Applications of Biodegradable Magnesium-Based Materials in Reconstructive Oral and Maxillofacial Surgery: A Review

Overview of porous magnesium-based scaffolds: development, properties and biomedical applications

Magnesium (Mg) and its alloys are revolutionizing the field of interventional surgeries in the medical industry. Their high biocompatibility, biodegradability, and a similar elastic modulus to natural bone make porous Mg-based structures potential candidates for orthopedic implants and tissue engineering scaffolding. However, fabricating and machining porous Mg-based structures is challenging due to their complexity and difficulties in achieving uniform or gradient porosity. This review aims to thoroughly explore various fabrication procedures used to create metallic scaffolds, with a specific focus on those made from Mg-based alloys. Both traditional manufacturing techniques, including the directional solidification of metal-gas eutectic technique, pattern casting, methods using space holders, and modern fabrication methods, which are based on additive manufacturing, are covered in this review article. Furthermore, the paper highlights the most important findings of recent studies on Mg-based scaffolds in terms of their microstructure specifications, mechanical properties, degradation and corrosion behavior, antibacterial activity, and biocompatibility (both in vivo and in vitro). While extensive research has been conducted to optimize manufacturing parameters and qualities of Mg-based scaffolds for use in biomedical applications, specifically for bone tissue engineering applications, further investigation is needed to fabricate these scaffolds with specific properties, such as high resistance to corrosion, good antibacterial properties, osteoconductivity, osteoinductivity, and the ability to elicit a favorable response from osteoblast-like cell lines. The review concludes with recommendations for future research in the field of medical applications.

Evaluation of magnesium-based scaffolds fabricated using a modified sintering technique and two types of space holding agents (in vitro study)

OBJECTIVE

The aim of this work was to study the mechanical, degradation behavior and bioactivity of porous magnesium-based scaffolds alloyed with zinc and hydroxyapatite, fabricated using two different types of space holding agents and a modified powder metallurgy route.

METHODS

Powder particles of magnesium, zinc, hydroxyapatite (HA) and spacers were mixed, then mixtures were divided into 6 groups: IA (urea/0%HA), IB (urea/5%HA), IC (urea/7.5%HA), IIA (ammonium bicarbonate/0%HA), IIB (ammonium bicarbonate/5%HA) and IIC (ammonium bicarbonate/7.5%HA). A modified powder metallurgy route was used to fabricate the composites. Porosity analysis and microstructural characterization using Scanning Electron Microscope (SEM), Energy Dispersive X-ray Analysis (EDX), and X-ray Diffraction Analysis (XRD) were done. Evaluation of mechanical properties, in-vitro degradation rate in simulated body fluid (SBF) and in-vitro bioactivity using SEM and XRD were done. Data were statistically analyzed using two-way and three-way repeated ANOVA tests.

RESULTS

All scaffolds were found to be highly porous. Significant differences were observed regarding mechanical properties, degradation rate and concentration of magnesium released during degradation (P  < 0.0001). The results showed that group IIB had the lowest strength and fastest corrosion rate, while IB had the highest strength and elastic modulus and the slowest corrosion rate among all groups. Bioactivity evaluation revealed extensive formation of calcium phosphate crystals and precipitations covering the scaffolds' surfaces.

CONCLUSION

This study showed that using up to 5% HA as a reinforcing element with moderate compaction pressure and urea as a space holding agent can result in the fabrication of magnesium scaffolds suitable for orthopedic applications.

Two versus three magnesium screws for osteosynthesis of mandibular condylar head fractures: a finite element analysis

OBJECTIVES

Previous finite element analyses (FEA) have shown promising results for using two titanium screws in treating mandibular condylar head fractures but limited mechanical stability of a two-screw osteosynthesis with magnesium screws. Given the potential benefits of magnesium screws in terms of biocompatibility and resorption, this study aimed to compare two- and three-screw osteosynthesis solutions for a right condylar head fracture (AO CMF type p) with magnesium screws with a FEA.

MATERIALS AND METHODS

A previously validated finite element model simulating a 350 N bite on the contralateral molars was used to analyze von Mises stress within the screws, fragment deformation, and fracture displacement. All screws were modeled with uniform geometric specifications mirroring the design of Medartis MODUS® Mandible Hexadrive cortical screws.

RESULTS

The three-screw configuration demonstrated lower values for all three parameters compared to the two-screw scenario. There was a 30% reduction in maximum von Mises stress for the top screw and a 46% reduction for the bottom screw.

CONCLUSIONS

Fracture treatment with three magnesium screws could be a valuable and sufficiently stable alternative to the established treatment with titanium screws. Further studies on screw geometry could help improve material stability under mechanical loading, enhancing the performance of magnesium screws in clinical applications.

CLINICAL RELEVANCE

The use of magnesium screws for osteosynthesis of mandibular condylar head fractures offers the benefit of reducing the need for second surgery for hardware removal. Clinical data is needed to determine whether the advantages of resorbable screw materials outweigh potential drawbacks in condylar head fracture treatment.

Investigation of Mechanical and Corrosion Properties of New Mg-Zn-Ga Amorphous Alloys for Biomedical Applications

Magnesium alloys are considered as promising materials for use as biodegradable implants due to their biocompatibility and similarity to human bone properties. However, their high corrosion rate in bodily fluids limits their use. To address this issue, amorphization can be used to inhibit microgalvanic corrosion and increase corrosion resistance. The Mg-Zn-Ga metallic glass system was investigated in this study, which shows potential for improving the corrosion resistance of magnesium alloys for biodegradable implants. According to clinical tests, it has been demonstrated that Ga ions are effective in the regeneration of bone tissue. The microstructure, phase composition, and phase transition temperatures of sixteen Mg-Zn-Ga alloys were analyzed. In addition, a liquidus projection of the Mg-Zn-Ga system was constructed and validated through the thermodynamic calculations based on the CALPHAD-type database. Furthermore, amorphous ribbons were prepared by rapid solidification of the melt for prospective alloys. XRD and DSC analysis indicate that the alloys with the most potential possess an amorphous structure. The ribbons exhibit an ultimate tensile strength of up to 524 MPa and a low corrosion rate of 0.1-0.3 mm/year in Hanks' solution. Therefore, it appears that Mg-Zn-Ga metallic glass alloys could be suitable for biodegradable applications.

In vitro and in vivo evaluation of osteogenesis and antibacterial activity of MgGa alloys

MgGa alloys are considered highly potential biodegradable materials, owing to its good mechanical properties and appropriate corrosion resistance. However, it is still far from application due to the lack of biological evaluation. In the present study, biocompatibility, osteogenesis and antibacterial activity of extruded Mg-xGa (x = 1 and 5 wt%) alloys were investigated by in vitro cell culture experiments and in vivo implantation. The cell adhesion and proliferation of osteoblast precursor cells (MC3T3-E1) showed the excellent cytocompatibility of Mg-1Ga and poor cytocompatibility of Mg-5Ga. The osteogenic activity was evaluated and revealed that Ga3+ in the Mg-1Ga extract had the ability to enhance osteogenic differentiation through the facilitation of its early stages. In vivo studies in a rat femoral condyle model revealed that both Mg-1Ga and Mg-5Ga significantly promoted new bone formation without causing any adverse effects. Mg-5Ga exhibited a much higher corrosion rate in vivo than Mg-1Ga. Its osteogenic activity was better due to the rapid release of Mg2+ and Ga3+, but this caused premature structural integrity loss. Mg-1Ga and Mg-5Ga released Ga3+ to inhibit E. coli and S. aureus, with antibacterial rate increasing with Ga content. Our studies demonstrate that Mg-Ga alloys have the potential to be used as osteogenic and antibacterial implant materials. STATEMENT OF SIGNIFICANCE: This study evaluates the biocompatibility, osteogenesis, and antibacterial activity of Mg-Ga alloys, which are promising biodegradable materials for medical applications. The study finds that Mg-1Ga exhibits excellent cytocompatibility and promotes osteogenic differentiation, facilitating the early stages of osteoblast precursor cell development. In vivo studies in a rat femoral condyle model reveal that Mg-1Ga and Mg-5Ga significantly promote new bone formation without causing any adverse effects. The antibacterial activity of both alloys is evaluated against E. coli and S. aureus, with the inhibition rate increasing with Ga content. These findings suggest that Mg-Ga alloys have the potential to serve as osteogenic and antibacterial implant materials, providing significant insights into the development of novel biomedical implants.

Titanium versus plasma electrolytic oxidation surface-modified magnesium miniplates in a forehead secondary fracture healing model in sheep

Magnesium as a biodegradable material offers promising results in recent studies of different maxillo-facial fracture models. To overcome adverse effects caused by the fast corrosion of pure magnesium in fluid surroundings, various alloys, and surface modifications are tested in animal models. In specified cases, magnesium screws already appeared for clinical use in maxillofacial surgery. The present study aims to compare the bone healing outcome in a non-load-bearing fracture scenario of the forehead in sheep when fixed with standard-sized WE43 magnesium fixation plates and screws with plasma electrolytic oxidation (PEO) surface modification in contrast to titanium osteosynthesis. Surgery was performed on 24 merino mix sheep. The plates and screws were explanted en-bloc with the surrounding tissue after four and twelve weeks. The outcome of bone healing was investigated with micro-computed tomography, histological, immunohistological, and fluorescence analysis. There was no significant difference between groups concerning the bone volume, bone volume/ total volume, and newly formed bone in volumetric and histological analysis at both times of investigation. The fluorescence analysis revealed a significantly lower signal in the magnesium group after one week, although there was no difference in the number of osteoclasts per mm2. The magnesium group had significantly fewer vessels per mm2 in the healing tissue. In conclusion, the non-inferiority of WE43-based magnesium implants with PEO surface modification was verified concerning fracture healing under non-load-bearing conditions in a defect model. STATEMENT OF SIGNIFICANCE: Titanium implants, the current gold standard of fracture fixation, can lead to adverse effects linked to the implant material and often require surgical removal. Therefore, degradable metals like the magnesium alloy WE43 with plasma electrolytic oxidation (PEO) surface modification gained interest. Yet, miniplates of this alloy with PEO surface modification have not been examined in a fracture defect model of the facial skeleton in a large animal model. This study shows, for the first time, the non-inferiority of magnesium miniplates compared to titanium miniplates. In radiological and histological analysis, bone healing was undisturbed. Magnesium miniplates can reduce the number of interventions for implant removal, thus reducing the risk for the patient and minimizing the costs.

Scope of magnesium ceria nanocomposites for mandibular reconstruction: Degradation and biomechanical evaluation using a 3-dimensional finite element analysis approach

Magnesium/Ceria nanocomposites (Mg/xCeO2 NCs (x = 0.5 %, 1 % and 1.5 %)) prepared by using powder metallurgy and microwave sintering method are assessed for their corrosion rate for a period of 28 days. As per the immersion tests results, the addition of ceria nanoparticles to pure Mg, brought about a noteworthy improvement to corrosion resistance. A corrosion rate of approximately 0.84 mm/year for Mg/0.5CeO2 and 0.99 mm/year for Mg/1.0CeO2 nanocomposites were observed. Another aspect of the study involves employing the simulation method i.e. finite element analysis (FEA) to compare the stress distribution in magnesium-ceria nanocomposite based screws and circular bars especially for Mg/0.5CeO2 and Mg/1.0CeO2. Further, the simulation also gives a perception of the impact of masticatory forces, the biting force and shear stress exerted on the Mg/0.5CeO2 and Mg/1.0CeO2 based screws. The simulations results show that the screws showed an acceptable level of stresses for a biting force up to 300 N. The circular bar as well kept its stresses at acceptable levels for the same load of 300N. The shear stress results indicated that a biting force up to 602 N can be safely absorbed by Mg/0.5CeO2 screw. The comprehensive approach allows for a better understanding of the corrosion behavior, stress distribution, and mechanical properties of the Mg/CeO2 nanocomposites, enabling the development of effective temporary implants for craniofacial trauma fixation that can withstand normal physiological forces during mastication. The study reported in this paper aims to target Mg/xCeO2 NCs for temporary implants for craniofacial trauma fixation.

Resorbable magnesium metal membrane for sinus lift procedures: a case series

BACKGROUND

The purpose of this case series was to demonstrate the use of a magnesium membrane for repairing the perforated membrane in both direct and indirect approaches, as well as its application in instances where there has been a tear of the Schneiderian membrane.

CASE PRESENTATION

The case series included four individual cases, each demonstrating the application of a magnesium membrane followed by bone augmentation using a mixture of xenograft and allograft material in the sinus cavity. In the first three cases, rupture of Schneiderian membrane occurred as a result of tooth extraction, positioning of the dental implant, or as a complication during the procedure. In the fourth case, Schneiderian membrane was perforated as a result of the need to aspirate a polyp in the maxillary sinus. In case one, 10 mm of newly formed bone is visible four months after graft placement. Other cases showed between 15 and 20 mm of newly formed alveolar bone. No residual magnesium membrane was seen on clinical inspection. The vertical and horizontal augmentations proved stable and the dental implants were placed in the previously grafted sites.

CONCLUSION

Within the limitations of this case series, postoperative clinical examination, and panoramic and CBCT images demonstrated that resorbable magnesium membrane is a viable material for sinus lift and Schneiderian membrane repair. The case series showed successful healing and formation of new alveolar bone with separation of the oral cavity and maxillary sinus in four patients.

Nanotechnology development in surgical applications: recent trends and developments

This paper gives a detailed analysis of nanotechnology's rising involvement in numerous surgical fields. We investigate the use of nanotechnology in orthopedic surgery, neurosurgery, plastic surgery, surgical oncology, heart surgery, vascular surgery, ophthalmic surgery, thoracic surgery, and minimally invasive surgery. The paper details how nanotechnology helps with arthroplasty, chondrogenesis, tissue regeneration, wound healing, and more. It also discusses the employment of nanomaterials in implant surfaces, bone grafting, and breast implants, among other things. The article also explores various nanotechnology uses, including stem cell-incorporated nano scaffolds, nano-surgery, hemostasis, nerve healing, nanorobots, and diagnostic applications. The ethical and safety implications of using nanotechnology in surgery are also addressed. The future possibilities of nanotechnology are investigated, pointing to a possible route for improved patient outcomes. The essay finishes with a comment on nanotechnology's transformational influence in surgical applications and its promise for future breakthroughs.

Evaluation of the biocompatibility, antibacterial and anticancer effects of a novel nano-structured Fe-Mn-based biodegradable alloys in-vitro study

Scientific backgrounds

Development of nanostructured biodegradable alloys has generated a great deal of interest in the recent years as they offer promising bioactive materials for reconstruction of bony defects following traumatic fractures or surgical excision of tumors.

Objectives

The aim of the current study was to investigate the biocompatibility of Iron-Manganese -based alloys (Fe-Mn) with addition of copper (Cu), Tungsten (W) and cobalt (Co) to obtain 3 different alloys namely, Fe-Mn-Cu, Fe-Mn-W, and Fe-Mn-Co on normal oral epithelial cell line,and their possible anticancer effect on MG-63: osteosarcoma cell line.

Materials and methods

The sulforhodamine B (SRB) assay was used to assess cell viability percentage of both cell lines after exposure to discs of the proposed experimental alloys. Moreover, the antibacterial effect of such alloys against Escherichia coli (E. coli) was tested using disc diffusion susceptibility (Kirby-Bauer method) and colony suspension method.

Results

The cell viability percentage of oral epithelial cell line showed a significant increase in all the experimental groups in comparison to the control group. The highest percentage was observed in Fe-Mn-Co group, followed by Fe-Mn-W then Fe-Mn-Cu, at 24 and 72-h intervals, respectively. While the cell viability percentage of osteosarcoma cell line showed significant increase in all the experimental groups at 24-h intervals, it showed a significant drop in all the study groups at 72-h intervals. The lowest percentage was observed in Fe-Mn-Cu group, followed by Fe-Mn-W then Fe-Mn-Co. Moreover, all the examined study groups didn't show any inhibition zones against E. coli reference culture.

Conclusions

The novel nanostructured biodegradable Fe-Mn-Cu, Fe-Mn-W, and Fe-Mn-Co metal alloys exhibit good biocompatibility on oral epithelial cell lines with the enhancement of cell proliferation in a time-dependent manner that favors bone regeneration. On the other hand, all the alloys manifested possible anticancer activity against MG-63: osteosarcoma cell line. Furthermore, our study sheds the light on the importance of Co, W and Cu as promising alloying elements. However, the antibacterial activity of the examined alloys is still questionable.

Clinical relevance

The novel nanostructured biodegradable Fe-Mn-Cu, Fe-Mn-W, and Fe-Mn-Co metal alloys offer promising bioactive materials for reconstruction of bony defects following traumatic fractures or surgical excision of tumors, In addition, they could be excellent alternatives for undegradable or non-resorbable alloys that are commonly used. Moreover, they could be used as beneficial 3D printing materials to obtain patient-specific medical implants that favor bone regeneration in addition to manufacturing of plates and screws suitable for fracture fixation.

Bioactive Glasses Containing Strontium or Magnesium Ions to Enhance the Biological Response in Bone Regeneration

The non-surgical treatments are being required to reconstruct damaged tissue, prioritizing our body's natural healing process. Thus, the use of bioactive materials such as bioactive glass has been studied to support the repair and restoration of hard and soft tissue. Thus, in this work Bioglass 45S5 was developed, adding 1 and 2%mol of SrO or MgO and the physical and biological properties were evaluated. The addition of MgO and SrO at the studied concentrations promoted the slight increase in non-bridging oxygens number, observed through the temperature shift in phase transitions to lower values compared to Bioglass 45S5. The insertion of the ions also showed a positive effect on Saos-2 cell viability, decreasing the cytotoxic of Bioglass 45S5. Besides the Ca/P ratio on the pellets surface demonstrating no evidence of higher reactivity between Bioglass 45S5 and Bioglass with Sr and Mg, micrographs show that at 24 h the Ca/P rich layer is denser than in Bioglass 45S5 after the contact with simulated body fluid. The samples with Sr and Mg show a higher antibacterial effect compared to Bioglass 45S5. The addition of the studied ions may benefit the biological response of Bioglass 45S5 in dental applications as scaffolds or coatings.

Preclinical Evaluation of Bioactive Scaffolds for the Treatment of Mandibular Critical-Sized Bone Defects: A Systematic Review

This systematic review evaluated current in vivo research on regenerating critical-sized mandibular defects and discussed methodologies for mandibular bone tissue engineering. Out of the 3650 articles initially retrieved, 88 studies were included, and all studies that used a scaffold reported increased bone formation compared to negative controls. Combining scaffolds with growth factors and mesenchymal stem cells improved bone formation and healing. Bone morphogenic proteins were widely used and promoted significant bone formation compared to controls. However, discrepancies between studies exist due to the various methodologies and outcome measures used. The use of scaffolds with bioactive molecules and/or progenitor cells enhances success in mandibular bone engineering. Scaffold-based mandibular bone tissue engineering could be introduced into clinical practice due to its proven safety, convenience, and cost-effectiveness.

Corrosion Behavior and Biocompatibility of Hot-Extruded Mg-Zn-Ga-(Y) Biodegradable Alloys

Fixation screws and other temporary magnesium alloy fixation devices are used in orthopedic practice because of their biodegradability, biocompatibility and acceptable biodegradation rates. The substitution of dissolving implant by tissues during the healing process is one of the main requirements for biodegradable implants. Previously, clinical tests showed the effectiveness of Ga ions on bone tissue regeneration. This work is the first systematic study on the corrosion rate and biocompatibility of Mg-Zn-Ga-(Y) alloys prepared by hot extrusion, where Ga is an additional major alloying element, efficient as a bone-resorption inhibitor. Most investigated alloys have a low corrosion rate in Hanks' solution close to ~0.2 mm/year. No cytotoxic effects of Mg-2Zn-2Ga (wt.%) alloy on MG63 cells were observed. Thus, considering the high corrosion resistance and good biocompatibility, the Mg-2Zn-2Ga alloy is possible for applications in osteosynthesis implants with improved bone tissue regeneration ability.

Microstructure and Mechanical Properties of Hot-Extruded Mg-Zn-Ga-(Y) Biodegradable Alloys

Magnesium alloys are attractive candidates for use as temporary fixation devices in osteosynthesis because they have a density and Young's modulus similar to those of cortical bone. One of the main requirements for biodegradable implants is its substitution by tissues during the healing process. In this article, the Mg-Zn-Ga-(Y) alloys were investigated that potentially can increase the bone growth rate by release of Ga ions during the degradation process. Previously, the effectiveness of Ga ions on bone tissue regeneration has been proved by clinical tests. This work is the first systematic study on the microstructure and mechanical properties of Mg-Zn-Y alloys containing Ga as an additional major alloying element prepared by the hot-extrusion process. The microstructure and phase composition of the Mg-Zn-Ga-(Y) alloys in as-cast, heat-treated, and extruded conditions were analyzed. In addition, it was shown that the use of hot extrusion produces Mg-Zn-Ga-(Y) alloys with favorable mechanical properties. The tensile yield strength, ultimate tensile strength, and elongation at fracture of the MgZn4Ga4 alloy extruded at 150 °C were 256 MPa, 343 MPa, and 14.2%, respectively. Overall, MgZn4Ga4 alloy is a perspective for applications in implants for osteosynthesis with improved bone regeneration ability.