The unexplored role of alkali and alkaline earth elements (ALAEs) on the structure, processing, and biological effects of bioactive glasses

Bioactive glass has been employed in several medical applications since its inception in 1969. The compositions of these materials have been investigated extensively with emphasis on glass network formers, therapeutic transition metals, and glass network modifiers. Through these experiments, several commercial and experimental compositions have been developed with varying chemical durability, induced physiological responses, and hydroxyapatite forming abilities. In many of these studies, the concentrations of each alkali and alkaline earth element have been altered to monitor changes in structure and biological response. This review aims to discuss the impact of each alkali and alkaline earth element on the structure, processing, and biological effects of bioactive glass. We explore critical questions regarding these elements from both a glass science and biological perspective. Should elements with little biological impact be included? Are alkali free bioactive glasses more promising for greater biological responses? Does this mixed alkali effect show increased degradation rates and should it be employed for optimized dissolution? Each of these questions along with others are evaluated comprehensively and discussed in the final section where guidance for compositional design is provided.

Sol-gel synthesis of lithium doped mesoporous bioactive glass nanoparticles and tricalcium silicate for restorative dentistry: Comparative investigation of physico-chemical structure, antibacterial susceptibility and biocompatibility

Introduction: The sol-gel method for production of mesoporous bioactive glass nanoparticles (MBGNs) has been adapted to synthesize tricalcium silicate (TCS) particles which, when formulated with other additives, form the gold standard for dentine-pulp complex regeneration. Comparison of TCS and MBGNs obtained by sol-gel method is critical considering the results of the first ever clinical trials of sol-gel BAG as pulpotomy materials in children. Moreover, although lithium (Li) based glass ceramics have been long used as dental prostheses materials, doping of Li ion into MBGNs for targeted dental applications is yet to be investigated. The fact that lithium chloride benefits pulp regeneration in vitro also makes this a worthwhile undertaking. Therefore, this study aimed to synthesize TCS and MBGNs doped with Li by sol-gel method, and perform comparative characterizations of the obtained particles.

Methods: TCS particles and MBGNs containing 0%, 5%, 10% and 20% Li were synthesized and particle morphology and chemical structure determined. Powder concentrations of 15mg/10 mL were incubated in artificial saliva (AS), Hank’s balanced saline solution (HBSS) and simulated body fluid (SBF), at 37°C for 28 days and pH evolution and apatite formation, monitored. Bactericidal effects against S. aureus and E. coli, as well as possible cytotoxicity against MG63 cells were also evaluated through turbidity measurements.

Results: MBGNs were confirmed to be mesoporous spheres ranging in size from 123 nm to 194 nm, while TCS formed irregular nano-structured agglomerates whose size was generally larger and variable. From ICP-OES data, extremely low Li ion incorporation into MBGNs was detected. All particles had an alkalinizing effect on all immersion media, but TCS elevated pH the most. SBF resulted in apatite formation for all particle types as early as 3 days, but TCS appears to be the only particle to form apatite in AS at a similar period. Although all particles had an effect on both bacteria, this was pronounced for undoped MBGNs. Whereas all particles are biocompatible, MBGNs showed better antimicrobial properties while TCS particles were associated with greater bioactivity.

Conclusion: Synergizing these effects in dental biomaterials may be a worthwhile undertaking and realistic data on bioactive compounds targeting dental application may be obtained by varying the immersion media.

Effect of pH on the In Vitro Degradation of Borosilicate Bioactive Glass and Its Modulation by Direct Current Electric Field

Controlled ion release and mineralization of bioactive glasses are essential to their applications in bone regeneration. Tuning the chemical composition and surface structure of glasses are the primary means of achieving this goal. However, most bioactive glasses exhibit a non-linear ion release behavior. Therefore, modifying the immersion environment of glasses through external stimuli becomes an approach. In this study, the ion release and mineralization properties of a borosilicate bioactive glass were investigated in the Tris buffer and K₂HPO₄ solutions with different pH. The glass had a faster ion release rate at a lower pH, but the overly acidic environment was detrimental to hydroxyapatite production. Using a direct current (DC) electric field as an external stimulus, the pH of the immersion solution could be modulated within a narrow range, thereby modulating ion release from the glass. As a result, significant increases in ion release were observed after three days, and the development of porous mineralization products on the glass surface after six days. This study demonstrates the effectiveness of the DC electric field in modulating the ion release of the bioactive glass in vitro and provides a potential way to regulate the degradation of the glass in vivo.

A Review on the Recent Advancements on Therapeutic Effects of Ions in the Physiological Environments

This review focuses on the therapeutic effects of ions when released in physiological environments. Recent studies have shown that metallic ions like Ag+, Sr2+, Mg2+, Mn2+, Cu2+, Ca2+, P+5, etc., have shown promising results in drug delivery systems and regenerative medicine. These metallic ions can be loaded in nanoparticles, mesoporous bioactive glass nanoparticles (MBGNs), hydroxyapatite (HA), calcium phosphates, polymeric coatings, and salt solutions. The metallic ions can exhibit different functions in the physiological environment such as antibacterial, antiviral, anticancer, bioactive, biocompatible, and angiogenic effects. Furthermore, the metals/metalloid ions can be loaded into scaffolds to improve osteoblast proliferation, differentiation, bone development, fibroblast growth, and improved wound healing efficacy. Moreover, different ions possess different therapeutic limits. Therefore, further mechanisms need to be developed for the highly controlled and sustained release of these ions. This review paper summarizes the recent progress in the use of metallic/metalloid ions in regenerative medicine and encourages further study of ions as a solution to cure diseases.

In Vivo Evaluation of 3D-Printed Silica-Based Bioactive Glass Scaffolds for Bone Regeneration

Bioactive glasses are often designed as porous implantable templates in which newly-formed bone can grow in three dimensions (3D). This research work aims to investigate the bone regenerative capability of silicate bioactive glass scaffolds produced by robocasting in comparison with powder and granule-like materials (oxide system: 47.5SiO2-10Na2O-10K2O-10MgO-20CaO-2.5P2O5, mol.%). Morphological and compositional analyses performed by scanning electron microscopy (SEM), combined with energy dispersive spectroscopy (EDS) after the bioactivity studies in a simulated body fluid (SBF) confirmed the apatite-forming ability of the scaffolds, which is key to allowing bone-bonding in vivo. The scaffolds exhibited a clear osteogenic effect upon implantation in rabbit femur and underwent gradual resorption followed by ossification. Full resorption in favor of new bone growth was achieved within 6 months. Osseous defect healing was accompanied by the formation of mature bone with abundant osteocytes and bone marrow cells. These in vivo results support the scaffold’s suitability for application in bone tissue engineering and show promise for potential translation to clinical assessment.

In vitro and in ovo impact of the ionic dissolution products of boron-doped bioactive silicate glasses on cell viability, osteogenesis and angiogenesis

Due to the pivotal role of angiogenesis in bone regeneration, the angiogenic properties of biomaterials are of high importance since they directly correlate with the biomaterials’ osteogenic potential via ‘angiogenic-osteogenic coupling’ mechanisms. The impact of bioactive glasses (BGs) on vascularization can be tailored by incorporation of biologically active ions such as boron (B). Based on the ICIE16-BG composition (in mol%: 49.5 SiO₂, 36.3 CaO, 6.6 Na₂O, 1.1 P₂O₅, 6.6 K₂O), three B-doped BGs have been developed (compositions in mol%: 46.5/45.5/41.5 SiO₂, 36.3 CaO, 6.6 Na₂O, 1.1 P₂O₅, 6.6 K₂O, 3/4/8 B₂O₃). The influence of B-doping on the viability, cellular osteogenic differentiation and expression of osteogenic and angiogenic marker genes of bone marrow-derived mesenchymal stromal cells (BMSCs) was analyzed by cultivating BMSCs in presence of the BGs’ ionic dissolution products (IDPs). Furthermore, the influence of the IDPs on angiogenesis was evaluated in ovo using a chorioallantoic membrane (CAM) assay. The influence of B-doped BGs on BMSC viability was dose-dependent, with higher B concentrations showing limited negative effects. B-doping led to a slight stimulation of osteogenesis and angiogenesis in vitro. In contrast to that, B-doping significantly enhanced vascularization in ovo, especially in higher concentrations. Differences between the results of the in vitro and in ovo part of this study might be explained via the different importance of vascularization in both settings. The implementation of new experimental models that cover the ‘angiogenic-osteogenic coupling’ mechanisms is highly relevant, for instance via extending the application of the CAM assay from solely angiogenic to angiogenic and osteogenic purposes.

Co-doping of iron and copper ions in nanosized bioactive glass by reactive laser fragmentation in liquids

Bioactive glass (BG) is a frequently used biomaterial applicable in bone tissue engineering and known to be particularly effective when applied in nanoscopic dimensions. In this work, we employed the scalable reactive laser fragmentation in liquids method to produce nanosized 45S5 BG in the presence of light-absorbing Fe and Cu ions. Here, the function of the ions was twofold: (i) increasing the light absorption and thus causing a significant increase in laser fragmentation efficiency by a factor of 100 and (ii) doping the BG with bioactive metal ions up to 4 wt%. Our findings reveal an effective downsizing of the BG from micrometer-sized educts into nanoparticles having average diameters of <50 nm. This goes along with successful element-specific incorporation of the metal ions into the BG, inducing co-doping of Fe and Cu ions as verified by energy-dispersive X-ray spectroscopy (EDX). In this context, the overall amorphous structure is retained, as evidenced by X-ray powder diffraction (XRD). We further demonstrate that the level of doping for both elements can be adjusted by changing the BG/ion concentration ratio during laser fragmentation. Consecutive ion release experiments using inductively-coupled plasma mass spectrometry (ICP-MS) were conducted to assess the potential bioactivity of the doped nanoscopic BG samples, and cell culture experiments using MG-63 osteoblast-like cells demonstrated their cytocompatibility. The elegant method of in situ co-doping of Fe and Cu ions during BG nanosizing may provide functionality-advanced biomaterials for future studies on angiogenesis or bone regeneration, particularly as the level of doping may be adjusted by ion concentrations and ion type in solution.

In Vitro Dissolution of Na-Ca-P-Oxynitrides

Sodium-calcium-phosphate based oxynitride glasses and glass-ceramics doped with Mg, Si, and Nb were studied in vitro in simulated body fluid (SBF) under static conditions. The release of ions and pH changes up to 7 days of immersion were investigated. The nitrogen incorporation into phosphate glass matrix was found to notably influence in vitro dissolution only of homogenous glasses. Increasing the nitrogen content in the samples decreased the mean mass loss, while the niobate incorporation increased it. The correlation between the nitrogen content and increase in pH of SBF was also observed. The presence of phosphates crystallites was found to support the dissolution process at the beginning step (up to 3 days).

An In Vitro Evaluation of the Biological and Osteogenic Properties of Magnesium-Doped Bioactive Glasses for Application in Bone Tissue Engineering

Magnesium (Mg2+) is known to play a crucial role in mineral and matrix metabolism of bone tissue and is thus increasingly considered in the field of bone tissue engineering. Bioactive glasses (BGs) offer the promising possibility of the incorporation and local delivery of therapeutically active ions as Mg2+. In this study, two Mg2+-doped derivatives of the ICIE16-BG composition (49.46 SiO2, 36.27 CaO, 6.6 Na2O, 1.07 P2O5, 6.6 K2O (mol%)), namely 6Mg-BG (49.46 SiO2, 30.27 CaO, 6.6 Na2O, 1.07 P2O5, 6.6 K2O, 6.0 MgO (mol%) and 3Mg-BG (49.46 SiO2, 33.27 CaO, 6.6 Na2O, 1.07 P2O5, 6.6 K2O, 3.0 MgO (mol%)) were examined. Their influence on viability, proliferation and osteogenic differentiation of human mesenchymal stromal cells (MSCs) was explored in comparison to the original ICIE16-BG. All BGs showed good biocompatibility. The Mg2+-doped BGs had a positive influence on MSC viability alongside with inhibiting effects on MSC proliferation. A strong induction of osteogenic differentiation markers was observed, with the Mg2+-doped BGs significantly outperforming the ICIE16-BG regarding the expression of genes encoding for protein members of the osseous extracellular matrix (ECM) at certain observation time points. However, an overall Mg2+-induced enhancement of the expression of genes encoding for ECM proteins could not be observed, possibly due to a too moderate Mg2+ release. By adaption of the Mg2+ release from BGs, an even stronger impact on the expression of genes encoding for ECM proteins might be achieved. Furthermore, other BG-types such as mesoporous BGs might provide a higher local presence of the therapeutically active ions and should therefore be considered for upcoming studies.

Effect of Simultaneous Sintering of Bioglass to a Zirconia Core on Properties and Bond Strength

This study aimed to assess bioglass sintering to a zirconia core on surface properties and bonding strength to resin cement. Zirconia specimens were divided into four groups: G I: sintered; G II: bioglass modified zirconia (a bioglass slurry was sintered with zirconia at 1550 °C); G III: sandblasted using 50 μm Al₂O₃ particles; and G IV: Z-prime plus application. Surface morphology and chemical analysis were studied using a scanning electron microscope and energy-dispersive spectroscopy. Surface roughness was evaluated using a profilometer. Surface hardness was measured using an indentation tester. For the microshear bond strength test, resin cement cylinders were bonded to a zirconia surface. Half of the specimens were tested after 24 h; the other half were thermocycled (5-55 °C) for 1000 cycles. A shearing load was applied at a crosshead speed of 0.5 mm/min on a universal testing machine. Data were analyzed with ANOVA using SPSS software at (p < 0.05). Results: tThe mean surface roughness of G II was significantly higher than G I and G III. The microhardness of G II was significantly lower than all groups. For bond strength, there was no significant difference between groups II, III, and IV after thermocycling. Conclusions: Bioactive glass can increase the bond strength of zirconia to resin cement, and is comparable to sandblasting and Z-prime bonding agents.

Bioactive Glass Applications: A Literature Review of Human Clinical Trials

The use of bioactive glasses in dentistry, reconstructive surgery, and in the treatment of infections can be considered broadly beneficial based on the emerging literature about the potential bioactivity and biocompatibility of these materials, particularly with reference to Bioglass® 45S5, BonAlive® and 19-93B3 bioactive glasses. Several investigations have been performed (i) to obtain bioactive glasses in different forms, such as bulk materials, powders, composites, and porous scaffolds and (ii) to investigate their possible applications in the biomedical field. Although in vivo studies in animals provide us with an initial insight into the biological performance of these systems and represent an unavoidable phase to be performed before clinical trials, only clinical studies can demonstrate the behavior of these materials in the complex physiological human environment. This paper aims to carefully review the main published investigations dealing with clinical trials in order to better understand the performance of bioactive glasses, evaluate challenges, and provide an essential source of information for the tailoring of their design in future applications. Finally, the paper highlights the need for further research and for specific studies intended to assess the effect of some specific dissolution products from bioactive glasses, focusing on their osteogenic and angiogenic potential.

Early-Stage Dissolution Kinetics of Silicate-Based Bioactive Glass under Dynamic Conditions: Critical Evaluation

This manuscript presents a systematic and detailed study of ion release from 45S5 bioactive glass to develop a methodology to directly monitor dissolved ions in a simulated fluid via inductively coupled plasma optical emission spectrometry (ICP OES). For the kinetic study, two dynamic tests, an inline ICP test and a flow-through test, are performed with the same flow rate, temperature, pH, ionic strength of the solution, and sample surface to leaching solution volume ratio. The flow-through test allows for the measurement of an initial dissolution rate, as well the maximum amount of any species released from the surface of the glass. In addition, the data from the inline ICP test are obtained by immediate and direct monitoring of ions from the first minutes of contact of the glass with aqueous fluids with pH values of 4 and 7.4. The overall dissolution rates of the tested commercial bioactive glass in simulated body fluid (SBF) (pH 7.4) were significantly lower compared to the initial rate acquired. The methodology developed in this study can be applied to monitor the controlled release of ions with additional therapeutic functionalities, where the amount of ions released in the first minutes can be critical for the resulting biological performance.

DC and AC Conductivity, Biosolubility and Thermal Properties of Mg-Doped Na2O-CaO-P2O5 Glasses

Bioactive glasses have recently been extensively used to replace, regenerate, and repair hard tissues in the human body because of their ability to bond with living tissue. In this work, the effects of replacing Na₂O with MgO on the electrical, biosolubility, and thermal properties of the target glass 10Na₂O–60P₂O₅–30CaO (in mol%) were investigated. The electrical properties of the glasses were studied with the impedance spectroscopy technique. At 473 K, DC conductivity values decreased from 4.21 × 10⁻¹¹ to 4.21 × 10⁻¹² S cm⁻¹ after complete substitution of MgO for Na₂O. All samples had a similar activation energy of the DC conduction process ~1.27 eV. Conduction mechanisms were found to be due to hop of ions: Na⁺, Mg²⁺_, and probable H⁺. FTIR analysis showed that, as the Mg content increased, the Q² unit (PO₂⁻) shifted towards higher wavenumbers. The proportion of Q³ unit (P₂O₅) decreased in the glass structure. This confirmed that the replacement of Na⁺ by Mg²⁺ was accompanied by concurrent polymerization of the calcium–phosphate glass network. The biosolubility test in the phosphate-buffered saline solution showed that the magnesium addition enhanced the biosolubility properties of Na₂O–CaO–P₂O₅ glasses by increasing their dissolution rate and supporting forming CaP-rich layers on the surface. The glass transition temperature increased, and thermal stability decreased substantially upon substitution of Na₂O by MgO.

Fabrication and characterization of ZrO2 incorporated SiO2-CaO-P2O5 bioactive glass scaffolds

Sol-gel chemistry offers a flexible, widely accepted methodology that enables the creation of a new generation of bioactive glass (BG). In the current study, a sol-gel method was used to synthesize ZrO₂ incorporated 56SiO₂-34CaO-10P₂O₅ mol% bioactive glass. The highly crystalline structure was composed of small zirconium oxide nanoparticles (ZrO₂) of less than 200 nm in size. It was successfully fabricated using a hydrothermal method. Polyurethane foam (PU) was selected to fabricate a highly porous BG-ZrO₂ scaffold using a foam replica technique. The physicochemical, morphological properties of the BG-ZrO₂ compositions were evaluated using X-ray diffraction (XRD), Fourier transforms infrared (FTIR), thermo-gravimetric analysis (TGA), transmission electron microscope (TEM) and scanning electron microscope (SEM) with energy dispersive spectroscopy (EDS). In-vitro degradation analysis of the BG-ZrO₂ scaffolds was performed after immersion of the samples in simulated body fluid (SBF). The incorporation of ZrO₂ nanoparticles into the bioactive glass matrix enhances both the mechanical strength and thermal stability. Since the novel formed BG-ZrO₂ scaffolds possesses respectable antibacterial properties against some bacterial strains, this renders it an ideal tissue engineering substitute, capable of reducing failure rates in implants.

Preconditioning of Bioactive Glasses before Introduction to Static Cell Culture: What Is Really Necessary?

Due to their high bioreactivity, the in-vitro analysis of bioactive glasses (BGs) can be challenging when it comes to maintaining a physiological pH. To improve BG biocompatibility, a heterogenic spectrum of preconditioning approaches, such as "passivation" of the BGs by incubation in cell culture medium, are used but have never been directly compared. In this study, the effect of passivation periods of up to 72 h on pH alkalization and viability of human bone marrow-derived mesenchymal stromal cells was evaluated to determine a time-efficient passivation protocol using granules based on the 45S5-BG composition (in wt%: 45.0 SiO2, 24.5 Na2O, 24.5 CaO, 6.0 P2O5) in different concentrations. pH alkalization was most reduced after passivation of 24 h. Cell viability continuously improved with increasing passivation time being significantly higher after passivation of at least 24 h compared to non-passivated 45S5-BG and the necessary passivation time increased with increasing BG concentrations. In this setting, a passivation period of 24 h presented as an effective approach to provide a biocompatible cell culture setting. In conclusion, before introduction of BGs in cell culture, different passivation periods should be evaluated in order to meet the respective experimental settings, e.g., by following the experimental protocols used in this study.

Bioactive Glass (BG) ICIE16 Shows Promising Osteogenic Properties Compared to Crystallized 45S5-BG

The ICIE16-bioactive glass (BG) (48.0 SiO₂, 6.6 Na₂O, 32.9 CaO, 2.5 P₂O₅, 10.0 K₂O (wt %)) has been developed as an alternative to 45S5-BG, the original BG composition (45.0 SiO₂, 24.5 Na₂O, 24.5 CaO, 6.0 P₂O₅ (wt %)), with the intention of broadening the BG sintering window while maintaining bioactivity. Because there is a lack of reports on ICIE16-BG biological properties, the influence of ICIE16-BG on viability, proliferation, and osteogenic differentiation of human mesenchymal stromal cells (MSCs) was evaluated in direct comparison to 45S5-BG in this study. The BGs underwent heat treatment similar to that which is required in order to fabricate scaffolds by sintering, which resulted in crystallization of 45S5-BG (45S5-CBG) while ICIE16 remained amorphous. Granules based on both BGs were biocompatible, but ICIE16-BG was less harmful to cell viability, most likely due to a more pronounced pH alkalization in the 45S5-CBG group. ICIE16-BG outperformed 45S5-CBG in terms of osteogenic differentiation at the cellular level, as determined by the increased activity of alkaline phosphatase. However, granules from both BGs were comparable regarding the stimulation of expression levels of genes encoding for osseous extracellular matrix (ECM) proteins. The addition of therapeutically active ions to ICIE16-BG might further improve its ability to stimulate ECM production and should be investigated in upcoming studies.

Superior biocompatibility and comparable osteoinductive properties: Sodium-reduced fluoride-containing bioactive glass belonging to the CaO-MgO-SiO2 system as a promising alternative to 45S5 bioactive glass

Bioactive glasses (BGs) are promising bone substitute materials. However, under certain circumstances BGs such as the well-known 45S5 Bioglass® (composition in wt%: 45.0 SiO₂, 24.5 Na₂O, 24.5 CaO, 6.0 P₂O₅) act cytotoxic due to a strong increase in pH caused by a burst release of sodium ions. A potential alternative is a sodium-reduced fluoride-containing BG belonging to the CaO–MgO–SiO₂ system, namely BG1d-BG (composition in wt%: 46.1 SiO₂, 28.7 CaO, 8.8 MgO, 6.2 P₂O₅, 5.7 CaF₂, 4.5 Na₂O), that has already been evaluated in-vitro, in-vivo and in preliminary clinical trials. Before further application, however, BG1d-BG should be compared to the benchmark amongst BGs, the 45S5 Bioglass® composition, to classify its effect on cell viability, proliferation and osteogenic differentiation of human mesenchymal stem cells (MSCs). Therefore, in this study, the biocompatibility and osteogenic potential of both BGs were investigated in an indirect and direct culture setting to assess the effect of the ionic dissolution products and the BGs’ physical presence on the cells. The results indicated an advantage of BG1d-BG over 45S5 Bioglass® regarding cell viability and proliferation. Both BGs induced an earlier onset of osteogenic differentiation and accelerated the expression of late osteoblast marker genes compared to the control group. In conclusion, BG1d-BG is an attractive candidate for further experimental investigation. The basic mechanisms behind the different impact on cell behavior should be assessed in further detail, e.g. by further alteration of the BG compositions.

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45S5 Bioglass® is considered to be the benchmark amongst bioactive glasses (BGs).

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Sodium-reduced fluoride-containing BG1d BG was compared to 45S5-Bioglass®.

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Both BGs induced osteogenic differentiation of human MSCs.

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BG1d had an advantageous impact on cell viability and proliferation.

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BG1d-BG is an attractive candidate for further experimental investigation.