An overview of graphene-based hydroxyapatite composites for orthopedic applications

Fiber-Templated 3D Calcium-Phosphate Scaffolds for Biomedical Applications: The Role of the Thermal Treatment Ambient on Physico-Chemical Properties

A successful bone-graft-controlled healing entails the development of novel products with tunable compositional and architectural features and mechanical performances and is, thereby, able to accommodate fast bone in-growth and remodeling. To this effect, graphene nanoplatelets and Luffa-fibers were chosen as mechanical reinforcement phase and sacrificial template, respectively, and incorporated into a hydroxyapatite and brushite matrix derived by marble conversion with the help of a reproducible technology. The bio-products, framed by a one-stage-addition polymer-free fabrication route, were thoroughly physico-chemically investigated (by XRD, FTIR spectroscopy, SEM, and nano-computed tomography analysis, as well as surface energy measurements and mechanical performance assessments) after sintering in air or nitrogen ambient. The experiments exposed that the coupling of a nitrogen ambient with the graphene admixing triggers, in both compact and porous samples, important structural (i.e., decomposition of β-Ca3(PO4)2 into α-Ca3(PO4)2 and α-Ca2P2O7) and morphological modifications. Certain restrictions and benefits were outlined with respect to the spatial porosity and global mechanical features of the derived bone scaffolds. Specifically, in nitrogen ambient, the graphene amount should be set to a maximum 0.25 wt.% in the case of compact products, while for the porous ones, significantly augmented compressive strengths were revealed at all graphene amounts. The sintering ambient or the graphene addition did not interfere with the Luffa ability to generate 3D-channels-arrays at high temperatures. It can be concluded that both Luffa and graphene agents act as adjuvants under nitrogen ambient, and that their incorporation-ratio can be modulated to favorably fit certain foreseeable biomedical applications.

Review of the Applications of Biomedical Compositions Containing Hydroxyapatite and Collagen Modified by Bioactive Components

Regenerative medicine is becoming a rapidly evolving technique in today's biomedical progress scenario. Scientists around the world suggest the use of naturally synthesized biomaterials to repair and heal damaged cells. Hydroxyapatite (HAp) has the potential to replace drugs in biomedical engineering and regenerative drugs. HAp is easily biodegradable, biocompatible, and correlated with macromolecules, which facilitates their incorporation into inorganic materials. This review article provides extensive knowledge on HAp and collagen-containing compositions modified with drugs, bioactive components, metals, and selected nanoparticles. Such compositions consisting of HAp and collagen modified with various additives are used in a variety of biomedical applications such as bone tissue engineering, vascular transplantation, cartilage, and other implantable biomedical devices.

Improved Mechanical Properties of Ultra-High Shear Force Mixed Reduced Graphene Oxide/Hydroxyapatite Nanocomposite Produced Using Spark Plasma Sintering

The addition of nanomaterials, such as graphene and graphene oxide, can improve the mechanical properties of hydroxyapatite (HA) nanocomposites (NCPs). However, both the dispersive state of the starting materials and the sintering process play central roles in improving the mechanical properties of the final HA NCPs. Herein, we studied the mechanical properties of a reduced graphene oxide (r-GO)/HA NCP, for which an ultra-high shear force was used to achieve a nano-sized mixture through the dispersion of r-GO. A low-temperature, short-duration spark plasma sintering (SPS) process was used to realize high-density, non-decomposing r-GO/HA NCPs with an improved fracture toughness of 97.8% via the addition of 0.5 wt.% r-GO. Greater quantities of r-GO improve the hardness and the fracture strength. The improved mechanical properties of r-GO/HA NCPs suggest their future applicability in biomedical engineering, including use as sintered bodies in dentistry, plasma spray-coatings for metal surfaces, and materials for 3D printing in orthopedics.

Effect of Cerium-Containing Hydroxyapatite in Bone Repair in Female Rats with Osteoporosis Induced by Ovariectomy

Osteoporosis is a public health problem, with bone loss being the main consequence. Hydroxyapatite (HA) has been largely used as a bioceramic to stimulate bone growth. In our work, a cerium-containing HA (Ce-HA) has been proposed and its effects on the antimicrobial and bone-inducing properties were investigated. The synthesis of the materials occurred by the suspension–precipitation method (SPM). The XRD (X-ray Diffraction) confirmed the crystalline phase, and the Rietveld refinement confirmed the crystallization of HA and Ce-HA in a hexagonal crystal structure in agreement with ICSD n° 26205. Characterizations by FT-IR (Fourier Transform Infrared Spectroscopy), XPS (X-ray Photoemission Spectroscopy), and FESEM-EDS (Field Emission Scanning Electron Microscope-Energy Dispersive X-ray Spectroscopy) confirmed the presence of cerium (Ce3+ and Ce4+). The antibacterial activity of Has was evaluated against Staphylococcus aureus 25,923 and Escherichia coli 25,922 strains, which revealed that the material has antimicrobial properties and the cytotoxicity assay indicated that Ce-containing HA was classified as non-toxic. The effects of Ce-HA on bone repair, after application in bone defects in the tibia of female rats with osteoporosis induced by ovariectomy (OVX), were evaluated. After 15 and 30 days of implantation, the samples were analyzed by Raman, histology and X-ray microtomography. The results showed that the animals that had the induced bone defects filled with the Ce-HA materials had more expressive bone neoformation than the control group.

Improved nanomechanical and in-vitro biocompatibility of graphene oxide-carbon nanotube hydroxyapatite hybrid composites by synergistic effect

Hydroxyapatite (HAP) is an attractive bio-material for new bone growth process, hard tissue repair, bioactivity, osteoblast adhesion and proliferation due to its physicochemical resembles natural apatite. The intrinsic brittleness and poor mechanical properties of HAP restrict it for potential clinical applications. This problem is undertaken by exploiting the unique properties of carbon nanofillers (carbon nanotube (CNTs), graphene oxide (GO), graphene oxide-carbon nanotube (GCNTs) hybrid) which are used as reinforcement for preparing the carbon nanofillers based HAP composites. The nanomechanical and in-vitro biocompatibility of carbon nanofiller reinforced HAP composites have been studied. Carbon nanofiller reinforced HAP composites led to an improvement in nanomechanical and biocompatibility properties. The nanoindentation hardness and elastic modulus of GCNTs-HAP composites are significantly higher than other carbon nanofiller reinforced composites and pristine HAP powder. The in-vitro cytotoxicity of the prepared carbon nanofillers reinforced HAP composites is examined using MTT-assay on the MDCK cell line. The prepared GCNTs-HAP composites containing 2% of GCNTs nanofiller show higher cell viability, improved compatibility, and superior one cell proliferation induction than the other carbon nanofillers and HAP. These findings will provide the new prospects for utilizing the GO and its hybrid in HAP composites in bone repair, regeneration, augmentation and implantation.

Preliminary Studies on Graphene-Reinforced 3D Products Obtained by the One-Stage Sacrificial Template Method for Bone Reconstruction Applications

The bone remodeling field has shifted focus towards the delineation of products with two main critical attributes: internal architectures capable to promote fast cell colonization and good mechanical performance. In this paper, Luffa-fibers and graphene nanoplatelets were proposed as porogen template and mechanical reinforcing agent, respectively, in view of framing 3D products by a one-stage polymer-free process. The ceramic matrix was prepared through a reproducible technology, developed for the conversion of marble resources into calcium phosphates (CaP) powders. After the graphene incorporation (by mechanical and ultrasonication mixing) into the CaP matrix, and Luffa-fibers addition, the samples were evaluated in both as-admixed and thermally-treated form (compact/porous products) by complementary structural, morphological, and compositional techniques. The results confirmed the benefits of the two agents' addition upon the compact products' micro-porosity and the global mechanical features, inferred by compressive strength and elastic modulus determinations. For the porous products, overall optimal results were obtained at a graphene amount of <1 wt.%. Further, no influence of graphene on fibers' ability to generate at high temperatures internal interconnected-channels-arrays was depicted. Moreover, its incorporation led to a general preservation of structural composition and stability for both the as-admixed and thermally-treated products. The developed CaP-reinforced structures sustain the premises for prospective non- and load-bearing biomedical applications.

Effect of Hydroxyapatite Composite Nano-Artificial Bone on Treatment and Rehabilitation of Patients with Ankle Joint Injury

The formation of natural bone tissue is the result of the joint regulation of multiple template molecules. Although its complex hierarchical structure has been studied for many years, the mechanism of biomineralization of hard bone tissue has not been fully clarified. In this paper, the nanocomposites obtained by mineralization were characterized and analyzed, and the effect of the template on the crystal formation of hydroxyapatite was studied. The characterization results show that the main phase of the inorganic mineral obtained by template mineralization is the hydroxyapatite phase. The nano-apatite composite particles with an inorganic component content of 90.2% have the highest loading efficiency, reaching 67.9 mg/g. By statistical analysis of the pain scores at 5 days, 10 days, and 15 days after ankle injury, it was found that the average pain score of the treatment group was smaller than that of the control group. Two weeks later, the clinical efficacy judgment standard statistics show that the treatment group has a 22.5% improvement in healing rate, a significant increase in 3.18%, and a total effective rate of 8.71%, which is significantly better than the control group.

Osteogenic Properties of 3D-Printed Silica-Carbon-Calcite Composite Scaffolds: Novel Approach for Personalized Bone Tissue Regeneration

Carbon enriched bioceramic (C-Bio) scaffolds have recently shown exceptional results in terms of their biological and mechanical properties. The present study aims at assessing the ability of the C-Bio scaffolds to affect the commitment of canine adipose-derived mesenchymal stem cells (cAD-MSCs) and investigating the influence of carbon on cell proliferation and osteogenic differentiation of cAD-MSCs in vitro. The commitment of cAD-MSCs to an osteoblastic phenotype has been evaluated by expression of several osteogenic markers using real-time PCR. Biocompatibility analyses through 3-(4,5-dimethyl- thiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT), lactate dehydrogenase (LDH) activity, hemolysis assay, and Ames test demonstrated excellent biocompatibility of both materials. A significant increase in the extracellular alkaline phosphatase (ALP) activity and expression of runt-related transcription factor (RUNX), ALP, osterix (OSX), and receptor activator of nuclear factor kappa-Β ligand (RANKL) genes was observed in C-Bio scaffolds compared to those without carbon (Bio). Scanning electron microscopy (SEM) demonstrated excellent cell attachment on both material surfaces; however, the cellular layer on C-Bio fibers exhibited an apparent secretome activity. Based on our findings, graphene can improve cell adhesion, growth, and osteogenic differentiation of cAD-MSCs in vitro. This study proposed carbon as an additive for a novel three-dimensional (3D)-printable biocompatible scaffold which could become the key structural material for bone tissue reconstruction.

Graphene-Based Biomaterials for Bone Regenerative Engineering: A Comprehensive Review of the Field and Considerations Regarding Biocompatibility and Biodegradation

Graphene and its derivatives have continued to garner worldwide interest due to their unique characteristics. Having expanded into biomedical applications, there have been efforts to employ their exceptional properties for the regeneration of different tissues, particularly bone. This article presents a comprehensive review on the usage of graphene-based materials for bone regenerative engineering. The graphene family of materials (GFMs) are used either alone or in combination with other biomaterials in the form of fillers in composites, coatings for both scaffolds and implants, or vehicles for the delivery of various signaling and therapeutic agents. The applications of the GFMs in each of these diverse areas are discussed and emphasis is placed on the characteristics of the GFMs that have implications in this regard. In tandem and of importance, this article evaluates the safety and biocompatibility of the GFMs and carefully elucidates how various factors influence the biocompatibility and biodegradability of this new class of nanomaterials. In conclusion, the challenges and opportunities regarding the use of the GFMs in regenerative engineering applications are discussed, and future perspectives for the developments in this field are proposed.

Comparison of the effect of argon, hydrogen, and nitrogen gases on the reduced graphene oxide-hydroxyapatite nanocomposites characteristics

In this study, the effect of the argon, nitrogen, and hydrogen gases on the final properties of the reduced graphene oxide- hydroxyapatite nanocomposites synthesized by gas injected hydrothermal method was investigated. Four samples were synthesized, which in the first sample the pressure was controlled by volume change at a constant concentration. In subsequent samples, the pressure inside the autoclave was adjusted by the injecting gases. The initial pressure of the injected gases was 10 bar and the final pressure considered was 25 bar. The synthesized powders were consolidated at 950 °C and 2 MPa by spark plasma sintering method. The final samples were subjected to Vickers indentation analysis. The findings of this study indicate that the injection of argon, hydrogen, and nitrogen gases improved the mechanical properties of the nanocomposites. Injection of gases increased the crystallinity and particle size of hydroxyapatite, and this increase was greater for nitrogen gas than for others. Injection of these gases increased the rate of graphene oxide reduction and in this case the effect of nitrogen gas was greater than the others.

Enhanced Electrochemical Impedance Spectroscopy Analysis of Microbial Biofilms on an Electrochemically In Situ Generated Graphene Interface

Biofilms can cause many bacterial diseases, such as dental disease. An in vitro detection of biofilms may help to screen antibiofilm drugs. An impedance measurement based on an Au electrode has been successfully used for in vitro real-time monitoring of animal and human cell growth. However, microbial growth on the Au electrode produced a poor signal because of the small size of microbial cells. We have recently demonstrated that graphene derivatives can be produced on a carbon electrode through facile electrochemical activation, thus forming a reduced graphene oxide-carbon electrode (rGO-CE). Based on this fact, we hypothesized that an in vitro formed rugose graphene layer of rGO-CE may provide a large surface area for the growth of microbial biofilms and can therefore produce a strong impedance signal in response to a change in the biomass. In this study, three oral bacteria, Streptococcus mutans (S. mutans), Actinomyces viscosus (A. viscosus), and Lactobacillus fermentum (L. fermentum), were cultured on the surfaces of rGO-CE. As a result, the impedance response signal of the rGO-CE for the growth of S. mutans and A. viscosus was found to be 3.3 times and 6.0 times stronger than that of the Au electrode at 1.17 and 54.7 kHz, respectively. In particular, the poorly adhering strain of L. fermentum also produced a detectable signal on the graphene electrode but not on the Au electrode at 1.17 kHz. Furthermore, destructions of the biofilms grown on the rGO-CE by cetylpyridinium chloride were successfully monitored by impedance changes. Overall, it is promising to develop a graphene-based impedance biosensor platform for biofilm study and antibiofilm drug screening.

Enhanced osteogenesis and therapy of osteoporosis using simvastatin loaded hybrid system

Postmenopausal osteoporosis is a common chronic dynamic bone disorder, caused by estrogen deficiency. To address this issue, we constructed a controlled drug-release system composed of poly (N-isopropylacrylamide) brush modified mesoporous hydroxyapatite (MHA-SIM-P) loaded with simvastatin (SIM) using an ovariectomised (OVX) rat model. Quantitative alkaline phosphatase activity assay, alizarin red staining and RT-PCR were tested to evaluate the osteogenic ability in vitro. The results showed that the MHA-SIM-P nanoparticles significantly improved the osteogenic differentiation of OVX bone marrow stromal cells (BMSCs) in vitro. In osteoporotic animal model, the therapeutic efficiency for bone defect was evaluated by μCT analysis, tartrate-resistant acid phosphatase, haematoxylin and eosin staining, which showed improved bone formation and less osteoclastic response in OVX rats after surgery for 3 and 6 weeks. This polymer brush modified MHA system provided a sustained release system of hydrophobic SIM to inhibit osteoporosis together with MHA nanoparticle promoting the osteogenesis. Thus, this novel strategy exhibited great potential for promoting osteogenic ability and treating local osteoporotic defects.

Synthesis of Graphene Nanoribbons–Hydroxyapatite Nanocomposite Applicable in Biomedicine and Theranostics

In order to investigate the effect of graphene nanoribbons on the final properties of hydroxyapatite-based nanocomposites, a solvothermal method was used at 180 °C and 5 h for the synthesis of graphene nanoribbons–hydroxyapatite nanopowders by employing hydrogen gas injection. Calcium nitrate tetrahydrate and diammonium hydrogenphosphate were used as calcium and phosphate precursors, respectively. To synthesize the powders, a solvent containing diethylene glycol, anhydrous ethanol, dimethylformamide, and water was used. Graphene oxide nanoribbons were synthesized by chemical unzipping of carbon nanotubes under oxidative conditions. The synthesized powders were consolidated by spark plasma sintering methodat 950 °C and a pressure of 50 MPa. The powders and sintered samples were then evaluated using X-ray diffraction, Raman spectroscopy, high-resolution transmission electron microscopy, Vickers microindentation techniques, and biocompatibility assay. The findings of this study showed that the final powders synthesized by the solvothermal method had calcium to phosphate ratio of about 1.67. By adding a small amount of graphene nanoribbon (0.5%W), elastic modulus and hardness of hydroxyapatite increased dramatically. In biological experiments, the difference of hydroxyapatite effect in comparison with the nanocomposite was not significant. The findings of this study showed that graphene nanoribbons have a positive effect on the properties of hydroxyapatite, and these findings would be useful for the medical and theranostic application of this type of nanocomposites.

Freeze-dried multiscale porous nanofibrous three dimensional scaffolds for bone regenerations

Introduction: Simulating hydrophobic-hydrophilic composite face with hierarchical porous and fibrous architectures of bone extracellular matrix (ECM) is a key aspect in bone tissue engineering. This study focused on the fabrication of new three-dimensional (3D) scaffolds containing polytetrafluoroethylene (PTFE), and polyvinyl alcohol (PVA), with and without graphene oxide (GO) nanoparticles using the chemical cross-linking and freeze-drying methods for bone tissue application. The effects of GO on physicochemical features and osteoinduction properties of the scaffolds were evaluated through an in vitro study. Methods: After synthesizing the GO nanoparticles, two types of 3D scaffolds, PTFE/PVA (PP) and PTFE/PVA/GO (PPG), were developed by cross-linking and freeze-drying methods. The physicochemical features of scaffolds were assessed and the interaction of the 3D scaffold types with human adipose mesenchymal stem cells (hADSCs) including attachment, proliferation, and differentiation to osteogenic like cells were investigated. Results: GO nanoparticles were successfully synthesized with no agglomeration. The blending of PTFE as a hydrophobic polymer with PVA polymer and GO nanoparticles (hydrophilic compartments) were successful. Two types of 3D scaffolds had nano topographical structures, good porosities, hydrophilic surfaces, thermal stabilities, good stiffness, as well as supporting the cell attachments, proliferation, and osteogenic differentiation. Notably, GO incorporating scaffolds provided a better milieu for cell behaviors. Conclusion: Novel multiscale porous nanofibrous 3D scaffolds made from PTFE/ PVA polymers with and without GO nanoparticles could be an ideal candidate for bone tissue engineering as a 3D template.

Fabrication and Characterization of Polyetherimide Electrospun Scaffolds Modified with Graphene Nano-Platelets and Hydroxyapatite Nano-Particles

Solution electrospinning process (SEP) is a versatile technique for generating non-woven fibrous materials intended to a wide range of applications. One of them is the production of fibrous and porous scaffolds aiming to mimic bone tissue, as artificial extracellular matrices (ECM). In the present work, pure and nano-modified electrospun polyetherimide (PEI) scaffolds have been successfully fabricated. The nano-modified ones include (a) graphene nano-platelets (GNPs), (b) hydroxyapatite (HAP), and (c) mixture of both. After fabrication, the morphological characteristics of these scaffolds were revealed by using scanning electron (SEM) and transmission electron (TEM) microscopies, while porosity and mean fiber diameter were also calculated. In parallel, contact angle experiments were conducted so that the hydrophilicity level of these materials to be determined. Finally, the mechanical performance of the fabricated scaffolds was investigated by conducting uniaxial tensile tests. Ιn future work, the fabricated scaffolds will be further utilized for investigation as potential candidate materials for cell culture with perspective in orthopedic applications.

Preparation and biological properties of silk fibroin/nano-hydroxyapatite/graphene oxide scaffolds with an oriented channel-like structure

A novel SF/nHAp/GO hybrid scaffold with oriented channel-like structure in bone tissue engineering.

Micro/nano-structured TiO2 surface with dual-functional antibacterial effects for biomedical applications

Implant-associated infections are generally difficult to cure owing to the bacterial antibiotic resistance which is attributed to the widespread usage of antibiotics. Given the global threat and increasing influence of antibiotic resistance, there is an urgent demand to explore novel antibacterial strategies other than using antibiotics. Recently, using a certain surface topography to provide a more persistent antibacterial solution attracts more and more attention. However, the clinical application of biomimetic nano-pillar array is not satisfactory, mainly because its antibacterial ability against Gram-positive strain is not good enough. Thus, the pillar array should be equipped with other antibacterial agents to fulfill the bacteriostatic and bactericidal requirements of clinical application. Here, we designed a novel model substrate which was a combination of periodic micro/nano-pillar array and TiO2 for basically understanding the topographical bacteriostatic effects of periodic micro/nano-pillar array and the photocatalytic bactericidal activity of TiO2. Such innovation may potentially exert the synergistic effects by integrating the persistent topographical antibacterial activity and the non-invasive X-ray induced photocatalytic antibacterial property of TiO2 to combat against antibiotic-resistant implant-associated infections. First, to separately verify the topographical antibacterial activity of TiO2 periodic micro/nano-pillar array, we systematically investigated its effects on bacterial adhesion, growth, proliferation, and viability in the dark without involving the photocatalysis of TiO2. The pillar array with sub-micron motif size can significantly inhibit the adhesion, growth, and proliferation of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). Such antibacterial ability is mainly attributed to a spatial confinement size-effect and limited contact area availability generated by the special topography of pillar array. Moreover, the pillar array is not lethal to S. aureus and E. coli in 24 h. Then, the X-ray induced photocatalytic antibacterial property of TiO2 periodic micro/nano-pillar array in vitro and in vivo will be systematically studied in a future work. This study could shed light on the direction of surface topography design for future medical implants to combat against antibiotic-resistant implant-associated infections without using antibiotics.

Biomimetic Hydroxyapatite on Graphene Supports for Biomedical Applications: A Review

Hydroxyapatite (HA) has been widely used in fields of materials science, tissue engineering, biomedicine, energy and environmental science, and analytical science due to its simple preparation, low-cost, and high biocompatibility. To overcome the weak mechanical properties of pure HA, various reinforcing materials were incorporated with HA to form high-performance composite materials. Due to the unique structural, biological, electrical, mechanical, thermal, and optical properties, graphene has exhibited great potentials for supporting the biomimetic synthesis of HA. In this review, we present recent advance in the biomimetic synthesis of HA on graphene supports for biomedical applications. More focuses on the biomimetic synthesis methods of HA and HA on graphene supports, as well as the biomedical applications of biomimetic graphene-HA nanohybrids in drug delivery, cell growth, bone regeneration, biosensors, and antibacterial test are performed. We believe that this review is state-of-the-art, and it will be valuable for readers to understand the biomimetic synthesis mechanisms of HA and other bioactive minerals, at the same time it can inspire the design and synthesis of graphene-based novel nanomaterials for advanced applications.

Graphene oxide incorporated polycaprolactone/chitosan/collagen electrospun scaffold: Enhanced osteogenic properties for bone tissue engineering

This in vitro study aimed to evaluate the physicochemical and biological activity of the polycaprolactone/chitosan/collagen scaffolds incorporated with 0, 0.5, 3, and 6 wt% of graphene oxide (GO). Using standard tests and MG-63 cells, the characteristics of scaffolds were evaluated, and the behavior of osteoblasts were simulated, respectively. A non-significant decrease in nanofibers diameter was noted in scaffolds with a higher ratio of GO. The hydrophilicity and bioactivity of the scaffold surface, as well as cell attachment and proliferation, increased in correspondence to an increase in GO. The higher ratio of GO also improved the osteogenesis activity. GO increased the degradation rate, but it was negligible and seemed not enough to endanger stability. Modifying the scaffolds with GO did not make a significant change to the antibacterial effect.

Artifact expression of polylactic acid/hydroxyapatite/graphene oxide nanocomposite in CBCT: a promising dental material

OBJECTIVE

To evaluate the artifact expression of a new material-polylactic acid (PLA)/hydroxyapatite (HA)/graphene oxide (GO) nanocomposite-and compare it with that of commonly used dental materials, using cone-beam computed tomography.

MATERIALS AND METHODS

Cylinders of amalgam alloy, metal alloy, titanium, gutta-percha, and PLA/HA/GO were individually placed in the center of an acrylic phantom. Three images of each phantom + cylinder set were acquired using a Picasso Trio unit (Vatech, Hwaseong, South Korea) set at 90 kVp, 3.7 mA, 0.2 mm³ voxel size, and 12 × 8.5 cm FOV. Three images of a control group (sound phantom) were also obtained. Eight ROIs were established in each image to evaluate the standard deviation (S.D.) of gray values in the ImageJ Software. The Kruskal-Wallis test with the Student-Newman-Keuls post hoc was employed, considering a significance level of 5%.

RESULTS

There were no significant differences in S.D. between the control and PLA/HA/GO images (p = 0.712). Both control and PLA/HA/GO showed fewer image artifacts than the other materials (p < 0.05). The images of the amalgam alloy did not differ from the metal alloy images (p = 0.691), showing more artifacts than the gutta-percha (p = 0.028) and titanium (p = 0.051).

CONCLUSIONS

The PLA/HA/GO produced fewer artifacts and a better-quality image than the other tested materials.

CLINICAL RELEVANCE

The PLA/HA/GO has physical and biological properties similar to those of dental materials. Since it has produced fewer image artifacts, this new nanocomposite may be employed in the near future, enhancing the diagnosis in CBCT.

The synergistic effects of graphene-contained 3D-printed calcium silicate/poly-ε-caprolactone scaffolds promote FGFR-induced osteogenic/angiogenic differentiation of mesenchymal stem cells

Graphene-contained calcium silicate (CS)/polycaprolactone (PCL) scaffold (GCP) provides an alternative solution that can bring several bone formation properties, such as osteoinductive. This study finds out the optimal percentage of graphene additive to calcium silicate and polycaprolactone mixture for excellent in vitro and in vivo bone-regeneration ability, in addition, this scaffold could fabricate by 3D printing technology and demonstrates distinct mechanical, degradation, and biological behavior. With controlled structure and porosity by 3D printing, osteogenesis and proliferation capabilities of Wharton's Jelly derived mesenchymal stem cells (WJMSCs) were significantly enhanced when cultured on 3D printed GCP scaffolds. In this study, it was also discovered that fibroblast growth factor receptor (FGFR) plays an active role in modulating differentiation behavior of WJMSCs cultured on GCP scaffolds. The validation has been proved by analyzed the decreased cell proliferation, osteogenic-related protein (ALP and OC), and angiogenic-related protein (VEGF and vWF) with FGFR knockdown on all experimental groups. Moreover, this study infers that the GCP scaffold could induce the effects of proliferation, differentiation and related protein expression on WJMSCs through FGFR pathway. In summary, this research indicated the 3D-printed GCP scaffolds own the dual bioactivities to reach the osteogenesis and vascularization for bone regeneration.

Fabrication of Graphene Nanoplatelet-Incorporated Porous Hydroxyapatite Composites: Improved Mechanical and in Vivo Imaging Performances for Emerging Biomedical Applications

Three-dimensional nanocomposites exhibit unexpected mechanical and biological properties that are produced from two-dimensional graphene nanoplatelets and oxide materials. In the present study, various composites of microwave-synthesized nanohydroxyapatite (nHAp) and graphene nanoparticles (GNPs), (100 - x)HAp-xGNPs (x = 0, 0.1, 0.2, 0.3, and 0.5 wt %), were successfully synthesized using a scalable bottom-up approach, that is, a solid-state reaction method. The structural, morphological and mechanical properties were studied using various characterization techniques such as X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), and universal testing machine (UTM). XRD studies revealed that the prepared composites have high-order crystallinity. Addition of GNPs into nHAp significantly improved the mechanical properties. Three-dimensional nanocomposite 99.5HAp-0.5GNPs exhibited exceptionally high mechanical properties, for example, a fracture toughness of ∼116 MJ/m³, Young's modulus of ∼98 GPa, and compressive strength of 96.04 MPa, which were noticed to be much greater than in the pure nHAp. The MTT assay and cell imaging behaviors were carried out on the gut tissues of Drosophila third instars larvae and on primary rat osteoblast cells for the sample 99.5HAp-0.5GNPs that have achieved the highest mechanical properties. The treatment with lower concentrations of 10 μg/mL on the gut tissues of Drosophila and 1 and 5 μg/mL of this composite sample showed favorable cell viability. Therefore, owing to the excellent porous nature, interconnected surface morphology, and mechanical and biological properties, the prepared composite sample 99.5HAp-0.5GNPs stood as a promising biomaterial for bone implant applications.

Fabrication of Graphene Nanoplatelet-Incorporated Porous Hydroxyapatite Composites: Improved Mechanical and in Vivo Imaging Performances for Emerging Biomedical Applications

Three-dimensional nanocomposites exhibit unexpected mechanical and biological properties that are produced from two-dimensional graphene nanoplatelets and oxide materials. In the present study, various composites of microwave-synthesized nanohydroxyapatite (nHAp) and graphene nanoparticles (GNPs), (100 - x)HAp-xGNPs (x = 0, 0.1, 0.2, 0.3, and 0.5 wt %), were successfully synthesized using a scalable bottom-up approach, that is, a solid-state reaction method. The structural, morphological and mechanical properties were studied using various characterization techniques such as X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), and universal testing machine (UTM). XRD studies revealed that the prepared composites have high-order crystallinity. Addition of GNPs into nHAp significantly improved the mechanical properties. Three-dimensional nanocomposite 99.5HAp-0.5GNPs exhibited exceptionally high mechanical properties, for example, a fracture toughness of ∼116 MJ/m3, Young's modulus of ∼98 GPa, and compressive strength of 96.04 MPa, which were noticed to be much greater than in the pure nHAp. The MTT assay and cell imaging behaviors were carried out on the gut tissues of Drosophila third instars larvae and on primary rat osteoblast cells for the sample 99.5HAp-0.5GNPs that have achieved the highest mechanical properties. The treatment with lower concentrations of 10 μg/mL on the gut tissues of Drosophila and 1 and 5 μg/mL of this composite sample showed favorable cell viability. Therefore, owing to the excellent porous nature, interconnected surface morphology, and mechanical and biological properties, the prepared composite sample 99.5HAp-0.5GNPs stood as a promising biomaterial for bone implant applications.

Synthetic Biodegradable Aliphatic Polyester Nanocomposites Reinforced with Nanohydroxyapatite and/or Graphene Oxide for Bone Tissue Engineering Applications

This paper provides review updates on the current development of bionanocomposites with polymeric matrices consisting of synthetic biodegradable aliphatic polyesters reinforced with nanohydroxyaptite (nHA) and/or graphene oxide (GO) nanofillers for bone tissue engineering applications. Biodegradable aliphatic polyesters include poly(lactic acid) (PLA), polycaprolactone (PCL) and copolymers of PLA-PGA (PLGA). Those bionanocomposites have been explored for making 3D porous scaffolds for the repair of bone defects since nHA and GO enhance their bioactivity and biocompatibility by promoting biomineralization, bone cell adhesion, proliferation and differentiation, thus facilitating new bone tissue formation upon implantation. The incorporation of nHA or GO into aliphatic polyester scaffolds also improves their mechanical strength greatly, especially hybrid GO/nHA nanofilllers. Those mechanically strong nanocomposite scaffolds can support and promote cell attachment for tissue growth. Porous scaffolds fabricated from conventional porogen leaching, and thermally induced phase separation have many drawbacks inducing the use of organic solvents, poor control of pore shape and pore interconnectivity, while electrospinning mats exhibit small pores that limit cell infiltration and tissue ingrowth. Recent advancement of 3D additive manufacturing allows the production of aliphatic polyester nanocomposite scaffolds with precisely controlled pore geometries and large pores for the cell attachment, growth, and differentiation in vitro, and the new bone formation in vivo.

Preparation, Mechanical Properties, and Biocompatibility of Graphene Oxide-Reinforced Chitin Monofilament Absorbable Surgical Sutures

Chitin (CT) is a good material to prepare surgical sutures due to its conspicuous biological characteristics. However, the poor mechanical strength of pure CT sutures limits its application. In order to improve its strength, a composite monofilament absorbable suture was prepared in this study using graphene oxide and chitin (GO-CT) using a green method. FT-IR spectra showed that GO-CT contained the characteristic functional groups of GO and CT, indicating that a GO-CT suture was successfully obtained. With the addition of a small amount of GO (1.6wt% solution) in chitin, the breaking tensile strength, knot strength, and knot-pull strength of the GO-CT suture were significantly improved compared to the CT suture. The biocompatibility of the GO-CT suture in vitro was checked by tetrazolium-based colorimetric assays and no cytotoxicity to L929 cells was found. In vivo, the subcutaneous implantation of GO-CT sutures in the dorsal skin of rats found no abnormalities by hematoxylin-eosin staining. Furthermore, there were no significant changes in the gene expression of the inflammatory mediators, interleukin 1β (IL-1β), tumor necrosis factor-α, IL-6, IL-17A, interferon-γ, or IL-10; however, the expression of transforming growth factor β was significantly increased in the first week. In summary, GO-CT sutures may have potential as a suture material in the clinic.

Phosphate graphene as an intrinsically osteoinductive scaffold for stem cell-driven bone regeneration

Synthetic, resorbable scaffolds for bone regeneration have potential to transform the clinical standard of care. Here, we demonstrate that functional graphenic materials (FGMs) could serve as an osteoinductive scaffold: recruiting native cells to the site of injury and promoting differentiation into bone cells. By invoking a Lewis acid-catalyzed Arbuzov reaction, we are able to functionalize graphene oxide (GO) to produce phosphate graphenes (PGs) with unprecedented control of functional group density, mechanical properties, and counterion identity. In aqueous environments, PGs release inducerons, including Ca²⁺ and PO₄ ^3- Calcium phosphate graphene (CaPG) intrinsically induces osteogenesis in vitro and in the presence of bone marrow stromal cells (BMSCs), can induce ectopic bone formation in vivo. Additionally, an FGM can be made by noncovalently loading GO with the growth factor recombinant human bone morphogenetic protein 2 (rhBMP-2), producing a scaffold that induces ectopic bone formation with or without BMSCs. The FGMs reported here are intrinsically inductive scaffolds with significant potential to revolutionize the regeneration of bone.

Cisplatin-Loaded Graphene Oxide/Chitosan/Hydroxyapatite Composite as a Promising Tool for Osteosarcoma-Affected Bone Regeneration

Presently, tissue engineering approaches have been focused toward finding new potential scaffolds with osteoconductivity on bone-disease-affected cells. This work focused on the cisplatin (CDDP)-loaded graphene oxide (GO)/hydroxyapatite (HAP)/chitosan (CS) composite for enhancing the growth of osteoblast cells and prevent the development of osteosarcoma cells. The prepared composites were characterized for the confirmation of composite formation using Fourier transform infrared spectroscopy, scanning electron microscopy, transmission electron microscopy, and X-ray diffraction techniques. A flowerlike morphology was observed for the GO/HAP/CS-3/CDDP composite. UV-vis spectroscopy was used to observe the controlled release of CDDP from the GO/HAP/CS-3/CDDP composite, and 67.34% of CDDP was released from the composite over a time period of 10 days. The GO/HAP/CS-3/CDDP nanocomposites showed higher viability in comparison with GO/HAP/CS-3 on MG63 osteoblast-like cells and higher cytotoxicity against cancer cells (A549). The synthesized composite was found to show enhanced proliferative, adhesive, and osteoinductive effects on the alkaline phosphatase activity of osteoblast-like cells. Our results suggested that the CDDP-loaded GO/HAP/CS-3 nanocomposite has an immense prospective as a bone tissue replacement in the bone-cancer-affected tissues.

Graphene-Based Nanocomposites as Promising Options for Hard Tissue Regeneration

Tissues are often damaged by physical trauma, infection or tumors. A slight injury heals naturally through the normal healing process, while severe injury causes serious health implications. Therefore, many efforts have been devoted to treat and repair various tissue defects. Recently, tissue engineering approaches have attracted a rapidly growing interest in biomedical fields to promote and enhance healing and regeneration of large-scale tissue defects. On the other hand, with the recent advances in nanoscience and nanotechnology, various nanomaterials have been suggested as novel biomaterials. Graphene, a two-dimensional atomic layer of graphite, and its derivatives have recently been found to possess promoting effects on various types of cells. In addition, their unique properties, such as outstanding mechanical and biological properties, allow them to be a promising option for hard tissue regeneration. Herein, we summarized recent research advances in graphene-based nanocomposites for hard tissue regeneration, and highlighted their promising potentials in biomedical and tissue engineering.