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Li F, Ye J, Liu P, Jiang J, Chen X. An Overview on Bioactive Glasses for Bone Regeneration and Repair: Preparation, Reinforcement, and Applications. TISSUE ENGINEERING. PART B, REVIEWS 2025. [PMID: 39761075 DOI: 10.1089/ten.teb.2024.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2025]
Abstract
Synthetic bone transplantation has emerged in recent years as a highly promising strategy to address the major clinical challenge of bone tissue defects. In this field, bioactive glasses (BGs) have been widely recognized as a viable alternative to traditional bone substitutes due to their unique advantages, including favorable biocompatibility, pronounced bioactivity, excellent biodegradability, and superior osseointegration properties. This article begins with a comprehensive overview of the development and success of BGs in bone tissue engineering, and then focuses on their composite reinforcement systems with biodegradable metals, calcium-phosphorus (Ca-P)-based bioceramics, and biodegradable medical polymers, respectively. Moreover, the article outlines some frequently used manufacturing methods for three-dimensional BG-based bone bioscaffolds and highlights the remarkable achievements of these scaffolds in the field of bone defect repair in recent years. Lastly, based on the many potential challenges encountered in the preparation and application of BGs, a brief outlook on their future directions is presented. This review may help to provide new ideas for researchers to develop ideal BG-based bone substitutes for bone reconstruction and functional recovery.
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Affiliation(s)
- Fulong Li
- Materials Science and Engineering, School of Materials and Chemistry, University of Shanghai for Science & Technology, Shanghai, China
| | - Juelan Ye
- Biomedical Engineering, School of Health Science and Engineering, University of Shanghai for Science & Technology, Shanghai, China
| | - Ping Liu
- Materials Science and Engineering, School of Materials and Chemistry, University of Shanghai for Science & Technology, Shanghai, China
| | - Jiaqi Jiang
- Materials Science and Engineering, School of Materials and Chemistry, University of Shanghai for Science & Technology, Shanghai, China
| | - Xiaohong Chen
- Materials Science and Engineering, School of Materials and Chemistry, University of Shanghai for Science & Technology, Shanghai, China
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Bee SL, Hamid ZAA. Chitosan-based dental barrier membrane for periodontal guided tissue regeneration and guided bone regeneration: A review. Int J Biol Macromol 2025; 295:139504. [PMID: 39761899 DOI: 10.1016/j.ijbiomac.2025.139504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 12/21/2024] [Accepted: 01/02/2025] [Indexed: 01/12/2025]
Abstract
Guided tissue regeneration (GTR) and guided bone regeneration (GBR) are two common dental regenerative procedures used to repair periodontal defects caused by periodontitis. In both procedures, a barrier membrane is placed at the interface between the soft tissue and the periodontal defect, serving to impede the infiltration of soft tissue while creating a secluded space for periodontal regeneration. Recently, barrier membranes based on chitosan (CS) have emerged as a promising avenue for these applications. However, despite numerous studies on the development of CS-based membranes, comprehensive review articles specifically addressing their progress in GTR/GBR applications remain scarce. Herein, we review recent research and advancements in the use of CS-based membranes for periodontal GTR and GBR. The review begins by highlighting the advantageous properties of CS that make it a suitable biomaterial for GTR/GBR applications. Next, the development of composite CS-based membranes, reinforced with various compositions like bioactive fillers and therapeutic agents, is discussed in detail based on recent literature, with a focus on their enhanced efficacy in promoting periodontal regeneration. Finally, the review explores the emergence of functionally graded CS-based membranes, emphasizing their potential to address specific challenges encountered in GTR/GBR procedures.
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Affiliation(s)
- Soo-Ling Bee
- School of Materials and Mineral Resources Engineering, Engineering Campus, Universiti Sains Malaysia, 14300 Nibong Tebal, Penang, Malaysia.
| | - Zuratul Ain Abdul Hamid
- School of Materials and Mineral Resources Engineering, Engineering Campus, Universiti Sains Malaysia, 14300 Nibong Tebal, Penang, Malaysia.
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3
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Shlapakova LE, Pryadko AS, Zharkova II, Volkov A, Kozadaeva M, Chernozem RV, Mukhortova YR, Chesnokova D, Zhuikov VA, Zeltser A, Dudun AA, Makhina T, Bonartseva GA, Voinova VV, Shaitan KV, Romanyuk K, Kholkin AL, Bonartsev AP, Surmeneva MA, Surmenev RA. Osteogenic Potential and Long-Term Enzymatic Biodegradation of PHB-based Scaffolds with Composite Magnetic Nanofillers in a Magnetic Field. ACS APPLIED MATERIALS & INTERFACES 2024; 16:56555-56579. [PMID: 39377758 DOI: 10.1021/acsami.4c06835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/09/2024]
Abstract
Millions of people worldwide suffer from musculoskeletal damage, thus using the largest proportion of rehabilitation services. The limited self-regenerative capacity of bone and cartilage tissues necessitates the development of functional biomaterials. Magnetoactive materials are a promising solution due to clinical safety and deep tissue penetration of magnetic fields (MFs) without attenuation and tissue heating. Herein, electrospun microfibrous scaffolds were developed based on piezoelectric poly(3-hydroxybutyrate) (PHB) and composite magnetic nanofillers [magnetite with graphene oxide (GO) or reduced GO]. The scaffolds' morphology, structure, mechanical properties, surface potential, and piezoelectric response were systematically investigated. Furthermore, a complex mechanism of enzymatic biodegradation of these scaffolds is proposed that involves (i) a release of polymer crystallites, (ii) crystallization of the amorphous phase, and (iii) dissolution of the amorphous phase. Incorporation of Fe3O4, Fe3O4-GO, or Fe3O4-rGO accelerated the biodegradation of PHB scaffolds owing to pores on the surface of composite fibers and the enlarged content of polymer amorphous phase in the composite scaffolds. Six-month biodegradation caused a reduction in surface potential (1.5-fold) and in a vertical piezoresponse (3.5-fold) of the Fe3O4-GO scaffold because of a decrease in the PHB β-phase content. In vitro assays in the absence of an MF showed a significantly more pronounced mesenchymal stem cell proliferation on composite magnetic scaffolds compared to the neat scaffold, whereas in an MF (68 mT, 0.67 Hz), cell proliferation was not statistically significantly different when all the studied scaffolds were compared. The PHB/Fe3O4-GO scaffold was implanted into femur bone defects in rats, resulting in successful bone repair after nonperiodic magnetic stimulation (200 mT, 0.04 Hz) owing to a synergetic influence of increased surface roughness, the presence of hydrophilic groups near the surface, and magnetoelectric and magnetomechanical effects of the material.
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Affiliation(s)
- Lada E Shlapakova
- Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Artyom S Pryadko
- Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Irina I Zharkova
- Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow 119234, Russia
| | - Alexey Volkov
- P. Lumumba Peoples' Friendship University of Russia, 6 Miklukho-Maklaya Str., Moscow 117198, Russia
- Avtsyn Research Institute of Human Morphology at FSBSI Petrovsky National Research Centre of Surgery, 3 Tsyurupy Str., Moscow 117418, Russia
| | - Maria Kozadaeva
- Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Roman V Chernozem
- Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Yulia R Mukhortova
- Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Dariana Chesnokova
- Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow 119234, Russia
| | - Vsevolod A Zhuikov
- Research Center of Biotechnology, Russian Academy of Sciences, Leninsky Ave 33, Bldg. 2, Moscow 119071, Russia
| | - Angelina Zeltser
- Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow 119234, Russia
| | - Andrey A Dudun
- Research Center of Biotechnology, Russian Academy of Sciences, Leninsky Ave 33, Bldg. 2, Moscow 119071, Russia
| | - Tatiana Makhina
- Research Center of Biotechnology, Russian Academy of Sciences, Leninsky Ave 33, Bldg. 2, Moscow 119071, Russia
| | - Garina A Bonartseva
- Research Center of Biotechnology, Russian Academy of Sciences, Leninsky Ave 33, Bldg. 2, Moscow 119071, Russia
| | - Vera V Voinova
- Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow 119234, Russia
| | - Konstantin V Shaitan
- Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow 119234, Russia
| | - Konstantin Romanyuk
- Department of Physics & CICECO─Aveiro Institute of Materials, University of Aveiro, Aveiro 3810-193, Portugal
| | - Andrei L Kholkin
- Department of Physics & CICECO─Aveiro Institute of Materials, University of Aveiro, Aveiro 3810-193, Portugal
| | - Anton P Bonartsev
- Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow 119234, Russia
| | - Maria A Surmeneva
- Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Roman A Surmenev
- Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk 634050, Russia
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Lu YC, Chang TK, Lin TC, Yeh ST, Lin HS, Cheng QP, Huang CH, Fang HW, Huang CH. Potential role of calcium sulfate/β-tricalcium phosphate/graphene oxide nanocomposite for bone graft application_mechanical and biological analyses. J Orthop Surg Res 2024; 19:644. [PMID: 39396014 PMCID: PMC11470679 DOI: 10.1186/s13018-024-05142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 10/04/2024] [Indexed: 10/14/2024] Open
Abstract
BACKGROUND Bone grafts are extensively used for repairing bone defects and voids in orthopedics and dentistry. Moldable bone grafts offer a promising solution for treating irregular bone defects, which are often difficult to fill with traditional rigid grafts. However, practical applications have been limited by insufficient mechanical strength and rapid degradation. METHODS This study developed a ceramic composite bone graft composed of calcium sulfate (CS), β-tricalcium phosphate (β-TCP) with/without graphene oxide (GO) nano-particles. The biomechanical properties, degradation rate, and in-vitro cellular responses were investigated. In addition, the graft was implanted in-vivo in a critical-sized calvarial defect model. RESULTS The results showed that the compressive strength significantly improved by 135% and the degradation rate slowed by 25.5% in comparison to the control model. The addition of GO nanoparticles also improved cell compatibility and promoted osteogenic differentiation in the in-vitro cell culture study and was found to be effective at promoting bone repair in the in-vivo animal model. CONCLUSIONS The mixed ceramic composites presented in this study can be considered as a promising alternative for bone graft applications.
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Affiliation(s)
- Yung-Chang Lu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ting-Kuo Chang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tzu-Chiao Lin
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shu-Ting Yeh
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hung-Shih Lin
- Department of Neurosurgery, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Qiao-Ping Cheng
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Hsiung Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Orthopaedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan.
| | - Chang-Hung Huang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Lu C, Zhang YY, Peng SM, Gu M, Wong HM. Effects of graphene oxide and graphene quantum dots on enhancing CPP-ACP anti-caries ability of enamel lesion in a biofilm-challenged environment. J Dent 2024; 149:105319. [PMID: 39181432 DOI: 10.1016/j.jdent.2024.105319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/13/2024] [Accepted: 08/21/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE To investigate the anticaries effects of graphene oxide (GO) and graphene quantum dots (GQDs) combined with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on enamel in a biofilm-challenged environment. MATERIAL AND METHODS GO and GQDs were synthesised using citric acid. The antibiofilm and biofilm inhibition effects for Streptococcus mutans were evaluated by scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), and colony-forming units (CFU). Remineralisation ability was determined by assessing mineral loss, calcium-to-phosphorus ratio, and surface morphology. To create a biofilm-challenged environment, enamel blocks were immersed in S. mutans to create the lesion and then subjected to artificial saliva/biofilm cycling for 7 days. Anticaries effects of GO, GQDs, GQDs@CPP-ACP, GO@CPP-ACP, and CPP-ACP were determined by broth pH and mineral changes after 7-day pH cycling. Biocompatibility was tested using a Cell Counting Kit-8 (CCK8) assay for human gingival fibroblasts (HGF-1). RESULTS GQDs and GO presented significant antibiofilm and biofilm inhibition effects compared to the CPP-ACP and control groups (P < 0.05). The enamel covered by GQDs and GO showed better crystal structure formation and less mineral loss (P < 0.05) than that covered by CPP-ACP alone. After 7 days in the biofilm-challenged environment, the GO@CPP-ACP group showed less lesion depth than the CPP-ACP and control groups (P < 0.05). GO and GQDs showed good biocompatibility compared to the control group by CCK8 (P > 0.05) within 3 days. CONCLUSION GO and GQDs could improve the anti-caries effects of CPP-ACP, and CPP-ACP agents with GO or GQDs could be a potential option for enamel lesion management. CLINICAL SIGNIFICANCE GO and GQDs have demonstrated the potential to significantly enhance the anticaries effects of CPP-ACP. Incorporating these nanomaterials into CPP-ACP formulations could provide innovative and effective options for the management of enamel lesions, offering improved preventive and therapeutic strategies in dental care.
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Affiliation(s)
- Cheng Lu
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yu Yuan Zhang
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Si-Min Peng
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Min Gu
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Hai Ming Wong
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Gostaviceanu A, Gavrilaş S, Copolovici L, Copolovici DM. Graphene-Oxide Peptide-Containing Materials for Biomedical Applications. Int J Mol Sci 2024; 25:10174. [PMID: 39337659 PMCID: PMC11432502 DOI: 10.3390/ijms251810174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 09/15/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
This review explores the application of graphene-based materials (GBMs) in biomedicine, focusing on graphene oxide (GO) and its interactions with peptides and proteins. GO, a versatile nanomaterial with oxygen-containing functional groups, holds significant potential for biomedical applications but faces challenges related to toxicity and environmental impact. Peptides and proteins can be functionalized on GO surfaces through various methods, including non-covalent interactions such as π-π stacking, electrostatic forces, hydrophobic interactions, hydrogen bonding, and van der Waals forces, as well as covalent bonding through reactions involving amide bond formation, esterification, thiol chemistry, and click chemistry. These approaches enhance GO's functionality in several key areas: biosensing for sensitive biomarker detection, theranostic imaging that integrates diagnostics and therapy for real-time treatment monitoring, and targeted cancer therapy where GO can deliver drugs directly to tumor sites while being tracked by imaging techniques like MRI and photoacoustic imaging. Additionally, GO-based scaffolds are advancing tissue engineering and aiding tissues' bone, muscle, and nerve tissue regeneration, while their antimicrobial properties are improving infection-resistant medical devices. Despite its potential, addressing challenges related to stability and scalability is essential to fully harness the benefits of GBMs in healthcare.
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Affiliation(s)
- Andreea Gostaviceanu
- Institute for Interdisciplinary Research, Aurel Vlaicu University of Arad, Elena Drăgoi St., No. 2, 310330 Arad, Romania; (A.G.); (S.G.); (L.C.)
- Biomedical Sciences Doctoral School, University of Oradea, University St., No. 1, 410087 Oradea, Romania
| | - Simona Gavrilaş
- Institute for Interdisciplinary Research, Aurel Vlaicu University of Arad, Elena Drăgoi St., No. 2, 310330 Arad, Romania; (A.G.); (S.G.); (L.C.)
- Faculty of Food Engineering, Tourism and Environmental Protection, Aurel Vlaicu University of Arad, Elena Drăgoi St., No. 2, 310330 Arad, Romania
| | - Lucian Copolovici
- Institute for Interdisciplinary Research, Aurel Vlaicu University of Arad, Elena Drăgoi St., No. 2, 310330 Arad, Romania; (A.G.); (S.G.); (L.C.)
- Faculty of Food Engineering, Tourism and Environmental Protection, Aurel Vlaicu University of Arad, Elena Drăgoi St., No. 2, 310330 Arad, Romania
| | - Dana Maria Copolovici
- Institute for Interdisciplinary Research, Aurel Vlaicu University of Arad, Elena Drăgoi St., No. 2, 310330 Arad, Romania; (A.G.); (S.G.); (L.C.)
- Faculty of Food Engineering, Tourism and Environmental Protection, Aurel Vlaicu University of Arad, Elena Drăgoi St., No. 2, 310330 Arad, Romania
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Chaka KT, Cao K, Tesfaye T, Qin X. Nanomaterial-functionalized electrospun scaffolds for tissue engineering. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024:1-43. [PMID: 39259663 DOI: 10.1080/09205063.2024.2399909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 08/29/2024] [Indexed: 09/13/2024]
Abstract
Tissue engineering has emerged as a biological alternative aimed at sustaining, rehabilitating, or enhancing the functionality of tissues that have experienced partial or complete loss of their operational capabilities. The distinctive characteristics of electrospun nanofibrous structures, such as their elevated surface-area-to-volume ratio, specific pore sizes, and fine fiber diameters, make them suitable as effective scaffolds in tissue engineering, capable of mimicking the functions of the targeted tissue. However, electrospun nanofibers, whether derived from natural or synthetic polymers or their combinations, often fall short of replicating the multifunctional attributes of the extracellular matrix (ECM). To address this, nanomaterials (NMs) are integrated into the electrospun polymeric matrix through various functionalization techniques to enhance their multifunctional properties. Incorporation of NMs into electrospun nanofibrous scaffolds imparts unique features, including a high surface area, superior mechanical properties, compositional variety, structural adaptability, exceptional porosity, and enhanced capabilities for promoting cell migration and proliferation. This review provides a comprehensive overview of the various types of NMs, the methodologies used for their integration into electrospun nanofibrous scaffolds, and the recent advancements in NM-functionalized electrospun nanofibrous scaffolds aimed at regenerating bone, cardiac, cartilage, nerve, and vascular tissues. Moreover, the main challenges, limitations, and prospects in electrospun nanofibrous scaffolds are elaborated.
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Affiliation(s)
- Kilole Tesfaye Chaka
- Ethiopian Institute of Textile and Fashion Technology, Bahir Dar University, Bahir Dar, Ethiopia
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China
| | - Kai Cao
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China
| | - Tamrat Tesfaye
- Ethiopian Institute of Textile and Fashion Technology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Xiaohong Qin
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China
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Esmaeili M, Ghasemi S, Shariati L, Karbasi S. Evaluating the osteogenic properties of polyhydroxybutyrate-zein/multiwalled carbon nanotubes (MWCNTs) electrospun composite scaffold for bone tissue engineering applications. Int J Biol Macromol 2024; 276:133829. [PMID: 39002904 DOI: 10.1016/j.ijbiomac.2024.133829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/29/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
In this investigation, the electrospun nanocomposite scaffolds were developed utilizing poly-3-hydroxybutyrate (PHB), zein, and multiwalled carbon nanotubes (MWCNTs) at varying concentrations of MWCNTs including 0.5 and 1 wt%. Based on the SEM evaluations, the scaffold containing 1 wt% MWCNTs (PZ-1C) exhibited the lowest fiber diameter (384 ± 99 nm) alongside a suitable porosity percentage. The presence of zein and MWCNT in the chemical structure of the scaffold was evaluated by FTIR. Furthermore, TEM images revealed the alignment of MWCNTs with the fibers. Adding 1 % MWCNTs to the PHB-zein scaffold significantly enhanced tensile strength by about 69 % and reduced elongation by about 31 %. Hydrophilicity, surface roughness, crystallinity, and biomineralization were increased by incorporating 1 wt% MWCNTs, while weight loss after in vitro degradation was decreased. The MG-63 cells exhibited enhanced attachment, viability, ALP secretion, calcium deposition, and gene expression (COLI, RUNX2, and OCN) when cultivated on the scaffold containing MWCNTs compared to the scaffolds lacking MWCNTs. Moreover, the study found that MWCNTs significantly reduced platelet adhesion and hemolysis rates below 4 %, indicating their favorable anti-hemolysis properties. Regarding the aforementioned results, the PZ-1C electrospun composite scaffold is a promising scaffold with osteogenic properties for bone tissue engineering applications.
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Affiliation(s)
- Mahdie Esmaeili
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Hezarjerib Ave, Isfahan 8174673461, Iran
| | - Saeid Ghasemi
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Laleh Shariati
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Karbasi
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Castro JI, Payan-Valero A, Valencia-Llano CH, Valencia Zapata ME, Mina Hernández JH, Zapata PA, Grande-Tovar CD. Graphene Oxide Nanosheets for Bone Tissue Regeneration. Molecules 2024; 29:3263. [PMID: 39064841 PMCID: PMC11279378 DOI: 10.3390/molecules29143263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/01/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Bone tissue engineering is a promising alternative to repair wounds caused by cellular or physical accidents that humans face daily. In this sense, the search for new graphene oxide (GO) nanofillers related to their degree of oxidation is born as an alternative bioactive component in forming new scaffolds. In the present study, three different GOs were synthesized with varying degrees of oxidation and studied chemically and tissue-wise. The oxidation degree was determined through infrared (FTIR), X-ray diffraction (XRD), X-ray photoelectron (XPS), and Raman spectroscopy (RS). The morphology of the samples was analyzed using scanning electron microscopy (SEM). The oxygen content was deeply described using the deconvolution of RS and XPS techniques. The latter represents the oxidation degree for each of the samples and the formation of new bonds promoted by the graphitization of the material. In the RS, two characteristic bands were observed according to the degree of oxidation and the degree of graphitization of the material represented in bands D and G with different relative intensities, suggesting that the samples have different crystallite sizes. This size was described using the Tuinstra-Koenig model, ranging between 18.7 and 25.1 nm. Finally, the bone neoformation observed in the cranial defects of critical size indicates that the F1 and F2 samples, besides being compatible and resorbable, acted as a bridge for bone healing through regeneration. This promoted healing by restoring bone and tissue structure without triggering a strong immune response.
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Affiliation(s)
- Jorge Iván Castro
- Tribology, Polymers, Powder Metallurgy and Solid Waste Transformations Research Group, Universidad del Valle, Calle 13 No. 100-00, Cali 760001, Colombia;
| | - Alana Payan-Valero
- Grupo Biomateriales Dentales, Escuela de Odontología, Universidad del Valle, Calle 4B Número 36-00, Cali 760001, Colombia; (A.P.-V.); (C.-H.V.-L.)
| | - Carlos-Humberto Valencia-Llano
- Grupo Biomateriales Dentales, Escuela de Odontología, Universidad del Valle, Calle 4B Número 36-00, Cali 760001, Colombia; (A.P.-V.); (C.-H.V.-L.)
| | - Mayra Eliana Valencia Zapata
- Grupo de Materiales Compuestos, Escuela de Ingeniería de Materiales, Facultad de Ingeniería, Universidad del Valle, Calle 13 Número 100-00, Cali 760032, Colombia; (M.E.V.Z.); (J.H.M.H.)
| | - Jose Herminsul Mina Hernández
- Grupo de Materiales Compuestos, Escuela de Ingeniería de Materiales, Facultad de Ingeniería, Universidad del Valle, Calle 13 Número 100-00, Cali 760032, Colombia; (M.E.V.Z.); (J.H.M.H.)
| | - Paula A. Zapata
- Grupo de Polímeros, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago de Chile 9170020, Chile;
| | - Carlos David Grande-Tovar
- Grupo de Investigación de Fotoquímica y Fotobiología, Universidad del Atlántico, Carrera 30 Número 8-49, Puerto Colombia 081008, Colombia
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Mohammadi N, Alikhasi Amnieh Y, Ghasemi S, Karbasi S, Vaezifar S. Evaluation of the effects of decellularized extracellular matrix nanoparticles incorporation on the polyhydroxybutyrate/nano chitosan electrospun scaffold for cartilage tissue engineering. Int J Biol Macromol 2024; 273:133217. [PMID: 38897519 DOI: 10.1016/j.ijbiomac.2024.133217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 06/07/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024]
Abstract
Recent research focuses on fabricating scaffolds imitating the extracellular matrix (ECM) in texture, composition, and functionality. Moreover, specific nano-bio-particles can enhance cell differentiation. Decellularized ECM nanoparticles possess all of the mentioned properties. In this research, cartilage ECM, extracted from the cow's femur condyle, was decellularized, and ECM nanoparticles were synthesized. Finally, nanocomposite electrospun fibers containing polyhydroxybutyrate (PHB), chitosan (Cs) nanoparticles, and ECM nanoparticles were fabricated and characterized. TEM and DLS results revealed ECM nanoparticle sizes of 17.51 and 21.6 nm, respectively. Optimal performance was observed in the scaffold with 0.75 wt% ECM nanoparticles (PHB-Cs/0.75E). By adding 0.75 wt% ECM, the ultimate tensile strength and elongation at break increased by about 29 % and 21 %, respectively, while the water contact angle and crystallinity decreased by about 36° and 2 %, respectively. Uneven and rougher surfaces of the PHB-Cs/0.75E were determined by FESEM and AFM images, respectively. TEM images verified the uniform dispersion of nanoparticles within the fibers. After 70 days of degradation in PBS, the PHB-Cs/0.75E and PHB-Cs scaffolds demonstrated insignificant weight loss differences. Eventually, enhanced viability, attachment, and proliferation of the human costal chondrocytes on the PHB-Cs/0.75E scaffold, concluded from MTT, SEM, and DAPI staining, confirmed its potential for cartilage tissue engineering.
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Affiliation(s)
- Nayereh Mohammadi
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yasamin Alikhasi Amnieh
- Department of Veterinary Histology, School of Veterinary, Shahrekord University, Shahrekord, Iran
| | - Saeid Ghasemi
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Karbasi
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sedigheh Vaezifar
- Department of Medical Engineering, Payame Noor University, Tehran, Iran
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11
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Ghimire U, Kandel R, Ko SW, Adhikari JR, Kim CS, Park CH. Electrochemical technique to develop surface-controlled polyaniline nano-tulips (PANINTs) on PCL-reinforced chitosan functionalized (CS-f-Fe 2O 3) scaffolds for stimulating osteoporotic bone regeneration. Int J Biol Macromol 2024; 264:130608. [PMID: 38447840 DOI: 10.1016/j.ijbiomac.2024.130608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Bone defects pose significant challenges in orthopedic surgery, often leading to suboptimal outcomes and complications. Addressing these challenges, we employed a three-electrode electrochemical system to fabricate surface-controlled polyaniline nano-tulips (PANINTs) decorated polycaprolactone (PCL) reinforced chitosan functionalized iron oxide nanoparticles (CS-f-Fe2O3) scaffolds. These structures were designed to emulate the natural extracellular matrix (ECM) and promote enhanced osseointegration by establishing a continuous interface between host bone and graft, thereby improving both biological processes and mechanical stability. In vitro experiments demonstrated that PANINTs-PCL/CS-f-Fe2O3 substrates significantly promoted the proliferation, differentiation, and spontaneous outgrowth and extension of MC3T3-E1 cell activity. The nanomaterials exhibited increased cell viability and osteogenic differentiation, as evidenced by elevated expression of bone-related markers such as ALP, ARS, COL-I, RUNX2, and SPP-I, as determined by qRT-PCR. Our findings underscore the regenerative potential of in situ cell culture systems for bone defects, emphasizing the targeted stimulation of essential cell subpopulations to facilitate rapid bone tissue regeneration.
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Affiliation(s)
- Upasana Ghimire
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea
| | - Rupesh Kandel
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea; Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju 561-756, Republic of Korea.
| | - Sung Won Ko
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea; Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea
| | - Jhalak Raj Adhikari
- Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju 561-756, Republic of Korea
| | - Cheol Sang Kim
- Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea; Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju 561-756, Republic of Korea.
| | - Chan Hee Park
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea; Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju 561-756, Republic of Korea.
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12
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Patil R, Alimperti S. Graphene in 3D Bioprinting. J Funct Biomater 2024; 15:82. [PMID: 38667539 PMCID: PMC11051043 DOI: 10.3390/jfb15040082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Three-dimensional (3D) bioprinting is a fast prototyping fabrication approach that allows the development of new implants for tissue restoration. Although various materials have been utilized for this process, they lack mechanical, electrical, chemical, and biological properties. To overcome those limitations, graphene-based materials demonstrate unique mechanical and electrical properties, morphology, and impermeability, making them excellent candidates for 3D bioprinting. This review summarizes the latest developments in graphene-based materials in 3D printing and their application in tissue engineering and regenerative medicine. Over the years, different 3D printing approaches have utilized graphene-based materials, such as graphene, graphene oxide (GO), reduced GO (rGO), and functional GO (fGO). This process involves controlling multiple factors, such as graphene dispersion, viscosity, and post-curing, which impact the properties of the 3D-printed graphene-based constructs. To this end, those materials combined with 3D printing approaches have demonstrated prominent regeneration potential for bone, neural, cardiac, and skin tissues. Overall, graphene in 3D bioprinting may pave the way for new regenerative strategies with translational implications in orthopedics, neurology, and cardiovascular areas.
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Affiliation(s)
- Rahul Patil
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, DC 20057, USA;
- Center for Biological and Biomedical Engineering, Georgetown University, Washington, DC 20057, USA
| | - Stella Alimperti
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, DC 20057, USA;
- Center for Biological and Biomedical Engineering, Georgetown University, Washington, DC 20057, USA
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13
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Kandile NG, Ahmed ME, Mohamed MI, Mohamed HM. Therapeutic applications of sustainable new chitosan derivatives and its nanocomposites: Fabrication and characterization. Int J Biol Macromol 2024; 254:127855. [PMID: 37939771 DOI: 10.1016/j.ijbiomac.2023.127855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/14/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
Chitosan (CS) is a biologically active biopolymer used in different medical applications due to its biodegradability, biocompatibility, and nontoxicity. Nanotechnology is an exciting and quick developing field in medical applications. Nanoparticles have shown great potential in the treatment of cancer and inflammation. In the present work modification of chitosan and its (Ag, Au, or ZnO) nanocomposites by N-aminophthalimide (NAP) occurred through the reaction with epichlorohydrin (ECH) as a crosslinker in the presence or absence of glutaraldehyde (GA) under different reaction conditions using microwave irradiation to give modified chitosan derivatives CS-2, CS-6, and their nanocomposites. Modified chitosan derivatives were characterized using different tools. CS-2 and CS-6 derivatives displayed enhancement of thermal stability and crystallinity compared to chitosan. Additionally, CS-2, CS-6, and their nanocomposites exhibited improvements in antitumor activity against HeLa cancer cells and enzymatic inhibitory against trypsin and α-chymotrypsin enzymes compared to chitosan. However, CS-2 revealed the highest cell growth inhibition% toward HeLa cells (89.02 ± 1.46 %) and the enzymatic inhibitory toward α-chymotrypsin enzyme (17.13 ± 1.59 %). Furthermore, CS-Au-2 showed the highest enzymatic inhibitory against trypsin enzyme (28.14 ± 1.76 %). These results suggested that the new chitosan derivatives CS-2, CS-6, and their nanocomposites could be a platform for medical applications against HeLa cells, trypsin, and α-chymotrypsin enzymes.
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Affiliation(s)
- Nadia G Kandile
- Chemistry Department, Faculty of Women for Art, Science and Education, Ain Shams University, Heliopolis 11757, Cairo, Egypt
| | - Marwa ElS Ahmed
- Chemistry Department, Faculty of Women for Art, Science and Education, Ain Shams University, Heliopolis 11757, Cairo, Egypt
| | - Mansoura I Mohamed
- Chemistry Department, Faculty of Women for Art, Science and Education, Ain Shams University, Heliopolis 11757, Cairo, Egypt
| | - Hemat M Mohamed
- Chemistry Department, Faculty of Women for Art, Science and Education, Ain Shams University, Heliopolis 11757, Cairo, Egypt.
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14
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Ghasemi S, Alibabaie A, Saberi R, Esmaeili M, Semnani D, Karbasi S. Evaluation of the effects of zein incorporation on physical, mechanical, and biological properties of polyhydroxybutyrate electrospun scaffold for bone tissue engineering applications. Int J Biol Macromol 2023; 253:126843. [PMID: 37703978 DOI: 10.1016/j.ijbiomac.2023.126843] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/03/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023]
Abstract
Materials and fabrication methods significantly influence the scaffold's final features in tissue engineering. This study aimed to blend zein with polyhydroxybutyrate (PHB) at 5, 10, and 15 wt%, fabricate scaffolds using electrospinning, and then characterize them. SEM and mechanical analyses identified the scaffold with 10 wt% zein (PHB-10Z) as the optimal sample. Incorporating 10 wt% zein reduced fiber diameter from 894 ± 122 to 531 ± 42 nm while increasing ultimate tensile strength and elongation at break by approximately 53 % and 70 %, respectively. FTIR proved zein's presence in the scaffolds and possible hydrogen bonding with PHB. TGA confirmed the miscibility of polymers. DSC and XRD analyses indicated lower crystallinity for the PHB-10Z than for PHB. AFM evaluation indicated a rougher surface for the PHB-10Z in comparison to PHB. The PHB-10Z demonstrated a more hydrophobic surface and less weight loss after 100 days of degradation in PBS than PHB. The free radical scavenging assay exhibited antioxidant activity for the zein-containing scaffold. Eventually, enhanced cell attachment, viability, and differentiation in the PHB-10Z scaffold drawn from SEM, MTT, ALP activity, and Alizarin red staining of MG-63 cells confirmed that PHB-zein electrospun scaffold is a potent candidate for bone tissue engineering applications.
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Affiliation(s)
- Saeid Ghasemi
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Alibabaie
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
| | - Reyhane Saberi
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
| | - Mahdie Esmaeili
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Dariush Semnani
- Department of Textile Engineering, Isfahan University of Technology, Isfahan 84156-83111, Iran
| | - Saeed Karbasi
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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15
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Elenskaya N, Tashkinov M, Vindokurov I, Pirogova Y, Silberschmidt VV. Understanding of trabecular-cortical transition zone: Numerical and experimental assessment of multi-morphology scaffolds. J Mech Behav Biomed Mater 2023; 147:106146. [PMID: 37774442 DOI: 10.1016/j.jmbbm.2023.106146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
Applications of additive manufacturing (AM) in tissue engineering develop rapidly. AM offers layer-by-layer creation of complex objects, developed to restore functionality of, or replace, damaged tissues. Porous 3D-printed functional gradient structures are of particular interest: their special architecture makes it possible to simulate the heterogeneity of the replaced tissue and, by continuously changing the mechanical properties, to avoid the concentration of stresses that can be caused by abrupt geometric changes. Such structures also allow combinations of different types of unit cells and a smooth transition between them, making design of personalised scaffolds with optimal parameters for the replacement of damaged host tissue at the interface between tissues possible. This paper presents the results of development of scaffold structures with gradients of porosity and multi-morphology using unit cells based on triply periodic minimal surfaces (TPMS). The mechanical behaviour of additively manufactured scaffold prototypes made of polylactide acid (PLA) was studied under compressive loading. Strain fields on their surface were captured using the Vic-3d Micro-DIC digital image correlation system and compared with those obtained with detailed numerical simulations, employing elastic-plastic properties of PLA, obtained in experiments. The effect of gradient parameters and unit-cell morphology on the stress distribution in scaffolds was analysed. A smooth gradient transition between cells with different morphologies was found to reduce the probability of structural failure under intense compressive loading. A good agreement between numerical results and experimental data was achieved, which justifies application of the developed approach to design of personalised bone scaffolds.
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Affiliation(s)
- Nataliya Elenskaya
- Perm National Research Polytechnic University, Komsomolsky Ave., 29, Perm, Russia
| | - Mikhail Tashkinov
- Perm National Research Polytechnic University, Komsomolsky Ave., 29, Perm, Russia.
| | - Ilia Vindokurov
- Perm National Research Polytechnic University, Komsomolsky Ave., 29, Perm, Russia
| | - Yulia Pirogova
- Perm National Research Polytechnic University, Komsomolsky Ave., 29, Perm, Russia
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16
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Inchingolo F, Inchingolo AM, Latini G, Palmieri G, Di Pede C, Trilli I, Ferrante L, Inchingolo AD, Palermo A, Lorusso F, Scarano A, Dipalma G. Application of Graphene Oxide in Oral Surgery: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6293. [PMID: 37763569 PMCID: PMC10532659 DOI: 10.3390/ma16186293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
The current review aims to provide an overview of the most recent research in the last 10 years on the potentials of graphene in the dental surgery field, focusing on the potential of graphene oxide (GO) applied to implant surfaces and prosthetic abutment surfaces, as well as to the membranes and scaffolds used in Guided Bone Regeneration (GBR) procedures. "Graphene oxide" and "dental surgery" and "dentistry" were the search terms utilized on the databases Scopus, Web of Science, and Pubmed, with the Boolean operator "AND" and "OR". Reviewers worked in pairs to select studies based on specific inclusion and exclusion criteria. They included animal studies, clinical studies, or case reports, and in vitro and in vivo studies. However, they excluded systematic reviews, narrative reviews, and meta-analyses. Results: Of these 293 studies, 19 publications were included in this review. The field of graphene-based engineered nanomaterials in dentistry is expanding. Aside from its superior mechanical properties, electrical conductivity, and thermal stability, graphene and its derivatives may be functionalized with a variety of bioactive compounds, allowing them to be introduced into and improved upon various scaffolds used in regenerative dentistry. This review presents state-of-the-art graphene-based dental surgery applications. Even if further studies and investigations are still needed, the GO coating could improve clinical results in the examined dental surgery fields. Better osseointegration, as well as increased antibacterial and cytocompatible qualities, can benefit GO-coated implant surgery. On bacterially contaminated implant abutment surfaces, the CO coating may provide the optimum prospects for soft tissue sealing to occur. GBR proves to be a safe and stable material, improving both bone regeneration when using GO-enhanced graft materials as well as biocompatibility and mechanical properties of GO-incorporated membranes.
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Affiliation(s)
- Francesco Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (A.M.I.); (G.L.); (G.P.); (C.D.P.); (I.T.); (L.F.); (G.D.)
| | - Angelo Michele Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (A.M.I.); (G.L.); (G.P.); (C.D.P.); (I.T.); (L.F.); (G.D.)
| | - Giulia Latini
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (A.M.I.); (G.L.); (G.P.); (C.D.P.); (I.T.); (L.F.); (G.D.)
| | - Giulia Palmieri
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (A.M.I.); (G.L.); (G.P.); (C.D.P.); (I.T.); (L.F.); (G.D.)
| | - Chiara Di Pede
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (A.M.I.); (G.L.); (G.P.); (C.D.P.); (I.T.); (L.F.); (G.D.)
| | - Irma Trilli
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (A.M.I.); (G.L.); (G.P.); (C.D.P.); (I.T.); (L.F.); (G.D.)
| | - Laura Ferrante
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (A.M.I.); (G.L.); (G.P.); (C.D.P.); (I.T.); (L.F.); (G.D.)
| | - Alessio Danilo Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (A.M.I.); (G.L.); (G.P.); (C.D.P.); (I.T.); (L.F.); (G.D.)
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti–Pescara, 66100 Chieti, Italy; (F.L.); (A.S.)
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti–Pescara, 66100 Chieti, Italy; (F.L.); (A.S.)
| | - Gianna Dipalma
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (A.M.I.); (G.L.); (G.P.); (C.D.P.); (I.T.); (L.F.); (G.D.)
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