Three-dimensional printing of flash-setting calcium aluminate cement

Three-dimensional indirect printing of flash-setting calcium aluminate cement (CAC) was investigated. Upon water injection into a biphasic mixture of tricalcium aluminate (3CaO·Al₂O₃) and dodecacalcium heptaaluminate (12CaO·7Al₂O₃) (phase ratio 0.56/0.44) initially a gel formed acting as a bonding phase which stabilizes the printed object geometry. Post-exposure in water finally resulted in the formation of 2CaO·Al₂O₃·8H₂O and 4CaO·Al₂O₃·19H₂O reaction phases as confirmed by SEM, X-ray diffraction, and FTIR analyses. Reduction of porosity by volume expansion upon hydrolysis reaction from 50% after printing to 20% after post-treatment gave rise for an increase of compressive strength from 5 to 20 MPa, respectively. A bone regenerating scaffold for a micro-vascular loop model was fabricated by 3D printing and hydraulic reaction bonding to demonstrate the potential of using flash-setting calcium aluminate cement powder for biomedical ceramic applications.     

Premixed macroporous calcium phosphate cement scaffold

Calcium phosphate cement (CPC) sets in situ to form resorbable hydroxyapatite and is promising for orthopaedic applications. However, it requires on-site powder-liquid mixing during surgery, which prolongs surgical time and raises concerns of inhomogeneous mixing. The objective of this study was to develop a premixed CPC scaffold with macropores suitable for tissue ingrowth. To avoid the on-site powder-liquid mixing, the CPC paste was mixed in advance and did not set in storage; it set only after placement in a physiological solution. Using 30% and 40% mass fractions of mannitol porogen, the premixed CPC scaffold with fibers had flexural strength (mean ± sd; n = 5) of (3.9 ± 1.4) MPa and (1.8 ± 0.8) MPa, respectively. The scaffold porosity reached (68.6 ± 0.7)% and (74.7 ± 1.2)%, respectively. Osteoblast cells colonized in the surface macropores of the scaffold and attached to the hydroxyapatite crystals. Cell viability values for the premixed CPC scaffold was not significantly different from that of a conventional non-premixed CPC known to be biocompatible (P > 0.1). In conclusion, using fast-dissolving porogen and slow-dissolving fibers, a premixed macroporous CPC scaffold was developed with strength approaching the reported strengths of sintered porous hydroxyapatite implants and cancellous bone, and non-cytotoxicity similar to a biocompatible non-premixed CPC. Official contribution of the National Institute of Standards and Technology; not subject to copyright in the United States.     

Crystallization mechanisms of calcium phosphate cement for biological uses

Self-setting calcium phosphate cement for dental or surgical applications can be prepared by the addition of a liquid to a mixture of acidic and basic calcium phosphate. After hardening, the final compound becomes hydroxyapatite. Using an orthogonal central composite plan, the main factors which control the setting and the final hardness of the cement were defined and models are proposed. The mechanisms of crystallization, the role of free and linked water, and the nature of the final and intermediate compounds are described.This paper was accepted for publication after the 1995 Conference of the European Society of Biomaterials, Oporto, Portugal, 10–13 September.     

Influence of curing temperatures on the hydration of calcium aluminate cement/Portland cement/calcium sulfate blends

In this paper, the effects of curing temperature on the hydration of calcium aluminate cement (CAC) dominated ternary binders (studied CAC: Portland cement: calcium sulfate mass ratio were 22.5: 51.7: 25.8) were estimated at 0, 10, 20 and 40 °C, respectively. Both α-hemihydrate and natural anhydrite were employed as the main source of sulfate. The impacts of temperature on the phase assemblages, morphology and pore structure of pastes hydrated up to 3 days were determined by using X-ray diffraction (XRD), backscattered electron imaging (BEI) and mercury intrusion porosimetry (MIP). Results reveal that the main hydration products are firmly related to calcium sulphoaluminate based phases. Increasing temperature would result in a faster conversion from ettringite to plate-like monosulfate for both calcium sulfate doped systems. When the temperature increases to 40 °C, an extraordinary formation of strätlingite (C₂ASH₈) and aluminium hydroxide is observed in anhydrite doped pastes. Additionally, increased temperature exerts different effects on the pore structure, i.e. the critical pore diameter shifts to finer one for pastes prepared with α-hemihydrate, but changes to coarser one for those made with anhydrite. From the mechanical point of view, increased temperature accelerates the 1-day strength development prominently, while exerts marginal influence on the development of 3-day strength.     

Chemical activation of calcium aluminate cement composites cured at elevated temperature

The influence of sodium sulfate, as an activator, on the hydration of calcium aluminate cement (CAC)–fly ash (FA)–silica fume (SF) composites was investigated. Different mixes of CAC with 20% pozzolans (20% FA, 20% SF and 10% FA + 10% SF) were prepared and hydrated at 38 °C for up to 28 days. The hydration products were investigated by XRD, DSC and SEM. The results showed that sodium sulfate accelerated the hydration reactions of calcium aluminate cement as well as the reactions of FA and SF with CAH₁₀ and C₂AH₈ to form the strätlingite (C₂ASH₈). The later reactions prevent the strength loss by preventing the conversion of CAH₁₀ and C₂AH₈ to the cubic C₃AH₆ phase. The acceleration effect of Na₂SO₄ on the reactivity of fly ash was more pronounced than on the reactivity of silica fume with respect to reaction with CAH₁₀ and C₂AH₈ phases.     

Chemical activation of calcium aluminate cement composites cured at elevated temperature

The influence of sodium sulfate, as an activator, on the hydration of calcium aluminate cement (CAC)–fly ash (FA)–silica fume (SF) composites was investigated. Different mixes of CAC with 20% pozzolans (20% FA, 20% SF and 10% FA + 10% SF) were prepared and hydrated at 38 °C for up to 28 days. The hydration products were investigated by XRD, DSC and SEM. The results showed that sodium sulfate accelerated the hydration reactions of calcium aluminate cement as well as the reactions of FA and SF with CAH₁₀ and C₂AH₈ to form the strätlingite (C₂ASH₈). The later reactions prevent the strength loss by preventing the conversion of CAH₁₀ and C₂AH₈ to the cubic C₃AH₆ phase. The acceleration effect of Na₂SO₄ on the reactivity of fly ash was more pronounced than on the reactivity of silica fume with respect to reaction with CAH₁₀ and C₂AH₈ phases.     

Study of a hydraulic calcium phosphate cement for dental applications

Calcium phosphate-based cements (CPCs) have attracted much interest because of their good osteoconductivity for bone reconstruction. We obtained CPCs by mixing calcium bis-dihydrogenophosphate monohydrate (MCPM) and calcium oxide with water or sodium phosphate buffers (NaP) as liquid phase. Cement samples with different calcium-to-phosphate ratios (Ca/P), liquid-to-powder ratios (L/P) and liquid phases were analyzed by X-rays diffraction (XRD), pH-metry, extensometry and calorimetry. Antibacterial activity on two bacterial strains (Streptococcus mutans, Lactobacillus acidophilus) and a polycontaminated bacterial inoculum was also studied using the agar diffusion method. The best mechanical properties (25 MPa) corresponded to Ca/P ratios between 1.67 and 2.5, a 1 M sodium phosphate buffer pH 7, as liquid phase and a L/P ratio of 0.6 ml g^-1. The final setting time increased with the Ca/P ratio. The setting expansion, around 1–2%, depended on the Ca/P and L/P ratios. The inner temperature of the cements rose to 45° during setting then decreased rapidly. The injectability was 100% up to 3.5 min and then decreased. It increased with increasing the L/P ratio but to the detriment of the compressive strength and setting time. XRD analysis indicated that the setting reaction led to a mixture of calcium hydroxide and calcium-deficient hydroxyapatite even for a Ca/P ratio of 1.67. Consequently, the pH of the surrounding fluids rose to 11.5–12 during their dissolution. Bacterial growth inhibition was only clearly observed for Ca/P2. This bioactive calcium phosphate cement can potentially be employed for pulp capping and cavity lining as classical calcium hydroxide-based cements, but it is not usable, in the present formulation, for root canal filling because of its short setting time.     

Formation of macropores in calcium phosphate cement implants

A calcium phosphate cement (CPC) was shown to harden at ambient temperatures and form hydroxyapatite as the only end-product. Animal study results showed that CPC resorbed slowly and was replaced by new bone. For some clinical applications, it would be desirable to have macropores built into the CPC implant to obtain a more rapid resorption and concomitant osseointegration of the implant. The present study investigated the feasibility of a new method for producing macropores in CPC. Sucrose granules, NaHCO₃, and Na₂HPO₄ were sieved to obtain particle sizes in the range of 125 m to 250 m. The following mixtures of CPC powder (an equimolar mixture of tetracalcium phosphate, Ca₄(PO_{4 2}O, and dicalcium phosphate anhydrous, CaHPO₄) and one of the above additive granules were prepared: control–no additive; mixture A–0.25 mass fraction of sucrose; mixture B–0.25 mass fraction of NaHCO₃; mixture C–0.25 mass fraction of Na₂HPO₄, and mixture D–0.33 mass fraction of Na₂HPO₄. Cement samples were prepared by mixing 0.3 g of the above mixtures with 0.075 ml of the cement liquid (1 mol/l Na₂HPO₄). After hardening, the specimens were placed in water for 20 h at about 60 °C to completely dissolve the additive crystals. Well-formed macropores in the shapes of the entrapped crystals were observed by scanning electron microscope (SEM). The macroporosities (mean±standard deviation; n = 6) expressed as volume fraction in % were 0, 18.9 ± 1.7, 26.9 ± 1.6, 38.3 ± 4.4 and 50.3 ± 2.7 for the control, A, B, C and D, respectively. The diametral tensile strengths (mean±standard deviation; n = 3) expressed in MPa were 10.1 ± 0.7, 3.7 ± 0.3, 2.4 ± 0.2, 1.5 ± 0.5 and 0.4 ± 0.1, respectively, for the five groups. The results showed that macropores can readily be formed in CPC implants with the use of water-soluble crystals. The mechanical strength of CPC decreased with increasing macroporosity. © 2001 Kluwer Academic Publishers     

In vitro aging of a calcium phosphate cement

Cement samples made of -tricalcium phoshate (-TCP), phosphoric acid (PA) and water mixtures were incubated in several aqueous solutions to determine their stability over time. The effects of the cement composition and the incubating temperature were investigated in more detail. The cement samples contained mostly dicalcium phosphate dihydrate (DCPD) and remnants of -TCP crystals. Depending on the initial cement composition, a certain amount of dicalcium phosphate (DCP) crystals were formed. The larger the initial PA concentration, the larger the DCP amount. After setting, the cement composition was stable for at least 16 days up to 60 °C. Above that temperature, the DCPD crystals decomposed into DCP crystals. The latter reaction provoked a decrease of the pH of the incubation solution, phenomenon expected for a cement sample containing an excess of PA. As the cement samples contained an excess of -TCP, it was postulated that -TCP crystals became so covered by DCP or DCPD crystals during setting that the setting reaction was stopped prematurely. The latter phenomenon gave a good explanation for the low pH values measured in the incubation solutions. ©©2000 Kluwer Academic Publishers     

Non-decay type fast-setting calcium phosphate cement using chitosan

A non-decay type fast-setting calcium phosphate cement (nd-FSCPC) has been described, which did not decay but set within approximately 5–6 min even when the paste was immersed in serum immediately after mixing, and which forms hydroxyapatite as its end product. nd-FSCPC was produced by adding sodium alginate to the liquid phase of the base cement FSCPC. Sodium alginate forms a water-insoluble gel, and reduces the process of fluid penetration into the paste which is the cause of decay. The aim of this investigation was to confirm the mechanism of the non-decaying behaviour of nd-FSCPC proposed in a previous paper, using another chemical with properties similar to those of sodium alginate. Also, it was intended to further improve both the mechanical properties and tissue response of nd-FSCPC. Chitosan, which also forms a water-insoluble gel in the presence of calcium ions and has been reported to have pharmacologically beneficial effects on osteoconductivity, was added to the liquid phase of the base cement FSCPC. The cement thus prepared showed behaviour similar to that of nd-FSCPC using sodium alginate. The cement paste did not decay but set within approximately 5–6 min even when immersed in serum immediately after mixing. DTS value of the set mass was approximately 3–4 MPa, slightly lower than that of nd-FSCPC using sodium alginate, and no inhibitory effect was observed for the transformation of cement component to apatite within the range used in this investigation (up to 1.5%). Therefore, it was concluded that the mechanism of non-decaying behaviour was, at least in part, reduction of fluid penetration into the cement paste. nd-FSCPC using chitosan showed slightly poorer mechanical properties than that using sodium alginate. However, pharmacological effects such as osteoconductivity could be expected in nd-FSCPC using chitosan. Thus, this cement may be useful as a more sophisticated bioactive cement than nd-FSCPC using sodium alginate.     

Bond between reinforcing steel fibres and magnesium phosphate/calcium aluminate binders

The work reported provides new information on the bond between two types of steel fibres and two different rapid strengthening matrices, magnesia phosphate and accelerated calcium aluminate. Two new methods have been developed in order to investigate:

• •the tensile chemical (or adhesive) bond strength between steel fibres and a cement matrix;
• •the durability of the steel fibre cement matrix bond when exposed to hostile environments.

The first is a test to determine the tensile force necessary to produce fibre matrix failure. The rationale for the test was to provide a means of assessing the contribution of the chemical bond to the strength of FRC.The second is a single-fibre pull-out test suitably fabricated to identify the bond durability after exposure of the fibre to a hostile environment.In all tests there was the requirement of very rapid preparation as early hardening of the cement-based matrices was accompanied by rapid setting.     

Injectable and fast resorbable calcium phosphate cement for body-setting bone grafts

In this work a calcium phosphate (CPC)/polymer blend was developed with the advantage of being moldable and capable of in situ setting to form calcium deficient hydroxyapatite under physiological conditions in an aqueous environment at body temperature. The CPC paste consists in a mix of R cement, glycerol as a liquid phase carrier and a biodegradable hydrogel such as Polyvinyl alcohol, which acts as a binder. Microstructure and mechanical analysis shows that the CPC blend can be used as an injectable implant for low loaded applications and fast adsorption requirements. The storage for commercial distribution was also evaluated and the properties of the materials obtained do not significantly change during storage at −18°C.     

Development of a novel calcium phosphate cement composed mainly of calcium sodium phosphate with high osteoconductivity

Two novel calcium phosphate cements (CPC) have been developed using calcium sodium phosphate (CSP) as the main ingredient. The first of these cements, labeled CAC, contained CSP, α-tricalcium phosphate (TCP), and anhydrous citric acid, whereas the second, labeled CABC, contained CSP, α-TCP, β-TCP, and anhydrous citric acid. Biopex^®-R (PENTAX, Tokyo, Japan), which is a commercially available CPC (Com-CPC), and OSferion^® (Olympus Terumo Biomaterials Corp., Tokyo, Japan), which is a commercially available porous β-TCP, were used as reference controls for analysis. In vitro analysis showed that CABC set in 5.7 ± 0.3 min at 22 °C and had a compressive strength of 86.0 ± 9.7 MPa after 5 days. Furthermore, this material had a compressive strength of 26.7 ± 3.7 MPa after 2 h in physiologic saline. CAC showed a statistically significantly lower compressive strength in the presence of physiologic saline and statistically significantly longer setting times than those of CABC. CABC and CAC exhibited apatite-forming abilities in simulated body fluid that were faster than that of Com-CPC. Samples of the materials were implanted into the femoral condyles of rabbits for in vivo analysis, and subsequent histological examinations revealed that CABC exhibited superior osteoconductivity and equivalent bioresorbability compared with Com-CPC, as well as superior osteoconductivity and bioresorbability compared with CAC. CABC could therefore be used as an alternative bone substitute material.     

Premixed injectable calcium phosphate cement with excellent suspension stability

Premixed injectable calcium phosphate cement (p-ICPC) pastes have advantages over aqueous injectable calcium phosphate cement (a-ICPC) because p-ICPC remain stable during storage and harden only after placement into the defect. This paper focused on the suspension stability of p-ICPC paste by using fumed silica as a stabilizing agent and propylene glycol (PEG) as a continuous phase. Multiple light scanning techniques were first applied to evaluate the suspension stability. The results indicated that fumed silica effectively enhanced the suspension stability of p-ICPC pastes. The stabilizing effect of fumed silica results from the network structure formed in PEG because of its thixotropy. The p-ICPC could be eventually hydrated to form hydroxyapatite under aqueous circumstances by the unique replacement between water and PEG. p-ICPC (1) not only possesses proper thixotropy and compressive strength but has good injectability as well. p-ICPC (1) was cytocompatible and had no adverse effect on the attachment and proliferation of MG-63 cells in vitro. These observations may have applicability to the development of other nonaqueous injectable biomaterials for non-immediate filling and long-term storage.     

Preparation of porous apatite granules from calcium phosphate cement

A versatile method for preparing spherical, micro- and macroporous (micro: 2–10 and macro: 150–550 μm pores), carbonated apatitic calcium phosphate (Ap-CaP) granules (2–4 mm in size) was developed by using NaCl crystals as the porogen. The entire granule production was performed between 21 and 37 °C. A CaP cement powder, comprising α-Ca₃(PO₄)₂ (61 wt.%), CaHPO₄ (26%), CaCO₃ (10%) and precipitated hydroxyapatite, Ca₁₀(PO₄)₆(OH)₂ (3%), was dry mixed with NaCl crystals varying in size from 420 μm to 1 mm. Cement powder (35 wt.%) and NaCl (65 wt.%) mixture was kneaded with an ethanol–Na₂HPO₄ initiator solution, and the formed dough was immediately agitated on an automatic sieve shaker for a few minutes to produce the spherical granules. Embedded NaCl crystals were then leached out of the granules by soaking them in deionized water. CaP granules were micro- and macroporous with a total porosity of 50% or more. Granules were composed of carbonated, poorly crystallized, apatitic CaP phase. These were the first spherical and porous CaP granules ever produced from a self-setting calcium phosphate cement. The granules reached their final handling strength at the ambient temperature through the cement setting reaction, without having a need for sintering. Certain commercial equipment, instruments or materials are identified in this paper to foster understanding. Such identification does not imply recommendation or endorsement by the author, nor does it imply that the equipment or materials identified are necessarily the best available for the purpose.     

磷酸钙骨水泥化学活性及机械性能研究

在研究磷酸四钙制备方法的基础上,讨论其化学活性,发现该物质在高温时热稳定性不好,易于向能量更低的羟基磷灰石转化;在室温下又容易吸附空气中的水分子,发生缓慢水解.因此最好真空保存.     

Study on injectable and degradable cement of calcium sulphate and calcium phosphate for bone repair

Injectable calcium sulphate/phosphate cement (CSPC) with degradable characteristic was developed by introduction of calcium sulphate (CS) into calcium phosphate cement (CPC). The setting time, compressive strength, composition, degradation, cells and tissue responses to the CSPC were investigated. The results show that the injectable CSPC with optimum L/P ratio exhibited good injectability, and had suitable setting time and mechanical properties. Furthermore, the CSPC had good degradability and its degradation significantly faster than that of CPC in Tris–HCl solution. Cell culture results indicate that CSPC was biocompatible and could support MG63 cell attachment and proliferation. To investigate the in vivo biocompatibility and osteogenesis, the CSPC were implanted in the bone defects of rabbits. Histological evaluation shows that the introduction of CS into CPC enhanced the efficiency of new bone formation, and CSPC exhibited good biocompatibility, degradability and osteoconductivity with host bone in vivo. It can be concluded that the injectable CSPC had a significant clinical advantage over CPC, and might have potential to be applied in orthopedic, reconstructive and maxillofacial surgery, especially for minimally invasive techniques.