The cement setting reaction in the CaHPO4-alpha-Ca3(PO4)2 system: an X-ray diffraction study

Autologous Tooth Granulometry and Specific Surface Area with Three Grinding Methods: An In Vitro Study

A postextraction socket becomes a clinical challenge due to the fact that a series of changes associated with bone remodelling and resorption of the socket that occur after extraction, which limits the aesthetic and functional prognosis of implant-supported rehabilitations. It has been studied that the use of the autologous tooth-derived graft (ATDG) has regenerative properties and could therefore be useful for solving this type of problem. There is no consensus in the scientific literature on a standardized protocol for the use of the autologous tooth. Therefore, the aim of the present study was to evaluate the most relevant parameters to achieve the best properties of ground ATDG using three methods, namely Gouge forceps, electric grinder, and manual, that made up the study group (SG) and compared with the control group (CG) consisting of Bio-Oss®. The sample obtained by the electric grinder had the highest value of specific surface area (2.4025 ± 0.0218 m2/g), while the particle size as average diameter (751.9 µm) was the lowest and most homogeneous of the three groups. Therefore, the electric grinder allowed for obtaining ATDG with more regenerative properties due to its specific surface-area value and particle size in accordance with the xenograft with the greatest bibliographical support (Bio-Oss®). The higher specific surface increases the reaction with the physiological media, producing faster biological mechanisms.

Early Short-Term Postoperative Mechanical Failures of Current Ceramic-on-Ceramic Bearing Total Hip Arthroplasties

Although ceramic-on-ceramic (CoC) bearings have been shown to produce the smallest amount of wear volume in vitro as well as in vivo studies when used for total hip arthroplasties (THA), concerns about the failure of these bearing surfaces persist due to early failures observed after short postoperative time. In this study, an exhaustive analysis of the early failure occurred on the new generation of ceramic bearings, consisting of a composite alumina matrix-based material reinforced with yttria-stabilized tetragonal zirconia (Y-TZP) particles, chromium dioxide, and strontium crystals, was performed. For this study, 118 CoC bearings from 117 patients were revised. This article describes a group of mechanical failure CoC-bearing BIOLOX THA hip prosthesis patients without trauma history. The retrieved samples were observed under scanning electron microscopy (SEM), composition was analyzed with energy dispersive X-ray spectroscopy (EDX), and damaged surfaces were analyzed by grazing-incidence X-ray diffraction (GI-XRD) and white light interferometry. In the short term, CoC articulations provided similar mechanical behavior and functional outcome to those in XLPE cases. However, 5% more early mechanical failures cases were observed for the ceramic components. Although the fracture rate of third generation CoC couples is low, the present study shows the need to further improve the third generation of CoC-bearing couples for THA. Despite the improved wear compared to other materials, stress concentrators are sources of initial crack propagation, such as those found in the bore-trunnion areas. Moreover, in view of the evidence observed in this study, the chipping observed was due to the presence of monoclinic phase of the Y-TZP instead of tetragonal, which presents better mechanical properties. The results showed that total safety after receiving a THA is still a goal to be pursued.

Gelatin-Modified Calcium/Strontium Hydrogen Phosphates Stimulate Bone Regeneration in Osteoblast/Osteoclast Co-Culture and in Osteoporotic Rat Femur Defects-In Vitro to In Vivo Translation

The development and characterization of biomaterials for bone replacement in case of large defects in preconditioned bone (e.g., osteoporosis) require close cooperation of various disciplines. Of particular interest are effects observed in vitro at the cellular level and their in vivo representation in animal experiments. In the present case, the material-based alteration of the ratio of osteoblasts to osteoclasts in vitro in the context of their co-cultivation was examined and showed equivalence to the material-based stimulation of bone regeneration in a bone defect of osteoporotic rats. Gelatin-modified calcium/strontium phosphates with a Ca:Sr ratio in their precipitation solutions of 5:5 and 3:7 caused a pro-osteogenic reaction on both levels in vitro and in vivo. Stimulation of osteoblasts and inhibition of osteoclast activity were proven during culture on materials with higher strontium content. The same material caused a decrease in osteoclast activity in vitro. In vivo, a positive effect of the material with increased strontium content was observed by immunohistochemistry, e.g., by significantly increased bone volume to tissue volume ratio, increased bone morphogenetic protein-2 (BMP2) expression, and significantly reduced receptor activator of nuclear factor kappa-B ligand (RANKL)/osteoprotegerin (OPG) ratio. In addition, material degradation and bone regeneration were examined after 6 weeks using stage scans with ToF-SIMS and µ-CT imaging. The remaining material in the defects and strontium signals, which originate from areas exceeding the defect area, indicate the incorporation of strontium ions into the surrounding mineralized tissue. Thus, the material inherent properties (release of biologically active ions, solubility and degradability, mechanical strength) directly influenced the cellular reaction in vitro and also bone regeneration in vivo. Based on this, in the future, materials might be synthesized and specifically adapted to patient-specific needs and their bone status.

Strontium substitution of gelatin modified calcium hydrogen phosphates as porous hard tissue substitutes

Aiming at the generation of a high strontium-containing degradable bone substitute, the exchange of calcium with strontium in gelatin-modified brushite was investigated. The ion substitution showed two mineral groups, the high-calcium containing minerals with a maximum measured molar Ca/Sr ratio of 80%/20% (mass ratio 63%/37%) and the high-strontium containing ones with a maximum measured molar Ca/Sr ratio of 21%/79% (mass ratio 10%/90%). In contrast to the high-strontium mineral phases, a high mass loss was observed for the calcium-based minerals during incubation in cell culture medium (alpha-MEM), but also an increase in strength owing to dissolution and re-precipitation. This resulted for the former in a decrease of cation concentration (Ca + Sr) in the medium, while the pH value decreased and the phosphate ion concentration rose significantly. The latter group of materials, the high-strontium containing ones, showed only a moderate change in mass and a decrease in strength, but the Ca + Sr concentration remained permanently above the initial calcium concentration in the medium. This might be advantageous for a future planned application by supporting bone regeneration on the cellular level.

Biofunctionalization with a TGFβ-1 Inhibitor Peptide in the Osseointegration of Synthetic Bone Grafts: An In Vivo Study in Beagle Dogs

Objectives: The aim of this research was to determine the osseointegration of two presentations of biphasic calcium phosphate (BCP) biomaterial—one untreated and another submitted to biofunctionalization with a TGF-β1 inhibitor peptide, P144, on dental alveolus. Materials and Methods: A synthetic bone graft was used, namely, (i) Maxresorb^® (Botiss Klockner) (n = 12), and (ii) Maxresorb^® (Botiss Klockner) biofunctionalized with P144 peptide (n = 12). Both bone grafts were implanted in the two hemimandibles of six beagle dogs in the same surgical time, immediately after tooth extraction. Two dogs were sacrificed 2, 4, and 8 weeks post implant insertion, respectively. The samples were submitted to histomorphometrical and histological analyses. For each sample, we quantified the new bone growth and the new bone formed around the biomaterial’s granules. After optical microscopic histological evaluation, selected samples were studied using backscattered scanning electron microscopy (BS-SEM). Results: The biofunctionalization of the biomaterial’s granules maintains a stable membranous bone formation throughout the experiment timeline, benefitting from the constant presence of vascular structures in the alveolar space, in a more active manner that in the control samples. Better results in the experimental groups were proven both by quantitative and qualitative analysis. Conclusions: Synthetic bone graft biofunctionalization results in slightly better quantitative parameters of the implant’s osseointegration. The qualitative histological and ultramicroscopic analysis shows that biofunctionalization may shorten the healing period of dental biomaterials.

The use of physiological solutions or media in calcium phosphate synthesis and processing

This review examined the literature to spot uses, if any, of physiological solutions/media for the in situ synthesis of calcium phosphates (CaP) under processing conditions (i.e. temperature, pH, concentration of inorganic ions present in media) mimicking those prevalent in the human hard tissue environments. There happens to be a variety of aqueous solutions or media developed for different purposes; sometimes they have been named as physiological saline, isotonic solution, cell culture solution, metastable CaP solution, supersaturated calcification solution, simulated body fluid or even dialysate solution (for dialysis patients). Most of the time such solutions were not used as the aqueous medium to perform the biomimetic synthesis of calcium phosphates, and their use was usually limited to the in vitro testing of synthetic biomaterials. This review illustrates that only a limited number of research studies used physiological solutions or media such as Earle's balanced salt solution, Bachra et al. solutions or Tris-buffered simulated body fluid solution containing 27mM HCO3(-) for synthesizing CaP, and these studies have consistently reported the formation of X-ray-amorphous CaP nanopowders instead of Ap-CaP or stoichiometric hydroxyapatite (HA, Ca10(PO4)6(OH)2) at 37°C and pH 7.4. By relying on the published articles, this review highlights the significance of the use of aqueous solutions containing 0.8-1.5 mMMg(2+), 22-27mM HCO3(-), 142-145mM Na(+), 5-5.8mM K(+), 103-133mM Cl(-), 1.8-3.75mM Ca(2+), and 0.8-1.67mM HPO4(2-), which essentially mimic the composition and the overall ionic strength of the human extracellular fluid (ECF), in forming the nanospheres of X-ray-amorphous CaP.

Self-setting calcium orthophosphate formulations

In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are bioactive and biodegradable grafting bioceramics in the form of a powder and a liquid. After mixing, both phases form pastes, which set and harden forming either a non-stoichiometric calcium deficient hydroxyapatite or brushite. Since both of them are remarkably biocompartible, bioresorbable and osteoconductive, self-setting calcium orthophosphate formulations appear to be promising bioceramics for bone grafting. Furthermore, such formulations possess excellent molding capabilities, easy manipulation and nearly perfect adaptation to the complex shapes of bone defects, followed by gradual bioresorption and new bone formation. In addition, reinforced formulations have been introduced, which might be described as calcium orthophosphate concretes. The discovery of self-setting properties opened up a new era in the medical application of calcium orthophosphates and many commercial trademarks have been introduced as a result. Currently such formulations are widely used as synthetic bone grafts, with several advantages, such as pourability and injectability. Moreover, their low-temperature setting reactions and intrinsic porosity allow loading by drugs, biomolecules and even cells for tissue engineering purposes. In this review, an insight into the self-setting calcium orthophosphate formulations, as excellent bioceramics suitable for both dental and bone grafting applications, has been provided.

In vivo evaluation of resorbable bone graft substitutes in beagles: histological properties

Calcium phosphate cement (CPC) is a promising material for use in minimally invasive surgery for bone defect repairs due to its bone-like apatitic final setting product, biocompatibility, bioactivity, self-setting characteristics, low setting temperature, adequate stiffness, and easy shaping into complicated geometrics. However, even though CPC is stable in vivo, the resorption rate of this bone cement is very slow and its long setting time poses difficulties for clinical use. Calcium sulfate dehydrate (CSD) has been used as a filler material and/or as a replacement for cancellous bone grafts due to its biocompatibility. However, it is resorbed too quickly to be optimal for bone regeneration. This study examines the invivo response of a hydroxyapatite (HA), [apatitic phase (AP)]/calcium sulfate (CSD) composite using different ratios in the mandibular premolar sockets of beagles. The HA (AP)/CSD composite materials were prepared in the ratios of 30/70, 50/50, and 70/30 and then implanted into the mandibular premolar sockets for terms of 5 and 10 weeks. The control socket was left empty. The study shows better new bone morphology and more new bone area in the histological and the histomorphometric study of the HA (AP)/CSD in the 50/50 ratio.

Calcium orthophosphates: occurrence, properties, biomineralization, pathological calcification and biomimetic applications

The present overview is intended to point the readers' attention to the important subject of calcium orthophosphates. This type of materials is of special significance for human beings, because they represent the inorganic part of major normal (bones, teeth and antlers) and pathological (i.e., those appearing due to various diseases) calcified tissues of mammals. For example, atherosclerosis results in blood vessel blockage caused by a solid composite of cholesterol with calcium orthophosphates, while dental caries and osteoporosis mean a partial decalcification of teeth and bones, respectively, that results in replacement of a less soluble and harder biological apatite by more soluble and softer calcium hydrogenphosphates. Therefore, the processes of both normal and pathological calcifications are just an in vivo crystallization of calcium orthophosphates. Similarly, dental caries and osteoporosis might be considered an in vivo dissolution of calcium orthophosphates. Thus, calcium orthophosphates hold a great significance for humankind, and in this paper, an overview on the current knowledge on this subject is provided.

Calcium phosphate-based composites as injectable bone substitute materials

A major weakness of current orthopedic implant materials, for instance sintered hydroxyapatite (HA), is that they exist as a hardened form, requiring the surgeon to fit the surgical site around an implant to the desired shape. This can cause an increase in bone loss, trauma to the surrounding tissue, and longer surgical time. A convenient alternative to harden bone filling materials are injectable bone substitutes (IBS). In this article, recent progress in the development and application of calcium phosphate (CP)-based composites use as IBS is reviewed. CP materials have been used widely for bone replacement because of their similarity to the mineral component of bone. The main limitation of bulk CP materials is their brittle nature and poor mechanical properties. There is significant effort to reinforce or improve the mechanical properties and injectability of calcium phosphate cement (CPC) and this review resumes different alternatives presented in this specialized literature.

Calcium Orthophosphates in Nature, Biology and Medicine

The present overview is intended to point the readers’ attention to the important subject of calcium orthophosphates. These materials are of the special significance because they represent the inorganic part of major normal (bones, teeth and dear antlers) and pathological (i.e. those appearing due to various diseases) calcified tissues of mammals. Due to a great chemical similarity with the biological calcified tissues, many calcium orthophosphates possess remarkable biocompatibility and bioactivity. Materials scientists use this property extensively to construct artificial bone grafts that are either entirely made of or only surface-coated with the biologically relevant calcium ortho-phosphates. For example, self-setting hydraulic cements made of calcium orthophosphates are helpful in bone repair, while titanium substitutes covered by a surface layer of calcium orthophosphates are used for hip joint endoprostheses and as tooth substitutes. Porous scaffolds made of calcium orthophosphates are very promising tools for tissue engineering applications. In addition, technical grade calcium orthophosphates are very popular mineral fertilizers. Thus ere calcium orthophosphates are of great significance for humankind and, in this paper, an overview on the current knowledge on this subject is provided.

Calcium Orthophosphate Cements and Concretes

In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are a bioactive and biodegradable grafting material in the form of a powder and a liquid. Both phases form after mixing a viscous paste that after being implanted, sets and hardens within the body as either a non-stoichiometric calcium deficient hydroxyapatite (CDHA) or brushite, sometimes blended with unreacted particles and other phases. As both CDHA and brushite are remarkably biocompartible and bioresorbable (therefore, in vivo they can be replaced with newly forming bone), calcium orthophosphate cements represent a good correction technique for non-weight-bearing bone fractures or defects and appear to be very promising materials for bone grafting applications. Besides, these cements possess an excellent osteoconductivity, molding capabilities and easy manipulation. Furthermore, reinforced cement formulations are available, which in a certain sense might be described as calcium orthophosphate concretes. The concepts established by calcium orthophosphate cement pioneers in the early 1980s were used as a platform to initiate a new generation of bone substitute materials for commercialization. Since then, advances have been made in the composition, performance and manufacturing; several beneficial formulations have already been introduced as a result. Many other compositions are in experimental stages. In this review, an insight into calcium orthophosphate cements and concretes, as excellent biomaterials suitable for both dental and bone grafting application, has been provided.

Preparation of porous apatite granules from calcium phosphate cement

A versatile method for preparing spherical, micro- and macroporous (micro: 2-10 and macro: 150-550 microm pores), carbonated apatitic calcium phosphate (Ap-CaP) granules (2-4 mm in size) was developed by using NaCl crystals as the porogen. The entire granule production was performed between 21 and 37 degrees C. A CaP cement powder, comprising alpha-Ca3(PO4)2 (61 wt.%), CaHPO4 (26%), CaCO3 (10%) and precipitated hydroxyapatite, Ca10(PO4)6(OH)2 (3%), was dry mixed with NaCl crystals varying in size from 420 microm to 1 mm. Cement powder (35 wt.%) and NaCl (65 wt.%) mixture was kneaded with an ethanol-Na2HPO4 initiator solution, and the formed dough was immediately agitated on an automatic sieve shaker for a few minutes to produce the spherical granules. Embedded NaCl crystals were then leached out of the granules by soaking them in deionized water. CaP granules were micro- and macroporous with a total porosity of 50% or more. Granules were composed of carbonated, poorly crystallized, apatitic CaP phase. These were the first spherical and porous CaP granules ever produced from a self-setting calcium phosphate cement. The granules reached their final handling strength at the ambient temperature through the cement setting reaction, without having a need for sintering.

Novel low temperature setting nanocrystalline calcium phosphate cements for bone repair: osteoblast cellular response and gene expression studies

Low temperature setting calcium phosphate cements (CPC) formed from reactive calcium phosphate precursors are receiving great attention in the fields of orthopaedics and tissue engineering. The purpose of this study was to evaluate the mechanical properties and osteocompatibility of a novel calcium deficient hydroxyapatite (CDSHA) with a Ca/P ratio of 1.6 developed in our laboratories and compare it to a previously developed calcium deficient hydroxyapatite (CDHA) with a Ca/P ratio of 1.5. The results demonstrated that the calcium-deficient hydroxyapatites (HA) formed from the CPCs were similar to biological HA at physiological temperature and the elastic moduli of CDHA and CDSHA were found to be 174.42 +/- 20.41 MPa (p < 0.05) and 115.86 +/- 24.8 MPa (p < 0.05), respectively. The surface morphologies of the two calcium deficient HA's formed were identical with a micro/nano porous structure as evidenced from SEM. The cellular proliferation on CDHA, and CDSHA, was comparable to the control, tissue culture polystyrene (TCPS) (p < 0.05). Alkaline phosphatase activity was significantly elevated on CDHA and CDSHA matrices at early time points when compared with the control (TCPS) (p < 0.05). Osteoblast cells gene expression on CDHA, and CDSHA showed type I collagen, alkaline phosphatase, osteocalcin, and osteopontin activity at both 7 and 14 days of culture. Thus, novel calcium-deficient HAs, CDHA, and CDSHA formed at low temperature are promising candidates for orthopaedic applications based on their ability to promote osteoblast cell adhesion and gene expression in vitro.

Rheological enhancement of mechanically activated ?-tricalcium phosphate cements

Most biocements are two- or three-component acid-based systems with large differences in the component particle sizes, which occurs by virtue of the differing processing routes. This work aimed to improve injectability and strength of a single reactive component cement, that is, mechanically activated alpha-tricalcium phosphate (TCP)-based cement by adding 13-33 wt % of several fine-particle-sized (d(50) of 0.5-1.1 microm) fillers [dicalcium phosphate anhydrous (DCPA), titanium dioxide (TiO(2)), and calcium carbonate] to the monomodal alpha-TCP matrix (d(50) = 9.8 microm). A high zeta-potential was measured for all particles in trisodium citrate solution. The fraction of alpha-TCP cement "injected" through an 800-microm hypodermic needle was found to be only 35% at a powder-to-liquid ratio of 3.5 g/mL. In contrast, the use of fillers decreased cement viscosity to a point, where complete injectability could be obtained. Mechanistically, these additives disrupted alpha-TCP particle packing yet decreased the interparticle spacing by a factor of approximately 5.5 such that the electrostatic repulsion effect was enhanced. A strength improvement was found when DCPA and TiO(2) were used as fillers despite the lower degree of conversion of these cements. Compressive strengths of precompacted cement samples increased from 70 MPa for unfilled alpha-TCP cement to 140 (110) MPa for 23 wt % DCPA (or TiO(2)) fillers as a result of porosity reduction. Strength improvement for more clinically relevant uncompacted cements was achieved by higher powder-to-liquid ratio mixes for filled cements such that maximum strengths of 90 MPa were obtained for 23 wt % DCPA filler compared with 50 MPa for single-component alpha-TCP cement.

Low temperature method for the production of calcium phosphate fillers

Background

Calcium phosphate manufactured samples, prepared with hydroxyapatite, are used as either spacers or fillers in orthopedic surgery, but these implants have never been used under conditions of mechanical stress. Similar conditions also apply with cements. Many authors have postulated that cements are a useful substitute material when implanted in vivo. The aim of this research is to develop a low cristalline material similar to bone in porosity and cristallinity.

Methods

Commercial hydroxyapatite (HAp) and monetite (M) powders are mixed with water and compacted to produce cylindrical samples. The material is processed at a temperature of 37–120 degrees C in saturated steam to obtain samples that are osteoconductive. The samples are studied by X-ray powder diffraction (XRD), Vickers hardness test (HV), scanning electron microscopy (SEM), and porosity evaluation.

Results

The X-ray diffractions of powders from the samples show patterns typical of HAp and M powders. After thermal treatment, no new crystal phase is formed and no increase of the relative intensity of the peaks is obtained. Vicker hardness data do not show any relationship with treatment temperature. The total porosity decreases by 50–60% according to the specific thermal treatment. Scanning electron microscopy of the surfaces of the samples with either HAp 80%-M 20% (c) or Hap 50%-M 50% (f), show cohesion of the powder grains.

Conclusions

The dissolution-reprecipitation process is more intesive in manufactured samples (c) and (f), according to Vickers hardness data. The process occurs in a steam saturated environment between 37 degrees and 120 degrees C. (c) (f) manufactured samples show pore dimension distributions useful to cellular repopulation in living tissues.

Polymer--calcium phosphate cement composites for bone substitutes

The use of self-setting calcium phosphate cements (CPCs) as bioresorbable bone-replacement implant materials presently is limited to non-load-bearing applications because of their low compressive strength relative to natural bone. The present study investigated the possibility of strengthening a commercially available CPC, alpha-BSM, by incorporating various water-soluble polymers into the cement paste during setting. Several polyelectrolytes, poly(ethylene oxide), and the protein bovine serum albumin (BSA) were added in solution to the cement paste to create calcium phosphate-polymer composites. Composites formulated with the polycations poly(ethylenimine) and poly(allylamine hydrochloride) exhibited compressive strengths up to six times greater than that of pure alpha-BSM material, with a maximum value reached at intermediate polymer content and for the highest molecular weight studied. Composites containing BSA developed compressive strengths twice that of the original cement at protein concentrations of 13-25% by weight. In each case, XRD studies correlate the improvement in compressive strength with reduced crystallite dimensions, as evidenced by a broadening of the (0,0,2) reflection. This suggests that polycation or BSA adsorption inhibits crystal growth and possibly leads to a larger crystal aspect ratio. SEM results indicate a denser, more interdigitated microstructure. The increased strength was attributed to the polymer's capacity to bridge between multiple crystallites (thus forming a more cohesive composite) and to absorb energy through plastic flow.

Biological and medical significance of calcium phosphates

The inorganic part of hard tissues (bones and teeth) of mammals consists of calcium phosphate, mainly of apatitic structure. Similarly, most undesired calcifications (i.e. those appearing as a result of various diseases) of mammals also contain calcium phosphate. For example, atherosclerosis results in blood-vessel blockage caused by a solid composite of cholesterol with calcium phosphate. Dental caries result in a replacement of less soluble and hard apatite by more soluble and softer calcium hydrogenphosphates. Osteoporosis is a demineralization of bone. Therefore, from a chemical point of view, processes of normal (bone and teeth formation and growth) and pathological (atherosclerosis and dental calculus) calcifications are just an in vivo crystallization of calcium phosphate. Similarly, dental caries and osteoporosis can be considered to be in vivo dissolution of calcium phosphates. On the other hand, because of the chemical similarity with biological calcified tissues, all calcium phosphates are remarkably biocompatible. This property is widely used in medicine for biomaterials that are either entirely made of or coated with calcium phosphate. For example, self-setting bone cements made of calcium phosphates are helpful in bone repair and titanium substitutes covered with a surface layer of calcium phosphates are used for hip-joint endoprostheses and tooth substitutes, to facilitate the growth of bone and thereby raise the mechanical stability. Calcium phosphates have a great biological and medical significance and in this review we give an overview of the current knowledge in this subject.

Biological and medical significance of calcium phosphates

The inorganic part of hard tissues (bones and teeth) of mammals consists of calcium phosphate, mainly of apatitic structure. Similarly, most undesired calcifications (i.e. those appearing as a result of various diseases) of mammals also contain calcium phosphate. For example, atherosclerosis results in blood-vessel blockage caused by a solid composite of cholesterol with calcium phosphate. Dental caries result in a replacement of less soluble and hard apatite by more soluble and softer calcium hydrogenphosphates. Osteoporosis is a demineralization of bone. Therefore, from a chemical point of view, processes of normal (bone and teeth formation and growth) and pathological (atherosclerosis and dental calculus) calcifications are just an in vivo crystallization of calcium phosphate. Similarly, dental caries and osteoporosis can be considered to be in vivo dissolution of calcium phosphates. On the other hand, because of the chemical similarity with biological calcified tissues, all calcium phosphates are remarkably biocompatible. This property is widely used in medicine for biomaterials that are either entirely made of or coated with calcium phosphate. For example, self-setting bone cements made of calcium phosphates are helpful in bone repair and titanium substitutes covered with a surface layer of calcium phosphates are used for hip-joint endoprostheses and tooth substitutes, to facilitate the growth of bone and thereby raise the mechanical stability. Calcium phosphates have a great biological and medical significance and in this review we give an overview of the current knowledge in this subject.

Trabecular bone response to injectable calcium phosphate (Ca-P) cement

The aim of this study was to investigate the physicochemical, biological, and handling properties of a new developed calcium phosphate (Ca-P) cement when implanted in trabecular bone. Ca-P cement consisting of a powder and a liquid phase was implanted as a paste into femoral trabecular bone of goats for 3 days and 2, 8, 16, and 24 weeks. The cement was tested using three clinically relevant liquid-to-powder ratios. Polymethylmethacrylate bone cement, routinely used in orthopedics, was used as a control. The Ca-P cement was easy to handle and was fast setting with good cohesion when in contact with body fluids. X-ray diffraction at the different implantation periods showed that the cement had set as an apatite and remained stable over time. Histological evaluation after 2 weeks, performed on 10 microm un-decalcified sections, showed abundant bone apposition on the cement surface without any inflammatory reaction or fibrous encapsulation. At later time points, the Ca-P cement implants were totally covered by a thin layer of bone. Osteoclast-like cells, as present at the interface, had resorbed parts of the cement mass. At locations where Ca-P cement was resorbed, new bone was formed without loss of integrity between the bone bed and the cement. This demonstrated the osteotransductive property of the cement, i.e., resorption of the material by osteoclast-like cells, directly followed by the formation of new bone. Histological and histomorphometrical evaluation did not show any significant differences between the Ca-P cement implanted at the three different liquid/powder ratios. The results indicate that the investigated Ca-P cement is biocompatible, osteoconductive, as well as osteotransductive and is a candidate material for use as a bone substitute.

Transforming growth factor-beta1 incorporation in a calcium phosphate bone cement: material properties and release characteristics

The bone regenerative properties of calcium phosphate cements (CPCs) may be improved by the addition of growth factors, such as recombinant human transforming growth factor-beta1 (rhTGF-beta1). Previously, we showed that rhTGF-beta1 in CPC stimulated the differentiation of preosteoblastic cells from adult rat long bones. The intermixing of rhTGF-beta1 in CPC, which was subsequently applied to rat calvarial defects, enhanced bone growth around the cement and increased the degradation of the cement. However, it is unknown whether the addition of rhTGF-beta1 changes the material properties of CPC and what the characteristics of the release of rhTGF-beta1 from CPC are. Therefore, we determined in this study the release of rhTGF-beta1, in vitro, from the cement pellets as implanted in the rat calvariae. The possible intervening effects of rhTGF-beta1 intermixing on the clinical compliance of CPC were studied through an assessment of its compressive strength and setting time, as well as its crystallinity, calcium-to-phosphorus ratio, porosity, and microscopic structure. We prepared CPC by mixing calcium phosphate powder (58% alpha-tricalcium phosphate, 25% anhydrous dicalcium phosphate, 8.5% calcium carbonate, and 8.5% hydroxyapatite) with a liquid (3 g/mL). The liquid for standard CPC consisted of water with 4% disodium hydrogen phosphate, whereas the liquid for modified CPC was mixed with an equal amount of 4 mM hydrochloride with 0.2% bovine serum albumin. The hydrochloride liquid contained rhTGF-beta1 in different concentrations for the release experiments. Most of the rhTGF-beta1 incorporated in the cement pellets was released within the first 48 h. For all concentrations of intermixed rhTGF-beta1 (100 ng to 2.5 mg/g of CPC), approximately 0.5% was released in the first 4 h, increasing to 1.0% after 48 h. Further release was only about 0.1% from 2 days to 8 weeks. CPC modification slightly increased the initial setting time at 20 degrees C from 2.6 to 5 min but had no effect on the final setting time of CPC at 20 degrees C or the initial and final setting times at 37 degrees C. The compressive strength was increased from 18 MPa in the standard CPC to 28 MPa in the modified CPC only 4 h after mixing. The compressive strength diminished in the modified CPC between 24 h and 8 weeks from 55 to 25 MPa. No other significant change was found with the CPC modification for rhTGF-beta1. X-ray diffraction revealed that standard and modified CPCs changed similarly from the original components, alpha-tricalcium phosphate and anhydrous dicalcium phosphate, into an apatite cement. The calcium-to-phosphorus ratio, as determined with an electron microprobe, did not differ for standard CPC and modified CPC. Standard and modified CPCs became dense and homogeneous structures after 24 h, but the modified CPC contained more crystal plaques than the standard CPC, as observed with scanning electron microscopy (SEM). SEM and back- scattered electron images revealed that after 8 weeks the cements showed equally and uniformly dense structures with microscopic pores (<1 microm). Both CPCs showed fewer crystal plaques at 8 weeks than at 24 h. This study shows that CPC is not severely changed by its modification for rhTGF-beta1. The prolonged setting time of modified cement may affect the clinical handling but is still within acceptable limits. The compressive strength for both standard and modified cements was within the range of thin trabecular bone; therefore, both CPCs can withstand equal mechanical loading. The faster diminishing compressive strength of modified cement from 24 h to 8 weeks likely results in early breakdown and so might be favorable for bone regeneration. Together with the beneficial effects on bone regeneration from the addition of rhTGF-beta1 to CPC, as shown in our previous studies, we conclude that the envisaged applications for CPC in bone defects are upgraded by the intermixing of rhTGF-beta1. Therefore, the combination of CPC and rhTGF-beta1 forms a promising synthetic bone graft.

Effect on composition of dry mechanical grinding of calcium phosphate mixtures

For diverse reasons, calcium phosphates used to prepare hydraulic calcium phosphate cements can be ground mixed. The grinding with a rotating micromill of monocalcium phosphate monohydrate or anhydrous, dicalcium phosphate dihydrate or anhydrous with calcium oxide, calcium hydroxide, calcium carbonate, tetracalcium phosphate, or alpha- or beta-tricalcium phosphate was studied for different calcium to phosphate (Ca/P) ratios, rotating rates, masses of balls, and environmental conditions. During dry grinding by ball milling, anhydrous or hydrated acid calcium phosphates can mechanochemically react with anhydrous or hydrated basic calcium salts to form dicalcium phosphate dihydrate or anhydrous, noncrystalline calcium phosphate, and/or calcium deficient or stoichiometric hydroxyapatite, depending on the Ca/P ratio in the mixture and the time of grinding. The reaction rate is a function of the rotation rate and the mass of the balls. Water is not necessary to initiate the reaction but facilitates it because hydrated salts react faster than the corresponding anhydrous salts. Neither carbon dioxide nor carbonate ions seem to have any influence on the transformation kinetics. The transformations that occur during grinding influence the final mechanical properties of hydraulic calcium phosphate cements prepared from these materials. Thus, if a grinding step of the starting materials is planed, the grinding conditions will have to be particularly well defined to obtain reproducible results.

Effect on composition of dry mechanical grinding of calcium phosphate mixtures

For diverse reasons, calcium phosphates used to prepare hydraulic calcium phosphate cements can be ground mixed. The grinding with a rotating micromill of monocalcium phosphate monohydrate or anhydrous, dicalcium phosphate dihydrate or anhydrous with calcium oxide, calcium hydroxide, calcium carbonate, tetracalcium phosphate, or alpha- or beta-tricalcium phosphate was studied for different calcium to phosphate (Ca/P) ratios, rotating rates, masses of balls, and environmental conditions. During dry grinding by ball milling, anhydrous or hydrated acid calcium phosphates can mechanochemically react with anhydrous or hydrated basic calcium salts to form dicalcium phosphate dihydrate or anhydrous, noncrystalline calcium phosphate, and/or calcium deficient or stoichiometric hydroxyapatite, depending on the Ca/P ratio in the mixture and the time of grinding. The reaction rate is a function of the rotation rate and the mass of the balls. Water is not necessary to initiate the reaction but facilitates it because hydrated salts react faster than the corresponding anhydrous salts. Neither carbon dioxide nor carbonate ions seem to have any influence on the transformation kinetics. The transformations that occur during grinding influence the final mechanical properties of hydraulic calcium phosphate cements prepared from these materials. Thus, if a grinding step of the starting materials is planed, the grinding conditions will have to be particularly well defined to obtain reproducible results.

Setting characteristics and mechanical behaviour of a calcium phosphate bone cement containing tetracycline

Calcium phosphate cements are used for bone defect filling and they may also be used as delivery systems for active agents. The physicochemical behaviour of an ionic cement, with a final composition of hydroxyapatite, containing tetracycline hydrochloride was investigated. Chemical characterisation, X-ray diffraction analysis, compressive strength and tensile strength were performed. It is known that the antibiotic can be adsorbed on calcium phosphate compounds and the presence of chloride ions can strongly influence the behaviour of the cement. Adding more than 1% (w/w) of 95% pure tetracycline hydrochloride in the solid phase led to a cement with poor mechanical properties, but which, in addition to hydroxyapatite, contained residual starting reagents. For this reason, experiments were also performed with tetracycline previously treated with a calcium sulphate solution. Using a treated tetracycline, it was possible to introduce at least 7% (w/w) of active ingredient whilst still allowing the reaction to proceed to completion i.e. the formation of hydroxyapatite with good mechanical properties. Therefore, treating the tetracycline HCI with calcium sulphate solution prior to reaction conserved the activity of the antibiotic, limited the influence of the antibiotic on the cement evolution and retained the physical properties of the cement.

Precipitation of carbonated apatite in the cement system alpha-Ca(3)(PO(4))(2)-Ca(H(2)PO(4))(2)-CaCO(3)

Powder mixtures of alpha-Ca(3)(PO(4))(2), Ca(H(2)PO(4))(2), and CaCO(3) were investigated to assess their potential for the precipitation of a carbonated apatite suitable for cement applications from a supersaturated solution. Of particular interest was the requirement of carbon dioxide release during the setting reaction to obtain Ca(9-x)(HPO(4))(1-1.5x) (PO(4))(5-2.5x)(CO(3))(3.5x)(OH)(1 + 1.5x) with a fixed carbonate content. Results indicated that a compromise is necessary with respect to the maximum permissible level of CaCO(3) addition to the powder mixture as against appropriate setting and hardening properties. Cementlike materials with good setting and hardening properties were obtained when alpha-Ca(3)(PO(4))(2) was the main reactant using Ca(H(2)PO(4))(2) and CaCO(3) as additives in relative proportions of <10 wt % corresponding, approximately, to the stability field area (x,lambda) contained within the lines lambda = -1.5x, x = 0.3, and lambda = -1. Desirable workability and setting properties were lost as the parameters x and -lambda increased. Finally, it was also found to be virtually impossible to obtain a predetermined chemical composition for the setting apatite precipitate, since to increase the amount of carbon dioxide released from the initial powder mixture during setting, the solution pH would need to be decreased, and in doing so the nature of the precipitate could be altered to fulfil the thermodynamic conditions of the solubility diagrams of calcium phosphates.