A Review on the Enhancement of Calcium Phosphate Cement with Biological Materials in Bone Defect Healing

Abstract

Calcium phosphate cement (CPC) is a promising material used in the treatment of bone defects due to its profitable features of self-setting capability, osteoconductivity, injectability, mouldability, and biocompatibility. However, the major limitations of CPC, such as the brittleness, lack of osteogenic property, and poor washout resistance, remain to be resolved. Thus, significant research effort has been committed to modify and reinforce CPC. The mixture of CPC with various biological materials, defined as the materials produced by living organisms, have been fabricated by researchers and their characteristics have been investigated in vitro and in vivo. This present review aimed to provide a comprehensive overview enabling the readers to compare the physical, mechanical, and biological properties of CPC upon the incorporation of different biological materials. By mixing the bone-related transcription factors, proteins, and/or polysaccharides with CPC, researchers have demonstrated that these combinations not only resolved the lack of mechanical strength and osteogenic effects of CPC but also further improve its own functional properties. However, exceptions were seen in CPC incorporated with certain proteins (such as elastin-like polypeptide and calcitonin gene-related peptide) as well as blood components. In conclusion, the addition of biological materials potentially improves CPC features, which vary depending on the types of materials embedded into it. The significant enhancement of CPC seen in vitro and in vivo requires further verification in human trials for its clinical application.

A Review of the Application of Natural and Synthetic Scaffolds in Bone Regeneration

“…Calcium phosphate cement and hydroxyapatite exhibit great biocompatibility, osteoconductivity, resorbability, self-setting ability, injectability, and mouldability. It can act as a controlled drug carrier [37]. Many studies have tested the use of calcium phosphate cement and hydroxyapatite in bone regeneration in vitro and in vivo.…”

“…The major limitations of calcium phosphate cement and hydroxyapatite include low mechanical performance, poor washout resistance, and lack of osteogenic activities. The incorporation of other materials into calcium phosphate cement and hydroxyapatite has been proven to overcome these shortcomings and/or enhance the original features of the biomaterials [37,42]. Nair et al developed a composite scaffold comprising hydroxyapatite, tricalcium phosphate, and calcium silicate.…”

Percutaneous-Reinforced Osteoplasty: A Review of Emerging Treatment Strategies for Bone Interventions

“…In the event of secondary fracture, further fixation is almost impractical because of the permanent closure of the internal void from cement filling. Calcium phosphate cement may be preferable over PMMA bone cement for fracture repair in the given context because of its superior biological and osteogenic properties [ 99 ]. However, the inferior mechanical strength of calcium phosphate cement over PMMA cement requires further research to address this limitation.…”

The Osteogenic Properties of Calcium Phosphate Cement Doped with Synthetic Materials: A Structured Narrative Review of Preclinical Evidence

“…A recent review has been published to summarise the incorporation of CPC with materials derived from living organisms (including bone-related transcription factors, proteins, polysaccharides, and blood components) in treating bone defects [ 9 ]. Herein, the current review confers a comprehensive overview of the CPC reinforced by synthetic materials on their physical, mechanical, and biological properties ( Figure 1 ).…”