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      Analysis of bone healing with a novel bone wax substitute compared with bone wax in a porcine bone defect model

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          Abstract

          Aim:

          This pilot study describes a novel composite of hydroxyapatite and biodegradable polylactic acid with wax-like handling properties (BoneSeal ®). The goal was to compare quantitative measures of bone healing between BoneSeal versus Bone wax.

          Materials & methods:

          BoneSeal and Bone wax were introduced into separate defects of a single porcine specimen. After 6 weeks, the defect sites were harvested for analysis.

          Results:

          Both groups had similar hemostatic action. The amount of new bone was significantly greater at 6 weeks in the BoneSeal group (38.05%) versus the Bone wax group (11.88%), p = 0.028.

          Conclusion:

          In this pilot study, BoneSeal had higher amounts of new bone formation compared with Bone wax.

          Lay abstract

          This small pilot study compares two materials, Bone wax and BoneSeal, which could be used in bone surgery. In bone surgery, there is a need for the materials to stop bleeding as well as have good bone healing capabilities. We investigated the bone healing characteristics of two different materials. We implanted these materials into the arm and leg bones of a single pig. After a period of 6 weeks, we investigated the sites of implantation. We found that implantation sites of BoneSeal had higher amounts of new bone formation.

          Most cited references24

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          A comprehensive review of topical hemostatic agents: efficacy and recommendations for use.

          Since ancient times we have attempted to facilitate hemostasis by application of topical agents. In the last decade, the number of different effective hemostatic agents has increased drastically. In order for the modern surgeon to successfully choose the right agent at the right time, it is essential to understand the mechanism of action, efficacy and possible adverse events as they relate to each agent. In this article we provide a comprehensive review of the most commonly used hemostatic agents, subcategorized as physical agents, absorbable agents, biologic agents, and synthetic agents. We also evaluate novel hemostatic dressings and their application in the current era. Furthermore, wholesale acquisition prices for hospitals in the United States are provided to aid in cost analysis. We conclude with an expert opinion on which agent to use under different scenarios.
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            Biphasic calcium phosphate bioceramics: preparation, properties and applications.

            Biphasic calcium phosphate (BCP) bioceramics belong to a group of bone substitute biomaterials that consist of an intimate mixture of hydroxyapatite (HA), Ca(10)(PO(4))(6)(OH)(2), and beta-tricalcium phosphate (beta-TCP), Ca(3)(PO(4))(2), of varying HA/beta-TCP ratios. BCP is obtained when a synthetic or biologic calcium-deficient apatite is sintered at temperatures at and above 700 degrees C. Calcium deficiency depends on the method of preparation (precipitation, hydrolysis or mechanical mixture) including reaction pH and temperature. The HA/beta-TCP ratio is determined by the calcium deficiency of the unsintered apatite (the higher the deficiency, the lower the ratio) and the sintering temperature. Properties of BCP bioceramics relating to their medical applications include: macroporosity, microporosity, compressive strength, bioreactivity (associated with formation of carbonate hydroxyapatite on ceramic surfaces in vitro and in vivo), dissolution, and osteoconductivity. Due to the preferential dissolution of the beta-TCP component, the bioreactivity is inversely proportional to the HA/beta-TCP ratio. Hence, the bioreactivity of BCP bioceramics can be controlled by manipulating the composition (HA/beta-TCP ratio) and/or the crystallinity of the BCP. Currently, BCP bioceramics is recommended for use as an alternative or additive to autogeneous bone for orthopedic and dental applications. It is available in the form of particulates, blocks, customized designs for specific applications and as an injectible biomaterial in a polymer carrier. BCP ceramic can be used also as grit-blasting abrasive for grit-blasting to modify implant substrate surfaces. Exploratory studies demonstrate the potential uses of BCP ceramic as scaffold for tissue engineering, drug delivery system and carrier of growth factors.
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              Magnesium hydroxide temporarily enhancing osteoblast activity and decreasing the osteoclast number in peri-implant bone remodelling.

              Repeated observations of enhanced bone growth around various degradable magnesium alloys in vivo raise the question: what is the major mutual origin of this biological stimulus? Several possible origins, e.g. the metal surface properties, electrochemical interactions and biological effects of alloying elements, can be excluded by investigating the sole bone response to the purified major corrosion product of all magnesium alloys, magnesium hydroxide (Mg(OH)(2)). Isostatically compressed cylinders of pure Mg(OH)(2) were implanted into rabbit femur condyles for 2-6 weeks. We observed a temporarily increased bone volume (BV/TV) in the vicinity of Mg(OH)(2) at 4 weeks that returned to a level that was equal to the control at 6 weeks. The osteoclast surface (OcS/BS) was significantly reduced during the first four weeks around the Mg(OH)(2) cylinder, while an increase in osteoid surface (OS/BS) was observed at the same time. At 6 weeks, the OcS/BS adjacent to the Mg(OH)(2) cylinder was back within the same range of the control. The mineral apposition rate (MAR) was extensively enhanced until 4 weeks in the Mg(OH)(2) group before matching the control. Thus, the enhanced bone formation and temporarily decreased bone resorption resulted in a higher bone mass around the slowly dissolving Mg(OH)(2) cylinder. These data support the hypothesis that the major corrosion product Mg(OH)(2) from any magnesium alloy is the major origin of the observed enhanced bone growth in vivo. Further studies have to evaluate if the enhanced bone growth is mainly due to the local magnesium ion concentration or the local alkalosis accompanying the Mg(OH)(2) dissolution. Copyright (c) 2009 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Future Sci OA
                Future Sci OA
                FSOA
                Future Science OA
                Future Science Ltd (London, UK )
                2056-5623
                September 2018
                26 July 2018
                : 4
                : 8
                : FSO326
                Affiliations
                [1 ]New York Head & Neck Institute, Lenox Hill Hospital, New York, NY, 10075, USA
                [2 ]Hemostasis LLC, St Paul, MN, 55110, USA
                Author notes
                *Author for correspondence: ttham@ 123456northwell.edu
                Article
                10.4155/fsoa-2018-0004
                6153452
                30271614
                b9ce2e34-4beb-4fe9-a269-241652401bfa
                © 2018 Tham, Roberts, Shanahan, Burban, Costantino

                This work is licensed under a Creative Commons Attribution 4.0 License

                History
                : 10 January 2018
                : 05 June 2018
                : 26 July 2018
                Categories
                Preliminary Communication

                biocompatibility,biomaterials,bone wax hydroxyapatite,hemostasis,osteoconduction,porcine model

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