Role of interconnections in porous bioceramics on bone recolonization in vitro and in vivo

An innovative method to obtain porous PLLA scaffolds with highly spherical and interconnected pores

Scaffolding is an essential issue in tissue engineering and scaffolds should answer certain essential criteria: biocompatibility, high porosity, and important pore interconnectivity to facilitate cell migration and fluid diffusion. In this work, a modified solvent casting-particulate leaching out method is presented to produce scaffolds with spherical and interconnected pores. Sugar particles (200-300 microm and 300-500 microm) were poured through a horizontal Meker burner flame and collected below the flame. While crossing the high temperature zone, the particles melted and adopted a spherical shape. Spherical particles were compressed in plastic mold. Then, poly-L-lactic acid solution was cast in the sugar assembly. After solvent evaporation, the sugar was removed by immersing the structure into distilled water for 3 days. The obtained scaffolds presented highly spherical interconnected pores, with interconnection pathways from 10 to 100 mum. Pore interconnection was obtained without any additional step. Compression tests were carried out to evaluate the scaffold mechanical performances. Moreover, rabbit bone marrow mesenchymal stem cells were found to adhere and to proliferate in vitro in the scaffold over 21 days. This technique produced scaffold with highly spherical and interconnected pores without the use of additional organic solvents to leach out the porogen.

Porosity and pore size of beta-tricalcium phosphate scaffold can influence protein production and osteogenic differentiation of human mesenchymal stem cells: an in vitro and in vivo study

The interaction of stem cells and ceramics in bone regeneration is still poorly understood. The aim of this study was to examine the influence of the porosity (25%, 65% and 75%) of beta-tricalcium phosphate (TCP) ceramics on osteogenic differentiation of mesenchymal stem cells (MSC) in vitro and in vivo. For the in vitro portion of the study, TCP scaffolds loaded with MSC were kept in osteogenic induction medium for 21 days. For the in vivo portion of the study, scaffolds loaded with undifferentiated MSC were implanted subcutaneously into SCID mice for 8 weeks and compared with similarly implanted controls that were not loaded with MSC. Measurements of total protein as well as specific alkaline phosphatase (ALP) activity were taken as indicators of growth/matrix production and osteogenic differentiation. An increase in the total protein concentration was noted from day 1 to day 21 on the in vitro TCP 65% and TCP 75% scaffolds (p<0.05) with no such increase noted in the TCP 25% specimens. However, the specific alkaline phosphatase activity increased from day 1 to day 21 in all three in vitro specimens (p<0.02) and reached similar levels in each specimen by day 21. In vivo, ALP activity of cell-loaded TCP 65% ceramics was higher when compared with both the TCP 25% and TCP 75% specimens (p<0.046), and higher in the TCP 75% than TCP 25% specimens (p=0.008). Histology revealed mineralization by human cells in the pores of the TCP ceramic scaffolds with a trend toward greater calcification in TCP 65% and 75%. In summary, a higher porosity of TCP scaffolds does not necessarily mean a higher ALP activity in vivo. The distribution and size of the pores, as well as the surface structure, might play an important role for osteogenic differentiation in vivo.

Bone ingrowth in zirconia and hydroxyapatite scaffolds with identical macroporosity

The role of the material composition, porosity and surface topography of scaffolds for promotion of osteogenesis and osseointegration is not fully understood. The aim of the present study was to evaluate the effects of material composition and surface topography on bone ingrowth and bone contact. Designed macroporous ceramic scaffolds of zirconia and hydroxyapatite were used. Using free form fabrication (FFF) techniques an identical macroporosity in both materials was achieved. The scaffolds were implanted in rabbit tibia (cortical bone) and femur (trabecular bone). After 6 weeks of implantation the tissue response was assessed with histology and histomorphometry. The results showed significantly more bone ingrowth and bone contact in the hydroxyapatite scaffolds compared to the zirconia scaffold. Surface topography had no significant effect on bone contact inside the macropores regardless of material. This was observed in both cortical and trabecular bone sites. The study suggests that the difference between hydroxyapatite and zirconia was due to a difference in material chemistry.

Porous scaffold of gelatin-starch with nanohydroxyapatite composite processed via novel microwave vacuum drying

Hydroxyapatite (HA) is a fundamental mineral-based biomaterial, used for preparing composites for bone repair and regeneration. Gelatin blended with starch results in scaffold composites with enhanced mechanical properties. A gelatin-starch blend reinforced with HA nanocrystals (nHA) gave biocompatible composites with enhanced mechanical properties. In this study, a porous scaffold of gelatin-starch-nHA composites was fabricated through microwave vacuum drying and crosslinking using trisodium citrate. Three different composite scaffolds were prepared at three different percentages of nHA: 20%, 30% and 40%. The microstructures and compositions of the composites were analyzed. Within the porous structure, the nHA crystals were observed to precipitate. The interaction between the gelatin-starch network film and nHA crystalline material was studied using Fourier transform infrared (FTIR) spectroscopy and X-ray diffraction analysis (XRD). XRD reflections showed that there are two different minerals present in the scaffold composite. There were strong reflection peaks close to the 26 degrees and 32 degrees 2theta angles of HA, and close to the 8 degrees and 49 degrees 2theta angles for sodium citrate minerals. The FTIR result suggested that carboxyl groups, C=O and amino groups play crucial roles in HA formation on the surface of a gelatin network.

Hierarchical pore structure of calcium phosphate scaffolds by a combination of gel-casting and multiple tape-casting methods

The objective of this work was to design hierarchical pore structure scaffolds with potential applications in bone tissue regeneration. For that purpose, a bioceramic material such as biphasic calcium phosphate, which consists of a mixture of hydroxyapatite and beta-tricalcium phosphate, was selected. Multilayer pieces (MLP) with hierarchical pore structure were developed employing a new technique that combines gel casting and adding porogens, using multiple tape-casting methods. Pieces with functionally graded porosity were fabricated using porogens with different sizes. The porogens used were Porlat K85 and Porlat K86 with diameters <150 microm and 150-300 microm, respectively. Two types of sintered tapes, with different porosity, no cracking and enough interconnection size were selected. MLP with hierarchical pore structure were designed by the multiple tape-casting method. Interconnected pores whose sizes increase from interior tapes (1.6-3.6 microm) towards exterior tapes (20-51.5 microm) and interpenetration between tapes were achieved. Delamination or cracking were not observed after heat treatment. The flexural strength of pieces was investigated by the three-point bending test. This new combination of methods offers the possibility of manufacturing scaffolds with interconnected pore sizes ranging from 1.6 to 51.5 microm.

Fabrication of porous substrates: a review of processes using pore forming agents in the biomaterial field

This paper is a review of solid and casting manufacturing processes able to create porous materials, mainly in the biomaterial field. The considered methods are based on pore forming agents that are removed either by heating or by dissolution. All techniques lead to products presenting pores with amount, size, and shape are close to those of the initial pore formers. Porosities up to 90% with pores ranging from 1 to 2000 microm are reported. Major differences concern macrointerconnections that are more frequently obtained using foams, or porogens which undergo a melting stage during firing. Casting methods combined with solid free form fabrication are promising for the design of porous network through the manufacturing of 3D scaffolds corresponding to the desired porosity.

Beta-TCP bone graft substitutes in a bilateral rabbit tibial defect model

The use of artificial bone graft substitutes has increased as the surgical applications widen and the availability of allograft bone decreases. The ideal graft substitute should reabsorb with time to allow and encourage new bone formation whilst maintaining its properties as an osteoconductive scaffold until it is no longer required. A potential disadvantage of some synthetic substitutes is their long dissolution time. Beta-tricalcium phosphates (beta-TCPs) have some advantages when compared to hydroxyapatite (HA), when used as a filler, in that it is more rapidly reabsorbed. Three commercially available and clinically used beta-TCP bone graft substitutes with the same chemistry (Vitoss, Osferion, Chronos) but with varying macro and microscopic characteristics were investigated using a bilateral tibial metaphyseal defect model in New Zealand white rabbits. When placed into tibial defects all three materials performed similarly in terms of mechanical properties of the healing defects. A decrease in properties was found at 12 weeks where implant resorption was nearly achieved while remodelling of the anteromedial cortex had yet to be completed. All materials were osteoconductive and supported new bone formation while implant resorption with time differed between materials. Vitoss resorbed faster than the other materials and is likely to differences in particle geometry, pore structure and interconnectivity.

Upgrading Calcium Phosphate Scaffolds for Tissue Engineering Applications

The research on ceramic scaffolds for bone tissue engineering is, nowadays, one of the newest and most attractive topics in the field of materials for biomedical applications. These scaffolds are aimed to provide supporting or even enhance the reparative capacity of body. Biphasic calcium phosphates (BCPs) and silicon doped BCP are very interesting candidates to be used as materials for scaffolds fabrication in bone tissue engineering. BCPs and silicon doped BCP consist of a mixture of hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) or HA and α-tricalcium phosphate (α-TCP), respectively. For the regenerative purposes BCPs show better performance than HA because of the higher solubility of β-TCP compound, which facilitate the subsequent bone ingrowth in the implant. On the other, silicon doped BCP involve silicon that substituted into the apaptite crystal lattice for phosphorous with the subsequent charge imbalance. HA/α-TCP based bioceramics exhibits an important improvement of the bioactive behaviour with respect to non-substituted apatites. This work reviews the procedures to synthesise and fabricate scaffolds based on HA/β-TCP and silicon stabilised HA/α-TCP. Special attraction has been paid in the different synthesis methods and to the shaping of final scaffolds. By knowing the scaffold features at the crystallinity and macrostuctural level, the biocompatibility and clinical performance can be better understood, which will be also considered in this review.

Bone ingrowth in macroporous Bonelike for orthopaedic applications

The aim of this study was to evaluate the biological behaviour of porous scaffold structures of Bonelike which is suitable for either direct clinical use or tissue engineering applications. Porous cylindrical specimens 8x10mm were implanted in the lateral aspect of the tibia of 13 patients (mean age 54 years), during osteotomy surgery for the treatment of medial compartment osteoarthritis of the knee. Implanted cylinders were retrieved at the same time as the removal of the blade plates at 3, 6, 9 and 12 months. Scanning electron microscopy and histological evaluations were performed to observe the biological responses of human bone tissue to porous Bonelike. The penetration depth was determined for all implantation periods, and after 6 months it was already possible to see new bone in the centre of the implanted cylinders, which gives 100% of penetration depth for all implantations periods except for 3 months when bone could only be seen in the peripherical region. Regarding the percentage of the area covered by new bone calculated from two-dimensional histological sections, values of 53+/-15, 76+/-12 and 88+/-9% were achieved for 6, 9 and 12 months, respectively. Due to its structural features porous Bonelike permitted effective vascularization and bone ingrowth, and therefore was fully osteointegrated as shown in the histological surveys. A slow biomaterial degradation with implantation time is envisaged since the material has displayed surface degradation. Bonelike scaffolds show potential for complete ingrowth of osseous tissue and restoration of vascularization throughout the defected site.

Preparation and Evaluation of Porous Poly(3-hydroxybutyrate-co-3-hydroxyhexanoate)— Hydroxyapatite Composite Scaffolds

Poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) and PHBHHx—hydroxyapatite (HAP) composite scaffolds have been prepared by phase separation and subsequent sublimation of the solvent for bone tissue engineering. Scanning electron microscopy (SEM), porosity measurement, mechanical tests, and thermogravimertric analysis (TGA) are used to analyze the physical properties of the scaffolds. The biocompatibility and osteoconductivity are assessed by examining the morphology, proliferation, and differentiation of MC3T3-E1 osteoprogenitor cells seeded on the scaffolds. The PHBHHx—HAP composite scaffolds show better mechanical properties, biocompatibility, and osteoconductivity than the PHBHHx scaffolds. The results suggest that PHBHHx—HAP composite scaffolds can be employed as a promising candidate for bone reconstruction.

The influence of pore size on colonization of poly(L-lactide-glycolide) scaffolds with human osteoblast-like MG 63 cells in vitro

A degradable copolymer of L-lactide and glycolide (PLG) was synthesized by ring opening polymerization using zirconium acetylacetonate [Zr(acac)(4)] as a biocompatible initiator. The structure of the copolymer was studied by nuclear magnetic resonance spectroscopy (NMR) and gel permeation chromatography (GPC). Porous scaffolds of defined microstructure were prepared by solvent casting/salt particulate leaching, which resulted in the creation of three types of scaffolds with the same porosity (87%+/-1%) but with different diameters of the pores (600, 200 and 40 microm) and degree of interconnectivity. The potential of the scaffolds for cell colonization was tested in a conventional static cell culture system using human osteoblast-like MG 63 cells. As revealed by conventional fluorescence and confocal microscopy on days 5 and 7 after seeding, the cells on the scaffolds of large or medium pore size infiltrated the inside part of the material, whereas on the scaffolds of small pore size, the cells were retained on the material surface. On day 7 after seeding, the highest number of cells was found on the scaffolds of the largest pore size (more than 120,000 cells per sample of the diameter 15 mm and thickness 2 mm), whereas on the scaffolds with medium and smallest pore diameter, the number of cells was almost three times lower and similar for both pore sizes. These results corresponded well with the incorporation of bromodeoxyuridine into newly synthesized DNA, which was significantly higher in cells on scaffolds of the largest pore size than on the material with medium and smallest pore diameter. As indicated by the MTT test, the mitochondrial activity in cells on scaffolds with medium pore size was similar to that on the material with the highest pore size, and significantly higher than on scaffolds of the smallest pore diameter. These results suggest that PLG scaffolds with the largest pore diameter (600 microm) and better pore interconnectivity are the most suitable for colonization with osteogenic cells.

Fabrication of porous bioceramics with porosity gradients similar to the bimodal structure of cortical and cancellous bone

The aim of this study was to fabricate porous implant materials with graded pore structures similar to the bimodal structure of cortical and cancellous bone. Porous hydroxyapatite/tricalcium phosphate (HA/TCP) bioceramics with interconnected porosity and controlled pore sizes required to simulate natural bone tissue morphology were fabricated by a novel technique of vacuum impregnation of reticulated polymeric foams with ceramic slip. Functionally gradient materials (FGMs) with porosity gradients were made by joining different pore per inch (ppi) foams together by either stitching or pressfitting to form templates. Post production, no defects could be seen at the interface between the two different porosity sections. The macropore sizes of the HA/TCP bioceramics were larger than 100 mum which is appropriate for bone ingrowth. A sample with a graded porous structure which is close to the human bone morphology was also developed. The two component structures were conspicuously different but joined together firmly. Four point bend testing of FGM samples showed them to have similar mechanical properties to homogeneous ceramics based on foam templates with uniform pore sizes, with no evidence of interfacial weakness. Many potential biomedical applications could be developed utilising graded porous structures. The ease of processing will make it possible to fabricate a range of complex shapes for different applications.

Opening wedge high tibial osteotomy using 3D biomodelling Bonelike macroporous structures: case report

Two synthetic calcium phosphates in porous wedge shape, Bonelike and a commercial HA/beta-TCP biphasic material, were used as an alternative to bone autografts and allografts in the treatment of medial compartment osteoarthritis of varus knees. The structure of Bonelike has a 3D architecture that is computer controlled, and a composition that mimics the mineral composition of natural bone. The HA/beta-TCP biphasic material used as a control material in this study was prepared using conventional foaming based methods. No signs of inflammatory reactions were observed post-operatively for both materials. After 4 months signs of fusion at the osteotomy site and good integration of the implanted wedges were observed, showing good mechanical resistance. Concerning the final correction attained, the left knee revealed a satisfactory valgus of 10 degrees , but the right one only had a final value of 6 degrees . The clinical evaluation using International Knee Score (IKS) showed good outcome in all parameters with complete range of motion in both knees and climbing stairs without crutches with only slight pain.

The Effect of Slip Loading on the Properties of Porous Calcium Phosphate Bioceramics

Ceramic slips with powder loadings in the range of 80-140 wt% were used to investigate the effect of slip loading on the physical and mechanical properties of open pore HA/TCP bioceramics. The results indicated that increasing the slip loading had an effect on the properties of the samples. The average apparent density, the work of fracture and compressive strength all increased with slip loading. In contrast, the effect of increasing slip loading on the four-point bending strength was not significant.

Porous Biphasic and Triphasic Bioceramics Scaffolds Produced by Gelcasting

The present work suggests a modified gel casting process, including polyethylene wax spheres addition to the suspension with the objective of creating uniform and interconnected pores in the body of samples. In the present study, apatite powders were synthesized at pH 10 and pH 12 in order to give rise to biphasic and triphasic bioceramics after sintering.

Comparison of drying methods in the fabrication of collagen scaffold via indirect rapid prototyping

Porous collagen scaffolds with predefined 3-dimesional (3-D) networks of internal channels are fabricated via an indirect rapid prototyping technique. To obtain the scaffolds, two drying methods, namely critical point drying and freeze-drying were investigated. The latter was found to be a more suitable process as it induced less shrinkage and reproduced the design morphology accurately. The resulting scaffold contained internal hollow channels with porous foam-like structure occupying the surrounding volume. The mean diameter of the pores was 180 +/- 60 microm and the channels diameter obtained was measured as 437 +/- 100 microm. The channels were defined and strengthened by a layer of skin due to the process of freeze-drying. These networks of internal channels serve to enhance the mass transport rate through the scaffold and help to increase the depth of cells penetration in the scaffold.

Effect of Hydroxyapatite porous characteristics on healing outcomes in rabbit posterolateral spinal fusion model

Hydroxyapatite (HA) has been commonly used as a bone graft substitute in various kinds of clinical fields. To improve the healing capability of HA, many studies have been performed to reveal its optimal structural characteristics for better healing outcomes. In spinal reconstruction surgery, non-interconnected porous HAs have already been applied as a bone graft extender in order to avoid autogenous bone harvesting. However, there have been few experimental studies regarding the effects of the structural characteristics of HA in posterolateral lumbar intertransverse process spine fusion (PLF). The aims of this study were to investigate the effect of HA porous characteristics on healing outcomes in a rabbit PLF model in order to elucidate appropriate structural characteristics of HA as a bone graft extender. Thirty-six adult female Japanese White rabbits underwent bilateral intertransverse process fusion at the level of L5-6 without internal fixation. We prepared three types of HA with different porosities: HA with 15% porosity (HA15%), HA with 50% porosity (HA50%), and HA with 85% porosity (HA85%), all of which were clinically available materials. The HA15% and HA50% had few interconnecting pores, whereas the HA85%, which was a recently developed material, had abundant interconnecting pores. All rabbits were randomly divided into the following four groups according to the grafted materials: (1) HA15% + autogenous bone, (2) HA50% + autogenous bone, (3) HA85% + autogenous bone, (4) pure autogenous bone graft. The animals were euthanized at 5 weeks after surgery, and post-mortem analyses including biomechanical testing, radiographical and histological evaluations were performed. There was no statistically significant difference in either fusion rate and/or bending stiffness among the three HA groups. However, in histological and radiological analyses, both bone ingrowth rate and direct bone bonding rate in the HA85% group were significantly higher than those in the HA15% and HA50% groups, despite the similar value of bone volume rate in fusion mass among the three HA groups. In the HA85% group, bone ingrowth was achieved throughout the implanted HAs via interconnecting pores and there was excellent unification between the HA granules and the newly mineralized bone. On the other hand, in the non-interconnected porous HA groups, only a little bone ingrowth could be seen at the peripheral pores of the implanted HA, and its surface was mostly covered with fibrous tissue or empty space. The current study demonstrated that the HA porous characteristics had an effect on the histological outcomes in a rabbit PLF model. We would like to conclude that the interconnected high porous structure seems to be promising for the environment of PLF in the point of producing fusion mass with higher cellular viability. This is because the HA85% is superior in terms of integration with the newly formed bone in fusion mass compared to the non-interconnected porous HAs. However, the porous modifications of HA have little influence on fusion rate and mechanical strength because primary stabilization of the fusion segment is mainly achieved by bridging bone between the adjacent transverse processes outside the implanted materials, rather than the degree of integration between the newly formed bone and the HA granules in PLF.

Three-dimensional flow perfusion culture system for stem cell proliferation inside the critical-size beta-tricalcium phosphate scaffold

A 3-dimensional flow perfusion system has been created in our laboratory to provide continuous and homogeneous nutrient supply inside the critical-size beta-tricalcium phosphate (beta-TCP) scaffold and permit cell proliferation during long-term incubation. The critical-size porous cylindrical scaffold (14 mm in diameter, 30 mm in length) with a central tunnel was impregnated with sheep mesenchymal stem cells. In the flow perfusion group, the hybrid scaffolds were continuously perfused with complete alpha-minimum essential medium via a peristaltic pump for 7, 14, and 28 days. In the static culture group, the hybrid composites were immersed in the medium without perfusion for 14 and 28 days. The daily glucose consumption was much higher in the flow perfusion group than in the static group (p < 0.001). In the flow perfusion group, glucose consumption increased dramatically in the first 14 days, and the increase slowed in the last 14 days. In the static group, the increase occurred only in the first 14 days. Cell viability via MTT colorimetry increased with time, which coincided with the results of glucose consumption. Histological study showed that the cells proliferated through the whole scaffolds under the flow perfusion culture. While under the static culture, the cells survived and proliferated only inside the first to third rows of the macropores under the scaffold surface. The cell quantity increased with time under flow perfusion culture. The results suggest that flow perfusion culture is superior to static culture for mesenchymal stem cell proliferation in the critical-size porous scaffold. This perfusion culture system permits a constant nutrition supply into the center of a large-scale scaffold for at least 4 weeks. Determination of D-glucose in the culture medium is a noninvasive way to survey cell proliferation in this system.

Novel hydroxyapatite (HA) dual-scaffold with ultra-high porosity, high surface area, and compressive strength

A novel scaffold designed for tissue engineering applications, which we refer to as a "dual-scaffold" because its structure consists of two interlaced three-dimensional (3-D) hydroxyapatite (HA) networks, was fabricated using a combination of the rapid prototyping (RP) method and dip-coating process. To accomplish this, a graphite network acting as a template was prepared using the RP method and then uniformly dip-coated with HA slurry. The resultant sample was then heat-treated at 1250 degrees C for 3 h in air to remove the graphite network and consolidate the HA networks. An additional 3-D channel was formed by removing the graphite network, while preserving the pre-existing channel. The unique structure of the dual-scaffold endows it with unprecedented features, such as ultra-high porosity (>85%), a high surface area and high compressive strength, as well as a tightly controlled pore structure. In addition, an excellent cellular response was observed to the fabricated HA dual-scaffold.

The effect of the microstructure of β-tricalcium phosphate on the metabolism of subsequently formed bone tissue

The response of bone cells to a newly developed porous beta-tricalcium phosphate composed of rod-shaped particles (RSbeta-TCP), beta-TCP composed of conventional non-rod-shaped particles (Cbeta-TCP), and hydroxyapatite (HA) was analyzed using in vivo implantation and in vitro osteoclastogenesis systems. Implantation of the materials into the rabbit femur showed that RSbeta-TCP and Cbeta-TCP were bioresorbable, but HA was not. Up to 12 weeks after the implantation, bioresorption of RSbeta-TCP and Cbeta-TCP accompanied by the formation of new bone occurred satisfactorily. At 24 weeks post-implantation, most of the RSbeta-TCP had been absorbed, and active osteogenesis was preserved in the region. However, in the specimens implanted with Cbeta-TCP, the amount of not only the implanted Cbeta-TCP but also the newly formed bone tissue decreased, and bone marrow dominated the region. The implanted HA was unbioresorbable throughout the experimental period. When osteoclasts were generated on RSbeta-TCP, Cbeta-TCP, or HA disks, apparent resorption lacunae were formed on the RSbeta-TCP and Cbeta-TCP, but not HA disks. Quantitation of the calcium concentration in the culture media showed an earlier and more constant release of calcium from RSbeta-TCP than Cbeta-TCP. These results showed that the microstructure of beta-TCP affects the activity of bone cells and subsequent bone replacement.

Custom fabrication of composite tibial hemi-knee joint combining CAD/CAE/CAM techniques

A custom fabrication approach combining computer-aided design (CAD), computer-aided engineering (CAE), and computer-aided manufacturing (CAM) techniques for constructing a novel composite tibial hemi-knee joint is presented. Anatomical modelling was used to provide the computer model with specific geometry for individuals and the finite element method (FEM) was adopted to understand the loading distribution on each component of the composite substitute. Rapid prototyping (RP) was employed to build the negative patterns, based on which the titanium alloy tibial tray and the porous artificial bone were custom fabricated through quick casting and powder sintering techniques. The results show that the titanium alloy component bears most of the loading while the artificial bone shares little, which could prevent it from fracturing in vivo. The final porous artificial bone has controllable microchannels (600 microm) and random micropores (100-200 microm), which ensures full interconnectivity and is expected to address the biological consideration. Clinical application demonstrates that the composite tibial hemi-knee joint has enough mechanical strength and can fit with the upper hemi-knee joint. This novel approach provides a new way to repair large bone defects in the loading sites.

Preparation and Characterization of a Multilayer Biomimetic Scaffold for Bone Tissue Engineering

In scaffold based bone tissue engineering, both the pore size and the mechanical properties of the scaffold are of great importance. However, an increase in pore size is generally accompanied by a decrease in mechanical properties. In order to achieve both suitable mechanical properties and porosity, a multilayer scaffold is designed to mimic the structure of cancellous bone and cortical bone. A porous nano-hydroxyapatite—chitosan composite scaffold with a multilayer structure is fabricated and encased in a smooth compact chitosan membrane layer to prevent fibrous tissue ingrowth. The exterior tube is shown to have a small pore size (15—40 μm in diameter) for the enhancement of mechanical properties, while the core of the multilayer scaffold has a large pore size (predominantly 70—150 μm in diameter) for nutrition supply and bone formation. Compared with the uniform porous scaffold, the multilayer scaffold with the same size shows an enhanced mechanical strength and larger pore size in the center. More cells are shown to grow into the center of the multilayer scaffold in vitro than into the uniform porous scaffold under the same seeding condition. Finally, the scaffolds are implanted into a rabbit fibula defect to evaluate the osteoconductivity of the scaffold and the efficacy of the scaffold as a barrier to fibrous tissue ingrowth. At 12 weeks post operation, affluent blood vessels and bone formation are found in the center of the scaffold and little fibrous tissue is noted in the defect site.

Biphasic calcium phosphate: A comparative study of interconnected porosity in two ceramics

Interconnection, one of the main structural features of macroporous calcium-phosphate ceramics, contributes to the biological and physicochemical properties of bone substitutes. As no satisfactory method exists for evaluating this feature, analysis was performed to determine the permeability, tortuosity, and equivalent diameter of interconnecting channels, that is the parameters that appear to be representative of the way pores are linked. The testing of two ceramics with similar porosity levels revealed important differences in all three interconnection parameters. One ceramic showed poor permeability, corresponding to a small equivalent diameter for interconnecting channels in conjunction with a high tortuosity factor, while the other displayed high permeability, a large diameter for interconnecting channels, and a low tortuosity factor. The methodology used, which can be applied to the quantification of interconnection in all calcium-phosphate ceramics, constitutes the first step in a complete study of the role of this feature in cellular colonization of the ceramic, matrix dissolution, and drug release from the calcium-phosphate matrix.

In vivo behavior of calcium phosphate scaffolds with four different pore sizes

The goal of the present study was to assess the effect of macropore size on the in vivo behavior of ceramic scaffolds. For that purpose, beta-tricalcium phosphate (beta-TCP) cylinders with four different macropore sizes (150, 260, 510, and 1220 microm) were implanted into drill hole defects in cancellous bone of sheep and their resorption behavior was followed for 6, 12 and 24 weeks. The scaffolds were evaluated for biocompatibility, and new bone formation was observed macroscopically, histologically and histomorphometrically. Histomorphometrical measurements were performed for the whole defect area and for the area subdivided into three concentric rings (outer, medial, and inner ring). All implants were tolerated very well as evidenced by the low amount of inflammatory cells and the absence of macroscopic signs of inflammation. Resorption proceeded fast since less than 5% ceramic remained at 24-week implantation. Hardly any effect of macropore size was observed on the in vivo response. Samples with an intermediate macropore size (510 microm) were resorbed significantly faster than samples with smaller macropore sizes (150 and 260 microm). However, this fast resorption was associated with a lower bone content and a higher soft tissue content. At 12 and 24 weeks, the latter differences had disappeared. Bone was more abundant in the outer ring than in the rest of the blocks at 6 weeks, and in the outer and medial ring compared to the inner ring at 12 weeks.

Pore throat size and connectivity determine bone and tissue ingrowth into porous implants: three-dimensional micro-CT based structural analyses of porous bioactive titanium implants

A porous structure comprises pores and pore throats with a complex three-dimensional (3D) network structure, and many investigators have described the relationship between average pore size and the amount of bone ingrowth. However, the influence of network structure or pore throats for tissue ingrowth has rarely been discussed. Four types of bioactive porous titanium implants with different pore sizes and porosities (6mm in diameter and 15 mm long) were analyzed using specific algorithms for 3D analysis of interconnectivity based on a micro focus X-ray computed tomography system. In vivo histomorphometric analysis was performed using the very same implants implanted into the femoral condyles of male rabbits for 6 and 12 weeks. This matching study revealed that more poorly differentiated pores tended to have narrow pore throats, especially in their shorter routes to the outside. In addition, for assessment of the entire implant, we proposed new two indices that represent the degree of bone and tissue ingrowth into an implant by considering the effect of narrow pore throats. Data obtained suggest that this sort of novel analysis is useful for evaluating bone and tissue ingrowth into porous biomaterials.

The structure of the bond between bone and porous silicon-substituted hydroxyapatite bioceramic implants

The significance of micrometer-sized strut porosity in promoting bone ingrowth into porous hydroxyapatite (HA) scaffolds has only recently been noted. In this study, silicon-substituted HA (0.8 wt % Si-HA) with approximately 8.5% of the total porosity present as microporosity within the struts of the implant was prepared for high-resolution transmission electron microscopy (HR-TEM) via both ultramicrotomy and focused ion beam milling. Between the struts of the porous Si-HA, pores with varying shapes and sizes (1-10 microm in diameter) were characterized. Within the struts, the Si-HA contained features such as grain boundaries and triple-junction grain boundaries. Bone ingrowth and dissolution from a Si-HA implant were studied using HR-TEM after 6 weeks in vivo. Minor local dissolution occurred within several pores within the struts. Organized, mineralized collagen fibrils had grown into the strut porosity at the interface between the porous Si-HA implant and the surface of the surrounding bone. In comparison, deeper within the implant, disorganized and poorly mineralized fibers were observed within the strut porosity. These findings provide valuable insight into the development of bone around porous Si-HA implants.

Implant surfaces

Available in many shapes, sizes, and lengths, dental implants are also crafted from different materials with different surface proper-ties. Among the most desired characteristics of an implant are those that ensure that the tissue-implant interface will be established quickly and then will be firmly maintained. Because many variables affect oral implants, it is sometimes difficult to reliably predict the likelihood of an implant's success. It is especially difficult to assess whether the various modifications in the latest implants deliver improved performance. This article focuses primarily on important surface characteristics and their potential effects on the performance of dental implants.

Comparison between polyurethanes containing castor oil (soft segment) and cancellous bone autograft in the treatment of segmental bone defect induced in rabbits

The aim of this study is to compare polyurethanes containing castor oil (soft segment) in granular form compared to cancellous bone autograft applied to a segmental bone defect. Norfolk adult female rabbits - approximately 13 months of age with a mean body weight of 4.5 kg - are used. In both radial diaphyses, 1 cm osteoperiosteal segmental defects are created. The defect in the left radius is filled with the castor-oil-based polyurethane, and the right one, filled with cancellous bone autograft, collected from the left proximal humerus. The rabbits are euthanazed at 15, 30, 60, and 120 days postsurgery (5 animals/ period), for histological analyses. By radiographic analyses, at these time points, the bone regeneration is more evident and accelerated in the bone defects treated with the cancellous bone autograft. At 120 days postsurgery, the segmental bone defects treated with the cancellous bone autograft are totally reconstituted and remodeled, while the bone defects treated with polyurethane polymer have bone formation of 79%. Histological study shows that the polyurethane acts as a space filler, minimizing the local production of fibrous tissue. No granule degradation, resorption or any inflammatory reaction is detected. Thus, it is possible to conclude that the castor-oil-plant-based polyurethane - in the granule presentation - is biocompatible and osteointegrated, but does not show the same bone regeneration capacity as the cancellous bone autograft.

Clinical, radiological and histological study of the failure of cervical interbody fusions with bone substitutes

Few histological studies on bone substitutes in human cervical spine are available and the biological processes of bone substitutes are not well documented. The authors studied four failure cases of cervical interbody fusion: two cases with hydroxyapatite (HA), one case with beta-tricalcium phosphate ceramic (beta-TCP) and one case with xenograft (bovine bone). Clinical data showed that all the patients experienced neck pain with or without numbness of upper extremity due to fusion failure. Successful fusions were achieved after the salvage surgeries in which autograft were used. Radiographs showed that radiolucent lines were present in all cases. Two HA substitutes fractured without complications. One of them sank into the vertebral body. Some small beta-TCP fragments were found under the microscope. Histological study demonstrated only a few newly formed bones at the interface of the substitutes. The fragments of HA were encapsulated by fibrous tissue. The degradation process and bone regeneration were more active in beta-TCP than in HA. The intertrabecular spaces of bovine bone were filled with fibrous tissue. The results suggest that a porous calcium phosphate ceramic with special design might assure bone ingrowth and meet the mechanical requirements in cervical interbody fusion. The complications of these materials in the cervical spine should be highlighted.

Glycerol-l-lactide coating polymer leads to delay in bone ingrowth in hydroxyapatite implants

Glycerol-l-lactide as coating polymer for the delivery of basic fibroblast growth factor (bFGF) from hydroxyapatite (HA) ceramic implants was shown to lead to significant delay in bone ingrowth into the implants compared to implants without the coating polymer. The purpose of this work was to study bone ingrowth in HA ceramic implants with and without the coating polymer but without growth factors to enable differentiation between a locking effect of the pores by the polymer and the fact of inactivation of the growth factors by the polymer, which could both be possible for the delay. A defect was created in the subchondral region of both femurs in 24 miniature-pigs and was either filled by the HA implants with or without the coating polymer. Histomorphometry showed a significant delay in bone ingrowth in the polymer coated implants both after 6 and 12 weeks. Detailed histology revealed that the HA pores were completely "locked" by the polymer leading to complete loss of the osteoconductive properties of the HA. Also electron microscopy showed filling of the HA pores by the polymer. Therefore, it can be concluded that glycerol-l-lactide should not be used to coat HA ceramic implants due to significant delay in bone ingrowth.

Macroporous and nanofibrous polymer scaffolds and polymer/bone-like apatite composite scaffolds generated by sugar spheres

Scaffolds are crucial to tissue engineering/regeneration. In this work, a technique combining a unique phase-separation process with a novel sugar sphere template leaching process has been developed to produce three-dimensional scaffolds. The resulting scaffolds possess high porosities, well connected macropores, and nanofibrous pore walls. The technique advantageously controls macropore shape and size by sugar spheres, interpore opening size by assembly conditions (time and temperature of heat treatment), and pore wall morphology by phase-separation parameters. The bioactivity of a macroporous and nanofibrous poly(L-lactic acid) (PLLA) scaffold was demonstrated by the bone-like apatite deposition throughout the scaffold in a simulated body fluid (SBF). Preincorporation of nanosized hydroxyapatite eliminated the induction period and facilitated the apatite growth in the SBF. Interestingly, the apatite growth primarily occurred on the surface of the pores (internal and external) but not the interior of the nanofibrous network away from the pore surface. It was also noticed that the macropore size did not affect the apatite growth rate, while the interpore opening size did. The compressive modulus also increased substantially when a continuous apatite layer was formed on the pore walls of the scaffold. The resulting composite scaffold mimics natural bone matrix with the combination of an organic phase (a polymer such as PLLA) and an inorganic apatite phase. The demonstrated bioactivity of apatite layer, together with well-controlled macroporous and nanofibrous structures, makes the novel nanocomposite scaffolds desirable for bone tissue engineering.

Synthesis and characterization of porous β-tricalcium phosphate blocks

Porous beta-tricalcium phosphate (beta-TCP) blocks with four different macropore sizes (pore larger than 50 microm were synthesized using "calcium phosphate emulsions", and characterized by optical, geometrical, gravimetric, and radiological methods. The reproducibility of the synthesis method was excellent. Moreover, the macropore size could be easily controlled without modifying the microporosity (pore smaller than 50 microm) or the total porosity (microporosity+macroporosity). Based on the initial composition of the blocks and their final apparent density, the microporosity, macroporosity, and the total block porosity were calculated to be close to 21%, 54%, and 75%, respectively. These values were confirmed by microcomputed tomography (microCT). The mean macropore diameters were close to 150, 260, 510 and 1220 microm, as measured optically. Consistently lower values (25% lower) were obtained by microCT, but the linear correlation between microCT and optical method was high (r(2)>0.97). The macropore size distribution calculated from microCT scans appears to be narrow and normally distributed. The very good correlation between the results of the various methods and the possibility to determine the pore size distribution suggest that microCT is an ideal tool to non-destructively characterize macroporous calcium phosphate bone substitutes.

Particle migration and gap healing around trabecular metal implants

Bone on-growth and peri-implant migration of polyethylene particles were studied in an experimental setting using trabecular metal and solid metal implants. Cylindrical implants of trabecular tantalum metal and solid titanium alloy implants with a glass bead blasted surface were inserted either in an exact surgical fit or with a peri-implant gap into a canine knee joint. We used a randomised paired design. Polyethylene particles were injected into the knee joint. In both types of surgical fit we found that the trabecular metal implants had superior bone ongrowth in comparison with solid metal implants (exact fit: 23% vs. 7% [p=0.02], peri-implant gap: 13% vs. 0% [p=0.02]. The number of peri-implant polyethylene particles was significantly reduced around the trabecular metal implants with a peri-implant gap compared with solid implants.

Repair of osteochondral defects with autologous chondrocytes seeded onto bioceramic scaffold in sheep

At present, the most popular biomaterials used in cartilage tissue engineering are synthetic polymers. However, problems-such as acidic by-product accumulation and side effects in local or systemic inflammatory reactions during in vivo degradation-are drawing much attention. The polymers are also highly hydrophobic and degrade within 4 weeks, allowing insufficient time to support neocartilage formation. All these have made polymers less promising in clinical application. In this study, we tested a new bioceramic scaffold made of artificial synthesized powder of beta-tricalcium phosphate (beta-TCP) in a sheep model. Osteochondral defects were filled with a bioceramic-chondrocyte construct and neocartilage tissue completely resurfaced the cartilage defects after 24 weeks. Typical hyaline cartilage structure was generated in the engineered cartilage. Biodegradation of bioceramic was notable, leading to bioceramic fragmentation and particle formation. Numerous ceramic particles (size, 0.5-1.9 microm) and numerous macrophages were observed at the ceramic-tissue interface as well as in the marrow tissue. No macrophages were visible in the neocartilage tissue. Although long-term in vivo study is needed to further determine the pathological sequences of the beta-TCP-based cartilage construct, this study suggests that this bioceramic might be used to repair chondral or osteochondral defects and could be used as a scaffold for cartilage tissue engineering.

Preparation and characterization of nano-hydroxyapatite/chitosan composite scaffolds

A novel nano-hydroxyapatite (HA)/chitosan composite scaffold with high porosity was developed. The nano-HA particles were made in situ through a chemical method and dispersed well on the porous scaffold. They bound to the chitosan scaffolds very well. This method prevents the migration of nano-HA particles into surrounding tissues to a certain extent. The morphologies, components, and biocompatibility of the composite scaffolds were investigated. Scanning electron microscopy, porosity measurement, thermogravimetric analysis, X-ray diffraction, X-ray photoelectron spectroscopy, and Fourier transformed infrared spectroscopy were used to analyze the physical and chemical properties of the composite scaffolds. The biocompatibility was assessed by examining the proliferation and morphology of MC 3T3-E1 cells seeded on the scaffolds. The composite scaffolds showed better biocompatibility than pure chitosan scaffolds. The results suggest that the newly developed nano-HA/chitosan composite scaffolds may serve as a good three-dimensional substrate for cell attachment and migration in bone tissue engineering.

Histomorphometrische Evaluation poröser Titanprobenkörper anhand eines computergestützten Bildanalysesystems / Histomorphometric evaluation of bone ingrowth of porous titanium by a computer-assisted analyzing system

The objective of this study was to evaluate the bone ingrowth of a new vacuum plasma sprayed titanium surface (vps-ti) in comparison to cs-titanium implants in a göttinger minipig model. Fifteen göttinger minipigs each received the two implants, vacuum plasma sprayed titanium with a porosity of 50% and a pore size of 200 microm (vps-ti) and an implant with a similar porosity but a different pore size 500 microm (cs-ti), at the proximal femur metaphysis by press-fit technique. The pigs were euthanized at three different postsurgical periods: 4, 8 and 12 weeks. Each femur was harvested and qualitative (macroscopic and microscopic) and quantitative (histomorphometric) histological analysis was done on histological slides. The results indicated that there was a difference in bone ingrowth between the two implants, whereas the bone ingrowth of vps-ti was superior to cs-ti after 4 and 8 weeks healing time. 12 weeks post implantationem no statistiscal difference was evident. The pore size of 200 microm seemed superior to a pore size of 500 microm. Whether or not these effects lead to a better mechanical stability remains unanswered.

Removal of surface by-products from sintered hydroxyapatite: Effect of a chelation treatment on fibronectin adsorption and cell adhesion

It was observed that fibronectin precipitates when deposited on hydroxyapatite (HA) ceramics. Fibronectin's known affinity for calcium and the composition of the ceramic itself suggested that calcium release could be the main cause of this aggregation effect. It was then decided to investigate the effect of a surface chelation treatment on fibronectin adsorption, and MG63 cell adhesion, onto porous ceramics of hydroxyapatite (HA), beta-tricalcium phosphate (beta-TCP), and HA/TCP biphasic material (BCP). Those ceramics were immersed in an EDTA solution and the effect of this treatment on the material composition was assayed. X-ray diffraction data showed the presence of alpha- and beta-TCP phases in HA and BCP materials, which were both completely removed by the chelation treatment in the case of HA. On BCP, alpha-TCP was removed and beta-TCP partially dissolved. The TCP material, which was pure beta-TCP, underwent a mass loss, but no change in composition was observed. Adhesion of MG63 cells was overall higher on the fibronectin-coated EDTA-treated HA material, but was especially enhanced on EDTA-treated HA. Changes in surface morphologies, as compared with the use of scanning electron microscopy, did not seem to be related to the effects observed. The EDTA treatment proved to be a very efficient way of removing by-products of HA sintered materials, and thus enhancing the biocompatibility of the material.

Biomaterial challenges and approaches to stem cell use in bone reconstructive surgery

As life expectancy increases, so does the need to treat large bone defects. New biomaterials combined with osteogenic cells are now being developed as an alternative to autogenous bone grafts. The goal is to make the stem cells adhere to the scaffold, and then grow to differentiate into functional osteogenic cells and organize into healthy bone as the scaffold degrades. Decisive improvements have been made in the fields of stem cell biology, 3-D scaffold fabrication and tissue engineering, but the ideal bone substitute that fulfils all functional and safety requirements has yet to be developed.

Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: a radiological study with a new evaluation system

The capacity of two forms of porous beta-tricalcium phosphate bone substitutes (TCP) to promote bone healing in open wedge high tibial osteotomy (OWHTO) was studied. We reviewed the X-rays of 27 osteotomies, with either TCP wedges or TCP granules as filling material, to compare the bone healing rates and bone remodelling, at specific postoperative intervals. A new radiologic rating system for OWHTO was created and tested for clinical applicability. All osteotomies healed uneventfully and complete resorption of TCP was demonstrated at 1 year postoperative in 85% (n = 23) of the procedures. In 44% (n = 10) of these 23 procedures, the osteotomy site was no longer visible. No difference in bone healing rate and bone remodelling was found when comparing the use of granules to a wedge, and no adverse effects of TCP were observed. The good inter- (k = 0.7) and intraobserver (k = 0.6) reliability of the new radiologic rating system enables clinical use. Good bone healing was found in OWHTO with both wedges and granules of TCP.

Effect of glycerol-l-lactide coating polymer on bone ingrowth of bFGF-coated hydroxyapatite implants

Basic fibroblast growth factor (bFGF)-coated hydroxyapatite (HA) cylinders showed good bony incorporation in a previously conducted animal study. However, some cylinders exhibited focal inhomogeneous bone ingrowth. The purpose of the current study was to test whether glycerol-L-lactide polymer coating could improve release properties and bone incorporation of bFGF-coated HA implants. bFGF-coated HA cylinders with or without coating polymer were investigated for in vitro release of bFGF by an immuno-ligand-assay and also for bone ingrowth in miniature pigs after 42 and 84 days. Release from bFGF polymer composites was lower for the first 3 days compared to the other group but was more homogenous and detectable amounts were still found after 20 days. There was significant delay in bone ingrowth of the polymer implants in which even after 84 days bone ingrowth was not completed, whereas in the other group incorporation after 42 days occurred. Detailed histology revealed filling of the HA pores with the polymer, making ingrowth of the surrounding host bone impossible. Only after 84 days starting resorption of the polymer accompanied by bone ingrowth was found. The current study showed that glycerol-L-lactide is not suitable for coating of HA implants due to polymer induced "locking" of HA pores.

Mediation of bone ingrowth in porous hydroxyapatite bone graft substitutes

Previous investigations have shown that both the early biological response and the mechanical properties of a porous hydroxyapatite bone graft substitute are highly sensitive to its pore structure. The objective of this study was to evaluate whether the pore structure continued to influence bone integration in the medium to long term. Two screened batches of porous hydroxyapatite (PHA) designated as batch A and batch B, with porosities of approximately 60 and 80%, respectively, were selected for this study and implanted for periods of 5, 13, and 26 weeks into the lower femur of New Zealand White rabbits. Histomorphometric analysis of the absolute volume of bone ingrowth within batch A and B implants from 5 to 26 weeks showed that the absolute volume of bone ingrowth was consistently lower in batch A (10-21%), compared to batch B implants (24-31%). However, when the volume of bone ingrowth was normalised for the available pore space, this difference was reduced (23-47% and 32-42% for batches A and B, respectively). These observations suggest that differences in the volume of bone ingrowth initially depended on pore interconnectivity rather than pore size, whereas the volume or morphology of the PHA influenced the volume and morphology of bone ingrowth at later time points. Compression testing showed that bone ingrowth had a strong reinforcing effect on PHA bone graft substitutes, and a strong correlation was identified between mechanical properties and the absolute volume of ingrowth for both batches A and B. Furthermore, at 13 and 26 weeks, there was no significant variation in the ultimate compressive strength of integrated batch A and B implants. This similarity in ultimate mechanical properties indicated that the absolute volume of ingrowth may be mediated by the PHA structure through its impact on the dynamics of the local biomechanical environment. The results of push-out testing showed that fixation of PHA bone graft substitutes was independent of density within the range studied, with no significant difference in the interfacial shear stress between batches A and B at each time point throughout the study.

Theoretical model to determine the effects of geometrical factors on the resorption of calcium phosphate bone substitutes

A theoretical approach was used to determine the effect of geometrical factors on the resorption rate of calcium phosphate bone substitutes that are either dense, microporous, and/or contain spherical macropores. Two cases were considered: (a) macroporous blocks that can be invaded by resorbing cells either directly because the structure is fully open-porous, or indirectly after some resorption of the macropores walls and/or interconnections. (b) Microporous or dense blocks/granules that cannot be invaded by resorbing cells, i.e. can only be resorbed from the outside to the inside, layer by layer. The theoretical approach was based on five assumptions: (i) the pores are spherical; (ii) the pores are ordered according to a face-centered cubic packing; (iii) the resorption is surface-controlled; (iv) the resorption is only possible if the surface can be accessed by blood vessels of 50 microm in diameter; and (v) the resorption time of a given amount of calcium phosphate is proportional to the net amount of material. Based on these assumptions, the calculations showed that the resorption time of a macroporous block could be minimized at a specific pore radius. This pore radius depended (i) on the size of the bone substitute and (ii) on the interpore distance. Typical radii were in the range of 100-400 microm. These values are similar to the numerous pore size optima mentioned in the scientific literature. For microporous or dense blocks/granules, the model suggested that a relatively small radius should be preferred. Such a radius leads to an optimum combination of a high surface area favorizing resorption and the presence of large intergranular gaps favorizing blood vessel ingrowth. In that case, the optimum of granule radius is around 100-200 microm. Finally, a very good agreement was found between the predictions of the model and experimental data, i.e. the model explained in all but two cases the results with an accuracy superior to 80%. In conclusion, the model appears to be a useful tool to better understand in vivo results, and possibly better define the geometry and distribution of the pores as well as the size of a bone substitute.

Biological and biophysical principles in extracorporal bone tissue engineering

Advances in the field of bone tissue engineering have encouraged physicians to introduce these techniques into clinical practice. Bone tissue engineering is the construction, repair or replacement of damaged or missing bone in humans or animals. Engineering of bone can take place within the animal body or extracorporal in a bioreactor for later grafting into the body. Appropriate cell types and non-living substrata are minimal requirements for an extracorporal tissue engineering approach. This review discusses the biological and biophysical background of in vitro bone tissue engineering. Biochemical and biophysical stimuli of cell growth and differentiation are regarded as potent tools to improve bone formation in vitro. The paper focuses on basic principles in extracorporal engineering of bone-like tissues, intended to be implanted in animal experiments and clinical studies. Particular attention is given in this part to the contributions of cell and material science to the development of bone-like tissues. Several approaches are at the level of clinical applicability and it can be expected that widespread use of engineered bone constructs will change the surgeon's work in the near future.

Characterization of a bovine collagen–hydroxyapatite composite scaffold for bone tissue engineering

Different biomaterials have been used as scaffolds for bone tissue engineering. Here we characterize a biomaterial composed of sintered (1100 degrees C) and powdered hydroxyapatite (HA) and type I collagen (Coll), both of bovine origin, designed for osteoconductive and osteoinductive scaffolds. Coll/HA proportions were 1/2.6 and 1/1 (wet weight), and particles sizes varied from 200 to 400 microm. Vv (volume density) and Sv (surface to volume density) for the HA particles in the composite ranged from 0.48 +/- 0.06 to 0.55 +/- 0.02 and 5.090 +/- 0.545 to 6.366 +/- 0.289 microm(-1), respectively. Due to the relatively small changes in Vv and Sv, a macroporosity could be characterized for the biocomposite. X-ray diffraction and infrared spectroscopy showed that the sintered bone was composed essentially of HA with minimum additional groups such as surface calcium hydroxide, surface and crystal water, free carbon dioxide and possibly brushite. Mass spectrometry detected carbonates at A and B sites of HA, and weakly bound to the structure. Human osteoblasts adhered and spread on both the HA particle surface and the collagen fibers, which seemed to guide cells between adjacent particles. The biocomposite studied has several characteristics considered as ideal for its use as a scaffold for osteoconduction and osteoinduction.

Effect of ball milling on the processing of bone substitutes with calcium phosphate powders

Decreasing the microscale morphology of synthetic bone substitutes is of primary importance in order to enhance the morphology of the surface of the material, which is directly in contact with osteoconductive cells when it is implanted in bone. The aim of this study was to investigate the influence of ball milling of slurries on the microscale morphology of hydroxyapatite and tricalcium phosphate bone substitutes and the influence on their processing. Ball milling appeared to be a successful method in order to raise the sintering reactivity of the powders, that is, to decrease the sintering temperature and microstructural morphology of the material. However, it was demonstrated that ball milling had a great influence on dispersion, which became very difficult under long milling times because of dissolution of the calcium phosphate powders. Due to dissolution, ionic species were generated in the slurry and interfered with the dispersing agent. Moreover a reprecipitation process occurred simultaneously, and large particles of the most stable phase (HAP) formed. The presence of such large particles generated stress gradients and cracks in the material during the sintering stage.

Association of vancomycin and calcium phosphate by dynamic compaction: in vitro characterization and microbiological activity

Dynamic compaction has rarely been used to produce drug-delivery devices in granule form. This report considered four processes associating vancomycin and compared dynamic compaction with wet granulation, a classical method. In the wet granulation study, vancomycin was associated with biphasic calcium-phosphate (BCP) granules either by adsorption or incorporation with a new granulation. In the dynamic compaction study, BCP powder was compacted at 1.1, 1.5 and 1.9 MPa. The compacts obtained were crushed and sieved (200-500 microm), and the vancomycin solution was adsorbed on the resulting granules. After crushing and sieving, the compaction of BCP and vancomycin powders produced vancomycin-loaded granules. In each study, 4.76% of vancomycin was associated with BCP. Granules were characterized in terms of porosity, vancomycin release and vancomycin biological activity. Physicochemical studies of BCP and vancomycin showed their structural integrity after dynamic compaction, which prolonged vancomycin release time from 1 to 6 days. However, a microbiological assay indicated that vancomycin had been altered since only 27.7% was found to be active.