Effect of silica gel on the cohesion, properties and biological performance of brushite cement

Study on the Effect of Citric Acid-Modified Chitosan on the Mechanical Properties, Shrinkage Properties, and Durability of Concrete

As an environmentally friendly natural polymer, citric acid-modified chitosan (CAMC) can effectively regulate the hydration and exothermic processes of cement-based materials. However, the influence of CAMC on the macroscopic properties of concrete and the optimal dosage are still unclear. This work systematically investigates the effects of CAMC on the mixing performance, mechanical properties, shrinkage performance, and durability of concrete. The results indicated that CAMC has a thickening effect and prolongs the setting time of concrete. CAMC has a negative impact on the early strength of concrete, but it is beneficial for the development of the subsequent strength of concrete. With the increase in CAMC content, the self-shrinkage rate of concrete samples decreased from 86.82 to 14.52 με. However, the CAMC-0.6% sample eventually expanded, with an expansion value of 78.49 με. Moreover, the long-term drying shrinkage rate was decreased from 551.46 to 401.94 με. Furthermore, low-dose CAMC can significantly reduce the diffusion coefficient of chloride ions, improve the impermeability and density of concrete, and thereby enhance the freeze-thaw cycle resistance of concrete.

Biological and Mechanical Performance of Dual-Setting Brushite-Silica Gel Cements

Bone defects resulting from trauma, diseases, or surgical procedures pose significant challenges in the field of oral and maxillofacial surgery. The development of effective bone substitute materials that promote bone healing and regeneration is crucial for successful clinical outcomes. Calcium phosphate cements (CPCs) have emerged as promising candidates for bone replacement due to their biocompatibility, bioactivity, and ability to integrate with host tissues. However, there is a continuous demand for further improvements in the mechanical properties, biodegradability, and bioactivity of these materials. Dual setting of cements is one way to improve the performance of CPCs. Therefore, silicate matrices can be incorporated in these cements. Silicate-based materials have shown great potential in various biomedical applications, including tissue engineering and drug delivery systems. In the context of bone regeneration, silicate matrices offer unique advantages such as improved mechanical stability, controlled release of bioactive ions, and enhanced cellular responses. Comprehensive assessments of both the material properties and biological responses of our samples were conducted. Cytocompatibility was assessed through in vitro testing using osteoblastic (MG-63) and osteoclastic (RAW 264.7) cell lines. Cell activity on the surfaces was quantified, and scanning electron microscopy (SEM) was employed to capture images of the RAW cells. In our study, incorporation of tetraethyl orthosilicate (TEOS) in dual-curing cements significantly enhanced physical properties, attributed to increased crosslinking density and reduced pore size. Higher alkoxysilyl group concentration improved biocompatibility by facilitating greater crosslinking. Additionally, our findings suggest citrate's potential as an alternative retarder due to its positive interaction with the silicate matrix, offering insights for future dental material research. This paper aims to provide an overview of the importance of silicate matrices as modifiers for calcium phosphate cements, focusing on their impact on the mechanical properties, setting behaviour, and biocompatibility of the resulting composites.

The Influence of Nanosilica on Properties of Cement Based on Tetracalcium Phosphate/Monetite Mixture with Addition of Magnesium Pyrophoshate

The effect of nanosilica on the microstructure setting process of tetracalcium phosphate/nanomonetite calcium phosphate cement mixture (CPC) with the addition of 5 wt% of magnesium pyrophosphate (assigned as CT5MP) and osteogenic differentiation of mesenchymal stem cells cultured in cement extracts were studied. A more compact microstructure was observed in CT5MP cement with 0.5 wt% addition of nanosilica (CT5MP1Si) due to the synergistic effect of Mg₂P₂O₇ particles, which strengthened the cement matrix and nanosilica, which supported gradual growth and recrystallization of HAP particles to form compact agglomerates. The addition of 0.5 wt% of nanosilica to CT5MP cement caused an increase in CS from 18 to 24 MPa while the setting time increased almost twofold. It was verified that adding nanosilica to CPC cement, even in a low amount (0.5 and 1 wt% of nanosilica), positively affected the injectability of cement pastes and differentiation of cells with upregulation of osteogenic markers in cells cultured in cement extracts. Results revealed appropriate properties of these types of cement for filling bone defects.

The application of Bonelike® Poro as a synthetic bone substitute for the management of critical-sized bone defects - A comparative approach to the autograft technique - A preliminary study

The effective treatment of non-unions and critical-sized defects remains a challenge in the orthopedic field. From a tissue engineering perspective, this issue can be addressed through the application bioactive matrixes to support bone regeneration, such as Bonelike®, as opposed to the widespread autologous grafting technique. An improved formulation of Bonelike® Poro, was assessed as a synthetic bone substitute in an ovine model for critical-sized bone defects. Bone regeneration was assessed after 5 months of recovery through macro and microscopic analysis of the healing features of the defect sites. Both the application of natural bone graft or Bonelike® Poro resulted in bridging of the defects margins. Untreated defect remained as fibrous non-unions at the end of the study period. The characteristics of the newly formed bone and its integration with the host tissue were assessed through histomorphometric and histological analysis, which demonstrated Bonelike® Poro to result in improved healing of the defects. The group treated with synthetic biomaterial presented bone bridges of increased thickness and bone features that more closely resembled the native spongeous and cortical bone. The application of Bonelike® Poro enabled the regeneration of critical-sized lesions and performed comparably to the autograph technique, validating its octeoconductive and osteointegrative potential for clinical application as a therapeutic strategy in human and veterinary orthopedics.

Biomimetic trace metals improve bone regenerative properties of calcium phosphate bioceramics

The bone regenerative capacity of synthetic calcium phosphates (CaPs) can be enhanced through the enrichment with selected metal trace ions. However, defining the optimal elemental composition required for bone formation is challenging due to many possible concentrations and combinations of these elements. We hypothesized that the ideal elemental composition exists in the inorganic phase of the bone extracellular matrix (ECM). To study our hypothesis, we first obtained natural hydroxyapatite through the calcination of bovine bone, which was then investigated its reactivity with acidic phosphates to produce CaP cements. Bioceramic scaffolds fabricated using these cements were assessed for their composition, properties, and in vivo regenerative performance and compared with controls. We found that natural hydroxyapatite could react with phosphoric acid to produce CaP cements with biomimetic trace metals. These cements present significantly superior in vivo bone regenerative performance compared with cements prepared using synthetic apatite. In summary, this study opens new avenues for further advancements in the field of CaP bone biomaterials by introducing a simple approach to develop biomimetic CaPs. This work also sheds light on the role of the inorganic phase of bone and its composition in defining the regenerative properties of natural bone xenografts.

A ready-to-use acidic, brushite-forming calcium phosphate cement

Premixed calcium phosphate cements have been developed to simplify the usage of traditional calcium phosphate cements and reduce the influence of the setting reaction on the delivery process. However, difficulties in achieving a good cohesion, adequate shelf life and sufficient mechanical properties have so far impeded their use in clinical applications, especially for the more degradable acidic calcium phosphate cements. In this study, a brushite cement was developed from a series of ready-to-use calcium phosphate pastes. The brushite cement paste was formed via mixing of a monocalcium phosphate monohydrate (MCPM) paste and a β-tricalcium phosphate (β-TCP) paste with good injectability and adequate shelf life. The MCPM paste was based on a water-immiscible liquid with two surfactants and the β-TCP paste on a sodium hyaluronate aqueous solution. The effect of citric acid as a retardant was assessed. Formulations with suitable amounts of citric acid showed good cohesion and mechanical performance with potential for future clinical applications. STATEMENT OF SIGNIFICANCE: Acidic calcium phosphate cements have attracted extensive attention as bone substitute materials due to their ability to resorb faster than basic calcium phosphate cements in vivo. However, traditionally, short working times and low mechanical strength have limited their clinical application. Premixed cements could simplify the clinical use as well as improve property reproducibility, but short shelf lives, low cohesion and low mechanical properties have restricted the development. In this study, an injectable ready-to-use two-phase system consisting of an MCPM paste and a β-TCP paste was developed based on acidic cement. It shows good cohesion, compressive strength and adequate shelf life, which has the potential to be used in a dual chamber system for simplified and fast filling of bone defects in a minimally invasive manner. This will reduce surgery time, decrease the risk of contamination and ensure repeatable results.

Bone grafts and biomaterials substitutes for bone defect repair: A review

Bone grafts have been predominated used to treat bone defects, delayed union or non-union, and spinal fusion in orthopaedic clinically for a period of time, despite the emergency of synthetic bone graft substitutes. Nevertheless, the integration of allogeneic grafts and synthetic substitutes with host bone was found jeopardized in long-term follow-up studies. Hence, the enhancement of osteointegration of these grafts and substitutes with host bone is considerably important. To address this problem, addition of various growth factors, such as bone morphogenetic proteins (BMPs), parathyroid hormone (PTH) and platelet rich plasma (PRP), into structural allografts and synthetic substitutes have been considered. Although clinical applications of these factors have exhibited good bone formation, their further application was limited due to high cost and potential adverse side effects. Alternatively, bioinorganic ions such as magnesium, strontium and zinc are considered as alternative of osteogenic biological factors. Hence, this paper aims to review the currently available bone grafts and bone substitutes as well as the biological and bio-inorganic factors for the treatments of bone defect.

Functionalized biomimetic calcium phosphates for bone tissue repair

The design and development of novel materials for biomineralized tissues is an extremely attractive field of research where calcium phosphates (CaPs)-based materials for biomedical applications play a leading role. The biological performance of these compounds can be enhanced through functionalization with biologically active ions and molecules. This review reports on some important recent achievements in creating functionalized biomimetic CaP materials for applications in the musculoskeletal field. Particular attention is focused on the modifications of these inorganic compounds with bioactive ions, growth factors and drugs, as well as on recent trends in some important CaP applications as biomaterials - namely, as bone cements, coatings of metallic implants and scaffolds for regenerative medicine.

Effect of processing conditions of dicalcium phosphate cements on graft resorption and bone formation

Dicalcium phosphate cements (brushite and monetite) are resorbable biomaterials with osteoconductive potential for bone repair and regeneration that have yet to gain widespread commercial use. Brushite can be converted to monetite by heat treatments additionally resulting in various changes in the physico-chemical properties. However, since conversion is most commonly performed using autoclave sterilisation (wet heating), it is uncertain whether the properties observed for monetite as a result of heating brushite under dry conditions affect resorption and bone formation favourably. This study was designed to produce monetite grafts of differing physical form by autoclaving and dry heating (under vacuum) to be compared with brushite biomaterials in an orthotopic pre-clinical implantation model in rabbit for 12weeks. It was observed that monetite grafts had higher porosity and specific surface area than their brushite precursors. The autoclaved monetite grafts had compressive strength reduced by 50% when compared with their brushite precursors. However, the dry heat converted monetite grafts had compressive strength comparable with brushite. Results from in vivo experiments revealed that both types of monetite graft materials resorbed faster than brushite and more bone formation was achieved. There was no significant difference in the amount of bone formed between the two types of monetite grafts. The implanted brushite grafts underwent phase transformation to form hydroxyapatite, which ultimately limited bioresorption. However, this was not observed in both types of monetite grafts. In summary, both autoclaving and dry heating the preset brushite cement grafts resulted in monetite biomaterials which were more resorbable with potential to be investigated and optimized for orthopaedic and maxillofacial bone repair and regeneration applications.

STATEMENT OF SIGNIFICANCE

We present in this original research article a comparison between dicalcium phosphate cement based grafts (brushite and 2 types of monetite grafts prepared by wet and dry thermal processing) with regards to resorption and bone formation in vivo after orthotopic implantation in rabbit condylar femural region. To the best of our knowledge this is the first in vivo study that reports a comparison resorption and bone formation using brushite and two types of monetite biomaterials. Also, we have included in the manuscript a summary of all the in vivo studies performed on brushite and monetite biomaterials to date. This includes cement composition, physical properties (porosity and surface area), implantation and histomorphometrical details such as animal species, site of implantation, observation period, percentage bone tissue formation and residual graft material. In addition, we calculated the percentage resorption of graft materials based upon various implantation sites and included that into the discussion section. The results of this original research provides greater understanding of the resorption processes of dicalcium phosphate based grafts, allowing preparation of bone substitute materials with more predictable resorption profiles in future.

Effect of physicochemical properties of a cement based on silicocarnotite/calcium silicate on in vitro cell adhesion and in vivo cement degradation

A silicon calcium phosphate cement (Si-CPC) was developed to produce a composite of calcium phosphate and calcium silicate. The silicon cements prepared with low silicon (Si) content were composed of crystalline phases of brushite and silicocarnotite. However, the cements prepared with high Si content were mainly composed of amorphous phases of silicocarnotite, hydroxyapatite and calcium silicate. The cement porosity was about 40% with a shift of the average pore diameter to the nanometric range with increasing Si content. Interestingly, this new cement system provides a matrix with a high specific surface area of up to 29 m(2) g(-1). The cytocompatibility of the new Si-doped cements was tested with a human osteoblast-like cell line (MG-63) showing an enhancement of cell proliferation (up to threefold) when compared with unsubstituted material. Cements with a high silica content also improved the cell attachment. The in vivo results indicated that Si-CPCs induce the formation of new bone tissue, and modify cement resorption. We conclude that this cement provides an optimal environment to enhance osteoblast growth and proliferation that could be of interest in bone engineering.

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.

Reinforcement Strategies for Load-Bearing Calcium Phosphate Biocements

Calcium phosphate biocements based on calcium phosphate chemistry are well-established biomaterials for the repair of non-load bearing bone defects due to the brittle nature and low flexural strength of such cements. This article features reinforcement strategies of biocements based on various intrinsic or extrinsic material modifications to improve their strength and toughness. Altering particle size distribution in conjunction with using liquefiers reduces the amount of cement liquid necessary for cement paste preparation. This in turn decreases cement porosity and increases the mechanical performance, but does not change the brittle nature of the cements. The use of fibers may lead to a reinforcement of the matrix with a toughness increase of up to two orders of magnitude, but restricts at the same time cement injection for minimal invasive application techniques. A novel promising approach is the concept of dual-setting cements, in which a second hydrogel phase is simultaneously formed during setting, leading to more ductile cement–hydrogel composites with largely unaffected application properties.

Dual-setting brushite-silica gel cements

The current study describes a dual-mechanism-setting cement that combines a brushite-forming cement paste with a second inorganic silica-based precursor. Materials were obtained by pre-hydrolyzing tetraethyl orthosilicate (TEOS) under acidic conditions following the addition of a calcium phosphate cement (CPC) powder mixed of β-tricalcium phosphate and monocalcium phosphate. Cement setting occurred by a dissolution-precipitation process, while changes in pH during setting simultaneously initiated the condensation reaction of the hydrolyzed TEOS. This resulted in an interpenetrating phase composite material in which the macropores of the CPC were infiltrated by the microporous silica gel, leading to a higher density and a compressive strength ∼5-10 times higher than the CPC reference. This also altered the release of vancomycin as a model drug, whereby in contrast to the quantitative release from the CPC reference, 25% of the immobilized drug remained in the composite matrix. By varying the TEOS content in the composite, the cement phase composition could be controlled to form either brushite, anhydrous monetite or a biphasic mixture of both. The composites with the highest silicate content showed a cell proliferation similar to a hydroxyapatite reference with a significantly higher activity per cell. Surprisingly, the biological response did not seem to be attributed to the released silicate ions, but to the release of phosphate and the adsorption of magnesium ions from the cell culture medium.

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.

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.

Strontium ions substitution in brushite crystals: the role of strontium chloride

The incorporation of strontium chloride to brushite cement was successful to introduce strontium ions within the lattice of brushite crystals. The effect of strontium ions on brushite cement properties was concentration dependent; such that, the addition of 5% and 10% (w/w) SrCl₂ significantly increased the cement FST and the addition of 10% SrCl₂ decreased the cement tensile strength. Further, cement weight loss was shown to be increased by cement modification with SrCl₂. The combination of ionic substitution and the degradability of brushite cements would constitute a system for the local delivery of strontium ions in the treatment of osteoporosis.

Brushite-Forming Mg-, Zn- and Sr-Substituted Bone Cements for Clinical Applications

Calcium phosphate cements have been in clinical use for the last 10 years. Their most salient features include good biocompatibility, excellent bioactivity, self-setting characteristics, low setting temperature, adequate stiffness, and easy shaping to accomodate any complicated geometry. They are commonly used in filling bone defects and trauma surgeries as mouldable paste-like bone substitute materials. Substitution of trace elements, such as Mg, Sr and Zn ions, into the structure of calcium phosphates is the subject of widespread investigation nowadays, because of their impending role in the biological process. Subtle differences in composition and structure of these materials may have a profound effect on their in vivo behaviour. Therefore, the main goal of this paper is to provide a simple, but comprehensive overview of the present achievements relating to brushite-forming cements doped with Mg, Zn and Sr, and to identify new developments and trends. In particular, the influence of ionic substitution on the chemical, physical and biological properties of these materials is discussed.