BMP-2-Loaded HAp:Ln3+ (Ln = Yb, Er, Gd) Nanorods with Dual-Mode Imaging for Efficient MC3t3-E1 Cell Differentiation Regulation.

Effective bone tissue reconstitution improves the treatment success rate of dental implantation and preserves natural teeth during periodontal tissue repair. Hydroxyapatite (HAp) has received much attention in bone remodeling field because its mineralized structure is similar to that of the natural bone tissue. For this reason, it has been used as a carrier for growth factors. Although HAp possesses outstanding biomedical properties, its capacity of loading and releasing bone growth factors and promoting osteogenesis is not well understood. In this study, Ln3+ (Ln = Yb3+, Er3+, Gd3+)-doped HAp (HAp:Ln3+) nanorods were synthesized by one-step hydrothermal method. To improve its biocompatibility and surface properties, bone morphogenetic protein-2 (BMP-2) was loaded onto the surface of HAp:Ln3+ nanorods. The results showed that BMP-2 incorporation promoted bone formation and enhanced the expression of early bone-related gene and protein (RunX2, SP7, OPN). In addition, Yb3+- and Er3+-doped HAp nanorods were examined by upconversion luminescence with 980 nm near-infrared laser irradiation to monitor the delivery position of BMP-2 protein. Furthermore, due to the positive magnetism correlated with the concentration of Gd3+, HAp:Ln3+ with enhanced contrast brightening can be deemed as T1 MIR contrast agents. These findings indicate that HAp doped with rare-earth ions and loaded with BMP-2 has the potential to promote bone tissue repair and execute dual-mode imaging.

Electron microscopy analysis of the thermal phase transition from hydroxyapatita to ß-TCP observed in human teeth.

Samples of enamel and dentin from human molar teeth were heated in air from room temperature (25°C) up to 1200°C and the phase transition from hydroxyapatite (HAP) to tricalcium phosphate (ß-TCP) was recorded. The changes produced in morphology and chemical composition in the tooth during heating were analysed by light microscopy, scanning electron microscopy (SEM), characteristic x-ray energy dispersion spectroscopy (EDS), x-ray diffraction (XRD), electron diffraction, transmission electron microscopy (TEM) and high-resolution electron microscopy (HRTEM). The results indicated a high correlation relationship among Ca content, P content, O content and Na content, and the existence of the Kirkendall effect during the HAP- ß-TCP phase transition. LAY DESCRIPTION: This work is related with tooth materials. Samples of enamel and dentine from human molar teeth were heated in air from 25°C up to 1200°C and the phase transition from hydroxyapatite (HAP) to tricalcium phosphate (ß-TCP) was recorded. The ß-TCP phase is also known as whitlockite. The changes produced in morphology and chemical composition in the tooth during heating were analysed by electron microscopy and X-ray diffraction. The results indicated a high correlation relationship among Ca, P, O and Na contents, and the existence of the Kirkendall effect, the atomic diffusion producing voids, during the HAP- ß-TCP phase transition.

Thermoluminescence properties of gamma-irradiated nano-structure hydroxyapatite.

The suitability of nano-structured hydroxyapatite (HAP) for use as a thermoluminescence dosimeter was investigated. HAP samples were synthesized using a hydrolysis method. The formation of nanoparticles was confirmed by X-ray diffraction and average particle size was estimated to be ~30 nm. The glow curve exhibited a peak centered at around 200 °C. The additive dose method was applied and this showed that the thermoluminescence (TL) glow curves follow first-order kinetics due to the non-shifting nature of Tm after different doses. The numbers of overlapping peaks and related kinetic parameters were identified from Tm -Tstop through computerized glow curve deconvolution methods. The dependence of the TL responses on radiation dose was studied and a linear dose response up to 1000 Gy was observed for the samples.

Internal in vitro dosimetry for fish using hydroxyapatite-based EPR detectors.

A number of aquatic ecosystems were exposed to ionizing radiation as a result of the activities of the Mayak Production Association in the Southern Urals, former Soviet Union, in the 1950s. Currently, fishes inhabiting contaminated lakes are being actively studied. These investigations need dosimetric support. In the present paper the results of a pilot study for elaborating an EPR dosimeter which can be used for internal dosimetry in vitro are described. Biological hydroxyapatite is proposed here to be used as a detecting substance. More specifically, small hydroxyapatite grains are proposed for use as point detectors fixed in a solid matrix. After having been pelletized, the detectors were covered by Mylar and placed in the body of a fish to be stored in the fridge for several months. Application of the detectors for internal fish dosimetry demonstrated that the enamel sensitivity is sufficient for passive detection of ionizing radiation in fishes inhabiting contaminated lakes in the Southern Urals.

Combination of EPR measurements and DFT calculations to study nitrate impurities in the carbonated nanohydroxyapatite.

We demonstrate the application of the combined experimental-computational approach for studying the anionic impurities in hydroxyapatite (HAp). Influence of the carbonation level (x) on the concentration of the NO3(2-) radicals in the HAp nanocrystals of Ca10-xNax(PO4)6-x(CO3)x(OH)2 with x in the range 0 < x < 2 and average sizes of 30 nm is investigated by different analytical methods including electron paramagnetic resonance (EPR). Stable NO3(2-) radicals are formed under X-ray irradiation of nano-HAp samples from NO3(-) ions incorporated in trace amounts during the wet synthesis process. Density functional theory (DFT) based calculations show energetic preference for the PO4 group substitution by NO3(-) ions. Comparison of the calculated and experimental spectroscopic parameters (g and hyperfine tensors) reveals that EPR detects the NO3(2-) radicals located in the positions of the PO4 group only. It is shown that with the increase in x, the carbonate ions substitute the NO3(2-)/NO3(-) ions. DFT calculations confirm that carbonate incorporation in HAp structure is energetically more favorable than the formation of the nitrate defect.

Thermal, creep-recovery and viscoelastic behavior of high density polyethylene/hydroxyapatite nano particles for bone substitutes: effects of gamma radiation.

BACKGROUND: High Density Polyethylene (HDPE) is one of the most often used polymers in biomedical applications. The limitations of HDPE are its visco-elastic behavior, low modulus and poor bioactivity. To improve HDPE properties, HA nanoparticles can be added to form polymer composite that can be used as alternatives to metals for bone substitutes and orthopaedic implant applications. METHOD: In our previous work (BioMedical Engineering OnLine 2013), different ratios of HDPE/HA nanocomposites were prepared using melt blending in a co-rotating intermeshing twin screw extruder. The accelerated aging effects on the tensile properties and torsional viscoelastic behavior (storage modulus (G') and Loss modulus (G")) at 80°C of irradiated and non-irradiated HDPE/HA was investigated. Also the thermal behavior of HDPE/HA were studied. In this study, the effects of gamma irradiation on the tensile viscoelastic behavior (storage modulus (E') and Loss modulus (E")) at 25°C examined for HDPE/HA nanocomposites at different frequencies using Dynamic Mechanical Analysis (DMA). The DMA was also used to analyze creep-recovery and relaxation properties of the nanocomposites. To analyze the thermal behavior of the HDPE/HA nanocomposite, Differential Scanning Calorimetry (DSC) was used. RESULTS: The microscopic examination of the cryogenically fractured surface revealed a reasonable distribution of HA nanoparticles in the HDPE matrix. The DMA showed that the tensile storage and loss modulus increases with increasing the HA nanoparticles ratio and the test frequency. The creep-recovery behavior improves with increasing the HA nanoparticle content. Finally, the results indicated that the crystallinity, viscoelastic, creep recovery and relaxation behavior of HDPE nanocomposite improved due to gamma irradiation. CONCLUSION: Based on the experimental results, it is found that prepared HDPE nanocomposite properties improved due to the addition of HA nanoparticles and irradiation. So, the prepared HDPE/HA nanocomposite appears to have fairly good comprehensive properties that make it a good candidate as bone substitute.

Surface charge and carbon contamination on an electron-beam-irradiated hydroxyapatite thin film investigated by photoluminescence and phase imaging in atomic force microscopy.

The surface properties of hydroxyapatite, including electric charge, can influence the biological response, tissue compatibility, and adhesion of biological cells and biomolecules. Results reported here help in understanding this influence by creating charged domains on hydroxyapatite thin films deposited on silicon using electron beam irradiation and investigating their shape, properties, and carbon contamination for different doses of incident injected charge by two methods. Photoluminescence laser scanning microscopy was used to image electrostatic charge trapped at pre-existing and irradiation-induced defects within these domains, while phase imaging in atomic force microscopy was used to image the carbon contamination. Scanning Auger electron spectroscopy and Kelvin probe force microscopy were used as a reference for the atomic force microscopy phase contrast and photoluminescence laser scanning microscopy measurements. Our experiment shows that by combining the two imaging techniques the effects of trapped charge and carbon contamination can be separated. Such separation yields new possibilities for advancing the current understanding of how surface charge influences mediation of cellular and protein interactions in biomaterials.

Effect of gamma irradiation on structural and biological properties of a PLGA-PEG-hydroxyapatite composite.

Gamma irradiation is able to affect various structural and biological properties of biomaterials In this study, a composite of Hap/PLGA-PEG and their ingredients were submitted to gamma irradiation doses of 25 and 50 KGy. Various properties such as molecular weight (GPC), thermal behavior (DSC), wettability (contact angle), cell viability (MTT assay), and alkaline phosphatase activity were studied for the composites and each of their ingredients. The results showed a decrease in molecular weight of copolymer with no change in the glass transition and melting temperatures after gamma irradiation. In general gamma irradiation can increase the activation energy ΔH of the composites and their ingredients. While gamma irradiation had no effect on the wettability of copolymer samples, there was a significant decrease in contact angle of hydroxyapatite and composites with increase in gamma irradiation dose. This study showed an increase in biocompatibility of hydroxyapatite with gamma irradiation with no significant effect on cell viability in copolymer and composite samples. In spite of the fact that no change occurred in alkaline phosphatase activity of composite samples, results indicated a decrease in alkaline phosphatase activity in irradiated hydroxyapatites. These effects on the properties of PLGA-PEG-hydroxyapatite can enhance the composite application as a biomaterial.

Calcium hydroxylapatite filler: an overview of safety and tolerability.

Soft tissue fillers are becoming increasingly important as nonsurgical treatment options for facial rejuvenation. Calcium hydroxylapatite (CaHA) is an injectable dermal filler that contains uniform CaHA microspheres suspended in an aqueous carboxymethylcellulose gel carrier. It is considered a long-lasting, but non-permanent filler, and is highly biocompatible with human tissue. No osteogenesis has been reported in extensive literature describing the use of CaHA in a variety of soft tissue applications. Injection of CaHA into the oral mucosa and the lips is an unapproved indication and may result in nodule formation. This occurs soon after injection and is a result of accumulated particles and not a granulomatous reaction. As with all biodegradable dermal fillers, CaHA can be associated with rare incidences of foreign body reactions, but only a handful of case reports have been documented in 10 years of clinical use. CaHA can be associated with local, short-term, injection-related adverse events, which are generally mild and resolve within a few days. Clinical trials that have followed patients for up to 3 years post-injection report no long-term or delayed-onset adverse events. CaHA is an effective and safe treatment option for a variety of aesthetic indications. This paper focuses on common safety concerns of patients and aesthetic physicians, including unfounded fears of osteogenesis and foreign body granulomas, providing an up-to-date overview of the tolerability and long-term safety of CaHA for aesthetic indications.

The effect of Er:YAG laser irradiation on hydroxyapatite-coated implants and fluoride-modified TiO2-blasted implant surfaces: a microstructural analysis.

The purpose of this study was to evaluate the microscopic changes and surface roughness on hydroxyapatite (HA)-coated implants following exposure to different powers and durations of Er:YAG laser irradiation in order to determine the proper pulse energy level and irradiation time. Ten HA-coated implants and ten fluoride-modified TiO2 implants were used. The implants were divided into a control (one implant) and test group (nine implants) for each implant type. Implants in the test groups were sub-divided into three groups (three implants per group) based on the applied laser pulse energy and irradiation time. The measurement of surface roughness was performed on all implants in the test groups using a white light interferometer before and after laser irradiation. R a values were recorded and compared in order to evaluate changes in surface roughness. For HA-coated implants, the R a values increased in all test groups after laser irradiation. However, mean R a values in the fluoride-modified TiO2-blasted implant test group were decreased after irradiation. There was no statistical difference. Scanning electron microscope analysis revealed surface alterations in both the HA-coated and fluoridated TiO2-blasted implants irradiated for 1.5 min at 100 mJ/pulse, 10 Hz. When the pulse energy and irradiation time increased, greater surface alterations, including surface flattening and microfractures, were observed. In conclusion, the results of the current study suggest that no changes could be observed in both HA-coated implants and fluoride-modified TiO2-blasted implants after irradiation at an intensity of 100 mJ/pulse, 10 Hz for 1 min performed to achieve surface detoxification.

Carbon-centered radicals in γ-irradiated bone substituting biomaterials based on hydroxyapatite.

Gamma irradiated synthetic hydroxyapatite, bone substituting materials NanoBone(®) and HA Biocer were examined using EPR spectroscopy and compared with powdered human compact bone. In every case, radiation-induced carbon centered radicals were recorded, but their molecular structures and concentrations differed. In compact bone and synthetic hydroxyapatite the main signal assigned to the CO(2) (-) anion radical was stable, whereas the signal due to the CO(3) (3-) radical dominated in NanoBone(®) and HA Biocer just after irradiation. However, after a few days of storage of these samples, also a CO(2) (-) signal was recorded. The EPR study of irradiated compact bone and the synthetic graft materials suggest that their microscopic structures are different. In FT-IR spectra of NanoBone(®), HA Biocer and synthetic hydroxyapatite the HPO(4) (2-) and CO(3) (2-) in B-site groups are detected, whereas in compact bone signals due to collagen dominate.

Effects of sterilisation by high-energy radiation on biomedical poly-(epsilon-caprolactone)/hydroxyapatite composites.

The effects of a high energy sterilization treatment on poly-epsilon-caprolactone/carbonated hydroxyapatite composites have been investigated. Poly-epsilon-caprolactone is a biodegradable polymer used as long-term bioresorbable scaffold for bone tissue engineering and carbonated hydroxyapatite is a bioactive material able to promote bone growth. The composites were gamma-irradiated in air or under nitrogen atmosphere with doses ranging from 10 to 50 kGy (i.e. to a value higher than that recommended for sterilization). The effects of the irradiation treatment were evaluated by vibrational spectroscopy (IR and Raman spectroscopies) coupled to thermal analysis (Differential Scanning Calorimetry and Thermogravimetry) and Electron Paramagnetic Resonance spectroscopy. Irradiation with the doses required for sterilization induced acceptable structural changes and damaging effects: only a very slight fragmentation of the polymeric chains and some defects in the inorganic component were observed. Moreover, the radiation sensitivity of the composites proved almost the same under the two different atmospheres.

Ultraviolet irradiation improves the hydrophilicity and osteo-conduction of hydroxyapatite.

BACKGROUND: Treating a titanium or titanium alloy implant with ultraviolet (UV) light is known to improve its associated cell growth and osseointegration. However, little is known about the effect of UV irradiation on hydroxyapatite (HA), which is also used frequently in orthopaedic and dental surgery. Here we examined the effect of UV irradiation on the hydrophilicity of HA, and on its osteoconduction ability in rats. METHODS: HA implants of low and high porosity were treated with UV light, and photofunctionalisation was assessed by the contact angle of a water drop on the surface. HA implants were also inserted into rat femurs, and the rats were killed 2 or 4 weeks later. The bone volume and bone area ratio were calculated from microcomputed tomography and histological data. RESULTS: The contact angle of a water drop on HA implants of both porosities was significantly reduced after UV irradiation. In the rat femurs, there was no significant difference in the bone volume between the UV light-treated and control implants at 2 or 4 weeks. The bone area ratio for the UV light-treated versus control implants was significantly increased at 2 weeks, but there was no significant difference at 4 weeks. CONCLUSIONS: The surface of UV-irradiated HA disks was hydrophilic, in contrast to that of non-irradiated HA disks. Photofunctionalisation accelerated the increase in the bone area ratio in the early healing stage. This technology can be applied to surgical cases requiring the early fusion of bone and HA.

X-band EPR imaging as a tool for gradient dose reconstruction in irradiated bones.

PURPOSE: Various tools are currently available for dose reconstruction in individuals after accidental exposure to ionizing radiation. Among the available biological analyses, Monte Carlo simulations, and biophysical methods, such as electron paramagnetic resonance (EPR), the latter has proved its usefulness for retrospective dosimetry. Although EPR spectroscopy is probably the most sensitive technique, it does not provide spatial dosimetric data. This information is, however, highly desirable when steep dose gradient irradiations are involved. The purpose of this work was to explore the possibilities of EPR imaging (EPRI) for spatial dose reconstruction in irradiated biological material. METHODS: X-band EPRI was used to reconstruct ex vivo the relative dose distribution in human bone samples and hydroxyapatite phantoms after irradiation with brachytherapy seeds or x rays. Three situations were investigated: Homogeneous, stepwise gradient, and continuous gradient irradiation. RESULTS: EPRI gave a faithful relative spin density distribution in bone samples and in hydroxyapatite phantoms. Measured dose ratios were in close agreement with the actual delivered dose ratios. EPRI was able to distinguish the dose gradients induced by two different sources (125I and 192Ir). However, the measured spatial resolution of the system was 1.9 mm and this appeared to be a limiting factor. The method could be improved by using new signal postprocessing strategies. CONCLUSIONS: This study demonstrates that EPRI can be used to assess the regional relative dose distribution in irradiated bone samples. The method is currently applicable to ex vivo measurements of small size samples with low variation in tissue density but is likely to be adapted for in vivo application using L-band EPRI.

Investigations on the in vitro bioactivity of swift heavy oxygen ion irradiated hydroxyapatite.

The effect of swift heavy oxygen ion irradiation of hydroxyapatite on its in vitro bioactivity was studied. The irradiation experiment was performed using oxygen ions at energy of 100 MeV with 1 x 10(12) and 1 x 10(13) ions/cm2 fluence range. The irradiated samples were characterized by glancing angle X-ray diffraction (GXRD), photoluminescence spectroscopy (PL) and scanning electron microscopy (SEM). GXRD showed that irradiated samples exhibited better crystallinity. The irradiated samples revealed an increase in PL intensity. In addition, the irradiated hydroxyapatite was found to have enhanced bioactivity.

In situ synthesis of hydroxyapatite coating by laser cladding.

HA bioceramic coatings were synthesized on titanium substrate by laser cladding using cheap calcium carbonate and calcium hydrogen phosphate. The thermodynamic condition for synthesizing HA was calculated by software Matlab 5.0, the microstructure and phase analysis of laser clad HA bioceramic coatings were studied by electron probe microanalyser (EPMA), X-ray diffractometer (XRD) and transmission electron microscopy (TEM). The theoretical results show that the Gibbs free enthalpy for the synthesis of HA phase is satisfied, and the presence of HA phase in the clad coatings was then further verified by XRD and the selected area diffraction patterns. When the laser power is 600W and the scanning speed is 3.5mm/s, the compact HA bioceramic coatings were obtained, which have cellular dendritic structure and consist of the phases of HA, alpha-Ca(2)P(2)O(7), CaO and CaTiO(3).

Influence of Er,Cr:YSGG laser treatment on microtensile bond strength of adhesives to enamel.

The current trend towards minimum-intervention dentistry has introduced laser technology as an alternative technique for cavity preparation. This study assessed the null hypothesis that enamel prepared either by Er,Cr:YSGG laser or conventional diamond bur is equally receptive to adhesive procedures. The buccal and lingual surfaces of 35 sound human molars were prepared with Er,Cr:YSGG laser or a medium-grit diamond bur. One etch&rinse (OptiBond FL) and three self-etch adhesives (Adper Prompt L-Pop, Clearfil SE Bond and Clearfil S3 Bond) were applied on laser-irradiated and bur-cut enamel, followed by the application of a 5-6 mm build-up of Z100. The micro-tensile bond strength (microTBS) was determined after 24 hours of storage in water at 37 degrees C. Prepared enamel surfaces and failure patterns were evaluated using a stereomicroscope and a field-emission-gun scanning electron microscope (Feg-SEM). The pTBS to laser-irradiated enamel was significantly lower than to bur-cut enamel (p<0.05), with the exception of Clearfil S3 Bond, which bonded equally effectively to both substrates. The latter presented the highest microTBS on laser-irradiated enamel, though it was not statistically different from the microTBS of OptiBond FL. SEM analysis revealed significant morphological alterations of the laser-irradiated enamel surface, such as areas of melted and recrystalized hydroxyapatite and deep extensive micro-cracks. In conclusion, the bonding effectiveness of adhesives to laser-irradiated enamel depends not only on the structural substrate alterations induced by the laser, but also on the characteristics of the adhesive employed.

Intracoronal stress transfer through enamel following RBC photopolymerisation: A synchrotron X-ray study.

OBJECTIVES: To measure the spatial distribution of crystallographic strain in tooth enamel induced by the photo-polymerisation of a dimethacrylate resin based composite cavity restoration. METHODS: Six sound first premolar teeth, allocated into two groups (n=3), were prepared with mesio-occlusal distal cavities. The enamel was machined at the point of maximum convexity on the outer tooth to create a vertical fin of thickness 100µm and 0.5mm depth to allow for synchrotron X-ray diffraction measurements. 2D diffraction patterns were used to determine crystallite orientation and quantify changes in the hydroxyapatite crystal lattice parameters, before and after photo-polymerisation of a composite material placed in the cavity, to calculate strain in the respective axis. The composite was photo-polymerised with either relatively high (1200mWcm-2, group 1) or low (480mWcm-2, group 2) irradiances using LED or quartz halogen light sources, respectively. A paired t-test was used to determine significant differences in strain between irradiance protocols at ɑ=0.001. RESULTS: Photo-polymerisation of the composite in the adjacent cavity induced significant changes in both the crystallographic c and a axes of the enamel measurement area. However the magnitude of strain was low with ∼0.1% difference before and after composite photo-polymerisation. Strain in enamel was not uniformly distributed and varied spatially as a function of crystallite orientation. Increased alignment of crystallites perpendicular to the cavity wall was associated with higher c axis strain. Additionally, strain was significantly greater in the c (p<0.001) and a axis (p<0.001) when using a high irradiance photo-polymerisation protocol. SIGNIFICANCE: Although cuspal deflection is routinely measured to indirectly assess the 'global' effect of composite shrinkage on the tooth-restoration complex, here we show that absolute strains generated in enamel are low, indicating strain relief mechanisms may be operative. The use of low irradiance protocols for photo-polymerisation resulted in reduced strain.

Study of laser created ZRO2 and hydroxyapatite/ZrO2 films for implantology.

Thin films of ZrO2 and hydroxyapatite/ZrO2 were created by excimer laser ablation on Ti6Al4V substrates. ZrO2 layers were fabricated in vacuum by KrF laser at various substrate temperatures and hydroxyapatite (HA) layers were fabricated in water vapor ambient by ArF laser and in water vapor/argon ambient by KrF excimer laser. Film properties were evaluated by XRD, SEM and WDX methods. The test of mechanical adhesion was proceeded on ZrO2 films. XRD analysis proved the presence of amorphous or crystalline HA in the deposited films. SEM method demonstrated smooth surface covered by droplets for both HA and ZrO2 films. Ca/P ratio of the HA films is higher than that of the natural HA and is within the range of 2.8-3.0. The HA/ZrO2 and ZrO2 samples were tested in vitro for cytotoxicity. The best results were received by the HA/ZrO2 samples in the test of cytotoxicity. Fibroblasts cultivating with HA/ZrO2 samples exhibited subconfluent and confluent growth and showed fibronectin homogenously.

Influence of backscatter radiation on cranial reconstruction implants.

OBJECTIVE: We aimed to evaluate backscatter dose variations in different cranial bone implant materials in an experimental model designed to simulate post-operative radiotherapy. METHODS: We assessed the radiation backscatter doses associated with sheet- and mesh-type titanium plates and hydroxyapatite (HAP) samples (porosity: 35%, 50% and 85%). The samples were irradiated with 6- and 10-MV photon beams from a linear accelerator. Measurements were obtained using an ionization chamber and radiochromic films cut from the same batch. RESULTS: At 6 MV, the titanium sheet showed the highest peak for backscattered radiation, followed by (in decreasing order) HAP30%, HAP50%, titanium mesh and HAP85%. At 10 MV, HAP30% showed the highest peak, followed by HAP50%, titanium sheet, titanium mesh and HAP85%. The peaks were at different depths in the titanium and HAP samples. The thickness of the human scalp is approximately 7 mm; therefore, measurements were obtained 0-7 mm above the implants to assess the likely dose on the scalp. A comparison of the maximum dose on the scalp showed the titanium sheet had the highest dose at both 6 and 10 MV. CONCLUSION: The backscatter dose differed with the density of the material and the backscatter depth was different for each material. Advances in knowledge: Ulcer formation due to radiotherapy after brain tumour depends on not only radiation but also the implant material. Therefore, the density and type of implant material should be considered when planning radiotherapy and selecting bone reconstruction materials.