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During the last decade, there has been a major increase in the interest of nanostructured materials in advanced technologies for biomedical and dental clinical applications. Nanostructured materials are associated with a variety of applications within the dental and biomedical field, for example nanoparticles in drug delivery systems and nanostructured scaffolds in tissue engineering. More importantly, nanotechnology has also been linked with the modification of surface properties of synthetic implants in an attempt to improve their bioactivity, reliability and protection from the release of harmful or unnecessary metal ions. This is achieved through the use of nanocoatings and nanocomposite coatings. These new-generation coatings based on inorganic materials and biological materials such as proteins and peptides are currently investigated and applied. This chapter aims to give an overview of the recent advances in nanocoatings and their composites being investigated or used in dentistry., (© 2015 S. Karger AG, Basel.)

Background: Narrowing of the femoral neck under the femoral component of the hip resurfacing has been noted previously and has raised concern. In this study we examined the X-rays of patients following Birmingham hip resurfacing surgery at 6-years follow-up., Methods: Bony changes proximally and distally were measured. Fifty-two patients were available for evaluation., Results: There were 40 (76.9%) men and 12 (23.1%) women, with a mean age of 52 years (25-64). The unoperated contralateral femoral neck was measured as a control. We found femoral neck narrowing proximally in 82.7% of patients and distally in 26.9% and on the contralateral side in 54.5%. The average narrowing was 3.6%. Widening was observed proximally in 17.3% and distally in 73.1% and on the contralateral side in 45.5%. The average widening was 3.9%. Four of the 52 patients had proximal narrowing exceeding 10% of the femoral neck diameter, and one of the 52 patients had inferior narrowing exceeding 10%., Conclusion: Gender, body mass index, component size and age did not affect remodelling. We conclude that the observed findings are likely to be a manifestation of a generalized remodelling response in the femoral neck rather than a localized and isolated narrowing at the junction of the component and the femoral neck., (© 2014 Royal Australasian College of Surgeons.)

This article aims to provide a brief background to the current applications of finite-element analysis (FEA) in nanomedicine and dentistry. FEA was introduced in orthopedic biomechanics in the 1970s in order to assess the stresses and deformation in human bones during functional loadings and in the design and analysis of implants. Since then, it has been applied with great frequency in orthopedics and dentistry in order to analyze issues such as implant design, bone remodeling and fracture healing, the mechanical properties of biomedical coatings on implants and the interactions at the bone-implant interface. More recently, FEA has been used in nanomedicine to study the mechanics of a single cell and to gain fundamental insights into how the particulate nature of blood influences nanoparticle delivery.

The aim of this study was to examine the bone regeneration properties of beta-tricalcium phosphate hydrothermally converted from foraminifera carbonate exoskeleton in the repair of rat calvarial defect. These natural materials possess unique interconnected porous network with uniform pore size distribution, which can be potentially advantageous. In total, 20 adult male Wistar rats received full-thickness calvarial defect with a diameter of 5 mm. The rate of newly formed bone was measured radiologically by X-ray and micro-computed tomography and by histologic examination. After 2 weeks, the beta-tricalcium phosphate group exhibited full closure of the defect site, while control group remained unrestored at the end of the 6-week experimentation. It was observed that the newly regenerated bone thickened over the course of the experiment in the beta-tricalcium phosphate group. No soft tissue reaction was observed around the beta-tricalcium phosphate implant and the rats remained healthy. These results showed that repair of the calvarial defect can be achieved by biomimetic beta-tricalcium phosphate macrospheres, which hold potential for application as bone grafts for bone augmentation surgeries.

Aims: This study gives a detailed evaluation of the antibiotic potential of a marine structure-based new drug delivery system produced by hydrothermally converting foraminifera exoskeletons to β-tricalcium phosphate (β-TCP) to treat clinical strain Staphylococcus aureus (MW2)., Materials & Methods: Foraminifera precursor materials were hydrothermally converted at 250°C for 48 h to produce β-TCP and loaded with gentamicin sulfate by adsorption for 24 h. The physicochemical properties of the material were characterized by scanning electron microscopy, powder x-ray diffraction and for pore size distribution profiles. The antibacterial efficacy of the system was tested for inhibition of S. aureus growth and in vitro cellular behavior were tested with human osteoblast cells (MG63) for cell viability., Discussion: Pore size distribution profiles showed that the structure allows the uniform distribution of nanopores of 1.5 nm and micropores of approximately 5 µm. The in vitro release profile indicates an initial burst release of 5% of total incorporated gentamicin. A time-delayed antibacterial efficacy test was designed to introduce the bacteria at predetermined time intervals from 0 to 60 min and showed that gentamicin prevents S. aureus grown in the same culture within 30 min, with no evidence of bacterial regrowth within 24 h. Human osteoblast cell (MG63) studies showed no detrimental effect on cell viability., Conclusion: In the light of these results nano- and micro-pores containing β-TCP spheres show promise as potential bone void filler particles with antibacterial effects.

Foraminifera carbonate exoskeleton was hydrothermally converted to biocompatible and biodegradable zinc-tricalcium phosphate (Zn-TCP) as an alternative biomimetic material for bone fracture repair. Zn-TCP samples implanted in a rat tibial defect model for eight weeks were compared with unfilled defect and beta-tricalcium phosphate showing accelerated bone regeneration compared with the control groups, with statistically significant bone mineral density and bone mineral content growth. CT images of the defect showed restoration of cancellous bone in Zn-TCP and only minimal growth in control group. Histological slices reveal bone in-growth within the pores and porous chamber of the material detailing good bone-material integration with the presence of blood vessels. These results exhibit the future potential of biomimetic Zn-TCP as bone grafts for bone fracture repair.

The aim of this study was to evaluate the therapeutic efficacy of biomimetic zinc-containing tricalcium phosphate (ZnTCP) produced by hydrothermally converting calcium carbonate exoskeletons from foraminifera, in the treatment of osteoporotic mice. X-Ray powder diffraction showed crystallographic structures matching JCPDS profile for tricalcium phosphate. Mass spectroscopy used to calculate total composition amount showed similar amount of calcium (5×10(4) µg/g) and phosphate (4×10(4) ppm) after conversion and the presence of zinc (5.18×10(3) µg/g). In vitro zinc release showed no release in PBS buffer and <1% zinc release in 7 days. In vivo evaluation was done in ovariectomized mice by implanting the ZnTCP samples in the soft tissues near the right femur bone for four weeks. Thirty ddY mice (5 weeks old, average weight of 21 g) were divided into six experimental groups (normal, sham, OVX, β-TCP, ZnTCP and direct injection of zinc). CT images were taken every two weeks where the bone mineral density (BMD) and bone mineral content (BMC) were calculated by software based on CT images. The ZnTCP group exhibits cortical and cancellous bone growth of 45% and 20% respectively. While sham, OVX and β-TCP suffered from bone loss. A correlation was made between the significant body weight increase in ZnTCP with the significant increase in plasma zinc level compared with OVX. The presented results indicate that biomimetic ZnTCP were effective in preventing and treating bone loss in osteoporotic mice model.

Bone formation and regeneration is a prolonged process that requires a slow drug release system to assist in the long-term recovery. A drug-delivery system is developed that allows for the controlled release of simvastin, without exhibiting the side effects associated with high concentrations of simvastatin, and is still capable of inducing constant bone formation., (Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

A vital ingredient for engineering bone tissue, in the culture dish, is the use of recombinant matrix and growth proteins to help accelerate the growth of cultivated tissues into clinically acceptable quantities. The skeletal organic matrices of calcifying marine invertebrates are an untouched potential source of such growth inducing proteins. They have the advantage of being ready-made and retain the native state of the original protein. Striking evidence shows that skeleton building bone morphogenic protein-2/4 (BMP) and transforming growth factor beta (TGF-β) exist within various marine invertebrates such as, corals. Best practice mariculture and the latest innovations in long-term marine invertebrate cell cultivation can be implemented to ensure that these proteins are produced sustainably and supplied continuously. This also guarantees that coral reef habitats are not damaged during the collection of specimens. Potential proteins for bone repair, either extracted from the skeleton or derived from cultivated tissues, can be identified, evaluated and retrieved using chromatography, cell assays and proteomic methods. Due to the current evidence for bone matrix protein analogues in marine invertebrates, together with the methods established for their production and retrieval there is a genuine prospect that they can be used to regenerate living bone for potential clinical use.

Biomimetic materials such as coral exoskeletons possess unique architectural structures with a uniform and interconnected porous network that can be beneficial as a scaffold material. In addition, these marine structures can be hydrothermally converted to calcium phosphates, while retaining the original structural properties. The ability of biomaterials to stimulate the local microenvironment is one of the main focuses in tissue engineering, and directly coating the scaffold with stem cells facilitates future potential applications in therapeutics and regenerative medicine. In this article we describe a new and simple method that uses a laboratory centrifuge to coat hydrothermally derived beta-tricalcium phosphate macrospheres from coral exoskeleton with stem cells. In this research the optimal seeding duration and speed were determined to be 1 min and 700 g. Scanning electron micrographs showed complete surface coverage by stem cells within 7 days of seeding. This study constitutes an important step toward achieving functional tissue-engineered implants by increasing our understanding of the influence of dynamic parameters on the efficiency and distribution of stem cell attachment to biomimetic materials and how stem cells interact with biomimetic materials.

With the global rise in aging of populations, the occurrence of osteoporosis will continue to increase. Biomaterial and pharmaceutical scientists continue to develop innovative strategies and materials to address this disease. In this article, we describe a new perspective and approach into the use of coral exoskeletons as a precursor material to synthesize a calcium phosphate-based drug delivery system. Studies detailing the methodology of the conversion methods and the strategies and approach for the development of these novel drug delivery systems are described. Furthermore, in vivo studies in osteoporotic mice using a drug loaded and chemically modified version of the biomimetic delivery system showed significant cortical and cancellous bone increases. These studies support the notion and the rationale for future research and development of the use of coral exoskeletons as materials for drug delivery applications.

Simvastatin have been shown to induce bone formation and there is currently a urgent need to develop an appropriate delivery system to sustain the release of the drug to increase therapeutic efficacy whilst reducing side effects. In this study, a novel drug delivery system for simvastatin by means of hydrothermally converting marine exoskeletons to biocompatible beta-tricalcium phosphate was investigated. Furthermore, the release of simvastatin was controlled by the addition of an outer apatite coating layer. The samples were characterized by x-ray diffraction analysis, fourier transform infrared spectroscopy, scanning electron microscopy and mass spectroscopy confirming the conversion process. The in-vitro dissolution of key chemical compositional elements and the release of simvastatin were measured in simulated body fluid solution showing controlled release with reduction of approximately 25% compared with un-coated samples. This study shows the potential applications of marine structures as a drug delivery system for simvastatin.

Bisphosphonate is known to be a very active drug in the treatment of osteoporosis and bone regeneration. A new method has been developed, utilizing nuclear magnetic resonance spectroscopy to identify and measure the amount of bisphosphonate in solution. A standard reference with similar functional group to that of the bisphosphonate was chosen and applied in the experimentation. The results showed that the use of nuclear magnetic resonance spectroscopy ((1)H-NMR) in determining the solvent residues of various pharmaceutical drugs has proved to be effective. Unlike chromatography, it is possible to use a universal reference standard as an internal standard assayed by quantitative NMR. Using the same theory, this method is capable of both identifying and quantifying the bisphosphonate in various solutions. This paper is the first publication showing this unique measurement method, which can be used in a range of pharmaceutical and biomedical applications., ((c) 2008 John Wiley & Sons, Ltd.)

The mechanical properties of pure synthetic hydroxyapatite and hydroxyapatite-carbon nanotube composites were examined. Vickers microhardness and nanoindentation using a Berkovich tipped indenter were used to determine the hardness, fracture toughness and Young's modulus of the pure hydroxyapatite matrix and the composite materials. Microscopy showed that for the composites produced the carbon nanotubes were present as discrete clumps. These clumps induced a detrimental effect on the hardness of the materials, while the fracture toughness values were not affected. This would be undesirable in terms of using the material for biomedical implant applications. It should be noted that the carbon nanotubes used contained free graphite. As the properties of the composite materials studied were not greatly improved over the matrix, it is speculated that if the graphite phase were removed from the reagent, this could in-turn enhance the properties of the material.

Orbital implants have been used for cosmesis following surgical removal of the eyeball, or enucleation, for over a century. Implant design has progressed significantly in recent years with the use of porous devices, with the theoretical advantages of reduced complications and improved cosmesis. However, in some cases the theoretical benefits have not fully translated into clinical results. In this article the use of orbital implants in enucleation, with a particular focus on the newer porous biomaterials that have gained prominence over the last 15 years, is reviewed. Specific factors identified as affecting the performance of porous orbital implants include the material used, pore size, and morphology. Mechanical factors have received little consideration in the past and may form a basis for the use of higher compliance porous materials in the future. Of the porous materials in use, current clinical evidence is not sufficient to suggest either that porous implants are superior to non-porous implants, or that one material is more suited to the application than another. Future developments in this field require randomized controlled clinical trials with extensive follow-up as complications may not become evident until over 5 years post-implantation.

Over the years, the use of hydroxyapatite as coatings for medical devices and drug-delivery systems has gone through a revolution - from being a rarity to being an absolute necessity. Without these coatings, many medical implants and devices would never reach their true potential in their intended applications, such as in the dental and orthopedic fields. Coatings of hydroxyapatite are often applied to metallic implants to alter their surface properties. The aim of this article is to present an evaluation of the published work regarding current research and applications and to review the methods used for the production of hydroxyapatite nanocoatings.

Coatings offer the possibility of modifying the surface properties of surgical-grade materials to achieve improvements in performance, reliability and biocompatibility. Sol-gel-derived coatings demonstrate promise owing to their relative ease of production, ability to form a physically and chemically pure and uniform coating over complex geometric shapes and potential to deliver exceptional mechanical properties owing to their nanocrystalline structure. Other advantages unique to sol-gel include the production of a homogeneous material, since mixing takes place on the atomic scale, and its relatively low processing temperature avoids decomposition of the coating materials and limits the damage to metallic substrate materials as a result of exposure to elevated temperatures. A range of materials can be adapted easily for a number of biomedical and engineering applications.