Lawrence C. Chow

BoneSource hydroxyapatite cement : A novel biomaterial for craniofacial skeletal tissue engineering and reconstruction

BoneSource-hydroxyapatite cement is a new self-setting calcium phosphate cement biomaterial. Its unique and innovative physical chemistry coupled with enhanced biocompatibility make it useful for craniofacial skeletal reconstruction. The general properties and clinical use guidelines are reviewed. The biomaterial and surgical applications offer insight into improved outcomes and potential new uses for hydroxyapatite cement systems.

Experimental hydroxyapatite cement cranioplasty.

Hydroxyapatite cement is a calcium phosphate-based material that when mixed with water forms a dense paste that sets within 15 minutes and isothermically converts in vivo to a microporous hydroxyapatite implant. This cement was used to reconstruct bilateral 2.5-cm-diameter full-thickness critical-sized parietal skull defects in six cats. One side was reconstructed with 100 percent hydroxyapatite cement, and the other with a mixture of 50 percent hydroxyapatite cement and 50 percent ground autogenous bone by weight. These animals were sacrificed at 6 and 12 months after implantation. Positive and negative controls also were prepared. The anatomic contour of the soft tissue overlying all hydroxyapatite cement implants was well maintained, there were no wound infections or structural failures, and the implants were well tolerated histologically. None of the negative (unreconstructed) control defects was completely filled with repair bone, and all positive (methyl methacrylate) controls demonstrated foreign-body giant-cell formation and fibrous encapsulation of the implants. Examination of decalcified and undecalcified sections revealed progressive but variable replacement of the cement by new bone and soft tissue without a change in the shape or volume of the hydroxyapatite cement-reconstructed areas. New bone comprised 77.3 and 64.7 percent of the tissue replacing the hydroxyapatite cement and hydroxyapatite cement-bone implants, respectively. Replacement of the hydroxyapatite cement implants by new bone is postulated to occur by a combination of osteoconduction and implant resorption. These results indicate that further experimental research leading to the possible application of hydroxyapatite cement for full-thickness calvarial defect reconstruction in humans is warranted.

Strong Nanocomposites with Ca, PO4, and F Release for Caries Inhibition

This article reviews recent studies on: (1) the synthesis of novel calcium phosphate and calcium fluoride nanoparticles and their incorporation into dental resins to develop nanocomposites; (2) the effects of key microstructural parameters on Ca, PO4, and F ion release from nanocomposites, including the effects of nanofiller volume fraction, particle size, and silanization; and (3) mechanical properties of nanocomposites, including water-aging effects, flexural strength, fracture toughness, and three-body wear. This article demonstrates that a major advantage of using the new nanoparticles is that high levels of Ca, PO4, and F release can be achieved at low filler levels in the resin, because of the high surface areas of the nanoparticles. This leaves room in the resin for substantial reinforcement fillers. The combination of releasing nanofillers with stable and strong reinforcing fillers is promising to yield a nanocomposite with both stress-bearing and caries-inhibiting capabilities, a combination not yet available in current materials.

Nano DCPA-Whisker Composites with High Strength and Ca and PO4 Release

The main challenges facing composite restorations are secondary caries and bulk fracture. The objective of this study was to develop nano DCPA (dicalcium phosphate anhydrous)-whisker composites with high strength and Ca and PO4 ion release to combat caries. Flexural strength for the nano DCPA-whisker composites at a nano DCPA:whisker mass ratio of 1:2 ranged from (148 ± 9) MPa to (167 ± 23) MPa, significantly higher than the (103 ± 32) MPa of an inlay/onlay commercial control composite without Ca-PO4 release. The nano DCPA-whisker composite released PO4 to a concentration of (1.95 ± 0.13) mmol/L and Ca of (0.68 ± 0.05) mmol/L. Compared with previous conventional Ca- and PO4-releasing composites, the nano DCPA-whisker composites had strengths two-fold higher, and released comparable or higher levels of Ca and PO4. In conclusion, combining nano-DCPA with whiskers yielded novel composites that released high levels of Ca and PO4 requisite for remineralization. These high-strength composites may provide a unique combination of stress-bearing and caries-inhibiting capabilities.

Effects of Calcium Phosphate Nanoparticles on Ca-PO4 Composite

Nano-particles of dicalcium phosphate anhydrous (DCPA) were synthesized for the first time. The objectives of this study were to incorporate DCPA nano-particles into resin for Ca-PO4 release to combat dental caries, and to investigate the filler level effects. Nano-DCPA and nano-silica-fused silicon nitride whiskers at a 1:1 ratio were used at filler mass fractions of 0–75%. The flexural strengths in MPa (mean ± SD; n = 6) of DCPA-whisker composites ranged from (106 ± 39) at 0% fillers to (114 ± 23) at 75% fillers, similar to (112 ± 22) of a non-releasing composite (TPH) (p > 0.1). The composite with 75% fillers in a NaCl solution (133 mmol/L, pH = 7.4, 37°C) yielded a Ca concentration of (0.65 ± 0.02) mmol/L and PO4 of (2.29 ± 0.07) mmol/L. Relationships were established between ion-release and DCPA volume fraction VDCPA: Ca = 4.46 VDCPA 1.6, and = 66.9 VDCPA 2.6. Nano-DCPA-whisker PO4 composites had high strength and released high levels of Ca-PO4 requisite for remineralization. These new nano-composites could provide the needed combination of stress-bearing and caries-inhibiting capabilities.

Novel CaF2 Nanocomposite with High Strength and Fluoride Ion Release

Secondary caries and restoration fracture remain common problems in dentistry. This study tested the hypothesis that combining nano-CaF2 and glass fillers would yield nanocomposites with high mechanical properties and F release. Novel CaF2 nanoparticles (56-nm) were synthesized via spray-drying and incorporated into resin. F release increased with increasing the nano-CaF2 content, or with decreasing pH (p < 0.05). F-release rates at 70-84 days were 1.13 µg/(cm2·day) and 0.50 µg/(cm2·day) for nanocomposites containing 30% and 20% nano-CaF2, respectively. They matched the 0.65 µg/(cm2·day) of resin-modified glass ionomer (p > 0.1). The nanocomposites had flexural strengths of 70-120 MPa, after 84-day immersion at pH 4, pH 5.5, and pH 7. These strengths were nearly three-fold that of resin-modified glass ionomer, and matched/exceeded a composite with little F release. In summary, novel CaF2 nanoparticles produced high F release at low filler levels, thereby making room in resin for reinforcement glass. This yielded nanocomposites with high F-release and stress-bearing properties, which may help reduce secondary caries and restoration fracture.