Crystal dissolution of biological and ceramic apatites

Chitosan as a Templating Agent of Calcium Phosphate Crystalline Phases in Biomimetic Mineralization: Theoretical and Experimental Studies

Highlighting the essential role of chitosan (CS), known for its biocompatibility, biodegradability, and ability to promote cell adhesion and proliferation, this study explores its utility in modulating the biomimetic mineralization of calcium phosphate (CaP). This approach holds promise for developing biomaterials suitable for bone regeneration. However, the interactions between the CS surface and in situ precipitated CaP still require further exploration. In the theoretical section, molecular dynamics (MD) simulations demonstrate that, at an appropriate pH level during the prenucleation stage, calcium ions (Ca2+) and hydrogen phosphate ions (HPO42-) form Posner-like clusters. Additionally, the interaction between these clusters and the CS molecule enhances system stability. Together, these phenomena facilitate the transition to subsequent heterogeneous nucleation on the surface of the organic matrix, which is a more controlled process than homogeneous nucleation in solution. Dynamic simulation results suggest that CS acts as a stabilizing matrix at pH 8.0 during biomimetic mineralization. In the experimental section, the effects of pH and the molecular weight of CS were investigated, with a focus on their impact on the crystal structure of the resulting material. X-ray diffraction and scanning electron microscopy analyses reveal that, under conditions of approximately pH 8.0 and a CS molecular weight of 20 000 g/mol, and controlled ion concentration, ultrasound radiation, and temperature, the dominant CaP phases in the material are carbonate-doped hydroxyapatite (CHA) and octacalcium phosphate (OCP). These findings suggest that CS, when adjusted for molecular weight and pH, facilitates the formation of CaP crystal phases that closely resemble the natural inorganic composition of bone, highlighting its protective and regulatory roles in the growth and maturation of crystals during mineralization. The theoretical predictions and experimental outcomes confirm the crucial role of CS as a templating agent, enabling the development of a biomimetic mineralization pathway. CS's ability to guide this process may prove valuable in the design of materials for bone tissue engineering, particularly in developing effective materials for bone tissue healing and regeneration.

Caries Etiology and Preventive Measures

Caries is a widespread disease in both children and adults. Caries is caused by the conversion of fermentable carbohydrates by plaque bacteria into acids on the tooth surface. Thus, it is important to focus on sugar reduction and plaque control. For efficient plaque removal/control, state-of-the-art toothpastes contain various active ingredients such as antimicrobial agents (e.g., chlorhexidine, stannous salts, and zinc salts), abrasives (e.g., calcium carbonate, calcium phosphates, and hydrated silica), surfactants (e.g., sodium lauryl sulfate and sodium methyl cocoyl taurate), and natural compounds (e.g., polyphenols and xylitol). Agents with pH-buffering and calcium-releasing properties (e.g., calcium carbonate and calcium phosphates) and biomimetic actives (e.g., hydroxyapatite) reverse the effects of the acids. Additionally, modern toothbrushes (i.e., electric toothbrushes) as well as dental floss and interdental brushes significantly help remove plaque from dental surfaces including interproximal surfaces. In conclusion, modern concepts in caries prevention should focus not only on tooth remineralization alone but also on the control of all the key factors involved in caries development.

Comparative Analysis of Bone Regeneration According to Particle Type and Barrier Membrane for Octacalcium Phosphate Grafted into Rabbit Calvarial Defects

This animal study was aimed to evaluate the efficacy of new bone formation and volume maintenance according to the particle type and the collagen membrane function for grafted octacalcium phosphate (OCP) in rabbit calvarial defects. The synthetic bone substitutes were prepared in powder form with 90% OCP and granular form with 76% OCP, respectively. The calvarial defects were divided into four groups according to the particle type and the membrane application. All specimens were acquired 2 weeks (n = 5) and 8 weeks (n = 5) after surgery. According to the micro-CT results, the new bone volume increased at 2 weeks in the 76% OCP groups compared to the 90% OCP groups, and the bone volume ratio was significantly lower in the 90% OCP group after 2 weeks. The histomorphometric analysis results indicated that the new bone area and its ratio in all experimental groups were increased at 8 weeks except for the group with 90% OCP without a membrane. Furthermore, the residual bone graft area and its ratio in the 90% OCP groups were decreased at 8 weeks. In conclusion, all types of OCP could be applied as biocompatible bone graft materials regardless of its density and membrane application. Neither the OCP concentration nor the membrane application had a significant effect on new bone formation in the defect area, but the higher the OCP concentration, the less graft volume maintenance was needed.

Carbonate substitution significantly affects the structure and mechanics of carbonated apatites

Bone mineral comprises nanoparticles of carbonate-substituted bioapatite similar to hydroxylapatite. Yet mechanical values of macroscopic-sized geological hydroxylapatite are often used to model bone properties due to a lack of experimental data for bioapatite. Here, we investigated the effects of carbonate substitution and hydration on biomimetic apatite response to load using in situ hydrostatic pressure loading and synchrotron x-ray diffraction. We find that increasing carbonate levels reduced the bulk modulus and elastic strain ratio. Elastic constants, determined using computational optimization techniques, revealed that compliance values and elastic moduli decreased with increasing carbonate content, likely a result of decreased bond strength due to CO₃^2- substitution and Ca²⁺ loss. Hydration environment had no clear effects on the elastic properties likely due to dissolution and reprecipitation processes modifying the crystal structure organization. These results reinforce the need to consider carbonate composition when selecting mechanical properties and provide robust data for carbonate-substituted apatite stiffness.

Hyaluronic acid oligosaccharides modified mineralized collagen and chitosan with enhanced osteoinductive properties for bone tissue engineering

In this study, we prepared a biomimetic hyaluronic acid oligosaccharides (oHAs)-based composite scaffold to develop a bone tissue-engineered scaffold for stimulating osteogenesis and endothelialization. The functional oHAs products were firstly synthesized, namely collagen/hyaluronic acid oligosaccharides/hydroxyapatite (Col/oHAs/HAP), chitosan/hyaluronic acid oligosaccharides (CTS/oHAs), and then uniformly distributed in poly (lactic-co-glycolic acid) (PLGA) solution followed by freeze-drying to obtain three-dimensional interconnected scaffolds as temporary templates for bone regeneration. The morphology, physicochemical properties, compressive strength, and degradation behavior of the fabricated scaffolds, as well as in vitro cell responses seeded on these scaffolds and in vivo biocompatibility, were investigated to evaluate the potential for bone tissue engineering. The results indicated that the oHAs-based scaffolds can promote the attachment of endothelial cells, facilitate the osteogenic differentiation of MC3T3-E1 and BMSCs, and have ideal biocompatibility and tissue regenerative capacity, suggesting their potential to serve as alternative candidates for bone tissue engineering applications.

Bone Regeneration Using Adipose-Derived Stem Cells in Injectable Thermo-Gelling Hydrogel Scaffold Containing Platelet-Rich Plasma and Biphasic Calcium Phosphate

For bone regeneration, a biocompatible thermo-gelling hydrogel, hyaluronic acid-g-chitosan-g-poly(N-isopropylacrylamide) (HA-CPN) was used as a three-dimensional organic gel matrix for entrapping rabbit adipose-derived stem cells (rASCs). Biphasic calcium phosphate (BCP) ceramic microparticles were embedded within the gel matrix as a mineralized bone matrix, which was further fortified with platelet-rich plasma (PRP) with osteo-inductive properties. In vitro culture of rASCs in HA-CPN and HA-CPN/PRP/BCP was compared for cell proliferation and osteogenic differentiation. Overall, HA-CPN/PRP/BCP was a better injectable cell carrier for osteogenesis of rASCs with increased cell proliferation rate and alkaline phosphatase activity, enhanced calcium deposition and mineralization of extracellular matrix, and up-regulated expression of genetic markers of osteogenesis. By implanting HA-CPN/PRP/BCP/rASCs constructs in rabbit critical size calvarial bone defects, new bone formation at the defect site was successfully demonstrated from computed tomography, and histological and immunohistochemical analysis. Taken together, by combining PRP and BCP as the osteo-inductive and osteo-conductive factor with HA-CPN, we successfully demonstrated the thermo-gelling composite hydrogel scaffold could promote the osteogenesis of rASCs for bone tissue engineering applications.

Biphasic Ceramics and Fibrin Sealant for Bone Reconstruction in Ear Surgery

Bone reconstruction is still a matter of concern in middle ear surgery despite the large number of surgical techniques proposed. A composite made of biphasic calcium phosphate ceramic granules mixed with human fibrin sealant, forming a moldable material that is easy to set for bone reconstruction, has been used with success over a 16-year period for reconstruction of the posterior canal wall or for mastoid obliteration. In a retrospective series of 72 ears with long-term follow-up (average follow-up of 46 months), regular microscopic examination, and computed tomographic controls, we have evaluated this bone reconstruction technique for radical mastoidectomy cavities or the closed technique. The bone reconstruction material provided an immediate anatomic reconstruction that remains stable and is well tolerated over the long term. A slight leakage of granules in the meatus was initially observed in several patients with transient aseptic otorrhea. Fifty-seven ears were followed up for 1 year or more. Satisfactory clinical results with complete regression of the mucous membrane disease were found in 82.4% of the patients, with perfect stability of the material in 65%. We did not observe any cases of recurrent cholesteatoma in or behind the filling material. Eighteen biopsies were performed between 8 and 84 months after surgery during a second surgical step performed for functional purposes or for recurrent cholesteatoma; 17 of the 18 cases showed osteointegration of the filling material. After a 16-year experiment, we consider this technique to be a highly satisfactory procedure that could be extended to other situations of bone reconstruction.

Effect of alumina on microstructure and compressive strength of a porous silicated hydroxyapatite

PURPOSE

We investigated the effects of alumina addition on microstructure and compressive strength of a porous silicate substituted hydroxyapatite (Si-HA).

METHODS

Hydroxyapatite (HA) was synthesized under precipitation conditions and 10 %Wt. of sol-gel derived CaO.P2O5.SiO2 based bioglass (BG) powder was added to HA. Polyurethane foam was used to form a high porous structure with integral porosity of 70%. Phase analysis was performed using XRD and FTIR and the microstructure was studied using SEM.

RESULTS

The results confirmed that the Si-HA was the only formed phase before Al2O3 addition while after addition the presence of silicon-incorporated HA and alumina without any other phases was proved using these analyses.

CONCLUSIONS

The porous structures of Si-HA and Al2O3 were synthesized using the replication technique. The compressive strength of porous bioceramics increased with increasing Al2O3 content up to 30 wt% (ANOVA, P<.05).

Resolving the CaP-bone interface: a review of discoveries with light and electron microscopy

It has long been known that the interfacial relationship between synthetic materials and tissue is influential in the success of implant materials. Instability at the implant interface has been shown, in some cases, to lead to complete implant failure. Bioceramics, and in particular calcium phosphates, form a large fraction of the implantable devices on the market today due to the biocompatibility they exhibit in contact with bone and tooth-like tissues. The characterization of such bioceramic-tissue interfaces has played a crucial role in understanding the behavior of bioceramics in vivo. In this review, we shed light on the preparation methods, technological approaches and key advances in resolving the interface between calcium phosphate bioceramics and bone, and share a future outlook on this field.

Comparision of osteoconductivity of biologic and artificial synthetic hydroxyapatite in experimental mastoid obliteration

CONCLUSIONS

To our knowledge, this is the first in vivo study to address the comparison between biologic hydroxyapatite (BHA) and artificial HA (AHA) materials for mastoid obliteration. From our results, it is believed that BHA has better osteoconductivity than AHA.

OBJECTIVE

The purpose of this study was to compare the osteoconductivity of AHA and BHA in a mastoid obliteration model in rats.

METHODS

BHA and AHA were fabricated. Bulla obliteration was carried out in group A (n = 10, BHA) and group B (n = 10, AHA). The animals were administered fluorescent bone labels for a qualitative evaluation of bone formation. Oxytetracycline hydrochloride was administered at 2 weeks, calcein at 4 weeks, and alizarin red at 8 weeks. The animals were sacrificed at 12 weeks post surgery. They were evaluated by micro-CT and histological investigation.

RESULTS

Neither BHA nor AHA exhibited signs of resorption until 12 weeks of obliteration. However, the accelerated osteoconductive bone formation in the BHA group was better than in the AHA group according to micro-CT and confocal microscopic findings.

Effects of porous beta-tricalcium phosphate-based ceramics used as an E. coli-derived rhBMP-2 carrier for bone regeneration

Recombinant human bone morphogenetic protein-2 (rhBMP-2) requires carriers for clinical effectiveness. In this study, whether porous beta-tricalcium phosphate (β-TCP)-based ceramics are ideal carriers for rhBMP-2 was investigated. Hydroxyapatite (HA), β-TCP, TCP/HA (80 %/20 %), HA with rhBMP-2, TCP with rhBMP-2, and TCP/HA (80 %/20 %) with rhBMP-2 were manufactured by a sponge method with a pore size of 300 μm or more and macro-porosity of 83 %. The alkaline phosphatase (ALP) activity and ALP expression of the cells with 100 % β-TCP granules were more increased than the those of cells with 100 % HA and TCP/HA (80 %/20 %) at the baseline or when treated with 15 ng/ml of rhBMP-2. In an SD rat calvarial defect model, new bone formation was evidently shown in the TCP 100 %-rhBMP-2 and TCP/HA (80 %/20 %)-rhBMP-2 groups, showing that the most affected area was filled with newly-formed bone, that the percent bone volume and trabecular number were larger when compared to the groups without rhBMP-2 treatment at both 4 and 8 weeks after surgery using micro-CT and histology. Porous TCP-based ceramic granules enhanced the osteoblastic differentiation in the hMSC system when treated with 15 ng/ml of rhBMP-2 and accelerated bone-healing by trabecular number in a rat calvarial defect model. Thus, in this study it was proposed that TCP-based ceramics might be useful carriers of rhBMP-2.

Synthesis and characterisation of large chlorapatite single-crystals with controlled morphology and surface roughness

This work describes the synthesis of chlorapatite single crystals using the molten salt method with CaCl(2) as a flux. By manipulating the processing conditions (amount of flux, firing time and temperature, and cooling rates) it is possible to manipulate the crystal morphology from microscopic fibres to large crystals (up to few millimetre long and ~100 μm thick). The crystal roughness can be controlled to achieve very flat surfaces by changing the melt composition "in situ" at high temperature. The Young modulus and hardness of the crystals are 110 ± 15 and 6.6 ± 1.5 GPa respectively as measured by nanoindentation. Crystal dissolution in Hanks solution starts around the defects. Several in vitro assays were performed; ClAp crystals with different size and shape are biocompatible. Cell apoptosis was very low at 5, 10, and 15 days (Caspase-3) for all the samples. Proliferation (MTT) showed to be influenced by surface roughness and size of the crystals.

Preparation and bioactive properties of novel bone-repair bionanocomposites based on hydroxyapatite and bioactive glass nanoparticles

Bionanocomposites based on ceramic nanoparticles and a biodegradable porous matrix represent a promising strategy for bone repair applications. The preparation and bioactive properties of bionanocomposites based on hydroxyapatite (nHA) and bioactive glass (nBG) nanoparticles were presented. nHA and nBG were synthesized with nanometric particle size using sol-gel/precipitation methods. Composite scaffolds were prepared by incorporating nHA and nBG into a porous alginate (ALG) matrix at different particle loads. The ability of the bionanocomposites to induce the crystallization of the apatite phase from simulated body fluid (SBF) was systematically evaluated using X-ray diffraction (XRD), scanning electron microscopy with energy dispersive X-ray analysis, and Fourier transform infrared spectroscopy. Both nHA/ALG and nBG/ALG composites were shown to notably accelerate the process of crystallization and growth of the apatite phase on the scaffold surfaces. For short immersion times in SBF, nBG (25%)-based nanocomposites induced a higher degree of apatite crystallization than nHA (25%)-based nanocomposites, probably due to the more reactive nature of the BG particles. Through a reinforcement effect, the nanoparticles also improve the mechanical properties and stability in SBF of the polymer scaffold matrix. In addition, in vitro biocompatibility tests demonstrated that osteoblast cells are viable and adhere well on the surface of the bionanocomposites. These results indicate that nHA- and nBG-based bionanocomposites present potential properties for bone repair applications, particularly oriented to accelerate the bone mineralization process.

Dissolution mechanism of calcium apatites in acids: A review of literature

Eight dissolution models of calcium apatites (both fluorapatite and hydroxyapatite) in acids were drawn from the published literature, analyzed and discussed. Major limitations and drawbacks of the models were conversed in details. The models were shown to deal with different aspects of apatite dissolution phenomenon and none of them was able to describe the dissolution process in general. Therefore, an attempt to combine the findings obtained by different researchers was performed which resulted in creation of the general description of apatite dissolution in acids. For this purpose, eight dissolution models were assumed to complement each other and provide the correct description of the specific aspects of apatite dissolution. The general description considers all possible dissolution stages involved and points out to some missing and unclear phenomena to be experimentally studied and verified in future. This creates a new methodological approach to investigate reaction mechanisms based on sets of affine data, obtained by various research groups under dissimilar experimental conditions.

Biological Response of Biphasic Hydroxyapatite/Tricalcium Phosphate Scaffolds Intended for Low Load-Bearing Orthopaedic Applications

In this study, a calcium phosphate scaffold of hydroxyapatite (HAp) and dicalcium phosphate dihydrate (DCPD) for application in osteoconductive and osteoinductive scaffolds was synthesized and characterized. The important note is that the prepared composites converted to HAp/tricalcium phosphate (TCP) after heat-treatment. This class of composites is interesting because porous HAp/TCP generally degrade more rapid than HAp due to the increased resorption rate of TCP. According to the obtained results, the values of elastic modulus, compressive strength and density of the samples reduced with increasing the percentage of the DCPD phase. It is worth mentioning that the mechanical properties of the prepared samples were near the natural compact bone. The samples were examined in vitro to confirm the apatite forming ability of the composites. Also, in vivo examination in a rabbit model was employed. After fully observation it was concluded that new bone formed on the pore walls, as osteoids and osteoclasts were evident two months postoperatively. Based on the obtained results, the prepared scaffolds seem to be a promising biomaterial for low weight bearing orthopaedic applications.

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

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

Visualizing biointerfaces in three dimensions: electron tomography of the bone-hydroxyapatite interface

A positive interaction between human bone tissue and synthetics is crucial for the success of bone-regenerative materials. A greater understanding of the mechanisms governing bone-bonding is often gained via visualization of the bone-implant interface. Interfaces to bone have long been imaged with light, X-rays and electrons. Most of these techniques, however, only provide low-resolution or two-dimensional information. With the advances in modern day transmission electron microscopy, including new hardware and increased software computational speeds, the high-resolution visualization and analysis of three-dimensional structures is possible via electron tomography. We report, for the first time, a three-dimensional reconstruction of the interface between human bone and a hydroxyapatite implant using Z-contrast electron tomography. Viewing this structure in three dimensions enabled us to observe the nanometre differences in the orientation of hydroxyapatite crystals precipitated on the implant surface in vivo versus those in the collagen matrix of bone. Insight into the morphology of biointerfaces is considerably enhanced with three-dimensional techniques. In this regard, electron tomography may revolutionize the approach to high-resolution biointerface characterization.

Porous beta tricalcium phosphate scaffolds used as a BMP-2 delivery system for bone tissue engineering

Macroporous beta tricalcium phosphate (beta-TCP) scaffolds were evaluated as potential carriers and delivery systems for bone morphogenetic protein-2 (BMP-2). Chemical etching was performed to increase the available surface and thus the protein loading. X-ray diffraction and infrared spectrocopy analyses confirmed the preparation of pure beta-TCP scaffolds. Scanning electron microscopy revealed interconnected porosity (64%) and a microporous surface after chemical etching. Scaffolds loaded with 30 and 15 microg of BMP-2 were implanted respectively into the back muscles and into femoral defects (condyle and diaphysis) of rabbits for 4 weeks. Histological observations confirmed the activity of the BMP-2 released from the scaffolds. Intramuscularly, bone was formed within the BMP-2-loaded scaffold pores. In the bone defects, the effect of released BMP-2 was similarly noticeable, as evaluated by histomorphometry. The incorporation of BMP-2 resulted in an amount of newly formed bone that was 1.3 times higher than with unloaded scaffolds. The implant site, however, did not have an effect on bone formation as no statistical differences were measured between cortical (diaphysis) and trabecular (condyle) defects. These results indicate the suitability of chemically etched beta-TCP scaffolds as BMP-2 carriers, in the context of bone regeneration.

The incorporation of strontium and zinc into a calcium-silicon ceramic for bone tissue engineering

In this study we developed novel scaffolds through the controlled substitution and incorporation of strontium and zinc into a calcium-silicon system to form Sr-Hardystonite (Sr-Ca(2)ZnSi(2)O(7), Sr-HT). The physical and biological properties of Sr-HT were compared to Hardystonite (Ca(2)ZnSi(2)O(7)) [HT]. We showed that Sr-HT scaffolds are porous with interconnected porous network (interconnectivity: 99%) and large pore size (300-500 microm) and an overall porosity of 78%, combined with a relatively high compressive strength (2.16+/-0.52 MPa). These properties are essential for enhancing bone ingrowth in load-bearing applications. Sr-HT ceramic scaffolds induced the attachment and differentiation of human bone derived cells (HOB), compared to that for the HT scaffolds. Sr-HT scaffolds enhanced expression of alkaline phosphatase, Runx-2, osteopontin, osteocalcin and bone sialoprotein. The in vivo osteoconductivity of the scaffolds was assessed at 3 and 6 weeks following implantation in tibial bone defects in rats. Histological staining revealed rapid new growth of bone into the pores of the 3D scaffolds with the Sr-HT and HT, relative to the beta-tricalcium phosphate (beta-TCP). In vivo, HT and Sr-HT produced distinct differences in the patterns of degradation of the materials, and their association with TRAP positive osteoclast-like cells with HT appearing more resistant compared to both Sr-HT and beta-TCP.

Investigation of calcium crystals in OA knees

For studies on matrix mineralization in osteoarthritis (OA), a clear analytical approach is necessary to identify and to quantify mineralization in the articular cartilage. The aim of this study is to develop an effective algorithm to quantify and to identify cartilage mineralization in the experimental setting. Four patients with OA of the knee undergoing total knee replacement and four control patients were included. Cartilage calcification was studied by digital contact radiography (DCR), field emission scanning electron microscopy (FE-SEM) X-ray element analysis and Raman spectroscopy (RS). DCR revealed mineralization in all OA cartilage specimens. No mineralization was observed in the control cartilage. Patient I showed rhomboid shaped crystals with a mean Ca:P molar ratio of 1.04 indicated the presence of calcium pyrophosphate dihydrate (CPPD) crystals, while Patients II, III and IV presented carbonate-substituted hydroxyapatite (HA). RS also showed the presence of CPPD crystals in Patient I while Patients II, III and IV revealed spectra confirming the presence of HA crystals. In the corresponding chondrocyte cell culture analyzed with SEM, the presence of CPPD crystals in the culture of Patient I and HA crystals in the culture of Patient II, III and IV was confirmed. No mineralization was found in the cell culture of the controls. The differentiation between BCP and CPPD crystals plays an important role, and the techniques presented here provide an accurate differentiation of these two types of crystals. For quantification of articular cartilage mineralization, DCR is a simple and accurate method.

Remodeling potentials of biphasic calcium phosphate granules in open wedge high tibial osteotomy

INTRODUCTION

Biphasic calcium phosphate (BCP) has proved to be an effective bone substitute, but it's effectiveness and remodeling potential in open wedge high tibial osteotomy (OWHTO) has not been analyzed yet. This study sought to evaluate the bone healing and remodeling potentials of BCP granules using a radiographic rating system in biplanar OWHTO.

MATERIALS AND METHODS

Fifteen patients (15 knees) underwent biplanar OWHTO. Bone gaps were filled with BCP granules. For radiographic evaluation, remodeling was divided into four phases. Phase 1 was accepted as rounded osteotomy sites, with clear distinction between BCP and bone, phase 2 was accepted as whitened osteotomy sites, with distinction between BCP and bone still visible, phase 3 was accepted as distinction between BCP and bone not visible and cloudy bone formation and phase 4 was accepted as full reformation of BCP granules (4A-BCP visible, 4B-disappearence of BCP) with no sign of osteotomy. Bone union was confirmed with clinical (full weight bearing without pain) and radiographic evaluation (cortical bridging callus on radiographs and phase 3 or greater remodeling). The time to full remodeling and the starting point of the consolidation on anteroposterior radiographs were noted. Complications were also noted at each clinical follow-up.

RESULTS

Mean follow-up was 27.2 months. The mean age was 55.8 years. At clinical follow-up, there were no wound healing problems, no loss of corrections, no infections, and no complications. All osteotomies successfully healed. According to the radiologic classification system, at the 6th week, 73.3% (11/15) of patients were in phase 1 and the remaining 26.7% (4/15) were in phase 2. At 12-month follow-up, 46.7 (7/15) of the patients were still in phase 3. After 2 years, all radiographs showed to be in phase 4A. Radiographic union was noted to progress from lateral to medial and finally central.

CONCLUSIONS

BCP can be successfully used as a bone substitute. The radiographic remodeling and consolidation process of BCP was found to be different from that of beta-tricalcium phosphate. In our patients with more than 2 years of follow-up, BCP granules did not completely remodel. As a result, this clinical study demonstrated that calcium phosphate granules containing hydroxyapatite had a long period of "creeping substitution" that lasts longer than 2 years.

Human osteoblasts adhesion and proliferation on magnesium-substituted tricalcium phosphate dense tablets

Tricalcium phosphate (TCP) is recognized as a promising bone replacement material due to its high bioactivity and resorbable properties. To mimic biological apatites, incorporation of magnesium (Mg) in TCP was proposed. Mg-substituted TCP (beta-TCMP) and beta-TCP dense tablets were obtained by pressing and sintering at 1,000 degrees C Mg-substituted calcium deficient apatite (Mg-CDA) and commercial TCP, respectively. The materials were characterized using X-ray diffraction, infrared spectroscopy and electron microscopy. Human osteoblast cells (SaOs2) were seeded onto the sintered tablets for 4 h, 24 h and 7 days. Results showed that Mg-CDA was completely transformed into beta-TCMP. Moreover, beta-TCMP stimulated adhesion and proliferation of human osteoblast cells. Consequently, the magnesium incorporation on calcium deficient apatites followed by sintering at 1,000 degrees C seems to be a useful path to obtain biocompatible and non cytotoxic dense tablets with TCP structure with potential application on bone engineering.

Bioactive materials in endodontics

Endodontic treatment in dentistry is a delicate procedure and many treatment attempts fail. Despite constant development of new root canal filling techniques, the clinician is confronted with both a complex root canal system and the use of filling materials that are harmful for periapical tissues. This paper evaluates reported studies on biomaterials used in endodontics, including calcium hydroxide, mineral trioxide aggregate, calcium phosphate ceramics and calcium phosphate cements. Special emphasis is made on promising new biomaterials, such as injectable bone substitute and injectable calcium phosphate cements. These materials, which combine biocompatibility, bioactivity and rheological properties, could be good alternatives in endodontics as root canal fillers. They could also be used as drug-delivery vehicles (e.g., for antibiotics and growth factors) or as scaffolds in pulp tissue engineering.

Defect induced asymmetric pit formation on hydroxyapatite

Defect sites on bone minerals play a critical role in bone remodeling processes. We investigated single crystal hydroxyapatite (100) surfaces bearing crystal defects under acidic dissolution conditions using real-time in situ atomic force microscopy. At defect sites, surface structure-dependent asymmetric hexagonal etch pits were formed, which dominated the overall dissolution rate. Meanwhile, dissolution from the flat terraces proceeded by stochastic formation of flat bottom etch pits. The resulting pit shapes were intrinsically dictated by the HAP crystal structure. Computational modeling also predicted different step energies associated with different facets of the asymmetric etch pits. Our microscopic observations of HAP dissolution are significant for understanding the effects of local surface structure on the bone mineral remodeling process and provide useful insights for the design of novel therapies for treating osteoporosis and dental caries.

Principles of demineralization: modern strategies for the isolation of organic frameworks. Part II. Decalcification

This is the second paper on principles of demineralization. The initial paper is dedicated to the common definitions and the history of demineralization. In present work we review the principles and mechanisms of decalcification, i.e., removing the mineral Ca-containing compounds (phosphates and carbonates) from the organic matrix in its two main aspects: natural and artificial. Natural chemical erosion of biominerals (cavitation of biogenic calcareous substrata by bacteria, fungi, algae, foraminifera, sponges, polychaetes, and mollusks) is driven by production of mineral and organic acids, acidic polysaccharides, and enzymes (cabonic anhydrase, alkaline and phosphoprotein phosphataes, and H(+)-ATPase). Examples of artifical decalcification includes demineralization of bone, dentin and enamel, and skeletal formations of corals and crustacean. The mechanism and kinetics of Ca-containing biomineral dissolution is analyzed within the framework of (i) diffusion-reaction theory; (ii) surface-reaction controlled, morphology-based theories, and (iii) phenomenological surface coordination models. The application of surface complexation model for describing and predicting the effect of organic ligands on calcium and magnesium dissolution kinetics is also described. Use of the electron microscopy-based methods for observation and visualization of the decalcification phenomenon is discussed.

Detection of calcium phosphate crystals in the joint fluid of patients with osteoarthritis - analytical approaches and challenges

Clinically, osteoarthritis (OA) is characterised by joint pain, stiffness after immobility, limitation of movement and, in many cases, the presence of basic calcium phosphate (BCP) crystals in the joint fluid. The detection of BCP crystals in the synovial fluid of patients with OA is fraught with challenges due to the submicroscopic size of BCP, the complex nature of the matrix in which they are found and the fact that other crystals can co-exist with them in cases of mixed pathology. Routine analysis of joint crystals still relies almost exclusively on the use of optical microscopy, which has limited applicability for BCP crystal identification due to limited resolution and the inherent subjectivity of the technique. The purpose of this Critical Review is to present an overview of some of the main analytical tools employed in the detection of BCP to date and the potential of emerging technologies such as atomic force microscopy (AFM) and Raman microspectroscopy for this purpose.

Dissolution of human teeth-derived hydroxyapatite

We have been interested in human teeth which consist of hydroxyapatite (HA), but do not degrade for a long time. In order to overcome dissolution and mechanical degradation of man-made HA, biologically derived hydroxyapatite (BHA) ceramics were prepared from human teeth and their dissolving behavior was investigated in distilled water for 3-14 days and compared with an artificial HA made of synthetic HA powder. BHA ceramics were prepared by calcining freshly extracted human teeth at 900 degrees C and followed by sintering at 1200 degrees C for 2 h. All detectable peaks in the artificial HA are identical to HA lattice planes, whereas BHA consisted of a mixture of HA and beta-tricalcium phosphate (TCP). Although the artificial HA was expected to be stable in water, the surface dissolution initiated at grain boundaries followed by generated many separated grains and their associated pores. On the other hand, BHA showed that definite grains considered as beta-TCP were predominantly dissolved and the grains were separated from the matrix leaving pores. In the mean time, the rest region, mainly consisting of HA, did not show any evidence of dissolution. It indicates that BHA showed rather stable grain boundaries and lack of excessive dissolution in liquid environment.

The effect of strontium incorporation into CaSiO3 ceramics on their physical and biological properties

CaSiO3 ceramics have been regarded as a potential bioactive material for bone regeneration. Strontium (Sr) as a trace element in human body has been found to have beneficial effects on bone formation. The aim of this study was to incorporate Sr into CaSiO3 bioactive ceramics and to investigate their effect(s) on phase transition, sintering property, apatite-formation ability, ionic dissolution, and human bone-derived cells (HBDC) proliferation. Sr containing CaSiO3 (Sr-CaSiO3) ceramics at various concentrations (0-10% Sr) were prepared. The incorporation of Sr into CaSiO3 promoted the phase transition from beta to alpha-CaSiO3 and enhanced ceramic densification but did not alter the mechanism and ability of apatite formation in SBF. The ionic dissolution rate of the Sr-CaSiO3 decreased compared to the CaSiO3. The addition of Sr decreased pH value in SBF. The effect of Sr-CaSiO3 extracts, carried out according to the International Standard Organization, on HBDC proliferation was evaluated. At high extract concentration (100 and 200 mg/mL), CaSiO3 was found to stimulate HBDC proliferation, however, the incorporation of Sr into CaSiO3 stimulated HBDC proliferation even at low extract concentration (ranging from 12.5, 25 to 50 mg/mL). Our results indicate that Sr-CaSiO3 ceramics improved the physical and biological properties of the pure CaSiO3 ceramics.

Nanoscale characterization of the interface between bone and hydroxyapatite implants and the effect of silicon on bone apposition

Silicon plays an important role in bone mineralization and formation and is therefore incorporated into a wide variety of medical implants and bone grafts used today. The significance of silicon (Si) can be understood through an analysis of the mechanisms of bone bonding to calcium containing biomaterials and through comparisons of hydroxyapatite (HA) and silicon-substituted hydroxyapatite (Si-HA). The addition of Si to HA causes a decrease in grain size that subsequently affects surface topography, dissolution-reprecipitation rates and the bone apposition process. Through the use of high-resolution transmission electron microscopy (HR-TEM) studies, the interactions between bone and silicon hydroxyapatite (Si-HA) at interfaces are reviewed and related to their impact on bone apposition and ultimately the performance of medical implants.

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

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

Osteointegration of femoral stem prostheses with a bilayered calcium phosphate coating

Our purpose was to evaluate the osteointegration of bilayered calcium phosphate (CaP)-coated femoral hip stems in a canine model. A first layer of hydroxyapatite (HA) 20 microm thick and a superficial layer of Biphasic Calcium Phosphate (BCP) 30 microm thick were plasma-sprayed on to the proximal region of sandblasted Ti6Al4V prostheses. Bilayered CaP-coated and non-coated canine femoral stems were implanted bilaterally under general anesthesia in 6 adult female Beagle dogs. After 6 and 12 months, a significant degradation of the bilayered coating occurred with a remainder of 33.1+/-12.4 and 23.6+/-9.2 microm in thickness, respectively. Lamellar bone apposition was observed on bilayered coated implants while fibrous tissue encapsulation was observed on non-coated femoral stems. The bone-implant contacts (BIC) were 91+/-3% and 81+/-8% for coated and 7+/-8% and 8+/-12% for non-coated implants, at 6 and 12 months, respectively. Our study supports the concept of a direct relationship between the biodegradation of CaP coating and the enhanced osteointegration of titanium prostheses. A bilayered CaP coating might therefore enhance bone apposition in the early stages because of the superior bioactivity of the BCP layer while the more stable HA layer might sustain bone bonding over long periods.

Progression of Experimental Chronic Peri-Implantitis in Dogs: Clinical and Radiographic Evaluation

BACKGROUND

The aim of this study was to evaluate the progression of experimental peri-implantitis in dogs using implants with different surface coatings.

METHODS

Thirty-six dental implants with four different surface coatings, commercially pure titanium (cpTi), titanium plasma sprayed (TPS), hydroxyapatite (HA), and acid-etched (AE), were placed in six mongrel dogs. Five months after implantation, peri-implantitis was induced by cotton ligatures to facilitate plaque accumulation for 60 days. After 60 days, the ligatures were removed and supragingival plaque control was initiated for 12 months. Probing depth (PD), clinical attachment level (CAL), vertical bone level (VBL), horizontal bone level (HBL), and mobility were obtained at baseline, and 20, 40, 60 (acute phase), and 425 days (chronic phase) after ligature removal.

RESULTS

PD and CAL changed around all implant surfaces after ligature placement (P<0.0001). However, the means of PD and CAL were not statistically significant among the different surfaces (P>0.05). The range of CAL variation, calculated between baseline and 60 days (acute phase) and between 60 and 425 days (chronic phase), decreased (P<0.05). Bone loss increased during the entire experiment (P<0.0001). The HA surface showed the greatest bone loss measurement (5.06+/- 0.38 mm) and the TPS showed the smallest bone loss (4.27+/- 0.62 mm). However, statistical significance was not assessed for different coatings (P>0.05).

CONCLUSIONS

The clinical data at the initial phase showed rapid and severe peri-implant tissue breakdown. However, removal of ligatures did not convert the acute destructive peri-implant phase to a non-aggressive lesion and the progression of peri-implantitis was observed at chronic phase. The experimental peri-implantitis in dogs may be a useful model to evaluate the progression of peri-implantitis.

In vivo assessment of hydroxyapatite and silicate-substituted hydroxyapatite granules using an ovine defect model

Phase pure hydroxyapatite (HA) and two silicate-substituted hydroxyapatites (0.8 and 1.5 wt% Si, or 2.6 and 4.9 wt% SiO4) were prepared by aqueous precipitation methods. The filter-cakes of HA and silicate-substituted hydroxyapatite (SiHA) compositions were processed into granules 1.0-2.0 mm in diameter and sintered at 1200 degrees C for 2 h. The sintered granules underwent full structural characterisation, prior to assessment in an ovine defect model by implantation for a period of 6 and 12 weeks. The results indicate that HA and SiHA implants were well accepted by the host tissue, with no evidence of inflammation. New bone formation was observed directly on the surfaces and in the spaces between the granular implants. Quantitative histomorphometry as determined by the percentage of bone ingrowth and bone coverage for both SiHA implant compositions was significantly greater than that for phase pure HA. These findings indicate that the in vivo bioactivity of hydroxyapatite was significantly improved by the incorporation of silicate ions into the HA structure, making SiHA ceramics attractive alternatives to conventional HA materials for use as bone graft substitute ceramics.

MBCP biphasic calcium phosphate granules and tissucol fibrin sealant in rabbit femoral defects: the effect of fibrin on bone ingrowth

An ageing population implies an increase in bone and dental diseases, which are in turn a source of numerous handicaps. These pathologies are an expensive burden for the European health system. As no specific bioactive materials are efficient enough to cope with this burden, we have to develop an injectable, mouldable, self-hardening bone substitute to support bone tissue reconstruction and augmentation. New, highly bioactive and suitable biomaterials have been developed to replace bone grafts in orthopedic revision and maxillofacial surgery for bone augmentation. These mouldable, self-hardening materials are based on the association of MBCP Biphasic Calcium Phosphate Granules and Tissucol Fibrin Sealant. The in vivo evaluation of ingrowth in relation to the composite was made in an experiment on rabbits. The results indicate that in the presence of fibrin sealant, newly-formed bone developed at a small distance from the surface of the calcium phosphate ceramic. Two different bone apposition processes were identified. Without the fibrin component (MBCP group), bone rested directly on the surface of the granules. This observation is commonly described as osteoconduction in calcium phosphate materials. On the contrary, the presence of the fibrinogen component seemed to modify this standard osteoconduction phenomenon: the newly-formed bone essentially grew at a distance from the surface of the granules, on the fibrillar network, and could be considered as an inductive phenomenon for osteogenic cell differentiation from mesenchymal stem cells.

Ultrastructural comparison of hydroxyapatite and silicon-substituted hydroxyapatite for biomedical applications

Silicon-substituted hydroxyapatite (Si-HA) has been shown to lead to significantly increased rates of bone apposition when compared with phase-pure hydroxyapatite (HA) bioceramic implants (Patel N, et al. J Mater Sci Mater Med 2002;13:1199-1206). However, uncertainty remains about the mechanism by which Si increases the in vivo bioactivity. In this study, defect structures in Si-HA were observed and characterized for the first time using high-resolution transmission electron microscopy. Using tilting experiments and the g. b = 0 criterion for invisibility, the Burgers vectors of dislocations in phase-pure HA and 0.8 wt % Si-HA were characterized to be screw and mixed in character. Dislocations were observed in both pure HA and 0.8 wt % Si-HA with no significant difference in dislocation density between HA and Si-HA. However, our findings suggest that an increased number of triple junctions in Si-HA may have a significant role in increasing the solubility of the material and the subsequent rate at which bone apposes Si-HA ceramics.

Small-animal models for testing macroporous ceramic bone substitutes

The aim of this study was to compare the bone colonization of a macroporous biphasic calcium phosphate (MBCP) ceramic in different sites (femur, tibia, and calvaria) in two animal species (rats and rabbits). A critical size defect model was used in all cases with implantation for 21 days. Bone colonization in the empty and MBCP-filled defects was measured with the use of backscattered electron microscopy (BSEM). In the empty cavities, bone healing remained on the edges, and did not bridge the critical size defects. Bone growth was observed in all the implantation sites in rats (approximately 13.6-36.6% of the total defect area, with ceramic ranging from 46.1 to 51.9%). The bone colonization appeared statistically higher in the femur of rabbits (48.5%) than in the tibia (12.6%) and calvaria (22.9%) sites. This slightly higher degree of bone healing was related to differences in the bone architecture of the implantation sites. Concerning the comparison between animal species, bone colonization appeared greater in rabbits than in rats for the femoral site (48.5% vs. 29.6%). For the other two sites (the tibia and calvaria), there was no statistically significant difference. The increased bone ingrowth observed in rabbit femurs might be due to the large bone surface area in contact with the MBCP ceramics. The femoral epiphysis of rabbits is therefore a favorable model for testing the bone-bonding capacity of materials, but a comparison with other implantation sites is subject to bias. This study shows that well-conducted and fully validated models with the use of small animals are essential in the development of new bone substitutes.

Bone ingrowth in bFGF-coated hydroxyapatite ceramic implants

This experimental study was performed to evaluate angiogenesis, bone formation, and bone ingrowth in response to osteoinductive implants of bovine-derived hydroxyapatite (HA) ceramics either uncoated or coated with basic fibroblast growth factor (bFGF) in miniature pigs. A cylindrical bone defect was created in both femur condyles of 24 miniature pigs using a saline coated trephine. Sixteen of the 48 defects were filled with HA cylinders coated with 50 microg rhbFG, uncoated HA cylinders, and with autogenous transplants, respectively. Fluorochrome labelled histological analysis, histomorphometry, and scanning electron microscopy were performed to study angiogenesis, bone formation and bone ingrowth. Complete bone ingrowth into bFGF-coated HA implants and autografts was seen after 34 days compared to 80 days in the uncoated HA group. Active ring-shaped areas of fluorochrome labelled bone deposition with dynamic bone remodelling were found in all cylinders. New vessels could be found in all cylinders. Histomorphometric analysis showed no difference in bone ingrowth over time between autogenous transplants and bFGF-coated HA implants. The current experimental study revealed comparable results of bFGF-coated HA implants and autogenous grafts regarding angiogenesis, bone synthesis and bone ingrowth.

Comparison of in vivo dissolution processes in hydroxyapatite and silicon-substituted hydroxyapatite bioceramics

The incorporation of silicate into hydroxyapatite (HA) has been shown to significantly increase the rate of bone apposition to HA bioceramic implants. However, uncertainty remains about the mechanism by which silicate increases the in vivo bioactivity of HA. In this study, high-resolution transmission electron microscopy was used to observe dissolution from HA, 0.8 wt% Si-HA and 1.5 wt% Si-HA implants after 6 and 12 weeks in vivo. Our observations confirmed that defects, in particular those involving grain boundaries, were the starting point of dissolution in vivo. Dissolution was observed to follow the order 1.5 wt% Si-HA>0.8 wt% Si-HA>pure HA and it was found to be particularly prevalent at grain boundaries and triple-junctions. These observations may help to explain the mechanism by which silicate ions increase the in vivo bioactivity of pure HA, and highlight the enhanced potential of these ceramics for biomedical applications.

Compactibility study of calcium phosphate biomaterials

This study investigated the micromechanism responsible for the densification and consolidation of powders during dynamic compaction, an experimental process in which ceramic is formed without heating. Three calcium-deficient apatites (CDA: two powders and a fibrous compound) and a biphasic calcium phosphate (BCP) were studied to determine their aptitude (rheological and physical properties) for compactibility under various dynamic compaction pressures. Powders were investigated for their physicochemistry, particle size, and flow time, and compacts for their compaction rate, density, specific area, mechanical characteristics, and disintegration time. Powder particles showed different morphological features depending on the synthesis protocol used, specific area and rheological behaviour. Compacts were not obtained with BCP, regardless of the gas pressure used, whereas CDA produced compacts with good mechanical properties (high hardness and compression stress), particularly for the fibrous compound. The poor compressibility and compactibility of BCP powders were confirmed, whereas fibrous CDA powders showed good compactibility conducive to high-quality filling of biomaterials.