title: Limitation of the antibiotic-eluting bone graft substitute: An example of gentamycin-impregnated calcium sulfate.
abstract: Patients with inadequate volume of alveolar processes or bone defects commonly require graft substitutes in oral, maxillofacial or orthopedic surgery. Ridge augmentation and reconstruction of facial bony defects with bone graft materials achieve better outcomes in functional and aesthetic rehabilitation. The injectable calcium sulfate filler is used widely in intra-operative applications. Calcium sulfate bone filler has been shown to upregulate bone formation-related mRNA genes in vitro and improve osseointegration in vivo. In addition, the bone graft substitute can be used as a drug delivery system for antibiotics to treat or prevent infections based on the clinical experiences. However, the influences of antibiotics addition on the calcium sulfate are not fully understood. In this study, calcium sulfate impregnated with gentamycin in different weight ratios was characterized. The results showed that gentamycin prolonged the hydration process and extended initial/final setting times of calcium sulfate. The addition of gentamycin slowed the conversion from calcium sulfate hemihydrate to dihydrate and changed the crystalline phase and microstructure. Higher amounts of gentamycin added resulted in faster degradation and lower mechanical strength of calcium sulfate. This study reveals that the extended setting time, decreased compressive strength, and the accelerated degradation of the gentamycin-impregnated calcium sulfate bone graft substitutes should be considered during intra-operative applications. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 80-87, 2018.
authors.affiliation: Department of Orthopedics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 10002, Taiwan.|Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, 30015, Taiwan.|Department of Orthopedics, En Chu Kong Hospital, New Taipei City, 23702, Taiwan.
authors.forename: Chang-Chin
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Dentistry, Taipei Medical University Hospital, Taipei, 11031, Taiwan.|School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan.
authors.forename: Yang-Kai
authors.initials: YK
authors.lastname: Huang
authors.affiliation: School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan.
authors.forename: Wei-Jen
authors.initials: WJ
authors.lastname: Chang
authors.affiliation: School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan.
authors.forename: Yun-Ching
authors.initials: YC
authors.lastname: Wu
authors.affiliation: Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan.|Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan.
authors.forename: Chen-Chie
authors.initials: CC
authors.lastname: Wang
authors.affiliation: School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan.|School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan.|Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan.
authors.forename: Kai-Chiang
authors.initials: KC
authors.lastname: Yang
mesh_terms: D000900:Anti-Bacterial Agents / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology; D018786:Bone Substitutes / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology; D002133:Calcium Sulfate / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology; D004343:Drug Implants; D005839:Gentamicins / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology; D013295:Streptococcus mutans / Q000254:growth & development*
chemical_list: D000900:Anti-Bacterial Agents; D018786:Bone Substitutes; D004343:Drug Implants; D005839:Gentamicins; D002133:Calcium Sulfate
keywords: bone defect; bone substitute; calcium sulfate; gentamycin; infection