Advances in Bioceramics for Bone Regeneration: A Narrative Review

Abstract

Large osseous defects resulting from trauma, tumor resection, or fracture render the inherent ability of the body to repair inadequate and necessitate the use of bone grafts to facilitate the recovery of both form and function of the bony defect sites. In the United States alone, a large number of bone graft procedures are performed yearly, making it an essential area of investigation and research. Synthetic grafts represent a potential alterative to autografts due to their patient-specific customizability, but currently lack widespread acceptance in the clinical space. Early in their development, non-autologous bone grafts composed of metals such as stainless steel and titanium alloys were favorable due to their biocompatibility, resistance to corrosion, mechanical strength, and durability. However, since their inception, bioceramics have also evolved as viable alternatives. This review aims to present an overview of the fundamental prerequisites for tissue engineering devices using bioceramics as well as to provide a comprehensive account of their historical usage and significant advancements over time. This review includes a summary of commonly used manufacturing techniques and an evaluation of their use as drug carriers and bioactive coatings-for therapeutic ion/drug release, and potential avenues to further enhance hard tissue regeneration.

Keywords: bioceramics; bone grafts; bone tissue regeneration.

Figure 1

Ashby chart showing the mechanical behavior of various materials relative to apatite and bone (B-HA = apatite, S-HA = sintered HAP), Reprinted with permission from Ref. [17], Copyright 2020, Elsevier. The Ashby chart highlights how synthetic graft materials may or may not closely mimic the mechanical properties of native bone—a parameter crucial for preventing complications such as stress-shielding. The graph serves as a valuable tool to identify and evaluate novel materials with suitable mechanical properties for bone graft applications. Additionally, it suggests the potential for combining materials to render unique properties that optimize both mechanical performance and biological integration. By mapping how different materials perform under stress, the figure facilitates selection of materials for bone grafting.

Figure 2

Methods by which bioceramics can administered for use in bone regeneration and repair. Reprinted with permission from Ref. [31], Copyright 2011, John Wiley and Sons.

Figure 3

Schematic of the hierarchical structure of bone. Image reprinted with permission from Ref. [33], Copyright 2013, Elsevier Ltd.

Figure 4

Evolution of biomaterials since the 1950s. Reprinted from [34] under the terms of the Creative Commons 4.0 CC BY license https://creativecommons.org/licenses/by/4.0/ (accessed on 29 August 2024).

Figure 5

(A) nHAP artificial bone. (B) nHAP artificial bone under scanning electron microscope. Image reprinted with permission from Ref. [64] Copyright 2014, Taylor & Francis Ltd.

Figure 6

Histomicrographs of the new bone formation at the defect site treated with β-TCP (β-TCP control), or argon-glow-discharge-plasma-treated β-TCP (β-TCP test) relative to empty defects (control) at the three different time points. Reprinted from Ref. [78] under the terms of the Creative Commons 4.0 CC BY license https://creativecommons.org/licenses/by/4.0/ (accessed on 29 August 2024).

Figure 7

(a) Histological examination of the defects treated with (a,b) OCP, (c,d) β-TCP, and (e,f) HA (hydroxyapatite). (▾) depicts the margin of the defect, while (*) highlights the implanted bioceramic. Scale bars: (a,c,e) 300 μm; (b,d,f) 200 μm. Histomorphometrical examination of (g) newly formed bone in the defect (n-Bone%) treated with OCP, β-TCP, and HA; and (h) remaining implants (r-Imp%); Symbols denote statistical significance, ‘B’ = newly formed bone. Reprinted with permission from Ref. [86], Copyright 2001, John Wiley and Sons.

Figure 8

Compositional diagram of Bioglass. Reproduced with permission from Ref. [107], Copyright 2006, Springer Nature.

Figure 9

Microstructures of bioactive glass scaffolds synthesized by (a) sol-gel; (b) sintering; (c) polymer foam replication; (d) Robocasting (3DP); and (e) unidirectional freezing. (f) Micro-computed tomography image scaffolds shown in (e). Reprinted with permission from [125], Copyright 2011, with permission from Elsevier.

Figure 10

Scanning electron micrographs of the surface microstructure of plasma-sprayed HA (hydroxyapatite) coatings at different plasma spray settings. Reprinted with permission from Ref. [164], Copyright 2020, with permission from Springer Nature.

Figure 11

Scanning electron micrographs and high magnification images (corresponding inserts) of nanotopography including (S0) smooth; (S1) nanorod; (S2) micropatterned; and (S3) micropattern/nanorod surface structures. Reprinted from [182] Copyright 2018, with permission from Elsevier.