A comprehensive review on metallic implant biomaterials and their subtractive manufacturing

Unveiling the governing role of 'remodeling triangle area' in soft-hard tissue interface equilibrium for metal implants advancement

Metal implants holds significant promise for diverse fixed prostheses. However, their long-term reliability and broader application are hindered by challenges related to the disequilibrium at the soft-hard tissue interface. By using anti-inflammatory (PDA/IL4) and pro-inflammatory (PDA/LPS/IFNγ) coatings to modulate distinct immune characteristics, we discovered a dynamic bioactive structure at the soft-hard tissue interface around metal implant, which we have named the 'Remodeling Triangle Area' (RTA). We further demonstrate that the RTA can be influenced by the PDA/IL4 coating to favor a phenotype that enhances both innate and adaptive immunity. This leads to stronger epithelial adhesion, the formation of dense connective tissue via IGF1 secretion, and a more balanced soft-hard tissue interface through the OPG/RANKL axis. Conversely, the PDA/LPS/IFNγ coating shifts the RTA towards a phenotype that activates the innate immune response. This results in a less cohesive tissue structure and bone resorption, characterized by reduced IGF1 secretion and an imbalanced OPG/RANKL axis. Over all, our study introduces the novel concept termed the 'Remodeling Triangle Area' (RTA), an immune-rich anatomical region located at the nexus of the implant interface, epithelial, connective, and bone tissue, which becomes highly interactive post-implantation to modulate the soft-hard tissue interface equilibrium. We believe that an RTA-centric, immunomodulatory approach has the potential to revolutionize the design of next-generation metal implants, providing unparalleled soft-hard tissue interface equilibrium properties.

Robust, stretchable bioelectronic interfaces for cardiac pacing enabled by interfacial transfer of laser-induced graphene via water-response, nonswellable PVA gels

Implantable cardiac pacemakers are crucial therapeutic tools for managing various cardiac conditions. For effective pacing, electrodes should exhibit flexibility, deformability, biocompatibility, and high conductivity/capacitance. Laser-induced graphene (LIG) shows promise due to its exceptional electrical and electrochemical properties. However, the fragility of LIG and the non-stretchability of polyimide substrates pose challenges when interfacing with the beating heart. Here, we present a simple method for fabricating robust, flexible, and stretchable bioelectronic interfaces by transferring LIG via water-responsive, nonswellable polyvinyl alcohol (PVA) gels. PVA solution penetrates the porous structure of LIG and solidifies into PVA xerogel as the solvent evaporates. The robust PVA xerogel enables the smooth transfer of LIG and prevents stretching of the LIG network during this process, which helps maintain its conductivity. When hydrated, the xerogel becomes a stable, nonswellable hydrogel. This gives the LIG-PVA hydrogel (LIG-PVA-H) composites with excellent conductivity (119.7 ± 4.3Ω sq-1), high stretchability (up to 420%), reliability (cyclic stretch under 15% strain, with ∼ 1-time resistance increase), and good stability in phosphate buffered saline. The LIG-PVA-H composites were used as biointerfaces for electrocardiogram signal recording and electrical pacing on rat hearts ex vivo and in vivo, using commercial setups and a custom-built implantable wireless device. This work expands the application of LIG in bioelectronic interfaces and facilitates the development of electrotherapy for cardiac diseases.

Recent development and applications of electrodeposition biocoatings on medical titanium for bone repair

Bioactive coatings play a crucial role in enhancing the osseointegration of titanium implants for bone repair. Electrodeposition offers a versatile and efficient technique to deposit uniform coatings onto titanium surfaces, endowing implants with antibacterial properties, controlled drug release, enhanced osteoblast adhesion, and even smart responsiveness. This review summarizes the recent advancements in bioactive coatings for titanium implants used in bone repair, focusing on various electrodeposition strategies based on material-structure synergy. Firstly, it outlines different titanium implant materials and bioactive coating materials suitable for bone repair. Then, it introduces various electrodeposition methods, including electrophoretic deposition, anodization, micro-arc oxidation, electrochemical etching, electrochemical polymerization, and electrochemical deposition, discussing their applications in antibacterial, osteogenic, drug delivery, and smart responsiveness. Finally, it discusses the challenges encountered in the electrodeposition of coatings for titanium implants in bone repair and potential solutions.

Advancements in supervised deep learning for metal artifact reduction in computed tomography: A systematic review

BACKGROUND

Metallic artefacts caused by metal implants, are a common problem in computed tomography (CT) imaging, degrading image quality and diagnostic accuracy. With advancements in artificial intelligence, novel deep learning (DL)-based metal artefact reduction (MAR) algorithms are entering clinical practice.

OBJECTIVE

This systematic review provides an overview of the performance of the current supervised DL-based MAR algorithms for CT, focusing on three different domains: sinogram, image, and dual domain.

METHODS

A literature search was conducted in PubMed, EMBASE, Web of Science, and Scopus. Outcomes were assessed using peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM) or any other objective measure comparing MAR performance to uncorrected images.

RESULTS

After screening, fourteen studies were selected that compared DL-based MAR-algorithms with uncorrected images. MAR-algorithms were categorised into the three domains. Thirteen MAR-algorithms showed a higher PSNR and SSIM value compared to the uncorrected images and to non-DL MAR-algorithms. One study showed statistically significant better MAR performance on clinical data compared to the uncorrected images and non-DL MAR-algorithms based on Hounsfield unit calculations.

CONCLUSION

DL MAR-algorithms show promising results in reducing metal artefacts, but standardised methodologies are needed to evaluate DL-based MAR-algorithms on clinical data to improve comparability between algorithms.

CLINICAL RELEVANCE STATEMENT

Recent studies highlight the effectiveness of supervised Deep Learning-based MAR-algorithms in improving CT image quality by reducing metal artefacts in the sinogram, image and dual domain. A systematic review is needed to provide an overview of newly developed algorithms.

Additive manufacturing of ceria and yttria incorporated toughened monolithic zirconia dental ceramic crowns: In vitro simulated aging behavior

STATEMENT OF PROBLEM

The comprehensive characterization of additively manufactured zirconia-based dental prostheses can promote widespread clinical application. However, simulated in vitro analysis of the aging behavior is lacking.

PURPOSE

The purpose of this in vitro study was to assess the simulated in vitro durability of monolithic transformation toughened additively manufactured zirconia-based restorations with different compositions to predict the clinical reliability depending on their ceramic composition.

MATERIAL AND METHODS

Crowns were 3-dimensionally (3D) printed by using a combination of custom-made stereolithography and a laser polymerized digital light processing process with high solid content slurries with suitable photo-interactive polymers. The main characteristics tested for mechanical behavior (structural reliability and flexural strength) were overall toughness and fatigue limits. Combinations of chemical compositions including yttria and ceria additives and processing conditions including pressing and sintering temperatures were applied to transform custom stereolithography and digitally light activated polymerized green parts to high strength and toughened ceramic crowns. The fluctuations in strength and toughness of as-sintered parts before and after physical thermocycling, physiochemical hydrothermal aging, and mechanical mastication simulation were studied via statistical methods (ANOVA) to indicate variable dependencies (α=.05).

RESULTS

Near theoretical density as high as 99.1%, minimum surface porosity as low as 0.25%, medium translucency, and high contrasts were achieved. The high original hardness near 19 GPa, a toughness of 6 to 7 MPa.m1/2, and 1300 MPa flexural strength with 95% confidence interval in as-sintered specimens satisfied the requirements for crowns. The simultaneously yttria and ceria stabilized systems should be able to resist low-temperature degradation aging with decreases as small as 2% in flexural strength and near 25% in fatigue fracture limits. The structure and process dependency of the mechanical properties of flexural strength (P<.020), hardness (P<.030), and modulus of elasticity (P<.020) were statistically significant while the toughness showed significant dependency (P≤.001).

CONCLUSIONS

The 3D printed posterior crowns with enhanced mechanical properties and augmented simulated in vitro durability can be manufactured by adding tetragonal phase stabilizer oxides (ceria and yttria) to zirconia-based ingredients. The combination of both oxide stabilizers in the additive manufacturing of crowns is a significant approach to improving clinical performance, enhanced toughness, and fatigue limit before and after physicomechanical, mechanochemical, and thermocyclic aging analysis.

Finite element modeling of stress distribution and safety factors in a Ti-27Nb alloy hip implant under real-world physiological loading scenarios

Total hip arthroplasty (THA) is one of the most successful orthopaedic interventions globally, with over 450,000 procedures annually in the U.S. alone. However, issues like aseptic loosening, dislocation, infection and stress shielding persist, necessitating complex, costly revision surgeries. This highlights the need for continued biomaterials innovation to enhance primary implant integrity and longevity. Implant materials play a pivotal role in determining long-term outcomes, with titanium alloys being the prominent choice. However, emerging evidence indicates scope for optimized materials. The nickel-free β titanium alloy Ti-27Nb shows promise with excellent biocompatibility and mechanical properties. Using finite element analysis (FEA), this study investigated the biomechanical performance and safety factors of a hip bone implant made of nickel-free titanium alloy (Ti-27Nb) under actual loading during routine day life activities for different body weights. The FEA modelled physiological loads during walking, jogging, stair ascent/descent, knee bend, standing up, sitting down and cycling for 75 kg and 100 kg body weights. Comparative analyses were conducted between untreated versus 816-hour simulated body fluid (SBF) treated implant conditions to determine in vivo degradation effects. The FEA predicted elevated von Mises stresses in the implant neck for all activities, especially stair climbing, due to its smaller cross-section. Stresses increased substantially with a higher 100 kg body weight compared to 75 kg, implying risks for heavier patients. Safety factors were reduced by up to 58% between body weights, although remaining above the desired minimum value of 1. Negligible variations were observed between untreated and SBF-treated responses, attributed to Ti-27Nb's excellent biocorrosion resistance. This comprehensive FEA provided clinically relevant insights into the biomechanical behaviour and integrity of the Ti-27Nb hip implant under complex loading scenarios. The results can guide shape and material optimization to improve robustness against repetitive stresses over long-term use. Identifying damage accumulation and failure risks is crucial for hip implants encountering real-world variable conditions. The negligible SBF effects validate Ti-27Nb's resistance to physiological degradation. Overall, the study significantly advances understanding of Ti-27Nb's suitability for reliable, durable hip arthroplasties with low revision rates.

Therapeutic biomaterials with liver X receptor agonists based on the horizon of material biology to regulate atherosclerotic plaque regression in situ for devices surface engineering

Percutaneous coronary interventional is the main treatment for coronary atherosclerosis. At present, most studies focus on blood components and smooth muscle cells to achieve anticoagulation or anti-proliferation effects, while the mediated effects of materials on macrophages are also the focus of attention. Macrophage foam cells loaded with elevated cholesterol is a prominent feature of atherosclerotic plaque. Activation of liver X receptor (LXR) to regulate cholesterol efflux and efferocytosis and reduce the number of macrophage foam cells in plaque is feasible for the regression of atherosclerosis. However, cholesterol efflux promotion remains confined to targeted therapies. Herein, LXR agonists (GW3965) were introduced on the surface of the material and delivered in situ to atherogenic macrophages to improve drug utilization for anti-atherogenic therapy and plaque regression. LXR agonists act as plaque inhibition mediated by multichannel regulation macrophages, including lipid metabolism (ABCA1, ABCG1 and low-density lipoprotein receptor), macrophage migration (CCR7) and efferocytosis (MerTK). Material loaded with LXR agonists significantly reduced plaque burden in atherosclerotic model rats, most importantly, it did not cause hepatotoxicity and adverse reactions such as restenosis and thrombosis after material implantation. Both in vivo and in vitro evaluations confirmed its anti-atherosclerotic capability and safety. Overall, multi-functional LXR agonist-loaded materials with pathological microenvironment regulation effect are expected to be promising candidates for anti-atherosclerosis and have potential applications in cardiovascular devices surface engineering.

Pediatric Diaphyseal Forearm Fracture Management with Biodegradable Poly-L-Lactide-Co-Glycolide (PLGA) Intramedullary Implants: A Longitudinal Study

Background: Pediatric forearm fractures represent a substantial proportion of childhood injuries, requiring effective and minimally invasive treatments. Our study investigated the mid-term outcomes of biodegradable poly-L-lactide-co-glycolide (PLGA) intramedullary implants in managing diaphyseal forearm fractures in children. Methods: A follow-up cohort study was conducted with 38 patients treated with PLGA implants. Control examinations were performed one year post-operation, assessing bone healing through radiographic evaluations and functional outcomes using injured and uninjured limb range of motion (ROM) comparisons. Scarring was evaluated employing the Vancouver Scar Scale (VSS), and satisfaction via a questionnaire. Results: Children were predominantly female (76.4%), with a mean age of 9.71 (SD: 2.69) years. Effective fracture stabilization and bone healing were found in all patients, with a minor reduction (mean difference of -1.5°, p = 0.282) in elbow flexion on the operated side (139.3°) compared to the intact (140.8°). Elbow extension presented negligible average changes (0.2°, p = 0.098). Forearm movements were slightly reduced on the operated side (mean pronation: 80.8° vs. 83.7°, p = 0.166; average supination: 83.5° vs. 85.7°, p = 0.141). Wrist palmar flexion and dorsiflexion showed no significant differences. VSS ratings indicated minimal scarring (mean guardian and doctor scores were 1.13 and 0.55, respectively, p = 0.020), and all patients reported satisfaction with the treatment outcomes. Conclusions: Biodegradable implants are effective for pediatric forearm fractures, providing stable bone healing while preserving functional ROM with minimal scarring and high patient satisfaction. PLGA proved to be a viable alternative to traditional metal implants, eliminating secondary removal surgeries.

Exploring the potential of intermetallic alloys as implantable biomaterials: A comprehensive review

This review delves into the utilization of intermetallic alloys (IMAs) as advanced biomaterials for medical implants, scrutinizing their conceptual framework, fabrication challenges, and diverse manufacturing techniques such as casting, powder metallurgy, and additive manufacturing. Manufacturing techniques such as casting, powder metallurgy, additive manufacturing, and injection molding are discussed, with specific emphasis on achieving optimal grain sizes, surface roughness, and mechanical properties. Post-treatment methods aimed at refining surface quality, dimensional precision, and mechanical properties of IMAs are explored, including the use of heat treatments to enhance biocompatibility and corrosion resistance. The review presents an in-depth examination of IMAs-based implantable biomaterials, covering lab-scale developments and commercial-scale implants. Specific IMAs such as Nickel Titanium, Titanium Aluminides, Iron Aluminides, Magnesium-based IMAs, Zirconium-based IMAs, and High-entropy alloys (HEAs) are highlighted, with detailed discussions on their mechanical properties, including strength, elastic modulus, and corrosion resistance. Future directions are outlined, with an emphasis on the anticipated growth in the orthopedic devices market and the role of IMAs in meeting this demand. The potential of porous IMAs in orthopedics is explored, with emphasis on achieving optimal pore sizes and distributions for enhanced osseointegration. The review concludes by highlighting the ongoing need for research and development efforts in IMAs technologies, including advancements in design and fabrication techniques.

Biomedical Device Surface Treatment by Laser-Driven Hydroxyapatite Penetration-Synthesis Technique for Gapless PEEK-to-Bone Integration

Polyetheretherketone (PEEK), a bioinert polymer known for its mechanical properties similar to bone, is capable of averting stress shielding. Due to these attributes, it finds applications in diverse fields like orthopedics, encompassing cervical disc replacement for the neck and spine, along with dentistry and plastic surgery. However, due to insufficient bonding with bone, various methods such as hydroxyapatite (HA) coating on the surface are attempted. Nonetheless, the interface between the polymer and ceramic, two different materials, tended to delaminate after transplantation, posing challenges in preventing implant escape or dislodgement. This research delves into the laser-driven hydroxyapatite penetration-synthesis technique. Differing from conventional coating methods that bond layers of dissimilar materials like HA and PEEK, this technology focuses on synthesizing and infiltrating ionized HA within the PEEK substrate resulting in an interface-free HA-PEEK surface. Conversely, HA-PEEK with this technology applied achieves complete, gap-free direct bone-implant integration.  Our research involved the analysis of various aspects. By means of these, we quantitatively assesed the enhanced bone bonding characteristics of HA-PEEK surfaces treated with this approach and offered and explanation for the mechanism responsible for direct bone integration.

Challenges and Pitfalls of Research Designs Involving Magnesium-Based Biomaterials: An Overview

Magnesium-based biomaterials hold remarkable promise for various clinical applications, offering advantages such as reduced stress-shielding and enhanced bone strengthening and vascular remodeling compared to traditional materials. However, ensuring the quality of preclinical research is crucial for the development of these implants. To achieve implant success, an understanding of the cellular responses post-implantation, proper model selection, and good study design are crucial. There are several challenges to reaching a safe and effective translation of laboratory findings into clinical practice. The utilization of Mg-based biomedical devices eliminates the need for biomaterial removal surgery post-healing and mitigates adverse effects associated with permanent biomaterial implantation. However, the high corrosion rate of Mg-based implants poses challenges such as unexpected degradation, structural failure, hydrogen evolution, alkalization, and cytotoxicity. The biocompatibility and degradability of materials based on magnesium have been studied by many researchers in vitro; however, evaluations addressing the impact of the material in vivo still need to be improved. Several animal models, including rats, rabbits, dogs, and pigs, have been explored to assess the potential of magnesium-based materials. Moreover, strategies such as alloying and coating have been identified to enhance the degradation rate of magnesium-based materials in vivo to transform these challenges into opportunities. This review aims to explore the utilization of Mg implants across various biomedical applications within cellular (in vitro) and animal (in vivo) models.

Exploring the Interplay between Tribocorrosion and Surface Chemistry of the ASTM F139 Surgical Stainless Steel in Phosphate-Buffered Saline Solution

Surgical ASTM F139 stainless steel is used for temporary fixtures in the biomedical field. Tribocorrosion is a major concern in this application. The aim of the present work was to study the interplay between tribocorrosion behavior and the surface chemistry of the ASTM F139 stainless steel in phosphate-buffered saline solution (PBS). Sliding wear tests were conducted against alumina balls at different electrochemical potentials: open circuit potential (OCP), cathodic potential (-100 mV versus the OCP), and anodic potentials (+200 mVAg/AgCl and +700 mVAg/AgCl). The normal load was 20 N. The wear volume was estimated based on micrographs obtained from the wear tracks using confocal laser scanning microscopy. Moreover, the wear tracks were also examined by scanning electron microscopy (SEM). The surface chemistry of the ASTM F139 specimens was analyzed by X-ray photoelectron spectroscopy (XPS). The wear volume was dependent on the electrochemical potential, being maximized at +700 mVAg/AgCl. Delamination areas and grooves were observed in the wear tracks. Detailed assessment of the surface chemistry inside the wear tracks allowed identification of the main chemical species and their relative quantities, thus enabling correlation of the passive film composition with the observed tribocorrosion behavior.

Recent Advances in Two-Dimensional Nanomaterials for Healthcare Monitoring

The development of advanced technologies for the fabrication of functional nanomaterials, nanostructures, and devices has facilitated the development of biosensors for analyses. Two-dimensional (2D) nanomaterials, with unique hierarchical structures, a high surface area, and the ability to be functionalized for target detection at the surface, exhibit high potential for biosensing applications. The electronic properties, mechanical flexibility, and optical, electrochemical, and physical properties of 2D nanomaterials can be easily modulated, enabling the construction of biosensing platforms for the detection of various analytes with targeted recognition, sensitivity, and selectivity. This review provides an overview of the recent advances in 2D nanomaterials and nanostructures used for biosensor and wearable-sensor development for healthcare and health-monitoring applications. Finally, the advantages of 2D-nanomaterial-based devices and several challenges in their optimal operation have been discussed to facilitate the development of smart high-performance biosensors in the future.

Current update and trend of 3D printing in spinal surgery: A bibliometric analysis and review of literature

Incorporation of three-dimensional (3D) printing technology into the field of spinal surgery is on the rise. A bibliometric analysis of the current topic was carried out to elaborate the trend and to navigate future research. A Scopus database search was conducted with keywords related to 3D printing, spine, and surgery. The final 792 articles were extracted and further analyzed with VOSviewer 1.6.19 and Biblioshiny. The first published article was in 2002. A notable increase in articles in 2014 might be attributable to the availability of cheaper 3D printers which rose significantly on a global scale in 2011. China leads in terms of published research on 3D printing in spinal surgery, followed by the US, Australia, and India. The author's keyword co-occurrence analysis reveals 8 theme clusters, including preoperative and intraoperative measures, biomodelling, spinal neoplasms, biomechanics of 3D-printed materials, degenerative spinal diseases, minimally invasive surgery, and bioprinting. The top 15 of the most recently cited keywords are listed to provide future researchers to produce impactful articles. Two strategic diagrams of 2 periods (2002-2018 and 2018-2023) show the theme's evolution. We found 6 consistent themes in keyword co-occurrence analysis and the strategic diagram analysis, that are promising subjects for future research. Overall, this bibliographic study indicates the expanding importance of 3D printing in spinal surgery and suggests several critical themes and impactful keywords for future researchers.

Evaluation of Time-Dependent Corrosion Inhibition Rate for f-MWCNT-BCP Composite Coatings on 316L Stainless Steel in Simulated Body Fluid for Orthopedic Implantation

A well-developed-multiwall carbon nanotube (f-MWCNT)/biphasic calcium phosphate (BCP) composites were synthesized using ultrasonication method for orthopedic implantation applications. The formation of composites and its phase was confirmed by using X-ray diffraction. The presence of various functional groups was identified by using Fourier transform infra-red (FT-IR) spectroscopy. The presence of f-MWCNT was confirmed by Raman spectroscopy. High-resolution transmission electron microscopy (HR-TEM) analysis revealed that BCP units were bound by the surface of f-MWCNTs. The synthesized composites were coated on medical grade 316L stainless steel substrates using electro deposition technique. To determine its corrosion resistance characteristics, the developed substrates were exposed to a simulated bodily fluid (SBF) solution for 0, 4, and 7 days. These results strongly suggest that the coated composites can be utilized for bone tissue repair.

Surface (bio)-functionalization of metallic materials: How to cope with real interfaces?

Metallic materials are an important class of biomaterials used in various medical devices, owing to a suitable combination of their mechanical properties. The (bio)-functionalization of their surfaces is frequently performed for biocompatibility requirements, as it offers a powerful way to control their interaction with biological systems. This is particularly important when physicochemical processes and biological events, mainly involving proteins and cells, are initiated at the host-material interface. This review addresses the state of "real interfaces" in the context of (bio)-functionalization of metallic materials, and the necessity to cope with it to avoid frequent improper evaluation of the procedure used. This issue is, indeed, well-recognized but often neglected and emerges from three main issues: (i) ubiquity of surface contamination with organic compounds, (ii) reactivity of metallic surfaces in biological medium, and (iii) discrepancy in (bio)-functionalization procedures between expectations and reality. These disturb the assessment of the strategies adopted for surface modifications and limit the possibilities to provide guidelines for their improvements. For this purpose, X-ray photoelectrons spectroscopy (XPS) comes to the rescue. Based on significant progresses made in methodological developments, and through a large amount of data compiled to generate statistically meaningful information, and to insure selectivity, precision and accuracy, the state of "real interfaces" is explored in depth, while looking after the two main constituents: (i) the bio-organic adlayer, in which the discrimination between the compounds of interest (anchoring molecules, coupling agents, proteins, etc) and organic contaminants can be made, and (ii) the metallic surface, which undergoes dynamic processes due to their reactivity. Moreover, through one of the widespread (bio)-functionalization strategy, given as a case study, a particular attention is devoted to describe the state of the interface at different stages (composition, depth distribution of contaminants and (bio)compounds of interest) and the mode of protein retention. It is highlighted, in particular, that the occurrence or improvement of bioactivity does not demonstrate that the chemical schemes worked in reality. These aspects are particularly essential to make progress on the way to choose the suitable (bio)-functionalization strategy and to provide guidelines to improve its efficiency.

Near-infrared Ⅱ light-assisted Cu-containing porous TiO2 coating for combating implant-associated infection

Treatment implant-associated infections remains a severe challenge in the clinical practice. This work focuses on the fabrication of Cu-containing porous TiO2 coatings on titanium (Ti) by a combination of magnetron sputtering and dealloying techniques. Additionally, photothermal therapy is employed to enhance the effect of Cu ions in preventing bacterial infection. After the dealloying, most of Cu element was removed from the magnetron sputtered Cu-containing films, and porous TiO2 coatings were prepared on Ti. The formation of porous nanostructures significantly enhanced the photothermal conversion performance under NIR-II light irradiation. The combined effect of hyperthermia and Cu ions demonstrated enhanced antibacterial activity in both in vitro and in vivo experiments, and the antibacterial efficiency can reach 99% against Streptococcus mutans. Moreover, the porous TiO2 coatings also exhibited excellent biocompatibility. This modification of the titanium surface structure through dealloying changes may offer a novel approach to enhance the antimicrobial properties of titanium implants.

Design of Laser Activated Antimicrobial Porous Tricalcium Phosphate-Hydroxyapatite Scaffolds for Orthopedic Applications

The field of bone tissue engineering is steadily being improved by novel experimental approaches. Nevertheless, microbial adhesion after scaffold implantation remains a limitation that could lead to the impairment of the regeneration process, or scaffold rejection. The present study introduces a methodology that employs laser-based strategies for the development of antimicrobial interfaces on tricalcium phosphate-hydroxyapatite (TCP-HA) scaffolds. The outer surfaces of the ceramic scaffolds with inner porosity were structured using a femtosecond laser (λ = 800 nm; τ = 70 fs) for developing micropatterns and altering local surface roughness. The pulsed laser deposition of ZnO was used for the subsequent functionalization of both laser-structured and unmodified surfaces. The impact of the fs irradiation was investigated by Raman spectroscopy and X-ray diffraction. The effects of the ZnO-layered ceramic surfaces on initial bacterial adherence were assessed by culturing Staphylococcus aureus on both functionalized and non-functionalized scaffolds. Bacterial metabolic activity and morphology were monitored via the Resazurin assay and microscopic approaches. The presence of ZnO evidently decreased the metabolic activity of bacteria and led to impaired cell morphology. The results from this study have led to the conclusion that the combination of fs laser-structured surface topography and ZnO could yield a potential antimicrobial interface for implants in bone tissue engineering.

Tuning biodegradability, bone-bonding capacity, and wear resistance of zinc-30% magnesium intermetallic alloy for use in load-bearing bone applications

This work aimed to improve the rapid biodegradation, poor wear resistance properties, and lack of bioactivity of metallic biomaterials to be used in orthopedic applications. In this context, zinc-magnesium (Zn-Mg) alloy with successive contents of calcium silicate (CaSiO3) and silicon nitride (Si3N4) was prepared using powder metallurgy technique. After sintering, their phase composition and microstructure were investigated using the X-ray diffraction technique and scanning electron microscopy (SEM), respectively. Furthermore, their degradation behavior and ability to form hydroxyapatite (HA) layer on the sample surface after immersion in simulated body fluid (SBF) were monitored using weight loss measurements, inductively coupled plasma-atomic emission spectroscopy, and SEM. Moreover, their tribo-mechanical properties were measured. The results obtained showed that the successive contents of CaSiO3 were responsible for improving the bioactivity behavior as indicated by a good formation of the HA layer on the samples' surface. Additionally, ceramic materials were responsible for a continuous decrease in the released ions in the SBF solution as indicated by the ICP results. The tribology properties were significantly improved even after exposure to different loads. Based on the above results, the prepared nanocomposites are promising for use in orthopedic applications.

Development of bioactive and antimicrobial nano-topography over selective laser melted Ti6Al4V implant and its in-vitro corrosion behavior

Additive manufacturing (AM) or 3D printing of bone defect models is gaining much attention in the biomedical field as it could significantly facilitate the development of customized implants with a high degree of dimensional accuracy. Due to their satisfactory biocompatibility and minimal stress shielding effect, Ti6Al4V (Ti64) alloys are increasingly preferred in the development of such implants. However, their poor osseointegration abilities and lack of antibacterial properties often cause implant loosening and microbial infections, leading to implant failure. To address these drawbacks, we propose in this work a simple surface modification approach of customized Ti64 alloys (3D printed Ti6Al4V) that enables the formation of porous calcium titanate (CT) over their surface as well as the incorporation of silver nanoparticles (AgNPs) into the thus formed porous network. The successful CT formation with the incorporation of AgNPs throughout the 3D printed Ti64 surface and their influence in changing the morphological and mechanical behaviour were studied by Raman spectroscopy, SEM, AFM, Contact angle measurement, XPS, HR-TEM and nano-indentation. Antibacterial studies using Staphylococcus aureus and Escherichia coli, and in-vitro cell studies using MG-63 cell lines showed that surface modified samples resulting from the proposed method exhibit satisfactory antimicrobial property and are highly biocompatible. The obtained surface modified samples also showed a significant improvement in corrosion resistance as compared to unmodified 3D printed Ti64 alloys. The improvement in corrosion resistance was revealed by electrochemical impedance Spectroscopy (EIS). Obtained results emphasis that thus surface modified 3D printed Ti64 alloys are promising candidates for hard tissue implant applications.

Fibronectin Conformations after Electrodeposition onto 316L Stainless Steel Substrates Enhanced Early-Stage Osteoblasts' Adhesion but Affected Their Behavior

The implantation of metallic orthopedic prostheses is increasingly common due to an aging population and accidents. There is a real societal need to implement new metal implants that combine durability, good mechanical properties, excellent biocompatibility, as well as affordable costs. Since the functionalization of low-cost 316L stainless steel substrates through the successive electrodeposition of a polypyrrole film (PPy) and a calcium phosphate deposit doped with silicon was previously carried out by our labs, we have also developed a bio-functional coating by electrodepositing or oxidating of fibronectin (Fn) coating. Fn is an extracellular matrix glycoprotein involved in cell adhesion and differentiation. Impacts of either electrodeposition or oxidation on the structure and functionality of Fn were first studied. Thus, electrodeposition is the technique that permits the highest deposition of fibronectin, compared to adsorption or oxidation. Furthermore, electrodeposition seems to strongly modify Fn conformation by the formation of intermingled long fibers, resulting in changes to the accessibility of the molecular probes tested (antibodies directed against Fn whole molecule and Fn cell-binding domain). Then, the effects of either electrodeposited Fn or oxidized Fn were validated by the resulting pre-osteoblast behavior. Electrodeposition reduced pre-osteoblasts' ability to remodel Fn coating on supports because of a partial modification of Fn conformation, which reduced accessibility to the cell-binding domain. Electrodeposited Fn also diminished α5 integrin secretion and clustering along the plasma membrane. However, the N-terminal extremity of Fn was not modified by electrodeposition as demonstrated by Staphylococcus aureus attachment after 3 h of culture on a specific domain localized in this region. Moreover, the number of pre-osteoblasts remains stable after 3 h culture on either adsorbed, oxidized, or electrodeposited Fn deposits. In contrast, mitochondrial activity and cell proliferation were significantly higher on adsorbed Fn compared with electrodeposited Fn after 48 h culture. Hence, electro-deposited Fn seems more favorable to pre-osteoblast early-stage behavior than during a longer culture of 24 h and 48 h. The electrodeposition of matrix proteins could be improved to maintain their bio-activity and to develop this promising, fast technique to bio-functionalize metallic implants.

Evaluation of Gelatin/Hyaluronic Acid-Generated Bridging in a 3D-Printed Titanium Cage for Bone Regeneration

3D-printed titanium (Ti) cages present an attractive alternative for addressing issues related to osteoporosis-induced fractures, accidental fractures, and spinal fusion surgery due to disc herniation. These Ti-based bone implants possess superior strength compared to other metals, allowing for versatile applications in orthopedic scenarios. However, when used as standalone solutions, certain considerations may arise, such as interaction with soft tissues. Therefore, to overcome these issues, the combination with hydrogel has been considered. In this study, to impart Ti with regenerative abilities a 3D-printed Ti cage was loaded with gelatin and hyaluronic acid (G-H) to improve the cell attachment ability of the Ti-based bone implants. The void spaces within the mesh structure of the 3D Ti cage were filled with G-H, creating a network of micro-sized pores. The filled G-H acted as the bridge for the cells to migrate toward the large inner pores of the 3D Ti cage. Due to the microporous surface and slow release of gelatin and hyaluronic acid, the biocompatibility of the coated Ti cage was increased with an elevation in osteoconduction as depicted by the up-regulation of bone-related gene expressions. The in vivo implantation in the rabbit femur model showed enhanced bone regeneration due to the coated G-H on the Ti cage compared to the pristine hollow Ti cage. The G-H filled the large holes of the 3D Ti cage that acted as a bridge for the cells to travel inside the implant and aided in the fast regeneration of bone.

Revolutionizing biomedicine: advancements, applications, and prospects of nanocomposite macromolecular carbohydrate-based hydrogel biomaterials: a review

Nanocomposite hydrogel biomaterials represent an exciting Frontier in biomedicine, offering solutions to longstanding challenges. These hydrogels are derived from various biopolymers, including fibrin, silk fibroin, collagen, keratin, gelatin, chitosan, hyaluronic acid, alginate, carrageenan, and cellulose. While these biopolymers possess inherent biocompatibility and renewability, they often suffer from poor mechanical properties and rapid degradation. Researchers have integrated biopolymers such as cellulose, starch, and chitosan into hydrogel matrices to overcome these limitations, resulting in nanocomposite hydrogels. These innovative materials exhibit enhanced mechanical strength, improved biocompatibility, and the ability to finely tune drug release profiles. The marriage of nanotechnology and hydrogel chemistry empowers precise control over these materials' physical and chemical properties, making them ideal for tissue engineering, drug delivery, wound healing, and biosensing applications. Recent advancements in the design, fabrication, and characterization of biopolymer-based nanocomposite hydrogels have showcased their potential to transform biomedicine. Researchers are employing strategic approaches for integrating biopolymer nanoparticles, exploring how nanoparticle properties impact hydrogel performance, and utilizing various characterization techniques to evaluate structure and functionality. Moreover, the diverse biomedical applications of these nanocomposite hydrogels hold promise for improving patient outcomes and addressing unmet clinical needs.

Bisphosphonate-incorporated coatings for orthopedic implants functionalization

Bisphosphonates (BPs), the stable analogs of pyrophosphate, are well-known inhibitors of osteoclastogenesis to prevent osteoporotic bone loss and improve implant osseointegration in patients suffering from osteoporosis. Compared to systemic administration, BPs-incorporated coatings enable the direct delivery of BPs to the local area, which will precisely enhance osseointegration and bone repair without the systemic side effects. However, an elaborate and comprehensive review of BP coatings of implants is lacking. Herein, the cellular level (e.g., osteoclasts, osteocytes, osteoblasts, osteoclast precursors, and bone mesenchymal stem cells) and molecular biological regulatory mechanism of BPs in regulating bone homeostasis are overviewed systematically. Moreover, the currently available methods (e.g., chemical reaction, porous carriers, and organic material films) of BP coatings construction are outlined and summarized in detail. As one of the key directions, the latest advances of BP-coated implants to enhance bone repair and osseointegration in basic experiments and clinical trials are presented and critically evaluated. Finally, the challenges and prospects of BP coatings are also purposed, and it will open a new chapter in clinical translation for BP-coated implants.

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.

Machine Learning Paves the Way for High Entropy Compounds Exploration: Challenges, Progress, and Outlook

Machine learning (ML) has emerged as a powerful tool in the research field of high entropy compounds (HECs), which have gained worldwide attention due to their vast compositional space and abundant regulatability. However, the complex structure space of HEC poses challenges to traditional experimental and computational approaches, necessitating the adoption of machine learning. Microscopically, machine learning can model the Hamiltonian of the HEC system, enabling atomic-level property investigations, while macroscopically, it can analyze macroscopic material characteristics such as hardness, melting point, and ductility. Various machine learning algorithms, both traditional methods and deep neural networks, can be employed in HEC research. Comprehensive and accurate data collection, feature engineering, and model training and selection through cross-validation are crucial for establishing excellent ML models. ML also holds promise in analyzing phase structures and stability, constructing potentials in simulations, and facilitating the design of functional materials. Although some domains, such as magnetic and device materials, still require further exploration, machine learning's potential in HEC research is substantial. Consequently, machine learning has become an indispensable tool in understanding and exploiting the capabilities of HEC, serving as the foundation for the new paradigm of Artificial-intelligence-assisted material exploration.

Deploying a Novel Approach to Prepare Silver Nanoparticle Bellamya bengalensis Extract Conjugate Coating on Orthopedic Implant Biomaterial Discs to Prevent Potential Biofilm Formation

This study is based on the premise of investigating antibacterial activity through a novel conjugate of silver nanoparticles (AgNPs) and antimicrobial peptides (AMPs) in line with a green synthesis approach by developing antimicrobial-coated implants to prevent bacterial resistance. The AMPs were obtained from Bellamya Bengalensis (BB), a freshwater snail, to prepare the nanocomposite conjugate, e.g., AgNPs@BB extract, by making use of UV-Visible spectroscopy. The antimicrobial assessment of AgNPs@BB extract conjugate was performed using the Resazurin Microtiter Assay Method (REMA), followed by the use of three biocompatible implant materials (titanium alloys, Ti 6AL-4V stainless steel 316L, and polyethylene). Finally, the coating was analyzed under confocal microscopy. The results revealed a significant reduction of biofilm formation on the surfaces of implants coated with conjugate (AgNPs@BB extract) in comparison to uncoated implants. For the MTT assay, no significant changes were recorded for the cells grown on the AgNPs/AMP++ sample in high concentrations. Staphylococcus epidermidis, however, showed more prominent growth on all implants in comparison to Staphylococcus aureus. It is evident from the results that Staphylococcus epidermidis is more susceptible to AgNPs@BB extract, while the minimum inhibitory concentration (MIC) value of AgNPs@BB extract conjugates and biosynthesized AgNPs was also on the higher side. This study indicates that AgNPs@BB extract carries antibacterial activity, and concludes that an excessive concentration of AgNPs@BB extract may affect the improved biocompatibility. This study recommends using robust, retentive, and antimicrobial coatings of AgNPs@BB extract for implantable biocompatible materials in accordance with the novel strategy of biomaterial applications.

Advances and Prospects in Materials for Craniofacial Bone Reconstruction

The craniofacial region is composed of 23 bones, which provide crucial function in keeping the normal position of brain and eyeballs, aesthetics of the craniofacial complex, facial movements, and visual function. Given the complex geometry and architecture, craniofacial bone defects not only affect the normal craniofacial structure but also may result in severe craniofacial dysfunction. Therefore, the exploration of rapid, precise, and effective reconstruction of craniofacial bone defects is urgent. Recently, developments in advanced bone tissue engineering bring new hope for the ideal reconstruction of the craniofacial bone defects. This report, presenting a first-time comprehensive review of recent advances of biomaterials in craniofacial bone tissue engineering, overviews the modification of traditional biomaterials and development of advanced biomaterials applying to craniofacial reconstruction. Challenges and perspectives of biomaterial development in craniofacial fields are discussed in the end.

Recent developments in nanomaterials for upgrading treatment of orthopedics diseases

Nanotechnology has changed science in the last three decades. Recent applications of nanotechnology in the disciplines of medicine and biology have enhanced medical diagnostics, manufacturing, and drug delivery. The latest studies have demonstrated this modern technology's potential for developing novel methods of disease detection and treatment, particularly in orthopedics. According to recent developments in bone tissue engineering, implantable substances, diagnostics and treatment, and surface adhesives, nanomedicine has revolutionized orthopedics. Numerous nanomaterials with distinctive chemical, physical, and biological properties have been engineered to generate innovative medication delivery methods for the local, sustained, and targeted delivery of drugs with enhanced therapeutic efficacy and minimal or no toxicity, indicating a very promising strategy for effectively controlling illnesses. Extensive study has been carried out on the applications of nanotechnology, particularly in orthopedics. Nanotechnology can revolutionize orthopedics cure, diagnosis, and research. Drug delivery precision employing nanotechnology using gold and liposome nanoparticles has shown especially encouraging results. Moreover, the delivery of drugs and biologics for osteosarcoma is actively investigated. Different kind of biosensors and nanoparticles has been used in the diagnosis of bone disorders, for example, renal osteodystrophy, Paget's disease, and osteoporosis. The major hurdles to the commercialization of nanotechnology-based composite are eventually examined, thus helping in eliminating the limits in connection to some pre-existing biomaterials for orthopedics, important variables like implant life, quality, cure cost, and pain and relief from pain. The potential for nanotechnology in orthopedics is tremendous, and most of it looks to remain unexplored, but not without challenges. This review aims to highlight the up tp date developments in nanotechnology for boosting the treatment modalities for orthopedic ailments. Moreover, we also highlighted unmet requirements and present barriers to the practical adoption of biomimetic nanotechnology-based orthopedic treatments.

Solid implantable devices for sustained drug delivery

Implantable drug delivery systems (IDDS) are an attractive alternative to conventional drug administration routes. Oral and injectable drug administration are the most common routes for drug delivery providing peaks of drug concentrations in blood after administration followed by concentration decay after a few hours. Therefore, constant drug administration is required to keep drug levels within the therapeutic window of the drug. Moreover, oral drug delivery presents alternative challenges due to drug degradation within the gastrointestinal tract or first pass metabolism. IDDS can be used to provide sustained drug delivery for prolonged periods of time. The use of this type of systems is especially interesting for the treatment of chronic conditions where patient adherence to conventional treatments can be challenging. These systems are normally used for systemic drug delivery. However, IDDS can be used for localised administration to maximise the amount of drug delivered within the active site while reducing systemic exposure. This review will cover current applications of IDDS focusing on the materials used to prepare this type of systems and the main therapeutic areas of application.

Biological Activity and Thrombogenic Properties of Oxide Nanotubes on the Ti-13Nb-13Zr Biomedical Alloy

The success of implant treatment is dependent on the osseointegration of the implant. The main goal of this work was to improve the biofunctionality of the Ti-13Nb-13Zr implant alloy by the production of oxide nanotubes (ONTs) layers for better anchoring in the bone and use as an intelligent carrier in drug delivery systems. Anodization of the Ti-13Nb-13Zr alloy was carried out in 0.5% HF, 1 M (NH₄)₂SO₄ + 2% NH₄F, and 1 M ethylene glycol + 4 wt.% NH₄F electrolytes. Physicochemical characteristics of ONTs were performed by high-resolution electron microscopy (HREM), X-ray photoelectron spectroscopy (XPS), and scanning Kelvin probe (SKP). Water contact angle studies were conducted using the sitting airdrop method. In vitro biological properties and release kinetics of ibuprofen were investigated. The results of TEM and XPS studies confirmed the formation of the single-walled ONTs of three generations on the bi-phase (α + β) Ti-13Nb-13Zr alloy. The ONTs were composed of oxides of the alloying elements. The proposed surface modification method ensured good hemolytic properties, no cytotoxity for L-929 mouse cells, good adhesion, increased surface wettability, and improved athrombogenic properties of the Ti-13Nb-13Zr alloy. Nanotubular surfaces allowed ibuprofen to be released from the polymer matrix according to the Gallagher-Corrigan model.

Effect of Si Content on the Thermal Expansion of Ti15Mo(0-2 Si) Biomaterial Alloys during Different Heating Rates

Thermal expansion measurements were used to characterize phase transformations in metastable β-Ti alloys (Ti15MoxSi) without and with various Si additions (where x = 0, 0.5, 1.0, 1.5, and 2 in wt.%) during linear heating at two heating rates of 5 and 10 °C/min up to 850 °C. For this study, five alloys were developed and examined in terms of their presence phases, microstructures, and starting and final transformation temperatures. According to the results, all of the as-cast samples primarily include an equiaxed β-Ti phase. The influence of phase transformation on the material dimensions was discussed and compared with the variations in Si contents. The transformation was investigated using a dilatometric technique for the developed alloys during continuous heating and cooling. The dilatometric curve of heating revealed two distinct reflection points as the heating temperature increased. The starting transformation temperature (T_s) to obtain the ω-phase was reported at 359 °C without Si addition; whereas the final transformation temperature (T_f) of the dissolution of α-phase was obtained at 572 °C at a heating rate of 10 °C/min. At 2 wt.% Si, the first derivative curves reported T_s and T_f transforming temperatures of 314-565 °C (at a 5 °C/min heating rate) and 270-540 °C (at a 10 °C/min heating rate), respectively. The T_s and T_f transforming temperatures were significantly decreased with Si additions, which decreased the β-transus temperature. Moreover, the thermal expansion coefficient curves of the investigated alloys without and with 2 wt.% Si were studied. The transformation heating curves have an S-shaped pattern, according to the results.

Surface modification of biodegradable Mg alloy by adapting µEDM capabilities with cryogenically-treated tool electrodes

Biomaterials are engineered to develop an interaction with living cells for therapeutic and diagnostic purposes. The last decade reported a tremendously rising shift in the requirement for miniaturized biomedical implants exhibiting high precision and comprising various biomaterials such as non-biodegradable titanium (Ti) alloys and biodegradable magnesium (Mg) alloys. The excellent mechanical properties and lightweight characteristics of Mg AZ91D alloy make it an emerging material for biomedical applications. In this regard, micro-electric discharge machining (µEDM) is an excellent method that can be used to make micro-components with high dimensional accuracy. In the present research, attempts were made to improve the µEDM capabilities by using cryogenically-treated copper (CTCTE) and brass tool electrodes (CTBTE) amid machining of biodegradable Mg AZ91D alloy, followed by their comparison with a pair of untreated copper (UCTE) and brass tool electrodes (UBTE) in terms of minimum machining-time and dimensional-irregularity. To investigate the possible modification on the surfaces achieved with minimum machining-time and dimensional-irregularity, the morphology, chemistry, micro-hardness, corrosion resistance, topography, and wettability of these surfaces were further examined. The surface produced by CTCTE exhibited the minimum surface micro-cracks and craters, acceptable recast layer thickness (2.6 µm), 17.45% improved micro-hardness, satisfactory corrosion resistance, adequate surface roughness (Ra: 1.08 µm), and suitable hydrophobic behavior (contact angle: 119°), confirming improved biodegradation rate. Additionally, a comparative analysis among the tool electrodes revealed that cryogenically-treated tool electrodes outperformed the untreated ones. CTCTE-induced modification on the Mg AZ91D alloy surface suggests its suitability in biodegradable medical implant applications.

Effect of oxidation at an elevated temperature on the evolution of phases, microstructure, and properties of the oxide films formed on the surface of TiZr

This study examined the evolution of the microstructure, microhardness, corrosion resistance, and selective leaching properties of oxide films formed on the surface of a Ti-50Zr (%) alloy during heat treatment at 600 °C for various time intervals. According to our experimental results, the growth and evolution of oxide films can be divided into three stages. In stage I (heat treatment for less than 2 min), ZrO₂ was first formed on the surface of the TiZr alloy, which slightly improved its corrosion resistance. In stage II (heat treatment for 2-10 min), the initially generated ZrO₂ is gradually transformed into ZrTiO₄ from the top to the bottom of the surface layer. The formation of ZrTiO₄ significantly improves the microhardness and corrosion resistance of the alloy. In stage III (heat treatment for more than 10 min), microcracks appeared and propagated on the surface of the ZrTiO₄ film, deteriorating the surface properties of the alloy. The ZrTiO₄ began to peel off after heat treatment for more than 60 min. The untreated and heat-treated TiZr alloys exhibited excellent selective leaching properties in Ringer's solution, whereas a trace amount of suspended ZrTiO₄ oxide particles formed in the solution after soaking the 60 min heat-treated TiZr alloy for 120 days. Surface modification of the TiZr alloy by generating an intact ZrTiO₄ oxide film effectively improved its microhardness and corrosion resistance; however, oxidation should be performed appropriately to obtain materials with optimal properties for biomedical applications.

Influence of Spin Coating and Dip Coating with Gelatin/Hydroxyapatite for Bioresorbable Mg Alloy Orthopedic Implants: In Vitro and In Vivo Studies

Suitable biomechanical properties, good biocompatibility, and osteoconductivity of a degradable magnesium (Mg) alloy make it a potential material for orthopedic implants. The main limitation of Mg is its high corrosion rate in the human body. Surface modification is necessary to improve the Mg corrosion resistance. In this work, a polymeric layer of gelatin/nanohydroxyapatite (Gel/nHA) was coated on a ZK60 Mg alloy by dip coating and spin coating to test the corrosion resistance and biocompatibility in vitro and in vivo. The results from the in vitro test revealed that the coated groups reduced the corrosion rate with the corrosion current density by 59 and 81%, from 31.22 to 12.83 μA/cm² and 5.83 μA/cm² in the spin coating and dip coating groups, respectively. The dip coating group showed better corrosion resistance than the spin coating group with the lowest released hydrogen content (17.5 mL) and lowest pH value (8.23) and reducing the current density by 45%. In vitro, the relative growth rate was over 75% in all groups tested with MG63, demonstrating that the Mg substrate and coating materials were within the safety range. The dip coating and spin coating groups enhanced the cell proliferation with significantly higher OD values (3.3, 3.0, and 2.5, respectively) and had better antihemolysis and antiplatelet adhesion abilities than the uncoated group. The two coating methods showed no difference in the cellular response, cell migration, hemolysis, and platelet adhesion test. In in vivo tests in rats, the dip coating group also showed a higher corrosion resistance with a lower corrosion rate and mass loss than the spin coating group. In addition, the blood biochemistry and histopathology results indicated that all materials used in this study were biocompatible with living subjects. The present research confirmed that the two methods have no noticeable difference in cell and organ response but the corrosion resistance of dip coating was higher than that of spin coating either in vitro or in vivo.

Characterization of PLA/PCL/Nano-Hydroxyapatite (nHA) Biocomposites Prepared via Cold Isostatic Pressing

Hydroxyapatite has the closest chemical composition to human bone. Despite this, the use of nano-hydroxyapatite (nHA) to produce biocomposite scaffolds from a mixture of polylactic acid (PLA) and polycaprolactone (PCL) using cold isostatic pressing has not been studied intensively. In this study, biocomposites were created employing nHA as an osteoconductive filler and a polymeric blend of PLA and PCL as a polymer matrix for prospective usage in the medical field. Cold isostatic pressing and subsequent sintering were used to create composites with different nHA concentrations that ranged from 0 to 30 weight percent. Using physical and mechanical characterization techniques such as Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), and density, porosity, tensile, and flexural standard tests, it was determined how the nHA concentrations affected the biocomposite's general properties. In this study, the presence of PLA, PCL, and nHA was well identified using FTIR, XRD, and SEM methods. The biocomposites with high nHA content showed intense bands for symmetric stretching and the asymmetric bending vibration of PO₄^3-. The incorporation of nHA into the polymeric blend matrix resulted in a rather irregular structure and the crystallization became more difficult. The addition of nHA improved the density and tensile and flexural strength of the PLA/PCL matrix (0% nHA). However, with increasing nHA content, the PLA/PCL/nHA biocomposites became more porous. In addition, the density, flexural strength, and tensile strength of the PLA/PCL/nHA biocomposites decreased with increasing nHA concentration. The PLA/PCL/nHA biocomposites with 10% nHA had the highest mechanical properties with a density of 1.39 g/cm³, a porosity of 1.93%, a flexural strength of 55.35 MPa, and a tensile strength of 30.68 MPa.

Poly (Ether-Ether-Ketone) for Biomedical Applications: From Enhancing Bioactivity to Reinforced-Bioactive Composites-An Overview

The global orthopedic market is forecasted to reach US$79.5 billion by the end of this decade. Factors driving the increase in this market are population aging, sports injury, road traffic accidents, and overweight, which justify a growing demand for orthopedic implants. Therefore, it is of utmost importance to develop bone implants with superior mechanical and biological properties to face the demand and improve patients' quality of life. Today, metallic implants still hold a dominant position in the global orthopedic implant market, mainly due to their superior mechanical resistance. However, their performance might be jeopardized due to the possible release of metallic debris, leading to cytotoxic effects and inflammatory responses in the body. Poly (ether-ether-ketone) (PEEK) is a biocompatible, high-performance polymer and one of the most prominent candidates to be used in manufacturing bone implants due to its similarity to the mechanical properties of bone. Unfortunately, the bioinert nature of PEEK culminates in its diminished osseointegration. Notwithstanding, PEEK's bioactivity can be improved through surface modification techniques and by the development of bioactive composites. This paper overviews the advantages of using PEEK for manufacturing implants and addresses the most common strategies to improve the bioactivity of PEEK in order to promote enhanced biomechanical performance.

Recent Advancements in Metallic Drug-Eluting Implants

Over the past decade, metallic drug-eluting implants have gained significance in orthopedic and dental applications for controlled drug release, specifically for preventing infection associated with implants. Recent studies showed that metallic implants loaded with drugs were substituted for conventional bare metal implants to achieve sustained and controlled drug release, resulting in a desired local therapeutic concentration. A number of secondary features can be provided by the incorporated active molecules, including the promotion of osteoconduction and angiogenesis, the inhibition of bacterial invasion, and the modulation of host body reaction. This paper reviews recent trends in the development of the metallic drug-eluting implants with various drug delivery systems in the past three years. There are various types of drug-eluting implants that have been developed to meet this purpose, depending on the drug or agents that have been loaded on them. These include anti-inflammatory drugs, antibiotics agents, growth factors, and anti-resorptive drugs.

Metals Biotribology and Oral Microbiota Biocorrosion Mechanisms

During the last decades, metal-based biomaterials have been extensively explored to be used as biocompatible metals for biomedical applications, owing to their superior mechanical properties and corrosion resistance. Consequently, for long-term implanted medical devices, to assure the biomaterials' reliability, functionality, and biocompatibility, studying the various bio-tribological damage mechanisms to obtain the optimum properties is one of the most important goals. In this review, we consider the most important metal-based biomaterials such as stainless steel, alloys of titanium (Ti), cobalt-chromium (Co-Cr), and Nichel-Titatium (Ni-Ti), as well Magnesium (Mg) alloys and with Tantalum (Ta), emphasizing their characteristics, clinical applications, and deterioration over time. The influence of metal elements on biological safety, including significant effects of metal-based biomaterials in dentistry were discussed, considering the perspectives of surface, mechanical properties, corrosion behaviors, including interactions, bio-mechanisms with tissues, and oral environments. In addition, the role of the oral microbiota was explored due to its role in this erosion condition, in order to further understand the mechanism of metal-based biomaterials implanted on the microflora balance of aerobic and anaerobic bacteria in an oral environment.

Enhanced abrasive-mixed-µ-EDM performance towards improved surface characteristics of biodegradable Mg AZ31B alloy

The non-degradable metallic implants, such as bone screws, often act as the source of dysfunction and harmful corrosion products in the aqueous environment inside the human body. Many of these implants are fixed either temporarily or permanently into the human body, and therefore, both need to match tight tolerances with a remarkably finished surface to eradicate burrs or striations. In this regard, the new generation of degradable magnesium (Mg) alloy implants with excellent osseointegration and low elasticity (like that of human bone), minimizing stress shielding, have been identified as potential candidates to challenge surgical procedures reintervention. However, the biological response of an implant toward the cells in vivo can be predominantly regulated by modifying the surface chemistry, morphology, and corrosion characteristics. Powder or abrasive-mixed-micro-electric discharge machining (A-M-µ-EDM) is gaining attention for executing precision machining and achieving a simultaneous surface modification on micro-manufactured surfaces, suitable for clinical applications. Therefore, the present research aimed at improving the surface characteristics of Mg AZ31B alloy via an augmented performance of A-M-µ-EDM by adopting copper and brass-micro-electrodes (C-µ-E and B-µ-E) in association with distinct abrasive particle concentrations (APCs: 0, 1.5, 3, 4.5, and 6 g/l) of bioactive zinc abrasives. To enhance the A-M-µ-EDM capabilities, the experiments were designed with a one-variable-at-a-time (OVAT) strategy, and the trial runs were conducted using different combinations of µ-electrodes and APCs. The superior performance of A-M-µ-EDM was noticed with the fusion of C-µ-E and 3 g/l APC in terms of minimum machining time (MT) and dimensional deviation (DD). The additional outcomes of this work reported favorable improvements in surface morphology, chemistry, topography, wettability, microhardness, and corrosion resistance on the A-M-µ-EDMed sample of interest.

Analysis of disordered abrasive scratches on titanium surfaces and their impact on nuclear translocation of yes-associated protein

The morphology of the metallic surface of an implant is important for its contact with bone tissue as it directly affects osteoblast functions, such as cell adhesion, proliferation, and differentiation. Firm contact between the implant and cells creates a barrier that prevents inflammation and bacterial infections. Therefore, optimizing surface morphology, such as surface roughness adjustments, is essential to improving the adhesion between the implant and cells for successful tissue regeneration. However, the manner in which the cells sense the surface roughness and morphology remains unclear. Previously, we analyzed cell adhesion behavior and observed that inhibited cell spreading can delay osteoblast functions. Therefore, assuming that the surface morphology can be sensed through cell spreading, we investigated the cell spreading area and yes-associated protein (YAP) localization in mouse osteoblasts (MC3T3-E1) on a titanium surface with disordered abrasive scratches. Surface roughness of 100-150 nm was obtained by polishing, which inhibited the cell spreading, indicating that YAP localization in the nucleus was lower than that on other surfaces. The obtained results indicate that the cells sense the surface environment based on their spreading area, which regulates cellular functions via the Hippo pathway.

Characterization of PLA/PCL/Green Mussel Shells Hydroxyapatite (HA) Biocomposites Prepared by Chemical Blending Methods

Recently, there has been an increase in the number of studies conducted on the process of developing hydroxyapatite (HA) to use in biocomposites. HA can be derived from natural sources such as bovine bone. The HA usage obtained from green mussel shells in biocomposites in this study will be explored. The research goal is to investigate the composition effect of biomaterials derived from polycaprolactone (PCL), polylactic acid (PLA), as well as HA obtained from green mussel shells with a chemical blending method on mechanical properties and degradation rate. First, 80 mL of chloroform solution was utilized to immerse 16 g of the PLA/PCL mixture with the ratios of 85:15 and 60:40 for 30 min. A magnetic stirrer was used to mix the solution for an additional 30 min at a temperature and speed of 50 °C and 300 rpm. Next, the hydroxyapatite (HA) was added in percentages of 5%, 10%, and 15%, as well as 20% of the PLA/PCL mixture's total weight. It was then stirred for 1 h at 100 rpm at 65 °C to produce a homogeneous mixture of HA and polymer. The biocomposite mixture was then added into a glass mold as per ASTM D790. Following this, biocomposite specimens were tested for their density, biodegradability, and three points of bending in determining the effect of HA and polymer composition on the degradation rate and mechanical properties. According to the findings of this study, increasing the HA and PLA composition yields a rise in the mechanical properties of the biocomposites. However, the biocomposite degradation rate is increasing.

Immune Profiling and Multiplexed Label-Free Detection of 2D MXenes by Mass Cytometry and High-Dimensional Imaging

There is a critical unmet need to detect and image 2D materials within single cells and tissues while surveying a high degree of information from single cells. Here, a versatile multiplexed label-free single-cell detection strategy is proposed based on single-cell mass cytometry by time-of-flight (CyTOF) and ion-beam imaging by time-of-flight (MIBI-TOF). This strategy, "Label-free sINgle-cell tracKing of 2D matErials by mass cytometry and MIBI-TOF Design" (LINKED), enables nanomaterial detection and simultaneous measurement of multiple cell and tissue features. As a proof of concept, a set of 2D materials, transition metal carbides, nitrides, and carbonitrides (MXenes), is selected to ensure mass detection within the cytometry range while avoiding overlap with more than 70 currently available tags, each able to survey multiple biological parameters. First, their detection and quantification in 15 primary human immune cell subpopulations are demonstrated. Together with the detection, mass cytometry is used to capture several biological aspects of MXenes, such as their biocompatibility and cytokine production after their uptake. Through enzymatic labeling, MXenes' mediation of cell-cell interactions is simultaneously evaluated. In vivo biodistribution experiments using a mixture of MXenes in mice confirm the versatility of the detection strategy and reveal MXene accumulation in the liver, blood, spleen, lungs, and relative immune cell subtypes. Finally, MIBI-TOF is applied to detect MXenes in different organs revealing their spatial distribution. The label-free detection of 2D materials by mass cytometry at the single-cell level, on multiple cell subpopulations and in multiple organs simultaneously, will enable exciting new opportunities in biomedicine.

Microstructure and Electrochemical Characterization of Ti-Sn Binary Alloys for Dental Applications

This work investigated the microstructure and corrosion behaviors of Ti-Sn alloys with x wt% Sn (x = 5, 10, 15, and 20) for dental applications. The microstructures of commercially pure titanium (cp-Ti) and Ti-Sn alloys were characterized by X-ray diffractometry, optical microscopy, and transmission electron microscopy. The Vickers hardness of the Ti-Sn alloys was compared to that of cp-Ti. The corrosion behaviors of Ti-Sn alloys were tested in 0.9% NaCl solution at 37 °C using open circuit potential, potentiodynamic polarization, AC impedance, and galvanic corrosion tests. Ti-Sn alloys had a hexagonal close-packed structure and their microstructures were transformed from the equiaxed structure with irregular grain boundaries to the martensitic structure as the content of Sn in Ti-Sn alloys increased by over 15 wt%. Among the sample groups, Ti-15Sn and Ti-20Sn alloys exhibited better Vickers hardness values. Ti-Sn alloys had better corrosion resistance than cp-Ti. Ti-15Sn, which showed narrow martensitic bands, exhibited the highest corrosion resistance properties in AC impedance measurements due to its higher resistance and better capacitive parameters. Among the tested groups, the galvanic coupling of Ti-15Sn with cp-Ti showed higher corrosion potentials and lower current densities, which indicates that there was higher corrosion resistance.

Bio-high entropy alloys: Progress, challenges, and opportunities

With the continuous progress and development in biomedicine, metallic biomedical materials have attracted significant attention from researchers. Due to the low compatibility of traditional metal implant materials with the human body, it is urgent to develop new biomaterials with excellent mechanical properties and appropriate biocompatibility to solve the adverse reactions caused by long-term implantation. High entropy alloys (HEAs) are nearly equimolar alloys of five or more elements, with huge compositional design space and excellent mechanical properties. In contrast, biological high-entropy alloys (Bio-HEAs) are expected to be a new bio-alloy for biomedicine due to their excellent biocompatibility and tunable mechanical properties. This review summarizes the composition system of Bio-HEAs in recent years, introduces their biocompatibility and mechanical properties of human bone adaptation, and finally puts forward the following suggestions for the development direction of Bio-HEAs: to improve the theory and simulation studies of Bio-HEAs composition design, to quantify the influence of composition, process, post-treatment on the performance of Bio-HEAs, to focus on the loss of Bio-HEAs under actual service conditions, and it is hoped that the clinical application of the new medical alloy Bio-HEAs can be realized as soon as possible.

3D printing in Ophthalmology: From medical implants to personalised medicine

3D printing was invented thirty years ago. However, its application in healthcare became prominent only in recent years to provide solutions for drug delivery and clinical challenges, and is constantly evolving. This cost-efficient technique utilises biocompatible materials and is used to develop model implants to provide a greater understanding of human anatomy and diseases, and can be used for organ transplants, surgical planning and for the manufacturing of advanced drug delivery systems. In addition, 3D printed medical devices and implants can be customised for each patient to provide a more tailored treatment approach. The advantages and applications of 3D printing can be used to treat patients with different eye conditions, with advances in 3D bioprinting offering novel therapy applications in ophthalmology. The purpose of this review paper is to provide an in-depth understanding of the applications and advantages of 3D printing in treating different ocular conditions in the cornea, glaucoma, retina, lids and orbits.

Influence of Magnesium Content on the Physico-Chemical Properties of Hydroxyapatite Electrochemically Deposited on a Nanostructured Titanium Surface

The aim of this research was to obtain hydroxyapatite (HAp)-based coatings doped with different concentrations of Mg on a Ti nanostructured surface through electrochemical techniques and to evaluate the influence of Mg content on the properties of HAp. The undoped and doped HAp-based coatings were electrochemically deposited in galvanostatic pulsed mode on titania nanotubes with a diameter of ~72 nm, being designed to enhance the adhesion of the HAp coatings to the Ti substrate. The obtained materials were investigated by Scanning Electron Microscopy (SEM), Energy Dispersive Spectroscopy (EDS), X-Ray Diffraction (XRD), and Fourier-Transform Infra-Red spectroscopy (FTIR). The adhesion of the coatings to the substrate was also evaluated with the help of the “tape-test” and the micro-scratch test. The morphology (SEM) of all the coatings is made of very thin and narrow ribbon-like crystals, with some alterations with respect to the Mg amount in the coatings. Thus, a concentration of 1 mM of Mg in the electrolyte leads to wider and thicker ribbon-like crystals, while a concentration of 1.5 mM in the electrolyte generated a morphology that resembles the undoped HAp. Both phase composition (XRD) and chemical bonds (FTIR) analysis proved the formation of HAp in all coatings. Moreover, according to XRD, all coatings have a strong orientation toward the (002) plane. Irrespective of the Mg content, all coatings registered an average roughness between approx. 500 and 600 nm, while the coating thickness increased after addition of Mg, from a value of 9.6 μm, for the undoped HAp, to 11.3 μm and ~13.7 μm for H/Mg1 and H/Mg2, respectively. In terms of adhesion, it was shown that the coatings a H/Mg2 had a poorer adhesion when compared to H/Mg1 and the undoped HAp (H), which registered similar adhesion, indicating that a concentration of 1.5 mM of Mg in the electrolyte reduces the adhesion of the Hap-based coatings to the nanostructured surface. The obtained results indicated that Mg concentrations up to 1 mM in the electrolyte can enhance the properties of HAp-based coatings electrochemically deposited on a nanostructured surface, while even a slightly higher concentration of 1.5 mM can negatively impact the characteristics of HAp coatings.

Decellularized Wharton Jelly Implants Do Not Trigger Collagen and Cartilaginous Tissue Production in Tracheal Injury in Rabbits

BACKGROUND

Tracheal lesions are pathologies derived from the most diverse insults that can result in a fatal outcome. Despite the number of techniques designed for the treatment, a limiting factor is the extent of the extraction. Therefore, strategies with biomaterials can restructure tissues and maintain the organ's functionality, like decellularized Wharton's jelly (WJ) as a scaffold. The aim is to analyze the capacity of tracheal tissue regeneration after the implantation of decellularized WJ in rabbits submitted to a tracheal defect.

METHODS

An in vivo experimental study was undertaken using twenty rabbits separated into two groups (n = 10). Group 1 submitted to a tracheal defect, group 2 tracheal defect, and implantation of decellularized WJ. The analyses were performed 30 days after surgery through immunohistochemistry.

RESULTS

Inner tracheal area diameter (p = 0.643) didn't show significance. Collagen type I, III, and Aggrecan highlighted no significant difference between the groups (both collagens with p = 0.445 and the Aggrecan p = 0.4).

CONCLUSION

The scaffold appears to fit as a heterologous implant and did not trigger reactions such as rejection or extrusion of the material into the recipient. However, these results suggested that although the WJ matrix presents several characteristics as a biomaterial for tissue regeneration, it did not display histopathological benefits in trachea tissue regeneration.