BACKGROUNDWear debris of polyethylene has become a restraining factor of the durability for total hip arthroplasty (THA). Ceramic on ceramic (COC) has better wear resistance while the squeaking sound and prosthesis fracture are of concern. It is still a controversy that bearing couples are better for THA.

METHODSWe performed a systematic review of all English articles identified from PubMed (1966-), Embase (1980-) and the Cochrane Library. Clinical outcomes, complications, revision rates, and radiographic outcomes of COC-THA and ceramic on polyethylene (COP)-THA were compared and evaluated.

RESULTSEight prospective randomized trials enrolling a total of 1508 patients and 1702 THA surgeries were identified. Our results demonstrated the prosthesis fracture and the squeaking sound is significantly higher in COC group and higher wear rate of the COP. Hip function, loosening rate, dislocation rate, revision rate, and the osteolysis rate were comparable between two groups. According to Grading of Recommendations Assessment, Development and Evaluation system assessment, the strength of evidence was high for prosthesis fracture, dislocation, osteolysis, and moderate for radiolucent line or loosening, hip noise, and revision.

CONCLUSIONSUp to now, there is insufficient evidence to identify any clinical advantage of COC compared with COP. Longer follow-up of larger randomized trial is needed to clarify the outcomes.

Arthroplasty, Replacement, Hip ; methods ; Ceramics ; therapeutic use ; Hip Prosthesis ; Humans ; Polyethylene ; therapeutic use

Revision rates of total hip arthroplasty have decreased after introducing total hip arthroplasty (THA) using ceramic component, since ceramic components could reduce components wear and osteolysis. The fracture of a ceramic component is a rare but potentially serious event. Thus, ceramic on polyethylene articulation is gradually spotlighted to reduce ceramic component fracture. There are a few recent reports of ceramic head fracture with polyethylene liner. Herein, we describe a case of a ceramic head component fracture with polyethylene liner. The fractured ceramic head was 28 mm short neck with conventional polyethylene liner. We treated the patient by total revision arthroplasty using 4th generation ceramic on ceramic components.
Adult ; Arthroplasty, Replacement, Hip/*methods ; Ceramics/*therapeutic use ; Female ; Hip Prosthesis ; Humans ; Polyethylene/*therapeutic use ; *Prosthesis Failure

BACKGROUND: Bioactive glass-ceramics have the ability to directly bind to bones and have been widely used as bone graft substitutes due to their high osteoconductivity and biocompatibility. CaO-SiO2-P2O5-B2O3 glass-ceramics are known to have good osteoconductivity and are used as bone graft extenders. METHODS: This study aimed to evaluate the effects of the resorbing properties of glass-ceramics in bone fusion after producing and analyzing three types of CaO-SiO2-P2O5-B2O3 glass-ceramics with high osteoconductivity that had enhanced resorption by having an increased B2O3 content. The three types of CaO-SiO2-P2O5-B2O3 glass-ceramics with B2O3 contents of 8.0, 9.0, and 9.5 weight % were designated and grouped as P20B80, P10B90, and P5B95, respectively. Glass-ceramic types were tested for fusion rates and bone formation by employing the lumbar 5-6 intertransverse process fusion model in 51 New Zealand male rabbits. Bioactivity was assessed by soaking in simulated body fluid (SBF). RESULTS: In vitro study results showed sufficient hydroxycarbonate apatite layer formation occurred for P20B80 in1 day, for P10B90 in 3 days, and for P5B95 in 5 days after soaking in SBF. For the rabbit lumbar spine posterolateral fusion model, the autograft group recorded a 100% fusion rate with levels significantly higher than those of P20B80 (29.4%), P10B90 (0%), and P5B95 (14.3%), with high resorbing properties. Resorbing property differences among the three glass-ceramic groups were not significant. Histological results showed new bone formation confirming osteoconductivity in all three types of glass-ceramics. Radiomorphometric results also confirmed the resorbing properties of the three glass-ceramic types. CONCLUSIONS: The high resorbing properties and osteoconductivity of porous glass-ceramics can be advantageous as no glass-ceramics remain in the body. However, their relatively fast rate of resorption in the body negatively affects their role as an osteoconductive scaffold as glass-ceramics are resorbed before bony fusion.
Animals ; Bone Resorption ; Bone Substitutes/adverse effects/*therapeutic use ; Ceramics/adverse effects/*therapeutic use ; Electric Conductivity ; Lumbosacral Region/*surgery ; Male ; Rabbits ; Spinal Fusion/*methods

OBJECTIVETo repair segmental mandibular defects with autogenous bone marrow stromal cells (BMSCs) and coralline hydroxyapatite.

METHODSIsolated BMSCs were in vitro expanded and osteogenically induced. In 11 canines, a 3 cm segmental mandibular defect in right mandible was created. Five canine's defects were repaired with cell-scaffold constructs made from induced BMSCs and coralline hydroxyapatite (CHA); Others were repaired with CHA as control. The engineered bone was evaluated by X-ray, CT, gross and histological examination, biomechanical test 12, 26, 32 weeks post-operation respectively.

RESULTSBMSCs grew well on the CHA. X-ray and CT images showed better callus formation at connection sites in experimental group over time while worse formation at connection sites eventually in control group. At 32 weeks post-operation in experimental group, the defects were well repaired grossly. Histologically, there were bony healing and lamellar bone formation, in experimental group fibrous healing and woven bone formation in control group. Biomechanical test revealed no significant difference between experimental group and normal control group.

CONCLUSIONSCanine segmental mandibular defects can be ultimately repaired with the tissue-engineered bone generated by autogenous osteogenic BMSCs and CHA scaffold.

Animals ; Bone Marrow Cells ; cytology ; Bone Substitutes ; Ceramics ; therapeutic use ; Dogs ; Hydroxyapatites ; therapeutic use ; Mandible ; physiology ; Mandibular Injuries ; pathology ; surgery ; Mesenchymal Stromal Cells ; cytology ; Tissue Engineering ; Tissue Scaffolds

OBJECTIVEThe present study aimed to review the characteristics and influencing factors of squeaking after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and to analyze the possible mechanisms of the audible noise.

DATA SOURCESThe data analyzed in this review were based on articles from PubMed and Web of Science.

STUDY SELECTIONThe articles selected for review were original articles and reviews found based on the following search terms: "total hip arthroplasty", "ceramic-on-ceramic", "hip squeaking", and "hip noise."

RESULTSThe mechanism of the squeaking remains unknown. The possible explanations included stripe wear, edge loading, a third body, fracture of the ceramic liner, and resonance of the prosthesis components. Squeaking occurrence is influenced by patient, surgical, and implant factors.

CONCLUSIONSMost studies indicated that squeaking after CoC THA was the consequence of increasing wear or impingement, caused by prosthesis design, patient characteristics, or surgical factors. However, as conflicts exist among different articles, the major reasons for the squeaking remain to be identified.

Arthroplasty, Replacement, Hip ; adverse effects ; Ceramics ; therapeutic use ; Hip Prosthesis ; Humans ; Noise ; adverse effects ; Osteoarthritis, Hip ; surgery

BACKGROUND: We analyzed the data for primary total hip arthroplasty (THA) in the Korean nationwide database to assess (1) the epidemiology and national trends of bearing surface usage in THAs and (2) the prevalence of each type of bearing surface according to age, gender, hospital type, primary payer, and hospital procedure volume. METHODS: A total of 30,881 THAs were analyzed using the Korean Health Insurance Review and Assessment Service database for 2007 through 2011. Bearing surfaces were sub-grouped according to device code for national health insurance claims and consisted of ceramic-on-ceramic (CoC), metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and metal-on-metal (MoM). The prevalence of each type of bearing surface was calculated and stratified by age, gender, hospital type, primary payer, and procedure volume of each hospital. RESULTS: CoC was the most frequently used bearing surface (76.7%), followed by MoP (11.9%), CoP (7.3%), and MoM (4.1%). The proportion of THAs using a CoC bearing surface increased steadily from 71.6% in 2007 to 81.4% in 2011, whereas the proportions using CoP, MoP, and MoM bearing surfaces decreased. The order of prevalence was identical to that in the general population regardless of age, gender, hospital type, primary payer, and hospital procedure volume. CONCLUSIONS: The trends and epidemiology of bearing surface usage in THAs in Korea are different from those in other countries, and the CoC bearing surface is the most prevalent articulation. In future, the results of a large-scale study using nationwide data of THAs involving a CoC bearing surface will be reported in Korea.
Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/methods/*statistics & numerical data/*trends ; Ceramics/therapeutic use ; Cross-Sectional Studies ; Female ; Hip Prosthesis/*statistics & numerical data ; Humans ; Male ; Metals/therapeutic use ; Middle Aged ; Polyethylene/therapeutic use ; Republic of Korea/epidemiology

Bone is a unique organ composed of mineralized hard tissue, unlike any other body part. The unique manner in which bone can constantly undergo self-remodeling has created interesting clinical approaches to the healing of damaged bone. Healing of large bone defects is achieved using implant materials that gradually integrate with the body after healing is completed. Such strategies require a multidisciplinary approach by material scientists, biological scientists, and clinicians. Development of materials for bone healing and exploration of the interactions thereof with the body are active research areas. In this review, we explore ongoing developments in the creation of materials for regenerating hard tissues.
Animals ; Bone Regeneration/*drug effects ; Bone Substitutes/*therapeutic use ; Bone and Bones/*drug effects/pathology/physiopathology ; Ceramics/therapeutic use ; Diffusion of Innovation ; Fracture Healing/drug effects ; Humans ; Hydrogels ; Polymers/therapeutic use ; Regenerative Medicine/*trends ; Tissue Engineering/*trends ; Treatment Outcome

OBJECTIVETo decide the safe dissection plane and evaluate the multiple materials used for the fronto-temporal augmentation.

METHODSClinical anatomical observation were made during the fronto-temporal operations. Forty-one patients were treated for the fronto-temporal augmentation with various granular or patched materials in different anatomical plane.

RESULTSFour relatively safe dissection planes were found in the fronto-temporal area: (1) subcutaneous or above superficial temporal fascia, (2) subgalea plane 1.5 cm above the zygomatic arch, (3) between the deep temporal fascia and the temporal muscle, and (4) beneath the temporal periosteum. With the follow-ups from 6 months to 1 year, the appearance after the fronto-temporal augmentation in each patient was satisfactory or improved, except for the fat granule group with partial absorption and the ePTFE or Medpor hypothesis group shown a stepped contouring at the margin in a few patients.

CONCLUSIONFour dissection planes could be shown in the fronto-temporal region for the augmentation plasty with different advantages and disadvantages. The combination could be overcome the disadvantages to improve the results. Fat granule could be the best autograft for frontotemporal augmentation.

Adult ; Biocompatible Materials ; therapeutic use ; Ceramics ; therapeutic use ; Durapatite ; therapeutic use ; Face ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Materials Testing ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Temporal Bone ; surgery ; Treatment Outcome

To develop ideal ceramic artificial bone for accelerating the process of repairing segment defect of long bone, tubing tricalcium phosphate (TTCP) and column tricalcium phosphate (CTCP) ceramic artificial bones were implanted separately into radial defects of 1 cm in adult rabbits. Specimens were taken in 4 and 12 weeks. The samples were examined by gross histomorphological observation, quantitative measurement of new bone formation and bending strength. The amount of new bone formation in TTCP was more than that in CTCP at 4 and 12 weeks postoperatively. At 12 weeks after operation, the grafted materials were bonded closely with host bone. The degradation rate of TTCP was faster than that of CTCP, and the bending strength of TTCP was stronger than that of CTCP(P < 0.01). The results showed that the design of TTCP is relatively rational and TTCP could accelerate the repair of segment defect of long bone more rapidly than CTCP. TTCP is an ideal artificial bone material.
Animals ; Biocompatible Materials ; chemistry ; Bone Substitutes ; chemistry ; therapeutic use ; Calcium Phosphates ; chemistry ; Ceramics ; chemistry ; Implants, Experimental ; Materials Testing ; Rabbits ; Radius ; surgery

Objective: To evaluate the clinical outcomes of computer aided design and computer aided manufacturing (CAD/CAM) ceramic endocrowns in endodontically treated posterior teeth after five years by a retrospective study. Methods: Patients who received CAD/CAM ceramic endocrowns after endodontically treatment in Department of Endodontics, School of Stomatology, The Fourth Military Medical University between January 2016 and June 2017 were invited for this clinical study. Clinical performance was evaluated in the aspect of color match, anatomic form,marginal adaptation, restoration integrity and secondary caries. Survival rate of the restorations was calculated by the use of Kaplan-Meier method. Log-rank test was applied as well for the sake of analyzing the effect of tooth position, sex and materials to the survival rate of the restorations. Results: Seventy-four patients, 25 men and 49 women with age of (38.8±10.2) years, participated in this study for a total of 101 CAD/CAM ceramic endocrowns after observation period of (62.8±12.0) months. There were 8 failed cases among 101 restorations, 5 were loss of retention, 2 were ceramic fracture and 1 was secondary caries respectively. In particular, 93% (89/96) restorations got score A on anatomic form and 95% (91/96) restorations got score A on marginal adaptation, while 38% (36/96) restorations showed the good color match compared with the abutment teeth. The estimated cumulative survival rate of CAD/CAM ceramic endocrowns in endodontically treated posterior teeth after 5 years was 93.0% (95%CI: 87.9%-98.1%). The single-factor Log-rank analysis demonstrated that there was no statistically significant difference in the survival rate of CAD/CAM ceramic endocrowns among men and women, premolars and molars, position in the dental arch, or different materials (χ²<0.01, P=0.957; χ²=0.64, P=0.422; χ²=0.69, P=0.407; χ²=0.88, P=0.349). Conclusions: Based on this clinical study, the clinical performance of CAD/CAM ceramic endocrowns in endodontically treated posterior teeth after five years is reliable, which could be a general option to restore nonvital teeth.
Humans ; Male ; Female ; Adult ; Middle Aged ; Crowns ; Dental Porcelain/therapeutic use* ; Retrospective Studies ; Dental Prosthesis Design ; Dental Stress Analysis ; Materials Testing ; Computer-Aided Design ; Ceramics