Medical Cement – Bone Cement and Dental Cement Explained
In medicine, cement refers to a biocompatible bonding or filling material used in orthopedics and dentistry to securely fix implants, prostheses, or restorations in place.
Things worth knowing about "Cement"
In medicine, cement refers to a biocompatible bonding or filling material used in orthopedics and dentistry to securely fix implants, prostheses, or restorations in place.
What Is Medical Cement?
Medical cement is a collective term for biocompatible bonding and fixation materials used across various medical specialties. The most well-known applications include orthopedic surgery (bone cement), dentistry (dental cement), and spinal surgery. Despite sharing a name, these materials differ considerably in their chemical composition, mechanism of action, and clinical indications.
Types of Medical Cement
Bone Cement
Bone cement -- most commonly based on polymethylmethacrylate (PMMA) -- is widely used in orthopedic and trauma surgery to fix artificial joints such as hip and knee prostheses to the surrounding bone. It consists of a powder and a liquid component that, when mixed, undergo a chemical polymerization reaction and harden. Bone cement does not act as a glue; instead, it serves as an interfill material that distributes mechanical loads evenly between the prosthesis and the bone.
Dental Cement
Dental cement is an umbrella term covering a range of materials used in dentistry for the permanent or temporary fixation of crowns, bridges, inlays, and as cavity liners. Common types include:
- Glass ionomer cement (GIC): Chemically bonds to enamel and dentine, releases fluoride, and is frequently used in pediatric dentistry.
- Zinc phosphate cement: One of the oldest dental cements, used for definitive crown and bridge cementation.
- Resin cement (composite cement): Offers high aesthetics and strong adhesion; preferred for all-ceramic restorations.
- Zinc oxide eugenol cement: Used as a temporary cement due to its soothing effect on the dental pulp.
Vertebroplasty and Kyphoplasty Cement
In spinal surgery, bone cement is used to treat vertebral compression fractures, particularly those caused by osteoporosis. In vertebroplasty, liquid cement is injected directly into the fractured vertebral body. In kyphoplasty, a balloon is first inflated to restore vertebral height before the cement is introduced.
Composition and Mechanism of Action
Most medical cements rely on a chemical hardening reaction -- either polymerization or an acid-base reaction. PMMA-based bone cement polymerizes upon mixing, generating heat in an exothermic reaction. This heat must be carefully managed during surgery, as excessive temperatures can damage surrounding tissue. Dental cements harden through acid-base reactions or light-activated polymerization, depending on the type.
Benefits and Risks
Benefits
- Excellent primary stability for implants and prostheses
- Immediate load-bearing capacity after hardening
- Versatile in consistency and clinical application
- Some formulations contain antibiotics (e.g., gentamicin-loaded bone cement) to reduce infection risk
Risks and Side Effects
- Bone cement implantation syndrome (BCIS): A rare but potentially life-threatening drop in blood pressure occurring during cemented hip arthroplasty.
- Cement leakage: Unintended migration of cement into adjacent structures, such as blood vessels during vertebroplasty.
- Allergic reactions: To cement components such as methacrylate monomers.
- Long-term loosening: Cemented prostheses may become loose over time as the bone-cement interface degrades.
Application and Processing
Medical cement is always prepared and applied under sterile conditions by trained professionals such as surgeons and dentists. Working time is limited and must be strictly observed. Modern vacuum mixing systems for bone cement reduce porosity and improve the mechanical properties of the hardened material. In dentistry, both self-curing and light-curing systems are available, offering flexibility depending on the clinical situation.
References
- Breusch, S. J. & Malchau, H. (Eds.) - The Well-Cemented Total Hip Arthroplasty. Springer, Berlin (2005).
- van Noort, R. - Introduction to Dental Materials. 4th Edition. Mosby Elsevier, Edinburgh (2013).
- European Federation of National Associations of Orthopaedics and Traumatology (EFORT) - Guidelines on Bone Cement Use in Joint Replacement. www.efort.org (accessed 2024).
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