Performance of brushite plaster as kidney stone phantoms for laser lithotripsy

Artificial phantoms used in photothermal near-infrared laser lithotripsy research generally fail to mimic both the chemical and the physical properties of human stones. Though high-energy, 1 J pulses are capable of fracturing hard human stones into several large fragments along natural boundaries, similar behavior has not been observed in commonly used gypsum plasters like BegoStone. We developed a new brushite-based plaster formulation composed of ≈90% brushite that undergoes rapid fracture in the manner of human stones under fragmentation pulse regimes. Single-pulse (1 J) ablation crater volumes for phantoms were not significantly different from those of pure brushite stones. Control over crater volumes was demonstrated by varying phosphorous acid concentration in the plaster formulation. Fragmentation of cylindrical brushite phantoms was filmed using a high-speed camera which demonstrated rapid fragmentation in < 100 µs during the bubble expansion phase of a short pulse from a high-powered Ho:YAG laser (Lumenis Pulse 120 H). The rapid nature of observed fracture suggests increasing laser pulse energy by increasing laser pulse duration will not improve fragmentation performance of laser lithotripters. Brushite plaster phantoms are a superior alternative to gypsum plasters for laser lithotripsy research due to their better mimicry of stone composition, controllable single-pulse crater volumes, and fragmentation behavior.

Physiologically engineered porous titanium/brushite scaffolds for critical-size bone defects: A design and manufacturing study

Repairing critical-size bone defects still represents a critical clinical challenge in the field of trauma surgery. This study focuses on a physiological design and manufacturing of porous composite scaffold (titanium Ti with 10 % mole iron doped brushite DCPD-Fe3+) which can mimic the biomechanical properties of natural cortical bone, specifically for the purpose of repairing critical-size defects. To achieve this, the principle of design of experiments (DOE) was applied for investigating the impact of sintering temperature, mineral ratio, and volume fraction of porosity on the mechanical properties of the fabricated scaffolds. The fabricated scaffolds had open porosity up to 60 %, with pore size approximately between 100 μm and 850 μm. The stiffness of the porous composite scaffolds varied between 3.30 GPa and 20.50 GPa, while the compressive strength ranged from approximately 130 MPa-165 MPa at sintering temperatures equal to or exceeding 1000 °C. Scaffolds with higher porosity and mineral content demonstrated lower stiffness values, resembling natural bone. Numerical simulation was employed by Ansys Workbench to investigate the stress and strain distribution of a critical size defect in mid-shaft femur which was designed to be replaced with the fabricated scaffold. The fabricated scaffolds showed flexible biomechanical behaviour at the bone/scaffold interface, generating lower stress levels and indicating a better match with the femoral shaft stiffness. The experimental and numerical findings demonstrated promising applications for manufacturing a patient-specific bone scaffold for critical and potentially large defects for reducing stress shielding and minimizing non-union risk.

Efficient low-concentration phosphate removal from sub-healthy surface water by adsorbent prepared based on functional complementary strategy

The remediation of low-concentration phosphorus polluted surface water (LP-SW) is one of most challenging environmental issues worldwide. Adsorption is more suitable for LP-SW remediation due to its low cost and operability. Based on the strategy of functional complementation among industrial solid wastes (ISWs), ISW-based phosphate absorbent material (PAM) was prepared from coal ash (CA, binder), rich‑calcium (Ca) carbide slag (CS, active component) and iron salt (functional reagent) by optimizing materials ratios and roasting conditions. PAM prepared under optimal conditions (Fe/CC-2opt) had good phosphate adsorption efficiency. Notably, Fe/CC-2opt not only ensured that the effluent met Environmental Quality Standards for Surface Water (pH = 6.0-9.0), but also facilitated the formation of brushite instead of hydroxyapatite due to FeSO4 addition. Compared with hydroxyapatite, brushite had greater potential application value as fertilizer due to its solubility and high P/Ca ratio. The possible mechanisms of phosphate adsorption by PAM included surface precipitation, surface complexation, electrostatic adsorption and release of Ca2+/OH-. Preparation cost of PAM was 80 US$/ton, and treatment cost was 0.07 US$/g P. Regeneration efficiency of PAM was still above 80 % after five cycles. The design idea and result of this study provide theoretical basis and technical support for the preparation of PAM with low cost, commercial production and great adsorption capacity.

Fiber support prevents colloid-facilitated contamination induced by dissolution-precipitation of a calcium phosphate adsorbent

During the adsorptive removal of hazardous metal contaminants, dissolution-precipitation of sparingly soluble adsorbents may result in the formation of toxic colloidal suspensions, triggering secondary pollution. Therefore, we studied the prevention of colloid-facilitated contamination in a model adsorption system of dicalcium phosphate dihydrate (DCPD, CaHPO₄·2H₂O) and Cd²⁺ as an adsorbent and adsorbate. Upon adding pure DCPD powder into a 500 mg L^-1 Cd²⁺ solution of pH ≌ 7.0, aggregates of spheroidal Cd-bearing primary particles, within 0.040-0.95 μm size range, were generated via dissolution-precipitation. The accumulated volume of these submicron particles (10.8%) was greater than that of the submicron particles from the exposure of DCPD to deionized water (4.48%). While the Cd-carrying submicron particles, which are responsible for colloidal recontamination, appeared to form via homogeneous nucleation, their formation was suppressed using polyacrylonitrile fibers (PANFs) as supporting substrates. Thus, heterogeneous nucleation on PANFs formed hexagonal columnar microparticles of a new phase, pentacadmium dihydrogen tetrakis (phosphate) tetrahydrate (Cd₅H₂(PO₄)₄·4H₂O). Together with dissolution-precipitation on the native DCPD, nucleation and growth on the PANFs accelerated the depletion of the dissolved species, reducing the degree of supersaturation along the DCPD-water interface. Although the PANFs decreased the Cd adsorption capacity to 56.7% of that of DCPD, they prevented the formation of small aggregates of Cd-bearing particles. Other sparingly soluble adsorbents can be compounded with PANF to prevent the generation of toxic colloids.

Development and evaluation of local regenerative biomimetic bone-extracellular matrix scaffold loaded with nano-formulated quercetin for orthopedic fractures

The prevalence of bone injuries is greatly increasing each year and the proper healing of fractures without any complications is very challenging. Self-setting calcium phosphate cements (CPCs) have attracted great attention as bioactive synthetic bone substitutes. Quercetin (QT) is a multipurposed drug with reported bone-conserving properties. The loading of QT and QT-phospholipid complex within nanostructured lipid carriers (NLC) was proposed to overcome the poor physical properties of the drug and to introduce the use of bioactive excipients as phospholipids and olive oil. The aim of this work was to formulate a regenerative scaffold loaded with nano-formulated QT for local treatment of orthopedic fractures. For the first time, scaffolds composed of brushite CPC were prepared and loaded with quercetin lipid nano-systems. In vitro tests proved that the addition of lipid nano-systems did not deteriorate the properties of CPC where QT-NLC/CPC showed an adequate setting time, appropriate compressive strength, and porosity. The scanning electron microscope confirmed maintenance of nanoparticles integrity within the cement. Using a rat femur bone defect animal model, the histological results showed that the QT-NLC/CPC had a superior bone healing potential compared to crude unformulated QT/CPC. In conclusion, QT-NLC /CPC are promising lipid nano-composite materials that could enhance bone regeneration.

The fate of Cd during the replacement of Cd-bearing calcite by calcium phosphate minerals

Carbonate-bound speciation is a critical sink of potentially toxic elements (PTEs) like cadmium (Cd) in soil and sediment. In a phosphate-rich environment, carbonate minerals could be replaced by phosphate minerals such as dicalcium phosphate dihydrate (DCPD, also known as brushite), octacalcium phosphate (OCP), and hydroxylapatite (HAP). Currently, it is unclear the migration and fate of PTEs during the replacement of PTEs-bearing carbonates by HAP and related intermediate minerals. Therefore, we synthesized Cd-bearing calcite by the coprecipitation method and converted it to DCPD, OCP, and HAP to investigate the redistribution and fate of Cd. The results showed that Cd incorporation in calcite significantly inhibited their replacement by DCPD and OCP, respectively. 1.26% of Cd in calcite was released into the solution when DCPD replaced calcite, and subsequently, most of the released Cd was recaptured by OCP. Significantly, the released Cd was below 0.05‰ when all the solid converted to HAP. These results suggested that with the application of phosphate fertilizer in alkaline soil, the secondary calcium phosphate minerals could control the environmental behavior of Cd.

Brushite nanoparticles based electrochemical sensor for detection of uric acid, xanthine, hypoxanthine and caffeine

The research in the field of biosensors has recently been focused on the design and development of functional electrode materials that can respond to changes in their biochemical environment. Here, we report the synthesis of dicalcium phosphate dihydrate (DCPD), also known as brushite (CaHPO₄·2H₂O) by soft chemical method and its application for electrochemical sensing of four different analytes. Phase purity, structure, chemical composition and surface morphology of the synthesized nanoparticles have been investigated using powder XRD, FTIR, SEM, XPS and HRTEM methods. Electrochemical sensor was prepared by modifying GCE with brushite and the modified electrodes were successfully used for either independent or simultaneous determination of uric acid, xanthine, hypoxanthine and caffeine in their mixture. The brushite/GCE exhibited four strong well-defined separate peaks corresponding to the oxidation of UA, XN, HXN and CF in phosphate buffer saline (PBS) at pH 7.4. The fabricated electrode showed low detection limits (S/N = 3) of 0.576, 1.0, 0.076 and 1.26 μM for UA, XN, HXN and CF respectively. Practical application of the fabricated electrode has been demonstrated by determining UA, XN, HXN and CF in human urine and coffee samples by direct method. The brushite offers scope for fabrication of sensor systems for implantable medical applications.

Fabrication and mechanical properties of newly developed triphasic blocks composed of gypsum-brushite-monetite for bone graft applications

Objective

A triphasic bone graft block composed of gypsum, brushite, and monetite is expected to be better for regenerating bone than a gypsum-hydroxyapatite-tricalcium phosphate block. Therefore, the aim of this study was to fabricate and evaluate the mechanical properties of a newly developed triphasic block composed of gypsum, brushite, and monetite.

Materials and method

Triphasic blocks were prepared by mixing calcium sulfate hemihydrate, brushite, and monetite powders with distilled water at a powder-to-liquid ratio of 0.5. The content of calcium sulfate hemihydrate was fixed at 50%, and the contents of brushite and monetite powders were varied. After molding and setting, the obtained blocks were characterized, and their mechanical properties were evaluated.

Results

The triphasic blocks were prepared and could maintain their shape without collapsing. The XRD characterization of the obtained triphasic blocks showed that only three phases existed in the block. Calcium sulfate hemihydrate was transformed into its dihydrate form and provided mechanical strength to the block through a setting mechanism. The transformation of calcium sulfate hemihydrate into its dihydrate crystals formed an interlocked structure that was disrupted in triphasic blocks, as observed in SEM images. The disruption of the interlocked structure resulted in lower mechanical strength of the obtained triphasic blocks compared to the set gypsum control. The variation in brushite and monetite composition did not affect the mechanical properties of the triphasic blocks.

Conclusion

The triphasic gypsum-brushite-monetite block was successfully prepared, and no other crystal phases were found. The triphasic blocks could maintain their shape after setting. The addition of brushite and monetite powders disrupted the interlocked structure of the set gypsum crystal, resulting in a decrease in mechanical strength. Furthermore, the variation in brushite and monetite powders did not affect the mechanical properties of the triphasic blocks.

Silk fibroin hydrogels induced and reinforced by acidic calcium phosphate - A simple way of producing bioactive and drug-loadable composites for biomedical applications

Silk fibroin (SF) hydrogels have attracted extensive interest in biomedical applications due to their biocompatibility and wide availability. However, their generally poor mechanical properties limit their utility. Here, injectable, ready-to-use SF-based composites, simultaneously induced and reinforced by acidic calcium phosphates, were prepared via a dual-paste system requiring no complex chemical/physical treatment. The composite was formed by mixing a monocalcium phosphate monohydrate paste with a β-tricalcium phosphate/SF paste. The conformational transition of SF in an acidic environment forms continuous networks, and the acidic calcium phosphate, brushite and monetite, formed simultaneously in the networks during mixing. The composites displayed a partly elastomeric compression behavior, with mechanical properties increasing with an increasing calcium phosphate and β-sheet content at the lower calcium phosphate contents evaluated (22.2-36.4 wt%). While the stiffness was still relatively low, the materials presented a high elasticity and ductility, and no failure at stresses in the range of failure stresses of trabecular bone. Furthermore, the calcium phosphate confers bioactivity to the material, and the composites with a promising in vitro cell response also showed potential as drug vehicles, using vancomycin as a model drug. These dual-paste systems exhibit potential utility in biomedical applications, such as bone void fillers and drug vehicles.

Ferric iron incorporation promotes brushite hydrolysis and enhances cadmium immobilization

Dissolution-precipitation processes on the surface of brushite (dicalcium phosphate dihydrate, DCPD) control the migration and transformation of potentially harmful elements (PHEs). The incorporation of impurities could affect the properties of DCPD and its interactions with PHEs. In this study, we synthesized Fe³⁺-bearing DCPD via coprecipitation and investigated the influence of Fe³⁺ incorporation on the crystal structure, hydrolysis process, and Cd removal performance. Fe-bearing DCPD had lattice expansion due to the coupled substitution of Fe³⁺ and NH₄⁺ for Ca²⁺. Therefore, the Cd removal performance of Fe-DCPD was enhanced, with a maximum Cd uptake capacity of 431.6 mg/g, which is 1.77 times that of Fe-free DCPD (244.4 mg/g). Furthermore, Fe-DCPD also exhibited a faster hydrolysis rate, which was up to 2.67 times that of Fe-free DCPD and accelerated Cd's transfer to the stable host mineral, hydroxylapatite. Cd was first caught by the DCPD surface in a weakly crystalline form and then incorporated into the hydroxylapatite structure during crystallization. Based on the X-ray photoelectron spectroscopy and thermogravimetric analysis results, we concluded that the decrease in interstitial water due to Fe incorporation was responsible for accelerating hydrolysis and enhancing Cd immobilization. In all, the incorporation of Fe³⁺ into DCPD could promote its transformation and improve its Cd uptake capacity. Our results suggest that Fe-DCPD could be a promising candidate for environmental remediation.

High toughness resorbable brushite-gypsum fiber-reinforced cements

The ideal bone substitute material should be mechanically strong, biocompatible with a resorption rate matching the rate of new bone formation. Brushite (dicalcium phosphate dihydrate) cement is a promising bone substitute material but with limited resorbability and mechanical properties. To improve the resorbability and mechanical performance of brushite cements, we incorporated gypsum (calcium sulfate dihydrate) and diazonium-treated polyglactin fibers which are well-known for their biocompatibility and bioresorbability. Here we show that by combining brushite and gypsum, we were able to fabricate biocompatible composite cements with high fracture toughness (0.47 MPa·m^1/2) and a resorption rate that matched the rate of new bone formation. Adding functionalized polyglactin fibers to this composite cement further improved the fracture toughness up to 1.00 MPa·m^1/2. XPS and SEM revealed that the improvement in fracture toughness is due to the strong interfacial bonding between the functionalized fibers and the cement matrix. This study shows that adding gypsum and functionalized polyglactin fibers to brushite cements results in composite biomaterials that combine high fracture toughness, resorbability, and biocompatibility, and have great potential for bone regeneration.

Efficient adsorptive removal of Cobalt(II) ions from water by dicalcium phosphate dihydrate

Although the radionuclide ⁶⁰Co is widely used, its presence in various effluents demands its removal to preclude environmental pollution and detrimental effects on human health. This study investigated the batch adsorption performance of a potential cobalt adsorbent, dicalcium phosphate dihydrate (DCPD), in immobilizing Co²⁺ from water. The influences of solution pH, contact time, initial concentration, and competing cations were examined and discussed. Stable cobalt uptake was observed at pH 4-8. The sorption kinetics showed a multi-stage uptake profile, implying that several mechanisms are involved in the adsorption process. Microscopy and structural analysis revealed that DCPD decomposes to its anhydrous form during adsorption, which explains the multistep curve over the entire adsorption period. However, the non-apatitic transformation is not exclusive to cobalt uptake. Intraparticle diffusion also contributed to the overall removal kinetics of Co²⁺ from water. Considering the Sips isotherm model, the maximum Co²⁺ adsorption capacity of DCPD was 441 mg g^-1. Cobalt uptake selectivity dropped in the presence of Ca²⁺ ions, from 1.21 × 10⁴ to 207 mL g^-1, indicating DCPD would be more applicable in treating soft ⁶⁰Co-contaminated waters. Structural analysis, elemental mapping, and qualitative analysis of solid residues confirmed that ion exchange is involved in the removal of cobalt from aqueous solutions.

Ion-doped Brushite Cements for Bone Regeneration

Decades of research in orthopaedics has culminated in the quest for formidable yet resorbable biomaterials using bioactive materials. Brushite cements most salient features embrace high biocompatibility, bioresorbability, osteoconductivity, self-setting characteristics, handling, and injectability properties. Such type of materials is also effectively applied as drug delivery systems. However, brushite cements possess limited mechanical strength and fast setting times. By means of incorporating bioactive ions, which are incredibly promising in directing cell fate when incorporated within biomaterials, it can yield biomaterials with superior mechanical properties. Therefore, it is a key to develop fine-tuned regenerative medicine therapeutics. A comprehensive overview of the current accomplishments of ion-doped brushite cements for bone tissue repair and regeneration is provided herein. The role of ionic substitution on the cements physicochemical properties, such as structural, setting time, hydration products, injectability, mechanical behaviour and ion release is discussed. Cell-material interactions, osteogenesis, angiogenesis, and antibacterial activity of the ion-doped cements, as well as its potential use as drug delivery carriers are also presented. STATEMENT OF SIGNIFICANCE: Ion-doped brushite cements have unbolted a new era in orthopaedics with high clinical interest to restore bone defects and facilitate the healing process, owing its outstanding bioresorbability and osteoconductive/osteoinductive features. Ion incorporation expands their application by increasing the osteogenic and neovascularization potential of the materials, as well as their mechanical performance. Recent accomplishments of brushite cements incorporating bioactive ions are overviewed. Focus was placed on the role of ions on the physicochemical and biological properties of the biomaterials, namely their structure, setting time, injectability and handling, mechanical behaviour, ion release and in vivo osteogenesis, angiogenesis and vascularization. Antibacterial activity of the cements and their potential use for delivery of drugs are also highlighted herein.

LITHORISK.COM: the novel version of a software for calculating and visualizing the risk of renal stone

Estimation of state of saturation with stone-forming salt represents a reliable tool to assess the overall risk. The available methods are based on computer-assisted ab initio calculations. Our earlier method URSUS was subsequently substituted by Lithorisk®, a software including visualization of risk profiles. Unfortunately, Lithorisk does not adapt to new versions of Windows® and Macintosh® Apple, neither runs on smartphones or tablets. We propose a novel version of the software which can be directly used online on any device equipped by different operating systems. Upon online connection and after registration, the software is ready for unlimited accesses, in either Italian, English or French. After digiting input variables (urea and creatinine also included) in a fixed dashboard, state of saturation is promptly given. In addition to state of saturation (ß) with calcium oxalate, brushite and uric acid, ß struvite and cystine are available. Both input variables and ß results are graphically depicted as green or red horizontal bars to indicate recommended values. The software was implemented with equations allowing to omit sulphate and ammonium excretion for users with difficult access to these measurements. This simplified version, tested for ßCaOx and ßBsh on 100 urine samples showed close correlation with the full version. The software gives a list of total and free concentrations and soluble complex species distribution. Results can be printed or saved as PDF. So, we propose an easily accessible software to estimate state of saturation usable on any operating system and personal device.

Insitu magnesium calcium phosphate cements formation: From one pot powders precursors synthesis to in vitro investigations

Calcium phosphate cements are of great interest for researchers and their applications in medical practice expanded. Nevertheless, they have a number of drawbacks including the insufficient level of mechanical properties and low degradation rate. Struvite (MgNH4PO4) -based cements, which grew in popularity in recent years, despite their neutral pH and acceptable mechanical performance, release undesirable NH4 + ions during their resorption. This issue could be avoided by replacement of ammonia ions in the cement liquid with sodium, however, such cements have a pH values of 9-10, leading to cytotoxicity. Thus, the main goal of this investigation is to optimize the composition of cements to achieve the combination of desirable properties: neutral pH, sufficient mechanical properties, and the absence of cytotoxicity, applying Na2HPO4-based cement liquid. For this purpose, cement powders precursors in the CaO-MgO-P2O5 system were synthesized by one-pot process in a wide composition range, and their properties were investigated. The optimal performance was observed for the cements with (Ca + Mg)/P ratio of 1.67, which are characterized by newberyite phase formation during setting reaction, pH values close to 7, sufficient compressive strength up to 22 ± 3 MPa (for 20 mol.% of Mg), dense microstructure and adequate matrix properties of the surface. This set of features make those materials promising candidates for medical applications.

Phosphate recovery from aqueous solution by K-zeolite synthesized from fly ash for subsequent valorisation as slow release fertilizer

The sorption of phosphate by K-zeolites synthesized from fly ash (FA) by hydrothermal conversion is investigated in this study. The aim is the synthesis of Ca bearing K-zeolites to recover phosphate from urban and industrial wastewater effluents. The loaded zeolites are considered as a by-products rich in essential nutrients such K and P (KP1) with a potential use as slow release fertilizer. A number of synthesis conditions (temperature, KOH-solution/FA ratio, KOH concentration, and activation time) were applied on two FA samples (FA-TE and FA-LB) with similar glass content but different content of crystalline phases, to optimize the synthesis of a zeolitic sorbent suitable for the subsequent phosphate uptake. Merlinoite and W rich zeolitic products synthesized from FA-LB and FA-TE were found to have sorption properties for phosphate removal. A maximum phosphate sorption capacity of 250 mgP-PO₄/g and 142 mgP-PO₄/g for the zeolitic products selected (KP1-LB and KP1-TE, respectively) was achieved. The dominant phosphate sorption mechanism, in the pH range (6-9) of treated wastewater effluents, indicated that sorption proceeds via a diffusion-controlled process involving phosphate ions coupled with calcium supply dissolution from K-zeolitic products and subsequent formation of brushite (CaHPO₄ 2H₂O(s)). The phosphate loaded sorbent containing a relatively soluble phosphate mineral is appropriate for its use as a synthetic slow release fertilizer. The simultaneous valorisation of fly ash waste and the P recovery from treated wastewaters effluents, (a nutrient with scarce natural resources and low supply) by obtaining a product with high potential for land restoration and agriculture will contribute to develop one example of circularity.

Analysis of the osteogenic and mechanical characteristics of iron (Fe2+/Fe3+)-doped β‑calcium pyrophosphate

The calcium phosphate is the main mineral constituent of bone. Although there has been significant amount of research on finding ideal synthetic bone, no suitable scaffold material has yet been found. In this investigation, the iron doped brushite (CaHPO₄·2H₂O) has been investigated for osteogenic potential and mechanical properties. The synthesis of iron-oxide doping in the form of Fe^2+,3+-ions were carried out using the solution based method in which the ammonium hydrogen phosphate and calcium nitrate solutions were used in stoichiometric ratio for synthesizing CaHPO₄·2H₂O, with doping concentrations of Fe^2+,3+-ions between 5 mol% and 30 mol%. The synthesized powders were analysed using X-ray powder diffraction, FTIR, SEM and Raman spectroscopic techniques. The heat treatment of synthesized powder was carried out at 1000 °C in air for 5 h, and it was found that the dominant crystalline phase in samples with <20 mol% was β-CPP, which also formed an iron-rich solid solution phase. Increasing the concentrations of Fe^2+,3+-ions enhances the phase fraction of FePO₄ and amorphous phase. Amongst the Fe^2+,3+-doped β-CPP minerals, it was found that the 10 mol% Fe^2+,3+-doped β-CPP offers the best combination of bio-mechanical and osteogenic properties as a scaffold for bone tissue regenerative engineering.

Qualitative and Quantitative Assessment of Remineralizing Effect of Prophylactic Toothpaste Promoting Brushite Formation: A Randomized Clinical Trial

BACKGROUND

Currently various studies are conducted to improve the effect of existing and developing new remineralizing agents. One of the trends in remineralizing therapy is the development of toothpaste allowing brushite crystals formation in the demineralized lesions of hard tooth tissues.

AIM

The aim of this study was to assess the effect of toothpaste, forming a brushite, on the functional acid resistance of enamel and the speed of its remineralization.

MATERIALS AND METHODS

This was a randomized controlled double-blind clinical study. Sixty consent patients aged 20-25 years were enrolled in the three groups: test group (n = 20), positive control group (n = 20), and negative control group (n = 20), which used brushite-forming toothpaste, toothpaste with hydroxyapatite (HAP), and toothpaste without remineralizing agents, respectively. The hygiene indices, the rate of enamel remineralization, the dynamics of acid resistance of enamel, and the level of enamel sensitivity were determined at baseline, after 2 and 4 weeks to assess the effectiveness of toothpastes. Friedman rank sum test (for related variables) and the Kruskal-Wallis rank sum test (for independent variables) with Nemenyi post hoc test were used for statistical comparisons.

RESULTS

The study test and positive control groups showed significantly greater acid resistance of enamel (P > 0.05) and rate of its remineralization at the study endpoints as compared with negative control group.In the test and positive control groups, Schiff index values significantly decreased after 4 weeks, whereas in the negative control group no significant differences were observed at the study time points. The oral hygiene level improved significantly after 2 and 4 weeks in all groups.

CONCLUSION

The 30-day use of paste that promotes brushite formation and paste with hydroxyapatite resulted in faster enamel remineralization and higher enamel resistance. Brushite-containing toothpaste may be used as an alternative to HAP containing for remineralizing and desensitizing treatment.

Predicting the risk of kidney stone formation in the nephron by 'reverse engineering'

Although most kidney stones are found in the calyx, they are usually initiated upstream in the nephron by precipitation there of certain incipient mineral phases. The risk of kidney stone formation can thus be indicated by changes in the degree of saturation of these minerals in the nephron fluid. To this end, relevant concentration profiles in the fluid along the nephron have been calculated by starting with specified urine compositions and imposing constraints from the corresponding, much less variable, blood compositions. A model for supersaturation within ten sections of both long and short nephrons has accordingly been developed based on this 'reverse engineering' of the necessary substance concentrations coupled with chemical speciation distributions calculated by our Joint Expert Speciation System (JESS). This allows the likelihood of precipitation to be assessed based on Ostwald's 'Rule of Stages'. Differences between normal and stone-former profiles have been used to identify sections in the nephron where conditions seem most likely to induce heterogeneous nucleation.

A ready-to-use acidic, brushite-forming calcium phosphate cement

Premixed calcium phosphate cements have been developed to simplify the usage of traditional calcium phosphate cements and reduce the influence of the setting reaction on the delivery process. However, difficulties in achieving a good cohesion, adequate shelf life and sufficient mechanical properties have so far impeded their use in clinical applications, especially for the more degradable acidic calcium phosphate cements. In this study, a brushite cement was developed from a series of ready-to-use calcium phosphate pastes. The brushite cement paste was formed via mixing of a monocalcium phosphate monohydrate (MCPM) paste and a β-tricalcium phosphate (β-TCP) paste with good injectability and adequate shelf life. The MCPM paste was based on a water-immiscible liquid with two surfactants and the β-TCP paste on a sodium hyaluronate aqueous solution. The effect of citric acid as a retardant was assessed. Formulations with suitable amounts of citric acid showed good cohesion and mechanical performance with potential for future clinical applications. STATEMENT OF SIGNIFICANCE: Acidic calcium phosphate cements have attracted extensive attention as bone substitute materials due to their ability to resorb faster than basic calcium phosphate cements in vivo. However, traditionally, short working times and low mechanical strength have limited their clinical application. Premixed cements could simplify the clinical use as well as improve property reproducibility, but short shelf lives, low cohesion and low mechanical properties have restricted the development. In this study, an injectable ready-to-use two-phase system consisting of an MCPM paste and a β-TCP paste was developed based on acidic cement. It shows good cohesion, compressive strength and adequate shelf life, which has the potential to be used in a dual chamber system for simplified and fast filling of bone defects in a minimally invasive manner. This will reduce surgery time, decrease the risk of contamination and ensure repeatable results.

Highly flexible and degradable dual setting systems based on PEG-hydrogels and brushite cement

With respect to the composition of natural bone, we established a degradable dual setting system of different poly(ethylene glycol) (PEG)-based hydrogels combined with a brushite cement. The idea was to reinforce the inorganic calcium phosphate mineral phase with an organic, polymeric phase to alter the cement's properties towards ductility and elasticity. Extremely flexible samples were produced via this dual setting approach with a fully reversible elasticity of the samples containing high molecular weight PEG-based hydrogel precursors. Using the decalcifying agent EDTA, the whole inorganic phase was dissolved due to Ca²⁺-complexation and dimensionally stable hydrogels were obtained, indicating a homogenous polymeric phase within the composites. This was also confirmed by SEM-analysis, where no discontinuities or agglomerations of the phase were observed. Additional XRD-measurements proved a significant influence of the coherent polymeric matrix on the conversion from β-TCP/MCPA to brushite with a decrease in signal intensity. The results confirmed a parallelly running process of setting reaction and gelation without an inhibition of the conversion to brushite and the formation of interpenetrating networks of hydrogel and cement. The strengths of this newly developed dual setting system are based on the material degradability as well as flexibility, which can be a promising tool for bone regeneration applications in non-load bearing craniomaxillofacial defects.

STATEMENT OF SIGNIFICANCE

Brushite based calcium phosphate cements (CPCs) are known as bone replacement materials, which degrade in vivo and are replaced by native bone. However, the pure inorganic material shows a brittle fracture behavior. Here, the addition of a polymeric phase can influence the mechanical properties to create more ductile and flexible materials. This polymeric phase should ideally form during cement setting by a polymerization reaction to achieve high polymer loads without altering cement viscosity and it should be degradable in vivo similar to the cement itself. Therefore, we developed a dual setting system based on simultaneous cement setting of brushite and lactide modified poly(ethylene glycol) dimethacrylate (PEG-PLLA-DMA)-based hydrogel. It was evident that the gels form a continuous phase within the cement after radical polymerization with a strong reduction of cement brittleness.

Simultaneous structuring and mineralization of silk fibroin scaffolds

Silk fibroin is commonly used as scaffold material for tissue engineering applications. In combination with a mineralization with different calcium phosphate phases, it can also be applied as material for bone regeneration. Here, we present a study which was performed to produce mineralized silk fibroin scaffolds with controlled macroporosity. In contrast to former studies, our approach focused on a simultaneous gelation and mineralization of silk fibroin by immersion of frozen silk fibroin monoliths in acidic calcium phosphate solutions. This was achieved by thawing frozen silk fibroin monoliths in acidic calcium phosphate solution, leading to the precipitation of monocalcium phosphate within the silk fibroin matrix. In the second approach, a conversion of incorporated β-tricalcium phosphate particles into brushite was successfully achieved. Furthermore, a controlled cryostructuring process of silk fibroin scaffolds was carried out leading to the formation of parallel-oriented pores with diameters of 30–50 µm.

Trivalent chromium incorporated in a crystalline calcium phosphate matrix accelerates materials degradation and bone formation in vivo

Remodeling of calcium phosphate bone cements is a crucial prerequisite for their application in the treatment of large bone defects. In the present study trivalent chromium ions were incorporated into a brushite forming calcium phosphate cement in two concentrations (10 and 50 mmol/mol β-tricalcium phosphate) and implanted into a femoral defect in rats for 3 and 6 month, non-modified brushite was used as reference. Based on our previous in vitro findings indicating both an enhanced osteoclastic activity and cytocompatibility towards osteoprogenitor cells we hypothesized a higher in vivo remodeling rate of the Cr³⁺ doped cements compared to the reference. A significantly enhanced degradation of the modified cements was evidenced by micro computed tomography, X-ray and histological examinations. Furthermore the formation of new bone tissue after 6 month of implantation was significantly increased from 29% to 46% during remodeling of cements, doped with the higher Cr³⁺ amount. Time of flight secondary ion mass spectrometry (ToF-SIMS) of histological sections was applied to investigate the release of Cr³⁺ ions from the cement after implantation and to image their distribution in the implant region and the surrounding bone tissue. The relatively weak incorporation of chromium into the newly formed bone tissue is in agreement to the low chromium concentrations which were released from the cements in vitro. The faster degradation of the Cr³⁺ doped cements was also verified by ToF-SIMS. The positive effect of Cr³⁺ doping on both degradation and new bone formation is discussed as a synergistic effect of Cr³⁺ bioactivity on osteoclastic resorption on one hand and improvement of cytocompatibility and solubility by structural changes in the calcium phosphate matrix on the other hand.

STATEMENT OF SIGNIFICANCE

While biologically active metal ions like strontium, magnesium and zinc are increasingly applied for the modification of ceramic bone graft materials, the present study is the first report on the incorporation of low doses of trivalent chromium ions into a calcium phosphate based biomaterial and testing of its performance in bone defect regeneration in vivo. Chromium(III)-doped calcium phosphate bone cements show improved cytocompatibility and both degradation rate and new bone formation in vivo are significantly increased compared to the reference cement. This important discovery might be the starting point for the application of trivalent chromium salts for the modification of bone graft materials to increase their remodelling rate.

Long-term radiographic appearance of calcium-phosphate synthetic bone grafts after surgical treatment of tibial plateau fractures

OBJECTIVES

Synthetic bone grafts (SBGs) are widely used to fill bone defects after fracture reduction. This study assessed the long-term resorption of two different calcium phosphate products (A=ChronOS™ inject and B=Norian^® SRS^®; both DePuy Synthes, Oberdorf, Switzerland) used in the surgical treatment of tibial plateau fractures.

DESIGN

Long-term clinical and radiologic follow-up of 52 patients after surgical treatment of intraarticular tibial plateau fractures augmented with SBGs.

SETTING

The study was performed at a level 3 trauma center.

PATIENTS

Between January 2000 and December 2006 a total of 52 patients with intraarticular tibial plateau fractures were operatively treated and augmented with SBGs consisting of a Brushite matix with β-TCP granules (SBG A) or hydroxylapatite with 4-6% carbonate content (SBG B). 46 patients could be contacted and 38 were included in the study. Half of the patients received SBG A and the other half SBG B.

MAIN OUTCOME MEASUREMENTS

Loss of reduction and SBG resorption was investigated by comparison of follow-up X-ray images to pre- and postoperative X-ray images. Furthermore, pain, activity level and knee function were evaluated by means of questionnaires and clinical examination.

RESULTS

The mean age of patients was 59.7±12.5years. The follow-up was 8.6±0.9years for SBG A and 11.6±1.4years for SBG B (p<0.001). In most cases SBG A was completely resorbed in a homogenous pattern, while SBG B was still visible on the X-ray images revealing a peripheral resorption pattern. A loss of reduction (>2mm) could be observed in two patients with SBG A and two patients with SBG B, although only one of them had an impaired knee function.

CONCLUSIONS

The composite SBG A reveals a comprehensive long-term resorption in comparison to SBG B. Nevertheless, both provided suitable mechanical support as part of the surgical treatment of tibial plateau fractures.

LEVEL OF EVIDENCE

Case series, Level IV.

In vitro ion adsorption and cytocompatibility of dicalcium phosphate ceramics

BACKGROUND

In vitro cell testing of degradable bioceramics such as brushite or monetite is often challenging due to the ion release into or adsorption from the culture medium. These ionic changes are then mostly responsible for cell proliferation and activity, which prohibits the investigation of effects originating from surface topography or further material modifications.

METHODS

Here, we aimed to solve this problem by developing a pre-conditioning regime following the repeated immersion of brushite and monetite samples in various Ca2+, Mg2+ and PO43- containing electrolytes, followed by studying ion adsorption / release as well as changes in phase composition and in vitro cytocompatibility with MG63 cells.

RESULTS

The results demonstrated that by using DMEM cell culture medium in a ratio of 10 ml/sample was sufficient to minimize changes of ionic composition after 7 d with a daily change of the medium. This leads to changes of the surface composition with dissolution of the brushite phase. In turn, this also positively influences the in vitro cytocompatibility with a 2-3 fold higher cell number and cell activity on the DMEM pretreated surfaces.

CONCLUSIONS

Controlled sample washing prior to cell testing using DMEM medium seems to be a valuable procedure not only to stabilize the pH during cell culture but also to maintain ion concentrations within a cell friendly range.

The Bone Building Blues: Self-hardening copper-doped calcium phosphate cement and its in vitro assessment against mammalian cells and bacteria

A blue calcium phosphate cement with optimal self-hardening properties was synthesized by doping whitlockite (β-TCP) with copper ions. The mechanism and the kinetics of the cement solidification process were studied using energy dispersive X-ray diffraction and it was found out that hardening was accompanied by the phase transition from TCP to brushite. Reduced lattice parameters in all crystallographic directions resulting from the rather low (1:180) substitution rate of copper for calcium was consistent with the higher ionic radius of the latter. The lower cationic hydration resulting from the partial Ca→Cu substitution facilitated the release of constitutive hydroxyls and lowered the energy of formation of TCP from the apatite precursor at elevated temperatures. Addition of copper thus effectively inhibited the formation of apatite as the secondary phase. The copper-doped cement exhibited an antibacterial effect, though exclusively against Gram-negative bacteria, including E. coli, P. aeruginosa and S. enteritidis. This antibacterial effect was due to copper ions, as demonstrated by an almost negligible antibacterial effect of the pure, copper-free cement. Also, the antibacterial activity of the copper-containing cement was significantly higher than that of its precursor powder. Since there was no significant difference between the kinetics of the release of copper from the precursor TCP powder and from the final, brushite phase of the hardened cement, this has suggested that the antibacterial effect was not solely due to copper ions, but due to the synergy between cationic copper and a particular phase and aggregation state of calcium phosphate. Though inhibitory to bacteria, the copper-doped cement increased the viability of human glial E297 cells, murine osteoblastic K7M2 cells and especially human primary lung fibroblasts. That this effect was also due to copper ions was evidenced by the null effect on viability increase exhibited by the copper-free cements. The difference in the mechanism of protection of dehydratases in prokaryotes and eukaryotes was used as a rationale for explaining the hereby evidenced selectivity in biological response. It presents the basis for the consideration of copper as a dually effective ion when synergized with calcium phosphates: toxic for bacteria and beneficial for the healthy cells.

Effect of processing conditions of dicalcium phosphate cements on graft resorption and bone formation

Dicalcium phosphate cements (brushite and monetite) are resorbable biomaterials with osteoconductive potential for bone repair and regeneration that have yet to gain widespread commercial use. Brushite can be converted to monetite by heat treatments additionally resulting in various changes in the physico-chemical properties. However, since conversion is most commonly performed using autoclave sterilisation (wet heating), it is uncertain whether the properties observed for monetite as a result of heating brushite under dry conditions affect resorption and bone formation favourably. This study was designed to produce monetite grafts of differing physical form by autoclaving and dry heating (under vacuum) to be compared with brushite biomaterials in an orthotopic pre-clinical implantation model in rabbit for 12weeks. It was observed that monetite grafts had higher porosity and specific surface area than their brushite precursors. The autoclaved monetite grafts had compressive strength reduced by 50% when compared with their brushite precursors. However, the dry heat converted monetite grafts had compressive strength comparable with brushite. Results from in vivo experiments revealed that both types of monetite graft materials resorbed faster than brushite and more bone formation was achieved. There was no significant difference in the amount of bone formed between the two types of monetite grafts. The implanted brushite grafts underwent phase transformation to form hydroxyapatite, which ultimately limited bioresorption. However, this was not observed in both types of monetite grafts. In summary, both autoclaving and dry heating the preset brushite cement grafts resulted in monetite biomaterials which were more resorbable with potential to be investigated and optimized for orthopaedic and maxillofacial bone repair and regeneration applications.

STATEMENT OF SIGNIFICANCE

We present in this original research article a comparison between dicalcium phosphate cement based grafts (brushite and 2 types of monetite grafts prepared by wet and dry thermal processing) with regards to resorption and bone formation in vivo after orthotopic implantation in rabbit condylar femural region. To the best of our knowledge this is the first in vivo study that reports a comparison resorption and bone formation using brushite and two types of monetite biomaterials. Also, we have included in the manuscript a summary of all the in vivo studies performed on brushite and monetite biomaterials to date. This includes cement composition, physical properties (porosity and surface area), implantation and histomorphometrical details such as animal species, site of implantation, observation period, percentage bone tissue formation and residual graft material. In addition, we calculated the percentage resorption of graft materials based upon various implantation sites and included that into the discussion section. The results of this original research provides greater understanding of the resorption processes of dicalcium phosphate based grafts, allowing preparation of bone substitute materials with more predictable resorption profiles in future.

Mg substituted apatite coating from alkali conversion of acidic calcium phosphate

In this work, two solutions were developed: the first, rich in Ca²⁺, PO₄^3- ions and the second, rich in Ca²⁺, PO₄^3- and Mg²⁺, defined as Mg-modified precursor solution. For each Mg-modified precursor solution, the concentrations of Mg²⁺ ions were progressively increased by 5%, 10% and 15%wt. The aims of this research were to investigate the influence of magnesium ions substitution in calcium phosphate coatings on titanium surface and to evaluate these coatings by bioactivity assay in McCoy culture medium. The obtained coatings were characterized by X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) analysis, and the presence of Mg ions was confirmed by the inductively coupled plasma atomic emission spectroscopy (ICP) analysis. In vitro bioactivity assay in McCoy culture medium showed bioactivity after 14days in incubation for the HA and 10% Mg-monetite coatings. The high chemical stability of Mg-HA coatings was verified by the bioactivity assays, and no bone-like apatite deposition, characteristic of bioactivity, was observed for Mg-HA coatings, for the time period used in this study.

Cu2+, Co2+ and Cr3+ doping of a calcium phosphate cement influences materials properties and response of human mesenchymal stromal cells

The application of biologically active metal ions to stimulate cellular reactions is a promising strategy to accelerate bone defect healing. Brushite-forming calcium phosphate cements were modified with low doses of Cu²⁺, Co²⁺ and Cr³⁺. The modified cements released the metal ions in vitro in concentrations which were shown to be non-toxic for cells. The release kinetics correlated with the solubility of the respective metal phosphates: 17-45 wt.-% of Co²⁺ and Cu²⁺, but <1 wt.-% of Cr³⁺ were released within 28days. Moreover, metal ion doping led to alterations in the exchange of calcium and phosphate ions with cell culture medium. In case of cements modified with 50mmol Cr³⁺/mol β-tricalcium phosphate (β-TCP), XRD and SEM analyses revealed a significant amount of monetite and a changed morphology of the cement matrix. Cell culture experiments with human mesenchymal stromal cells indicated that the observed cell response is not only influenced by the released metal ions but also by changed cement properties. A positive effect of modifications with 50mmol Cr³⁺ or 10mmol Cu²⁺ per mol β-TCP on cell behaviour was observed in indirect and direct culture. Modification with Co²⁺ resulted in a clear suppression of cell proliferation and osteogenic differentiation. In conclusion, metal ion doping of the cement influences cellular activities in addition to the effect of released metal ions by changing properties of the ceramic matrix.

Molecular level interactions in brushite-aminoacids composites

The interaction of aminoacids (Glycine, Proline, Lysine) with brushite based bone cements has been investigated by several techniques (FTIR spectroscopy, Thermogravimetry-TG, Scanning Electron Microscopy-SEM, mechanical properties studies), with the aim to elucidate the properties of the resulting composite materials and the interaction occurring at molecular level between the inorganic matrix and the organic moieties. Brushite phase is predominantly obtained also in the presence of aminoacids added during preparation of the bone cement. Focusing on Glycine incorporation, the presence of a fraction of bulk Glycine, weakly interacting with the inorganic matrix, together with Glycine specifically interacting with adsorption sites can be envisaged, as pointed out by FT IR and thermogravimetric data. In detail, FT-IR data evidenced changes in shape and position of bands associated to stretching modes of the carboxylic groups in Glycine structure, which can be explained by the coordination of these functional groups with the Ca ions in the matrix. Heating this composite at controlled temperature results in the detection of a condensation products, either cyclic condensation product, either dipeptide. Diffuse and not specific H-bonding seems to be the main form of interaction of Proline and Lysine with brushite. Due to the coordination with Ca ions here described, Glycine can act as retardant during brushite preparation, allowing good workability of the resulting composite.

Efficacy of the biomaterials 3wt%-nanostrontium-hydroxyapatite-enhanced calcium phosphate cement (nanoSr-CPC) and nanoSr-CPC-incorporated simvastatin-loaded poly(lactic-co-glycolic-acid) microspheres in osteogenesis improvement: An explorative multi-phase experimental in vitro/vivo study

AIMS

The purpose of this multi-phase explorative in vivo animal/surgical and in vitro multi-test experimental study was to (1) create a 3wt%-nanostrontium hydroxyapatite-enhanced calcium phosphate cement (Sr-HA/CPC) for increasing bone formation and (2) creating a simvastatin-loaded poly(lactic-co-glycolic acid) (SIM-loaded PLGA) microspheres plus CPC composite (SIM-loaded PLGA+nanostrontium-CPC). The third goal was the extensive assessment of multiple in vitro and in vivo characteristics of the above experimental explorative products in vitro and in vivo (animal and surgical studies).

METHODS AND RESULTS PERTAINING TO SR-HA/CPC

Physical and chemical properties of the prepared Sr-HA/CPC were evaluated. MTT assay and alkaline phosphatase activities, and radiological and histological examinations of Sr-HA/CPC, CPC and negative control were compared. X-ray diffraction (XRD) indicated that crystallinity of the prepared cement increased by increasing the powder-to-liquid ratio. Incorporation of Sr-HA into CPC increased MTT assay (biocompatibility) and ALP activity (P<0.05). Histomorphometry showed greater bone formation after 4weeks, after implantation of Sr-HA/CPC in 10 rats compared to implantations of CPC or empty defects in the same rats (n=30, ANOVA P<0.05). METHODS AND RESULTS PERTAINING TO SIM-LOADED PLGA MICROSPHERES+NANOSTRONTIUM-CPC COMPOSITE: After SEM assessment, the produced composite of microspheres and enhanced CPC were implanted for 8weeks in 10 rabbits, along with positive and negative controls, enhanced CPC, and enhanced CPC plus SIM (n=50). In the control group, only a small amount of bone had been regenerated (localized at the boundary of the defect); whereas, other groups showed new bone formation within and around the materials. A significant difference was found in the osteogenesis induced by the groups sham control (16.96±1.01), bone materials (32.28±4.03), nanostrontium-CPC (24.84±2.6), nanostrontium-CPC-simvastatin (40.12±3.29), and SIM-loaded PLGA+nanostrontium-CPC (44.8±6.45) (ANOVA P<0.001). All the pairwise comparisons were significant (Tukey P<0.01), except that of nanostrontium-CPC-simvastatin and SIM-loaded PLGA+nanostrontium-CPC. This confirmed the efficacy of the SIM-loaded PLGA+nanostrontium-CPC composite, and its superiority over all materials except SIM-containing nanostrontium-CPC.

Characterization of alginate-brushite in-situ hydrogel composites

In the present study alginate-brushite composite hydrogels were in-situ synthetized and characterized with respect to preparation parameters. Specifically, the influence of initial pH value and initial concentration of phosphate precursor on the in-situ fabrication of the composite hydrogel were taken into account. The composite hydrogels were characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), thermogravimetric (TGA, DTG) and differential thermal analysis (DTA). Finally, the cell viability tests were carried out (MTT) over the incubation time period of 3, 7, and 14days. The results revealed that the formation and the crystalline stability of brushite were highly dependent on the initial pH value. It was shown that as the pH reached to the value of 6, characteristics peaks of brushite appeared in the FTIR spectra. Besides, the XRD and thermal analysis results were in a good accordance with those of FTIR. In addition, the SEM images demonstrated that the plate like brushite was formed inside the alginate matrix. Also, a considerable impact of pH variation on the biocompatibility of samples was noticed so that the majority of samples especially those prepared in the acidic conditions were toxic.

Galvanic deposition and characterization of brushite/hydroxyapatite coatings on 316L stainless steel

In this work, brushite and brushite/hydroxyapatite (BS, CaHPO4·H2O; HA, Ca10(PO4)6(OH)2) coatings were deposited on 316L stainless steel (316LSS) from a solution containing Ca(NO3)2·4H2O and NH4H2PO4 by a displacement reaction based on a galvanic contact, where zinc acts as sacrificial anode. Driving force for the cementation reaction arises from the difference in the electrochemical standard potentials of two different metallic materials (316LSS and Zn) immersed in an electrolyte, so forming a galvanic contact leading to the deposition of BS/HA on nobler metal. We found that temperature and deposition time affect coating features (morphology, structure, and composition). Deposits were characterized by means of several techniques. The morphology was investigated by scanning electron microscopy, the elemental composition was obtained by X-ray energy dispersive spectroscopy, whilst the structure was identified by Raman spectroscopy and X-ray diffraction. BS was deposited at all investigated temperatures covering the 316LSS surface. At low and moderate temperature, BS coatings were compact, uniform and with good crystalline degree. On BS layers, HA crystals were obtained at 50°C for all deposition times, while at 25°C, its presence was revealed only after long deposition time. Electrochemical studies show remarkable improvement in corrosion resistance.

Brushite foams--the effect of Tween® 80 and Pluronic® F-127 on foam porosity and mechanical properties

Resorbable calcium phosphate based bone void fillers should work as temporary templates for new bone formation. The incorporation of macropores with sizes of 100 -300 µm has been shown to increase the resorption rate of the implant and speed up bone ingrowth. In this work, macroporous brushite cements were fabricated through foaming of the cement paste, using two different synthetic surfactants, Tween® 80 and Pluronic® F-127. The macropores formed in the Pluronic samples were both smaller and less homogeneously distributed compared with the pores formed in the Tween samples. The porosity and compressive strength (CS) were comparable to previously developed hydroxyapatite foams. The cement foam containing Tween, 0.5M citric acid in the liquid, 1 mass% of disodium dihydrogen pyrophosphate mixed in the powder and a liquid to powder ratio of 0.43 mL/g, showed the highest porosity values (76% total and 56% macroporosity), while the CS was >1 MPa, that is, the hardened cement could be handled without rupture of the foamed structure. The investigated brushite foams show potential for future clinical use, both as bone void fillers and as scaffolds for in vitro bone regeneration.

Phosphorus removal performance and speciation in virgin and modified argon oxygen decarburisation slag designed for wastewater treatment

Argon oxygen decarburisation (AOD) slag may be used for phosphorus (P) removal, as its high pH and weatherable calcium (Ca) minerals provide sufficient Ca(2+) and OH(-) for calcium phosphate (Ca-PO4) precipitation. This study examined the P removal performance of AOD slag for use as wastewater treatment material. Batch experiments were carried out using both synthetic P solution and real wastewater, followed by chemical modelling and X-ray absorption near edge structure (XANES) spectroscopy. The influences of initial P concentration, slag dose and modification by polyethylene glycol (PEG), an effective agent for generation of porous materials, were investigated to determine the optimal conditions for P removal by AOD slag. It was found that virgin AOD slag removed 94.8% of P from a synthetic P solution in 4 h and 97.8% in 10 h. This high P removal was accompanied by a rapid increase in pH from 7.0 to 10.74. The maximum P removal capacity (PRC) from synthetic P solution ranged from 1.3 to 27.5 mg P g(-1). The optimal AOD dose for P removal from wastewater, determined in 8-h batch experiments, was 25 g L(-1). PEG modification increased the reaction rate and resulted in higher final pH, increasing PRC by 47.9%. Combined Visual MINTEQ and XANES analysis for detailed examination of P removal mechanisms revealed that the main P removal mechanism was precipitation of calcium phosphate. According to the XANES analysis, the main Ca-PO4 precipitate formed on virgin AOD slag under low initial P concentration and high pH was apatite, while brushite was the dominant product at high initial P concentration and low pH.

In vitro degradation and in vivo resorption of dicalcium phosphate cement based grafts

There are two types of DCP: dihydrated (brushite) and anhydrous (monetite). After implantation, brushite converts to hydroxyapatite (HA) which resorbs very slowly. This conversion is not observed after implantation of monetite cements and result in a greater of resorption. The precise mechanisms of resorption and degradation however of these ceramics remain uncertain. This study was designed to investigate the effect of: porosity, surface area and hydration on in vitro degradation and in vivo resorption of DCP. Brushite and two types of monetite cement based grafts (produced by wet and dry thermal conversion) were aged in phosphate buffered saline (PBS) and bovine serum solutions in vitro and were implanted subcutaneously in rats. Here we show that for high relative porosity grafts (50-65%), solubility and surface area does not play a significant role towards in vitro mass loss with disintegration and fragmentation being the main factors dictating mass loss. For grafts having lower relative porosity (35-45%), solubility plays a more crucial role in mass loss during in vitro ageing and in vivo resorption. Also, serum inhibited dissolution and the formation of HA in brushite cements. However, when aged in PBS, brushite undergoes phase conversion to a mixture of octacalcium phosphate (OCP) and HA. This phase conversion was not observed for monetite upon ageing (in both serum and PBS) or in subcutaneous implantation. This study provides greater understanding of the degradation and resorption process of DCP based grafts, allowing us to prepare bone replacement materials with more predictable resorption profiles.

The effect of water on the mechanical properties of soluble and insoluble ceramic cements

Ceramic cements are good candidates for the stabilization of fractured bone due to their potential ease of application and biological advantages. New formulations of ceramic cements have been tested for their mechanical properties, including strength, stiffness, toughness and durability. The changes in the mechanical properties of a soluble cement (calcium sulfate) upon water-saturation (saturation) was reported in our previous study, highlighting the need to test ceramic cements using saturated samples. It is not clear if the changes in the mechanical properties of ceramic cements are exclusive to soluble cements. Therefore the aim of the present study was to observe the changes in the mechanical properties of soluble and insoluble ceramic cements upon saturation. A cement with high solubility (calcium sulfate dihydrate, CSD) and a cement with low solubility (dicalcium phosphate dihydrate, DCPD) were tested. Three-point bending tests were performed on four different groups of: saturated CSD, non-saturated CSD, saturated DCPD, and non-saturated DCPD samples. X-ray diffraction analysis and scanning electron microscopy were also performed on a sample from each group. Flexural strength, effective flexural modulus and flexural strain at maximum stress, lattice volume, and crystal sizes and shape were compared, independently, between saturated and non-saturated groups of CSD and DCPD. Although material dissolution did not occur in all cases, all calculated mechanical properties decreased significantly in both CSD and DCPD upon saturation. The results indicate that the reductions in the mechanical properties of saturated ceramic cements are not dependent on the solubility of a ceramic cement. The outcome raised the importance of testing any implantable ceramic cements in saturated condition to estimate its in vivo mechanical properties.

Dual-setting brushite-silica gel cements

The current study describes a dual-mechanism-setting cement that combines a brushite-forming cement paste with a second inorganic silica-based precursor. Materials were obtained by pre-hydrolyzing tetraethyl orthosilicate (TEOS) under acidic conditions following the addition of a calcium phosphate cement (CPC) powder mixed of β-tricalcium phosphate and monocalcium phosphate. Cement setting occurred by a dissolution-precipitation process, while changes in pH during setting simultaneously initiated the condensation reaction of the hydrolyzed TEOS. This resulted in an interpenetrating phase composite material in which the macropores of the CPC were infiltrated by the microporous silica gel, leading to a higher density and a compressive strength ∼5-10 times higher than the CPC reference. This also altered the release of vancomycin as a model drug, whereby in contrast to the quantitative release from the CPC reference, 25% of the immobilized drug remained in the composite matrix. By varying the TEOS content in the composite, the cement phase composition could be controlled to form either brushite, anhydrous monetite or a biphasic mixture of both. The composites with the highest silicate content showed a cell proliferation similar to a hydroxyapatite reference with a significantly higher activity per cell. Surprisingly, the biological response did not seem to be attributed to the released silicate ions, but to the release of phosphate and the adsorption of magnesium ions from the cell culture medium.

Control of in vivo mineral bone cement degradation

The current study aimed to prevent the formation of hydroxyapatite reprecipitates in brushite-forming biocements by minimizing the availability of free Ca(2+) ions in the cement matrix. This was achieved by both maximizing the degree of cement setting to avoid unreacted, calcium-rich cement raw materials which can deliver Ca(2+) directly to the cement matrix after dissolution, and by a reduction in porosity to reduce Ca(2+) diffusion into the set cement matrix. In addition, a biocement based on the formation of the magnesium phosphate mineral struvite (MgNH4PO4·6H2O) was tested, which should prevent the formation of low-solubility hydroxyapatite reprecipitates due to the high magnesium content. Different porosity levels were fabricated by altering the powder-to-liquid ratio at which the cements were mixed and the materials were implanted into mechanically unloaded femoral defects in sheep for up to 10 months. While the higher-porosity brushite cement quantitatively transformed into crystalline octacalcium phosphate after 10 months, slowing down cement resorption, a lower-porosity brushite cement modification was found to be chemically stable with the absence of reprecipitate formation and minor cement resorption from the implant surface. In contrast, struvite-forming cements were much more degradable due to the absence of mineral reprecipitates and a nearly quantitative cement degradation was found after 10 months of implantation.

Evaluation of new treatment for incipient enamel demineralization using 45S5 bioglass

Bioglass 45S5 is a silica-based bioactive glass capable of depositing a layer of hydroxyl carbonate apatite on the surface of the glass when immersed in body fluids. The present paper studies a new technique for treating early human dental enamel caries lesions by using a paste composed of 45S5 bioglass and phosphoric acid. Artificial caries lesions were induced in enamel flat surfaces by means of a decalcification solution. All specimens were exposed to a brushing-abrasion challenge to test the durability of any newly formed layer resulting from the application of 45S5 bioglass paste. The specimens treated with bioglass paste showed complete coverage with a layer of brushite crystals. The brushing-abrasion challenge did not statistically affect the percentage of enamel coverage with the crystalline layer formed by the application of bioglass (p<0.05). These crystals were converted to hydroxyapatite crystals when stored in artificial saliva for 14 days. The current technique suggests the possibility of restoring incipient enamel erosive lesion with an abrasion durable layer of hydroxyapatite crystals.

Smart designing of new hybrid materials based on brushite-alginate and monetite-alginate microspheres: bio-inspired for sequential nucleation and growth

In this report new hybrid materials based on brushite-alginate and monetite-alginate were prepared by self-assembling alginate chains and phosphate source ions via a gelation process with calcium ions. The alginate served as nanoreactor for nucleation and growth of brushite or/and monetite due to its gelling and swelling properties. The alginate gel framework, the crystalline phase and morphology of formed hybrid biomaterials were shown to be strongly dependent upon the concentration of the phosphate precursors. These materials were characterized by thermogravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM) and energy dispersive x-ray analysis (EDX).

The effect of composition on mechanical properties of brushite cements

Due to a fast setting reaction, good biological properties, and easily available starting materials, there has been extensive research within the field of brushite cements as bone replacing material. However, the fast setting of brushite cement gives them intrinsically low mechanical properties due to the poor crystal compaction during setting. To improve this, many additives such as citric acid, pyrophosphates, and glycolic acid have been added to the cement paste to retard the crystal growth. Furthermore, the incorporation of a filler material could improve the mechanical properties when used in the correct amounts. In this study, the effect of the addition of the two retardants, disodium dihydrogen pyrophosphate and citric acid, together with the addition of β-TCP filler particles, on the mechanical properties of a brushite cement was investigated. The results showed that the addition of low amounts of a filler (up to 10%) can have large effects on the mechanical properties. Furthermore, the addition of citric acid to the liquid phase makes it possible to use lower liquid-to-powder ratios (L/P), which strongly affects the strength of the cements. The maximal compressive strength (41.8MPa) was found for a composition with a molar ratio of 45:55 between monocalcium phosphate monohydrate and beta-tricalcium phosphate, an L/P of 0.25ml/g and a citric acid concentration of 0.5M in the liquid phase.

Solubility of CaHPO4 · 2H2O in the Quaternary System Ca(OH)2 - H3PO4 - NaCl - H2O at 25 °C

Solubility of CaHPO4 · 2H2O was determined in the quaternary system Ca(OH)2 - H3PO4 - NaCl - H2O at 25 °C in the pH range 4.39-6.38; ionic strengths of the saturated solutions varied from 0.00485 to 0.545, Satisfactory constancy in the solubility product, (K sp = [ Ca 2 + ] ⋅ [ HPO 4 2 - ] ⋅ γ Ca 2 + ⋅ γ HPO 4 2 - = 2.49 ± 0.05 × 10 - 7   mol 2 × 1 - 2 ) was obtained when (i) the ion activity coefficients, γ i , were calculated with the Debye-Hückel equation, log   γ i = - A Z i 2 I / ( 1 + B α i I ) + 0.0626   I ; the value 0.0626 for the coefficient in the linear term was derived from the solubility data by utilizing a statistical procedure, and (ii) formation of an ion pairNaHPO 4 - was taken into account; a statistically derived value for the stability constant of this ion pair is 7.0 ± 2.4 1 × mol-1. The ion pairNaHPO 4 - appears to have significant concentrations in physiological fluids.