Impact of Zn-Modified Hydroxyapatite Whiskers on Physicochemical and Biological Properties of Poly(ε-Caprolactone) Composites Intended for Implantable Medical Devices

Poly(ε-caprolactone) (PCL)-hydroxyapatite (HAP) biocomposites were produced by thermal processing to test the impact of HAP addition on the physicochemical and biological properties of PCL. Two different HAPs: zinc-modified and unmodified, were added to the polymer matrix to enhance their biocompatibility, surface properties, and antimicrobial activity. The overall properties of biocomposites were assessed by thermal and mechanical analysis, while their structure and morphology were assessed by electron microscopy and infrared spectroscopy. A short-term degradation process of the composites in terms of their medical application was carried out, and biocompatibility was investigated regarding cytocompatibility, immunocompatibility, and bactericidal activity. PCL/HAP composites with 15 wt.% HAP offer the best-balanced properties with a moderate decrease in mechanical strength, cytocompatibility, and a moderate increase in antimicrobial activity. All the composites show high cytocompatibility with both L929 fibroblasts and hFOB 1.19 human fetal osteoblasts. Zn modification promoted their antimicrobial properties, and they have been proven safe for use in a short degradation test. Therefore, the PCL/HAP and PCL/HAP_Zn biocomposites have potential for medical applications, especially for bone regeneration.

A methodological comparison of synthesizing heavy metal substituted bioapatite

This study evaluates two methods-maturation and direct precipitation-for synthesizing heavy metal substituted biomimetic hydroxyapatite (HA), focusing on their efficacy in mimicking human bone composition and crystallinity. Cobalt (Co) and chromium (Cr) substitutions were investigated due to their relevance to metal-on-metal implant degradation and the potential integration of these ions into bone mineral. The maturation method involves prolonged incubation, producing amorphous and bioresorbable apatites, while the direct precipitation (DP) method achieves rapid synthesis of highly crystalline apatites through controlled titration. Both approaches were characterized using X-ray diffraction (XRD), Raman spectroscopy, and Fourier Transform Infrared (FTIR) spectroscopy, confirming the apatitic nature of the samples and lattice strain induced by metal ion substitution. This study highlights the maturation method's adaptability for long-term biological interactions and the DP method's mechanical stability for load-bearing applications. Comparison of the structural and chemical properties of substituted HA from each method provides insights into optimizing synthesis techniques for diverse biomedical applications, such as bone tissue engineering and mitigating the effects of heavy metal ion release on bone health. These findings contribute to advancing hydroxyapatite-based biomaterials tailored for therapeutic and regenerative medicine needs.

Preparation of SF-gel-CS-Hap bionic biphasic porous scaffolds and evaluation of physical, mechanical and biological properties

Objective: Full-thickness cartilage defect are usually accompanied by subchondral bone damage, which is difficult to self-repair once damaged due to the lack of vascularization and innervation. In this study, a biphasic composite scaffold was developed by combining vacuum freeze-drying and iterative freeze-thawing with gelatin, chitosan, silk fibroin, and hydroxyapatite as the basic materials to explore the feasibility of using them for the repair of total cartilage defects. Methods and Results: Six groups of SF-CS-Gel-nHap porous scaffolds (Hap-0%, Hap-1%, Hap- 2%, Hap-3%, Hap-4%, Hap-5%) were prepared by vacuum freeze-drying and chemical cross-linking using filipin protein (SF), gelatin (Gel), chitosan (CS) and hydroxyapatite (Hap) as the base materials. A series of characterization methods were used to systematically analyze and test the morphological features as well as physical and mechanical properties of the scaffolds. Then a novel bionic biphasic porous scaffold was developed by a combination of freeze-drying and freeze-thawing using the SF-CS-Gel as the cartilage phase and the SF-CS-Gel-2%Hap as the subchondral bone phase. Finally, it was co-cultured with chondrocytes to verify the biological properties of the SF-CS-Gel/SF-CS-Gel-2%Hap bionic biphasic porous composite scaffold in vitro. The results showed that the SF-CS-Gel/SF-CS-Gel-2%Hap biphasic scaffolds had a highly porous mesh structure, with an average pore size of 156.06 ± 42.36 μm in the cartilage phase and 214.38 ± 65.82 μm in the subchondral bone phase. Co-cultured with chondrocytes, the live and dead cells stained, cck-8 growth and proliferation curves showed that the bionic scaffolds had good biocompatibility and cytotoxicity. Cytoskeletal staining showed that the morphology of chondrocytes in the bionic scaffolds could maintain three-dimensional growth as in vivo. Conclusion: The results showed that SF-CS-Gel/SF-CS-Gel-2%Hap biphasic scaffolds have good biocompatibility, biodegradability, stability, appropriate mechanical properties and porosity, and are suitable for repairing articular cartilage and subchondral bone. It is expected to be used as a repair material for articular cartilage in clinical applications.

Hydrogels empowered mesenchymal stem cells and the derived exosomes for regenerative medicine in age-related musculoskeletal diseases

As the population ages, musculoskeletal diseases (MSK) have emerged as a significant burden for individuals, healthcare systems, and social care systems. Recently, regenerative medicine has exhibited vast potential in age-related MSK, with mesenchymal stromal cells (MSCs) and their derived exosomes (Exos) therapies showing distinct advantages. However, these therapies face several limitations, including issues related to ensuring stability and effective distribution within the body. Hydrogels, acting as an ideal carrier, can enhance the therapeutic effects and application range of MSCs and Exos derived from MSCs (MSC-Exos). Therefore, this review comprehensively summarizes the application progress of MSCs and MSC-Exos combined with hydrogels in age-related MSK disease research. It aims to provide a detailed perspective, showcasing the functional enhancement of MSCs and MSC-Exos when incorporated into hydrogels. Additionally, this review explores their potential and challenges in treating age-related MSK diseases, offering references for future research directions and potential innovative strategies.

A Sr@Ag-based spatiotemporal and step-release scaffold against chronic osteomyelitis, fabricated by coaxial 3D-printing

Chronic osteomyelitis (OM) represents a severe and persistent infectious bone disease. Effective treatment requires controlled anti-inflammatory releases and bone regeneration across disease phases. A Sr@Ag-based scaffold was successfully printed, featuring micron-scale coaxial fibers containing Ag-doped hydroxyapatite (HA) in the outer layer of PLLA and Sr-doped HA in the inner layer of PLLA, facilitating the spatiotemporal and sequential release of Ag and Sr ions during OM treatment. Most antibacterial agent (Ag) was released during the first 20 days, followed by a slow-release plateau over the next 40 days in phosphate-buffered saline solution (PBS). Meanwhile, the pro-angiogenic agent (Sr) was released in minimal amounts during the initial 20 days, followed by a rapid and considerable release in the following 40 days. The coaxial design effectively inhibited the growth of Staphylococcus aureus and Escherichia coli while preserving the viability of bone cells. The ion-based scaffold exhibited broad-spectrum antibacterial effects and enhanced bone-regenerating gene expression in a complex air-bacteria environment. The Sr@Ag-based coaxial scaffold demonstrated effective antibacterial activity during the early stage and exhibited excellent non-toxic bone regeneration results during the middle and late stages in vivo. This work offered a promising treatment strategy through sequential anti-inflammatory and pro-osteogenic effects for infectious bone-defect diseases.

Cu/Gd co-doped hydroxyapatite/poly lactic-co-glycolic acid composites enhance MRI imaging and bone defect regeneration

Background: The hydroxyapatite (HA)/poly(lactide-co-glycolide) acid (PLGA) composite material is a widely used orthopedic implant due to its excellent biocompatibility and plasticity. Recent advancements in cation doping have expanded its potential biological applications. However, conventional HA/PLGA composites are not visible under X-rays post-implantation and have limited osteogenic induction capabilities. Copper (Cu) is known to regulate osteoblast proliferation and differentiation, while gadolinium (Gd) can significantly enhance the magnetic resonance imaging (MRI) capabilities of materials. Methods: This study aimed to investigate whether incorporating Cu and Gd into an HA/PLGA composite could enhance the osteogenic properties, in vivo bone defect repair, and MRI characteristics. We prepared a Cu/Gd@HA/PLGA composite and assessed its performance. Results: Material characterization confirmed that Cu/Gd@HA retained the morphology and crystal structure of HA. The Cu/Gd@HA/PLGA composite exhibited excellent nuclear magnetic imaging capabilities, porosity, and hydrophilicity, which are conducive to cell adhesion and implant detection. In vitro experiments demonstrated that the Cu/Gd@HA/PLGA composite enhanced the proliferation, differentiation, and adhesion of MC3T3-E1 cells, and upregulated COL-1 and BMP-2 expression at both gene and protein levels. In vivo studies showed that the Cu/Gd@HA/PLGA composite maintained strong T1-weighted MRI signals and significantly improved the bone defect healing rate in rats. Conclusion: These findings indicate that the Cu/Gd@HA/PLGA composites significantly enhance T1-weighted MRI capabilities, promote osteoblast proliferation and differentiation in vitro, and accelerate bone defect healing in vivo.

Silicate-substituted bovine-derived hydroxyapatite as a bone substitute in regenerative dentistry

Hydroxyapatite, renowned for its biocompatibility and osteoconductive properties, plays a fundamental role in bone regeneration owing to its resemblance to natural bone mineral, thus offering considerable potential for advancing tissue engineering strategies. In this article, the innovative integration of silicon ions into biogenic (bovine-derived) hydroxyapatite (SiBHA) via a tailored sol-gel process is reported. The resultant SiBHA scaffolds exhibited an interconnected microporous structure with a total porosity of 70% and pore dimensions ranging from 120 to 650 µm. Fourier-transform infrared spectroscopy and X-ray diffraction studies validated the effective incorporation of silicon ions into the BHA lattice, with energy-dispersive X-ray and inductively-coupled plasma mass spectrometry further confirming a Ca/P molar ratio for SiBHA between 1.63 and 1.74. Moreover, SiBHA scaffolds demonstrated commendable chemical and thermal stability. Of note, SiBHA scaffolds were found to display significantly enhanced mechanical properties, including compressive strength and Young's modulus, compared to the control BHA scaffolds. In vitro assessments highlighted the capacity of SiBHA scaffolds to foster cell viability, proliferation, and osteogenic differentiation of Saos-2 cells. Immunohistochemical analysis revealed a significant increase in osteonectin expression, a key bone matrix protein, after 14 days of incubation under osteogenic conditions. These findings highlight the biocompatibility and therapeutic potential of SiBHA scaffolds, suggesting their suitability as biomaterials for dental bone regeneration applications.

Strontium-containing mineralized phospholipid coatings improve osseointegration in osteoporotic rats

Surface treatments play an important role in enhancing the osseointegration of Titanium (Ti) and its alloys. This study introduces a method employing biomimetic hydroxyapatite (Hap) deposition guided by molecularly organized phospholipids, affixed to the metal implant surface. Using the Langmuir-Blodgett technique, phospholipids were deposited onto Ti-screws by using CaCl2 or CaCl2/SrCl2 aqueous solution in the subphase of a Langmuir trough in the target proportion (i.e. 10 and 90 mol% of Sr2+ in relation of Ca2+) followed by immersion in phosphate buffer and in supersaturated simulated body fluid. Coating composition and morphology were evaluated using infrared spectroscopy and scanning electron microscopy, respectively, while contact angle measurements assessed coating wettability and surface energy. Randomized screws were then implanted into the tibias of healthy and osteoporotic female rats (G1: Control-Machined, G2: Hap, G3: HapSr10, G4: HapSr90). Osseointegration, assessed 60 days post-implantation, included reverse torque, fluorochrome area, bone tissue-screw contact area, and linear extent of bone-screw contact. Results, grouped by surface treatment (Machined, Hap, HapSr10, HapSr90), revealed that the deposition of Hap, HapSr10, and HapSr90 resulted in thin and rough coatings composed of hydroxyapatite (Hap) on the screw surface with nanoscale pores. The coatings resulted in increased wettability and surface energy of Ti surfaces. The minerals are chemically similar to natural bone apatite as revealed by FTIR analysis. In vivo analyses indicated higher torque values for strontium-containing surfaces in the osteoporotic group (p = 0.02) and, in the control group superior torque for screw removal on the Hap surface (p = 0.023). Hydroxyapatite-treated surfaces enhance morphology, composition, and reactivity, promoting screw osseointegration in healthy and osteoporotic female rats. The incorporation of strontium into the mineral phase has been proposed to not only stimulate osteoblast activity but also reduce osteoclastic resorption, which may explain the improved outcomes observed here in experimental osteoporotic conditions.

Copper Versatility in Hydroxyapatite: Valence States, Clusters, and Optical Absorption Properties

The solid-state reaction between a stoichiometric hydroxyapatite (HA) and CuO at temperatures above 1100 °C produces pure Cux-HA phases for x ≤ 0.7 with the general formula Ca10CuIx(PO4)6(OH)2-xOx. The Cu atoms are located at the center of the hexagonal tunnels between two hydroxyl ligands, as determined by Fourier analysis based on XRD data. During heat treatment, the reduction of Cu2+ ions into Cu+ is concomitant with the stabilization of copper in HA in the hexagonal tunnel. The incorporation of monovalent copper within the apatite, as revealed by XANES spectroscopy, explains the violet color of the samples. The incorporation of Cu+ ions, by substitution of a hydrogen atom by copper(I), results in the formation of linear O-Cu-O chains where the majority of which are isolated for x ≤ 0.3. In addition, the EXAFS investigation showed, thanks to the linear geometry of these clusters that results in multiple diffusion effects, the existence of [CuO]n chains with n ≥ 2, which only appear clearly for higher copper contents x ≥ 0.5. The strong covalency of the Cu-O bond in such a dumbbell configuration would lead to strong hybridization between the 3d and 4s orbitals of copper and the 2p orbitals of oxygen, as illustrated by ESR signals. In the case of Cu-doped HA prepared by coprecipitation and annealed at a lower temperature (T ≤ 600 °C), copper substitutes calcium according to the theoretical formula Ca10-xCux(PO4)6(OH)2, mainly at the Ca(2) site. This local environment is in line with the Jahn-Teller distortion induced by the Cu2+ ion (as evidenced by UV-vis-NIR, XPS, and XANES-EXAFS spectroscopy analyses) and also allows copper-copper interactions from one site to another, as observed by ESR spectroscopy. This versatility of copper in HA gives it optical properties that change from a violet color with near-IR absorption to a blue hue. In all cases, Cu-O-Cu interactions persist whatever the valence state, and heat treatment induces a redox phenomenon, with copper exchanging between two sites close to each other.

Dual-Mode Release of IL-4 and TCP from a PGA-SF Core-Shell Electrospinning Scaffold for Enhanced Bone Regeneration through Synergistic Immunoregulation and Osteogenesis

The successful filling of bone defects remains challenging due to the incongruity between bone graft materials and the dynamic process of bone healing. Developing multifunctional materials matching the dynamic process of bone healing offers a viable solution to the current dilemma. Lines of evidence have shown that engineering osteoimmunomodulatory biomaterials can modulate the function of immune cells and thus promote bone regeneration. Herein, we utilized silk fibroin (SF) and polyglycolic acid (PGA) to create a PGA-SF core-shell fibrous scaffold, incorporating interleukin-4 (IL-4) and tricalcium phosphate (TCP) as a codelivery system (PGA/TCP-SF/IL-4), aiming to achieve an initial rapid release of IL-4 and sustained release of TCP. The PGA/TCP-SF/IL-4 scaffold mimicked the native bone structure and showed superior tenacity in the wetting regime. In vitro studies demonstrated that the PGA/TCP-SF/IL-4 scaffold significantly reduced the inflammatory response by upregulating the M2 macrophages, created a favorable microenvironment for osteogenesis, and facilitated osteogenic differentiation and mineralization. Implantation of the PGA/TCP-SF/IL-4 scaffold into the rat skull defect model notably increased the formation of new bones. IL-4 and TCP acted synergistically in attenuating inflammation and enhancing osteogenic differentiation. Overall, this multifunctional scaffold comprehensively considers the various demands in the bone defect region, which might have a significant potential for application in bone reconstruction.

Dental Applications of Ion-Substituted Hydroxyapatite: A Review of the Literature

Hydroxyapatite (HA) forms an essential constituent of human teeth and bone. Its distinctive characteristic features, such as bioactivity and osteoconductivity, make it an ideal candidate to be used as an implant coating in restorative dentistry and maxillofacial surgery for bone regeneration. However, low fracture toughness and brittleness are a few of the inherent features of HA, which limit its application in load-bearing areas. The potential of HA to engage its lattice structure with either partial or complete substitution with external ions has become an increasing area of research as this phenomenon has the potential to enhance the biological and functional properties of the material. Consequently, this review aimed to highlight the role of various substituted ions in dental applications. Data indicate that the newly formed HA-substituted biomaterials demonstrate enhanced remineralization and antimicrobial activity along with improved hardness. Ion-substituted HA offers a promising strategy for future clinical research as these materials may be incorporated into various dental products for therapeutic treatments.

In Vitro Evaluation of Cellular Interactions with Nanostructured Spheres of Alginate and Zinc-Substituted Carbonated Hydroxyapatite

The increasing demand for effective bone regeneration materials drives the exploration of biomaterials with enhanced bioactivity and biocompatibility, such as zinc-substituted compounds. This study investigates the in vitro cellular interactions with nanostructured spheres composed of alginate/carbonated hydroxyapatite (CHA), compared to zinc-substituted CHA (ZnCHA). This work aimed to compare the physicochemical properties and biological effects of ZnCHA and CHA on osteoblasts. ZnCHA was synthesized using a wet chemical method, followed by characterization through X-ray diffraction, Fourier transform infrared spectroscopy, total organic carbon analysis, Wavelength-dispersive X-ray spectroscopy, and BET surface area analysis to assess ion release and structural changes. Biological evaluation was conducted using cell viability, proliferation, and biomineralization assays on osteoblasts. Results showed successful incorporation of zinc and carbonate, leading to reduced crystallinity and increased surface area. Cell viability and proliferation assays indicated ZnCHA's cytocompatibility and enhanced osteoblastic activity, with increased mineralization nodules compared to CHA samples. The study concludes that ZnCHA composites are promising candidates for bone tissue engineering, demonstrating improved cytocompatibility and potential for further preclinical evaluations.

Histomorphometric Study of Non-critical Bone Defect Repair after Implantation of Magnesium-substituted Hydroxyapatite Microspheres

Objective  The present study aims to analyze histomorphometrically the repair of a non-critical bone defect after implantation of hydroxyapatite (HA) microspheres substituted by magnesium (Mg). Methods  Thirty rats were distributed into 3 experimental groups, evaluated at 15 and 45 days postoperatively: HAG (bone defect filled with HA microspheres); HAMgG (bone defect filled with HA microspheres replaced with 1 mol% Mg), and CG (bone defect without implantation of biomaterials). Results  After 15 days, the biomaterials filled the entire defect extent, forming a new osteoid matrix between the microspheres. In the CG, this neoformation was restricted to the edges with the deposition of loose connective tissue with reduced thickness. At 45 days, new bone formation filled almost the entire extension of the bone defect in the 3 groups, with statistically significant osteoid deposition in the CG despite the reduced thickness compared with the HAG and HAMgG. The groups with biomaterial implantation displayed a more abundant osteoid matrix than at 15 days. Conclusion  The biomaterials studied showed biocompatibility, osteoconductivity, and bioactivity. The Mg concentration in the substituted HA did not stimulate more significant bone formation than HA without this ion.

From Tooth Adhesion to Bioadhesion: Development of Bioabsorbable Putty-like Artificial Bone with Adhesive to Bone Based on the New Material "Phosphorylated Pullulan"

Bioabsorbable materials have a wide range of applications, such as scaffolds for regenerative medicine and cell transplantation therapy and carriers for drug delivery systems. Therefore, although many researchers are conducting their research and development, few of them have been used in clinical practice. In addition, existing bioabsorbable materials cannot bind to the body's tissues. If bioabsorbable materials with an adhesive ability to biological tissues can be made, they can ensure the mixture remains fixed to the affected area when mixed with artificial bone or other materials. In addition, if the filling material in the bone defect is soft and uncured, resorption is rapid, which is advantageous for bone regeneration. In this paper, the development and process of a new bioabsorbable material "Phosphorylated pullulan" and its capability as a bone replacement material were demonstrated. Phosphorylated pullulan, which was developed based on the tooth adhesion theory, is the only bioabsorbable material able to adhere to bone and teeth. The phosphorylated pullulan and β-TCP mixture is a non-hardening putty. It is useful as a new resorbable bone replacement material with an adhesive ability for bone defects around implants.

Platelet-rich fibrin (PRF) modified nano-hydroxyapatite/chitosan/gelatin/alginate scaffolds increase adhesion and viability of human dental pulp stem cells (DPSC) and osteoblasts derived from DPSC

Bone tissue regeneration strategies have incorporated the use of natural polymers, such as hydroxyapatite (nHA), chitosan (CH), gelatin (GEL), or alginate (ALG). Additionally, platelet concentrates, such as platelet-rich fibrin (PRF) have been suggested to improve scaffold biocompatibility. This study aimed to develop scaffolds composed of nHA, GEL, and CH, with or without ALG and lyophilized PRF, to evaluate the scaffold's properties, growth factor release, and dental pulp stem cells (DPSC), and osteoblast (OB) derived from DPSC viability. Four scaffold variations were synthesized and lyophilized. Then, degradation, swelling profiles, and morphological analysis were performed. Furthermore, PDGF-BB and FGF-B growth factors release were quantified by ELISA, and cytotoxicity and cell viability were evaluated. The swelling and degradation profiles were similar in all scaffolds, with pore sizes ranging between 100 and 250 μm. FGF-B and PDGF-BB release was evidenced after 24 h of scaffold immersion in cell culture medium. DPSC and OB-DPSC viability was notably increased in PRF-supplemented scaffolds. The nHA-CH-GEL-PRF scaffold demonstrated optimal physical-biological characteristics for stimulating DPSC and OB-DPSC cell viability. These results suggest lyophilized PRF improves scaffold biocompatibility for bone tissue regeneration purposes.

Efficacy of sintered Zinc-doped fluorapatite scaffold as an antimicrobial regenerative bone filler for dental applications

OBJECTIVES

The objective of this study was to assess whether zinc-doped fluorapatite (ZnFA) could serve as an effective antimicrobial dental bone filler for bone regeneration compared to autografts.

METHODS

FA and 2 % zinc-doped FA (2ZnFA) were synthesized and characterized in-house. Compressed and sintered FA and 2ZnFA disks were incubated with bacteria to assess antimicrobial properties. Adipose-derived stem cells were cultured on these discs to evaluate the surfaces' ability to support cell growth and promote osteogenic differentiation. Surfaces exhibiting the highest expressions of the bone markers osteopontin and osteocalcin were selected for an in vivo study in a rat mandibular defect model. Twenty rats were divided into 5 groups, equally, and a 5 mm surgical defect of the jaw was left untreated or filled with 2ZnFA, FA, autograft, or demineralized bone matrix (DBM). At 12 weeks, the defects and surrounding tissues were harvested and subjected to microCT and histological evaluations.

RESULTS

Standard techniques such as FTIR, ICP-MS, fluoride probe, and XRD revealed the sintered FA and ZnFA's chemical compositions and structures. Bacterial studies revealed no significant differences in surface bacterial adhesion properties between FA and 2ZnFA, but significantly fewer bacterial loads than control titanium discs (p < 0.05). Cell culture data confirmed that both surfaces could support cell growth and promote the osteogenic differentiation of stem cells. MicroCT analysis confirmed statistical similarities in bone regeneration within FA, 2ZnFA, and autograft groups.

CONCLUSION

The data suggests that both FA and 2ZnFA could serve as alternatives to autograft materials, which are the current gold standard. Moreover, these bone fillers outperformed DBM, an allograft material commonly used as a dental bone void filler.

CLINICAL SIGNIFICANCE

The use of FA or 2ZnFA for treating mandibular defects led to bone regeneration statistically similar to autograft repair and significantly outperformed the widely used dental bone filler, DBM. Additional translational research may confirm FA-based materials as superior substitutes for existing synthetic bone fillers, ultimately enhancing patient outcomes.

The Incorporation of Zinc into Hydroxyapatite and Its Influence on the Cellular Response to Biomaterials: A Systematic Review

Zinc is known for its role in enhancing bone metabolism, cell proliferation, and tissue regeneration. Several studies proposed the incorporation of zinc into hydroxyapatite (HA) to produce biomaterials (ZnHA) that stimulate and accelerate bone healing. This systematic review aimed to understand the physicochemical characteristics of zinc-doped HA-based biomaterials and the evidence of their biological effects on osteoblastic cells. A comprehensive literature search was conducted from 2022 to 2024, covering all years of publications, in three databases (Web of Science, PUBMED, Scopus), retrieving 609 entries, with 36 articles included in the analysis according to the selection criteria. The selected studies provided data on the material's physicochemical properties, the methods of zinc incorporation, and the biological effects of ZnHA on bone cells. The production of ZnHA typically involves the wet chemical synthesis of HA and ZnHA precursors, followed by deposition on substrates using processes such as liquid precursor plasma spraying (LPPS). Characterization techniques confirmed the successful incorporation of zinc into the HA lattice. The findings indicated that zinc incorporation into HA at low concentrations is non-cytotoxic and beneficial for bone cells. ZnHA was found to stimulate cell proliferation, adhesion, and the production of osteogenic factors, thereby promoting in vitro mineralization. However, the optimal zinc concentration for the desired effects varied across studies, making it challenging to establish a standardized concentration. ZnHA materials are biocompatible and enhance osteoblast proliferation and differentiation. However, the mechanisms of zinc release and the ideal concentrations for optimal tissue regeneration require further investigation. Standardizing these parameters is essential for the effective clinical application of ZnHA.

Biological Surface Layer Formation on Bioceramic Particles for Protein Adsorption

In the biomedical fields of bone regenerative therapy, the immobilization of proteins on the bioceramic particles to maintain their highly ordered structures is significantly important. In this review, we comprehensively discussed the importance of the specific surface layer, which can be called "non-apatitic layer", affecting the immobilization of proteins on particles such as hydroxyapatite and amorphous silica. It was suggested that the water molecules and ions contained in the non-apatitic layer can determine and control the protein immobilization states. In amorphous silica particles, the direct interactions between proteins and silanol groups make it difficult to immobilize the proteins and maintain their highly ordered structures. Thus, the importance of the formation of a surface layer consisting of water molecules and ions (i.e., a non-apatitic layer) on the particle surfaces for immobilizing proteins and maintaining their highly ordered structures was suggested and described. In particular, chlorine-containing amorphous silica particles were also described, which can effectively form the surface layer of protein immobilization carriers. The design of the bio-interactive and bio-compatible surfaces for protein immobilization while maintaining the highly ordered structures will improve cell adhesion and tissue formation, thereby contributing to the construction of social infrastructures to support super-aged society.

Tooth acellular extrinsic fibre cementum incremental lines in humans are formed by parallel branched Sharpey's fibres and not by its mineral phase

In humans, the growth pattern of the acellular extrinsic fibre cementum (AEFC) has been useful to estimate the age-at-death. However, the structural organization behind such a pattern remains poorly understood. In this study tooth cementum from seven individuals from a Mexican modern skeletal series were analyzed with the aim of unveiling the AEFC collagenous and mineral structure using multimodal imaging approaches. The organization of collagen fibres was first determined using: light microscopy, transmission electron microscopy (TEM), electron tomography, and plasma FIB scanning electron microscopy (PFIB-SEM) tomography. The mineral properties were then investigated using: synchrotron small-angle X-ray scattering (SAXS) for T-parameter (correlation length between mineral particles); synchrotron X-ray diffraction (XRD) for L-parameter (mineral crystalline domain size estimation), alignment parameter (crystals preferred orientation) and lattice parameters a and c; as well as synchrotron X-ray fluorescence for spatial distribution of calcium, phosphorus and zinc. Results show that Sharpey's fibres branched out fibres that cover and uncover other collagen bundles forming aligned arched structures that are joined by these same fibres but in a parallel fashion. The parallel fibres are not set as a continuum on the same plane and when they are superimposed project the AEFC incremental lines due to the collagen birefringence. The orientation of the apatite crystallites is subject to the arrangement of the collagen fibres, and the obtained parameter values along with the elemental distribution maps, revealed this mineral tissue as relatively homogeneous. Therefore, no intrinsic characteristics of the mineral phase could be associated with the alternating AEFC incremental pattern.

Probing the influence of strontium doping and annealing temperature on the structure and biocompatibility of hydroxyapatite nanorods

Among numerous biologically important metal cations, strontium (Sr2+) has received much attention in bone tissue regeneration because of its osteoinductive properties combined with its ability to inhibit osteoclast activity. In this study, strontium-doped hydroxyapatite (Sr-HAp) nanorods with varying molar ratios of Ca : Sr (10 : 0, 9 : 1, 5 : 5, 3 : 7 and 0 : 10) were synthesized using the chemical precipitation technique. The synthesized Sr-HAp nanostructures were characterized using powder X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), transmission electron microscopy, energy dispersive X-ray spectroscopy, and Raman and Fourier transform infrared (FTIR) spectroscopies to understand their structural and morphological features, and composition. XRD results revealed the formation of HAp nanostructures, whose unit cell volume increased as a function of the dopant level. The reaction process investigation showed the formation of hydroxyapatite (HAp), strontium apatite (SAp) and various Sr-HAp phases. FESEM micrographs displayed the morphological transformation of Sr-HAp from nanorods to nanosheets upon increasing the dopant level. In the FTIR spectra, the bands of the PO43- group shifted towards a lower wavenumber upon increasing the dopant concentration in Sr-HAp that signifies the structural distortion due to the presence of a large amount of strontium ions. The peaks of PO43- and OH- vibrations in the Raman spectra were further analysed to corroborate the structural distortion of Sr-HAp. Selected area electron diffraction patterns obtained using TEM reveal the reduced crystallinity of Sr-HAp due to Sr-doping, which is in line with the XRD results. Finally, the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay showed that the synthesized Sr-HAp has no toxic effect on the survival and growth of mesenchymal stem cells. In summary, the synthesized novel Sr-HAp nanorods exhibit great promise for bone tissue engineering applications.

Enhanced Mechanical Properties, Corrosion Resistance, Cytocompatibility, Osteogenesis, and Antibacterial Performance of Biodegradable Mg-2Zn-0.5Ca-0.5Sr/Zr Alloys for Bone-Implant Application

Magnesium (Mg) alloys are widely used in bone fixation and bone repair as biodegradable bone-implant materials. However, their clinical application is limited due to their fast corrosion rate and poor mechanical stability. Here, the development of Mg-2Zn-0.5Ca-0.5Sr (MZCS) and Mg-2Zn-0.5Ca-0.5Zr (MZCZ) alloys with improved mechanical properties, corrosion resistance, cytocompatibility, osteogenesis performance, and antibacterial capability is reported. The hot-extruded (HE) MZCZ sample exhibits the highest ultimate tensile strength of 255.8 ± 2.4 MPa and the highest yield strength of 208.4 ± 2.8 MPa and an elongation of 15.7 ± 0.5%. The HE MZCS sample shows the highest corrosion resistance, with the lowest corrosion current density of 0.2 ± 0.1 µA cm-2 and the lowest corrosion rate of 4 ± 2 µm per year obtained from electrochemical testing, and a degradation rate of 368 µm per year and hydrogen evolution rate of 0.83 ± 0.03 mL cm-2 per day obtained from immersion testing. The MZCZ sample shows the highest cell viability in relation to MC3T3-E1 cells among all alloy extracts, indicating good cytocompatibility except at 25% concentration. Furthermore, the MZCZ alloy shows good antibacterial capability against Staphylococcus aureus.

Response of human peripheral blood monocyte-derived macrophages (PBMM) to demineralized and decellularized bovine bone graft substitutes

The performance of apparently biocompatible implanted bovine bone grafts may be compromised by unresolved chronic inflammation, and poor graft incorporation leading to implant failure. Monitoring the intensity and duration of the inflammatory response caused by implanted bone grafts is crucial. In this study, the ability of demineralized (DMB) and decellularized (DCC) bovine bone substitutes in initiating inflammatory responses to peripheral blood monocyte-derived macrophages (PBMMs) was investigated. The response of PBMMs to bone substitutes was evaluated by using both direct and indirect cell culture, reactive oxygen species (ROS) generation, apoptosis, immunophenotyping, and cytokine production. Analysis of DMB and DCC substitutes using scanning electron microscope (SEM) showed a roughened surface with a size ranging between 500 and 750 μm. PBMMs treated with DMB demonstrated cell aggregation and clumping mimicking lipopolysaccharide (LPS) treated PBMMs and a higher proliferation ability (166.93%) compared to control (100%) and DCC treatments (115.64%; p<0.001) at 24h. This was associated with a significantly increased production of intracellular ROS in PBMMs exposed to DMB substitutes than control (3158.5 vs 1715.5; p<0.001) and DCC treatment (2117.5). The bone substitute exposure also caused an increase in percentage apoptosis which was significantly (p<0.0001) higher in both DMB (27.85) and DCC (29.2) treatment than control (19.383). A significant increase in proinflammatory cytokine expression (TNF-α: 3.4 folds; p<0.05) was observed in DMB substitute-treated PBMMs compared to control. Notably, IL-1β mRNA was significantly higher in DMB (21.75 folds; p<0.0001) than control and DCC (5.01 folds). In contrast, DCC substitutes exhibited immunoregulatory effects on PBMMs, as indicated by the expression for CD86, CD206, and HLDR surface markers mimicking IL-4 treatments. In conclusion, DMB excites a higher immunological response compared to DCC suggesting decellularization process of tissues dampen down inflammatory reactions when exposed to PBMM.

Doxorubicin loaded cerium substituted hydroxyapatite nanoparticles: A promising new therapeutic approach for bone regeneration, doxorubicin delivery, and cancer treatment

The current study used the precipitation method to prepare pure calcium hydroxyapatite (HA) and cerium-substituted hydroxyapatite (Ce-HA) nanoparticles, where cerium ions were exchanged into the HA structure at different concentrations ranging from 3 to 7 wt%. X-ray powder diffraction (XRD), field emission scanning electron microscopy (FE-SEM), high resolution transmission electron microscopy (HR-TEM), Fourier transform infrared (FTIR) spectroscopy, Brunauer-Emmett-Teller (BET) surface area measurements, and zeta potential were used to examine the structural characteristics of the nanoparticles. Additionally, the antibacterial and antifungal effects of the produced materials on Gram-positive, Gram-negative, and fungal bacterial species were studied. Nanoparticles with cerium doping showed effective antibacterial and antifungal properties. All samples were tested for bioactivity in simulated body fluid (SBF), and the formation of an apatite layer on their surfaces was highlighted using SEM in conjunction with energy-dispersive X-rays (EDX).Doxorubicin (DOX) release from Ce-HA nanoparticles and pure HA was tested in phosphate-buffered saline (PBS) for up to 28 days. Both nanoparticles were able to release the drug while still being semi-fully loaded. Similarly, the cytotoxic effect of all produced samples on the MG-63 cell line was evaluated, and all samples showed good cytocompatibility. The cytotoxic effect of doxorubicin-loaded nanoparticles showed promising anticancer activity against bone cancer cells, especially samples with high cerium content. The resulting nanoparticles show excellent promising ability for the delivery of doxorubicin to bone cancer with the capacity for bone regeneration.

Enhancing osteoblast proliferation and bone regeneration by poly (amino acid)/selenium-doped hydroxyapatite

Among various biomaterials employed for bone repair, composites with good biocompatibility and osteogenic ability had received increasing attention from biomedical applications. In this study, we doped selenium (Se) into hydroxyapatite (Se-HA) by the precipitation method, and prepared different amounts of Se-HA-loaded poly (amino acid)/Se-HA (PAA/Se-HA) composites (0, 10 wt%, 20 wt%, 30 wt%) byin-situmelting polycondensation. The physical and chemical properties of PAA/Se-HA composites were characterized by x-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), scanning electron microscopy (SEM) and their mechanical properties. XRD and FT-IR results showed that PAA/Se-HA composites contained characteristic peaks of PAA and Se-HA with amide linkage and HA structures. DSC and TGA results specified the PAA/Se-HA30 composite crystallization, melting, and maximum weight loss temperatures at 203.33 °C, 162.54 °C, and 468.92 °C, respectively, which implied good thermal stability. SEM results showed that Se-HA was uniformly dispersed in PAA. The mechanical properties of PAA/Se-HA30 composites included bending, compressive, and yield strengths at 83.07 ± 0.57, 106.56 ± 0.46, and 99.17 ± 1.11 MPa, respectively. The cellular responses of PAA/Se-HA compositesin vitrowere studied using bone marrow mesenchymal stem cells (BMSCs) by cell counting kit-8 assay, and results showed that PAA/Se-HA30 composites significantly promoted the proliferation of BMSCs at the concentration of 2 mg ml-1. The alkaline phosphatase activity (ALP) and alizarin red staining results showed that the introduction of Se-HA into PAA enhanced ALP activity and formation of calcium nodule. Western blotting and Real-time polymerase chain reaction results showed that the introduction of Se-HA into PAA could promoted the expression of osteogenic-related proteins and mRNA (integrin-binding sialoprotein, osteopontin, runt-related transcription factor 2 and Osterix) in BMSCs. A muscle defect at the back and a bone defect at the femoral condyle of New Zealand white rabbits were introduced for evaluating the enhancement of bone regeneration of PAA and PAA/Se-HA30 composites. The implantation of muscle tissue revealed good biocompatibility of PAA and PAA/Se-HA30 composites. The implantation of bone defect showed that PAA/Se-HA30 composites enhanced bone formation at the defect site (8 weeks), exhibiting good bone conductivity. Therefore, the PAA-based composite was a promising candidate material for bone tissue regeneration.

Mechanical properties of simulated dentin caries treated with metal cations and L-ascorbic acid 2-phosphate

This pH cycling study aimed to investigate the effects of L-Ascorbic acid 2-phosphate (AA2P) salts of Mg, Zn, Mn, Sr, and Ba on the surface microhardness, compressive strength, diametral tensile strength (DTS), and solubility of root canal dentin. 186 cylindrical dentin specimens from 93 teeth were fortified with optimal concentrations of AA2P salts of Mg (0.18 mM), Zn (5.3 µM), Mn (2.2 × 10-8 M), Sr (1.8 µM), and Ba (1.9 µM). Saline was used as the control group. These dentin specimens underwent a 3-day cycling process simulating dentin caries formation through repeated sequences of demineralization and remineralization. Surface microhardness at 100 and 500 µm depths (n = 10/subgroup), scanning electron microscopy (n = 3/group), compressive strength (n = 10/group), DTS (n = 6/group), and solubility (n = 5/group) tests were performed to analyze the dentin specimens. Data were analyzed using Kolmogorov-Smirnov, one-way ANOVA, and Post Hoc Tukey tests (p < 0.05). The control group had significantly lower microhardness at both depths (p < 0.001), reduced DTS (p = 0.001), decreased compressive strength (p < 0.001), and higher weight loss (p < 0.001) than all other groups. The Sr group had the highest compressive strength and microhardness among all the groups. The microhardness was significantly higher for the 500 µm depth than the 100 µm depth (p < 0.001), but the difference in microhardness between depths across groups was not significant (p = 0.211). All fortifying solutions provided some protection against artificial caries lesions. Therefore, these elements might have penetrated and reinforced the demineralized dentin against acid dissolution.

Exploration of Whitlockite Nanostructures for Hemostatic Applications

Background Calcium magnesium phosphate (CMP)-based whitlockite is a promising biomaterial for hemostasis and regenerative applications. Regenerative approaches aim to advance tissue repair and recovery in different clinical scenarios. Whitlockite is a biocompatible and biodegradable mineral that has garnered impressive consideration for its interesting properties, making it an appealing candidate for therapeutic applications. Aim This study aimed to evaluate the hemostatic behavior of synthesized whitlockite nanoparticles. Materials and methods Coprecipitation and hydrothermal methods were used to synthesize whitlockite nanoparticles. Calcium nitrate, magnesium nitrate, and diammonium hydrogen phosphate were used as precursors to prepare this material. Results Crystalline phases of whitlockite (Ca3Mg)3(PO4) and calcium magnesium phosphate Ca7Mg2P6O2 were observed through X-ray diffraction (XRD) patterns, along with relevant properties of the phosphate functional group detected through Raman spectra. This study explores the hemostatic adequacy of CMP-based whitlockite using different methodologies. The capacity of the materials to actuate platelet conglomeration and encourage clot arrangement is assessed using in vitro experiments. Moreover, this study investigates the regenerative potential of CMP-based whitlockite in tissue-building applications. Conclusion The structural and morphological parameters provide crucial insights into the proper formation of the material, and the hemoclot assessment aids in understanding its coagulation behavior. Future investigations and clinical trials will be instrumental in fully harnessing the potential of CMP-based whitlockite for advancing hemostasis and regenerative medicine.

Incorporating strontium enriched amorphous calcium phosphate granules in collagen/collagen-magnesium-hydroxyapatite osteochondral scaffolds improves subchondral bone repair

Osteochondral defect repair with a collagen/collagen-magnesium-hydroxyapatite (Col/Col-Mg-HAp) scaffold has demonstrated good clinical results. However, subchondral bone repair remained suboptimal, potentially leading to damage to the regenerated overlying neocartilage. This study aimed to improve the bone repair potential of this scaffold by incorporating newly developed strontium (Sr) ion enriched amorphous calcium phosphate (Sr-ACP) granules (100-150 μm). Sr concentration of Sr-ACP was determined with ICP-MS at 2.49 ± 0.04 wt%. Then 30 wt% ACP or Sr-ACP granules were integrated into the scaffold prototypes. The ACP or Sr-ACP granules were well embedded and distributed in the collagen matrix demonstrated by micro-CT and scanning electron microscopy/energy dispersive x-ray spectrometry. Good cytocompatibility of ACP/Sr-ACP granules and ACP/Sr-ACP enriched scaffolds was confirmed with in vitro cytotoxicity assays. An overall promising early tissue response and good biocompatibility of ACP and Sr-ACP enriched scaffolds were demonstrated in a subcutaneous mouse model. In a goat osteochondral defect model, significantly more bone was observed at 6 months with the treatment of Sr-ACP enriched scaffolds compared to scaffold-only, in particular in the weight-bearing femoral condyle subchondral bone defect. Overall, the incorporation of osteogenic Sr-ACP granules in Col/Col-Mg-HAp scaffolds showed to be a feasible and promising strategy to improve subchondral bone repair.

Polyelectrolyte-Cation Complexes Using PAsp-Sr Complexes Induce Biomimetic Mineralization with Antibacterial Ability

Remineralized dentin with an antibacterial ability is still a significant challenge in dentistry. Previously, a polyelectrolyte-calcium complexes pre-precursor (PCCP) process is proposed for rapid collagen mineralization. In the present study, the expansion concept of the PCCP process is explored by replacing the calcium with other cations, such as strontium. The results of transmission electron microscopy (TEM), 3D stochastic optical reconstruction microscopy, energy-dispersive X-ray analysis, Fourier transform infrared spectroscopy, and high-resolution TEM with selected area electron diffraction demonstrate that biomimetic mineralization of collagen fibrils and demineralized dentin could be fulfilled with Sr&F-codoped hydroxyapatite (HAp) after they are treated with poly-aspartic acid-strontium (PAsp-Sr) suspension followed by a phosphate&fluoride solution. Moreover, dentin remineralized with Sr&F-codoped HAp exhibits in vitro and in vivo antibacterial ability against Streptococcus mutans. The cytotoxicity and oral mucosa irritation tests reveal excellent biocompatibility of mineralization mediums (PAsp-Sr suspension and phosphate&fluoride solution). The demineralized dentin's mechanical properties (elastic modulus and microhardness) could be restored almost to that of the intact dentin. Hence, the expansion concept of the PCCP process that replaces calcium ions with some cationic ions along with fluorine opens up new horizons for generating antibacterial remineralized dentin containing ions-doped HAp with excellent biocompatibility via biomimetic mineralization technology.

A Porous Fluoride-Substituted Bovine-Derived Hydroxyapatite Scaffold Constructed for Applications in Bone Tissue Regeneration

Hydroxyapatite is widely used in bone implantation because of its similar mineral composition to natural bone, allowing it to serve as a biocompatible osteoconductive support. A bovine-derived hydroxyapatite (BHA) scaffold was developed through an array of defatting and deproteinization procedures. The BHA scaffold was substituted with fluoride ions using a modified sol-gel method to produce a bovine-derived fluorapatite (BFA) scaffold. Fourier-transform infrared spectroscopy and X-ray diffraction analysis showed that fluoride ions were successfully substituted into the BHA lattice. According to energy dispersive X-ray analysis, the main inorganic phases contained calcium and phosphorus with a fluoride ratio of ~1-2 wt%. Scanning electron microscopy presented a natural microporous architecture for the BFA scaffold with pore sizes ranging from ~200-600 μm. The BHA scaffold was chemically stable and showed sustained degradation in simulated-body fluid. Young's modulus and yield strength were superior in the BFA scaffold to BHA. In vitro cell culture studies showed that the BFA was biocompatible, supporting the proliferative growth of Saos-2 osteoblast cells and exhibiting osteoinductive features. This unique technique of producing hydroxyapatite from bovine bone with the intent of producing high performance biomedically targeted materials could be used to improve bone repair.

Biological Properties and Medical Applications of Carbonate Apatite: A Systematic Review

Bone defects represent an everyday challenge for clinicians who work in the fields of orthopedic surgery, maxillofacial and oral surgery, otorhinolaryngology, and dental implantology. Various bone substitutes have been developed and utilized, according to the needs of bone reconstructive surgery. Carbonate apatite has gained popularity in recent years, due to its excellent tissue behavior and osteoconductive potential. This systematic review aims to evaluate the role of carbonate apatite in bone reconstructive surgery and tissue engineering, analyze its advantages and limitations, and suggest further directions for research and development. The Web of Science, PubMed, and Scopus electronic databases were searched for relevant review articles, published from January 2014 to 21 July 2023. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eighteen studies were included in the present review. The biological properties and medical applications of carbonate apatite (CO3Ap) are discussed and evaluated. The majority of articles demonstrated that CO3Ap has excellent biocompatibility, resorbability, and osteoconductivity. Furthermore, it resembles bone tissue and causes minimal immunological reactions. Therefore, it may be successfully utilized in various medical applications, such as bone substitution, scaffolding, implant coating, drug delivery, and tissue engineering.

Sintered fluorapatite scaffolds as an autograft-like engineered bone graft

Hydroxyapatite (HA)-based materials are widely used as bone substitutes due to their inherent biocompatibility, osteoconductivity, and bio-absorption properties. However, HA scaffolds lack compressive strength when compared to autograft bone. It has been shown that the fluoridated form of HA, fluorapatite (FA), can be sintered to obtain this desired strength as well as slower degradation properties. Also, FA surfaces have been previously shown to promote stem cell differentiation toward an osteogenic lineage. Thus, it was hypothesized that FA, with and without stromal vascular fraction (SVF), would guide bone healing to an equal or better extent than the clinical gold standard. The regenerative potentials of these scaffolds were tested in 32 Lewis rats in a femoral condylar defect model with untreated (negative), isograft (positive), and commercial HA as controls. Animals were survived for 12 weeks post-implantation. A semi-quantitative micro-CT analysis was developed to quantify the percent new bone formation within the defects. Our model showed significantly higher (p < .05) new bone depositions in all apatite groups compared to the autograft group. Overall, the FA group had the most significant new bone deposition, while the differences between HA, FA, and FA + SVF were insignificant (p > .05). Histological observations supported the micro-CT findings and highlighted the presence of healthy bone tissues without interposing capsules or intense immune responses for FA groups. Most importantly, the regenerating bone tissue within the FA + SVF scaffolds resembled the architecture of the surrounding trabecular bone, showing intertrabecular spaces, while the FA group presented a denser cortical bone-like architecture. Also, a lower density of cells was observed near FA granules compared to HA surfaces, suggesting a reduced immune response. This first in vivo rat study supported the tested hypothesis, illustrating the utility of FA as a bone scaffold material.

Research progress of vascularization strategies of tissue-engineered bone

The bone defect caused by fracture, bone tumor, infection, and other causes is not only a problematic point in clinical treatment but also one of the hot issues in current research. The development of bone tissue engineering provides a new way to repair bone defects. Many animal experimental and rising clinical application studies have shown their excellent application prospects. The construction of rapid vascularization of tissue-engineered bone is the main bottleneck and critical factor in repairing bone defects. The rapid establishment of vascular networks early after biomaterial implantation can provide sufficient nutrients and transport metabolites. If the slow formation of the local vascular network results in a lack of blood supply, the osteogenesis process will be delayed or even unable to form new bone. The researchers modified the scaffold material by changing the physical and chemical properties of the scaffold material, loading the growth factor sustained release system, and combining it with trace elements so that it can promote early angiogenesis in the process of induced bone regeneration, which is beneficial to the whole process of bone regeneration. This article reviews the local vascular microenvironment in the process of bone defect repair and the current methods of improving scaffold materials and promoting vascularization.

Biomimetic Scaffolds Based on Mn2+-, Mg2+-, and Sr2+-Substituted Calcium Phosphates Derived from Natural Sources and Polycaprolactone

The occurrence of bone disorders is steadily increasing worldwide. Bone tissue engineering (BTE) has emerged as a promising alternative to conventional treatments of bone defects, developing bone scaffolds capable of promoting bone regeneration. In this research, biomimetic scaffolds based on ion-substituted calcium phosphates, derived from cuttlefish bone, were prepared using a hydrothermal method. To synthesize Mn2+-substituted scaffolds, three different manganese concentrations (corresponding to 1, 2.5, and 5 mol% Mn substitutions for Ca into hydroxyapatite) were used. Also, syntheses with the simultaneous addition of an equimolar amount (1 mol%) of two (Mg2+ and Sr2+) or three ions (Mn2+, Mg2+, and Sr2+) were performed. A chemical, structural, and morphological characterization was carried out using X-ray diffraction, Fourier transform infrared spectroscopy, and scanning electron microscopy. The effects of the ion substitutions on the lattice parameters, crystallite sizes, and fractions of the detected phases were discussed. Multi-substituted (Mn2+, Mg2+, and Sr2+) scaffolds were coated with polycaprolactone (PCL) using simple vacuum impregnation. The differentiation of human mesenchymal stem cells (hMSCs), cultured on the PCL-coated scaffold, was evaluated using histology, immunohistochemistry, and reverse transcription-quantitative polymerase chain reaction analyses. The expression of collagen I, alkaline phosphatase, and dentin matrix protein 1 was detected. The influence of PCL coating on hMSCs behavior is discussed.

Physicochemical Properties and Simulation of Magnesium/Zinc Binary-Substituted Hydroxyapatite with Enhanced Biocompatibility and Antibacterial Ability

Ionic substitution can effectively activate the surface of hydroxyapatite (HA) for bone repair and regeneration processes. Therefore in this study, magnesium (Mg)-, zinc (Zn)-, and Mg/Zn-codoped HA was prepared by a hydrothermal method. The results of experimental and first-principles calculations verify the existence of Mg and Zn ions in the HA structure by altering cell parameters, crystallinity, and particle size. The results also showed that Mg and Zn are actively accommodated at the Ca(1) and Ca(2) positions, which not only inhibit HA formation but also promote calcium-deficient HA, and when the codoping content increased to 10%Mg and 10%Zn, the HA transformed completely to the whitlockite phase. Furthermore, the impact of codoping on biocompatibility was examined by employing MC3T3 cells. The in vitro study revealed that 5%Mg and 5%Zn single and -codoped HA promoted the proliferation of MC3T3 cells and 5%Mg-doped and -codoped HA stimulated MC3T3 cell differentiation, while 5%Zn-doped and -codoped HA revealed worthy antibacterial properties. Overall, the obtained results demonstrate that cosubstituted HA (5%Mg and 5%Zn) is promising, which not only eradicates bacteria (Escherichia coli and Staphylococcus aureus) but also induces bone regeneration. These findings suggest that 5%Mg and 5%Zn binary-substituted HA is a very promising biomaterial for hard tissue scaffolds and bone repair.

The Use of Nano-Hydroxyapatite (NH) for Socket Preservation: Communication of an Upcoming Multicenter Study with the Presentation of a Pilot Case Report

Background and Objectives: The use of biomaterials in dentistry is extremely common. From a commercial perspective, different types of osteoconductive and osteoinductive biomaterials are available to clinicians. In the field of osteoconductive materials, clinicians have biomaterials made of heterologous bones at their disposal, including biomaterials of bovine, porcine, and equine origins, and biomaterials of natural origin, such as corals and hydroxyapatites. In recent years, it has become possible to synthesize nano-Ha and produce scaffolds using digital information. Although a large variety of biomaterials has been produced, there is no scientific evidence that proves their absolute indispensability in terms of the preservation of postextraction sites or in the execution of guided bone regeneration. While there is no scientific evidence showing that one material is better than another, there is evidence suggesting that several products have better in situ permanence. This article describes a preliminary study to evaluate the histological results, ISQ values, and prevalence of nano-HA. Materials and Methods: In this study, we planned to use a new biomaterial based on nanohydroxyapatite for implantation at one postextraction site; the nano-HA in this study was NuvaBONE (Overmed, Buccinasco, Milano, Italy). This is a synthetic bone graft substitute that is based on nanostructured biomimetic hydroxyapatite for application in oral-maxillofacial surgery, orthopedics, traumatology, spine surgery, and neurosurgery. In our pilot case, a patient with a hopeless tooth underwent extraction, and the large defect remaining after the removal of the tooth was filled with nano-HA to restore the volume. Twelve months later, the patient was booked for implant surgery to replace the missing tooth. At the time of the surgery, a biopsy of the regenerated tissue was taken using a trephine of 4 mm in the inner side and 8 mm deep. Results: The histological results of the biopsy showed abundant bone formation, high values of ISQ increasing from the insertion to the prosthetic phase, and a good reorganization of hydroxyapatite granules during resorption. The implant is in good function, and the replaced tooth shows good esthetics. Conclusions: The good results of this pilot case indicate starting the next Multicentric study to have more and clearer information about this nanohydroxyapatite (NH) compared with control sites.

Guided Bone Regeneration Using Barrier Membrane in Dental Applications

Guided bone regeneration (GBR) is a widely used technique in preclinical and clinical studies due to its predictability. Its main purpose is to prevent the migration of soft tissue into the osseous wound space, while allowing osseous cells to migrate to the site. GBR is classified into two main categories: resorbable and non-resorbable membranes. Resorbable membranes do not require a second surgery but tend to have a short resorption period. Conversely, non-resorbable membranes maintain their mechanical strength and prevent collapse. However, they require removal and are susceptible to membrane exposure. GBR is often used with bone substitute graft materials to fill the defect space and protect the bone graft. The membrane can also undergo various modifications, such as surface modification and biological factor loading, to improve barrier functions and bone regeneration. In addition, bone regeneration is largely related to osteoimmunology, a new field that focuses on the interactions between bone and the immune system. Understanding these interactions can help in developing new treatments for bone diseases and injuries. Overall, GBR has the potential to be a powerful tool in promoting bone regeneration. Further research in this area could lead to advancements in the field of bone healing. This review will highlight resorbable and non-resorbable membranes with cellular responses during bone regeneration, provide insights into immunological response during bone remodeling, and discuss antibacterial features.

Remineralization Induced by Biomimetic Hydroxyapatite Toothpastes on Human Enamel

This work aimed to compare the effect of four new toothpastes (P1-P4) based on pure and biomimetic substituted nano-hydroxyapatites (HAPs) on remineralization of human enamel. Artificially demineralized enamel slices were daily treated for ten days with different toothpastes according to the experimental design. Tooth enamel surfaces were investigated using atomic force microscope (AFM) images and surface roughness (Ra) determined before and after treatment. The surface roughness of enamel slices was statistically analyzed by one-way ANOVA and Bonferroni's multiple comparison test. X-ray diffraction (XRD) and Fourier transform infrared (FTIR) data revealed the HAP structure with crystal sizes between 28 and 33 nm and crystallinity between 29 and 37%. The average size of HAP particles was found to be between 30 and 40 nm. The Ra values indicated that P3 (HAP-Mg-Zn-Sr-Si) toothpaste was the most effective after 10 days of treatment, leading to the lowest mean roughness. The P3 and P2 (HAP) toothpastes were found to be effective in promoting remineralization. Specifically, their effectiveness can be ranked as follows: P3 = P2 > P4 (HAP-Mg-Zn-Si) > P1 (HAP-Zn), considering both the chemical composition and the size of their constitutive nanoparticles. The proposed toothpastes might be used successfully to treat early tooth decay.

Microporous Hydroxyapatite-Based Ceramics Alter the Physiology of Endothelial Cells through Physical and Chemical Cues

Incorporation of silicate ions in calcium phosphate ceramics (CPC) and modification of their multiscale architecture are two strategies for improving the vascularization of scaffolds for bone regenerative medicine. The response of endothelial cells, actors for vascularization, to the chemical and physical cues of biomaterial surfaces is little documented, although essential. We aimed to characterize in vitro the response of an endothelial cell line, C166, cultivated on the surface CPCs varying either in terms of their chemistry (pure versus silicon-doped HA) or their microstructure (dense versus microporous). Adhesion, metabolic activity, and proliferation were significantly altered on microporous ceramics, but the secretion of the pro-angiogenic VEGF-A increased from 262 to 386 pg/mL on porous compared to dense silicon-doped HA ceramics after 168 h. A tubulogenesis assay was set up directly on the ceramics. Two configurations were designed for discriminating the influence of the chemistry from that of the surface physical properties. The formation of tubule-like structures was qualitatively more frequent on dense ceramics. Microporous ceramics induced calcium depletion in the culture medium (from 2 down to 0.5 mmol/L), which is deleterious for C166. Importantly, this effect might be associated with the in vitro static cell culture. No influence of silicon doping of HA on C166 behavior was detected.

Research Hotspots and Trends of Bone Xenograft in Clinical Procedures: A Bibliometric and Visual Analysis of the Past Decade

BACKGROUND

Bone defect therapy is a common clinical challenge for orthopedic and clinical physicians worldwide, and the therapeutic effect affects the physiological function and healthy life quality of millions of patients. Compared with traditional autogenous bone transplants, bone xenografts are attracting attention due to their advantages of unlimited availability and avoidance of secondary damage. However, there is currently a lack of bibliometric analysis on bone xenograft. This study aimed to use bibliometric methods to analyze the literature on bone xenograft from 2013 to 2023, to explore the current status, hotspots, and future trends of research in this field, and to promote its development and progress.

METHODS

Using the Web of Science Core Collection database, we retrieved and collected publication data related to xenogeneic bone grafting materials worldwide from January 2013 to March 2023. Origin (2021), CiteSpace (6.2.R2 standard), and an online bibliometric platform were used for bibliometric analysis and data visualization.

RESULTS

A total of 3395 documents were retrieved, and 686 eligible papers were selected. The country and institutions with the highest number of publications and centrality were the United States (125 papers, centrality = 0.44) and the University of Zurich (29 papers, centrality = 0.28), respectively. The most cited author was Araujo MG (163 times), and the author with the most significant centrality was Froum SJ (centrality = 0.09). The main keyword clusters were "tissue engineering", "sinus floor elevation", "dental implants", "tooth extraction", and "bone substitutes". The most significant bursting keywords in the last three years were "platelet rich fibrin".

CONCLUSIONS

Research on bone xenograft is steadily growing and will continue to rise. Currently, research hotspots and directions are mainly focused on dental implants related to bone-augmentation techniques and bone tissue engineering. In the future, research hotspots and directions may focus on decellularization technology and investigations involving platelet-rich fibrin.

α-Tricalcium phosphate cement reinforced with silk fibroin: A high strength biomimetic bone cement with chloride-substituted hydroxyapatite

In the past decades, bone defects have become an increasing factor in the development of disability in patients, impacting their quality of life. Large bone defects have minor chances to self-repair, requiring surgical intervention. Therefore, α-TCP-based cements are rigorously studied for the development of bone filling and replacement applications due to the possibility of application in minimally invasive procedures. However, α-TCP-based cements do not present adequate mechanical properties for most orthopedic applications. The aim of this study is to develop a biomimetic α-TCP cement reinforced with 0.250-1.000 wt% of silk fibroin using non-dialyzed SF solutions. Samples with SF additions higher than 0.250 wt% presented complete transformation of the α-TCP to a biphasic CDHA/HAp-Cl material, which could enhance the osteoconductivity of the material. Samples reinforced with concentrations of 0.500 wt% SF showed an increase of 450% of the fracture toughness and 182% of the compressive strength of the control sample, even with 31.09% porosity, which demonstrates good coupling between the SF and the CPs. All samples reinforced with SF showed a microstructure with smaller needle-like crystals when compared to the control sample, which possibly contributed to the material's reinforcement. Moreover, the composition of reinforced samples did not affect the cytotoxicity of the CPCs and enhanced the cell viability presented by the CPC without SF addition. Hence, biomimetic CPCs with mechanical reinforcement through the addition of SF were successfully obtained through the developed methodology, with the potential to be further evaluated as a suitable material for bone regeneration.

From Synthesis to Clinical Trial: Novel Bioinductive Calcium Deficient HA/β-TCP Bone Grafting Nanomaterial

Maxillary sinus augmentation is a commonly used procedure for the placement of dental implants. However, the use of natural and synthetic materials in this procedure has resulted in postoperative complications ranging from 12% to 38%. To address this issue, we developed a novel calcium deficient HA/β-TCP bone grafting nanomaterial using a two-step synthesis method with appropriate structural and chemical parameters for sinus lifting applications. We demonstrated that our nanomaterial exhibits high biocompatibility, enhances cell proliferation, and stimulates collagen expression. Furthermore, the degradation of β-TCP in our nanomaterial promotes blood clot formation, which supports cell aggregation and new bone growth. In a clinical trial involving eight cases, we observed the formation of compact bone tissue 8 months after the operation, allowing for the successful installation of dental implants without any early postoperative complications. Our results suggest that our novel bone grafting nanomaterial has the potential to improve the success rate of maxillary sinus augmentation procedures.

Manufacturing methods, properties, and potential applications in bone tissue regeneration of hydroxyapatite-chitosan biocomposites: A review

Hydroxyapatite (HA) and chitosan (CS) biopolymer are the major materials investigated for biomedical purposes. Both of these components play an important role in the orthopedic field as bone substitutes or drug release systems. Used separately, the hydroxyapatite is quite fragile, while CS mechanical strength is very weak. Therefore, a combination of HA and CS polymer is used, which provides excellent mechanical performance with high biocompatibility and biomimetic capacity. Moreover, the porous structure and reactivity of the hydroxyapatite-chitosan (HA-CS) composite allow their application not only as a bone repair but also as a drug delivery system providing controlled drug release directly to the bone site. These features make biomimetic HA-CS composite a subject of interest for many researchers. Through this review, we provide the important recent achievements in the development of HA-CS composites, focusing on manufacturing techniques, conventional and novel three-dimensional bioprinting technology, and physicochemical and biological properties. The drug delivery properties and the most relevant biomedical applications of the HA-CS composite scaffolds are also presented. Finally, alternative approaches are proposed to develop HA composites with the aim to improve their physicochemical, mechanical, and biological properties.

Advanced applications of strontium-containing biomaterials in bone tissue engineering

Strontium (Sr) and strontium ranelate (SR) are commonly used therapeutic drugs for patients suffering from osteoporosis. Researches have showed that Sr can significantly improve the biological activity and physicochemical properties of materials in vitro and in vivo. Therefore, a large number of strontium containing biomaterials have been developed for repairing bone defects and promoting osseointegration. In this review, we provide a comprehensive overview of Sr-containing biomaterials along with the current state of their clinical use. For this purpose, the different types of biomaterials including calcium phosphate, bioactive glass, and polymers are discussed and provided future outlook on the fabrication of the next-generation multifunctional and smart biomaterials.

Investigation of Surface Layers on Biological and Synthetic Hydroxyapatites Based on Bone Mineralization Process

In this review, the current status of the influence of added ions (i.e., SiO₄^4-, CO₃^2-, etc.) and surface states (i.e., hydrated and non-apatite layers) on the biocompatibility nature of hydroxyapatite (HA, Ca₁₀(PO₄)₆(OH)₂) is discussed. It is well known that HA is a type of calcium phosphate with high biocompatibility that is present in biological hard tissues such as bones and enamel. This biomedical material has been extensively studied due to its osteogenic properties. The chemical composition and crystalline structure of HA change depending on the synthetic method and the addition of other ions, thereby affecting the surface properties related to biocompatibility. This review illustrates the structural and surface properties of HA substituted with ions such as silicate, carbonate, and other elemental ions. The importance of the surface characteristics of HA and its components, the hydration layers, and the non-apatite layers for the effective control of biomedical function, as well as their relationship at the interface to improve biocompatibility, has been highlighted. Since the interfacial properties will affect protein adsorption and cell adhesion, the analysis of their properties may provide ideas for effective bone formation and regeneration mechanisms.

The biological functions of europium-containing biomaterials: A systematic review

The biological functions of rare-earth elements (REEs) have become a focus of intense research. Recent studies have demonstrated that ion doping or alloying of some REEs can optimize the properties of traditional biomaterials. Europium (Eu), which is an REE with low toxicity and good biocompatibility, has promising applications in biomedicine. This article systematically reviews the osteogenic, angiogenic, neuritogenic, antibacterial, and anti-tumor properties of Eu-containing biomaterials, thereby paving the way for biomedical applications of Eu. Data collection for this review was completed in October 2022, and 30 relevant articles were finally included. Most articles indicated that doping of Eu ions or Eu-compound nanoparticles in biomaterials can improve their osteogenic, angiogenic, neuritogenic, antibacterial, and anti-tumor properties. The angiogenic, antibacterial, and potential neuritogenic effects of Eu(OH)₃ nanoparticles have also been demonstrated.

Effect of Alleviating Fibrosis with EGCG-Modified Bone Graft in Murine Model Depended on Less Accumulation of Inflammatory Macrophage

In response to current trends in the modification of guided bone regeneration (GBR) materials, we aimed to build upon our previous studies on epigallocatechin-3-gallate (EGCG) by immersing a commonly used bone graft primarily composed of hydroxyapatite (HA) in EGCG solution, expecting to obtain superior bone material integration after implantation. Bone grafts are commonly used for bone repair, in which the bone extracellular matrix is stimulated to promote osteogenesis. However, due to its profibrosis effect, this osteoconductive material commonly exhibits implant failure. In addition to providing a basic release profile of EGCG-modified bone graft (E-HA) to clarify the relationship between this material and the environment, we have examined the integration effect via subcutaneous implantation experiments. In this manner, we have assessed the aggregation of proinflammatory macrophages, the formation of fibrous capsules, and an enhanced cell viability observed in cultured RAW 264.7 cells. Among these results, we focus on proinflammatory macrophages due to their close relationship with fibrosis, which is the most important process in the immune response. Immunofluorescent staining results showed that E-HA substantially compromised the formation of fibrous capsules in hematoxylin-eosin-stained sections, which exhibited less proinflammatory macrophage recruitment; meanwhile, the cell viability was improved. This work lays the foundation for future studies on GBR.

Embryotoxicity and visual-motor response of functionalized nanostructured hydroxyapatite-based biomaterials in zebrafish (Danio rerio)

Hydroxyapatite (HA) is a biomaterial widely used in biomedical applications. Many studies have shown that ionic substituents can be incorporated into HA to produce a mineral composition more similar to natural bone tissue with more favorable biological characteristics for application in bone regeneration. However, its potentially toxic effects need to be evaluated before full approval for human use. For this purpose, an embryotoxicity test was performed on zebrafish according to OECD guideline 236. Zebrafish embryos were exposed to 1 or 3 microspheres of alginate containing nanoparticles of HA and carbonate (CHA), strontium (SrHA), and zinc-substituted HA (ZnHA) from 4 to 120 h post-fertilization (hpf). Lethality and developmental endpoints were evaluated. In addition, larval behavior at 168 hpf was also analyzed to observe whether biomaterials adversely affect optomotor and avoidance responses (neurotoxicity), as well as the oxidative stress pattern through qPCR. After 120 h exposure to all microspheres with different patterns of crystallinity, porosity, nanoparticle size, surface area, and degradation behavior, there was no mortality rate greater than 20%, indicating the non-embryotoxic character of these biomaterials. All experimental groups showed positive optomotor and avoidance responses, which means that embryo exposure to the tested biomaterials had no neurotoxic effects. Furthermore, larvae exposed to one SrHA microsphere showed a better optomotor response than the control. Furthermore, the biomaterials did not change the pattern of mRNA levels of genes related to oxidative stress even after 120 hpf. The growing number of new HA-based biomaterials produced should be accompanied by increased studies to understand the biosafety of these compounds, especially in alternative models, such as zebrafish embryos. These results reinforce our hypothesis that ion-substituted HA biomaterials do not impose toxicological effects, cause development and neuromotor impairment, or increase oxidative stress in zebrafish embryos being useful for medical devices and in the process of bone regeneration.

Metal-polyphenol network coated magnetic hydroxyapatite for pH-activated MR imaging and drug delivery

Engineered nanoparticles responsive to tumor microenvironment parameters such as pH have been developed as drug carriers and for magnetic resonance imaging (MRI) as contrast agents (CA). Nanoscale hydroxyapatite (HAP) has good biocompatibility and specific inhibition of tumor cells. However, the inherent tendency of nanoscale HAP to agglomerate and degrade under natural conditions has hindered its further application. To address this challenge, polyacrylic acid-coordinated Mn²⁺ and F^- co-doped nanoscale HAP (Mn_xFHA-PAA) were developed for MRI and doxorubicin (DOX) loading. Moreover, the metal-polyphenol network (MPN) formed by ligating tannic acid (TA) and Fe³⁺ was successfully functionalized onto the surface of Mn_xFHA-PAA-DOX. The pH-sensitive MPN improves biocompatibility and therapeutic efficacy while preventing the premature release of DOX in a neutral environment. It was demonstrated that the mesoporous structure of Mn_xFHA-PAA@TA-Fe nanoparticles with good dispersion, high specific surface area and large pore size, which can reach more than 90 % encapsulation efficiency (EE) for DOX. Mn_xFHA-PAA-DOX@TA-Fe degrades at low pH and releases Mn²⁺ and DOX that are confined in the nanoparticles. Binding of Mn²⁺ to proteins leads to increased relaxation and enhanced MRI contrast. Such nanoparticles with sensitive pH responsiveness have great potential for tumor diagnosis and therapeutic synergy.