Bioresorbable Magnesium-Based Alloys as Novel Biomaterials in Oral Bone Regeneration: General Review and Clinical Perspectives

Challenges and Pitfalls of Research Designs Involving Magnesium-Based Biomaterials: An Overview

Magnesium-based biomaterials hold remarkable promise for various clinical applications, offering advantages such as reduced stress-shielding and enhanced bone strengthening and vascular remodeling compared to traditional materials. However, ensuring the quality of preclinical research is crucial for the development of these implants. To achieve implant success, an understanding of the cellular responses post-implantation, proper model selection, and good study design are crucial. There are several challenges to reaching a safe and effective translation of laboratory findings into clinical practice. The utilization of Mg-based biomedical devices eliminates the need for biomaterial removal surgery post-healing and mitigates adverse effects associated with permanent biomaterial implantation. However, the high corrosion rate of Mg-based implants poses challenges such as unexpected degradation, structural failure, hydrogen evolution, alkalization, and cytotoxicity. The biocompatibility and degradability of materials based on magnesium have been studied by many researchers in vitro; however, evaluations addressing the impact of the material in vivo still need to be improved. Several animal models, including rats, rabbits, dogs, and pigs, have been explored to assess the potential of magnesium-based materials. Moreover, strategies such as alloying and coating have been identified to enhance the degradation rate of magnesium-based materials in vivo to transform these challenges into opportunities. This review aims to explore the utilization of Mg implants across various biomedical applications within cellular (in vitro) and animal (in vivo) models.

Metallic Materials for Bone Repair

Repair of large bone defects caused by trauma or disease poses significant clinical challenges. Extensive research has focused on metallic materials for bone repair because of their favorable mechanical properties, biocompatibility, and manufacturing processes. Traditional metallic materials, such as stainless steel and titanium alloys, are widely used in clinics. Biodegradable metallic materials, such as iron, magnesium, and zinc alloys, are promising candidates for bone repair because of their ability to degrade over time. Emerging metallic materials, such as porous tantalum and bismuth alloys, have gained attention as bone implants owing to their bone affinity and multifunctionality. However, these metallic materials encounter many practical difficulties that require urgent improvement. This article systematically reviews and analyzes the metallic materials used for bone repair, providing a comprehensive overview of their morphology, mechanical properties, biocompatibility, and in vivo implantation. Furthermore, the strategies and efforts made to address the short-comings of metallic materials are summarized. Finally, the perspectives for the development of metallic materials to guide future research and advancements in clinical practice are identified.

Near-Infrared Spectroscopy for the In Vivo Monitoring of Biodegradable Implants in Rats

Magnesium (Mg) alloys possess unique properties that make them ideal for use as biodegradable implants in clinical applications. However, reports on the in vivo assessment of these alloys are insufficient. Thus, monitoring the degradation of Mg and its alloys in vivo is challenging due to the dynamic process of implant degradation and tissue regeneration. Most current works focus on structural remodeling, but functional assessment is crucial in providing information about physiological changes in tissues, which can be used as an early indicator of healing. Here, we report continuous wave near-infrared spectroscopy (CW NIRS), a non-invasive technique that is potentially helpful in assessing the implant-tissue dynamic interface in a rodent model. The purpose of this study was to investigate the effects on hemoglobin changes and tissue oxygen saturation (StO₂) after the implantation of Mg-alloy (WE43) and titanium (Ti) implants in rats' femurs using a multiwavelength optical probe. Additionally, the effect of changes in the skin on these parameters was evaluated. Lastly, combining NIRS with photoacoustic (PA) imaging provides a more reliable assessment of tissue parameters, which is further correlated with principal component analysis.

Antibacterial Activity and Cell Viability of Biomimetic Magnesian Calcite Coatings on Biodegradable Mg

Mg is a material of choice for biodegradable implants. The main challenge for using Mg in temporary implants is to provide protective surfaces that mitigate its rapid degradation in biological fluids and also confer sufficient cytocompatibility and bacterial resistance to Mg-coated surfaces. Even though carbonate mineralization is the most important source of biominerals, such as the skeletons and shells of many marine organisms, there has been little success in the controlled growth of carbonate layers by synthetic processes. We present here the formation mechanism, antibacterial activity, and cell viability of magnesian calcite biomimetic coatings grown on biodegradable Mg via a green, one-step route. Cell compatibility assessment showed cell viability higher than 80% after 72 h using fibroblast cells (NCTC, clone L929) and higher than 60% after 72 h using human osteoblast-like cells (SaOS-2); the cells displayed a normal appearance and a density similar to the control sample. Antimicrobial potential evaluation against both Gram-positive (Staphylococcus aureus (ATCC 25923)) and Gram-negative (Pseudomonas aeruginosa (ATCC 27853)) strains demonstrated that the coated samples significantly inhibited bacterial adhesion and biofilm formation compared to the untreated control. Calcite coatings grown on biodegradable Mg by a single coating process showed the necessary properties of cell compatibility and bacterial resistance for application in surface-modified Mg biomaterials for temporary implants.

Applications of Biodegradable Magnesium-Based Materials in Reconstructive Oral and Maxillofacial Surgery: A Review

Reconstruction of defects in the maxillofacial region following traumatic injuries, craniofacial deformities, defects from tumor removal, or infections in the maxillofacial area represents a major challenge for surgeons. Various materials have been studied for the reconstruction of defects in the maxillofacial area. Biodegradable metals have been widely researched due to their excellent biological properties. Magnesium (Mg) and Mg-based materials have been extensively studied for tissue regeneration procedures due to biodegradability, mechanical characteristics, osteogenic capacity, biocompatibility, and antibacterial properties. The aim of this review was to analyze and discuss the applications of Mg and Mg-based materials in reconstructive oral and maxillofacial surgery in the fields of guided bone regeneration, dental implantology, fixation of facial bone fractures and soft tissue regeneration.

Evaluation of Microstructure and Mechanical Properties of a Ti10Mo8Nb Alloy for Biomedical Applications

The growth of the elderly population is urging for more suitable biomaterials to allow the performance of better surgical and implant procedures and accelerate the patient’s healing because the elderly are more vulnerable to orthopedic and dental problems. β-phase Ti alloys can improve the mechanical properties of implants by reducing their elastic modulus and, consequently, the effects of stress shielding within bones. Therefore, the objective of this article is to study a novel ternary β-phase alloy of Ti10Mo8Nb produced by an electric arc furnace and rotary forge. The microstructure and mechanical properties of the Ti10Mo8Nb alloy were investigated in order to evaluate its suitability for biomedical applications and compare its characteristics with those present in Ti-alloys commerced or widely researched for prosthetic purposes. A tensile test, Vickers microhardness test, use of microstructure of optical microscopy for examination of microstructure, X-ray diffraction and hemolysis analysis were carried out. Thus, the Ti10Mo8Nb alloy showed suitable properties for biomedical applications, as well as having the potential to reduce the possibility to occur stress shielding after prosthetic implantations, especially for orthopedics and dentistry.

Gallium-Strontium Phosphate Conversion Coatings for Promoting Infection Prevention and Biocompatibility of Magnesium for Orthopedic Applications

Device-associated infections remain a clinical challenge. The common strategies to prevent bacterial infection are either toxic to healthy mammalian cells and tissue or involve high doses of antibiotics that can prompt long-term negative consequences. An antibiotic-free coating strategy to suppress bacterial growth is presented herein, which concurrently promotes bone cell growth and moderates the dissolution kinetics of resorbable magnesium (Mg) biomaterials. Pure Mg as a model biodegradable material was coated with gallium-doped strontium-phosphate through a chemical conversion process. Gallium was distributed in a gradual manner throughout the strontium-phosphate coating, with a compact structure and a gallium-rich surface. It was demonstrated that the coating protected the underlying Mg parts from significant degradation in minimal essential media at physiological conditions over 9 days. In terms of bacteria culture, the liberated gallium ions from the coatings upon Mg specimens, even though in minute quantities, inhibited the growth of Gram-positiveStaphylococcus aureus, Gram-negative Escherichia coli, andPseudomonas aeruginosa ─ key pathogens causing infection and early failure of the surgical implantations in orthopedics and trauma. More importantly, the gallium dopants displayed minimal interferences with the strontium-phosphate-based coating which boosted osteoblasts and undermined osteoclasts in in vitro co-cultures. This work provides a new strategy to prevent bacterial infection and control the degradation behavior of Mg-based orthopedic implants, while preserving osteogenic features of the devices.

Biodegradable Magnesium Biomaterials—Road to the Clinic

In recent decades, we have witnessed radical changes in the use of permanent biomaterials. The intrinsic ability of magnesium (Mg) and its alloys to degrade without releasing toxic degradation products has led to a vast range of applications in the biomedical field, including cardiovascular stents, musculoskeletal, and orthopedic applications. With the use of biodegradable Mg biomaterials, patients would not suffer second surgery and surgical pain anymore. Be that as it may, the main drawbacks of these biomaterials are the high corrosion rate and unexpected degradation in physiological environments. Since biodegradable Mg-based implants are expected to show controllable degradation and match the requirements of specific applications, various techniques, such as designing a magnesium alloy and modifying the surface characteristics, are employed to tailor the degradation rate. In this paper, some fundamentals and particular aspects of magnesium degradation in physiological environments are summarized, and approaches to control the degradation behavior of Mg-based biomaterials are presented.

User Experience and Sustainability of 3D Printing in Dentistry

BACKGROUND

3D printing is a rapidly developing technology in the healthcare industry and in dentistry. Its application clearly shows that this area of digital dentistry has potential for everyday usage across all fields, including prosthodontics, orthodontics, maxillofacial surgery, and oral implantology. However, despite gaining ground, there is a lack of information about how specialists (dentists and dental technicians) use additive technology. Our research group aimed to investigate the impact of social media on additive manufacturing technology among dental specialists and their everyday usage of 3D printing.

METHODS

This paper investigated specialists' everyday usage of 3D printers via an online survey (Google Forms). The survey questions aimed to discover the number of 3D printers used, the accessibility of the devices, the annual cost, and the design programs. Since specialists tend to build online communities on social media, we circulated our study questionnaire using our profiles on LinkedIn, Facebook, and Instagram platforms during our research.

RESULTS

A total of 120 responses were received from 20 countries, with the most significant numbers being from Hungary 23.7% (n = 27), the United States 18.4% (n = 21), and the United Kingdom 7.9% (n = 9). Most of the participants were dentists (n = 68) or dental technicians (n = 29), but some CAD/CAM specialists (n = 23) also completed our survey. The participants had an average of 3.8 years (±0.7) of experience in the 3D printing field, and owned a total of 405 printing devices (3.6 on average/person).

CONCLUSIONS

The impact of social media on this research field is growing increasingly. Hence, we support specialists in joining virtual communities on professional platforms. This article intended to provide a practical overview, feedback, and direction for dentists interested in 3D printing technology. From our survey, we can conclude that additive technology is broadening dental applications and the services that we can provide for our patients.

Monitoring Dynamic Recrystallisation in Bioresorbable Alloy Mg-1Zn-0.2Ca by Means of an In Situ Acoustic Emission Technique

The tensile behaviour of the biocompatible alloy Mg-1Zn-0.2Ca (in wt.%) in the fine-grained state, obtained by severe plastic deformation via multiaxial isothermal forging, has been investigated in a wide range of temperatures (20 ÷ 300) °C and strain rates (5 × 10⁻⁴ ÷ 2 × 10⁻²) s⁻¹ with the measurements of acoustic emission (AE). The dependences of mechanical properties, including the yield stress, ultimate strength, ductility, and the strain-hardening rate, on the test temperature and strain rate, were obtained and discussed. It is shown for the first time that an acoustic emission method is an effective tool for in situ monitoring of the dynamic recrystallisation (DRX) process. The specific behaviour of the acoustic emission spectral density reflected by its median frequency as a function of strain at various temperatures can serve as an indicator of the DRX process’s completeness.

Biofunctional magnesium-coated Ti6Al4V scaffolds promote autophagy-dependent apoptosis in osteosarcoma by activating the AMPK/mTOR/ULK1 signaling pathway

The recurrence of osteosarcoma (OS) after reconstruction using Ti6Al4V prostheses remains a major problem in the surgical treatment of OS. Modification of the surfaces of Ti6Al4V prostheses with antitumor functions is an important strategy for improving therapeutic outcomes. Magnesium (Mg) coating has been shown to be multifunctional: it exhibits osteogenic and angiogenic properties and the potential to inhibit OS. In this study, we determined the proper concentration of released Mg²⁺ with respect to OS inhibition and biosafety and evaluated the anti-OS effects of Mg-coated Ti6Al4V scaffolds. We found that the release of Mg²⁺ during short-term and long-term degradation could significantly inhibit the proliferation and migration of HOS and 143B cells. Increased cell apoptosis and excessive autophagy were also observed, and further evidence of AMPK/mTOR/ULK1 signaling pathway activation was obtained both in vitro and in vivo, which suggested that the biofunctional scaffolds induce OS inhibition. Our study demonstrates the ability of an Mg coating to inhibit OS and may contribute to the further application of Mg-coated Ti6Al4V prostheses.

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Multifunctional Mg coating is considerable surface modification for Ti6Al4V prostheses.

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Mg²⁺ releasing by the scaffolds could significantly inhibit the proliferation and migration of OS cells.

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The biofunctional scaffolds could inhibit OS by activating autophagy-dependent apoptosis.

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The AMPK/mTOR/ULK-1 pathway was involved in autophagy-depended apoptosis induced by the scaffolds.

The Influence of Hydroxyapatite and Alumina Particles on the Mechanical Properties and Corrosion Behavior of Mg-Zn Hybrid Composites for Implants

Considering the necessity for a biodegradable implant alloy with good biocompatibility and mechanical strength, dual ceramic particles of HAP and Al₂O₃ were added to Mg-Zn alloy to produce a new hybrid composite using powder metallurgy. The paper reports the mechanical and corrosion behaviour of Mg-Zn/HAP/Al₂O₃ hybrid composites containing variable wt.% HAP and Al₂O₃ with 15 wt.% total ceramic content. The powders of Mg, Zn, Al₂O₃ and HAP were milled in a high-energy ball mill, and then compacted under 400 MPa and sintered at 300 °C. Density and compression strength increased with increasing Al₂O₃ content. HAP facilitated weight gain in Hanks balanced salt solution due to deposition of an apatite layer which promoted anodic behaviour with higher corrosion resistance. A hybrid composite of Mg alloy with 5 wt.% Al₂O₃ and 10 wt.% HAP displayed 153 MPa compressive strength, 1.37 mm/year corrosion resistance and bioactivity with a CA:P ratio of 1:1.55 and appears to be the most promising biodegradable implant material tested.

Applications of Magnesium and Its Alloys: A Review

Magnesium is a promising material. It has a remarkable mix of mechanical and biomedical properties that has made it suitable for a vast range of applications. Moreover, with alloying, many of these inherent properties can be further improved. Today, it is primarily used in the automotive, aerospace, and medical industries. However, magnesium has its own set of drawbacks that the industry and research communities are actively addressing. Magnesium’s rapid corrosion is its most significant drawback, and it dramatically impeded magnesium’s growth and expansion into other applications. This article reviews both the engineering and biomedical aspects and applications for magnesium and its alloys. It will also elaborate on the challenges that the material faces and how they can be overcome and discuss its outlook.