Processing and tensile properties of hydroxyapatite-whisker-reinforced polyetheretherketone

Calcium Orthophosphate (CaPO4) Containing Composites for Biomedical Applications: Formulations, Properties, and Applications

The goal of this review is to present a wide range of hybrid formulations and composites containing calcium orthophosphates (abbreviated as CaPO4) that are suitable for use in biomedical applications and currently on the market. The bioactive, biocompatible, and osteoconductive properties of various CaPO4-based formulations make them valuable in the rapidly developing field of biomedical research, both in vitro and in vivo. Due to the brittleness of CaPO4, it is essential to combine the desired osteologic properties of ceramic CaPO4 with those of other compounds to create novel, multifunctional bone graft biomaterials. Consequently, this analysis offers a thorough overview of the hybrid formulations and CaPO4-based composites that are currently known. To do this, a comprehensive search of the literature on the subject was carried out in all significant databases to extract pertinent papers. There have been many formulations found with different material compositions, production methods, structural and bioactive features, and in vitro and in vivo properties. When these formulations contain additional biofunctional ingredients, such as drugs, proteins, enzymes, or antibacterial agents, they offer improved biomedical applications. Moreover, a lot of these formulations allow cell loading and promote the development of smart formulations based on CaPO4. This evaluation also discusses basic problems and scientific difficulties that call for more investigation and advancements. It also indicates perspectives for the future.

An HA/PEEK scaffold with modified crystallinity via 3D-bioprinting for multiple applications in hard tissue engineering

Hard tissues, especially teeth and bones, are highly mineralized and the large-scale defect or total loss of them is irreversible. There is still no ideal strategy for the reconstruction of various hard tissue defects that can achieve the balance between biological and mechanical properties. Polyether ether ketone (PEEK) has the potential to substitute for natural hard tissue in defect areas but is limited by its biological inertness. The addition of hydroxyapatite (HA) can significantly improve the osteogenic properties and osteointegration of PEEK materials. But the mechanical properties of HA/PEEK scaffolds are far from satisfaction making scaffolds easy to fracture. We put forward a strategy to balance the mechanical and biological properties of HA/PEEK scaffolds via the regulation of the inner crystallinity and HA mixing ratio and we systematically evaluated the modified HA/PEEK scaffolds through material characterization,in vitroandin vivoexperiments. And we found that the 20%HA/PEEK scaffolds with low crystallinity achieved the required strength and elasticity, and exhibited the characteristics of promoting the proliferation, migration and osteogenic differentiation of bone marrow mesenchymal stem cells. The results of the implantation of beagles' teeth, mandible and rib showed that the 20%HA/PEEK scaffold with low crystallinity could well withstand the local complex force in the defect area and combine well with natural bone tissue, which made it a candidate for a practical versatile hard tissue engineering scaffold.

Amyloid-Mediated Nanoarchitectonics with Biomimetic Mineralization of Polyetheretherketone for Enhanced Osseointegration

Polyetheretherketone (PEEK), a widely used implant material, has attracted the attention of scientific researchers because of its bone-matched elastic modulus, radiolucency, and chemical resistance. However, the bioinert chemical properties of PEEK do not promote bone apposition once implanted. In this study, using a phase-transitioned lysozyme (PTL) nanofilm as a sandwiched layer, a robust hydroxyapatite (HAp) coating on PEEK (HAp@PTL@PEEK) is constructed. The PTL nanofilm shows strong adhesion to the PEEK surface and induces biomimetic mineralization to form a compact HAp coating on PEEK in simulated body fluids. This HAp coating not only shares a higher adhesion strength and better stability but can also be applied to implants with complex 3D structures. HAp@PTL@PEEK showed significantly enhanced osteogenic capacity when cultured with rat bone marrow mesenchymal stem cells by promoting initial cell adhesion, proliferation, and osteogenic differentiation in vitro. In vivo evaluations utilizing models of femoral condyle defects and skull defects confirm that the HAp coating substantially augments bone remodeling and osseointegration ability. Compared with the traditional method, our modified method is simpler, more environmentally friendly, and uses less hazardous components. Furthermore, the obtained HAp coating shares a higher adhesion strength to PEEK and a better osteogenic capacity. The study offers a novel method to improve the osseointegration of PEEK-based implants in biointerfaces and tissue engineering.

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

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

Fabrication and properties of interweaved poly(ether ether ketone) composite scaffolds

This paper interweaved scaffolds with poly(ether ether ketone) (PEEK) and poly(lactic acid)/Walnut shell/hydroxypatite (PLA/WS/HA) composites by using fused filament fabrication technology, although there was a huge difference in thermal property term between PLA and PEEK. In order to keep mechanical properties of PEEK scaffold and remedy the stress loss produced by pores, PLA/WS/HA composites were used to fill the pores with gradient form outside-in (0.4-0.8 mm, 0.6-1.0 mm, 0.8-1.2 mm and 1.6-2.0 mm). The thermal stability, tensile and compression properties, tensile fracture surface morphology, cytotoxicity and in vivo experiment were investigated. The results showed: the scaffolds were intact without any flashes and surface destruction, and kept a well thermal stability. Compared with the PEEK porous scaffolds, the tensile fracture stress and strain, compression yield stress and strain of interweaved scaffolds were dramatically enhanced by 24.1%, 438%, 359.1% and 921.2%, respectively, and they climbed to the climax at 8 wt% of WS. In vivo experiment showed that the degradation of PLA/WS/HA composites synchronized with the adhesion, proliferation and ingrowth of bone cells, keeping the stable biomechanical properties of interweaved scaffolds. Those experiments showed that interweaved PEEK-PLA/WS/HA scaffolds had the potential to be used as bone implant in tissue engineering.

Strategies to improve bioactive and antibacterial properties of polyetheretherketone (PEEK) for use as orthopedic implants

Polyetheretherketone (PEEK) has gradually become the mainstream material for preparing orthopedic implants due to its similar elastic modulus to human bone, high strength, excellent wear resistance, radiolucency, and biocompatibility. Since the 1990s, PEEK has increasingly been used in orthopedics. Yet, the widespread application of PEEK is limited by its bio-inertness, hydrophobicity, and susceptibility to microbial infections. Further enhancing the osteogenic properties of PEEK-based implants remains a difficult task. This article reviews some modification methods of PEEK in the last five years, including surface modification of PEEK or incorporating materials into the PEEK matrix. For surface modification, PEEK can be modified by chemical treatment, physical treatment, or surface coating with bioactive substances. For PEEK composite material, adding bioactive filler into PEEK through the melting blending method or 3D printing technology can increase the biological activity of PEEK. In addition, some modification methods such as sulfonation treatment of PEEK or grafting antibacterial substances on PEEK can enhance the antibacterial performance of PEEK. These strategies aim to improve the bioactive and antibacterial properties of the modified PEEK. The researchers believe that these modifications could provide valuable guidance on the future design of PEEK orthopedic implants.

The Synthesis of Hydroxyapatite by Hydrothermal Process with Calcium Lactate Pentahydrate: The Effect of Reagent Concentrations, pH, Temperature, and Pressure

Hydroxyapatite and other calcium phosphates in the form of whiskers are lately widely considered as fillers for biocomposites due to their special biological and reinforcing properties. Depending on the method of synthesis, apatite whiskers of various sizes and phase composition can be obtained. In our work, hydroxyapatite (HAp) whiskers were successfully prepared in reaction between calcium lactate pentahydrate and orthophosphoric acid. The advantage of the proposed technique is the simple but precise control of the HAp crystal morphology and high product purity which is necessary for biomedical applications. The effect of reagent concentrations, pH, reaction temperature, and pressure on HAp whiskers' morphology and composition was investigated. In the result, we obtained hydroxyapatite of different morphology such as whiskers, hexagonal rods, and nanorods. The products were characterized by SEM, XRD, and FTIR. In this work, the synthesis of HAp whiskers by direct decomposition of calcium lactate pentahydrate chelates under hydrothermal conditions was showed for the first time.

Modification of polyetheretherketone (PEEK) physical features to improve osteointegration

Polyetheretherketone (PEEK) has been widely applied in orthopedics because of its excellent mechanical properties, radiolucency, and biocompatibility. However, the bioinertness and poor osteointegration of PEEK have greatly limited its further application. Growing evidence proves that physical factors of implants, including their architecture, surface morphology, stiffness, and mechanical stimulation, matter as much as the composition of their surface chemistry. This review focuses on the multiple strategies for the physical modification of PEEK implants through adjusting their architecture, surface morphology, and stiffness. Many research findings show that transforming the architecture and incorporating reinforcing fillers into PEEK can affect both its mechanical strength and cellular responses. Modified PEEK surfaces at the macro scale and micro/nano scale have positive effects on cell-substrate interactions. More investigations are necessary to reach consensus on the optimal design of PEEK implants and to explore the efficiency of various functional implant surfaces. Soft-tissue integration has been ignored, though evidence shows that physical modifications also improve the adhesion of soft tissue. In the future, ideal PEEK implants should have a desirable topological structure with better surface hydrophilicity and optimum surface chemistry.

Endowing Polyetheretherketone Implants with Osseointegration Properties: In Situ Construction of Patterned Nanorod Arrays

Polyetheretherketone (PEEK) is widely used in orthopedic and craniomaxillofacial surgeries as it exhibits excellent biocompatibility, mechanical property, and chemical stability. However, its clinical application is limited by the biological inertness of PEEK. Numerous efforts have been made to improve the bioactivity of this polymer over the years. However, modification methods that can not only promote osteogenesis but also maintain excellent properties are still limited. Hence, a facile hot die formation technique is developed for establishing patterned nanorod arrays on the PEEK surface in situ. This method can maintain the excellent properties of PEEK and can be used in implantation as it can facilitate osteogenic activity in the absence of any organic/inorganic differentiation-inducing factors. PEEK with 200-nm patterned nanorod arrays on the surface exhibits excellent osteogenic properties. This result is obtained by assessing the osteogenic differentiation properties of rat adipose-derived stem cells at the gene and protein levels in vitro. In vivo experimental results reveal that the surface-modified cylindrical PEEK 200 implants present with excellent osseointegration properties. Moreover, they can tightly bind with the surrounding bone tissue. A practical method for manufacturing single-component PEEK implants with excellent osseointegration properties is reported, and the materials can be possibly used as orthopedic implants.

3D-Printed Strong Dental Crown with Multi-Scale Ordered Architecture, High-Precision, and Bioactivity

Mimicking the multi-scale highly ordered hydroxyapatite (HAp) nanocrystal structure of the natural tooth enamel remains a great challenge. Herein, a bottom-up step-by-step strategy is developed using extrusion-based 3D printing technology to achieve a high-precision dental crown with multi-scale highly ordered HAp structure. In this study, hybrid resin-based composites (RBCs) with "supergravity +" HAp nanorods can be printed smoothly via direct ink writing (DIW) 3D printing, induced by shear force through a custom-built nozzle with a gradually shrinking channel. The theoretical simulation results of finite element method are consistent with the experimental results. The HAp nanorods are first highly oriented along a programmable printing direction in a single printed fiber, then arranged in a layer by adjusting the printing path, and finally 3D printed into a highly ordered and complex crown structure. The printed samples with criss-crossed layers by interrupting crack propagation exhibit a flexural strength of 134.1 ± 3.9 MPa and a compressive strength of 361.6 ± 8.9 MPa, which are superior to the corresponding values of traditional molding counterparts. The HAp-monodispersed RBCs are successfully used to print strong and bioactive dental crowns with a printing accuracy of 95%. This new approach can help provide customized components for the clinical restoration of teeth.

Graphene oxide-reinforced poly (ether-ether-ketone)/silica composites with improved mechanical performance and surface bioactivity

The control of interfacial interaction between polymers and fillers is essential for the fabrication of high-performance polymer composites. In this work, poly(ether-ether-ketone)/silica (PEEK/SiO₂) and PEEK/SiO₂/graphene oxide (GO) composite were prepared by ball milling-ultrasonic dispersion combined with melt extrusion injection molding. GO nanosheets were introduced as the interfacial enhancer to improve interfacial binding between SiO₂ and PEEK. Mechanical tests showed that the incorporation of SiO₂ and GO greatly optimized the modulus, strength, and fracture toughness of the composites. The tensile strength and Young's modulus of the PEEK/SiO₂ composites increases with the increase of SiO₂ content. The maximum tensile strength and Young's modulus of the PEEK/SiO₂ composites are approximate 95.9 ± 0.6 MPa and 4.007 ± 0.005 GPa at 30 wt% of SiO₂, an increase of 6.4% and 21.2% than that of pure PEEK. The maximum tensile strength and Young's modulus of the PEEK/SiO₂/GO composite are further improved to approximate 101.5 ± 0.7 MPa and 4.62 ± 0.08 GPa at a GO content of 1.5% wt, which is 12.6% and 39.4% higher than that of pure PEEK. In addition, SEM images show that numerous HA formed on the surface of the PEEK/SiO₂/GO composite after immersion in SBF for 7 days, and the HA layer becomes gradually thicker after 14 days, implying the good osteogenic activity of PEEK/SiO₂/GO composites. Therefore, these results suggest that the use of GO as a novel filler surface modifier for the preparation of high-performance composites may become a novel interfacial design strategy for the development of high-performance composites.

3D printed PEEK/HA composites for bone tissue engineering applications: Effect of material formulation on mechanical performance and bioactive potential

Polyetheretherketone (PEEK) is a biocompatible polymer widely used for biomedical applications. Because it is biologically inert, bioactive phases, such as nano-hydroxyapatite (HA), have been added to PEEK in order to improve its bioactivity. 3D printing (3DP) technologies are being increasingly used today to manufacture patient specific devices and implants. However, processing of PEEK is challenging due to its high melting point which is above 340 °C. In this study, PEEK-based filaments containing 10 wt% of pure nano-HA, strontium (Sr)- doped nano-HA and Zinc (Zn)-doped nano-HA were produced via hot-melt extrusion and subsequently 3D printed via fused deposition modelling (FDM), following an initial optimization process. The raw materials, extruded filaments and 3D printed samples were characterized in terms of physicochemical, thermal and morphological analysis. Moreover, the mechanical performance of 3D printed specimens was assessed via tensile tensing. Although an increase in the melting point and a reduction in crystallization temperature was observed with the addition of HA and doped HA to pure PEEK, there was no noticeable increase in the degree of crystallinity. Regarding the mechanical behavior, no significant differences were detected following the addition of the inorganic phases to the polymeric matrix, although a small reduction in the ultimate tensile strength (~14%) and Young's modulus (~5%) in PEEK/HA was observed in comparison to pure PEEK. Moreover, in vitro bioactivity of 3D printed samples was evaluated via a simulated body fluid immersion test for up to 28 days; the formation of apatite was observed on the surfaces of sample surfaces containing HA, SrHA and ZnHA. These results indicate the potential to produce bioactive, 3DP PEEK composites for challenging applications such as in craniofacial bone repair.

Effect of Low Hydroxyapatite Loading Fraction on the Mechanical and Tribological Characteristics of Poly(Methyl Methacrylate) Nanocomposites for Dentures

Denture base materials need appropriate mechanical and tribological characteristics to endure different stresses inside the mouth. This study investigates the properties of poly(methyl methacrylate) (PMMA) reinforced with different low loading fractions (0, 0.2, 0.4, 0.6, and 0.8 wt.%) of hydroxyapatite (HA) nanoparticles. HA nanoparticles with different loading fractions are homogenously dispersed in the PMMA matrix through mechanical mixing. The resulting density, Compressive Young's modulus, compressive yield strength, ductility, fracture toughness, and hardness were evaluated experimentally; the friction coefficient and wear were estimated by rubbing the PMMA/HA nanocomposites against stainless steel and PMMA counterparts. A finite element model was built to determine the wear layer thickness and the stress distribution along the nanocomposite surfaces during the friction process. In addition, the wear mechanisms were elucidated via scanning electron microscopy. The results indicate that increasing the concentration of HA nanoparticles increases the stiffness, compressive yield strength, toughness, ductility, and hardness of the PMMA nanocomposite. Moreover, tribological tests show that increasing the nanoparticle weight fraction considerably decreases the friction coefficient and wear loss.

Both Phosphonic Acid- and Fluorine-Containing Poly(aryl ether)-hydroxyapatite Biocomposites: Toward Enhanced Biocompatibility and Bonelike Elastic Modulus

Metal-based implants possess excellent mechanical strength, corrosion resistance, and biocompatibility and can deliver favorable performances in clinic treatments. However, modulus mismatching is considered a common defect for metal-based materials, while polymer-based materials with a bonelike elastic modulus have been regarded as one of the most promising candidates for bone replacement implants. In this work, a phosphonic acid- and fluorine-containing poly(aryl ether) (PAE) resin is designed and synthesized, which is determined to be an amorphous polymer with excellent thermostability. The elastic modulus of composites is improved to 15.7 GPa by reinforcing with 60 wt % hydroxyapatite (HA), which demonstrates admirable protein adsorption and hydrophilicity. After 14 days of immersion in simulated body fluid, a layer of HA deposition can be observed, indicating favorable bioactivity in advance, and the preliminary in vitro cell experiments also suggest that PAE-HA composites possess favorable cell responses on adhesion, proliferation, and differentiation, which reveal the feasibility of synthesized polymers to be employed as bone replacement materials, while the adjustability in molecular chains also leaves room for further investigations.

Polyetheretherketone and Its Composites for Bone Replacement and Regeneration

In this article, recent advances in the development, preparation, biocompatibility and mechanical properties of polyetheretherketone (PEEK) and its composites for hard and soft tissue engineering are reviewed. PEEK has been widely employed for fabricating spinal fusions due to its radiolucency, chemical stability and superior sterilization resistance at high temperatures. PEEK can also be tailored into patient-specific implants for treating orbital and craniofacial defects in combination with additive manufacturing process. However, PEEK is bioinert, lacking osseointegration after implantation. Accordingly, several approaches including surface roughening, thin film coating technology, and addition of bioactive hydroxyapatite (HA) micro-/nanofillers have been adopted to improve osseointegration performance. The elastic modulus of PEEK is 3.7-4.0 GPa, being considerably lower than that of human cortical bone ranging from 7-30 GPa. Thus, PEEK is not stiff enough to sustain applied stress in load-bearing orthopedic implants. Therefore, HA micro-/nanofillers, continuous and discontinuous carbon fibers are incorporated into PEEK for enhancing its stiffness for load-bearing applications. Among these, carbon fibers are more effective than HA micro-/nanofillers in providing additional stiffness and load-bearing capabilities. In particular, the tensile properties of PEEK composite with 30wt% short carbon fibers resemble those of cortical bone. Hydrophobic PEEK shows no degradation behavior, thus hampering its use for making porous bone scaffolds. PEEK can be blended with hydrophilic polymers such as polyglycolic acid and polyvinyl alcohol to produce biodegradable scaffolds for bone tissue engineering applications.

Preparation of Poly(ether-ether-ketone)/Nanohydroxyapatite Composites with Improved Mechanical Performance and Biointerfacial Affinity

Poly(ether-ether-ketone) (PEEK) displays promising potential in hard tissue repair and orthopedic surgery due to its adaptable mechanical performance, good chemical resistance, and bioinertness. However, the low biointerfacial affinity of pure PEEK implants and the decrease of mechanical strength after processing greatly limit their clinical applications. In this work, the influences on mechanical performance and biointerfacial affinity of the PEEK/nanohydroxyapatite (nHA) composites are systematically investigated. Results show that the mechanical performance of PEEK/nHA composites was improved by adjusting the nHA content. The maximum values of the tensile, compressive, bending, and impact strength of the composites were increased by approximately 16.2, 25, 54, and 21%, respectively, when compared with that of pure PEEK. Studies in vitro show that PEEK/nHA composites display good cytocompatibility and promote the biomimic formation of HA, adhesion, and proliferation of L929 cells on the surface. Studies in vivo demonstrate that, compared to the pure PEEK, PEEK/nHA composites exhibit higher biointerfacial affinity, including the adhesion and encapsulation of muscle tissues on the surface of the implants and the suppression of inflammatory reaction around the implants. Our findings could pave the way for extensive applications of PEEK/nHA composites in hard tissue repair, particularly orthopedic surgery.

Preparation of Amorphous Poly(aryl ether nitrile ketone) and Its Composites with Nano Hydroxyapatite for 3D Artificial Bone Printing

PEEK had been used to fabricate artificial bones by 3D printing widely, but it expressed unsatisfactory interlayer performance of 3D printing and weak compatibility with nano hydroxyapatite(nHA) due to the limits of molecular structures. Here an amorphous poly(aryl ether ketone) for 3D bone printing, PEK-CN, was designed and synthesized via nucleophilic substitution from 4,4'-difluorobenzophenone, phenolphthalein and 2,6-dichlorobenzonitrile, which possessed much stronger interlayer strength due to van der Waals force between polar groups(-CNs). Specifically, the stronger interlayer strength resulted in lower porosity(3% with 100% infill rate) and more comparable mechanical properties(the maximum tensile strength was ∼110 MPa) to cortical bone. Importantly, PEK-CN had passed in vitro cytotoxicity testing and samples of human mandible and maxillary bones based on PEK-CN were printed by fused deposition modeling(FDM) successfully. Moreover, PEK-CN/nHA composites were obtained to enhance bioactivity of resin, and PEK-CN without limits of crystal lattices expressed excellent compatibility with nano hydroxyapatite. Our work provided a high performance resin for 3D bone printing, which would bring better solutions for artificial bone materials.

Undercut macrostructure topography on and within an interbody cage improves biomechanical stability and interbody fusion

BACKGROUND CONTEXT

The interface and interactions between an interbody cage, graft material, and host bone can all participate in the fusion. Shortcomings of Poly(aryl-ether-ether-ketone) interbody cages have been addressed with novel titanium surfaces. Titanium surfaces paired with macroscale topography features on the endplates and within the aperture may provide additional benefits.

PURPOSE

To evaluate the influence of cage design parameters on interbody fusion in a large animal preclinical model.

STUDY DESIGN/SETTING

A comparative preclinical large animal model was performed to evaluate how macroscale topography features of an interbody cage can facilitate early integration between the host bone, graft material, and interbody cage and these effects on biomechanical stability and fusion.

METHODS

Forty single level interbody fusions (L4-L5) using iliac crest autograft and bilateral pedicle screw fixation were performed in adult sheep to evaluate the effect of undercut macrostructure topography features of an interbody cage on the endplates and within the aperture. Fusions were evaluated at 6 and 12 weeks (n=10 per group) using radiography, microcomputed tomography, biomechanical integrity, and histology endpoints.

RESULTS

The presence of the undercut macrostructures present on the endplates and within the aperture statistically improved biomechanical integrity at 6 and 12 weeks compared with controls. Microcomputed tomography and histology demonstrated bony interdigitation within the endplate and aperture features contributing to the improvement in properties.

CONCLUSIONS

The present study demonstrates that Poly(aryl-ether-ether-ketone) implants with titanium surfaces can be augmented by undercut macrostructures present on the endplates and within the aperture to provide opportunities for a series of anchoring points that, with new bone formation and remodelling, result in earlier and improved biomechanical integrity of the treated level.

CLINICAL SIGNIFICANCE

This preclinical study showed that bone interdigitation with the undercut macrostructures present on the endplates and within the aperture resulted in improved fusion and biomechanical stability in a clinically relevant spinal fusion model. Future clinical study is warranted to evaluate such implants' performance in humans.

2D titanium carbide(MXene) nanosheets and 1D hydroxyapatite nanowires into free standing nanocomposite membrane: in vitro and in vivo evaluations for bone regeneration

Bone loss or insufficiency remains a great challenge for implant integrated and subsequently functional loading, where developing biomaterials to augment bone quantity and regenerate alveolar bone defects at implant site is vitally necessary. Recently, MXene, as a large new family of 2D materials, exhibits a great prospect in biomedical applications owing to its ultrathin structure and morphology with a range of extraordinary properties such as chemical, electronic, optical and biological properties etc. Besides, hydroxyapatite is a favorable biomaterial with outstanding bioactivity and osteogenic capacity. In this study, we prepared free standing UHAPNWs/MXene nanocomposite membranes via introducing ultralong hydroxyapatite nanowires (UHAPNWs) with different weight ratios into MXene to explore their potential in bone regeneration. SEM, XPS, FTIR, XRD, tensile strength, Young's modulus and water contact angles were used to characterize the morphology, chemical composition, surface properties, mechanical properties and hydrophilicity of the materials. Subsequently, in vitro studies like cell adhesion, proliferation and osteogenic differentiation of MC3T3-E1 were evaluated. The incorporation of UHAPNWs improved mechanical properties and hydrophilicity with an enhancement in cell adhesion, proliferation, and osteogenic differentiation. More importantly, 10 wt% UHAPNWs/MXene exhibited the optimal mechanical properties while biological improvement was more pronounced along with the addition of UHAPNWs when the weight fraction of UHAPNWs was from 0 to 30 wt%. Furthermore, in vivo experiments the UHAPNWs/MXene nanocomposite membranes effectively enhanced bone tissue formation quantitatively and qualitatively in a rat calvarial bone defect. Therefore, an appropriate amount of UHAPNWs into MXene plays a positive and evident role in enhancing mechanical properties, biocompatibility and osteoinductivity, leading a novel inorganic composite material for regeneration of bone tissue.

Fabrication and characterization of an electrostatically bonded PEEK- hydroxyapatite composites for biomedical applications

In this study, it was aimed to produce electrostatically induced polyetheretherketone (PEEK) and strontium substituted hydroxyapatite (SrHA) composites. SrHA nanoparticles (5 and 10 vol%) were introduced in the PEEK matrix to increase its mechanical properties and osseointegration. In order to disperse and homogeneously distribute the nanoparticles within the matrix, an electrostatic bond was developed between the PEEK and nanoparticles by wet processing through the attraction of the oppositely charged particles. Particles were pressed and sintered according to the Taguchi Design of experiments (DoE) array. The effects of SrHA reinforcement, sintering temperature and time on the density, crystallinity and crystallite sizes were determined with density test, DSC and XRD, respectively. The disks were also analyzed via SEM, FTIR, compression, microhardness, and nanoindentation tests and were immersed into the simulated body fluid (SBF). The composites produced from electrostatically induced powders presented a homogenous microstructure as SEM analysis illustrated the homogenous dispersion and distribution of the SrHA nanoparticles. The SrHA nanoparticles decreased the relative density and crystallinity of the composite, whereas, the rise in the sintering temperature and time enhanced the relative density, according to the DoE results. SrHA reinforcement improved the reduced modulus and nanoindentation hardness of the PEEK (348.47 MPa, 5.97 GPa) to 392.02 MPa and 6.65 GPa, respectively. SrHA promoted the bioactivity of the composite: an apatite layer covered the surface of PEEK/10SrHA composite after 14 days incubation. These promising results suggest that the electrostatically bonded composite powders would be used to produce homogenous PEEK based bioactive composites.

Mechanical properties, hemocompatibility, cytotoxicity and systemic toxicity of carbon fibers/poly(ether-ether-ketone) composites with different fiber lengths as orthopedic implants

Poly(ether-ether-ketone) (PEEK) has attracted more and more attention due to its chemical resistance, biocompatibility and other properties. Furthermore, carbon fibers-PEEK composite (CF-PEEK) has been considered as a novel implant because of its high mechanical strength and elastic modulus that matching with human bones. However, the length of CF has a great influence on mechanical strength and elastic modulus of the randomly distributed chopped CF-PEEK composites. In this work, CF-PEEK composites with more than 10 times length difference of fibers (length of short CF: 150-200 μm and length of long CF: 2-3 mm) were studied. As the results shown, the mechanical strength (including tensile strength, bending strength and compressive strength) of long CF-PEEK composites were more than two times of that of short CF-PEEK composites. Meanwhile, tensile modulus and bending modulus of the two kinds of composites matched well with the modulus of human cortical bone. In addition, according to the results of cytotoxicity test and hemocompatibility assessment, it indicated that the two kinds of CF-PEEK composites showed mild toxicity and no hemolytic reaction. And the histopathological section of systemic toxicity test showed that the CF-PEEK composites had no obvious acute toxicity to organisms.

Bioactive poly(etheretherketone) composite containing calcium polyphosphate and multi-walled carbon nanotubes for bone repair: Mechanical property and in vitro biocompatibility

Poly(etheretherketone) exhibits good biocompatibility, excellent mechanical properties, and bone-like stiffness. However, the natural bio-inertness of pure poly(etheretherketone) hinders its applications in biomedical field, especially when direct bone-implant osteo-integration is desired. For developing an alternative biomaterial for load-bearing orthopedic application, combination of bioactive fillers with poly(etheretherketone) matrix is a feasible approach. In this study, a bioactive multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite was prepared through a compounding and injection-molding process for the first time. Bioactive calcium polyphosphate was added to polymer matrix to enhance the bioactivity of the composite, and incorporation of multi-walled carbon nanotubes to composite was aimed to improve both the mechanical property and biocompatibility. Furthermore, the microstructures, surface hydrophilicity, and mechanical property of multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite, as well as the cellular responses of MC3T3-E1 osteoblast cells to this material were investigated. The mechanical testing revealed that mechanical performance of the resulting ternary composite was significantly enhanced by adding the multi-walled carbon nanotubes and the mechanical values obtained were close to or higher than those of human cortical bone. More importantly, cell culture tests showed that initial cell adhesion, cell viability, and osteogenic differentiation of MC3T3-E1 cells were significantly promoted on the multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite. Accordingly, the multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite may be used as a promising bone repair material in dental and orthopedic applications.

Biofunctional Mg coating on PEEK for improving bioactivity

High purity Mg was successfully coated on polyetheretherketone (PEEK) by vapor deposition method in order to improve the bioactivity including antibacterial property of PEEK implant. The morphology and elemental composition of the coating were characterized by scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS), showing that the coating was mainly composed of Mg at deposition temperature of 175 °C, 185 °C, 200 °C and 230 °C. The higher the substrate temperature was, the larger the Mg particle size was. The coating degraded and gradually peeled off from the surface of PEEK after up to 21 days' immersion. It was found that the degradation of Mg coating could strongly kill Staphylococcus aureus with antibacterial rate reaching to 99%. Mg can be expected to be coated on those bio-inert biomaterials to offer specific bioactivities.

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High purity Mg was coated on PEEK by vapor deposition method.

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The Mg coating degraded and gradually peeled off from the surface of PEEK after up to 21 days immersion.

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The degradation of Mg coating could strongly kill Staphylococcus aureus with antibacterial rate reaching to 99%.

Preparation, mechanical properties and in vitro cytocompatibility of multi-walled carbon nanotubes/poly(etheretherketone) nanocomposites

Desired bone repair material must have excellent biocompatibility and high bioactivity. Moreover, mechanical properties of biomaterial should be equivalent to those of human bones. For developing an alternative biocomposite for load-bearing orthopedic application, combination of bioactive fillers with polymer matrix is a feasible approach. In this study, a series of multi-walled carbon nanotubes (MWCNTs)/poly(etheretherketone) (PEEK) bioactive nanocomposites were prepared by a novel coprecipitation-compounding and injection-molding process. Scanning electron microscope (SEM) images revealed that MWCNTs were adsorbed on the surface of PEEK particles during the coprecipitation-compounding process and dispersed homogeneously in the nanocomposite because the conjugated PEEK polymers stabilized MWCNTs by forming strong π-π stack interactions. The mechanical testing revealed that mechanical performance of PEEK was significantly improved by adding MWCNTs (2-8 wt%) and the experimental values obtained were close to or higher than that of human cortical bone. In addition, incorporation of MWCNTs into PEEK matrix also enhanced the roughness and hydrophilicity of the nanocomposite surface. In vitro cytocompatibility tests demonstrated that the MWCNTs/PEEK nanocomposite was in favor of cell adhesion and proliferation of MC3T3-E1 osteoblast cells, exhibiting excellent cytocompatibility and biocompatibility. Thus, this MWCNTs/PEEK nanocomposite may be used as a promising bone repair material in orthopedic implants application.

A novel composite scaffold comprising ultralong hydroxyapatite microtubes and chitosan: preparation and application in drug delivery

The composite scaffold comprising ultralong hydroxyapatite microtubes and chitosan with high drug loading capacity and sustained drug release properties has been successfully prepared.

Nanohydroxyapatite Effect on the Degradation, Osteoconduction and Mechanical Properties of Polymeric Bone Tissue Engineered Scaffolds

BACKGROUND

Statistical reports show that every year around the world approximately 15 million bone fractures occur; of which up to 10% fail to heal completely and hence lead to complications of non-union healing. In the past, autografts or allografts were used as the “gold standard” of treating such defects. However, due to various limitations and risks associated with these sources of bone grafts, other avenues have been extensively investigated through which bone tissue engineering; in particular engineering of synthetic bone graft substitutes, has been recognised as a promising alternative to the traditional methods.

METHODS

A selective literature search was performed.

RESULTS

Bone tissue engineering offers unlimited supply, eliminated risk of disease transmission and relatively low cost. It could also lead to patient specific design and manufacture of implants, prosthesis and bone related devices. A potentially promising building block for a suitable scaffold is synthetic nanohydroxyapatite incorporated into synthetic polymers. Incorporation of nanohydroxyapatite into synthetic polymers has shown promising bioactivity, osteoconductivity, mechanical properties and degradation profile compared to other techniques previously considered.

CONCLUSION

Scientific research, through extensive physiochemical characterisation, in vitro and in vivo assessment has brought together the optimum characteristics of nanohydroxyapatite and various types of synthetic polymers in order to develop nanocomposites of suitable nature for bone tissue engineering. The aim of the present article is to review and update various aspects involved in incorporation of synthetic nanohydroxyapatite into synthetic polymers, in terms of their potentials to promote bone growth and regeneration in vitro, in vivo and consequently in clinical applications.

Polyetheretherketone Hybrid Composites with Bioactive Nanohydroxyapatite and Multiwalled Carbon Nanotube Fillers

Polyetheretherketone (PEEK) hybrid composites reinforced with inorganic nanohydroxyapatite (nHA) and multiwalled carbon nanotube (MWNT) were prepared by melt-compounding and injection molding processes. The additions of nHA and MWNT to PEEK were aimed to increase its elastic modulus, tensile strength, and biocompatibility, rendering the hybrids suitable for load-bearing implant applications. The structural behavior, mechanical property, wettability, osteoblastic cell adhesion, proliferation, differentiation, and mineralization of the PEEK/nHA-MWNT hybrids were studied. X-ray diffraction and SEM observation showed that both nHA and MWNT fillers are incorporated into the polymer matrix of PEEK-based hybrids. Tensile tests indicated that the elastic modulus of PEEK can be increased from 3.87 to 7.13 GPa by adding 15 vol % nHA and 1.88 vol % MWNT fillers. The tensile strength and elongation at break of the PEEK/(15% nHA)-(1.88% MWNT) hybrid were 64.48 MPa and 1.74%, respectively. Thus the tensile properties of this hybrid were superior to those of human cortical bones. Water contact angle measurements revealed that the PEEK/(15% nHA)-(1.88% MWNT) hybrid is hydrophilic due to the presence of nHA. Accordingly, hydrophilic PEEK/(15% nHA)-(1.88% MWNT) hybrid promoted the adhesion, proliferation, differentiation, and mineralization of murine MC3T3-E1 osteoblasts on its surface effectively on the basis of cell culture, fluorescence microscopy, MTT assay, WST-1 assay, alkaline phosphatase activity, and Alizarin red staining tests. Thus the PEEK/(15% nHA)-(1.88% MWNT) hybrid has the potential to be used for fabricating load-bearing bone implants.

Effect of notch sensitivity on the mechanical properties of HA/PEEK functional gradient biocomposites

Biomaterials used as loading-bearing orthopedic implants usually require various excellent properties such as mechanical, bioactive and bio-tribological performances. Moreover, all of the orthopedic applications feature stress concentrations (notch sensitivity) in their design. In the present work, hydroxyapatite-reinforced polyetheretherketone functional gradient biocomposites (HA/PEEK FGBm) were successfully prepared by the layer stacking method combined with hot pressing molding technology. The effects of notch geometry on the stress-strain behavior of HA/PEEK FGBm were evaluated. The fracture morphology was investigated by scanning electron microscopy (SEM). The study of the stress-strain behavior indicated that the tensile and flexural stresses of HA/PEEK FGBm linearly increased with increasing strain under all the notch sensitivities. The fracture strain of the biocomposites decreased with increasing stress concentration factor and total HA content in the functional biocomposites. Moreover, the tensile and flexural strengths of HA/PEEK FGBm were lower than those of homogeneous HA/PEEK biocomposites. The SEM observation of the fracture micro-morphology showed that the fracture mechanism of HA/PEEK FGBm was gradually controlled by the brittle fracture process. Furthermore, both the tensile and the flexural strengths of HA/PEEK FGBm decreased with the increase in stress concentration factor and total HA content in the biocomposites.

Influence of femtosecond laser on the osteogenetic efficiency of polyetheretherketone and its composite

Objective:

This study aimed to evaluate the effect of a femtosecond laser on the osteogenetic efficiency of polyetheretherketone (PEEK) and its composite for clinical applications.

Methods:

One hundred pieces of PEEK and its composite (6 × 4 × 2 mm3) were randomly divided into four groups and treated as follows: group A1, PEEK; group A2, PEEK + femtosecond laser; group B1, PEEK composite; and group B2, PEEK composite + femtosecond. The surface morphology of the pieces of each group was observed through scanning electron microscopy. The surface roughness and wettability, which were considered as the main parameters affecting cell adhesion characteristics of implants, were measured. The animals whose mandibles were implanted with the four groups of materials were killed at the end of 6 and 12 weeks. Various characterization tests, such as Cone Beam Computed Tomography (CBCT), push-out test, microscope test, and bone implant contact , were conducted to investigate the healing effect between materials and bones.

Results:

In group B1, the nanoparticles in PEEK were uniformly distributed. In groups A2 and B2, many periodic nanostructures were observed. The surface roughness and wettability of group B2 were significantly increased compared to those of the other groups ( p < 0.05). At each time point, the number of trabecular bones, contact strength, and BIC of group B2 were higher than those of the three other groups ( p < 0.05). Compared with those of group A1, the test results of group B1 were significantly improved.

Conclusion:

Femtosecond lasers can effectively enhance the biological activity of PEEK and its composite; PEEK composite exhibits better biological activity than PEEK.

Characterization of New PEEK/HA Composites with 3D HA Network Fabricated by Extrusion Freeforming

Addition of bioactive materials such as calcium phosphates or Bioglass, and incorporation of porosity into polyetheretherketone (PEEK) has been identified as an effective approach to improve bone-implant interfaces and osseointegration of PEEK-based devices. In this paper, a novel production technique based on the extrusion freeforming method is proposed that yields a bioactive PEEK/hydroxyapatite (PEEK/HA) composite with a unique configuration in which the bioactive phase (i.e., HA) distribution is computer-controlled within a PEEK matrix. The 100% interconnectivity of the HA network in the biocomposite confers an advantage over alternative forms of other microstructural configurations. Moreover, the technique can be employed to produce porous PEEK structures with controlled pore size and distribution, facilitating greater cellular infiltration and biological integration of PEEK composites within patient tissue. The results of unconfined, uniaxial compressive tests on these new PEEK/HA biocomposites with 40% HA under both static and cyclic mode were promising, showing the composites possess yield and compressive strength within the range of human cortical bone suitable for load bearing applications. In addition, preliminary evidence supporting initial biological safety of the new technique developed is demonstrated in this paper. Sufficient cell attachment, sustained viability in contact with the sample over a seven-day period, evidence of cell bridging and matrix deposition all confirmed excellent biocompatibility.

Augmenting the bioactivity of polyetheretherketone using a novel accelerated neutral atom beam technique

Polyetheretherketone (PEEK) is an alternative to metallic implants in orthopedic applications; however, PEEK is bioinert and does not osteointegrate. In this study, an accelerated neutral atom beam technique (ANAB) was employed to improve the bioactivity of PEEK. The aim was to investigate the growth of human mesenchymal stem cells (hMSCs), human osteoblasts (hOB), and skin fibroblasts (BR3G) on PEEK and ANAB PEEK.

METHODS

The surface roughness and contact angle of PEEK and ANAB PEEK was measured. Cell metabolic activity, proliferation and alkaline phosphatase (ALP) was measured and cell attachment was determined by quantifying adhesion plaques with cells.

RESULTS

ANAB treatment increased the surface hydrophilicity [91.74 ± 4.80° (PEEK) vs. 74.82 ± 2.70° (ANAB PEEK), p < 0.001] but did not alter the surface roughness. Metabolic activity and proliferation for all cell types significantly increased on ANAB PEEK compared to PEEK (p < 0.05). Significantly increased cell attachment was measured on ANAB PEEK surfaces. MSCs seeded on ANAB PEEK in the presence of osteogenic media, expressed increased levels of ALP compared to untreated PEEK (p < 0.05) CONCLUSION: Our results demonstrated that ANAB treatment increased the cell attachment, metabolic activity, and proliferation on PEEK. ANAB treatment may improve the osteointegration of PEEK implants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1438-1446, 2017.

Polyether ether ketone implants achieve increased bone fusion when coated with nano-sized hydroxyapatite: a histomorphometric study in rabbit bone

Polyether ether ketone (PEEK) possesses excellent mechanical properties similar to those of human bone and is considered the best alternative material other than titanium for orthopedic spine and trauma implants. However, the deficient osteogenic properties and the bioinertness of PEEK limit its fields of application. The aim of this study was to limit these drawbacks by coating the surface of PEEK with nano-scaled hydroxyapatite (HA) minerals. In the study, the biological response to PEEK, with and without HA coating, was investigated. Twenty-four screw-like and apically perforated implants in the rabbit femur were histologically evaluated at 3 weeks and 12 weeks after surgery. Twelve of the 24 implants were HA coated (test), and the remaining 12 served as uncoated PEEK controls. At 3 weeks and 12 weeks, the mean bone–implant contact was higher for test compared to control (P<0.05). The bone area inside the threads was comparable in the two groups, but the perforating hole showed more bone area for the HA-coated implants at both healing points (P<0.01). With these results, we conclude that nano-sized HA coating on PEEK implants significantly improved the osteogenic properties, and in a clinical situation this material composition may serve as an implant where a rapid bone fusion is essential.

Preparation Methods for Improving PEEK's Bioactivity for Orthopedic and Dental Application: A Review

There is an increased interest in the use of polyether ether ketone (PEEK) for orthopedic and dental implant applications due to its elastic modulus close to that of bone, biocompatibility, and its radiolucent properties. However, PEEK is still categorized as bioinert due to its low integration with surrounding tissues. Many studies have reported on methods to increase the bioactivity of PEEK, but there is still one-preparation method for preparing bioactive PEEK implant where the produced implant with desirable mechanical and bioactivity properties is required. The aim of this review is to present the progress of the preparation methods for improvement of the bioactivity of PEEK and to discuss the strengths and weaknesses of the existing methods.

Influence of sulfur content on bone formation and antibacterial ability of sulfonated PEEK

Polyetheretherketone (PEEK) is desirable in orthopedic and dental applications because its mechanical properties are similar to those of natural bones but the bioinertness and inferior osteoconduction of PEEK have hampered many clinical applications. In this work, PEEK is sulfonated by concentrated sulfuric acid to fabricate a three-dimensional (3D) network. A hydrothermal treatment is subsequently conducted to remove the residues and the temperature is adjusted to obtain different sulfur concentrations. In vitro cell proliferation and real-time PCR analyses disclose enhanced proliferation and osteogenic differentiation of rat bone mesenchymal stem cells (rBMSCs) on the samples with small sulfur concentrations. The in vitro antibacterial evaluation reveals that all the sulfonated samples possess excellent resistance against Staphylococcus aureus and Escherichia coli. The in vivo rat femur implantation model is adopted and X-ray, micro-CT, and histological analyses indicate that not only the premeditated injected bacteria cells are sterilized, but also new bone forms around the samples with small sulfur concentrations. The in vitro and in vivo results reveal that the samples subjected to the hydrothermal treatment to remove excess sulfur have better osseointegration and antibacterial ability and PEEK modified by sulfonation and hydrothermal treatment is promising in orthopedic and dental applications.

Preparation of polyetheretherketone composites with nanohydroxyapatite rods and carbon nanofibers having high strength, good biocompatibility and excellent thermal stability

The WST-1 assay shows that the PEEK/15 vol% nHA–1.9 vol% CNF hybrid composite has excellent biocompatibility.

Preparation, characterization, cellular response and in vivo osseointegration of polyetheretherketone/nano-hydroxyapatite/carbon fiber ternary biocomposite

As FDA-approved implantable material, polyetheretherketone (PEEK) is becoming a prime candidate to replace traditional surgical metallic implants made of titanium (Ti) and its alloys, since it has a lower elastic modulus than Ti. The bioinertness and defective osteointegration of PEEK, however, limit its clinical adoption as load-bearing dental/orthopedic material. The present work aimed at developing a PEEK bioactive ternary composite, polyetheretherketone/nano-hydroxyapatite/carbon fiber (PEEK/n-HA/CF), and evaluating it as a potential bone-repairing material by assessment of growth and differentiation of osteoblast-like MG63 cells and by estimation of osteointegration in vivo. Our results indicated that the adhesion, proliferation and osteogenic differentiation of cells, as well as the mechanical properties were greatly promoted for the PEEK/n-HA/CF biocomposite compared with pure PEEK matrix. More importantly, the ternary composite implant boosted in vivo bioactivity and osseointegration in canine tooth defect model. Thus, the PEEK/n-HA/CF ternary biocomposite with enhanced mechanics and biological performances hold great potential as bioactive implant material in dental and orthopedic applications.

Calcium Orthophosphate-Containing Biocomposites and Hybrid Biomaterials for Biomedical Applications

The state-of-the-art on calcium orthophosphate (CaPO4)-containing biocomposites and hybrid biomaterials suitable for biomedical applications is presented. Since these types of biomaterials offer many significant and exciting possibilities for hard tissue regeneration, this subject belongs to a rapidly expanding area of biomedical research. Through the successful combinations of the desired properties of matrix materials with those of fillers (in such systems, CaPO4 might play either role), innovative bone graft biomaterials can be designed. Various types of CaPO4-based biocomposites and hybrid biomaterials those are either already in use or being investigated for biomedical applications are extensively discussed. Many different formulations in terms of the material constituents, fabrication technologies, structural and bioactive properties, as well as both in vitro and in vivo characteristics have been already proposed. Among the others, the nano-structurally controlled biocomposites, those containing nanodimensional compounds, biomimetically fabricated formulations with collagen, chitin and/or gelatin, as well as various functionally graded structures seem to be the most promising candidates for clinical applications. The specific advantages of using CaPO4-based biocomposites and hybrid biomaterials in the selected applications are highlighted. As the way from a laboratory to a hospital is a long one and the prospective biomedical candidates have to meet many different necessities, the critical issues and scientific challenges that require further research and development are also examined.