Evaluation of Magnesium-based Medical Devices in Preclinical Studies: Challenges and Points to Consider

In vitro and in vivo degradation behavior of Mg-0.45Zn-0.45Ca (ZX00) screws for orthopedic applications

Magnesium (Mg) alloys have become a potential material for orthopedic implants due to their unnecessary implant removal, biocompatibility, and mechanical integrity until fracture healing. This study examined the in vitro and in vivo degradation of an Mg fixation screw composed of Mg-0.45Zn-0.45Ca (ZX00, in wt.%). With ZX00 human-sized implants, in vitro immersion tests up to 28 days under physiological conditions, along with electrochemical measurements were performed for the first time. In addition, ZX00 screws were implanted in the diaphysis of sheep for 6, 12, and 24 weeks to assess the degradation and biocompatibility of the screws in vivo. Using scanning electron microscopy (SEM) coupled with energy dispersive X-ray spectroscopy (EDX), micro-computed tomography (μCT), X-ray photoelectron spectroscopy (XPS), and histology, the surface and cross-sectional morphologies of the corrosion layers formed, as well as the bone-corrosion-layer-implant interfaces, were analyzed. Our findings from in vivo testing demonstrated that ZX00 alloy promotes bone healing and the formation of new bone in direct contact with the corrosion products. In addition, the same elemental composition of corrosion products was observed for in vitro and in vivo experiments; however, their elemental distribution and thicknesses differ depending on the implant location. Our findings suggest that the corrosion resistance was microstructure-dependent. The head zone was the least corrosion-resistant, indicating that the production procedure could impact the corrosion performance of the implant. In spite of this, the formation of new bone and no adverse effects on the surrounding tissues demonstrated that the ZX00 is a suitable Mg-based alloy for temporary bone implants.

Evaluation of Physiochemical and Biological Properties of Biofunctionalized Mg-Based Implants Obtained via Large-Scale PEO Process for Dentistry Applications

An increasing number of tooth replacement procedures ending with implant failure generates a great need for the delivery of novel biomedical solutions with appropriate mechanical characteristics that would mimic natural tissue and undergo biodegradation. This phenomenon constitutes a significant difficulty for scientists, since currently applied biomaterials dedicated for this purpose are based on stainless steel, Ti, and Ti and CoCr alloys. One of the most promising raw materials is magnesium, which has been proven to promote bone regeneration and accelerate the tissue healing process. Nevertheless, its high reactivity with body fluid components is associated with fast and difficult-to-control biocorrosion, which strongly limits the application of Mg implants as medical devices. The achievement of appropriate functionality, both physiochemical and biological, to enable the commercial use of Mg biomaterials is possible only after their superficial modification. Therefore, the obtainment of uniform, reproducible coatings increasing resistance to the aqueous environment of the human body combined with a nanostructured surface that enhances implant-cell behaviors is an extremely important issue. Herein, we present a successful strategy for the modification of Mg implants via the PEO process, resulting in the obtainment of biomaterials with lower corrosion rates and superior biological properties, such as the promotion of extracellular matrix formation and a positive impact on the proliferation of MG-63 cells. The implants were investigated regarding their chemical composition using the FT-IR and XRD methods, which revealed that MgO layer formation, as well as the incorporation of electrolyte components such as fluorine and silica, were responsible for the increased microhardness of the samples. An extensive study of the biomaterials' morphology confirmed that successful surface modification led to a microporous structure suitable for the attachment and proliferation of cells. The three-layer nature of the newly-formed coatings, typical for PEO modification, was confirmed via cross-section analysis. A biocorrosion and biodegradation study proved that applied modification increased their resistance to body fluids. The cell culture study performed herein confirmed that the correct adjustment of modification parameters results in a lack of cytotoxicity of the magnesium implants, cell proliferation enhancement, and improvement in extracellular matrix formation.

An In Vivo Rat Study of Bioresorbable Mg-2Zn-2Ga Alloy Implants

In the present study, pins made from the novel Mg-2Zn-2Ga alloy were installed within the femoral bones of six Wistar rats. The level of bioresorption was assessed after 1, 3, and 6 months by radiography, histology, SEM, and EDX. Significant bioresorption was evident after 3 months, and complete dissolution of the pins occurred at 6 months after the installation. No pronounced gas cavities could be found at the pin installation sites throughout the postoperative period. The animals' blood parameters showed no signs of inflammation or toxication. These findings are sufficiently encouraging to motivate further research to broaden the experimental coverage to increase the number of observed animals and to conduct tests involving other, larger animals.

Comparative Osteogenesis and Degradation Behavior of Magnesium Implant in Epiphysis and Diaphysis of the Long Bone in the Rat Model

Magnesium (Mg), as a biodegradable material, is a promising candidate for orthopedic surgery. Long-bone fractures usually occur in cancellous-bone-rich epiphysis at each end or the cortical-rich diaphysis in the center, with different bone healing processes. Little is known about the differences in results between the two regions when applying Mg implants. Therefore, this study aimed to compare the biodegradation and osteogenesis of Mg implants in a rat model's epiphysis and diaphysis of the long bone. Twelve male Sprague Dawley rats underwent Mg rod implantation in the distal femoral epiphyses and tibial diaphyses. Every three weeks for up to twelve weeks, degradation behavior, gas evolution, and new bone formation were measured by micro CT. Histomorphology was analyzed by Hematoxylin and Eosin, Villanueva bone staining, and TRAP staining for osteoclastogenesis evaluations. Micro-CT analysis showed statistically significant higher new bone formation in the epiphysis group than in the diaphysis group, which correlated with a lower gas volume. Histological analysis showed higher osseointegration of Mg implants in the epiphyseal region than in the diaphyseal region. The magnesium implant's osteoclastogenesis-inhibiting properties were shown in the surrounding areas in both the cortical bone of the diaphysis and the cancellous bone of the epiphysis. Our findings show the differences in the magnesium implant's osteogenesis and biodegradation in the epiphysis and the diaphysis. These dissimilarities indicate a better response of the epiphyseal region to the Mg implants, a promising biomaterial for orthopedic surgery applications.

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.

Topography Control of Micro-Nanosized Anatase Coating on Magnesium Alloy

Constructing surface topographies in the micro- or nanometer range is an effective way to improve the biocompatibility of biomaterials. For the present work, anatase coatings with controllable micro/nanoscale characteristics were successfully prepared on an MgZn alloy surface via solvothermal route, and their formation mechanisms are discussed. The features of the as-prepared coatings were characterized using a scanning electron microscope (SEM), a transmission electron microscope (TEM), an atomic force microscope (AFM), X-ray diffraction (XRD), and a contact angle goniometer. The corrosion behavior of the coatings was also evaluated by testing the open circuit potential (OCP) in SBF (Simulated Body Fluid). The results show that a gradual variation of the anatase coating morphologies was obtained through adjusting the solvothermal reaction conditions. With the increase of NH4F concentration in the solution, the cross-combined anatase nanosheets became more dispersed. The micro/nanostructured anatase coatings provide the MgZn alloy with good corrosion resistance, which increased with the density of anatase nanosheets in the coatings. In addition, the coatings exhibit the inhibition of platelet aggregation, and the micro/nano structures can also adsorb endothelial cells.

In vitro and in vivo evaluation of a novel bioresorbable magnesium scaffold with different surface modifications

The novel Resoloy® rare earth magnesium alloy was developed for bioresorbable vascular implant application, as an alternative to the WE43 used in Biotronik's Magmaris scaffold, which received CE approval in 2016. Initially, the Magmaris showed very promising preclinical and clinical results, but the formation of an unexpected conversion product and a too fast loss of integrity has proven to be a flaw. The safety and efficacy of Resoloy, which is intended to be bioresorbed without any remnants, has been investigated in an in vitro degradation study and a porcine coronary animal model. Four different groups of scaffolds composed of Resoloy (Res) as the backbone material and additionally equipped with a fluoride passivation layer (Res‐F), a polyester topcoat (Res‐P), or a duplex layer composed of a fluoride passivation layer and a polymeric topcoat (Res‐PF) were compared to a Magmaris scaffold in an in vitro degradation test. Preclinical safety and efficacy of Res‐F and Res‐PF were subsequently evaluated in a coronary porcine model for 12 and 28 days. Scanning electron microscope, quantitative coronary angiography, micro‐computed tomography, histopathology, and histomorphometry analyses were conducted to evaluate preclinical parameters and degradation behavior of the scaffolds. Res‐PF with a duplex layer shows the slowest degradation and the longest supporting force of all test groups. The in vitro data are confirmed by the results of the in vivo study, in which Res‐PF exhibited a longer supporting force than Res‐F, but also caused higher neointima formation. Both studied groups showed excellent biocompatibility. A starter colonization of the strut area with cells during bioresorption was observed. The in vitro degradation test shows that a combination of MgF₂ passivation and a PLLA topcoat on a Resoloy magnesium backbone (Res‐PF) leads to a much slower degradation and a longer support time than a Magmaris control group. In a preclinical study, the safety and efficacy of this duplex layer could be demonstrated. The beginning colonization of the degraded strut area by macrophages can be seen as clear indications that the resorption of the intermediate degradation product takes a different course than that of the Magmaris scaffold.

Properties of Titanium Oxide Coating on MgZn Alloy by Magnetron Sputtering for Stent Application

Constructing surface coatings is an effective way to improve the corrosion resistance and biocompatibility of magnesium alloy bioabsorbable implants. In this present work, a titanium oxide coating with a thickness of about 400 nm was successfully prepared on a MgZn alloy surface via a facile magnetron sputtering route. The surface features were characterized using scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and the contact angle method. The corrosion behavior and biocompatibility were evaluated. The results indicated that the amorphous TiO2 coating with a flat and dense morphology was obtained by magnetron-sputtering a titanium oxide target. The corrosion current density decreased from 1050 (bare MgZn alloy) to 49 μA/cm2 (sample with TiO2 coating), suggesting a significant increase in corrosion resistance. In addition, the TiO2 coating showed good biocompatibilities, including significant reduced hemolysis and platelet adhesion, and increased endothelial cell viability and adhesion.

Is There a Role for Absorbable Metals in Surgery? A Systematic Review and Meta-Analysis of Mg/Mg Alloy Based Implants

Magnesium (Mg) alloys have received attention in the literature as potential biomaterials for use as absorbable implants in oral and maxillofacial and orthopedic surgery applications. This study aimed to evaluate the available clinical studies related to patients who underwent bone fixation (patients), and received conventional fixation (intervention), in comparison to absorbable metals (comparison), in terms of follow-up and complications (outcomes). A systematic review and meta-analysis were performed in accordance with the PRISMA statement and PROSPERO (CRD42020188654), PICO question, ROBINS-I, and ROB scales. The relative risk (RR) of complications and failures were calculated considering a confidence interval (CI) of 95%. Eight studies (three randomized clinical trial (RCT), one retrospective studies, two case-control studies, and two prospective studies) involving 468 patients, including 230 Mg screws and 213 Titanium (Ti) screws, were analyzed. The meta-analysis did not show any significant differences when comparing the use of Mg and Ti screws for complications (p = 0.868). The estimated complication rate was 13.3% (95% CI: 8.3% to 20.6%) for the comparison group who received an absorbable Mg screw. The use of absorbable metals is feasible for clinical applications in bone surgery with equivalent outcomes to standard metal fixation devices.