PMMA-based composite materials with reactive ceramic fillers: IV. Radiopacifying particles embedded in PMMA beads for acrylic bone cements

Radiopaque Crystalline, Non-Crystalline and Nanostructured Bioceramics

Radiopacity is sometimes an essential characteristic of biomaterials that can help clinicians perform follow-ups during pre- and post-interventional radiological imaging. Due to their chemical composition and structure, most bioceramics are inherently radiopaque but can still be doped/mixed with radiopacifiers to increase their visualization during or after medical procedures. The radiopacifiers are frequently heavy elements of the periodic table, such as Bi, Zr, Sr, Ba, Ta, Zn, Y, etc., or their relevant compounds that can confer enhanced radiopacity. Radiopaque bioceramics are also intriguing additives for biopolymers and hybrids, which are extensively researched and developed nowadays for various biomedical setups. The present work aims to provide an overview of radiopaque bioceramics, specifically crystalline, non-crystalline (glassy), and nanostructured bioceramics designed for applications in orthopedics, dentistry, and cancer therapy. Furthermore, the modification of the chemical, physical, and biological properties of parent ceramics/biopolymers due to the addition of radiopacifiers is critically discussed. We also point out future research lacunas in this exciting field that bioceramists can explore further.

Denture Base Composites: Effect of Surface Modified Nano- and Micro-Particulates on Mechanical Properties of Polymethyl Methacrylate

The most commonly used denture base material, polymethyl methacrylate, lacks ideal mechanical properties, which are reflected in its relatively high failure rate. Several methods have been explored to reinforce the material and reduce the cost of denture repair and replacement. In this study, various surface modified filler particles at different concentrations were dispersed in conventional and high-impact denture base materials and tested for their improvement in mechanical properties. Inorganic filler particles were coated with different silane coupling agents using an ultrasonic device. The particulates were dispersed in the resin and the composites polymerised through an innovative dual-cure technique. Charpy impact test, single-edge notch three-point bend fracture toughness test and Biaxial Flexural Strength (BFS) were performed on the specimens. The results showed that mechanical properties of the denture base resin can be improved by incorporating filler particles; however, the surface characteristics, quantity and level of dispersion of the particles play critical role in the mechanical behaviour of the composites. The results of this study are a promising step towards developing more fracture-resistant denture base materials.

Acoustophoretic assembly of millimeter-scale Janus fibers

This article presents a method for the assembly of millimeter-scale Janus fibers using acoustophoresis as an assembly mechanism. An acoustic flow cell mounted to a 3D printer combines acoustophoresis and additive manufacturing in a unique approach that allows for the assembly of textured Janus fibers. A dispersion consisting of polymethylmethacrylate (PMMA) filler particles in a UV curable polymer resin is passed through an acoustically excited capillary tube. To fundamentally understand this process, we develop a suspension balance model that accounts for acoustophoresis and concentration-driven shear-induced diffusion. Once assembled, the particle-polymer dispersion is cured using UV illumination to create a polymer composite fiber with particles immobilized on one side in a Janus-like configuration. The Janus fiber is observed to modify the light transmission profile when rotated on an optical microscope stage. Tensile measurements of the fiber show that the Young's modulus of the Janus fiber (50.5 MPa) is approximately twice that of a fiber fabricated from the polymer alone (24.7 MPa). The process we describe here could serve as a pathway for the fabrication of a variety of functional Janus fibers with possible applications to wearable textiles, soft robotics or surgical sutures.

Nanotechnology for treating osteoporotic vertebral fractures

Osteoporosis is a serious public health problem affecting hundreds of millions of aged people worldwide, with severe consequences including vertebral fractures that are associated with significant morbidity and mortality. To augment or treat osteoporotic vertebral fractures, a number of surgical approaches including minimally invasive vertebroplasty and kyphoplasty have been developed. However, these approaches face problems and difficulties with efficacy and long-term stability. Recent advances and progress in nanotechnology are opening up new opportunities to improve the surgical procedures for treating osteoporotic vertebral fractures. This article reviews the improvements enabled by new nanomaterials and focuses on new injectable biomaterials like bone cements and surgical instruments for treating vertebral fractures. This article also provides an introduction to osteoporotic vertebral fractures and current clinical treatments, along with the rationale and efficacy of utilizing nanomaterials to modify and improve biomaterials or instruments. In addition, perspectives on future trends with injectable bone cements and surgical instruments enhanced by nanotechnology are provided.

Nanomaterials: the next step in injectable bone cements

Injectable bone cements (IBCs) are biocompatible materials that can be used as bone defect fillers in maxillofacial surgeries and in orthopedic fracture treatment in order to augment weakened bone due to osteoporosis. Current clinically available IBCs, such as polymethylmethacrylate and calcium phosphate cement, have certain advantages; however, they possess several drawbacks that prevent them from gaining universal acceptance. New gel-based injectable materials have also been developed, but these are too mechanically weak for load-bearing applications. Recent research has focused on improving various injectable materials using nanomaterials in order to render them suitable for bone tissue regeneration. This article outlines the requirements of IBCs, the advantages and limitations of currently available IBCs and the state-of-the-art developments that have demonstrated the effects of nanomaterials within injectable systems.

Synthesis and characterization of poly(methyl methacrylate)-based experimental bone cements reinforced with TiO2-SrO nanotubes

In an attempt to overcome existing limitations of experimental bone cements we here demonstrate a simple approach to synthesizing strontium-modified titania nanotubes (n-SrO-TiO(2) tubes) and functionalize them using the bifunctional monomer methacrylic acid. Then, using 'grafting from' polymerization with methyl methacrylate, experimental bone cements were produced with excellent mechanical properties, radiopacity and biocompatibility. Transmission electron microscopy (TEM), scanning electron microscopy (SEM), energy-dispersive spectroscopy mapping and backscattered SEM micrographs revealed a uniform distribution of SrO throughout the titanium matrix, with retention of the nanotubular morphology. Nanocomposites were then reinforced with 1, 2, 4 and 6 wt.% of the functionalized metal oxide nanotubes. Under the mixing and dispersion regime employed in this study, 2 wt.% appeared optimal, exhibiting a more uniform dispersion and stronger adhesion of the nanotubes in the poly(methyl methacrylate) matrix, as shown by TEM and SEM. Moreover, this optimum loading provided a significant increase in the fracture toughness (K(IC)) (20%) and flexural strength (40%) in comparison with the control matrix (unfilled) at P<0.05. Examination of the fracture surfaces by SEM showed that toughening was provided by the nanotubes interlocking with the acrylic matrix and crack bridging during fracture. On modifying the n-TiO(2) tubes with strontium oxide the nanocomposites exhibited a similar radiopacity to a commercial bone cement (CMW 1), while exhibiting a significant enhancement of osteoblast cell proliferation (242%) in vitro compared with the control at P<0.05.

Physical and mechanical properties of PMMA bone cement reinforced with nano-sized titania fibers

X-ray contrast medium (BaSO(4) or ZrO(2)) used in commercially available PMMA bone cements imparts a detrimental effect on mechanical properties, particularly on flexural strength and fracture toughness. These lower properties facilitate the chance of implant loosening resulting from cement mantle failure. The present study was performed to examine the mechanical properties of a commercially available cement (CMW1) by introducing novel nanostructured titania fibers (n-TiO(2) fibers) into the cement matrix, with the fibers acting as a reinforcing phase. The hydrophilic nature of the n-TiO(2) fibers was modified by using a bifunctional monomer, methacrylic acid. The n-TiO(2) fiber content of the cement was varied from 0 to 2 wt%. Along with the mechanical properties (fracture toughness (K (IC)), flexural strength (FS), and flexural modulus (FM)) of the reinforced cements the following properties were investigated: complex viscosity-versus-time, maximum polymerization temperature (T (max)), dough time (t (dough)), setting time (t (set)), radiopacity, and in vitro biocompatibility. On the basis of the determined mechanical properties, the optimized composition was found at 1 wt% n-TiO(2) fibers, which provided a significant increase in K (IC) (63%), FS (20%), and FM (22%), while retaining the handling properties and in vitro biocompatibility compared to that exhibited by the control cement (CMW1). Moreover, compared to the control cement, there was no significant change in the radiopacity of any of the reinforced cements at p = 0.05. This study demonstrated a novel pathway to augment the mechanical properties of PMMA-based cement by providing an enhanced interfacial interaction and strong adhesion between the functionalized n-TiO( 2) fibers and PMMA matrix, which enhanced the effective load transfer within the cement.

Effect of active hydroxyl groups on the interfacial bond strength of titanium with segmented polyurethane through gamma-mercapto propyl trimethoxysilane

The objective of this study was to investigate the effect of active hydroxyl groups on a titanium (Ti) surface on the bond strength between Ti and segmented polyurethane (SPU) composite through gamma-mercapto propyl trimethoxysilane (gamma-MPS). Active hydroxyl groups on Ti surface oxide were controlled by immersion in hydrogen peroxide (H2O2) with different lengths of immersion time, and the resulting concentrations of active hydroxyl groups were evaluated using a zinc-complex substitution technique. For the H2O2-treated Ti, it was characterized using X-ray photoelectron spectroscopy and scanning electron spectroscopy. For the bond strength of Ti/ gamma-MPS/SPU interface, it was determined using a shear bond test. Results showed that the bond strength increased with increase in the concentration of active hydroxyl groups. In terms of durability after immersion in water at 310 K for 30 days, it was found that bond strength was improved with increase in active hydroxyl groups. Based on the results obtained, active hydroxyl groups on the surface oxide film were clearly one of the causes governing the interfacial bond strength.

Synthesis of TiO(2)-PMMA nanocomposite: using methacrylic acid as a coupling agent

Inorganic-polymer nanocomposites are of significant interest for emerging materials due to their improved properties and unique combination of properties. Methacrylic acid (MA), a functionalization agent that can chemically link TiO2 nanomaterials (n-TiO2) and polymer matrix, was used to modify the surface of n-TiO2 using a Ti-carboxylic coordination bond. Then, the double bond in MA was copolymerized with methyl methacrylate (MMA) to form a n-TiO2-PMMA nanocomposite. The resulting n-TiO2-PMMA nanocomposite materials were characterized by using thermal analysis, electron microscopy, and elemental analysis. The dynamic mechanical properties (Young's and shear modulus) were measured using an ultrasonic pulse technique. The electron microscopy results showed a good distribution of the nanofillers in the polymer matrix. The glass transition temperature, thermal degradation temperature, and dynamic elastic moduli of the nanocomposites were shown to increase with an increase in the weight percentage of nanofibers in the composite. The resulting nanocomposites exhibited improved elastic properties and have potential application in dental composites and bone cements.

Structure and strength at the bonding interface of a titanium-segmented polyurethane composite through 3-(trimethoxysilyl) propyl methacrylate for artificial organs

The objective of this study was to investigate the structure and strength at the bonding interface of a titanium (Ti)-segmented polyurethane (SPU) composite through (3-trimethoxysilyl) propyl methacrylate (gamma-MPS) for artificial organs. The effects of the thickness of the gamma-MPS layer on the shear bonding strength between Ti and SPU were investigated. Ti disks were immersed in various concentrations of gamma-MPS solutions for several immersion times. The depth profiles of elements and the thickness of the gamma-MPS layer were determined by glow discharge optical emission spectroscopy and ellipsometry, respectively. The bonding stress at the Ti/gamma-MPS/SPU interface was evaluated with a shear bonding test. Furthermore, the fractured surface of a Ti-SPU composite was observed by optical microscopy and characterized using X-ray photoelectron spectroscopy. Consequently, the thickness of the gamma-MPS layer was controlled by the concentration of the gamma-MPS solution and immersion time. The shear bonding stress at the interface increased with the increase of the thickness of the gamma-MPS layer. Therefore, the control of the thickness of the gamma-MPS layer is significant to increase the shear bonding stress at the Ti/gamma-MPS/SPU interface. These results are significant to create composites for artificial organs consisting of other metals and polymers.

Improved mechanical properties of acrylic bone cement with short titanium fiber reinforcement

Acrylic bone cements are widely used in total joint arthroplasties to grout the prosthesis to bone. The changes in the tensile properties and fracture toughness of polymethylmethacrylate (PMMA) bone cements obtained by the addition of control and heat treated short titanium fibers are studied. Heat treatment of titanium fibers is conducted to precipitate titania particles on the fiber surface to improve the biocompatibility of the metal. Control and heat treated short titanium fibers (250 micro long and 20 micro diameter) were used as reinforcements at 3 volume %. X-ray diffraction indicated the presence of a rutile form of titania due to the heat treatments. The tensile and fracture properties were improved by the addition of fibers. Bone cements reinforced with titanium fibers heated at 550 degrees C for 1 h followed by 800 degrees C for 30 minutes show the largest increase in fracture toughness along with the smallest changes in elastic modulus and needs to be further investigated.

Improved mechanical properties of acrylic bone cement with short titanium fiber reinforcement

Acrylic bone cements are widely used in total joint arthroplasties to grout the prosthesis to bone. The changes in the tensile properties and fracture toughness of polymethylmethacrylate (PMMA) bone cements obtained by the addition of control and heat treated short titanium fibers are studied. Heat treatment of titanium fibers is conducted to precipitate titania particles on the fiber surface, which may improve the biocompatibility of the metal. Control (non-heat treated) and heat treated short titanium fibers (250 microm long and 20microm diameter) were used as reinforcements at 3 volume %. X-ray diffraction indicated the presence of a rutile form of titania due to the heat treatments. Results indicate that the tensile and fracture properties of unfilled bone cement were improved by the addition of control and heat-treated fibers. The fracture properties of bone cements reinforced with control titanium fibers were at least 10% higher than those reinforced with heat treated titanium fibers. Therefore, we recommend further studies on the use of non-heat treated titanium fibers to reinforce acrylic bone cement.

Graft copolymers of methyl methacrylate and poly([R]-3-hydroxybutyrate) macromonomers as candidates for inclusion in acrylic bone cement formulations: Compression testing

Graft copolymers of methyl methacrylate and biodegradable, biocompatible bacterial poly([R]-3-hydroxybutyrate) (PHB) blocks were synthesized and evaluated as possible constituents in acrylic bone cements for use in orthopaedic applications. The copolymers were produced by conventional free radical copolymerization and incorporated in one commercially available acrylic bone cement brand, Antibiotic Simplex (AKZ). Cements with formulations containing 6.7 and 13.5 wt % of PMMA-graft-PHB were prepared. The morphology of the graft copolymer particles was suggested to influence the ability of the modified cement to be processed. Formulations containing more than about 20 wt % of the graft copolymer resulted in cement doughs that, both after first preparation and several hours later, were either sandy or soft spongy in texture and, thus, would be unacceptable for use in orthopaedic applications. The morphologies of the powders and the volumetric porosity (p) and ultimate compressive strength (UCS) of the cured cements were determined. Micro computed tomography showed that the cements presented average porosities of 13.5-16.9%. It was found that, while the powder particle shape and size for the experimental cements were markedly different from those of AKZ, there was no significant difference in either p or UCS for these cements. The latter was determined to be about 85 MPa for the modified cements and 84 MPa for Antibiotic Simplex. Furthermore, the UCS of all the cements exceeded the minimum level for acrylic bone cements, as stipulated by ASTM F-451.

Adhesion enhancement of steel fibers to acrylic bone cement through a silane coupling agent

The use of a silane coupling agent (methacryloxypropyl-trichlorosilane) to improve the mechanical properties of steel fiber-reinforced acrylic bone cements was assessed. Changes to the tensile and fracture properties of bone cements reinforced with silane-coated or uncoated 316L stainless steel fibers of different aspect ratios were studied. Contact-angle measurements indicated that the coupling agent coats the metal surface through room temperature treatments in a short time (within 2 h). Push-out tests indicated that the interfacial shear strength of silane-coated 316L stainless steel rods is 141% higher than the uncoated rods. The elastic moduli, ultimate stresses, and fracture toughness of the silane-coated, steel fiber-reinforced bone cements are significantly higher than the bone cements reinforced with uncoated steel fibers. There were no differences in the tensile mechanical properties of the silane-coated or uncoated, steel fiber-reinforced cements after aging in a physiological saline solution, indicating that the bonding effectiveness is decreased by the intrusion of water at the metal-polymer interface. Because of possible biocompatibility issues with leaching of the silane coupling agent and no long-term mechanical benefit in simulated aging experiments, the use of these agents is not recommended for in vivo use.

Fracture toughness of steel-fiber-reinforced bone cement

Fractures in the bone-cement mantle (polymethyl methacrylate) have been linked to the failure of cemented total joint prostheses. The heat generated by the curing bone cement has also been implicated in the necrosis of surrounding bone tissue, leading to loosening of the implants. The addition of reinforcements may improve the fracture properties of bone cement and decrease the peak temperatures during curing. This study investigates the changes in the fracture properties and the temperatures generated in the ASTM F451 tests by the addition of 316L stainless steel fibers to bone cement. The influence of filler volume fraction (5-15% by volume) and aspect ratios (19, 46, 57) on the fracture toughness of the acrylic bone cement was assessed. Increasing the volume fraction of the steel fibers resulted in significant increases in the fracture toughness of the steel-fiber-reinforced composite. Fracture-toughness increases of up to 2.63 times the control values were obtained with the use of steel-fiber reinforcements. No clear trend in the fracture toughness was discerned for increasing aspect ratios of the reinforcements. There is a decrease in the peak temperatures reached during the curing of the steel-fiber-reinforced bone cement, though the decrease is too small to be clinically relevant. Large increases in the fatigue life of acrylic bone cement were also obtained by the addition of steel fibers. These results indicate that the use of steel fibers may enhance the durability of cemented joint prostheses.

Fatigue testing and performance of acrylic bone-cement materials: state-of-the-art review

Over the past three decades or so, a very large volume of literature has been generated on the impact of an assortment of variables on the fatigue lifetimes of a large number of acrylic bone-cement formulations. In the present article, this literature is examined critically to reveal areas of agreement, areas of disagreement, as well as a welter of underexplored and unexplored topics. For example, there is unanimity of support for the notion that an increase in the molecular weight of the powder constituents or the fully cured cement leads to an increase in the cement's fatigue life, whereas there is disagreement as to whether vacuum mixing the cement constituents leads to an increase in the fatigue life of the fully cured cement (relative to the hand-mixed counterpart). Among the underexplored topics is systematic study of the effect of test frequency on the fatigue results, whereas determination of the optimal concentration of the antibiotic in an antibiotic-loaded cement is an example of the unexplored topics. It is pointed out that resolving the controversies, addressing the underexplored topics, and filling the lacunae will allow comprehensive evaluations of acrylic bone-cement materials to be made. This enhanced body of knowledge will prove invaluable in the continued use of acrylic bone cement as the anchoring agent in cemented arthroplasties.

Injectable acrylic bone cements for vertebroplasty with improved properties

Currently commercially available acrylic bone cements lack adequate radiopacity and viscosity when they are used in percutaneous vertebroplasty (PVP). In this work improved formulations of radiopaque and injectable poly(methyl methacrylate) bone cements were prepared with different amounts (10-50 wt.%) of BaTiO3 or SrTiO3 particles as the radiopaque agent. Two sets of cements were prepared by using untreated or silanated radiopaque particles, respectively. The influence of the content and nature of the radiopaque agent as well as its silanation with 3-(trimethoxysilyl) propyl methacrylate (gamma-MPS), on the curing parameters, residual monomer content, radiopacity, mechanical properties, and injectability of the resulting materials, was examined. Doughing and setting times, maximum temperature, and compressive strength of all formulations fulfilled the requirements of standard specifications, with values of peak temperature in the range 57-72 degrees C and those of compressive strength between 114 and 135 MPa. Formulations containing at least 20 wt.% BaTiO3 or SrTiO3 had radiopacities equal to or greater than that corresponding to 2 mm of Al as required for surgical plastics. Injectability of any of the formulations provided 75-80 wt.% of the total mass manually injected through a conventional biopsy needle 4 min after mixing. Silanation of the BaTiO3 or SrTiO3 particles led to formulations with improved mechanical properties and injectability compared to those obtained with the untreated fillers.

Mechanical properties and radiopacity of experimental glass-silica-metal hybrid composites

OBJECTIVES

Experimental glass-silica-metal hybrid composites (polycomposites) were developed and tested mechanically and radiographically in this fundamental pilot study. To determine whether mechanical properties of a glass-silica filled two-paste dental composite based on a Bis-GMA/polyglycol dimethacrylate blend could be improved through the incorporation of titanium (Ti) particles (particle size ranging from 1 to 3 microm) or silver-tin-copper (Ag-Sn-Cu) particles (particle size ranging from 1 to 50 microm) we measured the diametral tensile strength, fracture toughness and radiopacity of five composites.

METHODS

The five materials were: I, the original unmodified composite (control group); II, as group I but containing 5% (wt/wt) of Ti particles; III, as group II but with Ti particles treated with 4-methacryloyloxyethyl trimellitate anhydride (4-META) to promote Ti-resin bonding; IV, as group I but containing 5% (wt/wt) of Ag-Sn-Cu particles; and V, as group IV but with the metal particles treated with 4-META. Ten specimens of each group were tested in a standard diametral tensile strength test and a fracture toughness test using a single-edge notched sample design and five specimens of each group were tested using a radiopacity test.

RESULTS

The diametral tensile strength increased statistically significantly after incorporation of Ti treated with 4-META, as tested by ANOVA (P=0.004) and Fisher's LSD test. A statistically significant increase of fracture toughness was observed between the control group and groups II, III and V as tested by ANOVA (P=0.003) and Fisher's LSD test. All other groups showed no statistically significant increase in diametral tensile strength and fracture toughness respectively when compared to their control groups. No statistically significant increase in radiopacity was found between the control group and the Ti filled composite, whereas a statistically significant increase in radiopacity was found between the control group and the Ag-Sn-Cu filled composite as tested by ANOVA (P=0.000) and Fisher's LSD procedure.

SIGNIFICANCE

The introduction of titanium and silver-tin-copper fillers has potential as added components in composites to provide increased mechanical strength and radiopacity, for example for use in core materials.