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Featured Application: This study provides an innovative approach to prevent the migration of carbonate apatite (CAp) granules during implantation. The proposed method combines the setting properties of calcium sulfate hemihydrate (CSH) with CAp granules, enabling their use as a stable, porous scaffold for bone regeneration. Granular bone substitutes are commonly used in dental treatments owing to their adaptability to irregular bone defects. However, granule migration during and after implantation poses a significant challenge, impairing bone regeneration. This study addresses this issue by setting carbonate apatite (CAp) granules using crystal interlocking owing to the bassanite (calcium sulfate hemihydrate (CSH))-to-gypsum (calcium sulfate dihydrate (CSD)) transformation on the granule surface. CAp granules were mixed with CSH slurry (water/CSH ratio of 0.4) at varying CSH/CAp ratios of 0.33, 0.43, 0.54, 0.67, and 0.82. At all of these mixing ratios, needle-shaped CSD crystals formed on the CAp granule surface, and the CSD crystals interlocked with each other; consequently, CAp granules were set. As the CSH/CAp ratio increased from 0.33 to 0.82, the CSD crystal length increased from 6.58 to 6.79 μm, while the setting time decreased from 30.3 to 15.5 min. Although the porosity of the set CAp granules decreased with an increase in the CSH/CAp ratio, the set granules maintained intergranular spaces of 77.3 μm at a CSH/CAp ratio of 0.82 conducive to cellular infiltration. After immersion in saline for six days, the set CAp granules at a CSH/CAp ratio of 0.82 maintained their original shape, demonstrating enhanced stability compared to lower CSH/CAp ratios where partial or complete collapse occurred. The porosity and specific surface area increased to 59.9% and 3.66 m2/g, respectively, and the intergranular spaces increased to 176.4 μm. Therefore, mixing the CAp granules with CSH at a ratio of 0.82 may prevent granule migration during and after implantation. Moreover, the CSD component of the granules is likely to resorb more rapidly than the CAp component in vivo, promoting porosity in the set granules and facilitating efficient bone replacement. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of CO3Ap granules in the mandibular bone defects by using computed tomography (CT) images. Methods: This study was retrospective case series of mandibular bone defect reconstruction using CO3Ap granules. Six patients with jawbone cysts treated by simultaneous grafting CO3Ap granules after cyst enucleation were enrolled. Patients without grafting CO3Ap granules were excluded. Mandibular bone height including buccolingual bone height, the change of perpendicular distance between the buccolingual line to the alveolar ridge, and the three-dimensional volume of remaining CO3Ap granules were analyzed using CT images obtained at 3, 6, 12, 18, and 24 months postoperatively. Results: Postoperative CT images showed that cortical and cancellous bone-like structures were formed on the grafting area periphery and inside the defect, respectively, with gradual resorption of the CO3Ap granules. Furthermore, there was no evidence of leaving bone defect even at the center of the lesion when the defect was successfully reconstructed by filling it with CO3Ap granules. The percentage volume of remaining CO3Ap granules to the volume at 3 months postoperatively were 76.1 ± 13.1%, 35.8 ± 22.5%, 25.0 ± 13.0%, and 9.9 ± 6.4% at 6, 12, 18, and 24 months postoperatively, and the volume reduction rate increased significantly within 12 months postoperatively. Conclusion: Grafting CO3Ap granules after the enucleation of a jawbone cyst is a good reconstructive treatment option for postoperative prosthetic treatment because CO3Ap granules are gradually replaced by new bone while preserving the contour of the mandibular bone. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Bone graft granules are valuable tools for ridge area bone grafting owing to their ease of manipulation and interconnected porous structure. Guided bone regeneration (GBR) using barrier membranes is commonly used for alveolar ridge augmentation; however, the surgical procedures are technically complicated. In this study, we fabricated bioresorbable mesh domes (BMDs) using two types of Vicryl mesh (woven and knitted types) containing carbonate apatite granules. BMD samples were prepared in three groups: upper sides made from the woven type (UW) and lower sides made from the woven type (LW) (the UW/LW group), upper sides made from the woven type (UW) and lower sides made from the knitted type (LK) (the UW/LK group), and upper sides made from the knitted type (UK) and lower sides made from the knitted type (LK) (the UK/LK group). The samples were subsequently implanted into rabbit calvaria, and radiomorphometric and histological analyses were conducted. The UK/LK group exhibited enhanced appositional bone formation because the knitted mesh on the skin side prevented the infiltration of a substantial amount of fibrous tissue. This increase in bone formation could be attributed to the interaction between granules and osteoprogenitors that pass through the mesh from the host bone. Conversely, the UW/LW and UW/LK groups presented limited appositional bone formation. Compared with knitted mesh, woven mesh might tend to be absorbed over a short span, allowing fibrous tissue invasion and inhibiting new bone formation. Additionally, BMDs could retain granules in a targeted location and avoid displacement of the granules to unintended locations. [ABSTRACT FROM AUTHOR]

Mesoporous calcium phosphate based-bioceramics with ionic substitution have attracted attention for treatment of bone diseases and bone regeneration. Carbonate apatite (CO3Ap) is a promising candidate for bone replacement through bone remodelling, similar to that of autologous bone, owing to the chemical composition of the bone mineral. In this work, we present a dual approach to synthesize mesoporous carbonate apatite (CO3Ap) and strontium-substituted CO3Ap (Sr-CO3Ap) artificial bone nanocrystals, aiming to assess the impact of strontium on CO3Ap characteristics and biological performance. Mesoporous CO3Ap was created by transforming hard templates composed of CaCO3, while Sr-substituted CaCO3 (Sr-CaCO3) microspheres were formed using an organic complexing agent to induce pore formation. The resulting CO3Ap and Sr-CO3Ap granules exhibited an irregular shape, with rod-like nanocrystals composing their particles. Adsorption/desorption isotherms confirmed the mesoporous nature of the structures, featuring pore sizes ranging from 10 to 50 nm. Specifically, mesoporous CO3Ap displayed slit-like pores, while Sr-CO3Ap showed cylinder-like ones. High-resolution transmission electron microscopy images of Sr-CO3Ap powder revealed mesopores within the particles, with Sr-CO3Ap exhibiting larger pore volume and specific surface area compared to CO3Ap. When osteoblast-like MC3T3-E1 cells were cultured on both CO3Ap and Sr-CO3Ap samples, they demonstrated good cell attachment, proliferation rates, and increased ALP activity, particularly evident at higher strontium concentrations. These findings suggest promising potential for further exploration of mesoporous apatite nanocrystals in bone replacement and drug delivery applications. [ABSTRACT FROM AUTHOR]

Among the various bone substitutes, carbonate apatite (CO3Ap) has received significant attention in the field of hard tissue regeneration due to its similarity in chemical composition to natural bone and its osteoconductivity and bioresorbability. This study aimed to develop a cost-effective method for fabricating porous CO3Ap blocks while maintaining a balance between porosity and mechanical properties. The level of interconnectivity in the porous structure was achieved by adjusting the pore volume fractions of the starting materials. The phase and microstructure characteristics of the porous CO3Ap blocks were assessed using techniques such as X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM). The diametral tensile strength (DTS) of the blocks was determined using a universal testing machine. The results demonstrated that the mechanical strength of the blocks stayed within a range that was suitable for handling properties. This advantage allows the porous blocks to withstand initial stress during implantation procedures or in the early stages of defect healing. [ABSTRACT FROM AUTHOR]

The newly developed mineral carbonated apatite has recently been proposed as a bone graft material for bone regenerative treatment in implant therapy. This case series details the clinical and radiographic outcomes of ridge preservation and ridge augmentation using only carbonated apatite as bone graft material for implant treatment. Twenty patients (36 sites) who required bone regeneration and implant placement were retrospectively assessed. Simultaneous carbonated apatite implant placement was performed using the simultaneous ridge preservation or augmentation approach on 24 sites in 13 patients with sufficient bone quantity for primary stabilization based on preoperative evaluation results. A staged ridge preservation or augmentation approach was used for the remaining 12 sites in seven patients with insufficient bone quantity. The mean regenerated bone height for each treatment method was as follows: simultaneous preservation, 7.4 ± 3.3 mm; simultaneous augmentation, 3.6 ± 2.3 mm; staged preservation, 7.2 ± 4.5 mm; and staged augmentation, 6.1 ± 2.7 mm. The mean regenerated bone width for each treatment method was as follows: simultaneous preservation, 6.5 ± 2.9 mm; simultaneous augmentation, 3.3 ± 2.5 mm; staged preservation, 5.5 ± 1.7 mm; and staged augmentation, 3.5 ± 1.9 mm. Ultimately, the use of carbonated apatite alone as a bone graft material in implant therapy resulted in stable and favorable bone regeneration. [ABSTRACT FROM AUTHOR]

Purpose: Maxillary molars have low alveolar bone height diameter due to the presence of the maxillary sinus; thus, a sinus lift may be required in some cases. Changes in the volume of bone substitutes can affect the success of implant therapy. Therefore, this study aimed to compare the changes in the volume of two different bone substitutes—one based on carbonate apatite and the other on octacalcium phosphate—used in maxillary sinus floor elevation. Methods: Nineteen patients and 20 sites requiring maxillary sinus floor elevation were included in the study. Digital Imaging and Communications in Medicine data for each patient obtained preoperatively and immediately and 6 months postoperatively were used to measure the volume of the bone grafting material using a three-dimensional image analysis software. The immediate postoperative volume of octacalcium phosphate was 95.3775 mm3 per piece of grafting material used. It was multiplied by the number of pieces used and converted to mL to determine the immediate postoperative volume. Results: The mean resorption values of carbonate apatite and octacalcium phosphate were 12.7 ± 3.6% and 17.3 ± 3.9%, respectively. A significant difference in the amount of resorption of the two bone replacement materials was observed (P = 0.04). Conclusions: The results of this study indicate that both bone substitute materials tend to resorb. The two bone grafting materials that are currently medically approved in Japan have not been in the market for a long time, and their long-term prognosis has not yet been reported. Further clinical data are warranted. [ABSTRACT FROM AUTHOR]

Bone defects represent an everyday challenge for clinicians who work in the fields of orthopedic surgery, maxillofacial and oral surgery, otorhinolaryngology, and dental implantology. Various bone substitutes have been developed and utilized, according to the needs of bone reconstructive surgery. Carbonate apatite has gained popularity in recent years, due to its excellent tissue behavior and osteoconductive potential. This systematic review aims to evaluate the role of carbonate apatite in bone reconstructive surgery and tissue engineering, analyze its advantages and limitations, and suggest further directions for research and development. The Web of Science, PubMed, and Scopus electronic databases were searched for relevant review articles, published from January 2014 to 21 July 2023. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eighteen studies were included in the present review. The biological properties and medical applications of carbonate apatite (CO3Ap) are discussed and evaluated. The majority of articles demonstrated that CO3Ap has excellent biocompatibility, resorbability, and osteoconductivity. Furthermore, it resembles bone tissue and causes minimal immunological reactions. Therefore, it may be successfully utilized in various medical applications, such as bone substitution, scaffolding, implant coating, drug delivery, and tissue engineering. [ABSTRACT FROM AUTHOR]

Proper analysis of urinary stone composition is a cornerstone for diagnosis, targeted treatment and recurrence prevention of urolithiasis. The aim of this study was to determine the composition, frequency and distribution of mixed stones according to gender and age of patients. A total of 42,519 urinary stones from 30,311 men and 12,208 women submitted between January 2007 and December 2020 were studied. Most urinary calculi consisted of two components (50.9%), followed by stones of a single constituent (27.1%) and three-component stones (21.9%), while four-component stones were only rarely identified (0.1%). Among all stones, 49.8% consisted of whewellite (COM), weddellite (COD), and mixtures of COM and COD, 33.8% were pure carbonate apatite (CA) and mixtures of CA with COM and/or COD, while 7.6% were composed of uric acid anhydrous (UAA), uric acid dihydrate (UAD), and mixed UAA and UAD. The remaining 8.8% of calculi were rare single-component stones and rare mixtures of various constituents. The number of stone components was inversely associated with age (p < 0.001). The proportion of men decreased significantly with the number of stone constituents, from 3.01:1 for single-component stones to 1.0:1 for four-component urinary calculi (p < 0.001). The vast majority of urinary calculi consisted of two or more components in varying proportions. While age was inversely associated with the number of stone constituents, the proportion of women increased significantly from single-component to four-component urinary calculi. A significant proportion of mixed stones could present a challenge for diagnosis and targeted recurrence prevention. [ABSTRACT FROM AUTHOR]

Introduction: This study was designed to determine the mineral composition of calculi in nephrocalcinosis with nephrolithiasis, diagnose the underlying disease, and monitor the course of renal function in patients with nephrocalcinosis-nephrolithiasis. Methods: Renal calculi extruded in a series of 8 patients with nephrocalcinosis were analysed using Fourier transmission infrared spectrometry. In 4 patients, next-generation sequencing using a nephrocalcinosis-nephrolithiasis panel was performed to determine the nature of the underlying disease. In addition, longitudinal analysis of renal function was performed in all patients. Results: Seven patients revealed carbonate apatite as the sole constituent of renal calculi. One patient showed a mixed composition of dicalcium phosphate dihydrate/carbonate apatite at first analysis yet in subsequent episodes also had calculi composed of pure carbonate apatite. Further molecular analysis displayed distal renal tubular acidosis in 2 of 4 patients who consented to sequencing. No known genetic defect could be found in the other two cases. In line with prior reports, decline of renal function was dependent on underlying disease. Distal renal tubular acidosis revealed a progressive course of renal failure, whereas other causes showed stable renal function in long term analysis. Conclusion: Nephrocalcinosis with nephrolithiasis is a rare condition with heterogeneous aetiology. Yet mineral composition of renal calculi predominantly consisted of pure carbonate apatite. This uniform finding is similar to subcutaneous calcifications of various origins and might propose a general principle of tissue calcification. Progressive decline of renal function was found in distal renal tubular acidosis, whereas other conditions remained stable over time. Plain Language Summary: Renal stones may occur in conditions that involve calcification of the kidney itself. In this case series, we chemically analysed these stones. In some cases, we also performed genetic tests. Interestingly, we found a similar composition in most stones, irrespective of the underlying disorder. This suggests a common mechanism of calcification. [ABSTRACT FROM AUTHOR]

Scaffolds having appropriate mechanical strength and providing a proper microenvironment for osteogenesis are expected to be effective alternatives to autografts for bone regeneration. In this study, ant‐nest type porous (ANP) scaffolds consisting of CO3Ap were fabricated using calcium carbonate powder or slurry and two types of polyurethane foam through a dissolution–precipitation reaction. ANP‐type, three‐dimensional, interconnected porous CO3Ap scaffolds were fabricated by burning out the struts of polyurethane foams embedded in CaCO3, followed by compositional transformation from CaCO3 to CO3Ap. The types of polyurethane foam and impregnation methods of CaCO3 into polyurethane form affected the geometry of the resulting ANP structures. Mechanical and in vivo biological performances of these scaffolds relied on the geometry of the ANP structures. The ANP structures displayed had a clear structural advantage in bone regeneration, owing to the promotion of cell and tissue migration throughout the scaffolds. In particular, ANP‐structured scaffolds, which had highest porosity, interconnectivity, and smallest strut thickness, had a mechanical strength comparable to cancellous bone, formed more new bone, were highly resorbed, resulting in cancellous bone‐like bone tissue regeneration at 12 weeks of healing. The results suggest that bone regeneration after the migration of cell and tissue into the entire scaffolds is affected by strut thickness preferentially over porosity and interconnectivity. ANP‐structured CO3Ap scaffolds are attractive for bone regeneration. [ABSTRACT FROM AUTHOR]

Autologous bone grafting is the primary method for treating alveolar clefts. However, bone grafting materials are desired as alternatives to autogenous bone to reduce surgical invasiveness. Here, we present an animal study evaluating the effect of carbonate apatite (CA) on the spontaneous eruption of permanent teeth. The bone grafting materials included CA, natural bovine bone (BB), and hydroxyapatite (HA). In 15 8-week-old male beagle dogs, the left mandibular deciduous premolars (DP) two and three were extracted and subsequently filled with CA, BB, and HA. The animals were euthanized after a predetermined number of days, and samples were collected for microcomputed tomography and histological evaluation. Spontaneous eruption of the succeeding permanent teeth (P3 and P4) was observed in the CA group at 14 weeks. Delayed eruption of the succeeding permanent teeth was observed in the BB and HA groups. CA could serve as a viable alternative to autogenous bone for treating alveolar clefts. [ABSTRACT FROM AUTHOR]

This study radiologically and histologically compared two bioresorbable bone substitutes with different compositions carbonate apatite (Cytrans® Granules; CGs) and ß-tricalcium phosphate (ß-TCP) for vertical bone augmentation on a rat skull using a polytetrafluoroethylene (PTFE) tubes. This PTFE tube was placed at the center of the skull, fixed with Super Bond, and augmented with CGs or ß-TCP granules. Specimens with surrounding tissue were harvested at 4, 8, and 12 weeks postoperatively, and radiological and histological evaluations were performed. The bone volume to total volume ratio (BV/TV) of the ß-TCP-implanted group was markedly higher than that of the CG-implanted group at 4 and 12 weeks postoperatively. Compared to CGs, ß-TCP exhibited the ability to form blood vessels into the graft material for a short period after transplantation, as well as an elevated production of collagen into ß-TCP granules during the bone formation process. [ABSTRACT FROM AUTHOR]

In the field of restorative dentistry, composite resin is quickly overtaking other materials in terms of usage. It resolves the issue of the toxic nature brought on by the amalgams’ mercury content. The mechanical properties of resin-based dental restorative composites can be enhanced with the addition of filler material. This study examines the effects of chitosan addition to dental composites with alumina, zirconia, and carbonate apatite nanoparticles on their characterization and hardness. The composite for direct restoration is prepared by mixing UDMA–TEGDMA–DMAEMA– HEMA as the matrix and alumina–zirconia–carbonate apatite as the filler in the presence of chitosan as a coupling agent. The weight ratio of filler to matrix used is 70:30. The effects of various concentrations of chitosan are varied at 2%, 4%, and 6%. Samples are prepared by a synthetizing process to obtain alumina–zirconia–carbonate apatite nanoparticles. The diffractogram from XRD shows the formation of t-ZrO2 and dahllite. SEM images reveals that the particle sizes of each sample with chitosan at 2%, 4%, and 6% are of 87.5 nm, 112.5 nm, and 150 nm, respectively. The hardness values of each sample with the same chitosan concentration are of 51.3 VHN, 28.24 VHN, and 25.48 VHN, respectively. Dental composites with less chitosan concentration promote a smaller size of alumina– zirconia–carbonate apatite nanoparticles and higher mechanical properties in dental restorative composites. [ABSTRACT FROM AUTHOR]

Carbonate apatite (CA) is a synthetic derivative of hydroxyapatite, which we have been exploring as a drug delivery nanocarrier in the context of cancer in vitro and in vivo. This nanocarrier showed great potential delivering anti-cancer drugs, plasmids containing tumour suppressor genes and siRNAs against oncogenes in pre-clinical models. We compared here two formulations of CA—the low-Ca2+ CA (made with 4 mM Ca2+) used for in vitro studies in cell lines and the high-Ca2+ CA (made with 40 mM Ca2+) used in mouse models—in terms of protein corona formed with different concentrations of serum in vivo and in vitro. The 10-fold more Ca2+ in high-Ca2+ CA helped produce enough particles in an injectable volume for in vivo delivery of therapeutics. Both formulations made particles of similar size, but their composition differed slightly in terms of Na and Mg content. In serum-containing media, the size of the particles was dependent on the serum concentration. The protein corona around both formulations was almost similar and included albumin, fetuin, haemoglobin, and immunoglobulins. CA was not cytotoxic, and instead an increased expression of ribosomal machinery and glycolytic and cytoskeletal proteins was observed, which promoted translation, growth, and proliferation in cancer cells. [ABSTRACT FROM AUTHOR]

Maxillary sinus augmentation with a lateral approach (MSA) is a well-established treatment. In this prospective study, we evaluated risk factors for postoperative bone graft displacement and reported the clinical application of long-term resorbable L-lactic acid/-caprolactone (PLA/PCL) as a barrier membrane to cover the open window in the lateral wall in MSA. Twenty-four patients underwent MSA according to the relevant criteria; CT data obtained before and 1 week (1 w) and 5–6 months (5 m) post-MSA, bone height changes, bone height reduction rates at 1 w and 5 m post-MSA, bone graft displacement measurements, and risk factors were examined. All patients showed bone height increments (p < 0.005). However, no difference was observed between 1 w and 5 m post-MSA. Bone graft displacement was observed in eight patients; the reduction rate from 1 w to 5 m post-MSA was 8.38% ± 4.88%. Sex, septa, maxillary sinus floor–palatal bone distance, and maxillary sinus floor–maxillary ostium distance were associated with bone graft displacement (p < 0.05). The height from the maxillary sinus floor to the palatal bone and the sinus angle influenced the augmentation degree (p < 0.05). The PLA/PCL membrane is compared favorably with other membranes and may be useful as a barrier membrane for the MSA open window. [ABSTRACT FROM AUTHOR]

Biodegradable guided bone regeneration (GBR) membranes consist primarily of collagen and aliphatic polyesters. This study assessed the comparative efficacy of a poly(l-lactic-caprolactone) [P(LA/CL)] membrane versus that of a collagen membrane in GBR. Patients requiring GBR simultaneously or before dental implant placement in edentulous regions were randomly assigned to one of two membranes. Within each membrane, they were subdivided into 3 groups: dental implants were placed simultaneously with GBR in groups A and B, and 180 days post-GBR in group C. The augmented bone width was measured at 1, 3, and 6 mm from the implant's neck (groups A and B) or the reference line (group C), utilizing cone-beam computed tomography images, immediately and 150 days post-surgery. A histological study was performed to evaluate bone formation in group C. No adverse events were observed. In the collagen group, the absorbed ratios of the augmented bone were 40.9 ± 36.7%, 29.4 ± 30.1%, and 11.1 ± 22.0% at 1, 3, and 6 mm, respectively; the ratio at 6 mm was significantly lower than that at 1 mm (p = 0.0442). In the P(LA/CL) group, those were 26.2 ± 27.3%, 17.1 ± 19.7%, and 13.3 ± 16.4% at 1, 3, and 6 mm, respectively, with no significant difference at each point. No significant inter-membrane differences were observed. The bone augmentation potential of the P(LA/CL) membrane matched that of the collagen membrane. P(LA/CL) could be used as a safe and effective membrane in GBR. [ABSTRACT FROM AUTHOR]

Metal materials used as bone implants are not new today. In fact, almost 70% of implant materials are made of metal. Magnesium biocomposites with Carbonate Apatite or Hydroxyapatite reinforcements have promising potential as implants, one of the properties of these composites is biocompatible and bioactive to accelerate bone growth. There have been many studies on the development of Mg-CAp and Mg-HAp as biocomposite implant materials. Various methods of making these biocomposites have been carried out, such as sintering, microwave, coating, casting, and extrusion. From the fabrication process, observations were made regarding mechanical properties and chemical structure. The results show that CAp and HAp can suppress the corrosion rate of Magnesium, which is one of the weak properties that must be improved. Then it can increase the biological activity of Mg composites and has the ability of bone induction and bone conduction. In addition, the mechanical properties have increased in tensile, compression, and microhardness testing. However, so far, the research on Mg-HAp and Mg-CAp has only been limited to animal testing and has not been applied to humans. So, the potential for development and research is still open actually to be implemented in the orthopedic field. [ABSTRACT FROM AUTHOR]

The rate of resorption of calcium phosphate self-hardening materials for bone regeneration can be changed by changing the phase composition. The Ca3(PO4)2/CaCO3/Ca(H2PO4)2·H2O/Na2HPO4·12H2O system is important for the synthesis of self-curing bioactive materials with variable resorption rates by changing the ratios of the initial components. Cement compositions in twelve figurative points of a four-component composition diagram at a fixed content in the α-Ca3(PO4)2 system were studied with XRD, FTIR, SEM, calorimetric, and volumetric methods to obtain an idea of the effect of composition on solubility in vitro and resorption in vivo. It was found that the presence of the highly resorbable phase of dicalcium phosphate dihydrate in cement and the substitution of phosphate ions with the carbonate ions of hydroxyapatite increased solubility in vitro and resorption in vivo. The obtained results confirm the possibility of changing the solubility of a final product in the Ca3(PO4)2/CaCO3/Ca(H2PO4)2·H2O/Na2HPO4·12H2O system by changing the ratio of the initial components. [ABSTRACT FROM AUTHOR]

The environment model is used to describe the location of carbonate in nine carbonated apatites containing varied percentages of carbonate and Na+, K+, or NH4+ ions. Unlike the traditional model for carbonate substitution, which identifies different locations and orientations of the carbonate ion in the apatite structure, the environment model utilizes the different structural surroundings to describe the different types of carbonate. The A-type carbonate environment is assigned to channels lined only with calcium ions (A-channel configuration = Ca6) or to channels containing one Na+ or a vacancy (A′-channel configuration = Ca5Na or Ca5▢), and the B-type carbonate environment is the surroundings of the replaced phosphate ion. The assignments are made by peak-fitting the carbonate asymmetric stretch region (ν3) of the IR spectrum, following previously published criteria. These assignments lead to the conclusion that the percentage of channel carbonate (A- and A′-environments) is greater than that of B-type for each of these carbonated apatites. In general, the use of triammonium phosphate as the phosphate source in the synthesis produces apatites with larger amounts of channel carbonate (A- and A′-environments), while the use of sodium-containing phosphate reagents produces smaller amounts of channel carbonate. The environment model provides explanations for the differences within IR and NMR spectra obtained for apatites containing a range of total carbonate content. The B-type appearance of the carbonate ν3 region of the IR spectrum is found primarily in apatites containing sodium, which allows increased amounts of carbonation via co-substitution of Na+ with carbonate and creation of A′-environments with populations equal to that of B-type carbonate. The presence of ammonium or alkali metal salts with cations larger than Na+ results in the utilization of a charge-balance mechanism that produces vacancies rather than cation substitution in the channel. The carbonated apatites formed with primary utilization of the vacancy mechanism generally contain greater percentages of carbonate in the A-environment and carbonate IR spectra that contain an obvious high-frequency peak at about 1550 cm–1. The multiple peaks in the solid state 13C NMR spectra previously observed for carbonated apatite are attributed to substitution in the A-, A′-, and B-environments rather than different stereo-chemical orientations of the carbonate ion. [ABSTRACT FROM AUTHOR]

Carbonate apatite (CO3Ap) is a bioceramic material with excellent properties for bone and dentin regeneration. To enhance its mechanical strength and bioactivity, silica calcium phosphate composites (Si-CaP) and calcium hydroxide (Ca(OH)2) were added to CO3Ap cement. The aim of this study was to investigate the effect of Si-CaP and Ca(OH)2 on the mechanical properties in terms of the compressive strength and biological characteristics of CO3Ap cement, specifically the formation of an apatite layer and the exchange of Ca, P, and Si elements. Five groups were prepared by mixing CO3Ap powder consisting of dicalcium phosphate anhydrous and vaterite powder added by varying ratios of Si-CaP and Ca(OH)2 and 0.2 mol/L Na2HPO4 as a liquid. All groups underwent compressive strength testing, and the group with the highest strength was evaluated for bioactivity by soaking it in simulated body fluid (SBF) for one, seven, 14, and 21 days. The group that added 3% Si-CaP and 7% Ca(OH)2 had the highest compressive strength among the groups. SEM analysis revealed the formation of needle-like apatite crystals from the first day of SBF soaking, and EDS analysis indicated an increase in Ca, P, and Si elements. XRD and FTIR analyses confirmed the presence of apatite. This combination of additives improved the compressive strength and showed the good bioactivity performance of CO3Ap cement, making it a potential biomaterial for bone and dental engineering applications. [ABSTRACT FROM AUTHOR]

Carbonate apatite (CO3Ap) is a major inorganic bone component and an effective bone substitute. To clarify the function of CO3Ap, we compared differences among CO3Ap, hydroxyapatite (HAp), and β-tricalcium phosphate (β-TCP) by focusing on mesenchymal stem cells (MSCs) that have a role in wound healing. For in vivo experiments, maxillary molars were removed and the bone substitute was inserted. MSC accumulation around extraction sockets was significantly promoted in CO3Ap and β-TCP groups. For in vitro experiments, MSCs were cultured with bone substitutes. The differentiation potential and amount of calcium deposition were significantly lower in CO3Ap and HAp groups than in the β-TCP group. Increases in insulin-like growth factor-I and vascular endothelial growth factor were found only in the CO3Ap group. CO3Ap-filled extraction sockets accumulated MSCs, and MSCs cultured in the presence of CO3Ap produced large amounts of growth factors. These results suggest that CO3Ap promotes healing of tooth extraction sockets. [ABSTRACT FROM AUTHOR]

The composition of carbonate apatite (CO3Ap) aids bone regeneration. Other features, such as porosity and pore interconnectivity of artificial bone, also govern bone regeneration. In general, a trade‐off exists between the porosity and mechanical strength of artificial bone. Therefore, this suggests that the interconnected pores in the ant‐nest‐type porous (ANP) structure of artificial bone accelerate bone regeneration by minimizing the sacrifice of mechanical strength. The unique structure of polyurethane foam has the potential to endow CO3Ap with an ANP structure without forming excess pores. This study investigated the efficacy of polyurethane foam as a porogen in providing ANP structure to CO3Ap artificial bone. The polyurethane foam was completely decomposed by sintering and the resulting CO3Ap displayed ANP structure with a compressive strength of approximately 15 MPa. Furthermore, in vivo experiments revealed that the migration of cells and tissues into the interior of CO3Ap through the interconnected pores accelerated bone regeneration in the ANP‐structured CO3Ap. Thus, this indicates that using polyurethane foam as a porogen endows the CO3Ap artificial bone with an ANP structure that accelerates bone regeneration. [ABSTRACT FROM AUTHOR]

Carbonated apatite is the inorganic component of natural bone while the carbonate ion in the structure influences biological activities and osteoconductivity. However, thermal stability of carbonate apatite is a major importance since thermal stability of carbonate apatite is a function of carbonate content presented in the structure and heat treatment atmosphere. This research work investigates the effects of different carbonate contents on carbonate substitution, thermal stability, physical and mechanical properties of carbonate apatite synthesized by a precipitation method. The results indicated that the carbonate content influenced the properties of carbonated apatite powders. High carbonate substitution (10-11 wt.%) promoted the decomposition of carbonated apatite after heat treatment at 900 °C while a low amount of carbonate substitution (approx. 2 wt.%) resulted in the relocation of carbonate group from phosphate site to hydroxyl site without decomposition. It also demonstrated that a high carbonate amount resulted in a superior mechanical performance. Dense carbonated apatite with high carbonate content has achieved a relative density of 97% and a maximum fracture toughness of 1.4 MPa•m1/2. In the contrary, low carbonate content resulted in a compact with high porosity of about 40% and a low toughness value of 0.35 MPa·m1/2 when treatment at 900 °C. [ABSTRACT FROM AUTHOR]

We have developed an autologous transplantation method using adipose tissue-derived multi-lineage progenitor cells (ADMPCs) as a method of periodontal tissue regeneration that can be adapted to severe periodontal disease. Our previous clinical study confirmed the safety of autologous transplantation of ADMPCs and demonstrated its usefulness in the treatment of severe periodontal disease. However, in the same clinical study, we found that the fibrin gel used as the scaffold material might have caused gingival recession and impaired tissue regeneration in some patients. Carbonate apatite has a high spacemaking capacity and has been approved in Japan for periodontal tissue regeneration. In this study, we selected carbonate apatite as a candidate scaffold material for ADMPCs and conducted an in vitro examination of its effect on the cellular function of ADMPCs. We further performed autologous ADMPC transplantation with carbonate apatite as the scaffold material in a model of one-wall bone defects in beagles and then analyzed the effect on periodontal tissue regeneration. The findings showed that carbonate apatite did not affect the cell morphology of ADMPCs and that it promoted proliferation. Moreover, no effect on secretor factor transcription was found. The results of the in vivo analysis confirmed the space-making capacity of carbonate apatite, and the acquisition of significant new attachment was observed in the group involving ADMPC transplantation with carbonate apatite compared with the group involving carbonate apatite application alone. Our results demonstrate the usefulness of carbonate apatite as a scaffold material for ADMPC transplantation. [ABSTRACT FROM AUTHOR]

Carbonate apatite (CO3Ap) granules are useful as a bone substitute because they can be remodeled to new natural bone in a manner that conforms to the bone remodeling process. However, reconstructing large bone defects using CO3Ap granules is difficult because of their granular shape. Therefore, we fabricated CO3Ap honeycomb blocks (HCBs) with continuous unidirectional pores. We aimed to elucidate the tissue response and availability of CO3Ap HCBs in the reconstruction of rabbit mandibular bone defects after marginal mandibulectomy. The percentages of the remaining CO3Ap area and calcified bone area (newly formed bone) were estimated from the histological images. CO3Ap area was 49.1 ± 4.9%, 30.3 ± 3.5%, and 25.5 ± 8.8%, whereas newly formed bone area was 3.0 ± 0.6%, 24.3 ± 3.3%, and 34.7 ± 4.8% at 4, 8, and 12 weeks, respectively, after implantation. Thus, CO3Ap HCBs were gradually resorbed and replaced by new bone. The newly formed bone penetrated most of the pores in the CO3Ap HCBs at 12 weeks after implantation. By contrast, the granulation tissue scarcely invaded the CO3Ap HCBs. Some osteoclasts invaded the wall of CO3Ap HCBs, making resorption pits. Furthermore, many osteoblasts were found on the newly formed bone, indicating ongoing bone remodeling. Blood vessels were also formed inside most of the pores in the CO3Ap HCBs. These findings suggest that CO3Ap HCBs have good osteoconductivity and can be used for the reconstruction of large mandibular bone defects. [ABSTRACT FROM AUTHOR]

Bone augmentation using artificial bone is an important option in dental defect prostheses. A bone substitute using carbonate apatite (CO3Ap), an inorganic component of bone, was reported to have promising bone formation and bone replacement ability. However, the osteoinductivity of artificial bone is less than autogenous bone (AB). In this study, CO3Ap with AB is demonstrated as a clinically effective bone substitute. For in vitro experiments, an osteoclast-like cell (RAW-D) was cultured in the presence of AB, CO3Ap, or both (Mix), and the number of osteoclasts was evaluated. Osteoblasts were also cultured under the same conditions, and the number of adherent cells was evaluated. For in vivo experiments, a few holes were created in the rat tibia and AB, CO3Ap, or Mix were added. At 0, 14, and 21 days, the tissue morphology of the wound area was observed, and the thickness of the cortical bone was measured. In vitro, Mix did not increase the number of osteoclasts or osteoblasts. However, in vivo, the rate of bone replacement remarkably increased with Mix on dome-shape. A bone-grafting material combining osteoinductive AB with abundant artificial bone is expected to be clinically easy to use and able to form bone. [ABSTRACT FROM AUTHOR]

The present study investigated the osteoclast differentiation potential and paracrine effects of osteoclasts on osteoblast differentiation when the cells were cultured directly on two bone substitutes (BSs): deproteinized bovine bone mineral (DBBM) and carbonate apatite (CO3Ap). Human primary osteoclasts cultured on the BSs were assessed by tartrate‐resistant acid phosphatase (TRAP) and actin ring staining. Thereafter, the mRNA levels of osteoclastic differentiation markers were quantified by real‐time PCR. Osteoblast behaviors in response to conditioned media collected from osteoclast cultures were investigated. Interestingly, mature osteoclasts were occasionally observed on the surface of the CO3Ap granules, whereas very few and small osteoclasts were observed on DBBM. Similarly, real‐time PCR analysis showed higher mRNA levels of osteoclast markers, including cathepsin K and TRAP, in the cells cultured on CO3Ap than in those cultured on DBBM. Furthermore, compared to DBBM, CO3Ap promoted osteoblast differentiation in human primary osteoblasts, whereas few paracrine effects of osteoclasts cultured with either BS were observed on the osteoblast differentiation potential. These limited results showed that CO3Ap provided a favorable surface for osteoclast differentiation, as well as osteoblasts, compared to DBBM in vitro. [ABSTRACT FROM AUTHOR]

The objective of this study was to clarify the efficiency of a combination of stem cells from human deciduous teeth and carbonate apatite in bone regeneration of calvarial defects. Immunodeficient mice (n = 5 for each group/4 groups) with artificial calvarial bone defects (5 mm in diameter) were developed, and stem cells from human deciduous teeth (SHEDs) and carbonate hydroxyapatite (CAP) granules were transplanted with an atelocollagen sponge as a scaffold. A 3D analysis using microcomputed tomography, and 12 weeks after transplantation, histological and immunohistochemical evaluations of markers of bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF), and cluster of differentiation (CD) 31 were performed. In the 3D analysis, regenerated bone formation was observed in SHEDs and CAP, with the combination of SHEDs and CAP showing significantly greater bone regeneration than that in the other groups. Histological and immunohistochemical evaluations showed that combining SHEDs and CAP enhanced the expression of BMP-2, VEGF, and CD31, and promoted bone regeneration. This study demonstrates that the combination of SHEDs and CAP transplantation may be a promising tool for bone regeneration in alveolar defects. [ABSTRACT FROM AUTHOR]

The porous architecture of artificial bones plays a pivotal role in bone ingrowth. Although salt leaching methods produce predictable porous architectures, their application in the low‐temperature fabrication of ceramics remains a challenge. Carbonate apatite (CO3Ap) blocks with three ranges of pore sizes: 100–200, 200–400, and 400–600 μm, were fabricated from CaCO3 blocks with embedded Na2HPO4 crystals as a porogen and accelerator for CaCO3‐to‐CO3Ap conversion. CaCO3 blocks were obtained from Ca(OH)2 compacts with Na2HPO4 by CO2 flow at 100% humidity. When carbonated under 100% water humidity, the dissolution of Na2HPO4 and the formation of hydroxyapatite were observed. Using 90% methanol and 10% water were beneficial in avoiding the Na2HPO4 consumption and generating the metastable CaCO3 vaterite, which was rapidly converted into CO3Ap in a Na2HPO4 solution in 7 days. For the histological evaluation, the CO3Ap blocks were implanted in rabbit femur defects. Four weeks after implantation, new bone was formed at the edges of the blocks. After 12 weeks, new bone was observed in the central areas of the material. Notably, CO3Ap blocks with pore sizes of 100–200 μm were the most effective, exhibiting approximately 23% new bone area. This study sheds new light on the fabrication of tailored porous blocks and provides a useful guide for designing artificial bones. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Infection-associated renal stones are commonly composed of magnesium-ammonium-phosphate (MAP) and carbonate apatite (CA). The clinical implications of these two different, but closely related stone types, are unknown. We sought to compare the clinical, microbiologic, and metabolic characteristics of patients with MAP and CA stone types. Methods: We retrospectively reviewed the medical records of patients from two centers (one in the United States and one in Israel) who underwent ureteroscopy or percutaneous nephrolithotomy between 2012 and 2020 and identified patients with a predominant stone analysis component of CA or MAP and clinical data supporting an infection stone. We analyzed and compared demographic data, medical history, postoperative fever, stone and urinary microbiology, and 24-hour urine studies. Results: A total of 79 and 75 patients met the inclusion criteria for the MAP and CA cohorts, respectively. No significant difference was found in patient demographics or comorbidities between the MAP and CA cohort. Female predominance was noted in both. Although there were no significant differences in 24-hour urine parameters between the cohorts, hypercalciuria was common in both cohorts (38% and 32% of patients in the MAP and CA cohorts, respectively). Gram-negative bacteria were more common in the MAP stone cultures. Postoperative fever was significantly more common in the MAP cohort (14.7% vs 3.8%, p < 0.016). Conclusions: MAP and CA stone formers share similar demographic characteristics with a clear female predominance. MAP stones patients appear more likely to develop postoperative fever, possibly related to a higher occurrence of gram-negative bacteria in the stone cultures of the MAP cohort. Although there were no significant differences among metabolic parameters, hypercalciuria was noted in approximately a third of the cohort. The clinical significance of this finding is yet to be determined. [ABSTRACT FROM AUTHOR]

Background: Low bone quantity and quality are serious problems that affect the prognosis of implants in the cosmetic field. Therefore, artificial bone substitutes are frequently used. However, whether there is a difference in the effect of either bone substitute on soft tissue healing is unclear given their greatly different absorbability. In this study, we used hydroxyapatite (HAp) and carbonate apatite (CO3Ap) as bone substitutes to analyze the epithelial and connective tissue healing after tooth extraction. Methods: In vitro, oral mucosa-derived epithelial cells (OECs) collected from 4-day-old Wistar rats were seeded on HAp or CO3Ap and evaluated for adhesion, proliferation, migration, apoptosis, and morphology. Fibroblasts (FBs) were also analyzed for their ability to express collagen. In vivo, the extraction of maxillary right first (M1) and second molars (M2) of 6-week-old male Wistar rats was performed, followed by insertion of HAp or CO3Ap granules into the M1 and M2 sites. The oral mucosal healing process was then evaluated histochemically after 7 and 14 days. Results: In vitro, high collagen expression by FBs in the CO3Ap group was observed and the surface analysis showed spreading of the FBs on the CO3Ap surface. However, the activity of OECs was suppressed on CO3Ap. Two weeks after CO3Ap implantation, soft tissue healing was observed, and recovery of the connective tissue was observed on the remaining CO3Ap. Conclusions: Our results suggest that the formation of soft tissues, including connective tissue, was promoted by CO3Ap in the extraction socket within a short period. [ABSTRACT FROM AUTHOR]

Carbonate apatite (CO3Ap) is an inorganic component of bone and replaces by natural bone after implantation into the bone defect. Because of this unique characteristic, CO3Ap granules have been used in the dental field. However, washing out of granules from the bone defect area is an issue. The aim of this study was to set CO3Ap granules by mixing CO3Ap granules with acidic phosphate solutions and evaluate the influence of the pH and ion components of the solutions. When Na+ was the counter ion, the amount of precipitated dicalcium phosphate dihydrate (DCPD) was small and the setting ability disappeared with increasing pH of the solutions. Alternatively, when the counter ion was Ca2+, the amount of precipitated DCPD was high and the setting ability was observed even at high pH. These results suggest the presence of Ca2+ in the acidic phosphate solution is a key for fabricating CO3Ap granular cement. [ABSTRACT FROM AUTHOR]

Porous architecture in bone substitutes, notably the interconnectivity of pores, is a critical factor for bone ingrowth. However, controlling the pore interconnectivity while maintaining the microarchitecture has not yet been achieved using conventional methods, such as sintering. Herein, we fabricated a porous block using the crystal growth of calcium sulfate dihydrate, and controlled the pore interconnectivity by limiting the region of crystal growth. The calcium sulfate dihydrate blocks were transformed to bone apatite, carbonate apatite (CO3Ap) through dissolution–precipitation reactions. Thus, CO3Ap blocks with 15% and 30% interconnected pore volumes were obtained while maintaining the microarchitecture: they were designated as CO3Ap-15 and CO3Ap-30, respectively. At 4 weeks after implantation in a rabbit femur defect, new bone formed throughout CO3Ap-30, whereas little bone was formed in the center region of CO3Ap-15. At 12 weeks after implantation, a large portion of CO3Ap-30 was replaced with new bone and the boundary with the host bone became blurred. In contrast, CO3Ap-15 remained in the defect and the boundary with the host bone was still clear. Thus, the interconnected pores promote bone ingrowth, followed by replacement of the material with new bone. These findings provide a useful guide for designing bone substitutes for rapid bone regeneration. Open in new tab Download slide [ABSTRACT FROM AUTHOR]

Critical‐size segmental defects are formidable challenges in orthopedic surgery. Various scaffolds have been developed to facilitate bone reconstruction within such defects. Many previously studied scaffolds achieved effective outcomes with a combination of high cost, high‐risk growth factors or stem cells. Herein, we developed honeycomb scaffolds (HCSs) comprising carbonate apatite (CO3Ap) containing 8% carbonate, identical to human bone composition. The CO3Ap HCSs were white‐columned blocks harboring regularly arranged macropore channels of a size and wall thickness of 156 ± 5 μm and 102 ± 10 μm, respectively. The compressive strengths of the HCSs parallel and perpendicular to the macropore channel direction were 51.0 ± 11.8 and 15.6 ± 2.2 MPa, respectively. The HCSs were grafted into critical‐sized segmental defects in rat femurs. The HCSs bore high‐load stresses without any observed breakage. Two‐weeks post‐implantation, calluses formed around the HCSs and immature bone formed in the HCS interior. The calluses and immature bone matured until 8 weeks via endochondral ossification. At 12 weeks post‐implantation, large parts of the HCSs were gradually replaced by newly formed bone. The bone reconstruction efficacy of the CO3Ap HCSs alone was comparable to that of protein and cell scaffolds, while achieving a lower cost and increased safety. [ABSTRACT FROM AUTHOR]

Corrosion-control coatings which can enhance bone formation and be completely replaced by bone are attractive for biodegradable Mg alloys. Carbonate apatite (CAp) and hydroxyapatite (HAp) coatings were formed on Mg-4 wt% Y-3 wt% rare earth (WE43) alloy as a corrosion-control and bioabsorbable coating in the coating solution with various concentrations of NaHCO3. The incorporation of carbonate group in apatite structure was examined using X-ray diffraction and Fourier transform infrared spectroscopy. Rat osteoclast precursor and MC3T3-E1 osteoblast cells were cultured on the CAp- and HAp-coated WE43 to examine the osteoclastic resorption and the alkaline phosphatase (ALP) activity, respectively. Mg ions in the used medium were quantified to examine the corrosion-control ability. The NaHCO3 addition in the solution resulted in the formation of B-type CAp in which the phosphate group of apatite structure was substituted with the carbonate group. The osteoclastic resorption was observed only for the CAp coatings as the cracking of the coatings and the corrosion of substrate WE43 strongly localized under osteoclast cell bodies. The CAp and HAp coatings significantly enhanced the ALP activity of osteoblasts. The CAp-coated WE43 specimens showed 1/5 smaller amount of Mg ion release than the uncoated WE43 on the first day of culturing osteoblasts. For the subsequent 22 days, the Mg ion release was reduced to 1/2 by the CAp coatings. In the presence of osteoclasts, the CAp coatings showed slightly lower corrosion protectiveness than the HAp coating. It was demonstrated that the CAp coatings can be a bioabsorbable and corrosion-control coating for biodegradable Mg alloys. [ABSTRACT FROM AUTHOR]

Titanium (Ti) implants that realize rapid osseointegration are required for favorable outcomes. Rough implant surfaces favor osseointegration, hence, coating implants with natural bone mineral, i.e., carbonate apatite (CO3Ap), may be effective for osseointegration. To achieve rapid osseointegration, rough‐Ti substrates are coated with CO3Ap (CO3Ap‐Ti) and the effects are evaluated in vitro and in vivo. For comparison, rough‐Ti without coating (rough‐Ti) and calcite‐coated rough‐Ti (calcite‐Ti) substrates are fabricated. The adhesive strengths of calcite and CO3Ap to the substrates are ≈56.6 and ≈76.8 MPa, respectively, being significantly higher than the strength defined in ISO13779‐2 (15 MPa). Calcite and CO3Ap coatings significantly promote preosteoblastic MC3T3‐E1 cell proliferation. Additionally, the CO3Ap coating promotes higher osteogenic differentiation activity than the calcite coating. Implantation of CO3Ap‐Ti into rabbit tibia defects prompts bone maturation, compared to calcite‐Ti or rough‐Ti implantation. The bone‐implant contact percentage with CO3Ap‐Ti and calcite‐Ti is higher than that with rough‐Ti. Consequently, CO3Ap‐Ti acquires a robust bond with the host bone at an early stage (4 weeks postimplantation), compared to calcite‐Ti or rough‐Ti: the CO3Ap‐Ti–bone bonding strength is ≈1.9‐ and ≈5.5‐fold higher than that of calcite‐Ti and rough‐Ti, respectively. Thus, CO3Ap coating of Ti implants effectively achieve rapid osseointegration. [ABSTRACT FROM AUTHOR]

Since bone apatite is a carbonate apatite containing carbonate in an apatitic structure, carbonate content may be one of the factors governing the osteoconductivity of apatitic bone substitutes. The aim of this study was to evaluate the effects of carbonate content on the osteoconductivity of apatitic bone substitutes using three commercially available bone substitutes for the reconstruction of alveolar bone defects of a beagle mandible with simultaneous dental implant installation. NEOBONE, Bio‐Oss, and Cytrans that contain 0.1, 5.5, and 12.0 mass% of carbonate, respectively, were used in this study. The amount of newly formed bone in the upper portion of the alveolar bone defect of the beagle's mandible was 0.7, 6.6, and 39.4% at 4 weeks after surgery and 4.7, 39.5, and 75.2% at 12 weeks after surgery for NEOBONE, Bio‐Oss, and Cytrans, respectively. The results indicate that bone‐to‐implant contact ratio was the largest for Cytrans. Additionally, the continuity of the alveolar ridge was restored in the case of Cytrans, whereas the continuity of the alveolar ridge was not sufficient when using NEOBONE and Bio‐Oss. Both Cytrans and Bio‐Oss that have a relatively larger carbonate content in their apatitic structure was resorbed with time. We concluded that carbonate content is one of important factors governing the osteoconductivity of apatitic bone substitutes. [ABSTRACT FROM AUTHOR]

The treatment of vertical bone defects caused by severe periodontal disease requires the regeneration of periodontal tissue. Although various bone substitutes have been clinically applied to vertical bone defect correction, the evaluation of these materials in periodontal tissue remains incomplete. The purpose of this study was to examine the bone regeneration abilities of various bone substitutes including Cytrans, Cerasorb, Neobone and Bio-Oss in a 3-wall bone defect animal model. All of these bone substitutes showed a similar healing ability to periodontal ligament and cementum. However, Cytrans showed the fastest bone healing ability compared with the other materials at 4 weeks post-transplantation. In addition, the recruitment of osteoclasts and endothelial cells was observed in Cytrans grafts at 4 weeks, but only detected at 8 weeks in the other materials. These results suggest that Cytrans promotes faster bone healing by inducing bone remodeling and angiogenesis. [ABSTRACT FROM AUTHOR]

Carbonate apatite (CO3Ap) granules are known to show good osteoconductivity and replaced to new bone. On the other hand, it is well known that a porous structure allows bone tissue to penetrate its pores, and the optimal pore size for bone ingrowth is dependent on the composition and structure of the scaffold material. Therefore, the aim of this study was to fabricate various porous CO3Ap granules through a two‐step dissolution–precipitation reaction using CaSO4 as a precursor and 30‐, 50‐, 120‐, and 205‐μm diameter microfibers as porogen and to find the optimal pore size of CO3Ap. Porous CO3Ap granules were successfully fabricated with pore size 8.2–18.7% smaller than the size of the original fiber porogen. Two weeks after the reconstruction of rabbit calvarial bone defects using porous CO3Ap granules, the largest amount of mature bone was seen to be formed inside the pores of CO3Ap (120) [porous CO3Ap granules made using 120‐μm microfiber] followed by CO3Ap (50) and CO3Ap (30). At 4 and 8 weeks, no statistically significant difference was observed based on the pore size, even though largest amount of mature bone was formed in case of CO3Ap (120). It is concluded, therefore, that the optimal pore size of the CO3Ap is that of CO3Ap (120), which is 85 μm. [ABSTRACT FROM AUTHOR]

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In recent years, focuse has moved to multiphase calcium orthophosphate scaffolds to balance the more stable calcium orthophosphate phase with another more soluble phase. This will enable the researchers to tailor the major biomedical properties to suit its intended application. In this study, beta tricalcium phosphate (β-TCP)/carbonate apatite (CO3 Ap) scaffolds were fabricated via freeze drying method. The effect of soaking time (2 h, 4 h and 6 h) on the phase transformation of β to alpha (α) phase was investigated. The scaffolds were sintered at 1300°C for respective soaking time and quenched in air to obtain biphasic β-TCP/α-TCP scaffolds. To obtain biphasic β-TCP/CO3 Ap scaffold, the obtained scaffolds were then subjected to hydrothermal treatment in 1 M of sodium bicarbonate at 200°C for 5 days for phase transformation of α-TCP phase into CO3 Ap phase via dissolution-precipitation process. X-ray diffraction (XRD) analysis before hydrothermal treatment confirms the existence of biphasic β and α phase at all soaking time. The percentage of α phase increases as soaking time increases. Fourier transform infrared (FTIR) analysis confirms the present of carbonate ions substitution into the scaffold after hydrothermal treatment. Therefore, it is concluded that as soaking time increases, the unstable phase of α-TCP increases in the biphasic β-TCP/ α-TCP scaffolds. Thus, the phase transformation from α-TCP phase to CO3 Ap phase increases as soaking time increases. [ABSTRACT FROM AUTHOR]

Two types of synthetic carbonate apatite [potassium-containing carbonate apatite (CAK) and sodium-containing carbonate apatite (CANa)] were prepared and characterized by thermogravimetric analysis, X-ray diffraction analysis (XRD) and Fourier transform infrared spectroscopy. The chemical formulas of carbonate apatite were determined to be Ca9.36K0.12(PO4)5.12(CO3)0.88(OH)1.73 and Ca8.72Na1.33(PO4)4.96(CO3)1.04(OH)1.80, respectively. Thermogravimetric analysis showed that the final weight loss at 1,200°C reached about 11.2% for CAK and 13.9% for CANa. Carbonate loss gradually occurred above 150°C and continued to 1,200°C. The crystallinity of the apatite phase was found to be much improved between 800 and 850°C for CAK and 750 and 800°C for CANa, where rapid carbonate loss occurred. A small amount of CaO formed above 900°C. For CANa, NaCaPO4 also formed above 700°C in both apatites. Although the lattice parameters of the carbonate apatites varied with temperature, the final a and c lattice parameters attained constant values of 0.9421 and 0.6881 nm. [ABSTRACT FROM AUTHOR]

Carbonate apatite (CO3Ap) block can be used as a bone substitute because it can be remodeled to new natural bone in a manner conforming with the bone remodeling process. Among the many porous structures available, honeycomb (HC) structure is advantageous for rapid replacement of CO3Ap to bone. In this study, the feasibility to fabricate a CO3Ap HC was studied, along with its initial tissue response in rabbit femur bone defect. First, a mixture of Ca(OH)2 and a wax‐based binder was extruded from a HC mold. Then the fabricated HC was heated for binder removal and carbonation at 450°C in a mixed O2–CO2 atmosphere, forming a CaCO3 HC. When the CaCO3 HC was immersed in 1 mol/L Na3PO4 solution at 80°C for 7 days, its composition changed from CaCO3 to CO3Ap, maintaining the structure of the original CaCO3 HC. Compressive strengths of the CaCO3 and CO3Ap HCs were 65.2 ± 7.4 MPa and 88.7 ± 4.7 MPa, respectively. When the rabbit femur bone defect was reconstructed with the CO3Ap HC, new bone penetrated the CO3Ap HC completely. Osteoclasts and osteoblasts were found on the surface of the newly formed bone and osteocytes were also found in the newly formed bone, indicating ongoing bone remodeling. Furthermore, blood vessels were formed inside the pores of CO3Ap HC. Therefore, CO3Ap HC has good potential as an ideal bone substitute. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1014–1020, 2019. [ABSTRACT FROM AUTHOR]

Geopolymer is a non-crystalline material based on aluminosilicate reaction exhibiting ceramic-like properties. It showed the possibility to use geopolymer as biomaterials by soaking in SBF solution to induct carbonate apatite onto the surface of samples. Carbonate apatite possesses good biocompatibility and bioactivity. The aims of this research were to study the geopolymer synthesis as a biomaterial to replace bones and the effects of Ca/P ratio on bioactivity properties of metakaolin-based geopolymers. For in vitro bioactivity test, the samples were soaked in SBF to study the influence of Ca(OH)2 contents on the surface reaction. The 14, 28, and 90 day-soaked sample surfaces were investigated using SEM, XRD, and FTIR characterization. The compressive strength of samples was also tested. The SEM micrographs revealed that the increase of Ca/P ratio resulted in the increase of the carbonate apatite on sample surfaces. FTIR results confirmed that the formation of Ca10(PO4)3(CO3)3(OH)2 was investigated. [ABSTRACT FROM AUTHOR]

Background: Studies of bone tissue engineering as a viable alternative to autogenous bone graft show promising results, although its mechanism and effectiveness remain only partially understood. Purpose: to explain the osteogenic differentiation of scaffold chitosan (Ch)–carbonate apatite (CA) in seeding with human amniotic mesenchymal stem cells (hAMSCs) on the regeneration of calvarial bone defects in rats. Materials and Methods: Shitosan-Carbonate Apatite (Ch-CA) scaffold was created by means of a freeze-drying method. Twenty Wistar rats were randomly divided into two groups: control and treatment. Defects were created in the calvarial bone of each treatment group with a scaffold subsequently implanted. After 8 weeks, the rats were terminated for histology and immunohistochemistry examination. Results: Expressions of vascular endothelial growth factor, bone morphogenetic protein2, Runt-related transcription factor 2 (RUNX2), and angiogenesis occurred earlier in the tissue-engineered group than that in the control group. An 8-week analysis also showed that the expression of RUNX2, alkaline phosphatase, osteocalcin, and collagen type 1 was at more elevated levels in the treatment group than that in the control group. Conclusion: These results showed that the combination of hAMSCs and Ch-CA scaffold may become one of the candidates for bone tissue engineering. [ABSTRACT FROM AUTHOR]

Background: Alveolar bone defects in children still have a high incidence. Conventional bone graft technique that has been used as a defect therapy is still not effective, so new techniques with tissue engineering approach are needed. Bone Morphogenetic Protein 4 (BMP4) as one of the indicators of osteogenic differentiation has not been widely studied, especially in the transplantation with combination of Stem Cells from Human Exfoliated Deciduous (SHED) and carbonate apatite. Aim and Objectives: This research aimed to determine the expression of BMP4 after SHED and carbonate apatite transplantation on Rattus norvegicus. Material and Methods: The combinations of SHED and carbonate apatite were transplanted on alveolar bone defects of 4 rats (Rattus norvegicus) as the treatment groups and another 4 rats were transplanted with carbonate apatite as the control groups. After 21 days, staining with Hematoxylin Eosin (HE) and Immunohistochemistry (IHC) BMP4 was performed. Results: BMP4 expression in the treatment groups was significantly higher when compared to the control groups. Discussion: Carbonate apatite has low crystallization rate and high osteoconductivity that produce more osteoblasts and increased BMP4 expression. Conclusion: The transplantation of SHED and carbonate apatite increased BMP4 expression as an indicator of osteogenic differentiation in rats. [ABSTRACT FROM AUTHOR]

The purpose of this study is to analyze the co-existence effect of 30 wt.% TCP-BG phases on degradation and precipitation behaviors of PLLA based composite scaffold in biological media. First, phase separation method was used to synthesize of the pure PLLA and the trinary composite scaffolds, and second they were immersed in SBF solution for 45 days. Subsequently, the degradation and precipitation characteristic were investigated by analyzing of pH value and weight changes of the immersed samples, the ability of biological products formation and the change of relative molecular weight of PLLA matrix as function of the degradation time. Finally, the experimental data of relative molecular weight change were verified by Han and Pan model and comparisons were made between them. Results have represented precipitation of huge amount of carbonate apatite on surface of the composite scaffold, and also the acidity of SBF media changes moderately which is prove better bioactivity properties compare to the pure PLLA scaffold. The results of comparison with the model point to quiet good agreement between them in early stage of degradation. So, the consequences suggest that the TCP-BG/PLLA composite scaffold have great potential to be applied in bone replacements or repairs. [ABSTRACT FROM AUTHOR]

Subcutaneous calcifications can lead to complications, including pain, inflammation, ulceration and immobilization. Studies on the pathophysiology of mineral compositions and effective treatment modalities are limited. We therefore studied 14 patients with subcutaneous calcifications. Mineral material was collected and analysed by Fourier transform infrared spectrometry. Blood analyses were run to evaluate systemic alterations of mineral metabolism. Carbonate apatite (CAP) was found to be the single constituent in the majority of patients (n = 9, 64.3%), 3 cases (21.4%) had a composition of CAP and calcium oxalate dihydrate and one case had a combination of CAP and magnesium ammonium phosphate, whereas CAP was the major component in all 4 cases. Only one case showed predominantly calcium oxalate. Thus, CAP was found to be the only or predominant component in most cases of subcutaneous calcifications. Chemical analyses of the mineral compositions may aid in the development of new treatment regimes to improve the solubility of mineral components and to decrease extraosseous calcifications. [ABSTRACT FROM AUTHOR]