The development of carbohydrate polymer- and protein-based biomaterials and their role in environmental health and hygiene: A review

Biological macromolecules have been significantly used in the medicine due to their certain therapeutic values. Macromolecules have been employed in medical filed in order to enhance, support, and substitute damaged tissues or any other biological function. In the past decade, the biomaterial field has developed considerably because of vast innovations in regenerative medicine, tissue engineering, etc. Different types of biological macromolecules such as natural protein and polysaccharide etc. and synthetic molecules such as metal based, polymer based, and ceramic based etc. have been discussed. These materials can be modified by coatings, fibres, machine parts, films, foams, and fabrics for utilization in biomedical products and other environmental applications. At present, the biological macromolecules can used in different areas like medicine, biology, physics, chemistry, tissue engineering, and materials science. These materials have been used to promote the healing of human tissues, medical implants, bio-sensors and drug delivery, etc. These materials also considered as environmentally sustainable as they are prepared in association with renewable natural resources and living organisms in contrast to non-renewable resources (petrochemicals). In addition, enhanced compatibility, durability and circular economy of biological materials make them highly attractive and innovative for current research.The present review paper summarizes a brief about biological macromolecules, their classification, methods of synthesis, and their role in biomedicine, dyes and herbal products.

Regenerative medicine for skeletal muscle loss: a review of current tissue engineering approaches

Skeletal muscle is capable of regeneration following minor damage, more significant volumetric muscle loss (VML) however results in permanent functional impairment. Current multimodal treatment methodologies yield variable functional recovery, with reconstructive surgical approaches restricted by limited donor tissue and significant donor morbidity. Tissue-engineered skeletal muscle constructs promise the potential to revolutionise the treatment of VML through the regeneration of functional skeletal muscle. Herein, we review the current status of tissue engineering approaches to VML; firstly the design of biocompatible tissue scaffolds, including recent developments with electroconductive materials. Secondly, we review the progenitor cell populations used to seed scaffolds and their relative merits. Thirdly we review in vitro methods of scaffold functional maturation including the use of three-dimensional bioprinting and bioreactors. Finally, we discuss the technical, regulatory and ethical barriers to clinical translation of this technology. Despite significant advances in areas, such as electroactive scaffolds and three-dimensional bioprinting, along with several promising in vivo studies, there remain multiple technical hurdles before translation into clinically impactful therapies can be achieved. Novel strategies for graft vascularisation, and in vitro functional maturation will be of particular importance in order to develop tissue-engineered constructs capable of significant clinical impact.

Regenerative Materials for Surgical Reconstruction: Current Spectrum of Materials and a Proposed Method for Classification

Chronic wound management is an enormous economic strain and quality-of-life issue for patients. Current treatments are ineffective or expensive and invasive. Materials (native and artificial) can act as the basis to enhance wound repair but often fall short of complete healing. The therapeutic index of materials have often been enhanced by combining them with drug or biologic elution technologies. Combination of materials with living drugs (cells) presents a new paradigm for enhancing therapy. Cell material interaction and therapeutic output will depend on variables ascribed to the living drug as well as variables ascribed to the underlying matrix. In this article, we review medical matrices currently approved by the US Food and Drug Administration (FDA) that would likely be the first generation of materials to be used in this manner. Currently there are hundreds of different materials on the market. Identification of the right combinations would benefit from a classification scheme to group materials with similar composition or derivation. We provide a classification scheme and FDA documentation references that should provide researchers and clinicians a starting point for testing these materials in the laboratory and rapidly transitioning cell therapies to the bedside.

Permanent Implantable Medical Devices in Exotic Pet Medicine

Medical devices are defined as implantable if they are intended to remain in the body after the procedure. In veterinary medicine, use of such devices is marginal but may find some indications. Use in exotic pet medicine is even more challenging due to size restriction and the limited data available. This review focuses on the esophageal and tracheal stent in the case of stricture, ureteral stent and subcutaneous ureteral bypass in the case of ureteral obstruction, permanent urinary diversion in the case of bladder atony, and pacemaker in the case of severe arrythmias. Comparative aspects are developed.

[Modern polyurethanes in cardiovascular surgery]

Currently, there is great clinical demand for synthetic tissue-engineered cardiovascular prostheses with good long-term patency. Polyurethanes belong to the class of polymers with excellent bio- and hemocompatibility. They are known to possess good mechanical properties, but are prone to processes of degradation in conditions of functioning in living organisms. Attempts at solving this problem have resulted in the development of various new subclasses of polyurethanes such as thermoplastic polyether polyurethanes, polyurethanes with a silicone segment, polycarbonate polyurethanes and nanocomposite polyurethanes. This was accompanied and followed by offering a series of new technologies of production of implantable medical devices such as vascular grafts, heart valves and others. In the presented review, we discuss biological and mechanical properties of modern subclasses of polyurethanes, as well as modern methods of manufacturing implantable medical devices made of polyurethanes, especially small-diameter vascular prostheses.

A Critical Review of the Durability of Adhesion to Tooth Tissue: Methods and Results

The immediate bonding effectiveness of contemporary adhesives is quite favorable, regardless of the approach used. In the long term, the bonding effectiveness of some adhesives drops dramatically, whereas the bond strengths of other adhesives are more stable. This review examines the fundamental processes that cause the adhesion of biomaterials to enamel and dentin to degrade with time. Non-carious class V clinical trials remain the ultimate test method for the assessment of bonding effectiveness, but in addition to being high-cost, they are time- and labor-consuming, and they provide little information on the true cause of clinical failure. Therefore, several laboratory protocols were developed to predict bond durability. This paper critically appraises methodologies that focus on chemical degradation patterns of hydrolysis and elution of interface components, as well as mechanically oriented test set-ups, such as fatigue and fracture toughness measurements. A correlation of in vitro and in vivo data revealed that, currently, the most validated method to assess adhesion durability involves aging of micro-specimens of biomaterials bonded to either enamel or dentin. After about 3 months, all classes of adhesives exhibited mechanical and morphological evidence of degradation that resembles in vivo aging effects. A comparison of contemporary adhesives revealed that the three-step etch-and-rinse adhesives remain the ‘gold standard’ in terms of durability. Any kind of simplification in the clinical application procedure results in loss of bonding effectiveness. Only the two-step self-etch adhesives approach the gold standard and do have some additional clinical benefits.

Useful surface parameters for biomaterial discrimination

Topographical features of biomaterials' surfaces are determinant when addressing their application site. Unfortunately up to date there has not been an agreement regarding which surface parameters are more representative in discriminating between materials. Discs (n = 16) of different currently used materials for implant prostheses fabrication, such as cast cobalt-chrome, direct laser metal soldered (DLMS) cobalt-chrome, titanium grade V, zirconia (Y-TZP), E-glass fiber-reinforced composite and polyetheretherketone (PEEK) were manufactured. Nanoscale topographical surface roughness parameters generated by atomic force microscopy (AFM), microscale surface roughness parameters obtained by white light interferometry (WLI) and water angle values obtained by the sessile-water-drop method were analyzed in order to assess which parameter provides the best optimum surface characterization method. Correlations between nanoroughness, microroughness, and hydrophobicity data were performed to achieve the best parameters giving the highest discriminatory power. A subset of six parameters for surface characterization were proposed. AFM and WLI techniques gave complementary information. Wettability did not correlate with any of the nanoroughness parameters while it however showed a weak correlation with microroughness parameters.

Demands and properties of alloplastic implants for the treatment of stress urinary incontinence

Surgical treatment of stress urinary incontinence changed dramatically with the introduction of the tension-free vaginal tape. Owing to its high efficacy and minimal patient discomfort this new minimally invasive procedure quickly obtained widespread acceptance and superseded the abdominal colposuspension as the gold standard. In the course of success of the original method a number of tension-free vaginal tapes flooded the market, varying in approach and material. These variations may strongly influence the safety, efficacy and long-term results of tension-free vaginal tape and its major modification, the transobturator technique. Therefore, it is the aim of this review to closely illuminate available materials and complications associated with this procedure. An extensive Medline search of the published literature up until 2006 on the subject of stress urinary incontinence was carried out. All sources identified were reviewed with particular attention to the method applied, the properties of the mesh materials and clinical complications. Apart from several technical variations, there are marked differences between the different vaginal sling materials, ranging from absorbable collagens over polypropylene to allografts. Although performed globally in substantial and increasing numbers, minimally invasive techniques for the surgical treatment of stress urinary incontinence are lacking sufficient safety data.

Tissue engineering in urethral reconstruction

Urethral strictures are one of the most common urological problems, yet the natural limitations of wound healing and the physiologic demands on the anatomic structures combine to also make urethral strictures one of the most challenging urological problems to manage. Proper wound healing demands well approximated edges because prolonged inflammation and granulation, required to close large, deep wounds, will result in excess collagen production, fibrosis, and the formation of a scar or, in the urethra, a stricture. Biomaterials have successfully been used to approximate the ECM of several different tissue types and can define a three dimensional space suitable for the formation of new tissues with both appropriate structure and appropriate function. Biomaterials can be broadly categorized as either synthetic polymers or tissue matrices, each with their advantages and limitations. Recent studies utilizing cell seeded natural biomaterials in urethral repair has yielded some promising results. However, advancements in the use of alternative sources of cells for matrix seeding and cell-seeded synthetic materials hold the possibility of even better results in the future.

The role of cements in dental lant success, Part I

Peri-implant disease can be the result of residual excess cement. While there is no ideal implant restorative cement, the clinician must be aware that the material selection for implant restorations should not be based on properties which are more suited to restoration of the natural dentition. More appropriate criteria would be those unique to implants and the specific challenges these medical devices bring to the restorative dentist.

Biocompatibility Study Based on Differential Sequestration Kinetics of CD14+CD16+ Blood Monocyte Subsets with Different Dialyzers

The immune defect in hemodialysis (HD) patients is associated with a monocyte dysfunction, including an increase in the production of proinflammatory cytokines. Blood membrane contact leads to an increase in cellular activation and sequestration into the capillary bed of the lung. The influence of the sequestration on the number of mature monocytes was studied by analyzing the fate of monocytes, particularly, the CD14+CD16+ subpopulation, during HD treatment. In thirty stable HD patients, the distinct cell populations were determined by differential blood counts and flow cytometry. Patients with diabetes or systemic vasculitis, those showing evidence of infectious complications or malignancy, or those taking immunosuppressive medications were excluded from the study. Cells from this study population were analyzed before the start, 30 min thereafter, and at the end of HD treatment, each time using a different dialyzer: hemophan, methylmethacrylate (PMMA), triacetate membrane, cuprophane/vitamin E, acrylonitrile, and sodium methallylsulfonate polymer (AN69). The CD14+CD16+ subset decreased at 30 min and remained suppressed for the course of dialysis. To examine whether currently used biocompatible membranes differ in their effect on the sequestration of monocyte subpopulations, temporal monocytic changes were comparatively analyzed during HD with a different dialyzer. The drop in the first 30 min until the end of HD treatment was significant (p<0.05), very uniform, and sharp in all patients, and was independent upon membrane type. The CD14+CD16+ monocyte subpopulation showed increased and longer margination from the blood circulation during HD. Given the fact that CD14+CD16+ monocytes represent a sensitive marker for inflammation or cellular activation, the depletion of these cells may offer an easily accessible parameter that is more sensitive than complement activation for biocompatibility studies on forthcoming, improved dialyzer membranes.

Injectable fillers: an American perspective

Since 1981, there has been a significant repertoire of United States Food and Drug Administrtion (FDA) approved fillers for both cosmetic rejuvenation and facial lipoatrophy. Currently available dermal fillers include bovine, human and porcine collagens, hyaluronic acids of animal and biosynthetic origin, poly-L-lactic acid, calcium hydroxylapatite, and polymethylmethacrylate. Many of these fillers were first available in Europe and Canada before their arrival in the United States (USA) and many of the complications known about these products have come from studies conducted both in the USA and abroad. Several of the fillers that are currently available abroad or are used in the USA off-label have been associated with significant complications. The authors review three of these fillers: liquid injectable silicone, DermaLive/DermaDeep, and Bio-Alcamid.

A novel combinatorial approach for understanding microstructural evolution and its relationship to mechanical properties in metallic biomaterials

The new generation of metallic biomaterials for prosthesis implantation (orthopedic and dental) typically have a Ti base with fully biocompatible alloying additions such as Nb, Ta, Zr, Mo, Fe and Sn. While the binary Ti-Ta and the ternary Ti-Nb-Ta systems are promising, the large composition space afforded by these systems offers tremendous scope in terms of alloy design via optimization of alloy composition and thermomechanical treatment. In the present paper a novel combinatorial approach has been developed for rapidly exploring the microstructural evolution and microstructure-microhardness (or elastic modulus) relationships in these systems. Using directed laser deposition, compositionally graded alloy samples have been fabricated and subsequently heat-treated to affect different microstructures in terms of the volume fraction and distribution of the alpha phase in the beta matrix as a function of composition. Subsequently, composition-specific indentation-based hardness and modulus information has been obtained from these graded samples, and the resulting data have been used to develop relationships between the composition, microstructure and mechanical properties. Such rapid combinatorial assessments can be very useful in optimizing not only the alloy composition but also the desired microstructure for achieving the best combination of properties for specific orthopedic or dental applications.

Avoiding and treating dermal filler complications

All fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of and accept these risks. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., too superficial an implantation of a long-lasting filler substance). Such adverse events can be treated with intradermal 5-fluorouracil, steroid injections, vascular lasers, or intense pulsed light, and later with dermabrasion or shaving. Late adverse events also include immunologic phenomena such as late-onset allergy and nonallergic foreign body granuloma. Both react well to intralesional steroid injections, which often have to be repeated to establish the right dose. Surgical excisions shall remain the last option and are indicated for hard lumps in the lips and visible hard nodules or hard granuloma in the subcutaneous fat.

Material selection: the moulder's view

Where is the best place to turn for help with plastics material selection? Sources of data and expertise are outlined here.

The Evolution of Soft Tissue Fillers in Clinical Practice

To remain experts in skin care and treatment, every dermatologist must be aware of the evolving role of soft tissue fillers in dermatology. Patients with facial scarring, lipodystrophy, contour abnormalities, and age- and sun-induced rhytids can be successfully treated. A literature review, industry recommendations, and the authors' experience serve to highlight fillers most appropriate for each patient's complaint. Newer agents, including the hyaluronic acids and human collagens, and long-lasting materials, such as polymethlymethracrylate and calcium hydroxlyapatite, are reviewed. This discussion of the specific risks, indications, and technical pearls for the various fillers will allow clinicians to accurately advise or treat patients.

Comparison between the in vitro surface transformations of AP40 and RKKP bioactive glasses

Two bioactive silica-phosphate glasses, AP40 and RKKP, were compared in their behaviour in simulated biological environment. Their chemical composition is practically identical, except that RKKP contains small amounts of amphoteric network-former oxides Ta2O5 and La2O3 (composition in wt% for AP40: beta-Ca3(PO4)2 24.50, SiO2 44.30, CaO 18.60, Na2O 4.60, K2O 0.19, MgO 2.82, CaF2 4.99; RKKP: beta-Ca3(PO4)2 24.23, SiO2 43.82, CaO 18.40, Na2O 4.55, K2O 0.19, MgO 2.79, CaF2 4.94, Ta2O5 0.99, La2O3 0.09). Previous investigations showed a better performance in osteopenic bone for RKKP. To gain more insight into these differences in biological behaviour, the in vitro bioactivity of the glasses was studied by treatment with a continuously replenished Hanks' Balanced Salt Solution (HBSS). The glasses were examined before and after HBSS treatment for 20 and 40 days by X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM), X-ray Energy Dispersion (EDX), Raman and IR vibrational spectroscopies. Some slight but notable differences between the two glasses were observed after HBSS treatment. IR and EDX analyses showed that deposits formed on both glasses were composed of a calcium deficient carbonate-apatite; however, the layer formed on RKKP glass was found to be slightly more calcium deficient and thinner. EDX analysis evidenced the presence of a small percentage of F- ions only in the layers formed on the RKKP samples. The differences disclosed, although slight, can contribute to the understanding of the different biological behaviour previously observed.

The effect of biomimetic apatite structure on osteoblast viability, proliferation, and gene expression

The conventional biomimetic apatite coating process can be accelerated by immersing substrates into concentrated simulated body fluid (5 x SBF) at 37 degrees C to form an initial coating of apatite precursor spheres, and transform the precursors into plate-like apatite structures. Depending on processing parameters, different apatite structures can be created over the same substrate. The purpose of this study is to investigate the effects of the different apatite microenvironment on cell spreading, viability, proliferation, and gene expression. MC3T3-E1 preosteoblasts were cultured on five surfaces: conventional apatite (CA), precursor apatite spheres (PreA), large plate-like apatites (LgA), small plate-like apatites (SmA), and tissue culture grade polystyrene (TCPS). PreA induced significantly higher cell death during the first two weeks. TCPS supported more uniform spreading (1 day) and higher proliferation (2 weeks) than CA, LgA, and SmA. Apatites restricted spreading and promoted the extension of cellular projections along the textured surfaces under confocal microscopy observation. By 3 weeks, LgA induced highest expression of mature osteogenic markers osteocalcin (OCN) and bone sialoprotein (BSP) in both regular and osteogenic culture media based on quantitative real-time RT-PCR. The results of this study suggest differential cell responses to subtle changes in apatite microenvironment.

Sol-gel synthesis of bioactive glass scaffolds for tissue engineering: Effect of surfactant type and concentration

Well-defined structural characteristics are some of the exigencies that have to be attended when scaffolds for bone tissue cell culture are designed. A high porosity (70-90%) and a high specific surface area and an average pore size>150 microm will contribute to allow cell migration throughout the structure, adhesion, and proliferation. At the same time, the biodegradation of the material should occur in a proper rate. One way to reach a structure with these characteristics is to produce foams during sol-gel processing of bioactive glasses (system CaO--SiO2--P2O5). The addition of a surfactant in the sol-gel solution is necessary for foam formation and to maintain its stability until complete gelation occurs. This study presents the performance evaluation of two surfactants [sodium lauryl ether sulfate (SLES) and Tergitol] to determine optimum conditions for foaming ability and stability properties. The anionic surfactant SLES showed better results in terms of foam volume and its stability. Bioactive glass foams obtained with use of this surfactant presented a higher and interconnected porosity. The porosity of the scaffolds produced was 90%, and the macropore size ranged from 100 to 500 microm.

[Review: pathophysiology and methodology of nasal packing]

Nasal packing is a frequent procedure to control spontaneous nasal bleeding or postoperative oozing following different types of nasal surgery. It strives for internal stabilization of the nasal framework and for optimizing wound healing by prevention of stenosis or synechia. A lot of different materials is used and there is no accepted standard concerning the type and application. A review on pathophysiology of the packed nose is given together with a survey on customary packing materials focussing on the specific merits, demerits and side-effects including economical aspects.

Plasma-treated polystyrene surfaces: model surfaces for studying cell-biomaterial interactions

Biocompatibility of biomaterials relates, amongst others, to the absence of adverse cellular reactions and modulation of cell adhesion and subsequent responses. With respect to tissue-engineering applications, most materials need to evoke cell adhesion and spreading, while potentially displaying differential cell function. Adhesion has frequently been studied in a controlled fashion, using adhesion-supporting and -inhibiting substrata. The aim of this study is to create a panel of related materials with gradually changing surface characteristics in order to sustain similar individual cell adhesion and spreading, yet different cell population behaviour. A series of polystyrene materials was created with increasing oxygen surface incorporation and, concurrently, decreasing water-contact angles. Individual cells adhered and spread on all surfaces whilst showing well-developed focal adhesions and stress fibres. Cell populations demonstrated a decreased growth on surfaces with lower wettability. The biochemical activity of cell populations was not influenced by the surface treatment, but cell proliferation on surfaces increased with increasing oxygen incorporation. Furthermore, surface coverage with assembled fibronectin matrix was higher on the substrata with higher wettability. Finally, the expression of the adhesion-related proteins cadherin-5, focal adhesion kinase and RhoA was increased on surfaces with higher wettability. Further explorations of the cell biological basis of the observed differential behaviour will give more detailed answers on the rules governing cell-material interactions.

Prediction of apatite lattice constants from their constituent elemental radii and artificial intelligence methods

Lattice constants (LCs) of all possible 96 apatite compounds, A(5)(BO(4))(3)C, constituted by A[double bond]Ba(2+), Ca(2+), Cd(2+), Pb(2+), Sr(2+), Mn(2+); B[double bond]As(5+), Cr(5+), P(5+), V(5+); and C[double bond]F(1-), Cl(1-), Br(1-), OH(1-), are predicted from their elemental ionic radii, using pattern recognition (PR) and artificial neural networks (ANN) techniques. In particular, by a PR study it is demonstrated that ionic radii predominantly govern the LCs of apatites. Furthermore, by using ANN techniques, prediction models of LCs a and c are developed, which reproduce well the measured LCs (R(2)=0.98). All the literature reported on 30 pure and 22 mixed apatite compounds are collected and used in the present work. LCs of all possible 66 new apatites (assuming they exist) are estimated by the developed ANN models. These proposed new apatites may be of interest to biomedical research especially in the design of new apatite biomaterials for bone remodeling. Similarly these techniques may also be applied in the study of interface growth behaviors involving other biomaterials.

Attachment and proliferation of neonatal rat calvarial osteoblasts on Ti6Al4V: effect of surface chemistries of the alloy

This study examined the cell attachment and proliferation of neonatal rat calvarial osteoblasts on Ti6Al4V alloy as affected by the surface modifications. The modifications could alter simultaneously the surface chemistries of the alloy (elemental difference of Ti, Al, V, Cu and Ni about 300-600mum thick examined by EDS) as well as the XPS nano-surface characteristics of oxides on the metal surface (chemistries of oxides, amphoteric OH group adsorbed on oxides, and oxide thickness). Three materials including two from modifications and a control were examined. It is argued that a slight change of the nano-surface characteristics of oxides as a result of the modifications neither alters the in vitro capability of Ca and P ion adsorption nor affects the metal ion dissolution behavior of the alloy. This implies that any influence on the cytocompatibility of the materials should only be correlated to the effect of surface chemistries of the alloy and the associated metal ion dissolution behavior of the alloy. The experimental results suggest that the cell response of neonatal rat calvarial osteoblasts on the Ti6Al4V alloy should neither be affected by the variation of surface chemistries of the alloy in a range studied.

Compressive and Shear Properties of Commercially Available Polyurethane Foams

Background: The shear properties of rigid polyurethane (PU-R) foams, routinely used to simulate cancellous bone, are not well characterized. Method of approach: The present assessment of the shear and compressive properties of four grades of Sawbones “Rigid cellular” PU-R foam tested 20 mm gauge diameter dumb-bell specimens in torsion and under axial loading. Results: Shear moduli ranged from 13.3 to 99.7 MPa, shear strengths from 0.7 MPa to 4.2 MPa. Compressive yield strains varied little with density while shear yield strains had peak values with “200 kgm−3” grade. Conclusions: PU-R foams may be used to simulate the elastic but not failure properties of cancellous bone.

Maximising tubing functionality, Part I: Proper selection of resins

Making an incorrect selection of polymeric materials, formulations and compounding can result in a compromised design and impaired functionality of the end product. Part I of this article provides guidance on how to simplify and expedite materials selection.

[Research development of hydroxyapatite-based composites used as hard tissue replacement]

Hydroxyapatite has been considered as the most promising materials for hard tissue replacements, due to its similar chemical composition and crystallographic structure to that of bone mineral. But the brittleness is one of the most serious obstacles for its wider applications as load-bearing implants. Therefore, various HA composites get much attention. In the present paper, HA composites were introduced according to the kind of reinforcement. Although bioactive ceramics, bioactive glass or glass-ceramic, bio-inactive ceramics, polymers and metals all have been used to fabricate HA composites, no one can well satisfy the requirements for hard tissue replacement. The vital problem of the existing HA composites is that the biological properties cannot match with the mechanical properties well.

In vitro performance of intramedullary cement restrictors in total hip arthroplasty

Contemporary cementing techniques in total hip arthroplasty include the use of a cement restrictor to occlude the intramedullary canal. As there are many different designs currently available it was the aim of our study to compare the stability of eight different systems. We investigated the displacement and the ability to occlude the femur of these cement restrictors during standardised cementing of artificial and fresh frozen femora. The maximal intramedullary pressures and the displacement of the plugs were continuously recorded and statistically evaluated. The results revealed significant differences between the tested cement restrictors. The expandable REX Cement Stop and the Exeter Plug achieved the highest stability and the least cement leakage. The more rigid designs (Palacos Plug, BUCK, Universal) in contrast showed inferior performance. Our biomechanical study emphasises the importance of cement restrictor selection, which can have a crucial influence on the fixation of a cemented total hip replacement.

Thermoplastic elastomers in medical applications

TPEs provide medical designers with a broad spectrum of soft-feel, hygienic materials that can readily fulfill accepted medical industry standards with the exception of body implants. Ultimate performance is a combination of tailor-made formulations coupled with innovative design that captures the capability of the material's properties and thermoplastic processing techniques, including combination with other polymers by coinjection moulding or coextrusion.

Particle size and morphology of UHMWPE wear debris in failed total knee arthroplasties--a comparison between mobile bearing and fixed bearing knees

Osteolysis induced by ultrahigh molecular weight polyethylene wear debris has been recognized as the major cause of long-term failure in total joint arthroplasties. In a previous study, the prevalence of intraoperatively identified osteolysis during primary revision surgery was much higher in mobile bearing knee replacements (47%) than in fixed bearing knee replacements (13%). We postulated that mobile bearing knee implants tend to produce smaller sized particles. In our current study, we compared the particle size and morphology of polyethylene wear debris between failed mobile bearing and fixed bearing knees. Tissue specimens from interfacial and lytic regions were extracted during revision surgery of 10 mobile bearing knees (all of the low contact stress (LCS) design) and 17 fixed bearing knees (10 of the porous-coated anatomic (PCA) and 7 of the Miller/Galante design). Polyethylene particles were isolated from the tissue specimens and examined using both scanning electron microscopy and light-scattering analyses. The LCS mobile bearing knees produced smaller particulate debris (mean equivalent spherical diameter: 0.58 microm in LCS, 1.17 microm in PCA and 5.23 microm in M/G) and more granular debris (mean value: 93% in LCS, 77% in PCA and 15% in M/G).

Cell orientation and cytoskeleton organisation on ground titanium surfaces

A stable connection between the biomaterial surface and the surrounding tissue is one of the most important prerequisites for the long-term success of implants. Therefore, a strong adhesion of the cells on the biomaterial surface is required. Beside the surface composition the surface topography influences the properties of the adherent cells. The quality of the connection between the cell and the biomaterial is-among other factors-determined by the dimensions of the surface topography. Osteoblasts and fibroblast-like cells in contact with a ground biomaterial surface spread in the direction of the surface structures. These aligned cells provide a more favourable adhesion behaviour than a spherically shaped cell. To determine the influence of the surface structure on the cell alignment and cytoskeleton organisation or arrangement, substrate discs of cp-titanium were ground, producing different roughness of the substrates. The oriented cells had a higher density of focal contacts when they were in contact with the edges of the grooves and showed a better organisation of the cytoskeleton and stronger actin fibres. These changes of the aligned cells depend on the peak to valley height of the surface structures.

Growth of osteoblast-like cells on porous hydroxyapatite ceramics: an in vitro study

Blocks of two porous synthetic hydroxyapatites (HA) with porosity fraction of 30-40 and 50-60 vol%, respectively and a coralline derived porous HA were evaluated in vitro in presence of the osteogenic line MC3T3-E1 and of L929 fibroblasts. The two tested biomaterials did not affect cellular proliferation (MTT test), but the contact inhibited alkaline phosphatase activity. Porous aggregates resulted perfectly biocompatible in the tests performed, since observations performed by light microscopy did not show any cell morphological change, osteoblast presented a stellar shape and typical pseudopodes. SEM observations showed intercellular matrix containing fibers on HA-based porous aggregates.

Replacing and renewing: synthetic materials, biomimetics, and tissue engineering in implant dentistry

Hundreds of thousands of implantations are performed each year in dental clinical practice. Dental implants are a small fraction of the total number of synthetic materials implanted into the human body in all fields of medicine. Basically, these millions of implants going into humans function adequately. But longevity and complications still are significant issues and provide opportunities for the creation of improved devices. This manuscript briefly reviews the history of dental implant devices and the concepts surrounding the word "biocompatibility." It then contrasts the foreign body reaction with normal healing. Finally, the article describes how ideas gleaned from the study of normal wound healing can be applied to improved dental implants. In a concluding section, three scenarios for dental implants twenty years from now are envisioned.

[Biomaterials and osseous regeneration]

The autologous bone graft is commonly used for the repair of bony defects, but its resorption is unpredictable, and there is an inherent morbidity of the donor site. There is a wide range of biomaterials that could be used as bone substitutes, depending on their bioactivity. Among bioactive materials, bioglasses present a linkage between their reactive surface and the adjacent bone although they cannot be colonized by bony ingrowth, moreover their fragility and resorption as particles limit their use. The osteoconductive biomaterials are either represented by the synthetized ceramics, such as hydroxyapatite (HA) or tricalcium phosphate (TCP), or either natural coral and the derived biomaterials of bony matrix. Coral exoskeleton or TCP are highly resorbable, but pure HA is only slightly. Bony ingrowth in osteoconductive materials is limited to the periphery of the implant which does not make it suitable for the repair of large defects. Research is focused on the adjunction of a biologically active substance to the osteoconductive matrix in order to enhance bony ingrowth. Osteoinductive materials such as bone growth factors in combination with a carrier can promote bone healing, especially when bone morphogenetic protein (BMP) is used. Nevertheless, even if their efficacy is demonstrated, their inocuity has not been totally confirmed. Furthermore, the dose used are far superior than in the physiological pathways. Hybrid biomaterials combine an osteoconductive carrier with bone marrow cells. Bone cell cultures could amplify to almost any extent the number of osteogenic cells for such a biomaterial. Bone substitutes will certainly be used in the future to repair bony defects.

Radiopaque polymeric materials for medical applications. Current aspects of biomaterial research

The aim of this review is to give an overview and some insight into different radiopaque polymeric materials that are currently used as medical implants or inserts. The advantages and limitations of each radiopaque polymeric material are summarized. The main method used to make medical implants radiologically visible is based on blending polymers with conventional radiopaque agents, blends which usually are a physical mixture of acrylic derivatives and inorganic salts. Other methods reported involve either the formation of single-phase radiopaque polymer salt complexes somehow preventing the release of the radiopacifying element by entrapment of the complex in a crosslinked network, or radiopaque polymerized monomers characterized by a radiopacifying element associated with the monomer unit prior to polymerization. In the near future, research will certainly concentrate on biocompatible radiopaque polymers with covalently bound opaque elements leading to stable polymers with properties equivalent to the nonopaque, parent polymer.

Hemorheological parameters for biocompatibility evaluation

Biomaterials have been extensively used for various clinical applications. Since blood is very sensitive to the presence of any foreign substances, testing for hemocompatibility is a major part of biocompatibility evaluation. At present, blood viscosity parameters are being used as screening tests for biomaterial compatibility. Successful use of these parameters will help eliminate many incompatible materials from being subjected to extensive testing. In this study, we evaluated the blood viscosity parameters (n = 10)--whole blood viscosity, plasma viscosity, red cell rigidity, hematocrit, and biochemical parameters (total proteins and albumin). A significant increase in hemorheological parameters after incubation with material was found to be an indicator of incompatibility.

[One hundred years of orthopedics in the Netherlands. VII. biomaterials]

The use of biomaterials in orthopaedics is becoming increasingly important. They are widely used in artificial joints, as bone replacement material and as resorbable material. Also (recombinant) bone morphogenetic proteins are used. Classification of biomaterials is based on composition (animal or human tissue, metals, polymers, ceramics or composites) or on biological reactions after implantation (bio-inert, bio-tolerant or bio-active). Depending on location and function biomaterials have to meet requirements with respect to durability (artificial joints), fixation (total hip prosthesis), flexibility (artificial ligaments), solubility (suture wire) and stiffness (plates and screws). The development of biomaterials is in full swing, focussing on the decrease of wear and the increase of durable fixation of artificial joints, and the induction of cells to form bone and cartilage tissue.