3D plotting in the preparation of newberyite, struvite, and brushite porous scaffolds: using magnesium oxide as a starting material.

Calcium phosphate (CaP)-containing materials, such as hydroxyapatite and brushite, are well studied bone grafting materials owing to their similar chemical compositions to the mineral phase of natural bone and kidney calculi. In recent studies, magnesium phosphate (MgP)-containing compounds, such as newberyite and struvite, have shown promise as alternatives to CaP. However, the different ways in degradation and release of Mg2+ and Ca2+ ions in vitro may affect the biocompatibility of CaP and MgP-containing compounds. In the present paper, newberyite, struvite, and brushite 3D porous structures were constructed by 3D-plotting combining with a two-step cementation process, using magnesium oxide (MgO) as a starting material. Briefly, 3D porous green bodies fabricated by 3D-plotting were soaked in (NH4)2HPO4 solution to form semi-manufactured 3D porous structures. These structures were then soaked in different phosphate solutions to translate the structures into newberyite, struvite, and brushite porous scaffolds. Powder X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy dispersive spectrometry (EDS) were used to characterize the phases, morphologies, and compositions of the 3D porous scaffolds. The porosity, compressive strength, in vitro degradation and cytotoxicity on MC3T3-E1 osteoblast cells were assessed as well. The results showed that extracts obtained from immersing scaffolds in alpha-modified essential media induced minimal cytotoxicity and the cells could be attached merely onto newberyite and brushite scaffolds. Newberyite and brushite scaffolds produced through our 3D-plotting and two-step cementation process showed the sustained in vitro degradation and excellent biocompatibility, which could be used as scaffolds for the bone tissue engineering.

Diffusion-Controllable Biomineralization Conducted In Situ in Hydrogels Based on Reversibly Cross-Linked Hyperbranched Polyglycidol.

We present biocompatible hydrogel systems suitable for biomineralization processes based on hyperbranched polyglycidol cross-linked with acrylamide copolymer bearing carbonyl-coordinated boronic acid. At neutral pH, diol functional groups of HbPGL react with boronic acid of polyacrylamide to generate 3D network in water by the formation of boronic ester cross-links. The dynamic associative/dissociative characteristics of the cross-links makes the network reversible. The presented hydrogels display self-healing properties and are injectable, facilitating gap filing of bone tissue. The 1H HR MAS DOSY NMR studies reveal that acrylamide copolymer plays the role of the network framework, whereas HbPGL macromolecules, due to their compact structure, move between reactive sites of the copolymer. The influence of the copolymer macromolecules entanglements and overall polymer concentrations on macromolecules mobility and stress relaxation processes is investigated. The process of hydrogel biomineralization results from hydrolysis of 1-naphthyl phosphate calcium salt catalyzed by encapsulation in hydrogel alkaline phosphatase. The environment of the hydrogel is entirely neutral toward the enzyme. However, the activity of alkaline phosphatase encapsulated within the hydrogel structure is diffusion-limited. In this article, based on the detailed characteristics of three model hydrogel systems, we demonstrate the influence of the hydrogel permeability on the encapsulated enzyme activity and calcium phosphate formation rate. The 1H HR MAS DOSY NMR is used to monitor diffusion low-molecular weight compound within hydrogels, whereas 31P HR MAS NMR facilitates monitoring of the progress of biomineralization in situ within hydrogels. The results show a direct correlation between low molecular diffusivity in hydrogels and network dynamics. We demonstrate that the morphology of in situ-generated calcium phosphate within three model HbPGL/poly(AM-ran-APBA) hydrogels of different low molecular permeability varies substantially from sparsely deployed large, well-defined crystals to an even distribution within the polymers polycrystalline continuous network.

Different post-processing conditions for 3D bioprinted α-tricalcium phosphate scaffolds.

The development of 3D printing hardware, software and materials has enabled the production of bone substitute scaffolds for tissue engineering. Calcium phosphates cements, such as those based on α-tricalcium phosphate (α-TCP), have recognized properties of osteoinductivity, osteoconductivity and resorbability and can be used to 3D print scaffolds to support and induce tissue formation and be replaced by natural bone. At present, however, the mechanical properties found for 3D printed bone scaffolds are only satisfactory for non-load bearing applications. This study varied the post-processing conditions of the 3D powder printing process of α-TCP cement scaffolds by either immersing the parts into binder, Ringer's solution or phosphoric acid, or by sintering in temperatures ranging from 800 to 1500 °C. The porosity, composition (phase changes), morphology, shrinkage and compressive strength were evaluated. The mechanical strength of the post-processed 3D printed scaffolds increased compared to the green parts and was in the range of the trabecular bone. Although the mechanical properties achieved are still low, the high porosity presented by the scaffolds can potentially result in greater bone ingrowth. The phases present in the scaffolds after the post-processing treatments were calcium-deficient hydroxyapatite, brushite, monetite, and unreacted α-TCP. Due to their chemical composition, the 3D printed scaffolds are expected to be resorbable, osteoinductive, and osteoconductive.

Design of an inorganic dual-paste apatite cement using cation exchange.

The use of hydraulic calcium phosphate cements (CPCs) as bone substitute is impaired by their relatively poor handling due to the need to mix a powder and a liquid during surgery. The aim of the present study was to assess the possibility to design CPCs as inorganic dual-paste cements, where both pastes would be stable for years, but would react as soon as they are mixed together. Results showed that aqueous pastes of α-tricalcium phosphate (α-TCP) powder could be stabilized for up to a year at room temperature by the use of 0.1 M Mg chloride solution. Adding a calcium chloride solution in a 1:4 volume ratio activated α-TCP pastes provided the Ca/Mg ratio was larger than one. Mechanistic investigations suggest that Ca ions can displace Mg cations adsorbed at the surface of α-TCP particles to initiate α-TCP transformation to calcium-deficient hydroxyapatite and concomitant paste hardening. The compressive strength (29 MPa) was similar to that of commercial formulations (5-80 MPa). Other divalent cations (Ba, Ni, Sr) had a similar effect although with a different degree of efficacy.

Setting time and formability of calcium phosphate cements prepared using modified dicalcium phosphate anhydrous powders.

Calcium phosphate cements (CPCs) were prepared using Ca4(PO4)2O (TeCP) and modified CaHPO4 (DCPA) to evaluate the effects of the powder properties for DCPA particles on the setting time and formability of the resulting CPCs. Two types of modified DCPA were prepared by milling commercially available DCPA with ethanol (to produce E-DCPA) or distilled water (to produce W-DCPA). The E-DCPA samples consisted of well-dispersed, fine primary particles, while the W-DCPA samples contained agglomerated particles, and had a smaller specific surface area. The mean particle size decreased with increased milling time in both cases. The raw CPC powders prepared using W-DCPA had a higher packing density than those prepared using E-DCPA, regardless of the mean particle size. The setting time of the CPC paste after mixing with distilled water decreased with decreases in the mean particle size and specific surface area, for both types of DCPA. The CPCs prepared using W-DCPA showed larger plasticity values compared with those prepared using E-DCPA, which contributed to the superior formability of the W-DCPA samples. The CPCs prepared using W-DCPA showed a short setting time and large plasticity values, despite the fact that only a small amount of liquid was used for the mixing of the raw CPC powders (a liquid-to-powder ratio of 0.25 g g(-1) was used). It is likely that the higher packing density of the raw CPC powders prepared using W-DCPA was responsible for the higher performance of the resulting CPCs.

Apatite bone cement reinforced with calcium silicate fibers.

Several research efforts have been made in the attempt to reinforce calcium phosphate cements (CPCs) with polymeric and carbon fibers. Due to their low compatibility with the cement matrix, results were not satisfactory. In this context, calcium silicate fibers (CaSiO3) may be an alternative material to overcome the main drawback of reinforced CPCs since, despite of their good mechanical properties, they may interact chemically with the CPC matrix. In this work CaSiO3 fibers, with aspect ratio of 9.6, were synthesized by a reactive molten salt synthesis and used as reinforcement in apatite cement. 5 wt.% of reinforcement addition has increased the compressive strength of the CPC by 250% (from 14.5 to 50.4 MPa) without preventing the cement to set. Ca and Si release in samples containing fibers could be explained by CaSiO3 partial hydrolysis which leads to a quick increase in Ca concentration and in silica gel precipitation. The latter may be responsible for apatite precipitation in needle like form during cement setting reaction. The material developed presents potential properties to be employed in bone repair treatment.

Development of a novel calcium phosphate cement composed mainly of calcium sodium phosphate with high osteoconductivity.

Two novel calcium phosphate cements (CPC) have been developed using calcium sodium phosphate (CSP) as the main ingredient. The first of these cements, labeled CAC, contained CSP, α-tricalcium phosphate (TCP), and anhydrous citric acid, whereas the second, labeled CABC, contained CSP, α-TCP, ß-TCP, and anhydrous citric acid. Biopex(®)-R (PENTAX, Tokyo, Japan), which is a commercially available CPC (Com-CPC), and OSferion(®) (Olympus Terumo Biomaterials Corp., Tokyo, Japan), which is a commercially available porous ß-TCP, were used as reference controls for analysis. In vitro analysis showed that CABC set in 5.7 ± 0.3 min at 22 °C and had a compressive strength of 86.0 ± 9.7 MPa after 5 days. Furthermore, this material had a compressive strength of 26.7 ± 3.7 MPa after 2 h in physiologic saline. CAC showed a statistically significantly lower compressive strength in the presence of physiologic saline and statistically significantly longer setting times than those of CABC. CABC and CAC exhibited apatite-forming abilities in simulated body fluid that were faster than that of Com-CPC. Samples of the materials were implanted into the femoral condyles of rabbits for in vivo analysis, and subsequent histological examinations revealed that CABC exhibited superior osteoconductivity and equivalent bioresorbability compared with Com-CPC, as well as superior osteoconductivity and bioresorbability compared with CAC. CABC could therefore be used as an alternative bone substitute material.

Influence of ibuprofen addition on the properties of a bioactive bone cement.

Bioactive bone cements can promote bone growth and the formation of a strong chemical bond between the implant and bone tissue increasing the lifetime of the prosthesis. This study aims at synthesizing a new bioactive bone cement with different amounts of ibuprofen (5, 10 and 20 wt%) using a low toxicity activator, and investigating its in vitro release profile. The effect of ibuprofen (IB) on the setting parameters, residual monomer and bioactivity in synthetic plasma was also evaluated. It was verified that the different IB contents do not prevent the growth of calcium phosphate aggregates on composite surfaces, confirming that the cements are potentially bioactive. A relevant advantage of these formulations was a significant improvement in their curing parameters with increasing IB amount, associated to a reduction of the peak temperature and an extension of the setting time. The investigated cements released an average of about 20 % of the total incorporated ibuprofen during 30 days test, with IB20 liberating the highest percentage of drug 20.6 %, and IB10 and IB5, respectively 19.1 and 17.6 %. This behavior was attributed to the low solubility of this drug in aqueous media and was also related with the hydrophobic character of the polymer. Regarding the therapeutic concentration sufficient to suppress inflammation, the cement with 10 % of ibuprofen achieved the required release rate for 1 week and the cement with 20 % for 2 weeks.

Injectable collagen/α-tricalcium phosphate cement: collagen-mineral phase interactions and cell response.

A bone inspired material was obtained by incorporating collagen in the liquid phase of an α-tricalcium phosphate cement, either in solubilized or in fibrilized form. This material was able to set in situ, giving rise to a calcium deficient hydroxyapatite (CDHA)/collagen composite. The morphology and distribution of collagen in the composite was shown to be strongly affected by the collagen pre-treatment. The interactions between collagen and the inorganic phase were assessed by FTIR. A red shift of the amide I band was indicative of calcium chelation by the collagen carbonyl groups. The rate of CDHA formation was not affected when diluted collagen solutions (1 mg/ml) were used, whereas injectability improved. The presence of solubilized collagen, even in low amount (1 %), increased cell adhesion and proliferation on the composites. Still in the absence of osteogenic medium, significant ALP activity was detected both in the inorganic and the collagen-containing cements. The maximum ALP activity was advanced in the collagen-containing cement as compared to the inorganic cement.

Hypothermic manipulation of bone cement can extend the handling time during vertebroplasty.

BACKGROUND: Polymethylmethacrylate (PMMA) is commonly used for clinical applications. However, the short handling time increases the probability of a surgeon missing the crucial period in which the cement maintains its ideal viscosity for a successful injection. The aim of this article was to illustrate the effects a reduction in temperature would have on the cement handling time during percutaneous vertebroplasty. METHODS: The injectability of bone cement was assessed using a cement compressor. By twisting the compressor, the piston transmits its axial load to the plunger, which then pumps the bone cement out. The experiments were categorized based on the different types of hypothermic manipulation that were used. In group I (room temperature, sham group), the syringes were kept at 22°C after mixing the bone cement. In group 2 (precooling the bone cement and the container), the PMMA powder and liquid, as well as the beaker, spatula, and syringe, were stored in the refrigerator (4°C) overnight before mixing. In group 3 (ice bath cooling), the syringes were immediately submerged in ice water after mixing the bone cement at room temperature. RESULTS: The average liquid time, paste time, and handling time were 5.1 ± 0.7, 3.4 ± 0.3, and 8.5 ± 0.8 min, respectively, for group 1; 9.4 ± 1.1, 5.8 ± 0.5, and 15.2 ± 1.2 min, respectively, for group 2; and 83.8 ± 5.2, 28.8 ± 6.9, and 112.5 ± 11.3 min, respectively, for group 3. The liquid and paste times could be increased through different cooling methods. In addition, the liquid time (i.e. waiting time) for ice bath cooling was longer than for that of the precooling method (p < 0.05). CONCLUSIONS: Both precooling (i.e. lowering the initial temperature) and ice bath cooling (i.e. lowering the surrounding temperature) can effectively slow polymerization. Precooling is easy for clinical applications, while ice bath cooling might be more suitable for multiple-level vertebroplasty. Clinicians can take advantage of the improved injectability without any increased cost.

Development and bioactivity evaluation of bioglasses with low Na2O content based on the system Na 2O-CaO-MgO-P 2O 5-SiO 2.

Osteoconductive bioglasses, free of K(2)O and Al(2)O(3) and with content of Na(2)O lower than 10 mol%, were designed based on the ratio (SiO(2) + MgO)/(P(2)O(5) + CaO + Na(2)O) in the system Na(2)O-CaO-MgO-P(2)O(5)-SiO(2). The developed glasses have shown a strong potential for the formation of hydroxycarbonated apatite (HCA) in vitro. The particles of HCA aggregates tend to be of finer size with increasing the ratio of (SiO(2) + MgO)/(CaO + P(2)O(5) + Na(2)O) in the glass chemical composition indicating significant bioactivity. Critical size bone defects created in the femurs of albino adult female rats, and grafted with the glass particles for 12 weeks post implantation, were completely healed by filling with mineralized bone matrix without infection showing a strong potential for new bone formation in vivo. Osteoblasts and osteocytes were observed close to the surface of the granular implants with active areas of bone deposition, resorption and remodelling. The bioglass with lowest (SiO(2) + MgO)/(CaO + P(2)O(5) + Na(2)O) ratio has shown the highest bioactivity while the bioglass with the highest (SiO(2) + MgO)/(CaO + P(2)O(5) + Na(2)O) has shown the lowest bioactivity. The newly formed bone in vivo has shown a similar structure to that of the original bone as indicated by the histology and microstructural results. In addition, Ca/P molar ratio of the newly formed bone was found to be (~1.67), which is similar to that of the original bone.

Effect of the calcium to phosphorus ratio on the setting properties of calcium phosphate bone cements.

α-Tricalcium phosphate (α-TCP) has become the main reactant of most experimental and commercial ceramic bone cements. It has calcium-to-phosphorus (Ca/P) ratio of 1.50. The present study expands and reports on the microstructures and mechanical properties of calcium phosphate (CP) cements containing sintered monolithic reactants obtained in the interval 1.29 < Ca/P < 1.77. The study focuses on their cement setting and hardening properties as well as on their microstructure and crystal phase evolution. The results showed that: (a) CP-cements made with reactants with Ca/P ratio other than 1.50 have longer setting and lower hardening properties; (b) CP-cements reactivity was clearly affected by the Ca/P ratio of the starting reactant; (c) reactants with Ca/P < 1.50 were composed of several phases, calcium pyrophosphate and α- and ß-TCP. Similarly, reactants with Ca/P > 1.50 were composed of α-TCP, tetracalcium phosphate and hydroxyapatite; (d) only the reactant with Ca/P = 1.50 was monophasic and was made of α-TCP, which transformed during the setting into calcium deficient hydroxyapatite; (e) CP-cements developed different crystal microstructures with specific features depending on the Ca/P ratio of the starting reactant.

Direct scaffolding of biomimetic hydroxyapatite-gelatin nanocomposites using aminosilane cross-linker for bone regeneration.

Hydroxyapatite-gelatin modified siloxane (GEMOSIL) nanocomposite was developed by coating, kneading and hardening processes to provide formable scaffolding for alloplastic graft applications. The present study aims to characterize scaffolding formability and mechanical properties of GEMOSIL, and to test the in vitro and in vivo biocompatibility of GEMOSIL. Buffer Solution initiated formable paste followed by the sol-gel reaction led to a final hardened composite. Results showed the adequate coating of aminosilane, 11-19 wt%, affected the cohesiveness of the powders and the final compressive strength (69 MPa) of the composite. TGA and TEM results showed the effective aminosilane coating that preserves hydroxyapatite-gelatin nanocrystals from damage. Both GEMOSIL with and without titania increased the mineralization of preosteoblasts in vitro. Only did titania additives revealed good in vivo bone formation in rat calvarium defects. The scaffolding formability, due to cohesive bonding among GEMOSIL particles, could be further refined to fulfill the complicated scaffold processes.

Setting solution concentration effect on properties of a TTCP/DCPA-derived calcium phosphate cement.

The present work was to investigate the effects of concentration of (NH(4))(2)HPO(4) (diammonium hydrogen phosphate) setting solution on properties of a tetracalcium phosphate (TTCP)/dicalcium phosphate anhydrous (DCPA)--derived calcium phosphate cement. Experimental results indicated that working/setting time of the cement paste decreased with increasing (NH(4))(2)HPO(4) concentration of the setting solution. After being immersed in Hanks' solution for 1 day or longer, the XRD intensities of initial TTCP and DCPA phases largely decreased, while apatite phase became dominant. More residual TTCP phase was observed in the 1 day-immersed cement prepared from higher concentration setting solutions. Compressive strength of the cement immersed for 1 day was consistently higher than that immersed for 30 min or 7 days. After being immersed for 1 day, the average CS value reached a maximal value (59 MPa) as (NH(4))(2)HPO(4) concentration was increased to 0.6 M, beyond that the cement strength decreased and maintained in a relatively high range of 47-54 MPa. Cells incubated with conditioned medium of Al(2)O(3) powder and with blank medium exhibited similar average viability values (0.80 and 0.78, respectively). The OD value with extractions of cement decreased with increasing (NH(4))(2)HPO(4) concentration of the setting solution. The average 0.25, 0.5 and 0.6 M--OD values were 0.78, 0.67 and 0.66, respectively. When setting solution concentration was greater than 0.6 M, the OD value sharply declined to 0.47.

[Preparation of alpha-tricalcium phosphate/HA whisker/carboxymethyl chitosan-gelatin composite porous bone cement].

In order to investigate the effects of HA whisker and carboxymethyl chitosan-gelatin(CMC-Gel) on the mechanical properties of porous calcium phosphate cement, a series of alpha-tricalcium phosphate (alpha-TCP), HA whisker and L-sodium glutamate porogen with different mass fractions were mixed, and setting liquid was added to them to prepare alpha-TCP/HA whisker composite porous bone cement. Then, the cement was immersed in a series of CMC-Gel solutions which had different weight ratios of CMC to Gel to prepare alpha-TCP/HA whisker/CMC-Gel composite porous bone cement. The compressive strengths and microstructure of cement were characterized by mechanical testing machine and SEM. The results showed that when the mass fraction of HA whisker is 4%, the compressive strength of alpha-TCP/HA whisker composite porous bone cement reaches 2.57MPa, which is 1.81 times that of alpha-TCP bone cement. When the weight ratio of CMC to Gel is 50:50, the compressive strength of alpha-TCP/HA whisker/CMC-Gel composite porous bone cement is 3. 34MPa, which is 2.35 times that of alpha-TCP bone cement, and the toughness of the composite cement is greatly improved as well.

A study of the relationship between process conditions and mechanical strength of mineralized red algae in the preparation of a marine-derived bone void filler.

Bone void fillers that can enhance biological function to augment skeletal repair have significant therapeutic potential in bone replacement surgery. This work focuses on the development of a unique microporous (0.5-10 microm) marine-derived calcium phosphate bioceramic granule. It was prepared from Corallina officinalis, a mineralized red alga, using a novel manufacturing process. This involved thermal processing, followed by a low pressure-temperature chemical synthesis reaction. The study found that the ability to maintain the unique algal morphology was dependent on the thermal processing conditions. This study investigates the effect of thermal heat treatment on the physiochemical properties of the alga. Thermogravimetric analysis was used to monitor its thermal decomposition. The resultant thermograms indicated the presence of a residual organic phase at temperatures below 500 degrees C and an irreversible solid-state phase transition from mg-rich-calcite to calcium oxide at temperatures over 850 degrees C. Algae and synthetic calcite were evaluated following heat treatment in an air-circulating furnace at temperatures ranging from 400 to 800 degrees C. The highest levels of mass loss occurred between 400-500 degrees C and 700-800 degrees C, which were attributed to the organic and carbonate decomposition respectively. The changes in mechanical strength were quantified using a simple mechanical test, which measured the bulk compressive strength of the algae. The mechanical test used may provide a useful evaluation of the compressive properties of similar bone void fillers that are in granular form. The study concluded that soak temperatures in the range of 600 to 700 degrees C provided the optimum physiochemical properties as a precursor to conversion to hydroxyapatite (HA). At these temperatures, a partial phase transition to calcium oxide occurred and the original skeletal morphology of the alga remained intact.

Development of a signal-inducing bone cement for magnetic resonance imaging.

PURPOSE: To develop a signal-inducing bone cement for musculoskeletal procedures in magnetic resonance imaging (MRI). MATERIALS AND METHODS: Acrylic resins were mixed with contrast agents (CAs) and water. We determined the ideal concentration of the components and assessed feasibility in cadaveric bones in an open high-field MR scanner. The contrast-to-noise ratio (CNR) in air and bone was evaluated and mechanical tests were achieved. We determined the amount of water that was not incorporated and measured the amount of CA released with photometric analysis. The cement was analyzed microscopically. RESULTS: Preparation and application of the CA-water-cement compound was feasible and its differentiation in MRI was clear. The maximal CNR(air) had a value of 157.5 (SD 18.3) in an interventional fast T1W turbo-spin echo (TSE) sequence. The compressive strength decreased with the amount of water added. Although nearly 50% of the water added was not incorporated in the cement, the CNR was sufficient for cement detection. The threshold for systemic toxicity of delivered CA was not reached and the microscopic analysis showed water bubbles in the cement. CONCLUSION: A signal-inducing bone cement is feasible for the use in MRI.

Thermal preparation of highly porous calcium phosphate bone filler derived from marine algae.

A sustainable marine-derived bioceramic with a unique porous structure has been developed for hard tissue repair. The conversion of alga was achieved through a novel technique, involving well controlled thermal processing followed by low pressure-temperature hydrothermal synthesis. In its preparation, a heat treatment step was required to remove the organic compounds from the algae, which reinforces the mineralised matrices. Its removal is necessary to prevent issue such as immune biocompatibility and ensure phase purity of the resultant biomaterial. This paper investigates the hydrothermal technique used for the transformation of mineralised red algae to hydroxyapatite that preserves the algae's unique structure. It specifically focuses on the effects of heat treatment on the morphology of the algae, TGA, SEM and hot stage XRD to quantity the changes.

Anti-washout carboxymethyl chitosan modified tricalcium silicate bone cement: preparation, mechanical properties and in vitro bioactivity.

Anti-washout CaF(2) stabilized C(3)S (F-C(3)S) bone cement was prepared by adding water-soluble carboxymethyl chitosan (CMCS) to the hydration liquid. The setting time, compressive strength and in vitro bioactivity of the CMCS modified F-C(3)S (CMCS-C(3)S) pastes were evaluated. The results indicate that CMCS-C(3)S pastes could be stable in the shaking simulated body fluid (SBF) after immediately mixed. The addition of CMCS significantly enhances the cohesion of particles, at the same time restrains the penetration of liquid, and thus endows the anti-washout ability. The setting times of the pastes increase with the increase of CMCS concentrations in the hydration liquid. Besides, the compressive strengths of CMCS-C(3)S pastes after setting for 1-28 days are lower than that of the pure F-C(3)S paste, but the sufficient strengths would be suitable for the clinical applications. The crystalline apatite deposited on the paste surface is retarded from 1 to 2 days for the addition of CMCS, but the quantities of deposited apatite are same after soaking in SBF for 3 days. As the result that pure C(3)S paste has shorter setting times than pure F-C(3)S paste, CMCS modified pure C(3)S pastes would have better anti-washout ability. Our study provides a convenient way to use C(3)S bone cement with excellent anti-washout ability when the pastes are exposed to biological fluids. The novel anti-washout CMCS-C(3)S bone cement with suitable setting times, sufficient strengths and in vitro bioactivity would have good prospects for medical application.

Evaluation of a novel radiopacifiying agent on the physical properties of surgical spineplex.

Polymethlylmethacrylate (PMMA) is the most frequently used cement for percutaneous vertebroplasty and kyphoplasty. To aid visualisation during surgery cements are doped with radiopacifying agents such as Barium sulphate (Ba(2)SO(4)) or Zirconium Dioxide (ZiO(2)). Mounting research suggests that these agents may impair the biocompatibility of the cements. However, incorporating an alternative radiopacifier agent with excellent biocompatibility would be a significant step forward. Bioactive radiopaque glasses incorporating elements such as strontium (Sr) and zinc (Zn), known to have beneficial and therapeutic effects on bone, are of great interest in this respect. In this study, the Ba(2)SO(4) of the commercially available Spineplex was incrementally replaced with a radiopaque therapeutic glass composition. The resulting effects on cement setting time, peak isotherm, ultimate compressive strength, Young's modulus (up to 30 days cement maturation) and radiopacity were evaluated. The substitution lead to an increase in cement setting time from 13.1 mins for Spineplex to 16.6-18.3 mins for the glass substituted cements. The peak exotherm during curing was reduced from 74 degrees C for Spineplex to a minimum of 51 degrees C for the fully substituted cement, indicating that reduced thermal necrosis in the in vivo setting is likely with these materials. Ultimate compressive strength and Young's modulus of each formulation showed no significant deterioration due to the substitution. Finally, the radiopacity of the substituted cements were reduced by up to a maximum of 18% in comparison to the control. However, the experimental formulations still maintained radiopacity equivalent to several millimetres of aluminium. As such the substituted cements had substantial equivalence to the Spineplex control. In order to assess the clinical relevance of these findings further investigation is warranted.