Tetracalcium phosphate: Synthesis, properties and biomedical applications

Tetracalcium phosphate/porous iron synergistically improved the mechanical, degradation and biological properties of polylactic acid scaffolds

Synergistically improving the mechanical and degradable properties of polylactic acid (PLA) scaffolds and endowing them with bioactivity are urgent problems to be solved in deepening their application in tissue engineering. In this work, tetracalcium phosphate (TTCP) and porous iron (pFe) were compounded by stirring and vacuum negative pressure, and then they were blended with polylactic acid and a porous scaffold (named TTCP@pFe/PLA) was prepared by selective laser sintering. On the one hand, molten polylactic acid penetrates the pores of porous iron to form an interlocking network, thereby achieving mechanical strengthening. On the other hand, the alkaline environment generated by the dissolution of tetracalcium phosphate can effectively catalyze the hydrolysis of polylactic acid to accelerate the degradation. Meanwhile, the dissolution of tetracalcium phosphate forms a local calcium-rich microenvironment, which rapidly induces apatite formation, that is, confers bioactivity on scaffolds. As a result, the TTCP@pFe/PLA scaffold exhibited a notable enhancement in mechanical strength, being 2.2 times stronger compared to the polylactic acid scaffold. More importantly, MC3T3E1 cells exhibit good adhesion, stretching, and proliferation on the composite scaffold, demonstrating good cytocompatibility. All these good properties of the TTCP@pFe/PLA scaffold indicate that it has potential applications as a novel alternative in bone tissue regeneration.

Repair of a rat calvaria defect with injectable strontium (Sr)-doped polyphosphate dicalcium phosphate dehydrate (P-DCPD) ceramic bone grafts

The trace element strontium (Sr) enhances new bone formation. However, delivering Sr, like other materials, in a sustained manner from a ceramic bone graft substitute (BGS) is difficult. We developed a novel ceramic BGS, polyphosphate dicalcium phosphate dehydrate (P-DCPD), which delivers embedded drugs in a sustained pattern. This study assessed the in vitro and in vivo performance of Sr-doped P-DCPD. In vitro P-DCPD and 10%Sr-P-DCPD were nontoxic and eluents from 10%Sr-P-DCPD significantly enhanced osteoblastic MC3T3 cell differentiation. A sustained, zero-order Sr release was observed from 10%Sr-P-DCPD for up to 70 days. When using this BGS in a rat calvaria defect model, both P-DCPD and 10% Sr-P-DCPD were found to be biocompatible and biodegradable. Histologic data from decalcified and undecalcified tissue showed that 10%Sr-P-DCPD had more extensive new bone formation compared with P-DCPD 12-weeks after surgery and the 10%Sr-P-DCPD had more organized new bone and much less fibrous tissue at the defect margins. The new bone was formed on the surface of the degraded ceramic debris within the bone defect area. P-DCPD represented a promising drug-eluting BGS for repair of critical bone defects.

Spectral Analysis of Strontium-Doped Calcium Phosphate/Chitosan Composite Films

Strontium-doped calcium phosphate/chitosan films were synthetized on silicon substrates using the radio-frequency magnetron sputtering technique and the matrix-assisted pulsed laser evaporation technique. The deposition conditions associated with the radio-frequency magnetron sputtering discharge, in particular, include the high temperature at the substrate, which promotes the formation of strontium-doped tetra calcium phosphate layers. The physical and chemical processes associated with the deposition of chitosan on strontium-doped calcium phosphate layers were investigated using Fourier Transform Infrared Spectroscopy, Energy Dispersive X-ray Spectroscopy, and Scanning Electron Microscopy. Mass spectrometry coupled with laser induced ablation of the composite films proved to be a useful tool in the detection of the molecular ions characteristic to chitosan chemical structure.

In Vitro and In Vivo Evaluation of a Bio-Inspired Adhesive for Bone Fixation

Compared to metallic hardware, an effective bone adhesive can revolutionize the treatment of clinically challenging situations such as comminuted, articular, and pediatric fractures. The present study aims to develop such a bio-inspired bone adhesive, based upon a modified mineral-organic adhesive with tetracalcium phosphate (TTCP) and phosphoserine (OPS) by incorporating nanoparticles of polydopamine (nPDA). The optimal formulation, which was screened using in vitro instrumental tensile adhesion tests, was found to be 50%_molTTCP/50%_molOPS-2%_wtnPDA with a liquid-to-powder ratio of 0.21 mL/g. This adhesive has a substantially stronger adhesive strength (1.0-1.6 MPa) to bovine cortical bone than the adhesive without nPDA (0.5-0.6 MPa). To simulate a clinical scenario of autograft fixation under low mechanical load, we presented the first in vivo model: a rat fibula glued to the tibia, on which the TTCP/OPS-nPDA adhesive (n = 7) was shown to be effective in stabilizing the graft without displacement (a clinical success rate of 86% and 71% at 5 and 12 weeks, respectively) compared to a sham control (0%). Significant coverage of newly formed bone was particularly observed on the surface of the adhesive, thanks to the osteoinductive property of nPDA. To conclude, the TTCP/OPS-nPDA adhesive fulfilled many clinical requirements for the bone fixation, and potentially could be functionalized via nPDA to offer more biological activities, e.g., anti-infection after antibiotic loading.

The Influence of Nanosilica on Properties of Cement Based on Tetracalcium Phosphate/Monetite Mixture with Addition of Magnesium Pyrophoshate

The effect of nanosilica on the microstructure setting process of tetracalcium phosphate/nanomonetite calcium phosphate cement mixture (CPC) with the addition of 5 wt% of magnesium pyrophosphate (assigned as CT5MP) and osteogenic differentiation of mesenchymal stem cells cultured in cement extracts were studied. A more compact microstructure was observed in CT5MP cement with 0.5 wt% addition of nanosilica (CT5MP1Si) due to the synergistic effect of Mg₂P₂O₇ particles, which strengthened the cement matrix and nanosilica, which supported gradual growth and recrystallization of HAP particles to form compact agglomerates. The addition of 0.5 wt% of nanosilica to CT5MP cement caused an increase in CS from 18 to 24 MPa while the setting time increased almost twofold. It was verified that adding nanosilica to CPC cement, even in a low amount (0.5 and 1 wt% of nanosilica), positively affected the injectability of cement pastes and differentiation of cells with upregulation of osteogenic markers in cells cultured in cement extracts. Results revealed appropriate properties of these types of cement for filling bone defects.

Modulated Laser Cladding of Implant-Type Coatings by Bovine-Bone-Derived Hydroxyapatite Powder Injection on Ti6Al4V Substrates-Part I: Fabrication and Physico-Chemical Characterization

The surface physico-chemistry of metallic implants governs their successful long-term functionality for orthopedic and dentistry applications. Here, we investigated the feasibility of harmoniously combining two of the star materials currently employed in bone treatment/restoration, namely, calcium-phosphate-based bioceramics (in the form of coatings that have the capacity to enhance osseointegration) and titanium alloys (used as bulk implant materials due to their mechanical performance and lack of systemic toxicity). For the first time, bovine-bone-derived hydroxyapatite (BHA) was layered on top of Ti6Al4V substrates using powder injection laser cladding technology, and then subjected, in this first stage of the research, to an array of physical-chemical analyses. The laser processing set-up involved the conjoined modulation of the BHA-to-Ti ratio (100 wt.% and 50 wt.%) and beam power range (500-1000 W). As such, on each metallic substrate, several overlapped strips were produced and the external surface of the cladded coatings was further investigated. The morphological and compositional (SEM/EDS) evaluations exposed fully covered metallic surfaces with ceramic-based materials, without any fragmentation and with a strong metallurgical bond. The structural (XRD, micro-Raman) analyses showed the formation of calcium titanate as the main phase up to maximum 800 W, accompanied by partial BHA decomposition and the consequential advent of tetracalcium phosphate (markedly above 600 W), independent of the BHA ratio. In addition, the hydrophilic behavior of the coatings was outlined, being linked to the varied surface textures and phase dynamism that emerged due to laser power increment for both of the employed BHA ratios. Hence, this research delineates a series of optimal laser cladding technological parameters for the adequate deposition of bioceramic layers with customized functionality.

Calcium Phosphate-Based Biomaterials for Bone Repair

Traumatic, tumoral, and infectious bone defects are common in clinics, and create a big burden on patient's families and society. Calcium phosphate (CaP)-based biomaterials have superior properties and have been widely used for bone defect repair, due to their similarities to the inorganic components of human bones. The biological performance of CaPs, as a determining factor for their applications, are dependent on their physicochemical properties. Hydroxyapatite (HAP) as the most thermally stable crystalline phase of CaP is mostly used in the form of ceramics or composites scaffolds with polymers. Nanostructured CaPs with large surface areas are suitable for drug/gene delivery systems. Additionally, CaP scaffolds with hierarchical nano-/microstructures have demonstrated excellent ability in promoting bone regeneration. This review focuses on the relationships and interactions between the physicochemical/biological properties of CaP biomaterials and their species, sizes, and morphologies in bone regeneration, including synthesis strategies, structure control, biological behavior, and the mechanisms of CaP in promoting osteogenesis. This review will be helpful for scientists and engineers to further understand CaP-based biomaterials (CaPs), and be useful in developing new high-performance biomaterials for bone repair.

Development of Injectable Calcium Sulfate and Self-Setting Calcium Phosphate Composite Bone Graft Materials for Minimally Invasive Surgery

The demand of bone grafting is increasing as the population ages worldwide. Although bone graft materials have been extensively developed over the decades, only a few injectable bone grafts are clinically available and none of them can be extruded from 18G needles. To overcome the existing treatment limitations, the aim of this study is to develop ideal injectable implants from biomaterials for minimally invasive surgery. An injectable composite bone graft containing calcium sulfate hemihydrate, tetracalcium phosphate, and anhydrous calcium hydrogen phosphate (CSH/CaP paste) was prepared with different CSH/CaP ratios and different concentrations of additives. The setting time, injectability, mechanical properties, and biocompatibility were evaluated. The developed injectable CSH/CaP paste (CSH/CaP 1:1 supplemented with 6% citric acid and 2% HPMC) presented good handling properties, great biocompatibility, and adequate mechanical strength. Furthermore, the paste was demonstrated to be extruded from a syringe equipped with 18G needles and exerted a great potential for minimally invasive surgery. The developed injectable implants with tissue repairing potentials will provide an ideal therapeutic strategy for minimally invasive surgery to apply in the treatment of maxillofacial defects, certain indications in the spine, inferior turbinate for empty nose syndrome (ENS), or reconstructive rhinoplasty.

Mark Coventry Award: Efficacy of Saline Wash Plus Antibiotics Doped Polyvinyl Alcohol (PVA) Composite (PVA-VAN/TOB-P) in a Mouse Pouch Infection Model

BACKGROUND

The efficacy of saline irrigation for treatment of periprosthetic infection (PJI) is limited by the presence of contaminated medical devices. This study evaluated treatment efficacy of locally placed polyvinyl alcohol (PVA)/bioceramic composite doped with vancomycin (PVA-VAN-P) or vancomycin and tobramycin (PVA-VAN/TOB-P) after saline irrigation in a mouse pouch infection model.

METHODS

Sutures were implanted into air pouches of BALB/cJ mice, then inoculated with Staphylococcus aureus. Mice were randomized into 6 groups (n = 6 each): (1) no bacteria; (2) bacteria without saline wash; (3) saline wash only; (4) saline wash + PVA-P; (5) saline wash + PVA-VAN-P, and (6) saline wash + PVA-VAN/TOB-P. After 7 days, pouches were washed with saline alone or with additional injection of 0.2 mL of the composites. Sacrifice occurred 14 days after the washout. Histology was performed on the pouch tissues and bacteria cultures on the washout fluid.

RESULTS

Bacterial culture (optical density) showed that infection persisted after saline irrigation (0.10 ± 0.14) but was effectively eradicated by the addition of PVA-VAN-P (0.05 ± 0.09) and PVA-VAN/TOB-P (0.002 ± 0.003, P < .05). These effects were confirmed by histology. Importantly, no residues of the PVA-P were detected in either the pouch washouts or pouch tissues.

CONCLUSION

PJI is common and problematic, and few innovations have changed clinical practice and/or outcome. Our data confirmed that the effect of saline irrigation was very limited in the presence of contaminated sutures. PVA-VAN/TOB-P was biodegradable, biocompatible, and effective in eradicating bacterial retention after saline irrigation. Application of PVA-VAN/TOB-P after saline irrigation could be an option for treatment of PJI and should be evaluated in future PJI animal models.

Synthesis, Characterization, Functionalization and Bio-Applications of Hydroxyapatite Nanomaterials: An Overview

Hydroxyapatite (HA) is similar to natural bone regarding composition, and its structure favors in biomedical applications. Continuous research and progress on HA nanomaterials (HA-NMs) have explored novel fabrication approaches coupled with functionalization and characterization methods. These nanomaterials have a significant role in many biomedical areas like sustained drug and gene delivery, bio-imaging, magnetic resonance, cell separation, and hyperthermia treatment due to their promising biocompatibility. This review highlighted the HA-NMs chemical composition, recent progress in synthesis methods, characterization and surface modification methods, ion-doping, and role in biomedical applications. HA-NMs have a substantial role as drug delivery vehicles, coating material, bone implant, coating, ceramic, and composite materials. Here, we try to summarize an overview of HA-NMs with the provision of future directions.

Characterization of Tetracalcium Phosphate/Monetite Biocement Modified by Magnesium Pyrophosphate

Magnesium pyrophosphate modified tetracalcium phosphate/monetite cement mixtures (MgTTCPM) were prepared by simple mechanical homogenization of compounds in a ball mill. The MgP₂O₇ was chosen due to the suitable setting properties of the final cements, in contrast to cements with the addition of amorphous (Ca, Mg) CO₃ or newberite, which significantly extended the setting time even in small amounts (corresponding ~to 1 wt% of Mg in final cements). The results showed the gradual dissolution of the same amount of Mg₂P₂O₇ phase, regardless of its content in the cement mixtures, and the refinement of formed HAP nanoparticles, which were joined into weakly and mutually bound spherical agglomerates. The compressive strength of composite cements was reduced to 14 MPa and the setting time was 5–10 min depending on the composition. Cytotoxicity of cements or their extracts was not detected and increased proliferative activity of mesenchymal stem cells with upregulation of osteopontin and osteonectin genes was verified in cells cultured for 7 and 15 days in cement extracts. The above facts, including insignificant changes in the pH of simulated body fluid solution and mechanical strength close to cancellous bone, indicate that MgTTCPM cement mixtures could be suitable biomaterials for use in the treatment of bone defects.

Probing the Structure, Cytocompatibility, and Antimicrobial Efficacy of Silver-, Strontium-, and Zinc-Doped Monetite

Calcium phosphate phases are among the most widely accepted compounds for biomaterial applications, of which the resorbable phases have gained particular attention in recent years. Brushite and its anhydrous form monetite are among the most interesting resorbable calcium phosphate phases that can be applied as cements and for in situ fabrication of three-dimensional (3D) implants. Of these two dicalcium phosphate compounds, monetite is more stable and undergoes slower degradation than brushite. The purpose of the current study is to synthesize and dope monetite with the antimicrobial elements silver and zinc and the osteoinductive element strontium and investigate the possible structural variations as well as their biocompatibility and antimicrobial effectiveness. For this, powder X-ray diffraction (PXRD), energy-dispersive X-ray spectroscopy (EDX), scanning electron microscopy (SEM), and cryo-transmission electron microscopy (cryo-TEM) were used to thoroughly study the synthesized structures. Moreover, the ASTM E-2149-01 protocol and a cell proliferation assay were used to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) and the cytocompatibility of the different phases with the Soas-2 cell line, respectively. The results confirm the successful synthesis and doping procedures, such that zinc was the most incorporated element into the monetite phase and strontium was the least incorporated element. The microbiological studies revealed that silver is a very effective antimicrobial agent at low concentrations but unsuitable at high concentrations because its cytotoxicity would prevail. On the other hand, doping the compounds with zinc led to a reasonable antimicrobial activity without compromising the biocompatibility to obviously high concentrations. The study also highlights that strontium, widely known for its osteoinductivity, bears an antimicrobial effect at high concentrations. The generated doped compounds could be beneficial for prospective studies as bone cements or for scaffold biomaterial applications.

The stability of tetracalcium phosphate/titanium implants: A short-term follow-up study

Background/purpose

Materials and methods

Results

Conclusion

The Use of Calcium Phosphates in Cosmetics, State of the Art and Future Perspectives

Calcium phosphates (CaPs) belong to a class of biomimetic materials widely employed for medical applications thanks to their excellent properties, such as biodegradability, biocompatibility and osteoinductivity. The recent trend in the cosmetics field of substituting potentially hazardous materials with natural, safe, and sustainable ingredients for the health of consumers and for the environment, as well as the progress in the materials science of academics and chemical industries, has opened new perspectives in the use of CaPs in this field. While several reviews have been focused on the applications of CaP-based materials in medicine, this is the first attempt to catalogue the properties and use of CaPs in cosmetics. In this review a brief introduction on the chemical and physical characteristics of the main CaP phases is given, followed by an up-to-date report of their use in cosmetics through a large literature survey of research papers and patents. The application of CaPs as agents in oral care, skin care, hair care, and odor control has been selected and extensively discussed, highlighting the correlation between the chemical, physical and toxicological properties of the materials with their final applications. Finally, perspectives on the main challenges that should be addressed by the scientific community and cosmetics companies to widen the application of CaPs in cosmetics are given.

Advances in Sintering Techniques for Calcium Phosphates Ceramics

Calcium phosphate (CaP) biomaterials are extensively used to reconstruct bone defects. They resemble a chemical similarity to the inorganic mineral present in bones. Thus, they are termed as the key players in bone regeneration. Sintering is a heat treatment process applied to CaP powder compact or fabricated porous material to impart strength and integrity. Conventional sintering is the simplest sintering technique, but the processing of CaPs at a high temperature for a long time usually leads to the formation of secondary phases due to their thermal instability. Furthermore, it results in excessive grain growth that obstructs the densification process, limiting the application of CaP’s ceramics in bone regeneration. This review focuses on advanced sintering techniques used for the densification of CaPs. These techniques utilize the synergy of temperature with one or more parameters such as external pressure, electromagnetic radiation, electric current, or the incorporation of transient liquid that boosts the mass transfer while lowering the sintering temperature and time.

Osteogenic potential and properties of injectable silk fibroin/tetracalcium phosphate/monetite composite powder biocement systems

The powdered cement tetracalcium phosphate/monetite/silk fibroin composite (CFIB) was prepared by simple mechanical milling of tetracalcium phosphate/monetite powder mixture with fibrous soluble silk fibroin (SF). The powder composite cement mixtures contained 5 and 10 wt % of SF and 2% NaH₂ PO₄ solution with 0.1% genipin was used as a liquid component. The setting time of CFIB cement increased with addition of SF from 5 to 25 min in fully injectable cement with 10 wt % of SF. The compressive strength of hardened composites was reduced to 14 MPa which is close to strength of cancellous bone. The 8% of SF from origin amount in CFIB composites was only desorbed from cements after 7 days soaking in simulated body fluid (SBF). It was found almost full transformation of calcium phosphate components in composite to rod-like nanohydroxyapatite after hardening of CFIB cements in SBF. The SF in hardened cements was present in fine globular form after dissolution, actively affected the fluidity of pastes, morphology of hydroxyapatite particles, and microstructure. The excellent cell proliferation and a high over expression of osteogenic gene markers in MSCs were confirmed after the long-time cultivation in CFIB10 cement extract. Injectable CFIB10 cements have appropriate properties for utilization in bone defect treatments with possible positive effect on healing process.

Structural Changes of Hydroxylapatite during Plasma Spraying: Raman and NMR Spectroscopy Results

Functional osseoconductive coatings based on hydroxylapatite (HAp) and applied preferentially by atmospheric plasma spraying to medical implant surfaces are a mainstay of modern implantology. During contact with the hot plasma jet, HAp particles melt incongruently and undergo complex dehydration and decomposition reactions that alter their phase composition and crystallographic symmetry, and thus, the physical and biological properties of the coatings. Surface analytical methods such as laser-Raman and nuclear magnetic resonance (NMR) spectroscopies are useful tools to assess the structural changes of HAp imposed by heat treatment during their flight along the hot plasma jet. In this contribution, the controversial information is highlighted on the existence or non-existence of oxyapatite, i.e., fully dehydrated HAp as a thermodynamically stable compound.

In Vivo Imaging of Biodegradable Implants and Related Tissue Biomarkers

Non-invasive longitudinal imaging of osseointegration of bone implants is essential to ensure a comprehensive, physical and biochemical understanding of the processes related to a successful implant integration and its long-term clinical outcome. This study critically reviews the present imaging techniques that may play a role to assess the initial stability, bone quality and quantity, associated tissue remodelling dependent on implanted material, implantation site (surrounding tissues and placement depth), and biomarkers that may be targeted. An updated list of biodegradable implant materials that have been reported in the literature, from metal, polymer and ceramic categories, is provided with reference to the use of specific imaging modalities (computed tomography, positron emission tomography, ultrasound, photoacoustic and magnetic resonance imaging) suitable for longitudinal and non-invasive imaging in humans. The advantages and disadvantages of the single imaging modality are discussed with a special focus on preclinical imaging for biodegradable implant research. Indeed, the investigation of a new implant commonly requires histological examination, which is invasive and does not allow longitudinal studies, thus requiring a large number of animals for preclinical testing. For this reason, an update of the multimodal and multi-parametric imaging capabilities will be here presented with a specific focus on modern biomaterial research.

Tetracalcium Phosphate/Monetite/Calcium Sulfate Hemihdrate Biocement Powder Mixtures Prepared by the One-Step Synthesis for Preparation of Nanocrystalline Hydroxyapatite Biocement-Properties and In Vitro Evaluation

A modified one-step process was used to prepare tetracalcium phosphate/monetite/calcium sulfate hemihydrate powder cement mixtures (CAS). The procedure allowed the formation of monetite and calcium sulfate hemihydrate (CSH) in the form of nanoparticles. It was hypothesized that the presence of nanoCSH in small amounts enhances the in vitro bioactivity of CAS cement in relation to osteogenic gene markers in mesenchymal stem cells (MSCs). The CAS powder mixtures with 15 and 5 wt.% CSH were prepared by milling powder tetracalcium phosphate in an ethanolic solution of both orthophosphoric and sulfuric acids. The CAS cements had short setting times (around 5 min). The fast setting of the cement samples after the addition of the liquid component (water solution of NaH₂PO₄) was due to the partial formation of calcium sulfate dihydrate and hydroxyapatite before soaking in SBF with a small change in the original phase composition in cement powder samples after milling. Nanocrystalline hydroxyapatite biocement was produced by soaking of cement samples after setting in simulated body fluid (SBF). The fast release of calcium ions from CAS5 cement, as well as a small rise in the pH of SBF during soaking, were demonstrated. After soaking in SBF for 7 days, the final product of the cement transformation was nanocrystalline hydroxyapatite. The compressive strength of the cement samples (up to 30 MPa) after soaking in simulated body fluid (SBF) was comparable to that of bone. Real time polymerase chain reaction (RT-PCR) analysis revealed statistically significant higher gene expressions of alkaline phosphatase (ALP), osteonectin (ON) and osteopontin (OP) in cells cultured for 14 days in CAS5 extract compared to CSH-free cement. The addition of a small amount of nanoCSH (5 wt.%) to the tetracalcium phosphate (TTCP)/monetite cement mixture significantly promoted the over expression of osteogenic markers in MSCs. The prepared CAS powder mixture with its enhanced bioactivity can be used for bone defect treatment and has good potential for bone healing.

Comparing the physicochemical properties of dicalcium phosphate dihydrate (DCPD) and polymeric DCPD (P-DCPD) cement particles

We developed a new and injectable poly-dicalcium phosphate dihydrate (P-DCPD) forming cement. The key structural difference between P-DCPD and classical DCPD is that P-DCPD is composed of interconnected P-DCPD crystals by interlocking to the polyphosphate chains. In contrast, DCPD is composed of a package of DCPD crystals with weak mutual ionic bonding. The purpose of this continuing study was to compare the physicochemical properties between P-DCPD and DCPD cement particles. Data collected from SEM, X-ray diffraction, and Raman Spectroscopy approaches demonstrated that P-DCPD has a more stable chemical structure than DCPD as evidenced by much less transformation to hydroxyapatite (HA) during setting. Nanoindentation showed a similar hardness while the elastic modulus of P-DCPD is much lower than DCPD that might be due to the much less HA transformation of P-DCPD. P-DCPD has much lower zeta potential and less hydrophilicity than DCPD because of its entangled and interconnected polyphosphate chains. It is expected that superhydrophilic DCPD undergoes faster dissolution than P-DCPD in an aqueous environment. Another interesting finding is that the pH of eluent from P-DCPD is more neutral (6.6-7.1) than DCPD (5.5-6.5). More extensive experiments are currently underway to further evaluate the potential impacts of the different physiochemical performance observed of P-DCPD and DCPD cement particles on the biocompatibility, degradation behavior and bone defect healing efficacy both in vivo and in vitro.

A distinctive release profile of vancomycin and tobramycin from a new and injectable polymeric dicalcium phosphate dehydrate cement (P-DCPD)

A novel injectable polymeric dicalcium phosphate dehydrate (P-DCPD) cement was developed with superior mechanical strength and excellent cohesion. The purpose of this study was to assess the in vitro performance of P-DCPD loaded with vancomycin (VAN-P), tobramycin (TOB-P) and combination of both (VAN/TOB-P) (10%, w/w). There is a distinctive release profile between VAN and TOB. VAN-P showed decreased initial burst (<30% within 3 d) and sustained VAN release (76% in 28 d). In the presence of TOB (VAN/TOB-P), >90% of VAN was released within 3 d (p < 0.05). Slow and limited TOB release was observed both in TOB-P (<5%) and in TOB/VAN-P (<1%) over 28 d. Zone of inhibition (ZOI) of Staphylococcus aureus growth showed that eluents collected from VAN-P had stronger and longer ZOI (28 d) than that from TOB-P (14 d, p < 0.05). Direct contact of VAN-P, TOB-P and VAN/TOB-P cements displayed persistent and strong ZOI for >3 weeks. Interestingly, the cement residues (28 d after drug release) still maintained strong ZOI ability. P-DCPD with or without antibiotics loading were nontoxic and had no inferior impacts on the growth of osteoblastic MC3T3 cells. VAN-P and TOB-P were injectable. No significant influence on setting time was observed in both VAN-P (11.7 ± 1.9 min) and VAN/TOB-P (10.8 ± 1.5 min) as compared to control (12.2 ± 2.6 min). We propose that a distinctive release profile of VAN and TOB observed is mainly due to different distribution pattern of VAN and TOB within P-DCPD matrix. A limited release of TOB might be due to the incorporation of TOB inside the crystalline lattice of P-DCPD crystals. Our data supported that the bactericidal efficacy of antibiotics-loaded P-DCPD is not only depend on the amount and velocity of antibiotics released, but also probably more on the direct contact of attached bacteria on the degrading cement surface.

Injectable calcium phosphate and styrene–butadiene polymer-based root canal filling material

Background

Three-dimensional obturation of the root canal system is mandatory for a successful root canal treatment. Using a filling material with optimal properties may enable the root canal to be sealed well and therefore obtain the desired obturation.

Objective

To develop a new injectable paste endodontic filling material using calcium phosphate powder and a styrene–butadiene emulsion polymer.

Methods

The powder phase comprised an equivalent molar ratio of tetracalcium phosphate, anhydrous dicalcium phosphate, bismuth oxide, and calcium chloride. The liquid phase comprised a styrene–butadiene rubber emulsion in distilled water. The powder and the liquid were mixed to achieve a paste consistency. The paste was subjected to various tests including flow, setting time, dimensional change, solubility, and radiopacity to indicate its suitability as a root canal filling material. All these tests were conducted according to the American National Standards Institute–American Dental Association for endodontic sealing materials. After passing these tests, the paste was submitted to an injectability test.

Results

The material showed acceptable flowability with 19.1 ± 1.3 min setting time and 0.61 ± 0.16% shrinkage after 30 days of storage. We found the highest solubility at 24 h (6.62 ± 0.58%), then the solubility decreased to 1.09 ± 0.08% within 3 days. The material was more radiopaque than a 3 mm step on an aluminum wedge. Furthermore, the material showed good injectability of 93.67 ± 1.80%.

Conclusions

The calcium phosphate powder in styrene–butadiene emulsion met basic requirements for a root canal filling material with promising properties.

Chitosan and Hydroxyapatite Based Biomaterials to Circumvent Periprosthetic Joint Infections

Every year, worldwide, millions of people suffering from joint pain undergo joint replacement. For most patients, joint arthroplasty reduces pain and improve function, though a small fraction will experience implant failure. One of the main reasons includes prosthetic joint infection (PJI), involving the prosthesis and adjacent tissues. Few microorganisms (MO) are required to inoculate the implant, resulting in the formation of a biofilm on its surface. Standard treatment includes not only removal of the infected prosthesis but also the elimination of necrotic bone fragments, local and/or systemic administration of antibiotics, and revision arthroplasty with a new prosthesis, immediately after the infection is cleared. Therefore, an alternative to the conventional therapeutics would be the incorporation of natural antimicrobial compounds into the prosthesis. Chitosan (Ch) is a potential valuable biomaterial presenting properties such as biocompatibility, biodegradability, low immunogenicity, wound healing ability, antimicrobial activity, and anti-inflammatory potential. Regarding its antimicrobial activity, Gram-negative and Gram-positive bacteria, as well as fungi are highly susceptible to chitosan. Calcium phosphate (CaP)-based materials are commonly utilized in orthopedic and dentistry for their excellent biocompatibility and bioactivity, particularly in the establishment of cohesive bone bonding that yields effective and rapid osteointegration. At present, the majority of CaP-based materials are synthetic, which conducts to the depletion of the natural resources of phosphorous in the future due to the extensive use of phosphate. CaP in the form of hydroxyapatite (HAp) may be extracted from natural sources as fish bones or scales, which are by-products of the fish food industry. Thus, this review aims to enlighten the fundamental characteristics of Ch and HAp biomaterials which makes them attractive to PJI prevention and bone regeneration, summarizing relevant studies with these biomaterials to the field.

Injectable calcium phosphate and styrene-butadiene polymer-based root canal filling material

Background

Three-dimensional obturation of the root canal system is mandatory for a successful root canal treatment. Using a filling material with optimal properties may enable the root canal to be sealed well and therefore obtain the desired obturation.

Objective

To develop a new injectable paste endodontic filling material using calcium phosphate powder and a styrene-butadiene emulsion polymer.

Methods

The powder phase comprised an equivalent molar ratio of tetracalcium phosphate, anhydrous dicalcium phosphate, bismuth oxide, and calcium chloride. The liquid phase comprised a styrene-butadiene rubber emulsion in distilled water. The powder and the liquid were mixed to achieve a paste consistency. The paste was subjected to various tests including flow, setting time, dimensional change, solubility, and radiopacity to indicate its suitability as a root canal filling material. All these tests were conducted according to the American National Standards Institute-American Dental Association for endodontic sealing materials. After passing these tests, the paste was submitted to an injectability test.

Results

The material showed acceptable flowability with 19.1 ± 1.3 min setting time and 0.61 ± 0.16% shrinkage after 30 days of storage. We found the highest solubility at 24 h (6.62 ± 0.58%), then the solubility decreased to 1.09 ± 0.08% within 3 days. The material was more radiopaque than a 3 mm step on an aluminum wedge. Furthermore, the material showed good injectability of 93.67 ± 1.80%.

Conclusions

The calcium phosphate powder in styrene-butadiene emulsion met basic requirements for a root canal filling material with promising properties.

Characterization of Properties, In Vitro and In Vivo Evaluation of Calcium Phosphate/Amino Acid Cements for Treatment of Osteochondral Defects

Novel calcium phosphate cements containing a mixture of four amino acids, glycine, proline, hydroxyproline and either lysine or arginine (CAL, CAK) were characterized and used for treatment of artificial osteochondral defects in knee. It was hypothesized that an enhanced concentration of extracellular collagen amino acids (in complex mixture), in connection with bone cement in defect sites, would support the healing of osteochondral defects with successful formation of hyaline cartilage and subchondral bone. Calcium phosphate cement mixtures were prepared by in situ reaction in a planetary ball mill at aseptic conditions and characterized. It was verified that about 30–60% of amino acids remained adsorbed on hydroxyapatite particles in cements and the addition of amino acids caused around 60% reduction in compressive strength and refinement of hydroxyapatite particles in their microstructure. The significant over-expression of osteogenic genes after the culture of osteoblasts was demonstrated in the cement extracts containing lysine and compared with other cements. The cement pastes were inserted into artificial osteochondral defects in the medial femoral condyle of pigs and, after 3 months post-surgery, tissues were analyzed macroscopically, histologically, immunohistochemically using MRI and X-ray methods. Analysis clearly showed the excellent healing process of artificial osteochondral defects in pigs after treatment with CAL and CAK cements without any inflammation, as well as formation of subchondral bone and hyaline cartilage morphologically and structurally identical to the original tissues. Good integration of the hyaline neocartilage with the surrounding tissue, as well as perfect interconnection between the neocartilage and new subchondral bone tissue, was demonstrated. Tissues were stable after 12 months’ healing.

Osteoclast and osteoblast response to strontium-doped struvite coatings on titanium for improved bone integration

To develop implants with improved bone ingrowth, titanium substrates were coated with homogeneous and dense struvite (MgNH4PO4·6H2O) layers by means of electrochemically assisted deposition. Strontium nitrate was added to the coating electrolyte in various concentrations, in order to fabricate Sr-doped struvite coatings with Sr loading ranging from 10.6 to 115 μg/cm2. It was expected and observed that osteoclast activity surrounding the implant was inhibited. The cytocompatibility of the coatings and the effect of Sr-ions in different concentrations on osteoclast formation were analyzed in vitro. Osteoclast differentiation was elucidated on morphological, biochemical as well as on gene expression level. It could be shown that moderate concentrations of Sr2+ had an inhibitory effect on osteoclast formation, while the growth of osteoblastic cells was not negatively influenced compared to pure struvite surfaces. In summary, the electrochemically deposited Sr-doped struvite coatings are a promising approach to improve bone implant ingrowth.

Injectable Enzymatically Hardened Calcium Phosphate Biocement

(1) Background: The preparation and characterization of novel fully injectable enzymatically hardened tetracalcium phosphate/monetite cements (CXI cements) using phytic acid/phytase (PHYT/F3P) hardening liquid with a small addition of polyacrylic acid/carboxymethyl cellulose anionic polyelectrolyte (PAA/CMC) and enhanced bioactivity. (2) Methods: Composite cements were prepared by mixing of calcium phosphate powder mixture with hardening liquid containing anionic polyelectrolyte. Phase and microstructural analysis, compressive strength, release of ions and in vitro testing were used for the evaluation of cement properties. (3) Results: The simple possibility to control the setting time of self-setting CXI cements was shown (7–28 min) by the change in P/L ratio or PHYT/F3P reaction time. The wet compressive strength of cements (up to 15 MPa) was close to cancellous bone. The increase in PAA content to 1 wt% caused refinement and change in the morphology of hydroxyapatite particles. Cement pastes had a high resistance to wash-out in a short time after cement mixing. The noncytotoxic character of CX cement extracts was verified. Moreover, PHYT supported the formation of Ca deposits, and the additional synergistic effect of PAA and CMC on enhanced ALP activity was found, along with the strong up-regulation of osteogenic gene expressions for osteopontin, osteocalcin and IGF1 growth factor evaluated by the RT-qPCR analysis in osteogenic αMEM 50% CXI extracts. (4) Conclusions: The fully injectable composite calcium phosphate bicements with anionic polyelectrolyte addition showed good mechanical and physico-chemical properties and enhanced osteogenic bioactivity which is a promising assumption for their application in bone defect regeneration.

Bioactive Tetracalcium Phosphate Scaffolds Fabricated by Selective Laser Sintering for Bone Regeneration Applications

Tetracalcium phosphate (TTCP), a potential biological scaffold material, has attracted increasing interest for bone regeneration applications due to its good biodegradability and biocompatibility. In this research, three-dimensional porous TTCP scaffolds were manufactured via selective laser sintering (SLS), and an in-depth and meticulous study on the influence of laser power on the microstructure and mechanical properties of TTCP scaffolds was performed. The results showed that the TTCP particles fused together and formed a solid object due to the decrease in the number of micro-pores in the scaffold as the laser power increased from 6 W to 9 W. The maximum compressive strength that the scaffold could withstand and the strength of the fracture toughness were 11.87 ± 0.64 MPa and 1.12 ± 0.1 MPa·m^1/2, respectively. When the laser power increased from 9 W to 10 W, the TTCP grains grew abnormally, resulting in diminished mechanical properties. The bioactivity tests showed that the surfaces of the scaffolds were entirely covered by bone-like apatite layers after soaking in simulated body fluid (SBF) for three days, indicating that the scaffolds exhibit excellent bioactivity. Moreover, cell experiments showed that the TTCP scaffolds had good biocompatibility. This study indicated that SLS-fabricated TTCP scaffolds may be a promising candidate for bone regeneration applications.

Study of the Morphology and Properties of Biocompatible Ca-P Coatings on Mg Alloy

Magnesium alloys are considered as potential biomaterials for use in orthopedic implantology. The main barrier to the use of Mg alloys in medicine is their overly fast and irregular degradation in body fluids. The use of protective calcium phosphate coatings to increase the corrosion resistance of Mg alloy (AM50 alloy: 4 wt.% Al, 0.3 wt.% Mn, 0.2 wt.% Zn, rest Mg) was examined in this study. The scientific goal of the study was the assessment of the influence of calcium phosphate layer morphology on the corrosion process in Ringer's solution. Modification of the coating morphology was obtained by changing the chemical composition of the phosphatizing bath using NaOH (NaAM50 sample) or ZnSO₄ (ZnAM50 sample). In practice, a more dense and uniform coating could be obtained by the immersion of AM50 alloy in a solution containing ZnSO₄ (ZnAM50 sample). In this study, an adhesion test performed on the ZnAM50 sample indicated that the critical load was 1.35 N. XRD phase analysis confirmed that the obtained coatings included dicalcium phosphate dihydrate (CaHPO₄*2H₂O). The coatings prepared on the NaAM50 and ZnAM50 samples are effective barriers against the progress of corrosion deeper into the substrate. After 120 h immersion in Ringer's solution, the volume of the evolved hydrogen was 5.6 mL/cm² for the NaAM50 and 3.4 mL/cm² for the ZnAM50 sample.

3D printed porous PLA/nHA composite scaffolds with enhanced osteogenesis and osteoconductivity in vivo for bone regeneration

Repair and regeneration of large bone defects is still a challenge, especially for defects which are the irregular and complex. Three-dimension (3D) printing, as an advanced fabrication technology, has been received considerable attentions due to its high precision, customized geometry and personalization. In this study, 3D porous polylactic acid/nano hydroxyapatite (PLA/nHA) composite scaffolds with enhanced osteogenesis and osteoconductivity were successfully fabricated by desktop fused deposition modeling technology. Morphological, composition and structural analysis revealed that nHA was successfully introduced into the PLA system and homogeneously dispersed in the printed PLA/nHA scaffolds. In vitro antibacterial experiment confirmed that the printed porous PLA/nHA scaffolds have good ability for loading and releasing vancomycin and levofloxacin. Meanwhile, MG-63 cells were used to evaluate the cytocompatibility of printed porous PLA/nHA scaffolds by proliferation and cellular morphological analysis. In addition, rabbit model was established to evaluate the osteogenesis and osteoconductivity of printed PLA/nHA scaffolds. All these results suggested that the 3D printed PLA/nHA scaffolds have great potential for repairing and regeneration of large bone defects.

Pre-Registration Assessment of Bone-Filling Products

The use of bone‐filling material to repair bone defects and fix implanted bone grafts is a developing area in medicine. Investigators can evaluate bone‐filling materials through use of several indices to make comparisons and to determine suitability for application in humans¹. However, it is quite difficult to transform their discovery into practical use, because the viability of the studied material might require examination of all aspects of properties. In addition, for a material to become a product, a complete procedure involving a declaration, registration, and approval is necessary. This article introduces the technical indices that the investigators and reporters should provide in their declaration and registration data to meet the relevant standards in China. The indices include physical and chemical properties, biocompatibility, biosecurity, pre‐clinical animal model tests, sterilization and disinfection, product duration, and packaging. Full consideration of all possible indices is crucial to realize the transformation from a designed product to a commercial medical device, which requires effective interaction between clinicians and engineers.

Bioinspired surface modification of orthopedic implants for bone tissue engineering

Biomedical implants have been widely used in various orthopedic treatments, including total hip arthroplasty, joint arthrodesis, fracture fixation, non-union, dental repair, etc. The modern research and development of orthopedic implants have gradually shifted from traditional mechanical support to a bioactive graft in order to endow them with better osteoinduction and osteoconduction. Inspired by structural and mechanical properties of natural bone, this review provides a panorama of current biological surface modifications for facilitating the interaction between medical implants and bone tissue and gives a future outlook for fabricating the next-generation multifunctional and smart implants by systematically biomimicking the physiological processes involved in formation and functioning of bones.

Osteoblast responses to injectable bone substitutes of kappa-carrageenan and nano hydroxyapatite

The combination of kappa-carrageenan (κ-CG) and hydroxyapatite (HA) to generate a bone substitute material has been underexplored to date. Carrageenans (CGs) have remarkable characteristics such as biocompatibility, hydrophilicity, and structural similarities with natural glycosaminoglycans (GAGs), and they have demonstrated the ability to stimulate cellular adhesion and proliferation. Hydroxyapatite nanoparticles have been one of the most investigated materials for bone regeneration due to their excellent biocompatibility, bioactivity and osteoconductivity. In particular, this study presents an approach for the preparation of new bioactive composites of κ-CG/nHA for numerous bone regeneration applications. We performed a set of in vitro experiments to evaluate the influence of the bone substitutes on human osteoblasts. Cell culture studies indicated that all samples tested were cytocompatible. Relative to control substrates, cellular attachment and proliferation were better on all the scaffold surfaces that were tested. The S2 and S3 samples, those permeated by 1.5 and 2.5 wt% of CG, respectively, exhibited an enhancement in cell spreading capacity compared to the S1 test materials which were comprised of 1 wt% of CG. Excellent osteoblast viability and adhesion were observed for each of the tested materials. Additionally, the bone substitutes developed for this study presented a distinct osteoconductive environment. Data supporting this claim were derived from alkaline phosphatase (ALP) and calcium deposition analyses, which indicated that, compared to the control species, ALP expression and calcium deposition were both improved on test κ-CG/nHA surfaces. In summary, the injectable bone substitute developed here demonstrated great potential for numerous bone regeneration applications, and thus, should be studied further. STATEMENT OF SIGNIFICANCE: The novelty of this work lies in the determination of the in vitro cytocompatibility behavior of carrageenan and hydroxyapatite composite materials used as injectable bone substitutes. This injectable biomaterial can fill in geometric complex defects, and it displays bioactivity as well as high bone regeneration capacity. In this study, we evaluated the behaviors of osteoblast cells in contact with the scaffolds, including cellular adhesion and proliferation, cellular metabolism, and mineralization on the fabricated injectable bone substitutes. The results show than the carrageenan and hydroxyapatite substitutes provided a biomaterial with a great capacity for promoting cellular growth, adhesion, and proliferation, as well as contributing an osteoinductive environment for osteoblast differentiation and osteogenesis.

Bioinspired Mineral-Organic Bioresorbable Bone Adhesive

Bioresorbable bone adhesives have potential to revolutionize the clinical treatment of the human skeletal system, ranging from the fixation and osteointegration of permanent implants to the direct healing and fusion of bones without permanent fixation hardware. Despite an unmet need, there are currently no bone adhesives in clinical use that provide a strong enough bond to wet bone while possessing good osteointegration and bioresorbability. Inspired by the sandcastle worm that creates a protective tubular shell around its body using a proteinaceous adhesive, a novel bone adhesive is introduced, based on tetracalcium phosphate and phosphoserine, that cures in minutes in an aqueous environment and provides high bone-to-bone adhesive strength. The new material is measured to be 10 times more adhesive than bioresorbable calcium phosphate cement and 7.5 times more adhesive than non-resorbable poly(methyl methacrylate) bone cement, both of which are standard of care in the clinic today. The bone adhesive also demonstrates chemical adhesion to titanium approximately twice that of its adhesion to bone, unlocking the potential for adherence to metallic implants during surrounding bony incorporation. Finally, the bone adhesive is shown to demonstrate osteointegration and bioresorbability over a 52-week period in a critically sized distal femur defect in rabbits.

Review of potential health risks associated with nanoscopic calcium phosphate

Calcium phosphate is applied in many products in biomedicine, but also in toothpastes and cosmetics. In some cases, it is present in nanoparticulate form, either on purpose or after degradation or mechanical abrasion. Possible concerns are related to the biological effect of such nanoparticles. A thorough literature review shows that calcium phosphate nanoparticles as such have no inherent toxicity but can lead to an increase of the intracellular calcium concentration after endosomal uptake and lysosomal degradation. However, cells are able to clear the calcium from the cytoplasm within a few hours, unless very high doses of calcium phosphate are applied. The observed cytotoxicity in some cell culture studies, mainly for unfunctionalized particles, is probably due to particle agglomeration and subsequent sedimentation onto the cell layer, leading to a very high local particle concentration, a high particle uptake, and subsequent cell death. There is no risk from an oral uptake of calcium phosphate nanoparticles due to their rapid dissolution in the stomach. The risk from dermal or mucosal uptake is very low. Calcium phosphate nanoparticles can enter the bloodstream by inhalation, but no adverse effects have been observed, except for a prolonged exposition to high particle doses. Calcium phosphate nanoparticles inside the body (e.g. after implantation or due to abrasion) do not pose a risk as they are typically resorbed and dissolved by osteoclasts and macrophages. There is no indication for a significant influence of the calcium phosphate phase or the particle shape (e.g. spherical or rod-like) on the biological response. In summary, the risk associated with an exposition to nanoparticulate calcium phosphate in doses that are usually applied in biomedicine, health care products, and cosmetics is very low and most likely not present at all.

STATEMENT OF SIGNIFICANCE

Calcium phosphate is a well-established biomaterial. However, there are occasions when it occurs in a nanoparticulate form (e.g. as nanoparticle or as nanoparticulate bone substitution material) or after abrasion from a calcium phosphate-coated metal implant. In the light of the current discussion on the safety of nanoparticles, there have been concerns about potential adverse effects of nano-calcium phosphate, e.g. in a statement of a EU study group from 2016 about possible dangers associated with non-spherical nano-hydroxyapatite in cosmetics. In the US, there was a discussion in 2016 about the dangers of nano-calcium phosphate in babyfood. In this review, the potential exposition routes for nano-calcium phosphate are reviewed, with special emphasis on its application as biomaterial.

Synthesis and Characterization of β-Tricalcium Phosphate Derived From Haliotis sp. Shells

PURPOSE

To develop a methodology for the synthesis of β-tricalcium phosphate (β-TCP, Ca3(PO4)2) from the shell of Haliotis sp. (abalone shell) and to verify its characterization and biocompatibility.

MATERIALS AND METHODS

Calcium oxide (CaO) was synthesized from abalone shell by sintering and was suspended in distilled water to prepare calcium hydroxide (Ca(OH)2). For the synthesis of calcium carbonate (CaCO3), carbon dioxide was used to infuse Ca(OH)2 at pH 7.4. CaCO3 was reacted with phosphoric acid at pH 6.0 to obtain dicalcium phosphate (CaHPO4). Subsequently, β-TCP was synthesized by a chemical reaction between CaHPO4 and CaO at 950°C to 1100°C for 3 hours. Fourier transform infrared spectroscopy (FT-IR) and x-ray diffraction (XRD) was performed to verify the physiochemical characteristics of the composite synthesized from abalone shell.

RESULTS

FT-IR and XRD results showed that β-TCP was successfully synthesized from abalone shell. The synthesized β-TCP did not affect cell viability of either normal human oral keratinocytes or osteoblastic MG-63 cells. These data indicate that β-TCP synthesized from abalone shell is biologically safe.

CONCLUSIONS

β-TCP (Ca3(PO4)2) synthesized from abalone shell can be used as a potential source of bone grafting material.

Additive manufacturing of biomaterials

Biomaterials are used to engineer functional restoration of different tissues to improve human health and the quality of life. Biomaterials can be natural or synthetic. Additive manufacturing (AM) is a novel materials processing approach to create parts or prototypes layer-by-layer directly from a computer aided design (CAD) file. The combination of additive manufacturing and biomaterials is very promising, especially towards patient specific clinical applications. Challenges of AM technology along with related materials issues need to be realized to make this approach feasible for broader clinical needs. This approach is already making a significant gain towards numerous commercial biomedical devices. In this review, key additive manufacturing methods are first introduced followed by AM of different materials, and finally applications of AM in various treatment options. Realization of critical challenges and technical issues for different AM methods and biomaterial selections based on clinical needs are vital. Multidisciplinary research will be necessary to face those challenges and fully realize the potential of AM in the coming days.

Calcium orthophosphates (CaPO4): Occurrence and properties

The present overview is intended to point the readers' attention to the important subject of calcium orthophosphates (CaPO₄). This type of materials is of the special significance for the human beings because they represent the inorganic part of major normal (bones, teeth and antlers) and pathological (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 CaPO₄, while dental caries (tooth decay) and osteoporosis (a low bone mass with microarchitectural changes) 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 hydrogenorthophosphates. Due to the compositional similarities to the calcified tissues of mammals, CaPO₄ are widely used as biomaterials for bone grafting purposes. In addition, CaPO₄ have many other applications. Thus, there is a great significance of CaPO₄ for the humankind and, in this paper, an overview on the current knowledge on this subject is provided.

Dentin remineralizing ability and enhanced antibacterial activity of strontium and hydroxyl ion co-releasing radiopaque hydroxyapatite cement

Dental caries is an infection of the mineralized tooth structures that advances when acid secreted by bacterial action on dietary carbohydrates diffuses and dissolves the tooth mineral leading to demineralization. During treatment, clinicians often remove only the superficial infected tooth structures and retain a part of affected carious dentin to prevent excessive dentin loss and pulp exposure. Calcium hydroxide is used to treat the affected dentin because it is alkaline, induces pulp-dentin remineralization and decreases bacterial infection. Presence of strontium ions has also been reported to exhibit anticariogenic activity, and promote enamel and dentin remineralization. The objective of the present study was to develop novel hydroxyapatite cement from tetracalcium phosphate which gradually releases hydroxyl and strontium ions to exhibit antibacterial activity. Its potential to remineralize the dentin sections collected from extracted human molar tooth was studied in detail. The pH of all the experimental cements exhibited a gradual increase to ~10.5 in 10 days with 10% strontium substituted tetracalcium phosphate cement (10SC) showing the highest pH value which was sustained for 6 weeks. 10SC showed better antibacterial property against S. aureus and E. coli at the end of 1 week compared to other cements studied. It also exhibited the highest radiopacity equivalent to 4.8 mm of Al standard. 10SC treated dentin section showed better remineralization ability and highest elastic modulus. We can conclude that the hydroxyl and strontium ions releasing tetracalcium phosphate cement exhibits good antibacterial property, radiopacity and has the potential to encourage dentin remineralization.

Incorporation of BMP-2 loaded collagen conjugated BCP granules in calcium phosphate cement based injectable bone substitutes for improved bone regeneration

The objective of the present study was to incorporate surface modified porous multichannel BCP granule into CPC to enhance its in vivo biodegradation and bone tissue growth. The multichannel BCP granule (15wt%) was first coated with collagen subsequent to BMP-2 loading (ccMCG-B). It was then embedded into CPC to form CPC-ccMCG-B system. The newly developed CPC-ccMCG-B system was then examined for SEM, EDX, XRD, setting time, compressive strength, injectability, pH change, BMP-2 release, in vitro as well as in vivo studies and further compared with CPC. Optimized CPC (0.45mL/g) was found based on setting time and compressive strength studies. In vivo studies exhibited improved new bone formation and better degradation of CPC after 2 and 4weeks of implantation as compared to CPC as resulted from effective BMP-2 signaling. Our results suggest that CPC-ccMCG-B system might be used as a promising injectable bone substitutes in clinical applications.

Calcium Phosphate Bioceramics: A Review of Their History, Structure, Properties, Coating Technologies and Biomedical Applications

Calcium phosphate (CaP) bioceramics are widely used in the field of bone regeneration, both in orthopedics and in dentistry, due to their good biocompatibility, osseointegration and osteoconduction. The aim of this article is to review the history, structure, properties and clinical applications of these materials, whether they are in the form of bone cements, paste, scaffolds, or coatings. Major analytical techniques for characterization of CaPs, in vitro and in vivo tests, and the requirements of the US Food and Drug Administration (FDA) and international standards from CaP coatings on orthopedic and dental endosseous implants, are also summarized, along with the possible effect of sterilization on these materials. CaP coating technologies are summarized, with a focus on electrochemical processes. Theories on the formation of transient precursor phases in biomineralization, the dissolution and reprecipitation as bone of CaPs are discussed. A wide variety of CaPs are presented, from the individual phases to nano-CaP, biphasic and triphasic CaP formulations, composite CaP coatings and cements, functionally graded materials (FGMs), and antibacterial CaPs. We conclude by foreseeing the future of CaPs.

A microstructural study of the degradation and calcium release from hydroxyapatite-calcium oxide ceramics made by infiltration

Hydroxyapatite pellets, partially densified in a low-temperature heat treatment, were infiltrated with calcium nitrate solution followed by in-situ precipitation of Ca(OH)₂ and CaCO₃. The infiltrated bodies were then densified to high relative density and the calcium carbonate transformed to calcium oxide during sintering and resulted in biphasic hydroxyapatite-CaO ceramics. This work investigated the influence of the infiltration on surface morphology, weight change, and microstructural-level degradation caused by exposure to saline at pH=7.4 and a temperature of 20°C. The CaO rendered the materials more susceptible to degradation, and released calcium into the saline faster than single phase, calcium deficient hydroxyapatite (HA) that were used as a control. In consequence, these ceramics could be used to release calcium into the culture microenvironments of bone tissue or bone marrow cells next to a scaffold surface.