Graphene oxide as an interface phase between polyetheretherketone and hydroxyapatite for tissue engineering scaffolds

Revolutionizing Dental Polymers: The Versatility and Future Potential of Polyetheretherketone in Restorative Dentistry

Polyetheretherketone (PEEK) has emerged as a revolutionary material in modern dentistry because of its unique combination of mechanical strength, biocompatibility, and versatility. This literature review examines the current applications and future potential of PEEK in various dental disciplines. PEEK's favorable properties, including its low specific weight, high strength-to-weight ratio, and ability to be easily machined, have led to its adoption in prosthetics, implantology, and dental esthetic restorations. This material has shown promise for fabricating crowns, bridges, removable partial denture frameworks, and implant components. PEEK's radiolucency and bone-like elastic modulus make it particularly suitable for dental implants and abutments. Additionally, its resistance to degradation and compatibility with various surface treatments enhances its long-term performance in the oral environment. While challenges such as bonding to other dental materials and aesthetic limitations exist, ongoing research is addressing these issues through surface modifications and composite formulations. As the dental field continues to evolve, PEEK's adaptability and biocompatibility position it a key player in the development of next-generation dental materials and techniques, potentially transforming patient care and treatment outcomes in dentistry.

Functionalization of 3D printed poly(lactic acid)/graphene oxide/β-tricalcium phosphate (PLA/GO/TCP) scaffolds for bone tissue regeneration application

The challenge of bone tissue regeneration implies the use of new advanced technologies for the manufacture of polymeric matrices, with 3D printing technology being a suitable option for tissue engineering due to its low processing cost, its simple operation and the wide use of biomaterials in biomedicine. Among the biopolymers used to obtain porous scaffolds, poly(lactic acid) (PLA) stands out due its mechanical and biodegradability properties, although its low bioactivity to promote bone regeneration is a great challenge. In this research, a 3D scaffold based on PLA reinforced with bioceramics such as graphene oxide (GO) and β-tricalcium phosphate (TCP) was designed and characterized by FTIR, XRD, DSC, SEM and mechanical tests. The in vitro biocompatibility, viability, and cell proliferation of the poly-l-lysine (POLYL) functionalized scaffold were investigated using Wharton Jelly mesenchymal stem cells (hWJ-MSCs) and confirmed by XPS. The incorporation of GO/TCP bioceramics into the PLA polymer matrix increased the mechanical strength and provided a thermal barrier during the fusion treatments that the polymeric material undergoes during its manufacturing. The results show that the functionalization of the scaffold with POLYL allows improving the cell adhesion, proliferation and differentiation of hWJ-MSCs. The resulting scaffold PLA/GO/TCP/POLYL exhibits enhanced structural integrity and osteogenic cues, rendering it a promising candidate for biomedical applications.

Exploration of mechanical properties and osseointegration capacity of porous PEEK composites containing strontium and alendronate under 3D printing: an emerging bone implant

The aim of this study was to evaluate the biomechanical and osseointegrative properties of 3D printed porous PEEK materials loaded with strontium (Sr) and alendronate (ALN), which prepared porous cylindrical material by a fused deposition molding process, coated with Sr and ALN by hydrothermal reaction and dopamine assistance. According to the different coating materials, it could be divided into the PEEK group, PEEK-ALN group, PEEK-Sr group and PEEK-ALN-Sr group. After completing the mechanical analyses, the materials were implanted into the femoral condyles of New Zealand rabbits and the osteogenic capacity of the bracket materials was assessed by Micro-CT scanning, histology and fluorescence staining. The results showed that ALN and Sr were successfully loaded onto the surface of the material, and the elastic modulus and porosity of the material were not changed significantly after loading. The Micro-CT revealed that the PEEK-ALN-Sr group exhibited differences in bone volume/total Volume (BV/TV), trabecular spacing (TB.Sp),trabecular thickness (TB.Th)and trabeculae number (TB.N) in comparison to the PEEK group and PEEK-ALN group. And more new bone tissues could be observed in the PEEK-ALN-Sr group under 3D reconstruction of the bone proliferation model, toluidine blue and fluorescence staining. Thus, we can conclude that the 3D printed porous PEEK material has stable pore size and porosity, which has an ideal structure for bone growth. The PEEK- ALN-Sr composite material can be used as an emerging bone implant due to its excellent elastic modulus and osseointegration ability and provides a clinically viable treatment for patients with bone defects.

Application of loaded graphene oxide biomaterials in the repair and treatment of bone defects

Addressing bone defects is a complex medical challenge that involves dealing with various skeletal conditions, including fractures, osteoporosis (OP), bone tumours, and bone infection defects. Despite the availability of multiple conventional treatments for these skeletal conditions, numerous limitations and unresolved issues persist. As a solution, advancements in biomedical materials have recently resulted in novel therapeutic concepts. As an emerging biomaterial for bone defect treatment, graphene oxide (GO) in particular has gained substantial attention from researchers due to its potential applications and prospects. In other words, GO scaffolds have demonstrated remarkable potential for bone defect treatment. Furthermore, GO-loaded biomaterials can promote osteoblast adhesion, proliferation, and differentiation while stimulating bone matrix deposition and formation. Given their favourable biocompatibility and osteoinductive capabilities, these materials offer a novel therapeutic avenue for bone tissue regeneration and repair. This comprehensive review systematically outlines GO scaffolds' diverse roles and potential applications in bone defect treatment.

Bioactivity, hemocompatibility, and inflammatory response of calcium incorporated sulfonated polyether ether ketone on mouse-derived bone marrow cells

Natural and synthetic polymeric materials, particularly soft and hard tissue replacements, are paramount in medicine. We prepared calcium-incorporated sulfonated polyether-ether ketone (SPEEK) polymer membranes for bone applications. The bioactivity was higher after 21 days of immersion in simulated body fluid (SBF) due to calcium concentration in the membrane. We present a new biomaterial healing system composed of calcium and sulfonated polyether ether ketone (Ca-SPEEK) that can function as a successful biomaterial without causing inflammation when tested on bone marrow cells. The Ca-SPEEK exhibited 13 ± 0.5% clot with low fibrin mesh formation compared to 21 ± 0.5% in SPEEK. In addition, the Ca-SPEEK showed higher protein adsorption than SPEEK membranes. As an inflammatory response, IL-1 and TNF-α in the case of Ca-SPEEK were lower than those for SPEEK. We found an early regulation of IL-10 in the case of Ca-SPEEK at 6 h, which may be attributed to the down-regulation of the inflammatory markers IL-1 and TNF-α. These results evidence the innovative bioactivity of Ca-SPEEK with low inflammatory response, opening venues for bone applications.

Development and application of hydroxyapatite-based scaffolds for bone tissue regeneration: A systematic literature review

Hydroxyapatite [HA, Ca10(PO4)6(OH)2], with its robust biocompatibility and bioactivity, has found extensive utility in bone grafting, replacement therapies, and supplemental medical materials. HA is highly regarded for its osteoconductive properties because it boasts hydrophilicity, nontoxicity, non-allergenicity, and non-mutagenicity. Nevertheless, HA's intrinsic mechanical weakness has spurred efforts to enhance its properties. This enhancement is achieved through ion incorporation, with elements such as magnesium, zinc, lithium, strontium, boron, and others being integrated into the HA structure. In the domain of orthopedics, HA-based scaffolds have emerged as a solution for addressing prevalent issues like bone deformities and defects stemming from congenital anomalies, injuries, trauma, infections, or tumors. The fabrication of three-dimensional scaffolds (3D scaffolds) has enabled advancements in bone regeneration and replacement, with a focus on practical applications such as repairing calvarial, skull, and femoral defects. In vitro and in vivo assessments have substantiated the effectiveness of 3D scaffolds for bone defect repair, regeneration, and tissue engineering. Beyond bone-related applications, scaffolds demonstrate versatility in enhancing cartilage healing and serving as bioimplants. The wide array of scaffold applications underscores their ongoing potential for further development in the realm of medical science.

Evaluation of the Antibacterial, Anti-Cervical Cancer Capacity, and Biocompatibility of Different Graphene Oxides

Cancer stands as one of the deadliest diseases in human history, marked by an inferior prognosis. While traditional therapeutic methods like surgery, chemotherapy, and radiation have demonstrated success in inhibiting tumor cell growth, their side effects often limit overall benefits and patient acceptance. In this regard, three different graphene oxides (GO) with variations in their degrees of oxidation were studied chemically and tissue-wise. The accuracy of the synthesis of the different GO was verified by robust techniques using X-ray photoelectron spectroscopy (XPS), as well as conventional techniques such as infrared spectroscopy (FTIR), RAMAN spectroscopy, and X-ray diffraction (XRD). The presence of oxygenated groups was of great importance. It affected the physicochemical properties of each of the different graphene oxides demonstrated in the presence of new vibrational modes related to the formation of new bonds promoted by the graphitization of the materials. The toxicity analysis in the Hep-2 cell line of graphene oxide formulations at 250 µg/mL on the viability and proliferation of these tumor cells showed low activity. GO formulations did not show high antibacterial activity against Staphylococcus aureus and Escherichia coli strains. However, the different graphene oxides showed biocompatibility in the subdermal implantation model for 30, 60, and 90 days in the biomodels. This allowed healing by restoring hair and tissue architecture without triggering an aggressive immune response.

Chitosan biopolymer functionalized with graphene oxide and titanium dioxide with Escin metallic nanocomposites for anticancer potential against colon cancer

Our study produced GO-TiO2-chitosan-escin nanocomposites (GTCEnc), characterized them using physical and biological methods, and evaluated their potential as cancer treatment candidates. Standard protocols were used to produce GTCEnc. Nanocomposites are created using XRD, FTIR, UV-Vis, and PL spectroscopy analysis. The morphology and ultrastructure of nanocomposites were investigated using SEM and TEM. Nanocomposites containing TiO2, GO, chitosan, and escin nanostructures were characterized using diffraction, microscopy, and spectroscopy; the antimicrobial activity of GTCEnc was investigated. Various methods were used to test the anticancer activity of GTCEnc against COLO 205 cell lines, including MTT, EtBr/AO, DAPI, JC-1, Annexin-V/FITC, cell cycle analysis, and activation of pro-apoptotic markers, such as caspase-3, -8, and -9. The nanocomposites were cytotoxic to COLO 205 cells, with an IC50 of 22.68 μg/mL, but not to 293T cells. In cells treated with nanomaterials, cytotoxicity, nuclear damage, apoptosis induction, and free radical production were significantly increased. Our finding suggests that GTCEnc has potent anticancer and antibacterial activity in vitro because of its unique nanocomposite properties and antibacterial and anticancer activity in vitro. Additional research is required to understand the clinical efficacy of these nanocomposites.

Polyether ether ketone coated with nanohydroxyapatite/graphene oxide composite promotes bioactivity and antibacterial activity at the surface of the material

Polyether ether ketone (PEEK) is considered an alternative material for manufacturing dental implants. However, PEEK lacks bioactivity and antibacterial action. In a series of experiments designed to enhance the surface properties of PEEK, we present a nanohydroxyapatite (nHA) and graphene oxide (GO) composite as a coating for PEEK-based dental implants to improve biological properties and antibacterial action. PEEK discs were polished, cleaned, and coated with the composite consisting of nHA particles doped with 0.75 wt% graphene oxide by a micro-emulsion technique according to patent US8,206,813. X-ray diffraction, field emission scanning electron microscopy-energy dispersive spectroscopy, and atomic force microscopy were utilized to characterize the composite coating. The wettability of the coated and non-coated samples was assessed by optical contact angle measurement. Antibacterial action of the composite coating was explored against S. aureus and E. coli and cytotoxicity determined utilizing osteoblast-like cells and gingival fibroblasts. The findings showed that the nHA/GO composite coating, approximately 1.3 μm thick, was homogenous with few micro-cracks and adhered to the PEEK surface. The surface roughness was reduced to 21.26 nm and the wettability was improved to 54.6⁰ after coating with the composite coating. Antibacterial activity was moderate, killing 99% of S. aureus and E. coli, with acceptable levels of cytotoxicity to mammalian osteoblast-like cells and gingival fibroblasts.

A scoping review of graphene-based biomaterials for in vivo bone tissue engineering

The growing demand for more efficient materials for medical applications brought together two previously distinct fields: medicine and engineering. Regenerative medicine has evolved with the engineering contributions to improve materials and devices for medical use. In this regard, graphene is one of the most promising materials for bone tissue engineering and its potential for bone repair has been studied by several research groups. The aim of this study is to conduct a scoping review including articles published in the last 12 years (from 2010 to 2022) that have used graphene and its derivatives (graphene oxide and reduced graphene) in preclinical studies for bone tissue regeneration, searching in PubMed/MEDLINE, Embase, Web of Science, Cochrane Central, and clinicaltrials.gov (to confirm no study has started with clinical trial). Boolean searches were performed using the defined key words "bone" and "graphene", and manuscript abstracts were uploaded to Rayyan, a web-tool for systematic and scoping reviews. This scoping review was conducted based on Joanna Briggs Institute Manual for Scoping Reviews and the report follows the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR) statement. After the search protocol and application of the inclusion criteria, 77 studies were selected and evaluated by five blinded researchers. Most of the selected studies used composite materials associated with graphene and its derivatives to natural and synthetic polymers, bioglass, and others. Although a variety of graphene materials were analyzed in these studies, they all concluded that graphene, its derivatives, and its composites improve bone repair processes by increasing osteoconductivity, osteoinductivity, new bone formation, and angiogenesis. Thus, this systematic review opens up new opportunities for the development of novel strategies for bone tissue engineering with graphene.

Material Extrusion 3D Printing (ME3DP) Process Simulations of Polymeric Porous Scaffolds for Bone Tissue Engineering

Bone tissue engineering (BTE) is an active area of research for bone defect treatment. Some polymeric materials have recently gained adequate attention as potential materials for BTE applications, as they are biocompatible, biodegradable, inexpensive, lightweight, easy to process, and recyclable. Polyetherimide (PEI), acrylonitrile butadiene styrene (ABS), and polyamide-12 (PA12) are potential biocompatible materials for biomedical applications due to their excellent physical, chemical, and mechanical properties. The current study presents preliminary findings on the process simulations for 3D-printed polymeric porous scaffolds for a material extrusion 3D printing (ME3DP) process to observe the manufacturing constraints and scaffold quality with respect to designed structures (porous scaffolds). Different unit cell designs (ventils, grid, and octet) for porous scaffolds, virtually fabricated using three polymeric materials (PEI, ABS, and PA12), were investigated for process-induced defections and residual stresses. The numerical simulation results concluded that higher dimensional accuracy and control were achieved for grid unit cell scaffolds manufactured using PEI material; however, minimum residual stresses were achieved for grid unit cell scaffolds fabricated using PA12 material. Future studies will include the experimental validation of numerical simulation results and the biomechanical performance of 3D-printed polymeric scaffolds.

Advancements and Utilizations of Scaffolds in Tissue Engineering and Drug Delivery

The drug development process requires a thorough understanding of the scaffold and its three-dimensional structure. Scaffolding is a technique for tissue engineering and the formation of contemporary functioning tissues. Tissue engineering is sometimes referred to as regenerative medicine. They also ensure that drugs are delivered with precision. Information regarding scaffolding techniques, scaffolding kinds, and other relevant facts, such as 3D nanostructuring, are discussed in depth in this literature. They are specific and demonstrate localized action for a specific reason. Scaffold's acquisition nature and flexibility make it a new drug delivery technology with good availability and structural parameter management.

Graphene oxide encapsulated forsterite scaffolds to improve mechanical properties and antibacterial behavior

It is very desirable to have good antibacterial properties and mechanical properties at the same time for bone scaffolds. Graphene oxide (GO) can increase the mechanical properties and antibacterial performance, while forsterite (Mg2SiO4) as the matrix can increase forsterite/GO scaffolds' biological activity for bone tissue engineering. Interconnected porous forsterite scaffolds were developed by space holder processes for bone tissue engineering in this research. The forsterite/GO scaffolds had a porosity of 76-78% with pore size of 300-450 μm. The mechanism of the mechanical strengthening, antibacterial activity, and cellular function of the forsterite/GO scaffold was evaluated. The findings show that the compressive strength of forsterite/1wt.% GO scaffold (2.4±0.1 MPa) was significantly increased, in comparison to forsterite scaffolds without GO (1.4±0.1 MPa). Validation of the samples' bioactivity was attained by forming a hydroxyapatite (HAp) layer on the forsterite/GO surface within in vitro immersion test. The results of cell viability demonstrated that synthesized forsterite scaffolds with low GO did not show cytotoxicity and enhanced cell proliferation. Antibacterial tests showed that the antibacterial influence of forsterite/GO scaffold was strongly correlated with GO concentration from 0.5 to 2 wt.%. The scaffold encapsulated with 2wt.% GO had the great antibacterial performance with bacterial inhibition rate around 90%. As results show, the produced forsterite/1wt.% GO can be an attractive option for bone tissue engineering.

Emerging zero-dimensional to four-dimensional biomaterials for bone regeneration

Bone is one of the most sophisticated and dynamic tissues in the human body, and is characterized by its remarkable potential for regeneration. In most cases, bone has the capacity to be restored to its original form with homeostatic functionality after injury without any remaining scarring. Throughout the fascinating processes of bone regeneration, a plethora of cell lineages and signaling molecules, together with the extracellular matrix, are precisely regulated at multiple length and time scales. However, conditions, such as delayed unions (or nonunion) and critical-sized bone defects, represent thorny challenges for orthopedic surgeons. During recent decades, a variety of novel biomaterials have been designed to mimic the organic and inorganic structure of the bone microenvironment, which have tremendously promoted and accelerated bone healing throughout different stages of bone regeneration. Advances in tissue engineering endowed bone scaffolds with phenomenal osteoconductivity, osteoinductivity, vascularization and neurotization effects as well as alluring properties, such as antibacterial effects. According to the dimensional structure and functional mechanism, these biomaterials are categorized as zero-dimensional, one-dimensional, two-dimensional, three-dimensional, and four-dimensional biomaterials. In this review, we comprehensively summarized the astounding advances in emerging biomaterials for bone regeneration by categorizing them as zero-dimensional to four-dimensional biomaterials, which were further elucidated by typical examples. Hopefully, this review will provide some inspiration for the future design of biomaterials for bone tissue engineering.

Carbon-Based Nanomaterials for Bone and Cartilage Regeneration: A Review

As the main load-bearing structure in the human body, bone and cartilage are susceptible to damage in sports and other activities. The repair and regeneration of bone and articular cartilage have been extensively studied in the past decades. Traditional approaches have been widely applied in clinical practice, but the effect varies from person to person and may cause side effects. With the rapid development of tissue engineering and regenerative medicine, various biomaterials show great potential in the regeneration of bone and cartilage. Carbon-based nanomaterials are solid materials with different structures and properties composed of allotropes of carbon, which are classified into zero-, one-, and two-dimensional ones. This Review systemically summarizes the different types of carbon-based nanomaterials, including zero-dimensional (fullerene, carbon dots, nanodiamonds), one-dimensional (carbon nanotubes), and two-dimensional (graphenic materials) as well as their applications in bone, cartilage, and osteochondral regeneration. Current limitations and future perspectives of carbon-based nanomaterials are also discussed.

Modulation of Conductivity of Alginate Hydrogels Containing Reduced Graphene Oxide through the Addition of Proteins

Modifying hydrogels in order to enhance their conductivity is an exciting field with applications in cardio and neuro-regenerative medicine. Therefore, we have designed hybrid alginate hydrogels containing uncoated and protein-coated reduced graphene oxide (rGO). We specifically studied the adsorption of three different proteins, BSA, elastin, and collagen, and the outcomes when these protein-coated rGO nanocomposites are embedded within the hydrogels. Our results demonstrate that BSA, elastin, and collagen are adsorbed onto the rGO surface, through a non-spontaneous phenomenon that fits Langmuir and pseudo-second-order adsorption models. Protein-coated rGOs are able to preclude further adsorption of erythropoietin, but not insulin. Collagen showed better adsorption capacity than BSA and elastin due to its hydrophobic nature, although requiring more energy. Moreover, collagen-coated rGO hybrid alginate hydrogels showed an enhancement in conductivity, showing that it could be a promising conductive scaffold for regenerative medicine.

Functionalized Porous Hydroxyapatite Scaffolds for Tissue Engineering Applications: A Focused Review

Biomaterials have been widely used in tissue engineering applications at an increasing rate in recent years. The increased clinical demand for safe scaffolds, as well as the diversity and availability of biomaterials, has sparked rapid interest in fabricating diverse scaffolds to make significant progress in tissue engineering. Hydroxyapatite (HAP) has drawn substantial attention in recent years owing to its excellent physical, chemical, and biological properties and facile adaptable surface functionalization with other innumerable essential materials. This focused review spotlights a brief introduction on HAP, scope, a historical outline, basic structural features/properties, various synthetic strategies, and their scientific applications concentrating on functionalized HAP in the diverse area of tissue engineering fields such as bone, skin, periodontal, bone tissue fixation, cartilage, blood vessel, liver, tendon/ligament, and corneal are emphasized. Besides clinical translation aspects, the future challenges and prospects of HAP based biomaterials involved in tissue engineering are also discussed. Furthermore, it is expected that researchers may find this review expedient in gaining an overall understanding of the latest advancement of HAP based biomaterials.

Antibacterial and Cellular Behaviors of Novel Zinc-Doped Hydroxyapatite/Graphene Nanocomposite for Bone Tissue Engineering

Bacteria are one of the significant causes of infection in the body after scaffold implantation. Effective use of nanotechnology to overcome this problem is an exciting and practical solution. Nanoparticles can cause bacterial degradation by the electrostatic interaction with receptors and cell walls. Simultaneously, the incorporation of antibacterial materials such as zinc and graphene in nanoparticles can further enhance bacterial degradation. In the present study, zinc-doped hydroxyapatite/graphene was synthesized and characterized as a nanocomposite material possessing both antibacterial and bioactive properties for bone tissue engineering. After synthesizing the zinc-doped hydroxyapatite nanoparticles using a mechanochemical process, they were composited with reduced graphene oxide. The nanoparticles and nanocomposite samples were extensively investigated by transmission electron microscopy, X-ray diffraction, and Raman spectroscopy. Their antibacterial behaviors against Escherichia coli and Staphylococcus aureus were studied. The antibacterial properties of hydroxyapatite nanoparticles were found to be improved more than 2.7 and 3.4 times after zinc doping and further compositing with graphene, respectively. In vitro cell assessment was investigated by a cell viability test and alkaline phosphatase activity using mesenchymal stem cells, and the results showed that hydroxyapatite nanoparticles in the culture medium, in addition to non-toxicity, led to enhanced proliferation of bone marrow stem cells. Furthermore, zinc doping in combination with graphene significantly increased alkaline phosphatase activity and proliferation of mesenchymal stem cells. The antibacterial activity along with cell biocompatibility/bioactivity of zinc-doped hydroxyapatite/graphene nanocomposite are the highly desirable and suitable biological properties for bone tissue engineering successfully achieved in this work.

Osteoinductive and antimicrobial mechanisms of graphene-based materials for enhancing bone tissue engineering

Graphene-based materials (GMs) have great application prospects in bone tissue engineering due to their osteoinductive ability and antimicrobial activity. GMs induce osteogenic differentiation through several mechanisms and pathways in bone tissue engineering. First of all, the surface and high hardness of the porous folds of graphene or graphene oxide (GO) can generate mechanical stimulation to initiate a cascade of reactions that promote osteogenic differentiation without any chemical inducers. In addition, change of the extracellular matrix (ECM), regulation of macrophage polarization, the oncostatin M (OSM) signaling pathway, the MAPK signaling pathway, the BMP signaling pathway, the Wnt/β-catenin signaling pathway, and other pathways are involved in GMs' regulation of osteogenesis. In bone tissue engineering, GMs prevent the formation of microbial biofilms mainly through preventing microbial adhesion and killing them. The former is mainly achieved by reducing surface free energy (SFE) and increasing hydrophobicity. The latter mainly includes oxidative stress and photothermal/photodynamic effects. Graphene and its derivatives (GDs) are mainly combined with bioactive ceramic materials, metal materials and macromolecular polymers to play an antimicrobial effect in bone tissue engineering. Concentration, number of layers, and type of GDs often affect the antimicrobial activity of GMs. In this paper, we reviewed relevant osteoinductive and antimicrobial mechanisms of GMs and their applications in bone tissue engineering.

3D printed PEEK/HA composites for bone tissue engineering applications: Effect of material formulation on mechanical performance and bioactive potential

Polyetheretherketone (PEEK) is a biocompatible polymer widely used for biomedical applications. Because it is biologically inert, bioactive phases, such as nano-hydroxyapatite (HA), have been added to PEEK in order to improve its bioactivity. 3D printing (3DP) technologies are being increasingly used today to manufacture patient specific devices and implants. However, processing of PEEK is challenging due to its high melting point which is above 340 °C. In this study, PEEK-based filaments containing 10 wt% of pure nano-HA, strontium (Sr)- doped nano-HA and Zinc (Zn)-doped nano-HA were produced via hot-melt extrusion and subsequently 3D printed via fused deposition modelling (FDM), following an initial optimization process. The raw materials, extruded filaments and 3D printed samples were characterized in terms of physicochemical, thermal and morphological analysis. Moreover, the mechanical performance of 3D printed specimens was assessed via tensile tensing. Although an increase in the melting point and a reduction in crystallization temperature was observed with the addition of HA and doped HA to pure PEEK, there was no noticeable increase in the degree of crystallinity. Regarding the mechanical behavior, no significant differences were detected following the addition of the inorganic phases to the polymeric matrix, although a small reduction in the ultimate tensile strength (~14%) and Young's modulus (~5%) in PEEK/HA was observed in comparison to pure PEEK. Moreover, in vitro bioactivity of 3D printed samples was evaluated via a simulated body fluid immersion test for up to 28 days; the formation of apatite was observed on the surfaces of sample surfaces containing HA, SrHA and ZnHA. These results indicate the potential to produce bioactive, 3DP PEEK composites for challenging applications such as in craniofacial bone repair.

Bioactivity of PEEK GRF30 and Ti6Al4V SLM in Simulated Body Fluid and Hank's Balanced Salt Solution

In recent years, scientists have defined two main paths for orthopedic implant fabrication: searching for new materials with properties closest to natural bone in order to reduce the stress-shielding effect or creating individually adapted geometry of the implant with the use and Rapid Prototyping methods. Therefore, materials such as PEEK GRF30 and Ti6Al4V selective laser melting (SLM) are of interest. They are defined as materials suitable for implants, however, the knowledge of their bioactivity, a feature which is one of the most desirable properties of biomaterials, is still insufficient. Using Simulated Body Fluid and Hank's Balanced Salt Solution, the bioactivity of PEEK GRF30 and Ti6Al4V SLM was assessed, as well as commercial Ti6Al4V as a reference material. Ten cylindrical samples of each material were prepared and immersed in solutions per period from 2 to 28 days at 37 °C. Optical analysis of the changes on the examined surfaces suggested that right after 2-day crystals with different morphologies were formed on each material. Further analysis of the chemical composition of the altered surfaces confirmed the formation of a calcium phosphate layer on them, however, the Ca/P ratio was slightly different from 1.67. On the basis of the obtained results, it can be concluded that both PEEK GRF30 and Ti6Al4V SLM are characterized by appropriate-comparable to Ti6Al4V-bioactivity.

Simultaneous engineering of nanofillers and patterned surface macropores of graphene/hydroxyapatite/polyetheretherketone ternary composites for potential bone implants

Incorporating bioactive nanofillers and creating porous surfaces are two common strategies used to improve the tissue integration of polyetheretherketone (PEEK) material. However, few studies have reported the combined use of both strategies to modify PEEK. Herein, for the first time, dual nanoparticles of graphene oxide (GO) and hydroxyapatite (HAp) were incorporated into PEEK matrix to obtain ternary composites that were laser machined to create macropores with diameters ranging from 200 μm to 600 μm on the surfaces. The surface morphology and chemistry, mechanical properties, and cellular responses of the composites were investigated. The results show that micropatterned pores with a depth of 50 μm were created on the surfaces of the composites, which do not significantly affect the mechanical properties of the resultant composites. More importantly, the incorporation of GO and HAp significantly improves the cell adhesion and proliferation on the surface of PEEK. Compared to the smooth surface composite, the composites with macroporous surface exhibit markedly enhanced cell viability. The combined use of nanofillers and surface macropores may be a promising way of improving tissue integration of PEEK for bone implants.

Bioinspired Modifications of PEEK Implants for Bone Tissue Engineering

In recent years, polyetheretherketone (PEEK) has been increasingly employed as an implant material in clinical applications. Although PEEK is biocompatible, chemically stable, and radiolucent and has an elastic modulus similar to that of natural bone, it suffers from poor integration with surrounding bone tissue after implantation. To improve the bioactivity of PEEK, numerous strategies for functionalizing the PEEK surface and changing the PEEK structure have been proposed. Inspired by the components, structure, and function of bone tissue, this review discusses strategies to enhance the biocompatibility of PEEK implants and provides direction for fabricating multifunctional implants in the future.

Interface design of carbon filler/polymer composites for electromagnetic interference shielding

The main three methods of interface design for carbon/polymer composites for different carbon materials.

Graphene-Based Biomaterials for Bone Regenerative Engineering: A Comprehensive Review of the Field and Considerations Regarding Biocompatibility and Biodegradation

Graphene and its derivatives have continued to garner worldwide interest due to their unique characteristics. Having expanded into biomedical applications, there have been efforts to employ their exceptional properties for the regeneration of different tissues, particularly bone. This article presents a comprehensive review on the usage of graphene-based materials for bone regenerative engineering. The graphene family of materials (GFMs) are used either alone or in combination with other biomaterials in the form of fillers in composites, coatings for both scaffolds and implants, or vehicles for the delivery of various signaling and therapeutic agents. The applications of the GFMs in each of these diverse areas are discussed and emphasis is placed on the characteristics of the GFMs that have implications in this regard. In tandem and of importance, this article evaluates the safety and biocompatibility of the GFMs and carefully elucidates how various factors influence the biocompatibility and biodegradability of this new class of nanomaterials. In conclusion, the challenges and opportunities regarding the use of the GFMs in regenerative engineering applications are discussed, and future perspectives for the developments in this field are proposed.

Preparation of Poly(ether-ether-ketone)/Nanohydroxyapatite Composites with Improved Mechanical Performance and Biointerfacial Affinity

Poly(ether-ether-ketone) (PEEK) displays promising potential in hard tissue repair and orthopedic surgery due to its adaptable mechanical performance, good chemical resistance, and bioinertness. However, the low biointerfacial affinity of pure PEEK implants and the decrease of mechanical strength after processing greatly limit their clinical applications. In this work, the influences on mechanical performance and biointerfacial affinity of the PEEK/nanohydroxyapatite (nHA) composites are systematically investigated. Results show that the mechanical performance of PEEK/nHA composites was improved by adjusting the nHA content. The maximum values of the tensile, compressive, bending, and impact strength of the composites were increased by approximately 16.2, 25, 54, and 21%, respectively, when compared with that of pure PEEK. Studies in vitro show that PEEK/nHA composites display good cytocompatibility and promote the biomimic formation of HA, adhesion, and proliferation of L929 cells on the surface. Studies in vivo demonstrate that, compared to the pure PEEK, PEEK/nHA composites exhibit higher biointerfacial affinity, including the adhesion and encapsulation of muscle tissues on the surface of the implants and the suppression of inflammatory reaction around the implants. Our findings could pave the way for extensive applications of PEEK/nHA composites in hard tissue repair, particularly orthopedic surgery.

Biodegradable materials for bone defect repair

Compared with non-degradable materials, biodegradable biomaterials play an increasingly important role in the repairing of severe bone defects, and have attracted extensive attention from researchers. In the treatment of bone defects, scaffolds made of biodegradable materials can provide a crawling bridge for new bone tissue in the gap and a platform for cells and growth factors to play a physiological role, which will eventually be degraded and absorbed in the body and be replaced by the new bone tissue. Traditional biodegradable materials include polymers, ceramics and metals, which have been used in bone defect repairing for many years. Although these materials have more or fewer shortcomings, they are still the cornerstone of our development of a new generation of degradable materials. With the rapid development of modern science and technology, in the twenty-first century, more and more kinds of new biodegradable materials emerge in endlessly, such as new intelligent micro-nano materials and cell-based products. At the same time, there are many new fabrication technologies of improving biodegradable materials, such as modular fabrication, 3D and 4D printing, interface reinforcement and nanotechnology. This review will introduce various kinds of biodegradable materials commonly used in bone defect repairing, especially the newly emerging materials and their fabrication technology in recent years, and look forward to the future research direction, hoping to provide researchers in the field with some inspiration and reference.

In Situ Generation of Hydroxyapatite on Biopolymer Particles for Fabrication of Bone Scaffolds Owning Bioactivity

Hydroxyapatite (HAP) can endow a biopolymer scaffold with good bioactivity and osteoconductive ability, while the interfacial bonding is fairly weak between HAP and biopolymers. In this study, HAP was in situ generated on poly(l-lactic acid) (PLLA) particles, and then they were used to fabricate a scaffold by selective laser sintering. Detailedly, PLLA particles were first functionalized by dopamine oxide polymerization, which introduced abundance active catechol groups on the particle surface, and subsequently, the catechol groups concentrated Ca²⁺ ions by chelation in a simulated body fluid solution, and then, Ca²⁺ ions absorbed PO₄^3- ions through electrostatic interactions for in situ nucleation of HAP. The results indicated that HAP was homogeneously generated on the PLLA particle surface, and HAP and PLLA exhibited good interfacial bonding in the HAP/PLLA scaffolds. Meanwhile, the scaffolds displayed excellent bioactivity by inducing apatite precipitation and provided a good environment for human bone mesenchymal stem cell attachment, proliferation, and osteogenic differentiation. More importantly, the ingrowth of blood vessel and the formation of new bone could be stimulated by the scaffolds in vivo, and the bone volume fraction and bone mineral density increased by 44.44 and 41.73% compared with the pure PLLA scaffolds, respectively. Serum biochemical indexes fell within the normal range, which indicated that there was no harmful effect on the normal functioning of the body after implanting the scaffold.

Endowing polyetheretherketone with anti-inflammatory ability and improved osteogenic ability

Both osteogenesis and anti-inflammatory bioactive materials play a vital role in the regeneration of skeletal defects. Bone inflammation is hard to cure and can lead to malformation or amputation. The purpose of this study is to use anti-inflammatory drugs to endow polyetheretherketone (PEEK) with the dual ability to achieve anti-inflammatory effects while maintaining favorable biocompatibility. In this experiment, the porous PEEK was immersed in an aspirin (ASP) solution after sulfonation, and the obtained porous PEEK had significantly improved the anti-inflammatory abilities. Additionally, grafting the bone forming peptide (BFP) onto the porous PEEK can distinctly enchance the osteogenesis capability. The effects of the BFP polypeptide on the proliferation of MC3T3-E1 cells and ALP activity, and the effects of aspirin on inflammation were systematically investigated. The modified material showed favorable biocompatibility and osteogenic ability. The results suggest that the combination of the BFP polypeptide with aspirin may lead to a synergetic effect on the stimulation of osteogenesis and on the reduction of inflammation.

Hydroxyapatite as a biomaterial - a gift that keeps on giving

The synthetic analogue to biogenic apatite, hydroxyapatite (HA) has a number of physicochemical properties that make it an attractive candidate for diagnosis, treatment of disease and augmentation of biological tissues. Here we describe some of the recent studies on HA, which may provide bases for a number of new medical applications. The content of this review is divided to different medical application modes utilizing HA, including tissue engineering, medical implants, controlled drug delivery, gene therapies, cancer therapies and bioimaging. A number of advantages of HA over other biomaterials emerge from this discourse, including (i) biocompatibility, (ii) bioactivity, (iii) relatively simple synthesis protocols for the fabrication of nanoparticles with specific sizes and shapes, (iv) smart response to environmental stimuli, (v) facile functionalization and surface modification through noncovalent interactions, and (vi) the capacity for being simultaneously loaded with a wide range of therapeutic agents and switched to bioimaging modalities for uses in theranostics. A special section is dedicated to analysis of the safety of particulate HA as a component of parenterally administrable medications. It is concluded that despite the fact that many benefits come with the usage of HA, its deficiencies and potential side effects must be addressed before the translation to the clinical domain is pursued. Although HA has been known in the biomaterials world as the exemplar of safety, this safety proves to be the function of size, morphology, surface ligands and other structural and compositional parameters defining the particles. For this reason, each HA, especially when it comes in a novel structural form, must be treated anew from the safety research angle before being allowed to enter the clinical stage.

The Impact of Bioceramic Scaffolds on Bone Regeneration in Preclinical In Vivo Studies: A Systematic Review

Bioceramic scaffolds are appealing for alveolar bone regeneration, because they are emerging as promising alternatives to autogenous and heterogenous bone grafts. The aim of this systematic review is to answer to the focal question: in critical-sized bone defects in experimental animal models, does the use of a bioceramic scaffolds improve new bone formation, compared with leaving the empty defect without grafting materials or using autogenous bone or deproteinized bovine-derived bone substitutes? Electronic databases were searched using specific search terms. A hand search was also undertaken. Only randomized and controlled studies in the English language, published in peer-reviewed journals between 2013 and 2018, using critical-sized bone defect models in non-medically compromised animals, were considered. Risk of bias assessment was performed using the SYRCLE tool. A meta-analysis was planned to synthesize the evidence, if possible. Thirteen studies reporting on small animal models (six studies on rats and seven on rabbits) were included. The calvarial bone defect was the most common experimental site. The empty defect was used as the only control in all studies except one. In all studies the bioceramic materials demonstrated a trend for better outcomes compared to an empty control. Due to heterogeneity in protocols and outcomes among the included studies, no meta-analysis could be performed. Bioceramics can be considered promising grafting materials, though further evidence is needed.

Bone Tissue Engineering via Carbon-Based Nanomaterials

Bone tissue engineering (BTE) has received significant attention due to its enormous potential in treating critical-sized bone defects and related diseases. Traditional materials such as metals, ceramics, and polymers have been widely applied as BTE scaffolds; however, their clinical applications have been rather limited due to various considerations. Recently, carbon-based nanomaterials attract significant interests for their applications as BTE scaffolds due to their superior properties, including excellent mechanical strength, large surface area, tunable surface functionalities, high biocompatibility as well as abundant and inexpensive nature. In this article, recent studies and advancements on the use of carbon-based nanomaterials with different dimensions such as graphene and its derivatives, carbon nanotubes, and carbon dots, for BTE are reviewed. Current challenges of carbon-based nanomaterials for BTE and future trends in BTE scaffolds development are also highlighted and discussed.

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.

Novel PEEK Copolymer Synthesis and Biosafety - I: Cytotoxicity Evaluation for Clinical Application

In this research, we synthesized novel polyetheretherketone (PEEK) copolymers and evaluated the biosafety and cytotoxicity of their composites for spinal cage applications in the orthopedic field. The PEEK copolymers and their composites were prepared through a solution polymerization method using diphenyl sulfone as a polymerization solvent. The composite of PEEK copolymer showed good mechanical properties similar to that of natural bone, and also showed good thermal characteristics for the processing of clinical use as spine cage. The results of an in vitro cytotoxicity test did not show any evidence of a toxic effect on the novel PEEK composite. On the basis of these cytotoxicity test results, the PEEK composite also proved its in vitro biosafety for application to an implantable spine cage.

Hierarchically designed bone scaffolds: From internal cues to external stimuli

Bone tissue engineering utilizes three critical elements - cells, scaffolds, and bioactive factors - to recapitulate the bone tissue microenvironment, inducing the formation of new bone. Recent advances in materials development have enabled the production of scaffolds that more effectively mimic the hierarchical features of bone matrix, ranging from molecular composition to nano/micro-scale biochemical and physical features. This review summarizes recent advances within the field in utilizing these features of native bone to guide the hierarchical design of materials and scaffolds. Biomimetic strategies discussed in this review cover several levels of hierarchical design, including the development of element-doped compositions of bioceramics, the usage of molecular templates for in vitro biomineralization at the nanoscale, the fabrication of biomimetic scaffold architecture at the micro- and nanoscale, and the application of external physical stimuli at the macroscale to regulate bone growth. Developments at each level are discussed with an emphasis on their in vitro and in vivo outcomes in promoting osteogenic tissue development. Ultimately, these hierarchically designed scaffolds can complement or even replace the usage of cells and biological elements, which present clinical and regulatory barriers to translation. As the field progresses ever closer to clinical translation, the creation of viable therapies will thus benefit from further development of hierarchically designed materials and scaffolds.

Glycyrrhetinic acid-modified graphene oxide mediated siRNA delivery for enhanced liver-cancer targeting therapy

Graphene oxide (GO) has attracted huge attention in biomedical field in recent years. However, limited attempts have been invested in utilizing GO on active targeted delivery for gene therapy in liver cancer treatments. Glycyrrhetinic acid (GA) has been reported to be widely used as a targeting ligand to functionalize nanomaterials to treat hepatocellular carcinoma. In this article, GA is employed as a liver targeting ligand to construct GA, polyethylene glycol (PEG), polyamidoamine dendrimer (Dendrimer) and nano-graphene oxide (NGO) conjugate (GA-PEG-NGO-Dendrimer, GPND) for siRNA delivery for the first time. As we expected, GPND exhibited excellent stability, low toxicity, negligible hemolytic activity and remarkably high transfection efficiency in vitro. We also found effective VEGFa gene silencing in both mRNA and protein level in HepG2 cells. Notably, siRNA efficiently gathered in liver tumor tissues by the delivery of GPND, and eventually the growth of tumor tissues were inhibited with enhanced targeting capability and no obvious pathological changes. Moreover, histopathological results preliminarily support the high in vivo safety of GPND/anti-VEGFa siRNA nanocomplex. Collectively, GPND/siRNA nanocomplex, with high safety, targeting and transfection as well as prolonged half-life, is a promising nanomedicine and may provide a new direction for highly-specific targeted gene therapy.

Carbon based nanomaterials for tissue engineering of bone: Building new bone on small black scaffolds: A review

Tissue engineering is a rapidly-growing approach to replace and repair damaged and defective tissues in the human body. Every year, a large number of people require bone replacements for skeletal defects caused by accident or disease that cannot heal on their own. In the last decades, tissue engineering of bone has attracted much attention from biomedical scientists in academic and commercial laboratories. A vast range of biocompatible advanced materials has been used to form scaffolds upon which new bone can form. Carbon nanomaterial-based scaffolds are a key example, with the advantages of being biologically compatible, mechanically stable, and commercially available. They show remarkable ability to affect bone tissue regeneration, efficient cell proliferation and osteogenic differentiation. Basically, scaffolds are templates for growth, proliferation, regeneration, adhesion, and differentiation processes of bone stem cells that play a truly critical role in bone tissue engineering. The appropriate scaffold should supply a microenvironment for bone cells that is most similar to natural bone in the human body. A variety of carbon nanomaterials, such as graphene oxide (GO), carbon nanotubes (CNTs), fullerenes, carbon dots (CDs), nanodiamonds and their derivatives that are able to act as scaffolds for bone tissue engineering, are covered in this review. Broadly, the ability of the family of carbon nanomaterial-based scaffolds and their critical role in bone tissue engineering research are discussed. The significant stimulating effects on cell growth, low cytotoxicity, efficient nutrient delivery in the scaffold microenvironment, suitable functionalized chemical structures to facilitate cell-cell communication, and improvement in cell spreading are the main advantages of carbon nanomaterial-based scaffolds for bone tissue engineering.

Synthetic Biodegradable Aliphatic Polyester Nanocomposites Reinforced with Nanohydroxyapatite and/or Graphene Oxide for Bone Tissue Engineering Applications

This paper provides review updates on the current development of bionanocomposites with polymeric matrices consisting of synthetic biodegradable aliphatic polyesters reinforced with nanohydroxyaptite (nHA) and/or graphene oxide (GO) nanofillers for bone tissue engineering applications. Biodegradable aliphatic polyesters include poly(lactic acid) (PLA), polycaprolactone (PCL) and copolymers of PLA-PGA (PLGA). Those bionanocomposites have been explored for making 3D porous scaffolds for the repair of bone defects since nHA and GO enhance their bioactivity and biocompatibility by promoting biomineralization, bone cell adhesion, proliferation and differentiation, thus facilitating new bone tissue formation upon implantation. The incorporation of nHA or GO into aliphatic polyester scaffolds also improves their mechanical strength greatly, especially hybrid GO/nHA nanofilllers. Those mechanically strong nanocomposite scaffolds can support and promote cell attachment for tissue growth. Porous scaffolds fabricated from conventional porogen leaching, and thermally induced phase separation have many drawbacks inducing the use of organic solvents, poor control of pore shape and pore interconnectivity, while electrospinning mats exhibit small pores that limit cell infiltration and tissue ingrowth. Recent advancement of 3D additive manufacturing allows the production of aliphatic polyester nanocomposite scaffolds with precisely controlled pore geometries and large pores for the cell attachment, growth, and differentiation in vitro, and the new bone formation in vivo.

Adhesion and Proliferation of Osteoblast-Like Cells on Porous Polyetherimide Scaffolds

The purpose of this work was to investigate the porous polyetherimide scaffold (P-PEIs) as an alternative biopolymer for bone tissue engineering. The P-PEIs was fabricated via solvent casting and particulate leaching technique. The morphology, phase composition, roughness, hydrophilicity, and biocompatibility of P-PEIs were evaluated and compared with polyetherimide (PEI) and Ti6Al4V disks. P-PEIs showed a biomimetic porous structure with a modulus of 78.95 ± 2.30 MPa. The water contact angle of P-PEIs was 75.4 ± 3.39°, which suggested that P-PEIs had a wettability surface. Moreover, P-PEIs provides a feasible environment for cell adhesion and proliferation. The relative cell adhesion capability and the cell morphology on P-PEIs were better than PEI and Ti6Al4V samples. Furthermore, the MC3T3-E1 cells on P-PEIs showed faster proliferation rate than other groups. It was revealed that the P-PEIs could be a potential material for the application of bone regeneration.