Biphasic Calcium Phosphate Ceramics for Bone Regeneration and Tissue Engineering Applications

Osteoinductive potential of graphene and graphene oxide for bone tissue engineering: a comparative study

BACKGROUND

Bone defects, especially critical-size bone defects, and their repair pose a treatment challenge. Osteoinductive scaffolds have gained importance given their potential in bone tissue engineering applications.

METHODS

Polycaprolactone (PCL) scaffolds are used for their morphological, physical, cell-compatible and osteoinductive properties. The PCL scaffolds were prepared by electrospinning, and the surface was modified by layer-by-layer deposition using either graphene or graphene oxide.

RESULTS

Graphene oxide-coated PCL (PCL-GO) scaffolds showed a trend for enhanced physical properties such as fibre diameter, wettability and mechanical properties, yield strength, and tensile strength, compared to graphene-modified PCL scaffolds (PCL-GP). However, the surface roughness of PCL-GP scaffolds showed a higher trend than PCL-GO scaffolds. In vitro studies showed that both scaffolds were cell-compatible. Graphene oxide on PCL scaffold showed a trend for enhanced osteogenic differentiation of human umbilical cord Wharton's jelly-derived Mesenchymal Stem Cells without any differentiation media than graphene on PCL scaffolds after 21 days.

CONCLUSION

Graphene oxide showed a trend for higher mineralisation, but this trend is not statistically significant. Therefore, graphene and graphene oxide have the potential for bone regeneration and tissue engineering applications. Future in vivo studies and clinical trials are warranted to justify their ultimate clinical use.

3D printing technology and its combination with nanotechnology in bone tissue engineering

With the graying of the world's population, the morbidity of age-related chronic degenerative bone diseases, such as osteoporosis and osteoarthritis, is increasing yearly, leading to an increased risk of bone defects, while current treatment methods face many problems, such as shortage of grafts and an incomplete repair. Therefore, bone tissue engineering offers an alternative solution for regenerating and repairing bone tissues by constructing bioactive scaffolds with porous structures that provide mechanical support to damaged bone tissue while promoting angiogenesis and cell adhesion, proliferation, and activity. 3D printing technology has become the primary scaffold manufacturing method due to its ability to precisely control the internal pore structure and complex spatial shape of bone scaffolds. In contrast, the fast development of nanotechnology has provided more possibilities for the internal structure and biological function of scaffolds. This review focuses on the application of 3D printing technology in bone tissue engineering and nanotechnology in the field of bone tissue regeneration and repair, and explores the prospects for the integration of the two technologies.

Evaluation of Time-Dependent Corrosion Inhibition Rate for f-MWCNT-BCP Composite Coatings on 316L Stainless Steel in Simulated Body Fluid for Orthopedic Implantation

A well-developed-multiwall carbon nanotube (f-MWCNT)/biphasic calcium phosphate (BCP) composites were synthesized using ultrasonication method for orthopedic implantation applications. The formation of composites and its phase was confirmed by using X-ray diffraction. The presence of various functional groups was identified by using Fourier transform infra-red (FT-IR) spectroscopy. The presence of f-MWCNT was confirmed by Raman spectroscopy. High-resolution transmission electron microscopy (HR-TEM) analysis revealed that BCP units were bound by the surface of f-MWCNTs. The synthesized composites were coated on medical grade 316L stainless steel substrates using electro deposition technique. To determine its corrosion resistance characteristics, the developed substrates were exposed to a simulated bodily fluid (SBF) solution for 0, 4, and 7 days. These results strongly suggest that the coated composites can be utilized for bone tissue repair.

Shape Memory Effect of Four-Dimensional Printed Polylactic Acid-Based Scaffold with Nature-Inspired Structure

The four-dimensional (4D) printing is an evolving technology that has immense scope in various fields of science and technology owing to ever-challenging needs of human. It is an innovative upgradation of 3D printing procedure, which instills smart capabilities into materials such that they respond to external stimulus. This article aims to investigate the feasibility of 4D printing of polylactic acid (PLA)-based composite scaffolds fabricated by incorporating four different nature-inspired architectures (honeycomb, giant water lily, spiderweb, and nautilus shell). The composites were developed by adding 1, 3, and 5 wt.% of Calcium Phosphate (CaP) into PLA. Various thermomechanical tests were accomplished to evaluate the properties of developed material. Furthermore, the shape memory characteristics of these scaffolds were examined using thermally controlled conditions. The characterization tests displayed favorable outcomes in terms of thermal stability and hydrophilic nature of the PLA and PLA/CaP composite materials. It was found that the honeycomb structure showed the best shape memory and mechanical behavior among the four designs. Furthermore, the introduction of CaP was found to enhance mechanical strength and shape memory property, whereas the surface integrity was adversely affected. This study can play a vital role in developing self-fitting high-shape recovery biomedical scaffolds for bone-repair applications.

Investigation on the physical properties and biocompatibility of zirconia-alumina-silicate@diopside composite materials and its in vivo toxicity study in embryonic zebrafish

Bioceramic materials have a wide range of applications in the biomedical field, such as in the repair of bone defects and dental surgery. Silicate-based bioceramics have attracted biomedical researchers' interest due to their bioactivity and biodegradability. In this study, extended the scope of ZAS utilization in bone tissue engineering by introducing calcium-magnesium-silicate (diopside, CMS) as an interface material aim to develop a machinable bioceramic composite (ZASCMS) by the sol-gel method. The physicochemical characterization, in vitro biological properties and in vivo zebrafish cytotoxicity study of ZAS-based composites as a function of CMS contents, 0, 25, 50, 75 and 100 wt%, were performed. Results showed that the as-prepared ZASCMS possessed porous architecture with well-interconnected pore structure. Results also revealed that the mechanical properties of ZASCMS composite materials were gradually improved with increasing CMS contents. The ZASCMS composites with more than 50 wt% CMS had the highest compressive strength and modulus of 6.78 ± 0.62 MPa and 340.10 ± 16.81 MPa, respectively. Regarding in vitro bioactivities, the composite scaffolds were found to stimulate osteoblast-like UMR-106 cell adhesion, growth, and proliferation. The antibacterial activity of the ZASCMS composite scaffolds was tested against Staphylococcus epidermidis (S. epidermidis) and Escherichia coli (E. coli) also exhibited an antibacterial property. Furthermore, the in vivo studies using embryonic zebrafish were exposed to as-prepared particles (0-500 μg mL-1) and showed that the synthesized ZAS, CMS and ZASCMS composite particles were non-toxic based on the evaluation of survivability, hatching rate and embryonic morphology. In conclusions, our results indicated that the synthesized composite exhibited their biological properties and antibacterial activity, which could well be a promising material with high potential to be applied in orthopaedic and dental tissue engineering.

Autologous blood clots: a natural biomaterial for wound healing

Repair after injury in mammalian tissue involves a complex cascade of events, with the formation of local blood clots being essential for the initial phases of wound healing. As a result, emerging research has sought to harness this biological activity to generate a pro-regenerative biomaterial to speed up wound healing. According to recent studies, “blood clots” created in vitro can be employed as an orthobiologic-based biomaterial for promoting tissue regeneration. Even though such research is still in its early phases, numerous studies show encouraging results that suggest autologous blood clots created in vitro might be a valuable treatment for soft tissue and orthopedic injuries. In this article, we discuss the function of blood clots in physiologic healing, how exogenous material can affect this process, and the most recent clinical research that proposes the use of autologous blood clots as a therapeutically beneficial biomaterial.

Use of Poly Lactic-co-glycolic Acid Nano and Micro Particles in the Delivery of Drugs Modulating Different Phases of Inflammation

Chronic inflammation contributes to the pathogenesis of many diseases, including apparently unrelated conditions such as metabolic disorders, cardiovascular diseases, neurodegenerative diseases, osteoporosis, and tumors, but the use of conventional anti-inflammatory drugs to treat these diseases is generally not very effective given their adverse effects. In addition, some alternative anti-inflammatory medications, such as many natural compounds, have scarce solubility and stability, which are associated with low bioavailability. Therefore, encapsulation within nanoparticles (NPs) may represent an effective strategy to enhance the pharmacological properties of these bioactive molecules, and poly lactic-co-glycolic acid (PLGA) NPs have been widely used because of their high biocompatibility and biodegradability and possibility to finely tune erosion time, hydrophilic/hydrophobic nature, and mechanical properties by acting on the polymer's composition and preparation technique. Many studies have been focused on the use of PLGA-NPs to deliver immunosuppressive treatments for autoimmune and allergic diseases or to elicit protective immune responses, such as in vaccination and cancer immunotherapy. By contrast, this review is focused on the use of PLGA NPs in preclinical in vivo models of other diseases in which a key role is played by chronic inflammation or unbalance between the protective and reparative phases of inflammation, with a particular focus on intestinal bowel disease; cardiovascular, neurodegenerative, osteoarticular, and ocular diseases; and wound healing.

Inorganic/organic combination: Inorganic particles/polymer composites for tissue engineering applications

Biomaterials have ushered the field of tissue engineering and regeneration into a new era with the development of advanced composites. Among these, the composites of inorganic materials with organic polymers present unique structural and biochemical properties equivalent to naturally occurring hybrid systems such as bones, and thus are highly desired. The last decade has witnessed a steady increase in research on such systems with the focus being on mimicking the peculiar properties of inorganic/organic combination composites in nature. In this review, we discuss the recent progress on the use of inorganic particle/polymer composites for tissue engineering and regenerative medicine. We have elaborated the advantages of inorganic particle/polymer composites over their organic particle-based composite counterparts. As the inorganic particles play a crucial role in defining the features and regenerative capacity of such composites, the review puts a special emphasis on the various types of inorganic particles used in inorganic particle/polymer composites. The inorganic particles that are covered in this review are categorised into two broad types (1) solid (e.g., calcium phosphate, hydroxyapatite, etc.) and (2) porous particles (e.g., mesoporous silica, porous silicon etc.), which are elaborated in detail with recent examples. The review also covers other new types of inorganic material (e.g., 2D inorganic materials, clays, etc.) based polymer composites for tissue engineering applications. Lastly, we provide our expert analysis and opinion of the field focusing on the limitations of the currently used inorganic/organic combination composites and the immense potential of new generation of composites that are in development.

Advanced applications of strontium-containing biomaterials in bone tissue engineering

Strontium (Sr) and strontium ranelate (SR) are commonly used therapeutic drugs for patients suffering from osteoporosis. Researches have showed that Sr can significantly improve the biological activity and physicochemical properties of materials in vitro and in vivo. Therefore, a large number of strontium containing biomaterials have been developed for repairing bone defects and promoting osseointegration. In this review, we provide a comprehensive overview of Sr-containing biomaterials along with the current state of their clinical use. For this purpose, the different types of biomaterials including calcium phosphate, bioactive glass, and polymers are discussed and provided future outlook on the fabrication of the next-generation multifunctional and smart biomaterials.

Properties of Coatings Based on Calcium Phosphate and Their Effect on Cytocompatibility and Bioactivity of Titanium Nickelide

Coatings based on calcium phosphate with thicknesses of 0.5 and 2 μm were obtained by high-frequency magnetron sputtering on NiTi substrates in an argon atmosphere. The coating was characterized using X-ray diffraction, scanning electron microscopy, atomic force microscopy, and in vitro cytocompatibility and bioactivity studies. A biphasic coating of tricalcium phosphate (Ca₃(PO₄)₂) and hydroxyapatite (Ca₁₀(PO₄)₆(OH)₂) with a 100% degree of crystallinity was formed on the surface. The layer enriched in calcium, phosphorus, and oxygen was observed using scanning electron microscopy and energy-dispersive X-ray spectroscopy. Scanning electron microscopy showed that the surface structure is homogeneous without visible defects. The 2 µm thick coating obtained by sputtering with a deposition time of 4 h and a deposition rate of 0.43 µm/h is uniform, contains the highest amount of the calcium phosphate phase, and is most suitable for the faster growth of cells and accelerated formation of apatite layers. Samples with calcium phosphate coatings do not cause hemolysis and have a low cytotoxicity index. The results of immersion in a solution simulating body fluid show that NiTi with the biphasic coating promotes apatite growth, which is beneficial for biological activity.

The Impact of Hydroxyapatite Sintering Temperature on Its Microstructural, Mechanical, and Biological Properties

Hydroxyapatite (HA), the principal mineral of bone tissue, can be fabricated as an artificial calcium phosphate (CaP) ceramic and potentially used as bioceramic material for bone defect treatment. Nevertheless, the production method (including the applied sintering temperature) of synthetic hydroxyapatite directly affects its basic properties, such as its microstructure, mechanical parameters, bioabsorbability, and osteoconductivity, and in turn influences its biomedical potential as an implantable biomaterial. The wide application of HA in regenerative medicine makes it necessary to explain the validity of the selection of the sintering temperature. The main emphasis of this article is on the description and summarization of the key features of HA depending on the applied sintering temperature during the synthesis process. The review is mainly focused on the dependence between the HA sintering temperature and its microstructural features, mechanical properties, biodegradability/bioabsorbability, bioactivity, and biocompatibility.

Development of a novel regenerative therapy for malignant bone tumors using an autograft containing tumor inactivated by high hydrostatic pressurization (HHP)

Surgical resection of malignant bone tumors leads to significant defects in the normal surrounding tissues that should be reconstructed to avoid amputation. Our research aimed to inactivate osteosarcoma (OS)-affected bone to obtain autologous bone grafts for bone defect reconstruction using a novel therapy called high hydrostatic pressurization (HHP) therapy. The key points are complete tumor death and preservation of the non-denatured native extracellular matrix (ECM) and bone tissue by HHP. Previously, we found that HHP at 200 MPa for 10 min can completely inactivate cells in normal skin and skin tumors, including malignant melanoma and squamous cell carcinoma while maintaining their original biochemical properties and biological components. Based on our previous research, this study used HHP at 200 MPa for 10 min to eradicate OS. We prepared an OS cell line (LM8), pressurized it at 200 MPa for 10 min, and confirmed its inactivation through morphological observation, WST-8 assay, and live/dead assay. We then injected OS cells with or without HHP into the bone marrow of the murine tibia, after which we implanted tumor tissues with or without HHP into the anterior surface of the tibia. After HHP, OS cells did not proliferate and were assessed using a live/dead assay. The pressurized cells and tumors did not grow after implantation. The pressurized bone was well prepared as tumor-free autologous bone tissues, resulting in the complete eradication of OS. This straightforward and short-pressing treatment was proven to process the tumor-affected bone to make a transplantable and tumor-free autologous bone substitute.

Brushite mineralised Scots pine (Pinus sylvestris L.) sapwood - revealing mineral crystallization within a wood matrix by in situ XRD

Dicalcium phosphate dihydrate (CaHPO4·2H2O, DCPD, brushite) crystals were synthesised within Scots pine sapwood via a wet-chemistry route from aqueous solutions of Ca(CH3COO)2 and NH4H2PO4 salts. SEM/EDS analysis was used to assess the saturation of the wood cell lumina and cell wall as well as morphological features and elemental composition of the co-precipitated mineral. Brushite mineral crystallization and crystallite growth within the wood matrix was studied by in situ XRD. The chemical composition of the mineral before and after the dissolution was evaluated using FTIR spectroscopy. The overall impact of brushite on the thermal behaviour of wood was studied by TGA/DSC and TGA/DTA/MS analysis under oxidative and pyrolytic conditions. Bending and compression strength perpendicular and parallel to the fibre directions as well as bending strengths in longitudinal and transverse directions of the mineralised wood were also evaluated. Results indicate the viability of the wet-chemistry processing route for wood reinforcement with crystalline calcium phosphate (CaP)-based minerals, and imply a potential in producing hybrid bio-based materials that could be attractive in the construction sector as an environmentally friendly building material.

Biosynthesised Silver Nanoparticles Loading onto Biphasic Calcium Phosphate for Antibacterial and Bone Tissue Engineering Applications

Biphasic calcium phosphate (BCP) serves as one of the substitutes for bone as it consists of an intimate mixture of beta-tricalcium phosphate (β-TCP) and hydroxyapatite (HAP) in different ratios. BCP, because of its inbuilt properties such as osteoconductivity, biocompatibility, and biostability in several clinical models serves as a bone substituent for orthopedic applications. Therefore, the present study aimed to assess the effectiveness of silver (Ag) nanoparticles (NPs) combined with BCP composites for the orthopedic sector of bone tissue regeneration and growth. In this regard, we first synthesized Ag-BCP microclusters by the double-emulsion method and then characterized the composite for various physicochemical properties, including the crystallinity and crystal structure, bonding and functionality, porosity, morphology, surface charges, topography, and thermal stability. In addition, the antibacterial activity of Ag-BCP was tested against gram-positive and gram-negative microorganisms such as Staphylococcus aureus, Candida albicans, and Escherichia coli. Finally, the cytocompatibility of Ag-BCP was confirmed against the fibroblast cells in vitro.

Mechanical Properties and In Vitro Biocompatibility of Hybrid Polymer-HA/BAG Ceramic Dental Materials

The aim of this study is to prepare hybrid polymer-ceramic dental materials for chairside computer-aided design/computer-aided manufacturing (CAD/CAM) applications. The hybrid polymer-ceramic materials were fabricated via infiltrating polymerizable monomer mixtures into sintered hydroxyapatite/bioactive glass (HA/BAG) ceramic blocks and thermo-curing. The microstructure was observed by scanning electron microscopy and an energy-dispersive spectrometer. The phase structure was analyzed by X-ray diffraction. The composition ratio was analyzed by a thermogravimetric analyzer. The hardness was measured by a Vickers hardness tester. The flexural strength, flexural modulus, and compressive strength were measured and calculated by a universal testing machine. The growth of human gingival fibroblasts was evaluated by a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) colorimetric assay and immunofluorescence staining. The results showed that the sintering temperature and BAG content affected the mechanical properties of the hybrid polymer-ceramic materials. The X-ray diffraction analysis showed that high-temperature sintering promoted the partial conversion of HA to β-tricalcium phosphate. The values of the hardness, flexural strength, flexural modulus, and compressive strength of all the hybrid polymer-ceramic materials were 0.89-3.51 GPa, 57.61-118.05 MPa, 20.26-39.77 GPa, and 60.36-390.46 MPa, respectively. The mechanical properties of the hybrid polymer-ceramic materials were similar to natural teeth. As a trade-off between flexural strength and hardness, hybrid polymer-ceramic material with 20 wt.% BAG sintered at 1000 °C was the best material. In vitro experiments confirmed the biocompatibility of the hybrid polymer-ceramic material. Therefore, the hybrid polymer-ceramic material is expected to become a new type of dental restoration material.

A novel synthesis method and properties of calcium-deficient hydroxyapatite/α-TCP biphasic calcium phosphate

Biphasic calcium phosphate (BCP) is an important research field based on calcium phosphate biomaterials. In this paper, a new synthesis method of CDHA/α-TCP BCP was studied. By controlling the addition amount of citric acid, the relative contents of CDHA and α-TCP in the BCP were controlled. BCP bone cement was prepared with different proportions of BCP as raw materials. The BCP bone cement was characterized by XRD and SEM, and evaluated by measuring setting time, compressive strength, SBF immersion, and colorimetric CCK-8 assay. The results showed that the increase of CDHA content can lead to the reduction of the setting time of bone cement and delay the degradation rate of BCP bone cement.

Synthesis and Characterization of Calcium Phosphate Materials Derived from Eggshells from Different Poultry with and without the Eggshell Membrane

Calcium phosphate materials such as hydroxyapatite (HA) or tricalcium phosphate (β-TCP) are highly attractive due to their multitude of applications in bone replacement as well as their environmental and ecological credentials. In this research, quail, hen, duck, and pigeon eggshells were used as a calcium source to obtain calcium phosphate materials via the environmentally friendly wet synthesis. Using the eggshells with the organic membrane, the biphasic calcium phosphate materials composed mainly of HA were obtained. The second mineral phase was β-TCP in the case of using quail, hen, and pigeon eggshells and octacalcium phosphate (OCP) in the case of duck eggshells. The HA content in the obtained materials depended on the amount of membrane in the eggshells and decreased in the order of pigeon, duck, hen, and quail eggshells. The eggshell membrane removal from the eggshells caused the reduced content of HA and the presence of the more soluble β-TCP or OCP phase in the obtained materials. The calcium ions release profile in the PBS buffer indicates the potential biomedical application of these materials.

Highly Porous Composite Scaffolds Endowed with Antibacterial Activity for Multifunctional Grafts in Bone Repair

The present study deals with the development of multifunctional biphasic calcium phosphate (BCP) scaffolds coated with biopolymers—poly(ε-caprolactone) (PCL) or poly(ester urea) (PEU)—loaded with an antibiotic drug, Rifampicin (RFP). The amounts of RFP incorporated into the PCL and PEU-coated scaffolds were 0.55 ± 0.04 and 0.45 ± 0.02 wt%, respectively. The in vitro drug release profiles in phosphate buffered saline over 6 days were characterized by a burst release within the first 8h, followed by a sustained release. The Korsmeyer–Peppas model showed that RFP release was controlled by polymer-specific non-Fickian diffusion. A faster burst release (67.33 ± 1.48%) was observed for the PCL-coated samples, in comparison to that measured (47.23 ± 0.31%) for the PEU-coated samples. The growth inhibitory activity against Escherichia coli and Staphylococcus aureus was evaluated. Although the RFP-loaded scaffolds were effective in reducing bacterial growth for both strains, their effectiveness depends on the particular bacterial strain, as well as on the type of polymer coating, since it rules the drug release behavior. The low antibacterial activity demonstrated by the BCP-PEU-RFP scaffold against E. coli could be a consequence of the lower amount of RFP that is released from this scaffold, when compared with BCP-PCL-RFP. In vitro studies showed excellent cytocompatibility, adherence, and proliferation of human mesenchymal stem cells on the BCP-PEU-RFP scaffold surface. The fabricated highly porous scaffolds that could act as an antibiotic delivery system have great potential for applications in bone regeneration and tissue engineering, while preventing bacterial infections.

FDA-approved bone grafts and bone graft substitute devices in bone regeneration

To induce bone regeneration there is a complex cascade of growth factors. Growth factors such as recombinant BMP-2, BMP-7, and PDGF are FDA-approved therapies in bone regeneration. Although, BMP shows promising results as being an alternative to autograft, it also has its own downfalls. BMP-2 has many adverse effects such as inflammatory complications such as massive soft-tissue swelling that can compromise a patient's airway, ectopic bone formation, and tumor formation. BMP-2 may also be advantageous for patients not willing to give up smoking as it shows bone regeneration success with smokers. BMP-7 is no longer an option for bone regeneration as it has withdrawn off the market. PDGF-BB grafts in studies have shown PDGF had similar fusion rates to autologous grafts and fewer adverse effects. There is also an FDA-approved bioactive molecule for bone regeneration, a peptide P-15. P-15 was found to be effective, safe, and have similar outcomes to autograft at 2 years post-op for cervical radiculopathy due to cervical degenerative disc disease. Growth factors and bioactive molecules show some promising results in bone regeneration, although more research is needed to avoid their adverse effects and learn about the long-term effects of these therapies. There is a need of a bone regeneration method of similar quality of an autograft that is osteoconductive, osteoinductive, and osteogenic. This review covers all FDA-approved bone regeneration therapies such as the "gold standard" autografts, allografts, synthetic bone grafts, and the newer growth factors/bioactive molecules. It also covers international bone grafts not yet approved in the United States and upcoming technologies in bone grafts.

Biphasic calcium phosphate microspheres in biomedical applications

Biphasic calcium phosphate (BCP) microspheres benefit from, on the one hand, a desired shape offering improved flowability and injectability to fill complex-shaped bone defects and on the other hand, a promising combination of bioresorbability, bioactivity, biocompatibility, osteogenesis and angiogenesis. The biofunctional characteristics of BCP microspheres are mainly controlled by varying the constitute phase ratio, porosity and surface roughness, which are all determined by the used production route and its parameters. In this paper, the manufacturing methods, properties and applications of BCP microspheres are reviewed and concluded in terms of future work directions to develop their uses in biomedicine, particularly in bone tissue regenerative and delivery applications.

Clinical Applications of Cell-Scaffold Constructs for Bone Regeneration Therapy

Bone tissue engineering (BTE) is a process of combining live osteoblast progenitors with a biocompatible scaffold to produce a biological substitute that can integrate into host bone tissue and recover its function. Mesenchymal stem cells (MSCs) are the most researched post-natal stem cells because they have self-renewal properties and a multi-differentiation capacity that can give rise to various cell lineages, including osteoblasts. BTE technology utilizes a combination of MSCs and biodegradable scaffold material, which provides a suitable environment for functional bone recovery and has been developed as a therapeutic approach to bone regeneration. Although prior clinical trials of BTE approaches have shown promising results, the regeneration of large bone defects is still an unmet medical need in patients that have suffered a significant loss of bone function. In this present review, we discuss the osteogenic potential of MSCs in bone tissue engineering and propose the use of immature osteoblasts, which can differentiate into osteoblasts upon transplantation, as an alternative cell source for regeneration in large bone defects.

Bioactive Calcium Phosphate-Based Composites for Bone Regeneration

Calcium phosphates (CaPs) are widely accepted biomaterials able to promote the regeneration of bone tissue. However, the regeneration of critical-sized bone defects has been considered challenging, and the development of bioceramics exhibiting enhanced bioactivity, bioresorbability and mechanical performance is highly demanded. In this respect, the tuning of their chemical composition, crystal size and morphology have been the matter of intense research in the last decades, including the preparation of composites. The development of effective bioceramic composite scaffolds relies on effective manufacturing techniques able to control the final multi-scale porosity of the devices, relevant to ensure osteointegration and bio-competent mechanical performance. In this context, the present work provides an overview about the reported strategies to develop and optimize bioceramics, while also highlighting future perspectives in the development of bioactive ceramic composites for bone tissue regeneration.

The effectiveness of hydroxyapatite-beta tricalcium phosphate incorporated into stem cells from human exfoliated deciduous teeth for reconstruction of rat calvarial bone defects

OBJECTIVE

To investigate the effects of stem cells from the pulp of human exfoliated deciduous teeth (SHED) on biphasic calcium phosphate granules (BCP) to repair rat calvarial defects as compared to autogenous bone grafting.

MATERIALS AND METHODS

A defect with a 6-mm diameter was produced on the calvaria of 50 rats. BCP granules were incorporated into SHED cultures grown for 7 days in conventional (CM) or osteogenic (OM) culture media. The animals were allocated into 5 groups of 10, namely: clot, autogenous bone, BCP, BCP+SHED in CM (BCP-CM), and BCP+SHED in OM (BCP-OM). The presence of newly formed bone and residual biomaterial particles was assessed by histometric analysis after 4 and 8 weeks.

RESULTS

The autogenous group showed the largest newly formed bone area at week 8 and in the entire experimental period, with a significant difference in relation to the other groups (P < 0.05). At week 8, BCP-CM and BCP-OM groups showed homogeneous new bone formation (P = 0.13). When considering the entire experimental period, the BCP group had the highest percentage of residual particle area, with no significant difference from the BCP-CM group (P = 0.06) and with a significant difference from the BCP-OM group (P = 0.01). BCP-CM and BCP-OM groups were homogeneous throughout the experimental period (P = 0.59).

CONCLUSIONS

BCP incorporated into SHED cultures showed promising outcomes, albeit less pronounced than autogenous grafting, for the repair of rat calvarial defects.

CLINICAL RELEVANCE

BCP incorporated into SHED cultures showed to be an alternative in view of the disadvantages to obtain autogenous bone graft.

Three dimensional printed nanostructure biomaterials for bone tissue engineering

The suffering from organ dysfunction due to damaged or diseased tissue/bone has been globally on the rise. Current treatment strategies for non-union bone defects include: the use of autografts, allografts, synthetic grafts and free vascularized fibular grafts. Bone tissue engineering has emerged as an alternative for fracture repair to satisfy the current unmet need of bone grafts and to alleviate the problems associated with autografts and allografts. The technology offers the possibility to induce new functional bone regeneration using synergistic combination of functional biomaterials (scaffolds), cells, and growth factors. Bone scaffolds are typically made of porous biodegradable materials that provide the mechanical support during repair and regeneration of damaged or diseased bone. Significant progress has been made towards scaffold materials for structural support, desired osteogenesis and angiogenesis abilities. Thanks for innovative scaffolds fabrication technologies, bioresorbable scaffolds with controlled porosity and tailored properties are possible today. Despite the presence of different bone scaffold fabrication methods, pore size, shape and interconnectivity have not yet been fully controlled in most of the methods. Moreover, scaffolds with tailored porosity for specific defects are still difficult to manufacture. Nevertheless, such scaffolds can be designed and fabricated using three dimensional (3D) printing approaches. 3D printing technology, as an advanced tissue scaffold fabrication method, offers the opportunity to produce complex geometries with distinct advantages. The technology has been used for the production of various types of bodily constructs such as blood vessels, vascular networks, bones, cartilages, exoskeletons, eyeglasses, cell cultures, tissues, organs and novel drug delivery devices. This review focuses on 3D printed scaffolds and their application in bone repair and regeneration. In addition, different classes of biomaterials commonly employed for the fabrication of 3D nano scaffolds for bone tissue engineering application so far are briefly discussed.

Novel composite scaffolds based on alginate and Mg-doped calcium phosphate fillers: Enhanced hydroxyapatite formation under biomimetic conditions

In the present study, we synthesized hydroxyapatite (HAP) powders followed by the production of alginate based macroporous scaffolds with the aim to imitate the natural bone structure. HAP powders were synthesized by using a hydrothermal method, and after calcination, dominant phases in the powders, undoped and doped with Mg²⁺ were HAP and β-tricalcium phosphate, respectively. Upon mixing with Na-alginate, followed by gelation and freeze-dying, highly macroporous composite scaffolds were obtained with open and connected pores and uniformly dispersed mineral phase as determined by scanning electron microscopy. Mechanical properties of the scaffolds were influenced by the composition of calcium phosphate fillers being improved as Ca²⁺ concentration increased while Mg²⁺ concentration decreased. HAP formation within all scaffolds was investigated in simulated body fluid (SBF) during 28 days under static conditions while the best candidate (Mg substituted HAP filler, precursor solution with [Ca + Mg]/P molar ratio of 1.52) was investigated under more physiological conditions in a biomimetic perfusion bioreactor. The continuous SBF flow (superficial velocity of 400 μm/s) induced the formation of abundant HAP crystals throughout the scaffolds leading to improved mechanical properties to some extent as compared to the initial scaffolds. These findings indicated potentials of novel biomimetic scaffolds for use in bone tissue engineering.

Bone Regeneration Using PEVAV/β-Tricalcium Phosphate Composite Scaffolds in Standardized Calvarial Defects: Micro-Computed Tomographic Experiment in Rats

Bone regeneration using beta-tricalcium phosphate (β-TCP) can be practiced using a biocomposite scaffold. Poly(ethylene-co-vinylalcohol)/poly(δ-valerolactone)/β-tricalcium phosphate (PEVAV/β-TCP) composite scaffolds showed promising in vitro results. This study evaluated the bone regenerative potential of PEVAV/β-TCP biocomposite scaffolds in standardized calvarial defects in a rat model over 4 and 10 weeks. Bilateral calvarial defects (5 mm in diameter and about 1.5 mm thick, equivalent to the thickness of the calvaria) were created in 40 male Wistar albino rats. The defects were grafted with either commercially available β-TCP (positive control), PEVAV/β-TCP 70, or PEVAV/β-TCP 50, or left empty (negative control), depending on the group to which the animal was randomly assigned, to be covered before flap closure with resorbable collagen membrane (RCM). At 4 and 10 weeks post-surgery, the collected rat calvaria were evaluated using micro computed tomography (micro-CT) analysis, to assess the newly formed bone volume (NFBV), newly formed bone mineral density (NFBMD), and remaining graft volume (RGV). The results showed that calvarial defects grafted with the PEVAV/β-TCP biocomposite exhibited higher NFBV than did control defects, both at 4 and 10 weeks post-surgery. Furthermore, calvarial defects grafted with PEVAV/β-TCP 70 showed the highest NFBV among all grafting conditions, with a statistically significant difference recorded at 10 weeks post-surgery. The PEVAV/β-TCP composite scaffold showed potentiality for the regeneration of critical-sized calvarial bone defects in a rat model.

A network analysis of angiogenesis/osteogenesis-related growth factors in bone tissue engineering based on in-vitro and in-vivo data: A systems biology approach

The principal purpose of tissue engineering is to stimulate the injured or unhealthy tissues to revive their primary function through the simultaneous use of chemical agents, cells, and biocompatible materials. Still, choosing the appropriate protein as a growth factor (GF) for tissue engineering is vital to fabricate artificial tissues and accelerate the regeneration procedure. In this study, the angiogenesis and osteogenesis-related proteins' interactions are studied using their related network. Three major biological processes, including osteogenesis, angiogenesis, and angiogenesis regulation, were investigated by creating a protein-protein interaction (PPI) network (45 nodes and 237 edges) of bone regeneration efficient proteins. Furthermore, a gene ontology and a centrality analysis were performed to identify essential proteins within a network. The higher degree in this network leads to higher interactions between proteins and causes a considerable effect. The most highly connected proteins in the PPI network are the most remarkable for their employment. The results of this study showed that three significant proteins including prostaglandin endoperoxide synthase 2 (PTGS2), TEK receptor tyrosine kinase (TEK), and fibroblast growth factor 18 (FGF18) were involved simultaneously in osteogenesis, angiogenesis, and their positive regulatory. Regarding the available literature, the results of this study confirmed that PTGS2 and FGF18 could be used as a GF in bone tissue engineering (BTE) applications to promote angiogenesis and osteogenesis. Nevertheless, TEK was not used in BTE applications until now and should be considered in future works to be examined in-vitro and in-vivo.

Restoring Facial Contour and Harmony Using Biphasic Calcium Phosphate Bioceramics

Background:

The restoration of facial contour is one of the pillars for the treatment of facial disharmonies and deformities. Fat transplantation and fillers have been widely used to improve the positioning of soft tissues, which are, however, directly related to the conditions and positioning of the underlying bone tissue. Recontouring of the latter has been performed using osteotomies and several types of bone grafts or biomaterials, as inlay or onlay grafts/implants. Here, biphasic calcium phosphate bioceramics were applied in a series of cases, their long-term results are shown, and their advantages, discussed.

Methods:

A retrospective analysis of 20 patients, who were subjected to facial recontour with onlay implants of biphasic calcium phosphate bioceramics, is reported. Patients were seeking to improve facial harmony due to congenital deformities, trauma, tumor resection or signs of aging, and were followed for up to 16 years. Clinical data, radiographic images, and information regarding pain and other findings were retrieved from medical records.

Results:

Six patients were men and 14 were women. Their ages ranged from 19 to 64 years. Bioceramics were implanted under the periosteum through external or intraoral incisions. Some patients underwent combined procedures, such as rhinoplasties or facial lifting. None of the patients presented exacerbated inflammation or pain. One of them had infection in the intraoral incision, which was resolved with medication.

Conclusion:

All patients had improved facial contours following the use of bio-ceramics to augment bone tissue and presented stable results at long-term evaluation.

The impact of the size of bone substitute granules on macrophage and osteoblast behaviors in vitro

Objective

Bone substitute (BS) size might influence the clinical outcomes of guided bone regeneration (GBR) procedures. The aim of the present study was to investigate the influence of BS size on macrophage (Mφ) and osteoblast behaviors in vitro.

Materials and methods

Two different granule sizes (S and M/L) were assessed for four different commercial BSs: deproteinized bovine bone mineral (DBBM), biphasic calcium phosphate type 1 (BCP1), BCP type 2 (BCP2), and carbonate apatite (CO₃Ap). The BSs were compared for their impacts on the cell viability and differentiation potential of THP-1-derived Mφs and human osteoblast-like Saos-2 cells.

Results

The smaller granules showed higher material volumes and surface areas than the larger granules. Significantly higher viability of Mφs and Saos-2 cells was observed with the DBBM_L-size granules than with the DBBM_S-size granules. Gene expression experiments in Mφs revealed few differences between the two sizes of each BS, although higher CD206 mRNA levels were observed in the BCP1_L group and the CO₃Ap_M group than in the respective S-size groups on day 1. Only DBBM showed significantly higher mRNA levels of osteogenic markers, including Runx2 and osteocalcin, in Saos-2 cells in the S-size group than in the L-size group.

Conclusions

The S-size and L-size DBBM granules exhibited clear differences in cell outcomes: cells cultured on the S-size granules exhibited lower cell viability, higher osteopromotive ability, and no noticeable Mφ polarization changes.

Clinical relevance

A smaller granule size might be advantageous due to greater bone regeneration potential in the use of DBBM granules to treat defects.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-03804-z.

Poly(lactic-co-glycolic acid)-based composite bone-substitute materials

Research and development of the ideal artificial bone-substitute materials to replace autologous and allogeneic bones for repairing bone defects is still a challenge in clinical orthopedics. Recently, poly(lactic-co-glycolic acid) (PLGA)-based artificial bone-substitute materials are attracting increasing attention as the benefit of their suitable biocompatibility, degradability, mechanical properties, and capabilities to promote bone regeneration. In this article, we comprehensively review the artificial bone-substitute materials made from PLGA or the composites of PLGA and other organic and inorganic substances, elaborate on their applications for bone regeneration with or without bioactive factors, and prospect the challenges and opportunities in clinical bone regeneration.

Low-temperature extrusion-based 3D printing of icariin-laden scaffolds for osteogenesis enrichment

Despite the accessibility to porous architectures through various biofabrication approaches for tissue engineering, incorporating various active growth regulators within their matrices that act as biochemical cues is also an essential attribute for effective tissue growth. To address these facts, icariin (ICA)-encapsulated polymeric scaffolds are fabricated using a low-temperature extrusion-based three-dimensional (3D) printing technology for efficiently promoting osteogenesis. This approach not only resulted in the generation of porous architectures but also substantially maintained the bio-efficacy of the encapsulated ICA. Moreover, these composite scaffolds based on poly(ε-caprolactone) (PCL) and tricalcium phosphate (β-TCP) encapsulated with ICA (ITP scaffolds) are systematically characterized using various techniques before and after printing. Furthermore, various investigations relevant to biodegradability, biocompatibility, ICA release, and osteogenic ability of the ITP scaffolds are explored. The intact physiochemical properties of the materials, sustained release of ICA from the scaffolds, and high biosafety at various levels ranging from cellular to animal efficiently promoted the proliferation of mouse bone marrow mesenchymal stem cells (BMSCs) and their differentiation to osteoblasts. Together, the utilization of low-temperature extrusion approach provides a convenient and eco-friendly means of fabricating highly porous 3D architectures that supply the required growth regulators in their active form for tissue regeneration.

Tissue response to biphasic calcium phosphate covalently modified with either heparin or hyaluronic acid in a mouse subcutaneous implantation model

Biphasic calcium phosphate (BCP) materials are widely employed as bone substitute materials due to their resorption/degradation properties. Inflammation after implantation of such materials represents a prerequisite for bone tissue repair and regeneration but can be also problematic if it is not only transient and if it is followed by fibrosis and scarring. Here, we modified BCP covalently with hyaluronan (HA) and heparin (Hep), glycosaminoglycans that possess anti-inflammatory properties. Beside the characterization of particle surface properties, the focus was on in vivo tissue response after subcutaneous implantation in mice. Histological analysis revealed a decrease in signs of inflammatory response to BCP when modified with either HA or Hep. Reduced vascularization after 30 days was noticed when BCP was modified with either HA or Hep with greater cellularity in all examined time points. Compared to plain BCP, expression of endothelial-related genes Flt1 and Vcam1 was higher in BCP-HA and BCP-Hep group at day 30. Expression of osteogenesis-related genes Sp7 and Bglap after 30 days was the highest in BCP group, followed by BCP-Hep, while the lowest expression was in BCP-HA group which correlates with collagen amount. Hence, coating of BCP particles with HA seems to suppress inflammatory response together with formation of new bone-like tissue, while the presence of Hep delays the onset of inflammatory response but permits osteogenesis in this subcutaneous bone-forming model. Transferring the results of this study to other coated materials intended for biomedical application may also pave the way to reduction of inflammation after their implantation.

Cell Scaffolds for Bone Tissue Engineering

Currently, well-known surgical procedures for bone defects are classified into four types: (1) autogenous bone graft transplantation, (2) allogeneic bone graft transplantation, (3) xenogeneic bone graft transplantation, and (4) artificial bone graft transplantation. However, they are often risky procedures and related to postoperative complications. As an alternative, tissue engineering to regenerate new bone often involves the use of mesenchymal stem cells (MSCs), derived from bone marrow, adipose tissues, and so on, which are cultured into three-dimensional (3D) scaffolds to regenerate bone tissue by osteoinductive signaling. In this manuscript, we provide an overview of recent treatment of bone defects and the studies on the creation of cell scaffolds for bone regeneration. Bone regeneration from bone marrow-derived mesenchymal stem cells using silica nonwoven fabric by the authors' group were provided. Potential application and future direction of the present systems were also described.

Bone augmentation by replica-based bone formation

OBJECTIVE

The sources of iliac crest bone grafts are limited. Alternatives are evaluated due to the progress in biomaterial sciences. Synthetical hydroxyapatite (HA), ß-tricalcium phosphate (ß-TCP) or biphasic compounds, or even a mélange of HA and ß-TCP will replace bovine ceramics. The goal is maintenance of replica-based-bone formation (RBBF) for bone augmentation.

METHODS

2 female and 2 male patients between 41 and 73 years with 5 sinus elevations were evaluated. Sinus elevations with lateral fenestration, trapezoidal-muco-periosteal flaps and filling with micro-chambered beads (1.5 mm) was performed. A porcine-collagenous membrane and the refixated flap covered the defect. A biopsy program over 20 months was confirm confirm the maintenance of the newly formed bone.

RESULTS

A fast bone formation was pronounced. The biopsies revealed mature lamellar bone and full osseointegration of the ß-TCP implant. The biopsy after 20 months showed compact bone with osseointegration of minor rests of the ceramic implant. The defect revealed a mature bone stock already after 5 weeks.

SIGNIFICANCE

The introduction of the replica-based-bone formation (RBBF) around micro-chambered beads will change the paradigm of bone augmentation. The next step of the ongoing study has to redefine the interval for implant insertion. The clinical approach confirms the breakthrough to primary mature lamellar bone formation and will permit reduction of placement time for a dental implant.

Efficacy of bone formation of microporous sphere-shaped biphasic calcium phosphate in a rabbit skull bone defect model

Bone graft is required in various surgical procedures. Although autograft is the gold standard, it has limited availability. Various compounds have been proposed as alternatives such as biphasic calcium phosphate (BCP), which is the most widely used compound. The newly synthesized microporous sphere-shaped BCP has the advantage of increasing contact surface, and it can induce the formation of microbone structures. A putty-type contains the addition of a fluid carrier to the sphere-shaped BCP and can be easily used for a small orifice large bone defect. To compare the widely used BCP products, new bone formation and residual graft materials (RGM) were evaluated for 6 and 12 weeks in a rabbit calvarial bone defect model. Although existing BCP products and the microporous sphere-type product did not differ significantly with respect to new bone formation and RGM, the putty-type product was largely washed out and had low new bone formation at 6 and 12 weeks. Overall, the results suggest that microporous sphere-shaped BCP showed similar bone formation capability to existing products and was able to maintain higher initial mechanical stability.

Design and evaluation of collagen-inspired mineral-hydrogel nanocomposites for bone regeneration

Bone loss due to trauma and tumors remains a serious clinical concern. Due to limited availability and disease transmission risk with autografts and allografts, calcium phosphate bone fillers and growth factor-based substitute bone grafts are currently used in the clinic. However, substitute grafts lack bone regeneration potential when used without growth factors. When used along with the added growth factors, they lead to unwanted side effects such as uncontrolled bone growth. Collagen-based hydrogel grafts available on the market fail to provide structural guidance to native cells due to high water-solubility and faster degradation. To overcome these limitations, we employed bioinspired material design and fabricated three different hydrogels with structural features similar to native collagen at multiple length-scales. These hydrogels fabricated using polyionic complexation of oppositely charged natural polysaccharides exhibited multi-scale architecture mimicking nanoscale banding pattern, and microscale fibrous structure of native collagen. All three hydrogels promoted biomimetic apatite-like mineral deposition in vitro elucidating crystalline structure on the surface while amorphous calcium phosphate inside the hydrogels resulting in mineral-hydrogel nanocomposites. When evaluated in a non-load bearing critical size mouse calvaria defect model, chitosan - kappa carrageenan mineral-hydrogel nanocomposites enhanced bone regeneration without added growth factors compared to empty defect as well as widely used marketed collagen scaffolds. Histological assessment of the regenerated bone revealed improved healing and tissue remodeling with mineral-hydrogel nanocomposites. Overall, these collagen-inspired mineral-hydrogel nanocomposites showed multi-scale hierarchical structure and can potentially serve as promising bioactive hydrogel to promote bone regeneration. STATEMENT OF SIGNIFICANCE: Hydrogels, especially collagen, are widely used in bone tissue engineering. Collagen fibrils play arguably the most important role during natural bone development. Its multi-scale hierarchical structure to form fibers from fibrils and electrostatic charges enable mineral sequestration, nucleation, and growth. However, bulk collagen hydrogels exhibit limited bone regeneration and are mostly used as carriers for highly potent growth factors such as bone morphogenic protein-2, which increase the risk of uncontrolled bone growth. Thus, there is an unmet clinical need for a collagen-inspired biomaterial that can recreate structural hierarchy, mineral sequestration ability, and stimulate recruitment of host progenitor cells to facilitate bone regeneration. Here, we propose collagen-inspired bioactive mineral-hydrogel nanocomposites as a growth factor-free approach to guide and enhance bone regeneration.

The outcome of biphasic calcium phosphate bone substitute in a medial opening wedge high tibial osteotomy

BACKGROUND

Our objective was to assess clinical and radiological findings following a medial opening wedge high tibial osteotomy using a biphasic calcium phosphate (BCP) synthetic bone substitute, designed as a wedge with two differing zones of density. The in-vivo behaviour of this type of bone substitute over time is currently unknown.

HYPOTHESIS

Our hypothesis was that BCP synthetic bone would facilitate bone union and undergo replacement with host bone over the study period.

PATIENTS AND METHODS

Fifteen sequential patients were followed prospectively for minimum 4-years post-operatively. All patients were evaluated clinically using patient reported outcome measures and radiologically to evaluate alignment with maintenance of the osteotomy correction, and bone union with expected BCP dissolution.

RESULTS

All patients had good clinical scores with no reported complications at 4 years. In all cases there were radiographic findings of bone union with consolidation and no loss of correction. However the graft remained densely radiopaque at final follow-up.

DISCUSSIONS

This study demonstrates that a BCP graft in combination with a locking plate for a medial opening wedge HTO allows early weight-bearing, maintains correction and provides good clinical outcomes. Whilst higher densities of BCP are strong, they do not resorb fully, remaining radiographically visible. This may have implications for the performance of a future knee arthroplasty and caution should therefore be taken.

Scaffolds and coatings for bone regeneration

Bone tissue has an astonishing self-healing capacity yet only for non-critical size defects (<6 mm) and clinical intervention is needed for critical-size defects and beyond that along with non-union bone fractures and bone defects larger than critical size represent a major healthcare problem. Autografts are, still, being used as preferred to treat large bone defects. Mostly, due to the presence of living differentiated and progenitor cells, its osteogenic, osteoinductive and osteoconductive properties that allow osteogenesis, vascularization, and provide structural support. Bone tissue engineering strategies have been proposed to overcome the limited supply of grafts. Complete and successful bone regeneration can be influenced by several factors namely: the age of the patient, health, gender and is expected that the ideal scaffold for bone regeneration combines factors such as bioactivity and osteoinductivity. The commercially available products have as their main function the replacement of bone. Moreover, scaffolds still present limitations including poor osteointegration and limited vascularization. The introduction of pores in scaffolds are being used to promote the osteointegration as it allows cell and vessel infiltration. Moreover, combinations with growth factors or coatings have been explored as they can improve the osteoconductive and osteoinductive properties of the scaffold. This review focuses on the bone defects treatments and on the research of scaffolds for bone regeneration. Moreover, it summarizes the latest progress in the development of coatings used in bone tissue engineering. Despite the interesting advances which include the development of hybrid scaffolds, there are still important challenges that need to be addressed in order to fasten translation of scaffolds into the clinical scenario. Finally, we must reflect on the main challenges for bone tissue regeneration. There is a need to achieve a proper mechanical properties to bear the load of movements; have a scaffolds with a structure that fit the bone anatomy.

A Combination of Biphasic Calcium Phosphate (Maxresorb®) and Hyaluronic Acid Gel (Hyadent®) for Repairing Osseous Defects in a Rat Model

The aim of this in vivo study was to evaluate the efficacy of biphasic calcium phosphate (Maxresorb®, BCP) used in combination with hyaluronic acid (Hyadent®, HyA) gel for regeneration of osseous defects in a rat model. Bilateral femoral condylar bone defects (3 mm diameter and 3 mm depth) were created in 40 male Wistar rats. The defects were grafted as group I (BCP only), group II (BCP + HyA), group III (HyA only), and group IV (empty control). At four weeks and 10 weeks, the bone specimens were evaluated using histological and histomorphometrical analyses to identify the newly formed bone area (NF-BA (%)), as well as the remaining BCP particles (R-BCP (%)). Light microscopic examination indicated the absence of an inflammatory reaction within the bone defects after four weeks or 10 weeks of implantation. Significant new bone regeneration was present in the bone defects grafted with BCP or BCP + HyA biomaterials, as early as four weeks, compared to control groups. The addition of HyA to BCP did not significantly improve bone regeneration at four weeks or 10 weeks. Nevertheless, its role in bone healing and regeneration warrants further investigation.

Functionalization of Silk Fibers by PDGF and Bioceramics for Bone Tissue Regeneration

Bone regeneration is a complex, well-organized physiological process of bone formation observed during normal fracture healing and involved in continuous remodeling throughout adult life. An ideal medical device for bone regeneration requires interconnected pores within the device to allow for penetration of blood vessels and cells, enabling material biodegradation and bone ingrowth. Additional mandatory characteristics include an excellent resorption rate, a 3D structure similar to natural bone, biocompatibility, and customizability to multiple patient-specific geometries combined with adequate mechanical strength. Therefore, endless silk fibers were spun from native silk solution isolated from silkworm larvae and functionalized with osteoconductive bioceramic materials. In addition, transgenic silkworms were generated to functionalize silk proteins with human platelet-derived growth factor (hPDGF). Both, PDGF-silk and bioceramic modified silk were then assembled into 3D textile implants using an additive manufacturing approach. Textile implants were characterized in terms of porosity, compressive strength, and cyclic load. In addition, osteogenic differentiation of mesenchymal stem cells was evaluated. Silk fiber-based 3D textile implants showed good cytocompatibility and stem cells cultured on bioceramic material functionalized silk implants were differentiating into bone cells. Thus, functionalized 3D interconnected porous textile scaffolds were shown to be promising biomaterials for bone regeneration.

Synthesis and Characterization of Sintered Sr/Fe-Modified Hydroxyapatite Bioceramics for Bone Tissue Engineering Applications

In the current study, Sr/Fe co-substituted hydroxyapatite (HAp) bioceramics were prepared by the sonication-assisted aqueous chemical precipitation method followed by sintering at 1100 °C for bone tissue regeneration applications. The sintered bioceramics were analyzed for various structural and chemical properties through X-ray diffraction, scanning electron microscopy, and Fourier transform infrared spectroscopy, which confirmed the phase purity of HAp and Sr/Fe co-substitution into its lattice. The Vickers hardness measurement, high blood compatibility (less than 5% hemolysis), and ability to support the adhesion, proliferation, and osteogenic differentiation of human mesenchymal stem cells suggest the suitability of Sr/Fe:HAp bioceramics for bone implant applications. The physicochemical analysis revealed that the developed Sr/Fe:HAp bioceramics exhibited a polyphasic nature (HAp and βTCP) with almost identical structural morphology having a particle size less than 0.8 μm. The dielectric constant (ε') and dielectric loss (ε″) were potentially affected by the incorporated foreign ions together with the polyphasic nature of the material. The Sr/Fe co-substituted samples demonstrated extended drug (5-fluorouracil and amoxicillin) release profiles at the pH of physiological medium. The multifunctional properties of the developed HAp bioceramics enabled them to be an auspicious candidate for potential biomedical applications, including targeted drug-delivery applications, heating mediator in hyperthermia, and bone tissue repair implants.

Osterix-mCherry Expression Allows for Early Bone Detection in a Calvarial Defect Model

The process of new bone formation following trauma requires the temporal recruitment of cells to the site, including mesenchymal stem cells, preosteoblasts, and osteoblasts, the latter of which deposit minerals. Hence, bone repair, a process that is assessed by the extent of mineralization within the defect, can take months before it is possible to determine if a treatment is successful. Here, a fluorescently tagged Osterix, an early key gene in the bone formation cascade, is used as a predictive measure of bone formation. Using a calvarial defect model in mice, the ability to noninvasively track the Osterix transcription factor in an Osterix-mCherry mouse model is evaluated as a measure for bone formation following treatment with recombinant human Bone-Morphogenetic-Protein 2 (rhBMP-2). Two distinct delivery materials are utilized, an injectable nanocomposite hydrogel and a collagen sponge, that afford distinct release kinetics and it is found that cherry-fluorescent protein can be detected as early as 2 weeks following treatment. Osterix intensity correlates with subsequent bone formation and hence can serve as a rapid screening tool for osteogenic drugs or for the evaluation and optimization of delivery platforms.

Bone regeneration using β-tricalcium phosphate (β-TCP) block with interconnected pores made by setting reaction of β-TCP granules

We fabricated an interconnected dual porous β-tricalcium phosphate (β-TCP) block via a setting reaction of β-TCP granules. This β-TCP block was unique because it exhibits a fully interconnected macroporous structure with micropores in the walls surrounding macropores and a roughened surface. The porosity and diametral tensile strength of the resulting product were 58.1 ± 1.7% and 1.4 ± 0.2 MPa, respectively. Rabbit distal femur bone defects were reconstructed using the porous β-TCP block and the efficacy of the porous β-TCP block as an artificial bone substitute was evaluated histomorphometrically. For a dense β-TCP control, 4 weeks following implantation, only 0.2 ± 0.1% of the β-TCP was resorbed, and the amount of newly formed bone was limited (0.1 ± 0.1%), whereas when the defect was reconstructed with porous β-TCP, 9.2 ± 3.1% was resorbed, and the amount of new bone was 18.9 ± 5.5%. This represents an approximately 50-fold enhancement in resorption and a 200-fold increase in bone formation for our porous β-TCP block. Therefore, interconnected dual porous β-TCP made via β-TCP granule setting has good potential as an artificial bone substitute.

Evaluation of Peri-Implant Bone Grafting Around Surface-Porous Dental Implants: An In Vivo Study in a Goat Model

Dental implants with surface-porous designs have been recently developed. Clinically, peri-implant bone grafting is expected to promote early osseointegration and bone ingrowth when applied with surface-porous dental implants in challenging conditions. The aim of this study was to comparatively analyze peri-implant bone healing around solid implants and surface-porous implants with and without peri-implant bone grafting, using biomechanical and histomorphometrical assessment in a goat iliac bone model. A total of 36 implants (4.1 mm wide, 11.5 mm long) divided into three groups, solid titanium implant (STI; n = 12), porous titanium implants (PTI; n = 12) and PTI with peri-implant bone grafting using biphasic calcium phosphate granules (PTI + BCP; n = 12), were placed bilaterally in the iliac crests of six goats. The goats were sacrificed seven weeks post-operatively and then subjected to biomechanical (n = 6 per group) and histomorphometrical (n = 6 per group) assessment. The biomechanical assessment revealed no significant differences between the three types of implants. Although the peri-implant bone-area (PIBA%) measured by histomorphometry (STI: 8.63 ± 3.93%, PTI: 9.89 ± 3.69%, PTI + BCP: 9.28 ± 2.61%) was similar for the three experimental groups, the percentage of new bone growth area (BGA%) inside the porous implant portion was significantly higher (p < 0.05) in the PTI group (10.67 ± 4.61%) compared to the PTI + BCP group (6.50 ± 6.53%). These data demonstrate that peri-implant bone grafting around surface-porous dental implants does not significantly accelerate early osseointegration and bone ingrowth.