Enhancing dentin bonding through new adhesives formulations with natural polyphenols, tricalcium phosphate and chitosan

OBJECTIVES

The aim of the study was to develop new adhesive formulations that include natural polyphenols extracted from green tea (GTE), tricalcium phosphate (TCP) and chitosan to improve dentin bonding characteristics and cytotoxicity.

METHODS

Four experimental adhesives were formulated under laboratory conditions. The groups differed in the integration of either GTE and/or TCP + chitosan. The four experimental and one clinically proven reference adhesive underwent shear bond testing after 24 h and 6 months of aging (n = 200) with subsequent fractographic analysis. Bond morphology was analyzed under a scanning electron microscope. The presence of phenolic compounds was validated by high performance liquid chromatography. Cytotoxicity was assessed by the WST-1 colorimetric assay on eluates up to 6 months. Statistical analysis was performed by one- and three-way ANOVA, Games-Howell and Tukey's post-hoc test as well as multiple students t-tests (α = 0.05). Weibull analysis was further conducted.

RESULTS

The addition of GTE into the bonding agent did show immediate (p = 0.023, p = 0.013) and long-term (p < 0.001) effects on bond strength. After 24 h, GTE doped groups performed equal to the reference (p = 0.501, p = 0.270) and TCP and chitosan displayed improvements in reliability (m=4.0, m=4.3). Bond strength is retained after aging by adding GTE (p = 0.983). The additional presence of TCP and chitosan reduces it (p = 0.026). Excluding cohesive and mixed failures, the reference adhesive performed statistically equal to three of the four experimental groups. No long-term cytotoxic effects were shown.

SIGNIFICANCE

The integration of GTE can enhance bond strength and a calcium source helps to improve immediate bond reliability.

GelMA/TCP nanocomposite scaffold for vital pulp therapy

Pulp capping is a necessary procedure for preserving the vitality and health of the dental pulp, playing a crucial role in preventing the need for root canal treatment or tooth extraction. Here, we developed an electrospun gelatin methacryloyl (GelMA) fibrous scaffold incorporating beta-tricalcium phosphate (TCP) particles for pulp capping. A comprehensive morphological, physical-chemical, and mechanical characterization of the engineered fibrous scaffolds was performed. In vitro bioactivity, cell compatibility, and odontogenic differentiation potential of the scaffolds in dental pulp stem cells (DPSCs) were also evaluated. A pre-clinical in vivo model was used to determine the therapeutic role of the GelMA/TCP scaffolds in promoting hard tissue formation. Morphological, chemical, and thermal analyses confirmed effective TCP incorporation in the GelMA nanofibers. The GelMA+20%TCP nanofibrous scaffold exhibited bead-free morphology and suitable mechanical and degradation properties. In vitro, GelMA+20%TCP scaffolds supported apatite-like formation, improved cell spreading, and increased deposition of mineralization nodules. Gene expression analysis revealed upregulation of ALPL, RUNX2, COL1A1, and DMP1 in the presence of TCP-laden scaffolds. In vivo, analyses showed mild inflammatory reaction upon scaffolds' contact while supporting mineralized tissue formation. Although the levels of Nestin and DMP1 proteins did not exceed those associated with the clinical reference treatment (i.e., mineral trioxide aggregate), the GelMA+20%TCP scaffold exhibited comparable levels, thus suggesting the emergence of differentiated odontoblast-like cells capable of dentin matrix secretion. Our innovative GelMA/TCP scaffold represents a simplified and efficient alternative to conventional pulp-capping biomaterials. STATEMENT OF SIGNIFICANCE: Vital pulp therapy (VPT) aims to preserve dental pulp vitality and avoid root canal treatment. Biomaterials that bolster mineralized tissue regeneration with ease of use are still lacking. We successfully engineered gelatin methacryloyl (GelMA) electrospun scaffolds incorporated with beta-tricalcium phosphate (TCP) for VPT. Notably, electrospun GelMA-based scaffolds containing 20% (w/v) of TCP exhibited favorable mechanical properties and degradation, cytocompatibility, and mineralization potential indicated by apatite-like structures in vitro and mineralized tissue deposition in vivo, although not surpassing those associated with the standard of care. Collectively, our innovative GelMA/TCP scaffold represents a simplified alternative to conventional pulp capping materials such as MTA and Biodentine™ since it is a ready-to-use biomaterial, requires no setting time, and is therapeutically effective.

α-Tricalcium phosphate cement reinforced with silk fibroin: A high strength biomimetic bone cement with chloride-substituted hydroxyapatite

In the past decades, bone defects have become an increasing factor in the development of disability in patients, impacting their quality of life. Large bone defects have minor chances to self-repair, requiring surgical intervention. Therefore, α-TCP-based cements are rigorously studied for the development of bone filling and replacement applications due to the possibility of application in minimally invasive procedures. However, α-TCP-based cements do not present adequate mechanical properties for most orthopedic applications. The aim of this study is to develop a biomimetic α-TCP cement reinforced with 0.250-1.000 wt% of silk fibroin using non-dialyzed SF solutions. Samples with SF additions higher than 0.250 wt% presented complete transformation of the α-TCP to a biphasic CDHA/HAp-Cl material, which could enhance the osteoconductivity of the material. Samples reinforced with concentrations of 0.500 wt% SF showed an increase of 450% of the fracture toughness and 182% of the compressive strength of the control sample, even with 31.09% porosity, which demonstrates good coupling between the SF and the CPs. All samples reinforced with SF showed a microstructure with smaller needle-like crystals when compared to the control sample, which possibly contributed to the material's reinforcement. Moreover, the composition of reinforced samples did not affect the cytotoxicity of the CPCs and enhanced the cell viability presented by the CPC without SF addition. Hence, biomimetic CPCs with mechanical reinforcement through the addition of SF were successfully obtained through the developed methodology, with the potential to be further evaluated as a suitable material for bone regeneration.

An effectiveness and economic analyses of tricalcium phosphate combined with iliac bone graft versus RhBMP-2 in single-level XLIF surgery in Thailand

STUDY DESIGN

Retrospective study.

OBJECTIVES

To perform effectiveness and economic analyses using data from a retrospective study of patients who underwent XLIF surgery using tricalcium phosphate combined with iliac bone graft (TCP + IBG) or BMP-2 in Thailand.

METHODS

Data were collected from retrospective review of the medical charts and the spine registry of Siriraj Hospital, Bangkok, Thailand. The patients were divided into two groups (TCP + IBG group and BMP-2 group). Demographic, perioperative data, radiographic, clinical results, and quality of life related to health were collected and analyzed at 2-year follow-up. All economic data were collected during the perioperative period and presented as total charge, bone graft, implant/instrumentation, operative service, surgical supply, transfusion, medication, anesthesia, laboratory, and physical therapy.

RESULTS

Twenty-five TCP + IBG and 30 BMP-2 patients with spondylolisthesis and spinal stenosis as primary diagnosis were included. There were no significant differences in all demographic parameters (gender, age, underlying disease, diagnosis, and level of spine) between these two groups. During the perioperative period, the TCP + IBG group had more mean blood loss and more postoperative complications compared to the BMP-2 group. At 2 years of follow-up, there were no significant differences between the radiographic and clinical outcomes of the TCP + IBG and BMP-2 groups. The fusion rate for TCP + IBG and BMP-2 at 2 years of follow-up was 80% and 96.7%, respectively, and no statistically significant differences were observed. All clinical outcomes (Utility, Oswestry Disability Index, and EuroQol Visual Analog Scale) at 2-year follow-up improved significantly compared to preoperative outcomes, but there were no significant differences between the TCP + IBG and BMP-2 groups, either at preoperatively or at 2-year follow-up. The total charge of TCP + IBG was statistically significantly lower than that of BMP-2. Furthermore, the charges of TCP + IBG and BMP-2 during the perioperative period in Thailand were up to three times less than those in the United States.

CONCLUSIONS

Using TCP + IBG as a standalone bone substitution for XLIF surgery with additional posterior instrumentation resulted in significantly lower direct medical charge compared to those using BMP-2 in the perioperative period. However, we could not detect a difference in the long-term radiographic and clinical outcomes of patients with TCP + IBG and BMP-2. These suggest that TCP + IBG may be a valuable alterative bone graft, especially in low- and middle-income countries.

Analyzing the anti-caries effect of fluoride varnish containing tricalcium phosphate using PIXE/PIGE

This study evaluated the effect of tricalcium phosphate-containing fluoride varnish on the prevention of root caries using an in-air micro-proton induced X-ray/gamma-ray emission system and microcomputed tomography. Either fluoride varnish (FV) or tricalcium phosphate-containing fluoride varnish (WV) was applied to root dentin, whereas dentin without varnish were considered controls. After immersion in saline, dentin sections were prepared, and concentration of fluoride ion was measured. These specimens were demineralized, and the mineral loss was measured. Caries inhibition in sound and demineralized dentin was observed in both FV and WV groups compared to the control group. Significantly low mineral loss was found especially in the demineralized dentin, which is probably due to the combination effect of calcium and fluoride ions at a concentration range of 100,000 ppm, as supplied by the varnish. The use of calcium-containing fluoride varnish, especially in demineralized dentin, is effective in arresting initial dentin caries.

Co-exposure to commercial food product ingredient E341 and E551 triggers cytotoxicity in human mesenchymal stem cells

Several nano-toxicological studies have assessed the prospective health risks of engineered nanostructures. Still, nanoscale ingredients from food products are not explored well, and only a few have attended to the possible effects of food additive-based nanoparticles in food. The physicochemical properties of food additives and their fate on human health are still unknown. To fill this knowledge gap, we examined the physicochemical characteristics of food product isolate E341/E551. Additionally, we assessed the consequence of these nanoscale E341 and E551 as co-exposure on human mesenchymal stem cells (hMSCs). The transmission electron microscope (TEM) images revealed that food product isolate (E341/E551) consists of nanoscale particles. The E551 and E341 have 20-50 nm and 70-200 nm diameters, respectively. Co-exposure of food additives SiO2 (E551) and Tricalcium phosphate (E341) effect on the cell viability, morphology, mitochondrial membrane potential, and reactive oxygen species (ROS) level of hMSCs were studied. The cell viability reduction, mitochondrial membrane potential loss, and ROS generation in E341/E551 co-exposed cells were observed. Our study suggests that E341/E551 co-exposure elevated the ROS level and mitochondrial membrane potential depletion at a high dose. The oxidative stress-related genes MDM3, TNFSF10, and POR have exhibited significant upregulation in the E341/E551 treatment group. These results conclude that long-term over-exposure to E341/E551 may be triggers health risks in a human. Further in vivo studies are required for food industry implications due to nanoscale ingredients in E341 and E551.

A simple and fast method for screening production of polymer-ceramic filaments for bone implant printing using commercial fused deposition modelling 3D printers

3D printing is a promising technique for obtaining bone implants. However, 3D printed bone implants, especially those printed using fused deposition modelling, are still in the experimental phase despite decades of work. Research on new materials faces numerous limitations, such as reagents' cost and machines' high prices to produce filaments for 3D printing polymer-ceramic composites for fused deposition modelling. This paper presents a simple, low-cost, and fast method of obtaining polymer-ceramic filaments using apparatus consisting of parts available in a hardware store. The method's versatility for producing the filaments was demonstrated on two different biodegradable polymers - polylactic acid and polycaprolactone - and different concentrations of calcium phosphate - β-tricalcium phosphate - in the composite, up to 50 % by weight. For screening purposes, numerous scaffolds were 3D printed from the obtained filaments on a commercial 3D printer. Structural, mechanical, and biological tests show that the 3D printed scaffolds are suitable for bone implants, as their structure, mechanical, and non-cytotoxic properties are evident. Moreover, the proposed method of composite forming is a simplification of the processes of manufacturing and researching 3D printed materials with potential applications in the regeneration of bone tissue.

Comparison of synthetic ceramic products formulated with autologous blood coagulum containing rhBMP6 for induction of bone formation

PURPOSE

Osteogrow, an osteoinductive device containing recombinant human Bone Morphogenetic Protein 6 (rhBMP6) in autologous blood coagulum, is a novel therapeutic solution for bone regeneration. This study aimed to evaluate different commercially available calcium phosphate synthetic ceramic particles as a compression-resistant matrix (CRM) added to Osteogrow implants to enhance their biomechanical properties.

METHODS

Osteogrow implants with the addition of Vitoss, ChronOs, BAM, and Dongbo ceramics (Osteogrow-C, where C stands for ceramics) were evaluated in the rodent subcutaneous ectopic bone formation assay. Osteogrow-C device was prepared as follows: rhBMP6 was added to blood, and blood was mixed with ceramics and left to coagulate. Osteogrow-C was implanted subcutaneously in the axillary region of Sprague-Dawley rats and the outcome was analyzed 21 days following implantation using microCT, histology, morphometric analyses, and immunohistochemistry.

RESULTS

Osteogrow-C implants with all tested ceramic particles induced the formation of the bone-ceramic structure containing cortical bone, the bone between the particles, and bone at the ceramic surfaces. The amount of newly formed bone was significant in all experimental groups; however, the highest bone volume was measured in Osteogrow-C implants with highly porous Vitoss ceramics. The trabecular number was highest in Osteogrow-C implants with Vitoss and ChronOs ceramics while trabeculae were thicker in implants containing BAM and Dongbo ceramics. The immunological response and inflammation were comparable among ceramic particles evaluated in this study.

CONCLUSION

Osteogrow-C bone regenerative device was effective with a broad range of commercially available synthetic ceramics providing a promising therapeutic solution for the regeneration of long bone fracture nonunion, large segmental defects, and spinal fusion surgeries.

An in vitro comparative evaluation of casein phosphopeptide-amorphous calcium phosphate fluoride, tricalcium phosphate and grape seed extract on remineralization of artificial caries lesion in primary enamel

OBJECTIVES

To evaluate and compare the remineralization potential of casein phosphopeptide-amorphous calcium phosphate fluoride, tricalcium phosphate and grape seed extract on artificial caries lesions in primary enamel.

STUDY DESIGN

A sample of 40 non-carious, primary molar teeth was collected and cut in longitudinal sections into three equal halves. Those 120 samples were divided into four equal groups. Group A: Sections treated with casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), Group B: Sections treated with tricalcium phosphate, Group C: Sections treated with grape seed extract Group D: Sections treated with deionized water (control group). Samples were evaluated for change in surface characteristics, mineral content using Scanning electron microscopy-energy dispersive X-ray analysis (SEM-EDX) and microhardness using Vicker's microhardness tester. Cavitated lesions were evaluated for Cone beam computer tomography to obtain baseline data post remineralization.

RESULTS

The remineralization potential of grape seed extract was found to be greater compared to tricalcium phosphate followed by CPP-ACPF.

CONCLUSION

All the three groups viz. CPP-ACPF, tricalcium phosphate and grape seed extract showed remineralization under the in vitro pH cycling model, while grape seed extract group showed significantly greater remineralization compared to the CPP-ACPF and tricalcium phosphate groups.

Rheological properties and decomposition rates of Gellan gum/hyaluronic acid/β-tricalcium phosphate mixtures

The effects of β-tricalcium phosphate (TCP) on the mixture of low acyl gellan gum (LA-GAGR) and hyaluronic acid (HA) were investigated for the rheological properties and decomposition rates. All the tested mixture samples exhibited shear-thinning and typical viscoelastic behaviors. The sample made with 1.0% TCP and 0.30% LA-GAGR had the highest viscosity and loss and storage moduli and displayed gel-like behavior with the highest swelling capacity. The same mixture also exhibited the lowest average cumulative decomposition rate. High concentrations of LA-GAGR and TCP increased the degree of cross-linking of the polysaccharides, and as a result, the mixture was more elastic and less fluidic and decomposed slower. The samples prepared by gradual mixing of LA-GAGR and TCP decomposed slower than the sample prepared by sudden mixing, which indicates the well-dispersed TCP enhanced cross-linking of the polymers. This study demonstrates the possible applicability of natural polysaccharide-based shear-thinning gels for biomedical applications.

Effects of integrated bioceramic and uniaxial drawing on mechanically-enhanced fibrogenesis for bionic periosteum engineering

Periosteum is clinically required for the management of large bone defects. Attempts to exploit the periosteum's participation in bone healing, however, have rarely featured biological and mechanical complexity for the scaffolds relevant to translational medicine. In this regard, we report engineering of bioinspired periosteum with co-delivery of ionic and geometry cues. The scaffold demonstrated microsheet-like fibre morphology and was developed based on bioresorbable poly(-caprolactone) and bioactive copper-doped tricalcium phosphate (Cu-TCP). A coordinated interaction was found between the effects of Cu-TCP addition and uniaxial drawing, leading to tunable fibrogenesis for different fibre morphologies, organisation, and surface wettability. The coordination resulted in significant enhancements in Young's Modulus, yield stress and ultimate stress along fibrous alignment, without causing reductions across fibres. This demonstrated mechanical anisotropy of the scaffold similar to natural periosteum, and seeding with mouse calvarial preosteoblasts, the scaffold supported cell alignment with deposition of CaP-like nodules and extracellular matrix. This work provides new insights on periosteum engineering with osteo-related composite fibres. The artificial periosteum can be used in clinical settings to facilitate repair of large bone defects.

Enhanced Lead (Pb) immobilization in red soil by phosphate solubilizing fungi associated with tricalcium phosphate influencing microbial community composition and Pb translocation in Lactuca sativa L

Phosphate (P) minerals and phosphate solubilizing fungi (PSF) play essential roles in lead (Pb) immobilization, but their roles in driving Pb bioavailability and ecological risks in red soil remains poorly understood. In this study, the inoculation of P. oxalicum and TCP successfully enhanced available P (AP) and urease concentrations in artificially Pb contaminated red soil. Combined P. oxalicum and TCP inoculation significantly reduced Pb bioavailability, bioaccessibility, leachability and mobility by increasing soil AP concentration and forming stable Pb-P compounds during the 21-day experiment. Soil AP and Pb bioavailability play an important role in shifting soil microbial communities induced by co-occurrence of P. oxalicum and TCP. Combined P. oxalicum and TCP could notably promote the relative abundances of predominant soil genus to enhance microbial resistance to soil Pb. Likewise, coexistence of P. oxalicum and TCP showed the highest biomass and better branch root development of Pb-stressed in lettuces (Lactuca sativa L.) in pot experiment, and significantly reduced up to 88.1% of Pb translocation from soil to root over control. The reductions of Pb translocation and accumulation in root in P. oxalicum + TCP treatment could enhance the oxidase activities and alleviate the oxidative damages of H2O2 and O2.- in shoot tissues. Our study provided strong evidence to use PSF associated with P materials for the stable and eco-friendly soil Pb remediation.

Combined effects of Penicillium oxalicum and tricalcium phosphate on lead immobilization: Performance, mechanisms and stabilities

Phosphorus (P) containing minerals are identified as effective Pb stabilizers in soil, while their low solubility limit the Pb immobilization efficiency. In this work, the combination of phosphate solubilizing fungi (PSF) Penicillium oxalicum and tricalcium phosphate (TCP) was constructed and applied to improve Pb immobilization stabilities in medium and soils. P. oxalicum+ TCP could significantly improve Pb²⁺ removal to above 99% under different TCP/Pb²⁺ and pH values. TCP and P. oxalicum could remarkably immobilize Pb by ion exchange, and PbC₂O₄ precipitation or surface adsorption, respectively. While the enhanced Pb immobilization in P. oxalicum+ TCP was explained by stronger Pb²⁺ interaction with tryptophan protein-like substances in extracellular polymeric substance, and the formation of the most stable Pb-phosphate compound hydroxypyromorphite (Pb₅(PO₄)₃OH). Toxicity characteristic leaching procedure test showed that only 0.91% of Pb²⁺ was leachable in P. oxalicum+ TCP treatment, significantly lower than that in P. oxalicum (2.90%) and TCP (7.52%) treatments. In addition, the lowest soil exchangeable Pb fraction (37.1%) and the highest available soil P (88.0 mg/kg) were both found in P. oxalicum+ TCP treatment. By synergistically forming stable Pb-containing products, thus the combination of PSF and P minerals could significantly improve Pb²⁺ immobilization and stability in soils.

Incorporation of 45S5 bioglass via sol-gel in β-TCP scaffolds: Bioactivity and antimicrobial activity evaluation

In this work, β-TCP (β-tricalcium phosphate) bioresorbable scaffolds were prepared by the gel casting method. Then, they were impregnated with a 45S5 bioglass sol gel solution to improve biocompatibility and promote bioactivity and antimicrobial activity. The β-TCP scaffolds had an apparent porosity of 72%, and after the incorporation of the bioglass, this porosity was maintained. The elements of the bioglass were incorporated into β-TCP matrix and there was a partial transformation from the β-TCP phase to the α-TCP (α-tricalcium phosphate) phase, besides the formation of bioactive calcium and sodium‑calcium silicates. The scaffolds β-TCP with 45S5 bioglass incorporated (β-TCP/45S5) did not show a reduction in their values of mechanical strength and Weibull modulus, despite the partial transformation to the α-TCP phase. Bioactivity, cell viability, and antimicrobial activity improved significantly for the β-TCP/45S5 scaffold comparing to the scaffold without the bioglass. The mineralization of carbonated hydroxyapatite was verified in Simulated Body Fluid (SBF). The cell viability, evaluated by the reduction of 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide - MTT in MG63 cells, increased by 178%, and β-TCP/45S5 scaffold also enhanced cell activity and osteoblast differentiation observed by means of total protein contend and alkaline phosphatase activity, respectively. The formation of growth inhibition zones was also observed in the disk diffusion assay for three tested microorganisms: Staphylococcus aureus, Escherichia coli and Candida albicans. To conclude, the vacuum impregnation method in 45S5 bioglass sol gel solution was effective in penetrating all the interconnected macroporosity of the scaffolds and covering the surface of the struts, which improved their biological properties in vitro, bioactivity and antibacterial activity, without reducing mechanical strength and porosity values. Thus, the β-TCP/45S5 scaffolds are shown as potential candidates for use in tissue engineering, mainly in bone tissue regeneration and recovery.

Bone Graft Options in Spinal Fusion: A Review of Current Options and the Use of Mesenchymal Cellular Bone Matrices

BACKGROUND

Spinal fusion is the mainstay treatment for various spinal conditions ranging from lumbar and cervical stenosis to degenerative spondylolisthesis as well as extensive deformity corrections. A new emerging category of allograft is cellular bone matrices (CBMs), which take allogeneic mesenchymal stem cells and incorporate them into an osteoconductive and osteoinductive matrix. This study reviewed the current spinal fusion options and new emerging treatment options.

METHODS

Articles were searched using PubMed. The search included English publications since January 1, 2014, using the search terms "cellular bone matrix," "mesenchymal stem cells spinal fusion," "spinal arthrodesis AND mesenchymal stem cells," and "spine fusion AND cellular bone matrix."

RESULTS

Spinal fusion is accomplished through the use of allografts, autografts, and bone graft substitutes in combination or alone. An emerging category of allograft is CBMs, in which an osteoconductive and osteoinductive matrix is filled with mesenchymal stem cells. Studies demonstrate that CBMs have achieved equivalent or better fusion rates compared with traditional options for anterior cervical discectomy and fusions and posterolateral lumbar fusions; however, the studies have been retrospective and lacking control groups and therefore not ideal.

CONCLUSIONS

Many treatment options have been successfully used in spinal fusion. Newer allografts such as CBMs have shown promising results in both animal and clinical studies. Further research is needed to determine the therapeutic dose of mesenchymal stem cells delivered within CBMs.

Antibacterial and cell-friendly copper-substituted tricalcium phosphate ceramics for biomedical implant applications

The development of new materials with antibacterial properties and the scope to decrease or eliminate the excessive antibiotic use is an urgent priority due to the growing antibiotic resistance-related mortalities. New bone substitute materials with intrinsic antibacterial characteristics are highly requested for various clinical applications. In this study, the choice of copper ions as substitutes for calcium in tricalcium phosphate (TCP) has been justified by their pronounced broad-spectrum antibacterial properties. Copper-substituted TCP (Cu-TCP) ceramics with the copper content of 1.4 and 0.1 wt% were synthesized by mechano-chemical activation. X-ray diffraction (XRD) analyses established that both pure and copper-containing compounds adopted the structure of whitlockite (β-TCP). XRD and electron paramagnetic resonance (EPR) spectroscopy revealed the partial isovalent substitution of calcium ions with copper ions in the β-TCP lattice. With the use of infrared and EPR spectroscopies, it was detected that carbonate ions got incorporated into the β-TCP structure during the synthesis procedure. By releasing the tension in the M(5)O6 octahedron consequential to the lower CaO bond length than the corresponding sum of ionic radii, the substitution of calcium with smaller copper ions stabilizes the structure of β-TCP. As concluded form the thermal analyses, the introduction of Cu prevented the polymorphic transformation of β- to α-TCP. At the same time, the introduction of Cu to the β-TCP structure enhanced the crystal growth and porosity of the ceramics, which had a positive effect on the cytocompatibility of the material. The MTT colorimetric assay showed that the metabolic activity of the mouse fibroblast NCTC L929 cell line during 24 h of incubation with 3-day extracts from Cu-TCP (1.4 wt%) and β-TCP pellets in the cell culture medium was similar to the negative control, indicating the absence of any inhibitory effects on cells. The seeding and the growth of human dental pulp stem cells on the surface of Cu-TCP (1.4 wt%) and β-TCP ceramics also showed the absence of any signs of cytotoxicity. Finally, microbiological assays demonstrated the antibacterial activity of Cu-TCP ceramics against Escherichia coli and Salmonella enteritidis, whereas β-TCP did not exhibit such an activity. Overall, the addition of Cu ions to β-TCP improves its antibacterial properties without diminishing the biocompatibility of the material, thus making it more attractive than pure β-TCP for clinical applications such as synthetic bone grafts and orthopaedic implant coatings.

Minimum 10 years clinical and radiological outcomes of acetabular revisions of total hip arthroplasties with tricalcium phosphate/hydroxyapatite bone graft substitute

BACKGROUND

Aseptic loosening is the most frequent indication for revision of total hip arthroplasty. Revision arthroplasty of acetabular component is a challenge for every surgeon because they have to simultaneously deal with the reconstruction of bone defects, adequate implant geometry and stable fixation. Allografts are the most frequently used materials in reconstruction of bone loss during revision surgeries. Because of an increasing number of revision hip arthroplasties and poor availability of allografts, we decided to use bone graft substitutes in acetabular revisions.

METHODS

Between September 2005 and January 2010, 44 revision arthroplasties in 43 patients were performed with the use of bone graft substitutes for acetabular defect reconstruction in revision of total hip arthroplasty. Acetabular bone defects were classified according to Paprosky. Seventeen hips were classified as IIA, 3 hips IIB, 3 hips IIC, 10 hips IIIA and 11 hips IIIB. Acetabular bone defects were reconstructed with tricalcium phosphate/hydroxyapatite bone graft substitute - BoneSave. Clinical and radiological examination was performed after 3 months, 1 year and then annually. Harris hip score was used for clinical evaluation. Survival analysis was performed with Kaplan-Meier method with aseptic loosening as the definition of endpoint.

RESULTS

The average follow-up period is 12 (range from 10 to 15) years. During the follow-up, three patients died after 24 months because of causes not related to surgery. None of the patients was lost to follow-up. The evaluation of clinical results revealed an increase in pre-operative HHS from average 38.3 (range 25 to 55) points to average 86.3 (range 45 to 95) points at the most recent follow-up. Radiographic evaluation showed the migration of one revision cage 12 months after surgery. Revision arthroplasty performed after 14 months revealed the partial incorporation of bone graft substitute. There were not any cases of loosening of revision acetabular cup at the most recent follow up examination in the remaining 39 patients. Bone graft substitute was not absorbed in all of these patients. The survival after 10 years amounted to 97.56%.

CONCLUSION

Bone graft substitute Bone Save may be suitable for acetabular revision surgery, however preoperative bone defect is critical for success and determining of a surgical technique, so this is multifactorial in this challenge surgery.

Tricalcium phosphate (-containing) biomaterials in the treatment of periodontal infra-bony defects: A systematic review and meta-analysis

OBJECTIVES

This study aimed to investigate the additional clinical benefit of tricalcium phosphate (TCP) (-containing) biomaterials compared to open flap debridement (OFD) in periodontal infra-bony defects.

DATA

A literature search was conducted in Pubmed, Embase and Cochrane library for entries published up to 14th July 2021. All randomized controlled trials (RCTs) that compared a TCP (-containing) material with OFD and studies that assessed a beta-TCP group alone, with vertical defect sites with PPD of ≥ 6 mm and/or presence of infra-bony defects of ≥ 3 mm and a minimum follow-up of 6 months were included. Risk of bias was assessed with the Oxford scale. The random-effects (RE) model was synthesized as differences between weighted average (MD) for probing pocket depth (PPD) and clinical attachment level (CAL) between TCP and OFD groups. An RE analysis was also performed for the beta-TCP group alone.

STUDY SELECTION

Data from 16 RCTs were included in the analysis. Six studies that represented 151 patients and sites were selected for meta-analysis. The overall MD with 95% CI at 6 months was calculated to be -0.47 [-0.83, -0.12; P = 0.0087] and -1.06 [-1.67, -0.46; P = 0.0006] for PPD and CAL, respectively. Whereas MD at 12 months for PPD and CAL was -0.89 [-1.54, -0.23; P = 0.0078] and -1.25 [-1.85, -0.66; P<0.0001], respectively. All results were in favor of TCP (-containing) group over OFD.

CONCLUSIONS

The results of the study suggest that the use of a TCP (-containing) material may have the potential for additional clinical improvement in PPD and CAL compared with OFD in infra-bony defects, given the limitations of the included evidence.

CLINICAL SIGNIFICANCE

The use of TCP as a bone graft substitute is becoming increasingly common. Therefore, it would be advantageous if an adjunctive benefit in the regeneration of infra-bony defects could be demonstrated to facilitate material selection.

Bone ingrowth observed in a cup removed during revision surgery for early dislocation after primary THA: A case report

Introduction and importance

Recently cementless total hip arthroplasty (THA) has shown good long-term results with excellent stability resulted from the porous coating of the implant. A hydroxyapatite-tricalcium phosphate (HA-TCP) coating on the porous surface is expected to promote bone ingrowth and to improve initial fixation of the implant. Here we report a case of bone ingrowth observed in a cup removed during revision surgery for early dislocation, 37 days after primary THA using a porous coating cup with HA-TCP.

Case presentation

A 61-year-old woman who has bilateral osteoarthritis underwent same-day bilateral THA. Both sides used porous coating cups with HA-TCP. Line-to-line technique and screw fixation were utilized. Anterior dislocation of the left hip occurred on days 27 and 31, and we performed cup revision on day 37 after surgery. We noted bone-like tissue on the posterior surface of the cup and in a vacant screw hole. Bone tissue was also confirmed in pathological findings.

Clinical discussion

Studies in animals have confirmed early bone ingrowth about 4 weeks after surgery with HA-TCP coated implants. In humans, the earliest report of bone ingrowth in cups is for a cup without HA-TCP coating, detected 5 weeks after surgery. In the present case, we used a porous coating cup with HA-TCP, and bone ingrowth was confirmed at approximately the same time as for the previous case.

Conclusion

Early clinical bone ingrowth was confirmed in an HA-TCP coated cup, occurring at about the same time after surgery as in previous reports.

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Cementless THA shows excellent long-term results for porous coating of implant.

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HA-TCP coating promotes bone ingrowth of mesenchymal cells.

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Post-THA revision showed good initial fixation with porous coating cup and HA-TCP.

Magnesium whitlockite - omnipresent in pathological mineralisation of soft tissues but not a significant inorganic constituent of bone

Whitlockite is a calcium phosphate that was first identified in minerals collected from the Palermo Quarry, New Hampshire. The terms magnesium whitlockite [Mg-whitlockite; Ca₁₈Mg₂(HPO₄)₂(PO₄)₁₂] and beta-tricalcium phosphate [β-TCP; β-Ca₃(PO₄)₂] are often used interchangeably since Mg-whitlockite is not easily distinguished from β-Ca₃(PO₄)₂ by powder X-ray diffraction although their crystalline structures differ significantly. Being both osteoconductive and bioresorbable, Mg-whitlockite is pursued as a synthetic bone graft substitute. In recent years, advances in development of synthetic Mg-whitlockite have been accompanied by claims that Mg-whitlockite is the second most abundant inorganic constituent of bone, occupying as much as 20-35 wt% of the inorganic fraction. To find evidence in support of this notion, this review presents an exhaustive summary of Mg-whitlockite identification in biological tissues. Mg-whitlockite is mainly found in association with pathological mineralisation of various soft tissues and dental calculus, and occasionally with enamel and dentine. With the exception of high-temperature treated tumoural calcified deposits around interphalangeal and metacarpal joints and rhomboidal Mg-whitlockite crystals in post-apoptotic osteocyte lacunae in human alveolar bone, this unusual mineral has never been detected in the extracellular matrix of mammalian bone. Characterisation techniques capable of unequivocally distinguishing between different calcium phosphate phases, such as high-resolution imaging, crystallography, and/or spectroscopy have exclusively identified bone mineral as poorly crystalline, ion-substituted, carbonated apatite. The idea that Mg-whitlockite is a significant constituent of bone mineral remains unsubstantiated. Contrary to claims that such biomaterials represent a bioinspired/biomimetic approach to bone repair, Mg-whitlockite remains, exclusively, a pathological biomineral. STATEMENT OF SIGNIFICANCE: Magnesium whitlockite (Mg-whitlockite) is a unique calcium phosphate that typically features in pathological calcification of soft tissues; however, an alarming trend emerging in the synthetic bioceramics community claims that Mg-whitlockite occupies 20-35 wt% of bone mineral and therefore synthetic Mg-whitlockite represents a biomimetic approach towards bone regeneration. By providing an overview of Mg-whitlockite detection in biological tissues and scrutinising a diverse cross-section of literature relevant to bone composition analysis, this review concludes that Mg-whitlockite is exclusively a pathological biomineral, and having never been reported in bone extracellular matrix, Mg-whitlockite does not constitute a biomimetic strategy for bone repair.

Injectable tricalcium phosphate/calcium sulfate granule enhances bone repair by reversible setting reaction

Towards repairing bone defects, calcium sulfate and calcium phosphate cement have been recognized as promising bone grafts. However, the current bone cements are generally lack of proper porosity for cell migration and new tissue formation. On the other hand, porous scaffold cannot be delivered by injection, which limits its use its clinical use. Herein, we develop a novel tricalcium phosphate/calcium sulfate granule to overcome the limitations of injectable cements and traditional scaffolds. The biocompatible granule underwent in situ self-setting to form scaffold with porous structure after injection. It contributes to calcium deposition and upregulation of osteogenic genes of mesenchymal stem cells in a time-dependent manner. Within three months, cavitary bone defects of distal rabbit femurs implanted the granules exhibited better bone formation than those with those implanted with autologous bone.

Bonding a titanium plate and soft tissue interface by using an adhesive bone paste composed of α-tricalcium phosphate and α-cyclodextrin/nonanyl group-modified poly(vinyl alcohol) inclusion complex

Adhesive bone pastes for dental implants and soft tissue interfaces were developed using α-tricalcium phosphate (α-TCP) and α-cyclodextrin (α-CD)/nonanyl group-modified poly(vinyl alcohol) (C9-PVA) inclusion complex solution (ICS). The thixotropic solution of α-CD/C9-PVA ICS was prepared by mixing α-CD and C9-PVA in deionized water. The α-CD/C9-PVA bone paste led to the highest bonding and shear adhesion between commercial pure titanium plates and soft tissue like collagen casing. Moreover, the compressive strength of these pastes reached 14.1 ± 3.8 MPa within 24 h incubation. Young's modulus of the α-CD/C9-PVA bone paste was lower than that of commercial calcium phosphate paste. Furthermore, the surface of α-CD/C9-PVA bone paste demonstrated excellent cell adhesion for cultured L929 fibroblast cells. Overall, the α-CD/C9-PVA bone paste can likely be effectively used to adhere dental implant abutments and soft tissue interfaces.

Boron-doped Biphasic Hydroxyapatite/β-Tricalcium Phosphate for Bone Tissue Engineering

Boron-doped hydroxyapatite/tricalcium phosphates (BHTs) were synthesized to study boron uptake and correlate structural alterations of incremental boron addition (0 to 10 mol%). BHTs with a Ca/P ratio of 1.6 were prepared by a wet precipitation/microwave reflux method, sieved (< 70 μm) and characterized. XRD and FTIR analyses revealed that boron slightly distorted apatite crystal, increased crystallinity (95.78 ± 2.08% for 5BHT) and crystallite size (103.39 ± 23.47 nm for 5BHT) and still, boron addition did not show any further detrimental effects. Total surface area (4.05 ± 0.82 m²/g for 10BHT) and mesoporosity (23.90 ± 7.92 μL/g for 10BHT) were expanded as boron content was increased. Moreover, boron addition made grains become smaller (0.21 ± 0.06 μm for 5BHT) and ordered while hardness (10.51 ± 0.86 GPa for 10BHT) increased. Boron incorporation enhanced bioactivity with significantly highest calcium phosphate deposition and protein adsorption (135.29 ± 29.58 μg on 10BHT). In return, boron favored highest alkaline phosphatase activity (4.80 ± 0.40 M_ALP/ng_DNA.min), intracellular calcium (23.61 ± 0.68 g/g_DNA), phosphate (31.84 ± 4.68 g/g_DNA), and protein (23.70 ± 3.46 g/g_DNA) storage in 5BHT without cytotoxicity (128 ± 18% viability compared to pure HT). Compared to literature, it can be pointed out that we successfully employed an optimal procedure for production of BHTs and incorporated significantly higher boron content in HT (5.23 mol%). Additionally, results tended to conclude that 5BHT samples (5 mol% boron in HT) demonstrated a very high potential to be used in composite bone tissue constructs.

Ionized jet deposition of antimicrobial and stem cell friendly silver-substituted tricalcium phosphate nanocoatings on titanium alloy

Orthopedic infections pose severe societal and economic burden and interfere with the capability of the implanted devices to integrate in the host bone, thus significantly increasing implants failure rate. To address infection and promote integration, here nanostructured antibacterial and bioactive thin films are proposed, obtained, for the first time, by Ionized Jet Deposition (IJD) of silver-substituted tricalcium phosphate (Ag-TCP) targets on titanium. Coatings morphology, composition and mechanical properties are characterized and proof-of-concept of biocompatibility is shown. Antimicrobial efficacy is investigated against four Gram positive and Gram negative bacterial strains and against C. albicans fungus, by investigating the modifications in planktonic bacterial growth in the absence and presence of silver. Then, for all bacterial strains, the capability of the film to inhibit bacterial adhesion is also tested. Results indicate that IJD permits a fine control over films composition and morphology and deposition of films with suitable mechanical properties. Biological studies show a good efficacy against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis and against fungus Candida albicans, with evidences of efficacy against planktonic growth and significant reduction of bacterial cell adhesion. No cytotoxic effects are evidenced for equine adipose tissue derived mesenchymal stem cells (ADMSCs), as no reductions are caused to cells viability and no interference is assessed in cells differentiation towards osteogenic lineage, in the presence of silver. Instead, thanks to nanostructuration and biomimetic composition, tricalcium phosphate (TCP) coatings favor cells viability, also when silver-substituted. These findings show that silver-substituted nanostructured coatings are promising for orthopedic implant applications.

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Silver-substituted TCP films on titanium are prepared by Ionized Jet Deposition

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Films are nanostructured, hard, with submicron thickness

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Adipose mesenchymal stem cells differentiate into osteogenic lineage on the surface of films

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Films show antimicrobial and anti-adhesive activity against several microorganisms

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Films are promising for application in orthopedic titanium implants

Convergence of scaffold-guided bone regeneration and RIA bone grafting for the treatment of a critical-sized bone defect of the femoral shaft

BACKGROUND

Critical-sized bone defects, mainly from trauma, infection or tumor resection are a challenging condition, often resulting in prolonged, complicated course of treatment. Autografts are considered as the gold standard to replace lost bone. However, limited amount of bone graft volume and donor-site morbidity have established the need for the development of alternative methods such as scaffold-based tissue engineering (TE). The emerging market of additive manufacturing (3D-printing) has markedly influenced the manufacturing of scaffolds out of a variety of biodegradable materials. Particularly medical-grade polycaprolactone and tricalcium phosphate (mPCL-TCP) scaffolds show appropriate biocompatibility and osteoconduction with good biomechanical strength in large preclinical animal models. This case report aims to show first evidence of the feasibility, safety, and efficacy of mPCL-TCP scaffolds applied in a patient with a long bone segmental defect.

CASE PRESENTATION

The presented case comprises a 29-year-old patient who has suffered a left-sided II° open femoral shaft fracture. After initial external fixation and subsequent conversion to reamed antegrade femoral nailing, the patient presented with an infection in the area of the formerly open fracture. Multiple revision surgeries followed to eradicate microbial colonization and attempt to achieve bone healing. However, 18 months after the index event, still insufficient diaphyseal bone formation was observed with circumferential bony defect measuring 6 cm at the medial and 11 cm at the lateral aspect of the femur. Therefore, the patient received a patient-specific mPCL-TCP scaffold, fitting the exact anatomical defect and the inserted nail, combined with autologous bone graft (ABG) harvested with the Reamer-Irrigator-Aspirator system (RIA-Synthes®) as well as bone morphogenetic protein-2 (BMP-2). Radiographic follow-up 12 months after implantation of the TE scaffold shows advanced bony fusion and bone formation inside and outside the fully interconnected scaffold architecture.

CONCLUSION

This case report shows a promising translation of scaffold-based TE from bench to bedside. Preliminary evidence indicates that the use of medical-grade scaffolds is safe and has the potential to improve bone healing. Further, its synergistic effects when combined with ABG and BMP-2 show the potential of mPCL-TCP scaffolds to support new bone formation in segmental long bone defects.

Effect of ErhBMP-2-loaded β-tricalcium phosphate on ulna defects in the osteoporosis rabbit model

Purpose

Autografts, the gold standard treatment for large bone defects, present complications, especially in conditions with reduced bone-repair capacity, such as osteoporosis. Escherichia coli-derived recombinant human bone morphogenesis protein-2 (ErhBMP-2), was used in this study to improve the osteoinductivity of β-tricalcium phosphate (β-TCP). This study evaluated the bone-repair capacity of ErhBMP-2-loaded β-TCP on osteoporosis rabbit model, relative to the sole use of autograft and β-TCP treatments.

Methods

The osteoporosis rabbit model was induced through ovariectomy and glucocorticoid dosing; 2-cm segmental ulnar defects were created, which were treated with either autograft, β-TCP alone, or ErhBMP-2-loaded β-TCP or left untreated. The quality of newly formed ulnae was evaluated 8 weeks after ulnar surgery through micro-CT, biomechanical, histological, and histomorphometric assessments.

Results

The osteoporosis rabbit model was developed and maintained till the end of the study. The maximal load and stiffness in the ErhBMP-2-loaded TCP group were significantly higher than those in the autograft group, whereas the TCP-alone group performed similarly as did the untreated group in the force loading and stiffness tests. According to the micro-CT evaluation, the ErhBMP-2-loaded TCP group had significantly higher bone volume relative to the autograft and TCP-alone groups. Histological assessments revealed better defect bridging and marrow formation in the ErhBMP-2-loaded TCP group relative to the TCP-alone group. Mineral apposition rates were significantly higher in the ErhBMP-2-loaded TCP and autograft groups than in the TCP-alone and untreated groups.

Conclusion

Relative to autografts, ErhBMP-2-loaded TCP, as an alternative grafting material, provides better or comparable healing on critical-sized long bone defects in the osteoporosis rabbit model.

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Erh-BMP-2 promoted the bone healing ability of β-TCP in osteoporosis animal model.

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New bone generated by Erh-BMP-2-loaded β-TCP was stiffer than that generated by autograft.

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ErhBMP-2-loaded TCP potentially being an alternative grafting material relative to autograft.

Comparative evaluation of enamel microhardness after using two different remineralizing agents on artificially demineralized human enamel: An in vitro study

AIM

The purpose of this study was to compare the remineralization outcomes of two agents using the Vickers microhardness test (VMHT) on artificially induced enamel subsurface lesions.

MATERIALS AND METHODS

Forty sound extracted premolars were selected as samples for the current study and divided into four groups of 10 teeth each: Clinpro (group 1), Remin Pro (group 2), untreated positive control (group 3), and a demineralized negative control (group 4). All the sample groups were assessed first at baseline then after demineralization and remineralization using DIAGNOdent. After the remineralization process, VMHT was performed on all sample groups to assess surface microhardness (SMH). The results obtained were then compared using a one-way analysis of variance (ANOVA) for the difference in SMH.

RESULTS

Vickers microhardness number values were analyzed using one-way ANOVA and samples in the experimental groups 1 and 2 showed a statistically significant difference compared to the control groups (P < 0.05). Remineralization was higher in the Remin Pro group, followed by Clinpro group.

CONCLUSIONS

The results of this in vitro study show that both Remin Pro and Clinpro are equally effective as remineralizing agents. Although Remin Pro tended to yield a higher microhardness, no significant differences were observed between the two agents.

RELEVANCE FOR PATIENTS

Enamel mineral loss leads to the degradation of the surface and subsurface structures of teeth. Natural remineralization that occurs physiologically is not sufficient to overcome the hurdles of mineral loss a tooth undergoes due to changes in food habits and lifestyle. A thought on remineralization and management such as prescribing remineralizing agents and regular professional topical fluoride applications would definitely render satisfactory results by a strong healthy enamel.

The five year outcome of a clinical feasibility study using a biphasic construct with minced autologous cartilage to repair osteochondral defects in the knee

PURPOSE

Autologous minced cartilage has been used to repair cartilage defects. We have developed a biphasic cylindrical osteochondral construct for such use in human knees, and report the five year post-operative outcomes.

METHODS

Ten patients with symptomatic osteochondral lesion at femoral condyles were treated by replacing pathological tissue with the osteochondral composites, each consisted a _DL-poly-lactide-co-glycolide chondral phase and a _DL-poly-lactide-co-glycolide/β-tricalcium phosphate osseous phase. A flat chamber between the two phases served as a reservoir to house double-minced (mechanical pulverization and enzymatical dissociation) autologous cartilage graft. The osteochondral lesion was drill-fashioned a pit of identical dimensions as the construct. Graft-laden construct was press fit to the pit. Post-operative outcome was evaluated using Knee Injury and Osteoarthritis Outcome Score (KOOS) up to five years. Regenerated tissue was sampled with arthroscopic needle biopsy for histology at one year, and imaged with magnetic resonance at one, three, and five years to evaluate the neocartilage with MOCART chart. Subchondral bone integration was evaluated with computed tomography at three and five years.

RESULTS

Nine patients completed the five-year follow-up. Post-operative mean KOOS, except that of the "symptom" subscale, had been significantly higher than pre-operation from one year and maintained to five years. The change of MOCRAT scores of the regenerated cartilage paralleled the change of KOOS. The osseous phase remained mineralized during the five-year period, yet did not fully integrate with the host bone.

CONCLUSIONS

This novel construct for chondrocyte implantation yielded promising mid-term outcome. It repaired the osteochondral lesion with hyaline-like cartilage durable for at least five years.

Visualizing Different Crystalline States during the Infrared Imaging of Calcium Phosphates

Methods utilizing relatively simple mathematical operations during physical analyses to enable the visualization of otherwise invisible correlations and effects are of particular appeal to researchers and students in pedagogical settings. At the same time, discerning the amorphous phase from its crystalline counterpart in materials is challenging with the use of vibrational spectroscopy and is nowhere as straightforward as in phase composition analytical methods such as X-ray diffraction. A method is demonstrated for the use of first- and second-order differentiation of Fourier transform infrared spectra of calcium phosphates to distinguish their amorphous states from the crystalline ones based on the exact line positioning rather than on comparatively vaguer band broadening and splitting effects. The study utilizes a kinetic approach, focusing on the comparison of spectral features of amorphous precursors annealed in air at different temperatures and aged for different periods of time in an aqueous solution until transforming to one or a mixture of crystalline phases, including hydroxyapatite and α- and β-tricalcium phosphate. One of the findings challenges the concept of the nucleation lag time preceding the crystallization from amorphous precursors as a "dead" period and derives a finite degree of constructive changes occurring at the atomic scale in its course. The differential method for highlighting spectral differences depending on the sample crystallinity allows for monitoring in situ the process of conversion of the amorphous calcium phosphate phase to its crystalline analogue(s). One such method can be of practical significance for synthetic solid state chemists testing for the chemical stability and/or concentration of the reactive amorphous phase in these materials, but also for biologists measuring the maturity of bone and medical researchers evaluating its phase composition and, thus, the state of metabolic and mechanical stability.

Mechanochemical activation with cyclodextrins followed by compaction as an effective approach to improving dissolution of rutin

Rutin is one of the most important flavonoids with poor bioavailability. This work aimed at addressing the issue of poor biopharmaceutical performance of rutin by applying a combination of complexation with secondary processing into tablets. Mechanical activation was the most suitable method of rutin complex formation with (2-hydroxypropyl)-β-cyclodextrin (HP-β-CD), while the β-cyclodextrin (β-CD) complex successfully formed by kneading with an ethanol/water mixture. Complexation was confirmed by thermal analysis, powder X-ray diffraction and vibrational spectroscopy. Dynamic vapour sorption showed that stability of powders at high humidity conditions was satisfactory, however, the β-CD complex retained around 8% of moisture. The complexes were compacted with or without tricalcium phosphate (TRI-CAFOS) filler at a range of compression pressures (19-113 MPa). The best tabletability was determined for rutin/HP-β-CD, compressibility for the TRI-CAFOS blends with complexes and compactibility for the rutin/HP-β-CD + TRI-CAFOS mix. Dissolution studies showed quicker and more complete dissolution (pH 1.2) of rutin/HP-β-CD tablets, however the compacts comprising the filler were superior than pure complexes. The tablets manufactured in this study appear to be promising delivery systems of rutin and it is recommended to combine rutin/HP-β-CD with TRI-CAFOS and compact at 38-76 MPa.

Biocompatibility of biphasic α,β-tricalcium phosphate ceramics in vitro

The biocompatibility of biphasic α,β-tricalcium phosphate ceramics, obtained by annealing a compact preform based on β-tricalcium phosphate powder, was studied in vitro. It was found that within 10–30 days the adhesion of primary dental pulp stem cells located on the surface of biphasic α,β-tricalcium phosphate ceramics is suppressed. Decrease of the cell number on the surface of biphasic α,β-tricalcium phosphate ceramics, most likely, can be associated with both the pH level (acidic) as a result of hydrolysis of the more soluble phase of α-tricalcium phosphate and with the nature of surface that changes as a result of the formation and growth of hydroxyapatite crystals.

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In vitro tests of biphasic α,β-tricalcium phosphate ceramics enriched with 65% of α-Ca₃(PO4)² modification were carried out.

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Surface morphology of α,β-tricalcium phosphate ceramics gradually changed during in vitro tests for 30 days.

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Sharp edges of hydroxyapatite plate crystallites formed at the surface of ceramics suppressed the cell activity.

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Acidification near the surface of ceramics containing biodegradable α-tricalcium phosphate suppressed the cell activity.

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Acidifying α-tricalcium phosphate is a perspective phase of ceramic composites in combination with alkalinizing phases.

High temperature CaSiO3-Ca3(PO4)2 ceramic promotes osteogenic differentiation in adult human mesenchymal stem cells

Silicophosphate calcium ceramics are widely used in orthopedic and oral surgery applications because of their properties for stimulating bone formation and bone bonding. These bioceramics, together with multipotent undifferentiated adult human mesenchymal stem cells, are serious candidates in the field of bone tissue engineering and regenerative medicine. For this reason, the influence of a novel 30 wt%CaSiO₃ - 70 wt%Ca₃(PO₄)₂ ceramic over a primary adult human mesenchymal stem cells culture has been investigated in this study, observing a total colonization of the biomaterial by cells at 21 days. The osteoinductive capacity of the materials was also studied: alkaline phosphatase activity, gene quantification of osteoblastic genes and calcium deposits stained by Alizarin Red test, showed evidences of osteogenic differentiation of adult human mesenchymal stem cells seeded with this bioceramic both in growth medium and osteogenic medium. Therefore, the 30 wt%CaSiO₃ - 70 wt%Ca₃(PO₄)₂ bioceramic represents a potential scaffold which could be used in the field of biomaterials for bone tissue engineering, allowing cell adhesion, proliferation and promoting osteogenic differentiation of adult human mesenchymal stem cells.

Incorporating N-acetylcysteine and tricalcium phosphate into epoxy resin-based sealer improved its biocompatibility and adhesiveness to radicular dentine

OBJECTIVE

This in vitro study was designed to evaluate the biocompatibility, adhesiveness, and antimicrobial activity of epoxy resin-based sealer associated with N-Acetylcysteine (NAC) or beta-tricalcium phosphate nanoparticles (β-TCP) as an experimental retro-filling material.

METHODS

Cytotoxicity was assessed using 2,3-Bis-(Methoxy-4-Nitro-5-Sulphophenyl)-2H-Tetrazolium-5-Carboxanilide (XTT) and Sulforhodamine B (SRB) assays after exposing human periodontal ligament fibroblasts to extracts of the materials for 1, 3, or 7 days. For the adhesive resistance test, root canals (48 single-root teeth) were instrumented with Reciproc #40 files (VDW GmbH, Germany) and obturated. After 7 days, the apices were sectioned and a retrograde cavity prepared and filled with the experimental materials (Mineral trioxide aggregate, Epoxy sealer, Epoxy sealer+NAC, and Epoxy sealer+β-TCP). For the push-out test, one 2-mm thick slice was obtained from the apical third of each specimen. Antimicrobial activity was performed using agar diffusion method. Biofilms were grown in microplates and exposed to the extracts of retro-filled materials, followed by analysis of growth inhibition on agar plates.

RESULTS

Epoxy sealer in association with β-TCP or NAC showed better bond strength while Mineral trioxide aggregate allowed for the lowest adhesion. Mineral trioxide aggregate, Epoxy sealer+β-TCP, and Epoxy sealer+NAC showed low cytotoxicity. Epoxy sealer was the most cytotoxic. In antimicrobial activity assays, all materials had no effect on Candida albicans. Addition of NAC improved the antimicrobial property of Epoxy sealer against Enterococcus faecalis compared to unmodified Epoxy sealer (P<0.05).

SIGNIFICANCE

Incorporating β-TCP or NAC with Epoxy sealer could improve the adhesiveness and biocompatibility for better use in endodontic therapy.

Comparable bone union progression after opening wedge high tibial osteotomy using allogenous bone chip or tri-calcium phosphate granule: a prospective randomized controlled trial

PURPOSE

The purpose of this study is to compare the progression rate of bone union and clinical outcomes of opening wedge high tibial osteotomy (OWHTO) using allogenous bone chip or tri-calcium phosphate (TCP) granule as bone graft materials. The hypothesis was that the bone union progression in OWHTOs using TCP granule grafts would be comparable to that of OWHTOs using allogenous bone chip grafts.

METHODS

Between 2011 and 2013, 54 patients who had undergone OWHTO for genu varum and osteoarthritis were randomized to one of the two groups at five centres. TCP granule was used to fill the defect in 27 patients and lyophilized allogenous bone chip was used in the other 27 patients. The degree of bone union was classified on a five-point scale and evaluated using plain radiographs of the knee at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, pain Visual Analogue Scale (VAS) score and complications were also evaluated.

RESULTS

The highest degree of bone union observed at 6 and 12 months postoperatively was grade 4, and the number of cases of union progression at each time-point was not significantly different between the two groups (p > 0.05). WOMAC and pain VAS scores also showed no differences between the two groups. No complications were observed during the 12-month period following OWHTO in either group.

CONCLUSION

OWHTO using TCP granule bone substitute showed similar bone union rates and clinical outcomes compared to allogenous bone chip grafts. TCP granule can be used as bone substitutes instead of allogenous bone chip grafts in OWHTO.

LEVEL OF EVIDENCE

Level 1.

Bioaccessibility study of calcium and vitamin D3 co-microencapsulated in water-in-oil-in-water double emulsions

Calcium and vitamin D₃ were co-encapsulated in three types of water-in-oil-in-water (W/O/W) double emulsions stabilized with biopolymers: gum arabic, sodium alginate (Alg) and chitosan (Ch). Three calcium salts with different solubility were used: calcium carbonate (CaC), tricalcium phosphate (CaP) and calcium gluconate (CaG). In order to study the bioavailability of calcium and vitamin D₃, the W/O/W double emulsions were subjected to digestion in simulated conditions using in vitro gastrointestinal models. The size of the oil droplets of all double emulsions increased in oral phase and decreased in gastric and intestinal phases. In the intestinal phase, the average diameter of oil globules in the W/O/W(Alg) and W/O/W(Ch) was d₂₃ = 6.56 ± 0.09 and d₂₃ = 5.33 ± 0.01 and the electro-kinetic potential was: ζ ≈ -25 mV and ζ ≈ -17 mV, respectively. Presence of calcium ions in the intestinal fluid decreased the free fatty acids content and decreased the bioaccessibility of vitamin D₃ due to the inhibition of micellization process.

Biological evaluation of porous nanocomposite scaffolds based on strontium substituted β-TCP and bioactive glass: An in vitro and in vivo study

In the current study, in vitro analysis of the osteogenic potential of different scaffolds based on strontium-substituted β-TCP (Sr-TCP) and bioactive glass (BG) ceramics was conducted using rabbit bone marrow-derived mesenchymal stem cells (rBMSCs) and the osteogenic ability of the prepared Sr-TCP and BG scaffold was evaluated through alkaline phosphatase activity, mineral deposition by Alizarin red staining, and osteoblastic gene expression experiments. The obtained in vitro results revealed that among experimental Sr-TCP/BG nanocomposite scaffold samples with the composition of Sr-TCP/BG: 100/0, 50/50, 75/25, and 25/75, the 50Sr-TCP/50BG sample presented better osteoinductive properties. Therefore, the optimized 50Sr-TCP/50BG nanocomposite scaffold was chosen for further in vivo experiments. In vivo implantation of 50Sr-TCP/50BG scaffold and hydroxyapatite (HA)/TCP granules in a rabbit calvarial defect model showed slow degradation of 50Sr-TCP/50BG scaffold and high resorption rate of HA/TCP granules at 5 months' post-surgery. However, the 50Sr-TCP/50BG scaffolds loaded by mesenchymal stem cells (MSCs) were mainly replaced with new bone even at 2 months post-implantation. Based on the obtained engineering and biological results, 50Sr-TCP/50BG nanocomposite scaffold containing MSCs could be considered as a promising alternative substitute even for load-bearing bone tissue engineering applications.

Comparison of plate, calcanealplasty and external fixation in the management of calcaneal fractures

OBJECTIVE

Managing displaced intra-articular calcaneal fractures remains controversial. The purpose of this study is to compare and identify the surgical technique with the best outcomes for the treatment of intra-articular calcaneal fractures.

MATERIALS AND METHODS

This is a retrospective multicentric study conducted between February 2000 and June 2014 in 206 patients with intra-articular calcaneal fractures presenting to the outpatient or emergency department of three different orthopaedic departments. The patients were treated with one of the following techniques: 1. Open reduction and internal fixation with screws and plate; 2. Percutaneous reduction and monolateral external fixation; and 3. Balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation.

RESULTS

Patients treated with open reduction and internal fixation using an extensive lateral approach had a mean AOFAS score of 71 points; those treated through a minimal incision and reduction and fixation with an external fixator had a mean score of 83.1 points; and those treated with the balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation had a mean score of 78.75 points. No statistically difference was found comparing the three types of treatment.

CONCLUSION

Displaced intra-articular calcaneal fractures are still technically demanding injuries to manage. The results of this study suggest that in comparison to open reduction, a percutaneous reduction and fixation leads to higher but not statistical functional scores minimizing the wound-healing complications.

Enhanced release of calcium phosphate additives from bioresorbable orthopaedic devices using irradiation technology is non-beneficial in a rabbit model: An animal study

Objectives

Bioresorbable orthopaedic devices with calcium phosphate (CaP) fillers are commercially available on the assumption that increased calcium (Ca) locally drives new bone formation, but the clinical benefits are unknown. Electron beam (EB) irradiation of polymer devices has been shown to enhance the release of Ca. The aims of this study were to: 1) establish the biological safety of EB surface-modified bioresorbable devices; 2) test the release kinetics of CaP from a polymer device; and 3) establish any subsequent beneficial effects on bone repair in vivo.

Methods

ActivaScrew Interference (Bioretec Ltd, Tampere, Finland) and poly(L-lactide-co-glycolide) (PLGA) orthopaedic screws containing 10 wt% β-tricalcium phosphate (β-TCP) underwent EB treatment. In vitro degradation over 36 weeks was investigated by recording mass loss, pH change, and Ca release. Implant performance was investigated in vivo over 36 weeks using a lapine femoral condyle model. Bone growth and osteoclast activity were assessed by histology and enzyme histochemistry.

Results

Calcium release doubled in the EB-treated group before returning to a level seen in untreated samples at 28 weeks. Extensive bone growth was observed around the perimeter of all implant types, along with limited osteoclastic activity. No statistically significant differences between comparative groups was identified.

Conclusion

The higher than normal dose of EB used for surface modification did not adversely affect tissue response around implants in vivo. Surprisingly, incorporation of β-TCP and the subsequent accelerated release of Ca had no significant effect on in vivo implant performance, calling into question the clinical evidence base for these commercially available devices.

Cite this article: I. Palmer, S. A. Clarke, F. J Buchanan. Enhanced release of calcium phosphate additives from bioresorbable orthopaedic devices using irradiation technology is non-beneficial in a rabbit model: An animal study. Bone Joint Res 2019;8:266–274. DOI: 10.1302/2046-3758.86.BJR-2018-0224.R2.

Development of chitosan encapsulated tricalcium phosphate biocomposite for fluoride retention

The powder form of tricalcium phosphate (TCP) causes the significant pressure drop which limit its application under field conditions. To trounce such technological troubles and to enhance the defluoridation capacity (DC) of TCP, chitosan (CS) encapsulated TCP polymeric composite was prepared by dispersing TCP particles into chitosan polymeric matrix to produce tricalcium phosphate/chitosan (TCPCS) composite which could be made into any desirable form. The synthesized TCPCS composite possesses an enhanced DC of 1034 mgF^-/kg than the individual components viz., TCP and chitosan which has got DC of 490 and 52 mgF^-/kg respectively. The prepared adsorbents were characterized by FTIR, SEM and EDAX analysis. The various physico-chemical properties such as contact time, solution pH, co-anions and temperature were optimized to get maximum defluoridation. The equilibrium and kinetic experiments were conducted for TCPCS composite toward fluoride removal. The practical applicability of TCPCS composite was examined at field conditions.

Bioactive calcium phosphate materials and applications in bone regeneration

BACKGROUND

Bone regeneration involves various complex biological processes. Many experiments have been performed using biomaterials in vivo and in vitro to promote and understand bone regeneration. Among the many biomaterials, calcium phosphates which exist in the natural bone have been conducted a number of studies because of its bone regenerative property. It can be directly contributed to bone regeneration process or assist in the use of other biomaterials. Therefore, it is widely used in many applications and has been continuously studied.

MAINBODY

Calcium phosphate has been widely used in bone regeneration applications because it shows osteoconductive and in some cases osteoinductive features. The release of calcium and phosphorus ions regulates the activation of osteoblasts and osteoclasts to facilitate bone regeneration. The control of surface properties and porosity of calcium phosphate affects cell/protein adhesion and growth and regulates bone mineral formation. Properties affecting bioactivity vary depending on the types of calcium phosphates such as HAP, TCP and can be utilized in various applications because of differences in ion release, solubility, stability, and mechanical strength. In order to make use of these properties, different calcium phosphates have been used together or mixed with other materials to complement their disadvantages and to highlight their advantages. Calcium phosphate has been utilized to improve bone regeneration in ways such as increasing osteoconductivity for bone ingrowth, enhancing osteoinductivity for bone mineralization with ion release control, and encapsulating drugs or growth factors.

CONCLUSION

Calcium phosphate has been used for bone regeneration in various forms such as coating, cement and scaffold based on its unique bioactive properties and bone regeneration effectiveness. Additionally, several studies have been actively carried out to improve the efficacy of calcium phosphate in combination with various healing agents. By summarizing the properties of calcium phosphate and its research direction, we hope that calcium phosphate can contribute to the clinical treatment approach for bone defect and disease.

Mechanical and tribological properties of the tricalcium phosphate - magnesium oxide composites

The mechanical of the tricalcium phosphate matrix sintered with different amounts of the magnesium oxide have been investigated. The tricalcium phosphate - magnesium oxide composites were characterized by using the mechanical properties such as rupture strength, Vickers hardness and elastic modulus. The effects of the sintering process on the structural changes of the composites were investigated. At 1300 °C, the highest performance was obtained for the tricalcium phosphate containing 5 wt% MgO. The maximum mechanical strength and Young's modulus of the composites reached 9 MPa and 38 GPa, respectively. The result can be explained by the formation of both, liquid phase, which helps to fill the pores in the microstructure, and a new phase relative to the calcium magnesium phosphate. At 1400 °C and beyond 5 wt% MgO, the performances of the composites are hindered by the intragranular porosity formation and by the exaggerated grain growth. The addition of the magnesium oxide to the tricalcium phosphate matrix promotes the reduction of the wear rate and the friction coefficient. The composites performances are close to the enamel.

Comparative studies on thin polycaprolactone-tricalcium phosphate composite scaffolds and its interaction with mesenchymal stem cells

Background

Hybrid scaffolds combining biodegradable polymers and ceramic particles for control of cell adhesion and proliferation are interesting materials for tissue engineering applications. Combinations of biodegradable polymers and ceramics are to provide higher beneficial functionalities to tissue engineering scaffolds with addition of different cell specific bio-factors. Many such hybrid combinations have been reported by several researchers around the world by using various methods and solvents as well as bioactive matrix polymers to fabricate such biomaterials. However, thin hybrid scaffolds with high porosity, cell adhesion factors and biodegradability, as well as the ability to support stem cells often require tedious processes like electrospinning, freeze drying, etc. A simple method to develop porous biodegradable hybrid scaffolds with proper cell adhesion factors is still the need of the hour in tissue engineering and regenerative medicine.

Method

Thin biodegradable poly(ε-caprolactone) (PCL) based hybrid scaffolds were developed in combination with α-tricalcium phosphate (TCP) particles, gelatin and fibronectin separately and the fabricated scaffolds were evaluated systematically using human mesenchymal stem cells (hMSCs) for tissue engineering applications. A simple modified solvent casting method combined with gas foaming process was used to develop porous thin hybrid structures and compared their properties with those of corresponding non-porous hybrid scaffolds. The TCP particles distribution, morphology, biodegradability and functional groups of the different hybrid scaffolds were analyzed using energy-dispersive X-ray spectroscopy (EDX), light microscopy/scanning electron microscopy (SEM), buffer solutions and Fourier-transform infrared spectroscopy (FTIR), respectively The cellular and tissue regeneration behaviors such as in vitro cell attachment (live/dead assay), cell proliferation (CCK-8 assay) and histological studies were performed using hMSCs.

Results

Thin PCL-based hybrid scaffolds were fabricated using modified solvent casting method. Homogeneous distribution of TCP particles in the scaffolds were confirmed by EDX. Cellular interactions of the hybrid scaffolds demonstrated overall higher cell adhesion, proliferation and tissue regeneration on the non-porous thin films of PCL-TCP, PCL-TCP-gelatin and PCL-TCP-fibronectin. Coating of fibronectin was remarkable in induction of cell adhesion and proliferation.

Conclusions

The experimental results revealed that diversely designed PCL-TCP thin hybrid films showed high cell interaction and proliferation with hMSCs. From the results of the cell viability, attachment, proliferation and histological analyses as well as their biodegradation and coating effects, we conclude that these thin PCL-TCP hybrid films are suitable for tissue engineering applications.

Balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation for calcaneal fracture: A retrospective analysis of 42 patients

INTRODUCTION

The treatment of intra-articular calcaneal fractures is still complex and controversial. Although open reduction and internal fixation (ORIF) is favored by many authors, several percutaneous techniques have been introduced to reduce complications and to obtain satisfactory clinical and radiological results. Among these percutaneous treatments, balloon reduction and bone graft augmentation is gaining an increasing popularity.

MATERIALS AND METHODS

We retrospectively examined a series of 42 patients treated operatively with a minimally invasive reduction technique using an inflatable bone tamp filled with tricalcium phosphate (calcaneoplasty) for Sander's type II, III and IV calcaneal fractures between 2010 and 2015. Conventional X-rays and CT scan were performed pre-operatively, at 3 and 12 months post-operatively and at the last-follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) score and the Maryland Foot Score (MFS) were used for clinical evaluation. Bohler's angle and the Score Analysis of Verona (SAVE) were calculated to assess bone reduction.

RESULTS

All 42 patients were available for clinical and radiographic follow-up at an average of 665 months (range 38-92). At the last follow-up the mean AOFAS score was 82.1 (good) and the mean MFS was 80.8 (good). The mean Bohler's angle improved from 1.29° pre-operatively to 27.8° at the last follow-up. The SAVE highlighted good and excellent results in 30 (72%) patients. There were only 3 (7.1%) cases of superficial skin infection with only 6 (14.2%) patients complaining of residual pain. No cases of adverse reaction or deep infection were observed.

CONCLUSIONS

Calcaneoplasty appears to be a valid option of treatment for calcaneal fractures and a reliable alternative to ORIF. This technique allows stable fracture reduction and early weight-bearing combined with good clinical and radiological results and few complications.

Effect of water glass coating of tricalcium phosphate granules on in vivo bone formation

BACKGROUND

Recently, some authors introduced a water glass (WG, sodium-silicate glass; Na₂O·SiO₂·nH₂O) coating over tricalcium phosphate (TCP) bioceramic to modulate its resorption rate and enhance the bone cell behaviors. In this study, four different types of granular samples were prepared to evaluate the ability of new bone formation in vivo using micro-computed tomography and histology.

METHODS

Four types sample groups: group A (pure HA as a negative resorption control); group B (pure TCP as a positive resorption control); group C (WG-coated TCP as an early resorption model); and group D (same as group C but heat-treated at 500°C as a delayed resorption model). Cylindrical tube-type carriers with holes were fabricated with HA by extrusion and sintering. Each carrier was filled densely with each granular sample. Four types of tubes were implanted into the medial femoral condyle and medial tibial condyle of New Zealand White rabbits.

RESULTS

The HA group (A) showed the lowest amount of new bone formation. All the TCP sample groups (B, C, and D) showed more new bone formation. On the other hand, among the TCP groups, group C (early resorption model) showed slightly more bone formation. The amount of residual bioceramics was most abundant in the HA group (A). All the TCP sample groups showed less residual bioceramics than group A. Among the TCP groups, group C showed slightly more residual bioceramics. Group B showed the lowest amount of residual bioceramics.

CONCLUSIONS

The WG-coated TCP sample (group C) is the best bone substitute candidate because of its proper biodegradation rate and the Si ions release because the WG-coated layer reduces the material resorption and enhances the new bone formation. That is, the WG-coated TCP is believed to be the best material for the application of an artificial bone substitute material.

Effects of three-dimensionally printed polycaprolactone/β-tricalcium phosphate scaffold on osteogenic differentiation of adipose tissue- and bone marrow-derived stem cells

BACKGROUND

Autogenous bone grafts have several limitations including donor-site problems and insufficient bone volume. To address these limitations, research on bone regeneration is being conducted actively. In this study, we investigate the effects of a three-dimensionally (3D) printed polycaprolactone (PCL)/tricalcium phosphate (TCP) scaffold on the osteogenic differentiation potential of adipose tissue-derived stem cells (ADSCs) and bone marrow-derived stem cells (BMSCs).

METHODS

We investigated the extent of osteogenic differentiation on the first and tenth day and fourth week after cell culture. Cytotoxicity of the 3D printed PCL/β-TCP scaffold was evaluated by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium assay, prior to osteogenic differentiation analysis. ADSCs and BMSCs were divided into three groups: C, only cultured cells; M, cells cultured in the 3D printed PCL/β-TCP scaffold; D, cells cultured in the 3D printed PCL/β-TCP scaffold with a bone differentiation medium. Alkaline phosphatase (ALP) activity assay, von Kossa staining, reverse transcription-polymerase chain reaction (RT-PCR), and Western blotting were performed for comparative analysis.

RESULTS

ALP assay and von Kossa staining revealed that group M had higher levels of osteogenic differentiation compared to group C. RT-PCR showed that gene expression was higher in group M than in group C, indicating that, compared to group C, osteogenic differentiation was more extensive in group M. Expression levels of proteins involved in ossification were higher in group M, as per the Western blotting results.

CONCLUSION

Osteogenic differentiation was increased in mesenchymal stromal cells (MSCs) cultured in the 3D printed PCL/TCP scaffold compared to the control group. Osteogenic differentiation activity of MSCs cultured in the 3D printed PCL/TCP scaffold was lower than that of cells cultured on the scaffold in bone differentiation medium. Collectively, these results indicate that the 3D printed PCL/TCP scaffold promoted osteogenic differentiation of MSCs and may be widely used for bone tissue engineering.

Enhanced In Vivo Bone and Blood Vessel Formation by Iron Oxide and Silica Doped 3D Printed Tricalcium Phosphate Scaffolds

Calcium phosphate (CaP) ceramics show significant promise towards bone graft applications because of the compositional similarity to inorganic materials of bone. With 3D printing, it is possible to create ceramic implants that closely mimic the geometry of human bone and can be custom-designed for unusual injuries or anatomical sites. The objective of the study was to optimize the 3D-printing parameters for the fabrication of scaffolds, with complex geometry, made from synthesized tricalcium phosphate (TCP) powder. This study was also intended to elucidate the mechanical and biological effects of the addition of Fe+3 and Si+4 in TCP implants in a rat distal femur model for 4, 8, and 12 weeks. Doped with Fe+3 and Si+4 TCP scaffolds with 3D interconnected channels were fabricated to provide channels for micronutrients delivery and improved cell-material interactions through bioactive fixation. Addition of Fe+3 into TCP enhanced early-stage new bone formation by increasing type I collagen production. Neovascularization was observed in the Si+4 doped samples after 12 weeks. These findings emphasize that the additive manufacturing of scaffolds with complex geometry from synthesized ceramic powder with modified chemistry is feasible and may serve as a potential candidate to introduce angiogenic and osteogenic properties to CaPs, leading to accelerated bone defect healing.

Effect of metformin on dental pulp stem cells attachment, proliferation and differentiation cultured on biphasic bone substitutes

OBJECTIVE

To evaluate to the effect of metformin on attachment of human dental pulp stem cells (hDPSCs) and their proliferation and osteogenic differentiation on biphasic hydroxyapatite/beta-tricalcium phosphate granules of macro-porous biphasic calcium phosphate (MBCP).

MATERIALS AND METHODS

This in vitro study included four groups: A:hDPSCs + MBCP + Metfromin, B:hDPSCs + MBCP, C:hDPSCs + Metformin and D:hDPSCs (control). Attachment of hDPSCs to bone granules in groups A and B was observed by scanning electron microscopy on days 1 and 7 of cultivation. Cell viability was assessed by MTT assay on days 1, 3, and 7 after cell seeding. Differentiation of the hDPSCs was assessed by measurement of alkaline phosphatase activity on days 3, 7, 14 and 21 after cell culturing in standard and osteogenic media. The data was analyzed by two-way ANOVA at a significance level of p = 0.05.

RESULTS

The hDPSCs had firmly attached to the surface of MBCP granules, especially in group A. The MTT values increased in all groups from day 1 to day 7 (p < 0.001). The highest MTT values were observed in group C followed by the control group and groups A and B (p < 0.001). Alkaline phosphatase activity also increased in all groups between days 3 to 21 (p < 0.001) except between days 7 and 14 in standard media (p = 0.094). In standard media, groups with MBCP granules (A and B) showed higher activity (p < 0.05). In osteogenic media, the groups with metformin (A and C) showed higher alkaline phosphatase activity (p < 0.05).

CONCLUSION

This in vitro study showed that 100 Mol/L metformin increased attachment and proliferation of hDPSCs on biphasic granules. Osteogenic differentiation of hDPSCs also increased in the presence of metformin.

Allogenic vs. synthetic granules for bone tissue engineering: an in vitro study

The aim of this study was to compare human dental pulp stem cells' (DPSCs) attachment, proliferation and osteogenic differentiation on allogenic and synthetic biphasic bone granules. In this in vitro study, two types of bone granules were used: allograft [freeze-dried bone allograft (FDBA)] and biphasic granules [hydroxyapatite/beta-tricalcium phosphate (HA/β-TCP)]. By isolation of DPSCs, their attachment to bone granules was observed by scanning electron microscope (SEM) at day 1 and 7 of cultivation. Vital cells were measured by MTT assay at 1, 3, and 7 days of cell culture. Comparison of vital cells at different time points was considered as cell proliferation. Finally, differentiation of DPSCs was evaluated by measurement of alkaline phosphatase (ALP) activity 3, 7, 14, and 21 days after cell seeding in standard and osteogenic media. Data were analyzed using two-way ANOVA with a significant level of 0.05. Attachment of DPSCs on FDBA granules seemed relatively stronger. The number of cells (based on MTT values) and ALP activity of the cells cultured on both study groups increased between time points (p ≤ 0.001). FDBA granules had more cells compared to HA/β-TCP granules (p < 0.001). There was no significant difference between ALP activity of two study groups cultured in the standard medium (p = 0.347) and they were both higher than the control group (p < 0.05). In the osteogenic medium, FDBA group had significantly higher ALP activity compared to HA/β-TCP (p = 0.035) and control (p = 0.001) groups while there was no significant difference between ALP activity of HA/β-TCP and control groups (p = 0.645). In conclusion, current in vitro study revealed that FDBA granules have more potential in supporting DPSCs attachment and proliferation and inducing their ALP activity compared to HA/β-TCP granules. Therefore, FDBA could serve as a proper bone substitute material.

High strength, biodegradable and cytocompatible alpha tricalcium phosphate-iron composites for temporal reduction of bone fractures

In this work alpha tricalcium phosphate (α-TCP)/iron (Fe) composites were developed as a new family of biodegradable, load-bearing and cytocompatible materials. The composites with composition from pure ceramic to pure metallic samples were consolidated by pulsed electric current assisted sintering to minimise processing time and temperature while improving their mechanical performance. The mechanical strength of the composites was increased and controlled with the Fe content, passing from brittle to ductile failure. In particular, the addition of 25 vol% of Fe produced a ceramic matrix composite with elastic modulus much closer to cortical bone than that of titanium or biodegradable magnesium alloys and specific compressive strength above that of stainless steel, chromium-cobalt alloys and pure titanium, currently used in clinic for internal fracture fixation. All the composites studied exhibited higher degradation rate than their individual components, presenting values around 200 μm/year, but also their compressive strength did not show a significant reduction in the period required for bone fracture consolidation. Composites showed preferential degradation of α-TCP areas rather than β-TCP areas, suggesting that α-TCP can produce composites with higher degradation rate. The composites were cytocompatible both in indirect and direct contact with bone cells. Osteoblast-like cells attached and spread on the surface of the composites, presenting proliferation rate similar to cells on tissue culture-grade polystyrene and they showed alkaline phosphatase activity. Therefore, this new family of composites is a potential alternative to produce implants for temporal reduction of bone fractures.

STATEMENT OF SIGNIFICANCE

Biodegradable alpha-tricalcium phosphate/iron (α-TCP/Fe) composites are promising candidates for the fabrication of temporal osteosynthesis devices. Similar to biodegradable metals, these composites can avoid implant removal after bone fracture healing, particularly in young patients. In this work, α-TCP/Fe composites are studied for the first time in a wide range of compositions, showing not only higher degradation rate in vitro than pure components, but also good cytocompatibility and mechanical properties controllable with the Fe content. Ceramic matrix composites show high specific strength and low elastic modulus, thus better fulfilling the requirements for bone fractures fixation. A significant advance over previous works on the topic is the use of pulsed electric current assisted sintering together with α-TCP, convenient to improve the mechanical performance and degradation rate, respectively.

Cultivation of EPC and co-cultivation with MSC on β-TCP granules in vitro is feasible without fibronectin coating but influenced by scaffolds' design

INTRODUCTION

Meanwhile, the osteoconductive properties of frequently used synthetic bone grafts can be improved by the use of osteoinductive cells and growth factors. Nevertheless, the cultivation of endothelial progenitor cells (EPC) seems to be difficult and requires a pre-conditioning of the scaffolds with fibronectin. Additionally, the influence of the scaffolds' design on cell cultivation is not fully elucidated.

METHODS

As scaffold, a commercially available β-tricalcium phosphate was used. 5 × 10⁵ EPC, or 5 × 10⁵ MSC or a combination of each 2.5 × 10⁵ cells was seeded onto the granules. We investigated seeding efficiency, cell morphology, cell metabolism, adherence, apoptosis and gene expression of EPC and MSC in this in vitro study on days 2, 6 and 10.

RESULTS

Total number of adherent cells was higher on the β-TCP without fibronectin coating. The number of cells in all approaches significantly declined when a solid β-TCP was used. Metabolic activity of MSC was comparable throughout the scaffolds and increased until day 10. Additionally, the amount of supernatants VEGF was higher for MSC than for EPC.

DISCUSSION

Our results demonstrate that a coating of the scaffold for successful cultivation of EPC in vitro is not necessary. Furthermore, our study showed that structural differences of the scaffolds significantly influenced cell adherence and metabolic activity. Thereby, the influence on EPC seems to be higher than on MSC.