gms | German Medical Science

Objectives: Implant-related infections are common in trauma and orthopedic surgery and leads to healing failure due to osteolysis. The primary challenge to treat infections is attributed to the application of biodegradable antiseptic paste. Further, effective treatment of infections can be challenging due to limited penetration into the infected region. In such cases, controlled release of antimicrobial paste can be an alternative to treat such infections. One promising possible solution is a ready to inject anti-septic, anti-microbial, bone regenerating and biodegradable cement. This study aims to develop an antimicrobial paste that transitions from flowable to solid upon injection, enhancing bone healing and providing mechanical support without cytotoxic effects. The focus is on achieving a balance between antibacterial efficacy and biocompatibility.

Methods: In this prospective experimental study, a blend of collagen, calcium hydroxide, and PVP-Iodine was formulated to create the antimicrobial paste. Its properties, including flowability, hardening time, cytotoxicity to rat cells, and antibacterial effectiveness against E. coli, were rigorously evaluated. The study utilized in vitro testing for both cytotoxicity and antibacterial assessments, with statistical analysis to ascertain effectiveness and safety. The methodology ensured adherence to evidence-based medicine (EbM) levels for robust data evaluation and clinical paper review.

Results and conclusion: The paste exhibited significant antibacterial activity, notably reducing E. coli proliferation. The iodine component displayed superior antibacterial effects, expanding the inhibition zone from 2 cm at 3 hours to over 6 cm after 24 hours. Calcium hydroxide presented a stable inhibition zone around 6 cm, while beef gelatin's effect increased by approximately 1 cm at each time interval, peaking after 24 hours. Cell viability tests revealed no cytotoxicity, with initial cell counts at 10.1 million, of which 8.86 million were viable. Post-exposure, the fluid paste mixture promoted the highest cell growth, with a total of 13 million cells/ml, marking a 108% increase in viable cells. Percentage growth values indicated the fluid paste mixture achieved the highest total cell count increase at 16%, surpassing collagen at 15% and the control’s 14%. The solidified paste mixture matched the control's growth rate at 13%, with PVP10 at 11% and calcium hydroxide at the lowest growth rate of 9%. The optimized antimicrobial paste effectively supports bone healing and prevents bacterial infection without harming adjacent cells. Its ability to transition from a flowable to a solid state, combined with its high antibacterial efficacy and compatibility with cell growth, positions it as a promising tool for medical applications in bone healing. The precise percentages and growth values underscore the paste’s potential for enhancing bone regeneration while maintaining a safe profile for clinical use.