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Gu Y, Liu Y, Bühring J, Tian L, Koblenzer M, Schröder KU, Li F, Van Dessel J, Politis C, Jahr H, Sun Y. Biocompatibility and osteogenic capacity of additively manufactured biodegradable porous WE43 scaffolds: An in vivo study in a canine model. BIOMATERIALS ADVANCES 2024; 164:213984. [PMID: 39153456 DOI: 10.1016/j.bioadv.2024.213984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/25/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024]
Abstract
Magnesium is the most promising absorbable metallic implant material for bone regeneration and alloy WE43 is already FDA approved for cardiovascular applications. This study investigates the cyto- and biocompatibility of novel additively manufactured (AM) porous WE43 scaffolds as well as their osteogenic potential and degradation characteristics in an orthotopic canine bone defect model. The cytocompatibility was demonstrated using modified ISO 10993-conform extract-based indirect and direct assays, respectively. Additionally, degradation rates of WE43 scaffolds were quantified in vitro prior to absorption tests in vivo. Complete blood cell counts, blood biomarker analyses, blood trace element analyses as well as multi-organ histopathology demonstrated excellent biocompatibility of porous y WE43 scaffolds for bone defect repair. Micro-CT analyses further showed a relatively higher absorption rate during the initial four weeks upon implantation (i.e., 36 % ± 19 %) than between four and 12 weeks (41 % ± 14 %), respectively. Of note, the porous WE43 implants were surrounded by newly formed bony tissue as early as four weeks after implantation when unmineralized trabecular ingrowth was detected. After 12 weeks, a substantial amount of mineralized bone was detected inside and around the gradually disappearing implants. This first study on AM porous WE43 implants in canine bone defects demonstrates the potential of this alloy for in vivo applications in humans. Our data further underscore the need to control initial bulk absorption kinetics through surface modifications.
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Affiliation(s)
- Yifei Gu
- Department of Stomatology, The Fourth Affiliated Hospital of Soochow University, 215000 Suzhou, China; OMFS-IMPATH Research Group, Department of Biomedical Sciences, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Yiwen Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Craniofacial Trauma and Orthognathic Surgery, School of Stomatology, FMMU, 710000 Xi'an, China
| | - Jannik Bühring
- Institute of Structural Mechanics and Lightweight Design, RWTH Aachen University, 52062 Aachen, Germany
| | - Lei Tian
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Craniofacial Trauma and Orthognathic Surgery, School of Stomatology, FMMU, 710000 Xi'an, China.
| | - Maximilian Koblenzer
- Department of Anatomy and Cell Biology, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Kai-Uwe Schröder
- Institute of Structural Mechanics and Lightweight Design, RWTH Aachen University, 52062 Aachen, Germany
| | - Feng Li
- OMFS-IMPATH Research Group, Department of Biomedical Sciences, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Jeroen Van Dessel
- OMFS-IMPATH Research Group, Department of Biomedical Sciences, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Biomedical Sciences, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Holger Jahr
- Institute of Structural Mechanics and Lightweight Design, RWTH Aachen University, 52062 Aachen, Germany; Department of Anatomy and Cell Biology, University Hospital RWTH Aachen, 52074 Aachen, Germany.
| | - Yi Sun
- OMFS-IMPATH Research Group, Department of Biomedical Sciences, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium.
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2
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Ding C, Lv H, Huang S, Hu M, Liao Y, Meng X, Gao M, Chen H, Feng X, Wu Z. The Application Progress of Nonthermal Plasma Technology in the Modification of Bone Implant Materials. ACS Biomater Sci Eng 2024. [PMID: 39227180 DOI: 10.1021/acsbiomaterials.4c00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
With the accelerating trend of global aging, bone damage caused by orthopedic diseases, such as osteoporosis and fractures, has become a shared international event. Traffic accidents, high-altitude falls, and other incidents are increasing daily, and the demand for bone implant treatment is also growing. Although extensive research has been conducted in the past decade to develop medical implants for bone regeneration and healing of body tissues, due to their low biocompatibility, weak bone integration ability, and high postoperative infection rates, pure titanium alloys, such as Ti-6A1-4V and Ti-6A1-7Nb, although widely used in clinical practice, have poor induction of phosphate deposition and wear resistance, and Ti-Zr alloy exhibits a lack of mechanical stability and processing complexity. In contrast, the Ti-Ni alloy exhibits toxicity and low thermal conductivity. Nonthermal plasma (NTP) has aroused widespread interest in synthesizing and modifying implanted materials. More and more researchers are using plasma to modify target catalysts such as changing the dispersion of active sites, adjusting electronic properties, enhancing metal carrier interactions, and changing their morphology. NTP provides an alternative option for catalysts in the modification processes of oxidation, reduction, etching, coating, and doping, especially for materials that cannot tolerate thermodynamic or thermosensitive reactions. This review will focus on applying NTP technology in bone implant material modification and analyze the overall performance of three common types of bone implant materials, including metals, ceramics, and polymers. The challenges faced by NTP material modification are also discussed.
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Affiliation(s)
- Chengbiao Ding
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Hao Lv
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230602, China
| | - Suoni Huang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Mengxuan Hu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Yanxinyue Liao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Xinyue Meng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Ming Gao
- Department of Emergency Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Hemu Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Xiaojun Feng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Zhengwei Wu
- School of Nuclear Science and Technology, University of Science and Technology of China, Hefei, Anhui 230026, China
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Qiu T, Yang R, Chen L, Liu G, Han J, Guo C. Duplex Fluorinated and Atomic Layer Deposition-Derived ZrO 2 Coatings Improve the Corrosion Resistance and Mechanical Properties of Mg-2Zn-0.46Y-0.5Nd (wt.%) Alloy Plates and Screws. MATERIALS (BASEL, SWITZERLAND) 2024; 17:3485. [PMID: 39063780 PMCID: PMC11278270 DOI: 10.3390/ma17143485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/30/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
This study investigated the corrosion resistance and mechanical properties of Mg-2Zn-0.46Y-0.5Nd (wt.%) alloy plates and screws with fluorinated coatings and atomic layer deposition (ALD)-derived zirconia (ZrO2) coatings in vitro under physiological stress conditions. Synthetic polyurethane hemimandible replicas were split and fixed as the following three groups of magnesium alloy plates and screws: no additional surface coating treatment (Group A), with fluorinated coatings (Group B), and with duplex fluorinated and ALD-derived 100 nm ZrO2 coatings (Group C). A circulating stress of 1-10 N was applied to the distal bone segment, and a 4-week simulated body fluid immersion test was employed to study the remaining material volume and the mechanical properties of the different groups. Compared with Group A and Group B, the degradation rate of magnesium alloy plates and screws' head regions was significantly slowed down under the protection of duplex MgF2/ZrO2 coatings (p < 0.01). There was no significant difference in the degradation rate of the screw shaft region between groups (p = 0.077). In contrast to fluoride coatings, duplex MgF2/ZrO2 coatings maintained the mechanical strength of magnesium alloy plates and screws after a 14 day in vitro SBF immersion test. We conclude that duplex MgF2/ZrO2 coatings exhibited a certain protective effect on the Mg alloy plates and screws under physiological stress conditions.
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Affiliation(s)
- Tiancheng Qiu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China; (T.Q.); (L.C.)
| | - Rong Yang
- Department of General Dentistry, Peking University School and Hospital of Stomatology, Beijing 100081, China;
| | - Liangwei Chen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China; (T.Q.); (L.C.)
| | - Guanqi Liu
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Department of Dental Materials, Peking University School and Hospital of Stomatology, Beijing 100081, China;
| | - Jianmin Han
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Department of Dental Materials, Peking University School and Hospital of Stomatology, Beijing 100081, China;
| | - Chuanbin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China; (T.Q.); (L.C.)
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4
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Ali W, Ordoño J, Kopp A, González C, Echeverry-Rendón M, LLorca J. Cytocompatibility, cell-material interaction, and osteogenic differentiation of MC3T3-E1 pre-osteoblasts in contact with engineered Mg/PLA composites. J Biomed Mater Res A 2024. [PMID: 38899796 DOI: 10.1002/jbm.a.37767] [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: 03/04/2024] [Revised: 05/29/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
Bioabsorbable Mg wire-reinforced poly-lactic acid (PLA) matrix composites are potential candidate for load-bearing orthopedic implants offering tailorable mechanical and degradation properties by stacking sequence, volume fraction and surface modification of Mg wires. In this study, we investigated the cytocompatibility, cell-material interaction, and bone differentiation behavior of MC3T3-E1 pre-osteoblast cells for medical-grade PLA, Mg/PLA, and PEO-Mg/PLA (having PEO surface modification on Mg wires) composites. MTT and live/dead assay showed excellent biocompatibility of both composites while cell-material interaction analysis revealed that cells were able to adhere and proliferate on the surface of composites. Cells on the longitudinal surface of composites showed a high and uniform cell density while those on transversal surfaces initially avoided Mg regions but later migrated back after the formation of the passivation layer. Bone differentiation tests showed that cells in extracts of PLA and composites were able to initiate the differentiation process as osteogenesis-related gene expressions, alkaline phosphatase protein quantity, and calcium mineralization increased after 7 and 14 days of culture. Interestingly, the bone differentiation response of PEO-Mg/PLA composite was found to be similar to medical-grade PLA, proving its superiority over Mg/PLA composite.
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Affiliation(s)
- Wahaaj Ali
- IMDEA Materials Institute, Getafe, Madrid, Spain
- Department of Material Science and Engineering, Universidad Carlos III de Madrid, Leganés, Madrid, Spain
| | - Jesus Ordoño
- IMDEA Materials Institute, Getafe, Madrid, Spain
| | | | - Carlos González
- IMDEA Materials Institute, Getafe, Madrid, Spain
- Department of Materials Science, Polytechnic University of Madrid/Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Javier LLorca
- IMDEA Materials Institute, Getafe, Madrid, Spain
- Department of Materials Science, Polytechnic University of Madrid/Universidad Politécnica de Madrid, Madrid, Spain
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5
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Ma C, An H, Kim YK, Kim SY, Jang YS, Lee MH. Polycaprolactone-MXene coating for controlling initial biodegradation of magnesium implant via near-infrared light. RSC Adv 2024; 14:19718-19725. [PMID: 38899034 PMCID: PMC11185355 DOI: 10.1039/d4ra00799a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The mechanical strength of magnesium implants undergoes a rapid decline after implantation due to bioabsorption, which can lead to the risk of rupture. To ensure sustained mechanical strength and initiate bioabsorption selectively upon specific external stimuli until the bone regains sufficient support, we developed a biosafe near-infrared light (NIR)-sensitive polymer coating using polycaprolactone (PCL) and Ti3C2 (MXenes). The synthetic MXene powders were characterized using SEM, EDS, and XRD, and the amount of MXenes had a proliferation-promoting effect on MC3T3-E1, as observed through cell assays. The PCL-MXene coating was successfully prepared on the magnesium surface using the casting coating method, and it can protect the magnesium surface for up to 28 days by decreasing the corrosion ratio. However, the coating can be easily degraded after exposure to NIR light for 20 minutes to expose the magnesium substrate, especially in a liquid environment. Meanwhile, the magnesium implant with the PCL-MXene coating has no cytotoxicity toward MC3T3-E1. These findings can provide a new solution for the development of controlled degradation implants.
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Affiliation(s)
- Chen Ma
- Department of Dental Biomaterials, Institute of Biodegradable Materials, School of Dentistry, Jeonbuk National University Jeon-Ju 54896 Republic of Korea
- School of Stomatology, Shandong First Medical University Jinan 250117 Shandong China
| | - Hao An
- Department of Dental Biomaterials, Institute of Biodegradable Materials, School of Dentistry, Jeonbuk National University Jeon-Ju 54896 Republic of Korea
| | - Yu-Kyoung Kim
- Department of Dental Biomaterials, Institute of Biodegradable Materials, School of Dentistry, Jeonbuk National University Jeon-Ju 54896 Republic of Korea
| | - Seo-Young Kim
- Department of Dental Biomaterials, Institute of Biodegradable Materials, School of Dentistry, Jeonbuk National University Jeon-Ju 54896 Republic of Korea
| | - Yong-Seok Jang
- Department of Dental Biomaterials, Institute of Biodegradable Materials, School of Dentistry, Jeonbuk National University Jeon-Ju 54896 Republic of Korea
| | - Min-Ho Lee
- Department of Dental Biomaterials, Institute of Biodegradable Materials, School of Dentistry, Jeonbuk National University Jeon-Ju 54896 Republic of Korea
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Hassan N, Krieg T, Kopp A, Bach AD, Kröger N. Challenges and Pitfalls of Research Designs Involving Magnesium-Based Biomaterials: An Overview. Int J Mol Sci 2024; 25:6242. [PMID: 38892430 PMCID: PMC11172609 DOI: 10.3390/ijms25116242] [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: 04/17/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Magnesium-based biomaterials hold remarkable promise for various clinical applications, offering advantages such as reduced stress-shielding and enhanced bone strengthening and vascular remodeling compared to traditional materials. However, ensuring the quality of preclinical research is crucial for the development of these implants. To achieve implant success, an understanding of the cellular responses post-implantation, proper model selection, and good study design are crucial. There are several challenges to reaching a safe and effective translation of laboratory findings into clinical practice. The utilization of Mg-based biomedical devices eliminates the need for biomaterial removal surgery post-healing and mitigates adverse effects associated with permanent biomaterial implantation. However, the high corrosion rate of Mg-based implants poses challenges such as unexpected degradation, structural failure, hydrogen evolution, alkalization, and cytotoxicity. The biocompatibility and degradability of materials based on magnesium have been studied by many researchers in vitro; however, evaluations addressing the impact of the material in vivo still need to be improved. Several animal models, including rats, rabbits, dogs, and pigs, have been explored to assess the potential of magnesium-based materials. Moreover, strategies such as alloying and coating have been identified to enhance the degradation rate of magnesium-based materials in vivo to transform these challenges into opportunities. This review aims to explore the utilization of Mg implants across various biomedical applications within cellular (in vitro) and animal (in vivo) models.
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Affiliation(s)
- Nourhan Hassan
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Cologne, 50937 Cologne, Germany
- Institute for Laboratory Animal Science and Experimental Surgery, University of Aachen Medical Center, Faculty of Medicine, RWTH-Aachen University, 52074 Aachen, Germany
- Biotechnology Department, Faculty of Science, Cairo University, Giza 12613, Egypt
| | - Thomas Krieg
- Translational Matrix Biology, Medical Faculty, University of Cologne, 50937 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50937 Cologne, Germany
- Center for Molecular Medicine (CMMC), University of Cologne, 50937 Cologne, Germany
| | | | - Alexander D. Bach
- Department of Plastic, Aesthetic and Hand Surgery, St. Antonius Hospital Eschweiler, 52249 Eschweiler, Germany
| | - Nadja Kröger
- Institute for Laboratory Animal Science and Experimental Surgery, University of Aachen Medical Center, Faculty of Medicine, RWTH-Aachen University, 52074 Aachen, Germany
- Department of Plastic, Aesthetic and Hand Surgery, St. Antonius Hospital Eschweiler, 52249 Eschweiler, Germany
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Scarano A, Khater AGA, Gehrke SA, Inchingolo F, Tari SR. Animal Models for Investigating Osseointegration: An Overview of Implant Research over the Last Three Decades. J Funct Biomater 2024; 15:83. [PMID: 38667540 PMCID: PMC11051165 DOI: 10.3390/jfb15040083] [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: 02/24/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Dental implants and bone augmentation are among dentistry's most prevalent surgical treatments; hence, many dental implant surfaces and bone grafts have been researched to improve bone response. Such new materials were radiologically, histologically, and histomorphometrically evaluated on animals before being used on humans. As a result, several studies used animals to evaluate novel implant technologies, biocompatibility, surgical techniques, and osseointegration strategies, as preclinical research on animal models is essential to evaluate bioactive principles (on cells, compounds, and implants) that can act through multiple mechanisms and to predict animal behavior, which is difficult to predict from in vitro studies alone. In this study, we critically reviewed all research on different animal models investigating the osseointegration degree of new implant surfaces, reporting different species used in the osseointegration research over the last 30 years. Moreover, this is the first study to summarize reviews on the main animal models used in the translational research of osseointegration, including the advantages and limitations of each model and determining the ideal location for investigating osseointegration in small and large animal models. Overall, each model has advantages and disadvantages; hence, animal selection should be based on the cost of acquisition, animal care, acceptability to society, availability, tolerance to captivity, and housing convenience. Among small animal models, rabbits are an ideal model for biological observations around implants, and it is worth noting that osseointegration was discovered in the rabbit model and successfully applied to humans.
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Affiliation(s)
- Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti–Pescara, 66100 Chieti, Italy;
| | - Ahmad G. A. Khater
- Faculty of Oral and Dental Medicine, Egyptian Russian University (ERU), Badr City 11829, Egypt;
- Health Affairs Directorate, Egyptian Ministry of Health and Population, Banisuif 62511, Egypt
| | | | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Sergio Rexhep Tari
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti–Pescara, 66100 Chieti, Italy;
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Ruf P, Orassi V, Fischer H, Steffen C, Kreutzer K, Duda GN, Heiland M, Checa S, Rendenbach C. Biomechanical evaluation of CAD/CAM magnesium miniplates as a fixation strategy for the treatment of segmental mandibular reconstruction with a fibula free flap. Comput Biol Med 2024; 168:107817. [PMID: 38064852 DOI: 10.1016/j.compbiomed.2023.107817] [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: 10/17/2023] [Revised: 11/21/2023] [Accepted: 12/03/2023] [Indexed: 01/10/2024]
Abstract
Titanium patient-specific (CAD/CAM) plates are frequently used in mandibular reconstruction. However, titanium is a very stiff, non-degradable material which also induces artifacts in the imaging. Although magnesium has been proposed as a potential material alternative, the biomechanical conditions in the reconstructed mandible under magnesium CAD/CAM plate fixation are unknown. This study aimed to evaluate the primary fixation stability and potential of magnesium CAD/CAM miniplates. The biomechanical environment in a one segmental mandibular reconstruction with fibula free flap induced by a combination of a short posterior titanium CAD/CAM reconstruction plate and two anterior CAD/CAM miniplates of titanium and/or magnesium was evaluated, using computer modeling approaches. Output parameters were the strains in the healing regions and the stresses in the plates. Mechanical strains increased locally under magnesium fixation. Two plate-protective constellations for magnesium plates were identified: (1) pairing one magnesium miniplate with a parallel titanium miniplate and (2) pairing anterior magnesium miniplates with a posterior titanium reconstruction plate. Due to their degradability and reduced stiffness in comparison to titanium, magnesium plates could be beneficial for bone healing. Magnesium miniplates can be paired with titanium plates to ensure a non-occurrence of plate failure.
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Affiliation(s)
- Philipp Ruf
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany; Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Vincenzo Orassi
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Heilwig Fischer
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany; Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery, Augustenburger Platz 1, Berlin, 13353, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Charitéplatz 1, Berlin, 10117, Germany
| | - Claudius Steffen
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Georg N Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Sara Checa
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
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9
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Giavaresi G, Bellavia D, De Luca A, Costa V, Raimondi L, Cordaro A, Sartori M, Terrando S, Toscano A, Pignatti G, Fini M. Magnesium Alloys in Orthopedics: A Systematic Review on Approaches, Coatings and Strategies to Improve Biocompatibility, Osteogenic Properties and Osteointegration Capabilities. Int J Mol Sci 2023; 25:282. [PMID: 38203453 PMCID: PMC10778661 DOI: 10.3390/ijms25010282] [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: 11/09/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
There is increasing interest in using magnesium (Mg) alloy orthopedic devices because of their mechanical properties and bioresorption potential. Concerns related to their rapid degradation have been issued by developing biodegradable micro- and nanostructured coatings to enhance corrosion resistance and limit the release of hydrogen during degradation. This systematic review based on four databases (PubMed®, Embase, Web of Science™ and ScienceDirect®) aims to present state-of-the-art strategies, approaches and materials used to address the critical factors currently impeding the utilization of Mg alloy devices. Forty studies were selected according to PRISMA guidelines and specific PECO criteria. Risk of bias assessment was conducted using OHAT and SYRCLE tools for in vitro and in vivo studies, respectively. Despite limitations associated with identified bias, the review provides a comprehensive analysis of preclinical in vitro and in vivo studies focused on manufacturing and application of Mg alloys in orthopedics. This attests to the continuous evolution of research related to Mg alloy modifications (e.g., AZ91, LAE442 and WE43) and micro- and nanocoatings (e.g., MAO and MgF2), which are developed to improve the degradation rate required for long-term mechanical resistance to loading and excellent osseointegration with bone tissue, thereby promoting functional bone regeneration. Further research is required to deeply verify the safety and efficacy of Mg alloys.
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Affiliation(s)
- Gianluca Giavaresi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (D.B.); (A.D.L.); (V.C.); (L.R.); (A.C.); (M.S.)
| | - Daniele Bellavia
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (D.B.); (A.D.L.); (V.C.); (L.R.); (A.C.); (M.S.)
| | - Angela De Luca
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (D.B.); (A.D.L.); (V.C.); (L.R.); (A.C.); (M.S.)
| | - Viviana Costa
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (D.B.); (A.D.L.); (V.C.); (L.R.); (A.C.); (M.S.)
| | - Lavinia Raimondi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (D.B.); (A.D.L.); (V.C.); (L.R.); (A.C.); (M.S.)
| | - Aurora Cordaro
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (D.B.); (A.D.L.); (V.C.); (L.R.); (A.C.); (M.S.)
| | - Maria Sartori
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (D.B.); (A.D.L.); (V.C.); (L.R.); (A.C.); (M.S.)
| | - Silvio Terrando
- Ortopedia Generale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (S.T.); (A.T.); (G.P.)
| | - Angelo Toscano
- Ortopedia Generale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (S.T.); (A.T.); (G.P.)
| | - Giovanni Pignatti
- Ortopedia Generale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (S.T.); (A.T.); (G.P.)
| | - Milena Fini
- Direzione Scientifica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy;
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10
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Fuest S, Smeets R, Gosau M, Aavani F, Knipfer C, Grust ALC, Kopp A, Becerikli M, Behr B, Matthies L. Layer-by-Layer Deposition of Regenerated Silk Fibroin─An Approach to the Surface Coating of Biomedical Implant Materials. ACS Biomater Sci Eng 2023; 9:6644-6657. [PMID: 37983947 DOI: 10.1021/acsbiomaterials.3c00852] [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] [Indexed: 11/22/2023]
Abstract
Biomaterials and coating techniques unlock major benefits for advanced medical therapies. Here, we explored layer-by-layer (LbL) deposition of silk fibroin (SF) by dip coating to deploy homogeneous films on different materials (titanium, magnesium, and polymers) frequently used for orthopedic and other bone-related implants. Titanium and magnesium specimens underwent preceding plasma electrolytic oxidation (PEO) to increase hydrophilicity. This was determined as surface properties were visualized by scanning electron microscopy and contact angle measurements as well as Fourier transform infrared spectroscopy (FTIR) analysis. Finally, biological in vitro evaluations of hemocompatibility, THP-1 cell culture, and TNF-α assays were conducted. A more hydrophilic surface could be achieved using the PEO surface, and the contact angle for magnesium and titanium showed a reduction from 73 to 18° and from 58 to 17°, respectively. Coating with SF proved successful on all three surfaces, and coating thicknesses of up to 5.14 μm (±SD 0.22 μm) were achieved. Using FTIR analysis, it was shown that the insolubility of the material was achieved by post-treatment with water vapor annealing, although the random coil peak (1640-1649 cm-1) and the α-helix peak (at 1650 cm-1) were still evident. SF did not change hemocompatibility, regardless of the substrate, whereas the PEO-coated materials showed improved hemocompatibility. THP-1 cell culture showed that cells adhered excellently to all of the tested material surfaces. Interestingly, SF coatings induced a significantly higher amount of TNF-α for all materials, indicating an inflammatory response, which plays an important role in a variety of physiological processes, including osteogenesis. LbL coatings of SF are shown to be promising candidates to modulate the body's immune response to implants manufactured from titanium, magnesium, and polymers. They may therefore facilitate future applications for bioactive implant coatings. However, further in vivo studies are needed to confirm the proposed effects on osteogenesis in a physiological environment.
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Affiliation(s)
- Sandra Fuest
- Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | - Farzaneh Aavani
- Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | - Christian Knipfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | - Audrey Laure Céline Grust
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | | | - Mustafa Becerikli
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Levi Matthies
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
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11
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Chen L, Yan Z, Qiu T, Zhu J, Liu G, Han J, Guo C. Long-Term Temporospatial Complementary Relationship between Degradation and Bone Regeneration of Mg-Al Alloy. ACS APPLIED BIO MATERIALS 2023; 6:4703-4713. [PMID: 37865928 PMCID: PMC10664755 DOI: 10.1021/acsabm.3c00488] [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: 07/05/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023]
Abstract
The utilization of guided tissue regeneration membranes is a significant approach for enhancing bone tissue growth in areas with bone defects. Biodegradable magnesium alloys are increasingly being used as guided tissue regeneration membranes due to their outstanding osteogenic properties. However, the degradation rates of magnesium alloy bone implants documented in the literature tend to be rapid. Moreover, many studies focus only on the initial 3-month period post-implantation, limiting their applicability and impeding clinical adoption. Furthermore, scant attention has been given to the interplay between the degradation of magnesium alloy implants and the adjacent tissues. To address these gaps, this study employs a well-studied magnesium-aluminum (Mg-Al) alloy membrane with a slow degradation rate. This membrane is implanted into rat skull bone defects and monitored over an extended period of up to 48 weeks. Observations are conducted at various intervals (2, 4, 8, 12, 24, and 48 weeks) following the implantation. Assessment of degradation behavior and tissue regeneration response is carried out using histological sections, micro-CT scans, and scanning electron microscopy (SEM). The findings reveal that the magnesium alloy membranes demonstrate remarkable biocompatibility and osteogenic capability over the entire observation duration. Specifically, the Mg-Al alloy membranes sustain their structural integrity for 8 weeks. Notably, their osteogenic ability is further enhanced as a corrosion product layer forms during the later stages of implantation. Additionally, our in vitro experiments employing extracts from the magnesium alloy display a significant osteogenic effect, accompanied by a notable increase in the expression of osteogenic-related genes. Collectively, these results strongly indicate the substantial potential of Mg-Al alloy membranes in the context of guided tissue regeneration.
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Affiliation(s)
- Liangwei Chen
- Department
of Oral and Maxillofacial Surgery, Peking
University School and Hospital of Stomatology, Beijing 100081, China
| | - Ziyu Yan
- Department
of Oral and Maxillofacial Surgery, Peking
University School and Hospital of Stomatology, Beijing 100081, China
| | - Tiancheng Qiu
- Department
of Oral and Maxillofacial Surgery, Peking
University School and Hospital of Stomatology, Beijing 100081, China
| | - Jianhua Zhu
- Department
of Oral and Maxillofacial Surgery, Peking
University School and Hospital of Stomatology, Beijing 100081, China
| | - Guanqi Liu
- National
Engineering Laboratory for Digital and Material Technology of Stomatology,
Department of Dental Materials, Peking University
School and Hospital of Stomatology, Beijing 100081, China
| | - Jianmin Han
- National
Engineering Laboratory for Digital and Material Technology of Stomatology,
Department of Dental Materials, Peking University
School and Hospital of Stomatology, Beijing 100081, China
| | - Chuanbin Guo
- Department
of Oral and Maxillofacial Surgery, Peking
University School and Hospital of Stomatology, Beijing 100081, China
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12
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Deichsel A, Glasbrenner J, Raschke MJ, Klimek M, Peez C, Briese T, Herbst E, Kittl C. Interference screws manufactured from magnesium display similar primary stability for soft tissue anterior cruciate ligament graft fixation compared to a biocomposite material - a biomechanical study. J Exp Orthop 2023; 10:103. [PMID: 37815666 PMCID: PMC10564698 DOI: 10.1186/s40634-023-00663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
PURPOSE Biodegradable interference screws (IFS) can be manufactured from different biomaterials. Magnesium was previously shown to possess osteoinductive properties, making it a promising material to promote graft-bone healing in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare IFS made from magnesium to a contemporary biocomposite IFS. METHODS In a porcine model of ACL reconstruction, deep porcine flexor tendons were trimmed to a diameter of 8 mm, sutured in Krackow technique, and fixed with either 8 × 30 mm biocomposite IFS (Bc-IFS) or 8 × 30 mm magnesium IFS (Mg-IFS) in an 8 mm diameter bone tunnel in porcine tibiae. Cyclic loading for 1000 cycles from 0 to 250 N was applied, followed by load to failure testing. Elongation, load to failure and stiffness of the tested constructs was determined. RESULTS After 1000 cycles at 250 N, elongation was 4.8 mm ± 1.5 in the Bc-IFS group, and 4.9 mm ± 1.5 in the Mg-IFS group. Load to failure was 649.5 N ± 174.3 in the Bc-IFS group, and 683.8 N ± 116.5 in the Mg-IFS group. Stiffness was 125.3 N/mm ± 21.9 in the Bc-IFS group, and 122.5 N/mm ± 20.3 in the Mg-IFS group. No significant differences regarding elongation, load to failure and stiffness between Bc-IFS and Mg-IFS were observed. CONCLUSION Magnesium IFS show comparable biomechanical primary stability in comparison to biocomposite IFS and may therefore be an alternative to contemporary biodegradable IFS.
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Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Matthias Klimek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany.
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13
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Döhner C, Beyerle H, Graw JA, Soost C, Burchard R. Biomechanical comparison of different implants for PIP arthrodesis. Foot Ankle Surg 2023; 29:518-524. [PMID: 36842926 DOI: 10.1016/j.fas.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/17/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Surgical correction of hammertoe deformities with arthrodesis of the proximal interphalangeal joint (PIP) is one of the most frequent forefoot procedures. Recently, new intramedullary fixation devices for PIP arthrodesis have been introduced. The aim of this study was to compare a newly developed absorbable intramedullary implant made of magnesium (mm.PIP), an already available intramedullary implant made of titanium (PipTree), and the classical Kirschner-wire (K-wire). METHODS The three intramedullary devices (mm.PIP, PipTree, and K-wire) for PIP arthrodesis were compared. A classical arthrodesis of the PIP joint was performed on fifty-four composite synthetic bone pairs. After arthrodesis, torsional load, weight-bearing and cyclic load tests were performed, and stability of the synthetic bone pairs was analyzed. RESULTS The mm.PIP was the most torsion resistant (mm.PIP vs. PipTree and K-wire, p < 0.001). The PipTree showed the best overall stability during cyclic weight-bearing simulation (PipTree vs. mm.PIP and K-wire, p < 0.001). K-wire demonstrated the highest breaking loads during bending tests (K-wire vs. mm-PIP and PipTree, p < 0.001). CONCLUSION Biomechanical properties of two new intramedullar implants, the bioresorbable mm.PIP made of magnesium and the PipTree made of titanium, were found to be comparable to the biomechanical properties of a K-wire which is commonly used for this procedure. Future work should be directed towards a clinical assessment of the bioabsorbable fixation devices for hammertoe procedures.
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Affiliation(s)
- Claudia Döhner
- University of Giessen and Marburg, Department of Orthopaedics and Traumatology, Marburg, Germany; Department of Orthopaedics and Trauma Surgery, Lahn-Dill-Kliniken, Wetzlar, Dillenburg, Germany
| | - Hanna Beyerle
- University of Giessen and Marburg, Department of Orthopaedics and Traumatology, Marburg, Germany
| | - Jan A Graw
- Department of Anesthesiology and Intensive Care Medicine, Ulm University Hospital, Ulm, Germany
| | | | - Rene Burchard
- University of Giessen and Marburg, Department of Orthopaedics and Traumatology, Marburg, Germany; Department of Orthopaedics and Trauma Surgery, Lahn-Dill-Kliniken, Wetzlar, Dillenburg, Germany.
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14
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Wang C, Liu J, Min S, Liu Y, Liu B, Hu Y, Wang Z, Mao F, Wang C, Ma X, Wen P, Zheng Y, Tian Y. The effect of pore size on the mechanical properties, biodegradation and osteogenic effects of additively manufactured magnesium scaffolds after high temperature oxidation: An in vitro and in vivo study. Bioact Mater 2023; 28:537-548. [PMID: 37457041 PMCID: PMC10344631 DOI: 10.1016/j.bioactmat.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/30/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
The effects of pore size in additively manufactured biodegradable porous magnesium on the mechanical properties and biodegradation of the scaffolds as well as new bone formation have rarely been reported. In this work, we found that high temperature oxidation improves the corrosion resistance of magnesium scaffold. And the effects of pore size on the mechanical characteristics and biodegradation of scaffolds, as well as new bone formation, were investigated using magnesium scaffolds with three different pore sizes, namely, 500, 800, and 1400 μm (P500, P800, and P1400). We discovered that the mechanical characteristics of the P500 group were much better than those of the other two groups. In vitro and in vivo investigations showed that WE43 magnesium alloy scaffolds supported the survival of mesenchymal stem cells and did not cause any local toxicity. Due to their larger specific surface area, the scaffolds in the P500 group released more magnesium ions within reasonable range and improved the osteogenic differentiation of bone mesenchymal stem cells compared with the other two scaffolds. In a rabbit femoral condyle defect model, the P500 group demonstrated unique performance in promoting new bone formation, indicating its great potential for use in bone defect regeneration therapy.
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Affiliation(s)
- Chaoxin Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Jinge Liu
- Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | - Shuyuan Min
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Yu Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Bingchuan Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Yuanyu Hu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Zhengguang Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Fengbiao Mao
- Institute of Medicine Innovation and Research, Peking University Third Hospital, Beijing, 100191, China
| | - Caimei Wang
- Beijing AKEC Medical Co., Ltd., Beijing, 102200, China
| | - Xiaolin Ma
- Beijing AKEC Medical Co., Ltd., Beijing, 102200, China
| | - Peng Wen
- Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | - Yufeng Zheng
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
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15
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Detailing the influence of PEO-coated biodegradable Mg-based implants on the lacuno-canalicular network in sheep bone: A pilot study. Bioact Mater 2023; 26:14-23. [PMID: 36875051 PMCID: PMC9975618 DOI: 10.1016/j.bioactmat.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
An increasing prevalence of bone-related injuries and aging geriatric populations continue to drive the orthopaedic implant market. A hierarchical analysis of bone remodelling after material implantation is necessary to better understand the relationship between implant and bone. Osteocytes, which are housed and communicate through the lacuno-canalicular network (LCN), are integral to bone health and remodelling processes. Therefore, it is essential to examine the framework of the LCN in response to implant materials or surface treatments. Biodegradable materials offer an alternative solution to permanent implants, which may require revision or removal surgeries. Magnesium alloys have resurfaced as promising materials due to their bone-like properties and safe degradation in vivo. To further tailor their degradation capabilities, surface treatments such as plasma electrolytic oxidation (PEO) have demonstrated to slow degradation. For the first time, the influence of a biodegradable material on the LCN is investigated by means of non-destructive 3D imaging. In this pilot study, we hypothesize noticeable variations in the LCN caused by altered chemical stimuli introduced by the PEO-coating. Utilising synchrotron-based transmission X-ray microscopy, we have characterised morphological LCN differences around uncoated and PEO-coated WE43 screws implanted into sheep bone. Bone specimens were explanted after 4, 8, and 12 weeks and regions near the implant surface were prepared for imaging. Findings from this investigation indicate that the slower degradation of PEO-coated WE43 induces healthier lacunar shapes within the LCN. However, the stimuli perceived by the uncoated material with higher degradation rates induces a greater connected LCN better prepared for bone disturbance.
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16
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Kovacevic S, Ali W, Martínez-Pañeda E, LLorca J. Phase-field modeling of pitting and mechanically-assisted corrosion of Mg alloys for biomedical applications. Acta Biomater 2023; 164:641-658. [PMID: 37068554 DOI: 10.1016/j.actbio.2023.04.011] [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: 12/24/2022] [Revised: 03/21/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
A phase-field model is developed to simulate the corrosion of Mg alloys in body fluids. The model incorporates both Mg dissolution and the transport of Mg ions in solution, naturally predicting the transition from activation-controlled to diffusion-controlled bio-corrosion. In addition to uniform corrosion, the presented framework captures pitting corrosion and accounts for the synergistic effect of aggressive environments and mechanical loading in accelerating corrosion kinetics. The model applies to arbitrary 2D and 3D geometries with no special treatment for the evolution of the corrosion front, which is described using a diffuse interface approach. Experiments are conducted to validate the model and a good agreement is attained against in vitro measurements on Mg wires. The potential of the model to capture mechano-chemical effects during corrosion is demonstrated in case studies considering Mg wires in tension and bioabsorbable coronary Mg stents subjected to mechanical loading. The proposed methodology can be used to assess the in vitro and in vivo service life of Mg-based biomedical devices and optimize the design taking into account the effect of mechanical deformation on the corrosion rate. The model has the potential to advocate further development of Mg alloys as a biodegradable implant material for biomedical applications. STATEMENT OF SIGNIFICANCE: A physically-based model is developed to simulate the corrosion of bioabsorbable metals in environments that resemble biological fluids. The model captures pitting corrosion and incorporates the role of mechanical fields in enhancing the corrosion of bioabsorbable metals. Model predictions are validated against dedicated in vitro corrosion experiments on Mg wires. The potential of the model to capture mechano-chemical effects is demonstrated in representative examples. The simulations show that the presence of mechanical fields leads to the formation of cracks accelerating the failure of Mg wires, whereas pitting severely compromises the structural integrity of coronary Mg stents. This work extends phase-field modeling to bioengineering and provides a mechanistic tool for assessing the service life of bioabsorbable metallic biomedical devices.
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Affiliation(s)
- Sasa Kovacevic
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK.
| | - Wahaaj Ali
- IMDEA Materials Institute, C/Eric Kandel 2, Getafe 28906, Madrid, Spain; Department of Material Science and Engineering, Universidad Carlos III de Madrid, Leganes 28911, Madrid, Spain
| | - Emilio Martínez-Pañeda
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK.
| | - Javier LLorca
- IMDEA Materials Institute, C/Eric Kandel 2, Getafe 28906, Madrid, Spain; Department of Materials Science, Polytechnic University of Madrid, E. T. S. de Ingenieros de Caminos, 28040 Madrid, Spain.
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17
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van Gaalen K, Quinn C, Weiler M, Gremse F, Benn F, McHugh PE, Vaughan TJ, Kopp A. Predicting localised corrosion and mechanical performance of a PEO surface modified rare earth magnesium alloy for implant use through in-silico modelling. Bioact Mater 2023; 26:437-451. [PMID: 36993789 PMCID: PMC10040519 DOI: 10.1016/j.bioactmat.2023.03.009] [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: 01/13/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/28/2023] Open
Abstract
In this study, the influence of a plasma electrolytic oxidation (PEO) surface treatment on a medical-grade WE43-based magnesium alloy is examined through an experimental and computational framework that considers the effects of localised corrosion features and mechanical properties throughout the corrosion process. First, a comprehensive in-vitro immersion study was performed on WE43-based tensile specimens with and without PEO surface modification, which included fully automated spatial reconstruction of the phenomenological features of corrosion through micro-CT scanning, followed by uniaxial tensile testing. Then the experimental data of both unmodified and PEO-modified groups were used to calibrate parameters of a finite element-based surface corrosion model. In-vitro, it was found that the WE43-PEO modified group had a significantly lower corrosion rate and maintained significantly higher mechanical properties than the unmodified. While corrosion rates were ∼50% lower in the WE43-PEO modified specimens, the local geometric features of corroding surfaces remained similar to the unmodified WE43 group, however evolving after almost the double amount of time. We were also able to quantitatively demonstrate that the PEO surface treatment on magnesium continued to protect samples from corrosion throughout the entire period tested, and not just in the early stages of corrosion. Using the results from the testing framework, the model parameters of the surface-based corrosion model were identified for both groups. This enabled, for the first time, in-silico prediction of the physical features of corrosion and the mechanical performance of both unmodified and PEO modified magnesium specimens. This simulation framework can enable future in-silico design and optimisation of bioabsorbable magnesium devices for load-bearing medical applications. Examination of corrosion morphology and mechanics of PEO modified WE43. Automated phenomenological tracking of corrosion features by PitScan. Corrosion model of unmodified WE43 and WE43 PEO modified. Calibration through geometrical features and mechanical parameters followed. PEO treatment does not influence the severity of localised corrosion.
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Affiliation(s)
- Kerstin van Gaalen
- Biomechanics Research Centre (BioMEC), Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
- Meotec GmbH, Aachen, Germany
| | - Conall Quinn
- Biomechanics Research Centre (BioMEC), Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
| | - Marek Weiler
- Institute for Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany
| | - Felix Gremse
- Institute for Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany
- Gremse-IT GmbH, Aachen, Germany
| | - Felix Benn
- Meotec GmbH, Aachen, Germany
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, United Kingdom
| | - Peter E. McHugh
- Biomechanics Research Centre (BioMEC), Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
| | - Ted J. Vaughan
- Biomechanics Research Centre (BioMEC), Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
- Corresponding author. Biomechanics Research Centre (BioMEC), Biomedical Engineering, University of Galway, Galway, Ireland.
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18
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Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances. Polymers (Basel) 2022; 14:polym14142782. [PMID: 35890557 PMCID: PMC9316877 DOI: 10.3390/polym14142782] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 02/06/2023] Open
Abstract
Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.
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19
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Rotator cuff repair with biodegradable high-purity magnesium suture anchor in sheep model. J Orthop Translat 2022; 35:62-71. [PMID: 36186661 PMCID: PMC9471965 DOI: 10.1016/j.jot.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/01/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Rotator cuff tear has become one of the diseases affecting people's living quality. Conventional anchor materials such as titanium alloy and poly-lactic acid can lead to postoperative complications like bone defects and aseptic inflammation. Magnesium (Mg)-based implants are biodegradable and biocompatible, with strong potential to be applied in orthopaedics. Methods In this study, we developed a high-purity (HP) Mg suture anchor and studied its mechanical properties and degradation behavior in vitro. Furthermore, we described the use of high-purity Mg to prepare suture anchor for the rotator cuff repair in sheep. Results The in vitro tests showed that HP Mg suture anchor possess proper degradation behavior and appropriate mechanical property. Animal experiment indicated that HP Mg suture anchor provided reliable anchoring function in 12 weeks and showed no toxic effect on animal organs. Conclusion In summary, the HP Mg anchor presented in this study had favorable mechanical property and biosecurity. The translational potential of this article: The translational potential of this article is to use high-purity Mg to develop a degradable suture anchor and verify the feasibility of the application in animal model. This study provides a basis for further research on the clinical application of biodegradable high-purity Mg suture anchor.
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Chen J, Dai J, Qian J, Li W, Li R, Pang D, Wan G, Li P, Xu S. Influence of Surface Roughness on Biodegradability and Cytocompatibility of High-Purity Magnesium. MATERIALS 2022; 15:ma15113991. [PMID: 35683285 PMCID: PMC9182346 DOI: 10.3390/ma15113991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022]
Abstract
High-purity magnesium (Mg) is a promising biodegradable metal for oral and maxillofacial implants. Appropriate surface roughness plays a critical role in the degradation behavior and the related cellular processes of biodegradable Mg-based metals. Nevertheless, the most optimized surface roughness has been questionable, especially for Mg-based oral and maxillofacial implants. Three representative scales of surface roughness were investigated in this study, including smooth (Sa < 0.5 µm), moderately rough (Sa between 1.0−2.0 µm), and rough (Sa > 2.0 µm). The results indicated that the degradation rate of the Mg specimen in the cell culture medium was significantly accelerated with increased surface roughness. Furthermore, an extract test revealed that Mg with different roughness did not induce an evident cytotoxic effect. Nonetheless, the smooth Mg surface had an adversely affected cell attachment. Therefore, the high-purity Mg with a moderately rough surface exhibited the most optimized balance between biodegradability and overall cytocompatibility.
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Affiliation(s)
- Jiahao Chen
- Department of Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China; (J.C.); (J.D.)
| | - Jingtao Dai
- Department of Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China; (J.C.); (J.D.)
| | - Junyu Qian
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China; (J.Q.); (G.W.)
| | - Weirong Li
- Medical Device Division, Dongguan Eontec Co., Ltd., Dongguan 523662, China; (W.L.); (R.L.); (D.P.)
| | - Ronghui Li
- Medical Device Division, Dongguan Eontec Co., Ltd., Dongguan 523662, China; (W.L.); (R.L.); (D.P.)
| | - Dong Pang
- Medical Device Division, Dongguan Eontec Co., Ltd., Dongguan 523662, China; (W.L.); (R.L.); (D.P.)
| | - Guojiang Wan
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China; (J.Q.); (G.W.)
| | - Ping Li
- Department of Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China; (J.C.); (J.D.)
- Correspondence: (P.L.); (S.X.)
| | - Shulan Xu
- Department of Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China; (J.C.); (J.D.)
- Correspondence: (P.L.); (S.X.)
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Determining the Tightrope Tightening Force for Effective Fixation of the Tibiofibular Syndesmosis during Osteomeatal Synthesis of Fibula Injuries. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12104903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The issue of choosing the method for optimal surgical treatment of a broken fibula has been debatable for many years. At the same time, concomitant repair of tibiofibular syndesmosis injuries does not have a unified approach. It has been determined that osteosynthesis of broken shin bones with syndesmosis injury should combine stable fixation of the broken bone and should not limit the elastic properties of the syndesmosis. In case of a broken fibula, it is recommended to use a stable extracortical fixator and an elastic connection of the syndesmosis injury using a tightrope. An analytical model of the broken fibula, which is blocked with an extracortical fixator metal plate and elastically fixed with a tightrope, has been developed. The research object is the stress–strain state of the “broken fibula–extracortical titanium plate” composition under the action of tightrope tightening fixation. The main research result is an analytical dependence, which makes it possible to determine the permissible value of the tightrope tightening force for elastic fixation of the tibiofibular syndesmosis. The research results have been tested numerically, and the influence of the parameters of plate, bone and damage localization on the permissible value of the tightrope tightening force has been analyzed. By using the rational tightrope tightening force with stable–elastic fixation of the broken shin, it is possible to reduce the time before the start of loading on the injured extremity and accelerate the functional recovery of the patient.
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Oxyhydroxide-Coated PEO–Treated Mg Alloy for Enhanced Corrosion Resistance and Bone Regeneration. J Funct Biomater 2022; 13:jfb13020050. [PMID: 35645258 PMCID: PMC9149893 DOI: 10.3390/jfb13020050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 12/20/2022] Open
Abstract
Plasma electrolytic oxidation (PEO) is widely used as a surface modification method to enhance the corrosion resistance of Mg alloy, the most likely applied biodegradable material used in orthopedic implants. However, the pores and cracks easily formed on the PEO surface are unfavorable for long-term corrosion resistance. In this study, to solve this problem, we used simple immersion processes to construct Mn and Fe oxyhydroxide duplex layers on the PEO-treated AZ31 (PEO–Mn/Fe). As control groups, single Mn and Fe oxyhydroxide layers were also fabricated on PEO (denoted as PEO–Mn and PEO–Fe, respectively). PEO–Mn showed a similar porous morphology to the PEO sample. However, the PEO–Fe and PEO–Mn/Fe films completely sealed the pores on the PEO surfaces, and no cracks were observed even after the samples were immersed in water for 7 days. Compared with PEO, PEO–Mn, and PEO–Fe, PEO–Mn/Fe exhibited a significantly lower self-corrosion current, suggesting better corrosion resistance. In vitro C3H10T1/2 cell culture showed that PEO–Fe/Mn promoted the best cell growth, alkaline phosphatase activity, and bone-related gene expression. Furthermore, the rat femur implantation experiment showed that PEO–Fe/Mn–coated Mg showed the best bone regeneration and osteointegration abilities. Owing to enhanced corrosion resistance and osteogenesis, the PEO–Fe/Mn film on Mg alloy is promising for orthopedic applications.
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Electrochemical Short-Time Testing Method for Simulating the Degradation Behavior of Magnesium-Based Biomaterials. METALS 2022. [DOI: 10.3390/met12040591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In regenerative medicine, degradable, magnesium-based biomaterials represent a promising material class. The low corrosion resistance typical for magnesium is advantageous for this application since the entire implant degrades in the presence of the aqueous body fluids after fulfilling the intended function, making a second operation for implant removal obsolete. To ensure sufficient stability within the functional phase, the degradation behavior must be known for months. In order to reduce time and costs for these long-time investigations, an electrochemical short-time testing method is developed and validated, accelerating the dissolution process of a magnesium alloy with and without surface modification based on galvanostatic anodic polarization, enabling a simulation of longer immersion times. During anodic polarization, the hydrogen gas formed by the corrosion process increases linearly. Moreover, the gas volume shows a linear relationship to the dissolving mass, enabling a defined dissolution of magnesium. As a starting point, corrosion rates of both variants from three-week immersion tests are used. A simplified relationship between the current density and the dissolution rate, determined experimentally, is used to design the experiments. Ex situ µ-computed tomography scans are performed to compare the degradation morphologies of both test strategies. The results demonstrate that a simulation of the degradation rates and, hence, considerable time saving based on galvanostatic anodic polarization is possible. Since the method is accompanied by a changed degradation morphology, it is suitable for a worst-case estimation allowing the exclusion of new, unsuitable magnesium systems before subsequent preclinical studies.
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Orassi V, Fischer H, Duda GN, Heiland M, Checa S, Rendenbach C. In Silico Biomechanical Evaluation of WE43 Magnesium Plates for Mandibular Fracture Fixation. Front Bioeng Biotechnol 2022; 9:803103. [PMID: 35223813 PMCID: PMC8866862 DOI: 10.3389/fbioe.2021.803103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022] Open
Abstract
Titanium fixation devices are the gold standard for the treatment of mandibular fractures; however, they present serious limitations, such as non-degradability and generation of imaging artifacts. As an alternative, biodegradable magnesium alloys have lately drawn attention due to their biodegradability and biocompatibility. In addition, magnesium alloys offer a relatively high modulus of elasticity in comparison to biodegradable polymers, being a potential option to substitute titanium in highly loaded anatomical areas, such as the mandible. This study aimed to evaluate the biomechanical competence of magnesium alloy WE43 plates for mandibular fracture fixation in comparison to the clinical standard or even softer polymer solutions. A 3D finite element model of the human mandible was developed, and four different fracture scenarios were simulated, together with physiological post-operative loading and boundary conditions. In a systematic comparison, the material properties of titanium alloy Ti-6Al-4V, magnesium alloy WE43, and polylactic acid (PLA) were assigned to the fixation devices, and two different plate thicknesses were tested. No failure was predicted in the fixation devices for any of the tested materials. Moreover, the magnesium and titanium fixation devices induced a similar amount of strain within the healing regions. On the other hand, the PLA devices led to higher mechanical strains within the healing region. Plate thickness only slightly influenced the primary fixation stability. Therefore, magnesium alloy WE43 fixation devices seem to provide a suitable biomechanical environment to support mandibular fracture healing in the early stages of bone healing. Magnesium WE43 showed a biomechanical performance similar to clinically used titanium devices with the added advantages of biodegradability and radiopacity, and at the same time it showed a remarkably higher primary stability compared to PLA fixation devices, which appear to be too unstable, especially in the posterior and more loaded mandibular fracture cases.
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Affiliation(s)
- Vincenzo Orassi
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Berlin-Brandenburg School for Regenerative Therapies, Berlin, Germany
| | - Heilwig Fischer
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sara Checa
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- *Correspondence: Sara Checa,
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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