The influence of alloying and fabrication techniques on the mechanical properties, biodegradability and biocompatibility of zinc: A comprehensive review

Additively manufactured biodegradable porous zinc

Additively manufacturing (AM) opens up the possibility for biodegradable metals to possess uniquely combined characteristics that are desired for bone substitution, including bone-mimicking mechanical properties, topologically ordered porous structure, pore interconnectivity and biodegradability. Zinc is considered to be one of the promising biomaterials with respect to biodegradation rate and biocompatibility. However, no information regarding the biodegradability and biocompatibility of topologically ordered AM porous zinc is yet available. Here, we applied powder bed fusion to fabricate porous zinc with a topologically ordered diamond structure. An integrative study was conducted on the static and dynamic biodegradation behavior (in vitro, up to 4 weeks), evolution of mechanical properties with increasing immersion time, electrochemical performance, and biocompatibility of the AM porous zinc. The specimens lost 7.8% of their weight after 4 weeks of dynamic immersion in a revised simulated body fluid. The mechanisms of biodegradation were site-dependent and differed from the top of the specimens to the bottom. During the whole in vitro immersion time of 4 weeks, the elastic modulus values of the AM porous zinc (E = 700-1000 MPa) even increased and remained within the scope of those of cancellous bone. Indirect cytotoxicity revealed good cellular activity up to 72 h according to ISO 10,993-5 and -12. Live-dead staining confirmed good viability of MG-63 cells cultured on the surface of the AM porous zinc. These important findings could open up unprecedented opportunities for the development of multifunctional bone substituting materials that will enable reconstruction and regeneration of critical-size load-bearing bone defects. STATEMENT OF SIGNIFICANCE: No information regarding the biodegradability and biocompatibility of topologically ordered AM porous zinc is available. We applied selective laser melting to fabricate topologically ordered porous zinc and conducted a comprehensive study on the biodegradation behavior, electrochemical performance, time-dependent mechanical properties, and biocompatibility of the scaffolds. The specimens lost 7.8% of their weight after4 weeks dynamic biodegradation while their mechanical properties surprisingly increased after 4 weeks. Indirect cytotoxicity revealed good cellular activity up to 72 h. Intimate contact between MG-63 cells and the scaffolds was also observed. These important findings could open up unprecedented opportunities for the development of multifunctional bone substituting materials that mimic bone properties and enable full regeneration of critical-size load-bearing bony defects.

Evaluation of a Zn-2Ag-1.8Au-0.2V Alloy for Absorbable Biocompatible Materials

Zinc (Zn) and Zn-based alloys have been proposed as a new generation of absorbable metals mainly owing to the moderate degradation behavior of zinc between magnesium and iron. Nonetheless, mechanical strength of pure Zn is relatively poor, making it insufficient for the majority of clinical applications. In this study, a novel Zn–2Ag–1.8Au–0.2V (wt.%) alloy (Zn–Ag–Au–V) was fabricated and investigated for use as a potential absorbable biocompatible material. Microstructural characterization indicated an effective grain-refining effect on the Zn alloy after a thermomechanical treatment. Compared to pure Zn, the Zn–Ag–Au–V alloy showed significantly enhanced mechanical properties, with a yield strength of 168 MPa, an ultimate tensile strength of 233 MPa, and an elongation of 17%. Immersion test indicated that the degradation rate of the Zn–Ag–Au–V alloy in Dulbecco’s phosphate buffered saline was approximately 7.34 ± 0.64 μm/year, thus being slightly lower than that of pure Zn. Biocompatibility tests with L929 and Saos-2 cells showed a moderate cytotoxicity, alloy extracts at 16.7%, and 10% concentration did not affect metabolic activity and cell proliferation. Plaque formation in vitro was reduced, the Zn–Ag–Au–V surface inhibited adhesion and biofilm formation by the early oral colonizer Streptococcus gordonii, indicating antibacterial properties of the alloy.

Zn-Mg Biodegradable Composite: Novel Material with Tailored Mechanical and Corrosion Properties

Zinc-based alloys represent one of the most highly developed areas regarding biodegradable materials. Despite this, some general deficiencies such as cytotoxicity and poor mechanical properties (especially elongation), are not properly solved. In this work, a Zn-5Mg (5 wt.% Mg) composite material with tailored mechanical and superior corrosion properties is prepared by powder metallurgy techniques. Pure Zn and Mg are mixed and subsequently compacted by extrusion at 200 °C and an extrusion ratio of 10. The final product possesses appropriate mechanical properties (tensile yield strength = 148 MPa, ultimate tensile strength = 183 MPa, and elongation = 16%) and decreased by four times the release of Zn in the initial stage of degradation compared to pure Zn, which can highly decrease cytotoxicity effects and therefore positively affect the initial stage of the healing process.

The Fundamental Comparison of Zn-2Mg and Mg-4Y-3RE Alloys as a Perspective Biodegradable Materials

Biodegradable materials are of interest for temporary medical implants like stents for restoring damaged blood vessels, plates, screws, nails for fixing fractured bones. In the present paper new biodegradable Zn-2Mg alloy prepared by conventional casting and hot extrusion was tested in in vitro and in vivo conditions. Structure characterization and mechanical properties in tension and compression have been evaluated. For in vivo tests, hemispherical implants were placed into a rat cranium. Visual observation of the living animals, an inspection of implant location and computed tomography CT imaging 12 weeks after implantation were performed. Extracted implants were studied using scanning electron microscopy (SEM) on perpendicular cuts through corrosion products. The behaviour of zinc alloy both in in vitro and in vivo conditions was compared with commercially used Mg-based alloy (Mg-4Y-3RE) prepared by conventional casting and hot extrusion. Both compressive and tensile yield strengths of Zn and Mg-based alloys were similar; however, the brittleness of Mg-4Y-3RE was lower. Zn and Mg-based implants have no adverse effects on the behaviour or physical condition of rats. Moreover, gas bubbles and the inflammatory reaction of the living tissue were not detected after the 12-week period.

Response of human periosteal cells to degradation products of zinc and its alloy

Zinc (Zn) and its alloys are proposed as promising resorbable materials for osteosynthesis implants. Detailed studies should be undertaken to clarify their properties in terms of degradability, biocompatibility and osteoinductivity. Degradation products of Zn alloys might affect directly adjacent cellular and tissue responses. Periosteal stem cells are responsible for participating in intramembranous ossification during fracture healing. The present study aims at examining possible effects emanating from Zn or Zn-4Ag (wt%) alloy degradation products on cell viability and osteogenic differentiation of a human immortalized cranial periosteal cell line (TAg cells). Therefore, a modified extraction method was used to investigate the degradation behavior of Zn and Zn-4Ag alloys under cell culture conditions. Compared with pure Zn, Zn-4Ag alloy showed almost fourfold higher degradation rates under cell culture conditions, while the associated degradation products had no adverse effects on cell viability. Osteogenic induction of TAg cells revealed that high concentration extracts significantly reduced calcium deposition of TAg cells, while low concentration extracts enhanced calcium deposition, indicating a dose-dependent effect of Zn ions. Our results give evidence that the observed cytotoxicity effects were determined by the released degradation products of Zn and Zn-4Ag alloys, rather than by degradation rates calculated by weight loss. Extracellular Zn ion concentration was found to modulate osteogenic differentiation of TAg cells. These findings provide significant implications and guidance for the development of Zn-based alloys with an optimized degradation behavior for Zn-based osteosynthesis implants.

Selection of extraction medium influences cytotoxicity of zinc and its alloys

Zinc (Zn) alloys have been considered as promising absorbable metals, mainly due to their moderate degradation rates ranging between magnesium alloys and iron alloys. The degradation behavior depends on the specific physiological environment. Released metallic ions and corrosion products directly influence biocompatibility. The initial contact of orthopedic implants or vascular stents after implantation will be with blood. In this study, fetal bovine serum (FBS) was used as a model system of blood components. We investigated the influence of FBS on in vitro degradation behavior and cytotoxicity of pure Zn, and Zn-4Ag and Zn-2Ag-1.8Au-0.2 V (wt%) alloys. The initial degradation rates in FBS were assessed and compared with the degradation and toxicity in four other common physiological model systems: DMEM cell culture medium ± FBS and McCoy's 5A medium ± FBS. Test samples in pure FBS showed the highest initial degradation rates, and accordingly, FBS supplemented media accelerated the degradation process as well. Moreover, an extract test according to ISO 10993-5 and -12 with L929 and Saos-2 cells was performed to investigate the role of FBS in the extraction medium. The cytotoxic effects observed in the tests were correlated with FBS-mediated Zn²⁺ release. These findings have significant implications regarding the selection of appropriate media for in vitro degradation and cytotoxicity evaluation of Zn and its alloys. STATEMENT OF SIGNIFICANCE: Metallic zinc and its alloys have been considered as promising biodegradable metals, mainly due to their moderate degradation rates. However, in vitro cytotoxicity tests according to the current ISO 10993 standard series are not suitable to predict biocompatibility of Zn alloys due to the inconsistent correlation between in vitro and in vitro biocompatibility. In this study, we show that the outcomes of standardized in vitro cytotoxicity tests of Zn and Zn alloys are influenced by fetal bovine serum in the extraction vehicle because FBS promotes Zn²⁺ release during the extraction process. The results of the study provide significant information for selection of appropriate model systems to evaluate in vitro degradation behavior and cytotoxicity.

Additive manufacturing of biodegradable metals: Current research status and future perspectives

The combination of biodegradable metals and additive manufacturing (AM) leads to a revolutionary change of metal implants in many aspects including materials, design, manufacturing, and clinical applications. The AM of nondegradable metals such as titanium and CoCr alloys has proven to be a tremendous success in clinical applications. The AM of biodegradable metals including magnesium (Mg), iron (Fe), and zinc (Zn) is still in its infancy, although much progress has been made in the research field. Element loss and porosity are common processing problems for AM of biodegradable metals like Zn and Mg, which are mainly caused by evaporation during melting under a high-energy beam. The resulting formation quality and properties are closely related to material, design, and processing, making AM of biodegradable metals a typical interdisciplinary subject involving biomaterials, mechanical engineering, and medicine. This work reviews the state of research and future perspective on AM of biodegradable metals from extensive viewpoints such as material, processing, formation quality, design, microstructure, and properties. Effects of powder properties and processing parameters on formation quality are characterized in detail. The microstructure and metallurgical defects encountered in the AM parts are described. Mechanical and biodegradable properties of AM samples are introduced. Design principles and potential applications of biodegradable metal implants produced by AM are discussed. Finally, current research status is summarized together with some proposed future perspectives for advancing knowledge about AM of biodegradable metals. STATEMENT OF SIGNIFICANCE: Rapid development of research and applications on biodegradable metals and additive manufacturing (AM) has been made in recent years. Customized geometric shapes of medical metals with porous structure can be realized accurately and efficiently by laser powder bed fusion (L-PBF), which is beneficial to achieve reliable stress conduction and balanced properties. This review introduces the development history and current status of AM of biodegradable metals and then critically surveys L-PBF of Mg-, Fe-, and Zn-based metals from multiple viewpoints including materials, processing, formation quality, structural design, microstructure, and mechanical and biological properties. The present findings are summarized together with some proposed future challenges for advancing AM of biodegradable metals into real clinical applications.

Long-term in vivo study of biodegradable Zn-Cu stent: A 2-year implantation evaluation in porcine coronary artery

In the present study, a novel biodegradable Zn-0.8Cu coronary artery stent was fabricated and implanted into porcine coronary arteries for up to 24 months. Micro-CT analysis showed that the implanted stent was able to maintain structural integrity after 6 months, while its disintegration occurred after 9 months of implantation. After 24 months of implantation, approximately 28 ± 13 vol% of the stent remained. Optical coherence tomography and histological analysis showed that the endothelialization process could be completed within the first month after implantation, and no inflammation responses or thrombosis formation was observed within 24 months. Cross-section analysis indicated that the subsequent degradation products had been removed in the abluminal direction, guaranteeing that the strut could be replaced by normal tissue without the risk of contaminating the circulatory system, causing neither thrombosis nor inflammation response. The present work demonstrates that the Zn-0.8Cu stent has provided sufficient structural supporting and exhibited an appropriate degradation rate during 24 months of implantation without degradation product accumulation, thrombosis, or inflammation response. The results indicate that the Zn-0.8Cu coronary artery stent is promising for further clinical applications. STATEMENT OF SIGNIFICANCE: Although Zn and its alloys have been considered to be potential candidates of biodegradable metals for vascular stent use, by far, no Zn-based stent with appropriate medical device performance has been reported because of the low mechanical properties of zinc. The present work presents promising results of a Zn-Cu biodegradable vascular stent in porcine coronary arteries. The Zn-Cu stent fabricated in this work demonstrated adequate medical device performance both in vitro and in vivo and degraded at a proper rate without safety problems induced. Furthermore, large animal models have more cardiovascular similarities as humans. Results of this study may provide further information of the Zn-based stents for translational medicine research.

Challenges in the use of zinc and its alloys as biodegradable metals: Perspective from biomechanical compatibility

To date, more than fifty articles have been published on the feasibility studies of zinc and its alloys as biodegradable metals. These preliminary in vitro and in vivo studies showed acceptable biodegradability and reasonable biocompatibility in bone and blood microenvironments for the experimental Zn-based biodegradable metals and, for some alloy systems, superior mechanical performance over Mg-based biodegradable metals. For instance, the Zn-Li alloys exhibited higher UTS (UTS), and the Zn-Mn alloys exhibited higher elongation (more than 100%). On the one hand, similar to Mg-based biodegradable metals, insufficient strength and ductility, as well as relatively low fatigue strength, may lead to premature failure of medical devices. On the other hand, owing to the low melting point of the element Zn, several new uncertainties with regard to the mechanical properties of biomedical zinc alloys, including low creep resistance, high susceptibility to natural aging, and static recrystallization (SRX), may lead to device failure during storage at room temperature and usage at body temperature. This paper comprehensively reviews studies on these mechanical aspects of industrial Zn and Zn alloys in the last century and biomedical Zn and Zn alloys in this century. The challenges for the future design of biomedical zinc alloys as biodegradable metals to guarantee 100% mechanical compatibility are pointed out, and this will guide the mechanical property design of Zn-based biodegradable metals. STATEMENT OF SIGNIFICANCE: Previous studies on mechanical properties of industrial Zn and Zn alloys in the last century and biomedical Zn and Zn alloys in this century are comprehensively reviewed herein. The challenges for the future design of zinc-based biodegradable materials considering mechanical compatibility are pointed out. Common considerations such as strength, ductility, and fatigue behaviors are covered together with special attention on several new uncertainties including low creep resistance, high susceptibility to natural aging, and static recrystallization (SRX). These new uncertainties, which are not significantly observed in Mg-based and Fe-based materials, are largely due to the low melting point of the element Zn and may lead to device failure during storage at room temperature and clinical usage at body temperature. Future studies are urgently needed on these topics.

Current status and perspectives of zinc-based absorbable alloys for biomedical applications

Absorbable metals have the potential to serve as the next generation of temporary medical implant devices by safely dissolving in the human body upon vascular tissue healing and bone regeneration. Their implementation in the market could greatly reduce the need of costly and risky additional surgeries for either implant replacement or removal, often required in current permanent implants. Despite the extensive research done over the last two decades on magnesium (Mg) and iron (Fe) based alloys, they have not generally shown a satisfactory combination of mechanical properties, biocompatibility and controlled degradation rate in the physiological environment. Consequently, zinc (Zn) based alloys were introduced in the last few years as alternative materials to overcome the limitations of Fe and Mg-based alloys. The blend of different alloying elements and processing conditions have led to a wide variety of Zn-based alloys having tunable mechanical properties and corrosion rates. This review provides the most recent progress in the development of absorbable Zn-based alloys for biomedical implant applications, primarily for cardiovascular and orthopedic devices. Their biocompatibility, processability and metallurgical aspects, as well as their mechanical behavior and corrosion properties are presented and discussed, including their opportunities, limitations and future research directions. STATEMENT OF SIGNIFICANCE: Temporary orthopedic bioimplants have become increasingly popular as they offer an alternative to prevent complications, like infections or secondary surgeries, often related to the implantation of permanent devices. Iron and magnesium alloys were extensively studied as candidates for absorbable medical applications, but they generally failed to provide a desirable mechanical performance and corrosion characteristics in the physiological environment. Zinc was introduced in the last decade as a potential implant material after showing outstanding biocompatibility and biodegradability. This review summarizes the research advances to date and provides a thorough discussion of the future challenges of absorbable zinc alloys to satisfy the demanding clinical benchmarks for absorbable medical applications. Their biocompatibility, mechanical, and corrosion aspects, both in vitro and in vivo, are comprehensively reviewed and assessed accordingly.

The Prospects for Biodegradable Zinc in Wound Closure Applications

Zinc is identified as a promising biodegradable metal along with magnesium and iron. In the last 5 years, considerable progress is made on understanding the mechanical properties, biodegradability, and biocompatibility of zinc and its alloys. A majority of these studies have focused on using zinc for absorbable cardiovascular and orthopedic device applications. However, it is likely that zinc is also suitable for other biomedical applications. In this work, the prospects for zinc in the fabrication of wound closure devices such as absorbable sutures, staples, and surgical tacks are critically assessed, with the aim of inspiring future research on biodegradable Zn for this medical application.

Absorbable Mg surgical tack: Proof of concept &in situ fixation strength

A prototype magnesium (Mg) surgical tack is tested comparatively against commercially available tacks made of titanium (ProTack^tm, Medtronic) and PLGA (AbsorbaTack^tm, Medtronic). The pull-out force is measured in situ in a lap-shear pull-out test, using porcine abdominal muscle tissue as a model. The Mg tack had a pull-out force comparable to those of the commercially available tacks. The majority of the Mg tacks also had a more ductile failure mode (i.e. the tacks deformed prior to failure), compared to the commercial tacks which pulled directly from the tissue with no deformation. The Mg tacks deformed as they were removed from the tissue, causing less damage to the tissue in the process. This is the first reported use of a Mg alloy in this application, and the proof of concept indicates that this is an area that deserves further interest and study.

Investigation of zinc‑copper alloys as potential materials for craniomaxillofacial osteosynthesis implants

In this study, zinc‑copper (ZnCu) alloys were investigated regarding their feasibility as absorbable metals for osteosynthesis implants, especially in the craniomaxillofacial area. Mechanical properties and in vitro corrosion behavior of as-rolled Zn-xCu (x = 1, 2 and 4 wt%) alloys were systematically evaluated and screened. The as-rolled Zn4Cu alloy had mechanical properties that were superior to the most absorbable craniomaxillofacial osteosynthesis materials recently reported. The addition of Cu to Zn showed to have no apparent effect on the corrosion rates of the samples. The rolling process on Zn and Zn1Cu resulted in more uniform corrosion than on as-cast counterparts after 28 days immersion. Furthermore, the Zn4Cu alloys exhibited no apparent cytotoxic effect towards L929, TAg or Saos-2 cells. Proliferation rates of TAg and Saos-2 cells were shown to be activated by specific Zn ion concentrations in the as-rolled Zn4Cu alloy extracts. Analysis of in vitro antibacterial properties revealed that the as-rolled Zn4Cu alloy possessed the potential to inhibit biofilm formation of mixed oral bacteria. We conclude that the as-rolled Zn4Cu alloy might be a promising material for fabrication of craniomaxillofacial osteosynthesis implants.