Objective : This paper describes our experience and implant technique for cranioplasty of a large cranial defects using a porous polyethylene implant[Medpor] and compares the results with polymethylmethacrylate[PMMA]. Methods : Sixteen cranioplasties were performed using Medpor[n= 10] and PMMA[n=6] implants between June 2003 and January 2005. The criterion for patient enrollment was a defect larger than 10cm in diameter. This study compared the operation times and complications. Results : The operation times ranged from 105 to 250minutes[Mean $180^{\circ}{\pm}44minutes$) in Medpor and from 185 to 460minutes [mean 128minutes] in PMMA. The absolute operation times were shorter using the Medpor implant and the differences were statistically significant[P=0.030]. Satisfactory cosmetic results were obtained in all cases using the Medpor implant and with no implant-related complications. Bone ingrowth to the medpor implant was presumed to be the result on an increase in Houndsfield units of the implant, particularly at the marginal areas in the serial follow-up brain computed tomography images. Conclusion : It is believed that the properties of a Medpor implant make this implant an good alternative to the existing methods of a cranial contour correction. However, a further follow-up study will be needed.
A new technique for the preparation of porous vascular prostheses was investigated. Polyurethane solution (10 to 14wt%) was injected into a mold. After freezing at low temperature $(0^{\circ}C\sim-40^{\circ}C)$, solvent was dissolved out with water at $0^{\circ}C$ to form porous tubes. The average pore size $(<10{\mu}m)$and pore occupation (10% to 51%) were easily changed by changing polyurethane concentration, freezing temperature, and freezing methods. This technique can give a proper pore size $(30\sim60{\mu}m)$ for tissue ingrowth, and suitable compliances for matching with arteries and veins. This method might give a desired compliant graft for artificial implantation with the presently valid medical polymers.
The purpose of this study was to investigate the effect of timing of implant insertion on osseointegration after tooth extraction. Fifteen mongrel dogs, weighing 15kg or more, were used. The lower right 1st, 2nd, 3rd, 4th premolars and 1st molar were extracted under general anesthesia. Implants were inserted at 2, 4, and 8 weeks after extraction of the teeth, being designated as 2-, 4-, and 8-week groups, respectively. Results obtained were as follows. 1. Macroscopically there was neither an infection at the implant site nor an exposure of the implant. 2. Histologically the surrounding bone of the implant was less mature in the 2-week group than in the 4- and 8-week groups. 3. The implant-bone contact ranged from 75 to 82%, with no significant differences among the groups. No increase in the implant-bone contact was found with increasing healing periods from 4 to 12 weeks after implant insertions. 4. The average depth (0.64mm) of the fibrous connective tissue ingrowth in the 2-week group was slightly deeper than those in the 4- (0.51mm) and 8-week (0.53mm) groups at 12 weeks after implant insertion. 5. the implant-bone interfacial bond strengths were 73.05 kgf in the 2-week group, 69.71 kgf in the 4-week group and 73.76 kgf in the 8-week group. No significant difference was noted in pullout force among the groups. The degree of confidence of interfacial bone strength was highest in the 8-week group, followed by the 4- and 2-week groups. These results indicate that at least 4 weeks of healing period will be required before implant is to be inserted following tooth extraction.
Distribution of size class, population regeneration and changes in the population structure of Quercus mongolica were studied from 1994 to 1999 in Mt. Jumbong (128°27' E, 38° 04' N) of Mt. Sorak National Park and Biosphere Reserve in central Korea. Three 20m × 20m permanent quadrats were set up at the elevation of 900m. The vegetation of the study site was dominated by Quercus mongolica and Acer pseudosieboldianum, but little change was observed in the community structure from 1995 to 1999. Most mortality in the study site was observed in small trees of A. pseudosieboldianum and Tilia amurensis. Mean annual growth in dbh (diameter of breast height) of Q. mongolica for 4 years was only 0.09cm, and no ingrowth of saplings (dbh < 2.5cm) into tree class was observed during the study period. Among the 21 Q. mongolica trees studied in the permanent quadrats. all the smaller trees (dbh < 30cm) were established in 1920 ∼ 1950, while many bigger trees (with 40cm < dbh < 80cm) were established in 1750 ∼ 1800, indicating that its establishment was episodic. Distribution of dbh classes among Q. mongolica trees shows that smaller trees were poorly represented, and no saplings of Q. mongolica occurred in the permanent quadrats studied, indicating that currently Q. mongolica is not regenerating well in the study site. Total seed production of Q. mongolica in 1994 was estimated as 88 acorns per square meter in the study site. Rate of predation including caching of acorns was highest in 1994, then declined sharply thereafter. Most of the acorns which managed to survive in the first year were predated in the second year, and only 5% of the acorns produced in 1994 survived into the third year. No seeds produced in 1994 or seedlings germinated from them succeeded to survive to 5 years after seed production. However, seedling emergence rate and seedling survival were high in the early growing season in 1995. These results suggest that predation can be a significant factor in the regeneration of Q. mongolica. and that Q. mongolica is not regenerating well in Mt. Jumbong and needs large scale disturbances for its new recruitment.
The purpose of this study was to evaluate the effect of tricalcium phosphate and Vitapex on the dogs' periapical tissues. Twenty mandibular premolars from 5 healthy dogs were used for this study. After the animals were anesthetized intramuscularly, pulp chambers were open and pulp tissue was extirpated with a barbed broach and H-file. Then the working length of the root canal was measured with H-file and pulp tissue was completely removed. Before the actual canal filling, the root canals of twenty teeth have been experimentally infected with opening the pulp chamber for 5 weeks. Periapical radiographs of the experimental teeth were taken to monitor the periapical pathological condition. Each root apex of 20 premolars was perforated with engine reamer and the root canals were enlarged with No. 30-60 H-files. They were divided into treated as follows. Control group: The root canal was filled with gutta-percha. Experimental group 1: The canal was dried with sterile paper points and mixture of tricalcium phosphate and physiological saline was overfilled beyond the root apex with a lentulo spiral. Then the root canal was filled gutta-percha and lateral condensation and the pulp chamber was filled with Caviton. Experimental group 2: The root canals were overfilled with Vitapex and were treated in the same manner as those in experimental group 1 At 1,2,3, and 8 weeks after experiment, the periapical tissues including the alveolar bone were fixed with 10% formalin solution for I week and decalcified with Plank-Rycho solution for 5 weeks. The specimens were embedded in paraffin and serial sections were cut into a thickness of 6 ${\mu}m$ at the plane of the root apex. Hematoxyline-eosin and Masson's trichrome stain were made for the histo-pathological examinations. The results were as follows: 1. Ingrowth of collagen fiber was observed from 1 week in control group and experimental groups. 2. The rate of bone formation of experimental group 1 was accelerated more than that of experimental group 2. 3. Resorption of cementum was seen in control group, but apposition of cementum was seen in experimental groups.
Purpose: The key points of treatment of cryptotia are the elevation of invaginated ear helix and the correction of deformed cartilage. Prevention of stabilized cartilage contouring from returning to the previous state is also important. The authors carried otoplasty by modified Onizuka's method or Ohmori's method that conchal cartilage graft or high density polyethylene implant(MEDPOR$^{(R)}$) graft served as fixation after spreading posterior aspect of adhered antihelix and a splint for prevention of recurrence of cartilage deformities. The aim of this study is to reveal the availability of the high density polyethylene implant(MEDPOR$^{(R)}$) graft for the correction of cryptotia. Methods: We have repaired 17 cryptotic deformities using cartilage graft from cavum of concha(12 cases) or high density polyethylene implant(5 cases) for correction of deformed cartilage. We investigate the operative time, complications, and satisfaction of postoperative ear shape on both autogenous cartilage graft group and high density polyethylene implant graft group. Results: There was 1 case of reinvagination on autogenous cartilage graft group. Implant exposure was occurred on high density polyethylene implant graft group, as 1 case. These were statistically no differences between autogenous cartilage graft group and high density polyethylene implant graft group to the satisfaction of ear shape. Conclusion: High density polyethylene implant(MEDPOR$^{(R)}$) present an alternative to autogenous material as they allow of fibrovascular ingrowth, leading to stability of the implant and decreased infection rates. The correction of deformed cartilage by using the high density polyethylene implant(MEDPOR$^{(R)}$) is a good option for the treatment of cryptotia.
In cementless total hip arthroplasty(THA), an initial stability of the femoral component is mandatory to achieve bony inyowth and secondary long term fixation. Primary stability of the femoral component can be obtained by minimizing the magnitude of relative micromotions at bone stem interface. An accurate evaluation of interf'ace micromotion and stress/strain fields in the bone-implant system may be relevant for better understanding of clinical situations and improving THA design. Recently finite element method(FEM) was introduced in'orthopaedic research field due to its unique capacity to evaluate stress in structure of complex shape, loading and material behavior. The authors developed the 3-dimensional finite element model of proximal femur with $Multilock^{TM}$ stem of 1179 blick elements to analyse the micromotions and mechanical behaviors at the bone-stem inteface in early post-operative period for the load simulating single leg stance. The results indicates that the values of relative motion for this well fit stem were $150{\mu}m$ in maximum $82{\mu}m$ in minimum and the largest relative motion was developed in medial region of Proximal femur and in anterior-posterior direction. The motion in the proximal bone was much greater than in the distal bone and the stress pattern showed high stress concentration on the cortex near the tip of the stem. These findings indicate that the loading on the hip joint in the early postoperative situation before achieving bony ingrowth could produce large micromotion of $150{\mu}m$ and clinicaly non-cemented THA patient should not be allowed weight bearing strictly early in the postoperative period.
Drug releasing porous poly($\varepsilon$-caprolactone) (PCL)-chitosan matrices were fabricated for bone regenerative therapy. Porous matrices made of biodegradable polymers have been playing a crucial role as bone substitutes and as tissue-engineered scaffolds in bone regenerative therapy. The matrices provided mechanical support for the developing tissue and enhanced tissue formation by releasing active agent in controlled manner. Chitosan was employed to enhance hydrophilicity and biocompatibility of the PCL matrices. PDGF-BB was incorporated into PCL-chitosan matrices to induce enhanced bone regeneration efficacy. PCL-chitosan matrices retained a porous structure with a 100-200 $\mu$m pore diameter that was suitable for cellular migration and osteoid ingrowth. $NaHCO_3$ as a porogen was incorporated 5% ratio to polymer weight to form highly porous scaffolds. PDGF-BB was released from PCL-chitosan matrices maintaining therapeutic concentration for 4 week. High osteoblasts attachment level and proliferation was observed from PCL-chitosan matrices. Scanning electron microscopic examination indicated that cultured osteoblasts showed round form and spread pseudopods after 1 day and showed broad cytoplasmic extension after 14 days. PCL-chitosan matrices promoted bone regeneration and PDGF-BB loaded matrices obtained enhanced bone formation in rat calvarial defect. These results suggested that the PDGF-BB releasing PCL-chitosan porous matrices may be potentially used as tissue engineering scaffolds or bone substitutes with high bone regenerative efficacy.
Recently, for the reconstruction of bony defect and cosmetic improvement, many graft materials and implants have been widely used in the various surgical situations. The alloplastic materials have many advantages such as simplicity of operation, no additional need of surgery, and easy manipulation. The $Medpor^{TM}$(porous high-density polyethylene, Porex Co., USA) was initially studied in 1972 for surgical implant and introduced as an implant material for oral and maxillofacial region by Sauer and King in 1988. This material permits full ingrowth of bone into the implants, substantially increasing the implant's incorporation into the recipient site. It can be shaved during the surgery, which results in an improvement and prefabricated various size and shapes to fit into the surgical defect. The $Medpor^{TM}$ was used in 32 patients from 1995 to 1997 at the maxillofacial region. It was used for paranasal augmentation in 24 cases, for malar augmentation in 2 cases, for infraorbital augmentation in 2 cases, for mandibular angle augmentation in 2 cases, for mandibular body augmentation in 2 cases, for chin vertical augmentation in 1 case. It was mainly fixed with miniplate or screw. There were few complications except one infection and one exposure of the implant.
Ko, Ki Seong;Lee, Jung Seok;Park, Kyung Min;Lee, Yunki;Oh, Dong Hwan;Son, Joo Young;Kwon, Oh Hee;Eom, Min Yong;Park, Ki Dong
Biomaterials and Biomechanics in Bioengineering
/
제2권1호
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pp.23-32
/
2015
Facile immobilization of growth factors in hyaluronic acid (HA) hydrogels using dual enzymes is reported in the paper. The hydrogels were formed by using horseradish peroxidase (HRP) and hydrogen peroxide ($H_2O_2$) and transforming growth factor-${\beta}3$ (TGF-${\beta}3$) was covalently conjugated on the hydrogels in situ using tyrosinase (Ty) without any modifications. For the preparation of hydrogels, HA was grafted with poly(ethylene glycol) (PEG), which was modified with a tyrosine. The gelation times of the HA hydrogels were ranging from 415 to 17 s and the storage moduli was dependent on the concentration of $H_2O_2$ and Ty (470-1600 Pa). A native TGF-${\beta}3$ (200 ng/mL) was readily encapsulated in the HA hydrogels and 17% of the TGF-${\beta}3$ was released over 1 month at the Ty concentration of 0.5 KU/mL, while the release was faster when 0.3 KU/mL of Ty was used for the encapsulation (27%). It can be suggested that the growth factors resident in the hydrogels for a long period of time may lead cells proliferating and differentiating, whereas the growth factors that are initially released from the hydrogels can induce the ingrowth of cells into the matrices. Therefore, the dual enzymatic methods as facile gel forming and loading of various native growth factors or therapeutic proteins could be highly promising for tissue regenerative medicines.
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