Advanced smart biomaterials and constructs for hard tissue engineering and regeneration

Hard tissue repair and regeneration cost hundreds of billions of dollars annually worldwide, and the need has substantially increased as the population has aged. Hard tissues include bone and tooth structures that contain calcium phosphate minerals.Smart biomaterial-based tissue engineering and regenerative medicine methods have the exciting potential to meet this urgent need. Smart biomaterials and constructs refer to biomaterials and constructs that possess instructive/inductive or triggering/stimulating effects on cells and tissues by engineering the material's responsiveness to internal or external stimuli or have intelligently tailored properties and functions that can promote tissue repair and regeneration. The smart material-based approaches include smart scaffolds and stem cell constructs for bone tissue engineering; smart drug delivery systems to enhance bone regeneration; smart dental resins that respond to pH to protect tooth structures; smart pH-sensitive dental materials to selectively inhibit acid-producing bacteria; smart polymers to modulate biofilm species away from a pathogenic composition and shift towards a healthy composition; and smart materials to suppress biofilms and avoid drug resistance. These smart biomaterials can not only deliver and guide stem cells to improve tissue regeneration and deliver drugs and bioactive agents with spatially and temporarily controlled releases but can also modulate/suppress biofilms and combat infections in wound sites. The new generation of smart biomaterials provides exciting potential and is a promising opportunity to substantially enhance hard tissue engineering and regenerative medicine efficacy.

Dental remineralization via poly(amido amine) and restorative materials containing calcium phosphate nanoparticles

Tooth decay is prevalent,and secondary caries causes restoration failures,both of which are related to demineralization.There is an urgent need to develop new therapeutic materials with remineralization functions.This article represents the first review on the cutting edge research of poly(amido amine)(PAMAM) in combination with nanoparticles of amorphous calcium phosphate (NACP).PAMAM was excellent nucleation template,and could absorb calcium (Ca) and phosphate (P) ions via its functional groups to activate remineralization.NACP composite and adhesive showed acid-neutralization and Ca and P ion release capabilities.PAMAM +NACP together showed synergistic effects and produced triple benefits: excellent nucleation templates,superior acidneutralization,and ions release.Therefore,the PAMAM+NACP strategy possessed much greater remineralization capacity than using PAMAM or NACP alone.PAMAM+NACP achieved dentin remineralization even in an acidic solution without any initial Ca and P ions.Besides,the long-term remineralization capability of PAMAM+NACP was established.After prolonged fluid challenge,the immersed PAMAM with the recharged NACP still induced effective dentin mineral regeneration.Furthermore,the hardness of predemineralized dentin was increased back to that of healthy dentin,indicating a complete remineralization.Therefore,the novel PAMAM+NACP approach is promising to provide long-term therapeutic effects including tooth remineralization,hardness increase,and caries-inhibition capabilities.

Induced Pluripotent Stem Cell-derived Mesenchymal Stem Cell Seeding on Biofunctionalized Calcium Phosphate Cements

Induced pluripotent stem ceils （iPSCs） have great potential due to their proliferation and differentiation capability. The objectives of this study were to generate iPSC-derived mesenchymal stem cells （iPSC-MSCs）, and investigate iPSC-MSC proliferation and osteogenic differentiation on calcium phosphate cement （CPC） containing biofunctional agents for the first time. Human iPSCs were derived from marrow CD34＋ cells which were reprogrammed by a single episomal vector, iPSCs were cultured to form embryoid bodies （EBs）, and MSCs migrated out of EBs. Five biofunctional agents were incorporated into CPC： RGD （Arg-Gly-Asp） peptides, fibronectin （Fn）, fibronectin-like engineered polymer protein （FEPP）, extracellular matrix Geltrex, and platelet concentrate, iPSC-MSCs were seeded on five biofunctionalized CPCs： CPC-RGD, CPC-Fn, CPC- FEPP, CPC-Geltrex, and CPC-Platelets. iPSC-MSCs on biofunctional CPCs had enhanced proliferation, actin fiber expression, osteogenic differentiation and mineralization, compared to control. Cell proliferation was greatly increased on biofunctional CPCs. iPSC-MSCs underwent osteogenic differentiation with increased alkaline phosphatase, Runx2 and coUagen-I expressions. Mineral synthesis by iPSC-MSCs on CPC-Platelets was 3-fold that of CPC control. In conclusion, iPSCs showed high potential for bone engineering, iPSC- MSCs on biofunctionalized CPCs had cell proliferation and bone mineralization that were much better than traditional CPC. iPSC-MSC-CPC constructs are promising to promote bone regeneration in craniofacial/ orthopedic repairs.

Effects of water-aging for 6 months on the durability of a novel antimicrobial and protein-repellent dental bonding agent

Biofilms at the tooth-restoration bonded interface can produce acids and cause recurrent caries. Recurrent caries is a primary reason for restoration failures. The objectives of this study were to synthesize a novel bioactive dental bonding agent containing dimethylaminohexadecyl methacrylate(DMAHDM) and 2-methacryloyloxyethyl phosphorylcholine(MPC) to inhibit biofilm formation at the tooth-restoration margin and to investigate the effects of water-aging for 6 months on the dentin bond strength and protein-repellent and antibacterial durability. A protein-repellent agent(MPC) and antibacterial agent(DMAHDM) were added to a Scotchbond multi-purpose(SBMP) primer and adhesive. Specimens were stored in water at 37 °C for 1, 30, 90, or 180 days(d).At the end of each time period, the dentin bond strength and protein-repellent and antibacterial properties were evaluated. Protein attachment onto resin specimens was measured by the micro-bicinchoninic acid approach. A dental plaque microcosm biofilm model was used to test the biofilm response. The SBMP + MPC + DMAHDM group showed no decline in dentin bond strength after water-aging for 6 months, which was significantly higher than that of the control(P < 0.05). The SBMP + MPC + DMAHDM group had protein adhesion that was only 1/20 of that of the SBMP control(P < 0.05). Incorporation of MPC and DMAHDM into SBMP provided a synergistic effect on biofilm reduction. The antibacterial effect and resistance to protein adsorption exhibited no decrease from 1 to 180 d(P > 0.1). In conclusion, a bonding agent with MPC and DMAHDM achieved a durable dentin bond strength and long-term resistance to proteins and oral bacteria. The novel dental bonding agent is promising for applications in preventive and restorative dentistry to reduce biofilm formation at the tooth-restoration margin.

Inhibition of CCL2 by bindarit alleviates diabetes-associated periodontitis by suppressing inflammatory monocyte infiltration and altering macrophage properties

Diabetes-associated periodontitis(DP)aggravates diabetic complications and increases mortality from diabetes.DP is caused by diabetes-enhanced host immune-inflammatory responses to bacterial insult.In this study,we found that persistently elevated CCL2 levels in combination with proinflammatory monocyte infiltration of periodontal tissues were closely related to DP.Moreover,inhibition of CCL2 by oral administration of bindarit reduced alveolar bone loss and increased periodontal epithelial thickness by suppressing periodontal inflammation.Furthermore,bindarit suppressed the infiltration of proinflammatory monocytes and altered the inflammatory properties of macrophages in the diabetic periodontium.This finding provides a basis for the development of an effective therapeutic approach for treating DP.

Toward dental caries: Exploring nanoparticle-based platforms and calcium phosphate compounds for dental restorative materials

Millions of people worldwide suffer from a toothache due to tooth cavity,and often permanent tooth loss.Dental caries,also known as tooth decay,is a biofilm-dependent infectious disease that damages teeth by minerals loss and presents a high incidence of clinical restorative polymeric fillings(tooth colored fillings).Until now,restorative polymeric fillings present no bioactivity.The complexity of oral biofilms contributes to the difficulty in developing effective novel dental materials.Nanotechnology has been explored in the development of bioactive dental materials to reduce or modulate the activities of caries-related bacteria.Nano-structured platforms based on calcium phosphate and metallic particles have advanced to impart an anti-caries potential to restorative materials.The bioactivity of these platforms induces prevention of mineral loss of the hard tooth structure and antibacterial activities against caries-related pathogens.It has been suggested that this bioactivity could minimize the incidence of caries around restorations(CARS)and increase the longevity of such filling materials.The last few years witnessed growing numbers of studies on the preparation evaluations of these novel materials.Herein,the caries disease process and the role of pathogenic caries-related biofilm,the increasing incidence of CARS,and the recent efforts employed for incorporation of bioactive nanoparticles in restorative polymer materials as useful strategies for prevention and management of caries-related-bacteria are discussed.We highlight the status of the most advanced and widely explored interaction of nanoparticle-based platforms and calcium phosphate compounds with an eye toward translating the potential of these approaches to the dental clinical reality.

Novel dental implant modifications with two-staged double benefits for preventing infection and promoting osseointegration in vivo and in vitro

Peri-implantitis are a major problem causing implant failure these days.Accordingly,anti-infection during the early stage and subsequent promotion of osseointegration are two main key factors to solve this issue.Micro-arc oxidation(MAO)treatment is a way to form an oxidation film on the surface of metallic materials.The method shows good osteogenic properties but weak antibacterial effect.Therefore,we developed combined strategies to combat severe peri-implantitis,which included the use of a novel compound,PD,comprising dendrimers poly(amidoamine)(PAMAM)loading dimethylaminododecyl methacrylate(DMADDM)as well as MAO treatment.Here,we explored the chemical properties of the novel compound PD,and proved that this compound was successfully synthesized,with the loading efficiency and encapsulation efficiency of 23.91%and 31.42%,respectively.We further report the two-stage double benefits capability of PD+MAO:(1)in the first stage,PD+MAO could decrease the adherence and development of biofilms by releasing DMADDM in the highly infected first stage after implant surgery both in vitro and in vivo;(2)in the second stage,PD+MAO indicated mighty anti-infection and osteoconductive characteristics in a rat model of peri-implantitis in vivo.This study first reports the two-staged,double benefits of PD+MAO,and demonstrates its potential in clinical applications for inhibiting peri-implantitis,especially in patients with severe infection risk.

3D-printed Mechanically Strong Calcium Phosphate Cement Scaffold with Metformin/Stem Cell-encapsulating Alginate Microbeads for Bone Tissue Engineering

The utilization of Calcium Phosphate Cement(CPC)is limited due to its low mechanical strength and difficulty to seed cells deep into the scaffold.The objectives of this study were to:(1)develop a 3D-printed CPC-dopamine-metformin scaffold encapsulating human periodontal ligament stem cells(hPDLSCs),(2)investigate the effect of dopamine on the performance of CPC,and(3)evaluate the effect of microbead degradation and metformin release on the osteogenic differentiation of the released hPDLSCs.The mechanical property of the CPC scaffolds was elevated by adding dopamine,and the CPC scaffold with 7 wt.%dopamine had the highest compressive strength(7.35 MPa).Four types of microbeads with different content of alginate(oxidized alginate),hPDLSCs,and 2%metformin were fabricated.Morphological and cell counting kit tests confirm that the hPDLSCs are protected by microbeads encapsulation during the CPC setting process.The alkaline phosphatase test indicates that the osteogenic differentiation of hPDLSCs was enhanced by the fast release of cells and metformin.The microbeads consisting of 2%oxidized alginate and 2%metformin were optimal for cell delivery due to favorable cell release and osteogenic differentiation.This CPC scaffold is promising used for bone regeneration in dental,craniofacial,and orthopedic applications.