Mg-Zr-Sr alloys as biodegradable implant materials

Novel Mg–Zr–Sr alloys have recently been developed for use as biodegradable implant materials. The Mg–Zr–Sr alloys were prepared by diluting Mg–Zr and Mg–Sr master alloys with pure Mg. The impact of Zr and Sr on the mechanical and biological properties has been thoroughly examined. The microstructures and mechanical properties of the alloys were characterized using optical microscopy, X-ray diffraction and compressive tests. The corrosion resistance was evaluated by electrochemical analysis and hydrogen evolution measurement. The in vitro biocompatibility was assessed using osteoblast-like SaOS2 cells and MTS and haemolysis tests. In vivo bone formation and biodegradability were studied in a rabbit model. The results indicated that both Zr and Sr are excellent candidates for Mg alloying elements in manufacturing biodegradable Mg alloy implants. Zr addition refined the grain size, improved the ductility, smoothed the grain boundaries and enhanced the corrosion resistance of Mg alloys. Sr addition led to an increase in compressive strength, better in vitro biocompatibility, and significantly higher bone formation in vivo. This study demonstrated that Mg–xZr–ySr alloys with x and y ⩽5 wt.% would make excellent biodegradable implant materials for load-bearing applications.

Effects of zirconium and strontium on the biocorrosion of Mg-Zr-Sr alloys for biodegradable implant applications

The successful applications of magnesium (Mg) alloys as biodegradable orthopedic implants are mainly restricted due to their rapid degradation rate in the physiological environment, leading to a loss of mechanical integrity. This study systematically investigated the degradation behaviors of novel Mg-Zr-Sr alloys using electrochemical techniques, hydrogen evolution, and weight loss in simulated body fluid (SBF). The microstructure and degradation behaviors of the alloys were characterized using optical microscopy, XRD, SEM, and EDX. The results indicate that Zr and Sr concentrations in Mg alloys strongly affected the degradation rate of the alloys in SBF. A high concentration of 5 wt% Zr led to acceleration of anodic dissolution, which significantly decreased the biocorrosion resistance of the alloys and their biocompatibility. A high volume fraction of Mg17Sr2 phases due to the addition of excessive Sr (over 5 wt%) resulted in enhanced galvanic effects between the Mg matrix and Mg17Sr2 phases, which reduced the biocorrosion resistance. The average Sr release rate is approximately 0.15 mg L^-1 day^-1, which is much lower than the body burden and proves its good biocompatibility. A new biocorrosion model has been established to illustrate the degradation of alloys and the formation of degradation products on the surface of the alloys. It can be concluded that the optimal concentration of Zr and Sr is less than 2 wt% for as-cast Mg-Zr-Sr alloys used as biodegradable orthopedic implants.

Effects of alloying elements on the corrosion behavior and biocompatibility of biodegradable magnesium alloys: a review

Magnesium (Mg) based alloys have been extensively considered for their use as biodegradable implant materials. However, controlling their corrosion rate in the physiological environment of the human body is still a significant challenge. One of the most effective approaches to address this challenge is to carefully select alloying compositions with enhanced corrosion resistance and mechanical properties when designing the Mg alloys. This paper comprehensively reviews research progress on the development of Mg alloys as biodegradable implant materials, highlighting the effects of alloying elements including aluminum (Al), calcium (Ca), lithium (Li), manganese (Mn), zinc (Zn), zirconium (Zr), strontium (Sr) and rare earth elements (REEs) on the corrosion resistance and biocompatibility of Mg alloys, from the viewpoint of the design and utilization of Mg biomaterials. The REEs covered in this review include cerium (Ce), erbium (Er), lanthanum (La), gadolinium (Gd), neodymium (Nd) and yttrium (Y). The effects of alloying elements on the microstructure, corrosion behavior and biocompatibility of Mg alloys have been critically summarized based on specific aspects of the physiological environment, namely the electrochemical effect and the biological behavior. This journal is © the Partner Organisations 2014.

Histologic and biomechanical evaluation of 2 resorbable-blasting media implant surfaces at early implantation times

This study evaluated 3 implant surfaces in a dog model: (1) resorbable-blasting media + acid-etched (RBMa), alumina-blasting + acid-etching (AB/AE), and AB/AE + RBMa (hybrid). All of the surfaces were minimally rough, and Ca and P were present for the RBMa and hybrid surfaces. Following 2 weeks in vivo, no significant differences were observed for torque, bone-to-implant contact, and bone-area fraction occupied measurements. Newly formed woven bone was observed in proximity with all surfaces.

Mechanical properties, in vitro corrosion and biocompatibility of newly developed biodegradable Mg-Zr-Sr-Ho alloys for biomedical applications

Our previous studies have demonstrated that Mg-Zr-Sr alloys can be anticipated as excellent biodegradable implant materials for load-bearing applications. In general, rare earth elements (REEs) are widely used in magnesium (Mg) alloys with the aim of enhancing the mechanical properties of Mg-based alloys. In this study, the REE holmium (Ho) was added to an Mg-1Zr-2Sr alloy at different concentrations of Mg1Zr2SrxHo alloys (x = 0, 1, 3, 5 wt. %) and the microstructure, mechanical properties, degradation behaviour and biocompatibility of the alloys were systematically investigated. The results indicate that the addition of Ho to Mg1Zr2Sr led to the formation of the intermetallic phases MgHo3, Mg2Ho and Mg17Sr2 which resulted in enhanced mechanical strength and decreased degradation rates of the Mg-Zr-Sr-Ho alloys. Furthermore, Ho addition (≤5 wt. %) to Mg-Zr-Sr alloys led to enhancement of cell adhesion and proliferation of osteoblast cells on the Mg-Zr-Sr-Ho alloys. The in vitro biodegradation and the biocompatibility of the Mg-Zr-Sr-Ho alloys were both influenced by the Ho concentration in the Mg alloys; Mg1Zr2Sr3Ho exhibited lower degradation rates than Mg1Zr2Sr and displayed the best biocompatibility compared with the other alloys.

Biological performance of a polycaprolactone-based scaffold plus recombinant human morphogenetic protein-2 (rhBMP-2) in an ovine thoracic interbody fusion model

Introduction. We develop a sheep thoracic spine interbody fusion model to study the suitability of polycaprolactone-based scaffold and recombinant human bone morphogenetic protein-2 (rhBMP-2) as a bone graft substitute within the thoracic spine. The surgical approach is a mini- open thoracotomy with relevance to minimally invasive deformity correction surgery for adolescent idiopathic scoliosis. To date there are no studies examining the use of this biodegradable implant in combination with biologics in a sheep thoracic spine model. Methods. In the present study, six sheep underwent a 3-level (T6/7, T8/9 and T10/11) discectomy with randomly allocated implantation of a different graft substitute at each of the three levels; (i) calcium phosphate (CaP) coated polycaprolactone based scaffold plus 0.54µg rhBMP-2, (ii) CaP coated PCL- based scaffold alone or (iii) autograft (mulched rib head). Fusion was assessed at six months post-surgery. Results. Computed Tomographic scanning demonstrated higher fusion grades in the rhBMP-2 plus PCL- based scaffold group in comparison to either PCL-based scaffold alone or autograft. These results were supported by histological evaluations of the respective groups. Biomechanical testing revealed significantly higher stiffness for the rhBMP-2 plus PCL- based scaffold group in all loading directions in comparison to the other two groups. Conclusions. The results of this study demonstrate that rhBMP-2 plus PCL-based scaffold is a viable bone graft substitute, providing an optimal environment for thoracic interbody spinal fusion in a large animal model.

Biological performance of a polycaprolactone-based scaffold plus recombinant human morphogenetic protein-2 (rhBMP-2) in an ovine thoracic interbody fusion model

PURPOSE. We develop a sheep thoracic spine interbody fusion model to study the suitability of polycaprolactone-based scaffold and recombinant human bone morphogenetic protein-2 (rhBMP-2) as a bone graft substitute within the thoracic spine. The surgical approach is a mini- open thoracotomy with relevance to minimally invasive deformity correction surgery for adolescent idiopathic scoliosis. To date there are no studies examining the use of this biodegradable implant in combination with biologics in a sheep thoracic spine model. METHODS. In the present study, six sheep underwent a 3-level (T6/7, T8/9 and T10/11) discectomy with randomly allocated implantation of a different graft substitute at each of the three levels; (i) calcium phosphate (CaP) coated polycaprolactone-based scaffold plus 0.54μg rhBMP-2, (ii) CaP coated PCL- based scaffold alone or (iii) autograft (mulched rib head). Fusion was assessed at six months post-surgery. RESULTS. Computed Tomographic scanning demonstrated higher fusion grades in the rhBMP-2 plus PCL- based scaffold group in comparison to either PCL-based scaffold alone or autograft. These results were supported by histological evaluations of the respective groups. Biomechanical testing revealed significantly higher stiffness for the rhBMP-2 plus PCL- based scaffold group in all loading directions in comparison to the other two groups. CONCLUSION. The results of this study demonstrate that rhBMP-2 plus PCL- based scaffold is a viable bone graft substitute, providing an optimal environment for thoracic interbody spinal fusion in a large animal model.

Biocompatible magnesium alloys for hard tissue engineering

 Novel Mg-Zr-Sr and Mg-1Zr-2Sr-xDy/yHo alloys have recently been developed for use as biodegradable implant materials. These alloys are recommended to be promising biodegradable implant materials as they have enhanced corrosion resistance and excellent biocompatibility.

Treatment of gingival recession: Comparative study between subepithelial connective tissue graft and guided tissue regeneration

Background: Various procedures have been proposed to treat gingival recession, but few studies compare these procedures to each other. The purpose of this study was to evaluate a clinical comparison of subepithelial connective tissue graft (SCTG) and guided tissue regeneration (GTR) with a collagen membrane in the treatment of gingival recessions in humans. Methods: Twenty-four defects were treated in 12 patients who presented canine or pre-molar Miller Class I and/or II bilateral gingival recessions. Both treatments were performed in all patients, and clinical measurements were obtained at baseline and 18 months after surgery. These clinical measurements included gingival recession height (GR), root coverage (RC), probing depth (PD), keratinized tissue width (KT), and final esthetic result. Results: Both SCTG and GTR with a bioabsorbable membrane and bone graft demonstrated significant clinical and esthetic improvement for gingival recession coverage. The SCTG group was statistically significantly better than GTR for height of GR (SCTG = 0.2 mm, GTR = 1.12 mm, P = 0.02) and KT (SCTG = 4.58 mm, GTR = 2.5 mm, P <0.0001). However, PD was statistically significantly better for GTR than SCTG treatment (GTR = 1.66 mm, SCTG = 1.00, P = 0.01). The 2 procedures were statistically similar in root coverage (SCTG = 95.6%, GTR = 84.2%, P = 0.073). The esthetic condition after both treatments was satisfactory (P = 0.024). Conclusions: It was concluded that the gingival recessions treated with the SCTG group were superior for GR, RC, and KT clinical parameters, while GTR demonstrated better PD reduction. The final esthetic results were similar using both techniques.

Histologic Evaluation of the Osteoinductive Property of Autogenous Demineralized Dentin Matrix on Surgical Bone Defects in Rabbit Skulls Using Human Amniotic Membrane for Guided Bone Regeneration

The aim of this investigation was to evaluate the osteoinductive property of autogenous demineralized dentin matrix (ADDM) on experimental surgical bone defects in the parietal bone of rabbits using the guided bone regeneration (GBR) technique incorporating human amniotic membrane (HAM). Thirty-six rabbits were divided into 2 groups, HAM and ADDM+HAM. It was possible to conclude that HAM did not interfere with bone repair and was resorbed. Slices of ADDM induced direct bone formation and were incorporated by the newly formed bone tissue and remodeled. The bone defects healed faster in the ADDM+HAM group than in the group with HAM only.

Histological outcomes on the development of new space-making devices for maxillary sinus floor augmentation

Background: Previous studies have pointed out that the mere elevation of the maxillary sinus membrane promotes bone formation without the use of augmentation materials. Purpose: This experimental study aimed at evaluating if the two-stage procedure for sinus floor augmentation could benefit from the use of a space-making device in order to increase the bone volume to enable later implant installation with good primary stability. Materials and Methods: Six male tufted capuchin primates (Cebus apella) were subjected to extraction of the three premolars and the first molar on both sides of the maxilla to create an edentulous area. The sinuses were opened using the lateral bone-wall window technique, and the membrane was elevated. One resorbable space-making device was inserted in each maxillary sinus, and the bone window was returned in place. The animals were euthanatized after 6 months, and biopsy blocks containing the whole maxillary sinus and surrounding soft tissues were prepared for ground sections. Results: The histological examination of the specimens showed bone formation in contact with both the schneiderian membrane and the device in most cases even when the device was displaced. The process of bone formation indicates that this technique is potentially useful for two-stage sinus floor augmentation. The lack of stabilization of the device within the sinus demands further improvement of space-makers for predictable bone augmentation. Conclusions: It is concluded that (1) the device used in this study did not trigger any important inflammatory reaction; (2) when the sinus membrane was elevated, bone formation was a constant finding; and (3) an ideal space-making device should be stable and elevate the membrane to ensure a maintained connection between the membrane and the secluded space. © 2009 Wiley Periodicals, Inc.

Avaliação da mucosa sinusal do coelho à presença de implante biodegradável

Pensando em melhorar a qualidade de vida dos pacientes com doenças do humor vítreo, os oftalmologistas começaram a utilizar recentemente implantes biodegradáveis com corticoide. Estes mesmos implantes podem ser uma alternativa no tratamento da RSC e, para isso, realizamos um estudo experimental em seios maxilares de coelhos. OBJETIVO: Avaliar histologicamente a mucosa de seio maxilar de coelhos após a colocação de implante biodegradável de prednisolona. MÉTODO: Dezoito coelhos foram divididos aleatoriamente em dois grupos: Grupo 1: no seio maxilar esquerdo foi inserido um implante biodegradável com prednisolona; Grupo 2: No seio maxilar esquerdo foi inserido um implante biodegradável sem medicação. Os seios maxilares do lado direito serviram como controle. Após 7, 14 e 28 dias foram escolhidos aleatoriamente três coelhos de cada grupo e a resposta tecidual inflamatória foi avaliada. RESULTADOS: Foi encontrada diferença não significativa de inflamação na mucosa, quando comparamos o grupo de coelhos que receberam implantes com e sem medicação com o grupo controle; ou quando comparamos o grupo que recebeu implante com prednisolona com o grupo que recebeu implante sem medicação. CONCLUSÃO: Não foram observados sinais de toxicidade ou inflamação na mucosa do seio maxilar do coelho à presença do implante com ou sem prednisolona.

An Investigation on Biocompatibility of Bio-Absorbable Polymer Coated Magnesium Alloys

Advances in biomaterials have enabled medical practitioners to replace diseased body parts or to assist in the healing process. In situations where a permanent biomaterial implant is used for a temporary application, additional surgeries are required to remove these implants once the healing process is complete, which increases medical costs and patient morbidity. Bio-absorbable materials dissolve and are metabolized by the body after the healing process is complete thereby negating additional surgeries for removal of implants. Magnesium alloys as novel bio-absorbable biomaterials, have attracted great attention recently because of their good mechanical properties, biocompatibility and corrosion rate in physiological environments. However, usage of Mg as biodegradable implant has been limited by its poor corrosion resistance in the physiological solutions. An optimal biodegradable implant must initially have slow degradation to ensure total mechanical integrity then degrade over time as the tissue heals. The current research focuses on surface modification of Mg alloy (MZC) by surface treatment and polymer coating in an effort to enhance the corrosion rate and biocompatibility. It is envisaged that the results obtained from this investigation would provide the academic community with insights for the utilization of bio-absorbable implants particularly for patients suffering from atherosclerosis. The alloying elements used in this study are zinc and calcium both of which are essential minerals in the human metabolic and healing processes. A hydrophobic biodegradable co-polymer, polyglycolic-co-caprolactone (PGCL), was used to coat the surface treated MZC to retard the initial degradation rate. Two surface treatments were selected: (a) acid etching and (b) anodization to produce different surface morphologies, roughness, surface energy, chemistry and hydrophobicity that are pivotal for PGCL adhesion onto the MZC. Additionally, analyses of biodegradation, biocompatibility, and mechanical integrity were performed in order to investigate the optimum surface modification process, suitable for biomaterial implants. The study concluded that anodization created better adhesion between the MZC and PGCL coating. Furthermore, PGCL coated anodized MZC exhibited lower corrosion rate, good mechanical integrity, and better biocompatibility as compared with acid etched.

Biodegradable Mg-Zr-Ca alloys for bone implant materials

Mg–Zr–Ca alloys were developed for new biodegradable bone implant materials. The microstructure and mechanical property of the Mg–xZr–yCa [x=0·5, 1·0% and y=1·0, 2·0% (wt-% hereafter)] alloys were characterised by optical microscopy, compressive and hardness tests. The in vitro cytotoxicity of the alloys was assessed using osteoblast-like SaOS₂ cells. The corrosion behaviour of these alloys was evaluated by soaking the alloys in simulated body fluid (SBF) and modified minimum essential medium (MMEM). Results indicated that the mechanical properties of the Mg–Zr–Ca are in the range of the mechanical properties of natural bone. The corrosion rate and biocompatibility decreases with the increase in the Ca content in the Mg–Zr–Ca alloys. The solutions of SBF and MMEM with the immersion of the Mg–Zr–Ca alloys show strong alkalisation. The Zr addition to the Mg–Zr–Ca alloys leads to an increase in the corrosion resistance, compressive strength and the ductility of the alloys, and a decrease in the elastic modulus of the Mg–Zr–Ca alloys.

Zirconium, calcium, and strontium contents in magnesium based biodegradable alloys modulate the efficiency of implant-induced osseointegration

Development of new biodegradable implants and devices is necessary to meet the increasing needs of regenerative orthopedic procedures. An important consideration while formulating new implant materials is that they should physicochemically and biologically mimic bone-like properties. In earlier studies, we have developed and characterized magnesium based biodegradable alloys, in particular magnesium-zirconium (Mg-Zr) alloys. Here we have reported the biological properties of four Mg-Zr alloys containing different quantities of strontium or calcium. The alloys were implanted in small cavities made in femur bones of New Zealand White rabbits, and the quantitative and qualitative assessments of newly induced bone tissue were carried out. A total of 30 experimental animals, three for each implant type, were studied, and bone induction was assessed by histological, immunohistochemical and radiological methods; cavities in the femurs with no implants and observed for the same period of time were kept as controls. Our results showed that Mg-Zr alloys containing appropriate quantities of strontium were more efficient in inducing good quality mineralized bone than other alloys. Our results have been discussed in the context of physicochemical and biological properties of the alloys, and they could be very useful in determining the nature of future generations of biodegradable orthopedic implants.