Bioinorganic supplementation of calcium phosphate-based bone substitutes to improve in vivo performance: a systematic review and meta-analysis of animal studies

Supplementation of CaP-based bone graft substitutes with bioinorganics such as strontium, zinc or silicon is an interesting approach to increase the biological performance in terms of bone regenerative potential of calcium phosphate (CaP)-based bone substitutes. However, the in vivo efficacy of this approach has not been systematically analyzed, yet. Consequently, we performed a systematic review using the available literature regarding the effect of bioinorganic supplementation in CaP-based biomaterials on new bone formation and material degradation in preclinical animal bone defect models and studied this effect quantitatively by performing a meta-analysis. Additional subgroup analyses were used to study the effect of different bioinorganics, animal model, or phase category of CaP-based biomaterial on bone formation or material degradation. Results show that bioinorganic supplementation increases new bone formation (standardized mean difference [SMD]: 1.43 SD, confidence interval [CI]: 1.13-1.73). Additional subgroup analysis showed that strontium, magnesium and silica significantly enhanced bone formation, while zinc did not have any effect. This effect of bioinorganic supplementation on new bone formation was stronger for DCPD or β-TCP and biphasic CaPs than for HA or α-TCP (p < 0.001). In general, material degradation was slightly hindered by bioinorganic supplementation (mean difference [MD]: 0.84%, CI: 0.01-1.66), with the exception of strontium that significantly enhanced degradation. Overall, bioinorganic supplementation represents an effective approach to enhance the biological performance of CaP-based bone substitutes.

Defluoridation of water through the transformation of octacalcium phosphate into fluorapatite

The consumption of water with fluoride concentration higher than 1.5 mg/L (WHO recommended limit) is recognized to cause serious diseases, and fluoride removal from natural contaminated waters is a health priority for more than 260 million people worldwide. The octacalcium phosphate (OCP), a mineralogical precursor of bio-apatite, is here tested as a fluoride remover. A new two-step method for the synthesis of OCP is proposed: 1) synthesis of brushite from calcium carbonate and phosphoric acid; 2) subsequent hydrolysis of brushite. Fluoride removal experiments are performed in batch-mode using different initial concentrations of fluoride (from 40 to 140 mg/L) and reaction times. Most of fluoride is removed within the first 2 h of all experiments, and the drinkable limit of 1.5 mg/L is reached within a minimum of 3 h for an initial fluoride concentration of 40 mg/L. The experimental fluoride removal capacity of OCP is 25.7 mg/g, and 4 g of OCP can effectively treat 1 L of water with fluoride concentration up to 50 times higher than the drinking limit of 1.5 mg/L. XRD and chemical characterization of the solid phases, before and after the removal experiments, indicate that OCP transforms into fluorapatite (FAP) uptaking fluoride from solution.

Mitochondria-Mediated Pathway Regulates C2C12 Cell Apoptosis Induced by Fluoride

This study was designed to investigate the mechanisms of excessive fluoride-induced apoptosis via mitochondria-mediated pathway in skeletal muscle cells (C2C12 cells). C2C12 cells were cultured with the fluoride concentrations (0, 1, and 2.5 mmol/L) for 48 h. The morphology and ultrastructural changes of C2C12 cells were observed using a light microscope and transmission electron microscope (TEM). The protein expression levels of apoptosis factors, including Bax, Bcl-2, cytochrome c (Cyt c), caspase-3, and caspase-9, were measured using real-time polymerase chain reaction (real-time PCR) and immunocytofluorescence. The morphology and ultrastructure of C2C12 cells were seriously damaged by fluoride at 1 and 2.5 mmol/L doses, including swollen mitochondria, vacuolization, ridge breakage, and disappearance of the nuclear membrane. Simultaneously, compared with the control group, the expression levels of Bax, Bcl-2, Cyt c, caspase-3, and caspase-9 were up-regulated after fluoride treatment. Excessive fluoride damages the ultrastructure in mitochondria, leading to the release of Cyt c from the mitochondria to cytoplasm in C2C12 cells; thereby, activated caspases cascade apoptosis process through a mitochondria-mediated pathway.

Antibacterial and bioactive coatings on titanium implant surfaces

Various surface modifications have been tried for enhancing osseointegration of the dental implants like mechanical and/or chemical treatments and deposition of calcium phosphate coatings. The objective of this research was to develop calcium-phosphate based thin coatings with antibacterial and bioactive properties for potential application in dental implants. Titanium (Ti) discs were immersed in different calcifying solutions: CaP (positive control), F-CaP, Zn-CaP, and FZn-CaP and incubated for 24 h. Negative control was uncoated Ti discs. Coated surfaces were characterized using X-ray diffraction, scanning electron microscopy and energy dispersive spectroscopy. Antibacterial properties were tested using Porphyromonas gingivalis because of its strong association with periodontal and peri-implant infections. Bacterial adhesion and colonization were studied at different timepoints. The coated surfaces had compositional characteristics similar to that of bone mineral and they inhibited the growth, colonization and adherence of P. gingivalis, resulted in reduced thickness of biofilms and bacterial inhibition in the culture medium as compared to the positive and negative controls (p < 0.05). There was no significant difference between the experimental groups (p > 0.05). It has been previously demonstrated that these coatings have excellent in vitro bioactivity (formed carbonate hydroxyapatite when immersed in a simulated body fluid). Such coatings can enhance osseointegration and prevent infection in implants, thereby improving the success rates of implants. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2218-2227, 2017.

Effects of fluoridation of porcine hydroxyapatite on osteoblastic activity of human MG63 cells

Biological hydroxyapatite, derived from animal bones, is the most widely used bone substitute in orthopedic and dental treatments. Fluorine is the trace element involved in bone remodeling and has been confirmed to promote osteogenesis when administered at the appropriate dose. To take advantage of this knowledge, fluorinated porcine hydroxyapatite (FPHA) incorporating increasing levels of fluoride was derived from cancellous porcine bone through straightforward chemical and thermal treatments. Physiochemical characteristics, including crystalline phases, functional groups and dissolution behavior, were investigated on this novel FPHA. Human osteoblast-like MG63 cells were cultured on the FPHA to examine cell attachment, cytoskeleton, proliferation and osteoblastic differentiation for in vitro cellular evaluation. Results suggest that fluoride ions released from the FPHA play a significant role in stimulating osteoblastic activity in vitro, and appropriate level of fluoridation (1.5 to 3.1 atomic percents of fluorine) for the FPHA could be selected with high potential for use as a bone substitute.

Development of a novel fluorapatite-forming calcium phosphate cement with calcium silicate: in vitro and in vivo characteristics

Aim of this study was to develop a novel fluorapatite-forming calcium phosphate cement (FA-CPC) with tricalcium silicate (TCS) for endodontic applications and to examine its in vitro and in vivo characteristics. The FA-CPC powder consisted of 62.8% CaHPO4, 30.8% CaCO3, and 6.4% NaF. One part of TCS was combined with 9 parts of FA-CPC powder (FA-CPC with TCS). A 1.5 M phosphate solution was used as cement liquid. Setting time (ST), diametral tensile strength (DTS), phase composition by X-ray diffraction (XRD), and cement alkalinity were analyzed. Cement biocompatibility was assessed using rat subcutaneous model. Cement ST was 10.3±0.6 min and DTS was 3.89±0.76 MPa. XRD patterns showed that highly crystalline apatitic material was the only significant phase present and pH value was approximate 11.0. FA-CPC with TCS demonstrated similar biocompatibility as that of mineral trioxide aggregate control. These results suggest that FA-CPC with TCS may be useful for endodontic applications.