In vivo biocompatibility and mechanical study of novel bone-bioactive materials for prosthetic implantation

Maxillofacial Reconstruction With Three Dimensional Resin Bone Substitutes as an Alternative to Transition Group of Metals: A Structured Review

In recent years, novel technologies and techniques have allowed today the production of controlled architecture materials. Although autogenous bone graft substitutes remain the gold standard, enormous defects require supplementary alloplastic substitutes for reconstruction. Polymers have lately been explored for the same purpose and their biological performance has been under research since the last decade. The aim of this review is to analyse maxillofacial reconstruction with three-dimensional resin bone substitutes. A Problem Intervention Comparison Outcomes (PICO) analysis was done and a search was carried out in the Cochrane Database, PubMed, Google Scholar etc databases and a hand search was done to collect the related literature. All articles for maxillofacial reconstruction with three-dimensional resin bone substitutes were scrutinised. The manuscripts published from 1990 till May 2021, were included in this review. A total of 106 articles were obtained from a PICO-based keyword search, and 91 manuscripts were retrieved after excluding the duplicates. Out of these 57 manuscripts were excluded on the basis of title and abstract. From the remaining 34 studies, 17 were excluded after reading the full text based on the inclusion and exclusion criteria. During data extraction, four studies were removed and finally, 13 studies were included in this research. From this scoping review, we could conclude that polymethylmethacrylate and polylactic acid formulations are very promising resin bone substitutes for 3-dimensional reconstruction of maxillofacial defects. However, rigorous long-term clinical trials are needed to validate this conclusion.

Characterization methods of bone-implant-interfaces of bioresorbable and titanium implants by fracture mechanical means

Bioresorbable materials for implants have become increasingly researched over the last years. The bone-implant-interfaces of three different implant materials, namely a new bioresorbable magnesium alloy, a new self-reinforced polymer implant and a conventional titanium alloy, were tested using various methods: push-out tests, SEM and EDX analyses as well as surface analyses based on stereoscopic 3D pictures were conducted. The fracture energy is proposed as a very significant reference value for characterizing the mechanical performance of a bone-implant system. By using a video-extensometer system instead of, as is commonly done, tracking the movement of the crosshead in the push-out tests, the accuracy of measurement could be increased.

pH-Responsive microgel dispersions for repairing damaged load-bearing soft tissue

An important challenge for colloid scientists is to design injectable dispersions that provide structural support for damaged soft tissue and enable regeneration of tissue over the longer term. In this article we highlight a new area of research that aims to produce pH-responsive microgel dispersions that restore the mechanical properties of damaged, load-bearing, soft tissue. Chronic back pain due to degeneration of the intervertebral disc (IVD) is a major health problem and is the primary potential application for the work discussed. pH-Responsive microgel dispersions contain cross-linked polymer particles that swell when the pH approaches the pKa of the incorporated ionic co-monomer. The work considered here involves microgel particles containing MAA (methacrylic acid). The particles show pronounced pH-triggered swelling. The concentrated microgel dispersions change from a fluid to a gel at pH values greater than ca. 6.2, which is within the physiological pH range. The rheological properties are pH-dependent and can be adjusted using particle composition or concentration. Degenerated IVDs containing injected, gelled, microgel dispersions show improved mechanical properties. The disc height under biomechanically meaningful loads can be restored to values observed in non-degenerated IVDs. We also discuss the steps required to provide a minimally invasive injectable microgel system for restoring both the IVD mechanical properties and regenerating tissue in vivo. The approach discussed should also be suitable for other soft tissue types in the body.

Microgel particles containing methacrylic acid: pH-triggered swelling behaviour and potential for biomaterial application

pH-responsive microgels are crosslinked polymer particles that swell when the pH approaches the pK(a) of the ionic monomer incorporated within the particles. In recent work from our group it was demonstrated that the mechanical properties of degenerated intervertebral discs (IVDs) could be restored to normal values by injection of poly(EA/MAA/BDDA) (ethylacrylate, methacrylic acid and butanediol diacrylate) microgel dispersions [J.M. Saunders, T. Tong, C.L. Le Maitre, T.J. Freemont, B.R. Saunders, Soft Matter 3 (2007) 486]. In this work we report the pH dependent swelling and rheological properties of poly(MMA/MAA/EGDMA) (methylmethacrylate and ethyleneglycol dimethacrylate) microgel dispersions. This system was investigated because it contains monomers that are already used as biomaterials. The poly(MMA/MAA/EGDMA) particles exhibit pH-triggered volume swelling ratios of up to ca. 250. The swelling onset for these particles occurs at pH values greater than ca. 6.0. A pK(a) for these particles of ca. 6.7 is consistent with titration and swelling data. Fluid-to-gel phase diagrams for concentrated poly(MMA/MAA/EGDMA) dispersions were determined as a function of polymer volume fraction and pH using tube-inversion measurements. The rheological properties for the gelled microgel dispersions were investigated using dynamic rheology measurements. The elastic modulus data for the poly(MMA/MAA/EGDMA) gelled dispersions were compared to data for poly(EA/MAA/BDDA) microgels. A similar pH-dependence for the elastic modulus was apparent. The maximum elastic modulus was achieved at a pH of about 7.0. The elastic modulus is an exponentially increasing function of polymer volume fraction at pH 7.0. Preliminary cell challenge experimental data are reported that indicate that gelled poly(MMA/MAA/EGDMA) microgel dispersions are biocompatible with cells from human intervertebral discs. However, the duration over which these experiments could be performed was limited by gradual redispersion of the gelled microgel dispersions. Based on the results presented it is suggested that poly(MMA/MAA/EGDMA) microgel would be a good candidate as a biomaterial for structural support of soft connective tissues.

Apatite formation and cellular response of a novel bioactive titanium

The modification of titanium and titanium alloy surface properties by chemical and electrochemical techniques has opened new possibilities to improve the bioactivity and, in general, the biological performance of the implants once in vivo. One of the main aims is the achievement of a surface oxide layer that stimulates hydroxylapatite mineralization and, also, shows osteoconductive properties once in the host. In the present study, two different bioactive surfaces have been prepared following the method purposed by the group of Kokubo and a new method, BioSpark, involving high voltage anodic polarisation and alkali etching both on surface mineralization potential. The aim of the present work was to evaluate and compare the mineralization capability and the early cell response of titanium modified with a new bioactive method and with a well-known and widely tested biomimetic treatment, both compared to non treated titanium. Physical and chemical (energy dispersion spectroscopy, thin film X-ray diffractometry) and morphological (scanning electron microscopy) characterisation of the novel surface features has been performed. Also the effect of the novel surface properties on both hydroxyapatite precipitation and early cellular response has been investigated using in vitro models. The results have shown that both treatments produce an active outer layer on titanium but do not impair cells activity and support osteoblasts processes. BioSpark showed high bioactivity and good mineral phase deposition even after early incubation time, these properties were found in Kokubo's surface as previously published. Mineralisation mechanisms of the two materials were different, and while this mechanisms was well characterised and reported for Kokubo's surface, it was still unclear for BioSpark. In this paper an explanation was given and catalytic properties of the latter surface was bound to both well known crystal titanium oxide exhibiting anatase lattice and a certain level of calcium and phosphorus doping, which promoted chemical and physical variation in anatase properties. At the same time early osteoblasts response to Kokubo's and BioSpark's surface was characterised and, no significant differences was found.

Biological stability and osteoconductivity in rabbit tibia of pulsed laser deposited hydroxylapatite coatings

A comparative study of the biological stability and the osteoconductivity of hydroxylapatite (HA) coatings produced by pulsed laser deposition (PLD) and plasma spraying (PS) was conducted. Three different implant groups were used: grit-blasted titanium rods coated with HA-PLD (2-microm-thick), grit-blasted titanium rods coated with HA-PS (50-microm-thick), and uncoated. Implantation took place into the proximal tibia of 12 mature New Zealand White rabbits for 24 weeks. Samples were evaluated using descriptive histology and histomorphometry. While HA-PS implants showed considerable instability and reduction in thickness after 24 weeks, but no statistical difference to the titanium group, the HA-PLD group showed a significant higher amount of bone apposition (Scheffé test, p<0.05) than the other two groups, without signs of degradation or dissolution. Remarkably, after 6 months, the almost intact thin pulsed laser deposited coating could be observed by electron microscopy in extended areas.

Fixation of revision implants is improved by a surgical technique to crack the sclerotic bone rim

Revision joint replacement has poorer outcomes compared with primary joint replacement, and these poor outcomes have been associated with poorer fixation. We investigated a surgical technique done during the revision operation to improve access from the marrow space to the implant interface by locally cracking the sclerotic bone rim that forms during aseptic loosening. Sixteen implants were inserted bilaterally by distal femur articulation of the knee joint of eight dogs, using our controlled experimental model that replicates the revision setting (sclerotic bone rim, dense fibrous tissue, macrophages, elevated cytokines) by pistoning a loaded 6.0-mm implant 500 microm into the distal femur with particulate PE. At 8 weeks, one of two revision procedures was done. Both revision procedures included complete removal of the membrane, scraping, lavaging, and inserting a revision plasma-spray Ti implant. The crack revision procedure also used a splined tool to circumferentially locally perforate the sclerotic bone rim before insertion of an identical revision implant. Superior fixation was achieved with the cracking procedure in this experimental model. Revision implants inserted with the rim cracking procedure had a significantly higher pushout strength (fivefold median increase) and energy to failure (sixfold median increase), compared with the control revision procedure. Additional evaluation is needed of local perforation of sclerotic bone rim as a simple bone-sparing means to improve revision implant fixation and thereby increase revision implant longevity.