Effect of βTCP filled polyetheretherketone on osteoblast cell proliferation in vitro

Neoteric Semiembedded β-Tricalcium Phosphate Promotes Osteogenic Differentiation of Mesenchymal Stem Cells under Cyclic Stretch

β-Tricalcium phosphate (β-TCP) is a bioactive material for bone regeneration, but its brittleness limits its use as a standalone scaffold. Therefore, continuous efforts are necessary to effectively integrate β-TCP into polymers, facilitating a sturdy ion exchange for cell regulation. Herein, a novel semiembedded technique was utilized to anchor β-TCP nanoparticles onto the surface of the elastic polymer, followed by hydrophilic modification with the polymerization of dopamine. Cell adhesion and osteogenic differentiation of mesenchymal stem cells (MSCs) under static and dynamic uniaxial cyclic stretching conditions were investigated. The results showed that the new strategy was effective in promoting cell adhesion, proliferation, and osteogenic induction by the sustained release of Ca2+ in the vicinity and creating a reasonable roughness. Specifically, released Ca2+ from β-TCP could activate the calcium signaling pathway, which further upregulated calmodulin and calcium/calmodulin-dependent protein kinase II genes in MSCs. Meanwhile, the roughness of the membrane and the uniaxial cyclic stretching activated the PIEZO1 signaling pathway. Chemical and mechanical stimulation promotes osteogenic differentiation and increases the expression of related genes 2-8-fold. These findings demonstrated that the neoteric semiembedded structure was a promising strategy in controlling both chemical and mechanical factors of biomaterials for cell regulation.

Evaluation of polyetheretherketone composites modified by calcium silicate and carbon nanotubes for bone regeneration: mechanical properties, biomineralization and induction of osteoblasts

Desired orthopedic implant materials must have a good biological activity and possess appropriate mechanical property that correspond to those of human bone. Although polyetheretherketone (PEEK) has displayed a promising application prospect in musculoskeletal and dentistry reconstruction thanks to its non-biodegradability and good biocompatibility in the body, the poor osseointegration and insufficient mechanical strength have significantly limited its application in the repair of load-bearing bones and surgical operations. In this study, carbon nanotubes (CNT)/calcium silicate (CS)/polyetheretherketone ternary composites were fabricated for the first time. The addition of CS was mainly aimed at improving biological activities and surface hydrophilicity, but it inevitably compromised the mechanical strength of PEEK. CNT can reinforce the composites even when brittle CS was introduced and further upgraded the biocompatibility of PEEK. The CNT/CS/PEEK composites exhibited higher mechanical strengths in tensile and bending tests, 64% and 90% higher than those of brittle CS/PEEK binary composites. Besides, after incorporation of CNT and CS into PEEK, the hydrophilicity, surface roughness and ability to induce apatite-layer deposition were significantly enhanced. More importantly, the adhesion, proliferation, and osteogenic differentiation of mouse embryo osteoblasts were effectively promoted on CNT/CS/PEEK composites. In contrast to PEEK, these composites exhibited a more satisfactory biocompatibility and osteoinductive activity. Overall, these results demonstrate that ternary CNT/CS/PEEK composites have the potential to serve as a feasible substitute to conventional metal alloys in musculoskeletal regeneration and orthopedic implantation.

Poly (Ether-Ether-Ketone) for Biomedical Applications: From Enhancing Bioactivity to Reinforced-Bioactive Composites-An Overview

The global orthopedic market is forecasted to reach US$79.5 billion by the end of this decade. Factors driving the increase in this market are population aging, sports injury, road traffic accidents, and overweight, which justify a growing demand for orthopedic implants. Therefore, it is of utmost importance to develop bone implants with superior mechanical and biological properties to face the demand and improve patients' quality of life. Today, metallic implants still hold a dominant position in the global orthopedic implant market, mainly due to their superior mechanical resistance. However, their performance might be jeopardized due to the possible release of metallic debris, leading to cytotoxic effects and inflammatory responses in the body. Poly (ether-ether-ketone) (PEEK) is a biocompatible, high-performance polymer and one of the most prominent candidates to be used in manufacturing bone implants due to its similarity to the mechanical properties of bone. Unfortunately, the bioinert nature of PEEK culminates in its diminished osseointegration. Notwithstanding, PEEK's bioactivity can be improved through surface modification techniques and by the development of bioactive composites. This paper overviews the advantages of using PEEK for manufacturing implants and addresses the most common strategies to improve the bioactivity of PEEK in order to promote enhanced biomechanical performance.

Mechanical performance and bioactivation of 3D-printed PEEK for high-performance implant manufacture: a review

Polyetheretherketone (PEEK) has stood out as the leading high-performance thermoplastic for the replacement of metals in orthopaedic, trauma and spinal implant applications due to its high biocompatibility and mechanical properties. Despite its potential for custom-made medical devices, 3D-printed PEEK's mechanical performance depends on processing parameters and its bioinertness may hinder bone opposition to the implant. Concerning these challenges, this review focuses on the available literature addressing the improvement of the mechanical performance of PEEK processed through "fused filament fabrication" (FFF) along with literature on bioactivation of PEEK for improved osseointegration. The reviewed research suggests that improvements can be achieved in mechanical performance of 3D-printed PEEK with adequate FFF parametrization while different bioactivation techniques can be used to improve the bioperformance of 3D-printed PEEK. The adequate approaches towards these procedures can increase PEEK's potential for the manufacture of high-performance custom-made implantable devices that display improved bone-implant integration and prevent stress shielding of the treated bone.

Endowing Polyetheretherketone Implants with Osseointegration Properties: In Situ Construction of Patterned Nanorod Arrays

Polyetheretherketone (PEEK) is widely used in orthopedic and craniomaxillofacial surgeries as it exhibits excellent biocompatibility, mechanical property, and chemical stability. However, its clinical application is limited by the biological inertness of PEEK. Numerous efforts have been made to improve the bioactivity of this polymer over the years. However, modification methods that can not only promote osteogenesis but also maintain excellent properties are still limited. Hence, a facile hot die formation technique is developed for establishing patterned nanorod arrays on the PEEK surface in situ. This method can maintain the excellent properties of PEEK and can be used in implantation as it can facilitate osteogenic activity in the absence of any organic/inorganic differentiation-inducing factors. PEEK with 200-nm patterned nanorod arrays on the surface exhibits excellent osteogenic properties. This result is obtained by assessing the osteogenic differentiation properties of rat adipose-derived stem cells at the gene and protein levels in vitro. In vivo experimental results reveal that the surface-modified cylindrical PEEK 200 implants present with excellent osseointegration properties. Moreover, they can tightly bind with the surrounding bone tissue. A practical method for manufacturing single-component PEEK implants with excellent osseointegration properties is reported, and the materials can be possibly used as orthopedic implants.

3D printing of PEEK and its composite to increase biointerfaces as a biomedical material- A review

Poly ether-ether-ketone (PEEK) is a polymer with better lignin biocompatibility than other polymers. It is good for biomedical engineering applications. This research summarises the outcomes of an evaluation conducted on PEEK material composites, such as cellular calcium hydroxyapatite (CHAp) for medical applications. Prospects of PEEK for medical implant are highlighted. Critical analysis and review on 3D printing of PEEK, CHAp and their biological macromolecular behaviours are presented. An electronic search was carried out on Scupos database, Google search and peer-reviewed papers published in the last ten years. Because of the extraordinary strength and biological behaviours of PEEK and its composite of CHAp, 3D-printed PEEK has several biomedical applications, and its biological macromolecular behaviour leads to health sustainability. This work highlights its biological macromolecular behaviours as a bone implant material and the optimum 3D printing process for PEEK and CHAp for medical applications. The current problems with printing PEEK and CHAp are investigated along with their possible uses. Possible solutions to improve the 3D printability of PEEK and CHAp are explained based on scientific mechanisms. This detailed report stands to benefit both scientific community and medical industry to enhance 3D printing concepts for PEEK and CHAp.

The study on calcium polyphosphate/poly-amino acid composite for supportive bone substitute materials in vitro

A poly-amino acid/calcium polyphosphate composite with high mechanical strength, excellent stability and biological activity was prepared and studied for bone-repaired.

Bioactive-Enhanced Polyetheretherketone Dental Implant Materials: Mechanical Characterization and Cellular Responses

The aim of this study was to characterize the mechanical properties of a bioactive-modified polyetheretherketone (PEEK) manufacturing approach for dental implants and to compare the in vitro biological behavior with titanium alloy (Ti6Al4V) as the reference. PEEK, PEEK with 5% hydroxyapatite (HA), PEEK with 5% beta-tricalcium phosphate (βTCP), and Ti6Al4V discs were produced using hot pressing technology to create a functionally graded material (FGM). Surface roughness values (Ra, Rz), water contact angle, shear bond strength, and Vickers hardness tests were performed. Human osteoblasts and gingival fibroblasts bioactivity was evaluated by a resazurin-based method, alkaline phosphatase activity (ALP), and confocal laser scanning microscopy (CLSM) images of fluorescent-stained fibroblasts. Morphology and cellular adhesion were confirmed using field emission gun-scanning electron microscopy (FEG-SEM). Group comparisons were tested using analysis of variance (Tukey post hoc test), α = .05. All groups presented similar roughness values (P > .05). Ti6Al4V group was found to have the highest contact angle (P < .05). Shear bond strength and Vickers hardness of different PEEK materials were similar (P > .05); however, the mean values in the Ti6Al4V group were significantly higher when compared with those of the other groups (P < .05). Cell viability and proliferation of osteoblast and fibroblast cells were higher in the PEEK group (P < .05). PEEK-βTCP showed the highest significant ALP activity over time (P < .05 at 14 days of culture). An enhanced bone and soft-tissue cell behavior on pure PEEK was obtained to the gold standard (Ti6Al4V) with equivalent roughness. The results substantiate the potential role of chemical composition rather than physical properties of materials in biological responses. The addition of 5% HA or βTCP by FGM did not enhance PEEK mechanical properties or periodontal cell behavior.

Bioactive amorphous magnesium phosphate-polyetheretherketone composite filaments for 3D printing

OBJECTIVE

The aim of this study was to develop bioactive and osseointegrable polyetheretherketone (PEEK)-based composite filaments melt-blended with novel amorphous magnesium phosphate (AMP) particles for 3D printing of dental and orthopedic implants.

MATERIALS AND METHODS

A series of materials and biological analyses of AMP-PEEK were performed. Thermal stability, thermogravimetric and differential scanning calorimetry curves of as-synthesized AMP were measured. Complex viscosity, elastic modulus and viscous modulus were determined using a rotational rheometer. In vitro bioactivity was analyzed using SBF immersion method. SEM, EDS and XRD were used to study the apatite-forming ability of the AMP-PEEK filaments. Mouse pre-osteoblasts (MC3T3-E1) were cultured and analyzed for cell viability, proliferation and gene expression. For in vivo analyses, bare PEEK was used as the control and 15AMP-PEEK was chosen based on its in vitro cell-related results. After 4 or 12 weeks, animals were euthanized, and the femurs were collected for micro-computed tomography (μ-CT) and histology.

RESULTS

The collected findings confirmed the homogeneous dispersion of AMP particles within the PEEK matrix with no phase degradation. Rheological studies demonstrated that AMP-PEEK composites are good candidates for 3D printing by exhibiting high zero-shear and low infinite-shear viscosities. In vitro results revealed enhanced bioactivity and superior pre-osteoblast cell function in the case of AMP-PEEK composites as compared to bare PEEK. In vivo analyses further corroborated the enhanced osseointegration capacity for AMP-PEEK implants.

SIGNIFICANCE

Collectively, the present investigation demonstrated that AMP-PEEK composite filaments can serve as feedstock for 3D printing of orthopedic and dental implants due to enhanced bioactivity and osseointegration capacity.

Fabrication and characterization of an electrostatically bonded PEEK- hydroxyapatite composites for biomedical applications

In this study, it was aimed to produce electrostatically induced polyetheretherketone (PEEK) and strontium substituted hydroxyapatite (SrHA) composites. SrHA nanoparticles (5 and 10 vol%) were introduced in the PEEK matrix to increase its mechanical properties and osseointegration. In order to disperse and homogeneously distribute the nanoparticles within the matrix, an electrostatic bond was developed between the PEEK and nanoparticles by wet processing through the attraction of the oppositely charged particles. Particles were pressed and sintered according to the Taguchi Design of experiments (DoE) array. The effects of SrHA reinforcement, sintering temperature and time on the density, crystallinity and crystallite sizes were determined with density test, DSC and XRD, respectively. The disks were also analyzed via SEM, FTIR, compression, microhardness, and nanoindentation tests and were immersed into the simulated body fluid (SBF). The composites produced from electrostatically induced powders presented a homogenous microstructure as SEM analysis illustrated the homogenous dispersion and distribution of the SrHA nanoparticles. The SrHA nanoparticles decreased the relative density and crystallinity of the composite, whereas, the rise in the sintering temperature and time enhanced the relative density, according to the DoE results. SrHA reinforcement improved the reduced modulus and nanoindentation hardness of the PEEK (348.47 MPa, 5.97 GPa) to 392.02 MPa and 6.65 GPa, respectively. SrHA promoted the bioactivity of the composite: an apatite layer covered the surface of PEEK/10SrHA composite after 14 days incubation. These promising results suggest that the electrostatically bonded composite powders would be used to produce homogenous PEEK based bioactive composites.

On the Future Design of Bio-Inspired Polyetheretherketone Dental Implants

Polyetheretherketone (PEEK) is a promising implant material because of its excellent mechanical characteristics. Although this polymer is a standard material in spinal applications, PEEK is not in use in the manufacturing of dental implants, where titanium is still the most-used material. This may be caused by its relative bio-inertness. By the use of various surface modification techniques, efforts have been made to enhance its osseointegrative characteristics to enable the polymer to be used in dentistry. In this feature paper, the state-of-the-art for dental implants is given and different surface modification techniques of PEEK are discussed. The focus will lie on a covalently attached surface layer mimicking natural bone. The usage of such covalently anchored biomimetic composite materials combines many advantageous properties: A biocompatible organic matrix and a mineral component provide the cells with a surrounding close to natural bone. Bone-related cells may not recognize the implant as a foreign body and therefore, may heal and integrate faster and more firmly. Because neither metal-based nor ceramics are ideal material candidates for a dental implant, the combination of PEEK and a covalently anchored mineralized biopolymer layer may be the start of the desired evolution in dental surgery.

Silicon nitride enhances osteoprogenitor cell growth and differentiation via increased surface energy and formation of amide and nanocrystalline HA for craniofacial reconstruction

The bioactive silicon nitride (Si₃N₄) has been FDA cleared for use as spinal intervertebral arthrodesis devices. Because its surface properties promote bone ongrowth and ingrowth, it also has the potential to benefit craniofacial reconstruction. Thus, the aim of this work was to determine whether the surface properties of Si₃N₄ could enhance the osteoblast cell growth, differentiation and nucleation of hydroxyapatite (HA) crystals compared to conventional implant materials such as titanium (Ti) and polyether ether ketone (PEEK). X-ray absorbance near-edge structure analysis (XANES) indicated the presence of Si-Si, Si-O and Si-N bonding. Surface wettability studies confirmed that Si₃N₄ exhibits the lowest contact angle and highest surface energy. Cell culture studies showed that osteoblast growth was enhanced on Si₃N₄ after 1 day and up to 7 days. Si₃N₄ surface induced highest surface coverage and thickness of nanocrystalline HA (211) and (203) in cell-free in vitro studies after 7 days of culture. Raman spectroscopy analysis confirmed the presence of surface functional groups consisting of phosphate and carbonate species. Interestingly, Si₃N₄ surface showed amide and hydroxyproline groups, the precursors to collagen, which were not observed on Ti and PEEK surfaces. Furthermore, Si₃N₄ surface indicated high expression of RUNX2, enhanced cell differentiation and dense collagenous ECM after 30 days of the in vitro study. The present study concluded that Si₃N₄ surface enhances osteoprogenitor cell adhesion, growth, RUNX2 expression and ECM formation via the coupled effects of higher surface energy and the presence of amide and nanocrystalline HA functional groups.

Bioactive poly(etheretherketone) composite containing calcium polyphosphate and multi-walled carbon nanotubes for bone repair: Mechanical property and in vitro biocompatibility

Poly(etheretherketone) exhibits good biocompatibility, excellent mechanical properties, and bone-like stiffness. However, the natural bio-inertness of pure poly(etheretherketone) hinders its applications in biomedical field, especially when direct bone-implant osteo-integration is desired. For developing an alternative biomaterial for load-bearing orthopedic application, combination of bioactive fillers with poly(etheretherketone) matrix is a feasible approach. In this study, a bioactive multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite was prepared through a compounding and injection-molding process for the first time. Bioactive calcium polyphosphate was added to polymer matrix to enhance the bioactivity of the composite, and incorporation of multi-walled carbon nanotubes to composite was aimed to improve both the mechanical property and biocompatibility. Furthermore, the microstructures, surface hydrophilicity, and mechanical property of multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite, as well as the cellular responses of MC3T3-E1 osteoblast cells to this material were investigated. The mechanical testing revealed that mechanical performance of the resulting ternary composite was significantly enhanced by adding the multi-walled carbon nanotubes and the mechanical values obtained were close to or higher than those of human cortical bone. More importantly, cell culture tests showed that initial cell adhesion, cell viability, and osteogenic differentiation of MC3T3-E1 cells were significantly promoted on the multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite. Accordingly, the multi-walled carbon nanotubes/calcium polyphosphate/poly(etheretherketone) composite may be used as a promising bone repair material in dental and orthopedic applications.

Surface characteristics of dental implants: A review

OBJECTIVES

During the last decades, several changes of paradigm have modified our view on how biomaterials' surface characteristics influence the bioresponse. After becoming aware of the role of a certain microroughness for improved cellular contact and osseointegration of dental titanium implants, the likewise important role of surface energy and wettability was increasingly strengthened. Very recently, synergistic effects of nanoscaled topographical features and hydrophilicity at the implant/bone interface have been reported.

METHODS

Questions arise about which surface roughness and wetting data are capable to predict the bioresponse and, ultimately, the clinical performance. Current methods and approaches applied for topographical, wetting and surface energetic analyses are highlighted. Current knowledge of possible mechanisms explaining the influence of roughness and hydrophilicity at the biological interface is presented.

RESULTS

Most marketed and experimental surfaces are based on commonly available additive or subtractive surface modifying methods such as blasting, etching or anodizing. Different height, spatial, hybrid and functional roughness parameters have been identified as possible candidates able to predict the outcome at hard and soft tissue interfaces. Likewise, hydrophilic implants have been proven to improve the initial blood contact, to support the wound healing and thereby accelerating the osseointegration.

SIGNIFICANCE

There is clear relevance for the influence of topographical and wetting characteristics on a macromolecular and cellular level at endosseous implant/biosystem interfaces. However, we are still far away from designing sophisticated implant surfaces with the best possible, selective functionality for each specific tissue or cavity interface. Firstly, because our knowledge of the respective surface related reactions is at best fragmentary. Secondly, because manufacturing of multi-scaled complex surfaces including distinct nanotopographies, wetting properties, and stable cleanliness is still a technical challenge and far away from being reproducibly transferred to implant surfaces.

Physicochemical and biological assessment of PEEK composites embedding natural amorphous silica fibers for biomedical applications

The main aim of this study was to assess the physicochemical and biological properties of a novel poly(ether ether ketone) (PEEK) composite containing 30%wt natural amorphous silica fibers (NASF). PEEK and NASF powders were previously functionalized by atomization and citric acid in order to enhance adhesion between polymeric matrix and fillers. Then, composites were produced by cold compression molding technique at 350°C for 3h. Materials were characterized by chemical, microstructural, thermophysical, mechanical and cytotoxic analysis. The results of the mechanical assays showed that the incorporation fibers increased the elastic modulus of the resultant PEEK composite in 56% while its microhardness increased in 26.7%. Chemical and microscopic analyses detected a good interfacial adhesion between PEEK and NASF. The results of the cytotoxicity assays indicated that PEEK/NASF composites stimulated the metabolic activity of fibroblasts and therefore a high cytocompatibility was noticed. PEEK composites embedding natural amorphous silica fibers revealed a high potential to be used in medicine and dentistry replacing several polymeric and composite materials.

Effect of notch sensitivity on the mechanical properties of HA/PEEK functional gradient biocomposites

Biomaterials used as loading-bearing orthopedic implants usually require various excellent properties such as mechanical, bioactive and bio-tribological performances. Moreover, all of the orthopedic applications feature stress concentrations (notch sensitivity) in their design. In the present work, hydroxyapatite-reinforced polyetheretherketone functional gradient biocomposites (HA/PEEK FGBm) were successfully prepared by the layer stacking method combined with hot pressing molding technology. The effects of notch geometry on the stress-strain behavior of HA/PEEK FGBm were evaluated. The fracture morphology was investigated by scanning electron microscopy (SEM). The study of the stress-strain behavior indicated that the tensile and flexural stresses of HA/PEEK FGBm linearly increased with increasing strain under all the notch sensitivities. The fracture strain of the biocomposites decreased with increasing stress concentration factor and total HA content in the functional biocomposites. Moreover, the tensile and flexural strengths of HA/PEEK FGBm were lower than those of homogeneous HA/PEEK biocomposites. The SEM observation of the fracture micro-morphology showed that the fracture mechanism of HA/PEEK FGBm was gradually controlled by the brittle fracture process. Furthermore, both the tensile and the flexural strengths of HA/PEEK FGBm decreased with the increase in stress concentration factor and total HA content in the biocomposites.

Polyetheretherketone (PEEK) for medical applications

Polyetheretherketone (PEEK) is a polyaromatic semi-crystalline thermoplastic polymer with mechanical properties favorable for bio-medical applications. Polyetheretherketone forms: PEEK-LT1, PEEK-LT2, and PEEK-LT3 have already been applied in different surgical fields: spine surgery, orthopedic surgery, maxillo-facial surgery etc. Synthesis of PEEK composites broadens the physicochemical and mechanical properties of PEEK materials. To improve their osteoinductive and antimicrobial capabilities, different types of functionalization of PEEK surfaces and changes in PEEK structure were proposed. PEEK based materials are becoming an important group of biomaterials used for bone and cartilage replacement as well as in a large number of diverse medical fields. The current paper describes the structural changes and the surface functionalization of PEEK materials and their most common biomedical applications. The possibility to use these materials in 3D printing process could increase the scientific interest and their future development as well.

Augmenting the bioactivity of polyetheretherketone using a novel accelerated neutral atom beam technique

Polyetheretherketone (PEEK) is an alternative to metallic implants in orthopedic applications; however, PEEK is bioinert and does not osteointegrate. In this study, an accelerated neutral atom beam technique (ANAB) was employed to improve the bioactivity of PEEK. The aim was to investigate the growth of human mesenchymal stem cells (hMSCs), human osteoblasts (hOB), and skin fibroblasts (BR3G) on PEEK and ANAB PEEK.

METHODS

The surface roughness and contact angle of PEEK and ANAB PEEK was measured. Cell metabolic activity, proliferation and alkaline phosphatase (ALP) was measured and cell attachment was determined by quantifying adhesion plaques with cells.

RESULTS

ANAB treatment increased the surface hydrophilicity [91.74 ± 4.80° (PEEK) vs. 74.82 ± 2.70° (ANAB PEEK), p < 0.001] but did not alter the surface roughness. Metabolic activity and proliferation for all cell types significantly increased on ANAB PEEK compared to PEEK (p < 0.05). Significantly increased cell attachment was measured on ANAB PEEK surfaces. MSCs seeded on ANAB PEEK in the presence of osteogenic media, expressed increased levels of ALP compared to untreated PEEK (p < 0.05) CONCLUSION: Our results demonstrated that ANAB treatment increased the cell attachment, metabolic activity, and proliferation on PEEK. ANAB treatment may improve the osteointegration of PEEK implants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1438-1446, 2017.

Preparation Methods for Improving PEEK's Bioactivity for Orthopedic and Dental Application: A Review

There is an increased interest in the use of polyether ether ketone (PEEK) for orthopedic and dental implant applications due to its elastic modulus close to that of bone, biocompatibility, and its radiolucent properties. However, PEEK is still categorized as bioinert due to its low integration with surrounding tissues. Many studies have reported on methods to increase the bioactivity of PEEK, but there is still one-preparation method for preparing bioactive PEEK implant where the produced implant with desirable mechanical and bioactivity properties is required. The aim of this review is to present the progress of the preparation methods for improvement of the bioactivity of PEEK and to discuss the strengths and weaknesses of the existing methods.

Response of Human Osteoblast to n-HA/PEEK--Quantitative Proteomic Study of Bio-effects of Nano-Hydroxyapatite Composite

Nano-sized hydroxyapatite (n-HA) is considered as a bio-active material, which is often mixed into bone implant material, polyetheretherketone (PEEK). To reveal the global protein expression modulations of osteoblast in response to direct contact with the PEEK composite containing high level (40%) nano-sized hydroxyapatite (n-HA/PEEK) and explain its comprehensive bio-effects, quantitative proteomic analysis was conducted on human osteoblast-like cells MG-63 cultured on n-HA/PEEK in comparison with pure PEEK. Results from quantitative proteomic analysis showed that the most enriched categories in the up-regulated proteins were related to calcium ion processes and associated functions while the most enriched categories in the down-regulated proteins were related to RNA process. This enhanced our understanding to the molecular mechanism of the promotion of the cell adhesion and differentiation with the inhibition of the cell proliferation on n-HA/PEEK composite. It also exhibited that although the calcium ion level of incubate environment hadn't increased, merely the calcium fixed on the surface of material had influence to intracellular calcium related processes, which was also reflect by the higher intracellular Ca(2+) concentration of n-HA/PEEK. This study could lead to more comprehensive cognition to the versatile biocompatibility of composite materials. It further proves that proteomics is useful in new bio-effect discovery.

Plasma Surface Functionalized Polyetheretherketone for Enhanced Osseo-Integration at Bone-Implant Interface

This study aims at improving osseo-integration at the bone-implant interface of polyetheretherketone (PEEK) by water (H2O) and ammonia (NH3) plasma immersion ion implantation (PIII). The pertinent surface characteristics including surface energy, roughness, morphology, and chemical composition are investigated systematically and the in vitro biological performance is evaluated by cell adhesion and proliferation, alkaline phosphatase (ALP) activity, real-time RT-PCR evaluation, and mineralization tests. In vivo osseo-integration is examined via implanting samples into the distal femur of the rats. The hydrophilicity, surface roughness, cell adhesion, and proliferation, ALP activity, and osteogenic differentiation after H2O PIII or NH3 PIII are improved significantly. Furthermore, substantially enhanced osseo-integration is achieved in vivo. Nonline-of-sight plasma surface functionalization, which is particularly suitable for biomedical implants with an irregular geometry, does not alter the bulk compressive yield strength and elastic modulus of the materials. Consequently, the favorable bulk attributes of PEEK are preserved while the surface biological properties are enhanced thus boding well for wider orthopedic application of the biopolymer.

Enhanced bioactivity and osseointegration of PEEK with accelerated neutral atom beam technology

Polyetheretherketone (PEEK) is growing in popularity for orthopedic, spinal, and trauma applications but has potential significant limitations in use. PEEK is biocompatible, similar in elasticity to bone, and radiolucent, but is inert and therefore does not integrate well with bone. Current efforts are focusing on increasing the bioactivity of PEEK with surface modifications to improve the bone-implant interface. We used a novel Accelerated Neutral Atom Beam (ANAB) technology to enhance the bioactivity of PEEK. Human osteoblast-like cells seeded on ANAB-treated PEEK result in significantly enhanced proliferation compared with control PEEK. Cells grown on ANAB-treated PEEK increase osteogenic expression of ALPL (1.98-fold, p < 0.002), RUNX2 (3.20-fold, p < 0.002), COL1A (1.94-fold, p < 0.015), IBSP (2.78-fold, p < 0.003), and BMP2 (1.89-fold, p < 0.004). Cells grown on these treated surfaces also lead to an increased mineralization (6.4-fold at 21 days, p < 0.0005). In an ovine study, ANAB-treated PEEK implants resulted in enhanced bone-in-contact by 3.09-fold (p < 0.014), increased push-out strength (control 1959 ± 1445 kPa; ANAB 4068 ± 1197 kPa, p < 0.05), and evidence of bone ingrowth at both the early (4 weeks) and later (12 weeks) time points. Taken together, these data suggest that ANAB treatment of PEEK has the potential to enhance its bioactivity, leading to bone formation and significantly decreasing osseointegration time of orthopedic and spinal implants. ANAB treatment, therefore, may significantly enhance the performance of PEEK medical implants and lead to improved clinical outcomes. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 531-543, 2017.

In Vivo Osseointegration Performance of Titanium Dioxide Coating Modified Polyetheretherketone Using Arc Ion Plating for Spinal Implant Application

Polyetheretherketone (PEEK), which has biomechanical performance similar to that of human cancellous bone, is used widely as a spinal implant material. However, its bioinertness and hydrophobic surface properties result in poor osseointegration. This study applies a novel modification method, arc ion plating (AIP), that produces a highly osteoblast compatible titanium dioxide (TiO2) coatings on a PEEK substrate. This PEEK with TiO2 coating (TiO2/PEEK) was implanted into the femurs of New Zealand white male rabbits to evaluate its in vivo performance by the push-out test and histological observation. Analytical results show that AIP can prepare TiO2 coatings on bullet-shaped PEEK substrates as implant materials. After prolonged implantation in rabbits, no signs of inflammation existed. Newly regenerated bone formed more prominently with the TiO2/PEEK implant by histological observation. The shear strength of the bone/implant interface increases as implantation period increases. Most importantly, bone bonding performance of the TiO2/PEEK implant was superior to that of bare PEEK. The rutile-TiO2 coatings achieved better osseointegration than the anatase-TiO2 coatings. Therefore, AIP-TiO2 can serve as a novel surface modification method on PEEK for spinal interbody fusion cages.

Current strategies to improve the bioactivity of PEEK

The synthetic thermoplastic polymer polyetheretherketone (PEEK) is becoming a popular component of clinical orthopedic and spinal applications, but its practical use suffers from several limitations. Although PEEK is biocompatible, chemically stable, radiolucent and has an elastic modulus similar to that of normal human bone, it is biologically inert, preventing good integration with adjacent bone tissues upon implantation. Recent efforts have focused on increasing the bioactivity of PEEK to improve the bone-implant interface. Two main strategies have been used to overcome the inert character of PEEK. One approach is surface modification to activate PEEK through surface treatment alone or in combination with a surface coating. Another strategy is to prepare bioactive PEEK composites by impregnating bioactive materials into PEEK substrate. Researchers believe that modified bioactive PEEK will have a wide range of orthopedic applications.

Research on Biological Properties of PEEK Based Composites

PEEK based composites have been increasingly employed as biomaterials due to its excellent biological characteristics. In this paper, the biocompatibility, bioactivity, bio-tribology and biomechanics of PEEK composites were investigated. The results showed that PEEK possesses excellent cellular and blood compatibility. The bioactivity of PEEK could be improved by various techniques such as plasma treatment, surface grafting, surface deposition and addition of bioactive glass ceramic in the PEEK matrix. The results of bio-tribology showed that the biotribological properties of PEEK based composites could be comparable with that of traditional artificial joint materials such as UHMWPE. It is even superior to UHMWPE under certain conditions. The biomechanical properties of PEEK composites showed that they can improve the initial stability, reduce the stress shielding and improve bonding strength between bone and implant after replacement, while they are compared with traditional implants such as stainless steel, titanium alloy and Co-Cr-Mo alloy.

3D interconnected porous HA scaffolds with SiO2 additions: effect of SiO2 content and macropore size on the viability of human osteoblast cells

3D interconnected porous scaffolds of HA and HA with various additions of SiO2 were fabricated using a polymeric template technique, to make bioceramic scaffolds consisting of macrostructures of the interconnected macropores. Three different sizes of the polyurethane template were used in the fabrication process to form different size interconnected macropores, to study the effect of pore size on human osteoblast cell viability. The template used allowed fabrication of scaffolds with pore sizes of 45, 60, and 75 ppi, respectively. Scanning microscopy was used extensively to observe the microstructure of the sintered samples and the characteristics of cells growing on the HA surfaces of the interconnected macropores. It has been clearly demonstrated that the SiO2 addition has influenced both the phase transformation of HA to TCP (β-TCP and α-TCP) and also affected the human osteoblast cell viability grown on these scaffolds.

[After titanium, peek ?]

The PEEK-Optima(®), composite mixture of polyetheretherketon and inert materials, is used in orthopedics, spinal surgery and cranio-facial surgery. It could be used in dental implantology because of its biological and mechanical properties. The results of an experimental and finite element study made on basal implant prototypes, on basal implantology show that PEEK, contrary to titanium, has a compound structure that allows to optimize the distribution of masticatory forces around the implant. These results should be confirmed by a clinical study according to research regulation.

PEEK biomaterials in trauma, orthopedic, and spinal implants

Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of spine implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the spine community. For mature fields, such as total joint replacements and fracture fixation implants, radiolucency is an attractive but not necessarily critical material feature.