High early strength calcium phosphate bone cement: effects of dicalcium phosphate dihydrate and absorbable fibers

Engineering 3D Printed Scaffolds with Tunable Hydroxyapatite

Orthopedic and craniofacial surgical procedures require the reconstruction of bone defects caused by trauma, diseases, and tumor resection. Successful bone restoration entails the development and use of bone grafts with structural, functional, and biological features similar to native tissues. Herein, we developed three-dimensional (3D) printed fine-tuned hydroxyapatite (HA) biomimetic bone structures, which can be applied as grafts, by using calcium phosphate cement (CPC) bioink, which is composed of tetracalcium phosphate (TTCP), dicalcium phosphate anhydrous (DCPA), and a liquid [Polyvinyl butyral (PVB) dissolved in ethanol (EtOH)]. The ink was ejected through a high-resolution syringe nozzle (210 µm) at room temperature into three different concentrations (0.01, 0.1, and 0.5) mol/L of the aqueous sodium phosphate dibasic (Na2HPO4) bath that serves as a hardening accelerator for HA formation. Raman spectrometer, X-ray diffraction (XRD), and scanning electron microscopy (SEM) demonstrated the real-time HA formation in (0.01, 0.1, and 0.5) mol/L Na2HPO4 baths. Under those conditions, HA was formed at different amounts, which tuned the scaffolds' mechanical properties, porosity, and osteoclast activity. Overall, this method may pave the way to engineer 3D bone scaffolds with controlled HA composition and pre-defined properties, which will enhance graft-host integration in various anatomic locations.

The Addition of Poly(Vinyl Alcohol) Fibers to Apatitic Calcium Phosphate Cement Can Improve Its Toughness

Calcium phosphate cements, and in particular hydroxyapatite cements, have been widely investigated for use as bone void fillers due to their chemical similarity to bone and related osteoconductivity. However, they are brittle, which limits their use to non-load-bearing applications. The aim of the current study was to improve the toughness of hydroxyapatite cements through fiber reinforcement. The effect of the addition of hydrophilic, poly(vinyl-alcohol) (PVA) fibers to hydroxyapatite cement was evaluated in terms of mechanical properties, including compressive strength, diametral tensile strength and toughness (work of fracture), as well as setting time, phase composition and cement morphology. The fiber reinforcement enhanced the fracture resistance of the hydroxyapatite cement, but also simultaneously reduced the compressive strength and setting time of the cements. However, cement with 5 wt % of fibers (of the powder component) could be considered a good compromise, with a compressive strength of 46.5 ± 4.6 MPa (compared to 62.3 ± 12.8 MPa of that without fibers), i.e., still much greater than that of human trabecular bone (0.1–14 MPa). A significantly higher diametral tensile strength (9.2 ± 0.4 MPa) was found for this cement compared to that without fibers (7.4 ± 1.5 MPa). The work of fracture increased four times to 9.1 ± 1.5 kJ/m² in comparison to the pristine apatite. In summary, the hydroxyapatite cements could be reinforced by suitable amounts of PVA fibers, which resulted in enhancing the material’s structural integrity and ductility, and increased the material’s resistance to cracking.

Properties of reduced graphene/carbon nanotubes reinforced calcium phosphate bone cement in a microwave environment

In this work, the setting process of reduced graphene (RGO)/carbon nanotubes (CNTs) reinforced calcium phosphate cement (CPC) were conducted in a microwave environment. The introduction of microwave can increase the reaction temperature, speed up the vibration of water molecules and eliminate bubbles from the interface between RGO, CNTs and the substrate. Comparing with CPC without microwave treatment, the final setting time of composites after microwave treatment are almost a half, the flexural strength and the compressive strength are increased by 19.86% and 21.68% respectively, which are 17.38 MPa and 104.52 MPa. Meanwhile, the CPC composites remain the excellent bioactivity.

Different post-processing conditions for 3D bioprinted α-tricalcium phosphate scaffolds

The development of 3D printing hardware, software and materials has enabled the production of bone substitute scaffolds for tissue engineering. Calcium phosphates cements, such as those based on α-tricalcium phosphate (α-TCP), have recognized properties of osteoinductivity, osteoconductivity and resorbability and can be used to 3D print scaffolds to support and induce tissue formation and be replaced by natural bone. At present, however, the mechanical properties found for 3D printed bone scaffolds are only satisfactory for non-load bearing applications. This study varied the post-processing conditions of the 3D powder printing process of α-TCP cement scaffolds by either immersing the parts into binder, Ringer's solution or phosphoric acid, or by sintering in temperatures ranging from 800 to 1500 °C. The porosity, composition (phase changes), morphology, shrinkage and compressive strength were evaluated. The mechanical strength of the post-processed 3D printed scaffolds increased compared to the green parts and was in the range of the trabecular bone. Although the mechanical properties achieved are still low, the high porosity presented by the scaffolds can potentially result in greater bone ingrowth. The phases present in the scaffolds after the post-processing treatments were calcium-deficient hydroxyapatite, brushite, monetite, and unreacted α-TCP. Due to their chemical composition, the 3D printed scaffolds are expected to be resorbable, osteoinductive, and osteoconductive.

Enhanced bone formation in sheep vertebral bodies after minimally invasive treatment with a novel, PLGA fiber-reinforced brushite cement

BACKGROUND CONTEXT

Injectable, brushite-forming calcium phosphate cements (CPC) show potential for bone replacement, but they exhibit low mechanical strength. This study tested a CPC reinforced with poly(l-lactide-co-glycolide) acid (PLGA) fibers in a minimally invasive, sheep lumbar vertebroplasty model.

PURPOSE

The study aimed to test the in vivo biocompatibility and osteogenic potential of a PLGA fiber-reinforced, brushite-forming CPC in a sheep large animal model.

STUDY DESIGN/SETTING

This is a prospective experimental animal study.

METHODS

Bone defects (diameter: 5 mm) were placed in aged, osteopenic female sheep, and left empty (L2) or injected with pure CPC (L3) or PLGA fiber-reinforced CPC (L4; fiber diameter: 25 µm; length: 1 mm; 10% [wt/wt]). Three and 9 months postoperation (n=20 each), the structural and functional CPC effects on bone regeneration were documented ex vivo by osteodensitometry, histomorphometry, micro-computed tomography (micro-CT), and biomechanical testing.

RESULTS

Addition of PLGA fibers enhanced CPC osteoconductivity and augmented bone formation. This was demonstrated by (1) significantly enhanced structural (bone volume/total volume, shown by micro-CT and histomorphometry; 3 or 9 months) and bone formation parameters (osteoid volume and osteoid surface; 9 months); (2) numerically enhanced bone mineral density (3 and 9 months) and biomechanical compression strength (9 months); and (3) numerically decreased bone erosion (eroded surface; 3 and 9 months).

CONCLUSIONS

The PLGA fiber-reinforced CPC is highly biocompatible and its PLGA fiber component enhanced bone formation. Also, PLGA fibers improve the mechanical properties of brittle CPC, with potential applicability in load-bearing areas.

Mechanical properties of α-tricalcium phosphate-based bone cements incorporating regenerative biomaterials for filling bone defects exposed to low mechanical loads

Calcium phosphate-based cements with enhanced regenerative potential are promising biomaterials for the healing of bone defects in procedures such as percutaneous vertebroplasty. With a view to the use of such cements for low load bearing applications such as sinus augmentation or filling extraction sites. However, the inclusion of certain species into bone cement formulations has the potential to diminish the mechanical properties of the formulations and thereby reduce their prospects for clinical translation. Consequently, we have prepared α-tricalcium phosphate (α-TCP)-based bone cements including materials that we would expect to improve their regenerative potential, and describe the mechanical properties of the resulting formulations herein. Formulations incorporated α-TCP, hydroxyapatite, biopolymer-thickened wetting agents, sutures, and platelet poor plasma. The mechanical properties of the composites were composition dependent, and optimized formulations had clinically relevant mechanical properties. Such calcium phosphate-based cements have potential as replacements for cements such as those based on polymethylmethacrylate.

Calcium phosphate cements for bone substitution: chemistry, handling and mechanical properties

Since their initial formulation in the 1980s, calcium phosphate cements (CPCs) have been increasingly used as bone substitutes. This article provides an overview on the chemistry, kinetics of setting and handling properties (setting time, cohesion and injectability) of CPCs for bone substitution, with a focus on their mechanical properties. Many processing parameters, such as particle size, composition of cement reactants and additives, can be adjusted to control the setting process of CPCs, concomitantly influencing their handling and mechanical performance. Moreover, this review shows that, although the mechanical strength of CPCs is generally low, it is not a critical issue for their application for bone repair--an observation not often realized by researchers and clinicians. CPCs with compressive strengths comparable to those of cortical bones can be produced through densification and/or homogenization of the cement matrix. The real limitation for CPCs appears to be their low fracture toughness and poor mechanical reliability (Weibull modulus), which have so far been only rarely studied.

Quantifying effects of interactions between polyacrylic acid and chlorhexidine in dicalcium phosphate – forming cements

Polyacrylic acid has been shown to control setting and improve mechanical and antibacterial release properties of brushite bone cements.

Self-setting calcium orthophosphate formulations

In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are bioactive and biodegradable grafting bioceramics in the form of a powder and a liquid. After mixing, both phases form pastes, which set and harden forming either a non-stoichiometric calcium deficient hydroxyapatite or brushite. Since both of them are remarkably biocompartible, bioresorbable and osteoconductive, self-setting calcium orthophosphate formulations appear to be promising bioceramics for bone grafting. Furthermore, such formulations possess excellent molding capabilities, easy manipulation and nearly perfect adaptation to the complex shapes of bone defects, followed by gradual bioresorption and new bone formation. In addition, reinforced formulations have been introduced, which might be described as calcium orthophosphate concretes. The discovery of self-setting properties opened up a new era in the medical application of calcium orthophosphates and many commercial trademarks have been introduced as a result. Currently such formulations are widely used as synthetic bone grafts, with several advantages, such as pourability and injectability. Moreover, their low-temperature setting reactions and intrinsic porosity allow loading by drugs, biomolecules and even cells for tissue engineering purposes. In this review, an insight into the self-setting calcium orthophosphate formulations, as excellent bioceramics suitable for both dental and bone grafting applications, has been provided.

Reinforcement of a new calcium phosphate cement with RGD-chitosan-fiber

Calcium phosphate cement (CPC) has been widely used in orthopedic and dental applications. A critical limitation of CPC is low strength and high susceptibility to severe fracture. Surgeons can use it only to reconstruct non-stress bearing bone, raising the need for a tougher new generation of CPC. Fibers have been used as a reinforcement of CPC to improve the strength of a pure CPC scaffold. The RGD peptides (Arg-Gly-Asp) have been used to improve the biocompatibility of the scaffold, via physical adsorption. The purpose of this study was to develop a novel CPC scaffold reinforced by RGD peptide-bearing chitosan fibers (RGD-fiber-CPC). Our data showed that the RGD-fiber-CPC scaffold had an increased flexural strength, and stimulated new bone formation in an animal model. The RGD-fiber-CPC is a novel bone graft substitute in orthopedic surgery.

Polymeric additives to enhance the functional properties of calcium phosphate cements

The vast majority of materials used in bone tissue engineering and regenerative medicine are based on calcium phosphates due to their similarity with the mineral phase of natural bone. Among them, calcium phosphate cements, which are composed of a powder and a liquid that are mixed to obtain a moldable paste, are widely used. These calcium phosphate cement pastes can be injected using minimally invasive surgery and adapt to the shape of the defect, resulting in an entangled network of calcium phosphate crystals. Adding an organic phase to the calcium phosphate cement formulation is a very powerful strategy to enhance some of the properties of these materials. Adding some water-soluble biocompatible polymers in the calcium phosphate cement liquid or powder phase improves physicochemical and mechanical properties, such as injectability, cohesion, and toughness. Moreover, adding specific polymers can enhance the biological response and the resorption rate of the material. The goal of this study is to overview the most relevant advances in this field, focusing on the different types of polymers that have been used to enhance specific calcium phosphate cement properties.

Structural and material approaches to bone tissue engineering in powder-based three-dimensional printing

This article reviews the current state of knowledge concerning the use of powder-based three-dimensional printing (3DP) for the synthesis of bone tissue engineering scaffolds. 3DP is a solid free-form fabrication (SFF) technique building up complex open porous 3D structures layer by layer (a bottom-up approach). In contrast to traditional fabrication techniques generally subtracting material step by step (a top-down approach), SFF approaches allow nearly unlimited designs and a large variety of materials to be used for scaffold engineering. Today's state of the art materials, as well as the mechanical and structural requirements for bone scaffolds, are summarized and discussed in relation to the technical feasibility of their use in 3DP. Advances in the field of 3DP are presented and compared with other SFF methods. Existing strategies on material and design control of scaffolds are reviewed. Finally, the possibilities and limiting factors are addressed and potential strategies to improve 3DP for scaffold engineering are proposed.

Strontium Hydroxyapatite Synthesis, Characterization and Cell Cytotoxicity

Strontium hydroxyapatite powders was prepared by the hydrothermal method using Sr(NO3)2 and (NH4)2HPO4 as reagents. Fourier transform infrared spectroscopy, X-ray diffraction, Transmission electron microscope, Energy dispersive X-ray, and Thermogravimetric-differential thermal analysis were employed to investigate the crystalline phase, chemical composition, morphology, and thermal stability of the Strontium hydroxyapatite. And the cytotoxicity of Strontium hydroxyapatite was analyzed through MTT assay. Results showed that Strontium hydroxyapatite prepared by hydrothermal Method has excellent crystal structure, good dispersion, high purity, and rod-like morphology with dimensions 200-500 nm in length and 20 nm in diameter. Meanwhile, the apatite has poor thermal stability. However, the apatite is cytocompatible and may have better biocompatibility, which can serve as strontium source incorporation into calcium phosphate cement and for bone repair.

Reinforcing of a calcium phosphate cement with hydroxyapatite crystals of various morphologies

A series of biocomposite materials was successfully prepared by reinforcing advanced calcium phosphate cement with hydroxyapatite fibrous and elongated plate-like particles. Powder X-ray diffraction showed that ball-milled biocomposite precursors (dicalcium and tetracalcium phosphates) entirely transform to a single phase hydroxyapatite end product within 7 h at 37 °C. Electron microscopy showed that the resultant biocomposites are constituted of nanoscaled cement particles intimately associated with the reinforcement crystals. The influence of shape, size, and concentration of the hydroxyapatite filler on the compression strength of reinforced cements is discussed. The best compression strength of 37 ± 3 MPa (enhancement of ∼50% compared to pure cement) was achieved using submicrometer-sized hydroxyapatite crystals with complementary shapes. Nanoindentation revealed that averaged elastic modulus and hardness values of the cements are consistent with those reported for trabecular and cortical human bones, indicating a good match of the micromechanical properties for their potential use for bone repair. The stiffness of the biocomposites was confirmed to gradate-compliant cement matrix, cement-filler interface, and stiff filler-as a result of the structuring at the nanometer-micrometer level. This architecture is critical in conditioning the final mechanical properties of the functional composite biomaterial. In vitro cell culture experiments showed that the developed biomaterial system is noncytotoxic.

Tetracalcium phosphate: Synthesis, properties and biomedical applications

Monoclinic tetracalcium phosphate (TTCP, Ca(4)(PO(4))(2)O), also known by the mineral name hilgenstockite, is formed in the (CaO-P(2)O(5)) system at temperatures>1300 degrees C. TTCP is the only calcium phosphate with a Ca/P ratio greater than hydroxyapatite (HA). It appears as a by-product in plasma-sprayed HA coatings and shows moderate reactivity and concurrent solubility when combined with acidic calcium phosphates such as dicalcium phosphate anhydrous (DCPA, monetite) or dicalcium phosphate dihydrate (DCPD, brushite). Therefore it is widely used in self-setting calcium phosphate bone cements, which form HA under physiological conditions. This paper aims to review the synthesis and properties of TTCP in biomaterials applications such as cements, sintered ceramics and coatings on implant metals.

Human bone marrow stem cell-encapsulating calcium phosphate scaffolds for bone repair

Due to its injectability and excellent osteoconductivity, calcium phosphate cement (CPC) is highly promising for orthopedic applications. However, a literature search revealed no report on human bone marrow mesenchymal stem cell (hBMSC) encapsulation in CPC for bone tissue engineering. The aim of this study was to encapsulate hBMSCs in alginate hydrogel beads and then incorporate them into CPC, CPC-chitosan and CPC-chitosan-fiber scaffolds. Chitosan and degradable fibers were used to mechanically reinforce the scaffolds. After 21 days, that the percentage of live cells and the cell density of hBMSCs inside CPC-based constructs matched those in alginate without CPC, indicating that the CPC setting reaction did not harm the hBMSCs. Alkaline phosphate activity increased by 8-fold after 14 days. Mineral staining, scanning electron microscopy and X-ray diffraction confirmed that apatitic mineral was deposited by the cells. The amount of hBMSC-synthesized mineral in CPC-chitosan-fiber matched that in CPC without chitosan and fibers. Hence, adding chitosan and fibers, which reinforced the CPC, did not compromise hBMSC osteodifferentiation and mineral synthesis. In conclusion, hBMSCs were encapsulated in CPC and CPC-chitosan-fiber scaffolds for the first time. The encapsulated cells remained viable, osteodifferentiated and synthesized bone minerals. These self-setting, hBMSC-encapsulating CPC-based constructs may be promising for bone tissue engineering applications.

An in vitro and in vivo investigation of the biological behavior of a ferrimagnetic cement for highly focalized thermotherapy

The cancer treatment by local hyperthermia, using a high frequency electromagnetic field is an extensively studied subject. For this propose it was developed a ferrimagnetic cement (FC) to be injected directly into the tumor. In this study it was determined the FC injectability, its capability to generate heat when placed within a magnetic field and its interaction with a modified simulated body fluid using SEM/EDS and XRD. The FC biological response was assessed by the intramuscular implantation in rats and histological analysis of the surrounding tissues. The results suggest that FC can be injected directly into the tumor, its temperature can be increased when exposed to a magnetic field and the surface of the immersed samples quickly becomes coated with precipitate denoting its ionic change with the surrounding medium. The histological analysis revealed a transient local inflammatory reaction, similar to the control material, only slightly more abundant during the first weeks, with a gradual decrease over the implantation time. Based on these results, we concluded that FC might be useful for highly focalized thermotherapy, with a good potential for clinical use.

Culture human mesenchymal stem cells with calcium phosphate cement scaffolds for bone repair

Because of its moldability and excellent osteoconductivity, calcium phosphate cement (CPC) is highly promising for craniofacial and orthopedic applications. The objectives of this study were to investigate the response of human mesenchymal stem cells (hMSCs) to a high-strength CPC-chitosan scaffold and to examine cell proliferation and osteogenic differentiation. hMSCs were seeded onto CPC-chitosan composite, CPC control, and tissue culture polystyrene (TCPS). Alkaline phosphatase activity (ALP) and mineralization of hMSCs were measured. CPC-chitosan had a flexural strength (mean + or - SD; n = 5) of (19.5 + or - 1.4) MPa, higher than (8.0 + or - 1.4) MPa of CPC control (p < 0.05). The percentage of live hMSCs on CPC-chitosan was (90.5 + or - 1.3)% at 8 days, matching (90.7 + or - 3.8)% of CPC control (p > 0.1). The CPC-chitosan surface area covered by the attached hMSCs increased from (51 + or - 11)% at 1 day to (90 + or - 4)% at 8 days (p < 0.05), matching those of CPC control (p > 0.1). Hence, the CPC strength was significantly increased via chitosan without compromising the hMSC response. At 8 days, there was a significant increase in ALP of cells in osteogenic media (10.99 + or - 0.93) [(mM pNpp/min)/(microg DNA)] versus control media (3.62 + or - 0.40) (p < 0.05). hMSCs in osteogenic media exhibited greater mineralization area of (47.5 + or - 19.7)% compared with (6.1 + or - 2.3)% in control medium on TCPS (p < 0.05). In conclusion, hMSCs showed excellent attachment and viability on the strong and tough CPC-chitosan scaffold, matching the hMSC response on CPC control. hMSCs were successfully differentiated down the osteogenic lineage. Hence, the strong, in situ hardening CPC-chitosan scaffold may be useful as a moderate load-bearing vehicle to deliver hMSCs for maxillofacial and orthopedic bone tissue engineering.

Fatigue and human umbilical cord stem cell seeding characteristics of calcium phosphate-chitosan-biodegradable fiber scaffolds

Calcium phosphate cement (CPC) has in situ-setting ability and bioactivity, but the brittleness and low strength limit CPC to only non-load-bearing bone repairs. Human umbilical cord mesenchymal stem cells (hUCMSCs) can be harvested without an invasive procedure required for the commonly studied bone marrow MSCs. However, little has been reported on hUCMSC delivery via bioactive scaffolds for bone tissue engineering. The objectives of this study were to develop CPC scaffolds with improved resistance to fatigue and fracture, and to investigate hUCMSC delivery for bone tissue engineering. In fast fracture, CPC with 15% chitosan and 20% polyglactin fibers (CPC-chitosan-fiber scaffold) had flexural strength of 26mPa, higher than 10mPa for CPC control (p<0.05). In cyclic loading, CPC-chitosan-fiber specimens that survived 2x10(6) cycles had the maximum stress of 10MPa, compared to 5MPa of CPC control. CPC-chitosan-fiber specimens that failed after multiple cycles had a mean stress-to-failure of 9MPa, compared to 5.8MPa for CPC control (p<0.05). hUCMSCs showed excellent viability when seeded on CPC and CPC-chitosan-fiber scaffolds. The percentage of live cells reached 96-99%. Cell density was about 300cells/mm(2) at day 1; it proliferated to 700cells/mm(2) at day 4. Wst-1 assay showed that the stronger CPC-chitosan-fiber scaffold had hUCMSC viability that matched the CPC control (p>0.1). In summary, this study showed that chitosan and polyglactin fibers substantially increased the fatigue resistance of CPC, and that hUCMSCs had excellent proliferation and viability on the scaffolds.

Calcium Orthophosphate Cements and Concretes

In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are a bioactive and biodegradable grafting material in the form of a powder and a liquid. Both phases form after mixing a viscous paste that after being implanted, sets and hardens within the body as either a non-stoichiometric calcium deficient hydroxyapatite (CDHA) or brushite, sometimes blended with unreacted particles and other phases. As both CDHA and brushite are remarkably biocompartible and bioresorbable (therefore, in vivo they can be replaced with newly forming bone), calcium orthophosphate cements represent a good correction technique for non-weight-bearing bone fractures or defects and appear to be very promising materials for bone grafting applications. Besides, these cements possess an excellent osteoconductivity, molding capabilities and easy manipulation. Furthermore, reinforced cement formulations are available, which in a certain sense might be described as calcium orthophosphate concretes. The concepts established by calcium orthophosphate cement pioneers in the early 1980s were used as a platform to initiate a new generation of bone substitute materials for commercialization. Since then, advances have been made in the composition, performance and manufacturing; several beneficial formulations have already been introduced as a result. Many other compositions are in experimental stages. In this review, an insight into calcium orthophosphate cements and concretes, as excellent biomaterials suitable for both dental and bone grafting application, has been provided.

Mesenchymal stem cell proliferation and differentiation on an injectable calcium phosphate-chitosan composite scaffold

Calcium phosphate cement (CPC) can be molded or injected to form a scaffold in situ, has excellent osteoconductivity, and can be resorbed and replaced by new bone. However, its low strength limits CPC to non-stress-bearing repairs. Chitosan could be used to reinforce CPC, but mesenchymal stem cell (MSC) interactions with CPC-chitosan scaffold have not been examined. The objective of this study was to investigate MSC proliferation and osteogenic differentiation on high-strength CPC-chitosan scaffold. MSCs were harvested from rat bone marrow. At CPC powder/liquid (P/L) mass ratio of 2, flexural strength (mean+/-sd; n=5) was (10.0+/-1.1) MPa for CPC-chitosan, higher than (3.7+/-0.6) MPa for CPC (p<0.05). At P/L of 3, strength was (15.7+/-1.7)MPa for CPC-chitosan, higher than (10.2+/-1.8)MPa for CPC (p<0.05). Percentage of live MSCs attaching to scaffolds increased from 85% at 1 day to 99% at 14 days. There were (180+/-37) cells/mm(2) on scaffold at 1 day; cells proliferated to (1808+/-317) cells/mm(2) at 14 days. SEM showed MSCs with healthy spreading and anchored on nano-apatite crystals via cytoplasmic processes. Alkaline phosphatase activity (ALP) was (557+/-171) (pNPP mM/min)/(microg DNA) for MSCs on CPC-chitosan, higher than (159+/-47) on CPC (p<0.05). Both were higher than (35+/-32) of baseline ALP for undifferentiated MSCs on tissue-culture plastic (p<0.05). In summary, CPC-chitosan scaffold had higher strength than CPC. MSC proliferation on CPC-chitosan matched that of the FDA-approved CPC control. MSCs on the scaffolds differentiated down the osteogenic lineage and expressed high levels of bone marker ALP. Hence, the stronger CPC-chitosan scaffold may be useful for stem cell-based bone regeneration in moderate load-bearing maxillofacial and orthopedic applications.

Improved injectability and in vitro degradation of a calcium phosphate cement containing poly(lactide-co-glycolide) microspheres

An injectable calcium phosphate cement (CPC) containing 30 wt.% poly(lactide-co-glycolide) (PLGA) microspheres was developed in the present study. Sodium citrate solution was used as the cement liquid phase. The effects of sodium citrate concentration on the injectability, rheological properties, mechanical strength and self-setting properties of CPC containing PLGA microspheres were systematically investigated. The in vitro degradation behavior of the composite during immersion in phosphate buffer solution was also studied. With an increase in sodium citrate concentration, the viscosity and yield stress of the paste were reduced, thereby improving the injectability. At a sodium citrate concentration of 15%, the injectability of the paste reached 95%. The compressive strength of the specimen was also enhanced by the addition of sodium citrate. The specimens had a compressive strength of 32.24+/-2.72 MPa at 15% sodium citrate concentration, compared to 22.15+/-3.60 MPa for the specimen without sodium citrate. The in vitro degradation results demonstrate that incorporated PLGA microspheres can provide the required high strength to CPC in the early stage, which would gradually degrade to create macropores for bone ingrowth. In conclusion, an in situ macropore-generable CPC exhibited excellent injectability and high early strength, and should be a promising material for bone repair and bone reconstruction.

Self-setting bioactive calcium-magnesium phosphate cement with high strength and degradability for bone regeneration

Calcium phosphate cement (CPC) has been successfully used in clinics as bone repair biomaterial for many years. However, poor mechanical properties and a low biodegradation rate limit any further applications. Magnesium phosphate cement (MPC) is characterized by fast setting, high initial strength and relatively rapid degradation in vivo. In this study, MPC was combined with CPC to develop novel calcium-magnesium phosphate cement (CMPC). The setting time, compressive strength, phase composition of hardened cement, degradation in vitro, cells responses in vitro by MG-63 cell culture and tissue responses in vivo by implantation of CMPC in bone defect of rabbits were investigated. The results show that CMPC has a shorter setting time and markedly better mechanical properties than either CPC or MPC. Moreover, CMPC showed significantly improved degradability compared to CPC in simulated body fluid. Cell culture results indicate that CMPC is biocompatible and could support cell attachment and proliferation. To investigate the in vivo biocompatibility and osteogenesis, the CMPC samples were implanted into bone defects in rabbits. Histological evaluation showed that the introduction of MPC into CPC enhanced the efficiency of new bone formation. CMPC also exhibited good biocompatibility, biodegradability and osteoconductivity with host bone in vivo. The results obtained suggest that CMPC, having met the basic requirements of bone tissue engineering, might have a significant clinical advantage over CPC, and may have the potential to be applied in orthopedic, reconstructive and maxillofacial surgery.

High-strength, in situ-setting calcium phosphate composite with protein release

The aim of this study was to develop a mechanically-strong calcium phosphate cement (CPC) with protein release. Chitosan was used to strengthen CPC and control protein release. Mass fraction of protein release = mass of released protein/mass of total protein incorporated into the specimen. Flexural strength (mean +/- sd; n = 6) of CPC containing 100 ng/mL of protein increased from 8.0 +/- 1.4 MPa with 0% chitosan, to 19.8 +/- 1.4 MPa with 15% chitosan (p < 0.05). The latter exceeded the reported strengths of sintered porous hydroxyapatite implants and cancellous bone. When the chitosan mass fraction was increased from 0% to 10% and 15%, protein release varied from 0.60 +/- 0.03 to 0.41 +/- 0.04, and to 0.23 +/- 0.07, respectively (p < 0.05). When powder:liquid ratio increased from 2:1 to 3:1 and 4:1, protein release changed from 0.89 +/- 0.10 to 0.41 +/- 0.04, and to 0.23 +/- 0.07, respectively p < 0.05. Therefore, chitosan content and powder:liquid ratio successfully controlled the protein release. The protein release mass fraction, M, was related to CPC porosity P by: M = 16.9 P(4.5). In summary, a mechanically-strong CPC with controlled protein release was formulated. Protein release was proportional to CPC porosity. The in situ-hardening, nano-apatite composite may have potential for bone tissue engineering, especially when both mechanical strength and controlled release of therapeutic/bioactive agents are needed.

Injectable and strong nano-apatite scaffolds for cell/growth factor delivery and bone regeneration

OBJECTIVES

Seven million people suffer bone fractures each year in the U.S., and musculoskeletal conditions cost $215 billion/year. The objectives of this study were to develop moldable/injectable, mechanically strong and in situ-hardening calcium phosphate cement (CPC) composite scaffolds for bone regeneration and delivery of osteogenic cells and growth factors.

METHODS

Tetracalcium phosphate [TTCP: Ca(4)(PO(4))(2)O] and dicalcium phosphate (DCPA: CaHPO(4)) were used to fabricate self-setting calcium phosphate cement. Strong and macroporous scaffolds were developed via absorbable fibers, biopolymer chitosan, and mannitol porogen. Following established protocols, MC3T3-E1 osteoblast-like cells (Riken, Hirosaka, Japan) were cultured on the specimens and inside the CPC composite paste carrier.

RESULTS

The scaffold strength was more than doubled via reinforcement (p<0.05). Relationships and predictive models were established between matrix properties, fibers, porosity, and overall composite properties. The cement injectability was increased from about 60% to nearly 100%. Cell attachment and proliferation on the new composite matched those of biocompatible controls. Cells were able to infiltrate into the macropores and anchor to the bone mineral-like nano-apatite crystals. For cell delivery, alginate hydrogel beads protected cells during cement mixing and setting, yielding cell viability measured via the Wst-1 assay that matched the control without CPC (p>0.1). For growth factor delivery, CPC powder:liquid ratio and chitosan content provided the means to tailor the rate of protein release from CPC carrier.

SIGNIFICANCE

New CPC scaffolds were developed that were strong, tough, macroporous and osteoconductive. They showed promise for injection in minimally invasive surgeries, and in delivering osteogenic cells and osteoinductive growth factors to promote bone regeneration. Potential applications include various dental, craniofacial, and orthopedic reconstructions.

Injectable calcium phosphate cement: effects of powder-to-liquid ratio and needle size

Calcium phosphate cement (CPC) sets in situ and forms apatite with excellent osteoconductivity and bone-replacement capability. The objectives of this study were to formulate an injectable tetracalcium phosphate-dicalcium phosphate cement (CPC(D)), and investigate the powder/liquid ratio and needle-size effects. The injection force (mean +/- SD; n = 4) to extrude the paste increased from (8 +/- 2) N using a 10-gauge needle to (144 +/- 17) N using a 21-gauge needle (p < 0.05). With the 10-gauge needle, the mass percentage of extruded paste was (95 +/- 4)% at a powder/liquid ratio of 3; it decreased to (70 +/- 12)% at powder/liquid = 3.5 (p < 0.05). A relationship was established between injection force, F, and needle lumen cross-sectional area, A: F = 5.0 + 38.7/A(0.8). Flexural strength, S, (mean +/- SD; n = 5) increased from (5.3 +/- 0.8) MPa at powder/liquid= 2 to (11.0 +/- 0.8) MPa at powder/liquid = 3.5 (p < 0.05). Pore volume fraction, P, ranged from 62.4% to 47.9%. A relationship was established: S = 47.7 x (1 - P)(2.3). The strength of the injectable CPC(D) matched/exceeded the reported strengths of sintered porous hydroxyapatite implants that required machining. The novel injectable CPC(D) with a relatively high strength may be useful in filling defects with limited accessibility such as periodontal repair and tooth root-canal fillings, and in minimally-invasive techniques such as percutaneous vertebroplasty to fill the lesions and to strengthen the osteoporotic bone.

Effect of the calcium to phosphate ratio of tetracalcium phosphate on the properties of calcium phosphate bone cement

Six different tetracalcium phosphate (TTCP) products were synthesized by solid state reaction at high temperature by varying the overall calcium to phosphate ratio of the synthesis mixture. The objective was to evaluate the effect of the calcium to phosphate ratio on a TTCP-dicalcium phosphate dihydrate (DCPD) cement. The resulting six TTCP-DCPD cement mixtures were characterized using X-ray diffraction analysis, scanning electron microscopy, and pH measurements. Setting times and compressive strength (CS) were also measured. Using the TTCP product with a Ca/P ratio of 2.0 resulted in low strength values (25.61 MPa) when distilled water was used as the setting liquid, even though conversion to hydroxyapatite was not prevented, as confirmed by X-ray diffraction. The suspected CaO presence in this TTCP may have affected the cohesiveness of the cement mixture but not the cement setting reaction, however no direct evidence of CaO presence was found. Lower Ca/P ratio products yielded cements with CS values ranging from 46.7 MPa for Ca/P ratio of 1.90 to 38.32 MPa for Ca/P ratio of 1.85. When a dilute sodium phosphate solution was used as the setting liquid, CS values were 15.3% lower than those obtained with water as the setting liquid. Setting times ranged from 18 to 22 min when water was the cement liquid and from 7 to 8 min when sodium phosphate solution was used, and the calcium to phosphate ratio did not have a marked effect on this property.

Self-setting properties of a β-dicalcium silicate reinforced calcium phosphate cement

Beta-dicalcium silicate was used to reinforce the injectable calcium phosphate cement (iCPC) for the first time in this study. The influence of the content of beta-dicalcium silicate on the mechanical properties, setting time, rheological properties, injectability, phase evolution, microstructure, and biodegradability of iCPC was systematically investigated. The results demonstrated that the addition of 8 wt % beta-dicalcium silicate obviously enhanced the compressive strength of the CPC from 26.5 to 47.5 MPa, and did not significantly influence the biodegradability, setting time, injectability, phase evolution, and microstructure of the CPC. The beta-dicalcium silicate-reinforced iCPC with relatively high mechanical property should have potential prospects for the wider applications in surgery such as orthopedics, oral, and maxillofacial surgery.

Short-fibre reinforcement of calcium phosphate bone cement

Calcium phosphate cement (CPC) sets to form hydroxyapatite, a major component of mineral bone, and is gaining increasing interest in bone repair applications. However, concerns regarding its brittleness and tendency to fragment have limited its widespread use. In the present study, short-fibre reinforcement of an apatitic calcium phosphate has been investigated to improve the fracture behaviour. The fibres used were polypropylene (PP) fibres, 50 μm in diameter and reduced in length by cryogenic grinding. The compressive strength and fracture behaviour were examined. Fibre addition of up to 10 wt% had a significant effect on composite properties, with the energy absorbed during failure being significantly increased, although this tended to be accompanied with a slight drop in compressive strength. The fibre reinforcement mechanisms appeared to be crack bridging and fibre pull-out. The setting time of the CPC with fibre reinforcement was also investigated and was found to increase with fibre volume fraction.

Premixed calcium phosphate cements: synthesis, physical properties, and cell cytotoxicity

OBJECTIVES

Calcium phosphate cement (CPC) is a promising material for dental, periodontal, and craniofacial repairs. However, its use requires on-site powder-liquid mixing that increases the surgical placement time and raises concerns of insufficient and inhomogeneous mixing. The objective of this study was to determine a formulation of premixed CPC (PCPC) with rapid setting, high strength, and good in vitro cell viability.

METHODS

PCPCs were formulated from CPC powder+non-aqueous liquid+gelling agent+hardening accelerator. Five PCPCs were thus developed: PCPC-Tartaric, PCPC-Malonic, PCPC-Citric, PCPC-Glycolic, and PCPC-Malic. Formulations and controls were compared for setting time, diametral tensile strength, and osteoblast cell compatibility.

RESULTS

Setting time (mean+/-S.D.; n=4) for PCPC-Tartaric was 8.2+/-0.8 min, significantly less than the 61.7+/-1.5 min for the Premixed Control developed previously (p<0.001). On 7th day immersion, the diametral tensile strength of PCPC-Tartaric reached 6.5+/-0.8 MPa, higher than 4.5+/-0.8 MPa of Premixed Control (p=0.036). Osteoblast cells displayed a polygonal morphology and attached to the nano-hydroxyapatite crystals in the PCPCs. All cements had similar live cell density values (p=0.126), indicating that the new PCPCs were as cell compatible as a non-premixed CPC control known to be biocompatible. Each of the new PCPCs had a cell viability that was not significantly different (p>0.1) from that of the non-premixed CPC control.

SIGNIFICANCE

PCPCs will eliminate the powder-liquid mixing during surgery and may also improve the cement performance. The new PCPCs supported cell attachment and yielded a high cell density and viability. Their mechanical strengths approached the reported strengths of sintered porous hydroxyapatite implants and cancellous bone. These nano-crystalline hydroxyapatite cements may be useful in dental, periodontal, and craniofacial repairs.