3D printing of PEEK–cHAp scaffold formedical bone implant

The major drawback associated with PEEK implants is their biologically inert surface,which caused unsatisfactory cellular response and poor adhesion between the implants and surrounding soft tissues against proper bone growth.In this study,polyetheretherketone(PEEK)was incorporated with calcium hydroxyapatite(cHAp)to fabricate a PEEK-cHAp biocomposite,using the fused deposition modeling(FDM)method and a surface treatment strategy to create microporous architectures onto the filaments of PEEK lattice scaffold.Also,nanostructure and morphological tests of the PEEK-cHAp biocomposite were modeled and analyzed on the FDM-printed PEEK-cHAp biocomposite sample to evaluate its mechanical and thermal strengths as well as in vitro cytotoxicity via a scanning electron microscope(SEM).A technique was used innovatively to create and investigate the porous nanostructure of the PEEK with controlled pore size and distribution to promote cell penetration and biological integration of the PEEK-cHAp into the tissue.In vivo tests demonstrated that the surface-treated micropores facilitated the adhesion of newly regenerated soft tissues to form tight implant-tissue interfacial bonding between the cHAp and PEEK.The results of the cell culture depicted that PEEK-cHAp exhibited better cell proliferation attachment spreading and higher alkaline phosphatase activity than PEEK alone.Apatite islands formed on the PEEK-cHAp composite after immersion in simulated body fluid of Dulbecco’s modified Eagle medium(DMEM)for 14 days and grew continuously with more or extended periods.The microstructure treatment of the crystallinity of PEEK was comparatively and significantly different from the PEEK-cHAp sample,indicating a better treatment of PEEK-cHAp.The in vitro results obtained from the PEEK-cHAp biocomposite material showed its biodegradability and performance suitability for bone implants.This study has potential applications in the field of biomedical engineering to strengthen the conceptual knowledge of FDM and medical implants fabricated from PEEK-cHAp biocomposite materials.

Advances in biocermets for bone implant applications

As two promising biomaterials for bone implants,biomedical metals have favorable mechanical properties and good machinability but lack of bioactivity;while bioceramics are known for good biocompatibility or even bioactivity but limited by their high brittleness.Biocermets,a kind of composites composing of bioceramics and biomedical metals,have been developed as an effective solution by combining their complementary advantages.This paper focused on the recently studied biocermets for bone implant applications.Concretely,biocermets were divided into ceramic-based biocermets and metal-based biocermets according to the phase percentages.Their characteristics were systematically summarized,and the fabrication methods for biocermets were reviewed and compared.Emphases were put on the interactions between bioceramics and biomedical metals,as well as the performance improvement mechanisms.More importantly,the main methods for the interfacial reinforcing were summarized,and the corresponding interfacial reinforcing mechanisms were discussed.In addition,the in vitro and in vivo biological performances of biocermets were also reviewed.Finally,future research directions were proposed on the advancement in component design,interfacial reinforcing and forming mechanisms for the fabrication of high-performance biocermets.

Additive manufacturing of multi-morphology graded titanium scaffolds for bone implant applications

Porous Titanium scaffolds have attracted widespread attention as bone implants for avoiding the stress shielding effect and promoting bone-in-growth.In this study,multi-morphology graded scaffolds hy-bridized by Primitive and Gyroid structures with porosity of 50,60,and 70%were designed(denoted as PG50,PG60,and PG70,respectively)and fabricated by selective laser melting.The simulation results showed that the maximum von-Mises stress of hybridized scaffolds increased from 504.22 to 884.24 MPa with porosity.The permeability and average pore size of multi-morphology PG50,PG60,and PG70 were in the range of 3.58×10^(-9)-5.50×10^(-9) m^(2) and 568.1-758.4μm,respectively.The microstructure of multi-morphology graded scaffolds consisted of a fully martensiticα′phase.Tested permeabilities of PG50 and PG60 were 3.27×10^(-9) and 4.35×10^(-9) m^(2),respectively,which were within the range of human bone(0.01-12.1×10^(-9) m^(2)).Elastic modulus and compressive yield strength of PG50 and PG60 ranged within 5.93^(-9).86 and 180.06-257.08 MPa,respectively.Therein,the PG50 not only exhibited a similar elastic modulus compared to human cortical bone(10.1 GPa)but also had higher strength(257.08 vs 131 MPa).The results of in vitro biocompatibility assay showed that PG50 and PG60 have better cyto-compatibility than mono-morphology scaffolds with the same porosity.Taken together,PG50 is promising to be used for the restoration of bone defects due to its excellent mechanical properties,appropriate per-meability,and good cytocompatibility.

Osteotomy Protocol for Implant Insertion of One Day Biotech: One Drill, One Implant

Background: Four factors determine the quality of an implantology kit: 1) Heat generated by the drills;2) Morphology of the osteotomy according to the diameter of the implant;3) Efficiency of collecting autologous bone;and 4) Osteotomy execution time. Materials and Methods: This article examines the heat produced by drills during osteotomy, focusing on the effect of the following factors: drilling technique;volume of autologous bone harvested;drilling time;implant primary stability;and the percentage of osseointegrated implants after primary healing. Discussion: The four factors mentioned above are analyzed based on the data obtained for sequential, biological, and One Drill milling techniques. Conclusions: 1) One Drill is the fastest technique for performing the osteotomy;2) All techniques stay within the biological temperature range of living bone, with the lowest increase in temperature achieved using One Drill with irrigation;3) The bone harvested showed no statistically significant differences between biological milling and the One Drill technique, both far superior to the sequential technique;and 4) There is no statistically significant difference in the number of osseointegrated implants among the three techniques analyzed.

Corrosion and biocompatibility improvement of magnesium-based alloys as bone implant materials:a review

Magnesium(Mg)or its alloys are widely tested as potential orthopedic implants,particularly as biodegradable alloys for fracture fixation due to their mechanical properties are close to those of bone.Currently,available Mg or its alloys are confronted with challenges in passing regulatory biosafety tests prior to clinical trials due to its fast degradation and associated degradation products.The degradation of Mg is accompanied by the release of Mg ions,the rise of pH and osmolality in surrounding environments.According to the standard of ISO 10993 Part 13,the pH value shall be appropriate to the site of intended use maintaining in an appropriate range.Approaches to overcome these challenges include the selection of adequate alloying elements,proper surface treatment techniques and control of the degradation rate of Mg or its alloys developed as orthopedic implants.To date,Mg or its alloy-based bone implants have not yet been widely used in clinical applications as medical implants.This review critically summarized published methods to improve the corrosion resistance of Mg and its alloys.The current progress on in vitro cytotoxicity and in vivo biocompatibility properties of these metals was also reviewed.This review aimed to provide a reference for further research and development(R&D)of biodegradable Mg and its alloys with regard to the evaluation of their corrosion process and biocompatibility and facilitation of their translation to clinical applications.

Porous silicon carbide coated with tantalum as potential material for bone implants

Porous silicon carbide(SiC)has a specific biomorphous microstructure similar to the trabecular microstructure of human bone.Compared with that of bioactive ceramics,such as calcium phosphate,SiC does not induce spontaneous interface bonding to living bone.In this study,bioactive tantalum(Ta)metal deposited on porous SiC scaffolds by chemical vapour deposition was investigated to accelerate osseointegration and improve the bonding to bones.Scanning electron microscopy indicated that the Ta coating evenly covered the entire scaffold structure.Energy-dispersive spectroscopy and X-ray diffraction analysis showed that the coating consisted of Ta phases.The bonding strength between the Ta coating and the SiC substrate is 88.4MPa.The yield strength of porous SiC with a Ta coating(pTa)was 45.862.9MPa,the compressive strength was 61.463.2MPa and the elasticmodulus was4.8GPa.When MG-63 human osteoblasts were co-cultured with pTa,osteoblasts showed good adhesion and spreading on the surface of the pTa and its porous structure,which showed that it has excellent bioactivity and cyto-compatibility.To further study the osseointegration properties of pTa.PTa and porous titanium(pTi)were implanted into the femoral neck of goats for 12weeks,respectively.The Van-Gieson staining of histological sections results that the pTa group had better osseointegration than the pTi group.These results indicate that coating bioactive Ta metal on porous SiC scaffolds could be a potential material for bone substitutes.

Bone cement implantation syndrome during hip replacement in a patient with pemphigus and Parkinson’s disease: A case report

BACKGROUND Bone cement implantation syndrome(BCIS)is characterized by hypotension,arrhythmia,diffuse pulmonary microvascular embolism,shock,cardiac arrest,any combination of these factors,or even death following bone cement implantation.CASE SUMMARY An 80-year-old patient with pemphigus and Parkinson’s disease underwent total hip replacement under spinal subarachnoid block and developed acute pulmonary embolism after bone cement implantation.The patient received mask mechanical ventilation with a continuous intravenous infusion of adrenaline(2μg/mL)at a rate of 30 mL/h.Subsequently,the symptoms of BCIS were markedly alleviated,and the infusion rate of adrenaline was gradually reduced until the infusion was completely stopped 45 min later.The patient was then transferred to the Department of Orthopedics,and anticoagulation therapy began at 12 h postoperatively.No other complications were observed.CONCLUSION This is a rare case of BCIS in a high-risk patient with pemphigus and Parkinson’s disease.

Marginal bone loss around non-submerged implants is associated with salivary microbiome during bone healing

Marginal bone loss during bone healing exists around non-submerged dental implants. The aim of this study was to identify the relationship between different degrees of marginal bone loss during bone healing and the salivary microbiome. One hundred patients were recruited, and marginal bone loss around their implants was measured using cone beam computed tomography during a 3-month healing period. The patients were divided into three groups according to the severity of marginal bone loss.Saliva samples were collected from all subjected and were analysed using 16 SMiSeq sequencing. Although the overall structure of the microbial community was not dramatically altered, the relative abundance of several taxonomic groups noticeably changed. The abundance of species in the phyla Spirochaeta and Synergistetes increased significantly as the bone loss became more severe. Species within the genus Treponema also exhibited increased abundance, whereas Veillonella, Haemophilus and Leptotrichia exhibited reduced abundances, in groups with more bone loss. Porphyromonasgingivalis, Treponemadenticola and Streptococcus intermedius were significantly more abundant in the moderate group and/or severe group. The severity of marginal bone loss around the non-submerged implant was associated with dissimilar taxonomic compositions. An increased severity of marginal bone loss was related to increased proportions of periodontal pathogenic species. These data suggest a potential role of microbes in the progression of marginal bone loss during bone healing.

The Behavior of New Hydrophilic Composite Bone Cements for Immediate Loading of Dental Implant

We introduced the hydrophilic groups to acrylic bone cement to improve compliance and achieve more interdigitation between the bone and the acrylic bone cement in order to create better substrates for immediate loading. FTIR-ATR, contact angle, and maximum breach torque were employed for measurement. The results reveal that the introduction of hydrophilic functional groups has increased PMMA＇s surface hydrophilicity after contact angle test. FTIR-ATR results suggest the hydrophilic groups participate in the polymerization reactions, and maximum breach torque of the hydrophilic acrylic bone cements is near 110 Ncm torque. Those effects make it possible for conventional acrylic bone cement application in immediate loading of dental implant.

Mechanical Experiment for 3D Printing of Titanium Bone Bionic Dental Implants

[Objectives] To explore the flexural strength of 3D printed titanium bone bionic dental implants and provide a scientific basis for the clinical application of 3D printed porous bionic bone dental implants. [Methods] The cone-beam CT( CBCT) image information of 20 premolars extracted by orthodontic requirement was collected,and a new porous bone bionic dental implant was produced using modeling software and 3D printer. The premolars were divided into two groups( A and B). The universal testing machine was used to test the flexural strength of the two groups and the difference in flexural strength between the two groups was compared through statistics. [Results]Twenty 3D printed porous titanium bone bionic implants were accurately produced; the morphology of group A and group B were extremely similar to each other; the average flexural strength of group A was 2 767. 92 N,while the average flexural strength of group B was 778. 77 N,showing that the average flexural strength of group A was significantly higher than that of group B,and the difference was statistically significant( P < 0. 05).[Conclusions]The personalized porous structure root implants produced by 3D printing technology are very similar to the target tooth morphology,and show high accuracy and small error of production. Besides,the flexural strength of 3D printed personalized porous structure root implants can fully meet the requirements of the maximum occlusal force for dental implant restoration. It is expected to provide a scientific basis for clinical application of 3 D printed porous bionic bone tooth implants.

Successful Resuscitation of Bone Cement Implantation Syndrome in a Patient with Pre-Existing Pulmonary Hypertension: A Case Report

Background: In patients with pre-existing pulmonary hypertension undergoing surgery, there is an inherent risk of decompensation and right ventricular failure. Cemented hemi-arthroplasty in patients with pre-existing pulmonary hypertension predisposes them even more to morbidity and mortality from bone cement implantation syndrome (BCIS) with worsening of pulmonary hypertension. This risk should be recognized and steps taken for increased awareness, risk counselling and minimization of adverse effects. Case: We report a case of successful resuscitation of a patient with pre-existing pulmonary hypertension who developed 2 episodes of cardiac arrests—Grade 3 BCIS, shortly after cement implantation. Learning Points: Patients with pre-existing pulmonary hypertension for cemented hemi-arthroplasty are at additional risks and should be identified. Adequate risk counselling needs to be undertaken prior to surgery. A multi-disciplinary team effort is required. Discussion should be undertaken with the orthopaedic surgeon about the risks and benefits of using cemented implants. The anaesthetist needs to be vigilant for signs of BCIS, especially at the time of cement implantation and institute immediate resuscitation. Supportive treatment is the mainstay of management.

Animal Modelling of Lumbar Corpectomy and Fusion and in vivo Growth of Spine Supporting Bone by Titanium Cage Implants: An Experimental Study

In this study a lumbar spinal fusion animal model is established to assess the effect of spinal fusion cage,and explore theminimum area ratio of titanium cage section to vertebral section that ensures bone healing and biomechanical property.Lumbarcorpectomy was conducted by posterolateral approach with titanium cage implantation combined with plate fixation.Titaniumcages with the same length but different diameters were used.After implantation of titanium cages,the progress of bone healingwas observed and the bone biomechanical properties were measured,including deformation and displacement in axial compression,flexion,extension,and lateral bending motion.The factors affecting the in vivo growth of spine supporting body wereanalyzed.The results show that the area ratio of titanium cage section to vertebral section should reach 1/2 to ensure the bonehealing,sufficient bone intensity and biomechanical properties.Some bone healing indicators,such as BMP,suggest that there isa relationship between the peak time and the peak value of bone formation and metabolism markers and the bone healing strength.

A Comparative Study of Bone Resorption between Implant Placement Sites and Non-Implant Placement Sites after Autogenous Block Bone Grafts in the Anterior Maxilla

The aim of this study was to compare the bone resorption differences between implant placement sites (IPS) and non-implant placement sites (NIPS) after autogenous block bone grafts in the anterior maxilla. Fourteen patients (58 edentulous sites) with alveolar atrophy in the anterior maxilla were treated with autogenous block bone grafts. CBCT examinations were performed at 1 month before surgery (T0), immediately after surgery (T1), 3 to 4 months after surgery (T2), 6 to 7 months after surgery before implant placement (T3), 12 to 13 months after surgery (T4), and the longest follow-up point (T5). Alveolar crestal and basal bone width (ACBW, ABBW), and alveolar bone height (ABH) were measured and divided into IPS (30 sites) and NIPS (28 sites). All results were compared by the Wilcoxon Signed Rank test. The bone resorption changes for both groups were the same. For these three parameters, ACBW didn’t change significantly from T2 to T3 and T4 to T5, ABBW didn’t change at every period from T2 to T5, and ABH didn’t change from T4 to T5. The bone resorption volume of ACBW and ABH in NIPS were more than in IPS after implant placement surgery, while the volume of ABBW was similar in both groups. At T5, the bone resorption percentages of ACBW, ABBW, and ABH were 25.57%, 16.85% and 43.84% in IPS, and 33.55%, 15.92% and 46.44% in NIPS. A more rapid loss of alveolar crest in NIPS resulted from implant placement surgery, and this reminded us of the importance of immediate implant placement.

The Stability Analysis of Implants Installed in Osteotomies with Different Types of Controlled Bone Defects

The stability parameters of implants （ITV, ISQ ＆ PTV） according to different sizes of controlled bone defects made in implant osteotomies were analyzed and the correlation among the three kinds of implant stability parameters was tested in this study. 45 tapped screw-type dental implants were inserted in three types of implant osteotomies made in 8 fresh-frozen pig femoral bones： Typel - without coronal bone defect, Type2 - with 3 mm coronal bone defects, and Type3 - with 6 mm coronal bone defects. The insertion torque values, ISQ ＆ PTV of implants were measured and analyzed statistically. It is concluded that the circumferential coronal bone defects statistically influence the primary stability of implants; ITV, ISQ and PTV are suitable and available to detect the peri-implant coronal bone defects in 3 mm increments, and ITV and PTV are more sensitive to coronal cortical bone loss. There was a strong correlation between ITV and ISQ.

The Tissue Reactions and Changes of a Surface of Various Metal Implants after Their Introduction in a Bone Tissue in Experiment

Screw metal implants (3S, Israel) with rough or smooth polished surface were introduced in a tibial proximal condyle of not purebred rabbits. The condition of surrounding tissues in 2 and 6 months after implantation was compared by light microscopy and X-ray methods. Within 6 months after operation the considerable distinctions of radiological and morphological data were revealed not. 2 months later after introduction of implants with a rough surface the effort enclosed for its twisting is, much more, than for removal of the polished product. However, stability of fixing of implants was practically made even at 6 months. On remote rough implants there is a set of tissue scraps whereas on products with a smooth surface the tissue remains were much less. Surrounding tissues strongly join a rough surface, grow into cavities, and during removal of such products there is a considerable trauma of tissues round an implantation place. Smooth implants have the smaller area of contact with organism tissues, they are fixed due to bicortical implantation, during removal easily get out and don’t break off surrounding tissues. The signs of inflammation and formation of merged multinuclear macrophages were not found at all cases, which give evidence to the inertness of material of the mentioned articles for living organism. In some observations however and by implantation of the rough article and by introduction of polished implants, metal particles were found, but after use of the foreign body with grit-blasted treatment of surface metal was found more frequently, and its fragments had larger volume.

Study of the bones tissue reparation using nanostructured titanium implants with hydroxylapatite coatings by scanning electron microscopy

A method of medical implants (biocomposites) preparation based on nanostructured titanium with nanocrystalline bioactive hydroxylapatite coatings is developed. The operative treatment using these implants improves the regeneration of bone tissue for rats, as compared to the “false-operated” animals. The morphological data at 7, 14, 21, 45 days are obtained by means of scanning electron microscopy and discussed.

Comparison of Success Rate and Radiological Bone Loss in Patients with Mini-Implant versus Conventional-Sized Implant Removable Prostheses: A Meta-Analysis

Background: The objective of this meta-analysis was to assess whether mini-implants have added benefit in terms of implants success rate and average bone loss over conventional-sized implants after one year of follow-up. Methods: An electronic search of randomized clinical trials was conducted in MEDLINE (via PubMed), Cochrane Central Register of Clinical Trials (CENTRAL) and Web of Science for studies including complete or partial edentulous patients requiring two or four mini-implants or conventional/ standard-sized implants in the maxilla or mandible for implant-supported removable prostheses who completed 12 months of follow-up. Results: The search provided 194 unique articles which were screened for title and abstract. Screening generated 12 articles which went through full-text analysis using eligibility criteria, and 4 articles were included for meta-analysis. Meta-analysis of these studies indicated a non-significant difference in the success rate between the two interventions (OR = 1.69 [0.74, 3.85;p = 0.21]). Bone loss estimates resulted in a significant bone reduction (Mean Difference = -0.74 [-0.95, -0.53;p < 0.05]) in favor of two mini-implants when compared with two conventional-sized implants, but when compared four mini- with two conventional-sized implants, the estimates were non-significant (Mean Difference = -0.24 [-0.69, 0.20;p = 0.29]). Conclusion: The current evidence does not provide solid evidence of the benefits of one intervention over the other. More studies with follow-up times of 10 and more years are needed as current studies have described the short-term outcomes.

Simultaneous Upper and Lower Jaw Extractions, Autogenous Bone Augmentation and Temporary Implant Placement with Immediate Loading

Aims: We expanded the known technique for simultaneously augmenting an atrophic maxilla and placement of immediate provisional implants (IPI), followed by immediate loading by performing surgery in both jaws simultaneously. Feasibility of this new technique, implant survival and success were evaluated as well as prosthetic success. Materials and Methods: All patients undergoing simultaneous bone grafting and IPI placement with immediate loading at our institute between the 1st of June 2016 and the 30th of May 2018 were included and followed up for at least one year postoperatively. Results: 3 patients were followed for a mean period of 25.67 months (20 - 29 months). 33 IPIs were placed. All were immobile at second stage surgery without signs of infection. No provisional bridges were lost and no infections were noted. After second stage surgery, none of these 36 final dental implants were lost. There was some bone loss at one implant. In all patients, good functional and aesthetic results were obtained without any unforeseen complications. This renders the implant survival at 100% and the success rate at 97%. Conclusion: The technique is complex due to the intricate step-by-step process that is required and depends on a dedicated team to ensure a proper workflow. When performed correctly, the protocol shows good and predictable results.

Design multifunctional Mg–Zr coatings regulating Mg alloy bioabsorption

Magnesium(Mg)alloys are widely used for temporary bone implants due to their favorable biodegradability,cytocompatibility,hemocompatibility,and close mechanical properties to bone.However,rapid degradation and inadequate strength limit their applicability.To overcome this,the direct current magnetron sputtering technique is employed for surface coating in Mg-based alloys using various zirconium(Zr)content.This approach presents a promising strategy for simultaneously improving corrosion resistance,maintaining biocompatibility,and enhancing strength without compromising osseointegration.By leveraging Mg’s inherent biodegradability,it has the potential to minimize the need for secondary surgeries,thereby reducing costs and resources.This paper is a systematic study aimed at understanding the corrosion mechanisms of Mg–Zr coatings,denoted Mg-xZr(x=0–5 at.%).Zr-doped coatings exhibited columnar growth leading to denser and refined structures with increasing Zr content.XRD analysis confirmed the presence of the Mg(00.2)basal plane,shifting towards higher angles(1.15°)with 5 at.%Zr doping due to lattice parameter changes(i.e.,decrease and increase of“c”and“a”lattice parameters,respectively).Mg–Zr coatings exhibited“liquidphilic”behavior,while Young’s modulus retained a steady value around 80 GPa across all samples.However,the hardness has significantly improved across all samples’coating,reaching the highest value of(2.2±0.3)GPa for 5 at.%Zr.Electrochemical testing in simulated body fluid(SBF)at 37℃ revealed a significant enhancement in corrosion resistance for Mg–Zr coatings containing 1.0–3.4 at.%Zr.Compared with the 5 at.%Zr coating which exhibited a corrosion rate of 32 mm/year,these coatings displayed lower corrosion rates,ranging from 1 to 12 mm/year.This synergistic enhancement in mechanical properties and corrosion resistance,achieved with 2.0–3.4 at.%Zr,suggests potential ability for reducing stress shielding and controlled degradation performance,and consequently,promising functional biodegradable materials for temporary bone implants.

Effect of the implant composite of poly lactide-co-glycolide and bone mesenchymal stem cells modified by basic fibroblast growth factor on injured spinal cord in rats

Objective To investigate the effect of the implant composite of poly lactide-co-glycolide(PLGA)and bone mesenchymal stem cells (BMSCs) modified by basic fibroblast growth factor (bFGF) on injured spinal cord in rats.Methods Two hundred and