite and organic materials. The hydroxyapatite layers are parallel with the surface of the bone and consist of numerous thin and long hydroxyapatite sheet fibers. The hydroxyapatite sheet fibers in different hydroxyapatite make a little angle with each other and compose a kind of screwy microstructure. The maximum pullout force of the screwy microstructure was investigated and compared with that of parallel microstructure. It shows that the maximum pullout force of the screwy microstructure is markedly larger than that of the parallel microstructure, which was experimentally validated.

Formation of c-Axis Aligned Hydroxyapatite Sheet by Simultaneous Imposition of High Magnetic Field and Mold Rotation During Slip Casting Process

A high magnetic field is a useful tool to control the crystal alignment of non-magnetic materials such as ceramics and polymers. In the case of Hydroxyapatite crystal, the a,b-axis is aligned parallel to the direction of an imposed magnetic field. This fact implies that the alignment of the c-axis is not controllable only using a high static magnetic field due to the freedom of the c-axis in a plane perpendicular to a magnetic field direction. In this study, a high static magnetic field and mold rotation was simultaneously so applied during a slip casting process as to align the c-axis of HAp poly crystals.