Calcium phosphate‐based composites as injectable bone substitute materials

Low, Kah Ling; Tan, Soon Huat; Zein, Sharif Hussein Sharif; Roether, Judith A.; Mouriño, Viviana; Boccaccını, Aldo R.

doi:10.1002/jbm.b.31619

Cited by 196 publications

(170 citation statements)

References 186 publications

(211 reference statements)

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“…Polymeric additives have earlier been used in CPCs with the purpose of improving their mechanical properties, injectability, resorption rate and biocompatibility (Dorozhkin 2009;Neumann & Epple 2006;Low et al 2010;Perez et al 2012;Engstrand et al 2013). The polymers, which are often biodegradable, can be added to the matrix either solubilized in the liquid phase or as a second phase, as particles or fibers.…”

Section: Introductionmentioning

confidence: 99%

A novel strategy to enhance interfacial adhesion in fiber-reinforced calcium phosphate cement

Gallinetti

Mestres

Canal

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

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Calcium phosphate cements (CPCs) are extensively used as synthetic bone grafts, but their poor toughness limits their use to nonload-bearing applications. Reinforcement through introduction of fibers and yarns has been evaluated in various studies but always resulted in a decrease in elastic modulus or bending strength when compared to the CPC matrix. The aim of the present work was to improve the interfacial adhesion between fibers and matrix to obtain tougher biocompatible fiberreinforced calcium phosphate cements (FRCPCs). This was done by adding a polymer solution to the matrix, with chemical affinity to the reinforcing chitosan fibers, namely trimethyl chitosan (TMC). The improved wettability and chemical affinity of the chitosan fibers with the TMC in the liquid phase led to an enhancement of the interfacial adhesion. This resulted in an increase of the work of fracture (several hundred-fold increase), while the elastic modulus and bending strength were maintained similar to the materials without additives. Additionally the TMC-modified CPCs showed suitable biocompatibility with an osteoblastic cell line. Graphical Abstract (for review) Highlights HIGHLIGHTS• Calcium phosphate cements were reinforced with chitosan fibers and soluble chitosan• The chemical affinity of fibers and matrix improved interfacial adhesion• Mechanical reinforcement was achieved thanks to a good fiber-matrix adhesion• Fiber-reinforced cements were significantly tougher than non-reinforced analogues • The modified cement matrix supported osteoblast proliferation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 -2 - AbstractCalcium phosphate cements (CPCs) are extensively used as synthetic bone grafts, but their poor toughness limits their use to non-load-bearing applications. Reinforcement through introduction of fibers and yarns has been evaluated in various studies but always resulted in a decrease in elastic modulus or bending strength when compared to the CPC matrix. The aim of the present work was to improve the interfacial adhesion between fibers and matrix to obtain tougher biocompatible fiber-reinforced calcium phosphate cements (FRCPCs). This was done by adding a polymer solution to the matrix, with chemical affinity to the reinforcing chitosan fibers, namely trimethyl chitosan (TMC). The improved wettability and chemical affinity of the chitosan fibers with the TMC in the liquid phase led to an enhancement of the interfacial adhesion. This resulted in an increase of the work of fracture (several hundred-fold increase), while the elastic modulus and bending strength were maintained similar to the materials without additives. Additionally the TMC-modified CPCs showed suitable biocompatibility with an osteoblastic cell line.

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Section: Introductionmentioning

confidence: 99%

A novel strategy to enhance interfacial adhesion in fiber-reinforced calcium phosphate cement

Gallinetti

Mestres

Canal

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

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“…During surgery, this often requires the surgeon to reshape the surgical site around the shape and structure of the implant causing an increase in bone loss, trauma to the surrounding tissue and longer surgical time (18). In addition, filling bone voids with individual particles may lead to incomplete filling of the defect or granule dispersion and loss during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Synthetic bone graft substitutes based on calcium phosphate materials are valid alternatives to tissue transplants and have been utilised clinically for over three decades, with varying efficacy and success (14). A limitation with current CaP bone substitute materials is that they often exist in a dry granular form, limiting handling ability during surgery (3). In the last 15 years, injectable and moldable forms of bone substitute material, such as pastes and putties, have been developed as they offer many advantages including increased handling ability and are able to completely fill contained defects of complex geometric shapes (4) In addition and with the development of minimally invasive surgical methods, the requirement to treat bony defects with directly injectable biomaterials is increasing (3).…”

Section: Introductionmentioning

confidence: 99%

“…A limitation with current CaP bone substitute materials is that they often exist in a dry granular form, limiting handling ability during surgery (3). In the last 15 years, injectable and moldable forms of bone substitute material, such as pastes and putties, have been developed as they offer many advantages including increased handling ability and are able to completely fill contained defects of complex geometric shapes (4) In addition and with the development of minimally invasive surgical methods, the requirement to treat bony defects with directly injectable biomaterials is increasing (3). The combination of hydrogels and calcium phosphate particles is emerging as a well-established trend for bone substitutes.…”

Section: Introductionmentioning

confidence: 99%

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The effect of an alginate carrier on bone formation in a hydroxyapatite scaffold

et al. 2015

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This study investigated the osteoconductive properties of a porous hydroxyapatite (HA) scaffold manufactured using a novel technique similar to the bread-making process, alone and in combination with an alginate polysaccharide fibre gel (HA/APFG putty) and autologous bone marrow aspirate (BMA). The hypothesis was that the HA/APFG putty would be as osteoconductive as granular HA and that the presence of BMA would further enhance bone formation in an ovine femoral condyle critical defect model. Thirty-six defects were created and either (1) porous HA granules, (2) HA/APFG putty or (3) HA/APFG putty + BMA were implanted. Following retrieval at 6 and 12 weeks, image analysis techniques were used to quantify bone apposition rates, new bone area, bone-HA scaffold contact and implant resorption.At 6 weeks post-surgery, significantly lower bone apposition rates were observed in the HA/APFG putty group when compared to the HA (p = 0.014) and HA/APFG putty + BMA (p = 0.014) groups. At 12 weeks, significantly increased amounts of new bone formation was measured within the HA scaffold (33.56 ± 3.53%) when compared to both the HA/APFG putty (16.69 ± 2.7%; p = 0.043) and defects containing HA/APFG putty + BMA (19.31 ± 3.8%; p = 0.043).The use of an alginate polysaccharide fibre gel as a carrier for injectable CaP bone substitute materials delayed bone formation in this model compared to HA granules alone which enhanced bone formation especially within the interconnected smaller pores. Our results also showed that the addition of autologous bone marrow aspirate did not further enhance its osteoconductive properties. Further work is Does an Alginate Gel Carrier Effect Bone Formation? 2 required to optimize the degradation rate of this alginate polysaccharide fibre gel binging agent before use as a directly injectable material used for bone defect repair.

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“…quality) of the damaged tissue surrounding the defect because of trauma, tumour or infection increases the complexity of the bone restoration procedures. In this scenario of clinical need, research on new materials for bone repair is growing at a rapid rate and today, calcium orthophosphates are extensively investigated on account of their compositional similarity to that of the bone mineral phase, biocompatibility and osteconductive properties [2][3][4][5]. Among the different calcium orthophosphates, brushite (dicalcium phosphate dihydrate, DCPD: CaHPO 4 .…”

Section: Introductionmentioning

confidence: 99%

Structural changes and biological responsiveness of an injectable and mouldable monetite bone graft generated by a facile synthetic method

Cama

Gharibi

Knowles

et al. 2014

J. R. Soc. Interface.

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Brushite (dicalcium phosphate dihydrate) and monetite (dicalcium phosphate anhydrous) are of considerable interest in bone augmentation owing to their metastable nature in physiological fluids. The anhydrous form of brushite, namely monetite, has a finer microstructure with higher surface area, strength and bioresorbability, which does not transform to the poorly resorbable hydroxyapatite, thus making it a viable alternative for use as a scaffold for engineering of bone tissue. We recently reported the formation of monetite cements by a simple processing route without the need of hydrothermal treatment by using a high concentration of sodium chloride in the reaction mix of b-tricalcium phosphate and monocalcium phosphate monohydrate. In this paper, we report the biological responsiveness of monetite formed by this method. The in vitro behaviour of monetite after interaction and ageing both in an acellular and cellular environment showed that the crystalline phase of monetite was retained over three weeks as evidenced from X-ray diffraction measurements. The crystal size and morphology also remained unaltered after ageing in different media. Human osteoblast cells seeded on monetite showed the ability of the cells to proliferate and express genes associated with osteoblast maturation and mineralization. Furthermore, the results showed that monetite could stimulate osteoblasts to undergo osteogenesis and accelerate osteoblast maturation earlier than cells cultured on hydroxyapatite scaffolds of similar porosity. Osteoblasts cultured on monetite cement also showed higher expression of osteocalcin, which is an indicator of the maturation stages of osteoblastogenesis and is associated with matrix mineralization and bone forming activity of osteoblasts. Thus, this new method of fabricating porous monetite can be safely used for generating three-dimensional bone graft constructs.

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Calcium phosphate‐based composites as injectable bone substitute materials

Cited by 196 publications

References 186 publications

A novel strategy to enhance interfacial adhesion in fiber-reinforced calcium phosphate cement

A novel strategy to enhance interfacial adhesion in fiber-reinforced calcium phosphate cement

The effect of an alginate carrier on bone formation in a hydroxyapatite scaffold

Structural changes and biological responsiveness of an injectable and mouldable monetite bone graft generated by a facile synthetic method

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