Bioceramics for Clinical Application in Regenerative Dentistry

Fabrication of strontium ions substituted hydroxyapatite from the shells of the golden apple snail (Pomacea canaliculate L) with enhanced osteoconductive and improved biological properties

The use of biogenic calcium ions for the source of hydroxyapatite (HAp or HA) are very common and have been being explored extensively. However, it usually results high crystalline HA, due to high reaction and decomposition temperatures. In this study, strontium (Sr2+) doped HA from the golden apple snail shells (Pomacea canaliculate L) was successfully synthesized. It was indicated that Sr ions completely replaced calcium (Ca) ions, increased the lattice constant, and consecutively reduced HA crystallinity. Smaller crystal size and β-type carbonate (CO32-) ions substitution with Ca/P close to 1.67 molar ratio that mimic bone crystals were observed in Sr-doped HA, with significant increased rate of MC3T3-E1 cells viability and higher IC50 values. It was proven that Sr ions substitution resolved challenges on the use of biogenic sources for HA fabrication. Further in vivo study is needed to continue to valorise the results into real biomedical and clinical applications.

Biomaterial Scaffolds for Periodontal Tissue Engineering

Advanced periodontitis poses a significant threat to oral health, causing extensive damage and loss of both hard and soft periodontal tissues. While traditional therapies such as scaling and root planing can effectively halt the disease's progression, they often fail to fully restore the original architecture and function of periodontal tissues due to the limited capacity for spontaneous regeneration. To address this challenge, periodontal tissue engineering has emerged as a promising approach. This technology centers on the utilization of biomaterial scaffolds, which function as three-dimensional (3D) templates or frameworks, supporting and guiding the regeneration of periodontal tissues, including the periodontal ligament, cementum, alveolar bone, and gingival tissue. These scaffolds mimic the extracellular matrix (ECM) of native periodontal tissues, aiming to foster cell attachment, proliferation, differentiation, and, ultimately, the formation of new, functional periodontal structures. Despite the inherent challenges associated with preclinical testing, the intensification of research on biomaterial scaffolds, coupled with the continuous advancement of fabrication technology, leads us to anticipate a significant expansion in their application for periodontal tissue regeneration. This review comprehensively covers the recent advancements in biomaterial scaffolds engineered specifically for periodontal tissue regeneration, aiming to provide insights into the current state of the field and potential directions for future research.

3D printing technology and its combination with nanotechnology in bone tissue engineering

With the graying of the world's population, the morbidity of age-related chronic degenerative bone diseases, such as osteoporosis and osteoarthritis, is increasing yearly, leading to an increased risk of bone defects, while current treatment methods face many problems, such as shortage of grafts and an incomplete repair. Therefore, bone tissue engineering offers an alternative solution for regenerating and repairing bone tissues by constructing bioactive scaffolds with porous structures that provide mechanical support to damaged bone tissue while promoting angiogenesis and cell adhesion, proliferation, and activity. 3D printing technology has become the primary scaffold manufacturing method due to its ability to precisely control the internal pore structure and complex spatial shape of bone scaffolds. In contrast, the fast development of nanotechnology has provided more possibilities for the internal structure and biological function of scaffolds. This review focuses on the application of 3D printing technology in bone tissue engineering and nanotechnology in the field of bone tissue regeneration and repair, and explores the prospects for the integration of the two technologies.

Oxygen-Deficient Bioceramics: Combination of Diagnosis, Therapy, and Regeneration

The journey of ceramics in medicine has been synchronized with an evolution from the first generation-alumina, zirconia, etc.-to the third -3D scaffolds. There is an up-and-coming member called oxygen-deficient or colored bioceramics, which have recently found their way through biomedical applications. The oxygen vacancy steers the light absorption toward visible and near infrared regions, making the colored bioceramics multifunctional-therapeutic, diagnostic, and regenerative. Oxygen-deficient bioceramics are capable of turning light into heat and reactive oxygen species for photothermal and photodynamic therapies, respectively, and concomitantly yield infrared and photoacoustic images. Different types of oxygen-deficient bioceramics have been recently developed through various synthesis routes. Some of them like TiO2- x , MoO3- x , and WOx have been more investigated for biomedical applications, whereas the rest have yet to be scrutinized. The most prominent advantage of these bioceramics over the other biomaterials is their multifunctionality endowed with a change in the microstructure. There are some challenges ahead of this category discussed at the end of the present review. By shedding light on this recently born bioceramics subcategory, it is believed that the field will undergo a big step further as these platforms are naturally multifunctional.

Biomimetic Hydrogel Applications and Challenges in Bone, Cartilage, and Nerve Repair

Tissue engineering and regenerative medicine is a highly sought-after field for researchers aiming to compensate and repair defective tissues. However, the design and development of suitable scaffold materials with bioactivity for application in tissue repair and regeneration has been a great challenge. In recent years, biomimetic hydrogels have shown great possibilities for use in tissue engineering, where they can tune mechanical properties and biological properties through functional chemical modifications. Also, biomimetic hydrogels provide three-dimensional (3D) network spatial structures that can imitate normal tissue microenvironments and integrate cells, scaffolds, and bioactive substances for tissue repair and regeneration. Despite the growing interest in various hydrogels for biomedical use in previous decades, there are still many aspects of biomimetic hydrogels that need to be understood for biomedical and clinical trial applications. This review systematically describes the preparation of biomimetic hydrogels and their characteristics, and it details the use of biomimetic hydrogels in bone, cartilage, and nerve tissue repair. In addition, this review outlines the application of biomimetic hydrogels in bone, cartilage, and neural tissues regarding drug delivery. In particular, the advantages and shortcomings of biomimetic hydrogels in biomaterial tissue engineering are highlighted, and future research directions are proposed.

Hyperbaric oxygen therapy efficacy on mandibular defect regeneration in rats with diabetes mellitus: an animal study

BACKGROUND

This study aimed to investigate the influence of hyperbaric oxygen therapy on mandibular critical-sized defect regeneration in rats with experimentally induced type I diabetes mellitus. Restoration of large osseous defects in an impaired osteogenic condition such as diabetes mellitus is a challenging task in clinical practice. Therefore, investigating adjunctive therapies to accelerate the regeneration of such defects is crucial.

MATERIALS AND METHODS

Sixteen albino rats were divided into two groups (n = 8/group). To induce diabetes mellitus, a single streptozotocin dosage was injected. Critical-sized defects were created in the right posterior mandibles and filled with beta-tricalcium phosphate graft. The study group was subjected to 90-min sessions of hyperbaric oxygen at 2.4 ATA, for 5 consecutive days per week. Euthanasia was carried out after 3 weeks of therapy. Bone regeneration was examined histologically and histomorphometrically. Angiogenesis was assessed by immunohistochemistry against vascular endothelial progenitor cell marker (CD34) and the microvessel density was calculated.

RESULTS

Exposure of diabetic animals to hyperbaric oxygen resulted in superior bone regeneration and increased endothelial cell proliferation, which were revealed histologically and immunohistochemically, respectively. These results were confirmed by histomorphometric analysis which disclosed a higher percentage of new bone surface area and microvessel density in the study group.

CONCLUSIONS

Hyperbaric oxygen has a beneficial effect on bone regenerative capacity, qualitatively and quantitively, as well as the ability to stimulate angiogenesis.

Property and biological effects of the cuttlebone derived calcium phosphate particles, a potential bioactive bone substitute material

Cuttlebone (CB) is a marine waste-derived biomaterial and a rich source of calcium carbonate for the biosynthesis of the calcium phosphate (CaP) particles. The current study aimed to synthesize CB derived biphasic calcium phosphate (CB-BCP) and investigate biological activity of the CB-CaP: hydroxyapatite (CB-HA), beta-tricalcium phosphate (CB-b-TCP) and biphasic 60:40 (w/w) HA/b-TCP (CB-BCP) with the human dental pulp stem cells (hDPSCs). The particles were synthesized using solid state reactions under mild condition and properties of the particles were compared with a commercial BCP as a reference material. Morphology, particle size, physicochemical properties, mineral contents, and the ion released patterns of the particles were examined. Then the particle/cell interaction, cell cytotoxicity and osteogenic property of the particles were investigated in the direct and indirect cell culture models. It was found that an average particles size of the CB-HA was 304.73 ± 4.19 nm, CB-b-TCP, 503.17 ± 23.06 nm and CB-BCP, 1394.67 ± 168.19 nm. The physicochemical characteristics of the CB-CaP were consistent with the HA, b-TCP and BCP. The highest level of calcium (Ca) was found in the mineral contents and the preincubated medium of the CB-BCP and traces of fluoride, magnesium, strontium, and zinc were identified in the CB-CaP. The cell cytotoxicity and osteogenic property of the particles were dose dependent. The particles adhered on cell surface and were internalized into the cell cytoplasm. The CB-BCP and CB-HA indirectly and directly promote osteoblastic differentiations of the hDPSCs in stronger levels than other groups. The CB-BCP and CB-HA were potential bioactive bone substitute materials.

Induction of protein specific antibody by carbonated hydroxy apatite as a candidate for mucosal vaccine adjuvant

Buccal mucosae are considered as a site for vaccine delivery since they are relatively abundant with antigen-presenting dendritic cells, mainly Langerhans cells. In this study, we formulated carbonated hydroxy apatite (CHA) with ovalbumin (OVA) (denoted as CHA-OVA), incorporated it into bilayer buccal membrane to form hydrogel films containing CHA-OVA complex for vaccination via buccal mucosae. Ethylcellulose blend with polyethylene glycol 400 were used as impermeable backing layer. Physical properties of all tested buccal membranes were found suitable for mucosal application. In vitro and ex vivo release study showed there was no burst release of OVA found from all tested formula. From the in vivo examination, rabbit buccal mucosae vaccinated by mucoadhesive membranes containing CHA-OVA complex demonstrated mucosal specific antibody induction, represented the potential of CHA as a candidate of needle-free vaccine adjuvant. Future research is awaiting to investigate proper CHA crystallinity in complex with protein against targeted diseases.

Recent Advances of Pullulan and/or Dextran-Based Materials for Bone Tissue Engineering Strategies in Preclinical Studies: A Systematic Review

Bone tissue engineering (BTE) strategies are increasingly investigated to overcome the limitations of currently used bone substitutes and to improve the bone regeneration process. Among the natural polymers used for tissue engineering, dextran and pullulan appear as natural hydrophilic polysaccharides that became promising biomaterials for BTE. This systematic review aimed to present the different published applications of pullulan and dextran-based biomaterials for BTE. An electronic search in Pubmed, Scopus, and Web of Science databases was conducted. Selection of articles was performed following PRISMA guidelines. This systematic review led to the inclusion of 28 articles on the use of pullulan and/or dextran-based biomaterials to promote bone regeneration in preclinical models. Sixteen studies focused on dextran-based materials for bone regeneration, six on pullulan substitutes and six on the combination of pullulan and dextran. Several strategies have been developed to provide bone regeneration capacity, mainly through their fabrication processes (functionalization methods, cross-linking process), or the addition of bioactive elements. We have summarized here the strategies employed to use the polysaccharide scaffolds (fabrication process, composition, application usages, route of administration), and we highlighted their relevance and limitations for BTE applications.

Challenges and strategy in treatment with exosomes for cell-free-based tissue engineering in dentistry

In dentistry, problems of craniofacial, osteochondral, periodontal tissue, nerve, pulp or endodontics injuries, and osteoarthritis need regenerative therapy. The use of stem cells in dental tissue engineering pays a lot of increased attention, but there are challenges for its clinical applications. Therefore, cell-free-based tissue engineering using exosomes isolated from stem cells is regarded an alternative approach in regenerative dentistry. However, practical use of exosome is restricted by limited secretion capability of cells. For future regenerative treatment with exosomes, efficient strategies for large-scale clinical applications are being studied, including the use of ceramics-based scaffold to enhance exosome production and secretion which can resolve limited exosome secretory from the cells when compared with the existing methods available. Indeed, more research needs to be done on these strategies going forward.

Development of a hydroxyapatite nanoparticle-based gel for enamel remineralization -A physicochemical properties and cell viability assay analysis

Nano-hydroxyapatite (nHA) was synthesized from abalone mussel shells (Haliotis asinina) using a precipitation method, and gel HA-Abalone was developed using the carbomer materials with concentrations of 0, 10, 20, 30, and 40 wt%. The specimens used were 25 freshly extracted caries-free premolar teeth, and the treatment was done twice a day for 14 days. Gel HA-Abalone 20 wt%, with a crystallite size of 14.70±1.21 nm, was the best concentration to achieve the best remineralization (~863 VHN) of the superficial layer. Based on the results of cell viability assay on gel HA-Abalone 20 wt%, the growth of NIH/3T3 cells was inhibited beginning at a gel concentration of 1,000 µg/mL, and the half maximal inhibitory concentration (IC₅₀) value was 1,497 µg/mL. Based on to the one-way analysis of variance (ANOVA), the result reflected statistically significant differences in the average of the cell viability and enamel surface microhardness values (p<0.05).

Effectiveness of beta-tricalcium phosphate in comparison with other materials in treating periodontal infra-bony defects around natural teeth: a systematic review and meta-analysis

BACKGROUND

Beta-tricalcium phosphate in regenerative surgery has shown promising results in terms of bone gain and new vital bone formation; however, several studies have contradicted this finding. The aim of this study was to evaluate the effectiveness of beta-tricalcium phosphate compared to other grafting materials in the regeneration of periodontal infra-bony defects.

METHODS

Electronic database (Cochrane, MEDLINE, PubMed, Embase, Science Citation Index Expanded) and manual searches for related data were performed up until March 2020. The outcomes were pocket depth reduction, clinical attachment level gain, and amount of bone fill.

RESULTS

Five studies were selected based on the inclusion criteria. Bone regeneration with beta-tricalcium phosphate was observed to be superior to that with debridement alone but showed comparable results to other bone graft materials in terms of pocket depth reduction, clinical attachment level gain, and bone fill. Regenerative procedures for periodontal infra-bony defects that used beta-tricalcium phosphate in combination with other growth factors yielded superior outcomes. The meta-analysis revealed that for cases with two-wall defects, the use of beta-tricalcium phosphate yielded statistically significant differences in pocket depth reduction and clinical attachment level gain, but not in bone fill.

CONCLUSIONS

Beta-tricalcium phosphate appears to be a promising material for use in periodontal infra-bony defect regeneration around natural teeth. However, randomized clinical trials with larger sample sizes and more controlled study designs are needed to support these findings.

Possible Implications for Improved Osteogenesis? The Combination of Platelet-Rich Fibrin With Different Bone Substitute Materials

Bone substitute materials (BSM) are widely used in oral regeneration, but sufficient angiogenesis is crucial for osteogenesis. The combination of BSM with autologous thrombocyte concentrations such as platelet-rich fibrin (PRF) may represent a clinical approach to overcome this limitation. This study analyzes the early influence on osteoblast (HOB) in vitro. Here, four different BSM (allogeneic, alloplastic, and two of xenogeneic origin) were combined with PRF. After the incubation with osteoblasts for 24 h, cell viability, migration, and proliferation were assessed. Next, marker of proliferation, migration, and differentiation were evaluated on gene and protein levels in comparison to the native BSM and osteoblast alone. Addition of PRF increased viability for both the xenogeneic BSM (p = 0.0008, p = 0.032, respectively) in comparison to HOB and vs. native BSM (p = 0.008), and led to a tendency for increased cell proliferation and migration for all BSM (each p > 0.05). On gene basis, allogeneic and alloplastic BSM displayed a significantly increased RUNX2 expression (each p = 0.050). Expression of alkaline phosphatase for alloplastic (p = 0.050) and collagen-1 for xenogeneic BSM (p = 0.05) were significantly increased in combination with PRF. In addition, bone morphogenic protein was expressed significantly higher when xenogeneic material was combined with PRF in comparison to HOB alone (each p = 0.05). In summary, the combination of PRF with different BSM increases initial viability and may influence early proliferation and migration potential of osteoblast via RUNX2, alkaline phosphatase, collagen, and BMP2 especially in combination with alloplastic and xenogeneic BSM. Biofunctionalization of BSM using PRF might improve osteogenesis and extend the range of indications.

Bioceramic hydroxyapatite-based scaffold with a porous structure using honeycomb as a natural polymeric Porogen for bone tissue engineering

Background

The application of bioceramic hydroxyapatite (HA) derived from materials high in calcium to tissue engineering has been of concern, namely scaffold. Scaffold pores allow for cell mobility metabolic processes, and delivery of oxygen and nutrients by blood vessel. Thus, pore architecture affects cell seeding efficiency, cell viability, migration, morphology, cell proliferation, cell differentiation, angiogenesis, mechanical strength of scaffolds, and, eventually, bone formation. Therefore, to improve the efficacy of bone regeneration, several important parameters of the pore architecture of scaffolds must be carefully controlled, including pore size, geometry, orientation, uniformity, interconnectivity, and porosity, which are interrelated and whose coordination affects the effectiveness of bone tissue engineering. The honeycomb (HCB) as natural polymeric porogen is used to pore forming agent of scaffolds. It is unique for fully interconnected and oriented pores of uniform size and high mechanical strength in the direction of the pores. The aim of this study was therefore to evaluate the effect of HCB concentration on macropore structure of the scaffolds.

Methods

Bioceramic hydroxyapatite (HA) was synthesized from abalone mussel shells (Halioitis asinina) using a precipitation method, and HA-based scaffolds were fabricated with honeycomb (HCB) as the porogen agent. Pore structure engineering was successfully carried out using HCB at concentrations of 10, 20, and 30 wt%.

Results

The Energy Dispersive X-Ray Spectroscopy (EDS) analysis revealed that the Ca/P molar ratio of HA was 1.67 (the stoichiometric ratio of HA). The Fourier Transform Infrared Spectroscopy (FTIR) spectra results for porous HA-based scaffolds and synthesized HA showed that no chemical decomposition occurred in the HA-based scaffold fabrication process. The porosity of the scaffold tended to increase when higher concentrations of HCB were added. XRD data show that the HCB was completely degraded from the scaffold material. The cell metabolic activity and morphology of the HA + HCB 30 wt% scaffold enable it to facilitate the attachment of MC3T3E1 cells on its surface.

Conclusion

HCB 30 wt% is the best concentration to fabricate the scaffold corresponding to the criteria for pores structure, crystallographic properties, chemical decomposition process and cell viability for bone tissue engineering.

Biodegradable materials for bone defect repair

Compared with non-degradable materials, biodegradable biomaterials play an increasingly important role in the repairing of severe bone defects, and have attracted extensive attention from researchers. In the treatment of bone defects, scaffolds made of biodegradable materials can provide a crawling bridge for new bone tissue in the gap and a platform for cells and growth factors to play a physiological role, which will eventually be degraded and absorbed in the body and be replaced by the new bone tissue. Traditional biodegradable materials include polymers, ceramics and metals, which have been used in bone defect repairing for many years. Although these materials have more or fewer shortcomings, they are still the cornerstone of our development of a new generation of degradable materials. With the rapid development of modern science and technology, in the twenty-first century, more and more kinds of new biodegradable materials emerge in endlessly, such as new intelligent micro-nano materials and cell-based products. At the same time, there are many new fabrication technologies of improving biodegradable materials, such as modular fabrication, 3D and 4D printing, interface reinforcement and nanotechnology. This review will introduce various kinds of biodegradable materials commonly used in bone defect repairing, especially the newly emerging materials and their fabrication technology in recent years, and look forward to the future research direction, hoping to provide researchers in the field with some inspiration and reference.

An insight into cell-laden 3D-printed constructs for bone tissue engineering

In this review, we have spotlighted various combinations of bioinks to optimize the biofabrication of 3D bone constructs.

Effect of Irrigants on the Push-Out Bond Strength of Two Bioceramic Root Repair Materials

The purpose of this study was to compare different irrigants’ effect on two EndoSequence root repair materials’ push-out bond strength. Sixty root slices were filled either with EndoSequence premixed fast-set putty or regular-set paste, and then immersed either in sodium hypochlorite, chlorhexidine gluconate, or saline (as control) for 30 min, after which the slices were subjected to the push-out test. The surface structures were evaluated with Scanning Electron Microscopy and Fourier Transform Infrared. Fast-set putty exhibited greater displacement resistance when immersed in saline and subjected to adhesive failure mode, while regular-set paste showed greater resistance when immersed in chlorhexidine and subjected to cohesive failure mode. Infrared analysis showed changes in organic filler, and carbonate and phosphate bands after using irrigants. The lowest carbonate/phosphate ratio was found for chlorhexidine in both materials. Therefore, sodium hypochlorite reduced EndoSequence root repair materials’ displacement resistance markedly.