Novel bioactive composite bone cements based on the beta-tricalcium phosphate-monocalcium phosphate monohydrate composite cement system

Regulation of the antibiotic elution profile from tricalcium phosphate bone cement by addition of bioactive glass

This work aimed at tailoring of different properties of antibacterial drug delivery Ca-phosphate cements by incorporation of bioactive glass (BG). The cements were prepared from beta-tricalcium phosphate cement (β-TCP) and BG based on 50 SiO2-20 CaO-15 Na2O-7 B2O3-4 P2O5-4 Al2O3 wt% with different percentages of BG [5, 10, 15, and 20% (w/w)]. The composite cements were characterized by XRD, FTIR, and TEM. Moreover, in vitro bioactivity and biodegradation were evaluated in the simulated body fluid (SBF) at 37 °C. In addition, physical properties and mechanical strength were determined. Also, the effect of glass addition on the drug release profile was examined using gentamicin. Finally, the antimicrobial activity was studied against Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumonia bacteria, one unicellular fungal strain (Candida albicans), and one multicellular fungal strain (Mucor racemosus). The results showed that after soaking in SBF, the compression strength values ranged from 14 to 36 MPa, the bulk densities and porosities were within 1.35 to 1.49 g/cm3 and 51.3 to 44.71%, respectively. Furthermore, gentamicin was released in a sustained manner, and BG decreased the released drug amount from ~ 80% (in pure β-TCP) to 47-53% in the composite cements. A drug release profile that is sustained by all samples was achieved. The antimicrobial test showed good activity of gentamicin-conjugated cements against bacteria and fungi used in this study. Additionally, cytotoxicity results proved that all samples were safe on MG-63 cells up to 50 µg/mL with no more than 7-12% dead cells. From the view of the physico-mechanical properties, bioactivity, biodegradation, and drug release rate, 20BG/β-TCP sample was nominated for practical bone grafting material, where it showed appropriate setting time and a relatively high mechanical strength suitable for cancellous bone.

Effects of Superfine Tricalcium Silicate Powder on the Physicochemical and Mechanical Properties of Its Premixed Cement as a Root Canal Filling Material

Calcium silicate-based cement is a promising material for filling root canals. However, it has several drawbacks to its clinical application, including difficult operation and low curing strength. In this study, we successfully prepared an ultrafine tricalcium silicate powder and investigated the effects of this ultrafine powder on the performance of the premixed tricalcium silicate cement, including the curing process, setting time, hydration products, microstructure, injectivity, fluidity, and compressive strength. The results demonstrate that the addition of ultrafine tricalcium silicate powder alters the hydration product content and product morphology of the premixed cement. By increasing the content of the ultrafine powder, the injectable property of the cement can be increased to more than 95%, the fluidity can be increased from 18 mm to 35 mm, and the curing time can be shortened from 13 h to 11 h. Notably, the addition of the ultrafine powder greatly enhances the compressive strength of the hardened cement, which increases from 20.6 MPa to 51.0 MPa. These results indicate that altering the particle size distribution of the powder is an effective method for enhancing the physicochemical and mechanical properties of tricalcium silicate cement as a root canal filling material.

Incorporation of strontium borosilicate bioactive glass in calcium aluminate biocement: Physicomechanical, bioactivity and antimicrobial properties

Strontium borosilicate bioactive glass (SrBG) and calcium aluminate cement (CA) composites have been synthesized. The primary goal of this work is to evaluate how SrBG affects the bioactivity and physico-mechanical characteristics of CA. To fulfill this aim, SrBG was prepared by melt-quenching method and utilized as a substitute for CA by 5, 10, 15, and 20 wt%. To estimate the biological behavior of the prepared specimens, hydrᴏxyapatite layer (HA) establishment on the surface of cement paste was followed; after their immersion in a solution resembles human blood plasma (simulated body fluid solution (SBF)) at a temperature of about37 ± 0.5 °C for 4 weeks. The variations of pH, Ca and P ions concentrations in the SBF solution after soaking were determined. Compressive strength, apparent porosity, and bulk density were also measured. Via Fourier transform IR spectroscopy and X-ray diffraction analyses, the main components had been analyzed. Using scanning electron microscope (SEM) attached to energy dispersive spectroscopy, morphology of the samples was investigated. Additionally, the antimicrobial property was also assessed. The results proved that the hydrᴏxyapatite layer (HA) was developed on the surface of the prepared samples after soaking in the biological solution (SBF). It was also found that increasing SrBG percent in synthesized samples promotes the physico-mechanical characteristics and also the bioactivity performance of CA cement. Finally, these materials also showed good inhibition behavior towards bacterial biᴏfilms, against S. aureus and E. coli. after 48h. This makes these materials excellent candidates for preventing growth of bacteria after their implantation in teeth or bone.

Influence of pH and ion components in the liquid phase on the setting reaction of carbonate apatite granules

Carbonate apatite (CO₃Ap) is an inorganic component of bone and replaces by natural bone after implantation into the bone defect. Because of this unique characteristic, CO₃Ap granules have been used in the dental field. However, washing out of granules from the bone defect area is an issue. The aim of this study was to set CO₃Ap granules by mixing CO₃Ap granules with acidic phosphate solutions and evaluate the influence of the pH and ion components of the solutions. When Na⁺ was the counter ion, the amount of precipitated dicalcium phosphate dihydrate (DCPD) was small and the setting ability disappeared with increasing pH of the solutions. Alternatively, when the counter ion was Ca²⁺, the amount of precipitated DCPD was high and the setting ability was observed even at high pH. These results suggest the presence of Ca²⁺ in the acidic phosphate solution is a key for fabricating CO₃Ap granular cement.

Composition and Properties of Triple Superphosphate Obtained from Oyster Shells and Various Concentrations of Phosphoric Acid

Triple superphosphates [TSPs, Ca(H₂PO₄)₂·H₂O] were produced by exothermic reactions of oyster shells and different concentrations of phosphoric acid (10, 20, 30, 40, 50, 60, and 70% w/w) in a molar ratio of 1:2. The percentage yields, P₂O₅ and CaO contents, metal impurities, and thermal behaviors of all the as-prepared products are dependent on the concentrations of phosphoric acid added during the production processes, which confirm to get the best optimum of 60% w/w phosphoric acid. All the as-prepared products were characterized by several characterization methods [X-ray fluorescence, thermal gravimetric/derivative thermal gravimetric analysis, powder X-ray diffraction, Fourier-transform infrared spectroscopy, and scanning electron microscopy], verifying that all the obtained compounds are TSP that can be used as fertilizers without metal toxic contaminants. From the successful results, the method for TSP production can be applied in the fertilizer industry based on starting waste materials of oyster shells that can replace the use of unsustainable phosphate or calcium minerals obtained from nonliving things.

Bioactive Calcium Phosphate-Based Composites for Bone Regeneration

Calcium phosphates (CaPs) are widely accepted biomaterials able to promote the regeneration of bone tissue. However, the regeneration of critical-sized bone defects has been considered challenging, and the development of bioceramics exhibiting enhanced bioactivity, bioresorbability and mechanical performance is highly demanded. In this respect, the tuning of their chemical composition, crystal size and morphology have been the matter of intense research in the last decades, including the preparation of composites. The development of effective bioceramic composite scaffolds relies on effective manufacturing techniques able to control the final multi-scale porosity of the devices, relevant to ensure osteointegration and bio-competent mechanical performance. In this context, the present work provides an overview about the reported strategies to develop and optimize bioceramics, while also highlighting future perspectives in the development of bioactive ceramic composites for bone tissue regeneration.

Developing a novel magnesium calcium phosphate/sodium alginate composite cement with high strength and proper self-setting time for bone repair

In this work, novel magnesium calcium phosphate/sodium alginate composite cements were successfully fabricated with a proper setting time (5-24 min) and high compressive strength (91.1 MPa). The physicochemical and biological properties of the cement in vitro were fully characterized. The composite cements could gradually degrade in PBS as the soaking time increase, and the weight loss reached 20.74% by the end of 56th day. The cements could induce the deposition of Ca-P layer in SBF. Cell experiments proved that the extracts of the composite cements can effectively promote the proliferation and differentiation of the mouse bone marrow mesenchymal stem cells (MSCs). These preliminary results indicate that the magnesium calcium phosphate/sodium alginate composite cements could be promising as potential bone repair candidate materials.

Titanium-based composite scaffolds reinforced with hydroxyapatite-zirconia: Production, mechanical and in-vitro characterization

In this study, titanium (Ti)-based composite scaffolds reinforced with hydroxyapatite-zirconia (HA-ZrO₂) were successfully produced with powder metallurgy and atmosphere-controlled sintering processes. The scaffolds structures were theoretically selected as 40% and 60% porosity, and fabricated with approximately 1.47 and 4.02 std dev values, respectively. The porosity of the scaffolds was verified by Archimedes' measurements. The scaffolds were characterized by DTA, SEM/EDS, XRD analyses. The mechanical behaviors of the scaffolds were evaluated by compression and hardness tests. Besides, the electrochemical corrosion behaviors of the structures were compared with potentiodynamic scanning (PDS) measurements in simulated body fluids (SBF) at 37 ± 1 °C. It has been observed that all scaffolds have a bimodal porous structure as they contain varying proportions of micropores as well as macropores in desired dimensions. Biocompatible phases such as Ti_xP_y, Ca₃(PO₄)₂ and CaTiO₃, respectively, were found in the microstructure after sintering. In compression tests, 40% porous Ti had the highest strength with 37.98 MPa, interestingly, the lowest strength was seen in Ti/HA-ZrO₂ scaffold with 60% porosity with 3.80 MPa. Young's modulus values of all scaffolds vary between 1.67 - 7.20 GPa, due to the bimodal pore structure and composition effect. However, in-vitro corrosion resistance of scaffolds decreased with HA reinforcement, while increased with ZrO₂ additive to HA.

Biomechanical Evaluation of an Injectable Alginate / Dicalcium Phosphate Cement Composites for Bone Tissue Engineering

Biocompatible dicalcium phosphate (DCP) cements are widely used as bone repair materials. In this study, we aimed to investigate the impact of different amounts of sodium alginate (SA) on the microstructural, mechanical, and biological properties of DCP cements. Beta-tricalcium phosphate (β-TCP) was prepared using a microwave-assisted wet precipitation system. Lattice parameters of the obtained particles determined from X-ray diffraction (XRD), were in good match with a standard phase of β-TCP. Scanning electron microscopy (SEM) examination revealed that the particles were in globular shape. Furthermore, all functional groups of β-TCP were also detected using Fourier-transform infrared spectroscopy (FTIR) spectra. DCP cement (pure phase) was synthesized using monocalcium phosphate monohydrate (MCPM)/β-TCP powder mixture blended with 1.0 mL of water. SA/DCP cement composites were synthesized by dissolving different amounts of SA into water (1.0 mL) to obtain different final concentrations (0.5%, 1%, 2% and 3%). The prepared cements were characterized with XRD, SEM, FTIR and Thermogravimetric analysis (TGA). XRD results showed that pure DCP and SA/DCP cements were in a good match with Monetite phase. SEM results confirmed that addition of SA inhibited the growth of DCP particles. Setting time and injectability behaviour were significantly improved upon increasing the SA amount into DCP cements. In vitro biodegradation was evaluated using Simulated body fluid (SBF) over 21 days at 37 °C. The highest cumulative weight loss (%) in SBF was observed for 2.0% SA/DCP (about 26.52%) after 21 days of incubation. Amount of Ca²⁺ ions released in SBF increased with the addition of SA. DCP and SA/DCP cements showed the highest mechanical strength after 3 days of incubation in SBF and declined with prolonged immersion periods. In vitro cell culture experiments were conducted using Dental pulp stem cells (DPSCs). Viability and morphology of cells incubated in extract media of DCP and SA/DCP discs after 24 h incubation was studied with MTT assay and fluorescence microscopy imaging, respectively. All cements were cytocompatible and viability of cells incubated in extracts of cements was higher than observed in the control group. Based on the outcomes, SA/DCP bone cements have a promising future to be utilized as bone filler.

Cu-loaded Brushite bone cements with good antibacterial activity and operability

Bone defect-related surgical procedures are traumatic processes carrying potential inflammation and infection risks in the clinic, which are associated with prolonged antibiotic therapy that promotes bacterial antibiotic-resistance. In the present study, Cu-loaded brushite bone cements were designed, and the properties of the bone cements were evaluated. The setting time of the cement was prolonged from 12 to 50 min as the copper content increased. All cements were anti-washout, and the injectable coefficient of the cements was approximately 88%. Scanning electron microscopy results revealed that the crystal grains grew larger and thicker as the copper content in the cement increased, and brushite was determined to be the dominant crystalline phase for all the cements. However, a small amount of newly formed calcium copper phosphate was observed in the cement. Simultaneously, band shifts were observed in the Fourier transform infrared spectroscopy results at a Cu content of 5%. Moreover, the addition of Cu improved the compressive strength of brushite cements, and all cements were degradable. Furthermore, the Cu-loaded brushite bone cements performed well in inhibiting the growth and proliferation of Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, and the diameter of the inhibition zone increased with increasing copper content. The study revealed that the Cu-loaded brushite bone cements possessed good cellular affinity to mouse bone marrow stem cells when a lower dose of copper was added in vitro. These results support the great potential of injectable antibacterial brushite bone cement specifically for bone tissue defect-related repair and regeneration.

Development of injectable chitosan/biphasic calcium phosphate bone cement and in vitro and in vivo evaluation

Injectable biphasic calcium phosphate bone cements (BCPCs) composed of β-tricalcium phosphate (β-TCP) and hydroxyapatite (HA) have been intensively investigated because of their high rate of biodegradation, bioactivity and osteoconductivity, which can be adjusted by changing the ratio between β-TCP and HA phases after setting. The aim of this study was to evaluate the performance of 1 wt% chitosan fiber additive with biphasic calcium phosphate as an injectable bone cement both in vitro and in vivo. In vitro evaluation of compressive strength, degradation rate, morphology, and cell and alkaline phosphatase activities was done by comparison with bone cement without β-TCP. The in vivo results for micro-CT scanning and histological examinations for three groups (control, BCPC and commercial biphasic calcium phosphate granules) were characterized and compared. After the addition of 20 wt% β-TCP to calcium phosphate cement, the initial and final setting times of the sample were 3.92 min and 11.46 min, respectively, which were not significantly different from cement without β-TCP. The degradation time of the BCPC material was longer than that of calcium phosphate cement alone. The healing process was significantly faster for BCPC than for the control and commercial product groups. Therefore, this is the first evidence that BCPC is an attractive option for bone surgery due to its faster stimulation of healing and faster degradation rate.

High strength brushite bioceramics obtained by selective regulation of crystal growth with chiral biomolecules

Chirality seems to play a key role in mineralization. Indeed, in biominerals, the biomolecules that guide the formation and organization of inorganic crystals and help construct materials with exceptional mechanical properties, are homochiral. Here, we show that addition of homochiral l-(+)-tartaric acid improved the mechanical properties of brushite bioceramics by decreasing their crystal size, following the classic Hall-Petch strengthening effect; d-(-)-tartaric acid had the opposite effect. Adding l-(+)-Tar increased both the compressive strength (26 MPa) and the fracture toughness (0.3 MPa m^1/2) of brushite bioceramics, by 33% and 62%, respectively, compared to brushite bioceramics without additives. In addition, l-(+)-tartaric acid enabled the fabrication of cements with high powder-to-liquid ratios, reaching a compressive strength and fracture toughness as high as 32.2 MPa and 0.6 MPa m^1/2, respectively, approximately 62% and 268% higher than that of brushite bioceramics prepared without additives, respectively. Characterization of brushite crystals from the macro- to the atomic-level revealed that this regulation is attributable to a stereochemical matching between l-(+)-tartaric acid and the chiral steps of brushite crystals, which results in inhibition of brushite crystallization. These findings provide insight into understanding the role of chirality in mineralization, and how to control the crystallographic structure of bioceramics to achieve high-performance mechanical properties. STATEMENT OF SIGNIFICANCE: Calcium-phosphate cements are promising bone repair materials. However, their suboptimal mechanical properties limit their clinical use. Natural biominerals have remarkable mechanical properties that are the result of controlled size, shape and organization of their inorganic crystals. This is achieved by biomineralization proteins that are homochiral, composed of l- amino acids. Despite the importance of chiral l-biomolecules in biominerals, using homochiral molecules to fabricate bone cements has not been studied yet. In this study, we showed that homochiral l-(+)-tartaric acid can regulate the crystal structure and improve the mechanical properties of a calcium-phosphate cement. Hence, these findings open the door for a new way of designing strong bone cement and highlight the importance of chirality in bioceramics.

Eggshell derived brushite bone cement with minimal inflammatory response and higher osteoconductive potential

Brushite cements are known for excellent osteoconductive and degradation properties, however, its widespread use is limited due to rapid setting time and poor mechanical properties. The eggshell derived calcium phosphates exhibits improved physical and biological properties due to the presence of biologically relevant ions. In this study, eggshell derived brushite cement (EB) was fabricated using β-tricalcium phosphate synthesized from eggshells. The presence of trace elements in EB prolonged its setting time. The size of brushite crystals in EB was found to be smaller than the pure brushite cement (PB) leading to increased initial compressive strength and higher in vitro degradation rate. The L6 and MG63 cell lines exhibited good biocompatibility with the cement at the end 72 h. In vivo studies of the cements were performed in rat calvarial defect model. Micro CT analysis showed faster degradation and accelerated bone formation in EB filled defect. Histological studies revealed infiltration of inflammatory cells into the implant site for both the cements till 6th week. However, inflammation was found to be significantly reduced at the 12th week in EB compared to PB leading to complete bone bridge formation. Multi-ion substituted EB seems to be a potential bone substitute material with a reasonable setting time for ease of handling, higher mechanical strength, minimal inflammatory response and higher bone regeneration.

Effect of Baghdadite Substitution on the Physicochemical Properties of Brushite Cements

Brushite cements have been clinically used for irregular bone defect filling applications, and various strategies have been previously reported to modify and improve their physicochemical properties such as strength and injectability. However, strategies to address other limitations of brushite cements such as low radiopacity or acidity without negatively impacting mechanical strength have not yet been reported. In this study, we report the effect of substituting the beta-tricalcium phosphate reactant in brushite cement with baghdadite (Ca₃ZrSi₂O₉), a bioactive zirconium-doped calcium silicate ceramic, at various concentrations (0, 5, 10, 20, 30, 50, and 100 wt%) on the properties of the final brushite cement product. X-ray diffraction profiles indicate the dissolution of baghdadite during the cement reaction, without affecting the crystal structure of the precipitated brushite. EDX analysis shows that calcium is homogeneously distributed within the cement matrix, while zirconium and silicon form cluster-like aggregates with sizes ranging from few microns to more than 50 µm. X-ray images and µ-CT analysis indicate enhanced radiopacity with increased incorporation of baghdadite into brushite cement, with nearly a doubling of the aluminium equivalent thickness at 50 wt% baghdadite substitution. At the same time, compressive strength of brushite cement increased from 12.9 ± 3.1 MPa to 21.1 ± 4.1 MPa with 10 wt% baghdadite substitution. Culture medium conditioned with powdered brushite cement approached closer to physiological pH values when the cement is incorporated with increasing amounts of baghdadite (pH = 6.47 for pure brushite, pH = 7.02 for brushite with 20 wt% baghdadite substitution). Baghdadite substitution also influenced the ionic content in the culture medium, and subsequently affected the proliferative activity of primary human osteoblasts in vitro. This study indicates that baghdadite is a beneficial additive to enhance the radiopacity, mechanical performance and cytocompatibility of brushite cements.

Bioactive injectable polymethylmethacrylate/silicate bioceramic hybrid cements for percutaneous vertebroplasty and kyphoplasty

Polymethylmethacrylate (PMMA) cement has been widely used to fill and stabilize hard tissue defects in clinical surgery, especially in percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). However, the dense body of pure PMMA in defects has no ability to promote bone regeneration. We herein aim to fabricate novel PMMA/silicate bioceramic hybrid cements by adding bioactive calcium silicate (CS) particles into PMMA to endow PMMA/CS hybrid cements with bioactivity and biodegradability without losing the excellent mechanical strength and injectability. Following comprehensive characterization of the physicochemical properties and in vitro bioactivity study, our results showed compared with PMMA cement, the constructed PMMA/CS hybrid cements possessed significantly lower curing temperatures and simultaneously retained the acceptable mechanical strength and injectability. Moreover, obvious bioactive ion release and hydroxyapatite formation could be detected and observed after the PMMA/CS hybrid cements were soaked in simulated body fluid, indicating their pronounced bioactivity. A further in vivo study of the PMMA/CS hybrid cements on goat vertebral body defect models reflected that the PMMA/CS hybrid cements could be biodegraded well and could significantly promote new bone formation in defects 6 months of post-injection. Our results suggest that PMMA/CS hybrid cements may be promising candidates for PVP and PKP in clinic.

Progress of Regenerative Therapy in Orthopedics

PURPOSE OF REVIEW

To conduct a thorough appraisal of recent and inventive advances in the field of bone tissue engineering using biomaterials, cell-based research, along with the incorporation of biomimetic properties using surface modification of scaffolds.

RECENT FINDINGS

This paper will provide an overview on different biomaterials and emerging techniques involved in the fabrication of scaffolds, brief description of signaling pathways involved in osteogenesis, and the effect of surface modification on the fate of progenitor cells. The current strategies used for regenerative medicine like cell therapy, gene transfer, and tissue engineering have opened numerous therapeutic avenues for the treatment of various disabling orthopedic disorders. Precise strategy utilized for the reconstruction, restoration, or repair of the bone-related tissues exploits cells, biomaterials, morphogenetic signals, and appropriate mechanical environment to provide the basic constituents required for creating new tissue. Combining all the above strategies in clinical trials would pave the way for successful "bench to bedside" transformation in bone healing.

Hydrolysis, setting properties and in vitro characterization of wollastonite/newberyite bone cement mixtures

Bone cements based on magnesium phosphates such as newberyite (N; MgHPO₄.3H₂O) have been shown as potential bone substitutes due to their biocompatibility, biodegradability and ability to support osteoblast differentiation and proliferation. Newberyite can hydrolyze to hydrated magnesium phosphate compounds (e.g. bobierite (Mg₃(PO₄)₂.8H₂O)) at alkaline conditions. In this study, 25 and 50 wt% of crystalline β -wollastonite (woll; CaSiO₃) was admixed to newberyite powder in order to both enhance the acid-base hydrolysis of newberyite and to produce a functional bone cement. The setting process of wollastonite/newberyite cement mixtures started with the hydrolysis of the wollastonite with further transformation of newberyite into bobierite and the formation of magnesium silicate phase. The results demonstrated that 25 wollastonite/newberyite and 50 wollastonite/newberyite cement pastes at optimal powder/liquid ratios had final setting times of ∼34 and 25 min and compressive strength values of 18 and 32 MPa after seven days setting, respectively. The tests of cytotoxicity of cement extracts on osteoblastic cells and contact cytotoxicity of the cement substrates showed different results. The osteoblasts cultured in cement extracts readily proliferated which confirmed the non-cytotoxic concentration of ions released from both cements. On the other hand, a strong cytotoxic character of 25 wollastonite/newberyite sample surface in contrary to high (∼80%) proliferation activity of cells on the 50 wollastonite/newberyite cement substrate was observed. The differences in cell proliferation activity was attributed to different surface topographies of cement substrates, where needle-like precipitated microcrystals of magnesium phosphate phase (in 25 wollastonite/newberyite cement) prevented the adhesion and proliferation of osteoblasts contrary to the smoother surface covered by extremely fine nanoparticles in the 50 wollastonite/newberyite cement.

Dicalcium Phosphate Anhydrous: An Appropriate Bioceramic in Regeneration of Critical-Sized Radial Bone Defects in Rats

The present study aimed to evaluate and compare the effectiveness of composites of calcium phosphates including β-tri calcium phosphate (β-TCP), dicalcium phosphate anhydrous (DCPA, monetite), mono-calcium phosphate monohydrate (MCPM), and hydroxyapatite (HA) with the chitosan-gelatin-platelet gel (CGP) on the healing of experimentally induced critical size radial bone defects in rats after 8 weeks of injury. Eighty bilateral bone defects were created in the radial bones of 40 adult male Sprague-Dawley rats. The defects were either left empty (untreated or defect group), or treated with autograft, CGP, CGP-DCP, CGP-TCP, CGP/β-TCP/DCPA (CGP-TD), CGP-TD/MCPM (CGP-TDM), and CGP-TDM/HA (CGP-TDMH) scaffolds. The injured forelimbs were evaluated by radiography, gross morphology, three-dimensional computed tomography scanning, histopathology, histomorphometry, scanning electron microscopy, and biomechanical testing. The materials were analyzed using X-ray diffraction to verify the crystalline nature of their structures, and their crystallinity was revealed based on the diffraction peaks achieved from the XRD analysis. The best results were achieved by the CGP-DCP scaffold and the autograft. The CGP-TCP and CGP-TDMH scaffolds were not degraded, while the CGP-DCP, CGP-TDM, CGP-TD, and CGP scaffolds were biodegraded and enhanced bone formation compared with the CGP-TCP and CGP-TDMH groups (P < 0.05). Overall, the CGP-DCP treated defects showed significant improvement in bone formation and union, bone volume, maximum load, and stiffness compared to the CGP group (P < 0.05). It could be concluded that the CGP-DCP scaffold can be considered as a suitable substitute to autograft. In fact, this study demonstrated that DCPA or monetite has high healing potential due to its biocompatibility, biodegradability and biomechanical, osteoconductive and osteoinductive properties of this bioceramic.

The in vitro evolution of resorbable brushite cements: A physico-chemical, micro-structural and mechanical study

The mechanisms by which calcium phosphate bone substitutes evolve and are resorbed in vivo are not yet fully known. In particular, the formation of intermediate phases during resorption and evolution of the mechanical properties may be of crucial interest for their clinical efficiency. The in vitro tests proposed here are the first steps toward understanding these phenomena. Microporous Dicalcium Phosphate Dihydrate (DCPD) samples were immersed in tris(hydroxymethyl)aminomethane (TRIS) and Phosphate Buffered Saline (PBS) solutions, with or without daily refresh of the medium, for time-points up to 14days. Before and after immersion, samples were extensively characterised in terms of morphology, chemistry (XRD coupled with Rietveld analysis), microstructure (X-ray tomography, SEM observations) and local mechanical properties (instrumented micro-indentation). The composition of the immersion solutions was monitored in parallel (pH, elemental analysis). The results show the influence and importance of the experimental set-up and protocol on the formation of apatite and octacalcium phosphate concurrently to DCPD dissolution; moreover, strong inter-correlations between physico-chemistry, microstructure and mechanics are demonstrated.

STATEMENT OF SIGNIFICANCE

Ideally, the resorption kinetics of biodegradable bone substitutes should be controlled to favor the healing processes of bone. Although biodegradable bone grafts are already used in surgeries, their resorption process is still partially unknown. The present work studies these resorption phenomena, their kinetics and mechanisms and their consequences on the properties of a calcium phosphate resorbable material. The original in vitro approach developed in this work couples for the first time physico-chemical, micro-structural and mechanical assessments. The dissolution of the CaP phase in body fluids and the reprecipitation of more stable phases are studied on a local scale, which has permitted to evidence and monitor the development of a gradient of properties between the surface and the core of the samples.

Calcium Phosphate Bioceramics: A Review of Their History, Structure, Properties, Coating Technologies and Biomedical Applications

Calcium phosphate (CaP) bioceramics are widely used in the field of bone regeneration, both in orthopedics and in dentistry, due to their good biocompatibility, osseointegration and osteoconduction. The aim of this article is to review the history, structure, properties and clinical applications of these materials, whether they are in the form of bone cements, paste, scaffolds, or coatings. Major analytical techniques for characterization of CaPs, in vitro and in vivo tests, and the requirements of the US Food and Drug Administration (FDA) and international standards from CaP coatings on orthopedic and dental endosseous implants, are also summarized, along with the possible effect of sterilization on these materials. CaP coating technologies are summarized, with a focus on electrochemical processes. Theories on the formation of transient precursor phases in biomineralization, the dissolution and reprecipitation as bone of CaPs are discussed. A wide variety of CaPs are presented, from the individual phases to nano-CaP, biphasic and triphasic CaP formulations, composite CaP coatings and cements, functionally graded materials (FGMs), and antibacterial CaPs. We conclude by foreseeing the future of CaPs.

Characterization of alginate-brushite in-situ hydrogel composites

In the present study alginate-brushite composite hydrogels were in-situ synthetized and characterized with respect to preparation parameters. Specifically, the influence of initial pH value and initial concentration of phosphate precursor on the in-situ fabrication of the composite hydrogel were taken into account. The composite hydrogels were characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), thermogravimetric (TGA, DTG) and differential thermal analysis (DTA). Finally, the cell viability tests were carried out (MTT) over the incubation time period of 3, 7, and 14days. The results revealed that the formation and the crystalline stability of brushite were highly dependent on the initial pH value. It was shown that as the pH reached to the value of 6, characteristics peaks of brushite appeared in the FTIR spectra. Besides, the XRD and thermal analysis results were in a good accordance with those of FTIR. In addition, the SEM images demonstrated that the plate like brushite was formed inside the alginate matrix. Also, a considerable impact of pH variation on the biocompatibility of samples was noticed so that the majority of samples especially those prepared in the acidic conditions were toxic.

Synthesis and osteo-compatibility of novel reduced graphene oxide-aminosilica hybrid nanosheets

Combination of silica component with other materials is one of the current strategies to design bone regenerative materials. In this study, novel reduced graphene oxide (RGO)-aminosilica hybrid nanosheets with enhanced osteo-compatibility were synthesized from a mixture of 3-aminopropyltriethoxysilane (APTES), graphene oxides (GO) and water. The presence of APTES in the mixture not only caused the conversion of GO to RGO, but also led to the hydrolysis and condensation of itself. It was for the first time reported the reducing role of APTES in the conversion of GO to RGO. It was found that the silicon (IV) ions were released from the hybrid nanosheets in a sustained way. The in vitro osteo-compatibility was evaluated by incubating the hybrid nanosheets with osteoblast MC3T3-E1 cells. A water soluble tetrazolium salt assay quantitatively indicated that the hybrid nanosheets had no significant toxicity and exhibited good biocompatibility. An alkaline phosphatase assay quantitatively indicated that the hybrid nanosheets enhanced the osteoblast differentiation compared to the GO nanosheets. An immunochemical assay further qualitatively indicated that the hybrid nanosheets stimulated the production of osteopontin as typical marker for osteoblast differentiation. Thus, the resultant hybrids nanosheets had a potential application in the bone regeneration.

Effects of Silicon on Osteoclast Cell Mediated Degradation, In Vivo Osteogenesis and Vasculogenesis of Brushite Cement

Calcium phosphate cements (CPCs) are being widely used for treating small scale bone defects. Among the various CPCs, brushite (dicalcium phosphate dihydrate, DCPD) cement is widely used due to its superior solubility and ability to form new bone. In the present study, we have studied the physical, mechanical, osteoclast-like-cells differentiation and in vivo osteogenic and vasculogenic properties of silicon (Si) doped brushite cements. Addition of Si did not alter the phase composition of final product and regardless of Si level, all samples included β-tricalcium phosphate (β-TCP) and DCPD. 1.1 wt. % Si addition increased the compressive strength of undoped brushite cement from 4.78±0.21 MPa to 5.53±0.53 MPa, significantly. Cellular activity was studied using receptor activator of nuclear factor κβ ligand (RANKL) supplemented osteoclast-like-cells precursor RAW 264.7 cell. Phenotypic expressions of the cells confirmed successful differentiation of RAW264.7 monocytes to osteoclast-like-cells on undoped and doped brushite cements. An increased activity of osteoclast-like cells was noticed due to Si doping in the brushite cement. An excellent new bone formation was found in all cement compositions, with significant increase in Si doped brushite samples as early as 4 weeks post implantation in rat femoral model. After 4 weeks of implantation, no significant difference was found in blood vessel formation between the undoped and doped cements, however, a significant increase in vasculgenesis was found in 0.8 and 1.1 wt. % Si doped brushite cements after 8 weeks. These results show the influence of Si dopant on physical, mechanical, in vitro osteoclastogenesis and in vivo osteogenic and vasculogenic properties of brushite cements.

Mechanisms of in Vivo Degradation and Resorption of Calcium Phosphate Based Biomaterials

Calcium phosphate ceramic materials are extensively used for bone replacement and regeneration in orthopedic, dental, and maxillofacial surgical applications. In order for these biomaterials to work effectively it is imperative that they undergo the process of degradation and resorption in vivo. This allows for the space to be created for the new bone tissue to form and infiltrate within the implanted graft material. Several factors affect the biodegradation and resorption of calcium phosphate materials after implantation. Various cell types are involved in the degradation process by phagocytic mechanisms (monocytes/macrophages, fibroblasts, osteoblasts) or via an acidic mechanism to reduce the micro-environmental pH which results in demineralization of the cement matrix and resorption via osteoclasts. These cells exert their degradation effects directly or indirectly through the cytokine growth factor secretion and their sensitivity and response to these biomolecules. This article discusses the mechanisms of calcium phosphate material degradation in vivo.

Calcium orthophosphates (CaPO4): occurrence and properties

The present overview is intended to point the readers' attention to the important subject of calcium orthophosphates (CaPO4). This type of materials is of the special significance for the human beings because they represent the inorganic part of major normal (bones, teeth and antlers) and pathological (i.e., those appearing due to various diseases) calcified tissues of mammals. For example, atherosclerosis results in blood vessel blockage caused by a solid composite of cholesterol with CaPO4, while dental caries and osteoporosis mean a partial decalcification of teeth and bones, respectively, that results in replacement of a less soluble and harder biological apatite by more soluble and softer calcium hydrogenorthophosphates. Therefore, the processes of both normal and pathological calcifications are just an in vivo crystallization of CaPO4. Similarly, dental caries and osteoporosis might be considered as in vivo dissolution of CaPO4. In addition, natural CaPO4 are the major source of phosphorus, which is used to produce agricultural fertilizers, detergents and various phosphorus-containing chemicals. Thus, there is a great significance of CaPO4 for the humankind and, in this paper, an overview on the current knowledge on this subject is provided.

Long-Term In Vitro Degradation of a High-Strength Brushite Cement in Water, PBS, and Serum Solution

Bone loss and fractures may call for the use of bone substituting materials, such as calcium phosphate cements (CPCs). CPCs can be degradable, and, to determine their limitations in terms of applications, their mechanical as well as chemical properties need to be evaluated over longer periods of time, under physiological conditions. However, there is lack of data on how the in vitro degradation affects high-strength brushite CPCs over longer periods of time, that is, longer than it takes for a bone fracture to heal. This study aimed at evaluating the long-term in vitro degradation properties of a high-strength brushite CPC in three different solutions: water, phosphate buffered saline, and a serum solution. Microcomputed tomography was used to evaluate the degradation nondestructively, complemented with gravimetric analysis. The compressive strength, chemical composition, and microstructure were also evaluated. Major changes from 10 weeks onwards were seen, in terms of formation of a porous outer layer of octacalcium phosphate on the specimens with a concomitant change in phase composition, increased porosity, decrease in object volume, and mechanical properties. This study illustrates the importance of long-term evaluation of similar cement compositions to be able to predict the material's physical changes over a relevant time frame.

Novel tricalcium silicate/magnesium phosphate composite bone cement having high compressive strength, in vitro bioactivity and cytocompatibility

Although inorganic bone cements such as calcium phosphate cements have been widely applied in orthopaedic and dental fields because of their self-setting ability, development of high-strength bone cement with bioactivity and biodegradability remains a major challenge. Therefore, the purpose of this study is to prepare a tricalcium silicate/magnesium phosphate (C3S/MPC) composite bone cement, which is intended to combine the excellent bioactivity of C3S with remarkable self-setting properties and mechanical strength of MPC. The self-setting and mechanical properties, in vitro induction of apatite formation and degradation behaviour, and cytocompatibility of the composite cements were investigated. Our results showed that the C3S/MPC composite cement with an optimal composition had compressive strength up to 87 MPa, which was significantly higher than C3S (25 MPa) and MPC (64 MPa). The setting time could be adjusted between 3 min and 29 min with the variation of compositions. The hydraulic reaction products of the C3S/MPC composite cement were composed of calcium silicate hydrate (CSH) derived from the hydration of C3S and gel-like amorphous substance. The C3S/MPC composite cements could induce apatite mineralization on its surface in SBF solution and degraded gradually in Tris-HCl solution. Besides, the composite cements showed good cytocompatibility and stimulatory effect on the proliferation of MC3T3-E1 osteoblast cells. Our results indicated that the C3S/MPC composite bone cement might be a new promising high-strength inorganic bioactive material which may hold the potential for bone repair in load-bearing site.

Nano-hydroxyapatite/chitosan-starch nanocomposite as a novel bone construct: Synthesis and in vitro studies

A novel ternary nanocomposite system incorporating hydroxyapatite, chitosan and starch (n-HA/CS-ST) has been synthesized by co-precipitation method at room temperature, addressing the issues of biocompatibility, mechanical strength and cytotoxicity required for bone tissue engineering. The interactions, crystallite size, surface morphology and thermal stability against n-HA/CS nanocomposite have been obtained by comparing the results of FTIR, SEM, TEM, DLS, XRD and TGA/DTA. A comparative study of bioactivity and thermal stability of n-HA/CS and n-HA/CS-ST nanocomposites revealed that the incorporation of starch as templating agent enhanced these properties in n-HA/CS-ST nanocomposite. A lower swelling rate of n-HA/CS-ST relative to n-HA/CS indicates a higher mechanical strength supportive of bone tissue ingrowths. The MTT assay on murine fibroblast L929 and human osteoblasts-like MG-63 cells and in vitro bioactivity of n-HA/CS-ST matrix referred superior non-toxic nature of n-HA/CS-ST nanocomposite and greater possibility of osteointegration in vivo respectively. Furthermore n-HA/CS-ST exhibited improved antibacterial property against both Gram-positive and Gram-negative bacteria relative to n-HA/CS.

Do novel cement-type biomaterials reveal ion reactivity that affects cell viability in vitro?

Calcium phosphate bioceramics have been studied as bone filler materials for years and have become a component of many commercial products. It is widely known that surface-reactive biomaterials may cause changes in the concentration of crucial ions in the surrounding environment, thereby affecting cell metabolism and viability. The aim of this study was to produce five cement-type biomaterials and characterize their phase composition using X-ray diffraction method, and porosity and pore size distribution using mercury intrusion porosimeter. We then evaluated ion interactions of the novel biomaterials with the surrounding environment (culture medium). A commercially available bone substitute, HydroSet™ (Stryker®), was used as a reference. MTT and NRU cytotoxicity tests were performed to assess the effect of changes in the concentration of crucial ions (calcium, magnesium, phosphate) on osteoblast metabolism and viability in vitro. Our study clearly indicated that various biomaterials demonstrated different ion reactivity and consequently may cause changes in ion concentration in the local environment. Critically low or high values of calcium, magnesium, and phosphate concentrations in the medium exerted cytotoxic effects on the cultured cells. Moreover, we discovered that the chemical composition of the culture medium had a substantial influence on ion interactions with biomaterials.

Rational design and fabrication of a β-dicalcium silicate-based multifunctional cement with potential for root canal filling treatment

Gypsum-introduced, CaO-rich dicalcium silicate-based cements exhibit multifunctional physicochemical and biological properties and meet some challenging criteria in root canal therapy.

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.

A novel injectable calcium phosphate cement-bioactive glass composite for bone regeneration

Background

Calcium phosphate cement (CPC) can be molded or injected to form a scaffold in situ, which intimately conforms to complex bone defects. Bioactive glass (BG) is known for its unique ability to bond to living bone and promote bone growth. However, it was not until recently that literature was available regarding CPC-BG applied as an injectable graft. In this paper, we reported a novel injectable CPC-BG composite with improved properties caused by the incorporation of BG into CPC.

Materials and Methods

The novel injectable bioactive cement was evaluated to determine its composition, microstructure, setting time, injectability, compressive strength and behavior in a simulated body fluid (SBF). The in vitro cellular responses of osteoblasts and in vivo tissue responses after the implantation of CPC-BG in femoral condyle defects of rabbits were also investigated.

Results

CPC-BG possessed a retarded setting time and markedly better injectability and mechanical properties than CPC. Moreover, a new Ca-deficient apatite layer was deposited on the composite surface after immersing immersion in SBF for 7 days. CPC-BG samples showed significantly improved degradability and bioactivity compared to CPC in simulated body fluid (SBF). In addition, the degrees of cell attachment, proliferation and differentiation on CPC-BG were higher than those on CPC. Macroscopic evaluation, histological evaluation, and micro-computed tomography (micro-CT) analysis showed that CPC-BG enhanced the efficiency of new bone formation in comparison with CPC.

Conclusions

A novel CPC-BG composite has been synthesized with improved properties exhibiting promising prospects for bone regeneration.

Microstructure and chemistry affects apatite nucleation on calcium phosphate bone graft substitutes

The bioactivity of calcium phosphate bone grafts of varying chemistry and strut-porosity was compared by determining the rate of formation of hydroxycarbonate apatite crystals on the material surface after being soaked in simulated body fluid for up to 30 days. Three groups of silicate-substituted hydroxyapatite material were tested, with each group comprising a different quantity of strut-porosity (23, 32, and 46 % volume). A commercially available porous β-tricalcium phosphate bone graft substitute was tested for comparison. Results indicate that strut-porosity of a material affects the potential for formation of a precursor to bone-like apatite and further confirms previous findings that β-tricalcium phosphate is less bioactive than hydroxyapatite.

Influence of water content on hardening and handling of a premixed calcium phosphate cement

Handling of calcium phosphate cements is difficult, where problems often arise during mixing, transferring to syringes, and subsequent injection. Via the use of premixed cements the risk of handling complications is reduced. However, for premixed cements to work in a clinical situation the setting time needs to be improved. The objective of this study is to investigate the influence of the addition of water on the properties of premixed cement. Monetite-forming premixed cements with small amounts of added water (less than 6.8 wt.%) were prepared and the influence on injectability, working time, setting time and mechanical strength was evaluated. The results showed that the addition of small amounts of water had significant influence on the properties of the premixed cement. With the addition of just 1.7 wt.% water, the force needed to extrude the cement from a syringe was reduced from 107 (±15) N to 39 (±9) N, the compression strength was almost doubled, and the setting time decreased from 29 (±4) min to 19 (±2) min, while the working time remained 5 to 6h. This study demonstrates the importance of controlling the water content in premixed cement pastes and how water can be used to improve the properties of premixed cements.

Physicochemical properties and in vitro biocompatibility of a hydraulic calcium silicate/tricalcium aluminate cement for endodontic use

This study sought to prepare a calcium silicate cement (CSC) with varying additions of tricalcium aluminate (Ca(3)Al(2)O(6), C(3)A), and to find an optimal amount of C(3)A by evaluating the effect of C(3)A on the physicochemical and in vitro biological properties of the CS/C(3)A cement. The results indicated that the addition of C(3)A into CSC reduced the setting time and improved the compressive strength especially at the early stage of setting. However, the 15% C(3)A was too much for the CS/C(3)A system and did harm to its strength development. Furthermore, the CS/C(3)A cement was bioactive and biocompatible in vitro, and had a stimulatory effect on the cell growth, when the content of C(3)A was 5 or 10%. When compared with the commercially available Dycal(®), the CS/C(3)A cement was notably more compatible with the human dental pulp cells. Therefore, the CS/C(3)A cement with 5-10% C(3)A produced the best compromise between setting and in vitro biological properties, and may be a promising candidate for endodontic use.

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.

Calcium orthophosphates: occurrence, properties, biomineralization, pathological calcification and biomimetic applications

The present overview is intended to point the readers' attention to the important subject of calcium orthophosphates. This type of materials is of special significance for human beings, because they represent the inorganic part of major normal (bones, teeth and antlers) and pathological (i.e., those appearing due to various diseases) calcified tissues of mammals. For example, atherosclerosis results in blood vessel blockage caused by a solid composite of cholesterol with calcium orthophosphates, while dental caries and osteoporosis mean a partial decalcification of teeth and bones, respectively, that results in replacement of a less soluble and harder biological apatite by more soluble and softer calcium hydrogenphosphates. Therefore, the processes of both normal and pathological calcifications are just an in vivo crystallization of calcium orthophosphates. Similarly, dental caries and osteoporosis might be considered an in vivo dissolution of calcium orthophosphates. Thus, calcium orthophosphates hold a great significance for humankind, and in this paper, an overview on the current knowledge on this subject is provided.