Long-term in vivo experimental investigations on magnesium doped hydroxyapatite bone substitutes

Physicochemical degradation of calcium magnesium phosphate (stanfieldite) based bone replacement materials and the effect on their cytocompatibility

Regenerative bone implants should be completely replaced by new bone within a period of time corresponding to the growth rate of native bone. To meet this requirement, suitable biomaterials must be biodegradable and promote osteogenesis. The combination of slowly degrading but osteoconductive calcium phosphates (CPs) with rapidly degrading and mechanically more resilient magnesium phosphates represents a promising material class for this purpose. In order to create the best possible conditions for optimal implant integration, microporous calcium magnesium phosphate (CMP) cements were processed using 3D powder printing. This technique enables the production of a defect-adapted implant with an optimal fit and a high degree of open porosity to promote bone ingrowth. Four different compositions of 3D printed CMP ceramics were investigated with regard to essential properties of bone implants, including chemical composition, porosity, microstructure, mechanical strength, and cytocompatibility. The ceramics consisted of farringtonite (Mg₃(PO₄)₂) and stanfieldite (Ca₄Mg₅(PO₄)₆), with either struvite (NH₄MgPO₄·6H₂O) or newberyite (MgHPO₄·3H₂O) and brushite (CaHPO₄·2H₂O) as additional phases. The CMP materials showed open porosities between 13 and 28% and compressive strengths between 11 and 17 MPa, which was significantly higher, as compared with clinically established CP. The cytocompatibility was evaluated with the human fetal osteoblast cell line hFOB 1.19 and was proven to be equal or to even exceed that of tricalcium phosphate. Furthermore, a release of 4-8 mg magnesium and phosphate ions per mg scaffold material could be determined for CMPs over a period of 21 d. In the case of struvite containing CMPs the chemical dissolution of the cement matrix was combined with a physical degradation, which resulted in a mass loss of up to 3.1 wt%. In addition to its beneficial physical and biological properties, the proven continuous chemical degradation and bioactivity in the form of CP precipitation indicate an enhanced bone regeneration potential of CMPs.

Ceramic bone graft substitute (Mg-HA) in spinal fusion: A prospective pilot study

Background: Iliac crest bone graft (ICBG) is considered the gold standard for spine surgical procedures to achieve a successful fusion due to its known osteoinductive and osteoconductive properties. However, complications related to harvesting procedure and donor site morbidity have been largely reported in the literature, favoring the development of a wide range of alternative products to be used as bone graft extenders or substitutes for spine fusion. Among all, ceramic-based biomaterials have been widely studied and employed in the last years as bone graft substitutes. Methods: We report here the results of a prospective pilot study aimed to evaluating the grade of ossification obtained by the use of an Mg-doped hydroxyapatite (HA) product to achieve postero-lateral fusion in degenerative spine diseases. Results: Results show a successful degree of fusion of about 62% at the 12-month follow-up and an improvement of quality of life and health status following surgery, as evaluated by clinical scores (ODI, VAS, and EQ-5L). No adverse events related to the material were reported. Conclusion: The present pilot study shows the effectiveness and the safety profile of an Mg-doped HA bone graft substitute used to achieve postero-lateral fusion in the treatment of degenerative spine diseases, laying down the basis for further larger clinical investigations.

Applications of Biodegradable Magnesium-Based Materials in Reconstructive Oral and Maxillofacial Surgery: A Review

Reconstruction of defects in the maxillofacial region following traumatic injuries, craniofacial deformities, defects from tumor removal, or infections in the maxillofacial area represents a major challenge for surgeons. Various materials have been studied for the reconstruction of defects in the maxillofacial area. Biodegradable metals have been widely researched due to their excellent biological properties. Magnesium (Mg) and Mg-based materials have been extensively studied for tissue regeneration procedures due to biodegradability, mechanical characteristics, osteogenic capacity, biocompatibility, and antibacterial properties. The aim of this review was to analyze and discuss the applications of Mg and Mg-based materials in reconstructive oral and maxillofacial surgery in the fields of guided bone regeneration, dental implantology, fixation of facial bone fractures and soft tissue regeneration.

Impact of Gamma Irradiation on the Properties of Magnesium-Doped Hydroxyapatite in Chitosan Matrix

This is the first report regarding the effect of gamma irradiation on chitosan-coated magnesium-doped hydroxyapatite (x_Mg = 0.1; 10 MgHApCh) layers prepared by the spin-coating process. The stability of the resulting 10 MgHApCh gel suspension used to obtain the layers has been shown by ultrasound measurements. The presence of magnesium and the effect of the irradiation process on the studied samples were shown by X-ray photoelectron spectroscopy (XPS). The XPS results obtained for irradiated 10 MgHApCh layers suggested that the magnesium and calcium contained in the surface layer are from tricalcium phosphate (TCP; Ca₃(PO₄)₂) and hydroxyapatite (HAp). The XPS analysis has also highlighted that the amount of TCP in the surface layer increased with the irradiation dose. The energy-dispersive X-ray spectroscopy (EDX) evaluation showed that the calcium decreases with the increase in the irradiation dose. In addition, a decrease in crystallinity and crystallite size was highlighted after irradiation. By atomic force microscopy (AFM) we have obtained images suggesting a good homogeneity of the surface of the non-irradiated and irradiated layers. The AFM results were also sustained by the scanning electron microscopy (SEM) images obtained for the studied samples. The effect of gamma-ray doses on the Fourier transform infrared spectroscopy (ATR-FTIR) spectra of 10 MgHApCh composite layers was also evaluated. The in vitro antifungal assays proved that 10 MgHApCh composite layers presented a strong antifungal effect, correlated with the irradiation dose and incubation time. The study of the stability of the 10 MgHApCh gel allowed us to achieve uniform and homogeneous layers that could be used in different biomedical applications.

Effect of magnesium oxide nanoparticles, hydroxyapatite and hydrogel on regeneration of transverse fracture of distal radius

Study's purpose of this study is to conduct synthesis and evaluate the effect of hydroxyapatite (HA) with hydrogel locally magnesium oxide nanoparticles (MgONPS) locally or intraperitoneally (IP) on the healing of the distal third radial fracture. Concentrations of MgONPs 200μg/ml, dissolved in 1 cc distilled water and the solution stirred by a stirrer for 10 min. HA 0.5 mg in 1ml hydrogel and the solution stirring at the vortex for 15 min. These materials were evaluated in vitro to ensure their suitability with the tissues. Seventy-five healthy adult male rabbits, aged about 1.5- 2 years old with average weighting  1.7- 2.3 Kg. B.W were used. Rabbits were divided into three groups randomly (n=25), group A (HA mixed hydrogel applied locally), group B (HA mixed with hydrogel and MgONPs applied locally) and group C (HA mixed hydrogel applied locally and MgONPs IP). Animals were anesthetized by i.m 40 mg/ kg B.W ketamine hydrochloride and 5mg/ kg B.W xylazine. A 5cm incision had made cranio-medially in the skin of the forelimb (right forelimb) and exposure radius and ulna. The macroscopic evaluation revealed that all groups at 2nd week showed bone reaction in different degrees.

Hydroxyapatite Based Materials for Bone Tissue Engineering: A Brief and Comprehensive Introduction

Hydroxyapatite (HA) is widely used in bone tissue engineering for its bioactivity and biocompatibility, and a growing number of researchers are exploring ways to improve the physical properties and biological functions of hydroxyapatite. Up to now, HA has been used as inorganic building blocks for tissue engineering or as nanofillers to blend with polymers, furthermore, various methods such as ion doping or surface modification have been also reported to prepare functionalized HA. In this review, we try to give a brief and comprehensive introduction about HA-based materials, including ion-doped HA, HA/polymer composites and surface modified HA and their applications in bone tissue engineering. In addition, the prospective of HA is also discussed. This review may be helpful for researchers to get a general understanding about the development of hydroxyapatite based materials.

Osseointegration of additive manufacturing Ti-6Al-4V and Co-Cr-Mo alloys, with and without surface functionalization with hydroxyapatite and type I collagen

The introduction of additive manufacturing (AM) technologies has profoundly revolutionized the implant manufacturing industry, with a particularly significant impact on the field of orthopedics. Electron Beam Melting (EBM) and Direct Metal Laser Sintering (DMLS) represents AM fabrication techniques with a pivotal role in the realization of complex and innovative structure starting from virtual 3D model data. In this study, Ti-6Al-4V and Co-Cr-Mo materials, developed by EBM (Ti-POR) and DMLS (Co-POR) techniques, respectively, with hydroxyapatite (Ti-POR + HA; Co-POR + HA) and type I collagen (Ti-POR-COLL; Co-POR-COLL) coatings, were implanted into lateral femoral condyles of rabbits. Osseointegration process was investigated by histological, histomorphometrical and microhardness evaluations at 4 and 12 weeks after implantation. Both Ti-6Al-4V and Co-Cr-Mo implants, with or without HA and COLL coatings, demonstrated good biocompatibility. As expected, HA coating hastened bone-to-implant contact (BIC) process, while collagen did not significantly improved the osseointegration process in comparison to controls. Regarding newly trabecular bone formation (B.Ar/T.Ar), Co-POR presented the highest values, significantly different from those of Co-POR-COLL. Over time, an increase of BIC parameter and a decrease of B.Ar/T.Ar were detected. Higher mineral apposition rate was observed for Ti-POR and Co-POR in comparison to Ti-POR-COLL and Co-POR-COLL, respectively, at 12 weeks. The same behavior was found for bone formation rate between Co-POR and Co-POR-COLL at 12 weeks. In conclusion, the AM materials guarantee a good osseointegration and provide a suitable environment for bone regeneration with the peculiarity of allowing personalized and patient-specific needs customization to further improve the long-term clinical outcomes.

Biological evaluation of bone substitute

Critical-sized defects (CSDs) caused by trauma, tumor resection, or skeletal abnormalities create a high demand for bone repair materials (BRMs). Over the years, scientists have been trying to develop BRMs and evaluate their efficacy using numerous developed methods. BRMs are characterized by osteogenesis and angiogenesis promoting properties, the latter of which has rarely been studied in vitro and in vivo. While blood vessels are required to provide nutrients. Bone mass maintains a dynamic balance under the joint action of osteolytic and osteogenic activity in which monocytes differentiate into osteolytic cells, and osteoprogenitor cells differentiate into osteogenic cells. This review would be helpful for inexperienced researchers as well as present a comprehensive overview of methods used to investigate the effect of BRMs on osteogenic cells, osteolytic cells, and blood vessels, as well as their biocompatibility and biological performance. This review is expected to facilitate further research and development of new BRMs.

Obtaining and Characterizing Thin Layers of Magnesium Doped Hydroxyapatite by Dip Coating Procedure

A simple dip coating procedure was used to prepare the magnesium doped hydroxyapatite coatings. An adapted co-precipitation method was used in order to obtain a Ca25−xMgx(PO4)6(OH)2, 25MgHAp (xMg = 0.25) suspension for preparing the coatings. The stabilities of 25MgHAp suspensions were evaluated using ultrasound measurements, zeta potential (ZP), and dynamic light scattering (DLS). Using transmission electron microscopy (TEM) and scanning electron microscopy (SEM) information at nanometric resolution regarding the shape and distribution of the 25MgHAp particles in suspension was obtained. The surfaces of obtained layers were evaluated using SEM and atomic force microscopy (AFM) analysis. The antimicrobial evaluation of 25MgHAp suspensions and coatings on various bacterial strains and fungus were realized. The present study presents important results regarding the physico-chemical and antimicrobial studies of the magnesium doped hydroxyapatite suspensions, as well as the coatings. The studies have shown that magnesium doped hydroxyapatite suspensions prepared with xMg = 0.25 presented a good stability and relevant antimicrobial properties. The coatings made using 25MgHAp suspension were homogeneous and showed remarkable antimicrobial properties. Also, it was observed that the layer realized has antimicrobial properties very close to those of the suspension. Both samples of the 25MgHAp suspensions and coatings have very good biocompatible properties.

Biological behavior of magnesium-substituted hydroxyapatite during bone repair

The aim of this study was to analyze the biological behavior and osteogenic potential of magnesium (Mg) substituted hydroxyapatite (HA) microspheres, implanted in a critical bone defect, considering that this ion is of great clinical interest, since it is closely associated with homeostasis and bone mineralization. For the purpose of this study, 30 rats were used to compose three experimental groups: GI - bone defect filled with HA microspheres; GII - bone defect filled with HA microspheres replaced with Mg; GIII - empty bone defect; evaluated at biological points of 15 and 45 days. The histological results, at 15 days, showed, in all the groups, a discrete chronic inflammatory infiltrate; biomaterials intact and surrounded by connective tissue; and bone neoformation restricted to the borders. At 45 days, in the GI and GII groups, an inflammatory response of discrete granulomatous chronic type was observed, and in the GIII there was a scarce presence of mononuclear inflammatory cells; in GI and GII, the microspheres were seen to be either intact or fragmented, surrounded by fibrous connective tissue rich in blood vessels; and discrete bone neoformation near the edges and surrounding some microspheres. In GIII, the mineralization was limited to the borders and the remaining area was filled by fibrous connective tissue. It was concluded that the biomaterials were biocompatible and osteoconductive, and the percentage of Mg used as replacement ion in the HA did not favor a greater bone neoformation in relation to the HA without the metal.

Trivalent chromium incorporated in a crystalline calcium phosphate matrix accelerates materials degradation and bone formation in vivo

Remodeling of calcium phosphate bone cements is a crucial prerequisite for their application in the treatment of large bone defects. In the present study trivalent chromium ions were incorporated into a brushite forming calcium phosphate cement in two concentrations (10 and 50 mmol/mol β-tricalcium phosphate) and implanted into a femoral defect in rats for 3 and 6 month, non-modified brushite was used as reference. Based on our previous in vitro findings indicating both an enhanced osteoclastic activity and cytocompatibility towards osteoprogenitor cells we hypothesized a higher in vivo remodeling rate of the Cr³⁺ doped cements compared to the reference. A significantly enhanced degradation of the modified cements was evidenced by micro computed tomography, X-ray and histological examinations. Furthermore the formation of new bone tissue after 6 month of implantation was significantly increased from 29% to 46% during remodeling of cements, doped with the higher Cr³⁺ amount. Time of flight secondary ion mass spectrometry (ToF-SIMS) of histological sections was applied to investigate the release of Cr³⁺ ions from the cement after implantation and to image their distribution in the implant region and the surrounding bone tissue. The relatively weak incorporation of chromium into the newly formed bone tissue is in agreement to the low chromium concentrations which were released from the cements in vitro. The faster degradation of the Cr³⁺ doped cements was also verified by ToF-SIMS. The positive effect of Cr³⁺ doping on both degradation and new bone formation is discussed as a synergistic effect of Cr³⁺ bioactivity on osteoclastic resorption on one hand and improvement of cytocompatibility and solubility by structural changes in the calcium phosphate matrix on the other hand.

STATEMENT OF SIGNIFICANCE

While biologically active metal ions like strontium, magnesium and zinc are increasingly applied for the modification of ceramic bone graft materials, the present study is the first report on the incorporation of low doses of trivalent chromium ions into a calcium phosphate based biomaterial and testing of its performance in bone defect regeneration in vivo. Chromium(III)-doped calcium phosphate bone cements show improved cytocompatibility and both degradation rate and new bone formation in vivo are significantly increased compared to the reference cement. This important discovery might be the starting point for the application of trivalent chromium salts for the modification of bone graft materials to increase their remodelling rate.

Concise Review: Biomimetic Functionalization of Biomaterials to Stimulate the Endogenous Healing Process of Cartilage and Bone Tissue

Musculoskeletal reconstruction is an ongoing challenge for surgeons as it is required for one out of five patients undergoing surgery. In the past three decades, through the close collaboration between clinicians and basic scientists, several regenerative strategies have been proposed. These have emerged from interdisciplinary approaches that bridge tissue engineering with material science, physiology, and cell biology. The paradigm behind tissue engineering is to achieve regeneration and functional recovery using stem cells, bioactive molecules, or supporting materials. Although plenty of preclinical solutions for bone and cartilage have been presented, only a few platforms have been able to move from the bench to the bedside. In this review, we highlight the limitations of musculoskeletal regeneration and summarize the most relevant acellular tissue engineering approaches. We focus on the strategies that could be most effectively translate in clinical practice and reflect on contemporary and cutting‐edge regenerative strategies in surgery. Stem Cells Translational Medicine2017;6:2186–2196

Histological Comparison of New Biodegradable Magnesium-Based Implants for Maxillofacial Applications

BACKGROUND

A variety of materials have been used for bone augmentation, distraction osteotomy, and in post-cancer patients following tumor removal. However, a temporary metal implant that would resorb after successful treatment is a new concept. Magnesium was suggested as a suitable material for these purposes because it is biocompatible, has better mechanical properties than titanium, and stimulates new bone formation. This study evaluates histological appearance of magnesium-based implants and the surrounding bone.

MATERIALS AND METHODS

Three magnesium-based biomaterials were tested in a rabbit bone defect model: magnesium-hydroxyapatite (Mg-HA), W4 (96 % magnesium, 4 % yttrium), and pure magnesium (pure Mg). Animals were sacrificed after 6 and 12 weeks and the samples were analyzed histologically and histomorphometrically.

RESULTS

Mg-HA had the highest mean amount of tartrate-resistant acid phosphatase (TRAP) positive cells at the implantation site of all groups. It had shown the fastest degradation rate already at 6 weeks but the least amount of new bone formation. New bone was seen forming in direct contact with pure Mg and W4. The mean gas volume was highest in W4 compared to pure Mg and Mg-HA but this difference was not statistically significant. W4 had the lowest mean number of TRAP-positive cells of all materials.

CONCLUSION

Pure Mg and W4 were shown to be the most promising materials in this study in respect to the bone response to the implant material. They could be used for screws and plates in bone augmentation procedures.