Electrophoretic co-deposition of PEEK-hydroxyapatite composite coatings for biomedical applications

Surface functionalization of hydroxyapatite nanoparticles for biomedical applications

This review completely covers the various aspects of hydroxyapatite (HAp) nanoparticles and their role in different biological situations, and provides the surface and interface contents on (i) hydroxyapatite nanoparticles and their hybridization with organic molecules, (ii) surface designing of hydroxyapatite nanoparticles to provide their biocompatibility and photofunction, and (iii) coating technology of hydroxyapatite nanoparticles. In particular, we summarized how the HAp nanoparticles interact with the different ions and molecules and highlighted the potential for hybridization between HAp nanoparticles and organic molecules, which is driven by the interactions of the HAp nanoparticle surface ions with several functional groups of biological molecules. In addition, we highlighted the studies focusing on the interfacial interactions between the HAp nanoparticles and proteins for exploring the enhanced biocompatibility. Such studies focus on how these interactions affect the hydration layers and protein adsorption. However, the hydration layer state involves diverse molecular interactions that can alter the shape of the adsorbed proteins, thereby affecting cell adhesion and spreading on the surfaces. We also summarized the relationship between the surface properties of the HAp nanoparticles and the hydration layer. Furthermore, we spotlighted the cytocompatible photoluminescent probes that can be developed by designing HAp/organic nanohybrid structures. We then emphasized the importance of photofunctionalization in theranostics, which involves the integration of diagnostics and therapy based on the surface design of the HAp nanoparticles. Furthermore, the coating techniques using HAp nanoparticles and HAp nanoparticle/polymer composites were outlined for fusing base biomaterials with biological tissues. The advantages of HAp/biocompatible polymer composite coatings include the ability to effectively cover porous or irregularly shaped surfaces while controlling the thickness of the coating layer, and the addition of HAp nanoparticles to the polymer matrix improves the mechanical properties, increases the roughness, and forms the morphologies that mimic bone nanostructures. Therefore, the fundamental design of hydroxyapatite nanoparticles and their surfaces was suggested from various aspects for biomedical applications.

A self-assembling graphene oxide coating for enhanced bactericidal and osteogenic properties of poly-ether-ether-ketone

Poly-ether-ether-ketone (PEEK) is a biomedical plastic that can be used for orthopedic implants, but it offers poor antibacterial properties and bioactivity. In this study, PEEK was sulfonated with the obtained porous structure adsorbing graphene oxide (GO). The surface microstructures and properties of the original PEEK, sulfonated PEEK (SPEEK), and GO-grafted PEEK (GO-SPEEK) were characterized. The results revealed that the GO-SPEEK surface is a 3D porous structure exhibiting superior hydrophilicity to the original PEEK. Although SPEEK was shown to possess antimicrobial properties against both Escherichia coli and Staphylococcus aureus, the bactericidal effect was even more significant for GO-SPEEK, at about 86% and 94%, respectively. In addition, the in vitro simulated-body-fluid immersion and cell experiments indicated that GO-SPEEK had much better hydroxyapatite (HA)-precipitation induction capacity and cell-material interactions (e.g., cell adhesion, proliferation, osteodifferentiation, and extracellular matrix mineralization. The tensile test revealed that the mechanical properties of PEEK were maintained after surface modification, as GO-SPEEK has comparable values of elastic modulus and tensile strength to PEEK. Our investigation sought a method to simultaneously endow PEEK with both good antimicrobial properties and bioactivity as well as mechanical properties, providing a theoretical basis for developing high-performance orthopedic implants in the clinic.

Surface Modification of Polyetheretherketone (PEEK) Intervertebral Fusion Implant Using Polydopamine Coating for Improved Bioactivity

The occurrence of bone diseases has been increasing rapidly, in line with the aging population. A representative spinal fusion material, polyetheretherketone (PEEK), is advantageous in this regard as it can work in close proximity to the elastic modulus of cancellous bone. However, if it is used without surface modification, the initial osseointegration will be low due to lack of bioactivity, resulting in limitations in surgical treatment. In this study, we aimed to modify the surface of PEEK cages to a hydrophilic surface by coating with polyethylene glycol (PEG), hyaluronic acid (HA), and polydopamine (PDA), and to analyze whether the coated surface exhibits improved bioactivity and changes in mechanical properties for orthopedic applications. Material properties of coated samples were characterized and compared with various PEEK groups, including PEEK, PEEK-PEG, PEEK-HA, and PEEK-PDA. In an in vitro study, cell proliferation was found to be enhanced on PDA-coated PEEK; it was approximately twice as high compared to the control group. In addition, mechanical properties, including static and torsion, were not affected by the presence of the coating. Thus, the results suggest that PEEK-PDA may have the potential for clinical application in fusion surgery for spinal diseases, as it may improve the rate of osseointegration.

PUD@HA/PEEK Scaffold Induces Subchondral Bone Regeneration to Repair Osteochondral Defect in Rabbits

Osteochondral defects (OCDs) pose a significant challenge in clinical practice, and recent advancements in their repair indicate that satisfying subchondral bone repair may be critical for this. Herein, a series of hydroxyapatite/poly(ether ether ketone) (HA/PEEK) scaffolds were fabricated with varying mass percentages (0, 20, 30, and 40%) to induce subchondral bone regeneration. Subsequently, an optimal scaffold with 40% HA/PEEK was selected to establish osteochondral scaffolds with poly(ether urethane) urea-Danshensu (PUD) for repairing the OCD. The material characteristics of HA/PEEK and PUD were investigated using scanning electron microscopy, tensile, swelling, and fatigue tests, and cytological experiments. The effects of serial HA/PEEK scaffolds on subchondral bone repair were then assessed by using microcomputed tomography, hard tissue slicing, and histological staining. Furthermore, the optimal 40% HA/PEEK scaffold was used to develop osteochondral scaffolds with PUD to observe the effect on the OCD repair. HA/PEEK materials exhibited an even HA distribution in PEEK. However, when composited with HA, PEEK exhibited inferior mechanical strength. 40%HA/PEEK scaffolds showed an optimum effect on in vivo subchondral bone repair. Cartilage regeneration on 40%HA/PEEK scaffolds was pronounced. After PUD was introduced onto the HA/PEEK, the PUD@40%HA/PEEK scaffold produced the expected effect on the repair of the OCD in rabbits. Therefore, achieving satisfactory subchondral bone repair can benefit surficial cartilage repair. The PUD@40%HA/PEEK scaffold could induce subchondral bone regeneration to repair the OCD in rabbits and could provide a novel approach for the repair of the OCD in clinical practice.

Electrophoretically deposited titanium and its alloys in biomedical engineering: Recent progress and remaining challenges

Over the past decade, titanium implants have gained popularity as the number of performed implantation operations has significantly increased. There are a number of methods for modifying the surface of biomaterials, which are aimed at extending the life of titanium implants. The developments in this field in recent years have required a comprehensive discussion of all the properties of electrophoretically deposited coatings on titanium and its alloys, taking into account their bioactivity. The development that took place in this field in recent years required a comprehensive discussion of all the properties of coatings electrophoretically deposited on titanium and its alloys, with particular emphasis on their bioactivity. Herein, we attempt to assess the influence of the electrophoretic deposition (EPD) process parameters on these coatings' biological and mechanical properties. Particular attention has been addressed to the in-vitro and in-vivo studies conducted hitherto. We have seen an increased interest in using titanium alloys without the addition of toxic compounds and gaps in the EPD field such as the uncommon endeavors to develop a "Design of experiments" approach as well as the lack of assessment of the surface free energy and detailed topography of electrophoretically deposited coatings. The exact correlation of coating properties with EPD process parameters still seems explicitly not understood, necessitating more future investigations. Ipso facto, the exact mechanism of particle agglomeration and Hamaker's law need to be fathomable.

Corrosion, surface, and tribological behavior of electrophoretically deposited polyether ether ketone coatings on 316L stainless steel for orthopedic applications

Electrophoretic deposition (EPD) of polyether ether ketone (PEEK) coatings on metallic implants has recently attracted a great deal of interest; however, further investigation into their corrosion, surface, and tribological properties is required for their clinical application. Using Potentiodynamic polarization and Mott-Schottky analysis of PEEK coatings, we analyzed the electrochemical corrosion behavior of electrophoretically deposited PEEK coatings on 316L stainless steel (SS) substrates. In addition, the tribological behavior of the coatings was determined through pin-on-disc and scratch testing. Initially, the EPD parameters were optimized using a Taguchi Design of Experiment (DoE) approach. The coatings exhibited irregular shaped grains along with ∼66 μm of thickness. Fourier transform infrared spectroscopy confirmed the presence of functional groups ascribed with PEEK. The coatings were moderately hydrophobic and had an average roughness of ∼2 μm. The corrosion studies demonstrated promising features of current density and corrosion potential, indicating that corrosion resistance significantly improves with PEEK coating. Electrochemical impedance spectroscopy also confirmed the corrosion resistance of PEEK coating. The coatings exhibited a slightly lower wear resistance than SS samples, but still possessed adequate wear and scratch resistance for biomedical applications. The current study confirmed that the PEEK coatings on metallic implants is effective for orthopedic applications where corrosion and tribology are major concerns.

Advanced surface engineering of titanium materials for biomedical applications: From static modification to dynamic responsive regulation

Titanium (Ti) and its alloys have been widely used as orthopedic implants, because of their favorable mechanical properties, corrosion resistance and biocompatibility. Despite their significant success in various clinical applications, the probability of failure, degradation and revision is undesirably high, especially for the patients with low bone density, insufficient quantity of bone or osteoporosis, which renders the studies on surface modification of Ti still active to further improve clinical results. It is discerned that surface physicochemical properties directly influence and even control the dynamic interaction that subsequently determines the success or rejection of orthopedic implants. Therefore, it is crucial to endow bulk materials with specific surface properties of high bioactivity that can be performed by surface modification to realize the osseointegration. This article first reviews surface characteristics of Ti materials and various conventional surface modification techniques involving mechanical, physical and chemical treatments based on the formation mechanism of the modified coatings. Such conventional methods are able to improve bioactivity of Ti implants, but the surfaces with static state cannot respond to the dynamic biological cascades from the living cells and tissues. Hence, beyond traditional static design, dynamic responsive avenues are then emerging. The dynamic stimuli sources for surface functionalization can originate from environmental triggers or physiological triggers. In short, this review surveys recent developments in the surface engineering of Ti materials, with a specific emphasis on advances in static to dynamic functionality, which provides perspectives for improving bioactivity and biocompatibility of Ti implants.

Electrophoretic Deposition, Microstructure, and Selected Properties of Poly(lactic-co-glycolic) Acid-Based Antibacterial Coatings on Mg Substrate

There is an urgent need to develop biodegradable implants that can degrade once they have fulfilled their function. Commercially pure magnesium (Mg) and its alloys have the potential to surpass traditional orthopedic implants due to their good biocompatibility and mechanical properties, and most critically, biodegradability. The present work focuses on the synthesis and characterization (microstructural, antibacterial, surface, and biological properties) of poly(lactic-co-glycolic) acid (PLGA)/henna (Lawsonia inermis)/Cu-doped mesoporous bioactive glass nanoparticles (Cu-MBGNs) composite coatings deposited via electrophoretic deposition (EPD) on Mg substrates. PLGA/henna/Cu-MBGNs composite coatings were robustly deposited on Mg substrates using EPD, and their adhesive strength, bioactivity, antibacterial activity, corrosion resistance, and biodegradability were thoroughly investigated. Scanning electron microscopy and Fourier transform infrared spectroscopy studies confirmed the uniformity of the coatings' morphology and the presence of functional groups that were attributable to PLGA, henna, and Cu-MBGNs, respectively. The composites exhibited good hydrophilicity with an average roughness of 2.6 μm, indicating desirable properties for bone forming cell attachment, proliferation, and growth. Crosshatch and bend tests confirmed that the adhesion of the coatings to Mg substrates and their deformability were adequate. Electrochemical Tafel polarization tests revealed that the composite coating adjusted the degradation rate of Mg substrate in a human physiological environment. Incorporating henna into PLGA/Cu-MBGNs composite coatings resulted in antibacterial activity against Escherichia coli and Staphylococcus aureus. The coatings stimulated the proliferation and growth of osteosarcoma MG-63 cells during the initial incubation period of 48 h (determined by the WST-8 assay).

Antibacterial and Proliferative Effects of NaOH-Coated Titanium, Zirconia, and Ceramic-Reinforced PEEK Dental Composites on Bone Marrow Mesenchymal Stem Cells

Several metallic and polymer-based implants have been fabricated for orthopedic applications. For instance, titanium (Ti), zirconia (Zr), and polyetheretherketone (PEEK) are employed due to their excellent biocompatibility properties. Hence, the present study aimed to compare the functional and biological properties of these three biomaterials with surface modification. For this purpose, Ti, Zr, and ceramic-reinforced PEEK (CrPEEK) were coated with NaOH and tested for the biological response. Our results showed that the surface modification of these biomaterials significantly improved the water contact, protein adhesion, and bioactivity compared with uncoated samples. Among the NaOH-coated biomaterials, Ti and CrPEEK showed higher protein absorption than Zr. However, the mineral binding ability was higher in CrPEEK than in the other two biomaterials. Although the coating improved the functional properties, NaOH coating did not influence the antibacterial effect against E. coli and S. aureus in these biomaterials. Similar to the antibacterial effects, the NaOH coating did not contribute any significant changes in cell proliferation and cell loading, and CrPEEK showed better biocompatibility among the biomaterials. Therefore, this study concluded that the surface modification of biomaterials could potentially improve the functional properties but not the antibacterial and biocompatibility, and CrPEEK could be an alternative material to Ti and Zr with desirable qualities in orthopedic applications.

Advances in Multifunctional Bioactive Coatings for Metallic Bone Implants

To fix the bone in orthopedics, it is almost always necessary to use implants. Metals provide the needed physical and mechanical properties for load-bearing applications. Although widely used as biomedical materials for the replacement of hard tissue, metallic implants still confront challenges, among which the foremost is their low biocompatibility. Some of them also suffer from excessive wear, low corrosion resistance, infections and shielding stress. To address these issues, various coatings have been applied to enhance their in vitro and in vivo performance. When merged with the beneficial properties of various bio-ceramic or polymer coatings remarkable bioactive, osteogenic, antibacterial, or biodegradable composite implants can be created. In this review, bioactive and high-performance coatings for metallic bone implants are systematically reviewed and their biocompatibility is discussed. Updates in coating materials and formulations for metallic implants, as well as their production routes, have been provided. The ways of improving the bioactive coating performance by incorporating bioactive moieties such as growth factors, osteogenic factors, immunomodulatory factors, antibiotics, or other drugs that are locally released in a controlled manner have also been addressed.

Recent Advancements in Materials and Coatings for Biomedical Implants

Metallic materials such as stainless steel (SS), titanium (Ti), magnesium (Mg) alloys, and cobalt-chromium (Co-Cr) alloys are widely used as biomaterials for implant applications. Metallic implants sometimes fail in surgeries due to inadequate biocompatibility, faster degradation rate (Mg-based alloys), inflammatory response, infections, inertness (SS, Ti, and Co-Cr alloys), lower corrosion resistance, elastic modulus mismatch, excessive wear, and shielding stress. Therefore, to address this problem, it is necessary to develop a method to improve the biofunctionalization of metallic implant surfaces by changing the materials’ surface and morphology without altering the mechanical properties of metallic implants. Among various methods, surface modification on metallic surfaces by applying coatings is an effective way to improve implant material performance. In this review, we discuss the recent developments in ceramics, polymers, and metallic materials used for implant applications. Their biocompatibility is also discussed. The recent trends in coatings for biomedical implants, applications, and their future directions were also discussed in detail.

Characterisation of Selected Materials in Medical Applications

Tissue engineering is an interdisciplinary field of science that has developed very intensively in recent years. The first part of this review describes materials with medical and dental applications from the following groups: metals, polymers, ceramics, and composites. Both positive and negative sides of their application are presented from the point of view of medical application and mechanical properties. A variety of techniques for the manufacture of biomedical components are presented in this review. The main focus of this work is on additive manufacturing and 3D printing, as these modern techniques have been evaluated to be the best methods for the manufacture of medical and dental devices. The second part presents devices for skull bone reconstruction. The materials from which they are made and the possibilities offered by 3D printing in this field are also described. The last part concerns dental transitional implants (scaffolds) for guided bone regeneration, focusing on polylactide–hydroxyapatite nanocomposite due to its unique properties. This section summarises the current knowledge of scaffolds, focusing on the material, mechanical and biological requirements, the effects of these devices on the human body, and their great potential for applications.

Microstructure and Selected Properties of Advanced Biomedical n-HA/ZnS/Sulfonated PEEK Coatings Fabricated on Zirconium Alloy by Duplex Treatment

In this work, sulfonated polyetheretherketone (S-PEEK)-based coatings, nanocrystalline ZnS and hydroxyapatite (n-HA) particles were developed on Zr-2.5Nb zirconium alloy substrates by electrophoretic deposition (EPD) combined with subsequent heat treatment. The properties of suspensions and deposition kinetics were studied. Cationic chitosan polyelectrolyte ensured the stabilization of the suspension and allowed for the co-deposition of all coating components on the cathode. The heating of the coated samples at a temperature of 450 °C and slow cooling resulted in sulfonation of the PEEK and the formation of dense coatings. The coatings were characterized by high roughness, hardness, modulus of elasticity and adhesion strength. The coatings revealed mild hydrophilicity, improved the electrochemical corrosion resistance of the alloy and induced the formation of hydroxyapatite with a cauliflower-like morphology on its surface during the Kokubo test. This work explored the great development potential of advanced sulfonated PEEK-based coatings, incorporating antibacterial and bioactive components by EPD combined with heat treatment to stimulate the surface properties of zirconium alloy for prospective dental and orthopedic applications. The antibacterial and osteoconductive properties of the obtained coatings should be further investigated.

Electrophoretic deposition of hydroxyapatite/chitosan nanocomposites: the effect of dispersing agents on the coating properties

In this study, electrophoretic deposition (EPD) was used for the coating on titanium (Ti) substrate with a composite of hydroxyapatite (HA)-chitosan (CS) in the presence of dispersing agents such as polyvinyl butyral (PVB), polyethylene glycol (PEG), and triethanolamine (TEA). The materials were characterized using X-ray diffraction (XRD), transmission electron microscopy (TEM), scanning electron microscopy (SEM), zeta potential, and Fourier transform infrared (FT-IR) spectroscopy. The addition of PVB, PEG, and TEA agents improved the development of Ti coating during the EPD process. These additives increased the suspension stability and promoted the formation of uniform and compact HA/CS nanocomposite coatings on Ti substrates. The electrochemical polarization tests (e.g., potentiodynamic test) of the substrate with and without coating were investigated. Data analysis showed high corrosion resistance of Ti substrate coated with the HA/CS NP composite. The corrosion potentials displayed a shift toward positive values indicating the increase in the corrosion resistance of Ti after coating. In addition to measuring calcium ion release at various pH values and contact times at a biological pH value of 5.5, the stabilities of Ti substrates coated with HA/CS and different dispersing agents were also evaluated. Ti substrates with high anticorrosion properties may have a new potential application in biomedicine.

Electrophoretic deposition was used for coating of titanium substrate with a composite of hydroxyapatite (HA)-chitosan (CS) in the presence of polyvinyl butyral (PVB), polyethylene glycol (PEG), and triethanolamine (TEA).

Facile and Versatile Surface Functional Polyetheretherketone with Enhanced Bacteriostasis and Osseointegrative Capability for Implant Application

Implant-associated infections and inadequate osseointegration are two challenges of implant materials in orthopedics. In this study, a lithium-ion-loaded (Li+)/mussel-inspired antimicrobial peptide (AMP) designed to improve the osseointegration and inhibit bacterial infections effectively is prepared on a polyetheretherketone (PEEK) biomaterial surface through the combination of hydrothermal treatment and mussel-inspired chemistry. The results illustrate that the multifunctional PEEK material demonstrated a great inhibitory effect on Escherichia coli and Staphylococcus aureus, which was attributed to irreversible bacterial membrane damage. In addition, the multifunctional PEEK can simultaneously upregulate the expression of osteogenesis-associated genes/proteins via the Wnt/β-catenin signaling pathway. Furthermore, an in vivo assay of an infection model revealed that the multifunctional PEEK implants killed bacteria with an efficiency of 95.03%. More importantly, the multifunctional PEEK implants accelerated the implant-bone interface osseointegration compared with pure PEEK implants in the noninfection model. Overall, this work provides a promising strategy for improving orthopedic implant materials with ideal osseointegration and infection prevention simultaneously, which may have broad application clinical prospects.

The Surface Characterisation of Fused Filament Fabricated (FFF) 3D Printed PEEK/Hydroxyapatite Composites

Polyetheretherketone (PEEK) is a high-performance thermoplastic polymer which has found increasing application in orthopaedics and has shown a lot of promise for 'made-to-measure' implants via additive manufacturing approaches. However, PEEK is bioinert and needs to undergo surface modification to make it at least osteoconductive to ensure a more rapid, improved, and stable fixation that will last longer in vivo. One approach to solving this issue is to modify PEEK with bioactive agents such as hydroxyapatite (HA). The work reported in this study demonstrates the direct 3D printing of PEEK/HA composites of up to 30 weight percent (wt%) HA using a Fused Filament Fabrication (FFF) approach. The surface characteristics and in vitro properties of the composite materials were investigated. X-ray diffraction revealed the samples to be semi-crystalline in nature, with X-ray Photoelectron Spectroscopy and Time-of-Flight Secondary Ion Mass Spectrometry revealing HA materials were available in the uppermost surface of all the 3D printed samples. In vitro testing of the samples at 7 days demonstrated that the PEEK/HA composite surfaces supported the adherence and growth of viable U-2 OS osteoblast like cells. These results demonstrate that FFF can deliver bioactive HA on the surface of PEEK bio-composites in a one-step 3D printing process.

Evolution of materials for implants in metastatic spine disease till date - Have we found an ideal material?

"Metastatic Spine Disease" (MSD) often requires surgical intervention and instrumentation with spinal implants. Ti6Al4V is widely used in metastatic spine tumor surgery (MSTS) and is the current implant material of choice due to improved biocompatibility, mechanical properties, and compatibility with imaging modalities compared to stainless steel. However, it is still not the ideal implant material due to the following issues. Ti6Al4V implants cause stress-shielding as their Young's modulus (110 gigapascal [GPa]) is higher than cortical bone (17-21 GPa). Ti6Al4V also generates artifacts on CT and MRI, which interfere with the process of postoperative radiotherapy (RT), including treatment planning and delivery. Similarly, charged particle therapy is hindered in the presence of Ti6Al4V. In addition, artifacts on CT and MRI may result in delayed recognition of tumor recurrence and postoperative complications. In comparison, polyether-ether-ketone (PEEK) is a promising alternative. PEEK has a low Young's modulus (3.6 GPa), which results in optimal load-sharing and produces minimal artifacts on imaging with less hinderance on postoperative RT. However, PEEK is bioinert and unable to provide sufficient stability in the immediate postoperative period. This issue may possibly be mitigated by combining PEEK with other materials to form composites or through surface modification, although further research is required in these areas. With the increasing incidence of MSD, it is an opportune time for the development of spinal implants that possess all the ideal material properties for use in MSTS. Our review will explore whether there is a current ideal implant material, available alternatives and whether these require further investigation.

A Multi-Criteria Assessment Strategy for 3D Printed Porous Polyetheretherketone (PEEK) Patient-Specific Implants for Orbital Wall Reconstruction

Pure orbital blowout fractures occur within the confines of the internal orbital wall. Restoration of orbital form and volume is paramount to prevent functional and esthetic impairment. The anatomical peculiarity of the orbit has encouraged surgeons to develop implants with customized features to restore its architecture. This has resulted in worldwide clinical demand for patient-specific implants (PSIs) designed to fit precisely in the patient's unique anatomy. Material extrusion or Fused filament fabrication (FFF) three-dimensional (3D) printing technology has enabled the fabrication of implant-grade polymers such as Polyetheretherketone (PEEK), paving the way for a more sophisticated generation of biomaterials. This study evaluates the FFF 3D printed PEEK orbital mesh customized implants with a metric considering the relevant design, biomechanical, and morphological parameters. The performance of the implants is studied as a function of varying thicknesses and porous design constructs through a finite element (FE) based computational model and a decision matrix based statistical approach. The maximum stress values achieved in our results predict the high durability of the implants, and the maximum deformation values were under one-tenth of a millimeter (mm) domain in all the implant profile configurations. The circular patterned implant (0.9 mm) had the best performance score. The study demonstrates that compounding multi-design computational analysis with 3D printing can be beneficial for the optimal restoration of the orbital floor.

Drug-Releasing Antibacterial Coating Made from Nano-Hydroxyapatite Using the Sonocoating Method

Medical implant use is associated with a risk of infection caused by bacteria on their surface. Implants with a surface that has both bone growth-promoting properties and antibacterial properties are of interest in orthopedics. In the current study, we fabricated a bioactive coating of hydroxyapatite nanoparticles on polyether ether ketone (PEEK) using the sonocoating method. The sonocoating method creates a layer by immersing the object in a suspension of nanoparticles in water and applying a high-power ultrasound. We show that the simple layer fabrication method results in a well-adhering layer with a thickness of 219 nm to 764 nm. Dropping cefuroxime sodium salt (Cef) antibiotic on the coated substrate creates a layer with a drug release effect and antibacterial activity against Staphylococcus aureus. We achieved a concentration of up to 1 mg of drug per cm² of the coated substrate. In drug release tests, an initial burst was observed within 24 h, accompanied by a linear stable release effect. The drug-loaded implants exhibited sufficient activity against S. aureus for 24 and 168 h. Thus, the simple method we present here produces a biocompatible coating that can be soaked with antibiotics for antibacterial properties and can be used for a range of medical implants.

3D printed chitosan-gelatine hydrogel coating on titanium alloy surface as biological fixation interface of artificial joint prosthesis

To improve the fixation of the prosthesis-bone interface and to prevent postoperative infection, a novel antimicrobial hydrogel coating is designed as the biological fixation interface of the artificial joint prosthesis. Antimicrobial chitosan (CS) and gelatine (GT) were used as bioinks to print a CS-GT hydrogel coating with reticulated porous structure on the titanium alloy substrate by 3D printing technology. The experimental results show that the 7CS-10GT hydrogel coating has a macro-grid structure and honeycomb micro-network structure, excellent hydrophilicity (35.64°), high mechanical strength (elastic modulus 0.92 MPa) and high bonding strength (3.36 MPa) with the titanium alloy substrate. In addition, the antimicrobial effect of 7CS-10GT hydrogel against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) is enhanced after immersion in nano‑silver. Moreover, the 7CS-10GT hydrogel displays good cell compatibility and supports proliferation of NIH-3 T3 cells. In summary, the 3D printed CS-GT antimicrobial hydrogel coating provides an ideal microenvironment for cell adhesion and bone growth due to the dual-scale porous network structure, good hydrophilicity and biocompatibility, thus promoting rapid fixation of the bone interface. This technology opens a new possibility for this biological fixation interface in artificial joint replacement.

3D printing of PEEK and its composite to increase biointerfaces as a biomedical material- A review

Poly ether-ether-ketone (PEEK) is a polymer with better lignin biocompatibility than other polymers. It is good for biomedical engineering applications. This research summarises the outcomes of an evaluation conducted on PEEK material composites, such as cellular calcium hydroxyapatite (CHAp) for medical applications. Prospects of PEEK for medical implant are highlighted. Critical analysis and review on 3D printing of PEEK, CHAp and their biological macromolecular behaviours are presented. An electronic search was carried out on Scupos database, Google search and peer-reviewed papers published in the last ten years. Because of the extraordinary strength and biological behaviours of PEEK and its composite of CHAp, 3D-printed PEEK has several biomedical applications, and its biological macromolecular behaviour leads to health sustainability. This work highlights its biological macromolecular behaviours as a bone implant material and the optimum 3D printing process for PEEK and CHAp for medical applications. The current problems with printing PEEK and CHAp are investigated along with their possible uses. Possible solutions to improve the 3D printability of PEEK and CHAp are explained based on scientific mechanisms. This detailed report stands to benefit both scientific community and medical industry to enhance 3D printing concepts for PEEK and CHAp.

Bioinspired Modifications of PEEK Implants for Bone Tissue Engineering

In recent years, polyetheretherketone (PEEK) has been increasingly employed as an implant material in clinical applications. Although PEEK is biocompatible, chemically stable, and radiolucent and has an elastic modulus similar to that of natural bone, it suffers from poor integration with surrounding bone tissue after implantation. To improve the bioactivity of PEEK, numerous strategies for functionalizing the PEEK surface and changing the PEEK structure have been proposed. Inspired by the components, structure, and function of bone tissue, this review discusses strategies to enhance the biocompatibility of PEEK implants and provides direction for fabricating multifunctional implants in the future.

Biomimetic vs. Direct Approach to Deposit Hydroxyapatite on the Surface of Low Melting Point Polymers for Tissue Engineering

Polymers are widely used in many applications in the field of biomedical engineering. Among eclectic selections of polymers, those with low melting temperature (T_m < 200 °C), such as poly(methyl methacrylate), poly(lactic-co-glycolic acid), or polyethylene, are often used in bone, dental, maxillofacial, and corneal tissue engineering as substrates or scaffolds. These polymers, however, are bioinert, have a lack of reactive surface functional groups, and have poor wettability, affecting their ability to promote cellular functions and biointegration with the surrounding tissue. Improving the biointegration can be achieved by depositing hydroxyapatite (HAp) on the polymeric substrates. Conventional thermal spray and vapor phase coating, including the Food and Drug Administration (FDA)-approved plasma spray technique, is not suitable for application on the low T_m polymers due to the high processing temperature, reaching more than 1000 °C. Two non-thermal HAp coating approaches have been described in the literature, namely, the biomimetic deposition and direct nanoparticle immobilization techniques. In the current review, we elaborate on the unique features of each technique, followed by discussing the advantages and disadvantages of each technique to help readers decide on which method is more suitable for their intended applications. Finally, the future perspectives of the non-thermal HAp coating are given in the conclusion.

Osteointegration of 3D-Printed Fully Porous Polyetheretherketone Scaffolds with Different Pore Sizes

Polyetheretherketone (PEEK) constitutes a preferred alternative material for orthopedic implants owing to its good mechanical properties and biocompatibility. However, the poor osseointegration property of PEEK implants has limited their clinical applications. To address this issue, in this study, we investigated the mechanical and biological properties of fully porous PEEK scaffolds with different pore sizes both in vitro and in vivo. PEEK scaffolds with designed pore sizes of 300, 450, and 600 μm and a porosity of 60% were manufactured via fused deposition modeling (FDM) to explore the optimum pore size. Smooth solid PEEK cylinders (PEEK-S) were used as the reference material. The mechanical, cytocompatibility, proliferative, and osteogenic properties of PEEK scaffolds were characterized in comparison to those of PEEK-S. In vivo dynamic contrast-enhanced magnetic resonance imaging, microcomputed tomography, and histological observation were performed after 4 and 12 weeks of implantation to evaluate the microvascular perfusion and bone formation afforded by the various PEEK implants using a New Zealand white rabbit model with distal femoral condyle defects. Results of in vitro testing supported the good biocompatibility of the porous PEEK scaffolds manufactured via FDM. In particular, the PEEK-450 scaffolds were most beneficial for cell adhesion, proliferation, and osteogenic differentiation. Results of in vivo analysis further indicated that PEEK-450 scaffolds exhibited preferential potential for bone ingrowth and vascular perfusion. Together, our findings support that porous PEEK implants designed with a suitable pore size and fabricated via three-dimensional printing constitute promising alternative biomaterials for bone grafting and tissue engineering applications with marked potential for clinical applications.

Fabrication and Characterization of Ag-Sr-Substituted Hydroxyapatite/Chitosan Coatings Deposited via Electrophoretic Deposition: A Design of Experiment Study

In this study, silver-strontium-doped hydroxyapatite (AgSr-HA)/chitosan composite coatings were deposited on a 316L stainless steel (SS) substrate via electrophoretic deposition (EPD). The Taguchi design of experiment (DoE) approach was used to optimize the EPD parameters such as the applied voltage, interelectrode spacing, and deposition time. Furthermore, the concentration of AgSr-HA particles in the suspension was also optimized via the DoE approach. DoE results demonstrated that the "homogeneous" coatings were obtained at the deposition time of 7 min, deposition voltage of 20 V, and at a concentration of 5 g/L AgSr-HA particles in the suspension. Scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), antibacterial studies, contact angle, and roughness measurements were performed to characterize the optimized coatings. SEM images confirmed the deposition of chitosan/AgSr-HA on the SS substrate. The wettability studies indicated the hydrophilic nature of the chitosan/AgSr-HA composite coatings, which confirmed that the developed coatings are suitable for biomedical applications, e.g., orthopedics. The average surface roughness of the chitosan/AgSr-HA composite coatings was in a suitable range used to attach the bone marrow stromal cells. Chitosan/AgSr-HA composite coatings showed an effective antibacterial effect against Gram-positive and Gram-negative bacteria. Moreover, the coatings developed apatite crystals on their surface upon immersion in simulated body fluid.

Electrodeposited Biocoatings, Their Properties and Fabrication Technologies: A Review

Coatings deposited under an electric field are applied for the surface modification of biomaterials. This review is aimed to characterize the state-of-art in this area with an emphasis on the advantages and disadvantages of used methods, process determinants, and properties of coatings. Over 170 articles, published mainly during the last ten years, were chosen, and reviewed as the most representative. The most recent developments of metallic, ceramic, polymer, and composite electrodeposited coatings are described focusing on their microstructure and properties. The direct cathodic electrodeposition, pulse cathodic deposition, electrophoretic deposition, plasma electrochemical oxidation in electrolytes rich in phosphates and calcium ions, electro-spark, and electro-discharge methods are characterized. The effects of electrolyte composition, potential and current, pH, and temperature are discussed. The review demonstrates that the most popular are direct and pulse cathodic electrodeposition and electrophoretic deposition. The research is mainly aimed to introduce new coatings rather than to investigate the effects of process parameters on the properties of deposits. So far tests aim to enhance bioactivity, mechanical strength and adhesion, antibacterial efficiency, and to a lesser extent the corrosion resistance.

Electrophoretic Co-deposition of Polyetheretherketone and Graphite Particles: Microstructure, Electrochemical Corrosion Resistance, and Coating Adhesion to a Titanium Alloy

The present study explores the possibilities of fabricating a graphite/polyetheretherketone (PEEK) composite coating on a Ti-6Al-4V titanium alloy through duplex treatment consisting of electrophoretic deposition (EPD) and heat treatment. It has been found that the electrophoretic co-deposition of graphite and PEEK microparticles can be performed from environmentally-friendly pure ethanolic suspensions. Zeta potential measurements and a study of the interaction between both particle types with the use of transmission electron microscopy allowed potential mechanisms of particle co-deposition to be indicated. Microstructure characterization was performed on macro-, micro- and nanoscale using visible light microscopy, X-ray diffractometry and electron microscopy. This allowed the coating homogeneity and distribution of graphite particles in the polymer matrix to be described. Graphite particles in the form of graphene nanosheet packages were relatively evenly distributed in the coating matrix and oriented parallel to the coating surface. The heat-treated coatings showed high scratch resistance and no adhesive type destruction was observed, but they were highly susceptible to deformation. The corrosion measurements were performed with use of electrochemical techniques like open circuit potential and linear sweep voltamperometry. The coated alloy indicated better electrochemical corrosion resistance compared with the uncoated alloy. This work showed the high versatility of the electrophoretic co-deposition of graphite and PEEK particles, which combined with post-EPD heat treatment allows composite coatings to be fabricated with controlled distribution of graphite particles.

Gaseous sulfur trioxide induced controllable sulfonation promoting biomineralization and osseointegration of polyetheretherketone implants

Fabricating a desired porous structure on the surface of biomedical polyetheretherketone (PEEK) implants for enhancing biological functions is crucial and difficult due to its inherent chemical inertness. In this study, a porous surface of PEEK implants was fabricated by controllable sulfonation using gaseous sulfur trioxide (SO₃) for different time (5, 15, 30, 60 and 90 min). Micro-topological structure was generated on the surface of sulfonated PEEK implants preserving original mechanical properties. The protein absorption capacity and apatite forming ability was thus improved by the morphological and elemental change with higher degree of sulfonation. In combination of the appropriate micromorphology and bioactive sulfonate components, the cell adhesion, migration, proliferation and extracellular matrix secretion were obviously enhanced by the SPEEK-15 samples which were sulfonated for 15 min. Finding from this study revealed that controllable sulfonation by gaseous SO₃ would be an extraordinarily strategy for improving osseointegration of PEEK implants by adjusting the microstructure and chemical composition while maintaining excellent mechanical properties.

Fabrication and Characterization of Zein/Hydroxyapatite Composite Coatings for Biomedical Applications

Stainless steel is renowned for its wide use as a biomaterial, but its relatively high corrosion rate in physiological environments restricts many of its clinical applications. To overcome the corrosion resistance of stainless steel bio-implants in physiological environments and to improve its osseointegration behavior, we have developed a unique zein/hydroxyapatite (HA) composite coating on a stainless steel substrate by Electrophoretic Deposition (EPD). The EPD parameters were optimized using the Taguchi Design of experiments (DoE) approach. The EPD parameters, such as the concentration of bio-ceramic particles in the polymer solution, applied voltage and deposition time were optimized on stainless steel substrates by applying a mixed design orthogonal Taguchi array. The coatings were characterized by using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX) and wettability studies. SEM images and EDX results indicated that the zein/HA coating was successfully deposited onto the stainless steel substrates. The wettability and roughness studies elucidated the mildly hydrophilic nature of the zein/HA coatings, which confirmed the suitability of the developed coatings for biomedical applications. Zein/HA coatings improved the corrosion resistance of bare 316L stainless steel. Moreover, zein/HA coatings showed strong adhesion with the 316L SS substrate for biomedical applications. Zein/HA developed dense HA crystals upon immersion in simulated body fluid, which confirmed the bone binding ability of the coatings. Thus the zein/HA coatings presented in this study have a strong potential to be considered for orthopedic applications.

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.

Curcumin-Containing Orthopedic Implant Coatings Deposited on Poly-Ether-Ether-Ketone/Bioactive Glass/Hexagonal Boron Nitride Layers by Electrophoretic Deposition

Electrophoretic deposition (EPD) was used to produce a multilayer coatings system based on chitosan/curcumin coatings on poly-ether-ether-ketone (PEEK)/bioactive glass (BG)/hexagonal boron nitride (h-BN) layers (previously deposited by EPD on 316L stainless steel) to yield bioactive and antibacterial coatings intended for orthopedic implants. Initially, PEEK/BG/h-BN coatings developed on 316L stainless steel (SS) substrates were analyzed for wear studies. Then, the EPD of chitosan/curcumin was optimized on 316L SS for suspension stability, thickness, and homogeneity of the coatings. Subsequently, the optimized EPD parameters were applied to produce chitosan/curcumin coatings on the PEEK/BG/h-BN layers. The multilayered coatings produced by EPD were characterized in terms of composition, microstructure, drug release kinetics, antibacterial activity, and in vitro bioactivity. Scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR) confirmed the deposition of chitosan/curcumin on the multilayer coating system. The release of curcumin upon immersion of multilayer coatings in phosphate-buffered saline (PBS) was confirmed by ultraviolet/visible (UV/VIS) spectroscopic analysis. The antibacterial effect of chitosan/curcumin as the top coating was determined by turbidity tests (optical density measurements). Moreover, the multilayer coating system formed an apatite-like layer upon immersion in simulated body fluid (SBF), which is similar in composition to the hydroxyapatite component of bone, confirming the possibility of achieving close bonding between bone and the coating surface.

The Influence of Electrophoretic Deposition Parameters and Heat Treatment on the Microstructure and Tribological Properties of Nanocomposite Si3N4/PEEK 708 Coatings on Titanium Alloy

Nanocomposite Si3N4/PEEK 708 coatings were successfully fabricated on the Ti-6Al-4V alloy substrate by electrophoretic deposition (EPD) and post-EPD heat treatment. The addition of chitosan polyelectrolyte into ethanolic-based suspensions enabled the cathodic co-deposition of ceramic and polymeric particles. Zeta potential measurements allowed the elaboration of stable suspensions. The selection of the optimal EPD voltage and time enabled uniform coatings to be obtained. Heating above the PEEK melting point and cooling with a furnace or in water resulted in the formation of dense coatings with semi-crystalline or amorphous polymer structures, respectively. Both coatings with a thickness in the range of 90–105 µm had good adhesion and scratch resistance to the substrates, despite the presence of relatively high degrees of open porosity. The coatings improved the tribological properties of the titanium alloy. However, a strong relationship between the polymeric matrix structure and wear resistance was observed. Semi-crystalline coatings proved to be significantly more wear resistant than amorphous ones.

Drug-loaded/grafted peptide-modified porous PEEK to promote bone tissue repair and eliminate bacteria

Bone restoration and related infection in bone defect repair remain thorny problems in clinical practice. Herein, a drug-loaded (chlorogenic acid, CGA)/grafted peptide (BFP) hydrogel system supported on a sulfonated polyetheretherketone (SPEEK) surface is constructed to address the problem of large-scale defects and related infections in clinical bone implantation. Briefly, the encapsulated chlorogenic acid is released during hydrogel degradation and can inhibit the growth of bacteria and provide a bacteria-free environment for new bone formation. In vitro experiments and cell adhesion/proliferation evaluation reveal that the chlorogenic acid-sodium alginate-peptide bridging system shows better bioaffinity than the control groups due to the BFP peptide on the surface of the hydrogel. In addition, bacterial experiments suggest that the released chlorogenic acid has excellent antibacterial activity against gram-negative and gram-positive bacteria. Therefore, the hydrogel bridging system has a prospective application in clinical applications for bone repair.

A comprehensive review of biodegradable synthetic polymer-ceramic composites and their manufacture for biomedical applications

The application of various materials in biomedical procedures has recently experienced rapid growth. One area that is currently receiving significant attention from the scientific community is the treatment of a number of different types of bone-related diseases and disorders by using biodegradable polymer-ceramic composites. Biomaterials, the most common materials used to repair or replace damaged parts of the human body, can be categorized into three major groups: metals, ceramics, and polymers. Composites can be manufactured by combining two or more materials to achieve enhanced biocompatibility and biomechanical properties for specific applications. Biomaterials must display suitable properties for their applications, about strength, durability, and biological influence. Metals and their alloys such as titanium, stainless steel, and cobalt-based alloys have been widely investigated for implant-device applications because of their excellent mechanical properties. However, these materials may also manifest biological issues such as toxicity, poor tissue adhesion and stress shielding effect due to their high elastic modulus. To mitigate these issues, hydroxyapatite (HA) coatings have been used on metals because their chemical composition is similar to that of bone and teeth. Recently, a wide range of synthetic polymers such as poly (l-lactic acid) and poly (l-lactide-co-glycolide) have been studied for different biomedical applications, owing to their promising biocompatibility and biodegradability. This article gives an overview of synthetic polymer-ceramic composites with a particular emphasis on calcium phosphate group and their potential applications in tissue engineering. It is hoped that synthetic polymer-ceramic composites such as PLLA/HA and PCL/HA will provide advantages such as eliminating the stress shielding effect and the consequent need for revision surgery.

Polymer coatings based on sulfonated-poly-ether-ether-ketone films for implant dentistry applications

Poly-ether-ether-ketone (PEEK) is one of the most important biocompatible polymers and its sulfonation has been studied for biomedical applications. The aim of the present study is to produce, to characterize and to assess bioactivity of PEEK coatings with sulfonated PEEK (SPEEK) films. Biomedical grade PEEK (Invibio®, Batch: D0602, grade: NI1) was functionalized using sulfuric acid 98%. SPEEK was dissolved into DMSO or into DMF, both at 10% mass/volume. PEEK bars (N = 18) and cylinders (N = 27) were manufactured by compression molding and heating. SPEEK/DMSO and SPEEK/DMF were drop casted at PEEK bars and dip coated at PEEK cylinders (PEEK + SPEEK/DMSO and PEEK + SPEEK/DMF). Characterization was performed through Fourier Transform Infrared Spectroscopy (FTIR), X-Ray Diffraction (XRD), Scanning Electron Microscope (SEM) and contact angle measurements. Bioactivity was assessed by immersion of samples at SBF for 1, 7 and 21 days, followed by SEM, energy-dispersive analysis (EDX) and FTIR analysis. Statistical analysis was carried out by one-way analysis of variance (ANOVA) (p = 0.05). Characteristic bands of PEEK and SPEEK, were identified through FTIR spectrum analysis, while semicrystallinity was confirmed by XRD. PEEK + SPEEK/DMF showed more evident physicochemical modifications. PEEK + SPEEK/DMSO provided a more regular and hydrophobic surface, observed through SEM and contact angle measurements. SEM/EDX showed that precipitates of calcium were formed at PEEK + SPEEK/DMSO and PEEK + SPEEK/DMF at all experimental times, but materials were not considered bioactive. Interesting surface properties were achieved with SPEEK coatings but the production of SPEEK films at PEEK surface has to be further improved and biologically tested. Schematic diagram showing the methodology applied in this study to prepare PEEK and SPEEK samples, as well as the promising application of the material.