Characterization of chlorhexidine-releasing, fast-setting, brushite bone cements

3D-Printed Bioactive Ca3SiO5 Bone Cement Scaffolds with Nano Surface Structure for Bone Regeneration

Silicate bioactive materials have been widely studied for bone regeneration because of their eminent physicochemical properties and outstanding osteogenic bioactivity, and different methods have been developed to prepare porous silicate bioactive ceramics scaffolds for bone-tissue engineering applications. Among all of these methods, the 3D-printing technique is obviously the most efficient way to control the porous structure. However, 3D-printed bioceramic porous scaffolds need high-temperature sintering, which will cause volume shrinkage and reduce the controllability of the pore structure accuracy. Unlike silicate bioceramic, bioactive silicate cements such as tricalcium silicate (Ca₃SiO₅ and C₃S) can be self-set in water to obtain high mechanical strength under mild conditions. Another advantage of using C₃S to prepare 3D scaffolds is the possibility of simultaneous drug loading. Herein, we, for the first time, demonstrated successful preparation of uniform 3D-printed C₃S bone cement scaffolds with controllable 3D structure at room temperature. The scaffolds were loaded with two model drugs and showed a loading location controllable drug-release profile. In addition, we developed a surface modification process to create controllable nanotopography on the surface of pore wall of the scaffolds, which showed activity to enhance rat bone-marrow stem cells (rBMSCs) attachment, spreading, and ALP activities. The in vivo experiments revealed that the 3D-printed C₃S bone cement scaffolds with nanoneedle-structured surfaces significantly improved bone regeneration, as compared to pure C₃S bone cement scaffolds, suggesting that 3D-printed C₃S bone cement scaffolds with controllable nanotopography surface are bioactive implantable biomaterials for bone repair.

N, Camargo NHA, Dallabrida AL, da Costa BD, Gil OG, Cambra-Moo O, Rodríguez MA, Canillas M. An in vivo study on bone formation behavior of microporous granular calcium phosphate

This study was developed based on in vivo investigation of microporous granular biomaterials based on calcium phosphates.

Micro-CT based modelling for characterising injection-moulded porous titanium implants

Design of prosthetic implants to ensure rapid and stable osseointegration remains a significant challenge, and continuous efforts have been directed to new implant materials, structures and morphology. This paper aims to develop and characterise a porous titanium dental implant fabricated by metallic powder injection-moulding. The surface morphology of the specimens was first examined with a scanning electron microscope (SEM), followed by microscopic computerised tomography (μ-CT) scanning to capture its 3D microscopic features non-destructively. The nature of porosity and pore sizes were determined statistically. A homogenisation technique based on the Hills-energy theorem was adopted to evaluate its directional elastic moduli, and the conservation of mass theorem was employed to quantify the oxygen diffusivity for bio-transportation feature. This porous medium was found to have pore sizes varying from 50 to 400 µm and the average porosity of 46.90 ± 1.83%. The anisotropic principal elastic moduli were found fairly close to the upper range of cortical bone, and the directional diffusivities could potentially enable radial osseous tissue ingrowth and vascularisation. This porous titanium successfully reduces the elastic modulus mismatch between implant and bone for dental and orthopaedic applications, and provides improved capacity for transporting oxygen, nutrient and waste for pre-vascular network formation. Copyright © 2016 John Wiley & Sons, Ltd.

Dental Composites with Calcium / Strontium Phosphates and Polylysine

Purpose

This study developed light cured dental composites with added monocalcium phosphate monohydrate (MCPM), tristrontium phosphate (TSrP) and antimicrobial polylysine (PLS). The aim was to produce composites that have enhanced water sorption induced expansion, can promote apatite precipitation and release polylysine.

Materials and Methods

Experimental composite formulations consisted of light activated dimethacrylate monomers combined with 80 wt% powder. The powder phase contained a dental glass with and without PLS (2.5 wt%) and/or reactive phosphate fillers (15 wt% TSrP and 10 wt% MCPM). The commercial composite, Z250, was used as a control. Monomer conversion and calculated polymerization shrinkage were assessed using FTIR. Subsequent mass or volume changes in water versus simulated body fluid (SBF) were quantified using gravimetric studies. These were used, along with Raman and SEM, to assess apatite precipitation on the composite surface. PLS release was determined using UV spectroscopy. Furthermore, biaxial flexural strengths after 24 hours of SBF immersion were obtained.

Results

Monomer conversion of the composites decreased upon the addition of phosphate fillers (from 76 to 64%) but was always higher than that of Z250 (54%). Phosphate addition increased water sorption induced expansion from 2 to 4% helping to balance the calculated polymerization shrinkage of ~ 3.4%. Phosphate addition promoted apatite precipitation from SBF. Polylysine increased the apatite layer thickness from ~ 10 to 20 μm after 4 weeks. The novel composites showed a burst release of PLS (3.7%) followed by diffusion-controlled release irrespective of phosphate addition. PLS and phosphates decreased strength from 154 MPa on average by 17% and 18%, respectively. All formulations, however, had greater strength than the ISO 4049 requirement of > 80 MPa.

Conclusion

The addition of MCPM with TSrP promoted hygroscopic expansion, and apatite formation. These properties are expected to help compensate polymerization shrinkage and help remineralize demineralized dentin. Polylysine can be released from the composites at early time. This may kill residual bacteria.

Visualising phase change in a brushite-based calcium phosphate ceramic

The resorption of brushite-based bone cements has been shown to be highly unpredictable, with strong dependence on a number of conditions. One of the major factors is phase transformation, with change to more stable phases such as hydroxyapatite affecting the rate of resorption. Despite its importance, the analysis of phase transformation has been largely undertaken using methods that only detect crystalline composition and give no information on the spatial distribution of the phases. In this study confocal Raman microscopy was used to map cross-sections of brushite cylinders aged in Phosphate Buffered Saline, Foetal Bovine Serum, Dulbecco's - Minimum Essential Medium (with and without serum). Image maps showed the importance of ageing medium on the phase composition throughout the ceramic structure. When aged without serum, there was dissolution of the brushite phase concomitant to the deposition of octacalcium phosphate (OCP) around the periphery of the sample. The deposition of OCP was detectable within five days and reduced the rate of brushite dissolution from the material. The use of serum, even at a concentration of 10vol% prevented phase transformation. This paper demonstrates the value of confocal Raman microscopy in monitoring phase change in biocements; it also demonstrates the problems with assessing material degradation in non-serum containing media.

Amelogenin Affects Brushite Crystal Morphology and Promotes Its Phase Transformation to Monetite

Amelogenin protein is involved in organized apatite crystallization during enamel formation. Brushite (CaHPO₄·2H₂O), one of the precursors of hydroxyapatite mineralization in vitro, has been used for fabrication of biomaterials for hard tissue repair. In order to explore its potential application in biomimetic material synthesis, we studied the influence of the enamel protein amelogenin on brushite morphology and phase transformation to monetite. Our results show that amelogenin can adsorb onto the surface of brushite, leading to the formation of layered morphology on the (010) face. Amelogenin promoted the phase transformation of brushite into monetite (CaHPO₄) in the dry state, presumably by interacting with crystalline water layers in brushite unit cells. Changes to the crystal morphology mediated by amelogenin continued even after the phase transformation from brushite to monetite, leading to the formation of organized platelets with an interlocked structure. This effect of amelogenin on brushite morphology and the phase transformation to monetite could provide a new approach to developing biomimetic materials.

A mini-review on novel intraperiodontal pocket drug delivery materials for the treatment of periodontal diseases

Periodontal disease is defined as chronic inflammatory condition characterized by the destruction of the periodontal tissues causing loss of connective tissue attachment, loss of alveolar bone, and the formation of pathological pockets around the diseased teeth. The use of systemic antibiotics has been advocated for its treatment, but concerns emerged with respect to adverse drug reactions and its contribution to bacterial resistance. Thus local drug delivery devices have been developed that aim to deliver a high concentration of antimicrobial drugs directly to the affected site, while minimizing drug's systemic exposure. A burst release of antimicrobial agent from carrier, resulting in a short and inadequate exposure of bacteria residing in periodontal pocket to the agent, remains the main challenge of current local delivery systems for the treatment of periodontal disease. This review aims to investigate and compare different local antimicrobial delivery systems with regard to the treatment of periodontal disease.

Assessments of antibacterial and physico-mechanical properties for dental materials with chemically anchored quaternary ammonium moieties: thiol-ene-methacrylate vs. conventional methacrylate system

OBJECTIVE

Fabrication of low shrinkage stress and strain dental resins containing highly available immobilized bactericidal moieties has been reported. The goal of this study is producing dental restorative materials with long-last antibacterial activity and reduced secondary caries. It is anticipated that antibacterial properties of quaternary ammonium moieties chemically immobilized in the backbone of dental resins is directly depended on accessibility of these functions. In the present study the antibacterial effect of a series of antibacterial monomers polymerized in a ternary thiol-ene-methacrylate system were compared with corresponding classical methacrylate system against Streptococcus mutans (an oral bacteria Strain). Physical and mechanical properties of dental materials obtained from these two systems were also evaluated and compared.

METHODS

The viscosities of the resin matrixes were measured on a MCR 300 rheometer. Degree of conversion (DC%) of monomers was measured using FTIR spectroscopy. The shrinkage-strain of photocured resins was measured using the bonded-disk technique. A universal testing machine combined with a stress measurement device was utilized to measure the polymerization-induced shrinkage stress. Viscoelastic properties of the samples were also determined by dynamic mechanical thermal analysis (DMTA). Assessment of antibacterial properties was performed through agar diffusion test (AD) to confirm non-release behavior of chemically anchored moieties. Quantitative assay of antibacterial activity was evaluated through direct contact test (DCT) against S. mutans. Direct contact cytotoxicity assay with fibroblast cell line L-929 was also performed to find more insight regarding cytotoxicity of the antibacterial matrixes. The data were analyzed and compared by ANOVA and Tukey HSD tests (significance level=0.05).

RESULTS

Neat methacrylate systems had significantly higher viscosity than thiol-ene-methacrylate analogous. The degree of conversion of methacrylate moieties in thiol-ene-methacrylate system was improved in comparison to conventional methacrylate system. Shrinkage stress and strain of thiol-ene-methacrylate system was lower than the neat methacrylate system. The thiol-ene-methacrylate systems show increased homogeneity and decreased glass transition temperature (Tg) and crosslink density (νc) in comparison to the neat methacrylate-based resins. The incorporated monofuctional quaternized monomer reduces degree of conversion, shrinkage stress and crosslink density of matrix. The results showed significant improvement in antibacterial activity and cytocompatibility of dental materials obtained from thiol-ene polymerization system.

SIGNIFICANCE

It was shown that with proper control of monomers molar ratio, significant improvement in antibacterial activity and cytocompatibility as well as acceptable mechanical properties can be attained for dental resins prepared through the application of thiol-ene polymerization methodology.

Stem cell differentiation-induced calcium silicate cement with bacteriostatic activity

The calcium silicate cement (CSC) on osteogenic differentiation of hMSCs and bacteriostatic abilities was more effective than calcium phosphate cement (CPC).

Designing polysaccharide-based antibacterial biomaterials for wound healing applications

In this study, the development and characterization of novel polymer blends based on chitosan-poly (vinyl alcohol) and physically cross-linked by freeze-thaw method for possible use in a variety of biomedical application is reported. The present investigation deals with designing savlon-loaded blend hydrogels (coined as cryogels) of poly (vinyl alcohol) (PVA) and chitosan by repeated freeze-thaw method and their characterization by SEM and FTIR techniques. The FTIR spectra clearly reveal that savlon-loaded chitosan and PVA blends are bonded together through hydrogen bonding. The SEM analysis suggests that cryogels show a well-defined porous morphology. The prepared cryogels were also investigated for swelling and deswelling behaviors. The results reveal that both the swelling and deswelling behaviors greatly depend on factors like chemical composition of the cryogels, number of freeze-thaw cycles, pH and temperature of the swelling bath. The savlon-loaded blends were also investigated for their in vitro blood compatibility and antibacterial activity.

Quantifying effects of interactions between polyacrylic acid and chlorhexidine in dicalcium phosphate – forming cements

Polyacrylic acid has been shown to control setting and improve mechanical and antibacterial release properties of brushite bone cements.

Self-setting calcium orthophosphate formulations

In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are bioactive and biodegradable grafting bioceramics in the form of a powder and a liquid. After mixing, both phases form pastes, which set and harden forming either a non-stoichiometric calcium deficient hydroxyapatite or brushite. Since both of them are remarkably biocompartible, bioresorbable and osteoconductive, self-setting calcium orthophosphate formulations appear to be promising bioceramics for bone grafting. Furthermore, such formulations possess excellent molding capabilities, easy manipulation and nearly perfect adaptation to the complex shapes of bone defects, followed by gradual bioresorption and new bone formation. In addition, reinforced formulations have been introduced, which might be described as calcium orthophosphate concretes. The discovery of self-setting properties opened up a new era in the medical application of calcium orthophosphates and many commercial trademarks have been introduced as a result. Currently such formulations are widely used as synthetic bone grafts, with several advantages, such as pourability and injectability. Moreover, their low-temperature setting reactions and intrinsic porosity allow loading by drugs, biomolecules and even cells for tissue engineering purposes. In this review, an insight into the self-setting calcium orthophosphate formulations, as excellent bioceramics suitable for both dental and bone grafting applications, has been provided.

High strength re-mineralizing, antibacterial dental composites with reactive calcium phosphates

OBJECTIVE

Development of high strength dental composites with adhesive, antibacterial and re-mineralizing potential.

MATERIALS

Urethane and triethylene glycol dimethacrylates were combined with HEMA (10 or 20wt%) and 2MP (2 or 10wt%), antibacterial chlorhexidine (2.5wt%) and chemical cure initiators. Reactive mono/tri calcium phosphate (CP) mixed with silica/silicon carbide nanoparticles (S) (CP:S weight ratio 1:2 or 2:1) was added (50wt%).

RESULTS

Decreasing CP/S ratio and HEMA content reduced monomer conversion at 15min from 93 to 63%. Conversely, decreasing CP/S increased initial "dry" compressive (137-203MPa) and flexural (79-116MPa) strength. With high HEMA content, these decreased by ∼15-20MPa upon 24h water storage. With low HEMA content, average decline was <8MPa due to reduced water sorption. Early water sorption induced mass increase, volume expansion, mono calcium phosphate dissolution and chlorhexidine release, were proportional to the initial calcium phosphate content. Furthermore, they increased ∼1.5 fold upon raising HEMA wt%. These diffusion controlled processes and strength decline slowed after 24h as phosphates reaction bound water within the materials. Increasing 2MP concentration reduced calcium release but did not affect strength. Formulations with high CP/S indicated greater antibacterial activity in agar diffusion and in vitro biofilm tests.

SIGNIFICANCE

New material use beneath a conventional composite could potentially reduce high failure rates associated with residual caries and bacterial microleakage.

Calcium phosphate cements as drug delivery materials

Calcium phosphate cements are used as synthetic bone grafts, with several advantages, such as their osteoconductivity and injectability. Moreover, their low-temperature setting reaction and intrinsic porosity allow for the incorporation of drugs and active principles in the material. It is the aim of the present work to: a) provide an overview of the different approaches taken in the application of calcium phosphate cements for drug delivery in the skeletal system, and b) identify the most significant achievements. The drugs or active principles associated to calcium phosphate cements are classified in three groups, i) low molecular weight drugs; ii) high molecular weight biomolecules; and iii) ions.

Calcium orthophosphate-based bone cements (CPCs): Applications, antibiotic release and alternatives to antibiotics

Calcium orthophosphate bone cements (CPCs) are widely used in orthopedic surgery. Implants are highly susceptible to infection and often lead to the formation of microbial biofilms. Antibiotics are often incorporated into bone cement to prevent infection. The increase in the number of microorganisms acquiring or developing resistance to antibiotics, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), is a major concern. Bacteriocins (antimicrobial peptides) offer an alternative to antibiotics. Their mode of activity involves permanent destabilization of the plasma membrane of target cells. A number of broad-spectrum bacteriocins produced by lactic acid bacteria and Bacillus spp. have recently been reported. In this REVIEW the major characteristics of calcium phosphate bone cements, prosthetic joint-associated infections, and treatment of these infections is discussed. The role of antimicrobial agents in CPCs is discussed and the possibility of incorporating bacteriocins in prosthetic devices is investigated.

Nisin F-loaded brushite bone cement prevented the growth of Staphylococcus aureus in vivo

AIMS

To determine if nisin F-loaded self-setting brushite cement could control the growth of Staphylococcus aureus in vivo.

METHODS AND RESULTS

  Brushite cement was prepared by mixing equimolar concentrations of β-tricalcium phosphate and monocalcium phosphate monohydrate. Nisin F was added at 5·0, 2·5 and 1·0% (w/w) and the cement moulded into cylinders. In vitro antibacterial activity was determined using a delayed agar diffusion assay. Release of nisin F from the cement was determined using BCA protein assays. Based on scanning electron microscopy and X-ray diffraction analysis, nisin F did not cause significant changes in cement structure or chemistry. Cement containing 5·0% (w/w) nisin F yielded the most promising in vitro results. Nisin F-loaded cement was implanted into a subcutaneous pocket on the back of mice and then infected with S. aureus Xen 36. Infection was monitored for 7 days, using an in vivo imaging system. Nisin F prevented S. aureus infection for 7 days and no viable cells were isolated from the implants.

CONCLUSIONS

Nisin F-loaded brushite cement successfully prevented in vivo growth of S. aureus.

SIGNIFICANCE AND IMPACT OF THE STUDY

Nisin F incorporated into bone cement may be used to control S. aureus infection in vivo.

Dicalcium phosphate cements: brushite and monetite

Dicalcium phosphate cements were developed two decades ago and ever since there has been a substantial growth in research into improving their properties in order to satisfy the requirements needed for several clinical applications. The present paper presents an overview of the rapidly expanding research field of the two main dicalcium phosphate bioceramics: brushite and monetite. This review begins with a summary of all the different formulae developed to prepare dicalcium phosphate cements, and their setting reaction, in order to set the scene for the key cement physical and chemical properties, such as compressive and tensile strength, cohesion, injectability and shelf-life. We address the issue of brushite conversion into either monetite or apatite. Moreover, we discuss the in vivo behavior of the cements, including their ability to promote bone formation, biodegradation and potential clinical applications in drug delivery, orthopedics, craniofacial surgery, cancer therapy and biosensors.

Development of remineralizing, antibacterial dental materials

Light curable methacrylate dental monomers containing reactive calcium phosphate filler (monocalcium phosphate monohydrate (MCPM) with particle diameter of 29 or 90microm) and beta-tricalcium phosphate (beta-TCP) at 1:1 weight ratio in a powder:liquid ratio (PLR) of 1:1 or 3:1 and chlorhexidine diacetate (0 or 5 wt.%), were investigated. Upon light exposure, approximately 90% monomer conversion was gained irrespective of the formulation. Increasing the PLR promoted water sorption by the set material, induced expansion and enhanced calcium, phosphate and chlorhexidine release. Concomitantly, a decline in compressive and biaxial flexural strengths occurred. With a reduction in MCPM particle diameter, however, calcium and phosphate release was reduced and less deterioration in strength observed. After 24h, the remaining MCPM had reacted with water and beta-TCP, forming, within the set materials, brushite of lower solubility. This provided a novel means to control water sorption, component release and strength properties. Measurable chlorhexidine release was observed for 6weeks. Both diffusion rate and total percentage of chlorhexidine release decreased with lowering PLR or by adding buffer to the storage solutions. Higher chlorhexidine release was associated with reduced bacterial growth on agar plates and in a biofilm fermenter. In cell growth media, brushite and hydroxyapatite crystals precipitated on the composite material surfaces. Cells spread on both these crystals and the exposed polymer composite surfaces, indicating their cell compatibility. These formulations could be suitable antibacterial, biocompatible and remineralizing dental adhesives/liners.

Chemical characterization of a degradable polymeric bone adhesive containing hydrolysable fillers and interpretation of anomalous mechanical properties

An experimental, light-curable, degradable polyester-based bone adhesive reinforced with phosphate glass particles ((P(2)O(5))(0.45)(CaO)(x)(Na(2)O)(0.55-)(x), x=0.3 or 0.4mol) or calcium phosphate (monocalcium phosphate/beta-tricalcium phosphate (MCPM/beta-TCP)) has been characterized. Early water sorption (8wt.% at 1week) by the unfilled set adhesive catalysed subsequent bulk degradation (4wt.% at 2weeks) and substantial decline in both elastic and storage moduli. Addition of phosphate glass fillers substantially enhanced this water sorption, catalysed greater bulk mass loss (40-50 and 52-55wt.%, respectively) but enabled generation of a microporous scaffold within 2weeks. The high levels of acidic polymer degradation products (38-50wt.% of original polymer) were advantageously buffered by the filler, which initially released primarily sodium trimetaphosphate (P(3)O93-). Calcium phosphate addition raised polymer water sorption to a lesser extent (16wt.%) and promoted intermediate early bulk mass loss (12wt.%) but simultaneous anomalous increase in modulus. This was attributed to MCPM reacting with absorbed water and beta-TCP to form more homogeneously dispersed brushite (CaHPO(4)) throughout the polymer. Between 2 and 10weeks, linear erosion of both polymer (0.5wt.%week(-1)) and composites (0.7-1.2wt.%week(-1)) occurred, with all fillers providing long-term buffer action through calcium and orthophosphate (PO43-) release. In conclusion, both fillers can raise degradation of bone adhesives whilst simultaneously providing the buffering action and ions required for new bone formation. Through control of water sorption catalysed filler reactions, porous structures for cell support or substantially stiffer materials may be generated.

Calcium Orthophosphate Cements and Concretes

In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are a bioactive and biodegradable grafting material in the form of a powder and a liquid. Both phases form after mixing a viscous paste that after being implanted, sets and hardens within the body as either a non-stoichiometric calcium deficient hydroxyapatite (CDHA) or brushite, sometimes blended with unreacted particles and other phases. As both CDHA and brushite are remarkably biocompartible and bioresorbable (therefore, in vivo they can be replaced with newly forming bone), calcium orthophosphate cements represent a good correction technique for non-weight-bearing bone fractures or defects and appear to be very promising materials for bone grafting applications. Besides, these cements possess an excellent osteoconductivity, molding capabilities and easy manipulation. Furthermore, reinforced cement formulations are available, which in a certain sense might be described as calcium orthophosphate concretes. The concepts established by calcium orthophosphate cement pioneers in the early 1980s were used as a platform to initiate a new generation of bone substitute materials for commercialization. Since then, advances have been made in the composition, performance and manufacturing; several beneficial formulations have already been introduced as a result. Many other compositions are in experimental stages. In this review, an insight into calcium orthophosphate cements and concretes, as excellent biomaterials suitable for both dental and bone grafting application, has been provided.