B Lübben1, G Geyer. 1. Klinik und Poliklinik für Hals-, Nasen-, Ohrenkranke der Universität Würzburg. Bjoern-Luebben@yahoo.de
Abstract
BACKGROUND: The hybrid bone substitute ionomeric cement achieves a stable and durable space-free bond to adjacent bone during hardening. Clinical studies have evaluated the material differently: Fully hardened ionomeric cement showed in middle ear surgery, e.g. as an ossicular prosthesis, good biocompatibility with outstanding functional results. In a few cases, freshly mixed ionomeric cement led to severe complications after contact with CSF in skull base surgery. Therefore we intended to evaluate the influence of early fluid contact on the quality of cement and to define the interval for a safe application of the material, using a cell culture model. Further we intended to investigate whether combining cement with homologous and alloplastic materials influenced its quality. METHODS: 1) Ionomeric cement (Ionocem) test bodies were placed in Ringer's solution at different times after the mixing phase. 2) Ionomeric cement (Ionocem) test bodies were coated with different clinically used homologous and alloplastic materials during the setting and hardening phase. The concentrations of released cement-forming ions and the toxic effects on mouse fibroblasts within cell cultures were measured. RESULTS: Cytotoxic effects were observed when ionomeric cement was not carefully protected from fluid contact for the first two hours after mixing. This was due to forced fast elution of large amounts of cement-constituting fluoride ions and aluminium ions and to the development of acid valences and their interactions. A total hardening time of less than 25 min had an especially unfavourable influence on cell behaviour. Cell impairments could be reduced significantly by coating the 30-minute cured cement with PDS sheeting and significantly by covering it with viscous collagene. On the other hand, cement toxicity was intensified in part by combinations with some other coating materials. CONCLUSIONS: Ionomeric cement should be kept dry and protected from any fluid contact for at least 30 minutes after mixing. Contact with soft tissue should also be avoided for this time. With a hardening time of 30 minutes, the quality and biocompatibility of glass ionomeric cement could be substantially optimized by coating it with PDS sheeting. These results should be verified in animal experiments and clinical trials.
BACKGROUND: The hybrid bone substitute ionomeric cement achieves a stable and durable space-free bond to adjacent bone during hardening. Clinical studies have evaluated the material differently: Fully hardened ionomeric cement showed in middle ear surgery, e.g. as an ossicular prosthesis, good biocompatibility with outstanding functional results. In a few cases, freshly mixed ionomeric cement led to severe complications after contact with CSF in skull base surgery. Therefore we intended to evaluate the influence of early fluid contact on the quality of cement and to define the interval for a safe application of the material, using a cell culture model. Further we intended to investigate whether combining cement with homologous and alloplastic materials influenced its quality. METHODS: 1) Ionomeric cement (Ionocem) test bodies were placed in Ringer's solution at different times after the mixing phase. 2) Ionomeric cement (Ionocem) test bodies were coated with different clinically used homologous and alloplastic materials during the setting and hardening phase. The concentrations of released cement-forming ions and the toxic effects on mouse fibroblasts within cell cultures were measured. RESULTS:Cytotoxic effects were observed when ionomeric cement was not carefully protected from fluid contact for the first two hours after mixing. This was due to forced fast elution of large amounts of cement-constituting fluoride ions and aluminium ions and to the development of acid valences and their interactions. A total hardening time of less than 25 min had an especially unfavourable influence on cell behaviour. Cell impairments could be reduced significantly by coating the 30-minute cured cement with PDS sheeting and significantly by covering it with viscous collagene. On the other hand, cement toxicity was intensified in part by combinations with some other coating materials. CONCLUSIONS: Ionomeric cement should be kept dry and protected from any fluid contact for at least 30 minutes after mixing. Contact with soft tissue should also be avoided for this time. With a hardening time of 30 minutes, the quality and biocompatibility of glass ionomeric cement could be substantially optimized by coating it with PDS sheeting. These results should be verified in animal experiments and clinical trials.