Accelerated bone ingrowth by local delivery of strontium from surface functionalized titanium implants

Vanadium and strontium co-doped hydroxyapatite enriched polycaprolactone matrices for effective bone tissue engineering: A synergistic approach

Scientific research targeted at enhancing scaffold qualities has increased significantly during the last few decades. This emphasis frequently centres on adding different functions to scaffolds in order to increase their usefulness as instruments in the field of regenerative medicine. This study aims to investigate the efficacy of a multifunctional sustainable polymer scaffold, specifically Polycaprolactone (PCL) embedded with hydroxyapatite co-doped with vanadium and strontium (HVS), for bone tissue engineering applications. Polycaprolactone was used to fabricate the scaffold, while hydroxyapatite co-doped with vanadium and strontium (HVS) served as the nanofiller. A thorough investigation of the physicochemical and biological characteristics of the HVS nanofiller was carried out using cutting-edge techniques including Dynamic Light Scattering (DLS), and X-ray Photoelectron Spectroscopy (XPS) and in vitro cell studies. A cell viability rate of more than 70 % demonstrated that the synthesised nanofiller was cytotoxic, but in an acceptable range. The mechanical, biological, and physicochemical properties of the scaffold were extensively evaluated after the nanofiller was integrated. The water absorption characteristics of scaffold were enhanced by the addition of HVS nanofillers, leading to increased swelling, porosity, and hydrophilicity. These improvements speed up the flow of nutrients and the infiltration of cells into the scaffold. The scaffold has been shown to have important properties that stimulate bone cell activity, including better biodegradability and improved mechanical strength, which increased from 5.30 ± 0.37 to 10.58 ± 0.42 MPa. Further, its considerable antimicrobial qualities, blood-compatible nature, and capacity to promote biomineralization strengthen its appropriateness for usage in biomedical applications. Mainly, enhanced Alkaline phosphatase (ALP) activity, Alizarin Red Staining (ARS) activity, and excellent cell adhesive properties, indicating the outstanding osteogenic potential observed in rat bone marrow-derived stromal cells (rBMSC). These combined attributes highlight the pivotal role of these nanocomposite scaffolds in the field of bone tissue engineering.

Laser-assisted manipulation of Volta potential pattern on the TC4 surface for improved hBMSCs osteogenesis

The Ti6Al4V (TC4) alloy, a prevalent biomedical material in orthopedics, still faces limitation of the insufficient osseointegration. To improve the bioactivity of TC4, introducing the electric environment onto the TC4 surface may be an effective way in the view of the necessity of endogenous electric microenvironment in bone regeneration. Herein, a Volta potential pattern was engendered on the TC4 surface via parallel laser patterning, so as to promote the osteogenic differentiation of cells. A 15 W laser successfully transformed the original α + β dual phase towards radially distributed lath-like martensite phase in the laser treated region. The atomic lattice distortion between the heterogeneous microstructures of the laser treated and untreated regions leads to a significant Volta potential fluctuation on the TC4 surface. The Volta potential pattern as well as the laser-engraved microgrooves respectively induced mutually orthogonal cell alignments. The hBMSCs osteogenic differentiation was significantly enhanced on the laser treated TC4 surfaces in comparison to the surface without the laser treatment. Moreover, a drastic Volta potential gradient on the TC4 surface (treated with 15 W power and 400 μm interval) resulted in the most pronounced osteogenic differentiation tendency compared to other groups. Modulating the electric environment on the TC4 surface by manipulating the phase transformation may provide an effective way in evoking favorable cell response of bone regeneration, thereby improving the bioactivity of TC4 implant.

Improved Biocompatibility and Angiogenesis of the Bone Titanium Scaffold through ERK1/2 Signaling Mediated by an Attached Strontium Element

The promotion of early osseointegration is crucial for the success of biomedical titanium implants. Physical and chemical modifications to the material surface can significantly compensate for the lack of biocompatibility and early osseointegration of the implant. In this study, we implanted strontium onto titanium plates and analyzed the effect of strontium-doped materials on angiogenesis and biocompatibility in the human bone structure. Our findings demonstrated that strontium-loaded titanium sheet materials effectively promote human umbilical vein endothelial cell (HUVEC) biocompatibility and vascular differentiation ability, as evidenced by proliferation-apoptosis assays, RT-qPCR for vascular neogenesis markers, ELISA for vascular endothelial growth factor (VEGF) levels, and nitric oxide (NO) analysis. Mechanism studies based on RNAseq and Western blotting analysis revealed that strontium can promote titanium material biocompatibility with HUVEC cells and vascular neovascularization ability by activating the extracellular signal-regulated kinase 1/2 (ERK1/2) signaling pathway. Meanwhile, blocking the ERK1/2 signaling pathway could reverse the promotional effect of vascular formation. Overall, we have successfully fabricated a multifunctional biocompatible bone implant with better histocompatibility and angiogenesis compared to uncoated implants.

Assessing the osseointegration potential of a strontium releasing nanostructured titanium oxide surface: A biomechanical study in the rabbit tibia plateau model

OBJECTIVES

To investigate the impact of a Ti-Sr-O technology, applied to either a turned surface or an SLA surface, on the mechanical robustness of osseointegration, benchmarked against the SLActive surface.

MATERIAL AND METHODS

Ti discs (6.25-mm-diameter and 2-mm-thick) with three different surfaces were inserted on the proximal-anterior part of the tibial plateau of adult Swedish loop rabbits: (I) turned surface modified with Ti-Sr-O (turned + Ti-Sr-O), (II) SLA surface modified with Ti-Sr-O (SLA + Ti-Sr-O), and (III) SLActive surface (SLActive). Following a healing period of 2 weeks and 4 weeks, the pull-out (PO) force needed to detach the discs from the bone was assessed, as a surrogate of osseointegration.

RESULTS

The SLActive surface exhibited statistically significant higher median PO forces, compared with the SLA + Ti-Sr-O surfaces at both 2- and 4 weeks post-op (p > .05). In this study, no single turned + Ti-Sr-O surface disk was integrated.

CONCLUSIONS

The tested Ti-Sr-O technology failed to enhance osseointegration; however, this finding may be related to the inappropriateness of the rabbit tibia plateau model for assessing third-generation implant surface technologies, due to the limited diffusion and clearance at the disk-bone interface.

Effects of aligned PLGA/SrCSH composite scaffolds on in vitro growth and osteogenic differentiation of human mesenchymal stem cells

Strontium (Sr) has important functions in bone remodeling. Incorporating strontium-doped α-calcium sulfate hemihydrate (SrCSH) into poly(lactic-co-glycolic acid) (PLGA) fibrous scaffolds were expected to increase its bio-activity and provide a potential material for bone tissue engineering. In the present study, Sr-containing aligned PLGA/SrCSH fibrous scaffolds similar to the architecture of natural bone were prepared via wet spinning. CCK-8 assay revealed that Sr-containing scaffolds possessed better bioactivity and supported favorable cell growth effectively. The aligned PLGA/SrCSH fibers exerted a contact effect on cell attachment, inducing regular cell alignment and influencing a series of cell behaviors. Releasing of high concentration Sr from a-PLGA/SrCSH scaffolds could induce high expression levels of BMP-2, increase ALP activity and upregulate RUNX-2 expression, and further promote the expressions of COL-I and OCN and the maximum mineralization. This study demonstrated that Sr and ordered structure in a-PLGA/SrCSH fibrous scaffolds could synergistically enhance the osteogenic differentiation of umbilical cord mesenchymal stem cells (UCMSCs) by regulating cell arrangement and expressions of osteogenic genes.

Design and Development of Tantalum and Strontium Ion Doped Hydroxyapatite Composite Coating on Titanium Substrate: Structural and Human Osteoblast-like Cell Viability Studies

In order to reduce the loosening of dental implants, surface modification with hydroxyapatite (HA) coating has shown promising results. Therefore, in this present study, the sol-gel technique has been employed to form a tantalum and strontium ion-doped hybrid HA layer coating onto the titanium (Ti)-alloy substrate. In this study, the surface modification was completed by using 3% tantalum pent oxide (Ta₂O₅), 3% strontium (Sr), and a combination of 1.5% Ta₂O₅ and 1.5% Sr as additives, along with HA gel by spin coating technique. These additives played a prominent role in producing a porous structure layer coating and further cell growth. The MG63 cell culture assay results indicated that due to the incorporation of strontium ions along with tantalum embedded in HA, cell proliferation increased significantly after a 48 h study. Therefore, the present results, including microstructure, crystal structure, binding energy, and cell proliferation, showed that the additives 1.5% Ta₂O₅ and 1.5% Sr embedded in HA on the Ti-substrate had an optimized porous coating structure, which will enhance bone in-growth in surface-modified Ti-implants. This material had a proper porous morphology with a roughness profile, which may be suitable for tissue in-growth between a surface-modified textured implant and bone interface and could be applicable for dental implants.

Silica coated high performance oxide ceramics promote greater ossification than titanium implants: an in vivo study

BACKGROUND

This in vitro study investigated the osseointegration and implant integration of high performance oxide ceramics (HPOC) compared to titanium implants in rabbits.

METHODS

Histomorphometry was conducted around the distal, proximal, medial, and lateral aspects of the HPOC to quantify the amount of mature and immature ossification within the bone interface. Histomorphometry was conducted by a trained musculoskeletal pathologist. The region of interest (ROI) represented the percentage of surrounding area of the implant. The percentage of ROI covered by osteoid implant contact (OIC) and mature bone implant contact (BIC) were assessed. The surrounding presence of bone resorption, necrosis, and/or inflammation were quantitatively investigated.

RESULTS

All 34 rabbits survived the 6- and 12-week experimental period. All HPOC implants remained in situ. The mean weight difference from baseline was + 647.7 mg (P < 0.0001). The overall OIC of the ceramic group was greater at 6 weeks compared to the titanium implants (P = 0.003). The other endpoints of interest were similar between the two implants at all follow-up points. No difference was found in BIC at 6- and 12-weeks follow-up. No bone necrosis, resorption, or inflammation were observed.

CONCLUSION

HPOC implants demonstrated a greater osteoid implant contact at 6 weeks compared to the titanium implants, with no difference found at 12 weeks. The percentage of bone implant contact of HPOC implants was similar to that promoted by titanium implants.

Existing and Novel Biomaterials for Bone Tissue Engineering

The treatment of bone defects remains one of the major challenges in modern clinical practice. Nowadays, with the increased incidence of bone disease in an aging population, the demand for materials to repair bone defects continues to grow. Recent advances in the development of biomaterials offer new possibilities for exploring modern bone tissue engineering strategies. Both natural and synthetic biomaterials have been used for tissue repair. A variety of porous structures that promote cell adhesion, differentiation, and proliferation enable better implant integration with increasingly better physical properties. The selection of a suitable biomaterial on which the patient's new tissue will grow is one of the key issues when designing a modern tissue scaffold and planning the entire treatment process. The purpose of this article is to present a comprehensive literature review of existing and novel biomaterials used in the surgical treatment of bone tissue defects. The materials described are divided into three groups-organic, inorganic, and synthetic polymers-taking into account current trends. This review highlights different types of existing and novel natural and synthetic materials used in bone tissue engineering and their advantages and disadvantages for bone defects regeneration.

Antibacterial Designs for Implantable Medical Devices: Evolutions and Challenges

The uses of implantable medical devices are safer and more common since sterilization methods and techniques were established a century ago; however, device-associated infections (DAIs) are still frequent and becoming a leading complication as the number of medical device implantations keeps increasing. This urges the world to develop instructive prevention and treatment strategies for DAIs, boosting the studies on the design of antibacterial surfaces. Every year, studies associated with DAIs yield thousands of publications, which here are categorized into four groups, i.e., antibacterial surfaces with long-term efficacy, cell-selective capability, tailored responsiveness, and immune-instructive actions. These innovations are promising in advancing the solution to DAIs; whereas most of these are normally quite preliminary “proof of concept” studies lacking exact clinical scopes. To help identify the flaws of our current antibacterial designs, clinical features of DAIs are highlighted. These include unpredictable onset, site-specific incidence, and possibly involving multiple and resistant pathogenic strains. The key point we delivered is antibacterial designs should meet the specific requirements of the primary functions defined by the “intended use” of an implantable medical device. This review intends to help comprehend the complex relationship between the device, pathogens, and the host, and figure out future directions for improving the quality of antibacterial designs and promoting clinical translations.

Functionalised High-Performance Oxide Ceramics with Bone Morphogenic Protein 2 (BMP-2) Induced Ossification: An In Vivo Study

This study investigated the in vivo osseointegration potential of high-performance oxide ceramics (HPOCs) with peptide bone morphogenic protein 2 (BMP-2), comparing them with titanium implants. Histomorphometry was conducted around the distal, proximal, medial, and lateral sides of the implants to quantify the amount of mature and immature ossification within the bone interface. We hypothesised that HPOCs functionalised with BMP-2 promote ossification. HPOCs functionalised with BMP-2 were manufactured at the Department of Dental Materials Science and Biomaterial Research of the RWTH University Aachen, Germany. Histomorphometry was conducted by a professional pathologist in all samples. The region of interest (ROI) represented the percentage of the surrounding area of the implant. The percentages of ROI covered by osteoid implant contact (OIC) and mature bone−implant contact (BIC) were assessed. The surrounding presence of bone resorption, necrosis, and/or inflammation was quantitatively investigated. A total of 36 rabbits were used for the experiments. No bone resorption, necrosis, or inflammation was found in any sample. At the 12-week follow-up, the overall BIC was significantly increased (p < 0.0001). No improvement was evidenced in OIC (p = 0.6). At the 6-week follow-up, the overall OIC was greater in the BMP-2 compared to the titanium group (p = 0.002). The other endpoints of interest evidenced similarity between the two implants at various follow-up time points (p > 0.05). In conclusion, alumina HPOCs functionalised with peptide BMP-2 promote in vivo ossification in a similar fashion to titanium implants.

Strontium-loaded titanium-15molybdenum surface improves physicochemical and biological propertiesin vitro

The titanium alloy composition and microdesign affect the dynamic interplay between the bone cells and titanium surface in the osseointegration process. The current study aimed to evaluate the surface physicochemical properties, electrochemical stability, and the metabolic response of the MC3T3-E1 cells (pre-osteoblast cell line) cultured onto titanium-15molybdenum (Ti-15Mo) discs treated with phosphoric acid (H₃PO₄) and sodium hydroxide (NaOH) and/or strontium-loading by the hydrothermal method. The x-ray dispersive energy spectroscopy (EDS) and x-ray diffraction (XRD) analysis showed no trace of impurities and the possible formation of hydrated strontium oxide (H₂O₂Sr), respectively. The confocal laser microscopy (CLSM) analysis indicated that titanium samples treated with strontium (Sr) showed greater surface roughness. The acid/alkali treatment prior to the hydrothermal Sr deposition improved the surface free energy and resistance to corrosion of the Ti-15Mo alloy. The acid/alkali treatment also provided greater retention of the Sr particles on the Ti-15Mo surfaces accordingly with inductively coupled plasma optical emission spectrometry (ICP-OES) analysis. The AlamarBlue and fluorescence analysis indicated noncytotoxic effects against the MC3T3-E1 cells, which allowed cells' adhesion and proliferation, with greater cells' spreading in the Sr-loaded Ti-15Mo samples. These findings suggest that Sr deposition by the hydrothermal method has the potential to enhance the physicochemical properties of the Ti-15Mo previously etched with H₃PO₄and NaOH, and also improve the initial events related to cell-mediated bone deposition.

Does the incorporation of strontium into calcium phosphate improve bone repair? A meta-analysis

Background

The application of calcium phosphate (CaP)-based bone substitutes plays an important role in periodontal regeneration, implant dentistry and alveolar bone reconstruction. The incorporation of strontium (Sr) into CaP-based bone substitutes appears to improve their biological properties, but the reported in vivo bone repair performance is inconsistent among studies. Herein, we conducted a systematic review and meta-analysis to investigate the in vivo performance of Sr-doped materials.

Methods

We searched PubMed, EMBASE (via OVIDSP), and reference lists to identify relevant animal studies. The search, study selection, and data extraction were performed independently by two investigators. Meta-analyses and sub-group analyses were conducted using Revman version 5.4.1. The heterogeneity between studies were assessed by I². Publication bias was investigated through a funnel plot.

Results

Thirty-five studies were finally enrolled, of which 16 articles that reported on new bone formation (NBF) were included in the meta-analysis, covering 31 comparisons and 445 defects. The overall effect for NBF was 2.25 (95% CI 1.61–2.90, p < 0.00001, I² = 80%). Eight comparisons from 6 studies reported the outcomes of bone volume/tissue volume (BV/TV), with an overall effect of 1.42 (95% CI 0.65–2.18, p = 0.0003, I² = 75%). Fourteen comparisons reported on the material remaining (RM), with the overall effect being -2.26 (95% CI − 4.02 to − 0.50, p = 0.0009, I² = 86%).

Conclusions

Our study revealed that Sr-doped calcium phosphate bone substitutes improved in vivo performance of bone repair. However, more studies are also recommended to further verify this conclusion.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02092-7.

Strontium Functionalization of Biomaterials for Bone Tissue Engineering Purposes: A Biological Point of View

Strontium (Sr) is a trace element taken with nutrition and found in bone in close connection to native hydroxyapatite. Sr is involved in a dual mechanism of coupling the stimulation of bone formation with the inhibition of bone resorption, as reported in the literature. Interest in studying Sr has increased in the last decades due to the development of strontium ranelate (SrRan), an orally active agent acting as an anti-osteoporosis drug. However, the use of SrRan was subjected to some limitations starting from 2014 due to its negative side effects on the cardiac safety of patients. In this scenario, an interesting perspective for the administration of Sr is the introduction of Sr ions in biomaterials for bone tissue engineering (BTE) applications. This strategy has attracted attention thanks to its positive effects on bone formation, alongside the reduction of osteoclast activity, proven by in vitro and in vivo studies. The purpose of this review is to go through the classes of biomaterials most commonly used in BTE and functionalized with Sr, i.e., calcium phosphate ceramics, bioactive glasses, metal-based materials, and polymers. The works discussed in this review were selected as representative for each type of the above-mentioned categories, and the biological evaluation in vitro and/or in vivo was the main criterion for selection. The encouraging results collected from the in vitro and in vivo biological evaluations are outlined to highlight the potential applications of materials’ functionalization with Sr as an osteopromoting dopant in BTE.

Local Release of Strontium from Sputter-Deposited Coatings at Implants Increases the Strontium-to-Calcium Ratio in Peri-implant Bone

It is well known that strontium (Sr) has a significant effect on peri-implant bone healing when administered systemically. Due to the risk of adverse effects of such treatments, new routes focusing on the local, sustained release of Sr from bone-implant contact surfaces have been explored, with success in in vivo experiments. However, the increase of Sr concentrations in the peri-implant bone has not been described in depth yet. Here, we show that a local, sustained Sr release from Ti-Sr-O physical vapor deposition (PVD) coatings by magnetron sputter coating increases the Sr/Ca ratio close to the implant in a rabbit model and that the Sr/Ca background level is reached approximately 500 μm from the implant.

Characterisation of Sr2+ mobility in osteoporotic rat bone marrow by cryo-ToF-SIMS and cryo-OrbiSIMS

Mass spectrometric imaging approach for ex vivo monitoring of drug transport in bone sections. Cryo-ToF-SIMS depth profiling and high-resolution imaging as well as OrbiSIMS analysis revealed inhomogeneous Sr2+ transport in rat bone marrow.

Titanium Implants and Local Drug Delivery Systems Become Mutual Promoters in Orthopedic Clinics

Titanium implants have always been regarded as one of the gold standard treatments for orthopedic applications, but they still face challenges such as pain, bacterial infections, insufficient osseointegration, immune rejection, and difficulty in personalizing treatment in the clinic. These challenges may lead to the patients having to undergo a painful second operation, along with increased economic burden, but the use of drugs is actively solving these problems. The use of systemic drug delivery systems through oral, intravenous, and intramuscular injection of various drugs with different pharmacological properties has effectively reduced the levels of inflammation, lowered the risk of endophytic bacterial infection, and regulated the progress of bone tumor cells, processing and regulating the balance of bone metabolism around the titanium implants. However, due to the limitations of systemic drug delivery systems-such as pharmacokinetics, and the characteristics of bone tissue in the event of different forms of trauma or disease-sometimes the expected effect cannot be achieved. Meanwhile, titanium implants loaded with drugs for local administration have gradually attracted the attention of many researchers. This article reviews the latest developments in local drug delivery systems in recent years, detailing how various types of drugs cooperate with titanium implants to enhance antibacterial, antitumor, and osseointegration effects. Additionally, we summarize the improved technology of titanium implants for drug loading and the control of drug release, along with molecular mechanisms of bone regeneration and vascularization. Finally, we lay out some future prospects in this field.

iTRAQ-based proteomic analysis reveals potential osteogenesis-promoted role of ATM in strontium-incorporated titanium implant

The present study aims to reveal the osteogenic roles played by DNA damage response biomarkers through implementing isobaric tags for relative and absolute quantitation (iTRAQ) technique. First, sandblasted large-grit double acid-etched (SLA) titanium implant and strontium-incorporated (SLA-Sr) titanium implant were used for inserting in the tibiae of rats. iTRAQ technique was used to detect protein expression changes and identify differentially expressed proteins (DEPs). In total, 19,343 peptides and 4280 proteins were screened out. Among them, 91 and 138 DEPs were identified in the SLA-Sr group after implantation for 3 and 7 days, respectively. Ataxia-telangiectasia mutated (ATM) protein up-regulated on the 3rd day showed a trend of further up-regulation on the 7th day. Moreover, functional enrichment analyses were also conducted to explore the biological function of DEPs during the initial stage of osseointegration in vivo, which revealed that the biological functions of the DEPs on the 7th day were mainly related to "mismatch repair" and "mitotic G1 DNA damage checkpoint." Analysis of the Reactome signaling pathway showed that ATM was associated with TP53's regulation and activation. Finally, DNA damage repair related genes were selected for validation at mRNA and protein expression levels. Real-time reverse transcription-polymerase chain reaction and immunohistochemistry validation results demonstrated that mRNA expression level of ATM was higher in SLA-Sr group. In conclusion, SLA-Sr titanium implant could initiate DNA damage repair by activating expression levels of ATM. This study was striving to reveal new faces of better osseointegration and shedding light on the biological function and underlying mechanisms of this important procedure.

Anti-infection mechanism of a novel dental implant made of titanium-copper (TiCu) alloy and its mechanism associated with oral microbiology

This work was focused on study of anti-infection ability and its underlying mechanism of a novel dental implant made of titanium-copper (TiCu) alloy. In general, most studies on antibacterial implants have used a single pathogen to test their anti-infection ability using infectious animal models. However, dental implant-associated infections are polymicrobial diseases. We innovatively combine the classic ligature model in dogs with sucrose-rich diets to induce oral infections via the canine native oral bacteria. The anti-infection ability, biocompatibility and underlying mechanism of TiCu implant were systematically investigated in comparison with pure Ti implant via general inspection, hematology, imageology (micro-CT), microbiology (16S rDNA and metagenome), histology, and Cu ion detections. Compared with Ti implant, TiCu implant demonstrated remarkable anti-infection potentials with excellent biocompatibility. Additionally, the underlying anti-infection mechanism of TiCu implant was considered to involve maintaining the oral microbiota homeostasis. It was found that the carbohydrates in the plaques formed on the surface of TiCu implant were metabolized through the tricarboxylic acid cycle (TCA) cycles, which prevented the formation of an acidic microenvironment and inhibited the accumulation of acidogens and pathogens, thereby maintaining the microflora balance between aerobic and anaerobic bacteria.

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Anti-infective ability of TiCu implant was proved in the peri-implant infection condition induced by natural oral bacteria.

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TiCu implant maintained the oral microbiota homeostasis and effectively inhibited the peri-implant infections.

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TiCu implant owned good biosafety and anti-infective actions with the potential for clinical applications.

Next-Generation Antibiotics, Bacteriophage Endolysins, and Nanomaterials for Combating Pathogens

This review presents various strategies to fight causative agents of infectious diseases. Species-specific programmable RNA-containing antibiotics open up new possibilities for creating next-generation of personalized drugs based on microbiome editing and can serve as a new tool for selective elimination of pathogenic bacterial species while keeping intact the rest of microbiota. Another promising approach in combating bacterial infections is genome editing using the CRISPR-Cas systems. Expanding knowledge on the molecular mechanisms of innate immunity has been actively used for developing new antimicrobials. However, obvious risks of using antibiotic adjuvants aimed at activation of the host immune system include development of the autoimmune response with subsequent organ damage. To avoid these risks, it is essential to elucidate action mechanisms of the specific ligands and signal molecules used as components of the hybrid antibiotics. Bacteriophage endolysins are also considered as effective antimicrobials against antibiotic-resistant bacteria, metabolically inactive persisters, and microbial biofilms. Despite significant advances in the design of implants with antibacterial properties, the problem of postoperative infections still remains. Different nanomodifications of the implant surface have been designed to reduce bacterial contamination. Here, we review bactericidal, fungicidal, and immunomodulating properties of compounds used for the implant surface nanomodifications, such as silver, boron nitride nanomaterials, nanofibers, and nanogalvanic materials.

Zn0.8Li0.1Sr-a biodegradable metal with high mechanical strength comparable to pure Ti for the treatment of osteoporotic bone fractures: In vitro and in vivo studies

The first in vivo investigation of Zn-based biodegradable metal aiming to treat osteoporotic bone fractures, a soaring threat to human health, is reported in this paper. Among the newly developed biodegradable metal system (ZnLiSr), Zn0.8Li0.1Sr exhibits excellent comprehensive mechanical properties, with an ultimate tensile strength (524.33 ± 18.01 MPa) comparable to pure Ti (the gold standard for orthopaedic implants), and a strength-ductility balance over 10 GPa%. The in vitro degradation tests using simulated body fluid (SBF) shows that Zn0.8Li0.1Sr manifests a uniform degradation morphology and smaller corrosion pits, with a degradation rate of 10.13 ± 1.52 μm year^-1. Real-time PCR and western blotting illustrated that Zn0.8Li0.1Sr successfully stimulated the expression of critical osteogenesis-related genes (ALP, COL-1, OCN and Runx-2) and proteins. Twenty-four weeks' in vivo implantations within ovariectomized (OVX) rats were conducted to evaluate the osteoporotic-bone-fracture-treating effects of Zn0.8Li0.1Sr, with pure Ti as control group. Micro-CT, histological and immunohistochemical evaluations all revealed that Zn0.8Li0.1Sr possesses a similar biosafety level to, while significantly superior osteogenesis-inducing and osteoporotic-bone-fracture-treating effects than pure Ti. ZnLiSr biodegradable alloys manifest excellent comprehensive mechanical properties, good biosafety and osteoporotic-bone-fracture-treating effects, which would provide preferable choices for future medical applications, especially in load-bearing positions.

Surface Modified Techniques and Emerging Functional Coating of Dental Implants

Dental implants are widely used in the field of oral restoration, but there are still problems leading to implant failures in clinical application, such as failed osseointegration, marginal bone resorption, and peri-implantitis, which restrict the success rate of dental implants and patient satisfaction. Poor osseointegration and bacterial infection are the most essential reasons resulting in implant failure. To improve the clinical outcomes of implants, many scholars devoted to modifying the surface of implants, especially to preparing different physical and chemical modifications to improve the osseointegration between alveolar bone and implant surface. Besides, the bioactive-coatings to promote the adhesion and colonization of ossteointegration-related proteins and cells also aim to improve the osseointegration. Meanwhile, improving the anti-bacterial performance of the implant surface can obstruct the adhesion and activity of bacteria, avoiding the occurrence of inflammation related to implants. Therefore, this review comprehensively investigates and summarizes the modifying or coating methods of implant surfaces, and analyzes the ossteointegration ability and anti-bacterial characteristics of emerging functional coatings in published references.

Impact of nanosystems in Staphylococcus aureus biofilms treatment

Staphylococcus aureus (S. aureus) is considered by the World Health Organization as a high priority pathogen for which new therapies are needed. This is particularly important for biofilm implant-associated infections once the only available treatment option implies a surgical procedure combined with antibiotic therapy. Consequently, these infections represent an economic burden for Healthcare Systems. A new strategy has emerged to tackle this problem: for small bugs, small particles. Here, we describe how nanotechnology-based systems have been studied to treat S. aureus biofilms. Their features, drawbacks and potentialities to impact the treatment of these infections are highlighted. Furthermore, we also outline biofilm models and assays required for preclinical validation of those nanosystems to smooth the process of clinical translation.

New insights into ToF-SIMS imaging in osteoporotic bone research

The present work focuses on the application of time-of-flight secondary ion mass spectrometry (ToF-SIMS) in osteoporotic bone research. In order to demonstrate the benefit, the authors present concrete application examples of ToF-SIMS in three different areas of bone research. ToF-SIMS as a mass spectrometric imaging technique allows simultaneous visualization of mineralized and nonmineralized bone tissue as well as implanted biomaterials and bone implant interphases. In the first example, the authors show that it is possible to study the incorporation and distribution of different components released from bone filler materials into bone with a single mass spectrometric measurement. This not only enables imaging of nonstained bone cross sections but also provides further insights beyond histologically obtained information. Furthermore, they successfully identified several mass fragments as markers for newly formed cartilage tissue and growth joint in bone. Different modes of ToF-SIMS as well as different SIMS instruments (IONTOF's TOF.SIMS 5 and M6 Hybrid SIMS, Ionoptika's J105) were used to identify these mass signals and highlight the high versatility of this method. In the third part, bone structure of cortical rat bone was investigated from bone sections embedded in technovit (polymethyl methacrylate, PMMA) and compared to cryosections. In cortical bone, they were able to image different morphological features, e.g., concentric arrangement of collagen fibers in so-called osteons as well as Haversian canals and osteocytes. In summary, the study provides examples of application and shows the strength of ToF-SIMS as a promising analytical method in the field of osteoporotic bone research.

Customized allogeneic bone grafts for maxillary horizontal augmentation: A 5-year follow-up radiographic and histologic evaluation

We report the histological evaluation of an individualized allogeneic bone block 5 years after alveolar ridge augmentation. The biopsy showed a well-vascularized lamellar bone with fatty incorporations without any avital allograft remnants. The presence of osteocytes, lining cells, macrophages, and blood vessels indicated a healthy and vital bone tissue.

A review of the latest insights into the mechanism of action of strontium in bone

Interest in strontium (Sr) has persisted over the last three decades due to its unique mechanism of action: it simultaneously promotes osteoblast function and inhibits osteoclast function. While this mechanism of action is strongly supported by in vitro studies and small animal trials, recent large-scale clinical trials have demonstrated that orally administered strontium ranelate (SrRan) may have no anabolic effect on bone formation in humans. Yet, there is a strong correlation between Sr accumulation in bone and reduced fracture risk in post-menopausal women, suggesting Sr acts via a purely physiochemical mechanism to enhance bone strength. Conversely, the local administration of Sr with the use of modified biomaterials has been shown to enhance bone growth, osseointegration and bone healing at the bone-implant interface, to a greater degree than Sr-free materials. This review summarizes current knowledge of the main cellular and physiochemical mechanisms that underly Sr's effect in bone, which center around Sr's similarity to calcium (Ca). We will also summarize the main controversies in Sr research which cast doubt on the 'dual-acting mechanism'. Lastly, we will explore the effects of Sr-modified bone-implant materials both in vitro and in vivo, examining whether Sr may act via an alternate mechanism when administered locally.

A bioceramic scaffold composed of strontium-doped three-dimensional hydroxyapatite whiskers for enhanced bone regeneration in osteoporotic defects

Reconstruction of osteoporotic bone defects is a clinical problem that continues to inspire the design of new materials. Methods: In this work, bioceramics composed of strontium (Sr)-doped hydroxyapatite (HA) whiskers or pure HA whiskers were successfully fabricated by hydrothermal treatment and respectively named SrWCP and WCP. Both bioceramics had similar three-dimensional (3D) porous structures and mechanical strengths, but the SrWCP bioceramic was capable of releasing Sr under physiological conditions. In an osteoporotic rat metaphyseal femoral bone defect model, both bioceramic scaffolds were implanted, and another group that received WCP plus strontium ranelate drug administration (Sr-Ran+WCP) was studied for comparison. Results: At week 1 post-implantation, osteogenesis coupled blood vessels were found to be more common in the SrWCP and Sr-Ran+WCP groups, with substantial vascular-like structures. After 12 weeks of implantation, comparable to the Sr-Ran+WCP group, the SrWCP group showed induction of more new bone formation within the defect as well as at the implant-bone gap region than that of the WCP group. Both the SrWCP and Sr-Ran+WCP groups yielded a beneficial effect on the surrounding trabecular bone microstructure to resist osteoporosis-induced progressive bone loss. While an abnormally high blood Sr ion concentration was found in the Sr-Ran+WCP group, SrWCP showed little adverse effect. Conclusion: Our results collectively suggest that the SrWCP bioceramic can be a safe bone substitute for the treatment of osteoporotic bone defects, as it promotes local bone regeneration and implant osseointegration to a level that strontium ranelate can achieve.

Osteogenesis-Related Gene Expression and Guided Bone Regeneration of a Strontium-Doped Calcium-Phosphate-Coated Titanium Mesh

Guided bone regeneration using a perforated titanium membrane is actively used in oral and orthopedic surgeries to provide space for the subsequent filling of a new bone in the case of bone defects and to achieve proper bone augmentation and reconstruction. The surface modification of a titanium membrane using a strontium-substituted calcium phosphate coating has become a popular trend to provide better bioactivity and biocompatibility on the membrane for improving the bone regeneration because strontium can stimulate not only the differentiation of osteoblasts but also inhibit the differentiation of osteoclasts. The strontium-doped calcium phosphate coating on the titanium mesh was formed by the cyclic precalcification method, and its effects on bone regeneration were evaluated by in vitro analysis of osteogenesis-related gene expression and in vivo evaluation of osteogenesis of the titanium mesh using the rat calvarial defect model in this study. It was identified that the strontium-doped calcium phosphate-treated mesh showed a higher expression of all genes related to osteogenesis in the osteoblast cells and resulted in new bone formation with better osseointegration with the mesh in the rat calvarial defect, in comparison with the results of untreated and calcium phosphate-treated meshes.

Descriptive retrospective study analyzing relevant factors related to dental implant failure

Background

The objective of this retrospective descriptive study was to analyze the characteristics of incident reports provided by dentists while using a specific brand of dental implants.

Material and Methods

The study was carried out in collaboration with Oxtein Iberia S.L.®, with the company providing access to the incident database in order to evaluate the characteristics of incidents from January 2014 to December 2017 (a total of 917 over four years). The data sheet recorded different variables during each of the stages of implant treatment, from initial implant placement to subsequent prosthetic rehabilitation. These variables included age, sex, systemic pathologies, smoking habits, bone quality, implant type, prosthesis type, and type of load applied, among others. SPSS Statistics was used to perform statistical analysis of the qualitative variables (univariate logistic regressions, χ2 test, Haberman's adjusted standardized residuals).

Results

The total study sample consisted of 44,415 implants shipped from Oxtein® warehouses on the dates indicated, of which 917 implants (2.1%) were flagged due to reports of lack of primary stability, failed osseointegration, or implant failure within one year of placement. When analyzing incident reports, it was observed that 61.6% of incidents occurred in male patients, compared to 38.4% in female patients. The average age of patients in the reported cases was 56.12 ± 12.15 years. A statistically significant correlation was discovered between incidents of implant failure and tobacco use, diabetes, heart disease, poor oral hygiene, previous infection, poor bone quality, and bruxism (p < 0.05). A (statistically significant) higher rate of incidents was also observed in tapered, internal connection, Grade IV titanium, narrow, and short implants.

Conclusions

Analysis of these implants reveals a higher rate of complication in short, tapered, internal connection and narrow-diameter implants. These data can help and encourage clinicians to use the utmost surgical precautions when placing these implants.

Key words:Pharmacovigilance, Dental implant, Dental implant failure.

Implant infections: adhesion, biofilm formation and immune evasion

Medical device-associated infections account for a large proportion of hospital-acquired infections. A variety of opportunistic pathogens can cause implant infections, depending on the type of the implant and on the anatomical site of implantation. The success of these versatile pathogens depends on rapid adhesion to virtually all biomaterial surfaces and survival in the hostile host environment. Biofilm formation on implant surfaces shelters the bacteria and encourages persistence of infection. Furthermore, implant-infecting bacteria can elude innate and adaptive host defences as well as biocides and antibiotic chemotherapies. In this Review, we explore the fundamental pathogenic mechanisms underlying implant infections, highlighting orthopaedic implants and Staphylococcus aureus as a prime example, and discuss innovative targets for preventive and therapeutic strategies.

Strontium enhances proliferation and osteogenic behavior of bone marrow stromal cells of mesenchymal and ectomesenchymal origins in vitro

Obejective

To investigate the effect of increasing Strontium (Sr) concentrations on the growth and osteogenic behavior of human bone marrow stromal cells (BMSCs) from mesenchymal (i.e., fibula) and ectomesenchymal (i.e., mandible) embryonic origins.

Materials and methods

Fibula and mandible BMSCs were cultured in media without (Ctrl) or with Sr in four diverse concentrations: Sr1, 11.3 × 10⁻³ mg/L, human seric physiological level; Sr2, 13 mg/L, human seric level after strontium ranelate treatment; Sr3, 130 mg/L, and Sr4, 360 mg/L. Proliferation rate (1, 3, and 7 days), osteogenic behavior (alkaline phosphatase [ALP] activity, 7 and 14 days; expression of osteogenic genes (ALP, osteopontin, and osteocalcin at 7, 14, and 21 days), and formation of mineralized nodules (14 and 21 days) of the BMSCs were assessed. Data was compared group‐ and period‐wise using analysis of variance tests.

Results

Fibula and mandible BMSCs cultured with Sr4 showed increased proliferation rate, and osteocalcin and osteopontin gene expression together with more evident formation of mineralized nodules, compared all other Sr concentrations. For both cell populations, Sr4 led to lower ALP activity, and ALP gene expression, compared with the other Sr concentrations.

Conclusion

BMSCs from mesenchymal (i.e., fibula) and ectomesenchymal (i.e., mandible) embryonic origins showed increased cellular proliferation and osteogenic behavior when cultured with Sr4, in vitro.

Use of Polyphenol Tannic Acid to Functionalize Titanium with Strontium for Enhancement of Osteoblast Differentiation and Reduction of Osteoclast Activity

Implant anchorage remains a challenge, especially in porous osteoporotic bone with high osteoclast activity. The implant surface is modified with osteogenic molecules to stimulate osseointegration. Strontium (Sr) is known for its osteogenic and anti-osteoclastogenic effects. In this study, Sr was immobilized on a titanium (Ti) surface using bioinspired polyphenol tannic acid (pTAN) coating as an ad-layer (Ti-pTAN). Two separate coating techniques were employed for comparative analysis. In the first technique, Ti was coated with a tannic acid solution containing Sr (Ti-pTAN-1Stp). In the second method, Ti was first coated with pTAN, before being immersed in a SrCl2 solution to immobilize Sr on Ti-pTAN (Ti-pTAN-2Stp). Ti-pTAN-1Stp and Ti-pTAN-2Stp augmented the alkaline phosphatase activity, collagen secretion, osteocalcin production and calcium deposition of MC3T3-E1 cells as compared to those of Ti and Ti-pTAN. However, osteoclast differentiation of RAW 264.7, as studied by TRAP activity, total DNA, and multinucleated cell formation, were decreased on Ti-pTAN, Ti-pTAN-1Stp and Ti-pTAN-2Stp as compared to Ti. Of all the substrates, osteoclast activity on Ti-pTAN-2Stp was the lowest. Hence, an economical and simple coating technique using pTAN as an adlayer preserved the dual biological effects of Sr. These results indicate a promising new approach to tailoring the cellular responses of implant surfaces.

Modification of Titanium Implant and Titanium Dioxide for Bone Tissue Engineering

Bone tissue engineering using titanium (Ti) implant and titanium dioxide (TiO₂) with their modification is gaining increasing attention. Ti has been adopted as an implant material in dental and orthopedic fields due to its superior properties. However, it still requires modification in order to achieve robust osteointegration between the Ti implant and surrounding bone. To modify the Ti implant, numerous methods have been introduced to fabricate porous implant surfaces with a variety of coating materials. Among these, plasma spraying of hydroxyapatite (HA) has been the most commonly used with commercial success. Meanwhile, TiO₂ nanotubes have been actively studied as the coating material for implants, and promising results have been reported about improving osteogenic activity around implants recently. Also porous three-dimensional constructs based on TiO₂ have been proposed as scaffolding material with high biocompatibility and osteoconductivity in large bone defects. However, the use of the TiO₂ scaffolds in load-bearing environment is somewhat limited. In order to optimize the TiO₂ scaffolds, studies have tried to combine various materials with TiO₂ scaffolds including drug, mesenchymal stem cells, Al₂O₃-SiO₂ solid and HA. This article will shortly introduce the properties of Ti and Ti-based implants with their modification, and review the progress of bone tissue engineering using the TiO₂ nanotubes and scaffolds.

Bioinspired surface modification of orthopedic implants for bone tissue engineering

Biomedical implants have been widely used in various orthopedic treatments, including total hip arthroplasty, joint arthrodesis, fracture fixation, non-union, dental repair, etc. The modern research and development of orthopedic implants have gradually shifted from traditional mechanical support to a bioactive graft in order to endow them with better osteoinduction and osteoconduction. Inspired by structural and mechanical properties of natural bone, this review provides a panorama of current biological surface modifications for facilitating the interaction between medical implants and bone tissue and gives a future outlook for fabricating the next-generation multifunctional and smart implants by systematically biomimicking the physiological processes involved in formation and functioning of bones.

Interface-driven Sr-morin complexation at Langmuir monolayers for bioactive coating design

Flavonoid-metal complexes are widely studied because of their interesting luminescent behavior and biological activity. Despite the extensive exploration of flavonoid-metal coordination processes in solution, the formation of complexes using the flavonoid molecule inserted in a lipid membrane has been little investigated. This effect could provide important insight into the biological activity of flavonoids at lipid membranes and could represent an attractive strategy to design supramolecular structures. Here, we studied the complexation between Sr²⁺ and morin inserted in an octadecylphosphonic acid (OPA) Langmuir monolayer. This is a relevant system due to the synergism imposed by the association of the Sr²⁺ ability to control bone formation/resorption with the morin antioxidative effect. Morin incorporation into the OPA monolayers and further Sr²⁺ complexation were monitored by surface pressure isotherms. Electronic absorption spectroscopy and fluorescence techniques showed Sr-morin complexation both in solution and at the air-liquid interface. Although morin complexation has been described to occur only at basic pH, the specific thermodynamic properties at the air-liquid interface drove metal complexation. LB films were deposited on Ti surfaces, and the resulting OPA/Sr-morin coatings exhibited high surface free energy and increase on its polar component. This optimized surface feature supported further serum protein adsorption and osteoblast growth and differentiation, indicating that these lipid-based coatings are promising for bioactive coating design. This study paves the way for the use of this lipid-based coating in the design of implants for faster osteointegration. Moreover, flavonoid-metal complexation at membranes could also help to shed light on the biological role played by flavonoids.

Grape Seed-Inspired Smart Hydrogel Scaffolds for Melanoma Therapy and Wound Healing

Grape-seed extracts contain rich flavonoids with oligomeric proanthocyanidins (OPC). In this study, OPC containing hydrogel scaffolds can function as a natural photothermal agent for melanoma therapy and bioactive biomaterial for wound healing. Inspired by grape-seed extracts, OPC were explored as a photothermal agent and endowed the hydrogel scaffolds with excellent and controlled photothermal ability. The rheological property of the hydrogel scaffolds responded to irradiation time of near infrared (NIR) laser, and OPC contents. The compressive mechanical property of the hydrogel scaffolds was well modulated by NIR laser irradiation with different impact durations. The controlled high temperature induced by OPC-containing hydrogel scaffolds under NIR laser irradiation could effectively kill melanoma cells and suppress tumor growth. In addition, OPC-containing hydrogel scaffolds supported the proliferation and migration of human dermal fibroblasts and human umbilical vein endothelial cells, as well as obviously promoted angiogenesis and skin regeneration in both tumor-caused and chronic wounds. Therefore, OPC-containing hydrogel scaffolds possessed controlled photothermal, rheological, and compressive mechanical properties under NIR laser stimuli, as well as excellent biocompatibility and bioactivity for melanoma therapy and wound healing.

Application of a Strontium-Loaded, Phase-Transited Lysozyme Coating to a Titanium Surface to Enhance Osteogenesis and Osteoimmunomodulation

Background

To fabricate strontium (Sr)-incorporated titanium (Ti) surfaces by a novel 1-step phase-transited lysozyme (PTL) treatment, and investigate the effects of the prepared samples on osteogenesis and osteoimmunoregulation.

Material/Methods

Five groups of titanium specimens were prepared, including Ti, PTL, PTL@10Sr (PTL coating with 10 mg/mL Sr), PTL@20Sr PTL coating with 20 mg/mL Sr), and PTL@50Sr (PTL coating with 50 mg/mL Sr) groups. Behaviors of bone marrow mesenchymal stem cells (BMSCs) such as initial attachment, spread, proliferation, and migration, on different surfaces were examined by immunofluorescence, MTS assay, and Transwell system. Then the osteogenic differentiation of BMSCs was detected. When an immune response was factored in, the polarization of macrophages induced by the prepared surfaces was detected by real-time PCR, and the response of BMSCs to macrophage-conditioned medium was assessed in terms of cell migration and osteogenic differentiation. Finally, an in vivo study was performed, using the rat femora implant model, to evaluate the potential for osteogenic induction and osteoimmunoregulation of materials.

Results

Our in vitro experiments indicated that PTL coating could improve cell spread and adhesion, and the stable Sr release of PTL@Sr layers could promote cell migration and osteogenesis. Moreover, PTL@Sr surface could regulate the immune response of macrophages resulting in enhanced BMSCs recruitment and osteogenic differentiation. The in vivo evaluation showed less inflammatory infiltration and improved bone formation in the PTL@20Sr group.

Conclusions

The Sr-loaded PTL layers have greater potential for the induction of osteogenic differentiation of BMSCs, meanwhile Sr-loaded PTL layers could adjust the immune response and thus promote osteogenesis both in vitro and in vivo.

P2000 - A high-nitrogen austenitic steel for application in bone surgery

Optimal treatment of bone fractures with minimal complications requires implant alloys that combine high strength with high ductility. Today, TiAl6V4 titanium and 316L steel are the most applied alloys in bone surgery, whereas both share advantages and disadvantages. The nickel-free, high-nitrogen austenitic steel X13CrMnMoN18-14-3 (1.4452, brand name: P2000) exhibits high strength in combination with superior ductility. In order to compare suitable alloys for bone implants, we investigated titanium, 316L steel, CoCrMo and P2000 for their biocompatibility and hemocompatibility (according to DIN ISO 10993-5 and 10993-4), cell metabolism, mineralization of osteoblasts, electrochemical and mechanical properties. P2000 exhibited good biocompatibility of fibroblasts and osteoblasts without impairment in vitality or changing of cell morphology. Furthermore, investigation of the osteoblasts function by ALP activity and protein levels of the key transcription factor RUNX2 revealed 2x increased ALP activity and more than 4x increased RUNX2 protein levels for P2000 compared to titanium or 316 steel, respectively. Additionally, analyses of osteoblast biomineralization by Alizarin Red S staining exhibited more than 6x increased significant mineralization of osteoblasts grown on P2000 as compared to titanium. Further, P2000 showed no hemolytic effect and no significant influence on hemocompatibility. Nanoindentation hardness tests of Titanium and 316L specimens exposed an indentation hardness (HIT) of about 4 GPa, whereas CoCrMo and P2000 revealed HIT of 7.5 and 5.6 GPa, respectively. Moreover, an improved corrosion resistance of P2000 compared to 316L steel was observed. In summary, we could demonstrate that the nickel-free high-nitrogen steel P2000 appears to be a promising alternative candidate for applications in bone surgery. As to nearly all aspects like biocompatibility and hemocompatibility, cell metabolism, mineralization of osteoblasts and mechanical properties, P2000 was similar to or revealed advantages against titanium, 316L or CoCrMo.

Investigation of strontium transport and strontium quantification in cortical rat bone by time-of-flight secondary ion mass spectrometry

Next-generation bone implants will be functionalized with drugs for stimulating bone growth. Modelling of drug release by such functionalized biomaterials and drug dispersion into bone can be used as predicting tool for biomaterials testing in future. Therefore, the determination of experimental parameters to describe and simulate drug release in bone is essential. Here, we focus on Sr2+ transport and quantification in cortical rat bone. Sr2+ dose-dependently stimulates bone-building osteoblasts and inhibits bone-resorbing osteoclasts. It should be preferentially applied in the case of bone fracture in the context of osteoporotic bone status. Transport properties of cortical rat bone were investigated by dipping experiments of bone sections in aqueous Sr2+ solution followed by time-of-flight secondary ion mass spectrometry (ToF-SIMS) depth profiling. Data evaluation was carried out by fitting a suitable mathematical diffusion equation to the experimental data. An average diffusion coefficient of D = (1.68 ± 0.57) · 10-13 cm2 s-1 for healthy cortical bone was obtained. This value differed only slightly from the value of D = (4.30 ± 1.43) · 10-13 cm2 s-1 for osteoporotic cortical bone. Transmission electron microscopy investigations revealed a comparable nano- and ultrastructure for both types of bone status. Additionally, Sr2+-enriched mineralized collagen standards were prepared for ToF-SIMS quantification of Sr2+ content. The obtained calibration curve was used for Sr2+ quantification in cortical and trabecular bone in real bone sections. The results allow important insights regarding the Sr2+ transport properties in healthy and osteoporotic bone and can ultimately be used to perform a simulation of drug release and mobility in bone.

Current Trends in Fabrication of Biomaterials for Bone and Cartilage Regeneration: Materials Modifications and Biophysical Stimulations

The aim of engineering of biomaterials is to fabricate implantable biocompatible scaffold that would accelerate regeneration of the tissue and ideally protect the wound against biodevice-related infections, which may cause prolonged inflammation and biomaterial failure. To obtain antimicrobial and highly biocompatible scaffolds promoting cell adhesion and growth, materials scientists are still searching for novel modifications of biomaterials. This review presents current trends in the field of engineering of biomaterials concerning application of various modifications and biophysical stimulation of scaffolds to obtain implants allowing for fast regeneration process of bone and cartilage as well as providing long-lasting antimicrobial protection at the site of injury. The article describes metal ion and plasma modifications of biomaterials as well as post-surgery external stimulations of implants with ultrasound and magnetic field, providing accelerated regeneration process. Finally, the review summarizes recent findings concerning the use of piezoelectric biomaterials in regenerative medicine.

Development of local strontium ranelate delivery systems and long term in vitro drug release studies in osteogenic medium

It has been recognized that the operative stabilization of osteoporotic fractures should be followed up with an appropriate osteoporosis treatment in order to decrease the risk of repeated fractures. Despite the good clinical results of strontium ranelate (SrRan) towards the osteoporosis treatment, high drug doses and long treatment period cause an increased risk of serious side effects. Novel local SrRan/poly(lactic acid) (SrRan/PLA) delivery systems containing from 3.57 ± 0.28 wt% to 24.39 ± 0.91 wt% of active substance were developed. In order to resemble the naturally occurring processes, osteogenic media (OM) was used as a release medium for long term (121 days) in vitro drug release studies and UV/VIS method for the determination of SrRan content in OM was developed and validated. Biomimetic calcium phosphate precipitates were found on the surface and in the pores of prepared delivery system after microcapsule exposure to OM for 121 days as well as SrRan particles, indicating that the release of the drug have not been completed within 121 days. In vitro cell viability evaluation approved no cytotoxic effects of microcapsule suspensions and extracts.

Strontium functionalized scaffold for bone tissue engineering

Drug functionalized scaffolds are currently being employed to improve local delivery of osteoprotective drugs with the aim of reducing their loading dose as well as unwanted systemic complications. In this study we tested a poly-(ε) caprolactone (PCL)-laponite-strontium ranelate (SRA) composite scaffold (PLS3) for its abilities to support growth and osteogenic differentiation of human marrow derived stromal stem cells (hMSC). The in vitro experiments showed the PLS3 scaffold supported cell growth and osteogenic differentiation. The in vivo implantation of hMSC seeded PLS3 scaffold in immunocompromised mice revealed vascularized ectopic bone formation. PLS3 scaffolds can be useful in bone regenerative applications in the fields of orthopaedics and dentistry.

Strontium enhances proliferation and osteogenic behavior of periodontal ligament cells in vitro

BACKGROUND AND OBJECTIVE

Strontium (Sr) enhances osteogenic differentiation of certain multipotent cells. Periodontal ligament cells (PDLCs) are known to be multipotent, and Sr might be useful in periodontal bone tissue engineering. This study investigates the effect of high concentration of Sr on the proliferation and osteogenic behavior of PDLCs in vitro.

MATERIAL AND METHODS

Primary human PDLCs were cultured in MEM + 10% FBS without (Ctrl) or with Sr in four diverse concentrations: Sr1, 11.3 × 10^-3  mg/L, human serum physiological level; Sr2, 13 mg/L, typical human serum level after strontium ranelate treatment; Sr3, 130 mg/L, and Sr4, 360 mg/L. The spreading area (2, 4, 6, 24 hours), proliferation rate (1, 3, 7 days), osteogenic behavior (alkaline phosphatase - ALP activity, 7 and 14 days; expression of osteogenic genes, ALP, Runt-related transcription factor 2 - RUNX2, osteopontin - OPN, osteocalcin - OCN, and osteoprotegerin -OPG, 1, 3, 7, 14, 21 days), and formation of mineralized nodules (14 and 21 days) of the PDLCs were assessed. Data were compared group- and period-wise using ANOVA tests.

RESULTS

Periodontal ligament cells cultured with Sr4 showed increased spreading area (after 4 hours), proliferation rate (from 3 days), and OCN and OPN (from 7 days) gene expression as compared to Ctrl, Sr1, Sr2, and Sr3. Sr4 also led to lower ALP activity (from 7 days), ALP (from 3 days), and RUNX2 (at 7 and 14 days) gene expression, together with more evident formation of mineralized nodules, compared to Ctrl, Sr1, Sr2, and Sr3.

CONCLUSION

Periodontal ligament cells responded to Sr4 with increased cellular proliferation and osteogenic behavior in vitro.