Metallic Biomaterials: Current Challenges and Opportunities

Nanoetched Stainless Steel Architecture Enhances Cell Uptake of Biomacromolecules and Alters Protein Corona Abundancy

Nanotexture on biocompatible surfaces promotes cell adhesion and proliferation. High aspect ratio nanoachitecture serves as an ideal interface between implant materials and host cells that is well-suited for localized therapeutic delivery. Despite this potential, nanotextured surfaces have not been widely applied for biomacromolecule delivery. Here, we employed a low-cost, industrially relevant nanoetching process to modify the surface of biocompatible stainless steel 316 (SS316L), creating nanotextured SS316L (NT-SS316L) as a material for intracellular biomacromolecule delivery. As biomacromolecule cargoes are adsorbed to the steel and ultimately would be used in protein-rich environments, we performed serum protein corona analysis on unmodified SS316L and NT-SS316L using tandem mass spectrometry. We observed an increase in proteins associated with cell adhesion on the surface of NT-SS316L compared to that of SS316L, supporting literature reports of enhanced adhesion on nanotextured materials. For delivery to adherent cells, a "hard corona" of model biomacromolecule cargoes including superfolder green fluorescent protein (sfGFP) charge variants, cytochrome c, and siRNA was adsorbed on NT-SS316L to assess delivery. Nanotextured surfaces enhanced cellular biomacromolecule uptake and delivered cytosolic-functional proteins and nucleic acids through energy-dependent endocytosis. Collectively, these findings indicate that NT-SS316L holds potential as a surface modification for implants to achieve localized drug delivery for a variety of biomedical applications.

Alginate as a Sustainable and Biodegradable Material for Medical and Environmental Applications-The Case Studies

Alginates are salts of alginic acid derived mainly from sea algae of the genus brown algae. They are also synthesized by some bacteria. They belong to negatively charged polysaccharides exhibiting some rheological properties. High plasticity and the ability to modify the structure are the reasons for their application in numerous industries. Moreover, when in contact with the living tissue, they do not trigger an immune response, and for this reason they are the most often tested materials for medical applications. The paper discusses the latest applications, including 3D bioprinting, drug delivery systems, and sorptive properties. Recognizing alginates as biomaterials, it emphasizes the necessity for precise processing and modification to industrialize them for specific uses. This review aims to provide a thorough understanding of the advancements in alginate research, underscoring their potential for innovative applications.

Fabrication of PTFE + TiO2/Ag coatings on 316L/polydopamine with advanced mechanical, bio-corrosion, and antibacterial properties for stainless steel Catheters

This study explores the corrosion resistance and antibacterial properties of a PTFE + TiO2/Ag coating applied to 316 L stainless steel. To enhance adhesion, a polydopamine interlayer was chemically deposited onto the steel surface. The PTFE + TiO2 coating was subsequently applied through immersion, followed by the deposition of silver nanoparticles using a chemical method. Optimization of the polydopamine interlayer involved varying temperature, time, stirring speed, and drying parameters. The optimal conditions for the polydopamine interlayer were determined to be 60 °C for 1 h, 300 rpm stirring, and 24-h drying in a freeze dryer. Analytical results demonstrated that both the PTFE + TiO2 and PTFE/PTFE + TiO2/Ag coatings exhibited exceptional corrosion resistance, with corrosion currents of 3.3 × 10-5 and 3.2 × 10-4 μA/cm2, respectively. Antibacterial assessments showcased the remarkable ability of the PTFE/PTFE + TiO2/Ag coating, containing 5% silver content, to effectively inhibit bacterial penetration within a 6.5 mm radius. Furthermore, this coating displayed a water contact angle of 143°, classifying it as a hydrophobic coating. The photocatalytic efficiency (Rs) was determined to be 3.18 × 10-3 A/W, a performance level comparable to that of a standard UV sensor. These findings underscore the substantial enhancements in corrosion resistance, antibacterial performance, and hydrophobic characteristics achieved with the PTFE + TiO2/Ag coating, particularly through the novel optimization of the polydopamine interlayer. This coating exhibits great promise for multifunctional protective applications in diverse fields, particularly demonstrating its suitability for implants and bio-coatings.

Application of PVD coatings in medical implantology for enhanced performance, biocompatibility, and quality of life

Physical vapor deposition (PVD) coating is a versatile and well-liked method for depositing thin films of materials onto surfaces in a range of industries. Due to their numerous functional and aesthetic benefits, PVD coatings are beneficial in several applications, from electronics and optics to automotive and medical equipment. PVD coating technology dramatically improves the effectiveness and quality of medical implants. PVD-coated medical implants improve osseointegration, lower wear and friction, increase corrosion resistance, and have antibacterial properties, which lead to better patient outcomes, fewer complications, and overall higher quality of life for people who need implantable medical devices. The essential concepts of PVD coating and the numerous deposition techniques and materials used are covered at the study's outset. The specific uses of PVD-coated medical implants are then highlighted, including those for orthopedic and dental implants and cardiovascular and neurosurgical devices. The review also emphasizes the critical contribution of PVD coatings to reducing wear and friction, improving corrosion resistance, augmenting biocompatibility, enhancing osseointegration, and aesthetic appeal. The challenges and prospects of PVD coating technologies were further addressed in this article. This review is invaluable for academics, doctors, and businesspeople interested in the beneficial combination of PVD coating and medical implantology.

Tuneable Recombinant Spider Silk Protein Hydrogels for Drug Release and 3D Cell Culture

Hydrogels are useful drug release systems and tissue engineering scaffolds. However, synthetic hydrogels often require harsh gelation conditions and can contain toxic by-products while naturally derived hydrogels can transmit pathogens and in general have poor mechanical properties. Thus, there is a need for a hydrogel that forms under ambient conditions, is non-toxic, xeno-free, and has good mechanical properties. A recombinant spider silk protein-derived hydrogel that rapidly forms at 37 °C is recently developed. The temperature and gelation times are well-suited for an injectable in situ polymerising hydrogel, as well as a 3D cell culture scaffold. Here, it is shown that the diffusion rate and the mechanical properties can be tuned by changing the protein concentration and that human fetal mesenchymal stem cells encapsulated in the hydrogels show high survival and viability. Furthermore, mixtures of recombinant spider silk proteins and green fluorescent protein (GFP) form gels from which functional GFP is gradually released, indicating that bioactive molecules are easily included in the gels, maintain activity and can diffuse through the gel. Interestingly, encapsulated ARPE-19 cells are viable and continuously produce the growth factor progranulin, which is detected in the cell culture medium over the study period of 31 days.

Nanoparticles in Bone Regeneration: A Narrative Review of Current Advances and Future Directions in Tissue Engineering

The rising demand for effective bone regeneration has underscored the limitations of traditional methods like autografts and allografts, including donor site morbidity and insufficient biological signaling. This review examines nanoparticles (NPs) in tissue engineering (TE) to address these challenges, evaluating polymers, metals, ceramics, and composites for their potential to enhance osteogenesis and angiogenesis by mimicking the extracellular matrix (ECM) nanostructure. The methods involved synthesizing and characterizing nanoparticle-based scaffoldsand integrating hydroxyapatite (HAp) with polymers to enhance mechanical properties and osteogenic potential. The results showed that these NPs significantly promote cell growth, differentiation, and bone formation, with carbon-based NPs like graphene and carbon nanotubes showing promise. NPs offer versatile, biocompatible, and customizable scaffolds that enhance drug delivery and support bone repair. Despite promising results, challenges with cytotoxicity, biodistribution, and immune responses remain. Addressing these issues through surface modifications and biocompatible molecules can improve the biocompatibility and efficacy of nanomaterials. Future research should focus on long-term in vivo studies to assess the safety and efficacy of NP-based scaffolds and explore synergistic effects with other bioactive molecules or growth factors. This review underscores the transformative potential of NPs in advancing BTE and calls for further research to optimize these technologies for clinical applications.

3D-printed polyether-ether ketone/carboxymethyl cellulose scaffolds coated with Zn-Mn doped mesoporous bioactive glass nanoparticles

Patient-specific fabrication of scaffold/implant requires an engineering approach to manufacture the ideal scaffold. Herein, we design and 3D print scaffolds comprised of polyether-ether-ketone (PEEK) and sodium-carboxymethyl cellulose (Na-CMC). The fabricated scaffold was dip coated with Zn and Mn doped bioactive glass nanoparticles (Zn-Mn MBGNs). The synthesized ink exhibit suitable shear-thinning behavior for direct ink write (DIW) 3D printing. The scaffolds were crafted with precision, featuring 85% porosity, 0.3 mm layer height, and 1.5 mm/s printing speed at room temperature. Scanning electron microscopy images reveal a well-defined scaffold with an average pore size of 600 ± 30 μm. The energy dispersive X-ray spectroscopy analysis confirmed a well dispersed/uniform coating of Zn-Mn MBGNs on the PEEK/Na-CMC scaffold. Fourier transform infrared spectroscopy approved the presence of PEEK, CMC, and Zn-Mn MBGNs. The tensile test revealed a Young's modulus of 2.05 GPa. Antibacterial assays demonstrate inhibition zone against Staphylococcus aureus and Escherichia Coli strains. Chick Chorioallantoic Membrane assays also present significant angiogenesis potential, owing to the antigenic nature of Zn-Mn MBGNs. WST-8 cell viability assays depicted cell proliferation, with a 103% viability after 7 days of culture. This study suggests that the PEEK/Na-CMC scaffolds coated with Zn-Mn MBGNs are an excellent candidate for osteoporotic fracture treatment. Thus, the fabricated scaffold can offer multifaceted properties for enhanced patient outcomes in the bone tissue regeneration.

The effect of screw insertion configuration of Sinus Tarsi plate on biomechanical performance using finite element analysis

Sinus Tarsi plates are used as implants for minimally invasive surgery of calcaneus bone fractures. This study evaluated the screw fixation patterns of Sinus Tarsi plates for optimal biomechanical performance. Six three-dimensional (3D) finite element models with different positional screws were evaluated for calcaneus fracture stabilization using Sinus Tarsi plates with 5, 6, and 7 holes. Walking stance conditions as heel strike, midstance, and push-off phases were used to compare loading. Results indicated that the equivalent (EQV) stress exhibited in the implant was higher than in the surrounding bone, with the highest value during the push-off phase. The maximum EQV stress or risk of failure decreased when an insertion screw was placed in the anterior bone using a 7-hole plate, and the most stable strain result at the fracture bone site was recorded for a Sinus Tarsi plate with 7 holes (TT 7-1). The screw insertion pattern and configuration of the Sinus Tarsi plate impacted the biomechanical performance of the calcaneal fracture.

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.

Biocompatible antibiotic-coupled nickel-titanium nanoparticles as a potential coating material for biomedical devices

The challenges facing metallic implants for reconstructive surgery include the leaching of toxic metal ions, a mismatch in elastic modulus between the implant and the treated tissue, and the risk of infection. These problems can be addressed by passivating the metal surface with an organic substrate and incorporating antibiotic molecules. Nitinol (NiTi), a nickel-titanium alloy, is used in devices for biomedical applications due to its shape memory and superelasticity. However, unmodified NiTi carries a risk of localized nickel toxicity and inadequately supports angiogenesis or neuroregeneration due to limited cell adhesion, poor biomineralization, and little antibacterial activity. To address these challenges, NiTi nanoparticles were modified using self-assembled phosphonic acid monolayers and functionalized with the antibiotics ceftriaxone and vancomycin via the formation of an amide. Surface modifications were monitored to confirm that phosphonic acid modifications were present on NiTi nanoparticles and 100% of the samples formed ordered films. Modifications were stable for more than a year. Elemental composition showed the presence of nickel, titanium, and phosphorus (1.9% for each sample) after surface modifications. Dynamic light scattering analysis suggested some agglomeration in solution. However, scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy confirmed a particle size distribution of <100 nm, the even distribution of nanoparticles on coverslips, and elemental composition before and after cell culture. B35 neuroblastoma cells exhibited no inhibition of survival and extended neurites of approximately 100 μm in total length when cultured on coverslips coated with only poly-l-lysine or with phosphonic acid-modified NiTi, indicating high biocompatibility. The ability to support neural cell growth and differentiation makes modified NiTi nanoparticles a promising coating for surfaces in metallic bone and nerve implants. NiTi nanoparticles functionalized with ceftriaxone inhibited Escherichia coli and Serratia marcescens (SM6) at doses of 375 and 750 μg whereas the growth of Bacillus subtilis was inhibited by a dose of only 37.5 μg. NiTi-vancomycin was effective against B. subtilis at all doses even after mammalian cell culture. These are common bacteria associated with infected implants, further supporting the potential use of functionalized NiTi in coating reconstructive implants.

Recent trends in bone tissue engineering: a review of materials, methods, and structures

Bone tissue engineering (BTE) provides the treatment possibility for segmental long bone defects that are currently an orthopedic dilemma. This review explains different strategies, from biological, material, and preparation points of view, such as using different stem cells, ceramics, and metals, and their corresponding properties for BTE applications. In addition, factors such as porosity, surface chemistry, hydrophilicity and degradation behavior that affect scaffold success are introduced. Besides, the most widely used production methods that result in porous materials are discussed. Gene delivery and secretome-based therapies are also introduced as a new generation of therapies. This review outlines the positive results and important limitations remaining in the clinical application of novel BTE materials and methods for segmental defects.

Finite element analysis of the effect of framework material and thickness on the biomechanical performance of 'All‑on‑Four' full-arch prosthesis

The aim of this research was to evaluate the stress distribution in the 'All-on-Four' prosthesis and the surrounding bone, with different framework materials and thicknesses. Five frameworks (alumina, zirconia, titanium, fiberglass reinforced resin (FRR), and polyether ether ketone (PEEK)) with two thicknesses (3.5 &5.5 mm) were stimulated in this research. A vertical force of 200 N was applied on a 1 mm circular area, at the cantilever, and at the region of the incisors, simulating different mastication mechanisms. The results illustrated that the 5.5 mm framework reduced the stresses on most parts, mucosa, and bone tissues, compared to 3.5 mm.

New strontium-based coatings show activity against pathogenic bacteria in spine infection

Infections of implants and prostheses represent relevant complications associated with the implantation of biomedical devices in spine surgery. Indeed, due to the length of the surgical procedures and the need to implant invasive devices, infections have high incidence, interfere with osseointegration, and are becoming increasingly difficult to threat with common therapies due to the acquisition of antibiotic resistance genes by pathogenic bacteria. The application of metal-substituted tricalcium phosphate coatings onto the biomedical devices is a promising strategy to simultaneously prevent bacterial infections and promote osseointegration/osseoinduction. Strontium-substituted tricalcium phosphate (Sr-TCP) is known to be an encouraging formulation with osseoinductive properties, but its antimicrobial potential is still unexplored. To this end, novel Sr-TCP coatings were manufactured by Ionized Jet Deposition technology and characterized for their physiochemical and morphological properties, cytotoxicity, and bioactivity against Escherichia coli ATCC 8739 and Staphylococcus aureus ATCC 6538P human pathogenic strains. The coatings are nanostructured, as they are composed by aggregates with diameters from 90 nm up to 1 μm, and their morphology depends significantly on the deposition time. The Sr-TCP coatings did not exhibit any cytotoxic effects on human cell lines and provided an inhibitory effect on the planktonic growth of E. coli and S. aureus strains after 8 h of incubation. Furthermore, bacterial adhesion (after 4 h of exposure) and biofilm formation (after 24 h of cell growth) were significantly reduced when the strains were cultured on Sr-TCP compared to tricalcium phosphate only coatings. On Sr-TCP coatings, E. coli and S. aureus cells lost their organization in a biofilm-like structure and showed morphological alterations due to the toxic effect of the metal. These results demonstrate the stability and anti-adhesion/antibiofilm properties of IJD-manufactured Sr-TCP coatings, which represent potential candidates for future applications to prevent prostheses infections and to promote osteointegration/osteoinduction.

Advancements in Photothermal Therapy Using Near-Infrared Light for Bone Tumors

Bone tumors, particularly osteosarcoma, are prevalent among children and adolescents. This ailment has emerged as the second most frequent cause of cancer-related mortality in adolescents. Conventional treatment methods comprise extensive surgical resection, radiotherapy, and chemotherapy. Consequently, the management of bone tumors and bone regeneration poses significant clinical challenges. Photothermal tumor therapy has attracted considerable attention owing to its minimal invasiveness and high selectivity. However, key challenges have limited its widespread clinical use. Enhancing the tumor specificity of photosensitizers through targeting or localized activation holds potential for better outcomes with fewer adverse effects. Combinations with chemotherapies or immunotherapies also present avenues for improvement. In this review, we provide an overview of the most recent strategies aimed at overcoming the limitations of photothermal therapy (PTT), along with current research directions in the context of bone tumors, including (1) target strategies, (2) photothermal therapy combined with multiple therapies (immunotherapies, chemotherapies, and chemodynamic therapies, magnetic, and photodynamic therapies), and (3) bifunctional scaffolds for photothermal therapy and bone regeneration. We delve into the pros and cons of these combination methods and explore current research focal points. Lastly, we address the challenges and prospects of photothermal combination therapy.

Surface (bio)-functionalization of metallic materials: How to cope with real interfaces?

Metallic materials are an important class of biomaterials used in various medical devices, owing to a suitable combination of their mechanical properties. The (bio)-functionalization of their surfaces is frequently performed for biocompatibility requirements, as it offers a powerful way to control their interaction with biological systems. This is particularly important when physicochemical processes and biological events, mainly involving proteins and cells, are initiated at the host-material interface. This review addresses the state of "real interfaces" in the context of (bio)-functionalization of metallic materials, and the necessity to cope with it to avoid frequent improper evaluation of the procedure used. This issue is, indeed, well-recognized but often neglected and emerges from three main issues: (i) ubiquity of surface contamination with organic compounds, (ii) reactivity of metallic surfaces in biological medium, and (iii) discrepancy in (bio)-functionalization procedures between expectations and reality. These disturb the assessment of the strategies adopted for surface modifications and limit the possibilities to provide guidelines for their improvements. For this purpose, X-ray photoelectrons spectroscopy (XPS) comes to the rescue. Based on significant progresses made in methodological developments, and through a large amount of data compiled to generate statistically meaningful information, and to insure selectivity, precision and accuracy, the state of "real interfaces" is explored in depth, while looking after the two main constituents: (i) the bio-organic adlayer, in which the discrimination between the compounds of interest (anchoring molecules, coupling agents, proteins, etc) and organic contaminants can be made, and (ii) the metallic surface, which undergoes dynamic processes due to their reactivity. Moreover, through one of the widespread (bio)-functionalization strategy, given as a case study, a particular attention is devoted to describe the state of the interface at different stages (composition, depth distribution of contaminants and (bio)compounds of interest) and the mode of protein retention. It is highlighted, in particular, that the occurrence or improvement of bioactivity does not demonstrate that the chemical schemes worked in reality. These aspects are particularly essential to make progress on the way to choose the suitable (bio)-functionalization strategy and to provide guidelines to improve its efficiency.

Effects of Addition of Lanthanum and Zinc Oxides on the Biological Properties of TiO2-SiO2-P2O5/CaO on Ion Exchange Resin for Bone Implantation

The spherical materials TiO2-SiO2-P2O5/CaO, TiO2-SiO2-P2O5/La2O3, and TiO2-SiO2-P2O5/ZnO deposited on the Tokem-250 cation exchanger have been synthesized with an alcoholic solution by the sol-gel method. The macroporous cation exchanger Tokem-250, which has high Ca2+, Zn2+, and La3+ ion selectivity, was used in the present study. This material has the ability to precipitate and mineralize calcium phosphates on its surface in biological media, since it has high porosity, a homogeneous structure with a uniform variation of elements, and the presence of active centers (Si4+, Ti4+) on the surface. The effect of lanthanum and zinc additives on biological properties has been studied. It was established that accumulation of Ca2+ and Mg2+ occurs faster on the surface of TiO2-SiO2-P2O5/ZnO in the SBF (simulated body fluid) model solution, showing higher reaction capacity. The amount of calcium and phosphorus ions on the surface of sample TiO2-SiO2-P2O5/La2O3 is greater due to the ability of lanthanum to coordinate a large number of ions (lanthanum coordination number is 10). The presence of zinc ions in the system causes the partial hemoglobin release from erythrocytes into the supernatant fluid. The samples with lanthanum ions reduce the amount of protein in plasma after incubation, which has a positive effect on the practical application.

The Effect of Solution Treatment Duration on the Microstructural and Mechanical Properties of a Cold-Deformed-by-Rolling Ti-Nb-Zr-Ta-Sn-Fe Alloy

The study presented in this paper is focused on the effect of varying the solution treatment duration on both the microstructural and mechanical properties of a cold-deformed by rolling Ti-30Nb-12Zr-5Ta-2Sn-1.25Fe (wt.%) alloy, referred to as TNZTSF. Cold-crucible induction using the levitation synthesis technique, conducted under an argon-controlled atmosphere, was employed to fabricate the TNZTSF alloy. After synthesis, the alloy underwent cold deformation by rolling, reaching a total deformation degree (total applied thickness reduction) of 60%. Subsequently, a solution treatment was conducted at 850 °C, with varying treatment durations ranging from 2 to 30 min in 2 min increments. X-ray diffraction (XRD) and scanning electron microscopy (SEM) techniques were utilized for the structural analysis, while the mechanical properties were assessed using both tensile and hardness testing. The findings indicate that (i) in both the cold-deformed-by-rolling and solution-treated states, the TNZTSF alloy exhibits a microstructure consisting of a single β-Ti phase; (ii) in the solution-treated state, the microstructure reveals a rise in the average grain size and a decline in the internal average microstrain as the duration of the solution treatment increases; and (iii) owing to the β-phase stability, a favorable mix of elevated strength and considerable ductility properties can be achieved.

Powder Bed Fusion 3D Printing in Precision Manufacturing for Biomedical Applications: A Comprehensive Review

Precision manufacturing requirements are the key to ensuring the quality and reliability of biomedical implants. The powder bed fusion (PBF) technique offers a promising solution, enabling the creation of complex, patient-specific implants with a high degree of precision. This technology is revolutionizing the biomedical industry, paving the way for a new era of personalized medicine. This review explores and details powder bed fusion 3D printing and its application in the biomedical field. It begins with an introduction to the powder bed fusion 3D-printing technology and its various classifications. Later, it analyzes the numerous fields in which powder bed fusion 3D printing has been successfully deployed where precision components are required, including the fabrication of personalized implants and scaffolds for tissue engineering. This review also discusses the potential advantages and limitations for using the powder bed fusion 3D-printing technology in terms of precision, customization, and cost effectiveness. In addition, it highlights the current challenges and prospects of the powder bed fusion 3D-printing technology. This work offers valuable insights for researchers engaged in the field, aiming to contribute to the advancement of the powder bed fusion 3D-printing technology in the context of precision manufacturing for biomedical applications.

Liquid metal biomaterials: translational medicines, challenges and perspectives

Until now, significant healthcare challenges and growing urgent clinical requirements remain incompletely addressed by presently available biomedical materials. This is due to their inadequate mechanical compatibility, suboptimal physical and chemical properties, susceptibility to immune rejection, and concerns about long-term biological safety. As an alternative, liquid metal (LM) opens up a promising class of biomaterials with unique advantages like biocompatibility, flexibility, excellent electrical conductivity, and ease of functionalization. However, despite the unique advantages and successful explorations of LM in biomedical fields, widespread clinical translations and applications of LM-based medical products remain limited. This article summarizes the current status and future prospects of LM biomaterials, interprets their applications in healthcare, medical imaging, bone repair, nerve interface, and tumor therapy, etc. Opportunities to translate LM materials into medicine and obstacles encountered in practices are discussed. Following that, we outline a blueprint for LM clinics, emphasizing their potential in making new-generation artificial organs. Last, the core challenges of LM biomaterials in clinical translation, including bio-safety, material stability, and ethical concerns are also discussed. Overall, the current progress, translational medicine bottlenecks, and perspectives of LM biomaterials signify their immense potential to drive future medical breakthroughs and thus open up novel avenues for upcoming clinical practices.

Tuning biodegradability, bone-bonding capacity, and wear resistance of zinc-30% magnesium intermetallic alloy for use in load-bearing bone applications

This work aimed to improve the rapid biodegradation, poor wear resistance properties, and lack of bioactivity of metallic biomaterials to be used in orthopedic applications. In this context, zinc-magnesium (Zn-Mg) alloy with successive contents of calcium silicate (CaSiO3) and silicon nitride (Si3N4) was prepared using powder metallurgy technique. After sintering, their phase composition and microstructure were investigated using the X-ray diffraction technique and scanning electron microscopy (SEM), respectively. Furthermore, their degradation behavior and ability to form hydroxyapatite (HA) layer on the sample surface after immersion in simulated body fluid (SBF) were monitored using weight loss measurements, inductively coupled plasma-atomic emission spectroscopy, and SEM. Moreover, their tribo-mechanical properties were measured. The results obtained showed that the successive contents of CaSiO3 were responsible for improving the bioactivity behavior as indicated by a good formation of the HA layer on the samples' surface. Additionally, ceramic materials were responsible for a continuous decrease in the released ions in the SBF solution as indicated by the ICP results. The tribology properties were significantly improved even after exposure to different loads. Based on the above results, the prepared nanocomposites are promising for use in orthopedic applications.

Octacalcium phosphate, a promising bone substitute material: a narrative review

Biomaterials have been used to supplement and restore function and structure by replacing or restoring parts of damaged tissues and organs. In ancient times, the medical use of biomaterials was limited owing to infection during surgery and poor surgical techniques. However, in modern times, the medical applications of biomaterials are diversifying owing to great developments in material science and medical technology. In this paper, we introduce biomaterials, focusing on calcium phosphate ceramics, including octacalcium phosphate, which has recently attracted attention as a bone graft material.

Improvement of corrosion resistance and adhesion of hydroxyapatite coating on AZ31 alloy by an anodizing intermediate layer

OBJECTIVES

The primary objective of this study is using an anodizing intermediate layer to improve corrosion resistance and adhesion of hydroxyapatite coated AZ31 alloy for applications in biodegradable implants.

METHODS

An anodizing intermediate layer was formed on the surface of AZ31 substrate at various anodizing voltage of 10, 20, 30, and 40 V respectively by anodizing process. HAp was grow on the surface of AZ31 substrate at 90°C and pH solution of 7.5 by chemical solution treatment method for 2 h. The coated samples were evaluated their corrosion behavior by Electrochemical measurements and biodegradation behavior by immersion test in Hank's balanced salts solution (HBSS) for 28 days via amount of Mg2+ ion released. While, their adhesion strength were evaluated by pull-off method. The amount of Mg2+ ions released of the samples was quantified by the Inductively coupled plasma mass spectrometry.

RESULTS

An anodizing intermediate layer was successfully synthesized at various voltages by anodizing process and HAp coatings were prepared by chemical solution treatment method. The corrosion rate of hydroxyapatite coated AZ31 alloy with an anodizing intermediate layer decreased 4.4 times, while adhesion strength increased about two times compared to the HAp coated AZ31 specimen without an anodizing layer and achieved ~14.70, ~6.92 MPa, respectively. After immersion test in HBSS, the adhesion strength of HAp/AZ31-HBSS-specimen decrease to 45% because of large corroded areas with depth holes of hundreds of micrometers. The slighter decrease in adhesion strength of HAp/30V/AZ31-HBSS-specimen to 22% is due to the contribution of the anodizing intermediate layer.

CONCLUSION

HAp coated AZ31 alloy specimen with the existence of a porous structure with an elliptical shape, uniform and high density of MgO on the surface at anodizing voltage of 30 V resulted in a significant increase in corrosion resistance and the adhesion strength of HAp coatings.

3D printing technology combined with personalized plates for complex distal intra-articular fractures of the trimalleolar ankle

This study investigated the effectiveness of 3D printing technology in combination with personalized custom-made steel plates in the treatment of complex distal intra-articular trimalleolar fractures, with the aim of providing a new approach to improve ankle joint function in patients. The 48 patients with complex distal intra-articular trimalleolar fractures included in the study were randomly divided into two groups: the personalized custom-made steel plate group (n = 24) and the conventional steel plate group (n = 24). A comparison was made between the two groups in terms of preoperative preparation time, hospitalization duration, surgical time, fracture reduction and internal fixation time, intraoperative fluoroscopy instances, surgical incision length, fracture healing time, follow-up duration, degree of fracture reduction, ankle joint functional recovery, and the occurrence of complications. The personalized steel plate group exhibited longer preoperative preparation time and hospitalization duration compared to the conventional steel plate group (p < 0.001). However, the personalized steel plate group demonstrated significantly shorter surgical duration, time for fracture reduction and internal fixation, reduced intraoperative fluoroscopy frequency, and a shorter overall surgical incision length (p < 0.001). Both groups displayed similar fracture healing times and follow-up durations (p > 0.05). The personalized steel plate group showed a higher rate of successful fracture reduction (87.5% vs. 79.2%, p > 0.05) and a lower incidence of complications (8.3% vs. 20.8%, p = 0.22), although these differences did not reach statistical significance. Furthermore, the personalized steel plate group exhibited superior ankle joint function scores during follow-up compared to the conventional steel plate group (p < 0.05). By utilizing 3D printing technology in conjunction with personalized custom-made steel plates, personalized treatment plans are provided for patients with complex comminuted tri-malleolar ankle fractures, enabling safer, more efficient, and satisfactory orthopedic surgeries.

Porosity modeling in a TiNbTaZrMo high-entropy alloy for biomedical applications

High-entropy alloys (HEAs) have attracted great attention for many biomedical applications. However, the nature of interatomic interactions in this class of complex multicomponent alloys is not fully understood. We report, for the first time, the results of theoretical modeling for porosity in a large biocompatible HEA TiNbTaZrMo using an atomistic supercell of 1024 atoms that provides new insights and understanding. Our results demonstrated the deficiency of using the valence electron count, quantification of large lattice distortion, validation of mechanical properties with available experimental data to reduce Young's modulus. We utilized the novel concepts of the total bond order density (TBOD) and partial bond order density (PBOD) via ab initio quantum mechanical calculations as an effective theoretical means to chart a road map for the rational design of complex multicomponent HEAs for biomedical applications.

Forged to heal: The role of metallic cellular solids in bone tissue engineering

Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.

Multifunctional nacre-like materials

Nacre, the iridescent inner layer of seashells, displays an exceptional combination of strength and toughness due to its 'brick-wall' architecture. Significant research has been devoted to replicating nacre's architecture and its associated deformation and failure mechanisms. Using the resulting materials in applications necessitates adding functionalities such as self-healing, force sensing, bioactivity, heat conductivity and resistance, transparency, and electromagnetic interference shielding. Herein, progress in the fabrication, mechanics, and multi-functionality of nacre-like materials, particularly over the past three years is systematically and critically reviewed. The fabrication techniques reviewed include 3D printing, freeze-casting, mixing/coating-assembling, and laser engraving. The mechanical properties of the resulting materials are discussed in comparison with their constituents and previously developed nacre mimics. Subsequently, the progress in incorporating multifunctionalities and the resulting physical, chemical, and biological properties are evaluated. We finally provide suggestions based on 3D/4D printing, advanced modelling techniques, and machine elements to make reprogrammable nacre-like components with complex shapes and small building blocks, tackling some of the main challenges in the science and translation of these materials.

Comprehensive Review on Biomaterials and Their Inherent Behaviors for Hip Repair Applications

Developing biomaterials for hip prostheses is challenging and requires dedicated attention from researchers. Hip replacement is an inevitable and remarkable orthopedic therapy for enhancing the quality of patient life for those who have arthritis as well as trauma. Generally, five types of hip replacement procedures are successfully performed in the current medical market: total hip replacements, hip resurfacing, hemiarthroplasty, bipolar, and dual mobility systems. The average life span of artificial hip joints is about 15 years, and several studies have been conducted over the last 60 years to improve the performance and thereby increase the lifespan of artificial hip joints. Present-day prosthetic hip joints are linked to the wide availability of biomaterials. Metals, ceramics, and polymers are some of the most promising types of biomaterials; nevertheless, each biomaterial has advantages and disadvantages. Metals and ceramics fail in most applications owing to stress shielding and the emission of wear debris; ongoing research is being carried out to find a remedy to these unfavorable responses. Recent research found that polymers and composites based on polymers are significant alternative materials for artificial joints. With growing research and several biomaterials, recent reviews lag in effectively addressing hip implant materials' individual mechanical, tribological, and physiological behaviors. This Review comprehensively investigates the historical evolution of artificial hip replacement procedures and related biomaterials' mechanical, tribological, and biological characteristics. In addition, the most recent advances are also discussed to stimulate and guide future researchers as they seek more effective methods and synthesis of innovative biomaterials for hip arthroplasty application.

In situ fabrication of cerium-incorporated hydroxyapatite/magnetite nanocomposite coatings with bone regeneration and osteosarcoma potential

With the ultimate goal of providing a novel platform able to inhibit bacterial adhesion, biofilm formation, and anticancer properties, cerium-doped hydroxyapatite films enhanced with magnetite were developed via spin-coating. The unique aspect of the current study is the potential for creating cerium-doped hydroxyapatite/Fe3O4 coatings on a titanium support to enhance the functionality of bone implants. To assure an increase in the bioactivity of the titanium surface, alkali pretreatment was done before deposition of the apatite layer. Scanning electron microscopy (SEM) in conjunction with energy-dispersive X-ray (EDX) spectroscopy, X-ray diffraction (XRD) analysis, and Fourier transform-infrared (FTIR) spectroscopy were used to evaluate coatings. Coatings demonstrated good efficacy against Staphylococcus aureus and Escherichia coli, with the latter showing the highest efficacy. In vitro bioactivity in simulated body fluid solution showed this material to be proficient for bone-like apatite formation on the implant surface. Electrochemical impedance spectroscopy was undertaken on intact coatings to examine the barrier properties of composites. We found that spin-coating at 4000 rpm could greatly increase the total resistance. After seeding with osteoblastic populations, Ce-HAP/Fe3O4 materials the adhesion and proliferation of cells. The heating capacity of the Ce-HAP/Fe3O4 film was optimal at 45 °C at 15 s at a frequency of 318 kHz. Osseointegration depends on many more parameters than hydroxyapatite production, so these coatings have significant potential for use in bone healing and bone-cancer therapy.

Structural analysis of novel drug targets for mitigation of Pseudomonas aeruginosa biofilms

Pseudomonas aeruginosa is an opportunistic human pathogen responsible for acute and chronic, hard to treat infections. Persistence of P. aeruginosa is due to its ability to develop into biofilms, which are sessile bacterial communities adhered to substratum and encapsulated in layers of self-produced exopolysaccharides. These biofilms provide enhanced protection from the host immune system and resilience towards antibiotics, which poses a challenge for treatment. Various strategies have been expended for combating biofilms, which involve inhibiting biofilm formation or promoting their dispersal. The current remediation approaches offer some hope for clinical usage, however, treatment and eradication of preformed biofilms is still a challenge. Thus, identifying novel targets and understanding the detailed mechanism of biofilm regulation becomes imperative. Structure-based drug discovery (SBDD) provides a powerful tool that exploits the knowledge of atomic resolution details of the targets to search for high affinity ligands. This review describes the available structural information on the putative target protein structures that can be utilized for high throughput in silico drug discovery against P. aeruginosa biofilms. Integrating available structural information on the target proteins in readily accessible format will accelerate the process of drug discovery.

3D printing metal implants in orthopedic surgery: Methods, applications and future prospects

Background

Currently, metal implants are widely used in orthopedic surgeries, including fracture fixation, spinal fusion, joint replacement, and bone tumor defect repair. However, conventional implants are difficult to be customized according to the recipient's skeletal anatomy and defect characteristics, leading to difficulties in meeting the individual needs of patients. Additive manufacturing (AM) or three-dimensional (3D) printing technology, an advanced digital fabrication technique capable of producing components with complex and precise structures, offers opportunities for personalization.

Methods

We systematically reviewed the literature on 3D printing orthopedic metal implants over the past 10 years. Relevant animal, cellular, and clinical studies were searched in PubMed and Web of Science. In this paper, we introduce the 3D printing method and the characteristics of biometals and summarize the properties of 3D printing metal implants and their clinical applications in orthopedic surgery. On this basis, we discuss potential possibilities for further generalization and improvement.

Results

3D printing technology has facilitated the use of metal implants in different orthopedic procedures. By combining medical images from techniques such as CT and MRI, 3D printing technology allows the precise fabrication of complex metal implants based on the anatomy of the injured tissue. Such patient-specific implants not only reduce excessive mechanical strength and eliminate stress-shielding effects, but also improve biocompatibility and functionality, increase cell and nutrient permeability, and promote angiogenesis and bone growth. In addition, 3D printing technology has the advantages of low cost, fast manufacturing cycles, and high reproducibility, which can shorten patients' surgery and hospitalization time. Many clinical trials have been conducted using customized implants. However, the use of modeling software, the operation of printing equipment, the high demand for metal implant materials, and the lack of guidance from relevant laws and regulations have limited its further application.

Conclusions

There are advantages of 3D printing metal implants in orthopedic applications such as personalization, promotion of osseointegration, short production cycle, and high material utilization. With the continuous learning of modeling software by surgeons, the improvement of 3D printing technology, the development of metal materials that better meet clinical needs, and the improvement of laws and regulations, 3D printing metal implants can be applied to more orthopedic surgeries.

The translational potential of this paper

Precision, intelligence, and personalization are the future direction of orthopedics. It is reasonable to believe that 3D printing technology will be more deeply integrated with artificial intelligence, 4D printing, and big data to play a greater role in orthopedic metal implants and eventually become an important part of the digital economy. We aim to summarize the latest developments in 3D printing metal implants for engineers and surgeons to design implants that more closely mimic the morphology and function of native bone.

Development and Fabrication of Biocompatible Ti-Based Bulk Metallic Glass Matrix Composites for Additive Manufacturing

Ti-based metallic glasses have a high potential for implant applications. The feasibility of a new biocompatible Ti-based bulk metallic glass composite for selective laser melting (SLM) had been examined. Therefore, it is necessary to design a high-glass-forming-ability Ti-based metallic glass (∆Tx = 81 K, γ = 0.427, γm = 0.763), to fabricate a partial glass-formable spherical powder (the volume fraction of the amorphous phase in the atomized Ti-based powders being 73% [size < 25 μm], 61% [25-37 μm], and 50% [37-44 μm]), and establish an SLM parameter (a scan rate of 600 mm/s, a power of 120 W, and an overlap of 10%). The Ti42Zr35Si5Co12.5Sn2.5Ta3 bulk metallic glass composite was successfully fabricated through SLM. This study demonstrates that the TiZrSiCoSnTa system constitutes a promising basis for the additive manufacturing process in terms of preparing biocompatible metallic glass composites into complicated graded foam shapes.

Structural optimization of orthopedic hip implant using parametric and non-parametric optimization techniques

This research investigates the reduction in weight of hip implant by the application of parametric and non-parametric optimization techniques. Orthopaedic hip implants can be made from metals, ceramics, composites, or metallic alloys and are generally solid structures. The stiffness of orthopaedic hip implant is a pertaining problem when implanted in the human body as Hip implant are stiffer than bone material and causes stress shielding. This results in bone weakening which causes osteoporosis. Reduction in mass of femur stem results in stiffness reduction of femur stem. Non-Parametric topology optimization results in 34.9% mass reduction and parametric optimization based on Central Composite Design technique in Design of Experiments (DoE) uses hole diameters as parameters and performs structural optimization that results in 22% mass reduction.

Solid implantable devices for sustained drug delivery

Implantable drug delivery systems (IDDS) are an attractive alternative to conventional drug administration routes. Oral and injectable drug administration are the most common routes for drug delivery providing peaks of drug concentrations in blood after administration followed by concentration decay after a few hours. Therefore, constant drug administration is required to keep drug levels within the therapeutic window of the drug. Moreover, oral drug delivery presents alternative challenges due to drug degradation within the gastrointestinal tract or first pass metabolism. IDDS can be used to provide sustained drug delivery for prolonged periods of time. The use of this type of systems is especially interesting for the treatment of chronic conditions where patient adherence to conventional treatments can be challenging. These systems are normally used for systemic drug delivery. However, IDDS can be used for localised administration to maximise the amount of drug delivered within the active site while reducing systemic exposure. This review will cover current applications of IDDS focusing on the materials used to prepare this type of systems and the main therapeutic areas of application.

Engineering 3D-Printed Advanced Healthcare Materials for Periprosthetic Joint Infections

The use of additive manufacturing or 3D printing in biomedicine has experienced fast growth in the last few years, becoming a promising tool in pharmaceutical development and manufacturing, especially in parenteral formulations and implantable drug delivery systems (IDDSs). Periprosthetic joint infections (PJIs) are a common complication in arthroplasties, with a prevalence of over 4%. There is still no treatment that fully covers the need for preventing and treating biofilm formation. However, 3D printing plays a major role in the development of novel therapies for PJIs. This review will provide a deep understanding of the different approaches based on 3D-printing techniques for the current management and prophylaxis of PJIs. The two main strategies are focused on IDDSs that are loaded or coated with antimicrobials, commonly in combination with bone regeneration agents and 3D-printed orthopedic implants with modified surfaces and antimicrobial properties. The wide variety of printing methods and materials have allowed for the manufacture of IDDSs that are perfectly adjusted to patients' physiognomy, with different drug release profiles, geometries, and inner and outer architectures, and are fully individualized, targeting specific pathogens. Although these novel treatments are demonstrating promising results, in vivo studies and clinical trials are required for their translation from the bench to the market.

Stem cells derived exosomes and biomaterials to modulate autophagy and mend broken hearts

Autophagy maintains cellular homeostasis and plays a crucial role in managing pathological conditions including ischemic myocardial injury leading to heart failure (HF). Despite treatments, no intervention can replace lost cardiomyocytes. Stem cell therapy offers potential for post-myocardial infarction repair but struggles with poor cell retention due to immune rejection. In the search for effective therapies, stem cell-derived extracellular vesicles (EVs), especially exosomes, have emerged as promising tools. These tiny bioactive molecule carriers play vital roles in intercellular communication and tissue engineering. They offer numerous therapeutic benefits including modulating immune responses, promoting tissue repair, and boosting angiogenesis. Additionally, biomaterials provide a conducive 3D microenvironment for cell, exosome, and biomolecule delivery, and enhance heart muscle strength, making it a comprehensive cardiac repair strategy. In this regard, the current review delves into the intricate application of extracellular vesicles (EVs) and biomaterials for managing autophagy in the heart muscle during cardiac injury. Central to our investigation is the exploration of how these elements interact within the context of cardiac repair and regeneration. Additionally, this review also casts light on the formidable challenges that plague this field, such as the issues of safety, efficacy, controlled delivery, and acceptance of these therapeutic strategies for effective clinical translation. Addressing these challenges is crucial for unlocking the full therapeutic potential of EV and biomaterial-based therapies and ensuring their successful translation from bench to bedside.

Engineering Antioxidant Surfaces for Titanium-Based Metallic Biomaterials

Prolonged inflammation induced by orthopedic metallic implants can critically affect the success rates, which can even lead to aseptic loosening and consequent implant failure. In the case of adverse clinical conditions involving osteoporosis, orthopedic trauma and implant corrosion-wear in peri-implant region, the reactive oxygen species (ROS) activity is enhanced which leads to increased oxidative stress. Metallic implant materials (such as titanium and its alloys) can induce increased amount of ROS, thereby critically influencing the healing process. This will consequently affect the bone remodeling process and increase healing time. The current review explores the ROS generation aspects associated with Ti-based metallic biomaterials and the various surface modification strategies developed specifically to improve antioxidant aspects of Ti surfaces. The initial part of this review explores the ROS generation associated with Ti implant materials and the associated ROS metabolism resulting in the formation of superoxide anion, hydroxyl radical and hydrogen peroxide radicals. This is followed by a comprehensive overview of various organic and inorganic coatings/materials for effective antioxidant surfaces and outlook in this research direction. Overall, this review highlights the critical need to consider the aspects of ROS generation as well as oxidative stress while designing an implant material and its effective surface engineering.

Elastin-like recombinamer-mediated hierarchical mineralization coatings on Zr-16Nb-xTi (x = 4,16 wt%) alloy surfaces improve biocompatibility

The biocompatibility of biomedical materials is vital to their applicability and functionality. However, modifying surfaces for enhanced biocompatibility using traditional surface treatment techniques is challenging. We employed a mineralizing elastin-like recombinamer (ELR) self-assembling platform to mediate mineralization on Zr-16Nb-xTi (x = 4,16 wt%) alloy surfaces, resulting in the modification of surface morphology and bioactivity while improving the biocompatibility of the material. We modulated the level of nanocrystal organization by adjusting the cross-linker ratio. Nanoindentation tests revealed that the mineralized configuration had nonuniformity with respect to Young's modulus and hardness, with the center areas having higher values (5.626 ± 0.109 GPa and 0.264 ± 0.022 GPa) compared to the edges (4.282 ± 0.327 GPa and 0.143 ± 0.023 GPa). The Scratch test results indicated high bonding strength (2.668 ± 0.117 N) between the mineralized coating and the substrate. Mineralized Zr-16Nb-xTi (x = 4,16 wt%) alloys had higher viability compared to untreated alloys, which exhibited high cell viability (>100 %) after 5 days and high alkaline phosphatase activity after 7 days. Cell proliferation assays indicated that MG 63 cells grew faster on mineralized surfaces than on untreated surfaces. Scanning electron microscopy imaging confirmed that the cells adhered and spread well on mineralized surfaces. Furthermore, hemocompatibility test results revealed that all mineralized samples were non-hemolytic. Our results demonstrate the viability of employing the ELR mineralizing platform to improve alloy biocompatibility.

Hierarchical hydrogel scaffolds with a clustered and oriented structure

Hydrogel scaffolds play a critical role in tissue engineering due to their hydrophilic network structure and good biocompatibility. Constructing anisotropic scaffolds geometrically similar to injured tissues is conducive to promoting the generation of tissue and organ equivalents, or to guiding and enhancing the regeneration of injured tissues. In this study, we developed polyvinyl alcohol (PVA)/alginate hierarchical hydrogel scaffolds with a clustered and oriented structure using a method that combines directional freezing and drying under stretching. Our hydrogel scaffolds with an adjustable modulus (50 kPa-20 MPa) can match different types of injured tissues. The clustered and oriented structure successfully guided the alignment and orientation of fibroblasts and chondrocytes. This work provides a new idea for constructing hydrogels with hierarchical and anisotropic microstructures, which have promising applications in tissue regeneration.

Surface modification techniques of titanium and titanium alloys for biomedical orthopaedics applications: A review

Biomedical alloys have an important share in orthopedic applications. Among them, titanium and its titanium alloys are widely used as implant materials because of their excellent mechanical properties and non-cytotoxicity. However, its disadvantages such as its biological inertness and poor antibacterial properties inhibit its further development. Therefore, the surface properties of titanium are crucial in the implantation process and determine the success of the implant. The main purpose of this review is to provide a comprehensive and detailed description of the modification techniques used for the surface modification of titanium implants. In this paper, the corresponding technical methods are introduced systematically from four aspects: mechanical method, physical surface modification, chemical surface modification and electrochemical technique to understand the experimental mechanism of each modification technique, and the above methods can indeed improve the various properties of titanium and its alloys. With the increasing demand for implants in the future, the requirements for surface properties will also increase. Therefore, the development of new coating materials with higher performance by combining various advantages of existing modification technologies is the main trend of future research on surface modification of titanium alloys.

Longitudinal surveillance of serum titanium ion levels in patients with indigenous 3D printed total temporomandibular joint replacement

The purpose of this longitudinal study was to surveil the serum titanium ion levels at various time intervals in patients with indigenous 3D-printed total temporomandibular joint replacement (TMJ TJR). The study was conducted on 11 patients (male: 8; female: 3) who had undergone unilateral or bilateral TMJ TJR. Blood samples were drawn preoperatively (T0), 3 months (T1), 6 months (T2), and 1 year (T3) postoperatively. Data were analyzed and a p value of < 0.05 was considered statistically significant. The mean serum titanium ion levels at T0, T1, T2, and T3 was 9.34 ± 8.70 µg/L (mcg/L), 35.97 ± 20.27 mcg/L, 31.68 ± 17.03 mcg/L, and 47.91 ± 15.47 mcg/L respectively. The mean serum titanium ion levels increased significantly at T1 (p = 0.009), T2 (p = 0.032), and T3 (p = 0.00) interval. There was no significant difference between unilateral and bilateral groups. Serum titanium ion continued to show increased levels till the last follow-up of 1 year. These initial serum titanium ion levels increase is due to the initial wear phase of the prosthesis which manifests over 1 year. Further studies with large sample sizes and long-term follow-ups are required to see the deleterious effect if any on the TMJ TJR.

Bioactive ZnO-assisted 1393 glass scaffold promotes osteogenic differentiation: Some studies

We developed ZnO-assisted 1393 bioactive glass-based scaffold with suitable mechanical properties through foam replica technique and observed to be suitable for bone tissue engineering application. However, the developed scaffolds' ability to facilitate cellular infiltration and integration was further assessed through in vivo studies in suitable animal model. Herein, the pure 1393 bioactive glass (BG) and ZnO-assisted 1393 bioactive glass- (ZnBGs; 1, 2, 4 mol% ZnO substitution for SiO₂ in pure BG is named as Z1BG, Z2BG, Z3BG, respectively) based scaffolds were prepared through sol-gel route, followed by foam replica techniques and characterized by a series of in vitro and some in vivo tests. Different cell lines like normal mouse embryonic cells (NIH/3T3), mouse bone marrow stromal cells (mBMSc), peripheral blood mononuclear cells, that is, lymphocytes and monocytes (PBMC) and U2OS (carcinogenic human osteosarcoma cells) were used in determination and comparative analysis of the biological compatibility of the BG and ZnBGs. Also, the alkaline phosphatase (ALP) activity, and osteogenic gene expression by primer-specific osteopontin (OPN), osteocalcin (OCN), and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) genes were performed to study osteogenic differentiability of the stromal cells in different BGs. Moreover, radiological and histopathological tests were performed in bone defect model of Wister rats to evaluate the in vivo bone regeneration and healing. Interestingly, these studies demonstrate augmented biological compatibility, and superior osteogenic differentiation in ZnBGs, in particular Z3BG than the pure BG in most cases.

Porous Biocoatings Based on Diatomite with Incorporated ZrO2 Particles for Biodegradable Magnesium Implants

In the present work, the surface of a biodegradable Mg alloy was modified to create porous diatomite biocoatings using the method of micro-arc oxidation. The coatings were applied at process voltages in the range of 350-500 V. We have studied the influence of the addition of ZrO₂ microparticles on the structure and properties of diatomite-based protective coatings for Mg implants. The structure and properties of the resulting coatings were examined using a number of research methods. It was found that the coatings have a porous structure and contain ZrO₂ particles. The coatings were mostly characterized by pores less than 1 μm in size. However, as the voltage of the MAO process increases, the number of larger pores (5-10 μm in size) also increases. However, the porosity of the coatings varied insignificantly and amounted to 5 ± 1%. It has been revealed that the incorporation of ZrO₂ particles substantially affects the properties of diatomite-based coatings. The adhesive strength of the coatings has increased by approximately 30%, and the corrosion resistance has increased by two orders of magnitude compared to the coatings without zirconia particles.

Improved osteogenic activity of NiTi orthopedic implant by HAp-Nb2O5 composite coatings: Materials and biological points of view

The surface properties of NiTi, as an interface between the synthetic implant and living tissue, play a vital role in guaranteeing implantation success, especially during the initial stage. This contribution endeavors to enhance the surface features of NiTi orthopedic implants through the application of HAp-based coatings, placing emphasis on assessing the influence of Nb₂O₅ particles concentration in the electrolyte on resultant properties of HAp-Nb₂O₅ composite electrodeposits. The coatings were electrodeposited via pulse current mode under galvanostatic current control from an electrolyte containing 0-1 g/L of Nb₂O₅ particles. Surface morphology, topography, and phase composition were evaluated using FESEM, AFM, and XRD, respectively. EDS was employed to study surface chemistry. In vitro biomineralization and osteogenic activity of the samples were studied by immersing the samples in SBF and incubating them with osteoblastic SAOS-2 cells, respectively. The added Nb₂O₅ particles, at the optimum concentration, stimulated biomineralization, suppressed the Ni ion leaching, and improved SAOS-2 cell adhesion and proliferation. NiTi implant coated by HAp-0.50 g/L Nb₂O₅ layer showed tremendous osteogenic properties. Overall, the HAp-Nb₂O₅ composite layers bring forth fascinating coating in vitro biological performance, reducing Ni leaching, and promoting osteogenic activity, which are fundamental for the successful use of NiTi in vivo.

Micro-hydroxyapatite reinforced Ti-based composite with tailored characteristics to minimize stress-shielding impact in bio-implant applications

Biomaterials having higher strength and increased bioactivity are widely researched topics in the area of scaffold and implant fabrication. Metal-based biomaterials are favorably suitable for load-bearing implants due to their outstanding mechanical and structural properties. The issue with pure metallic material used for bio-implant is the mismatch between the mechanical properties of the human body parts and the implant. The mismatch in modulus and hardness values causes damage to muscles and other body parts due to the phenomena of 'stress-shielding'. As per the rule of mixture, combining a biocompatible ceramic with metals will not only lower the overall mechanical strength, but will also enhance the composite's bioactivity. In the present work, a Metal-Ceramic composite of Ti and μ-HAp is processed through high-energy mechanical alloying. The μ-HAp powders (in a weight fraction of 1%, 2%, and 3%) were alloyed with Pure Ti powder sintered using microwave hybrid heating (MHH). The homogeneously alloyed materials were inspected for chemical and elemental characteristics using XRD, SEM-EDX, and FTIR analyses. Nano-mechanical and micro-hardness properties were inspected for the fabricated Ti- μ-HAp composites and it shows a decreasing trend. Elastic modulus declined from 130.8 GPa to 50.11 GPa for 3 wt% μ-HAp compared to pure-Ti sample. The mechanical behaviour of developed composites confirms that it can minimize the stress-shielding impact due to comparatively lesser strength and hardness than pure metallic samples.

Adipogenesis-Related Metabolic Condition Affects Shear-Stressed Endothelial Cells Activity Responding to Titanium

PURPOSE

Obesity has increased around the world. Obese individuals need to be better assisted, with special attention given to dental and medical specialties. Among obesity-related complications, the osseointegration of dental implants has raised concerns. This mechanism depends on healthy angiogenesis surrounding the implanted devices. As an experimental analysis able to mimic this issue is currently lacking, we address this issue by proposing an in vitro high-adipogenesis model using differentiated adipocytes to further investigate their endocrine and synergic effect in endothelial cells responding to titanium.

MATERIALS AND METHODS

Firstly, adipocytes (3T3-L1 cell line) were differentiated under two experimental conditions: Ctrl (normal glucose concentration) and High-Glucose Medium (50 mM of glucose), which was validated using Oil Red O Staining and inflammatory markers gene expression by qPCR. Further, the adipocyte-conditioned medium was enriched by two types of titanium-related surfaces: Dual Acid-Etching (DAE) and Nano-Hydroxyapatite blasted surfaces (nHA) for up to 24 h. Finally, the endothelial cells (ECs) were exposed in those conditioned media under shear stress mimicking blood flow. Important genes related to angiogenesis were then evaluated by using RT-qPCR and Western blot.

RESULTS

Firstly, the high-adipogenicity model using 3T3-L1 adipocytes was validated presenting an increase in the oxidative stress markers, concomitantly with an increase in intracellular fat droplets, pro-inflammatory-related gene expressions, and also the ECM remodeling, as well as modulating mitogen-activated protein kinases (MAPKs). Additionally, Src was evaluated by Western blot, and its modulation can be related to EC survival signaling.

CONCLUSION

Our study provides an experimental model of high adipogenesis in vitro by establishing a pro-inflammatory environment and intracellular fat droplets. Additionally, the efficacy of this model to evaluate the EC response to titanium-enriched mediums under adipogenicity-related metabolic conditions was analyzed, revealing significant interference with EC performance. Altogether, these data gather valuable findings on understanding the reasons for the higher percentage of implant failures in obese individuals.

Ceramic Materials for Biomedical Applications: An Overview on Properties and Fabrication Processes

A growing interest in creating advanced biomaterials with specific physical and chemical properties is currently being observed. These high-standard materials must be capable to integrate into biological environments such as the oral cavity or other anatomical regions in the human body. Given these requirements, ceramic biomaterials offer a feasible solution in terms of mechanical strength, biological functionality, and biocompatibility. In this review, the fundamental physical, chemical, and mechanical properties of the main ceramic biomaterials and ceramic nanocomposites are drawn, along with some primary related applications in biomedical fields, such as orthopedics, dentistry, and regenerative medicine. Furthermore, an in-depth focus on bone-tissue engineering and biomimetic ceramic scaffold design and fabrication is presented.

Novel hydrogels: are they poised to transform 3D cell-based assay systems in early drug discovery?

INTRODUCTION

Success in drug discovery remains unpredictable. However, more predictive and relevant disease models are becoming pivotal to demonstrating the clinical benefits of new drugs earlier in the lengthy drug discovery process. Novel hydrogel scaffolds are being developed to transform the relevance of such 3D cell-based in vitro assay systems.

AREAS COVERED

Most traditional hydrogels are still of unknown composition and suffer significant batch-to-batch variations, which lead to technical constraints. This article looks at how a new generation of novel synthetic hydrogels that are based on self-assembling peptides are poised to transform 3D cell-based assay systems by improving their relevance, reproducibility and scalability.

EXPERT OPINION

The emerging advantages of using these novel hydrogels for human 3D screening assays should enable the discovery of more cost-effective drugs, leading to improved patient benefits. Such a disruptive change could also reduce the considerable time lag from obtaining in vitro assay data to initiating clinical trials. There is now a sufficient body of data available in the literature to enable this ambition to become a reality by significantly improving the predictive validity of 3D cell-based assays in early drug discovery. Novel hydrogels are key to unlocking the full potential of these assay systems.

[Physiological reactions in the interface between cementless implants and bone]

BACKGROUND

Surgical treatment of patients with osteoarthritis of the hip and persisting symptoms under conservative therapy has become increasingly important against the background of an aging population.

OBJECTIVES

What are the physiological reactions in the interface between cementless implants and bone?

METHODS

The literature is reviewed, expert opinions and animal models are analyzed and discussed.

RESULTS

Surface coating of implants with hydroxyapatite or titanium can have positive effects on osteointegration. Additional local application of mediators might be beneficial for osteointegration in the future.

CONCLUSION

Early peri-implant bone healing directly after implantation and late remodeling of the bone-implant interface are essential for secondary implant stability.

An overview of translational research in bone graft biomaterials

Natural bone healing is often inadequate to treat fractures with critical size bone defects and massive bone loss. Immediate surgical interventions through bone grafts have been found to be essential on such occasions. Naturally harvested bone grafts, although are the preferred choice of the surgeons; they suffer from serious clinical limitations, including disease transmission, donor site morbidity, limited supply of graft etc. Synthetic bone grafts, on the other hand, offer a more clinically appealing approach to decode the pathways of bone repair through use of tissue engineered biomaterials. This article critically retrospects the translational research on various engineered biomaterials towards bringing transformative changes in orthopaedic healthcare. The first section of the article discusses about composition and ultrastructure of bone along with the global perspectives on statistical escalation of bone fracture surgeries requiring use of bone grafts. The next section reviews the types, benefits and challenges of various natural and synthetic bone grafts. An overview of clinically relevant biomaterials from traditionally used metallic, bioceramic, and biopolymeric biomaterials to new generation composites have been summarised. Finally, this narrative review concludes with the discussion on the emerging trends and future perspectives of the promising bone grafts.

Infection-responsive long-term antibacterial bone plates for open fracture therapy

The infections in open fracture induce high morbidity worldwide. Thus, developing efficient anti-infective orthopedic devices is of great significance. In this work, we designed a kind of infection-responsive long-term antibacterial bone plates. Through a facile and flexible volatilization method, a multi-aldehyde polysaccharide derivative, oxidized sodium alginate, was crosslinked with multi-amino compounds, gentamycin and gelatin, to fabricate a uniform coating on Ti bone plates via Schiff base reaction, which was followed by a secondary crosslinking process by glutaraldehyde. The double-crosslinked coating was stable under normal condition, and could responsively release gentamycin by the triggering of the acidic microenvironment caused by bacterial metabolism, owning to the pH-responsiveness of imine structure. The thickness of the coating was ranging from 22.0 μm to 63.6 μm. The coated bone plates (Ti-GOGs) showed infection-triggered antibacterial properties (>99%) and high biocompatibility. After being soaked for five months, it still possessed efficient antibacterial ability, showing its sustainable antibacterial performance. The in vivo anti-infection ability was demonstrated by an animal model of infection after fracture fixation (IAFF). At the early stage of IAFF, Ti-GOGs could inhibit the bacterial infection (>99%). Subsequently, Ti-GOGs could promote recovery of fracture of IAFF. This work provides a convenient and universal strategy for fabrication of various antibacterial orthopedic devices, which is promising to prevent and treat IAFF.