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Zhao H, Liu C, Liu Y, Ding Q, Wang T, Li H, Wu H, Ma T. Harnessing electromagnetic fields to assist bone tissue engineering. Stem Cell Res Ther 2023; 14:7. [PMID: 36631880 PMCID: PMC9835389 DOI: 10.1186/s13287-022-03217-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
Bone tissue engineering (BTE) emerged as one of the exceptional means for bone defects owing to it providing mechanical supports to guide bone tissue regeneration. Great advances have been made to facilitate the success of BTE in regenerating bone within defects. The use of externally applied fields has been regarded as an alternative strategy for BTE. Electromagnetic fields (EMFs), known as a simple and non-invasive therapy, can remotely provide electric and magnetic stimulation to cells and biomaterials, thus applying EMFs to assist BTE would be a promising strategy for bone regeneration. When combined with BTE, EMFs improve cell adhesion to the material surface by promoting protein adsorption. Additionally, EMFs have positive effects on mesenchymal stem cells and show capabilities of pro-angiogenesis and macrophage polarization manipulation. These advantages of EMFs indicate that it is perfectly suitable for representing the adjuvant treatment of BTE. We also summarize studies concerning combinations of EMFs and diverse biomaterial types. The strategy of combining EMFs and BTE receives encouraging outcomes and holds a promising future for effectively treating bone defects.
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Affiliation(s)
- Hongqi Zhao
- grid.33199.310000 0004 0368 7223Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China
| | - Chaoxu Liu
- grid.33199.310000 0004 0368 7223Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China
| | - Yang Liu
- grid.33199.310000 0004 0368 7223Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China
| | - Qing Ding
- grid.33199.310000 0004 0368 7223Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China
| | - Tianqi Wang
- grid.33199.310000 0004 0368 7223Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China
| | - Hao Li
- grid.33199.310000 0004 0368 7223Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Tian Ma
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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In Vitro Production of Calcified Bone Matrix onto Wool Keratin Scaffolds via Osteogenic Factors and Electromagnetic Stimulus. MATERIALS 2020; 13:ma13143052. [PMID: 32650489 PMCID: PMC7411850 DOI: 10.3390/ma13143052] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/15/2022]
Abstract
Pulsed electromagnetic field (PEMF) has drawn attention as a potential tool to improve the ability of bone biomaterials to integrate into the surrounding tissue. We investigated the effects of PEMF (frequency, 75 Hz; magnetic induction amplitude, 2 mT; pulse duration, 1.3 ms) on human osteoblast-like cells (SAOS-2) seeded onto wool keratin scaffolds in terms of proliferation, differentiation, and production of the calcified bone extracellular matrix. The wool keratin scaffold offered a 3D porous architecture for cell guesting and nutrient diffusion, suggesting its possible use as a filler to repair bone defects. Here, the combined approach of applying a daily PEMF exposure with additional osteogenic factors stimulated the cells to increase both the deposition of bone-related proteins and calcified matrix onto the wool keratin scaffolds. Also, the presence of SAOS-2 cells, or PEMF, or osteogenic factors did not influence the compression behavior or the resilience of keratin scaffolds in wet conditions. Besides, ageing tests revealed that wool keratin scaffolds were very stable and showed a lower degradation rate compared to commercial collagen sponges. It is for these reasons that this tissue engineering strategy, which improves the osteointegration properties of the wool keratin scaffold, may have a promising application for long term support of bone formation in vivo.
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Lullini G, Cammisa E, Setti S, Sassoli I, Zaffagnini S, Marcheggiani Muccioli GM. Role of pulsed electromagnetic fields after joint replacements. World J Orthop 2020; 11:285-293. [PMID: 32572365 PMCID: PMC7298453 DOI: 10.5312/wjo.v11.i6.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/14/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
Although the rate of patients reporting satisfaction is generally high after joint replacement surgery, up to 23% after total hip replacement and 34% after total knee arthroplasty of treated subjects report discomfort or pain 1 year after surgery. Moreover, chronic or subacute inflammation is reported in some cases even a long time after surgery. Another open and debated issue in prosthetic surgery is implant survivorship, especially when related to good prosthesis bone ingrowth. Pulsed Electro Magnetic Fields (PEMFs) treatment, although initially recommended after total joint replacement to promote bone ingrowth and to reduce inflammation and pain, is not currently part of usual clinical practice. The purpose of this review was to analyze existing literature on PEMFs effects in joint replacement surgery and to report results of clinical studies and current indications. We selected all currently available prospective studies or RCT on the use of PEMFs in total joint replacement with the purpose of investigating effects of PEMFs on recovery, pain relief and patients’ satisfaction following hip, knee or shoulder arthroplasty. All the studies analyzed reported no adverse effects, and good patient compliance to the treatment. The available literature shows that early control of joint inflammation process in the first days after surgery through the use of PEMFs should be considered an effective completion of the surgical procedure to improve the patient’s functional recovery.
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Affiliation(s)
- Giada Lullini
- Laboratorio di Analisi del Movimento e di valutazione funzionale protesi, IRCCS Istituto Ortopedico Rizzoli - DIBINEM - University of Bologna, Bologna 40100, Italy
| | - Eugenio Cammisa
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli - DIBINEM - University of Bologna, Bologna 40100, Italy
| | - Stefania Setti
- Laboratory of Clinical Biophysics, IGEA S.p.A. Clinical Biophysics, 41012 Carpi (Mo), Italy
| | - Iacopo Sassoli
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli - DIBINEM - University of Bologna, Bologna 40100, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli - DIBINEM - University of Bologna, Bologna 40100, Italy
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The Use of Pulsed Electromagnetic Fields to Promote Bone Responses to Biomaterials In Vitro and In Vivo. Int J Biomater 2018; 2018:8935750. [PMID: 30254677 PMCID: PMC6140132 DOI: 10.1155/2018/8935750] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/09/2018] [Indexed: 12/14/2022] Open
Abstract
Implantable biomaterials are extensively used to promote bone regeneration or support endosseous prosthesis in orthopedics and dentistry. Their use, however, would benefit from additional strategies to improve bone responses. Pulsed Electromagnetic Fields (PEMFs) have long been known to act on osteoblasts and bone, affecting their metabolism, in spite of our poor understanding of the underlying mechanisms. Hence, we have the hypothesis that PEMFs may also ameliorate cell responses to biomaterials, improving their growth, differentiation, and the expression of a mature phenotype and therefore increasing the tissue integration of the implanted devices and their clinical success. A broad range of settings used for PEMFs stimulation still represents a hurdle to better define treatment protocols and extensive research is needed to overcome this issue. The present review includes studies that investigated the effects of PEMFs on the response of bone cells to different classes of biomaterials and the reports that focused on in vivo investigations of biomaterials implanted in bone.
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Gujjalapudi M, Anam C, Mamidi P, Chiluka R, Kumar AG, Bibinagar R. Effect of Magnetic Field on Bone Healing around Endosseous Implants - An In-vivo Study. J Clin Diagn Res 2016; 10:ZF01-ZF04. [PMID: 27891492 DOI: 10.7860/jcdr/2016/21509.8666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/26/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION After implant placement, a stress-free healing period of 3-6 months is a pre-requisite to achieve good osseointegration. If this duration could be reduced, the patients would feel happier. Eventhough, immediate loading of implants is a clinically feasible concept; it is not possible in certain situations. Few studies have shown that Static magnetic field is useful to promote bone formation faster after the bone is wounded. AIM This pilot study was intended to evaluate the tissue response after implant placement under the influence of magnetic field. MATERIALS AND METHODS Twenty Tidal Spiral implants were used for this study. Two implants were placed in each patient in the anterior mandible corresponding to the B and D regions and the implant on the D region was exposed to magnetic field using safer magnet (Neodymium Boron Iron) and the implant on the B region served as a control. Both the implants were compared for stability using Resonance Frequency Analyzer (RFA) at Days 0, 30, 60 and 90. Mean Implant Stability Quotient (ISQ) values were compared on both sides using student's paired t-test and repeated measures ANOVA (analysis of variance). There was a significant difference in the mean ISQ values, hence, a post-hoc test was done to evaluate whether there is any difference between the follow-ups. RESULTS The average ISQ value for implants at 0 day in the B and D regions was 68.6 and 68.7 respectively. The average ISQ value at 30th day, 60th day and 90th day was 73.25, 76.05 and 78.95 respectively on the magnetic side (D region). Whereas on the non-magnetic side (B region) at 30th day, 60th day and 90th day was 68.45, 72.05 and 74.45 respectively. CONCLUSION The implant stability quotient values obtained on the magnetic side were significantly greater than on the non-magnetic side. Positive correlation exists between the magnetic field and osseointegration.
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Affiliation(s)
- Mahalakshmi Gujjalapudi
- Assistant Professor, Department of Prosthodontics, Government Dental College , Vijayawada, Andhra Pradesh, India
| | - Chandrasekar Anam
- Professor and Head, Department of Prosthodontics, SVS Dental College , Mahabubnagar, Telangana, India
| | - Praveen Mamidi
- Professor and Head, Department of Prosthodontics, PMVIDS and RC , Hyderabad, Telangana, India
| | - Radha Chiluka
- Senior Lecturer, Department of Prosthodontics, PMVIDS and RC , Hyderabad, Telangana, India
| | - A Gautam Kumar
- Professor, Department of Prosthodontics, PMVIDS and RC , Hyderabad, Telangana, India
| | - Ragini Bibinagar
- Senior Lecturer, Department of Prosthodontics, PMVIDS and RC , Hyderabad, Telangana, India
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Barak S, Neuman M, Iezzi G, Piattelli A, Perrotti V, Gabet Y. A new device for improving dental implants anchorage: a histological and micro-computed tomography study in the rabbit. Clin Oral Implants Res 2015; 27:935-42. [PMID: 26249830 DOI: 10.1111/clr.12661] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE In the present study, a new healing cap that could generate a pulsed electromagnetic field (PEMF) around titanium implants to stimulate peri-implant osteogenesis was tested in the rabbit model. MATERIALS AND METHODS A total of 22 implants were inserted in the proximal tibial metaphysis of 22 rabbits. A healing cap containing the active device was inserted in half of the implants (11 test implants); an "empty" healing cap was inserted in the other ones (11 control implants). The animals were euthanized after 2 and 4 weeks, and the samples were processed for micro-computed tomography and histology. The peri-implant volume was divided into coronal (where the PEMF was the strongest) and apical regions. RESULTS Most of the effects of the tested device were confined to the coronal region. Two weeks post-implantation, test implants showed a significant 56% higher trabecular bone fraction (BV/TV), associated with enhanced trabecular number (Tb.N, +37%) and connectivity density (Conn.D, +73%) as compared to the control group; at 4 weeks, the PEMF induced a 69% increase in BV/TV and 34% increase of Tb.N. There was no difference in the trabecular thickness (Tb.Th) at either time point. Furthermore, we observed a 48% higher bone-to-implant contact (BIC) in the test implants vs. controls after 2 weeks; this increase tended to remain stable until the fourth week. Mature trabecular and woven bone were observed in direct contact with the implant surface with no gaps or connective tissue at the bone-implant interface. CONCLUSIONS These results indicate that the PEMF device stimulated early bone formation around dental implants resulting in higher peri-implant BIC and bone mass already after 2 weeks which suggests an acceleration of the osseointegration process by more than three times.
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Affiliation(s)
| | | | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Vittoria Perrotti
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Yankel Gabet
- Department of Anatomy & Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Establishment of a novel in vitro test setup for electric and magnetic stimulation of human osteoblasts. Cell Biochem Biophys 2015; 70:805-17. [PMID: 24782061 DOI: 10.1007/s12013-014-9984-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
When large defects occur, bone regeneration can be supported by bone grafting and biophysical stimuli like electric and magnetic stimulation (EMS). Clinically established EMS modes are external coils and surgical implants like an electroinductive screw system, which combines a magnetic and electric field, e.g., for the treatment of avascular bone necrosis or pseudarthrosis. For optimization of this implant system, an in vitro test setup was designed to investigate effects of EMS on human osteoblasts on different 3D scaffolds (based on calcium phosphate and collagen). Prior to the cell experiments, numerical simulations of the setup, as well as experimental validation, via measurements of the electric parameters induced by EMS were conducted. Human osteoblasts (3 × 10(5) cells) were seeded onto the scaffolds and cultivated. After 24 h, screw implants (Stryker ASNIS III s-series) were centered in the scaffolds, and EMS was applied (3 × 45 min per day at 20 Hz) for 3 days. Cell viability and collagen type 1 (Col1) synthesis were determined subsequently. Numerical simulation and validation showed an adequate distribution of the electric field within the scaffolds. Experimental measurements of the electric potential revealed only minimal deviation from the simulation. Cell response to stimulation varied with scaffold material and mode of stimulation. EMS-stimulated cells exhibited a significant decrease of metabolic activity in particular on collagen scaffolds. In contrast, the Col1/metabolic activity ratio was significantly increased on collagen and non-sintered calcium phosphate scaffolds after 3 days. Exclusive magnetic stimulation showed similar but nonsignificant tendencies in metabolic activity and Col1 synthesis. The cell tests demonstrate that the new test setup is a valuable tool for in vitro testing and parameter optimization of the clinically used electroinductive screw system. It combines magnetic and electric stimulation, allowing in vitro investigations of its influence on human osteoblasts.
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Leesungbok R, Ahn SJ, Lee SW, Park GH, Kang JS, Choi JJ. The Effects of a Static Magnetic Field on Bone Formation Around a Sandblasted, Large-Grit, Acid-Etched–Treated Titanium Implant. J ORAL IMPLANTOL 2013. [DOI: 10.1563/aaid-joi-d-11-00101] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to compare the bone formation around commercial sandblasted, large-grit, acid-etched (SLA)–treated titanium implants with or without a neodymium magnet in a rabbit tibia through histomorphometric analysis. Commercial SLA-treated implants with or without neodymium magnets were placed in 10 rabbits. After incising the flat part of the rabbit's tibia and installation of the specimens of titanium implants, the nonmagnet group was stitched without magnet insertion. On the other hand, the magnet group was inserted with neodymium magnet, fixed with pattern resin, and stitched. At 3 and 6 weeks after surgery, the animals were sacrificed, and the specimens were obtained. Undecalcified specimens were prepared for histomorphometric analysis of the bone-to-implant contact ratio (BIC) and bone volume (BV). The histomorphometric findings of the cortical bone showed that the mean BVs of the magnet group (3 weeks, 75.99%; 6 weeks, 82.94%) were higher than those of the nonmagnet group (3 weeks, 74.58%; 6 weeks, 78.75%), but there were no significant differences between the 2 groups (P > .05). In the marrow bone, the mean BICs of the magnet group (3 weeks, 10.36%; 6 weeks, 10.41%) were higher than those of the nonmagnet group (3 weeks, 6.41%; 6 weeks, 7.36%). After 3 weeks of installation, there was a significant difference between the 2 groups (P < .05). In rabbit tibia, the SLA-treated titanium implants with a neodymium magnet can trigger faster early peri-implant bone formation than those without a magnet.
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Affiliation(s)
- Richard Leesungbok
- Department of Biomaterials & Prosthodontics, Kyung Hee University Hospital at Gangdong, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Su-Jin Ahn
- Department of Biomaterials & Prosthodontics, Kyung Hee University Hospital at Gangdong, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Suk-Won Lee
- Department of Biomaterials & Prosthodontics, Kyung Hee University Hospital at Gangdong, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Geon-Ho Park
- Department of Prosthodontics, School of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Joo-Sung Kang
- Department of Prosthodontics, School of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jung-Joo Choi
- Department of Prosthodontics, School of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
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Kim YD. Biophysical therapy and biostimulation in unfavorable bony circumstances: adjunctive therapies for osseointegration. J Korean Assoc Oral Maxillofac Surg 2012. [DOI: 10.5125/jkaoms.2012.38.4.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yong-Deok Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
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Dallari D, Fini M, Giavaresi G, Del Piccolo N, Stagni C, Amendola L, Rani N, Gnudi S, Giardino R. Effects of pulsed electromagnetic stimulation on patients undergoing hip revision prostheses: a randomized prospective double-blind study. Bioelectromagnetics 2009; 30:423-30. [PMID: 19384914 DOI: 10.1002/bem.20492] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this prospective, randomized, double-blind study, the effect of Pulsed Electromagnetic Fields (PEMFs) was investigated in 30 subjects undergoing hip revision using the Wagner SL stem. The subjects were treated for 6 h/day up to 90 days after revision. Study end points were assessed clinically by the functional scale of Merle D'Aubigné and instrumentally by Dual-Energy X-ray Absorptiometry (DXA) at the Gruen zones. Subject improvement according to Merle D'Aubigné scale was higher (P < 0.05) in subjects undergoing active stimulation compared to placebo. In analyzing the DXA findings, we subtracted for each area the postoperative bone mineral density (BMD) values from those measured at 90 days and we considered all results above 3.5% as responders. There were no significant differences in the average BMD values at each Gruen zone between the two groups both postoperatively and at 90 days investigation. In Gruen zones 5 and 6, corresponding to the medial cortex, we observed six responders (40%) in both areas in the control group, while in the stimulated group we observed 14 (93%) and 10 (66%) responders, respectively (both P < 0.05). This study showed that PEMF treatment aids clinical recovery and bone stock restoration.
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Affiliation(s)
- Dante Dallari
- VII Division of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
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Vera R, Picazo ML, Royuela M, Romo MA, Alpuente J, Bardasano JL. Bone Density Changes in Mouse Offspring after 50-HZ, 15-μT Electromagnetic Field Long-Term Exposure of two Generations. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/15368379909012902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rispoli FP, Corolla FM, Mussner R. The Use of Low Frequency Pulsing Electromagnetic Fields in Patients with Painful Hip Prostheses. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/15368378809027748] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Osteoformin Accelerates Fresh Fracture Healing in Rats. J Oral Maxillofac Surg 2007; 65:2470-4. [DOI: 10.1016/j.joms.2007.06.630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 03/06/2007] [Accepted: 06/06/2007] [Indexed: 11/18/2022]
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Vincent W, Andrasik F, Sherman R. Headache Treatment with Pulsing Electromagnetic Fields: A Literature Review. Appl Psychophysiol Biofeedback 2007; 32:191-207. [DOI: 10.1007/s10484-007-9045-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 10/09/2007] [Indexed: 11/28/2022]
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Akca K, Sarac E, Baysal U, Fanuscu M, Chang TL, Cehreli M. Micro-morphologic changes around biophysically-stimulated titanium implants in ovariectomized rats. Head Face Med 2007; 3:28. [PMID: 17634134 PMCID: PMC1947957 DOI: 10.1186/1746-160x-3-28] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 07/16/2007] [Indexed: 12/03/2022] Open
Abstract
Background Osteoporosis may present a risk factor in achievement of osseointegration because of its impact on bone remodeling properties of skeletal phsiology. The purpose of this study was to evaluate micro-morphological changes in bone around titanium implants exposed to mechanical and electrical-energy in osteoporotic rats. Methods Fifteen 12-week old sprague-dowley rats were ovariectomized to develop osteoporosis. After 8 weeks of healing period, two titanium implants were bilaterally placed in the proximal metaphyses of tibia. The animals were randomly divided into a control group and biophysically-stimulated two test groups with five animals in each group. In the first test group, a pulsed electromagnetic field (PEMF) stimulation was administrated at a 0.2 mT 4 h/day, whereas the second group received low-magnitude high-frequency mechanical vibration (MECHVIB) at 50 Hz 14 min/day. Following completion of two week treatment period, all animals were sacrificed. Bone sites including implants were sectioned, removed en bloc and analyzed using a microCT unit. Relative bone volume and bone micro-structural parameters were evaluated for 144 μm wide peri-implant volume of interest (VOI). Results Mean relative bone volume in the peri-implant VOI around implants PEMF and MECHVIB was significantly higher than of those in control (P < .05). Differences in trabecular-thickness and -separation around implants in all groups were similar (P > .05) while the difference in trabecular-number among test and control groups was significant in all VOIs (P < .05). Conclusion Biophysical stimulation remarkably enhances bone volume around titanium implants placed in osteoporotic rats. Low-magnitude high-frequency MECHVIB is more effective than PEMF on bone healing in terms of relative bone volume.
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Affiliation(s)
- Kivanc Akca
- Research Scholar, Division of Restorative Dentistry, The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, UCLAc School of Dentistry, USA
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Ebru Sarac
- Private Practice, Obstetrics and Gynecology, Ankara, Turkey
| | - Ugur Baysal
- Associate Professor, Department of Electrical and Electronics Engineering, Hacettepe University, Ankara, Turkey
| | - Mete Fanuscu
- Associate Clinical Professor, Division of Restorative Dentistry, The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, USA
| | - Ting-Ling Chang
- Associate Clinicial Professor, Division of Advanced Prosthodontics, The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, USA
| | - Murat Cehreli
- Associate Professor of Prosthodontics, CosmORAL Oral and Dental Health Polyclinics, Ankara, Turkey
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Digel I, Kurulgan E, Linder P, Kayser P, Porst D, Braem GJ, Zerlin K, Artmann GM, Artmann AT. Decrease in extracellular collagen crosslinking after NMR magnetic field application in skin fibroblasts. Med Biol Eng Comput 2007; 45:91-7. [PMID: 17203317 DOI: 10.1007/s11517-006-0144-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Accepted: 12/11/2006] [Indexed: 11/29/2022]
Abstract
Although biological effects of electromagnetic fields were investigated intensively, there is still no agreement on the significance of their effects. The underlying mechanisms and therapeutic importance are still mostly unknown too. In this study, primary cultures of human dermal fibroblasts were exposed to magnetic field at nuclear magnetic resonance (NMR) conditions for in total 5 days and 4 h/day. Among the investigated parameters were: cell proliferation rate, cell morphology, total protein concentration as well as content of skin-specific collagen types I, III, IV. NMR exposure induced distinct changes both in cellular and extracellular components. The extracellular matrix (ECM) of NMR-exposed cells had less cross-linked collagen. In particular, the increase of collagen of the soluble fraction was at 17.2 +/- 2.9% for type I, 27.0 +/- 1.86% for type III, 17.3 +/- 1.46% for type IV (N = 6). In the absence of resonance frequency, the effects of magnetic field on ECM were less profound.
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Affiliation(s)
- I Digel
- Department of Biomedical Engineering, Laboratory of Cell Biophysics, Aachen University of Applied Sciences, Ginsterweg 1, 52428, Juelich, Germany.
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Fini M, Giavaresi G, Giardino R, Cavani F, Cadossi R. Histomorphometric and mechanical analysis of the hydroxyapatite-bone interface after electromagnetic stimulation: an experimental study in rabbits. ACTA ACUST UNITED AC 2006; 88:123-8. [PMID: 16365135 DOI: 10.1302/0301-620x.88b1.16496] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We investigated the effect of stimulation with a pulsed electromagnetic field on the osseointegration of hydroxyapatite in cortical bone in rabbits. Implants were inserted into femoral cortical bone and were stimulated for six hours per day for three weeks. Electromagnetic stimulation improved osseointegration of hydroxyapatite compared with animals which did not receive this treatment in terms of direct contact with the bone, the maturity of the bone and mechanical fixation. The highest values of maximum push-out force (F(max)) and ultimate shear strength (sigma(u)) were observed in the treated group and differed significantly from those of the control group at three weeks (F(max); p < 0.0001; sigma(u), p < 0.0005).
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Affiliation(s)
- M Fini
- Experimental Surgery Laboratory, Research Institute Codivilla-Putti, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy.
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Fini M, Giavaresi G, Setti S, Martini L, Torricelli P, Giardino R. Current trends in the enhancement of biomaterial osteointegration: biophysical stimulation. Int J Artif Organs 2005; 27:681-90. [PMID: 15478539 DOI: 10.1177/039139880402700806] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To enhance bone implant osteointegration, many strategies for improving biomaterial properties have been developed which include optimization of implant material, implant design, surface morphology and osteogenetic coatings. Other methods that have been attempted to enhance endogenous bone healing around biomaterials are different forms of biophysical stimulations such as pulsed electromagnetic fields (PEMFs) and low intensity pulsed ultrasounds (LIPUS), which were initially developed to accelerate fracture healing. To aid in the use of adjuvant biophysical therapies in the management of bone-implant osteointegration, the present authors reviewed experimental and clinical studies published in the literature over the last 20 years on the combined use of biomaterials and PEMFs or LIPUS, and summarized the methodology, and the possible mechanism of action and effectiveness of the different biophysical stimulations for the enhancement of bone healing processes around bone implanted biomaterials.
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Affiliation(s)
- M Fini
- Department of Experimental Surgery, Research Institute Codivilla-Putti, Rizzoli Orthopedic Institute, Bologna, Italy
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Buzzá EP, Shibli JA, Barbeiro RH, Barbosa JRDA. Effects of electromagnetic field on bone healing around commercially pure titanium surface: histologic and mechanical study in rabbits. IMPLANT DENT 2003; 12:182-7. [PMID: 12861888 DOI: 10.1097/01.id.0000058385.23346.4d] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this pilot study was to evaluate the histologic and mechanical healing process in dental implants under the action of pulsed electromagnetic field (PEMF). MATERIALS AND METHODS Forty-eight commercially pure implant fixtures were implanted in tibiae metaphysis of 12 New Zealand white rabbits divided into experimental (PEMF) and control groups. A PEMF with pulse width of 85 microseconds and a pulse frequency of 20 Mc was applied for 30 minutes per day. The animals were killed 21 and 42 days after implantation. The mechanical tests were performed in all animals and bone biopsies were prepared for decalcified sections analysis. RESULTS Mechanical tests did not show significant differences between the groups (P > 0.05); however, statistically significant differences were observed over time (P < 0.0001). Similar histologic features were achieved for both groups. CONCLUSIONS These results suggest that PEMF stimulation does not improve the bone-healing process around commercially pure dental implants.
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Affiliation(s)
- Edmur Pereira Buzzá
- Department of Oral and Maxillofacial Surgery, Dental School of Piracicaba (UNICAMP), Piracicaba-São Paulo, Brazil
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Fini M, Cadossi R, Canè V, Cavani F, Giavaresi G, Krajewski A, Martini L, Aldini NN, Ravaglioli A, Rimondini L, Torricelli P, Giardino R. The effect of pulsed electromagnetic fields on the osteointegration of hydroxyapatite implants in cancellous bone: a morphologic and microstructural in vivo study. J Orthop Res 2002; 20:756-63. [PMID: 12168664 DOI: 10.1016/s0736-0266(01)00158-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Effects of pulsed electromagnetic fields (PEMFs, 75 Hz. 1.6 mT) were investigated in 12 rabbits after placing hydroxyapatite (HA) implants in their femoral condyles. Six animals were stimulated with PEMFs for three consecutive weeks, 6 h/day, while the remaining animals were sham-treated (Control Group). Rabbits were sacrificed at 3 and 6 weeks (after a 3-week non-stimulation period) for histomorphometric analysis and microhardness testing (at 200, 500, 1,000, 2,000 microm from the implant) around the implants. Histomorphometric analysis did not highlight any significant changes. On the contrary, there were statistically significant differences between the effects produced by PEMFs and Control Groups (F = 149.70, p < 0.0005) on the Affinity Index results, as well as by the experimental time of 6 and 3 weeks (F = 17.12, p = 0.001) on the same results. In PEMF-stimulated animals the microhardness (HV) values measured in trabecular bone at a distance of 200 and 500 microm from the implants, were significantly higher with respect to controls. At 6 weeks, HV values at the bone-implant interface in PEMF-stimulated animals were not significantly different with respect to normal bone, while they remained significantly lower in control animals. Both morphological and structural results demonstrated a positive therapeutic effect of PEMFs in accelerating HA osteointegration in trabecular bone.
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Nishiguchi S, Kato H, Neo M, Oka M, Kim HM, Kokubo T, Nakamura T. Alkali- and heat-treated porous titanium for orthopedic implants. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2001. [PMID: 11093179 DOI: 10.1002/1097-4636(200102)54:2%3c198::aid-jbm6%3e3.0.co;2-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study was carried out to investigate the effects of the alkali and heat treatments on the bone-bonding behavior of porous titanium implants. Porous titanium implants had a 4.6 mm solid core and a 0.7 mm thick porous outer layer using pure titanium plasma-spray technique. Three types of porous implants were prepared from these pieces: 1.control implant (CL implant) as manufactured 2.AW-glass ceramic bottom-coated implant (AW implant) in which AW-glass ceramic was coated on only the bottom of the pore of the implant 3.alkali- and heat-treated implant (AH implant), where implants were immersed in 5 mol/L NaOH solution at 60 degrees C for 24 h and subsequently heated at 600 degrees C for 1 h. The implants were inserted into bilateral femora of six dogs hemi-transcortically in a randomized manner. At 4 weeks, push-out tests revealed that the mean shear strengths of the CL, AW, and AH implants were about 10.8, 12.7, and 15.0 MPa, respectively. At 12 weeks there was no significant difference between the bonding strengths of the three types of the porous implants (16.0-16.7 MPa). Histologically and histomorphologically, direct bone contact with the implant surface was significantly higher in the AH implants than the CL and AW implants both at 4 and 12 weeks. Thus, the higher bonding strength between bone and alkali- and heat-treated titanium implants was attributed to the direct bonding between bone and titanium surface. In conclusion, alkali and heat treatments can provide porous titanium implants with earlier stable fixation.
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Affiliation(s)
- S Nishiguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Shougoin-kawaharacho 54, Sakyo-ku, Kyoto 606-8507, Japan.
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22
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Nishiguchi S, Kato H, Neo M, Oka M, Kim HM, Kokubo T, Nakamura T. Alkali- and heat-treated porous titanium for orthopedic implants. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2001; 54:198-208. [PMID: 11093179 DOI: 10.1002/1097-4636(200102)54:2<198::aid-jbm6>3.0.co;2-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study was carried out to investigate the effects of the alkali and heat treatments on the bone-bonding behavior of porous titanium implants. Porous titanium implants had a 4.6 mm solid core and a 0.7 mm thick porous outer layer using pure titanium plasma-spray technique. Three types of porous implants were prepared from these pieces: 1.control implant (CL implant) as manufactured 2.AW-glass ceramic bottom-coated implant (AW implant) in which AW-glass ceramic was coated on only the bottom of the pore of the implant 3.alkali- and heat-treated implant (AH implant), where implants were immersed in 5 mol/L NaOH solution at 60 degrees C for 24 h and subsequently heated at 600 degrees C for 1 h. The implants were inserted into bilateral femora of six dogs hemi-transcortically in a randomized manner. At 4 weeks, push-out tests revealed that the mean shear strengths of the CL, AW, and AH implants were about 10.8, 12.7, and 15.0 MPa, respectively. At 12 weeks there was no significant difference between the bonding strengths of the three types of the porous implants (16.0-16.7 MPa). Histologically and histomorphologically, direct bone contact with the implant surface was significantly higher in the AH implants than the CL and AW implants both at 4 and 12 weeks. Thus, the higher bonding strength between bone and alkali- and heat-treated titanium implants was attributed to the direct bonding between bone and titanium surface. In conclusion, alkali and heat treatments can provide porous titanium implants with earlier stable fixation.
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Affiliation(s)
- S Nishiguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Shougoin-kawaharacho 54, Sakyo-ku, Kyoto 606-8507, Japan.
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Shi D, Jiang G. Synthesis of hydroxyapatite films on porous Al2O3 substrate for hard tissue prosthetics. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 1998. [DOI: 10.1016/s0928-4931(98)00048-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Mooney V, Massie JB, Lind BI, Rah JH, Negri S, Holmes RE. Comparison of hydroxyapatite granules to autogenous bone graft in fusion cages in a goat model. SURGICAL NEUROLOGY 1998; 49:628-33; discussion 633-4. [PMID: 9637622 DOI: 10.1016/s0090-3019(98)00049-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the increased use of fusion cages to achieve lumbar intervertebral fusion, the question arises as to the potential for bone ingrowth from the host bone through the entire cage. Is it even necessary to have an autogenous graft to achieve total bone incorporation? METHODS Nine adult male goats had fusion cages implanted into three vertebral bodies. The design was Surgical Dynamics/Ray Fusion Cage, measuring 21 mm x 14 mm. In each animal, one fusion cage was filled with autogenous graft, one with hydroxyapatite, porous granules, and the other with nonporous granules. Amount of new bone formation was determined by backscatter electron microscopy at 3 months post implantation in all animals. RESULTS The histologic section shows that there was total incorporation in all specimens at 3 months. There was slightly more new bone (43%) with the nonporous granules compared with the porous granules (35%). The amount of residual void space was about the same in all specimens, indicating that the amount of new bone formation was similar and not statistically different in cages filled with hydroxyapatite granules versus granules of autogenous bone. CONCLUSION This study confirms that total incorporation by ingrowth of new bone can be expected in fusion cages. The amount of ingrowth is about the same for autogenous graft versus hydroxyapatite granules. Apparently, it is not necessary to use bone graft to achieve successful bone incorporation if an acceptable biocompatable lattice, such as hydroxyapatite granules, is used.
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Affiliation(s)
- V Mooney
- University of California, San Diego, Department of Orthopaedics, USA
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25
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Friedman RJ, An YH, Ming J, Draughn RA, Bauer TW. Influence of biomaterial surface texture on bone ingrowth in the rabbit femur. J Orthop Res 1996; 14:455-64. [PMID: 8676259 DOI: 10.1002/jor.1100140316] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to examine both the histologic and the mechanical characteristics of bone apposition to an experimental surface, arc-deposited titanium, in a rabbit model and to compare them with those of four previously studied surfaces: one layer of cobalt-chromium beads, three layers of cobalt-chromium beads, plasma-sprayed cobalt-chromium, and uncoated titanium alloy. Bilateral cylindrical implants were press-fit into the lateral femoral condyles of 70 adult New Zealand White rabbits, which were allowed unrestricted activity and then killed at 6 or 12 weeks. The distal femora were harvested, radiographed, and prepared for either mechanical or histologic evaluation. All of the implants with coated surfaces had significantly greater shear strength than the implants of grit-blasted titanium alloy after both 6 and 12 weeks. After 6 weeks, maximum bone apposition occurred in the beaded surfaces. After 12 weeks, the shear strengths and bone apposition of implants of arc-deposited titanium and of one and three layers of cobalt-chromium beads were significantly greater than those of implants of plasma-sprayed cobalt-chromium and grit-blasted titanium alloy. The histologic studies correlated with the mechanical results. After 12 weeks, the bone apposition and mechanical stability of arc-deposited titanium were similar to those of a single layer of beads. There appeared to be no advantage to multiple layers of beads, and the plasma-sprayed cobalt-chromium and grit-blasted titanium surfaces showed lower shear strength and bone apposition than the other groups.
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Affiliation(s)
- R J Friedman
- Departments of Orthopaedic Surgery, Medical University of South Carolina, Charleston 29425, USA
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Rubin J, McLeod KJ, Titus L, Nanes MS, Catherwood BD, Rubin CT. Formation of osteoclast-like cells is suppressed by low frequency, low intensity electric fields. J Orthop Res 1996; 14:7-15. [PMID: 8618169 DOI: 10.1002/jor.1100140104] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
With use of a solenoid to generate uniform time-varying electric fields, the effect of extremely low frequency electric fields on osteoclast-like cell formation stimulated by 1,25(OH)2D3 was studied in primary murine marrow culture. Recruitment of osteoclast-like cells was assessed by counting multinuclear, tartrate-resistant acid phosphatase positive cells on day 8 of culture. A solenoid was used to impose uniform time-varying electric fields on cells; sham exposures were performed with an identical solenoid with a null net electric field. During the experiments, both solenoids heated interiorly to approximately 1.5 degrees C above ambient incubator temperature. As a result of the heating, cultures in the sham solenoid formed more osteoclast-like cells than those on the incubator shelf (132 +/- 12%). For this reason, cells exposed to the sham solenoid were used for comparison with cultures exposed to the active coil. Marrow cells were plated at 1.4 x 10(6)/cm2 in square chamber dishes and exposed to 60 Hz electric fields at 9.6 muV/cm from days 1 to 8. Field exposure inhibited osteoclast-like cell recruitment by 17 +/- 3% as compared with sham exposure (p < 0.0001). Several variables, including initial cell plating density, addition of prostaglandin E2 to enhance osteoclast-like cell recruitment, and field parameters, were also assessed. In this secondary series, extremely low frequency fields inhibited osteoclast-like cell formation by 24 +/- 4% (p < 0.0001), with their inhibitory effect consistent throughout all variations in protocol. These experiments demonstrate that extremely low intensity, low frequency sinusoidal electric fields suppress the formation of osteoclast-like cells in marrow culture. The in vitro results support in vivo findings that demonstrate that electric fields inhibit the onset of osteopenia and the progression of osteonecrosis; this suggests that extremely low frequency fields may inhibit osteoclast recruitment in vivo.
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Affiliation(s)
- J Rubin
- Department of Medicine, Veterans Affairs Medical Center, Atlanta, Georgia, 30033, USA
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27
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Metsger DS, Arnala I, Faugere MC, Malluche HH. Histomorphometric analysis of tricalcium phosphate ceramic implanted into turkeys. Bone 1993; 14:243-8. [PMID: 8363863 DOI: 10.1016/8756-3282(93)90147-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Porous cylinders of tricalcium phosphate of two pore size distributions and four pore densities were implanted bilaterally into the ulnae of twelve skeletally mature turkeys. Morphometric analyses at two, four, and six post-operative months indicate implant resorption begins prior to the second post-operative month and that physical changes and biologic response continue at a rate dependent upon pore size distribution.
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Affiliation(s)
- D S Metsger
- University of Kentucky Medical Center, Lexington
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28
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Buch F, Jonsson B, Mallmin H, Kälebo P. The quantification of bone tissue regeneration after electromagnetic stimulation. Arch Orthop Trauma Surg 1993; 112:75-8. [PMID: 8457415 DOI: 10.1007/bf00420259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In this study a titanium implant, the bone harvest chamber (BHC), was used to evaluate the effect of electromagnetic stimulation on osteogenesis. The BHC was inserted with a minimum of surgical trauma in the proximal tibial metaphysis in six adult lop-eared rabbits. Bone anchorage occurred after 4 weeks. After implant incorporation bone tissue was harvested at 3-week intervals with the implant in situ without killing the animal. The regenerated bone tissue was analysed by means of microradiography and densitometry. A test group and a control group each comprised six rabbits. The test group was stimulated with a 72-Hz electromagnetic field. Bone tissue was harvested from each tibia six times during the stimulation time and twice after the stimulation had been turned off. The control group had the same harvest procedure performed from one leg. Results showed that electromagnetic stimulation can maintain constant high osteogenetic activity. After the electromagnetic stimulation was turned off the osteogenetic activity diminished rapidly and osteogenesis was significantly lower than during stimulation.
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Affiliation(s)
- F Buch
- Department of Orthopaedics, University Hospital of Uppsala, Sweden
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29
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Søballe K. Hydroxyapatite ceramic coating for bone implant fixation. Mechanical and histological studies in dogs. ACTA ORTHOPAEDICA SCANDINAVICA. SUPPLEMENTUM 1993; 255:1-58. [PMID: 8237337 DOI: 10.3109/17453679309155636] [Citation(s) in RCA: 231] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The success of bone ingrowth into porous coated implants depends on several factors which can be separated into five main groups: implant related factors, such as design of implant, surface structure and pore characteristics. status of host bone bed, such as underlying disease (rheumatoid arthritis, osteoporosis), available bone stock, use of drugs and surgical technique. mechanical stabilization and loading conditions applied on the implant. adjuvant therapies such as bone grafting and HA coating which might enhance the amount of bone ingrowth. remodeling of periprosthetic bone. Once bone ingrowth has occurred, maintenance of bony anchorage depends on bone remodeling at the interface. The present series of studies were performed in order to investigate the effect of some of these factors on bone ingrowth in relation to hydroxyapatite (HA) and titanium alloy (Ti) coating when subjected to pathological and mechanical conditions mimicking the clinical situation. HA- and Ti-coated implants were inserted into the femoral condyles of mature dogs. The observation period ranged from 4 to 16 weeks, and the results were evaluated by mechanical push-out testing, histomorphometric analysis, polarized light microscopy, UV fluorescence microscopy, collagen analysis and transmission electron microscopy (microanalysis). There were no complications related to the operative procedures and all dogs were terminated according to the original time schedule. Host bone related factors were studied in the initial experiments. First, the effect of a gap between bone and implant was studied and compared with press-fit insertion. The HA-coating yielded superior effect on bone ingrowth compared to Ti in situations where the implant was surrounded by a gap and also where the implants were inserted in press-fit. Gaps of 1 mm and 2 mm around the implant were bridged by bone around HA implants whereas significantly less amounts of bone filled the gap around Ti implants. The gap-healing capacity of bone was increased even at a relatively great distance (400 microns) from the HA surface. This finding indicates that the osteoconductive effect of HA is not limited to the bone forming capacity on the surface of the implant. A positive gradient of newly formed bone was found towards the HA-coating, this gradient not being found towards the Ti-coating. In order to investigate the significance of arthritic bone changes (osteopenia) on fixation of porous coated implants we adopted the Carragheenin-induced gonarthritis model resulting in substantial bone loss as determined by CT-scanning.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- K Søballe
- Department of Orthopedics, University Hospital of Aarhus, Denmark
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Abstract
The use of exogenous pulsed electromagnetic fields (PEMF) to stimulate the healing of nonunions and other long bone defects is common in medicine. This investigation used the dog model and image analysis of standardized radiographs to assess loss of residual ridge height following extractions. It demonstrates the effectiveness of intermittent PEMF to reduce the rate of residual ridge resorption. It further suggests there may be a causal relationship between residual ridge resorption and the alteration of endogenous bioelectric signals caused by the loss of teeth.
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Affiliation(s)
- L F Ortman
- Department of Removable Prosthodontics, University at Buffalo, School of Dental Medicine, N.Y
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31
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Mosheiff R, Klein BY, Leichter I, Chaimsky G, Nyska A, Peyser A, Segal D. Use of dual-energy X-ray absorptiometry (DEXA) to follow mineral content changes in small ceramic implants in rats. Biomaterials 1992; 13:462-6. [PMID: 1321675 DOI: 10.1016/0142-9612(92)90167-m] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Dual energy X-ray absorptiometry (DEXA) imaging was used to quantify bone ingrowth into hydroxyapatite (HA) ceramic implants in rats. HA cylinders implanted in the proximal tibiae were followed for 13 wk. The increase in alkaline phosphatase (ALP) activity within the implants preceded the increase in mineral content as measured non-invasively by the DEXA technique. This was consistent with the timing of ALP activity in respect of mineralization as they occur during fracture healing. The results show that DEXA imaging is useful in measuring bone ingrowth into small ceramic HA implants in vivo, despite the high mineral content background of the implant scaffold.
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Affiliation(s)
- R Mosheiff
- Department of Orthopedic Surgery, Hadassah University Hospital, Israel
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32
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Søballe K, Hansen ES, Brockstedt-Rasmussen H, Hjortdal VE, Juhl GI, Pedersen CM, Hvid I, Bünger C. Fixation of titanium and hydroxyapatite-coated implants in arthritic osteopenic bone. J Arthroplasty 1991; 6:307-16. [PMID: 1663154 DOI: 10.1016/s0883-5403(06)80181-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Retrieval studies of porous-coated prostheses have demonstrated deficient bony ingrowth in high percentages. Possible reasons for this are lack of initial mechanical stability and the presence of osteopenia. The authors studied ingrowth of osteopenic bone into titanium alloy (Ti) porous-coated implants with and without hydroxyapatite (HA) coating in an experimental dog model. Unilateral osteopenia of the knee with a 20% reduced bone density as judged by computed tomography (CT) scanning (P less than .001) was induced in 12 mature dogs by weekly intraarticular injections of Carragheenin into the right knee for 12 weeks, with the left knee serving as control. Ti porous-coated cylinders were inserted in press-fit bilaterally in the lateral femoral condyles in six dogs. HA-coated titanium plugs were implanted similarly in another sex-, age-, and weight-matched group of six dogs. Bony ingrowth after 4 weeks was significantly reduced for Ti implants in osteopenic bone compared to control bone, but HA-coated implants were covered by equal amounts of bone tissue. Bone-implant shear strength of Ti implants also was reduced in osteopenic bone compared to control bone. In control bone, the anchorage of Ti implants was stronger than HA-coated implants, whereas the fixation of Ti and HA-coated implants was equal in the osteopenic bone. The results demonstrate that the bony fixation of Ti porous-coated implants is weakened by the presence of experimentally induced osteopenia. However, the fixation of HA-coated implants was not affected by the osteopenic condition in the surrounding bone. The fixation of Ti and HA-coated implants was equal in osteopenic bone, whereas the fixation of Ti porous-coated implants was superior to that of HA-coated implants in control bone.
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Affiliation(s)
- K Søballe
- Biomechanics Laboratory, Orthopaedic Hospital, University of Aarhus, Denmark
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Abstract
The effect of pulsed electromagnetic fields (PEMFs) on bone loss associated with disuse was investigated by applying 1.5 Hz repetitions of 30 ms bursts of asymmetric pulses, varying from +2.5 to -135 mV, to bones deprived of their normal functional loading. The proximal portion of one fibula in each of a group of ovariectomised adult female beagle dogs was isolated from functional loading in vivo by proximal and distal osteotomies. Comparison of these prepared bones with their intact contralateral controls after 12 weeks, showed a 23% reduction in cross-sectional area. In similarly prepared bones exposed to PEMFs for 1 h per day, 5 days per week, this bone loss was substantially and significantly reduced to 9% (p = 0.029). There was no evidence of any new bone formation on the periosteal surface of prepared fibulae in treated or untreated situations. PEMF treatment was not associated with any significant change in number of osteons per mm2 formed within the cortex of the bones, their radial closure rate, or their degree of closure. The modulation in loss of bone area associated with exposure to PEMFs can, therefore, be inferred to be due to a reduction in resorption on the bone surface.
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Affiliation(s)
- T M Skerry
- Department of Anatomy, University of Bristol, U.K
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Ohgushi H, Okumura M, Tamai S, Shors EC, Caplan AI. Marrow cell induced osteogenesis in porous hydroxyapatite and tricalcium phosphate: a comparative histomorphometric study of ectopic bone formation. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 1990; 24:1563-70. [PMID: 2277053 DOI: 10.1002/jbm.820241202] [Citation(s) in RCA: 183] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To investigate the bone formation ability of porous hydroxyapatite (HA) and tricalcium phosphate (TCP), ceramic discs were implanted with or without rat marrow cells into subcutaneous sites in syngeneic rats. The discs of HA and TCP had identical microstructures: pore size was 190-230 microns, porosity was 50-60%, and they were fully interconnected. Implants without marrow cells (discs themselves) did not show bone formation, whereas implants with marrow cells showed bone formation in the pores of the ceramics. The bone formation of both HA and TCP occurred initially on the surface of the ceramic and progressed towards the center of the pore. The de novo bone was quantitated from decalcified serial sections of the implants. One month after implantation with marrow cells, the percentage fractions of the pore area filled with bone for implanted HA and TCP were 16.9 and 15.1, respectively. At 2 months after implantation with marrow cells, the fractions of bone were 34.3 and 30.9, respectively. These results indicate that both HA and TCP ceramics can show comparable osteogenic ability in the presence of marrow cells.
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Affiliation(s)
- H Ohgushi
- Department of Orthopedics, Nara Medical University, Japan
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Usui Y, Zerwekh JE, Vanharanta H, Ashman RB, Mooney V. Different effects of mechanical vibration on bone ingrowth into porous hydroxyapatite and fracture healing in a rabbit model. J Orthop Res 1989; 7:559-67. [PMID: 2544710 DOI: 10.1002/jor.1100070414] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effects of mechanical vibration on bone ingrowth into porous hydroxyapatite implants and fracture healing were examined radiographically, histomorphometrically, and biomechanically in a rabbit model. Fifty-three female NZW rabbits were used in this study. These rabbits were divided into four separate studies to assess the effects of 20 and 60 min of vibration/day in both implant and osteotomy models as compared with the respective non-vibrated controls. For the implant model, coral hydroxyapatite goniopora rods were implanted bilaterally into tibiae and for the osteotomy model, bilateral fibulae were osteotomized. A resonant frequency of 25 Hz mechanical vibration was used. After periods of 2, 3, 4, and 6 weeks of vibration, the rabbits were killed and examined. For the implant model, there was no significant difference between control, 20, or 60 min of vibration/day with respect to the rate or amount of new bone ingrowth. For the fracture model, 60 min of vibration/day produced a significantly larger callus as compared with the non-vibrated controls (p less than 0.05), whereas 20 min of vibration/day did not. Although biomechanical testing demonstrated a general trend for increased strength in the vibrated animals, it failed to reach significance. These results suggest that the mechanical vibration used in the present study had a beneficial effect on callus volume, possibly due to the stimulation of secondary bone healing processes, but does not appear to promote bone ingrowth into a porous hydroxyapatite implant.
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Affiliation(s)
- Y Usui
- Division of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9031
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