Bioactive Glass for Large Bone Repair

Biomineralized tetramethylpyrazine-loaded PCL/gelatin nanofibrous membrane promotes vascularization and bone regeneration of rat cranium defects

Conventional electrospinning produces nanofibers with smooth surfaces that limit biomineralization ability. To overcome this disadvantage, we fabricated a tetramethylpyrazine (TMP)-loaded matrix-mimicking biomineralization in PCL/Gelatin composite electrospun membranes with bubble-shaped nanofibrous structures. PCL/Gelatin membranes (PG), PCL/Gelatin membranes containing biomineralized hydroxyapatite (HA) (PGH), and PCL/Gelatin membranes containing biomineralized HA and loaded TMP (PGHT) were tested. In vitro results indicated that the bubble-shaped nanofibrous surface increased the surface roughness of the nanofibers and promoted mineralization. Furthermore, sustained-release TMP had an excellent drug release efficiency. Initially released vigorously, it reached stabilization at day 7, and the slow-release rate stabilized at 61.0 ± 1.8% at 28 days. All membranes revealed an intact cytoskeleton, cell viability, and superior adhesion and proliferation when stained with Ghost Pen Cyclic Peptide, CCK-8, cell adhesion, and EdU. In PGHT membranes, the osteogenic and vascularized gene expression of BMSCs and human vascular endothelial cells was significantly upregulated compared with that in other groups, indicating the PGHT membranes exhibited an effective vascularization role. Subsequently, the membranes were implanted in a rat cranium defect model for 4 and 8 weeks. Micro-CT and histological analysis results showed that the PGHT membranes had better bone regenerative patterns. Additionally, the levels of CD31 and VEGF significantly increased in the PGHT membrane compared with those in other membranes. Thus, PGHT membranes could accelerate the repair of cranium defects in vivo via HA and TMP synergistic effects.

The synergetic effect of hierarchical pores and micro-nano bioactive glass on promoting osteogenesis and angiogenesis in vitro

Hierarchical pores are important structural components of the bone tissue and are closely related to angiogenesis, nutrient transport, and metabolism involved in the repair of a bone defect. Here, we fabricated a composite scaffold having a hierarchical structure, based on micro-nano bioactive glass (MNBG) incorporated into poly (lactic-co-glycolic acid) (PLGA), and with camphene as a pore-forming agent for bone repair. The results showed that camphene formed abundant micropores in the walls of large pores, resulting in hierarchical pore structures ranging from a few microns to a hundred microns. Moreover, there was 2-3 folds increased in compressive modulus and the scaffolds showed a stable degradation rate and a higher degree of apatite crystallization than ordinary porous scaffolds. The results of in vitro studies showed that, when compared to ordinary porous scaffolds, PLGA-MNBG scaffolds with multi-holes could better promote the proliferation of bone marrow mesenchymal stem cells (BMSCs) and the expression of angiogenic marker (CD31) of human umbilical vein endothelial cells (HUVECs).

Regulated contribution of local and systemic immunity to new bone regeneration by modulating B/Sr concentration of bioactive borosilicate glass

The local immune response induced by bioactive borosilicate glass (BG) plays a vital role in bone regeneration, but its effect in the systemic immune response of distal tissues, such as spleen, remains unknown. In this study, the network structures and the relative theoretical structural descriptors (F_net) of the novel BG composition containing boron (B) and strontium (Sr) were calculated and stimulated by molecular dynamics (MD) simulation, and the linear relationships of F_net and B and Sr releasing rate in pure water and simulate body fluid were built. Next, the synergistic effects of the released B and Sr on promoting osteogenic differentiation, angiogenesis, and macrophage polarization were analyzed in vitro and convinced in rats skull models in vivo. Results show that the optimal synergistic effects of B and Sr both in vitro and in vivo released from 1393B2Sr8 BG increased vessel regeneration, modulated M2 macrophages polarization and promoted new-bone formation. Interestingly, the 1393B2Sr8 BG was found to mobilize monocytes from the spleen to the defects and subsequently modulate them into M2 macrophages. Then, these modulated cells cycled from the bone defects back to the spleen. To analyze the necessity of spleen-derived immune cells in bone regeneration, two contrasting rat models (with/without spleen) of skull defects were furtherly established. As results, rats without spleen had fewer M2 macrophages surrounding skull defects and the bone tissues recovered more slowly, indicating the beneficial effects on bone regeneration of circulating monocytes and polarized macrophages provided by spleen. The present study provides a new approach and strategy in optimizing complex composition of novel BG and sheds light on the importance of spleen through modulating systemic immune response to contribute to local bone regeneration.

A novel rapidly mineralized biphasic calcium phosphate with high acid-resistance stability for long-term treatment of dentin hypersensitivity

OBJECTIVES

Treating dental hypersensitivity (DH) rapidly and maintaining long-term effectiveness remains challenging. We aimed to address this problem by fabricating a novel rapidly mineralized biphasic calcium phosphate (RMBCP), which could rapidly elicit mineralization to form hydroxyapatite (HA) and perform excellent acid-resistant stability, thus effectively blocking the exposed dental tubules and protecting them from acid attack.

METHODS

RMBCP was firstly synthesized by precisely adjusting the molar ratio of acetic acid and calcium hydroxide and characterized by X-ray diffraction (XRD), X-ray fluorescence microprobe (XRF), Fourier-transform infrared (FTIR) spectrometer, scanning electron microscope (SEM), and transmission electron microscope (TEM). Subsequently, using a commercialized desensitizing agent, 45S5 bioglass (BG), as the control group, the mineralization performance of RMBCP was investigated in simulated body fluid (SBF), Dulbecco's modified eagle medium (DMEM), and even slightly acidic artificial saliva (pH=6.6). Moreover, the biocompatibility of RMBCP was studied. Finally, the tubule occlusion effect and acid-resistant stability of RMBCP were evaluated in vitro and in vivo.

RESULTS

The rapid mineralization behavior of RMBCP could easily adhere to the dentin surface and block the dentinal tubules completely in vitro and in vivo within 7days. RMBCP performed high acid-resistant stability to maintain the long-term therapeutic effect of DH treatment.

SIGNIFICANCE

Developing novel bioactive calcium phosphate materials with the ability to trigger mineralization for HA formation rapidly will be an effective strategy for the long-term treatment of dentin hypersensitivity.

Synthesis of Hierarchically Porous Bioactive Glass and Its Mineralization Activity

Mesoporous bioactive glass is a promising biomaterial for bone tissue engineering due to its good biocompatibility and bioactivity. In this work, we synthesized a hierarchically porous bioactive glass (HPBG) using polyelectrolyte-surfactant mesomorphous complex as template. Through the interaction with silicate oligomers, calcium and phosphorus sources were successfully introduced into the synthesis of hierarchically porous silica, and HPBG with ordered mesoporous and nanoporous structures was obtained. The morphology, pore structure and particle size of HPBG can be controlled by adding block copolymer as co-template or adjusting the synthesis parameters. The ability to induce hydroxyapatite deposition in simulated body fluids (SBF) demonstrated the good in vitro bioactivity of HPBG. Overall, this work provides a general method for the synthesis of hierarchically porous bioactive glasses.

Biological Fixation of Bioactive Bone Cement in Vertebroplasty: The First Clinical Investigation of Borosilicate Glass (BSG) Reinforced PMMA Bone Cement

PMMA bone cement has been clinically used for decades in vertebroplasty due to its high mechanical strength and satisfactory injectability. However, the interface between bone and PMMA is fragile and more prone to refracture in situ because PMMA lacks a proper biological response from the host bone with minimal bone integration and dense fibrous tissue formation. Here, we modified PMMA by incoporating borosilicate glass (BSG) with a dual glass network of [BO₃] and [SiO₄], which spontaneously modulates immunity and osteogenesis. In particular, the BSG modified PMMA bone cement (abbreviated as BSG/PMMA cement) provided an alkaline microenvironment that spontaneously balanced the activities between osteoclasts and osteoblasts. Furthermore, the trace elements released from the BSGs enhanced the osteogenesis to strengthen the interface between the host bone and the implant. This study shows the first clinical case after implantation of BSG/PMMA for three months using the dual-energy CT, which found apatite nucleation around PMMA instead of fibrous tissues, indicating the biological interface was formed. Therefore, BSG/PMMA is promising as a biomaterial in vertebroplasty, overcoming the drawback of PMMA by improving the biological response from the host bone.

Effect of pH on the In Vitro Degradation of Borosilicate Bioactive Glass and Its Modulation by Direct Current Electric Field

Controlled ion release and mineralization of bioactive glasses are essential to their applications in bone regeneration. Tuning the chemical composition and surface structure of glasses are the primary means of achieving this goal. However, most bioactive glasses exhibit a non-linear ion release behavior. Therefore, modifying the immersion environment of glasses through external stimuli becomes an approach. In this study, the ion release and mineralization properties of a borosilicate bioactive glass were investigated in the Tris buffer and K₂HPO₄ solutions with different pH. The glass had a faster ion release rate at a lower pH, but the overly acidic environment was detrimental to hydroxyapatite production. Using a direct current (DC) electric field as an external stimulus, the pH of the immersion solution could be modulated within a narrow range, thereby modulating ion release from the glass. As a result, significant increases in ion release were observed after three days, and the development of porous mineralization products on the glass surface after six days. This study demonstrates the effectiveness of the DC electric field in modulating the ion release of the bioactive glass in vitro and provides a potential way to regulate the degradation of the glass in vivo.

Modified Synthesis and Physicochemical Characterization of a Bioglass-Based Composite for Guided Bone Regeneration

Objectives

Bioglass composites and polymers are materials of great interest for the medical and dental areas due to their properties, combining the bioactivity of ceramic materials and the mechanical properties of polymers. The purpose of the present study was to develop and to characterize the physicochemical and morphological properties an experimental bioglass-based ternary composite composed associated with sodium carboxymethylcellulose (Na-CMC) and polyvinyl alcohol (PVA). The compatibility of functional groups with bioglass was previously evaluated. The composite was then synthesized and evaluated in terms of morphology, elemental composition, compressive strength, porosity, and bioactivity.

Materials and Methods

The bioglass was previously synthesized using a sol-gel route and characterized using FTIR analysis to identify the functional groups. The bone graft composite was then synthesized associating the bioglass with PVA, surfactant Triton X, and Na-CMC. The composite was then morphologically characterized using SEM/EDS. The porosity of the composite was analyzed using µCT, which also provided the composite compression strength. The composite was then evaluated in terms of its bioactivity using SEM/EDS analyses after immersion in SBF for 12, 24, 48, and 72 h.

Results

FTIR analysis confirmed, among other components, the presence of Si–O–Ca and Si–O–Si bonds, compatible with bioglass. SEM analysis exhibited a composite with a porous structure without spikes. The elemental mapping confirmed the presence of Si, Ca, and P in the composite. µCT analysis demonstrated a porous structure with 42.67% of open pores and an average compression strength of 124.7 MPa. It has also demonstrated ionic changes in the composite surface after immersion in SBF, with increasing detection of Ca and P as a function of time, highlighting its chemical bioactivity.

Conclusions

It can be concluded that the proposed bioglass-based composite presents a three-dimensional, well-structured, chemically bioactive porous structure, mechanically resistant for being reinforced with polymeric phases, with promising results as a synthetic bone graft, which makes it suitable for guided bone regeneration.

Large-sized bone defect repair by combining a decalcified bone matrix framework and bone regeneration units based on photo-crosslinkable osteogenic microgels

Physiological repair of large-sized bone defects is great challenging in clinic due to a lack of ideal grafts suitable for bone regeneration. Decalcified bone matrix (DBM) is considered as an ideal bone regeneration scaffold, but low cell seeding efficiency and a poor osteoinductive microenvironment greatly restrict its application in large-sized bone regeneration. To address these problems, we proposed a novel strategy of bone regeneration units (BRUs) based on microgels produced by photo-crosslinkable and microfluidic techniques, containing both the osteogenic ingredient DBM and vascular endothelial growth factor (VEGF) for accurate biomimic of an osteoinductive microenvironment. The physicochemical properties of microgels could be precisely controlled and the microgels effectively promoted adhesion, proliferation, and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) in vitro. BRUs were successfully constructed by seeding BMSCs onto microgels, which achieved reliable bone regeneration in vivo. Finally, by integrating the advantages of BRUs in bone regeneration and the advantages of DBM scaffolds in 3D morphology and mechanical strength, a BRU-loaded DBM framework successfully regenerated bone tissue with the desired 3D morphology and effectively repaired a large-sized bone defect of rabbit tibia. The current study developed an ideal bone biomimetic microcarrier and provided a novel strategy for bone regeneration and large-sized bone defect repair.

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The photo-crosslinkable microgels contained both osteogenic ingredient DBM powders and angiogenic growth factor VEGF.

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The photo-crosslinkable microgels effectively promote adhesion, proliferation, and osteogenic differentiation of BMSCs in vitro.

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Bone regeneration units (BRUs) successfully achieve reliable bone regeneration in vivo.

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The combination of DBM scaffold and BRUs successfully regenerate bone tissue with the desired 3D morphology and repair large-sized bone defect of rabbit tibia.

Effects of Boron Oxide Concentration and Carbon Nanotubes Reinforcement on Bioactive Glass Scaffolds for Bone Tissue Engineering

In this work, the effect of varying content of B₂O₃ with respect to SiO₂ on mechanical and bioactivity properties have been evaluated for borosilicate bioactive glasses containing SiO₂, B₂O₃, CaO and P₂O₅. The bioactive glasses have been synthesized using the sol-gel technique. The synthesized glasses were characterized by X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy and Field Emission Scanning electron microscopy (FESEM). These bioactive glasses were fabricated as scaffolds by using polymer foam replication method. Subsequently, in vitro bioactivity evaluation of borosilicate bioactive glass was done. Based on the XRD and energy-dispersive X-ray spectroscopy (EDS) results showing good apatite-formation ability when soaked in simulated body fluid (SBF), one of the bioactive glass (BG-B30 containing 30 mol% B₂O₃) was selected for further study. The compressive strength of the bioactive glass scaffolds was within the range of trabecular bone. However, it was found near the lower limit of the trabecular bone (0.2-12 MPa). Therefore, BG-B30 scaffold was reinforced with carbon nanotubes (CNTs) to allow for mechanical manipulation during tissue engineering applications. The compressive strength increased from 1.05 MPa to 7.42 MPa (a 606% increase) after reinforcement, while the fracture toughness rose from 0.12 MPa √ m to 0.45 MPa √ m (a 275% increase). Additionally, connectivity of the pores in the CNT reinforced BG-B30 scaffolds were evaluated and the pores were found to be well connected. The evaluated properties of the fabricated scaffolds demonstrate their potential as a synthetic graft for possible application in bone tissue engineering.

Staged Surgical Management of Open Navicular Fracture Secondary to a Gunshot Injury

The management guidelines of gunshot wound (GSW) injuries to the lower extremities have primarily been described more recently in the literature. A navicular fracture with adjacent joint involvement is presented from a GSW with initial external fixation management to prevent loss of anatomical alignment and successful staged definitive treatment with internal fixation. Based on previous experiences with rearfoot joint involvement from GSW injuries, we were able to direct definitive treatment with arthrodesis of violated joints. After a 1-year follow-up, the patient has returned to normal activities without any limitations. This case report demonstrates a stepwise approach to management of an open navicular fracture secondary to a GSW.

Locally Controlled Diffusive Release of Bone Morphogenetic Protein-2 Using Micropatterned Gelatin Methacrylate Hydrogel Carriers

In this work, a novel and simple bone morphogenetic protein (BMP)-2 carrier is developed, which enables localized and controlled release of BMP-2 and facilitates bone regeneration. BMP-2 is localized in the gelatin methacrylate (GelMA) micropatterns on hydrophilic semi-permeable membrane (SNM), and its controlled release is regulated by the concentration of GelMA hydrogel and BMP-2. The controlled release of BMP-2 is verified using computational analysis and quantified using fluorescein isothiocyanate-bovine serum albumin (FITC-BSA) diffusion model. The osteogenic differentiation of osteosarcoma MG-63 cells is manipulated by localized and controlled BMP-2 release. The calcium deposits are significantly higher and the actin skeletal networks are denser in MG-63 cells cultured in the BMP-2-immobilized GelMA micropattern than in the absence of BMP-2. The proposed BMP-2 carrier is expected to not only act as a barrier membrane that can prevent invasion of connective tissue during bone regeneration, but also as a carrier capable of localizing and controlling the release of BMP-2 due to GelMA micropatterning on SNM. This approach can be extensively applied to tissue engineering, including the localization and encapsulation of cells or drugs.

Vascularization Strategies in the Prevention of Nonunion Formation

Delayed healing and nonunion formation are major challenges in orthopedic surgery, which require the development of novel treatment strategies. Vascularization is considered one of the major prerequisites for successful bone healing, providing an adequate nutrient supply and allowing the infiltration of progenitor cells to the fracture site. Hence, during the last decade, a considerable number of studies have focused on the evaluation of vascularization strategies to prevent or to treat nonunion formation. These involve (1) biophysical applications, (2) systemic pharmacological interventions, and (3) tissue engineering, including sophisticated scaffold materials, local growth factor delivery systems, cell-based techniques, and surgical vascularization approaches. Accumulating evidence indicates that in nonunions, these strategies are indeed capable of improving the process of bone healing. The major challenge for the future will now be the translation of these strategies into clinical practice to make them accessible for the majority of patients. If this succeeds, these vascularization strategies may markedly reduce the incidence of nonunion formation. Impact statement Delayed healing and nonunion formation are a major clinical problem in orthopedic surgery. This review provides an overview of vascularization strategies for the prevention and treatment of nonunions. The successful translation of these strategies in clinical practice is of major importance to achieve adequate bone healing.

Evaluating the Effect of Non-cellular Bioactive Glass-Containing Scaffolds on Osteogenesis and Angiogenesis in in vivo Animal Bone Defect Models

The use of bone scaffolds to replace injured or diseased bone has many advantages over the currently used autologous and allogeneic options in clinical practice. This systematic review evaluates the current evidence for non-cellular scaffolds containing bioactive glass on osteogenesis and angiogenesis in animal bone defect models. Studies that reported results of osteogenesis via micro-CT and results of angiogenesis via Microfil perfusion or immunohistochemistry were included in the review. A literature search of PubMed, EMBASE and Scopus was carried out in November 2019 from which nine studies met the inclusion and exclusion criteria. Despite the significant heterogeneity in the composition of the scaffolds used in each study, it could be concluded that scaffolds containing bioactive glass improve bone regeneration in these models, both by osteogenic and angiogenic measures. Incorporation of additional elements into the glass network, using additives, and using biochemical factors generally had a beneficial effect. Comparing the different compositions of non-cellular bioactive glass containing scaffolds is however difficult due to the heterogeneity in bioactive glass compositions, fabrication methods and biochemical additives used.

Mechanical and degradative properties of PLDLA biodegradable pins with bioactive glass fibers in a beagle model

The present study aimed to evaluate the mechanical and degradative properties of poly(L-co-D,L-lactic acid)/silicate bioactive glass fibers (PLDLA/SGFs) composite pins in vivo. Both PLDLA and PLDLA/SGFs pins were inserted into the erector spinae muscles and femurs of beagle dogs and were harvested 6, 12, 16, 26, 52, 78, and 104 weeks after insertion. Bone formation around the pins was evaluated by micro-computed tomography. Mechanical properties were measured by the shear strength test. Thermogravimetric analysis, differential scanning calorimetry, and gel permeation chromatography were used to assess the degradation of these materials. The surface and cross-sectional morphology of both pins were observed using a scanning electron microscope. The experimental data demonstrated that PLDLA/SGFs pins can support new bone formation due to the influence of bioactive glass fibers. PLDLA/SGFs composite pins had higher initial shear strength and were relatively stable for at least 26 weeks. The addition of bioactive glass fibers accelerated the degradation rate of the composite pins. Thus, PLDLA/SGFs composite pins have promising potential for bone fixation applications.

Bioactive Pore-Forming Bone Adhesives Facilitating Cell Ingrowth for Fracture Healing

The effectiveness of commercial bone adhesives is known to be hampered by the weak efficacy of cell ingrowth. The strategy of macropore-forming, especially bioactive macropores, holds considerable promise to circumvent this problem, thereby promoting fracture healing. Herein, a class of bioactive glass-involved macropore-embedded bone adhesives is developed, which is capable of facilitating the migration of bone-derived mesenchymal stromal cells into the adhesive layer and differentiation into osteocytes. The integration of bioactive glass-particle-encapsulated porogens in the bone adhesives is key to this approach. A robust instant bonding on the bone adhesive and a high efficiency of bone regeneration on a mouse skull are observed, both of which are vital for clinical applications and personalized surgical procedures. This work represents a general strategy to design biomaterials with high cell-ingrowth efficacy.

Reconsidering Osteoconduction in the Era of Additive Manufacturing

Bone regeneration procedures in clinics and bone tissue engineering stand on three pillars: osteoconduction, osteoinduction, and stem cells. In the last two decades, the focus in this field has been on osteoinduction, which is realized by the use of bone morphogenetic proteins and the application of mesenchymal stem cells to treat bone defects. However, osteoconduction was reduced to a surface phenomenon because the supposedly ideal pore size of osteoconductive scaffolds was identified in the 1990s as 0.3-0.5 mm in diameter, forcing bone formation to occur predominantly on the surface. Meanwhile, additive manufacturing has evolved as a new tool to realize designed microarchitectures in bone substitutes, thereby enabling us to study osteoconduction as a true three-dimensional phenomenon. Moreover, by additive manufacturing, wide-open porous scaffolds can be produced in which bone formation occurs distant to the surface at a superior bony defect-bridging rate enabled by highly osteoconductive pores 1.2 mm in diameter. This review provides a historical overview and an updated definition of osteoconduction and related terms. In addition, it shows how additive manufacturing can be instrumental in studying and optimizing osteoconduction of bone substitutes, and provides novel optimized features and boundaries of osteoconductive microarchitectures. Impact Statement This review updates the definition of osteoconduction and draws clear lines to discriminate between osteoconduction, osseointegration, and osteoinduction. Moreover, additively manufactured libraries of scaffolds revealed that: osteoconduction is more a three-dimensional than a surface phenomenon; microarchitecture dictates defect bridging, which is the measure for osteoconduction; pore diameter or the diagonal of lattice microarchitectures of osteoconductive bone substitutes should be ∼1.2 mm.

Cellular Response to 3-D Printed Bioactive Silicate and Borosilicate Glass Scaffolds

The repair and regeneration of loaded segmental bone defects is a challenge for both materials and biomedical science communities. Our recent work demonstrated the capability of bioactive glass in supporting bone healing and defect bridging using a rabbit femur segmental defect model without growth factors or bone marrow stromal cells (BMSCs). Here in the current work, a comprehensive in vitro evaluation of bioactive silicate (13-93) and borosilicate (2B6Sr) glass scaffolds was conducted to provide further understanding of their biological performances and to establish a correlation between in vitro and in vivo behaviors. Our in vitro evaluation using a murine MC3T3-E1 cell line confirmed the capability of both scaffolds to support cell attachment, vascular endothelial growth factor (VEGF) formation, and to stimulate mineral deposition and osteoblast marker gene expression. In particular, borosilicate (2B6Sr) glass showed a better capability in supporting the mineralization and gene expression than silicate (13-93) glass, consistent with a faster bone healing ability in vivo. The current in vitro results, combined with our previous in vivo findings, provide a strong basis for the further translational evaluation of bioactive glass scaffolds and for potential preclinical practice. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 818-824, 2019.

Strength, toughness, and reliability of a porous glass/biopolymer composite scaffold

Development of bioactive glass and ceramic scaffolds intended for the reconstruction of large segmental bone defects remains a challenge for materials science due to the complexities involved in clinical implantation, bone-implant reaction, implant degradation and the multiple loading modes the implants subjected to. A comprehensive evaluation of the mechanical properties of inorganic scaffolds and exploration of new ways to toughen brittle constructs are critical prior to their successful application in loaded sites. A simple and widely adopted approach involves the coating of an inorganic scaffold with a polymeric material. In this work, a systematic evaluation of the influence of a biopolymer, polycaprolactone (PCL), coating on the mechanical performance of bioactive glass scaffolds was carried out. Results from this work indicate that a biopolymer PCL coating was more effective in increasing the compressive strength and reliability of the glass scaffold under compression, but less effective in improving its flexural strength or fracture toughness. This is the first report that reveals the limited successfulness of a polymer coating in improving the toughness of strong scaffolds, suggesting that new and novel ways of toughening inorganic scaffolds should be future research directions for scaffolds applied in loaded sites. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1209-1217, 2018.

[Research and application progress of bioactive glass in bone repair]

Objective

To review the research and application progress of bioactive glass in bone repair.

Methods

The recently published literature concerning bioactive glass in bone repair was reviewed and summarized.

Results

Bioactive glass can classified different types, such as bioactive glass particulate, bioactive glass scaffold, bioactive glass coating, injectable bioactive glass cement, and bioactive glass delivery system. Bioactive glass has been well studied in the field of bone repair due to its excellent biological properties. Also, the remarkable progress has been made in various aspects.

Conclusion

Bioactive glass is a reliable material of bone repair and will play an even more important role in the future.

Regenerating bone with bioactive glass scaffolds: A review of in vivo studies in bone defect models

Large bone defects resulting from fractures and disease are a medical concern, being often unable to heal spontaneously by the body's repair mechanisms. Bone tissue engineering (BTE) is a promising approach for treating bone defects through providing a template to guide osseous regeneration. 3D scaffolds with microstructure mimicking host bone are necessary in common BTE strategies. Bioactive glasses (BGs) attract researchers' attention as BTE scaffolds as they are osteoconductive and osteoinductive in certain formulations. In vivo animal models allow understanding and evaluation of materials' performance in the complex physiological environment, being an inevitable step before clinical trials. The aim of this paper is to review for the first time published research investigating the in vivo osseous regenerative capacity of 3D BG scaffolds in bone defect animal models, to better understand and evaluate the progress and future outlook of the use of such scaffolds in BTE. The literature analysis reveals that the regenerative capacity of BG scaffolds depends on several factors; including BG composition, fabrication method, scaffold microstructure and pore characteristics, in addition to scaffold pretreatment and whether or not the scaffolds are loaded with growth factors. In addition, animal species selected, defect size and implantation time affect the scaffold in vivo behavior and outcomes. The review of the literature also makes clear the difficulty encountered to compare different types of bioactive glass scaffolds in their bone forming ability. Even considering such limitations of the current state-of-the-art, results generated from animal bone defect models provide an essential source of information to guide the design of BG scaffolds in future.

STATEMENT OF SIGNIFICANCE

Bioactive glasses are at the centre of increasing research efforts in bone tissue engineering as the number of research groups around the world carrying out research on this type of biomaterials continues to increase. However, there are no previous reviews in literature which specifically cover investigations of the performance of bioactive glass scaffolds in bone defect animal models. This is the topic of the present review, in which we have analysed comprehensively all available literature in the field. The review thus fills a gap in the biomaterials literature providing a broad platform of information for researchers interested in bioactive glasses in general and specifically in the outcomes of in vivo models. Bioactive glass scaffolds of different compositions tested in relevant bone defect models are covered.

Tough and strong porous bioactive glass-PLA composites for structural bone repair

Bioactive glass scaffolds have been used to heal small contained bone defects but their application to repairing structural bone is limited by concerns about their mechanical reliability. In the present study, the addition of an adherent polymer layer to the external surface of strong porous bioactive glass (13-93) scaffolds was investigated to improve their toughness. Finite element modeling (FEM) of the flexural mechanical response of beams composed of a porous glass and an adherent polymer layer predicted a reduction in the tensile stress in the glass with increasing thickness and elastic modulus of the polymer layer. Mechanical testing of composites with structures similar to the models, formed from 13-93 glass and polylactic acid (PLA), showed trends predicted by the FEM simulations but the observed effects were considerably more dramatic. A PLA layer of thickness -400 µm, equal to -12.5% of the scaffold thickness, increased the load-bearing capacity of the scaffold in four-point bending by ~50%. The work of fracture increased by more than 10,000%, resulting in a non-brittle mechanical response. These bioactive glass-PLA composites, combining bioactivity, high strength, high work of fracture and an internal architecture shown to be conducive to bone infiltration, could provide optimal implants for healing structural bone defects.

Repair of rat calvarial defects using Si-doped hydroxyapatite scaffolds loaded with a bone morphogenetic protein-2-related peptide

Tissue engineering promises therapies ideal for treating conventional large bone injuries and defects. In the present study, we developed a novel Si-HA scaffold loaded with a synthetic BMP-2-related peptide, P28, and tested its ability to repair a critical-sized calvarial defect. We created a calvarial defect (5 mm in diameter) in the parietal bone of 32 rats and implanted one of the following biomaterials: No implant (control), Si-HA, P28/Si-HA, or rhBMP-2/Si-HA. As assessed by micro CT imaging and histological evaluations, the P28/Si-HA scaffold promoted bone recovery to a similar degree as the rhBMP-2/Si-HA scaffold. In addition, both P28/Si-HA and rhBMP-2/Si-HA promoted recovery better than Si-HA alone. The novel P28/Si-HA scaffold might represent a promising biomaterial for future bone tissue engineering applications. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1874-1882, 2016.

Antimicrobial activity of submicron glass fibres incorporated as a filler to a dental sealer

Two types of antimicrobial glass fibers containing ZnO and CaO, with diameters ranging from tens of nanometers to 1 µm, were successfully fabricated by a laser spinning technique. The antimicrobial performance was corroborated according to ISO 20743:2013, by using gram-negative (Escherichia coli) and gram-positive (Streptococcus oralis, Streptococcus mutans and Staphylococcus aureus) bacteria, and yeast (Candida krusei) (more than 3 logs of reduction). The metabolic activity and endosomal system of eukaryotic cells were not altered by using eluents of CaO glass submicrometric fibers and ZnO fibers at 1 : 10 dilution as cellular media (viability rates over 70%). A dental material was functionalized by embedding ZnO nanofibers above the percolation threshold (20% wt), creating a three-dimensional (3D) fiber network that added an antimicrobial profile. This new ZnO glass fiber composite is proved non-cytotoxic and preserved the antimicrobial effect after immersion in human saliva. This is the first time that a fiber-reinforced liner with strong antimicrobial-activity has been created to prevent secondary caries. The potential of developing new fiber-reinforced composites (FRCs) with antimicrobial properties opens up an extensive field of dental applications where most important diseases have an infectious origin.