Use Of Bioactive Glass Research Articles

Correlating immediate vapour reactivity with dentin remineralization and tubule occlusion capacity of a bioactive sol-gel borate glass

The use of bioactive glass as a mineralization agent in treating dentin hypersensitivity has been established for almost two decades where the melt-quench-derived silicate glass, 45S5, may be regarded as the gold standard formulation. Compared to silicate glasses, borate glasses are less chemically durable and have the potential to mineralize (i.e., convert to apatite) more rapidly. This study compared the apatite forming capacity of a sol-gel-derived calcium-borate glass, 40CaO–60B2O3 (SGB60), to that of 45S5, on demineralized dentin discs and its ability to occlude tubules on non-demineralized dentin discs, in vitro. Moreover, it investigated the vapour sorption reactivity of the glasses to explore the potential correlation between their immediate aqueous interactions and bioactivity in remineralization solution. Compared to 45S5, SGB60 demonstrated more rapid calcium-phosphate layer formation on demineralized dentin surfaces. On the other hand, after 24 h immersion in remineralization solution, the 45S5-induced calcium-phosphate layer occlusion of tubules in non-demineralized dentin surfaces appeared to be qualitatively greater than that induced by SGB60. Moreover, vapour sorption analysis under either air or nitrogen gas, demonstrated that the reactivity of 45S5 with vapour varied under the different purge gasses, with significant carbonate formation under air. In contrast, SGB60 showed a more rapid rate of initial weight increase with vapour under both purge gasses, and this vapour reactivity may be correlated to its more rapid calcium-phosphate layer formation on demineralized dentin surfaces when immersed in remineralization solution.

Synthesis of Mesoporous Core Shell Magnetite Bioactive Glass Nanoparticles for Magnetic Hyperthermia Treatment of Cancer

AbstractMultiple biological advances have made use of bioactive glass (BG) nanoparticles (NPs) in regenerative medicine, bone and tooth repair, drug and gene transfer, cancer treatment, and cosmetics. Normal biocompatible coatings alongside hydrocarbons, polymers, and silica significantly affect fundamental attributes of NPs. In this study, we synthesized a novel mesoporous BG NPs with magnetite core shell (AMAG_BG) using L‐arginine as a template processing magnetic hyperthermia (MH). BG network coverage on magnetite (AMAG) NPs were orchestrated first time by bio‐inspired synthesis in watery dissolvable. AMAG and AMAG_BG NPs were characterized by utilizing FE‐SEM, HR‐TEM, and BET analysis. The elemental composition of L‐arginine templated magnetite (AMAG) and AMAG_BG NPs was also determined by XPS and EDX analysis. Characteristics of AMAG_BG were contrasted with bare AMAG NPs in morphology, particle size, porosity, and composition. The fabricated BG NPs′ in‐vitro bioactivity and heat studies were successfully monitored after interaction with simulated bodily fluid (SBF). Magnetic studies and in‐vitro heat studies together demonstrated the behavior of BG NPs towards MH treatment of cancerous cells. Cytotoxicity tests on AMAG_BG NPs using U2OS and human blood cells with appropriate control experiments revealed biocompatibility. The study represents magnetic and thermal property‐dependent sustainable synthetic process of AMAG BG NPs for cancer treatment.

Use of bonalive in obliterative mastoidectomy: anatomical results and clinical outcome.

To investigate safety and efficacy of mastoid obliteration in canal-wall-down tympanoplasty performed for cholesteatoma using bioactive glass (BAG). The authors routinely adopt CWD tympanoplasty in case of massive cholesteatoma or revision surgery, performing obliteration with BAG to reduce the mastoid cavity and related disadvantages. We assessed anatomical results, infection control and cholesteatoma recurrence in obliterative mastoidectomy using BAG. The authors evaluated 66 patients treated with obliterative mastoidectomy using BAG during the period 2010-2021. 48.5% of the cases had first diagnosis of cholesteatoma, 48.5% had cholesteatoma recidivisms, and two patients underwent obliteration to improve clinical outcome. BAG granules were always moistened with venous blood to enhance their adhesion and reduce the risk of dispersion. Anatomical results were evaluated in otomicroscopy and infection control was assessed during follow-up visits. Periodical otomicroscopy was performed to check recurrent cholesteatoma. MRI-DWI was indicated only in case of clinical suspect of cholesteatoma. Authors followed 66 patients during a mean of 23months. No post-operative wound infections occured. The mean re-epithelialization time was 45days. At the last visit, control of infection was achieved in 97% of patients and a clinical stable anatomical cavity in all patients. No clinical suspect for recurrent cholesteatoma was found. The use of bioactive glass is safe and effective as obliteration material in cholesteatoma surgery. Authors pay a particular attention to obliterate only patients without suspect of epithelial residual, to correctly calibrate the ear canal and to completely cover the granules with graft.

Preservation Surgery of Septic Osteoarthritis and Osteomyelitis in the Diabetic Foot Using S53P4 Bioactive Glass—A Case Series

(1) Background: Preservation surgery of the diabetic foot aims at tissue sparing to avoid further pathological changes from developing, while ultimately preserving the limb. For this purpose, osteoregenerative, antimicrobial, and osteostimulative materials are now available. The aim of this case series is to demonstrate several clinical situations in which the use of bioactive glass, a third-generation biomaterial, can potentially be of benefit. (2) Methods: In this retrospective case series, we present patients with a diabetic foot complication with septic osteoarthritis, treated at the University Medical Centre Ljubljana, in the years 2020–2022. Patients received surgical care with resection of the affected joint and bone and placement of bioactive glass material. We observed patient characteristics, recurrence of septic osteoarthritis or osteomyelitis, and the need for amputation in the follow-up period. (3) Results: Of the 16 included patients, 8 received treatment of the metatarsophalangeal joints, 4 of the midfoot joints, and 4 of the ankle joints. Ten suffered from Charcot neuroarthropathy. None required readmission within 30 days or suffered early complications. One complication with recidivant septic osteoarthritis and osteomyelitis was observed. (4) Conclusions: Our case series presents possible applications for treatment with bioactive glass in various joints and bones affected by septic osteoarthritis of the diabetic foot.

Safety and Efficacy of Stand-Alone Bioactive Glass Injectable Putty or Granules in Posterior Vertebral Fusion for Adolescent Idiopathic and Non-Idiopathic Scoliosis

Posterior spinal fusion (PSF) is the standard procedure for the treatment of severe scoliosis. PSF is a standard procedure that combines posterior instrumentation with bone grafting and/or bone substitutes to enhance fusion. The aim of this retrospective study was to evaluate and compare the post-operative safety and efficiency of stand-alone bioactive glass putty and granules in posterior spine fusion for scoliosis in a paediatric cohort. A total of 43 children and adolescents were included retrospectively. Each patient's last follow-up was performed at 24 months and included clinical and radiological evaluations. Pseudarthrosis was defined as a loss of correction measuring >10° of Cobb angle between the pre-operative and last follow-up measurements. There was no significant loss of correction between the immediate post-operative timepoint and the 24-month follow-up. There was no sign of non-union, implant displacement or rod breakage. Bioactive glass in the form of putty or granules is an easily handled biomaterial but still a newcomer on the market. This study shows that the massive use of bioactive glass in posterior fusion, when combined with proper surgical planning, hardware placement and correction, is effective in providing good clinical and radiological outcomes.

Periodontal Therapy Using Bioactive Glasses: A Review

This paper reviews the use of bioactive glasses as materials for periodontal repair. Periodontal disease causes bone loss, resulting in tooth loosening and eventual tooth loss. However, it can be reversed using bioactive glass, typically the original 45S5 formulation (Bioglass®) at the defect site. This is done either by plcing bioactive glass granules or a bioactive glass putty at the defect. This stimulates bone repair and causes the defect to disappear. Another use of bioactive glass in periodontics is to repair so-called furcation defects, i.e., bone loss due to infection at the intersection of the roots in multi-rooted teeth. This treatment also gives good clinical outcomes. Finally, bioactive glass has been used to improve outcomes with metallic implants. This involves either placing bioactive glass granules into the defect prior to inserting the metal implant, or coating the implant with bioactive glass to improve the likelihood of osseointegration. This needs the glass to be formulated so that it does not crack or debond from the metal. This approach has been very successful, and bioactive glass coatings perform better than those made from hydroxyapatite.

Bioactive glass in the treatment of chronic osteomyelitis in children: Description of four consecutive cases and literature review

IntroductionChronic osteomyelitis in children is a rare condition. Debridement surgery, along with appropriate antibiotic therapy, is widely agreed to represent the best procedure in the treatment of chronic osteomyelitis but can result in an extensive dead space formation. In this study, we evaluated the use of bioactive glass to address dead space management. MethodsFour consecutive cases of chronic osteomyelitis treated with antibiotic therapy, one stage- surgical debridement and bioglass implantation between September 2016 and February 2017 were prospectively followed for a minimum of three years. Two cases followed acute hematogenous osteomyelitis, two cases followed fracture fixation. Clinical, histology, laboratory and radiographic findings were recorded. Primary endpoint was eradication of infection. Possible complication related to bioglass application were investigated. ResultsAll patients achieved healing at the latest follow-up of minimum three years. No successive surgical treatments were required at any time. No complications related to the bioglass were detected. Radiographic reconstruction of normal anatomy progressed through the years. ConclusionsBioglass for the treatment of dead space after surgical debridement appears a viable option in the treatment of chronic osteomyelitis in children.

Osteogenic Potential of Magnesium (Mg)-Doped Multicomponent Bioactive Glass: In Vitro and In Vivo Animal Studies

The use of bioactive glasses (BGs) has been quite fruitful in hard tissue engineering due to the capability of these materials to bond to living bone. In this work, a melt-derived magnesium (Mg)-doped BG (composition: 45SiO2–3P2O5–26CaO–15Na2O–7MgO–4K2O (mol.%)) was synthesized for being used in bone reconstruction. The prepared BGs were then manufactured as three-dimensional (3D) scaffolds by using the sponge replica approach. The microstructure of the samples was assessed by X-ray diffraction (XRD) and the surface morphology was observed by using scanning electron microscopy (SEM). The in vitro bioactivity and the release of osteo-stimulatory Mg2+ ions from the prepared samples were investigated over 7 days of incubation in simulated body fluids (SBF). In vitro cellular analyses revealed the compatibility of the Mg-doped BGs with human osteosarcoma cells (MG-63 cell line). Moreover, the Mg-doped BGs could induce bone nodule formation in vitro and improve the migratory ability of human umbilical vein endothelial cells (HUVECs). In vivo osteogenic capacity was further evaluated by implanting the BG-derived scaffolds into surgically-created critical-size bone defects in rats. Histological and immunohistological observations revealed an appropriate bone regeneration in the animals receiving the glass-based scaffolds after 12 weeks of surgery. In conclusion, our study indicates the effectiveness of the Mg-doped BGs in stimulating osteogenesis in both in vitro and in vivo conditions.

Use of bioactive glass doped with magnesium or strontium for bone regeneration: A rabbit critical-size calvarial defects study.

Background:This study aimed to evaluate the amount of bone regeneration in critical defects of rabbit calvaria filled with magnesium- and strontium-doped bioactive glasses.Materials and Methods:In this rabbit critical-size calvarial defects study, 12 male New Zealand white rabbits were randomly divided into two groups. On the calvaria of each rabbit, four lesions (two lesions in the frontal bone and two lesions in the peritoneal bone) were created with a diameter of 8 mm spaced apart. Each lesion was filled in with (1) strontium-doped bioactive glass, (2) magnesium-doped bioactive glass, (3) 45S5 bioactive glass, and (4) empty lesion (control). Six rabbits were sacrificed at the end of 4 weeks, and six rabbits were randomly sacrificed at the end of 8 weeks. Bone sections with a 5-μ thickness of rabbit calvary bone were prepared, and the percentage of new bone, connective tissue, and residual material were calculated in microscopic images. Statistical analysis was performed by two-way ANOVA and Bonferroni additional tests, and the level of significance was set at P < 0.05 in all categories.Results:At 4 weeks, magnesium-doped bioactive glass showed the highest new bone formation with a mean of 11.66 ± 2.64, followed by the strontium-doped bioactive glass with the mean of 11.10 ± 1.69 (P = 0.0001). While at week 8, the highest amount of new bone observed in the strontium-doped group with a mean of 28.22 ± 3.19, and then, the magnesium-doped bioactive glass with a mean of 22.55 ± 3.43 (P = 0.0001).Conclusion:Doping strontium and magnesium in the structure of bioactive glasses increases new bone regeneration in comparison with 45S5 bioactive glass.

Chronic Tibial Osteomyelitis - Use of Biactive Glass as an Alternative of Treatment: Report of a Case

<i>Background:</i> Chronic osteomyelitis is a disease usually of infectious origin. The main cause is post-traumatic, it affects the bone tissue and surrounding tissue, the most frequent causative agent is Staphylococcus aureus. The most affected bone is the tibia. <i>Case description:</i> A 42-year-old male with a diagnosis of chronic tibia osteomyelitis, with sequelae of previous surgical interventions, multiple antibiotic treatments, and type IV B classification by Cierny-Mader. <i>Methods:</i> Two-stage surgical management was chosen. Firstly, extensive bone and soft tissue debridement, placement of cement beads medicated with amikacin in the medullary cavity and osteoclast system for irrigation with vancomycin. In the second stage, free fibular bone grafting, fixation and stabilization with screws, bioactive glass placement in areas of interface between stabilized fibula and posterior tibial cortex. <i>Results:</i> Before a multitratada chronic osteomyelitis it is necessary to individualize and evaluate treatment alternatives, in this case the surgical management in two time, the use of medication beads, bone graft and the use of bioactive glass, achieved a complete eradication of the infection and favorable clinical evolution with optimal functional recovery of affected limb.

Bioactive Glass—An Extensive Study of the Preparation and Coating Methods

Diseases or complications that are caused by bone tissue damage affect millions of patients every year. Orthopedic and dental implants have become important treatment options for replacing and repairing missing or damaged parts of bones and teeth. In order to use a material in the manufacture of implants, the material must meet several requirements, such as mechanical stability, elasticity, biocompatibility, hydrophilicity, corrosion resistance, and non-toxicity. In the 1970s, a biocompatible glassy material called bioactive glass was discovered. At a later time, several glass materials with similar properties were developed. This material has a big potential to be used in formulating medical devices, but its fragility is an important disadvantage. The use of bioactive glasses in the form of coatings on metal substrates allows the combination of the mechanical hardness of the metal and the biocompatibility of the bioactive glass. In this review, an extensive study of the literature was conducted regarding the preparation methods of bioactive glass and the different techniques of coating on various substrates, such as stainless steel, titanium, and their alloys. Furthermore, the main doping agents that can be used to impart special properties to the bioactive glass coatings are described.

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

IntroductionThis study aims to describe the occurrence of postoperative complications related to cholesteatoma surgery and to determine factors influencing the most common complication, i.e. postoperative surgical site infection (SSI) in cases with and without mastoid obliteration. Materials and methodsRetrospective analyses were performed on surgically treated cholesteatomas in our hospital between 2013 and 2019. Patient characteristics, peri- and postoperative management and complications were reviewed. The cases were divided into two groups based on whether mastoid obliteration was performed or not. ResultsA total of 336 cholesteatoma operations were performed, of which 248 cases received mastoid obliteration. In total 21 complications were observed, of which SSI was the most common (15/21). No difference in occurrence of any postoperative complication was seen between the obliteration and no-obliteration group (p = 0.798), especially not in the number of SSI (p = 0.520). Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups. In the no-obliteration group a younger age (p = 0.015), as well as primary surgery (p = 0.022) increased the risk for SSI. In the obliteration group the use of bioactive glass (BAG) S53P4 was identified as independent predictor of SSI (p = 0.008, OR 5.940). DiscussionSSI is the most common postoperative complication in cholesteatoma surgery. The causes of SSI are multifactorial, therefore further prospective research is needed to answer which factors can prevent the development of an SSI in cholesteatoma surgery.

Bioactive Glass Applications: A Literature Review of Human Clinical Trials.

The use of bioactive glasses in dentistry, reconstructive surgery, and in the treatment of infections can be considered broadly beneficial based on the emerging literature about the potential bioactivity and biocompatibility of these materials, particularly with reference to Bioglass® 45S5, BonAlive® and 19-93B3 bioactive glasses. Several investigations have been performed (i) to obtain bioactive glasses in different forms, such as bulk materials, powders, composites, and porous scaffolds and (ii) to investigate their possible applications in the biomedical field. Although in vivo studies in animals provide us with an initial insight into the biological performance of these systems and represent an unavoidable phase to be performed before clinical trials, only clinical studies can demonstrate the behavior of these materials in the complex physiological human environment. This paper aims to carefully review the main published investigations dealing with clinical trials in order to better understand the performance of bioactive glasses, evaluate challenges, and provide an essential source of information for the tailoring of their design in future applications. Finally, the paper highlights the need for further research and for specific studies intended to assess the effect of some specific dissolution products from bioactive glasses, focusing on their osteogenic and angiogenic potential.

Antibacterial bioglass in dental implants: a canine clinical study

Abstract Background Peri-implantitis is considered the most challenging biological complication in implantology, as untreated disease can progress and result in implant loss. Therefore, disease prevention is crucial in daily clinical practice. It has been reported that the use of bioactive glass, as an implant coating, can stimulate tissue integration and accelerate tissue regeneration. Besides these properties, it is possible to promote bacterial activity by inserting silver into the bioglass Methods Bioglass with composition 45S5 was synthesised by the fusion method, replacing the amount of Na2CO3 by AgNO3 (BG 2% wt). The implants were resealed by the CoBlast® technique. Clinical cases with pathology of the mandible/maxilla were selected and implants dimensioned for the canine bone structure were applied. Results Three months after implantation, imaging exams, namely CT scans, showed no signs of early rejection by septic or cytotoxic loss. No decrease or loss of peri-implant bone was observed. In all cases the implants remained without signs of instability, and with sufficient support for the application of the exo-prosthesis or dental crown. The results of histological analysis showed no signs of infection or osteolysis. The zone of peri-implant fibrosis was not observable in the samples, showing a good evolution in implant osteointegration. Conclusions The results show promising evidences for the use of this biomaterial as a coating, since aseptic rejection, later on, and that related to the shape and biomaterials used in the implant's design, usually begins during the first 3 months.

Effects of Additional Use of Bioactive Glasses or a Hydroxyapatite Toothpaste on Remineralization of Artificial Lesions in vitro

Objectives: This in vitro study aimed to evaluate and compare the effect of two different bioactive glasses, a hydroxyapatite-containing, fluoride-free toothpaste (HTP) and a fluoride toothpaste (FTP) on the remineralization behavior of initial caries lesions. Materials and Methods: A total of 100 bovine enamel samples were randomly allocated to five groups of 20 samples each: NC = negative control group (artificial saliva); HTP = HTP group (Karex); FTP = FTP group (Elmex caries protection, 1,400 ppm); FTP + BG_nano = FTP followed by Actimins bioactive glass; FTP + BG_amorph = FTP followed by Schott bioactive glass. Radiographic documentation (advanced transversal microradiography; aTMR) was applied before and after all samples were exposed to a demineralizing gel for 10 days. Over a period of 28 days, samples were covered twice a day (every 12 h) with a toothpaste slurry of the respective test group or with artificial saliva in NC for 60 s and brushed with 15 brushing strokes. Samples in FTP + BG_nano and FTP + BG_amorph were additionally treated with the respective bioactive glass slurry for 30 s after brushing with the FTP. In the meantime, all samples were stored in artificial saliva. After 28 days, the structure of all samples was assessed again using aTMR and compared to the values measured after demineralization. The statistical evaluation of the integrated mineral loss was performed using Kruskal-Wallis test followed by a post hoc Conover test. Results: The FTP revealed the significantly highest increase of mineral content while the HTP showed the significantly lowest remineralization. Compared to artificial saliva, the use of the HTP or the combined application of FTP followed by bioactive glasses (FTP + BG_nano and FTP + BG_amorph) showed no significant remineralization. Conclusion: Under remineralizing in vitro conditions, brushing with 1,400 ppm FTP induced significantly more remineralization compared to storage in artificial saliva. The additional administration of both bioactive glasses as well as the substitutional brushing with an HTP resulted in significantly less remineralization compared to brushing with 1,400 ppm FTP.

Pilot Experience on the Use of S53P4 Bioactive Glass in the Surgical Management of Diabetic Foot Osteomyelitis.

To test safety and efficacy of bioactive glass, a novel material used to replace bone, able to completely bond itself to the host tissues on patients treated for osteomyelitis (OM) complicating a diabetic foot (DF). We evaluated a group of patients consecutively admitted in our department between September and December 2018, who underwent surgical DF procedures for OM and in whom the use of bioactive glass could limit the demolition phase of surgical procedure. Patients were treated with bioactive glass S53P4 on top of standard treatment directly in operating room. The patients were weekly controlled for 6 months or until complete healing. During follow-up, we analyzed primarily healing rate and secondarily time of healing, need for further debridement procedures, recurrences, and adverse or hypersensitivity reactions to study treatment. Ten DF patients were enrolled (male/female 6/4; mean age 56 ± 11 years; mean duration of diabetes 10.5 ± 4.7 years, mean hemoglobin A1c 7.2 ± 0.9%). Patients underwent surgical procedure during which, after an accurate debridement, bioactive glass was applied. A healing rate of 80% in a mean time of 34 ± 2 days, with only 1 patient who needed a second surgical look, was observed. Neither recurrences nor adverse events during follow-up were observed in treated patients. This pilot experience demonstrated that bioactive glass can be considered a useful tool for the surgical treatment of DF-related OM.

AGENTS USED FOR ENAMEL REMINERALISATION AND REDUCING DENTIN HYPERSENSITIVITY: A COMPREHENSIVE REVIEW

ремінералізація, гіперчутливість, десенситизація, емаль, дентинRemineralisation agents not only strengthen enamel resistance, but also can occlude dentine tubules, reducing teeth sensitivity. This article provides an overview of various available agents used for enamel remineralisation and dentin hypersensitivity treatment. Conventional fluorides are used in the form of solutions, varnishes, foam, gels, dentifrices, showing low remineralising and desensitising ability as compared to newer fluoride-content products. Deep fluoridation is an effective method for reducing dentin hypersensitivity for a long time; its remineralising potential is used for white spot lesions treatment, caries prevention, and fissure sealing. Most novel fluoride compounds showed higher remineralising and desensitising abilities as compared to conventional fluorides. Deep penetration fluoridation is an effective method for remineralisation and reducing dentin hypersensitivity in long time. Despite of the fact that calcium phosphate systems have demonstrated a benefit over conventional fluorides in remineralisation their desensitising ability was not confirmed by various studies. The use of bioactive glass in remineralisation and desensitisation is quite promising, but further researches need to be undertaken to prove its efficacy. «Curodont» and synthetic nanohydroxyapatite from biomimetic systems showed good results in the above-mentioned treatments, but more researches are required to confirm their clinical efficacy. There is no doubt that iontophoresis with calcium and fluoride substances is still the most effective method in the office remineralisation, however, its potential effect in desensitisation has to be better evaluated. Efficacy of different kinds of lasers alone or in combination with a remineralisation agent has been confirmed mostly in vitro studies, therefore, there is a lack of clinical trials to prove their benefit. In latter studies, dentin sealants and desensitisers occluded dentin tubules were superior to conventional fluorides and synthetic nanohydroxyapatites. Simultaneously, the data about calcium phosphate and deep penetration fluoridation efficacy over such desensitisers as dentin sealants and nerve sensitivity inhibitors are controversial and indicate that additional studies are required to deepen our knowledge of the insufficiently explored area of reducing dentin hypesensitivity. In spite of the new advances, the ideal treatment modality for remineralisation does not exist. Within last decades, dentistry has made significant steps towards the elusive goal of enamel remineralisation and dentin desensitisation, but more long-term сlinical controlled studies are needed to confirm and quantify these findings, as well as to identify additional factors that can potentiate these processes.

Bioactive glass as dead space management following debridement of type 3 chronic osteomyelitis.

Chronic osteomyelitis is a challenging condition to treat and although no exact treatment guidelines exist, the surgical management strategy includes wide resection of necrotic and infected bone followed by dead space management. This study evaluates the use of bioactive glass as a single-stage procedure for dead space management following surgical debridement. A consecutive series of 24 patients with Cierny-Mader type 3 osteomyelitis, treated between March 2016 and June 2018, were identified and evaluated retrospectively. Patients were managed with bioactive glass as dead space management following surgical debridement. Of the patients who completed more than 12 months follow-up, all fourteen (100%) showed complete resolution of symptoms. Of the remaining ten patients with less than 12 months follow-up, eight had complete resolution of symptoms. Therefore, a preliminary result of 22 out of 24 patients (91.65%) had resolution of symptoms following debridement and dead space management with bioactive glass. One patient experienced a complication related to the use of bioactive glass. This manifested as prolonged serous wound drainage that resolved with local wound care. The use of bioactive glass appears to be effective for dead space management following debridement of anatomical type 3 chronic osteomyelitis of the appendicular skeleton.

Feasible and pure P2O5-CaO nanoglasses: An in-depth NMR study of synthesis for the modulation of the bioactive ion release

The use of bioactive glasses (e.g. silicates, phosphates, borates) has demonstrated to be an effective therapy for the restoration of bone fractures, wound healing and vascularization. Their partial dissolution towards the surrounding tissue has shown to trigger positive bioactive responses, without the necessity of using growth factors or cell therapy, which reduces money-costs, side effects and increases their translation to the clinics. However, bioactive glasses often need from stabilizers (e.g. SiO44−, Ti4+, Co2+, etc.) that are not highly abundant in the body and which metabolization is not fully understood. In this study, we were focused on synthesizing pure calcium phosphate glasses without the presence of such stabilizers. We combined a mixture of ethylphosphate and calcium 2-methoxyethoxide to synthesize nanoparticles with different compositions and degradability. Synthesis was followed by an in-depth nuclear magnetic resonance characterization, complemented with other techniques that helped us to correlate the chemical structure of the glasses with their physiochemical properties and reaction mechanism. After synthesis, the organically modified xerogel (i.e. calcium monoethylphosphate) was treated at 200 or 350 °C and its solubility was maintained and controlled due to the elimination of organics, increase of phosphate-calcium interactions and phosphate polycondensation. To the best of our knowledge, we are reporting the first sol-gel synthesis of binary (P2O5-CaO) calcium phosphate glass nanoparticles in terms of continuous polycondensated phosphate chains structure without the addition of extra ions. The main goal is to straightforward the synthesis, to get a safer metabolization and to modulate the bioactive ion release. Additionally, we shed light on the chemical structure, reaction mechanism and properties of calcium phosphate glasses with high calcium contents, which nowadays are poorly understood. Statement of SignificanceThe use of bioactive inorganic materials (i.e. bioactive ceramics, glass-ceramics and glasses) for biomedical applications is attractive due to their good integration with the host tissue without the necessity of adding exogenous cells or growth factors. In particular, degradable calcium phosphate glasses are completely resorbable, avoiding the retention in the body of the highly stable silica network of silicate glasses, and inducing a more controllable degradability than bioactive ceramics. However, most calcium phosphate glasses include the presence of stabilizers (e.g. Ti4+, Na+, Co2+), which metabolization is not fully understood and complicates their synthesis. The development of binary calcium phosphate glasses with controlled degradability reduces these limitations, offering a simple and completely metabolizable material with higher transfer to the clinics.

Clinical applications of Bioactive glass S53P4 in bone infections: a systematic review.

Treatment of osteomyelitis, in of itself, is challenging but is further complicated by attendant bone infections. The management of bone infection, and bone rebuilding may be assisted by the use of bioactive glasses (BAGs) which have antimicrobial and osteo-stimulative proprieties. However, this clinical application and potential complications associated with BAGs (e.g., BAG S53P4), are poorly defined. The aim of this study is to review the results of clinical research using BAG S53P4 in the treatment of human bone infections. This review was conducted in accordance with the PRISMA statement. The following databases were searched: PubMed, Cochrane Library, EMBASE, and Scopus. We examined electronic databases from 1965 to 2018 using different combinations of the following keywords: "S53P4", "BonAlive", "infection" and "osteomyelitis". Eight studies were considered which included a total of 276 cases (mean age of 49.3 years). The most frequent pathogen isolated was Staphylococcus aureus. A one-step surgical procedure was performed in 89.85% of cases. Good clinical and radiological outcomes were reported with a mean follow-up of 21.5 months. Twenty-three complications (8.3% of total cases) were described with the recurrence of bone infection as the most common complication (6.15% of total cases). BAG-S53P4 seems to be a useful bone filler in orthopaedic surgery for osteomyelitis treatment. The attendant clinical results and associated rate of complications associated with BAG S53P4 use are comparable with those of other techniques in the short term. However, long-term follow-up studies are required in order to confirm the longevity of this treatment.