Surface modification of biodegradable magnesium and its alloys for biomedical applications

Copper-doped magnesium phosphate nanopowders for critical size calvarial bone defect intervention

Calvarial defects of bone present difficult clinical situations, and their restoration using biocompatible materials requires special treatments that enable bone regeneration. Magnesium phosphate (MgP) is known as an osteoinductive biomaterial because it contains Mg2+ ions and P ions that enhance the activity of osteoplast cells and help in bone regeneration. In this study, MgP and CuO-doped MgP were fabricated and characterized for their physicomechanical properties, particle size, morphology, surface area, antibacterial test, and in vitro bioactivity evaluation using the following techniques: X-rays diffraction, Fourier-transformer infrared, TEM, and Brunauer, Emmett and Teller (BET) surface area, X-rays photoelectron spectroscopy (XPS), and Scanning electron microscopy (SEM). Furthermore, these nanopowders were implanted in adult inbred male Wistar rats and studied after two periods (28 and 56 days). The results demonstrated that the obtained semiamorphous powders are in nanoscale (≤ 50 nm). XPS analysis ensured the preparation of MgP as mono MgP and CuO were incorporated in the structure as Cu2+ . The bioactivity was supported by the observation of calcium phosphate layer on the nanopowders' surface. The in vivo study demonstrated success of MgP nanopowders especially those doped with CuO in restoration of calvarial defect bone. Therefore, fabricated biomaterials are of great potential in restoration of bone calvarial defects.

Surface-modified titanium and titanium-based alloys for improved osteogenesis: A critical review

As implantable materials, titanium, and its alloys have garnered enormous interest from researchers for dental and orthopedic procedures. Despite their success in wide clinical applications, titanium, and its alloys fail to stimulate osteogenesis, resulting in poor bonding strength with surrounding bone tissue. Optimizing the surface topology and altered compositions of titanium and titanium-based alloys substantially promotes peri-implant bone regeneration. This review summarizes the utilization and importance of various osteogenesis components loaded onto titanium and its alloys. Further, different surface-modification methods and the release efficacy of loaded substances are emphasized. Finally, we summarize the article with prospects. We believe that further investigation studies must focus on identifying novel loading components, exploring various innovative, optimized surface-modification methods, and developing a sustained-release system on implant surfaces to improve peri-implant bone formation.

Guided Bone Regeneration Using Barrier Membrane in Dental Applications

Guided bone regeneration (GBR) is a widely used technique in preclinical and clinical studies due to its predictability. Its main purpose is to prevent the migration of soft tissue into the osseous wound space, while allowing osseous cells to migrate to the site. GBR is classified into two main categories: resorbable and non-resorbable membranes. Resorbable membranes do not require a second surgery but tend to have a short resorption period. Conversely, non-resorbable membranes maintain their mechanical strength and prevent collapse. However, they require removal and are susceptible to membrane exposure. GBR is often used with bone substitute graft materials to fill the defect space and protect the bone graft. The membrane can also undergo various modifications, such as surface modification and biological factor loading, to improve barrier functions and bone regeneration. In addition, bone regeneration is largely related to osteoimmunology, a new field that focuses on the interactions between bone and the immune system. Understanding these interactions can help in developing new treatments for bone diseases and injuries. Overall, GBR has the potential to be a powerful tool in promoting bone regeneration. Further research in this area could lead to advancements in the field of bone healing. This review will highlight resorbable and non-resorbable membranes with cellular responses during bone regeneration, provide insights into immunological response during bone remodeling, and discuss antibacterial features.

Bioabsorbable WE43 Mg alloy wires modified by continuous plasma-electrolytic oxidation for implant applications. Part I: Processing, microstructure and mechanical properties

In our work, a novel processing strategy for the continuous fabrication and surface modification of wires from Magnesium alloy WE43 by means of plasma-electrolytic oxidation (PEO) is presented. In the first step, wires with a strong basal texture and small grain size (≈ 1 μm) were manufactured by combined cold drawing and in-line stress-relief heat treatment steps that optimized the mechanical properties (in terms of strength and ductility) by means of annealing. In a second step, and to the best of our knowledge for the first time ever, the wires were continuously surface-modified with a novel plasma electrolytic oxidation process, which was able to create a homogeneous porous oxide layer made of MgO and Mg₃(PO₄)₂ on the wire surface. While the oxide layer slightly diminished the tensile properties, the strength of the surface-modified wires could be maintained close to 300 MPa with a strain-to-failure ≈ 8 %. Furthermore, the thickness of the oxide layer could be controlled by immersion time within the electrolytic bath and was adjusted to realize a thicknesses of ≈ 8 μm, which could be obtained in <20 s. Our experiments showed that the chemical composition, morphology and porosity of the oxide layer could be tailored by changing electrical parameters. The combined cold drawing and heat treatment process with additional continuous plasma electrolytic oxidation processing can be upscaled to produce a novel generation of bioabsorbable Mg wires with optimized mechanical, degradation and biological performance for use in biomedical applications.

Bioactive Synthetic Polymer-Based Polyelectrolyte LbL Coating Assembly on Surface Treated AZ31-Mg Alloys

Polyelectrolyte layer-by-layer (LbL) films on pretreated Mg containing 3 wt.% Al and 1 wt.% Zn (MgAZ31) alloy surfaces were prepared under physiological conditions offering improved bioresponse and corrosive protection. Pretreatments of the model MgAZ31 substrate surfaces were performed by alkaline and fluoride coating methods. The anti-corrosion and cytocompatibility behavior of pretreated substrates were evaluated. The LbL film assembly consisted of an initial layer of polyethyleneimine (PEI), followed by alternate layers of poly (lactic-co-glycolic acid) (PLGA) and poly (allylamine hydrochloride) (PAH), which self-arrange via electrostatic interactions on the pretreated MgAZ31 alloy substrate surface. The physicochemical characterization, surface morphologies, and microstructures of the LbL films were investigated using Fourier-transformed infrared spectroscopy (FTIR), atomic force microscopy (AFM), X-ray diffraction (XRD), and scanning electron microscopy (SEM). The in vitro stability studies related to the LbL coatings confirmed that the surface treatments are imperative to achieve the lasting stability of PLGA/PAH layers. Electrochemical impedance spectroscopy measurements demonstrated that pretreated and LbL multilayered coated substrates enhanced the corrosion resistance of the bare MgAZ31 alloy. Cytocompatibility studies using human mesenchymal stem cells seeded directly over the substrates showed that the pretreated and LbL-generated surfaces were more cytocompatible, displaying reduced cytotoxicity than the bare MgAZ31. The release of bovine serum albumin protein from the LbL films was also studied. The initial data presented cooperatively demonstrate the promise of creating LbL layers on Mg-related bioresorbable scaffolds to obtain improved surface bio-related activity.

Ceria-based coatings on magnesium alloys for biomedical applications: a literature review

Magnesium alloys are being studied for use in temporary orthopedic implants because of their mechanical properties, which are similar to those of human bone, and their good biocompatibility. However, their application is limited due to their rapid degradation, and early loss of their mechanical properties, decreasing the stability of the implant and its proper synchronization with tissue regeneration. In this regard, various surface coatings have been used to improve their biological, physico-chemical and biodegradation properties. Currently, one of the most explored strategies is using smart coatings because of their self-healing properties that can slow down the corrosion process of Mg and its alloys. Ceria-based materials show promise as coatings for these alloys. Their unique redox capacity not only provides Mg alloys with good self-healing properties but also interesting biological properties, which are described in this paper. Despite this, some problems and challenges related to the biocompatibility and application of these materials in coatings remain unsolved. In this article, a critical review is presented summarizing the most representative literature on ceria-based coatings on Mg alloys for their potential use as biomaterials. The results show that ceria is a versatile material that may be used in industrial and biomedical applications.

Polycaprolactone/chlorinated bioglass scaffolds doped with Mg and Li ions: Morphological, physicochemical, and biological analysis

The objective was to synthesize and characterize fine polycaprolactone (PCL) fibers associated with a new 58S bioglass obtained by the precipitated sol-gel route, produced by the electrospinning process in order to incorporate therapeutic ions (Mg and Li). In PCL/acetone solutions were added 7% pure bioglass, bioglass doped with Mg(NO₃ )₂ and Li₂ CO₃ and were subjected to electrospinning process. The fibers obtained were characterized morphologically, chemically and biologically. The results showed the presence of fine fibers at the nanometric scale and with diameters ranging from 0.67 to 1.92 μm among groups. Groups containing bioglass showed particles both inside and on the surface of the fibers. The components of the polymer, bioglass and therapeutic ions were present in the fibers produced. The produced fibers showed cell viability and induced the formation of mineralization nodules. It was observed the applicability of that methodology in making an improved biomaterial, which adds the osteoinductive properties of the bioglass to PCL and to those of therapeutic ions, applicable to guided bone regeneration.

Surface analysis of (Ti,Mg)N coated bone fixation devices following the rabbit femur surgery

BACKGROUND

Magnesium (Mg) enhances the bone regeneration, mineralization and attachment at the tissue/biomaterial interface.

OBJECTIVE

In this study, the effect of Mg on mineralization/osseointegration was determined using (Ti,Mg)N thin film coated Ti6Al4V based plates and screws in vivo.

METHODS

TiN and (Ti,Mg)N coated Ti6Al4V plates and screws were prepared using arc-PVD technique and used to fix rabbit femur fractures for 6 weeks. Then, mineralization/osseointegration was assessed by surface analysis including cell attachment, mineralization, and hydroxyapatite deposition on concave and convex sides of the plates along with the attachment between the screw and the bone.

RESULTS

According to Scanning Electron Microscopy (SEM) and Energy Dispersive Spectroscopy (EDS) analyses; cell attachment and mineralization were higher on the concave sides of the plates from both groups in comparison to the convex sides. However, mineralization was significantly higher on Mg-containing ones. The mean gray value indicating mineralized area after von Kossa staining was found as 0.48 ± 0.01 and 0.41 ± 0.04 on Mg containing and free ones respectively. Similarly, Fourier Transform Infrared Spectroscopy (FTIR) and X-ray diffraction (XRD) analyses showed that hydroxyapatite growth was abundant on the Mg-containing and concave sides of the plates. Enhanced mineralization and strong attachment to bone were also detected in EDS and SEM analyses of Mg-containing screws.

CONCLUSION

These findings indicated that (Ti,Mg)N coatings can be used to increase attachment at the implant tissue interface due to accelerated mineralization, cell attachment, and hydroxyapatite growth.

Composite Cement Materials Based on β-Tricalcium Phosphate, Calcium Sulfate, and a Mixture of Polyvinyl Alcohol and Polyvinylpyrrolidone Intended for Osteanagenesis

The primary purpose of the study, presented in this article, was to obtain a composite cement material intended for osteanagenesis. The β-tricalcium phosphate powder (β-TCP, β-Ca₃(PO₄)₂) was obtained by the liquid-phase method. Setting and hardening of the cement system were achieved by adding calcium sulfate hemihydrate (CSH, CaSO₄·1/2H₂O). An aqueous solution of polyvinyl alcohol (PVA), polyvinylpyrrolidone (PVP), and a PVA/PVP mixture were used as a polymer component. The methods of capillary viscometry and Fourier-transform infrared spectroscopy (FTIR) revealed the formation of intermolecular hydrogen bonds between polymer components, which determines the good miscibility of polymers. The physicochemical properties of the synthesized materials were characterized by X-ray diffraction (XRD) and FTIR methods, and the added amount of polymers does not significantly influence the processes of phase formation and crystallization of the system. The size of crystallites CSD remained in the range of 32-36 nm, regardless of the ratio of polymer components. The influence of the composition of composites on their solubility was investigated. In view of the lower solubility of pure β-TCP, as compared to calcium sulfate dihydrate (CSD, CaSO₄·2H₂O), the solubility of composite materials is determined to a greater degree by the CSD solubility. Complexometric titration showed that the interaction between PVA and PVP impeded the diffusion of calcium ions, and at a ratio of PVA to PVP of 1/1, the smallest exit of calcium ions from the system is observed. The cytotoxicity analysis results allowed us to establish the fact that the viability of human macrophages in the presence of the samples varied from 80% to 125% as compared to the control.

Performance of PEO/Polymer Coatings on the Biodegradability, Antibacterial Effect and Biocompatibility of Mg-Based Materials

Magnesium (Mg) alloys have recently attracted attention in biomedicine as biodegradable materials with non-toxic degradable products. Such compounds have become a frontier in the study of biodegradable materials because of their remarkable biomechanical compatibility and superior biocompatibility. The use of Mg-based implants reduces the negative consequences of permanent biological implants by eliminating the necessity for biomaterial surgery following the healing process. However, the quick deterioration, formation of considerable gas of hydrogen volumes and a rise in the body environment pH are obstacles in the application of Mg as an implant material. Hence, compelling advances for erosion resistance and biocompatibility of magnesium and its alloys are noteworthy. Surface modification may be a practical approach because it improves the erosion resistance compared with extensive preparation of a treated surface for progressed bone recovery and cell attachment. Coating produced by plasma electrolytic oxidation (PEO) seems a compelling method in order to enhance magnesium and the properties of its alloys. PEO-formed coatings cannot provide long-term protection in the physiological environment due to their porous nature. Thus, a polymer coating is applied on the porous PEO-formed coating, which is steadily applied on the surface. Polymer coatings improve the biocompatibility properties of Mg and its alloys and increase corrosion resistance. In this article, the most recent advancements in PEO/polymer composite coatings are reviewed, and the biocompatibility of such coatings is examined.

Biodegradable Mg-Sc-Sr Alloy Improves Osteogenesis and Angiogenesis to Accelerate Bone Defect Restoration

Magnesium (Mg) and its alloys are considered to be biodegradable metallic biomaterials for potential orthopedic implants. While the osteogenic properties of Mg alloys have been widely studied, few reports focused on developing a bifunctional Mg implant with osteogenic and angiogenic properties. Herein, a Mg-Sc-Sr alloy was developed, and this alloy's angiogenesis and osteogenesis effects were evaluated in vitro for the first time. X-ray Fluorescence (XRF), X-ray diffraction (XRD), and metallography images were used to evaluate the microstructure of the developed Mg-Sc-Sr alloy. Human umbilical vein/vascular endothelial cells (HUVECs) were used to evaluate the angiogenic character of the prepared Mg-Sc-Sr alloy. A mix of human bone-marrow-derived mesenchymal stromal cells (hBM-MSCs) and HUVEC cell cultures were used to assess the osteogenesis-stimulating effect of Mg-Sc-Sr alloy through alkaline phosphatase (ALP) and Von Kossa staining. Higher ALP activity and the number of calcified nodules (27% increase) were obtained for the Mg-Sc-Sr-treated groups compared to Mg-treated groups. In addition, higher VEGF expression (45.5% increase), tube length (80.8% increase), and number of meshes (37.9% increase) were observed. The Mg-Sc-Sr alloy showed significantly higher angiogenesis and osteogenic differentiation than pure Mg and the control group, suggesting such a composition as a promising candidate in bone implants.

Biodegradable magnesium fixation screw for barrier membranes used in guided bone regeneration

An ideal fixation system for guided bone (GBR) regeneration in oral surgery must fulfil several criteria that includes the provision of adequate mechanical fixation, complete resorption when no longer needed, complete replacement by bone, as well as be biocompatible and have a good clinical manageability. For the first time, a biodegradable magnesium fixation screw made of the magnesium alloy WZM211 with a MgF₂ coating has been designed and tested to fulfill these criteria. Adequate mechanical fixation was shown for the magnesium fixation screw in several benchtop tests that directly compared the magnesium fixation screw with an equivalent polymeric resorbable device. Results demonstrated slightly superior mechanical properties of the magnesium device in comparison to the polymeric device even after 4 weeks of degradation. Biocompatibility of the magnesium fixation screw was demonstrated in several in vitro and in vivo tests. Degradation of the magnesium screw was investigated in in vitro and in vivo tests, where it was found that the screw is resorbed slowly and completely after 52 weeks, providing adequate fixation in the early critical healing phase. Overall, the magnesium fixation screw demonstrates all of the key properties required for an ideal fixation screw of membranes used in guided bone regeneration (GBR) surgeries.

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The first comprehensive report on experimental data for a biodegradable metallic fixation pin for use in oral surgery is presented.

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Results demonstrated superior mechanical properties of the Mg fixation pin in comparison to the polymeric pin even after 4 weeks of degradation.

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The MgF₂ coated Mg pin made of alloy WZM211 has a slow corrosion rate with a service time of 4 weeks and is fully resorped at 52 weeks after implantation.

Biodegradable magnesium barrier membrane used for guided bone regeneration in dental surgery

Barrier membranes are commonly used as part of the dental surgical technique guided bone regeneration (GBR) and are often made of resorbable collagen or non-resorbable materials such as PTFE. While collagen membranes do not provide sufficient mechanical protection of the covered bone defect, titanium reinforced membranes and non-resorbable membranes need to be removed in a second surgery. Thus, biodegradable GBR membranes made of pure magnesium might be an alternative. In this study a biodegradable pure magnesium (99.95%) membrane has been proven to have all of the necessary requirements for an optimal regenerative outcome from both a mechanical and biological perspective. After implantation, the magnesium membrane separates the regenerating bone from the overlying, faster proliferating soft tissue. During the initial healing period, the membrane maintained a barrier function and space provision, whilst retaining the positioning of the bone graft material within the defect space. As the magnesium metal corroded, it formed a salty corrosion layer and local gas cavities, both of which extended the functional lifespan of the membrane barrier capabilities. During the resorption of the magnesium metal and magnesium salts, it was observed that the membrane became surrounded and then replaced by new bone. After the membrane had completely resorbed, only healthy tissue remained. The in vivo performance study demonstrated that the magnesium membrane has a comparable healing response and tissue regeneration to that of a resorbable collagen membrane. Overall, the magnesium membrane demonstrated all of the ideal qualities for a barrier membrane used in GBR treatment.

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First report on a biodegradable metallic barrier membrane for use in oral surgery is presented.

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The mechanical stability of the metallic barrier membrane provides a careful shielding of the augmented bone defect.

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Full resorption of metallic barrier membrane and bone healing is completed long before current standards for second surgical patient treatment.

Biodegradation of a Magnesium Alloy Fixation Screw Used in a Guided Bone Regeneration Model in Beagle Dogs

Nowadays, the most commonly used fixation systems are non-resorbable, but new resorbable magnesium alloy fixation screws have been introduced recently. Therefore, the aim of this study was to compare the magnesium fixation screw and the commonly used non-resorbable titanium screw in an animal model. Four 3-wall defect sites were covered with collagen membranes in the mandible of twenty beagle dogs (two sites on the left and two on the right). Each membrane was fixed with either four magnesium screws or four titanium screws. Post-operative follow-up revealed the expected observations such as transient inflammation and pain. Both groups showed a good healing response, with no differences between groups. Micro-CT analysis showed no significant difference between groups in terms of BV/TV or soft tissue volume. The void volume in the magnesium fixation screw group continued to decrease on average between the different timepoints, but not significantly. Furthermore, a gradual progression of the degradation process of the magnesium screws was observed in the same group. Magnesium screws and titanium screws showed equal performance in tissue regeneration according to GBR principles. An additional advantage of magnesium screws is their resorbable nature, which eliminates the need for a second surgical step to remove the screws.

Biocompatibility and corrosion evaluation of niobium oxide coated AZ31B alloy for biodegradable implants

Biodegradable magnesium (Mg) based implants have considerable interest in the biomedical field as their use nullifies the necessity for implant removal surgery and avoids the long-standing adverse reaction of permanent bioimplants. The degradation resistance and biocompatibility of the Mg alloys can be improved by coating them with a suitable thin film. Here, thin films of niobium and niobium oxide were developed on the AZ31B Mg alloy by sputtering technique and their biocompatibility and corrosion resistance was examined. X-ray diffraction (XRD) and Transmission electron microscope (TEM) techniques confirmed the crystallinity of the thin films. Subsequently, scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) techniques were employed to evaluate the morphology and chemical composition of the thin film surfaces, respectively. Thin-film coated Mg alloys revealed good corrosion resistance compared to their uncoated bare counterparts in simulated body fluid (SBF). The contact angle study was performed on the coated specimens to investigate their wettability which revealed their hydrophobic character. The cell viability studies on thin-film coated specimens exhibited significant cell proliferation, and cell morphological studies showed good cell attachment and growth. The in vitro MTT assay on mouse osteoblast precursor cells (MC3T3-E1) indicated that the Nb-based coatings are cytocompatible and promote cell proliferation.

A Systematic Review and Network Meta-Analysis of Biomedical Mg Alloy and Surface Coatings in Orthopedic Application

Magnesium alloys have great application prospects as ideal bone implant materials. However, their poor corrosion resistance limits their clinical orthopedic application. Surface modification promotes the corrosion resistance of magnesium. Conversion coatings, such as calcium phosphate (Ca-P) coating, microarc oxidation (MAO) treatment, and fluoride (FLU) treatment, have been extensively investigated in in vivo studies. This systematic review and network meta-analysis compared the influence of different conversion coatings on bone repair, material properties, and systemic host response in orthopedic applications. Using the PICOS model, the inclusion criteria for biodegradable magnesium and its alloys were determined for in vivo studies. Four databases were used. The standard and weight mean differences with 95% confidence intervals were used to analyze new bone formation and degradation rate. Network structure and forest plots were created, and ranking probabilities were estimated. The risk of bias and quality of evidence were assessed using SYRCLE, CERQual, and GRADE tools. In the qualitative analysis, 43 studies were selected, and the evaluation of each outcome indicator was not entirely consistent from article to article. In the quantitative analysis, 21 articles were subjected to network meta-analysis, with 16 articles on implant degradation and 8 articles for new bone formation. Additionally, SUCRA indicated that Ca-P coating exhibited the highest corrosion resistance, followed by FLU treatment. MAO demonstrated the best capability for new bone formation, followed by Ca-P coating. Ca-P coating exhibited the highest overall performance. To conclude, coated Mg can promote better new bone formation than bare Mg and has considerable biocompatibility. Ca-P-coated Mg and MAO-coated Mg have the greatest potential to significantly promote corrosion resistance and bone regeneration, respectively. The findings of this study will provide a theoretical basis for the investigation of composite coatings and guidance for the orthopedic application of Mg bone implants.

Fluoride Coatings on Magnesium Alloy Implants

After several years of research and development, it has been reported that magnesium alloys can be used as degradable metals in some medical device applications. Over the years, fluoride coatings have received increasing research attention for improving the corrosion resistance of magnesium. In this paper, different methods for preparing fluoride coatings and the characteristics of these coatings are reported for the first time. The influence of the preparation conditions of fluoride coatings, including the magnesium substrate, voltage, and electrolyte, on the coatings is discussed. Various properties of magnesium fluoride coatings are also summarized, with an emphasis on corrosion resistance, mechanical properties, and biocompatibility. We screened experiments and papers that planned the application of magnesium fluoride coatings in living organisms. We have selected the literature with the aim of enhancing the performance of in vivo implants for reading and further detailed classification. The authors searched PubMed, SCOPUS, Web of Science, and other databases for 688 relevant papers published between 2005 and 2021, citing 105 of them. The selected time range is the last 16 years. Furthermore, this paper systematically discusses future prospects and challenges related to the application of magnesium fluoride coatings to medical products.

Construction of a magnesium hydroxide/graphene oxide/hydroxyapatite composite coating on Mg–Ca–Zn–Ag alloy to inhibit bacterial infection and promote bone regeneration

The improved corrosion resistance, osteogenic activity, and antibacterial ability are the key factors for promoting the large-scale clinical application of magnesium (Mg)-based implants. In the present study, a novel nanocomposite coating composed of inner magnesium hydroxide, middle graphene oxide, and outer hydroxyapatite (Mg(OH)₂/GO/HA) is constructed on the surface of Mg-0.8Ca–5Zn-1.5Ag by a combined strategy of hydrothermal treatment, electrophoretic deposition, and electrochemical deposition. The results of material characterization and electrochemical corrosion test showed that all the three coatings have high bonding strength, hydrophilicity and corrosion resistance. In vitro studies show that Mg(OH)₂ indeed improves the antibacterial activity of the substrate. The next GO and GO/HA coating procedures both promote the osteogenic differentiation of MC3T3-E1 cells and show no harm to the antibacterial activity of Mg(OH)₂ coating, but the latter exhibits the best promoting effect. In vivo studies demonstrate that the Mg alloy with the composite coating not only ameliorates osteolysis induced by bacterial invasion but also promotes bone regeneration under both normal and infected conditions. The current study provides a promising surface modification strategy for developing multifunctional Mg-based implants with good corrosion resistance, antibacterial ability and osteogenic activity to enlarge their biomedical applications.

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A Mg(OH)₂/GO/HA composite coating with high bonding strength was constructed on the surface of Mg–Ca–Zn–Ag alloy.

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The outer HA layer with excellent osteogenic activity recovered the high corrosion resistance of inner Mg(OH)₂ layer.

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The Mg(OH)₂/GO/HA composite coating promoted new bone regeneration significantly under both normal and infected conditions.

Finding the Perfect Membrane: Current Knowledge on Barrier Membranes in Regenerative Procedures: A Descriptive Review

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) became common procedures in the corrective phase of periodontal treatment. In order to obtain good quality tissue neo-formation, most techniques require the use of a membrane that will act as a barrier, having as a main purpose the blocking of cell invasion from the gingival epithelium and connective tissue into the newly formed bone structure. Different techniques and materials have been developed, aiming to obtain the perfect barrier membrane. The membranes can be divided according to the biodegradability of the base material into absorbable membranes and non-absorbable membranes. The use of absorbable membranes is extremely widespread due to their advantages, but in clinical situations of significant tissue loss, the use of non-absorbable membranes is often still preferred. This descriptive review presents a synthesis of the types of barrier membranes available and their characteristics, as well as future trends in the development of barrier membranes along with some allergological aspects of membrane use.

Finding the Perfect Membrane: Current Knowledge on Barrier Membranes in Regenerative Procedures: A Descriptive Review

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) became common procedures in the corrective phase of periodontal treatment. In order to obtain good quality tissue neo-formation, most techniques require the use of a membrane that will act as a barrier, having as a main purpose the blocking of cell invasion from the gingival epithelium and connective tissue into the newly formed bone structure. Different techniques and materials have been developed, aiming to obtain the perfect barrier membrane. The membranes can be divided according to the biodegradability of the base material into absorbable membranes and non-absorbable membranes. The use of absorbable membranes is extremely widespread due to their advantages, but in clinical situations of significant tissue loss, the use of non-absorbable membranes is often still preferred. This descriptive review presents a synthesis of the types of barrier membranes available and their characteristics, as well as future trends in the development of barrier membranes along with some allergological aspects of membrane use.

Effect of Magnesium on Dentinogenesis of Human Dental Pulp Cells

Introducing therapeutic ions into pulp capping materials has been considered a new approach for enhancing regeneration of dental tissues. However, no studies have been reported on its dentinogenic effects on human dental pulp cells (HDPCs). This study was designed to investigate the effects of magnesium (Mg²⁺) on cell attachment efficiency, proliferation, differentiation, and mineralization of HDPCs. HDPCs were cultured with 0.5 mM, 1 mM, 2 mM, 4 mM, and 8 mM concentrations of supplemental Mg²⁺ and 0 mM (control). Cell attachment was measured at 4, 8, 12, 16, and 20 hours. Cell proliferation rate was evaluated at 3, 7, 10, 14, and 21 days. Crystal violet staining was used to determine cell attachment and proliferation rate. Alkaline phosphatase (ALP) activity was assessed using the fluorometric assay at 7, 10, and 14 days. Mineralization of cultures was measured by Alizarin red staining. Statistical analysis was done using multiway analysis of variance (multiway ANOVA) with Wilks' lambda test. Higher cell attachment was shown with 0.5 mM and 1 mM at 16 hours compared to control (P < 0.0001). Cells with 0.5 mM and 1 mM supplemental Mg²⁺ showed significantly higher proliferation rates than control at 7, 10, 14, and 21 days (P < 0.0001). However, cell proliferation rates decreased significantly with 4 mM and 8 mM supplemental Mg²⁺ at 14 and 21 days (P < 0.0001). Significantly higher levels of ALP activity and mineralization were observed in 0.5 mM, 1 mM, and 2 mM supplemental Mg²⁺ at 10 and 14 days (P < 0.0001). However, 8 mM supplemental Mg²⁺ showed lower ALP activity compared to control at 14 days (P < 0.0001), while 4 mM and 8 mM supplemental Mg²⁺showed less mineralization compared to control (P < 0.0001). The study indicated that the optimal (0.5–2 mM) supplemental Mg²⁺ concentrations significantly upregulated HDPCs by enhancing cell attachment, proliferation rate, ALP activity, and mineralization. Magnesium-containing biomaterials could be considered for a future novel dental pulp-capping additive in regenerative endodontics.

Biocompatibility Analyses of HF-Passivated Magnesium Screws for Guided Bone Regeneration (GBR)

Background: Magnesium (Mg) is one of the most promising materials for human use in surgery due to material characteristics such as its elastic modulus as well as its resorbable and regenerative properties. In this study, HF-coated and uncoated novel bioresorbable magnesium fixation screws for maxillofacial and dental surgical applications were investigated in vitro and in vivo to evaluate the biocompatibility of the HF coating. Methods: Mg alloy screws that had either undergone a surface treatment with hydrofluoric-acid (HF) or left untreated were investigated. In vitro investigation included XTT, BrdU and LDH in accordance with the DIN ISO 10993-5/-12. In vivo, the screws were implanted into the tibia of rabbits. After 3 and 6 weeks, degradation, local tissue reactions and bony integration were analyzed histopathologically and histomorphometrically. Additionally, SEM/EDX analysis and synchrotron phase-contrast microtomography (µCT) measurements were conducted. The in vitro analyses revealed that the Mg screws are cytocompatible, with improved results when the surface had been passivated with HF. In vivo, the HF-treated Mg screws implanted showed a reduction in gas formation, slower biodegradation and a better bony integration in comparison to the untreated Mg screws. Histopathologically, the HF-passivated screws induced a layer of macrophages as part of its biodegradation process, whereas the untreated screws caused a slight fibrous tissue reaction. SEM/EDX analysis showed that both screws formed a similar layer of calcium phosphates on their surfaces and were surrounded by bone. Furthermore, the µCT revealed the presence of a metallic core of the screws, a faster absorbing corrosion front and a slow absorbing region of corroded magnesium. Conclusions: Overall, the HF-passivated Mg fixation screws showed significantly better biocompatibility in vitro and in vivo compared to the untreated screws.

Biodegradable shape memory alloys: Progress and prospects

Shape memory alloys (SMAs) have a wide range of potential novel medical applications due to their superelastic properties and ability to restore and retain a 'memorised' shape. However, most SMAs are permanent and do not degrade in the body when used in implantable devices. The use of non-degrading metals may lead to the requirement for secondary removal surgery and this in turn may introduce both short and long-term health risks, or additional waste disposal requirements. Biodegradable SMAs can effectively eliminate these issues by gradually degrading inside the human body while providing the necessary support for healing purposes, therefore significantly alleviating patient discomfort and improving healing efficiency. This paper reviews the current progress in biodegradable SMAs from the perspective of biodegradability, mechanical properties, and biocompatibility. By providing insights into the status of SMAs and biodegradation mechanisms, the prospects for Mg- and Fe-based biodegradable SMAs to advance biodegradable SMA-based medical devices are explored. Finally, the remaining challenges and potential solutions in the biodegradable SMAs area are discussed, providing suggestions and research frameworks for future studies on this topic.

Magnesium Promotes the Regeneration of the Peripheral Nerve

Peripheral nerve injury is a common complication in trauma, and regeneration and function recovery are clinical challenges. It is indispensable to find a suitable material to promote peripheral nerve regeneration due to the limited capacity of peripheral nerve regeneration, which is not an easy task to design a material with good biocompatibility, appropriate degradability. Magnesium has captured increasing attention during the past years as suitable materials. However, there are little types of research on magnesium promoting peripheral nerve regeneration. In this review, we conclude the possible mechanism of magnesium ion promoting peripheral nerve regeneration and the properties and application of different kinds of magnesium-based biomaterials, such as magnesium filaments, magnesium alloys, and others, in which we found some shortcomings and challenges. So, magnesium can promote peripheral nerve regeneration with both challenge and potential.

Resorbable Mg2+-Containing Phosphates for Bone Tissue Repair

Materials based on Mg2+-containing phosphates are gaining great relevance in the field of bone tissue repair via regenerative medicine methods. Magnesium ions, together with condensed phosphate ions, play substantial roles in the process of bone remodeling, affecting the early stage of bone regeneration through active participation in the process of osteosynthesis. In this paper we provide a comprehensive overview of the usage of biomaterials based on magnesium phosphate and magnesium calcium phosphate in bone reconstruction. We consider the role of magnesium ions in angiogenesis, which is an important process associated with osteogenesis. Finally, we summarize the biological properties of calcium magnesium phosphates for regeneration of bone.

Corrosion Resistance of MgZn Alloy Covered by Chitosan-Based Coatings

Chitosan coatings are deposited on the surface of Mg20Zn magnesium alloy by means of the spin coating technique. Their structure was investigated using Fourier Transform Infrared Spectroscopy (FTIR) an X-ray photoelectron spectroscopy (XPS). The surface morphology of the magnesium alloy substrate and chitosan coatings was determined using Scanning Electron Microscope (FE-SEM) analysis. Corrosion tests (linear sweep voltamperometry and chronoamperometry) were performed on uncoated and coated magnesium alloy in the Hank's solution. In both cases, the hydrogen evolution method was used to calculate the corrosion rate after 7-days immersion in the Hank's solution at 37 °C. It was found that the corrosion rate is 3.2 mm/year and 1.2 mm/year for uncoated and coated substrates, respectively. High corrosion resistance of Mg20Zn alloy covered by multilayer coating (CaP coating + chitosan water glass) is caused by formation of CaSiO₃ and Ca₃(PO₄)₂ compounds on its surface.

Zinc and cerium synergistically enhance the mechanical properties, corrosion resistance, and osteogenic activity of magnesium as resorbable biomaterials

Magnesium and its alloys have the potential to serve as a revolutionary class of biodegradable materials, specifically in the field of degradable implants for orthopedics. However, the corrosion rate of commercially pure magnesium is high and does not match the rate of regeneration of bone tissues. In this work, magnesium alloys containing zinc and cerium, either alone or in combination, were investigated and compared with commercially-pure magnesium as biomaterials. The microstructure, mechanical properties, corrosion resistance, and response of osteoblastsin vitrowere systematically assessed. Results reveal that alloying with Ce results in grain refinement and weakening of texture. The tensile test revealed that the ternary alloy offered the best combination of elastic modulus (41.1 ± 0.5 GPa), tensile strength (234.5 ± 4.5 MPa), and elongation to break (17.1 ± 0.4%). The ternary alloy was also the most resistant to corrosion (current of 0.85 ± 0.05 × 10^-4A cm^-2) in simulated body fluid than the other alloys. The response of MC3T3-E1 cellsin vitrorevealed that the ternary alloy imparts minimal cytotoxicity. Interestingly, the ternary alloy was highly efficient in supporting osteogenic differentiation, as revealed by the expression of alkaline phosphatase and calcium deposition. In summary, the extruded Mg alloy containing both Zn and Ce exhibits a combination of mechanical properties, corrosion resistance, and cell response that is highly attractive for engineering biodegradable orthopedic implants.

Innovative Coatings of Metallic Alloys Used as Bioactive Surfaces in Implantology: A Review

Metallic implants are widely used in the field of implantology, but there are still problems leading to implant failures due to weak osseointegration, low mechanical strength for the implant, inadequate antibacterial properties, and low patient satisfaction. Implant failure can be caused by bacterial infections and poor osteointegration. To improve the implant functionalization, many researchers focus on surface modifications to prepare the proper physical and chemical conditions able to increase biocompatibility and osteointegration between implant and bone. Improving the antibacterial performance is also a key factor to avoid the inflammation in the human body. This paper is a brief review for the types of coatings used to increase osseointegration and biocompatibility for the successful use of metal alloys in the field of implantology.

Effect of pH of coating solution on the adhesion strength and corrosion resistance of hydroxyapatite and octacalcium phosphate coated WE43 alloy

Hydroxyapatite (HAp) and octacalcium phosphate (OCP) layers were formed on Mg- 4mass% Y- 3mass% rare earth (WE43) alloy by a chemical solution deposition method at various pH values of pH 5.5, 6.2, 7.5, and 8.6. Adhesion strength of HAp and OCP layers was evaluated before and after immersing in a medium for 14 days by a pull-off test. The corrosion resistance of these coatings was measured by polarization tests performed in a simulated body fluid (SBF). XRD analysis demonstrated that HAp coating layers were formed at pH 7.5 and 8.6, while OCP coating layers were formed at pH 5.5 and 6.2. Adhesion test results showed that the as-coated pH7.5-HAp layer had the highest adhesion strength of 8.6 MPa, which was attributed to the very dense structure of the coating layer. The as-coated pH8.6-HAp layer showed the adhesion strength of 6.5 MPa. The adhesion strength of the as-coated pH5.5- and pH6.2-OCP layers was 3.9 and 7.1 MPa, respectively, that was governed by the thick and fragile property of the layers. After immersing in the medium for 14 days, the adhesion strength of pH7.5- and pH8.6-specimens decreased to 5.8 and 5.6 MPa, respectively. The pitting corrosion and formation of Mg(OH)₂ under the HAp layers were responsible for the decrease of adhesion strength. The polarization tests in SBF at 37 °C showed that the corrosion current density decreased with the HAp and OCP coatings, indicating the improvement of the corrosion resistance of WE43 alloy. The HAp coatings improved the corrosion resistance more efficiently than the OCP coatings.

Enhancement of Bone Regeneration on Calcium-Phosphate-Coated Magnesium Mesh: Using the Rat Calvarial Model

Metallic biodegradable magnesium (Mg) is a promising material in the biomedical field owing to its excellent biocompatibility, bioabsorbability, and biomechanical characteristics. Calcium phosphates (CaPs) were coated on the surface of pure Mg through a simple alkali-hydrothermal treatment. The surface properties of CaP coatings formed on Mg were identified through wettability, direct cell seeding, and release tests since the surface properties of biomaterials can affect the reaction of the host tissue. The effect of CaP-coated Mg mesh on guided bone regeneration in rat calvaria with the critical-size defect was also evaluated in vivo using several comprehensive analyses in comparison with untreated Mg mesh. Following the application of protective CaP coating, the surface energy of Mg improved with higher hydrophilicity and cell affinity. At the same time, the CaP coating endowed Mg with higher Ca affinity and lower degradation. The Mg mesh with CaP coating had higher osteointegration and bone affinity than pristine Mg mesh.

Research status of biodegradable metals designed for oral and maxillofacial applications: A review

The oral and maxillofacial regions have complex anatomical structures and different tissue types, which have vital health and aesthetic functions. Biodegradable metals (BMs) is a promising bioactive materials to treat oral and maxillofacial diseases. This review summarizes the research status and future research directions of BMs for oral and maxillofacial applications. Mg-based BMs and Zn-based BMs for bone fracture fixation systems, and guided bone regeneration (GBR) membranes, are discussed in detail. Zn-based BMs with a moderate degradation rate and superior mechanical properties for GBR membranes show great potential for clinical translation. Fe-based BMs have a relatively low degradation rate and insoluble degradation products, which greatly limit their application and clinical translation. Furthermore, we proposed potential future research directions for BMs in the oral and maxillofacial regions, including 3D printed BM bone scaffolds, surface modification for BMs GBR membranes, and BMs containing hydrogels for cartilage regeneration, soft tissue regeneration, and nerve regeneration. Taken together, the progress made in the development of BMs in oral and maxillofacial regions has laid a foundation for further clinical translation.

Surface Modification of Biomedical MgCa4.5 and MgCa4.5Gd0.5 Alloys by Micro-Arc Oxidation

The aim of this work was to characterize the structure and corrosion properties of the MgCa_4.5(Gd_0.5) alloys surface treated by the micro-arc oxidation (MAO) process. The MgCa_4.5 and MgCa_4.5Gd_0.5 alloy samples were processed by MAO in an electrolyte composed of NaOH (10 g/dm³), NaF (10 g/dm³), NaH₂PO₄ (5 g/dm³), Na₂SiO₂·5H₂O (10 g/dm³) and water. Two different voltages (120 V and 140 V) were used in the MAO process. The alloys protected by an oxide layer formed in the MAO were then the subject of corrosion resistance tests in an environment simulating the human body (Ringer’s solution). After the experiments, the resulting samples were investigated using SEM, XPS and EDS techniques. The addition of Gd affected the fragmentation of the coating structure, thereby increasing the specific surface; higher voltages during the MAO process increased the number and size of surface pores. Corrosion tests showed that the MgCa_4.5Gd_0.5 alloys were characterized by low polarization resistances and high corrosion current densities. The studies indicated the disadvantageous influence of gadolinium on the corrosion resistance of MgCa_4.5 alloys. The immersion tests confirmed lower corrosion resistance of MgCa_4.5Gd_0.5 alloys compared to the referenced MgCa_4.5 ones. The MgCa_4.5 alloy with the MAO coating established at voltage 140 V demonstrated the best anticorrosion properties.

Magnetron sputtered magnesium-based thin film metallic glasses for bioimplants

Mg-based thin film metallic glasses (TFMGs) can viably decrease stress shielding caused by mismatch of the modulus of elasticity between the implant material and human bone. Here, Mg-based TFMGs were fabricated onto implantable substrates by ion assisted pulsed DC magnetron sputtering. The microstructure assessment and the impact of the principle constituents of the coatings were determined utilizing an x-ray diffractometer, a transmission electron microscope, and x-ray photoelectron spectroscopy. The hardness of these thin films was estimated to be 5.1 GPa. In vitro degradation tests including electrochemical studies and immersion tests in simulated body fluid revealed that the presence of zinc could raise the corrosion resistance of Mg-based TFMG. Indirect in vitro cytotoxicity using L929 fibroblast cells revealed that the TFMGs did not induce any toxicity in cells. Biomineralization experiments using Saos-2 cells promoted the formation of calcium phosphate on its surface.

Surface Modification of Biodegradable Mg-Based Scaffolds for Human Mesenchymal Stem Cell Proliferation and Osteogenic Differentiation

Magnesium alloys with coatings have the potential to be used for bone substitute alternatives since their mechanical properties are close to those of human bone. However, the surface modification of magnesium alloys to increase the surface biocompatibility and reduce the degradation rate remains a challenge. Here, FHA-Mg scaffolds were made of magnesium alloys and coated with fluorohydroxyapatite (FHA). Human mesenchymal stem cells (hMSCs) were cultured on FHA-Mg scaffolds and cell viability, proliferation, and osteogenic differentiation were investigated. The results showed that FHA-Mg scaffolds display a nano-scaled needle-like structure of aggregated crystallites on their surface. The average Mg²⁺ concentration in the conditioned media collected from FHA-Mg scaffolds (5.8–7.6 mM) is much lower than those collected from uncoated, Mg(OH)₂-coated, and hydroxyapatite (HA)-coated samples (32.1, 17.7, and 21.1 mM, respectively). In addition, compared with hMSCs cultured on a culture dish, cells cultured on FHA-Mg scaffolds demonstrated better proliferation and comparable osteogenic differentiation. To eliminate the effect of osteogenic induction medium, hMSCs were cultured on FHA-Mg scaffolds in culture medium and an approximate 66% increase in osteogenic differentiation was observed three weeks later, indicating a significant effect of the nanostructured surface of FHA-Mg scaffolds on hMSC behaviors. With controllable Mg²⁺ release and favorable mechanical properties, porous FHA-Mg scaffolds have a great potential in cell-based bone regeneration.

Osteogenesis, angiogenesis and immune response of Mg-Al layered double hydroxide coating on pure Mg

Layered double hydroxides (LDHs) are widely studied to enhance corrosion resistance and biocompatibility of Mg alloys, which are promising bone implants. However, the influence of LDH coating on the osteointegration of Mg implants lacks of a systematic study. In this work, Mg-Al LDH coating was prepared on pure Mg via hydrothermal treatment. The as-prepared Mg-Al LDH coated Mg exhibited better in vitro and in vivo corrosion resistance than bare Mg and Mg(OH)2 coated Mg. In vitro culture of mouse osteoblast cell line (MC3T3-E1) suggested that Mg-Al LDH coated Mg was more favorable for its osteogenic differentiation. In vitro culture of HUVECs revealed that cells cultured in the extract of Mg-Al LDH coated Mg showed superior angiogenic behaviors. More importantly, the immune response of Mg-Al LDH coated Mg was studied by in vitro culturing murine-derived macrophage cell line (RAW264.7). The results verified that Mg-Al LDH coated Mg could induce macrophage polarize to M2 phenotype (anti-inflammatory). Furthermore, the secreted factor in the macrophage-conditioned culture medium of Mg-Al LDH group was more suitable for the bone differentiation of rat bone marrow stem cells (rBMSCs) and the angiogenic behavior of human umbilical vein endothelial cells (HUVECs). Finally, the result of femoral implantation suggested that Mg-Al LDH coated Mg exhibited better osteointegration than bare Mg and Mg(OH)2 coated Mg. With favorable in vitro and in vivo performances, Mg-Al LDH is promising as protective coating on Mg for orthopedic applications.

Silane coatings modified with hydroxyapatite nanoparticles to enhance the biocompatibility and corrosion resistance of a magnesium alloy

The fast corrosion rate of magnesium alloys has restricted their use as biodegradable implants. Hence developing a practical approach to retard the corrosion rate of the AZ31 magnesium alloy, as well as promoting cell adhesion and proliferation is of great importance. Silane coatings were applied through dip coating, on samples pretreated in hydrofluoric acid. Samples were immersed in simulated body fluid at 37 °C, and the coating performance was assessed by electrochemical impedance spectroscopy. The coating morphologies of samples were investigated through field emission scanning electron microscopy and a cell viability/proliferation (MTT) test was performed to evaluate cellular response. A 2.2 μm-thick coating was accomplished, which increased the corrosion resistance to three orders of magnitude higher than that of the bare sample. Hydroxyapatite nanoparticles were added to the silane coating to improve biocompatibility and facilitate bone formation. Changing the concentration of hydroxyapatite nanoparticles not only helped to optimize the barrier properties of the silane coating but also ameliorated MG-63 osteoblastic cell growth. The findings showed great promise to enhance and maintain the corrosion barrier property and induce high osteoblastic differentiation by employing 1000 mg L⁻¹ of hydroxyapatite nanoparticles.

Incorporation of hydroxyapatite nanoparticles in silane coatings improves both corrosion resistance and cell viability on magnesium AZ31 implants.

Biocompatibility and Immune Response of a Newly Developed Volume-Stable Magnesium-Based Barrier Membrane in Combination with a PVD Coating for Guided Bone Regeneration (GBR)

To date, there are no bioresorbable alternatives to non-resorbable and volume-stable membranes in the field of dentistry for guided bone or tissue regeneration (GBR/GTR). Even magnesium (Mg) has been shown to constitute a favorable biomaterial for the development of stabilizing structures. However, it has been described that it is necessary to prevent premature degradation to ensure both the functionality and the biocompatibility of such Mg implants. Different coating strategies have already been developed, but most of them did not provide the desired functionality. The present study analyses a new approach based on ion implantation (II) with PVD coating for the passivation of a newly developed Mg membrane for GBR/GTR procedures. To demonstrate comprehensive biocompatibility and successful passivation of the Mg membranes, untreated Mg (MG) and coated Mg (MG-Co) were investigated in vitro and in vivo. Thereby a collagen membrane with an already shown biocompatibility was used as control material. All investigations were performed according to EN ISO 10993 regulations. The in vitro results showed that both the untreated and PVD-coated membranes were not cytocompatible. However, both membrane types fulfilled the requirements for in vivo biocompatibility. Interestingly, the PVD coating did not have an influence on the gas cavity formation compared to the uncoated membrane, but it induced lower numbers of anti-inflammatory macrophages in comparison to the pure Mg membrane and the collagen membrane. In contrast, the pure Mg membrane provoked an immune response that was fully comparable to the collagen membrane. Altogether, this study shows that pure magnesium membranes represent a promising alternative compared to the nonresorbable volume-stable materials for GBR/GTR therapy.

Mechanical properties and biodegradability of Mg-Zn-Ca alloys: homogenization heat treatment and hot rolling

In this study, Mg was alloyed with Zn and Ca to produce six different Mg-Zn-Ca alloys (designated as ZX alloys) by the gravity die casting method. Zn contents of the alloys were 1 wt., 3 wt., and 5 wt.% and Ca contents of the alloys were 0.2 wt. and 1.8 wt.%. Homogenization heat treatment was applied to all cast alloys. After that, a part of each homogenization heat-treated alloys was hot-rolled. Microstructure, mechanical properties, electrochemical and immersion corrosion behaviors at simulated physiological conditions of the heat-treated and hot-rolled alloys were compared. Increasing the amount of alloying elements (Zn and Ca) in Mg reduces grain size and improves the hardness. It was seen that the microstructure consisted of α-Mg as a matrix phase and intermetallic phases: Mg₂Ca phase for the alloy having Zn/Ca = 0.37 (ZX12) and Ca₂Mg₆Zn₃ phase for the other alloys. When the mechanical properties and corrosion rates of homogenized and hot-rolled alloys were compared, it was seen that hot-rolled ZX10-h (Mg-0.94Zn-0.16Ca) alloy can be considered as a fracture bone fixation plate material with its acceptable properties: 121 ± 2.1 MPa yield strength, 226 ± 3.7 MPa tensile strength, % 4.1 ± 0.2 elongation, and 0.062 mm/year immersion corrosion rate.

Osteogenic Effect of a Biodegradable BMP-2 Hydrogel Injected into a Cannulated Mg Screw

Cannulated screws, containing an internal hole for inserting a guide pin, are commonly used in the management of bone fractures. Cannulated Mg screws can be biodegraded easily because their increased surface area including that of the inner hole rapidly reacts with body fluids. To delay biodegradation of cannulated Mg screws and improve bone regeneration, we developed a specific type of screw by injecting it with gelatin hydrogels [10 wt % gelatin_(gel) with 0.09 v/v % glutaraldehyde (cross-linker)] containing different concentrations (5, 10, or 25 μg/mL) of bone morphogenic proteins (BMPs). We analyzed the properties and biocompatibility of the screws with and without BMP-2 and found that the release rate of BMP-2 in the hydrogel changed proportionately with the degradation rate of the cross-linked hydrogel. Loading BMP-2 in the hydrogel resulted in sustained release of BMP-2 for 25 to 40 days or more. The degradation rate of BMP-2 hydrogels was inversely proportional to the concentration of BMP-2. The injection of the hydrogels in the cannulated screw delayed biodegradation inside of the screw by simulated body fluid. It also induced uniform corrosion and the precipitation of bioactive compounds onto the surface of the screw. In addition, osteoblast proliferation was very active near the BMP-2 hydrogels, depending on the BMP-2 concentration. The BMP-2 in the hydrogel improved cell differentiation. The cannulated screw injected with 10 μL/mL BMP-2 hydrogel prevented implant biodegradation and enhanced osteoconduction and osteointegration inside and outside the screw. In addition, the properties of BMP-2-loaded hydrogels can be changed by controlling the amount of the cross-linker and protein, which could be useful for tissue regeneration in other fields.

Antimicrobial Properties of MgO Nanostructures on Magnesium Substrates

Magnesium (Mg) and its alloys have attracted increasing attention in recent years as medical implants for repairing musculoskeletal injuries because of their promising mechanical and biological properties. However, rapid degradation of Mg and its alloys in physiological fluids limited their clinical translation because the accumulation of hydrogen (H2) gas and fast release of OH- ions could adversely affect the healing process. Moreover, infection is a major concern for internally implanted devices because it could lead to biofilm formation, prevent host cell attachment on the implants, and interfere osseointegration, resulting in implant failure or other complications. Fabricating nanostructured magnesium oxide (MgO) on magnesium (Mg) substrates is promising in addressing both problems because it could slow down the degradation process and improve the antimicrobial activity. In this study, nanostructured MgO layers were created on Mg substrates using two different surface treatment techniques, i.e., anodization and electrophoretic deposition (EPD), and cultured with Staphylococcus aureus in vitro to determine their antimicrobial properties. At the end of the 24-h bacterial culture, the nanostructured MgO layers on Mg prepared by anodization or EPD both showed significant bactericidal effect against S. aureus. Thus, nanostructured MgO layers on Mg are promising for reducing implant-related infections and complications and should be further explored for clinical translation toward antimicrobial biodegradable implants.

Influence of Cu2+ Ions on the Corrosion Resistance of AZ31 Magnesium Alloy with Microarc Oxidation

The objectives of this study were to reduce the corrosion rate and increase the cytocompatibility of AZ31 Mg alloy. Two coatings were considered. One coating contained MgO (MAO/AZ31). The other coating contained Cu²⁺ (Cu/MAO/AZ31), and it was produced on the AZ31 Mg alloy via microarc oxidation (MAO). Coating characterization was conducted using a set of methods, including scanning electron microscopy, energy-dispersive spectrometry, X-ray photoelectron spectroscopy, and X-ray diffraction. Corrosion properties were investigated through an electrochemical test, and a H₂ evolution measurement. The AZ31 Mg alloy with the Cu²⁺-containing coating showed an improved and more stable corrosion resistance compared with the MgO-containing coating and AZ31 Mg alloy specimen. Cell morphology observation and cytotoxicity test via Cell Counting Kit-8 assay showed that the Cu²⁺-containing coating enhanced the proliferation of L-929 cells and did not induce a toxic effect, thus resulting in excellent cytocompatibility and biological activity. In summary, adding Cu ions to MAO coating improved the corrosion resistance and cytocompatibility of the coating.

Interaction of different cell types with magnesium modified by plasma electrolytic oxidation

Magnesium (Mg) is a material widely used in industrial applications due to its low weight, ductility, and excellent mechanical properties. For non-permanent implants, Mg is particularly well-suited because of its biodegradability, while its degradation products are not harmful. However, Mg is chemically reactive, and cytotoxic hydrogen gas is released as part of the degradation. This adverse degradation can be tuned using plasma electrolytic oxidation (PEO). With PEO, a surface layer of MgO/Mg(OH)₂ is deposited on the surface of Mg in a controlled way. The electrolytes used during PEO influence the surface's chemistry and topography and thus expectedly the biological response of adhered cells. In this study, thin samples of commercial pure of Mg (c.p Mg) were modified by PEO guided by different electrolytes, and the biological activity was assessed on vascular cells, immune cells, and repair cells (adipose tissue-derived stromal cells, ASCs). Vascular cells were more vulnerable than ASCs for compounds released by surface-coated Mg. All surface coatings supported the proliferation of adhered ASC. Released compounds from surface-coated Mg delayed but did not block in vitro wound closure of fibroblasts monolayers. Preformed endothelial tubes were vulnerable for released compounds, while their supporting ASC was not. We conclude that PEO-based surface-coating of Mg supports adhesion and future delivery of therapeutic vascular repair cells such as ASC, but that the observed vulnerability of vascular cells for coated Mg components warrants investigations in vivo.

Degradation, Bone Regeneration and Tissue Response of an Innovative Volume Stable Magnesium-Supported GBR/GTR Barrier Membrane

Introduction: Bioresorbable collagenous barrier membranes are used to prevent premature soft tissue ingrowth and to allow bone regeneration. For volume stable indications, only non-absorbable synthetic materials are available. This study investigates a new bioresorbable hydrofluoric acid (HF)-treated magnesium (Mg) mesh in a native collagen membrane for volume stable situations. Materials and Methods: HF-treated and untreated Mg were compared in direct and indirect cytocompatibility assays. In vivo, 18 New Zealand White Rabbits received each four 8 mm calvarial defects and were divided into four groups: (a) HF-treated Mg mesh/collagen membrane, (b) untreated Mg mesh/collagen membrane (c) collagen membrane and (d) sham operation. After 6, 12 and 18 weeks, Mg degradation and bone regeneration was measured using radiological and histological methods. Results: In vitro, HF-treated Mg showed higher cytocompatibility. Histopathologically, HF-Mg prevented gas cavities and was degraded by mononuclear cells via phagocytosis up to 12 weeks. Untreated Mg showed partially significant more gas cavities and a fibrous tissue reaction. Bone regeneration was not significantly different between all groups. Discussion and Conclusions: HF-Mg meshes embedded in native collagen membranes represent a volume stable and biocompatible alternative to the non-absorbable synthetic materials. HF-Mg shows less corrosion and is degraded by phagocytosis. However, the application of membranes did not result in higher bone regeneration.

Effect of Hydrothermal (Sr)-Hydroxyapatite Coatings on the Corrosion Resistance and Mg2+ Ion Release to Enhance Osteoblastic Cell Responses of AZ91D Alloy

The biomedical applications of Mg-based alloys are limited by their rapid corrosion rate in the body fluid. In this study, the hydrothermal synthesis is employed to produce protective bioactive hydroxyapatite coating (HAC) and strontium-substituted hydroxyapatite coating (Sr-HAC) to further enhance the corrosion resistance and in vitro biocompatibility of biodegradable AZ91D Mg alloy in physiological environments. For comparison, the brucite Mg(OH)₂ prepared by the alkaline pre-treatment is designated as a control group. Experimental evidences of XRD and XPS analysis confirm that Sr²⁺ ions can be incorporated into HA crystal structure. It is noted that the hydrothermally synthesized Sr-HAC conversion coating composed of a specific surface topography with the nanoscaled flake-like fine crystallites is constructed on the AZ91D Mg alloy. The hydrophilicity of Mg substrate is effectively enhanced with the decrease in static contact angles after performing alkaline and hydrothermal treatments. Potentiodynamic polarization measurements reveal that the nanostructured Sr-HAC-coated specimens exhibit superior corrosion resistance than HAC and alkaline pre-treated Mg(OH)₂. Moreover, immersion tests demonstrate that Sr-HAC provides favorable long-term stability for the Mg alloy with decreasing concentration of released Mg²⁺ ions in the SBF and the reduced corrosion rate during the immersion length of 30 days. The cells cultured on Sr-HAC specimens exhibit higher viability than those on the alkaline-pre-treated Mg(OH)₂ and HAC specimens. The Sr-substituted HA coating with a nanostructured surface topography can help to stimulate the cell viability of osteoblastic cells.

Characterization of a Bioresorbable Magnesium-Reinforced PLA-Integrated GTR/GBR Membrane as Dental Applications

Inferior mechanical properties have always been a limitation of the bioresorbable membranes in GBR/GTR. This study is aimed at fabricating a bioresorbable magnesium-reinforced polylactic acid- (PLA-) integrated membrane and investigating its mechanical properties, degradation rate, and biocompatibility. The uncoated and fluoride-coated magnesium alloys, AZ91, were made into strips. Then, magnesium-reinforced PLA-integrated membrane was made through integration. PLA strips were used in the control group instead of magnesium strips. Specimens were cut into rectangular shape and immersed in Hank's Balanced Salt Solution (HBSS) at 37°C for 4, 8, and 12 d. The weight loss of the AZ91 strips was measured. Three-point bending tests were conducted before and after the immersion to determine the maximum load on specimens. Potentiodynamic polarization (PDP), electrochemical impedance spectroscopy (EIS), scanning electron microscopy (SEM), and energy-dispersive spectroscopy (EDS) were conducted on coated and uncoated AZ91 plates to examine corrosion resistance. Murine fibroblast and osteoblast cells were cultured on circular specimens and titanium disks for 1, 3, and 5 d. Thereafter, WST test was performed to examine cell proliferation. As a result, the coated and uncoated groups showed higher maximum loads than the control group at all time points. The weight loss of AZ91 strips used in the coated group was lower than that in the uncoated group. PDP, EIS, SEM, and EDS showed that the coated AZ91 had a better corrosion resistance than the uncoated AZ91. The cell proliferation test showed that the addition of AZ91 did not have an adverse effect on osteoblast cells. Conclusively, the magnesium-reinforced PLA-integrated membrane has excellent load capacity, corrosion resistance, cell affinity, and proper degradation rate. Moreover, it has great potential as a bioresorbable membrane in the GBR/GTR application.

In Vivo Simulation of Magnesium Degradability Using a New Fluid Dynamic Bench Testing Approach

The degradation rate of magnesium (Mg) alloys is a key parameter to develop Mg-based biomaterials and ensure in vivo-mechanical stability as well as to minimize hydrogen gas production, which otherwise can lead to adverse effects in clinical applications. However, in vitro and in vivo results of the same material often differ largely. In the present study, a dynamic test bench with several single bioreactor cells was constructed to measure the volume of hydrogen gas which evolves during magnesium degradation to indicate the degradation rate in vivo. Degradation medium comparable with human blood plasma was used to simulate body fluids. The media was pumped through the different bioreactor cells under a constant flow rate and 37 °C to simulate physiological conditions. A total of three different Mg groups were successively tested: Mg WE43, and two different WE43 plasma electrolytically oxidized (PEO) variants. The results were compared with other methods to detect magnesium degradation (pH, potentiodynamic polarization (PDP), cytocompatibility, SEM (scanning electron microscopy)). The non-ceramized specimens showed the highest degradation rates and vast standard deviations. In contrast, the two PEO samples demonstrated reduced degradation rates with diminished standard deviation. The pH values showed above-average constant levels between 7.4–7.7, likely due to the constant exchange of the fluids. SEM revealed severe cracks on the surface of WE43 after degradation, whereas the ceramized surfaces showed significantly decreased signs of corrosion. PDP results confirmed the improved corrosion resistance of both PEO samples. While WE43 showed slight toxicity in vitro, satisfactory cytocompatibility was achieved for the PEO test samples. In summary, the dynamic test bench constructed in this study enables reliable and simple measurement of Mg degradation to simulate the in vivo environment. Furthermore, PEO treatment of magnesium is a promising method to adjust magnesium degradation.