BIOCERAMICS AND THE HUMAN BODY Proceedings of the International Congress on Bioceramics and the Human Body held in Faenza, Italy, 2-5 April, 1991, organised by the IRTEC-CNR Institute in collaboration with Agenzia Polo Ceramico. INTERNATIONAL SCIENTIFIC COMMI1TEE A. RAV AGLIOLI (IRTEC-CNR, Faenza-I), the President of the Congress G. BERGER (Academy of Science, Berlin--D) W. BONFIELD (Biomaterials Dept., Queen Mary & Westfield College-IRC, University of London-UK) E.Y. CHAO (Mayo Clinic, Rochester-USA) P. CRISTEL (European Society for Biomaterials, Paris-F) K. DE GROOT (University of Leiden-NL) G. DE MARIA (Universitl"La Sapienza" di Roma-I) C. DOYLE (How Medica International, Staines-UK) P. DUCHEYNE (Pennsylvania University, Philadelphia-USA) U. GROSS (European Society for Biomaterials, Berlin-D) G. HASTINGS (Biomaterials Dept., Queen Mary & Westfieid College-IRC, University of London-UK) G. HEIMKE (Clemson University-USA) S. HULBERT (American Society of Biomaterials Terre Harte-USA) A. KRAJEWSKI (IRTEC-CNR, Faenza-I) P.G. MARCHETTI (Istituti Ortopedici Rizzoli, Bologna-I) G. MURATORI (Gruppo Italiano Studi Implantari, Bologna-I) A. MORONI (Universitl di Bologna-I) H. OONISHI (Japanese Society for Biomaterials, Osaka-J) F.J. SCHOEN (American Society for Biomaterials, Boston-USA) P. TRANQUILLI LEALI (Universitl Cattolica, Roma-I) D. WILLIAMS (University of Liverpool-UK) H. WOLF (University of Berlin-D) ORGANIZING COMMl1TEE AND REPRESENTATIVES FROM SCIENTIFIC SOCIETIES G.N. BABINI (IRTEC-CNR, Faenza-I) W. BONFIELD (Biomaterials Dept., Queen Mary & Westfield College, IRC, University of London, London-UK) L. CINI (Societl Ceramica Ita1iana, Bologna-I) S. CONTOLI (Ospedale Civile, Faenza-I) P. CHRISTEL (European Society of Biomaterials, Paris-F) S. CHAO (Mayo-Clinic, Rochester-USA) S. GIANNINI (Istituti Ortopedici Rizzoli, Bologna-I) P. GIUSTI (Societl Italiana Biomateriali, Siena-I) P.G. MARCHETTI (Istituti Ortopedici Rizzoli, Bologna-I) F. MAROTTI (Soc. Ital. Biomeccanica Ortopedia Traumatologia, Modena-I) A. RAV AGLIOLI (IRTEC-CNR, Faenza-I) C. ROVELLI (Agenzia Polo Ceramico, Faenza-I) R. SILVESTRINI (CNR Biomaterials Program, Roma-I) M. SPECTOR (Society for Biomaterials, Atlanta-USA) T. SAKURAI (Japanese Society for Biomaterials, Tokyo--J) P.S. WALKER (European Society of Biomechanics, London-UK) BIOCERAMICS AND THE HUMAN BODY Edited by A. RAV AGLIOLI and A. KRAJEWSKI Research Institute tor Ceramic Technology, National Research Council, Faenza, Italy ELSEVIER APPLIED SCIENCE LONDON and NEW YORK ELSEVIER SCIENCE PUBLISHERS LID Crown House, Linton Road, Barking, Essex IGll 8JU, England Sole Distributor in the USA and Canada ELSEVIER SCIENCE PUBLISHING CO., INe. 655 Avenue of the Americas, New York, NY 10010, USA WITH 79 TABLES AND 320 ILLUSTRATIONS © 1992 ELSEVIER SCIENCE PUBLISHERS LID British Library Cataloguing in Publication Data International Congress on Bioceramics and the Human Body (1991: Faenza, Italy) Bioceramics and the human body. I. Title 11. Ravaglioli, A. III. Krajewski, A. 610.28 ISBN 1-85166-748-2 Library of Congress CIP data applied for No responsibiJity is assumed by the Publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Special regulations for readers in the USA This public~ion has been registered with the Copyright Clearance Center Inc. (CCC) , Salem, Massachusetts. Information can be obtained from the CCC about conditions under which photo- copies of parts of this publication may be made in the USA. All other copyright questions, incJuding photocopying outside the USA, should be referred to the publisher. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, e1ectronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. v PREFACE For a long time now ceramic materials have been produced for application in the chemical, steel, and glass industries in a variety of conditions, e.g. in the presence of high temperatures, reducing atmospheres, or corrosive liquids. With the advent of the nulcear reactor certain ceramics have been required to resist high radiation fluxes, extreme temperature gradients, or degradation in the presence of corrosive liquids while remaining dimensionally and mechanically stable, without developing fissures or any other kind of incon- venience over many years. The space age has turned to ceramics for a substantial contribution, for example in the case of missile and NASA shuttle coatings. Nowadays even man's life may depend on the performance of certain ceramic materials used as components of surgical implants designed for application inside a living organism-an environment obviously very different from that of a nuclear reactor or outer space but equally (perhaps more) hostile. These are in brief outline the materials discussed at the 'Bioceramics and the Human Body' Congress organized in Faenza with the involvement of 190 representatives from 21 countries. The Americans and the East Germans could not attend the Congress, the former owing to the Gulf War, then in a fast-developing stage, the latter for the well-known economic and relocation problems arising from unification. Their absence was certainly unfortunate, also in consideration of the fact that we collaborate with them in research on bioceramics. The Congress was promoted and organized by the IRTEC-CNR Institute in collaboration with the Agenzia Polo Ceramico. The latter put at our disposal their entire personnei, whom we now wish to thank for their competence in coordinating a meeting of such a specialized nature. Further collaboration came from various societies and institutes such as the European, the American, and the Japanese Societies for Biomaterials, the Istituti Ortopedici Rizzoli, and others. The aim of the Congress was to determine the state of affairs of ceramic science and technology with special reference to the capacity of ceramic materials for osteointegration, from the points of view of basic research and application. Special attention was addressed to the manufacturing of ceramics and their functional role in surgical applications. vi What the Congress achieved was to put forward proposals and compare the different successful or (so far very few) unsuccessful postoperative experiences carried out adopting ceramic prostheses in the shape of either bulk prototypes or coatings applied through highly sophisticated techniques (applications range from the maxillo-facial area to joint extremities). In future perspective, the Congress identified the targets of a further improvement of the already very good interaction between tissues and ceramics (whether inert or bioactive) and of the introduction of new materials such as SiC, ShN4, TiN, TaN, etc. In addition, the tendency emerged to give priority to working for the definition 0/ new standards regulating raw materials and finished products. A. RAVAGLIOLI A. KRAJEWSKI vii CONTENTS Preface............................................... ........................................ v Introductory Report ..................................................................... 1 A. Ravaglioli and A. Krajewski 1. Surgery of the prosthetic implantations Fifteen years' experiences with alumina-ceramic total hip-joint endo- protheses: a c1inical, histological and tribological analysis..................... 17 H. Plenk, Ir., M. Böhler, A. Walter, K. Knahr and M. Salzer Bio-functional adaptive behavior to ceramic implants .......................... 26 A. Toni, A. Sudanese, S. Stea, S. Squarzoni, P.P. Montina, A. Bueno Lozano, F. Calista, A. Pizzoferrato and A. Giunti A review on the aseptic total hip replacement failures ......................... 35 G. Monticelli, L. Romanini, O. Moreschini Solving of prosthetic problems through bioceramies ............................ 46 F. Zarotti Hand MP joint implant arthroplasty: the state of the art. Advantages and disadvantages of the most common implant arthroplasties .................... 49 A. Caroli and S. Zanasi Alumina total joint replacement of the first metatarso phalangeal joint: a biomechanical study of the design ................................................... 62 S. Giannini, A. Moroni, A. Krajewski, A. Ravaglioli, R. Martinetti, C. Farina Titanium hydroxylapatite coated metacarpo-phalangeal and interphalan- geal implant ................................................................................ 67 E.C. Marinoni, G. Venini and A. Ravaglioli Hydroxyapatite coated plate in the surgical treatment of the forearm non union with bone loss ..................................................................... 73 G.F. Zinghi, A. Moroni, L. Specchia, P. Bungaro, G. Gualdrini, G. Rollo, C. Sabato A study on HA-coated titanium dental implants, part I: stress analysis of dental implant ............................................................................. 78 liyong Chen, liming Zhou, Xingdong Zhang, Deri Wan, Shaoan Wang and Anyu Chen viii A study on HA-coated titanium dental implants, part 11: coating properties in vivo, implant design and clinical evaluation ....................................... 89 liyong Chen, liming Zhou, Xingdong Zhang, Deri Wan, Shaoan Wang and Anyu Chem Rehabilitation of radical mastoidectomy cavities with calcium phosphate ceramics ..................................................................................... 101 M. DeI Bo and A. Zaghis Clinical results of IMZ dental implants ............................................. 107 P. Passi Direct composite-ceramic restorations: a ciinical study ........................ 113 C. Prati, G. Montanari, E. Toschi and A. Savino Articulation of ceramic surfaces against polyethylene .......................... 118 R.M. Streicher, M. Semlitsch and R. Schön Hip anatomical uncemented ceramic arthroplasty (AN.C.A.): results at a 3-year follow-up ........................................................................... 124 L. Specchia,A. Moroni, L. Ponziani, G. Rollo, S. Pavone, V. Vendemia 2. Bioceramics: properties ud their technology of production Fluorapatite and hydroxyapatite heat-treated coatings for dental implants 130 H. W. Denissen, H.M. de Nieuport, W. Kalk, H. G. Schaeken and V. van den Hooft Porous titanium implants with and without hydroxyapatite coating ........ 141 A. Moroni, V. Caja, E. Egger, F. Gottsauner Wolf, L. Trinchese, G. Rollo and E. Y. Chao Surface reactivity and biocompatibility of bulk glass and glass coatings ... 148 B. Locardi Plasma spray systems for the deposition of materials for biomedical applications ................................................................................. 156 A. Salito, G. Barbezat, H. Filmer, I. Hochstrasser, A.R. Nicoll and F. Trotta Bioceramics for maxillofacial applications ......................................... 166 I.G.C. Wolke, C.P.A.T. Klein and K. de Groot Nucleation and growth of dicalcium phosphate dihydrate on titanium alloy substrates ................................................................................... 181 P. Royer, M. Freche, C. Rey Relationships between bulk and surface structure and biomaterial bio- compatibility ............................................................................... 189 A. Bertoluzza, M.A. Morelli and A. Tinti Experimental study on the properties of hydroxyapatite coated implants. 195 C. Gabbi, P. Borghetti, N. Antolotti, S. Pitteri Physico-chemical characterization of hydroxyapatite of unknown manufac- ture ........................................................................................... 203 A. Ravaglioli, A. Krajewski, A. Piancastelli and R. Martinetti ix Application of ceramic composites as implants: results and problems ..... 206 S.M. Barinov and Yu. V. Baschenko Radioactivity measurements of zirconia powders ................................ 211 G. Capannesi, A.F. Sedda, C. Piconi, F. Greco Microstructural analysis of bioceramic materials................................. 217 B. Bousjield Yttria and calcia partially stabilized zirconia for biomedical applications. 223 P. Fassina, N. Zaghini, A. Bukat, C. Piconi, F. Greco and S. Piantelli Mechanical properties of plasma sprayed ceramic coatings on orthopaedic implants ..................................................................................... 230 J. Rieu, H. Carrerot, J.-L. Aurelle, A. Rambert and G. Bousquet Plasma-spray coating of titanium supports with various ceramics: a study at the interface................................................................................ 236 A. Krajewski, A. Ravaglioli, V. Biasini, A. Martinetti, A. Piancastelli, S. Sturlese, S. Fioravanti, N. Antolotti, C. Mangano and F. Trotta Microstructure and microanalysis of bioglasses and glass-ceramics from the MgO-CaO-P20S-Si02 system with Zr02............................................ 244 J. Ma. Rincon and P. Callejas The colour of aluminium oxide ceramic implants .............................. .. 250 G. Willmann Dental ceramics and composite resins as restorative materials............... 256 C. Prati, E. Toschi, C. Nucci, R. Mongiorgi, A. Savino Reinforced silver glass-ionomer cement and light-cured H.E.M.A. glass- ionomer cement under silver-amalgam restorations: a microleakage study 260 C. Nucci, E. Toschi, R. Mongiorgi and C. Prati Tensile bond strength of dental porcelain to dental composite resins ...... 265 R. Mongiorgi, C. Prati, E. Toschi and G. Bertocchi Glass-ionomer cements as base for composite restorations ................... 270 E. Toschi, R. Mongiorgi, C. Prati, G. Valdre and C. Nucci 3. Biological characterization and effects on bioceramics Systemic control of tissue and cell reactions relating to ceramic implants 275 U. Gross, C. Müller-Mai and C. Voigt In vitro cytocompatibility and tissue reaction to ceramics ..................... 285 A. Pizzoferrato, E. Cenni, G. Ciapetti, S. Savarino and S. Stea Bioceramics in orthopaedic surgery: know how, status and preIiminary results ........................................................................................ 295 S. Giannini, A. Moroni, G. Coppola, L. Ponziani, A. Ravaglioli, A. Krajewski, A. Venturini, M. Pigato and D. ZaJfe Osseointegration of hydroxyapatite-coated and uncoated bulk alumina implants in the femur of Göttingen minipigs: mechanical testing of bonding strength .......................................................................... 302 J. Orth, S. Macedo, A. Wilke and P. Griss x Thromboresistance of Ti6Al4V, coated with a thin film of turbostratic carbon, for cardiovascular applications ............................................. 308 M.A. Gatti, E. Monari, M. Dondi, G. Noera, G. Fattori, F. Vallana, S. Rinaldi, and E. Pasquino TCP-impurities in HA-granules and crystalinity changes in plasma- ftamesprayed HA-coatings detected by spectroscopical methods and their consequences............................................................................... 317 M. Weinländer, H. Plenk, Jr., F. Adar and R. Holmes Longterm stability of TiN .............................................................. 321 M. Schaldach and A. Bolz In vitro toxicity of fine particles of hydroxyapatite .............................. 334 E.J. Evans and E.M.H. Clarke-Smith Differences in behaviour of cultured fetal rat osteoblasts upon bioglass and nonreactive glasses ................................................................. 340 W. C.A. Vrouwenvelder, C. G. Groot and K. de Groot Complement activation by ceramics ................................................. 345 I. Dion, A. Baquey, C. Baquey, T. Mesana, M. Pourtein, B. Candelon and J.-R. Monties Sister chromatid exchanges (SCEs) and proliferation rate index (PRI): the application of cytogenetic methods in biocompatibility field . . . . . . . . . . . . . 353 M. Cannas, S. Biasiol, A. Masse, A. Ruggeri and R. Strocchi Surface coating of PECVD a-SiC:H to improve biocompatibility ........... 360 A. Bolz and M. Schaldach Bone tissue response to hydroxyapatite-coated and uncoated titanium wire-MESHS in an in.fected site: results of an animal experiment .......... 366 A. Wilke, J. Orth,' M. Kraft and P. Griss Biocompatibility of siliconcarbide and siliconnitride ceramics: results of an animal experiment.................................................................... 372 J. Orth, M. Ludwig, W. Piening, A. Wilke and P. Griss Effect of Ti02 ceramic precursors on human lymphocyte mitogenesis ..... 378 S. Piantelli, G. Maccauro, P. Fassina and A. Bukat Experimental study of two corals used as bone implant in the sheep ...... 383 P. Jammet, F. Bonnei, P. Baldet, F. Souyris and M. Huguet Interfacial study of some inert and active ceramics implanted in bone .... 388 D. ZaJfe, S. Giannini, A. Moroni, A. Krajewski and A. Ravaglioli Surface charge of the bioglass treated by a physiological solution .......... 396 S. Szarska In vivo study of a new active glass for bone repair: short term results .... 402 A.M. Gatti, D. ZaJfe and O. Anderson A study of hydroxyapatite ceramics and its osteogenesis ...................... 408 Zhang Xingdong, Zhou Pin, Zhang Jianguo, Chen Weiqun and Wu Chuong Biological apatite as a material for artificial bone: a preliminary investi- gation on its possibility .................................................................. 417 K. Hirota