Graphene oxide-encapsulated baghdadite nanocomposite improved physical, mechanical, and biological properties of a vancomycin-loaded PMMA bone cement

Polymethyl methacrylate (PMMA) bone cement is commonly used in orthopedic surgeries to fill the bone defects or fix the prostheses. These cements are usually containing amounts of a nonbioactive radiopacifying agent such as barium sulfate and zirconium dioxide, which does not have a good interface compatibility with PMMA, and the clumps formed from these materials can scratch metal counterfaces. In this work, graphene oxide encapsulated baghdadite (GOBgh) nanoparticles were applied as radiopacifying and bioactive agent in a PMMA bone cement containing 2 wt.% of vancomycin (VAN). The addition of 20 wt.% of GOBgh (GOBgh20) nanoparticles to PMMA powder caused a 33.6% increase in compressive strength and a 70.9% increase in elastic modulus compared to the Simplex® P bone cement, and also enhanced the setting properties, radiopacity, antibacterial activity, and the apatite formation in simulated body fluid. In vitro cell assessments confirmed the increase in adhesion and proliferation of MG-63 cells as well as the osteogenic differentiation of human adipose-derived mesenchymal stem cells on the surface of PMMA-GOBgh20 cement. The chorioallantoic membrane assay revealed the excellent angiogenesis activity of nanocomposite cement samples. In vivo experiments on a rat model also demonstrated the mineralization and bone integration of PMMA-GOBgh20 cement within four weeks. Based on the promising results obtained, PMMA-GOBgh20 bone cement is suggested as an optimal sample for use in orthopedic surgeries.

Radiopacity Enhancements in Polymeric Implant Biomaterials: A Comprehensive Literature Review

Polymers as biomaterials possess favorable properties, which include corrosion resistance, light weight, biocompatibility, ease of processing, low cost, and an ability to be easily tailored to meet specific applications. However, their inherent low X-ray attenuation, resulting from the low atomic numbers of their constituent elements, i.e., hydrogen (1), carbon (6), nitrogen (7), and oxygen (8), makes them difficult to visualize radiographically. Imparting radiopacity to radiolucent polymeric implants is necessary to enable noninvasive evaluation of implantable medical devices using conventional imaging methods. Numerous studies have undertaken this by blending various polymers with contrast agents consisting of heavy elements. The selection of an appropriate contrast agent is important, primarily to ensure that it does not cause detrimental effects to the relevant mechanical and physical properties of the polymer depending upon the intended application. Furthermore, its biocompatibility with adjacent tissues and its excretion from the body require thorough evaluation. We aimed to summarize the current knowledge on contrast agents incorporated into synthetic polymers in the context of implantable medical devices. While a single review was found that discussed radiopacity in polymeric biomaterials, the publication is outdated and does not address contemporary polymers employed in implant applications. Our review provides an up-to-date overview of contrast agents incorporated into synthetic medical polymers, encompassing both temporary and permanent implants. We expect that our results will significantly inform and guide the strategic selection of contrast agents, considering the specific requirements of implantable polymeric medical devices.

The radiopacity of single-shade composite resins: A comparative evaluation

OBJECTIVE

The aim of this study was to evaluate the radiopacity of single-shade composite resins with group and multi-shade composite resins via a digital image analysis.

MATERIALS AND METHODS

Disc-shaped (5 mm in diameter, 2 mm in thickness) specimens were prepared with one multi-shade (Estelite Sigma Quick-ESQ), four single-shade (Omnichroma-OC, Charisma Topaz One-CTO, Vitra Unique-VU, and ZenChroma-ZC), three group-shade (G-aenial Achord-GA, Optishade-OS, and Estelite Asteria-EA), and one posterior composite resin (Estelite Posterior-EP) (n = 3). A radiographic image of all the specimens, an aluminum step-wedge, and a 2 mm thick tooth section were taken. Mean gray values (MGV) of the specimens, enamel, and dentin were calculated by ImageJ software. Composition analysis was performed with EDS, and SEM images (×10,000) were obtained. The data were analyzed with Kruskal-Wallis and Post hoc adjusted Bonferroni analysis (p = 0.05).

RESULTS

The mean MGV of CTO, the highest of all test groups, was significantly higher than OC and dentin (p = 0.04 and p = 0.009, relatively). The lowest mean MGV was also observed in a single-shade group, OC. EDS analysis showed that the tested materials comprised various radiopaque elements.

CONCLUSIONS

All of the single-shade and group-shade groups exceeded the MGV value of dentin, which is clinically expected from any restorative material.

CLINICAL SIGNIFICANCE

The radiopacity properties of various single-shade composite resins which as a category is a rising trend in esthetic dentistry were investigated. It is important for clinicians to be aware of novel materials' physical qualities including radiopacity, a daily clinical criteria for restorative materials.

Evaluation of radiopacity of cements used in implant-supported prosthesis by indirect digital radiography: an in-vitro study

In order to help dentists in choosing the right type of cement for implant-based prostheses, the radiopacity of commonly used cements available in the market was investigated by digital radiography with PSP sensor. In the present study, temporary cements of TempBond (Kerr, Germany), TempBond clear (Kerr, Germany), Dycal (Dentsply, USA) and permanent cements of Multilink N (Ivoclar, Brazil), Panavia F 2.0 (Kurrary, Japan), Fuji plus (GC, Japan), RelyX (3M, USA), Durelon (3M, USA) were used. Four pill-like samples with 0.5 mm and 1 mm thickness and 5 mm in diameter inside the silicon index as recommended by the manufacturer were prepared for each cement. Aluminum step wedge (99% aluminum alloy) was used as control. Using digital radiography, cement and aluminum step wedge samples were radiographed. The images of cement tablets were measured by digital radiography using DFW software to check their radiopacity values. Bonferroni test and Mann-Whitney U test were used for comparison of cements. The highest radiopacity between the group of 1 and 0.5 mm thickness was related to Glass ionomer Fujiplus GC (2407±45.99) and TempBond (137.21±22.46) cement, respectively. Whereas, the lowest radiopacity among the groups was related to Clear cement. The difference between the mean radiopacities among the studied groups was statistically significant (p<0.001). Based on the results, among the available cements, Glass ionomer Fujiplus GC and TempBond cement are the most efficient for 1 and 0.5 mm thickness, respectively, and Clear cement is the least efficient cement in both groups in terms of radiopacity.

Chemomechanical Properties and Biocompatibility of Various Premixed Putty-type Bioactive Ceramic Cements

INTRODUCTION

This study aimed to evaluate the chemomechanical properties and biocompatibility of recently introduced premixed putty-type bioactive ceramic cements (PPBCs).

METHODS

Including ProRoot MTA (PMTA) as a control, BC RRM fast-set putty (BCPT), Well-Root PT (WRPT), One-Fil PT (OFPT), and Endocem MTA premixed (ECPM) were compared to evaluate setting time, radiopacity, pH change, and microhardness. Biocompatibility on human dental pulp cells was compared using CCK-8 assay. Mineralization potential was evaluated using alkaline phosphatase activity, Alizarin Red S (ARS) staining, and quantitative real-time polymerase chain reaction with odontogenic gene marker. For data analysis, 1-way analysis of variance and Tukey's post hoc test were used at the significance level of 95%.

RESULTS

Among the PPBCs, BCPT presented the longest (552 ± 27) setting time (minutes) and others showed significantly shorter time than PMTA (334 ± 22) (P < .05). WRPT (6.20 ± 0.54) and OFPT (5.82 ± 0.50) showed significantly higher radiopacity values (mmAl) and others showed similar value compared with PMTA (P > .05). All PPBCs showed high alkaline pH from fresh materials and tended to increase according to time periods from 30 minutes to 12 hours. ECPM showed the highest value of microhardness (81.62 ± 5.90), WRPT showed similar, and others showed lower than PMTA (P < .05). All PPBCs showed biocompatibility in CCK-8 assay. All PPBCs showed similar or better value compared with PMTA in ALP and ARS staining, and ALP and DSPP marker expression (P < .05).

CONCLUSIONS

The PPBCs showed clinically acceptable chemomechanical properties and favorable mineralization potential.

Radiopacity of Sodium Zirconium Cyclosilicate in Computed Tomography: a case of a patient with Hyperkalemia and kidney disease

Sodium Zirconium Cyclosilicate (SZC) is commonly used for treating hyperkalemia because it sequesters gastrointestinal potassium ions, thereby reducing serum potassium levels. However, a less-discussed aspect of SZC is its radiopacity on x-ray-based imaging techniques. The European Medicines Agency (EMA) has only vaguely addressed this issue. Radiopaque substances like SZC can interfere with diagnostic imaging, creating challenges for clinicians and radiologists. We present the case of a 34-year-old Italian male to illustrate these concerns.

Multifunctionality of Iodinated Halogen-Bonded Polymer: Biodegradability, Radiopacity, Elasticity, Ductility, and Self-Healing Ability

A polymer with high contents of ester bonds and iodine atoms was synthesized, exhibiting sufficient biodegradability and radioactivity for biomedical applications. The iodine moieties of the synthesized polyester can generate halogen bonding between molecules, which may develop additional functional properties through the bonding. In this study, poly(glycerol adipate) (PGA) was selected and synthesized as a polyester, which was then adequately conjugated with three different types of iodine compounds via the hydroxy groups of PGA. It was found that the iodine compounds could effectively work as donors of halogen bonding. The thermal analysis by differential scanning calorimetry (DSC) revealed that the glass transition temperature increased with the increase in the strength of interactions caused by π-π stacking and halogen bonding, eventually reaching 49.6 °C for PGA with triiodobenzoic groups. An elastomeric PGA with monoiodobenzoic groups was also obtained, exhibiting a high self-healing ability at room temperature because of the reconstruction of halogen bonding. Such multifaceted performance of the synthesized polyester with controllable thermal/mechanical properties was realized by halogen bonding, leading to a promising biomaterial with multifunctionality.

Differences in radiopacity among CT contrast agents and concentrations: A quantitative study

BACKGROUND AND PURPOSE

Several studies in the literature have attempted to subjectively assess the degree of visualization of different neurovascular structures using different contrast agents and concentrations. Given the recent contrast shortages, we aim to objectively compare the radiopacity achieved with four angiographic contrast agents used in clinical practice.

METHODS

Isovue 370, Visipaque 320, Omnipaque 300, and Isovue 300 were each drawn up at 25%, 50%, 75%, and 100% concentrations and compared against normal saline and air syringes. CT scans were obtained, and regions of interest were analyzed for radiopacity using Hounsfield unit (HU) measurements. An aneurysm model with different contrast concentrations was also scanned and dimensions compared. Two-tailed t-tests and Cohen's d coefficients were applied to assess for differences in mean HU measurements.

RESULTS

Isovue 370 and Isovue 300 had the highest and lowest mean HU, respectively (p < .001). Visipaque 320 at 25% concentration had the lowest mean HU at -.76. Statistically similar agents (p < .05) were Visipaque 320 and Omnipaque 300 at a 100% concentration (p = .30), and Omnipaque 300 and Isovue 300 at a 25% concentration (p = .73). Aneurysm dimensions among Isovue 370, Visipaque 320, and Omnipaque 300 were all similar, whereas with Isovue 300, the dimensions were significantly smaller (p < .05).

CONCLUSION

Isovue 370 provides the highest HU radiopacity and the most accurate aneurysm measurements. Angiographic measurements obtained with Isovue 300 may underestimate the actual aneurysmal dimensions. Visipaque 320 and Omnipaque 300 at 100% concentration have similar mean HUs and are beneficial for patients with chronic kidney or cardiac disease.

Incorporating Tantalum Oxide Nanoparticles into Implantable Polymeric Biomedical Devices for Radiological Monitoring

Longitudinal radiological monitoring of biomedical devices is increasingly important, driven by the risk of device failure following implantation. Polymeric devices are poorly visualized with clinical imaging, hampering efforts to use diagnostic imaging to predict failure and enable intervention. Introducing nanoparticle contrast agents into polymers is a potential method for creating radiopaque materials that can be monitored via computed tomography. However, the properties of composites may be altered with nanoparticle addition, jeopardizing device functionality. Thus, the material and biomechanical responses of model nanoparticle-doped biomedical devices (phantoms), created from 0-40 wt% tantalum oxide (TaOx ) nanoparticles in polycaprolactone and poly(lactide-co-glycolide) 85:15 and 50:50, representing non, slow, and fast degrading systems, respectively, are investigated. Phantoms degrade over 20 weeks in vitro in simulated physiological environments: healthy tissue (pH 7.4), inflammation (pH 6.5), and lysosomal conditions (pH 5.5), while radiopacity, structural stability, mechanical strength, and mass loss are monitored. The polymer matrix determines overall degradation kinetics, which increases with lower pH and higher TaOx content. Importantly, all radiopaque phantoms could be monitored for a full 20 weeks. Phantoms implanted in vivo and serially imaged demonstrate similar results. An optimal range of 5-20 wt% TaOx nanoparticles balances radiopacity requirements with implant properties, facilitating next-generation biomedical devices.

Modification and evaluation of diatrizoate sodium containing polymethyl methacrylate bone cement

Polymethyl methacrylate (PMMA) bone cement is now widely used in percutaneous vertebro plasty (PVP) and percutaneous kyphoplasty (PKP). However, studies showed that the radiopacifiers (zirconia, barium sulfate, etc.) added to PMMA will have a negative impact on its use, e.g. barium sulfate will weaken the mechanical properties of bone cement and lead to bone absorption and aseptic loosening. Iodine is an element existing in the human body and has good imaging performance. Iodine contrast agent has been used in clinic for many years and has abundant clinical data. Therefore, using iodine instead of barium sulfate may be a promising choice. In this paper, the effect of different content of diatrizoate sodium (DTA, C₁₁H₈I₃N₂NaO₄) on the properties of PMMA was studied and compared with the traditional PMMA bone cement containing 30 wt% barium sulfate. The mechanical properties, setting properties, radiopacity, and biocompatibility of bone cement were evaluated. The compressive strength of PMMA bone cement with 20 wt% DTA can reach 76.38 MPa. DTA released from bone cement up to 14 days accounted for only 2.3% of its dosage. The water contact angle was 62.3°. The contrast of bone cement on X-ray film was comparable to that of bone cement containing 30 wt% barium. The hemolysis rate was lower than 4%, and there was no obvious hemolysis. PMMA with 20 wt% DTA can maintain the relative growth rate of MC3T3-E1 and L929 cells above 80%. The results show that adding 20 wt% DTA into PMMA can obtain good radiopacity while maintaining its mechanical properties, setting properties, and biocompatibility. DTA can be used as a promising candidate material for PMMA bone cement radiopacifier.

Modification of Polyvinyl Chloride Composites for Radiographic Detection of Polyvinyl Chloride Retained Surgical Items

The ever-present risk of surgical items being retained represents a real medical peril for the patient and potential liability issues for medical staff. Radiofrequency scanning technology is a very good means to substantially reduce such accidents. Radiolucent medical-grade polyvinyl chloride (PVC) used for the production of medical items is filled with radiopaque agents to enable X-ray visibility. The present study proves the suitability of bismuth oxychloride (BiOCl) and documents its advantages over the classical radiopaque agent barium sulfate (BaSO₄). An addition of BiOCl exhibits excellent chemical and physical stability (no leaching, thermo-mechanical properties) and good dispersibility within the PVC matrix. As documented, using half the quantity of BiOCl compared to BaSO₄ will provide a very good result. The conclusions are based on the methods of rotational rheometry, scanning electron microscopy, dynamic mechanical analysis, atomic absorption spectroscopy, and the verification of zero leaching of BiOCl out of a PVC matrix. X-ray images of the studied materials are presented, and an optimal concentration of BiOCl is evaluated.

Cell viability and physicochemical effects of different concentrations of bismuth trioxide in a mineral trioxide aggregate cement

PURPOSE

To evaluate the effect of three concentrations of bismuth trioxide (Bi₂O₃) on the biological and physicochemical properties of an experimental mineral trioxide aggregate-type (MTA-type) cement at different time points.

METHODS

Three experimental groups with white Portland cement containing 15, 20, or 25 wt% of Bi₂O₃ were assessed. Cellular proliferation in human periodontal ligament fibroblasts was evaluated with an MTT assay. Radiopacity, dimensional stability, pH, and compressive strength were evaluated at different time points.

RESULTS

Bismuth trioxide induced cell proliferation in the Bi15 and Bi25 groups in a time-dependent manner; pH was similar in all groups. Compressive strength was associated with time and bismuth concentration. Bi25 had significantly contracted at day 7 and expanded at day 14 (ANOVA P < 0.05, post hoc Tukey test P < 0.05).

CONCLUSION

A higher Bi₂O₃ concentration had a negative effect on the physical properties of the cement at all time points.

Incorporating Radiopacity into Implantable Polymeric Biomedical Devices for Clinical Radiological Monitoring

Longitudinal radiological monitoring of biomedical devices is increasingly important, driven by risk of device failure following implantation. Polymeric devices are poorly visualized with clinical imaging, hampering efforts to use diagnostic imaging to predict failure and enable intervention. Introducing nanoparticle contrast agents into polymers is a potential method for creating radiopaque materials that can be monitored via computed tomography. However, properties of composites may be altered with nanoparticle addition, jeopardizing device functionality. This, we investigated material and biomechanical response of model nanoparticle-doped biomedical devices (phantoms), created from 0-40wt% TaO x nanoparticles in polycaprolactone, poly(lactide-co-glycolide) 85:15 and 50:50, representing non-, slow and fast degrading systems, respectively. Phantoms degraded over 20 weeks in vitro, in simulated physiological environments: healthy tissue (pH 7.4), inflammation (pH 6.5), and lysosomal conditions (pH 5.5), while radiopacity, structural stability, mechanical strength and mass loss were monitored. The polymer matrix determined overall degradation kinetics, which increased with lower pH and higher TaO x content. Importantly, all radiopaque phantoms could be monitored for a full 20-weeks. Phantoms implanted in vivo and serially imaged, demonstrated similar results. An optimal range of 5-20wt% TaO x nanoparticles balanced radiopacity requirements with implant properties, facilitating next-generation biomedical devices.

3D-Printed Radiopaque Bioresorbable Stents to Improve Device Visualization

Bioresorbable stents (BRS) hold great promise for the treatment of many life-threatening luminal diseases. Tracking and monitoring of stents in vivo is critical for avoiding their malposition and inadequate expansion, which often leads to complications and stent failure. However, obtaining high X-ray visibility of polymeric BRS has been challenging because of their intrinsic radiolucency. This study demonstrates the use of photopolymerization-based 3D printing technique to fabricate radiopaque BRS by incorporating iodixanol, a clinical contrast agent, into a bioresorbable citrate-based polymer ink. The successful volumetric dispersion of the iodixanol through the 3D-printing process confers strong X-ray visibility of the produced BRS. Following in vitro degradation, the 3D-printed BRS embedded in chicken muscle maintains high X-ray visibility for at least 4 weeks. Importantly, the 3D-printed radiopaque BRS demonstrates good cytocompatibility and strong mechanical competence in crimping and expansion, which is essential for minimally invasive stent deployment. In addition, it is found that higher loading concentrations of iodixanol, e.g. 10 wt.%, results in more strut fractures in stent crimping and expansion. To conclude, this study introduces a facile strategy to fabricate radiopaque BRS through the incorporation of iodixanol in the 3D printing process, which could potentially increase the clinical success of BRS.

Graphene Oxide-based Endodontic Sealer: An in Vitro Study

The failure of endodontic treatment is directly associated with microbial infection in the root canal or periapical areas. An endodontic sealer that is both bactericidal and biocompatible is essential for the success of root canal treatments. This is one of the vital issues yet to be solved in clinical dental practice. This in vitro study assessed the effectiveness of graphene oxide (GO) composites GO-CaF2 and GO-Ag-CaF2 as endodontic sealer materials. Dentin slices were coated with either the GO-based composites or commonly used root canal sealers (non-eugenol zinc oxide sealer). The coated slices were treated in 0.9% NaCl, phosphate-buffered saline (PBS), and simulated body fluid (SBF) at 37˚C for 24 hours to compare their sealing effect on the dentin surface. In addition, the radiopacity of these composites was examined to assess whether they complied with the requirements of a sealer for good radiographic visualization. Scanning electron microscopy showed the significant sealing capability of the composites as coating materials. Radiographic images confirmed their radiopacity. Mineral deposition indicated their bioactivity, especially of GO-Ag-CaF2, and thus it is potential for regenerative application. They were both previously shown to be bactericidal to oral microbes and cytocompatible with host cells. With such a unique assemblage of critical properties, these GO-based composites show promise as endodontic sealers for protection against reinfection in root canal treatment and enhanced success in endodontic treatment overall.

Long-Term In Vitro Assessment of Biodegradable Radiopaque Composites for Fiducial Marker Fabrication

Biodegradable polymer-based composite materials may be successfully utilised to fabricate fiducial markers (FMs), which are intended to precisely label tumour margins during image-guided surgery or radiotherapy. However, due to matrix degradability, the stability of the functional properties of FMs depends on the chosen polymer. Thus, this study aimed to investigate novel radiopaque composites which varied in the polymeric matrix-polycaprolactone (PCL), poly(L-lactide-co-caprolactone) (P[LAcoCL]) with two molar ratios (70:30 and 85:15), and poly(L-lactide-co-glycolide) (with molar ratio 82:18). The radiopaque component of the materials was a mixture of barium sulphate and hydroxyapatite. The changes in water contact angle, stiffness, and radiopacity occurring during the 24-week-long degradation experiment were examined for the first time. This study comprehensively analyses the microstructural causes of composites behaviour within degradation experiments using thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), gel permitted chromatography (GPC), and scanning electron microscopy (SEM). The obtained results suggest that the utilized biodegradable matrix plays an essential role in radiopaque composite properties and stability thereof. This long-term in vitro assessment enabled a comparison of the materials and aided in choosing the most favourable composite for FMs' fabrication.

Discoloration Improvement by Mechanically-Milled Binary Oxides as Radiopacifier for Mineral Trioxide Aggregates

Mineral trioxide aggregates (MTA) have been widely used in endodontic treatments, but after some time, patients suffer tooth discoloration due to the use of bismuth oxide (Bi2O3) as a radiopacifier. Replacement of Bi2O3 with high energy ball-milled single (zirconia ZrO2; hafnia, HfO2; or tantalum pentoxide, Ta2O5) or binary oxide powder was attempted, and corresponding discoloration improvement was investigated in the present study. Bi2O3-free MTA is expected to exhibit superior discoloration. The radiopacity, diametral tensile strength, and discoloration of MTA-like cements prepared from the as-milled powder were investigated. Experimental results showed that MTA-like cements prepared using Ta2O5 exhibited a slightly higher radiopacity than that of HfO2 but had a much higher radiopacity than ZrO2. Milling treatment (30 min to 3 h) did not affect the radiopacities significantly. These MTA-like cements exhibited superior color stability (all measured ΔE00 < 1.0) without any perceptible differences after UV irradiation. MTA-like cements prepared using ZrO2 exhibited the best color stability but the lowest radiopacity, which can be improved by introducing binary oxide. Among the investigated samples, MTA-like cement using (ZrO2)50(Ta2O5)50 exhibited excellent color stability and the best overall performance with a radiopacity of 3.25 mmAl and a diametral tensile strength of 4.39 MPa.

Overviews on the Progress of Flowable Dental Polymeric Composites: Their Composition, Polymerization Process, Flowability and Radiopacity Aspects

A review article has been conducted including the main research results and comments referring to flowable dental polymeric materials. To begin with, the synthesis and composition of this category of composites is discussed, revealing the major components of the commercial products in terms of chemistry and proportion. Later, the polymerization characteristics are unfolded regarding the reaction time and rate, volumetric shrinkage and depth of cure for both photocurable and self-curable composites. To continue, some perspectives of the pre-treatment or accompanying processes that a clinician may follow to enhance the materials' performance are described. Fluidity is certainly associated with the progress of polymerization and the in-depth conversion of monomers to a polymeric network. Last, the aspects of radiopacity and translucency are commented on, showing that all flowable polymeric composites satisfy the radiography rule, while the masking ability depends on the fillers' properties and specimen thickness. The reviewing article is addressed to all field scientists and practitioners dealing with flowable dental composites studies or applications.

Immediate and Long-Term Radiopacity and Surface Morphology of Hydraulic Calcium Silicate-Based Materials

The present study aimed to evaluate and compare the radiopacity and surface morphology of AH Plus Bioceramic Sealer (AHPB), Bio-C Sealer (BIOC), Biodentine (BD), BioRoot RCS (BR), Grey-MTAFlow (GMF), White-MTAFlow (WMF), TotalFill BC Sealer (TF), and TotalFill BC Sealer HiFlow (TFHF) at different time moments—30 min, 24 h, and 28 days. Ten specimens of each material were prepared according to the ISO-6876:2012 standard and radiographed next to an aluminum step wedge using a digital sensor. The specimens were stored in a gelatinized Hank’s balanced salt solution at 37 °C between assessments. The mean grayscale values of each specimen were converted into equivalent aluminum thickness by a linear regression model. Characterization of the surface morphology was performed by using a scanning electron microscope at ×4.0k and ×10.0k magnifications. The radiographic analysis revealed that all the tested materials exceeded the ISO-specified limit of 3 mm Al, with the highest radiopacity presented by AHPB and the lowest by BD. None of the tested materials demonstrated considerable variances between the 30 min and the 24 h radiopacity level (p < 0.05), and statistically significant long-term radiopacity changes were exhibited by BR, TFHF, and TF (p > 0.05). All the specimens demonstrated a common feature of limited precipitate formation, with numerous unreacted particles still presented on the surface after 24 h, whereas the particle rearrangement and the deposition of precipitates were clearly observed after 28 days.

Bismuth Nanoparticle and Polyhydroxybutyrate Coatings Enhance the Radiopacity of Absorbable Inferior Vena Cava Filters for Fluoroscopy-Guided Placement and Longitudinal Computed Tomography Monitoring in Pigs

Inferior vena cava filters (IVCFs) constructed with poly-p-dioxanone (PPDO) are promising alternatives to metallic filters and their associated risks and complications. Incorporating high-Z nanoparticles (NPs) improves PPDO IVCFs' radiopacity without adversely affecting their safety or performance. However, increased radiopacity from these studies are insufficient for filter visualization during fluoroscopy-guided PPDO IVCF deployment. This study focuses on the use of bismuth nanoparticles (BiNPs) as radiopacifiers to render sufficient signal intensity for the fluoroscopy-guided deployment and long-term CT monitoring of PPDO IVCFs. The use of polyhydroxybutyate (PHB) as an additional layer to increase the surface adsorption of NPs resulted in a 2-fold increase in BiNP coating (BiNP-PPDO IVCFs, 3.8%; BiNP-PPDO + PHB IVCFs, 6.2%), enabling complete filter visualization during fluoroscopy-guided IVCF deployment and, 1 week later, clot deployment. The biocompatibility, clot-trapping efficacy, and mechanical strength of the control PPDO (load-at-break, 6.23 ± 0.13 kg), BiNP-PPDO (6.10 ± 0.09 kg), and BiNP-PPDO + PHB (6.15 ± 0.13 kg) IVCFs did not differ significantly over a 12-week monitoring period in pigs. These results indicate that BiNP-PPDO + PHB can increase the radiodensity of a novel absorbable IVCF without compromising device strength. Visualizing the device under conventional radiographic imaging is key to allow safe and effective clinical translation of the device.

Synthesis and Characterization of Novel Radiopaque Polycarbonate

Polymeric materials implanted in the human body are usually invisible under X-ray, and the mixing of heavy metal salts into polymeric materials by physical compounding often poses compatibility problems. A new iodine-containing cyclic carbonate monomer, 4-iodo-N-(2-oxo-1,3-dioxan-5-yl)benzamide (IBTMC), is synthesized, which has a degradable carbonate group as its basic structural unit and iodine atoms attached to the side chain in the form of covalent bonds. The ring-opening polymerization of IBTMC is achieved at room temperature under the catalysis of the solid superbase 1,5,7-triazabicyclo[4.4.0]dec-5-ene (TBD). The structure and X-ray developing ability of the synthesized polycarbonate are characterized by ¹ H-NMR, X-ray photoelectron spectroscopy (XPS), energy dispersive X-ray spectroscopy (EDS), Gel Permeation Chromatography (GPC), and micro-computed tomography (Micro-CT). The iodine atoms remain bound to the polymer as covalent bonds after a series of reactions and exhibit a high level of X-ray opacity. In vitro degradation experiments of the polymer prove that the polymer is degradable.

Distrontium Cerate as a Radiopaque Component of Hydraulic Endodontic Cement

This study aimed to synthesize distrontium cerate (2SrO·CeO2: S2Ce) and evaluate its properties as an alternative component of the endodontic cement. S2Ce cement was prepared through calcination of strontium hydroxide and cerium carbonate. Subsequently, the crystal phase was confirmed using X-ray diffraction. S2Ce cement exhibited a rapid setting time (121 min) and achieved a high compressive strength (72.1 MPa) at 1 d after mixing, comparable to the compressive strength of a commercial mineral trioxide aggregate (MTA) cement (ProRoot MTA) after 28 d post mixing. However, the compressive strength decreased after 28 d of storage when the W/P ratio was 0.30-0.40 (p < 0.05). Ion dissolution test of the S2Ce cement showed that strontium ions were released after immersion in water (5.27 mg/mL after 1 d), whereas cerium dissolution was not detected. S2Ce exhibited approximately three times higher radiopacity (9.0 mm aluminum thickness equivalent) compared to the commercial MTA (p < 0.05). These findings suggest that S2Ce is a possible component for hydraulic endodontic cement that demonstrates a rapid setting and high radiopacity.

Effect of Tantalum Pentoxide Addition on the Radiopacity Performance of Bi2O3/Ta2O5 Composite Powders Prepared by Mechanical Milling

Among the various phases of bismuth oxide, the high temperature metastable face-centered cubic δ phase attracts great attention due to its unique properties. It can be used as an ionic conductor or an endodontic radiopacifying material. However, no reports concerning tantalum and bismuth binary oxide prepared by high energy ball milling and serving as a dental radiopacifier can be found. In the present study, Ta₂O₅-added Bi₂O₃ composite powders were mechanically milled to investigate the formation of these metastable phases. The as-milled powders were examined by X-ray diffraction and scanning electron microscopy to reveal the structural evolution. The as-milled composite powders then served as the radiopacifier within mineral trioxide aggregates (i.e., MTA). Radiopacity performance, diametral tensile strength, setting times, and biocompatibility of MTA-like cements solidified by deionized water, saline, or 10% calcium chloride solution were investigated. The experimental results showed that subsequent formation of high temperature metastable β-Bi_7.8Ta_0.2O_12.2, δ-Bi₂O₃, and δ-Bi₃TaO₇ phases can be observed after mechanical milling of (Bi₂O₃)₉₅(Ta₂O₅)₅ or (Bi₂O₃)₈₀(Ta₂O₅)₂₀ powder mixtures. Compared to its pristine Bi₂O₃ counterpart with a radiopacity of 4.42 mmAl, long setting times (60 and 120 min for initial and final setting times) and 84% MG-63 cell viability, MTA-like cement prepared from (Bi₂O₃)₉₅(Ta₂O₅)₅ powder exhibited superior performance with a radiopacity of 5.92 mmAl (the highest in the present work), accelerated setting times (the initial and final setting time can be shortened to 25 and 40 min, respectively), and biocompatibility (94% cell viability).

Rapid Fabrication of MgNH4PO4·H2O/SrHPO4 Porous Composite Scaffolds with Improved Radiopacity via 3D Printing Process

Although bone repair scaffolds are required to possess high radiopacity to be distinguished from natural bone tissues in clinical applications, the intrinsic radiopacity of them is usually insufficient. For improving the radiopacity, combining X-ray contrast agents with bone repair scaffolds is an effective method. In the present research, MgNH₄PO₄·H₂O/SrHPO₄ 3D porous composite scaffolds with improved radiopacity were fabricated via the 3D printing technique. Here, SrHPO₄ was firstly used as a radiopaque agent to improve the radiopacity of magnesium phosphate scaffolds. X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy-dispersive spectroscopy (EDS) were used to characterize the phases, morphologies, and element compositions of the 3D porous composite scaffolds. The radiography image showed that greater SrHPO₄ contents corresponded to higher radiopacity. When the SrHPO₄ content reached 9.34%, the radiopacity of the composite scaffolds was equal to that of a 6.8 mm Al ladder. The porosity and in vitro degradation of the porous composite scaffolds were studied in detail. The results show that magnesium phosphate scaffolds with various Sr contents could sustainably degrade and release the Mg, Sr, and P elements during the experiment period of 28 days. In addition, the cytotoxicity on MC3T3-E1 osteoblast precursor cells was evaluated, and the results show that the porous composite scaffolds with a SrHPO₄ content of 9.34% possessed superior cytocompatibility compared to that of the pure MgNH₄PO₄·H₂O scaffolds when the extract concentration was 0.1 g/mL. Cell adhesion experiments showed that all of the scaffolds could support MC3T3-E1 cellular attachment well. This research indicates that MgNH₄PO₄·H₂O/SrHPO₄ porous composite scaffolds have potential applications in the bone repair fields.

Biological parameters, discolouration and radiopacity of calcium silicate-based materials in a simulated model of partial pulpotomy

AIM

To analyse the discolouration, radiopacity, pH and calcium ion release of Biodentine (BD), Bio-C repair (BCR) and Bio-C temp (BCT), as well as their biological effects on human dental pulp cells (hDPCs).

METHODOLOGY

Sixty-four extracted bovine incisors were prepared to simulate crown fractures with pulp exposure and open root apex. The roots were filled using a mixture of agar and blood (control), and BD, BCR or BCT were placed over this mixture. Colour assessment analyses of the samples were performed before and immediately after material insertion and repeated at 30 and 90 days, using a spectrophotometer. The colour change of each specimen was evaluated at the crown and calculated based on the CIELab colour space. Digital radiographs were acquired for radiopacity analysis. hDPCs were placed in contact with different dilutions of culture media previously exposed to such materials and tested for cell viability using the MTT assay. The pH and calcium ion release of all materials were measured after 24 h; the data were assessed using one-way analysis of variance (ANOVA). Cell viability was analysed by two-way ANOVA. Differences in colour parameters and wound-healing data were assessed by two-way repeated measures ANOVA (α = 0.05). Tukey's and Dunnett's tests were used to compare the experimental groups with the control group.

RESULTS

BCR had grater radiopacity and smaller colour alteration (ΔEab/ΔE00) than the other materials tested (p < .005; p < .001). No significant differences in pH were found amongst the tested materials (p > .05). BCT was associated with the largest release of calcium ions (p < .0001). BD had cell viability similar to that of the control at the lowest dilutions, and BCR was similar to that of the control, regardless of the dilution tested (p > .05). BCT had a lower percentage of viability than that of the control at all tested dilutions (p < .0001). Cell migration rates in BD and BCR were similar to those in the control group after 24 h and 48 h (p > .05), whilst BCT had larger voids than the control in both periods (p < .0001).

CONCLUSIONS

BCR, BCT and BD were associated with tooth discolouration. BCR had the lowest staining values, the highest radiopacity and viability greater than 80% hDPCs.

Microfluidic fabrication of imageable and resorbable polyethylene glycol microspheres for catheter embolization

Radiopaque and degradable hydrogel microspheres have a range of potential uses in medicine including proper placement of embolic material during occlusion procedures, acting as inherently embolic materials, and serving as drug carriers that can be located after injection. Current methods for creating radiopaque microspheres are either unable to fully and homogeneously incorporate radiopaque material throughout the microspheres for optimal imaging capabilities, do not result in degradable or fully compressible microspheres, or require elaborate, time-consuming preparation. We used a simple one-step microfluidic method to fabricate imageable, degradable polyethylene glycol (PEG) microspheres of varying sizes with homogenous dispersion of barium sulfate-a biocompatible, high-radiopacity contrast agent. The imageability of the microspheres was characterized using optical microscopy and microcomputed tomography as a function of barium sulfate loading. Microspheres with 20% wt/vol barium sulfate had a mean CT attenuation value of 1,510 HU, similar to that of cortical bone, which should enable visualization with soft tissue. Compared with unloaded microspheres, barium sulfate-loaded ones saw an increase in gelation and degradation times and storage modulus and decrease in swelling. Imageable microspheres retained compressibility and were injectable via catheter. The developed radiopaque, degradable PEG microspheres have various potential uses for interventional radiologists and imaging laboratories.

Functional Properties of Polyurethane Ureteral Stents with PLGA and Papaverine Hydrochloride Coating

Despite the obvious benefits of using ureteral stents to drain the ureters, there is also a risk of complications from 80-90%. The presence of a foreign body in the human body causes disturbances in its proper functioning. It can lead to biofilm formation on the stent surface, which may favor the development of urinary tract infections or the formation of encrustation, as well as stent fragmentation, complicating its subsequent removal. In this work, the effect of the polymeric coating containing the active substance-papaverine hydrochloride on the functional properties of ureteral stents significant for clinical practice were assessed. Methods: The most commonly clinically used polyurethane ureteral Double-J stent was selected for the study. Using the dip-coating method, the surface of the stent was coated with a poly(D,L-lactide-glycolide) (PLGA) coating containing the papaverine hydrochloride (PAP). In particular, strength properties, retention strength of the stent ends, dynamic frictional force, and the fluoroscopic visibility of the stent during X-ray imaging were determined. Results: The analysis of the test results indicates the usefulness of a biodegradable polymer coating containing the active substance for the modification of the surface of polyurethane ureteral stents. The stents coated with PLGA+PAP coating compared to polyurethane stents are characterized by more favorable strength properties, the smaller value of the dynamic frictional force, without reducing the fluoroscopic visibility.

Radiopacity endowed magnetic nanocomposite with hyperthermia andin vitromineralization potential: a combinatorial therapeutic system for osteosarcoma

The development of clinically advanced multifaceted therapeutic materials for osteosarcoma is at the forefront of cancer research. Accordingly, this work presents the design of a multifunctional magnetic nanocomposite composed of maghemite, strontium doped hydroxyapatite and silica nanoparticles prospectively holding indispensable therapeutic features such as magnetic hyperthermia,in vitrobiomineralization, sustained drug release and intrinsic radiopacity for the treatment of osteosarcoma. The optimal composition has been identified by sequentially modulating the ratio of precursors of the magnetic nanocomposite synthesized by sol-gel technique. Structural and morphological characterization by x-ray diffraction, fourier transform infrared spectrum, Brunauer-Emmet-Teller and transmission electron microscopy analyses followed by VSM, hyperthermia and micro-CT analyses essentially assisted in the selective configuration of biofunctional properties. Results exemplify that MSHSr1 has a saturation magnetization of 47.4 emu g^-1and attained hyperthermia temperature (42 °C) at a very low exposure time of 4 min. MSHSr1 is further unique with respect to its exceptional x-ray attenuation ability (contrast enhancement 154.5% in digital radiography; CT number 3100 HU), early biomimetic mineralization (in vitro) evident by the formation of spheroidal apatite layer (Ca/P ratio 1.33) harvested from FESEM-EDX analysis and controlled release of Doxorubicin, the clinically used chemotherapeutic drug: 87.7% at 120 h in tumour analogous pH (6.5) when compared to physiological pH (71.3% at 7.4). MTT assay complemented with cytoskeleton (F-actin) staining of human osteosarcoma (HOS) cells affirm biocompatibility of MSHSr1.In vitrobiomineralization authenticated by Alizarin red S and von Kossa staining has been further corroborated by semi-quantitative calcium estimation of HOS cells cultured with MSHSr1 for two weeks. The results therefore validate the multifunctionality of MSHSr1, and hence could be proposed as a combinatorial therapeutic nanocomposite for osteosarcoma treatment.

Radiopacity of resin-based CAD/CAM blocks assessed by areal grayscale pixel value measurement

PURPOSE

This study assessed radiopacity of resin-based computer-aided-design/computer-aided-manufacturing (CAD/CAM) materials by areal grayscale pixel value measurement.

METHODS

Radiopacities of six resin-based CAD/CAM block materials and resin composite were evaluated and compared to that of enamel and dentin. Specimens of 1-mm thickness were placed on photostimulable phosphor plate and irradiated with digital x-ray unit. On the radiographic image, regions of interests were determined for each specimen and areal grayscale pixel values were measured. Elemental analysis was performed with energy-dispersive x-ray spectroscopy (EDS) on field emission scanning electron microscope (FESEM) images of the specimens. Data were analyzed statistically (α = 0.05).

RESULTS

Radiopacity values of the restorative materials were significantly different from each other (P < 0.05). Radiopacity values of two resin-based CAD/CAM materials were significantly lower than that of dentin (P < 0.05). All tested restorative materials contain zirconium, three materials contain barium, and only resin composite contains lanthanum.

CONCLUSION

Four CAD/CAM materials with higher amounts of zirconia or barium (>18%) had radiopacity values significantly higher than the dentin; while two materials with lower amounts of zirconia (<4%) and/or no-barium, had radiopacity values significantly lower than the dentin. EDS analysis suggests materials containing elements with higher atom numbers such as zirconia and barium could exhibit higher radiopacity.

Crystallization Behavior and Mechanical Properties of Poly(ε-caprolactone) Reinforced with Barium Sulfate Submicron Particles

Poly(ε-caprolactone) (PCL) was mixed with submicron particles of barium sulfate to obtain biodegradable radiopaque composites. X-ray images comparing with aluminum samples show that 15 wt.% barium sulfate (BaSO4) is sufficient to present radiopacity. Thermal studies by differential scanning calorimetry (DSC) show a statistically significant increase in PCL degree of crystallinity from 46% to 52% for 25 wt.% BaSO4. Non-isothermal crystallization tests were performed at different cooling rates to evaluate crystallization kinetics. The nucleation effect of BaSO4 was found to change the morphology and quantity of the primary crystals of PCL, which was also corroborated by the use of a polarized light optical microscope (PLOM). These results fit well with Avrami-Ozawa-Jeziorny model and show a secondary crystallization that contributes to an increase in crystal fraction with internal structure reorganization. The addition of barium sulfate particles in composite formulations with PCL improves stiffness but not strength for all compositions due to possible cavitation effects induced by debonding of reinforcement interphase.

Post-administration dosimetry in yttrium-90 radioembolization through micro-CT imaging of radiopaque microspheres in a porcine renal model

The purpose of this study is to perform post-administration dosimetry in yttrium-90 radioembolization through micro-CT imaging of radiopaque microsphere distributions in a porcine renal model and explore the impact of spatial resolution of an imaging system on the extraction of specific dose metrics. Following the administration of radiopaque microspheres to the kidney of a hybrid farm pig, the kidney was explanted and imaged with micro-CT. To produce an activity distribution, 400 MBq of yttrium-90 activity was distributed throughout segmented voxels of the embolized vasculature based on an established linear relationship between microsphere concentration and CT voxel value. This distribution was down-sampled to coarser isotropic grids ranging in voxel size from 2.5 to 15 mm to emulate nominal resolutions comparable to those found in yttrium-90 PET and Bremsstrahlung SPECT imaging. Dose distributions were calculated through the convolution of activity distributions with dose-voxel kernels generated using the GATE Monte Carlo toolkit. Contours were computed to represent normal tissue and target volumes. Dose-volume histograms, dose metrics, and dose profiles were compared to a ground truth dose distribution computed with GATE. The mean dose to the target for all studied voxel sizes was found to be within 5.7% of the ground truth mean dose.D70was shown to be strongly correlated with image voxel size of the dose distribution (r² = 0.90).D70is cited in the literature as an important dose metric and its dependence on voxel size suggests higher resolution dose distributions may provide new perspectives on dose-response relationships in yttrium-90 radioembolization. This study demonstrates that dose distributions with large voxels incorrectly homogenize the dose by attributing escalated doses to normal tissues and reduced doses in high-dose target regions. High-resolution micro-CT imaging of radiopaque microsphere distributions can provide increased confidence in characterizing the absorbed dose heterogeneity in yttrium-90 radioembolization.

Radiopacity quantification and spectroscopic characterization of OrthoMTA and RetroMTA

The aim of this article was to investigate the unknown radiopacity performances of OrthoMTA and RetroMTA via means of a contemporary image analyzing methods and energy dispersive X-ray spectroscopy. Three commercial hydraulic calcium silicate-based cements and a calcium hydroxide-based paste were used. Pure-grade zirconium oxide, bismuth oxide, zinc oxide, barium sulfate, and calcium hydroxide were as references. An energy-dispersive X-ray spectroscopy instrument was used for the elemental analysis. Radiographic image data was obtained according to the International Organization for Standardization 6876-2012 specifications. The region of interest was determined for each specimen. Mean (±SD) grey values of the X-ray image data was measured with an image analyzing software. The calibration curve was created by curve-plotting software and the mean grey-values were matched versus Al values (mm Al). Data were analyzed with one-way ANOVA followed by Tukey's multiple comparison test. Spectroscopic characterization of the commercial materials was shown with assigned Carbon, oxygen, aluminum, silicon, calcium, zinc, zirconium, barium, tungsten, bismuth, and sulfur elements. The major radiopacifier/s of OrthoMTA is Bi, of RetroMTA is Zr, of BioDentine are Ba and Zr, and of ProCal is Ba. The radiopacity values of all commercial materials are significantly different (p < .05). The rank of the radiopacity values: RetroMTA (3.36 ± 0.29mmAl) > OrthoMTA (2.56 ± 0.19mmAl) > BioDentine (2.02 ± 0.12mmAl) > ProCal (1.46 ± 0.60mmAl). The study reported that the radiopacity values and spectral characterization of RetroMTA and OrthoMTA cements. The pixel-based and reproducible method could be used universally to the quantification of the radiodensity of digitally collected X-ray data.

A Radiopaque Nanoparticle-Based Ink Using PolyJet 3D Printing for Medical Applications

The aim of this study was to develop a 3D printable radiopaque ink and successfully print a finished artifact. Radiopaque 3D printing would be hugely beneficial to improve the visibility of medical devices and implants, as well as allowing more realistic phantoms and calibration aids to be produced. Most 3D printing technologies are polymer based. Polymers are naturally radiolucent, allowing X-rays to pass through, showing up as faint dark gray regions on X-ray detectors, as for soft tissues. During this study, a 3D printable ultraviolet (UV) curable resin containing zirconium oxide (ZrO₂) nanoparticles was developed. 5 wt.% ZrO₂ was dispersed in a base resin using a high-shear mixer. Particles remained in suspension for 6-8 h at room temperature, allowing time for 3D printing. A model of a hand including radiopaque bones and a test block demonstrating a range of internal radiopaque features were successfully 3D printed. Radiopacity was demonstrated in the 3D-printed models, and there was good dispersion of ZrO₂ within the resin matrix. The impregnated resin remained UV curable and viscosity was not compromised. In this study, 3D-printed radiopaque features demonstrated clear radiopacity under X-ray and microcomputed tomography imaging.

Radiopaque scaffolds based on electrospun iodixanol/polycaprolactone fibrous composites

Grafts based on biodegradable polymer scaffolds are increasingly used in tissue-engineering applications as they facilitate natural tissue regeneration. However, monitoring the position and integrity of these scaffolds over time is challenging due to radiolucency. In this study, we used an electrospinning method to fabricate biodegradable scaffolds based on polycaprolactone (PCL) and iodixanol, a clinical contrast agent. Scaffolds were implanted subcutaneously into C57BL/6 mice and monitored in vivo using longitudinal X-ray imaging and micro-computed tomography (CT). The addition of iodixanol altered the physicochemical properties of the PCL scaffold; notably, as the iodixanol concentration increased, the fiber diameter decreased. Radiopacity was achieved with corresponding signal enhancement as iodine concentration increased while exhibiting a steady time-dependent decrease of 0.96% per day in vivo. The electrospun scaffolds had similar performance with tissue culture-treated polystyrene in supporting the attachment, viability, and proliferation of human mesenchymal stem cells. Furthermore, implanted PCL-I scaffolds had more intense acute inflammatory infiltrate and thicker layers of maturing fibrous tissue. In conclusion, we developed radiopaque, biodegradable, biocompatible scaffolds whose position and integrity can be monitored noninvasively. The successful development of other imaging enhancers may further expand the use of biodegradable scaffolds in tissue engineering applications.

A Short Review on Biomedical Applications of Nanostructured Bismuth Oxide and Related Nanomaterials

In this review, we reported the main achievements reached by using bismuth oxides and related materials for biological applications. We overviewed the complex chemical behavior of bismuth during the transformation of its compounds to oxide and bismuth oxide phase transitions. Afterward, we summarized the more relevant studies regrouped into three categories based on the use of bismuth species: (i) active drugs, (ii) diagnostic and (iii) theragnostic. We hope to provide a complete overview of the great potential of bismuth oxides in biological environments.

The feasibility of degradable glass microspheres as transient embolic medical devices

The deliberate occlusion of blood flow through transarterial embolization is currently being used to treat conditions ranging from hemorrhages to hypervascular tumors. Degradable, imageable high borate glass microspheres (BRS2) were developed and tested to improve lesion targeting and promote a temporary vascular occlusion which is sufficient for most embolization procedure. A 48 hour pilot study, in a swine renal model, was conducted to assess the embolization effectiveness and potential risks of this new embolic agent. Bilateral embolization of the caudal branch of the renal arteries using test and control particles were performed in 4 pigs. Embolization efficacy, recanalization and resulting ischemia were evaluated at different time frame (0, 24 and 48 hours). The primary outcomes for this study were the assessment of: (i) embolization effectiveness, and (ii) vessel recanalization. The test article was found to occlude vessels as effectively as the control microspheres, with the use of a smaller volume of microspheres. At the 24 hour time point, over 95% of the material was found to be completely degraded, although little to no recanalization was observed. This data suggests that BRS2 is an effective embolic agent, however further investigations into the method of delivery are required prior to clinical implementation.

Imaging of Injectable Hydrogels Delivered into Myocardium with SPECT/CT

Injectable hydrogels are being widely explored for treatment after myocardial infarction (MI) through mechanical bulking or the delivery of therapeutics. Despite this interest, there have been few approaches to image hydrogels upon injection to identify their location, volume, and pattern of delivery, features that are important to understand toward clinical translation. Using a hyaluronic acid (HA) hydrogel as an example, the aim of this study is to introduce radiopacity to hydrogels by encapsulating a clinically used contrast agent (Omnipaque Iohexol, GE Healthcare) for imaging upon placement in the myocardium. Specifically, iohexol is encapsulated into shear-thinning and self-healing hydrogels formed through the mixing of HA-hydrazide and HA-aldehyde. Upon examination of a range of iohexol concentrations, a concentration of 100 mg mL-1 iohexol is deemed optimal based on the greatest contrast, while maintaining hydrogel mechanical properties and acceptable injection forces. In an acute porcine model of MI, hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) perfusion imaging is performed immediately and 3-4 days after hydrogel delivery to assess radiopacity and verify the hydrogel location within the perfusion defect. Hybrid SPECT/CT imaging demonstrates excellent radiopacity of the hydrogel within the perfusion defect immediately after intramyocardial hydrogel injection, demonstrating the feasibility of this method for short-term noninvasive hydrogel monitoring.

A Systematic Review on 3D-Printed Imaging and Dosimetry Phantoms in Radiation Therapy

INTRODUCTION

Additive manufacturing or 3-dimensional printing has become a widespread technology with many applications in medicine. We have conducted a systematic review of its application in radiation oncology with a particular emphasis on the creation of phantoms for image quality assessment and radiation dosimetry. Traditionally used phantoms for quality assurance in radiotherapy are often constraint by simplified geometry and homogenous nature to perform imaging analysis or pretreatment dosimetric verification. Such phantoms are limited due to their ability in only representing the average human body, not only in proportion and radiation properties but also do not accommodate pathological features. These limiting factors restrict the patient-specific quality assurance process to verify image-guided positioning accuracy and/or dose accuracy in "water-like" condition.

METHODS AND RESULTS

English speaking manuscripts published since 2008 were searched in 5 databases (Google Scholar, Scopus, PubMed, IEEE Xplore, and Web of Science). A significant increase in publications over the 10 years was observed with imaging and dosimetry phantoms about the same total number (52 vs 50). Key features of additive manufacturing are the customization with creation of realistic pathology as well as the ability to vary density and as such contrast. Commonly used printing materials, such as polylactic acid, acrylonitrile butadiene styrene, high-impact polystyrene and many more, are utilized to achieve a wide range of achievable X-ray attenuation values from -1000 HU to 500 HU and higher. Not surprisingly, multimaterial printing using the polymer jetting technology is emerging as an important printing process with its ability to create heterogeneous phantoms for dosimetry in radiotherapy.

CONCLUSION

Given the flexibility and increasing availability and low cost of additive manufacturing, it can be expected that its applications for radiation medicine will continue to increase.

Effects of Milling Time, Zirconia Addition, and Storage Environment on the Radiopacity Performance of Mechanically Milled Bi2O3/ZrO2 Composite Powders

Mineral trioxide aggregate (MTA) typically consists of Portland cement (75 wt.%), bismuth oxide (20 wt.%), and gypsum (5 wt.%) and is commonly used as endodontic cement. Bismuth oxide serving as the radiopacifying material reveals the canal filling effect after clinical treatment. In the present study, bismuth/zirconium oxide composite powder was prepared by high energy ball milling of (Bi₂O₃)_100−x (ZrO₂)_x (x = 5, 10, 15, and 20 wt.%) powder mixture and used as the radiopacifiers within MTA. The crystalline phases of the as-milled powders were examined by the X-ray diffraction technique. The radiopacities of MTA-like cements prepared by using as-milled composite powders (at various milling stages or different amount of zirconia addition) were examined. In addition, the stability of the as-milled powders stored in an ambient environment, an electronic dry box, or a glove box was investigated. The experimental results show that the as-milled powder exhibited the starting powder phases of Bi₂O₃ and ZrO₂ and the newly formed δ-Bi_7.38Zr_0.62O_2.31 phase. The longer the milling time or the larger the amount of the zirconia addition, the higher the percentage of the δ-Bi_7.38Zr_0.62O_2.31 phase in the composite powder. All the MTA-like cements prepared by the as-milled powder exhibited a radiopacity higher than 4 mmAl that is better than the 3 mmAl ISO standard requirement. The 30 min as-milled (Bi₂O₃)₉₅(ZrO₂)₅ composite powder exhibited a radiopacity of 5.82 ± 0.33 mmAl and degraded significantly in the ambient environment. However, storing under an oxygen- and humidity-controlled glove box can prolong a high radiopacity performance. The radiopacity was 5.76 ± 0.08 mmAl after 28 days in a glove box that was statistically the same as the original composite powder.

Bismuth-Doped Nanohydroxyapatite Coatings on Titanium Implants for Improved Radiopacity and Antimicrobial Activity

This study aims to present the possibility to obtain bismuth-doped nanohydroxyapatite coatings on the surface of the titanium implants by using a solution-derived process according to an established biomimetic methodology. The bioactivity of the titanium surface was increased by an alkali-thermal treatment. Then, under biomimetic conditions, the titanium surface was coated with a Bi-doped nanohydroxyapatite layer by using a modified supersaturated calcification solution (SCS) containing a bismuth salt. The apatite deposits were analyzed by scanning electron microscopy coupled with X-ray analysis (SEM-EDX), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), and digital X-rays radiography method. The results indicate that the Bi-doped nanohydroxyapatite coatings on titanium surface were produced. These coatings exhibit a good radiopacity, thus enhancing their applications in dental and orthopedic fields. Additionally, the Bi-doped nanohydroxyapatite coatings show significant antimicrobial activity against Escherichia coli and Staphylococcus aureus bacteria.

Experimental study of influence of composition on radiopacity of fiber post materials

This experimental study aims to evaluate the radiopacity of various fiber post materials and to determine the effects of material composition as analyzed by energy-dispersive X-ray spectrophotometry (EDS; EDAX Team Software; EDAX, Inc., Mahwah, NJ) on radiopacity. Five specimens of seven fiber post materials with 2-mm thickness were prepared and digital radiographs were taken with an aluminum stepwedge (SW) and 2-mm-thick tooth slice. The mean gray values (MGVs) of specimens were measured using the histogram function of a computer graphics program (Adobe Photoshop CS6; Adobe System, Inc., San Jose, CA). The MGVs of fiber post materials were compared with an aluminum SW and dentin of equal thickness. The fiber post specimens were examined by scanning electron microscopy and EDS analysis performed for the elementary analysis of material composition. The MGVs of fiber posts ranged between 83.67 ± 3.64 and 57.80 ± 7.08 pixels. Materials were sorted in descending order of MGV as follows: Reforpost, Carbopost, D.T. Light-Post, Easypost, Glassix Radiopaque, Dentolic Glass Fiber Post, and RelyX Fiber Post. All fiber posts demonstrated significantly higher radiopacity values than 2-mm-thick aluminum (p < .05). EDS analysis results indicated that the evaluated fiber posts included various elements for radiopacity in different ratios. All tested fiber post materials showed radiopacity values above the minimum recommendations of the International Organization for Standardization. EDS analysis results indicated that each manufacturer used different compositions of elements like zirconium, barium, titanium, and iron for achieving radiopacity in materials.

The influence of composite resin restoration radiopacity on radiographic diagnosis and decision-making

The objective of this study was to evaluate the influence of the radiopacity of composite resin restorations on the interpretation of phantom radiographic images and to correlate the diagnosis with clinical management. Eighty healthy extracted human third molars were divided into 4 groups (n = 20 each): 3 restorative groups and 1 group of untreated teeth. The radiopacity of the materials was evaluated objectively using 10-mm discs of the composite resins SureFil SDR Flow (SDR), Filtek Bulk Fill Flowable Restorative (Filtek Bulk), and Filtek Z250 XT (Z250). Standard Class II cavities were prepared in the teeth. In the SDR and Filtek Bulk groups, the respective material was placed as a 2-mm base, and the remainder of the cavity was restored with Z250. In the Z250 group, the entire preparation was filled with Z250 composite resin. Ten phantoms of 6 teeth each were created; each phantom included 1 molar selected randomly from each of the 4 groups and 2 healthy premolars. Bitewing radiographs of the phantoms were obtained with a digital phosphor plate system and stored. For the subjective analysis, 5 examiners evaluated each of the molars on the radiographs and established the diagnosis and treatment plan. The radiopacity of the materials was statistically similar (P = 0.413), and there was no statistically significant difference between groups in the interpretation of the images. The radiopacity of the materials met ISO standard 4049/2009. Diagnosis and decision-making were influenced by the radiopacity of the materials. Filtek Z250, which had the lowest radiopacity, was diagnosed correctly more often than SDR, which had higher radiopacity. Filtek Bulk had the highest opacity and the highest percentage of correct diagnoses. In clinical practice, radiographic visualization of restorations and dental structures is essential for establishing a correct diagnosis and treatment plan. A restorative material may be within the established requirements for radiopacity, but on radiographic evaluation it might not be differentiated from mineralized dental tissues.

Fabrication, Characterization, and Properties of Poly (Ethylene-Co-Vinyl Acetate) Composite Thin Films Doped with Piezoelectric Nanofillers

Ethylene vinyl acetate (EVA) is a copolymer comprehending the semi-crystalline polyethylene and amorphous vinyl acetate phases, which potentially allow the fabrication of tunable materials. This paper aims at describing the fabrication and characterization of nanocomposite thin films made of polyethylene vinyl acetate, at different polymer concentration and vinyl acetate content, doped with piezoelectric nanomaterials, namely zinc oxide and barium titanate. These membranes are prepared by solvent casting, achieving a thickness in the order of 100-200 µm. The nanocomposites are characterized in terms of morphological, mechanical, and chemical properties. Analysis of the nanocomposites shows the nanofillers to be homogeneously dispersed in EVA matrix at different vinyl acetate content. Their influence is also noted in the mechanical behavior of thin films, which elastic modulus ranged from about 2 to 25 MPa, while keeping an elongation break from 600% to 1500% and tensile strength from 2 up to 13 MPa. At the same time, doped nanocomposite materials increase their crystallinity degree than the bare ones. The radiopacity provided by the addition of the dopant agents is proven. Finally, the direct piezoelectricity of nanocomposites membranes is demonstrated, showing higher voltage outputs (up to 2.5 V) for stiffer doped matrices. These results show the potentialities provided by the addition of piezoelectric nanomaterials towards mechanical reinforcement of EVA-based matrices while introducing radiopaque properties and responsiveness to mechanical stimuli.

Effect of Baghdadite Substitution on the Physicochemical Properties of Brushite Cements

Brushite cements have been clinically used for irregular bone defect filling applications, and various strategies have been previously reported to modify and improve their physicochemical properties such as strength and injectability. However, strategies to address other limitations of brushite cements such as low radiopacity or acidity without negatively impacting mechanical strength have not yet been reported. In this study, we report the effect of substituting the beta-tricalcium phosphate reactant in brushite cement with baghdadite (Ca₃ZrSi₂O₉), a bioactive zirconium-doped calcium silicate ceramic, at various concentrations (0, 5, 10, 20, 30, 50, and 100 wt%) on the properties of the final brushite cement product. X-ray diffraction profiles indicate the dissolution of baghdadite during the cement reaction, without affecting the crystal structure of the precipitated brushite. EDX analysis shows that calcium is homogeneously distributed within the cement matrix, while zirconium and silicon form cluster-like aggregates with sizes ranging from few microns to more than 50 µm. X-ray images and µ-CT analysis indicate enhanced radiopacity with increased incorporation of baghdadite into brushite cement, with nearly a doubling of the aluminium equivalent thickness at 50 wt% baghdadite substitution. At the same time, compressive strength of brushite cement increased from 12.9 ± 3.1 MPa to 21.1 ± 4.1 MPa with 10 wt% baghdadite substitution. Culture medium conditioned with powdered brushite cement approached closer to physiological pH values when the cement is incorporated with increasing amounts of baghdadite (pH = 6.47 for pure brushite, pH = 7.02 for brushite with 20 wt% baghdadite substitution). Baghdadite substitution also influenced the ionic content in the culture medium, and subsequently affected the proliferative activity of primary human osteoblasts in vitro. This study indicates that baghdadite is a beneficial additive to enhance the radiopacity, mechanical performance and cytocompatibility of brushite cements.

Comparison of radiopacity of current restorative CAD/CAM blocks with digital radiography

OBJECTIVE

While the radiopacity of restorative material affects the radiographic diagnosis of the teeth, there is no data about the radiopacity of current restorative computer-aided design (CAD)/computer-aided manufacturing (CAM) materials. Therefore, the present study compared the radiopacity values of current restorative CAD/CAM blocks to facilitate the material choice within such a wide variety of materials.

MATERIALS AND METHODS

Specimens were prepared from 13 different restorative CAD/CAM blocks to compare with enamel and dentin. The specimens placed on the occlusal phosphor plate were imaged with aluminum step wedge and tooth section. The radiopacity values were calculated using the Image J program. The radiopacity values of the specimens were converted to mmAl values with the Curve Expert 1.4 program.

RESULTS

The difference between the radiopacity values of dentin and e.max CAD was not significant, however, they exhibited a significant difference from the other 14 groups (P < .05). Enamel and Obsidien, Suprinity, and Celtra Duo had greater radiopacity values with significant differences from the other 12 materials whereas the difference within these groups was not significant (P > .05).

CONCLUSIONS

The evaluated restorative CAD/CAM materials have significantly different radiopacity values. Among these permanent restoration blocks, the highest radiopacity value was observed in Celtra Duo, the lowest in Block HC.

CLINICAL SIGNIFICANCE

Cerasmart, Lava Ultimate, Obsidian, Vita Suprinity, Celtra Duo Blocks have adequate radiopacity for inlay, onlay and crown restorations, however, the use of Vita Enamic, Vita Mark II, GC LRF blocks and the others which have lower radiopacity value than dentin for the same kind of restorations depend on the radiopacity of the luting cement for the purpose of recurrent caries detection.

Sintering Pmperature-Dependence on Radiopacity of Bi(2-x) ZrxO(3+x/2) Powders Prepared by Sol-Gel Process

Bismuth oxide (Bi₂O₃) is an effective additive used to enhance radiography resolution for dental materials. However, there are potential concerns regarding its biocompatibility and connection to tissue discoloration. In the present study, we modified the radiopacity properties of Bi₂O₃ with zirconium oxide (ZrO₂) using a sol-gel process and investigated the composition, as well as the effects of heat treatment temperature using Thermogravimetry analysis (TGA), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FT-IR), transmission electron microscopy (TEM), and X-ray diffraction (XRD). The harvested Bi2-xZrxO3+x/2 particles showed that the dominant phase transferred from α-Bi₂O₃ to β-Bi7.38Zr0.62O12.31 after a heat treatment of over 750 °C for 2 h. As the x values of Bi2-xZrxO3+x/2 increased from 0.2 to 1.0, more zirconium oxide precipitated onto the particle surface, thus enhancing the surface roughness of particles. For sol-gel Bi1.8Zr0.2O3.1 powders (x = 0.2), the radiopacity values became 4.90 ± 0.23 and 5.83 ± 0.22 mmAl after a heat treatment of 500 °C and 750 °C, respectively.

Radiopaque and uniform alginate microspheres loaded with tantalum nanoparticles for real-time imaging during transcatheter arterial embolization

One restriction to the development and application of transcatheter arterial chemoembolization (TACE) therapy is the lack of an inherently radiopaque embolic whose location and distribution can be precisely visualized in real time and be used for non-invasive examination after surgery. Methods: A one-step electrospray method was developed to fabricate calcium alginate microspheres loaded with tantalum nanoparticles (Ta@CaAlg). The parameters of electrospraying were assessed. The in vivo X-ray imaging capability and embolic effect of Ta@CaAlg microspheres were evaluated in the renal arteries of normal rabbits by digital radiography and computed tomography. Doxorubicin hydrochloride (Dox) was chosen as a model drug, and the drug loading capacity and release behavior of these microspheres was valuated in vitro.Results: Spherical Ta@CaAlg microspheres with monodisperse sizes ranging from 150 to 1200 μm were fabricated by electrospraying. The results of an in vivo study showed that Ta@CaAlg microspheres possessed the qualities of both embolic agents and contrast media. They could not only feed back the real-time location and distribution of the embolic microspheres but also maintained clear X-ray imaging of embolized sites for up to 4 weeks as assessed by digital radiography and computed tomography. Digital subtraction angiography showed that they had an excellent embolic effect. Ta@CaAlg microspheres could be loaded with Dox to form "3-in-1" embolic microspheres. The maximum Dox loading was 97.3 mg Dox per mL beads and loaded microspheres exhibited pH-dependent release profiles. Conclusion: The X-ray opacity and drug-loading capability of Ta@CaAlg microspheres offers great promise in direct, real-time, in vivo investigation for TACE and long-term non-invasive re-examination.

Bench-to-clinic development of imageable drug-eluting embolization beads: finding the balance

This review describes the historical development of an imageable spherical embolic agent and focuses on work performed in collaboration between Biocompatibles UK Ltd (a BTG International group company) and the NIH to demonstrate radiopaque bead utility and bring a commercial offering to market that meets a clinical need. Various chemistries have been investigated and multiple prototypes evaluated in search of an optimized product with the right balance of handling and imaging properties. Herein, we describe the steps taken in the development of DC Bead LUMI™, the first commercially available radiopaque drug-eluting bead, ultimately leading to the first human experience of this novel embolic agent in the treatment of liver tumors.

An overview of development and status of fiber-reinforced composites as dental and medical biomaterials

Fibr-reinforced composites (FRC) have been used successfully for decades in many fields of science and engineering applications. Benefits of FRCs relate to physical properties of FRCs and versatile production methods, which can be utilized. Conventional hand lamination of prefabricated FRC prepregs is utilized still most commonly in fabrication of dental FRC devices but CAD-CAM systems are to be come for use in certain production steps of dental constructions and medical FRC implants. Although metals, ceramics and particulate filler resin composites have successfully been used as dental and medical biomaterials for decades, devices made out of these materials do not meet all clinical requirements. Only little attention has been paid to FRCs as dental materials and majority of the research in dental field has been focusing on particulate filler resin composites and in medical biomaterial research to biodegradable polymers. This is paradoxical because FRCs can potentially resolve many of the problems related to traditional isotropic dental and medical materials. This overview reviews the rationale and status of using biostable glass FRC in applications from restorative and prosthetic dentistry to cranial surgery. The overview highlights also the critical material based factors and clinical requirement for the succesfull use of FRCs in dental reconstructions.

Radiopaque Resists for Two-Photon Lithography To Enable Submicron 3D Imaging of Polymer Parts via X-ray Computed Tomography

Two-photon lithography (TPL) is a high-resolution additive manufacturing (AM) technique capable of producing arbitrarily complex three-dimensional (3D) microstructures with features 2-3 orders of magnitude finer than human hair. This process finds numerous applications as a direct route toward the fabrication of novel optical and mechanical metamaterials, miniaturized optics, microfluidics, biological scaffolds, and various other intricate 3D parts. As TPL matures, metrology and inspection become a crucial step in the manufacturing process to ensure that the geometric form of the end product meets design specifications. X-ray-based computed tomography (CT) is a nondestructive technique that can provide this inspection capability for the evaluation of complex internal 3D structure. However, polymeric photoresists commonly used for TPL, as well as other forms of stereolithography, poorly attenuate X-rays due to the low atomic number (Z) of their constituent elements and therefore appear relatively transparent during imaging. Here, we present the development of optically clear yet radiopaque photoresists for enhanced contrast under X-ray CT. We have synthesized iodinated acrylate monomers to formulate high-Z photoresist materials that are capable of forming 3D microstructures with sub-150 nm features. In addition, we have developed a formulation protocol to match the refractive index of the photoresists to the immersion medium of the objective lens so as to enable dip-in laser lithography, a direct laser writing technique for producing millimeter-tall structures. Our radiopaque photopolymer resists increase X-ray attenuation by a factor of more than 10 times without sacrificing the sub-150 nm feature resolution or the millimeter-scale part height. Thus, our resists can successfully replace existing photopolymers to generate AM parts that are suitable for inspection via X-ray CT. By providing the "feedstock" for radiopaque AM parts, our resist formulation is expected to play a critical role in enabling fabrication of functional polymer parts to tight design tolerances.