Bone Scaffold Materials in Periodontal and Tooth-supporting Tissue Regeneration: A Review

BACKGROUND AND OBJECTIVES

Periodontium is an important tooth-supporting tissue composed of both hard (alveolar bone and cementum) and soft (gingival and periodontal ligament) sections. Due to the multi-tissue architecture of periodontium, reconstruction of each part can be influenced by others. This review focuses on the bone section of the periodontium and presents the materials used in tissue engineering scaffolds for its reconstruction.

MATERIALS AND METHODS

The following databases (2015 to 2021) were electronically searched: ProQuest, EMBASE, SciFinder, MRS Online Proceedings Library, Medline, and Compendex. The search was limited to English-language publications and in vivo studies.

RESULTS

Eighty-three articles were found in primary searching. After applying the inclusion criteria, seventeen articles were incorporated into this study.

CONCLUSION

In complex periodontal defects, various types of scaffolds, including multilayered ones, have been used for the functional reconstruction of different parts of periodontium. While there are some multilayered scaffolds designed to regenerate alveolar bone/periodontal ligament/cementum tissues of periodontium in a hierarchically organized construct, no scaffold could so far consider all four tissues involved in a complete periodontal defect. The progress and material considerations in the regeneration of the bony part of periodontium are presented in this work to help investigators develop tissue engineering scaffolds suitable for complete periodontal regeneration.

Preparation and characterization of novel poly (lactic acid)/calcium oxide nanocomposites by electrospinning as a potential bone tissue scaffold

Calcium oxide nanoparticles (n-CaO) ca. 22 nm were obtained from eggshell waste. The n-CaO was incorporated into the PLA matrix in 10 and 20 wt% of filler content by electrospinning process to get PLA/n-CaO fibers with homogenous morphology and diameter as a potential use in scaffold for bone tissue regeneration. The incorporation of n-CaO into PLA modifies the mechanical properties, having a reinforcement effect on the matrix. The Young modulus for PLA/n-CaO nanocomposites increased between 122 and 138 % concerning neat PLA fibers, showing a more rigid behavior. The PLA/n-CaO nanocomposite fibers showed in vitro bioactivity, capable of inducing the precipitation of hydroxyapatite (HA) layer in the fiber surface after seven days in SBF solution. The biocidal and biological properties of PLA/n-Cao with 20 wt% showed a 30 % reduction in bacterial viability against S. aureus and 11 % against E. coli after 6 h of bacterial exposure. Furthermore, the fibers did not show a cytotoxic effect on the bone marrow ST-2 cell line, allowing cell adhesion and proliferation in the RPMI medium. The PLA/n-CaO with 20 wt% of nanoparticles showed a higher capacity to promote osteogenic differentiation, significantly increasing the alkaline phosphatase (ALP) expression after seven days compared to PLA and cell control. The in vivo analysis corroborated the biocompatibility of the prepared scaffolds; the presence of n-CaO in PLA reduced the formation of fibrous encapsulation of the material, improving the healing process. These results validated using n-CaO to enhance the functionality of polymer matrices as a PLA, bringing bioactive, biocide, and biocompatible properties, opening a new and interesting route to develop new biomaterials as a scaffold for bone tissue engineering.

Electrospinning of in situ synthesized silica-based and calcium phosphate bioceramics for applications in bone tissue engineering: A review

The field of bone tissue engineering (BTE) focuses on the repair of bone defects that are too large to be restored by the natural healing process. To that purpose, synthetic materials mimicking the natural bone extracellular matrix (ECM) are widely studied and many combinations of compositions and architectures are possible. In particular, the electrospinning process can reproduce the fibrillar structure of bone ECM by stretching a viscoelastic solution under an electrical field. With this method, nano/micrometer-sized fibres can be produced, with an adjustable chemical composition. Therefore, by shaping bioactive ceramics such as silica, bioactive glasses and calcium phosphates through electrospinning, promising properties for their use in BTE can be obtained. This review focuses on the in situ synthesis and simultaneous electrospinning of bioceramic-based fibres while the reasons for using each material are correlated with its bioactivity. Theoretical and practical considerations for the synthesis and electrospinning of these materials are developed. Finally, investigations into the in vitro and in vivo bioactivity of different systems using such inorganic fibres are exposed.

Novel non-resorbable polymeric-nanostructured scaffolds for guided bone regeneration

OBJECTIVE

The aim of this study was to evaluate the bone-regeneration efficiency of novel polymeric nanostructured membranes and the effect of zinc, calcium, titanium, and bone morpho-protein loading on membranes, through an in vivo rabbit model.

MATERIAL AND METHODS

Nanostructured membranes of methylmethacrylate were loaded with zinc, calcium, TiO₂ nanoparticles, and bone-morphogenetic protein (BMP). These membranes covered the bone defects prepared on the skulls of six rabbits. Animals were sacrificed 6 weeks after surgery. Micro computed tomography was used to evaluate bone architecture through BoneJ pluging and ImageJ script. Three histological processing of samples, including von Kossa silver nitrate, toluidine blue, and fluorescence by the deposition of calcein were utilized.

RESULTS

Zn-membranes (Zn-Ms) promoted the highest amount of new bone and higher bone perimeter than both unloaded and Ti-membranes (Ti-Ms). Ca-membranes (Ca-Ms) attained higher osteoid perimeter and bone perimeter than Zn-Ms. The skeleton analysis showed that Zn-Ms produced more branches and junctions at the trabecular bone than BMP-loaded membranes (BMP-Ms). Samples treated with Ti-Ms showed less bone formation and bony bridging processes. Both Zn-Ms and Ca-Ms achieved higher number of osteoblasts than the control group. BMP-Ms and Ca-Ms originated higher number of blood vessels than Ti-Ms and control group.

CONCLUSIONS

Zn incorporation in novel nanostructured membranes provided the highest regenerative efficiency for bone healing at the rabbit calvarial defects.

CLINICAL RELEVANCE

Zn-Ms promoted osteogenesis and enhanced biological activity, as mineralized and osteoid new bone with multiple interconnected ossified trabeculae appeared in close contact with the membrane.

Novel potential scaffold for periodontal tissue engineering

OBJECTIVE

The objective of the study is characterization of novel calcium and zinc-loaded electrospun matrices to be used for periodontal regeneration.

MATERIALS AND METHODS

A polymethylmetacrylate-based membrane was calcium or zinc loaded. Matrices were characterized morphologically by atomic force and scanning electron microscopy and mechanically probed by a nanoindenter. Biomimetic calcium phosphate precipitation on polymeric tissues was assessed. Cell viability tests were performed using oral mucosa fibroblasts. Data were analyzed by Kruskal-Wallis and Mann-Whitney tests or by ANOVA and Student-Newman-Keuls multiple comparisons.

RESULTS

Zinc and calcium loading on matrices did not modify their morphology but increased nanomechanical properties and decreased nanoroughness. Precipitation of calcium and phosphate on the matrix surfaces was observed in zinc-loaded specimens. Matrices were found to be non-toxic to cells in all the assays. Calcium- and zinc-loaded scaffolds presented a very low cytotoxic effect.

CONCLUSIONS

Zinc-loaded membranes permit cell viability and promoted mineral precipitation in physiological conditions. Based on the tested nanomechanical properties and scaffold architecture, the proposed membranes may be suitable for cell proliferation.

CLINICAL RELEVANCE

The ability of zinc-loaded matrices to promote precipitation of calcium phosphate deposits, together with their observed non-toxicity and its surface chemistry allowing covalent binding of proteins, may offer new strategies for periodontal regeneration.

Synthesis and characterization of CaO-loaded electrospun matrices for bone tissue engineering

OBJECTIVES

This study aims to synthesize and characterize biodegradable polymer-based matrices loaded with CaO nanoparticles for osteomyelitis treatment and bone tissue engineering.

MATERIALS AND METHODS

Poly(ε-caprolactone) (PCL) and PCL/gelatin (1:1, w/w) solutions containing CaO nanoparticles were electrospun into fibrous matrices. Scanning (SEM) and transmission (TEM) electron microscopy, Fourier transformed infrared (FTIR), energy dispersive X-ray spectroscopy (EDS), contact angle (CA), tensile testing, and antibacterial activity (agar diffusion assay) against Staphylococcus aureus were performed. Osteoprecursor cell (MC3T3-E1) response (i.e., viability and alkaline phosphatase expression/ALP) and infiltration into the matrices were evaluated.

RESULTS

CaO nanoparticles were successfully incorporated into the fibers, with the median fiber diameter decreasing after CaO incorporation. The CA decreased with the addition of CaO, and the presence of gelatin made the matrix very hydrophilic (CA = 0°). Increasing CaO concentrations progressively reduced the mechanical properties (p ≤ 0.030). CaO-loaded matrices did not display consistent antibacterial activity. MC3T3-E1 cell viability demonstrated the highest levels for CaO-loaded matrices containing gelatin after 7 days in culture. An increased ALP expression was consistently seen for PCL/CaO matrices when compared to PCL and gelatin-containing counterparts.

CONCLUSIONS

Despite inconsistent antibacterial activity, CaO nanoparticles can be effectively loaded into PCL or PCL/gelatin fibers without negatively affecting the overall performance of the matrices. More importantly, CaO incorporation enhanced cell viability as well as differentiation capacity, as demonstrated by an increased ALP expression.

CLINICAL SIGNIFICANCE

CaO-loaded electrospun matrices show potential for applications in bone tissue engineering.

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.

Hierarchically structured metal oxide/silica nanofibers by colloid electrospinning

We present herein a new concept for the preparation of nanofibrous metal oxides based on the simultaneous electrospinning of metal oxide precursors and silica nanoparticles. Precursor fibers are prepared by electrospinning silica nanoparticles (20 nm in diameter) dispersed in an aqueous solution of poly(acrylic acid) and metal salts. Upon calcination in air, the poly(acrylic acid) matrix is removed, the silica nanoparticles are cemented, and nanocrystalline metal oxide particles of 4-14 nm are nucleated at the surface of the silica nanoparticles. The obtained continuous silica fibers act as a structural framework for metal oxide nanoparticles and show improved mechanical integrity compared to the neat metal oxide fibers. The hierarchically nanostructured materials are promising for catalysis applications, as demonstrated by the successful degradation of a model dye in the presence of the fibers.

Nanofiber-based delivery of bioactive agents and stem cells to bone sites

Biodegradable nanofibers are important scaffolding materials for bone regeneration. In this paper, the basic concepts and recent advances of self-assembly, electrospinning and thermally induced phase separation techniques that are widely used to generate nanofibrous scaffolds are reviewed. In addition, surface functionalization and bioactive factor delivery within these nanofibrous scaffolds to enhance bone regeneration are also discussed. Moreover, recent progresses in applying these nanofiber-based scaffolds to deliver stem cells for bone regeneration are presented. Along with the significant advances, challenges and obstacles in the field as well as the future perspective are discussed.

Osteoconductive and degradable electrospun nonwoven poly(epsilon-caprolactone)/CaO-SiO2 gel composite fabric

A nonwoven ceramic/polymer composite fabric composed of randomly mixed bioactive and fast degradable CaO-SiO(2) gel fibers and biodegradable poly(epsilon-caprolactone) (PCL) fibers is prepared with a simultaneous electrospinning method for potential use as bone grafting materials. A 17% PCL solution is prepared using 1,1,3,3-hexafluoro-2-propanol as the solvent, whereas the CaO-SiO(2) gel solution is prepared via a condensation reaction following the hydrolysis of tetraethyl orthosilicate. PCL and CaO-SiO(2) gel solutions are spun simultaneously with two separate nozzles. As controls, pure PCL and CaO-SiO(2) gel nonwoven fabrics are also made by the same methods. The three nonwoven fabrics were exposed to simulated body fluid for 1 week and resulted in the deposition of a layer of apatite crystals on the surfaces of both the CaO-SiO(2) gel and PCL/CaO-SiO(2) gel composite fabrics, but not on the PCL fabric. A tensile strength test showed that the fracture behavior of the CaO-SiO(2) gel fabric was brittle, that of the PCL fabric was ductile-tough, and that of the PCL/CaO-SiO(2) gel composite fabric was intermediate between that of the CaO-SiO(2) gel and PCL fabrics. Our in vivo tests showed that the CaO-SiO(2) gel and PCL/CaO-SiO(2) gel composite fabrics had good osteoconductivity and fast degradation rates in calvarial defects of New Zealand white rabbits within 4 weeks, in contrast to the pure PCL fabric. Together, these results suggest that the composite fabric composed of PCL and CaO-SiO(2) gel fibers must have a great potential for use in applications such as bone grafting because of its good osteoconductivity and adequate mechanical properties.

Effects of poly(lactic-co-glycolic acid) (PLGA) degradability on the apatite-forming capacity of electrospun PLGA/SiO(2)-CaO nonwoven composite fabrics

We investigated the effects of poly(lactic-co-glycolic acid) (PLGA) degradability on the apatite-forming ability of electrospun PLGA/SiO(2)-CaO gel composite fabric. Two PLGA copolymer compositions with low and high degradability were used in experiments. A nonwoven polymer/ceramic composite fabric composed of randomly mixed microsized biodegradable PLGA fibers and nanosized bioactive SiO(2)-CaO gel fibers was prepared using a simultaneous electrospinning method. A 17 wt.% PLGA solution was prepared using 1,1,3,3-hexafluoro-2-propanol as a solvent, while the SiO(2)-CaO gel solution was prepared via a condensation reaction following hydrolysis of tetraethyl orthosilicate under acidic conditions. PLGA and SiO(2)-CaO gel solutions were spun simultaneously with two separate nozzles under electric fields of 1 and 2 kV/cm using two syringe pumps with flow rates of 7.5 and 5 mL/h, respectively. As controls, low and high degradable PLGA and SiO(2)-CaO gel nonwoven fabrics were also made by the same methods. The five nonwoven fabrics that were produced were exposed to simulated body fluid (SBF) for 1 week. SBF exposure resulted in the deposition of a layer of apatite crystals on the surfaces of both the SiO(2)-CaO gel and the low degradable PLGA/SiO(2)-CaO gel composite fabrics, but not on the low and high degradable PLGA or the high degradable PLGA/SiO(2)-CaO gel composite fabrics. The results are explained in terms of the acidity of the PLGA degradation products, which could have a direct influence on apatite dissolution.

Calcium phosphate coated electrospun fiber matrices as scaffolds for bone tissue engineering

Electrospun polymeric scaffolds are used for various tissue engineering applications. In this study, we applied a biomimetic coating method to provide electrospun scaffolds from a block copolymer-poly(ethylene oxide terephthalate)-poly(buthylene terephthalate), with a calcium phosphate layer to improve their bioactivity in bone tissue engineering. The in vitro studies with human mesenchymal stem cells demonstrated cell proliferation on both uncoated and coated samples. No significant effect of calcium phosphate coating was observed on the expression of alkaline phosphatase in vitro. Implantation of scaffold-goat mesenchymal stem cells constructs subcutaneously in nude mice resulted in bone formation in the calcium phosphate coated samples, in contrast to the uncoated ones, where no new bone formation was observed. The results of this study showed that the biomimetic method can successfully be used to coat electrospun scaffolds with a calcium phosphate layer, which improved the in vivo bioactivity of the polymer.