A novel and injectable strontium-containing hydroxyapatite bone cement for bone substitution: A systematic evaluation

Regulation of osteogenesis and angiogenesis by cobalt, manganese and strontium doped apatitic materials for functional bone tissue regeneration

Strontium, cobalt, and manganese ions are present in the composition of bone and useful for bone metabolism, even when combined with calcium phosphate in the composition of biomaterials. Herein we explored the possibility to include these ions in the composition of apatitic materials prepared through the cementitious reaction between ion-substituted calcium phosphate dibasic dihydrate, CaHPO4·2H2O (DCPD) and tetracalcium phosphate, Ca4(PO4)2O (TTCP). The results of the chemical, structural, morphological and mechanical characterization indicate that cobalt and manganese exhibit a greater delaying effect than strontium (about 15 at.%) on the cementitious reaction, even though they are present in smaller amounts within the materials (about 0.8 and 4.5 at.%, respectively). Furthermore, the presence of the foreign ions in the apatitic materials leads to a slight reduction of porosity and to enhancement of compressive strength. The results of biological tests show that the presence of strontium and manganese, as well as calcium, in the apatitic materials cultured in direct contact with human mesenchymal stem cells (hMSCs) stimulates their viability and activity. In contrast, the apatitic material containing cobalt exhibits a lower metabolic activity. All the materials have a positive effect on the expression of Vascular Endothelial Growth Factor (VEGF) and Von Willebrand Factor (vWF). Moreover, the apatitic material containing strontium induces the most significant reduction in the differentiation of preosteoclasts into osteoclasts, demonstrating not only osteogenic and angiogenic properties, but also ability to regulate bone resorption.

Preparation of composite calcium phosphate cement scaffold loaded with Hedysarum polysaccharides and its efficacy in repairing bone defects

It's imperative to create a more ideal biological scaffold for bone defect repair. Calcium phosphate bone cements (CPC) could be used as a scaffold. Some ingredients and osteogenic factors could be added to improve its poor mechanical properties and biological activity. As a macromolecule extracted from traditional Chinese medicine, Hedysarum polysaccharides (HPS) would significantly promote the osteogenic activity of bone biomaterials. Zirconium oxide and starch were added to the solid phase and citric acid was added to the liquid phase to optimize CPC. HPS was loaded onto the scaffold as an osteogenic factor, and the prepared CPS + HPS was characterized. Further, the cytocompatibility of CPS + HPS was assessed according to activity, differentiation, and calcification in neonatal rat calvarial osteoblasts, and the biosafety of CPS + HPS was evaluated according to acute toxicity, pyrogen, sensitization, and hemolysis. The success of CPS + HPS in repairing bone defects was evaluated by using a rabbit femur implantation experiment. After optimization, CPS-20-CA-5 containing 10% starch and 5% citric acid displayed the highest mechanical strength of 28.96 ± 0.03 MPa. HPS-50 was demonstrated to exert the best osteogenic effect. The combination of CPS + HPS achieved HPS-loaded CPC. Material characterization, cytocompatibility, biosafety, and femoral implantation experiments indicated that CPS + HPS possessed better pressure resistance and improved osteogenic ability in bone defect repair.CPS + HPS demonstrated effective pressure resistance and superior osteogenic ability, which may be of great significance for bone defects and bone tissue engineering to promote bone regeneration and repair.

Applications of Bioactive Strontium Compounds in Dentistry

Divalent cations have captured the interest of researchers in biomedical and dental fields due to their beneficial effects on bone formation. These metallic elements are similar to trace elements found in human bone. Strontium is a divalent cation commonly found in various biomaterials. Since strontium has a radius similar to calcium, it has been used to replace calcium in many calcium-containing biomaterials. Strontium has the ability to inhibit bone resorption and increase bone deposition, making it useful in the treatment of osteoporosis. Strontium has also been used as a radiopacifier in dentistry and has been incorporated into a variety of dental materials to improve their radiopacity. Furthermore, strontium has been shown to improve the antimicrobial and mechanical properties of dental materials, promote enamel remineralization, alleviate dentin hypersensitivity, and enhance dentin regeneration. The objective of this review is to provide a comprehensive review of the applications of strontium in dentistry.

Enhancing bioactivity and mechanical performances of hydroxyapatite-calcium sulfate bone cements for bone repair: in vivo histological evaluation in rabbit femurs

This study deals with synthesizing hydroxyapatite-calcium sulfate bone cements or HAP-xCaS for bone repair. The effect of CaS on the setting time, injectability, washout resistance, phase evolution, water absorption, and physical, microstructural, and mechanical properties, as well as in vitro apatite-forming ability test and pH behavior of the HAP were investigated. Implantation of bone cement in rabbit femur and in vivo histological analysis were also analyzed. Initial and final setting times decrease with increasing CaS, which would be helpful for clinical procedures. All compositions have mixed phases of HAP, CaS, brushite, and gypsum. The prepared bone cement exhibited a dense structure and increased linear shrinkage with increasing CaS content. Adding more CaS inhibited grain growth and improved the mechanical properties, including compressive strength (σ c), bending strength (σ f), and Young's modulus (E). SEM micrographs displayed that the x = 0.7 or HAP-0.7CaS bone cement produced the highest ability to induce in vitro apatite formation, indicating its biocompatibility. In vivo histological analysis for the HAP-0.7CaS bone cement demonstrated that more new bone formed around defects and bone cement particles. Osteoblasts were found peripherally at the bone trabeculae, and occasional osteoblast-like cells were observed at the granules after 4-8 weeks of implantation. The obtained results indicated that the HAP-0.7CaS bone cement has the potential to exhibit good bioactivity, injectability, and good mechanical properties for bone repair applications.

Rheological Analysis and Evaluation of Measurement Techniques for Curing Poly(Methyl Methacrylate) Bone Cement in Vertebroplasty

Vertebroplasty is a minimally invasive surgical procedure used to treat vertebral fractures, which conventionally involves injecting poly(methyl methacrylate) (PMMA) bone cement into the fractured vertebra. A common risk associated with vertebroplasty is cement leaking out of the vertebra during the injection, which may occur due to a lack of understanding of the complex flow behavior. Therefore, experiments to quantify the cement's flow properties are necessary for understanding and proper handling of the bone cement. In this study, we aimed to characterize the behavior of PMMA bone cement in its curing stages to obtain parameters that govern the flow behavior during injection. We used rotational and oscillatory rheometry for our measurements, as well as a custom-made injector setup that replicated a typical vertebroplasty setting. Our results showed that the complex viscoelastic behavior of bone cement is significantly affected by deformations and temperature. We found that the results from rotational tests, often used for characterizing the bone cement, are susceptible to measurement artifacts caused by wall slip and "ridge"-like formations in the test sample. We also found the Cox-Merz rule to be conditionally valid, which affects the use of oscillatory tests to obtain the shear-thinning characteristics of bone cement. Our findings identify important differences in the measured flow behavior of PMMA bone cement when assessed by different rheological methods, an understanding that is crucial for its risk-free usage in downstream medical applications.

Tubular Nanoclay-Enhanced Calcium Phosphate Mineralization and Assembly to Impart High Stiffness and Antimicrobial Properties

Achieving superior mechanical properties of composite materials in artificially engineered materials is a great challenge due to technical bottlenecks in the size and morphological modulation of inorganic nanominerals. Hence, a "bioprocess-inspired fabrication" is proposed to create multilayered organic-inorganic columnar structures. The sequential assembly of halloysite nanotubes (HNTs), polyelectrolytes (PAAs), and calcium phosphates (CaPs) results in organic-inorganic structures. PAA plays a crucial role in controlling the formation of CaP, guiding it into amorphous particles with smaller nanosizes. The introduction of HNT induces the assembly and maturation of CaP-PAA, leading to the formation of a highly crystalline hydroxyapatite. Poly(vinyl alcohol) was then woven into HNT-encapsulated hydroxyapatite nanorods, resulting in composite materials with basic hierarchical structures across multiple scales. The fabricated composite exhibits exceptional hardness (4.27 ± 0.33 GPa) and flexural strength (101.25 ± 1.72 MPa), surpassing those of most previously developed biological hard tissue materials. Additionally, the composite demonstrates effective antibacterial properties and corrosion resistance, attributed to the dense crystalline phase of CaP. This innovative approach showcases the potential of clay minerals, particularly HNT, in the advancement of biomaterial design. The outstanding mechanical and antimicrobial properties of clay-based composites make them a promising candidate for applications in hard tissue repair, offering versatility in biomedicine and engineering.

Revisiting Recent Tissue Engineering Technologies in Alveolar Cleft Reconstruction

Tissue engineering and regenerative medicine have received significant attention in treating degenerative disorders and presented unique opportunities for researchers. The latest research on tissue engineering and regenerative medicine to reconstruct the alveolar cleft has been reviewed in this study. Three approaches have been used to reconstruct alveolar cleft: Studies that used only stem cells or biomaterials and studies that reconstructed alveolar defects by tissue engineering using a combination of stem cells and biomaterials. Stem cells, biomaterials, and tissue-engineered constructs have shown promising results in the reconstruction of alveolar defects. However, some contrary issues, including stem cell durability and scaffold stability, were also observed. It seems that more prospective and comprehensive studies should be conducted to fully clarify the exact dimensions of the stem cells and tissue engineering reconstruction method in the therapy of alveolar cleft.

Modifying dental composites to formulate novel methacrylate-based bone cements with improved polymerisation kinetics, and mechanical properties

OBJECTIVES

The aim was to develop bone composites with similar working times, faster polymerisation and higher final conversion in comparison to Cortoss™. Additionally, low shrinkage/heat generation and improved short and longer-term mechanical properties are desirable.

METHODS

Four urethane dimethacrylate based composites were prepared using tri-ethylene-glycol dimethacrylate (TEGDMA) or polypropylene dimethacrylate (PPGDMA) diluent and 0 or 20 wt% fibres in the glass filler particles. FTIR was used to determine reaction kinetics, final degrees of conversions, and polymerisation shrinkage/heat generation at 37 °C. Biaxial flexural strength, Young's modulus and compressive strength were evaluated after 1 or 30 days in water.

RESULTS

Experimental materials all had similar inhibition times to Cortoss™ (140 s) but subsequent maximum polymerisation rate was more than doubled. Average experimental composite final conversion (76%) was higher than that of Cortoss™ (58%) but with less heat generation and shrinkage. Replacement of TEGDMA by PPGDMA gave higher polymerisation rates and conversions while reducing shrinkage. Early and aged flexural strengths of Cortoss™ were 93 and 45 MPa respectively. Corresponding compressive strengths were 164 and 99 MPa. Early and lagged experimental composite flexural strengths were 164-186 and 240-274 MPa whilst compressive strengths were 240-274 MPa and 226-261 MPa. Young's modulus for Cortoss™ was 3.3 and 2.2 GPa at 1 day and 1 month. Experimental material values were 3.4-4.8 and 3.0-4.1 GPa, respectively. PPGDMA and fibres marginally reduced strength but caused greater reduction in modulus. Fibres also made the composites quasi-ductile instead of brittle.

SIGNIFICANCE

The improved setting and higher strengths of the experimental materials compared to Cortoss™, could reduce monomer leakage from the injection site and material fracture, respectively. Lowering modulus may reduce stress shielding whilst quasi-ductile properties may improve fracture tolerance. The modified dental composites could therefore be a promising approach for future bone cements.

Titanium dioxide nanotubes increase purinergic receptor P2Y6 expression and activate its downstream PKCα-ERK1/2 pathway in bone marrow mesenchymal stem cells under osteogenic induction

Titanium dioxide (TiO₂) nanotubes can improve the osseointegration of pure titanium implants, but this exact mechanism has not been fully elucidated. The purinergic receptor P2Y6 is expressed in bone marrow mesenchymal stem cells (BMSCs) and participates in the regulation of bone metabolism. However, it is unclear as to whether P2Y6 is involved in the osteogenic differentiation of BMSCs induced by TiO₂ nanotubes. TiO₂ nanotubes were prepared on the surface of titanium specimens using the anodizing method and characterized their features. Quantitative reverse transcriptase polymerase chain reaction and western blotting were used to detect the expression of P2Y6, markers of osteogenic differentiation, and PKCα-ERK1/2. A rat femoral defect model was established to evaluate the osseointegration effect of TiO₂ nanotubes combined with P2Y6 agonists. The results showed that the average inner diameter of the TiO₂ nanotubes increased with an increase in voltage (voltage range of 30-90V), and the expression of P2Y6 in BMSCs could be upregulated by TiO₂ nanotubes in osteogenic culture. Inhibition of P2Y6 expression partially inhibited the osteogenic effect of TiO₂ nanotubes and downregulated the activity of the PKCα-ERK1/2 pathway. When using in vitro and in vivo experiments, the osteogenic effect of TiO₂ nanotubes when combined with P2Y6 agonists was more pronounced. TiO₂ nanotubes promoted the P2Y6 expression of BMSCs during osteogenic differentiation and promoted osteogenesis by activating the PKCα-ERK1/2 pathway. The combined application of TiO₂ nanotubes and P2Y6 agonists may be an effective new strategy to improve the osseointegration of titanium implants. STATEMENT OF SIGNIFICANCE: Titanium dioxide (TiO₂) nanotubes can improve the osseointegration of pure titanium implants, but this exact mechanism has not been fully elucidated. The purinergic receptor P2Y6 is expressed in bone marrow mesenchymal stem cells (BMSCs) and participates in the regulation of bone metabolism. However, it is unclear as to whether P2Y6 is involved in the osteogenic differentiation of BMSCs induced by TiO₂ nanotubes. For the first time, this study revealed the relationship between TiO₂ nanotubes and purine receptor P2Y6, and further explored its mode of action, which may provide clues as to the regulatory role of TiO₂ nanotubes on osteogenic differentiation of BMSCs. These findings will help to develop novel methods for guiding material design and biosafety evaluation of nano implants.

Sudoku of porous, injectable calcium phosphate cements - Path to osteoinductivity

With the increase of global population, people's life expectancy is growing as well. Humans tend to live more active lifestyles and, therefore, trauma generated large defects become more common. Instances of tumour resection or pathological conditions and complex orthopaedic issues occur more frequently increasing necessity for bone substitutes. Composition of calcium phosphate cements (CPCs) is comparable to the chemical structure of bone minerals. Their ability to self-set and resorb in vivo secures a variety of potential applications in bone regeneration. Despite the years-long research and several products already reaching the market, finding the right properties for calcium phosphate cement to be osteoinductive and both injectable and suitable for clinical use is still a sudoku. This article is focused on injectable, porous CPCs, reviewing the latest developments on the path toward finding osteoinductive material, which is suitable for injection.

In vivo mimicking injectable self-setting composite bio-cement: Scanning acoustic diagnosis and biological property evaluation for tissue engineering applications

Injectability and self-setting properties are important factors to increase the efficiency of bone regeneration and reconstruction, thereby reducing the invasiveness of hard tissue engineering procedures. In this study, 63S bioactive glass (BG), nano-hydroxyapatite (n-HAp), alumina, titanium dioxide, and methylene bis-acrylamide (MBAM)-mediated polymeric crosslinking composites were prepared for the formulation of an efficient self-setting bone cement. According to the cytocompatibility and physicochemical analyses, all the samples qualified the standard of the bio-composite materials. They revealed high thermal stability, injectability, and self-setting ability supported by ~ 10.73% (maximum) mass loss, ~ 92-93% injectability and 24 ± 5 min of initial setting time. Moreover, a cellular adhesion and proliferation study was additionally performed with osteoblasts like MG-63 cells, which facilitate pseudopod-like cellular extensions on the BG/n-HAp composite scaffold surface. The SAM study was employed to non-invasively assess the self-setting properties of the composite bio-cement using the post injected distribution and physical properties of the phantom. These results validate the significant potential characteristics of the BG/n-HAp self-setting bio-cement (16:4:2:1) for promising minimal-invasive bone tissue engineering applications.

Stiff and Tough Hydrogels Prepared Through Integration of Ionic Cross-linking and Enzymatic Mineralization

Enzymatic mineralization has become an effective approach to enhancing the stiffness of hydrogels for bone tissue engineering, but generally with limited toughness. On the other hand, double network cross-linking provides hydrogel with enhanced toughness. In this study, we integrated double cross-linking method with enzymatic mineralization to synthesize stiff and tough hydrogels. We have synthesized three kinds of sodium alginate-polyacrylamide (SA-PAM) double-network hydrogels and systematically compared the composition and structure differences, mechanical properties, and biological properties of the different hydrogels in the absence and presence of mineralization. In particular, we examined the role of specific cross-linking ions, i.e., calcium, zinc and strontium ions, in modulating the mineralization process. Synergistic effect of ionic cross-linking and enzymatic mineralization was clearly observed with dramatic increase in compressive modulus. In particular, mineralized hydrogel cross-linked with Sr2+ showed the highest compressive Young's modulus of 17.28 ± 3.56 MPa, which was 37 times of that of the original hydrogel. In addition, it had the highest tensile Young's modulus at 2.60 ± 0.25 MPa and 84 ± 5.5% elongation at break. Such synergistic effect from Sr2+ was attributed to a more uniformed mineralization process due to the early initiation of a more homogeneous nucleation process and subsequent denser mineralized structure. Cellular study also suggested that cell proliferation, adhesion and osteogenic differentiation were improved as a result of enzymatic mineralization. Our results provided an effective way for the preparation of stiff and tough hydrogels with osteogenesis, and demonstrated potential in bone tissue engineering applications. STATEMENT OF SIGNIFICANCE: : Hydrogels with excellent stiffness, stability and biocompatibility have attracted significant attentions in the bone tissue engineering applications. Our results suggested that the synergistic effect of ionic cross-linking and enzymatic mineralization rendered more enhancement of the compressive and tensile stiffness of SA-PAM DN hydrogels, as well as the toughness, swelling stability and cellular response. In particular, mineralized hydrogel cross-linked with Sr2+ showed the highest compressive Young's modulus of 17283 ± 3556KPa, which was 37 times of that of the original hydrogel. Such synergistic effect from Sr2+ was attributed to a more uniformed mineralization process. The cell proliferation, adhesion and osteogenic differentiation were greatly improved as a result of enzymatic mineralization, where the MSCs cultured on strontium ion cross-linked mineralized hydrogel showed the best performance.

Zinc-Doping Induces Evolution of Biocompatible Strontium-Calcium-Phosphate Conversion Coating on Titanium to Improve Antibacterial Property

Implant-associated infections (IAI) remains a common and devastating complication in orthopedic surgery. To reduce the incidence of IAI, implants with intrinsic antibacterial activity have been proposed. The surface functionalization and structure optimization of metallic implants can be achieved by surface modification using the phosphate chemical conversion (PCC) technique. Zinc (Zn) has strong antibacterial behavior toward a broad-spectrum of bacteria. Herein, Zn was incorporated into strontium-calcium-phosphate (SrCaP) coatings on titanium (Ti) via PCC method, and the influence of its doping amount on the phase, microstructure, antibacterial activity, and biocompatibility of the composite coating was researched. The results indicated that traces of Zn doping produced grain refinement of SrCaP coating with no significant effect on its phase and surface properties, while a higher Zn content induced its phase and microstructure transformed into zinc-strontium-phosphate (SrZn₂(PO₄)₂). SrCaP-Zn1 and SrCaP-Zn4 represented trace and high content Zn-doped coatings, respectively, which exhibited a similar bacterial attachment for a short time but showed inhibition of biofilm formation after continuous incubation up to 24 h. The killing rates of SrCaP-Zn1 coating for Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) reached 61.25% and 55.38%, respectively. While that data increased to 83.01% and 71.28% on SrCaP-Zn4 coating due to the more-releasing Zn²⁺. Furthermore, in vitro culture of MC3T3-E1 cells proved that the Zn-doped coatings also possessed excellent biocompatibility. This study provides a new perception for the phase and microstructural optimization of phosphate coatings on implant surfaces, as well as fabricating promising coatings with excellent biocompatibility and antimicrobial properties against IAI.

Anisotropic expansion effect of Sr doping on the crystal structure of hydroxyapatite

The anisotropic expansion effect of Sr on the HA crystal structure is proposed where the relative expansion rate in the c-axis direction is about 2.22 times that in the a-axis direction.

Research on the inhibition for aseptic loosening of artificial joints by Sr-doped calcium polyphosphate (SCPP)in vivo

Aseptic loosening of artificial joints is the most common complication after artificial joint replacement. Finding the solution to tackle aseptic loosening of artificial joints is a focus in bone and joint surgery research field.In vitrostudies of Sr-doped calcium polyphosphate (SCPP) have found by our team that it could promote osteoblast proliferation and inhibit osteoclast activity, and it has a potential inhibitory effect on aseptic loosening by suppressing the expression of receptor activator of nuclear factor-κ B ligand and improving the expression of OPG. The present study aims to confirm the conclusionin vitroby the mean of animal experiment. The Ti rod prosthesis coated with SCPP, calcium polyphosphate (CPP), and Ultra-high molecular weight polyethylene (UHMWPE were implanted in the femur (the internal surface of bone tunnel was also coated with SCPP, CPP and UHMWPE respectively). Radiography (x-rays, micro-CT), histochemistry (Hematoxylin-eosin staining (HE), methylene blue-acid fuchsin, Von Kossa histological staining), molecular biology (alkaline phosphatase and TRAP5b factors, Mir21-5p and Mir 26a-5p) were performed to analyzed the effects of SCPP within 20 weeks. The Radiography results showed that osteolysis with various severity occurred in all groups, and SCPP group had the mildest osteolysis. Histochemistry results showed that arthritis was milder in SCPP and CPP groups, while the bone formation in SCPP group was most significant. Its bone reconstruction effect was the best as well. The Molecular biology results showed that the bone reconstruction was out-sync in each group. Compared with other groups, the bone resorption occurred at the latest and the bone resorption time was the shortest in experimental animals of SCPP group. All results indicated that SCPP could promote osteoblast activity and bone reconstruction, improve the integration of bone interface between prosthesis and base bone, reduce osteoclast activity and shorten the osteoclast action time at the implantation sitein vivo. Thus, it could postpone or alleviate the occurrence and development of aseptic looseningin vivo. Therefore, SCPP could be a promising material for the construction of artificial joints with the ability to resist aseptic loosening.

Rapid Fabrication of MgNH4PO4·H2O/SrHPO4 Porous Composite Scaffolds with Improved Radiopacity via 3D Printing Process

Although bone repair scaffolds are required to possess high radiopacity to be distinguished from natural bone tissues in clinical applications, the intrinsic radiopacity of them is usually insufficient. For improving the radiopacity, combining X-ray contrast agents with bone repair scaffolds is an effective method. In the present research, MgNH₄PO₄·H₂O/SrHPO₄ 3D porous composite scaffolds with improved radiopacity were fabricated via the 3D printing technique. Here, SrHPO₄ was firstly used as a radiopaque agent to improve the radiopacity of magnesium phosphate scaffolds. X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy-dispersive spectroscopy (EDS) were used to characterize the phases, morphologies, and element compositions of the 3D porous composite scaffolds. The radiography image showed that greater SrHPO₄ contents corresponded to higher radiopacity. When the SrHPO₄ content reached 9.34%, the radiopacity of the composite scaffolds was equal to that of a 6.8 mm Al ladder. The porosity and in vitro degradation of the porous composite scaffolds were studied in detail. The results show that magnesium phosphate scaffolds with various Sr contents could sustainably degrade and release the Mg, Sr, and P elements during the experiment period of 28 days. In addition, the cytotoxicity on MC3T3-E1 osteoblast precursor cells was evaluated, and the results show that the porous composite scaffolds with a SrHPO₄ content of 9.34% possessed superior cytocompatibility compared to that of the pure MgNH₄PO₄·H₂O scaffolds when the extract concentration was 0.1 g/mL. Cell adhesion experiments showed that all of the scaffolds could support MC3T3-E1 cellular attachment well. This research indicates that MgNH₄PO₄·H₂O/SrHPO₄ porous composite scaffolds have potential applications in the bone repair fields.

Nanoscale Strontium-Substituted Hydroxyapatite Pastes and Gels for Bone Tissue Regeneration

Injectable nanoscale hydroxyapatite (nHA) systems are highly promising biomaterials to address clinical needs in bone tissue regeneration, due to their excellent biocompatibility, bioinspired nature, and ability to be delivered in a minimally invasive manner. Bulk strontium-substituted hydroxyapatite (SrHA) is reported to encourage bone tissue growth by stimulating bone deposition and reducing bone resorption, but there are no detailed reports describing the preparation of a systematic substitution up to 100% at the nanoscale. The aim of this work was therefore to fabricate systematic series (0–100 atomic% Sr) of SrHA pastes and gels using two different rapid-mixing methodological approaches, wet precipitation and sol-gel. The full range of nanoscale SrHA materials were successfully prepared using both methods, with a measured substitution very close to the calculated amounts. As anticipated, the SrHA samples showed increased radiopacity, a beneficial property to aid in vivo or clinical monitoring of the material in situ over time. For indirect methods, the greatest cell viabilities were observed for the 100% substituted SrHA paste and gel, while direct viability results were most likely influenced by material disaggregation in the tissue culture media. It was concluded that nanoscale SrHAs were superior biomaterials for applications in bone surgery, due to increased radiopacity and improved biocompatibility.