@phdthesis{Weichhold2023,
  author    = {Weichhold, Jan Lukas},
  title     = {Injectable calcium phosphate-based bone replacement cements},
  doi       = {10.25972/OPUS-32661},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-326616},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {The human body has very good self-healing capabilities for numerous different injuries to a variety of different tissues. This includes the main human mechanical framework, the skeleton. The skeleton is limited in its healing without additional aid by medicine mostly by the defect size. When the defect reaches a size above 2.5 cm the regeneration of the defect ends up faulty. Here is where implants, defect fillers and other support approaches developed in medicine can help the body to heal the big defect still successfully. Usually sturdy implants (auto-/allo-/xenogenic) are implanted in the defect to bridge the distance, but for auto- and allogenic implants a suitable donor site must be found and for all sources the implant needs to be shaped into the defect specific site to ensure a perfect fit, the best support and good healing. This shaping is very time consuming and prone to error, already in the planning phase. The use of a material that is moldable and sets in the desired shape shortly after applying negates these disadvantages. Cementitious materials offer exactly this property by being in a pasty stage after the powder and liquid components have been mixed and the subsequently hardening to a solid implant. These properties also enable the extrusion, and therefore may also enable the injection, of the cement via a syringe in a minimal invasive approach. To enable a good injection of the cement modifications are necessary. This work aimed to modify commonly used calcium phosphate-based cement systems based on α-TCP (apatitic) and β-TCP (brushitic). These have been modified with sodium phytate and phytic acid, respectively. Additionally, the α-TCP system has been modified with sodium pyrophosphate, in a second study, to create a storable aqueous paste that can be activated once needed with a highly concentrated sodium orthophosphate solution. The powder phase of the α-TCP cement system consisted of nine parts α-TCP and one part CDHA. These were prepared to have different particle sizes and therefore enable a better powder flowability through the bimodal size distribution. α-TCP had a main particle size of 20 μm and CDHA of 2.6 μm. The modification with sodium phytate led to an adsorption of phytate ions on the surface of the α-TCP particles, where they started to form complexes with the Ca2+ ions in the solution. This adsorption had two effects. The first was to make the calcium ions unavailable, preventing supersaturation and ultimately the precipitation of CDHA what would lead to the cement hardening. The second was the increase of the absolute value of the surface charge, zeta potential, of the powder in the cement paste. Here a decrease from +3 mV to -40 mV could be measured. A strong value for the zeta potential leads to a higher repulsion of similarly charged particles and therefore prevents powder agglomeration and clogging on the nozzle during injection. These two modifications (bimodal particles size distribution and phytic acid) lead to a significant increase in the paste injectability. The unmodified paste was injectable for 30 \% only, where all modified pastes were practically fully injectable ~90 \% (the residual paste remained in the nozzle, while the syringe plunger already reached the end of the syringe). A very similar observation could be made for the β-TCP system. This system was modified with phytic acid. The zeta potential was decreased even stronger from -10 ± 1.5 mV to -71.5 ± 12 mV. The adsorption of the phytate ions and subsequent formation of chelate complexes with the newly dissolved Ca2+ ions also showed a retarding effect in the cements setting reaction. Where the unmodified cement was not measurable in the rheometer, as the reaction was faster than the measurement setup (~1.5 min), the modified cements showed a transition through the gel point between 3-6 min. This means the pastes stayed between 2 and 4 times longer viscous than without the modification. Like with the first cement system also here the effects of the phytate addition showed its beneficial influence in the injectability measurement. The unmodified cement was not injectable at all, due to the same issue already encountered at the rheology measurements, but all modified pastes were fully injectable for at least 5 min (lowest phytate concentration) and at least 10 min (all other concentrations) after the mixing of powder and liquid. The main goal of the last modification with sodium pyrophosphate was to create a paste that was stable in aqueous environment without setting until the activation takes place, but it should still show good injectability as this was the desired way of application after activation. Like before also the zeta potential changed after the addition of pyrophosphate. It could be lowered from -22 ± 2mV down to -61 to -68 ± 4mV (depending on the pyrophosphate concentration). The pastes were stored in airtight containers at room temperature and checked for their phase composition over 14 days. The unmodified paste showed a beginning phase conversion to hydroxyapatite between 7 and 14 days. All other pastes were still stable and unreacted. The pastes were activated with a high concentrated (30 wt\%) sodium orthophosphate solution. After the activation the pastes were checked for their injectability and showed an increase from -57 ± 11\% for the unmodified paste to -89 ± 3\% (practically fully injectable as described earlier) for the best modified paste (PP005). It can be concluded that the goal of enabling full injection of conventional calcium phosphate bone cement systems was reached. Additional work produced a storage stable paste that still ensures full injectability. Subsequent work already used the storable paste and modified it with hyaluronic acid to create an ink for 3D extrusion printing. The first two cement systems have also already been investigated in cell culture for their influence on osteoblasts and osteoclasts. The next steps would have to go more into the direction of translation. Figuring out what properties still need to be checked and where the modification needs adjustment to enable a clinical use of the presented systems.},
  subject      = {Calciumphosphat},
  language  = {en}
}
@phdthesis{Holzmeister2023,
  author    = {Holzmeister, Ib},
  title     = {Branched silica precursors as additives for mineral bone cements},
  doi       = {10.25972/OPUS-27504},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-275044},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {Mineral biocements are brittle materials, which usually results in catastrophic failure during mechanical loading. Here, previous works demonstrated the feasibility of reducing brittleness by a dual-setting approach, in which a silica sol was simultaneously gelled during the setting of a brushite forming cement. The current thesis aimed at further improving this concept by both using a novel silicate based cement matrix for an enhanced bonding between cement and silica matrix as well as multifunctional silica precursors to increase the network density of the gel. Due to its well-known biocompatibility and osteogenic regeneration capacity, baghdadite was chosen as mineral component of such composites. This required in a first approach the conversion of baghdadite ceramics into self-setting cement formulations. This was investigated initially by using baghdadite as reactive filler in a brushite forming cement (Chapter 4). Here, the ß-TCP component in a equimolar mixture of ß-TCP and acidic monocalcium phosphate anhydrous was subsequently replaced by baghdadite at various concentrations (0, 5, 10, 20, 30, 50, and 100 wt\%) to study the influence on physicochemical cement properties such as mechanical performance, radiopacity, phase composition and microstructure. X-ray diffraction profiles demonstrated the dissolution of baghdadite during the cement reaction without affecting the crystal structure of the precipitated brushite phase. In addition, EDX analysis showed that calcium is homogeneously distributed in the cement matrix, while zirconium and silicon form cluster-like aggregates ranging in size from a few micrometers to more than 50 µm. X-ray images and µ-CT analyses indicate improved X-ray visibility with increased incorporation of baghdadite in brushite cement, with an aluminum equivalent thickness nearly doubling at a baghdadite content of 50 wt\%. At the same time, the compressive strength of brushite cement increased from 12.9 ± 3.1 MPa to 21.1 ± 4.1 MPa at a baghdadite content of 10 wt\%. Cell culture medium conditioned with powdered brushite cement approached physiological pH values when increasing amounts of baghdadite were added to the cement (pH = 6.47 for pure brushite, pH = 7.02 for brushite with 20 wt\% baghdadite substitution). Baghdadite substitution also affected the ion content in the culture medium and thus the proliferation activity of primary human osteoblasts in vitro. The results demonstrated for the first time the suitability of baghdadite as a reactive cement additive for improving the radiopacity, mechanical performance, and cytocompatibility of brushite cements. A second approach (Chapter 5) aimed to produce single component baghdadite cements by an increase of baghdadite solubility to initiate a self-setting cement reaction. For this, the material was mechanically activated by longer grinding times of up to 24h leading to both a decrease in particle and crystallite size as well as a partial amorphization of baghdadite. Baghdadite cements were formed by adding water at a powder to liquid ratio of 2.0 g/ml. Maximum compressive strengths were determined to be ~2 MPa after 3 days of setting for a 24-hour ground material. Inductively coupled plasma mass spectrometry (ICP-MS) measurements showed an incongruent dissolution profile of the set cements, with preferential dissolution of calcium and only minor release of zirconium ions. Cement formation occurs under alkaline conditions, with the unground raw powder resulting in a pH of 11.9 during setting, while prolonged grinding increases the pH to about 12.3. Finally, mechanically activated baghdadite cements were combined with inorganic silica networks (Chapter 6) to create dual-setting cements with a further improvement of mechanical performance. While a modification of the cement pastes with a TEOS derived sol was already thought to improve strength, it was hypothesized that using multi-arm silica precursors can further enhance their mechanical performance due to a higher network density. In addition, this should also reduce pore size of both gels and cement and hence will be able to adjust the release kinetics of incorporated drugs. For this, multi-armed silica precursors were synthesized by the reaction of various multivalent alcohols (ethylene glycol, glycerine, pentaerythrit) with an isocyanate modified silica precursor. After hydrolysis under acidic conditions, the sols were mixed with baghdadite cement powders in order to allow a simultaneous gel formation and cement setting. Since the silica monomers have a high degree of linkage sites, this resulted in a branched network that interpenetrated with the growing cement crystals. In addition to minor changes in the crystalline phase composition as determined by X-ray diffraction, the novel composites exhibited improved mechanical properties with up to 20 times higher compressive strength and further benefit from an about 50\% lower overall porosity than the reference pure baghdadite cement. In addition, the initial burst release of the model drug vancomycin was completely inhibited by the added silica matrix. This observation was verified by testing for the antimicrobial activity with Staphylococcus aureus by measuring the inhibition zones of selected samples after 24 h and 48 h, whereas the antimicrobial effectiveness of a constant vancomycin release could be demonstrated. The current thesis clearly demonstrated the high potential of baghdadite as a cement formulation for medical application. The initially poor mechanical properties of such cements can be overcome by special processing techniques or by combination with silica networks. The achieved mechanical performance is > 10 MPa and hence suitable for bone replacement under non-load bearing conditions. The high intrinsic radiopacity as well as the alkaline pH during setting may open the way ahead to further dental applications, e.g. as root canal sealers or filler in dental composites. Here, the high pH is thought to lead to antimicrobial properties of such materials similar to commonly applied calcium hydroxide or calcium silicates, however combined with an intrinsic radiopacity for X-ray imaging. This would simplify such formulations to single component materials which are less susceptible to demixing processes during transport, storage or processing.},
  subject      = {Zement},
  language  = {en}
}