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The powdered cement tetracalcium phosphate/monetite/silk fibroin composite (CFIB) was prepared by simple mechanical milling of tetracalcium phosphate/monetite powder mixture with fibrous soluble silk fibroin (SF). The powder composite cement mixtures contained 5 and 10 wt % of SF and 2% NaH2 PO4 solution with 0.1% genipin was used as a liquid component. The setting time of CFIB cement increased with addition of SF from 5 to 25 min in fully injectable cement with 10 wt % of SF. The compressive strength of hardened composites was reduced to 14 MPa which is close to strength of cancellous bone. The 8% of SF from origin amount in CFIB composites was only desorbed from cements after 7 days soaking in simulated body fluid (SBF). It was found almost full transformation of calcium phosphate components in composite to rod-like nanohydroxyapatite after hardening of CFIB cements in SBF. The SF in hardened cements was present in fine globular form after dissolution, actively affected the fluidity of pastes, morphology of hydroxyapatite particles, and microstructure. The excellent cell proliferation and a high over expression of osteogenic gene markers in MSCs were confirmed after the long-time cultivation in CFIB10 cement extract. Injectable CFIB10 cements have appropriate properties for utilization in bone defect treatments with possible positive effect on healing process.

Calcium phosphate cements (CPCs) belong to one of the most prominent biomaterials used for filling and regeneration of hard tissues, however poor mechanical and biological properties limit their widespread use in some clinical applications. To solve these problems, a biodegradable glycerol-citrate (G-CA) polyester was synthesized and coated on tricalcium phosphate cement (TCP) powders in amounts up to 10 wt% of the G-CA content using a simple solution infiltration technique in ethanol solution. Chemical and structural analysis of the G-CA elastomer and TCP/G-CA composites were thoroughly analyzed with chromatographic techniques, solid-state nuclear magnetic resonance (ssNMR), differential scanning calorimetry and thermogravimetry (DSC/TG), X-ray diffraction (XRD), Fourier-Transform Infrared spectroscopy (FTIR) and field emission scanning electron microscopy (SEM). The results demonstrated that the incorporation of 2.5 and 5 wt% of G-CA into TCP cement led to a significant increase of mechanical strength of the cements due to the formation of thin and homogeneous elastomer coating on cement particles, reinforcing the microstructure through hydrogen bonds between residual COOH groups of polymer and surface phosphate groups of the cement matrix. Additional in vitro testing of extracts cytotoxicity revealed a high proliferation of osteoblasts in all composites, demonstrating a promising application potential in regenerative medicine.

A modified one-step process was used to prepare tetracalcium phosphate/monetite/calcium sulfate hemihydrate powder cement mixtures (CAS). The procedure allowed the formation of monetite and calcium sulfate hemihydrate (CSH) in the form of nanoparticles. It was hypothesized that the presence of nanoCSH in small amounts enhances the in vitro bioactivity of CAS cement in relation to osteogenic gene markers in mesenchymal stem cells (MSCs). The CAS powder mixtures with 15 and 5 wt.% CSH were prepared by milling powder tetracalcium phosphate in an ethanolic solution of both orthophosphoric and sulfuric acids. The CAS cements had short setting times (around 5 min). The fast setting of the cement samples after the addition of the liquid component (water solution of NaH2PO4) was due to the partial formation of calcium sulfate dihydrate and hydroxyapatite before soaking in SBF with a small change in the original phase composition in cement powder samples after milling. Nanocrystalline hydroxyapatite biocement was produced by soaking of cement samples after setting in simulated body fluid (SBF). The fast release of calcium ions from CAS5 cement, as well as a small rise in the pH of SBF during soaking, were demonstrated. After soaking in SBF for 7 days, the final product of the cement transformation was nanocrystalline hydroxyapatite. The compressive strength of the cement samples (up to 30 MPa) after soaking in simulated body fluid (SBF) was comparable to that of bone. Real time polymerase chain reaction (RT-PCR) analysis revealed statistically significant higher gene expressions of alkaline phosphatase (ALP), osteonectin (ON) and osteopontin (OP) in cells cultured for 14 days in CAS5 extract compared to CSH-free cement. The addition of a small amount of nanoCSH (5 wt.%) to the tetracalcium phosphate (TTCP)/monetite cement mixture significantly promoted the over expression of osteogenic markers in MSCs. The prepared CAS powder mixture with its enhanced bioactivity can be used for bone defect treatment and has good potential for bone healing.

Novel calcium phosphate cements containing a mixture of four amino acids, glycine, proline, hydroxyproline and either lysine or arginine (CAL, CAK) were characterized and used for treatment of artificial osteochondral defects in knee. It was hypothesized that an enhanced concentration of extracellular collagen amino acids (in complex mixture), in connection with bone cement in defect sites, would support the healing of osteochondral defects with successful formation of hyaline cartilage and subchondral bone. Calcium phosphate cement mixtures were prepared by in situ reaction in a planetary ball mill at aseptic conditions and characterized. It was verified that about 30&ndash, 60% of amino acids remained adsorbed on hydroxyapatite particles in cements and the addition of amino acids caused around 60% reduction in compressive strength and refinement of hydroxyapatite particles in their microstructure. The significant over-expression of osteogenic genes after the culture of osteoblasts was demonstrated in the cement extracts containing lysine and compared with other cements. The cement pastes were inserted into artificial osteochondral defects in the medial femoral condyle of pigs and, after 3 months post-surgery, tissues were analyzed macroscopically, histologically, immunohistochemically using MRI and X-ray methods. Analysis clearly showed the excellent healing process of artificial osteochondral defects in pigs after treatment with CAL and CAK cements without any inflammation, as well as formation of subchondral bone and hyaline cartilage morphologically and structurally identical to the original tissues. Good integration of the hyaline neocartilage with the surrounding tissue, as well as perfect interconnection between the neocartilage and new subchondral bone tissue, was demonstrated. Tissues were stable after 12 months&rsquo, healing.

(1) Background: The preparation and characterization of novel fully injectable enzymatically hardened tetracalcium phosphate/monetite cements (CXI cements) using phytic acid/phytase (PHYT/F3P) hardening liquid with a small addition of polyacrylic acid/carboxymethyl cellulose anionic polyelectrolyte (PAA/CMC) and enhanced bioactivity. (2) Methods: Composite cements were prepared by mixing of calcium phosphate powder mixture with hardening liquid containing anionic polyelectrolyte. Phase and microstructural analysis, compressive strength, release of ions and in vitro testing were used for the evaluation of cement properties. (3) Results: The simple possibility to control the setting time of self-setting CXI cements was shown (7&ndash, 28 min) by the change in P/L ratio or PHYT/F3P reaction time. The wet compressive strength of cements (up to 15 MPa) was close to cancellous bone. The increase in PAA content to 1 wt% caused refinement and change in the morphology of hydroxyapatite particles. Cement pastes had a high resistance to wash-out in a short time after cement mixing. The noncytotoxic character of CX cement extracts was verified. Moreover, PHYT supported the formation of Ca deposits, and the additional synergistic effect of PAA and CMC on enhanced ALP activity was found, along with the strong up-regulation of osteogenic gene expressions for osteopontin, osteocalcin and IGF1 growth factor evaluated by the RT-qPCR analysis in osteogenic &alpha, MEM 50% CXI extracts. (4) Conclusions: The fully injectable composite calcium phosphate bicements with anionic polyelectrolyte addition showed good mechanical and physico-chemical properties and enhanced osteogenic bioactivity which is a promising assumption for their application in bone defect regeneration.

Novel enzymatically hardened tetracalcium phosphate/monetite cements were prepared applying phytic acid/phytase (PHYT/F3P) mixture as hardening liquid after dissolving in acetic acid solution (CX cement). Properties of the cements were compared with classic cement hardened with 2% NaH2PO4 (C cement) and cement hardened with acetic acid solution (CAC cement) only. In the microstructure of CX cement, columnar growth of hydroxyapatite particles was found in the form of walls around hydroxyapatite agglomerates originated from tetracalcium phosphate which were mutually separated by a material depleted low density zone. Wet compressive strengths (CS) of all cements were practically identical contrary to about 30% higher dry CS's of CX and CAC cements due to specific microstructure. It was verified noncytotoxic character of CX cement extracts and positive effect of CX cement on ALP activity and cell behavior during cultivation. The final Ca/P molar ratio and setting time of cement were effectively controlled by the amount of phytic acid and the change in PHYT/F3P mass ratio, or reaction time in hardening liquid, respectively.

Tetracalcium phosphate/nanomonetite (TTCPMH) cement composites with 7.5 and 15 wt% addition of melt-derived 45S5 bioactive glass were prepared by mechanical homogenization of powder components and 2% NaH 2 PO 4 solution was used as a hardening liquid. The properties of composites with the acidic (Ca/P ratio equal 1.5) or basic (Ca/P ratio equal 1.67) TTCPMH component were compared. Addition of glass component caused rapid rise in pH of composites up to 10. In microstructure of basic cement composite, the large bioglass particles weakly bounded to surrounding cement matrix were found contrary to a more compact microstructure of acidic cement composites with the high number of spherical silica particles. Both the significant refinement of hydroxyapatite particles and the change to needle-like morphology with rise in the content of bioglass were identified in hydroxyapatite coatings created during soaking of composites in phosphate buffered saline. In acidic cement mixtures, the increase of compressive strength with an amount of bioglass was found whereas the opposite tendency was revealed in the case of basic cement mixtures. The higher concentrations of ions were verified in solutions after immersion of acidic cement composites. The severe cytotoxicity of extracts and composite cement substrates containing 15 wt% of bioglass demonstrated adverse effects of both the ionic concentrations and unappropriate surface texture on proliferation of mesenchymal stem cells. The enhanced ALP activities of cells cultured on composite cements confirmed the positive effect of bioactive glass addition on differentiation of mesenchymal stem cells.

Magnesium containing calcium silicates have recently shown that they are promising materials for various biomedical application with potential use in the form of bulk ceramic, composite scaffold or coatings on metallic substrates. A novel akermanite (AK; Ca2MgSi2O7)/dicalcium phosphate dihydrate (DCPD, CaHPO4. H2O) cement mixture was tested in this work in order to produce an alternative AK/DCPD biocement for orthopedic applications. For comparison, we have prepared two cements mixed with 2.5 wt% NaH2PO4 solution (labeled as NaH2PO4 cement) and with the solution composed of organic 2.5 wt% citric acid a 2.5 wt% trisodium citrate (citrate cement) respectively. The results demonstrated only a partial dissolution of AK, regardless of the type of liquid used. On the other hand, the DCPD was completely hydrolyzed much faster in the citrate cement. The final hydration product was an amorhous quarternary phase of CaO-MgO-SiO2-P2O5 composition with the remaining unreacted akermanite embeded in the cement matrix. The highest early compressive strength was observed in the citrate cement (33 MPa), but much lower value was measured in NaH2PO4 cement (7 MPa) after 1 d setting. Different cell responses have been observed when the cells were cultured on the surfaces of cement substrates. While the NaH2PO4 cement demonstrated high proliferation activity of osteoblast, the citrate cement showed strong cytotoxic cell response, probably as a result of higher concentration of citrates on the cement surface, which can negatively affect the attachment and proliferation of osteoblastic cells.

The composite cement mixtures were prepared by mixing brushite (B) with, the amorphous hydrated calcium silicate phosphate (CSPH) or annealed calcium silicate phosphate (CSP composed of Si-saturated hydroxyapatite, wollastonite and silica) phases and water as liquid component. The contents of the silicate-phosphate phase in composites were 10.30 and 50 wt%. The significant effect of both the Ca/P ratio and different solubility of calcium silicate phosphate component in starting cement systems on setting time and phase composition of the final composite cements was demonstrated. The compressive strength of the set cements increased with the filler addition and the highest value (~ 48 MPa) exhibited the 50CSP/B cement composite. The final setting times of the composite cements decreased with the CSPH addition from about 25 to 17 min in 50CSHP/B and setting time of CSP/B composites was around 30 min. The higher content of silica in cements caused the precipitation of fine hydroxyapatite particles in the form of nanoneedles or thin plates perpendicularly oriented to sample surface. The analysis of in vitro cement cytotoxicity demonstrated the strong reduction in cytotoxicity of 10CSPH/B composite with time of cultivation (a low cytotoxicity after 9 days of culture) contrary to cements with higher calcium silicate-phosphate content. These results were attributed to the different surface topography of composite substrates and possible stimulation of cell proliferation by the slow continuously release of ions from 10CSPH/B cement.

Bone cements based on magnesium phosphates such as newberyite (N; MgHPO4.3H2O) have been shown as potential bone substitutes due to their biocompatibility, biodegradability and ability to support osteoblast differentiation and proliferation. Newberyite can hydrolyze to hydrated magnesium phosphate compounds (e.g. bobierite (Mg3(PO4)2.8H2O)) at alkaline conditions. In this study, 25 and 50 wt% of crystalline β -wollastonite (woll; CaSiO3) was admixed to newberyite powder in order to both enhance the acid-base hydrolysis of newberyite and to produce a functional bone cement. The setting process of wollastonite/newberyite cement mixtures started with the hydrolysis of the wollastonite with further transformation of newberyite into bobierite and the formation of magnesium silicate phase. The results demonstrated that 25 wollastonite/newberyite and 50 wollastonite/newberyite cement pastes at optimal powder/liquid ratios had final setting times of ∼34 and 25 min and compressive strength values of 18 and 32 MPa after seven days setting, respectively. The tests of cytotoxicity of cement extracts on osteoblastic cells and contact cytotoxicity of the cement substrates showed different results. The osteoblasts cultured in cement extracts readily proliferated which confirmed the non-cytotoxic concentration of ions released from both cements. On the other hand, a strong cytotoxic character of 25 wollastonite/newberyite sample surface in contrary to high (∼80%) proliferation activity of cells on the 50 wollastonite/newberyite cement substrate was observed. The differences in cell proliferation activity was attributed to different surface topographies of cement substrates, where needle-like precipitated microcrystals of magnesium phosphate phase (in 25 wollastonite/newberyite cement) prevented the adhesion and proliferation of osteoblasts contrary to the smoother surface covered by extremely fine nanoparticles in the 50 wollastonite/newberyite cement.

Self-setting simple calcium silicate/brushite (B) biocements with various Ca/P ratios were prepared by mutual mixing of both monocalcium silicate hydrate (CSH) or ?-wollastonite (woll) powders with B and the addition of 2 wt% NaH2PO4 solution as a hardening liquid. The phase composition of the final composites and the texture of the surface calcium phosphate/silica layer were controlled by the starting Ca/P ratio in composites and the pH during setting. It was verified that the presence of continuous bone-like calcium phosphate coating on the surface of the samples was not essential for in vitro osteoblast proliferation. The nanocrystalline calcium deficient hydroxyapatite and amorphous silica were found as the main setting products in composite mixtures with a Ca/P ratio close to the region of the formation of deficient hydroxyapatite-like calcium phosphates. No CSH phase with a lower Ca/Si ratio was identified after transformation. The results confirmed a small effect of the monocalcium silicate addition on the compressive strength (CS) of cements up to 30 wt% (around 20?25?MPa) and a significant rise of the value in 50 woll/B cement (65?MPa). The final setting times of the cement composites varied between 5 and 43?min depending on the P/L ratio and the type of monocalcium silicate phase in the cement mixture. 10CSH/B and 50 woll/B cements with different textures but free of both the needle-like and perpendicularly-oriented hydroxyapatite particles on the surface of the samples had low cytotoxicity.

Biphasic porous calcium phosphate ceramics was prepared by sintering of transformed tetracalcium phosphate-monetite cement. After annealing hydroxyapatite, β- or α-TCP were found as main phases in ceramic substrates and a highly microporous microstructure of cement ceramics was created without an addition of porosifier. The origin microstructure features characteristic by the presence of hollow particle agglomerates in cement were preserved in microstructure of cement ceramics after annealing but the hydroxyapatite particles rose in size up to 2 µm and obtained a more regular shape. A small decrease in compressive strength was demonstrated in ceramics sintered up to 1150 °C and enhanced osteoblast proliferation was revealed on cement ceramic substrates in comparison with cement sample and conventional ceramics. The ALP activity of osteoblasts decreased with rise in sintering temperature. The prepared cement microporous ceramics could be utilized as carrier for antibiotics, drugs, growth factors, enzymes or other substances stimulating healing process.

Non-cytotoxic and bioactive tetracalcium phosphate/nanomonetite/calcium silicate-phosphate cements were prepared by simple mechanical mixing of starting powder precursors based on acid or basic tetracalcium phosphate/nanomonetite mixtures with 1 or 5 wt% addition of precititated amorphous or crystalline calcium silicate phosphate phases. The small additions (1-2 wt%) of crystalline CaSiP phase caused about a two-fold rise in the compressive strength of cements (up to 70 MPa) with simultaneous preservation of short setting time (around 5 min) and refinement of nanohydroxyapatite particles in microstructure. The results verified a close pH to body fluids and enhanced steady state concentrations of Ca2+, silicate and phosphate ions during the soaking of acid than the basic composite mixtures in physiological solution. No cytotoxicity or suppressing in proliferation activity of osteoblasts were revealed after the addition of CaSiP phases to cement powder mixtures. The ALP activity of osteoblasts during the first two days of culture on all composite systems was significantly higher than on pure tetracalcium phosphate/nanomonetite substrates. The superior enhancing in ALP osteoblast activity was found on cements with amorphous CaSiP glass component (even at low contents), which confirms excellent in vitro osteoblast activity on composites and their possible utilization as bone cements in reconstruction medicine.

The biopolymer (polyhydroxybutyrate) microparticles-calcium phosphate composites were prepared by mechanical mixing of the basic composite components with the addition of hardening liquid after ethanol-composite mixture suspension moulding. The composite microstructures were more compact than the pure cement samples as confirmed by the lower values of specific areas and mesopore volumes. Both the specific areas and mesopore volumes decreased with soaking time in a simulated body fluid. The low polyhydroxybutyrate degradation in composites was found after soaking in simulated body fluid, which was terminated after one week. The formation of a dense apatite layer bonded directly to the surface of polyhydroxybutyrate microparticles was observed. The highest diametral tensile strength (13 MPa) and compressive strength (95 MPa) values of up to 50 % higher than in pure cement were measured in samples with 10 % of polyhydroxybutyrate. The addition of polyhydroxybutyrate microparticles had no effect on the setting time.