Influence of cross-linked PMMA beads on the mechanical behavior of self-curing acrylic cements

Enhancing mechanical properties of an injectable two-solution acrylic bone cement using a difunctional crosslinker

Two-solution bone cements modified with ethylene glycol-dimethacrylate (EG-DMA) as a crosslinker have been developed as an attempt to further improve the mechanical properties of acrylic bone cement. The result of this study shows that EG-DMA can increase the mechanical properties and fractional monomer conversion while preserving the thermal characteristics. The strength and bending modulus increase with EG-DMA concentrations at 5-10 vol % EG-DMA. Substituting the EG-DMA content past 10 vol % decreases the bending properties due to the effects of reduced monomer concentrations. Strengthened EG-DMA samples demonstrated an increase in ductility with noticeably different fracture surface morphologies than the control samples, indicated by microtroughs and ridge formation caused by excessive plastic strain. This work provides insight into the effect of substituting a crosslinker for MMA monomer in an injectable two-solution system and lays out the ideal concentrations of EG-DMA for superior mechanical or fractional monomer conversion properties. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 783-790, 2019.

Titanium Oxide (TiO₂)/Polymethylmethacrylate (PMMA) Denture Base Nanocomposites: Mechanical, Viscoelastic and Antibacterial Behavior

Currently, polymethylmethacrylate (PMMA) is the most popular denture base material. Most fractures of dentures that occur during function are due to its insufficient mechanical strength. The major drawbacks of PMMA are insufficient ductility, strength, and viscoelastic behavior. The purpose of this study was to evaluate a polymethylmethacrylate denture base material modified with TiO₂ nanoparticles in terms of nanomechanical, creep-recovery, and relaxation. Additionally, the effects of addition TiO₂ nanoparticles on the thermal and antimicrobial adhesion behaviors were investigated. Differential scanning calorimetry and thermogravimetric analysis indicated that the effect of small amounts of TiO₂ nanoparticles (1 wt. %, 2 wt. %, and 3 wt. %) on the degradation behavior of PMMA denture bases was insignificant. The nanomechanical test results of the PMMA and PMMA/TiO₂ nanocomposites indicated that the hardness and modulus in the nanoscale range improved due to TiO₂ addition. At a 1200-nm penetration depth, the modulus increased by 10%, 16%, and 29% and hardness increased by 18%, 24%, and 35% with the addition of 1 wt. %, 2 wt. %, and 3 wt. % TiO₂, respectively. Furthermore, the creep-recovery and relaxation behaviors of PMMA were significantly improved due to the addition of TiO₂. The creep strain decreased from 1.41% to 1.06%, 0.66%, and 0.49% with the addition of 1 wt. %, 2 wt. %, and 3 wt. % TiO₂, respectively. The relaxation test results showed that the initial stress under 1% strain improved to 19.9, 21.2, and 22 MPa with the addition of 1 wt. %, 2 wt. %, and 3 wt. % TiO₂, respectively. The improvement in the nanohardness, modulus, creep recovery, and relaxation behavior of PMMA due to the addition of TiO₂ nanoparticles indicated the role of the nanoparticles in increasing the PMMA matrix stiffness by reducing its mobility and free volume. TiO₂ nanoparticles also improved the antimicrobial behavior of PMMA by significantly reducing bacterial adherence with increasing TiO₂ ratio.

Angiogenic Rg1 /Sr-Doped TiO2 Nanowire/Poly(Propylene Fumarate) Bone Cement Composites

A new approach is provided for preparing radiopaque and angiogenic poly(propylene fumarate) (PPF) bone cements by integrating Sr-doped n-TiO₂ nanowires and ginsenoside Rg1 suitable for treating osteonecrosis. High aspect ratio radiopaque TiO₂ -nanowires are synthesized by strontium doping in supercritical CO₂ for the first time, showing a new phase, SrTiO₃ . PPF is synthesized using a transesterification method by reacting diethyl fumarate and propylene glycol, then functionalized using maleic anhydride to produce terminal carboxyl groups, which are subsequently linked to the nanowires. The strong interfacial adhesion between functionalized PPF and nanowires is examined by scanning electron microscopy, Fourier transform infrared, X-ray photoelectron spectroscopy, thermal analysis, and mechanical testing. An angiogenic modulator, ginsenoside Rg₁ , is integrated into the bone cement formulation with the mechanical properties, radiopacity, drug release, and angiogenesis behavior of the formed composites explored. The results show superior radiopacity and excellent release of ginsenoside Rg₁ in vitro, as well as a dose-dependent increase in the branching point numbers. The present study suggests this new methodology provides sufficient mechanical properties, radiopacity, and angiogenic activity to be suitable for cementation of necrotic bone.

Synergistic Effect of Mesoporous Silica and Hydroxyapatite in Loaded Poly(DL-lactic-co-glycolic acid) Microspheres on the Regeneration of Bone Defects

A microsphere composite made of poly(DL-lactic-co-glycolic acid) (PLGA), mesoporous silica nanoparticle (MSN), and nanohydroxyapatite (nHA) (PLGA-MSN/nHA) was prepared and evaluated as bone tissue engineering materials. The objective of this study was to investigate the synergistic effect of MSN/nHA on biocompatibility as well as its potential ability for bone formation. First, we found that this PLGA-MSN/nHA composite performed good characteristics on microstructure, mechanical strength, and wettability. By cell culture experiments, the adhesion and proliferation rate of the cells seeded on PLGA-MSN/nHA composite was higher than those of the controls and high levels of osteogenetic factors such as ALP and Runx-2 were detected by reverse transcriptase polymerase chain reaction. Finally, this PLGA-MSN/nHA composite was implanted into the femur bone defect in a rabbit model, and its ability to induce bone regeneration was observed by histological examinations. Twelve weeks after implantation, the bone defects had significantly more formation of mature bone and less residual materials than in the controls. These results demonstrate that this PLGA-MSN/nHA composite, introducing both MSN and nHA into PLGA microspheres, can improve the biocompatibility and osteoinductivity of composite in vitro and in vivo and had potential application in bone regeneration.

Effect of TiO2 Nanoparticles on Tensile Strength of Dental Acrylic Resins

Background and aims. Adding further fillers to dental resins may enhance their physical characteristics. The aim of this study was to evaluate the tensile strength of heat-curing acrylic resin reinforced by TiO2nanoparticles added into the resin matrix.

Materials and methods. Commercially available TiO₂ nanoparticles were obtained and characterized using X-ray diffrac-tion (XRD) and scanning electron microscopy (SEM) to determine their crystalline structure, particle size and morphology. TiO₂-acrylic resin nanocomposite was prepared by mixing 0.5, 1 and 2 (wt%) of surface modified TiO₂ nanoparticles in an amalgamator providing three groups of samples. Before curing, the obtained paste was packed into steel molds. After cur-ing, the specimens were removed from the molds. The tensile strength test samples were prepared according to ISO 1567.

Results. Two crystalline phases were found in TiO₂ nanoparticles including: (i) anatase as the major one, and (ii) rutile. The average particle size calculated according to the Scherrer equation was 20.4 nm, showing a normal size distribution. According to SEM images, the nanocomposite with 1wt% TiO₂ nanoparticles had a better distribution compared to other groups. In addition, the group by 1wt% TiO₂ exhibited higher tensile strength with a significant difference compared to other groups. ANOVA showed significant differences between the contents of TiO₂ particles in acrylic resin (F = 22.19; P < 0.001).

Conclusion. A considerable increase in tensile strength was observed with titania NPs reinforcement agents in 1wt% by weight. Further increase of TiO₂ nanoparticles decreased the tensile strength.

Bone cement based nanohybrid as a super biomaterial for bone healing

A novel nanohybrid based on bone cement has been developed which is capable of healing fractured bone in 30 days, one-third of the time required for the natural healing process. Nanohybrids of bone cement based on poly(methyl methacrylate) (PMMA), currently used as a grouting material in joint replacement surgery, were prepared by simple mixing with organically modified layered silicates of varying chemical compositions. The temperature arising from exothermic polymerization in one of the nanohybrids is 12 °C lower than that in pure bone cement, thus circumventing the reported cell necrosis that occurs during implantation with pure bone cement. The thermal stability and mechanical superiority of this nanohybrid were verified in terms of its higher degradation temperature, better stiffness, superior toughness, and significantly higher fatigue resistance compared with pure bone cement; these properties make it appropriate for use as an implant material. The biocompatibility and bioactivity of the nanohybrid were confirmed using cell adhesion, cell viability, and fluorescence imaging studies. Osteoconductivity and bone bonding properties were monitored in vivo in rabbits through radiographic imaging and histopathological studies of growing bone and muscle near the surgery site. The observed dissimilarity of the properties of two different nanoclays used as fillers were visualized through interactions measured using spectroscopic techniques. Studies of the influence of different elements on bioactivity showed a higher efficiency for the nanoclay containing greater amounts of iron.

[Influence of the physiological medium on the mechanical properties of bone cement: can current studies be extrapolated?]

PURPOSE

The use of bone cement is widespread in orthopaedic surgery. Most of the mechanical tests are performed in dry medium, making it difficult to extrapolate the results. The objective of this study is to assess if the mechanical properties of polymethylmethacrylate (PMMA), obtained in previous reports, are still present in a liquid medium.

MATERIAL AND METHOD

An experimental study was designed with antibiotic (vancomycin) loaded PMMA. Four groups were defined according to the medium (dry or liquid) and the pre-conditioning in liquid medium (one week or one month). Wear and flexural strength tests were performed according to ASTM and ISO standards. Volumetric wear, friction coefficient, tensile strength, and Young's modulus were analyzed. All samples were examined by scanning electron microscopy.

RESULTS

The samples tested in liquid medium showed lower wear and flexural strength values (P<.05). The kind of wear was modified from abrasive to adhesive in those samples studied in liquid medium. The samples with a pre-conditioning time showed lower values of wear (P<.05).

CONCLUSIONS

Caution is recommended when extrapolating the results of previous PMMA results. The different mechanical strength of the cement in a liquid medium, observed in saline medium, is much closer to the clinical situation.

Integrated biomimetic carbon nanotube composites for in vivo systems

As interest in using carbon nanotubes for developing biologically compatible systems continues to grow, biological inspiration is stimulating new directions for in vivo approaches. The ability to integrate nanotechnology-based systems in the body will provide greater successes if the implanted material is made to mimic elements of the biological milieu especially through tuning physical and chemical characteristics. Here, we demonstrate the highly successful capacity for in vivo implantation of a new carbon nanotube-based composite that is, itself, integrated with a hydroxyapatite-polymethyl methacrylate to create a nanocomposite. The success of this approach is grounded in finely tailoring the physical and chemical properties of this composite for the critical demands of biological integration. This is accomplished through controlling the surface modification scheme, which affects the interactions between carbon nanotubes and the hydroxyapatite-polymethyl methacrylate. Furthermore, we carefully examine cellular response with respect to adhesion and proliferation to examine in vitro compatibility capacity. Our results indicate that this new composite accelerates cell maturation through providing a mechanically competent bone matrix; this likely facilitates osteointegration in vivo. We believe that these results will have applications in a diversity of areas including carbon nanotube, regeneration, chemistry, and engineering research.

Synthesis and characterization of poly(methyl methacrylate)-based experimental bone cements reinforced with TiO2-SrO nanotubes

In an attempt to overcome existing limitations of experimental bone cements we here demonstrate a simple approach to synthesizing strontium-modified titania nanotubes (n-SrO-TiO(2) tubes) and functionalize them using the bifunctional monomer methacrylic acid. Then, using 'grafting from' polymerization with methyl methacrylate, experimental bone cements were produced with excellent mechanical properties, radiopacity and biocompatibility. Transmission electron microscopy (TEM), scanning electron microscopy (SEM), energy-dispersive spectroscopy mapping and backscattered SEM micrographs revealed a uniform distribution of SrO throughout the titanium matrix, with retention of the nanotubular morphology. Nanocomposites were then reinforced with 1, 2, 4 and 6 wt.% of the functionalized metal oxide nanotubes. Under the mixing and dispersion regime employed in this study, 2 wt.% appeared optimal, exhibiting a more uniform dispersion and stronger adhesion of the nanotubes in the poly(methyl methacrylate) matrix, as shown by TEM and SEM. Moreover, this optimum loading provided a significant increase in the fracture toughness (K(IC)) (20%) and flexural strength (40%) in comparison with the control matrix (unfilled) at P<0.05. Examination of the fracture surfaces by SEM showed that toughening was provided by the nanotubes interlocking with the acrylic matrix and crack bridging during fracture. On modifying the n-TiO(2) tubes with strontium oxide the nanocomposites exhibited a similar radiopacity to a commercial bone cement (CMW 1), while exhibiting a significant enhancement of osteoblast cell proliferation (242%) in vitro compared with the control at P<0.05.

Acrylic bone cements: influence of time and environment on physical properties

Acrylic bone cements are in extensive use in joint replacement surgery. They are weight bearing and load transferring in the bone-cement-prosthesis complex and therefore, inter alia, their mechanical properties are deemed to be crucial for the overall outcome. In spite of adequate preclinical test results according to the current specifications (ISO, ASTM), cements with inferior clinical results have appeared on the market. The aim of this study was to investigate whether it is possible to predict the long term clinical performance of acrylic bone cement on the basis of mechanical in vitro testing. We performed in vitro quasistatic testing of cement after aging in different media and at different temperatures for up to 5 years. Dynamic creep testing and testing of retrieved cement were also performed. Testing under dry conditions, as required in current standards, always gave higher values for mechanical properties than did storage and testing under more physiological conditions. We could demonstrate a continuous increase in mechanical properties when testing in air, while testing in water resulted in a slight decrease in mechanical properties after 1 week and then levelled out. Palacos bone cement showed a higher creep than CMW3G and the retrieved Boneloc specimens showed a higher creep than retrieved Palacos. The strength of a bone cement develops more slowly than the apparent high initial setting rate indicates and there are changes in mechanical properties over a period of five years. The effect of water absorption is important for the physical properties but the mechanical changes caused by physical aging are still present after immersion in water. The established standards are in need of more clinically relevant test methods and their associated requirements need better definition. We recommend that testing of bone cements should be performed after extended aging under simulated physiological conditions. Simple quasistatic and dynamic creep tests seem unable to predict clinical performance of acrylic bone cements when the products under test are chemically very similar. However, such testing might be clinically relevant if the cements exhibit substantial differences.

Bone tissue engineering therapeutics: controlled drug delivery in three-dimensional scaffolds

This paper provides an extensive overview of published studies on the development and applications of three-dimensional bone tissue engineering (TE) scaffolds with potential capability for the controlled delivery of therapeutic drugs. Typical drugs considered include gentamicin and other antibiotics generally used to combat osteomyelitis, as well as anti-inflammatory drugs and bisphosphonates, but delivery of growth factors is not covered in this review. In each case reviewed, special attention has been given to the technology used for controlling the release of the loaded drugs. The possibility of designing multifunctional three-dimensional bone TE scaffolds for the emerging field of bone TE therapeutics is discussed. A detailed summary of drugs included in three-dimensional scaffolds and the several approaches developed to combine bioceramics with various polymeric biomaterials in composites for drug-delivery systems is included. The main results presented in the literature are discussed and the remaining challenges in the field are summarized with suggestions for future research directions.

Novel mesoporous silica-based antibiotic releasing scaffold for bone repair

Tissue engineering scaffolds with a micro- or nanoporous structure and able to deliver special drugs have already been confirmed to be effective in bone repair. In this paper, we first evaluated the biomineralization properties and drug release properties of a novel mesoporous silica-hydroxyapatite composite material (HMS-HA) which was used as drug vehicle and filler for polymer matrices. Biomineralization can offer a credible prediction of bioactivity for the synthetic bone regeneration materials. We found HMS-HA exhibited good apatite deposition properties after being soaked in simulated body fluid (SBF) for 7 days. Drug delivery from HMS-HA particle was in line with Fick's law, and the release process lasted 12 h after an initial burst release with 60% drug release. A novel tissue engineering scaffold with the function of controlled drug delivery was developed, which was based on HMS-HA particles, poly(lactide-co-glycolide) (PLGA) and microspheres sintering techniques. Mechanical testing on compression, degradation behavior, pH-compensation effect and drug delivery behavior of PLGA/HMS-HA microspheres sintered scaffolds were analyzed. Cell toxicity and cell proliferation on the scaffolds was also evaluated. The results indicated that the PLGA/HMS-HA scaffolds could effectively compensate the increased pH values caused by the acidic degradation product of PLGA. The compressive strength and modulus of PLGA/HMS-HA scaffolds were remarkably high compared to pure PLGA scaffold. Drug delivery testing of the PLGA/HMS-HA scaffolds indicated that PLGA slowed gentamycin sulfate (GS) release from HMS-HA particles, and the release lasted for nearly one month. Adding HMS-HA to PLGA scaffolds improved cytocompatibility. The scaffolds demonstrated low cytotoxicity, and supported mesenchymal stem cells growth more effectively than pure PLGA scaffolds. To summarize, the data supports the development of PLGA/HMS-HA scaffolds as potential degradable and drug delivery materials for bone replacement.

Alternative acrylic bone cement formulations for cemented arthroplasties: present status, key issues, and future prospects

All the commercially available plain acrylic bone cement brands that are used in cemented arthroplasties are based on poly (methyl methacrylate) and, with a few exceptions, have the same constituents. It is well known that these brands are beset with many drawbacks, such as high maximum exotherm temperature, lack of bioactivity, and volumetric shrinkage upon curing. Furthermore, concerns have been raised about a number of the constituents, such as toxicity of the activator (N,N,dimethyl-p-toluidine) and possible involvement of the radiopacifier (BaSO(4) or ZrO(2) particles) in third-body wear. Thus, over the years, many research efforts have been expended to address these drawbacks, culminating in a large number of alternative formulations, which may be grouped into 16 categories. Although there are a number of reviews of the large literature that now exists on these formulations, each covers only some of the categories and none contains a detailed discussion of the germane issues. The objective of the present work, therefore, was to present a comprehensive and critical review of the whole field. In addition to succinct descriptions of the cements in each category, there are explicative summaries of literature reports, a detailed discussion of several key issues surrounding the potential for use of these cements in cemented arthroplasties, and a presentation of numerous ideas for future studies.

Effect of microencapsulated phase change materials on the thermo-mechanical properties of poly(methyl-methacrylate) based biomaterials

Microencapsulated paraffin based phase change material (PCM) have been incorporated into Poly(methyl-methacrylate) (PMMA) matrix in order to enhance the thermo-mechanical properties. Calorimetric and mechanical analyses are carried out and the thermo regulating potential of PMMA/PCM composites is investigated. Results indicate that the PCM phase has a negligible effect on the glass transition temperature of the PMMA matrix, and the thermal regulating capability spans around body temperature absorbing or releasing a thermal energy up to 30 J/g. One of the effect of the PCM phase into the cement is the reduction of the peak temperature developed during the exothermal reaction.