Novel tricalcium silicate/monocalcium phosphate monohydrate composite bone cement

Root canal irrigants effect on the compressive strength and calcium ion release of Biodentine

Compressive strength and calcium ion release are integral properties of Biodentine for its enhanced efficiency. The present study evaluated the effects of Dual Rinse HEDP (DR HEDP), ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) on the calcium ion release and compressive strength of Biodentine. Eighty Biodentine specimens were moulded and randomly divided into four groups (n = 20). Samples in group 1 were treated with 17 % EDTA; group 2 with DR HEDP; group 3 with 2.5 % NaOCl; and group 4 with distilled water. Samples were immersed in 10 mL of the test solutions for 1 min. The mean concentration of the calcium ion released was measured using atomic absorption spectrophotometry. The remaining 40 samples were tested for their compressive strength. Significant differences were determined among all the irrigants tested for calcium ion release and compressive strength. Samples treated with NaOCl had the lowest calcium ion release, while samples treated with 17 % EDTA had the largest calcium ions. No significant differences were measured between DR HEDP or distilled water. For compressive strength, samples treated with 2.5 % NaOCl had the lowest strength, while the highest values were obtained with distilled water. There was a significant difference between DR HEDP and EDTA, in which EDTA reduced the compressive strength significantly more than DR HEDP. DR HEDP had less detrimental effect on the calcium ion release and compressive strength of Biodentine.

Novel self-setting cements based on tricalcium silicate/(β-tricalcium phosphate/monocalcium phosphate anhydrous)/hydroxypropyl methylcellulose: From hydration mechanism to biological evaluations

Despite the clinical success of tricalcium silicate (TCS)-based materials in endodontics, the inferior handling characteristic, poor anti-washout property and slow setting kinetics hindered their wider applications. To solve these problems, an injectable fast-setting TCS/β-tricalcium phosphate/monocalcium phosphate anhydrous (β-TCP/MCPA) cement was developed for the first time by incorporation of hydroxypropyl methylcellulose (HPMC) and β-TCP/MCPA. The physical-chemical characterization (setting time, anti-washout property, injectability, compressive strength, apatite mineralization and sealing property) of TCS/(β-TCP/MCPA) were conducted. Its hydration mechanism was also investigated. Furthermore, the cytocompatibility and osteogenic/odontogenic differentiation of stem cells isolated from human exfoliated deciduous teeth (SHED) treated with TCS/β-TCP/MCPA were studied. The results showed that HPMC could provide TCS with good anti-washout ability and injectability but slow hydration process. However, β-TCP/MCPA effectively enhanced anti-washout characteristics and reduced setting time due to faster hydration kinetics. TCS/(β-TCP/MCPA) obtained around 90 % of injection rate and high compressive strength whereas excessive additions of β-TCP/MCPA compromised its injectability and compressive strength. TCS/(β-TCP/MCPA) can induce apatite deposition and form a tight marginal sealing at the dentin-cement interface. Additionally, TCS/(β-TCP/MCPA) showed good biocompatibility and promoted osteo/odontogenic differentiation of SHED. In general, our results indicated that TCS/(β-TCP/MCPA) may be particularly promising as an injectable bioactive cements for endodontic treatment.

Functionalization of poly (lactic-co-glycolic acid) nano‑calcium sulphate and fucoidan 3D scaffold using human bone marrow mesenchymal stromal cells for bone tissue engineering application

This study aimed to functionalize a novel porous PLGA (Poly lactic-co-glycolic acid) composite scaffold in combination with nano‑calcium sulphate (nCS) and/or fucoidan (FU) to induce osteogenic differentiation of human bone marrow stromal cells. The composite scaffolds (PLGA-nCS-FU, PLGA-nCS or PLGA-FU) were fabricated and subjected to characterization using Fourier-transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRD), Scanning electron microscopy (SEM) and Energy Dispersive X-Ray (EDX). The biocompatibility and osteogenic induction potential of scaffolds on seeded human bone marrow derived mesenchymal stromal cells (hBMSCs) were studied using cell attachment and alamar blue cell viability and alkaline phosphatase (ALP), osteocalcin and osteogenic gene expression, respectively. The composition of different groups was reflected in FTIR, XRD and EDX. The SEM micrographs revealed a difference in the surface of the scaffold before and after FU addition. The confocal imaging and SEM micrographs confirmed the attachment of cells onto all three composite scaffolds. However, the AB assay indicated a significant increase (p < 0.05) in cell viability/proliferation seeded on PLGA-nCS-FU on day 21 and 28 as compared with other combinations. A 2-fold significant increase (p < 0.05) in ALP and OC secretion of seeded hBMSCs onto PLGA-nCS-FU was observed when compared with other combinations. A significant increase in RUNX2, OPN, COL-I and ALP genes were observed in the cells seeded on PLGA-nCS-FU on day 14 and 28 as compared with day 0. In conclusion, the incorporation of both Fucoidan and Nano‑calcium sulphate with PLGA showed a promising improvement in the osteogenic potential of hBMSCs. Therefore, PLGA-nCS-FU could be the ideal candidate for subsequent pre-clinical studies to develop a successful bone substitute to repair critical bone defects.

The in vivo dissolution of tricalcium silicate bone cement

This study aimed to investigate the in vivo dissolution of tricalcium silicate (Ca₃ SiO₅ , C₃ S) bone cement in the rabbit femoral defect. Results indicated that C₃ S paste directly integrated with the bone tissue without the protection of the bone-like apatite. Calcium silicate hydrate gel (C-S-H gel) and Ca(OH)₂ were the main components of C₃ S paste. The dissolution model of C₃ S paste was a mass loss rather than a decrease in volume. The initial dissolution of C₃ S paste (0 ~ 6 weeks) was greatly attributed to the release of Ca(OH)₂ , and the later dissolution (>6 weeks) was attributed to the decalcification of C-S-H gel. Although the mass of C₃ S paste could decrease by more than 19 wt % after 6 weeks of implantation, the created pores (<1 μm) were not large enough for the bone tissue to migrate into C₃ S paste. The loss of Ca ions also resulted in the transformation of SiO₄ tetrahedrons from Q¹ and Q² to Q⁰ , Q³ , and Q⁴ in C-S-H gel. Because only isolated SiO₄ tetrahedrons (Q⁰ ) and Ca ions could be absorbed by the bone tissue, C₃ S paste gradually transformed into a silica-rich gel. The fundamental reason for no decrease in volume of C₃ S paste was that the SiO₄ tetrahedron network still maintained the frame structure of C₃ S paste during the implantation.

The impact of leuprolide acetate-loaded calcium phosphate silicate cement to bone regeneration under osteoporotic conditions

Osteoporosis is detrimental to the health of skeletal structure and significantly increases the risks of bone fracture. Moreover, bone regeneration is adversely impaired by increased osteoclastic activities as a result of osteoporosis. In this study, we developed a novel formulation of injectable bone cement based on calcium phosphate silicate cement (CPSC) and leuprolide acetate (LA). Several combinations of LA-CPSC bone cement were characterized and, it is found that LA could increase the setting time and compressive strength of CPSC in a concentration-dependent manner. Moreover, thein vitroresults revealed that LA-CPSC was biocompatible and able to encourage the osteoblast proliferation via the mTOR signalling pathway. Furthermore, the LA-CPSC was implanted in the osteoporotic rats to evaluate its effectiveness to repair bone fractures under the osteoporotic conditions. The biomarker study and micro-CT analyses indicated that LA-CPSC could effectively reduce the osteoclast activities and promote the bone regeneration. In conclusion, our study demonstrated that LA-CPSC injectable bone cement should be a viable solution to repair bone fractures under the osteoporotic conditions.

Retention of BioAggregate and MTA as coronal plugs after intracanal medication for regenerative endodontic procedures: an ex vivo study

Objectives

This study compared the retention of BioAggregate (BA; Innovative BioCeramix) and mineral trioxide aggregate (MTA; Angelus) as coronal plugs after applying different intracanal medications (ICMs) used in regenerative endodontics.

Materials and Methods

One-hundred human maxillary central incisors were used. The canals were enlarged to a diameter of 1.7 mm. Specimens were divided into 5 groups (n = 20) according to the ICM used: calcium hydroxide (CH), 2% chlorhexidine (CHX), triple-antibiotic paste (TAP), double-antibiotic paste (DAP), and no ICM (control; CON). After 3 weeks of application, ICMs were removed and BA or MTA were placed as the plug material (n = 10). The push-out bond strength and the mode of failure were assessed. The data were analyzed using 2-way analysis of variance, the Tukey's test, and the χ² test; p values < 0.05 indicated statistical significance.

Results

The type of ICM and the type of plug material significantly affected bond strength (p < 0.01). Regardless of the type of ICM, BA showed a lower bond strength than MTA (p < 0.05). For MTA, CH showed a higher bond strength than CON, TAP and DAP; CHX showed a higher bond strength than DAP (p < 0.01). For BA, CH showed a higher bond strength than DAP (p < 0.05). The mode of failure was predominantly cohesive for BA (p < 0.05).

Conclusions

MTA may show better retention than BA. The mode of bond failure with BA can be predominantly cohesive. BA retention may be less affected by ICM type than MTA retention.

Calcium silicate-based cements and functional impacts of various constituents

Calcium silicate-based cements have superior sealing ability, bioactivity, and marginal adaptation, which make them suitable for different dental treatment applications. However, they exhibit some drawbacks such as long setting time and poor handling characteristics. To overcome these limitations calcium silicates are engineered with various constituents to improve specific characteristics of the base material, and are the focus of this review. An electronic search of the PubMed, MEDLINE, and EMBASE via OVID databases using appropriate terms and keywords related to the use, application, and properties of calcium silicate-based cements was conducted. Two independent reviewers obtained and analyzed the full texts of the selected articles. Although the effects of various constituents and additives to the base Portland cement-like materials have been investigated, there is no one particular ingredient that stands out as being most important. Applying nanotechnology and new synthesis methods for powders most positively affected the cement properties.

A Comprehensive Study of Osteogenic Calcium Phosphate Silicate Cement: Material Characterization and In Vitro/In Vivo Testing

Vertebral compression fractures can be successfully restored by injectable bone cements. Here the as-yet unexplored in vitro cytotoxicity, in vivo biodegradation, and osteoconductivity of a new calcium phosphate silicate cements (CPSC) are studied, where monocalcium phosphate (MCP; 5, 10, and 15 wt%) is added to calcium silicate cement (CSC). Setting rate and compressive strength of CPSC decrease with the addition of MCP. The crystallinity, microstructure, and porosity of hardened CPSC are evaluated by X-ray diffractometer, Fourier transform infrared spectroscopy, and microcomputed tomography (CT). It is found that MCP reacts with calcium hydroxide, one of CSC hydration products, to precipitate apatite. While the reaction accelerates the hydration of CSC, the formation of calcium silicate hydrate gel is disturbed and highly porous microstructures form, resulting in weaker compressive strength. In vitro studies demonstrate that CPSC is noncytotoxic to osteoblast cells and promotes their proliferation. In the rabbit tibia implantation model, clinical X-ray and CT scans demonstrate that CPSC biodegrades slower and osseointegrates better than clinically used calcium phosphate cement (CPC). Histological studies demonstrate that CPSC is osteoconductive and induces higher bone formation than CPC, a finding that might warrant future clinical studies.

Novel tricalcium silicate/magnesium phosphate composite bone cement having high compressive strength, in vitro bioactivity and cytocompatibility

Although inorganic bone cements such as calcium phosphate cements have been widely applied in orthopaedic and dental fields because of their self-setting ability, development of high-strength bone cement with bioactivity and biodegradability remains a major challenge. Therefore, the purpose of this study is to prepare a tricalcium silicate/magnesium phosphate (C3S/MPC) composite bone cement, which is intended to combine the excellent bioactivity of C3S with remarkable self-setting properties and mechanical strength of MPC. The self-setting and mechanical properties, in vitro induction of apatite formation and degradation behaviour, and cytocompatibility of the composite cements were investigated. Our results showed that the C3S/MPC composite cement with an optimal composition had compressive strength up to 87 MPa, which was significantly higher than C3S (25 MPa) and MPC (64 MPa). The setting time could be adjusted between 3 min and 29 min with the variation of compositions. The hydraulic reaction products of the C3S/MPC composite cement were composed of calcium silicate hydrate (CSH) derived from the hydration of C3S and gel-like amorphous substance. The C3S/MPC composite cements could induce apatite mineralization on its surface in SBF solution and degraded gradually in Tris-HCl solution. Besides, the composite cements showed good cytocompatibility and stimulatory effect on the proliferation of MC3T3-E1 osteoblast cells. Our results indicated that the C3S/MPC composite bone cement might be a new promising high-strength inorganic bioactive material which may hold the potential for bone repair in load-bearing site.

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.

Microstructure and chemistry affects apatite nucleation on calcium phosphate bone graft substitutes

The bioactivity of calcium phosphate bone grafts of varying chemistry and strut-porosity was compared by determining the rate of formation of hydroxycarbonate apatite crystals on the material surface after being soaked in simulated body fluid for up to 30 days. Three groups of silicate-substituted hydroxyapatite material were tested, with each group comprising a different quantity of strut-porosity (23, 32, and 46 % volume). A commercially available porous β-tricalcium phosphate bone graft substitute was tested for comparison. Results indicate that strut-porosity of a material affects the potential for formation of a precursor to bone-like apatite and further confirms previous findings that β-tricalcium phosphate is less bioactive than hydroxyapatite.

In vitro studies of calcium phosphate silicate bone cements

A novel calcium phosphate silicate bone cement (CPSC) was synthesized in a process, in which nanocomposite forms in situ between calcium silicate hydrate (C-S-H) gel and hydroxyapatite (HAP). The cement powder consists of tricalcium silicate (C(3)S) and calcium phosphate monobasic (CPM). During cement setting, C(3)S hydrates to produce C-S-H and calcium hydroxide (CH); CPM reacts with the CH to precipitate HAP in situ within C-S-H. This process, largely removing CH from the set cement, enhances its biocompatibility and bioactivity. The testing results of cell culture confirmed that the biocompatibility of CPSC was improved as compared to pure C(3)S. The results of XRD and SEM characterizations showed that CPSC paste induced formation of HAP layer after immersion in simulated body fluid for 7 days, suggesting that CPSC was bioactive in vitro. CPSC cement, which has good biocompatibility and low/no cytotoxicity, could be a promising candidate as biomedical cement.

Anti-washout carboxymethyl chitosan modified tricalcium silicate bone cement: preparation, mechanical properties and in vitro bioactivity

Anti-washout CaF(2) stabilized C(3)S (F-C(3)S) bone cement was prepared by adding water-soluble carboxymethyl chitosan (CMCS) to the hydration liquid. The setting time, compressive strength and in vitro bioactivity of the CMCS modified F-C(3)S (CMCS-C(3)S) pastes were evaluated. The results indicate that CMCS-C(3)S pastes could be stable in the shaking simulated body fluid (SBF) after immediately mixed. The addition of CMCS significantly enhances the cohesion of particles, at the same time restrains the penetration of liquid, and thus endows the anti-washout ability. The setting times of the pastes increase with the increase of CMCS concentrations in the hydration liquid. Besides, the compressive strengths of CMCS-C(3)S pastes after setting for 1-28 days are lower than that of the pure F-C(3)S paste, but the sufficient strengths would be suitable for the clinical applications. The crystalline apatite deposited on the paste surface is retarded from 1 to 2 days for the addition of CMCS, but the quantities of deposited apatite are same after soaking in SBF for 3 days. As the result that pure C(3)S paste has shorter setting times than pure F-C(3)S paste, CMCS modified pure C(3)S pastes would have better anti-washout ability. Our study provides a convenient way to use C(3)S bone cement with excellent anti-washout ability when the pastes are exposed to biological fluids. The novel anti-washout CMCS-C(3)S bone cement with suitable setting times, sufficient strengths and in vitro bioactivity would have good prospects for medical application.

Preparation of Amorphous Calcium Phosphate/Triclcium Silicate Composite Powders

The amorphous calcium phosphate (ACP)/tricalcium silicate (Ca3SiO5, C3S) composite powders were synthesized in this paper. The exothermal behavior of C3S determined by isothermal conduction calorimetry indicated that the ACP could be synthesis by chemical precipitation method during the induction period (stage II) of C3S. The composite powders were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS). The results indicated that nanosized ACP particles deposited on the surface of C3S particles to form core-shell structure at pH=10.5, and the nCa/nP of ACP could be controlled between 1.0 and 1.5. The core-shell structure is stable after sintered at 500 oC for 3 h to remove the β-cyclodextrin (β-CD). As compared with the irregular C3S particles (1~5 μm), the composite powders particles are spherical with a diameter of 40~150 μm. Therefore, to obtain the smaller size of composite powders, it is expected to avoid the aggregate of C3S particles in the aqueous solution by addition of dispersant. As compared with C3S, the composite powders may contribute better injectability, strength and biocompatibility.

The apatite formation ability of CaF2 doping tricalcium silicates in simulated body fluid

The purpose of this study was to investigate the effects of CaF(2) on the apatite formation ability of tricalcium silicates (Ca(3)SiO(5), C(3)S) and the mechanism of apatite formation on C(3)S pastes. Different amounts of CaF(2) (0, 1, 2 and 3 wt%) were mixed in the raw materials during the synthesis process of C(3)S. The apatite formation ability of the CaF(2) doping C(3)S was examined by soaking the one-day setting pastes in simulated body fluid (SBF). The fluoride concentrations, pH values, structural and morphological variations of the pastes were examined during soaking in SBF. With the addition of CaF(2), the initial crystalline apatite formation time of the pastes was decreased from three days to one day. After soaking for seven days, the thicknesses of apatite layers depositing on the surface of C(3)S doped with 0, 1, 2 and 3 wt% CaF(2) were about 88, 102, 168 and 136 microm, respectively. C(3)S doped with 2 wt% CaF(2) showed the better ability to induce the formation of apatite. Furthermore, the mechanism of the apatite formation of the CaF(2) doping C(3)S pastes may be attributed to the formation and stability of F-substituted apatite determined by x-ray photoelectron spectroscopy (XPS) at the early age. The results indicated that CaF(2) doping C(3)S has better in vitro bioactivity, and may be used to prepare novel bone cement.

Novel bioactive composite bone cements based on the beta-tricalcium phosphate-monocalcium phosphate monohydrate composite cement system

Bioactive composite bone cements were obtained by incorporation of tricalcium silicate (Ca3SiO5, C3S) into a brushite bone cement composed of beta-tricalcium phosphate [beta-Ca3(PO4)2, beta-TCP] and monocalcium phosphate monohydrate [Ca(H2PO4)2.H2O, MCPM], and the properties of the new cements were studied and compared with pure brushite cement. The results indicated that the injectability, setting time and short- and long-term mechanical strength of the material are higher than those of pure brushite cement, and the compressive strength of the TCP/MCPM/C3S composite paste increased with increasing aging time. Moreover, the TCP/MCPM/C3S specimens showed significantly improved in vitro bioactivity in simulated body fluid and similar degradability in phosphate-buffered saline as compared with brushite cement. Additionally, the reacted TCP/MCPM/C3S paste possesses the ability to stimulate osteoblast proliferation and promote osteoblastic differentiation of the bone marrow stromal cells. The results indicated that the TCP/MCPM/C3S cements may be used as a bioactive material for bone regeneration, and might have significant clinical advantage over the traditional beta-TCP/MCPM brushite cement.

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.