The Potential of Magnesium Based Materials in Mandibular Reconstruction

Influence of bite force and implant elastic modulus on mandibular reconstruction with particulate-cancellous bone marrow grafts healing: An in silico investigation

This study aims to investigate tissue differentiation during mandibular reconstruction with particulate cancellous bone marrow (PCBM) graft healing using biphasic mechanoregulation theory under four bite force magnitudes and four implant elastic moduli to examine its implications on healing rate, implant stress distribution, new bone elastic modulus, mandible equivalent stiffness, and load-sharing progression. The finite element model of a half Canis lupus mandible, symmetrical about the midsagittal plane, with two marginal defects filled by PCBM graft and stabilized by porous implants, was simulated for 12 weeks. Eight different scenarios, which consist of four bite force magnitudes and four implant elastic moduli, were tested. It was found that the tissue differentiation pattern corroborates the experimental findings, where the new bone propagates from the superior side and the buccal and lingual sides in contact with the native bone, starting from the outer regions and progressing inward. Faster healing and quicker development of bone graft elastic modulus and mandible equivalent stiffness were observed in the variants with lower bite force magnitude and or larger implant elastic modulus. A load-sharing condition was found as the healing progressed, with M3 (Ti6Al4V) being better than M4 (stainless steel), indicating the higher stress shielding potentials of M4 in the long term. This study has implications for a better understanding of mandibular reconstruction mechanobiology and demonstrated a novel in silico framework that can be used for post-operative planning, failure prevention, and implant design in a better way.

Heat Treatment's Vital Role: Elevating Orthodontic Mini-Implants for Superior Performance and Longevity-Pilot Study

Orthodontic mini-implants are devices used for anchorage in various orthodontic treatments. We conducted a pilot study which aimed to observe preliminary trends regarding the impact of heat treatment on the elastic modulus of Ti6Al4V alloy and stainless steel 316L mini-implants. The initial phase involved testing the impact of heat treatment on the mechanical properties of Ti6Al4V alloy and stainless steel 316L mini-implants.

MATERIAL AND METHODS

Ten self-drilling mini-implants sourced from two distinct manufacturers (Jeil Medical Corporation® and Leone®) with dimensions of 2.0 mm diameter and 10 mm length were tested. They were separated into two material groups: Ti6Al4V and 316L. Using the CETRUMT-2 microtribometer equipment, indentation testing was conducted employing a diamond-tipped Rockwell penetrator at a constant force of 4.5 N.

RESULTS

Slight differences were observed in the elastic modulus of the Ti6Al4V alloy (103.99 GPa) and stainless steel 316L (203.20 GPa) compared to natural bone. The higher elastic moduli of these materials indicate that they are stiffer, which could potentially lead to stress-shielding phenomena and bone resorption. Heat treatment resulted in significant changes in mechanical properties, including elastic modulus reductions of approximately 26.14% for Ti6Al4V and 24.82% for 316L, impacting their performance in orthodontic applications.

CONCLUSION

Understanding the effects of heat treatment on these alloys is crucial for optimizing their biomechanical compatibility and longevity in orthodontic treatment. To fully evaluate the effects of heat treatment on mini-implants and to refine their design and efficacy in clinical practice, further research is needed.

Ce-doped MgO films on AZ31 alloy substrate for biomedical applications: preparation, characterization and testing

Magnesium ions, MgO nanoparticles and thin films, magnesium alloys and cerium compounds are materials intensively studied due to their corrosion protection, antibacterial and pharmacological properties. In this work, we have designed, prepared and investigated, novel thin films of MgO doped with cerium, deposited on Mg alloy (AZ31) for temporary implants, in order to enhance their life time. More precisely, we report on microstructure and corrosion behavior of MgO pure and doped with 0.1 at % Ce films, fabricated by sol-gel route coupled with spin-coating technique, on AZ31 alloy substrate. A modified sol-gel method that start from magnesium acetylacetonate, cerium nitrate and 2-methoxyethanol (as a stabilizer for the sol) was been used successfully for cerium doped MgO sol precursor preparation. The structure and morphology of the surface of the coatings, before and after immersion for 7-30 d in Hank's solution at 37 °C, were characterized by x-ray diffraction (XRD), scanning electron microscopy, high-resolution transmission electron microscope, x-ray photoelectron spectroscopy and Fourier infrared transmittance spectrum (FT-IR). A comparison between the corrosion protection of undoped MgO and MgO doped with 0.1 at % Ce coatings on the AZ31 alloy substrate is performed by electrochemical tests and immersion tests using open circuit potential and electrochemical impedance spectroscopy in Hank's solution, at 37 °C. The electrochemical results showed that the protection of the AZ31 alloy substrate against corrosion was better with the doped with 0.1 at % Ce MgO film deposited than with pure MgO coting. The investigations of the films after immersion in Hank's solution, at 37 °C, for 7, 21 and 30 d indicated that the grown layer on the film is bone like apatite that suggests a good bioactivity of 0.1 at % Ce-doped MgO coating. Our work demonstrates that the performance corrosion protection of the biodegradable magnesium alloys used for orthopedic applications, in simulated physiological environments (Hank and Ringer) can be enhanced through coating with Ce3+doped MgO sol-gel thin film.

Advanced Hydrogel systems for mandibular reconstruction

Mandibular defect becomes a prevalent maxillofacial disease resulting in mandibular dysfunctions and huge psychological burdens to the patients. Considering the routine presence of oral contaminations and aesthetic restoration of facial structures, the current clinical treatments are however limited, incapable to reconstruct the structural integrity and regeneration, spurring the need for cost-effective mandibular tissue engineering. Hydrogel systems possess great merit for mandibular reconstruction with precise involvement of cells and bioactive factors. In this review, current clinical treatments and distinct mode(s) of mandible formation and pathological resorption are summarized, followed by a review of hydrogel-related mandibular tissue engineering, and an update on the advanced fabrication of hydrogels with improved mechanical property, antibacterial ability, injectable form, and 3D bioprinted hydrogel constructs. The exploration of advanced hydrogel systems will lay down a solid foundation for a bright future with more biocompatible, effective, and personalized treatment in mandibular reconstruction.

3D Printing of Bioinert Oxide Ceramics for Medical Applications

Three-dimensionally printed metals and polymers have been widely used and studied in medical applications, yet ceramics also require attention. Ceramics are versatile materials thanks to their excellent properties including high mechanical properties and hardness, good thermal and chemical behavior, and appropriate, electrical, and magnetic properties, as well as good biocompatibility. Manufacturing complex ceramic structures employing conventional methods, such as ceramic injection molding, die pressing or machining is extremely challenging. Thus, 3D printing breaks in as an appropriate solution for complex shapes. Amongst the different ceramics, bioinert ceramics appear to be promising because of their physical properties, which, for example, are similar to those of a replaced tissue, with minimal toxic response. In this way, this review focuses on the different medical applications that can be achieved by 3D printing of bioinert ceramics, as well as on the latest advances in the 3D printing of bioinert ceramics. Moreover, an in-depth comparison of the different AM technologies used in ceramics is presented to help choose the appropriate methods depending on the part geometry.

Current Status and Outlook of Temporary Implants (Magnesium/Zinc) in Cardiovascular Applications

Medical application materials must meet multiple requirements, and the designed material must mimic the structure, shape. and support the formation of the replacing tissue. Magnesium (Mg) and Zinc alloys (Zn), as a “smart” biodegradable material and as “the green engineering material in the 21st century”, have become an outstanding implant material due to their natural degradability, smart biocompatibility, and desirable mechanical properties. Magnesium and Zinc are recognized as the next generation of cardiovascular stents and bioresorbable scaffolds. At the same time, improving the properties and corrosion resistance of these alloys is an urgent challenge. particularly to promote the application of magnesium alloys. A relatively fast deterioration rate of magnesium-based materials generally results in premature mechanical integrity compromise and local hydrogen build-up, resulting in restricted applicability. This review article aims to give a comprehensive comparison between Zn-based alloys and Mg-based alloys, focusing primarily on degradation and biocompatibility for cardiovascular applications. The recent clinical trials using these biodegradable metals have also been addressed.

In vitro cytotoxicity and osteogenic potential of quaternary Mg-2Zn-1Ca/X-Mn alloys for craniofacial reconstruction

Cytotoxicity of any biomedical material needs to be investigated for successful application within the human tissues. In this study, manganese in low amounts of 0.3, 0.5 and 0.7 (wt.%) was added to Mg2Zn1Ca alloy using Disintegrated Melt Deposition (DMD) followed by hot extrusion and the extruded alloys were tested for in vitro cytocompatibility using cell viability assays (CCK-8, LDH enzyme release assay, cell cytoskeleton and cell morphology) and in vitro osteogenic potential was evaluated using ALP, Alizarin Red and RT-PCR assays. Addition of manganese improved the cell viability and osteogenic potential in variable concentrations. The Mg2Zn1Ca /0.3 Mn and Mg2Zn1Ca /0.5 Mn alloys showed increased cell viability percentage compared to Mg2Zn1Ca alloys. The cytotoxicity percentage at the end of 24 h culture for Mg2Zn1Ca /0.3 Mn alloys showed lesser cytotoxicity percentage (~ 8%) when compared to the Mg2Zn1Ca /0.5 Mn (~ 13%) and Mg2Zn1Ca /0.7 Mn (~ 16%) samples. All the alloys showed good initial cell attachment, osteogenic potential and cell spreading. The results of this study validates great potential of Mg2Zn1Ca alloys with manganese addition and exhibited great potential for to be used as temporary implant materials in craniofacial reconstruction.

Compositional Tailoring of Mg-2Zn-1Ca Alloy Using Manganese to Enhance Compression Response and In-Vitro Degradation

The present study investigates Mg–2Zn–1Ca/XMn alloys as biodegradable implants for orthopedic fracture fixation applications. The effect of the presence and progressive addition of manganese (X = 0.3, 0.5, and 0.7 wt.%) on the degradation, and post-corrosion compressive response were investigated. Results suggest that the addition of manganese at 0.5 wt.% improved the corrosion resistance of Mg–2Zn–1Ca alloys. The pH values stabilized for the 0.5Mn-containing alloy and displayed a lower corrosion rate when compared to other Mg–2Zn–1Ca/Mn alloys. Mg–2Zn–1Ca showed a progressive reduction in the compressive strength properties at the end of day 21 whereas Mg–2Zn–1Ca/0.3Mn and Mg–2Zn–1Ca/0.5Mn samples showed a decrease until day 14 and stabilized around the same strength range after day 21. The ability of Mg–2Zn–1Ca/0.5Mn alloy to develop a network of protective hydroxide and phosphate layers has resulted in the corrosion control of the alloy. Mg–2Zn–1Ca/0.7Mn displays segregation of Mn particles at the grain boundaries resulting in decreased corrosion protection. The mechanism behind the corrosion protection of Mg–2Zn–1Ca alloys was discussed.

Corrosion Behavior and Biocompatibility of Na2EDTA-Induced Nacre Coatings on AZ91D Alloys Prepared via Hydrothermal Treatment

An effective method for controlling the corrosion rate of Mg-based implants must be urgently developed to meet the requirements of clinical applications. As a naturally occurring osteoid material, nacre offers a strategy to endow biomedical Mg alloys with excellent biocompatibility, and corrosion resistance. In this study, pearl powder and NaH2PO4 were used as precursors to deposit coatings on AZ91D alloy substrates hydrothermally based on Na2EDTA-assisted induction. Na2EDTA-induced nacre coatings were fabricated at various pH values, and its chemical composition and microstructure were analyzed via energy-dispersive X-ray, scanning electron microscopy, and X-ray diffraction spectroscopy. The corrosion-resistant performance and cytocompatibility of the samples were evaluated via electrochemical measurements and in vitro cell experiments. Results showed that the samples hydrothermally treated under faint acid conditions present excellent corrosion resistance, whereas the samples treated under slight alkaline conditions demonstrate improved biocompatibility due to high Ca and P content and large Ca/P atomic ratio. This study provides substantial evidence of the potential value of nacre coatings in expanding the biological applications of implanted biomaterials.

Biodegradation behaviors of magnesium(Mg)-based alloy nails in autologous bone grafts: In vivo study in rabbit skulls

OBJECTIVE

In this study, autologous bone grafts using bone-fixing nails made of magnesium-zinc-calcium ternary alloys were performed using rabbit skulls.

MATERIAL AND METHODS

Two types of nails for bone fixation were prepared: 2.5 mm width, 3 mm length and 2.5 mm width, 2 mm length. A disk-shaped bone with a diameter of 5 mm was resected from the parietal bone and fixed with a 3 mm long nail. As a control group, a 2 mm long nail was driven into the existing bone. The rabbits were sacrificed at 1, 4, 12, and 24 weeks after surgery. The resected samples were observed with micro X-ray CT, and embedded in methyl methacrylate to prepare non-decalcified specimens. The in vivo localization of elements was examined using energy-dispersive X-ray spectroscopy (EDS).

RESULTS

Micro X-ray CT images of samples showed volume reduction due to degradation in both the bone graft and control groups. No significant difference in the amount of degradation between the two groups was observed, however characteristic degradation processes were observed in each group. The samples stained with alizarin red S showed amorphous areas around the nails, which were considered as corrosion products and contacted directly with the newly formed bones. EDS analysis showed that corrosion products were mainly composed of magnesium and oxygen at an early stage, while calcium and phosphorus were detected on the surface layer during the long-term observation.

CONCLUSIONS

The degradation speed of the magnesium alloy nails varied depending on the shapes of the nails and surrounding tissue conditions. A calcium phosphate layer was formed on the surface of magnesium alloy nails, suggesting that the degradation rate of the nail was slow.

Biodegradable magnesium-based biomaterials: An overview of challenges and opportunities

As promising biodegradable materials with nontoxic degradation products, magnesium (Mg) and its alloys have received more and more attention in the biomedical field very recently. Having excellent biocompatibility and unique mechanical properties, magnesium-based alloys currently cover a broad range of applications in the biomedical field. The use of Mg-based biomedical devices eliminates the need for biomaterial removal surgery after the healing process and reduces adverse effects induced by the implantation of permanent biomaterials. However, the high corrosion rate of Mg-based implants leads to unexpected degradation, structural failure, hydrogen evolution, alkalization, and cytotoxicity. To overcome these limitations, alloying Mg with suitable alloying elements and surface treatment come highly recommended. In this area, open questions remain on the behavior of Mg-based biomaterials in the human body and the effects of different factors that have resulted in these challenges. In addition to that, many techniques are yet to be verified to turn these challenges into opportunities. Accordingly, this article aims to review major challenges and opportunities for Mg-based biomaterials to minimize the challenges for the development of novel biomaterials made of Mg and its alloys.

Biofunctional Elements Incorporated Nano/Microstructured Coatings on Titanium Implants with Enhanced Osteogenic and Antibacterial Performance

Bone fracture is prevalent among athletes and senior citizens and may require surgical insertion of bone implants. Titanium (Ti) and its alloys are widely used in orthopedics due to its high corrosion resistance, good biocompatibility, and modulus compatible with natural bone tissues. However, bone repair and regrowth are impeded by the insufficient intrinsic osteogenetic capability of Ti and Ti alloys and potential bacterial infection. The physicochemical properties of the materials and nano/microstructures on the implant surface are crucial for clinical success and loading with biofunctional elements such as Sr, Zn, Cu, Si, and Ag into nano/microstructured TiO2 coating has been demonstrated to enhance bone repair/regeneration and bacterial resistance of Ti implants. In this review, recent advances in biofunctional element-incorporated nano/microstructured coatings on Ti and Ti alloy implants are described and the prospects and limitations are discussed.

In-Vitro Degradation of Hollow Silica Reinforced Magnesium Syntactic Foams in Different Simulated Body Fluids for Biomedical Applications

This article reports the mechanical and biocorrosion behaviour of hollow silica nanosphere (SiO2) reinforced (0.5–2 vol.%) magnesium (Mg) syntactic foams. Room temperature tensile properties’ characterization suggests that the increased addition of hollow silica nanospheres resulted in a progressive increase in tensile yield strength (TYS) and ultimate tensile strength (UTS) with Mg-2 vol.% SiO2 exhibiting a maximum TYS of 167 MPa and a UTS of 217 MPa. The degradation behaviour of the developed Mg-SiO2 syntactic foams in four different simulated body fluids (SBFs): artificial blood plasma solution (ABPS), phosphate-buffered saline solution (PBS), artificial saliva solution (ASS) and Hanks’ balanced saline solution (HBSS) was investigated by using potentiodynamic polarization studies. Results indicate that corrosion resistance of the Mg-SiO2 syntactic foam decreases with increasing chloride ion concentration of the SBF. Mg-1.0 vol.% SiO2 displayed the best corrosion response and its corrosion susceptibility pertaining to corrosion rate and polarisation curves in different SBF solutions can be ranked in the following order: ABPS > PBS > HBSS > ASS. The surface microstructure demonstrated the presence of a better passivated layer on the syntactic foams compared to pure Mg. The observed increase in corrosion resistance is correlated with intrinsic changes in microstructure due to the presence of hollow silica nanospheres. Further, the effect of corrosive environment on the degradation behaviour of Mg has been elucidated.

Hollow silica reinforced magnesium nanocomposites with enhanced mechanical and biological properties with computational modeling analysis for mandibular reconstruction

The present study investigates Mg-SiO₂ nanocomposites as biodegradable implants for orthopedic and maxillofacial applications. The effect of presence and progressive addition of hollow silica nanoparticles (0.5, 1, and 1.5) vol.% on the microstructural, mechanical, degradation, and biocompatibility response of pure Mg were investigated. Results suggest that the increased addition of hollow silica nanoparticles resulted in a progressive increase in yield strength and ultimate compressive strength with Mg-1.5 vol.% SiO₂ exhibiting superior enhancement. The response of Mg-SiO₂ nanocomposites under the influence of Hanks’ balanced salt solution revealed that the synthesized composites revealed lower corrosion rates, indicating rapid dynamic passivation when compared with pure Mg. Furthermore, cell adhesion and proliferation of osteoblast cells were noticeably higher than pure Mg with the addition of 1 vol.% SiO₂ nanoparticle. The biocompatibility and the in vitro biodegradation of the Mg-SiO₂ nanocomposites were influenced by the SiO₂ content in pure Mg with Mg-0.5 vol.% SiO₂ nanocomposite exhibiting the best corrosion resistance and biocompatibility when compared with other nanocomposites. Enhancement in mechanical, corrosion, and biocompatibility characteristics of Mg-SiO₂ nanocomposites developed in this study are also compared with properties of other metallic biomaterials used in alloplastic mandibular reconstruction in a computational model.

Magnesium Alloys for Biomedical Applications

Interest in magnesium alloys as biodegradable metals has strongly grown over the last decades [...]

The Influence of Laser Surface Remelting on the Tribological Behavior of the ECAP-Processed AZ61 Mg Alloy and AZ61-Al2O3 Metal Matrix Composite

This paper deals with the tribological study of the laser remelted surfaces of the ECAP-processed AZ61 magnesium alloy and AZ61–Al₂O₃ metal matrix composite with 10 wt.% addition of Al₂O₃ nanoparticles. The study included the experimental optimization of the laser surface remelting conditions for the investigated materials by employing a 400 W continual wave fiber laser source. Tribological tests were performed in a conventional “ball-on-disc” configuration with a ceramic ZrO₂ ball under a 5 N normal load and a sliding speed of 100 mm/s. The results showed that both the incorporation of Al₂O₃ nanoparticles and the applied laser treatments led to recognizable improvements in the tribological properties of the studied AZ61–Al₂O₃ composites in comparison with the reference AZ61 alloy. Thus, the best improvement has been obtained for the laser modified AZ61–10 wt.% Al₂O₃ nanocomposite showing about a 48% decrease in the specific wear rate compared to the laser untreated AZ61 base material.

Development of AM Technologies for Metals in the Sector of Medical Implants

Additive manufacturing (AM) processes have undergone significant progress in recent years, having been implemented in sectors as diverse as automotive, aerospace, electrical component manufacturing, etc. In the medical sector, different devices are printed, such as implants, surgical guides, scaffolds, tissue engineering, etc. Although nowadays some implants are made of plastics or ceramics, metals have been traditionally employed in their manufacture. However, metallic implants obtained by traditional methods such as machining have the drawbacks that they are manufactured in standard sizes, and that it is difficult to obtain porous structures that favor fixation of the prostheses by means of osseointegration. The present paper presents an overview of the use of AM technologies to manufacture metallic implants. First, the different technologies used for metals are presented, focusing on the main advantages and drawbacks of each one of them. Considered technologies are binder jetting (BJ), selective laser melting (SLM), electron beam melting (EBM), direct energy deposition (DED), and material extrusion by fused filament fabrication (FFF) with metal filled polymers. Then, different metals used in the medical sector are listed, and their properties are summarized, with the focus on Ti and CoCr alloys. They are divided into two groups, namely ferrous and non-ferrous alloys. Finally, the state-of-art about the manufacture of metallic implants with AM technologies is summarized. The present paper will help to explain the latest progress in the application of AM processes to the manufacture of implants.

Characterization of an Extruded Mg-Dy-Nd Alloy during Stress Corrosion with C-Ring Tests

This study focuses on the characterization of the failure behavior of an extruded Mg10Dy1Nd alloy during stress corrosion. The microstructure, hardness, strength and corrosion behavior of binary alloys Mg10Dy and Mg1Nd are compared to those of the ternary alloy system. The ternary alloy Mg-Dy-Nd that is not fully recrystallized has the highest hardness but lacks ductility. The investigated alloys twin during plastic deformation. Static C-ring tests in Ringer solution were used to evaluate the stress corrosion properties, and stress corrosion could not be found. None of the alloys failed by fracturing, but corrosion pits formed to various extents. These corrosion pits were elliptical in shape and located below the surface. Some of the pits reduced the remaining wall thickness significantly, but the stress increased by the notch effect did not lead to crack initiation. Furthermore, the C-ring specimen was subjected to compressive loading until fracture. Whereas the Mg1Nd alloy showed ductile behavior, the alloys containing Dy fractured on the tensile side. The crack initiation and growth were mainly influenced by the twin boundaries. The Mg10Dy1Nd alloy had an inhomogeneous microstructure and low ductility, which resulted in a lower fracture toughness than that of the Mg10Dy alloy. There were features that indicate hydrogen-assisted fracture. Although adding Nd decreased the fracture toughness, it reduced the grain size and had a positive influence on the corrosion rate during immersion testing.

Comparative Study of the Structure, Properties, and Corrosion Behavior of Sr-Containing Biocoatings on Mg0.8Ca

A comparative analysis of the structure, properties and the corrosion behavior of the micro-arc coatings based on Sr-substituted hydroxyapatite (Sr-HA) and Sr-substituted tricalcium phosphate (Sr-TCP) deposited on Mg0.8Ca alloy substrates was performed. The current density during the formation of the Sr-HA coatings was higher than that for the Sr-TCP coatings. As a result, the Sr-HA coatings were thicker and had a greater surface roughness R_a than the Sr-TCP coatings. In addition, pore sizes of the Sr-HA were almost two times larger. The ratio (Ca + Sr + Mg)/P were equal 1.64 and 1.47 for Sr-HA and Sr-TCP coatings, respectively. Thus, it can be assumed that the composition of Sr-HA and Sr-TCP coatings was predominantly presented by (Sr,Mg)-substituted hydroxyapatite and (Sr,Mg)-substituted tricalcium phosphate. However, the average content of Sr was approximately the same for both types of the coatings and was equal to 1.8 at.%. The Sr-HA coatings were less soluble and had higher corrosion resistance than the Sr-TCP coatings. Cytotoxic tests in vitro demonstrated a higher cell viability after cultivation with extracts of the Sr-HA coatings.