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Fundamental Biomaterials: Metals
Azioni libro
Inizia a leggereLunghezza: 952 pagine9 ore
- Editore:
- Elsevier Science
- Pubblicato:
- Jul 19, 2018
- ISBN:
- 9780081022061
- Formato:
- Libro
Descrizione
Fundamental Biomaterials: Metals provides current information on the development of metals and their conversion from base materials to medical devices. Chapters analyze the properties of metals and discuss a range of biomedical applications, with a focus on orthopedics. While the book will be of great use to researchers and professionals in the development stages of design for more appropriate target materials, it will also help medical researchers understand, and more effectively communicate, the requirements for a specific application. With the recent introduction of a number of interdisciplinary bio-related undergraduate and graduate programs, this book will be an appropriate reference volume for students.
It represents the second volume in a three volume set, each of which reviews the most important and commonly used classes of biomaterials, providing comprehensive information on materials properties, behavior, biocompatibility and applications.
Provides current information on metals and their conversion from base materials to medical devices Includes analyses of types of metals, discussion of a range of biomedical applications, and essential information on corrosion, degradation and wear and lifetime prediction of metal biomaterials Explores both theoretical and practical aspects of metals in biomaterialsInformazioni sul libro
Fundamental Biomaterials: Metals
Lunghezza: 952 pagine9 ore
Descrizione
Fundamental Biomaterials: Metals provides current information on the development of metals and their conversion from base materials to medical devices. Chapters analyze the properties of metals and discuss a range of biomedical applications, with a focus on orthopedics. While the book will be of great use to researchers and professionals in the development stages of design for more appropriate target materials, it will also help medical researchers understand, and more effectively communicate, the requirements for a specific application. With the recent introduction of a number of interdisciplinary bio-related undergraduate and graduate programs, this book will be an appropriate reference volume for students.
It represents the second volume in a three volume set, each of which reviews the most important and commonly used classes of biomaterials, providing comprehensive information on materials properties, behavior, biocompatibility and applications.
Provides current information on metals and their conversion from base materials to medical devices Includes analyses of types of metals, discussion of a range of biomedical applications, and essential information on corrosion, degradation and wear and lifetime prediction of metal biomaterials Explores both theoretical and practical aspects of metals in biomaterials- Editore:
- Elsevier Science
- Pubblicato:
- Jul 19, 2018
- ISBN:
- 9780081022061
- Formato:
- Libro
Correlati a Fundamental Biomaterials
Anteprima del libro
Fundamental Biomaterials
India
1
Metallic biomaterials
State of the art and new challenges
Dr. J. Wilson, Department of Bioelectronics and Biosensors, Alagappa University, Karaikudi, Tamilnadu, India
Abstract
Biomedical applications of macro-, micro-, and nanomaterials are exponentially increasing every year due to their analogy to various cell receptors, ligands, structural proteins, and genetic materials. Among the various biomaterials available, metallic-based implant materials can provide scaffolds for excellent tissue/bone/organ repair that are needed to save and prolong the human being’s life. This review will therefore highlight recent advancements on metallic bioimplants with their advantages and limitations based on nanotechnology.
Keywords
Osseointegration; bioabsorbability; biomaterial; alloy
Acknowledgement
The author J. Wilson would like to thank DST-SERB, BRNS and UGC for financial assistance.
1.1 Introduction
With the rapid improvement of standards of living and progress of society the people are facing social pressure, which is accompanied by increased rates of occurrence of various diseases and thus limiting their life. With the broad application and swift improvement of microtraumatic intervention treatment, the implantation of biomaterials is recognized to be one of the most efficient strategies to save and prolong the life of the human community [1]. The wide use of antimicrobial and other antibiotic agents has led to a profound increase in difficulties to undertake neurosurgical, orthopedic, and cardiovascular treatment which adds additional financial pressure on the healthcare patients [2]. Hence the biomaterials are essential, nevertheless they tend to cause certain limitations such as mechanical failure, infection, and immunogenic reactions to implanted biomaterials. Remarkable research efforts have been demonstrated to the improvement of biomaterials to continue the physiological processes and functions critical to sustaining life [3].
1.2 Types of biomaterials
In ancient times, gold wires were used as a scaffold to tie an artificial tooth to its neighboring teeth. In the early 1900s bone plates were successfully used to repair bone fractures and to accelerate their healing. Later in the 1950–60s, blood vessel replacement was performed using hip joints and artificial heart valves. Generally, the biomaterials can be classified into the following types:
1.2.1 Metals
As a class of materials, metals are the most widely known scaffold for load-bearing implants. For instance, some of the most common orthopedic surgeries hold the choice of using metallic implants. These vary from simple wires, screws to fracture fixation plates, total joint prostheses for hips, ankles, knees, shoulders, and so on. Moreover, in orthopedics, metallic implants are chosen in cardiovascular surgery, maxillofacial surgery, and as dental materials. The most commonly employed metals and alloys used for medical device applications are stainless steel, titanium and titanium alloys, cobalt-based alloys, and tantalum-based alloys [4].
1.2.2 Polymers
A wide variety of polymers have been utilized as biomaterials in the medical field. Their applications range from facial prostheses to tracheal tubes, kidney, liver parts, heart components, dentures, to hip and knee joints. Also, polymeric biomaterials are added in the preparation of medical adhesives, sealants, and coatings for a variety of functions. The physical behavior of polymers possesses a close similarity to soft tissue which is useful to repair skin, tendon, cartilage, and vessel walls, as well as drug delivery and so on. Polyethylene is used for replacing joint prostheses, while polycaprolactone has been utilized in resorbable sutures, screws and plates for fracture fixation purposes [5].
1.2.3 Ceramics
Traditionally, ceramic materials were used as restorative materials in dentistry. These materials range from crowns, cements, and dentures. Some ceramic scaffolds are demonstrated in joint replacement augmentation and bone repair. However, their poor fracture toughness severely limits their applications for load-bearing applications [6].
1.2.4 Composites
The most successful composite biomaterials used in the field of dentistry are restorative materials and dental cements. Carbon-reinforced polymer and carbon–carbon composites are of great attraction for joint replacement and bone repair because of their low elastic modulus levels. However, composite materials are extensively utilized for prosthetic limbs, where their combination of low density/weight and high strength result in them being supreme scaffolds for such applications [7].
1.2.5 Nanocomposite materials
The higher water content materials provide cell friendly microenvironments for preparing various composites. Mammadov et al. [8] suggest that polymers can mimic angiogenesis in tissue regeneration. Zhao et al. [9] demonstrated tetra sulfonatophenylporphyrin derivatives adjuvant with TiO2 nanowhiskers for the ranostics of Rheumatoid Arthritis. Similarly, nano TiO2 has been used for coating of orthopedic prosthetic implants [10]. The TiO2 nanotubes-based composites have been demonstrated in the repair of articular joints, hip–knee joints, to control the wear and tear effect. The nanostructured TiO2 coated on the surface of prosthetic implants are highly safe with improved bone mineralization and osteoblast adhesion [11]. In nanotherapeutics, various magnetic nanostructures are used to alter the cells biochemical and physiological environment by moving the charged particles into the cell by enhanced membrane permeability [12]. The hydroxyapatite-based nanocomposites are favored for the nano 3D structure formation due to the promotion of cell organization, proliferation, and allowance of free movement of nutrients to the developing tissues. Ji et al. [13] suggest that nanohydroxyapatite–chitosan–gelatin-based scaffolds are used for osteogenesis. This is also supported by Fig. 1.1.
Figure 1.1 Biomimetic spiral–cylindrical scaffold based on hybrid chitosan/cellulose/nanohydroxyapatite membrane.
1.2.6 Natural biomaterials
Interestingly, there are new materials derived from the animal and plant world being considered for use as biomaterials. One of the advantages of using natural materials for implants is because the materials are similar to those found in our body. These materials are naturally toxin-free, carry specific protein binding sites, and the biochemical reactions assist tissue healing. However, natural materials suffer from immunogenicity. Another problem faced by these natural polymers is their tendency to denature at below their melting point temperature. This severely restricts their fabrication of different sizes and shapes of implants. Natural materials include collagen, chitin, coral, cellulose, and keratin [14].
1.2.7 Nanobiomaterials
Nanobiomaterials structurally are similar to various body proteins, ligands receptors, and DNA, whose size should be in the range of 10–100 nm for better biomedical applications. The size above 100 nm may induce embolism and in between 10 to 100 nm may be utilized as better drug delivery vesicle while around 10 nm may be in biomedical imaging [15]. However, the size below 10 nm is highly toxic and reactive. This permits them to interact freely with various body receptors and quickly cross the cell membrane [16]. Nanobiomaterials are widely utilized in nanodrug delivery systems [17], gene therapies [18], cancer photodynamic therapies [19], tissue engineering [20], and orthopedic implantation [21].
1.3 Behaviors of biomaterials
Any material that has been substituted into human body should be highly acceptable to the biological system, with minimum adverse effects. And, the following various factors that concern the healing process either influence this process independently or as cofactors with other multiple factors.
1.3.1 Biocompatibility
A perfect biomaterial scaffold should not suppress the activity of normal cells and should be toxin-free during and after implantation [22]. Moreover, it should also create well induced effects that may promote adhesion and healthy cell growth in the microenvironment, composed of nanostructures. This is mainly because of a larger specific surface area of nanostructures that can promote the adsorption of proteins, cell adhesion, and growth [23]. Hence more attractive nanomaterials are being synthesized with good biocompatibility for biomedical applications [24,25].
1.3.2 Mechanical property
The scaffold should satisfy good mechanical strength and provide transfer properties. Mechanical strength of required biomaterials has a broad range density. So different geometries with different mechanical strengths have been designed to form ideal scaffolds such as nanopillars, nanofibers, nanoparticles, and nanocomposites to face the mechanical behavior challenge [26] (Table 1.1).
Table 1.1
1.3.3 Vesicular structure
The vesicular structure with porous diameter 200–350 μm is a necessary behavior for bone repair scaffold materials, to guarantee the transportation of oxygen and nutrients [27]. The porous biomaterial ions dissociate after implantation, and the mechanical requirements of this need to be addressed [28].
1.3.4 High wear resistance
The biomaterial should demonstrate a high wear resistance and have a low friction coefficient when sliding over the body tissues. Any change of these parameters would structurally change the implanted biomaterial [29,30]. Additionally, the wear debris generated can create inflammation leading to the destruction of bone supporting the implant.
1.3.5 High corrosion resistance
An implant, made of a biomaterial with a low corrosion resistance can liberate metal ions in the body, which in turn results in toxic reactions [31].
1.3.6 Osseointegration
Osseointegration is nothing but a direct structural and functional connection between living bone and the surface of a load-carrying implanted biomaterial [32]. The chemistry, roughness, and topography of the surface are serious concerns for osseointegration [33]. Implant loosening is caused by the nonintegration of the biomaterial surface into the nearby bone [34]. It is reported that osseointegration is undesirable owing to the risk of removal of the implanted material after use [21]. However, a few researchers exhibited that the biomaterial could be detached safely [20].
1.3.7 Nontoxicity
The biomaterial should not affect the DNA and damage the cells. Toxic behavior is another important concern for implantation.
1.3.8 Long fatigue life
The high resistance and stress shielding behavior of biomaterial should demonstrate a fatigue behavior [22].
1.3.9 Bioabsorbability
Biological absorbability of the scaffold materials is another key factor for bone tissue regeneration [22]. An ideal scaffold should be disintegrated in vivo at a certain time, and provide a space for new bone regeneration. The degradation time of biomaterials is about 9 months. The nanobiomaterials are porous and biodegradable and can also provide mechanical support during the bone repair [35].
1.3.10 Angiogenesis
An essential requirement of scaffold for bone repair is to support the angiogenesis due to higher blood need in the bone tissues [27]. Oxygen and nutrients are crucial for cells and tissues regeneration within the scaffold. The wound healing as a result of inflammatory reaction can induce continuous formation of blood vessels after scaffold implant. Moreover, insufficient angiogenesis may block the delivery of nutrients and oxygen, which may result in apoptosis of cells [36].
1.4 Bioactivity of materials
Bioactivity is the capacity of scaffold to mimic the response in a living system [37]. The bioactive materials should elicit the biological response at the interface to develop a strong bond between the materials and the body [38]. Hence, the role of bioactivity of a scaffold is unavoidable for biomedical applications. The bioactive materials are mainly demonstrated by tailoring bioactive composites and surface coatings. A nanoarray of gold has been used for bone repair via osteoblasts [39]. The ceramic conjugated nanoparticles [40] and nanofibrous membranes made of fibroin/chitosan/nanohydroxyapatite used for modulation of bone regeneration, are excellent scaffolds for bone tissue engineering [41].
1.4.1 Nanocoating of implants
Nanostructured coating of various prosthetic implants is of higher interest in biomedical applications. The prosthetic main body is made of metallic alloy which articulates against polymer or ceramic–polymer surface. The excellent tribocorrosion and biocompatibility can be achieved via surface coating with nanowhiskers, nanotubes, graphite, diamond, titanium [42], and tantalum [43]. The antifriction coatings of the nanobiomaterials are also used to control the infections by loading antimicrobials on prosthetic surface. The Ti nanoparticles and Ag nanoparticles coated over the prosthetic implants are applied in orthopedic prosthetic implants to control postoperative problems and infections. Singh et al. [44] synthesized nanostructured hydroxyapatite coated on Ti-alloy to not only lower the graft-versus-host infection to orthopedic implants but also increase its biocompatibility. Stanic et al. [45] prepared silver fluroappatite nanopowder and exhibited excellent antibacterial effect on Klebsiella pneumoniae, Micrococcus luteus, and Staphylococcus aureus. The nanohydroxyapatite coated with a phospholipid bilayer provides longevity of implants.
1.5 Applications of biomaterials
1.5.1 Orthopedics
One of the most prominent application areas and a major focal point for biomaterials is for orthopedic implant devices such as the hip, knee, shoulder, ankle, and elbow.
1.5.2 Cardiovascular applications
In the cardiovascular, or circulatory, system, biomatarials are used to repair heart valves, endovascular stents, vascular grafts, stent grafts, and other cardiovascular grafts which can be successfully treated with implants (Fig. 1.2).
Figure 1.2 Cardiovascular applications of 3D printing.
1.5.3 Tissue engineering scaffolds
Tissue engineering is one of the most important ways to achieve tissues for repair or replacement applications. Its goal is to design and fabricate reproducible, bioactive, and bioresorbable 3D scaffolds with tailored properties that are able to maintain their structure and integrity for predictable periods of time, even under load-bearing conditions.
1.5.4 Ophthalmics
The tissues of the eye can suffer from several diseases, leading to refractive error and blindness. Diabetic retinopathy, cataracts, age-related macular degeneration are some of the ophthalmologic diseases. To improve the life of disease-affected people, there are implants of different biomaterials.
1.5.5 Dental applications
Within the mouth, both the tooth and supporting gum tissues can be readily destroyed by bacterially controlled diseases. Dental cavities, the demineralization and dissolution of teeth associated with the metabolic activity in plaque can cause extensive tooth loss. Tooth crowns and roots can be replaced or restored by a variety of materials.
1.5.6 Wound healing
One of the oldest uses of implantable biomaterials can be traced back to the introduction of sutures for wound closure. Another important wound-healing category is that of fracture fixation devices. These include bone plates, screws, nails, rods, wires, and other devices used for fracture treatment.
1.5.7 Drug-delivery systems
One of the fastest growing areas for implant applications is for devices for controlled and targeted delivery of drugs. In order to use the above-discussed scenario, various types of biomaterials are being used. Among them in this review we discuss in detail the metal-based biomaterials. The high strength and resistance to fracture of metallic materials can provide, proper processing, reliable long-term performance, good electrical conductivity for neuromuscular stimulation, all of which are excellent properties for implantation [46] (Table 1.2).
Table 1.2
1.6 Metallic biology origin and its developments
Early records evidenced the use of metallic implants in surgery in the 16th century [47,48]. In the following years rapid improvements in implant surgery together with the introduction of newly developed metals and alloys into clinical practice were also reported [49]. Wires and pins made of iron, gold, silver, and platinum have been utilized to implant different metal devices, but found largely failure because of infection after implantation. To answer this situation, metals (Fe, Co, Cr, Ti, Ni, Mo, Ta, and W) have been chosen for implants used in various forms [50]. Even though the implant metals have biocompatibility with hostile body environment, they suffer from corrosion, leading to corrosion products getting inserted into tissues, which in turn leads to undesirable effects [51]. One of the recent promising directions in the development of metallic implants with advanced behaviors is nanostructured biomaterials. The nanoscale size can influence to control the corrosion behavior [48]. Hence, the list of metals currently used in implantable devices is divided to into the following systems: iron–chromium–nickel alloys, cobalt-based alloys, titanium and its alloys, and tantalum [52].
Biomaterials are artificial materials, utilized to design different structures for implantations, to repair the diseased or lost parts of biological structures, in order to restore their function and be in contact with body fluids to interact with biological systems. Hence for biomaterials adapted for a medical application, the whole part of a living structure using the replaced biomaterial performs the natural function. Such functions may be relatively passive, or bioactive with a greater interaction with our biological system. A biomaterial is made of an autograft, allograft, or xenograft utilized as a transplant material. And the biomaterial must be biocompatible, i.e., not elicit an adverse response from the body. It must be nontoxic, noncarcinogenic, and have adequate mechanical and physical properties to serve as augmentation or replacement of body tissues. One of the primary uses of biomaterials is to physically replace hard or soft tissue damaged over an extended period of time by some pathological process, such as that caused by infection, fracture, and cancer, which may cause pain, disfigurement, loss of function, and/or destruction. In view of these problems, it may be possible to repair the diseased tissue and restore it with some appropriate synthetic biomaterial.
The various biomaterials used in the human body are heart artificial valves, stents, implantation in shoulders, hips, knees, elbows, ears, and dental structures [53]. The implanting biomaterials for hip, spinal, and knee repair are more available with enhanced specification nowadays. Human joints are frequently damaged due to degenerative problems such as arthritis leading to pain or loss of action. The degenerative illness results in degradation of the mechanical behavior of the bone owing to high loading/lack of self-healing process. It has been observed that 91% of the population above 40 years of age suffers from these kinds of diseases [54]. Synthetic biomaterials are the remedy to challenge these issues, by surgical implantation of these biomaterials of appropriate structures to restore the function of the repaired parts in the human body.
At present, the most commonly used stent materials include metal and polymer materials. Compared with polymer materials, metallic stents exhibit stable performance and therefore can provide preferable supporting strength. Nitinol (Ni–Ti), stainless steel (316L SS), cobalt–chromium (Co–Cr) alloy, tantalum (Ta), pure iron (Fe), platinum–iridium (Pt–Ir) alloy, and magnesium (Mg) alloys are the metallic biomaterials used for manufacturing stents [55]. Among these metallic stent materials, pure Fe and Mg alloys are the two metals that have been used for making biodegradable coronary stents. 316L SS, which is used as a balloon-expandable stent material, is well-known for its low yield strength (331 MPa) and high Young’s modulus (190 GPa) [56], whilst Ni–Ti alloy with Young’s modulus in the range of 75–83 GPa and yield strength ranging from 195 to 690 MPa [56], is widely used as a self-expandable stent material. However, both of them contain Ni, which may trigger a local immune response and inflammatory reactions [57].
In addition, 316L SS and Co–Cr alloys cause concerns due to their inadequate magnetic resonance imaging compatibility. Tantalum possesses excellent corrosion resistance but has poor mechanical properties; furthermore, the biocompatibility and hemocompatibility of Pt–Ir alloy need to be verified further [58]. It is well known that implant materials that have a high magnetic susceptibility are not appropriate for magnetic resonance imaging diagnostic in surgeries. In this regard, it is important to notify that Co–Cr alloys have a relatively high magnetic susceptibility, being ~1370×10−6 cm³/g in comparison to Ti with a magnetic susceptibility of 180×10−6 cm³/g. On the other hand, Ti and its alloys are preferred candidates for metallic stents due to their excellent biocompatibility and corrosion resistance [59]. Biehl et al. [60] demonstrated that the excellent hemocompatibility together with good mechanical properties of Ti–Ta and Ti–Nb alloys make them promising stent materials. In particular, apart from not inducing biological toxicity, which cannot be avoided for conventional stent materials, some new β type Ti alloys display excellent hyperelasticity, good corrosion resistance, favorable biocompatibility, and fracture toughness similar to that of α, β type Ti alloys [61]. This type of Ti alloy has become the hotspot in the field of metallic biomaterials due to its superior biocompatibility and biocompatible mechanical properties. In the design of new β type Ti alloys, alloying elements can be divided into α stabilizers, β stabilizers, and neutral elements according to their influences on the β transition temperature of Ti and their solubilities in α and β phases. Furthermore, β stabilizers are divided into isomorphous and eutectoid types. Considering the biocompatibility and the stability of β phase, β stabilizers such as Mo, Ta, Nb, Hf, Pd, and Fe are usually selected as primary additive elements in the design of a β type biomedical Ti alloy. Moreover, Zr can be used as a β stabilizer when used with combination of other β stabilizers such as Ta and Nb, and improve the performance of the Ti alloys [62]. In this study, Ta, Zr, and Hf were selected as the β stabilizers in order to achieve improved performance of the Ti alloys. Meanwhile, based on the d-electron alloy design method [63], and the molybdenum equivalence requirements [64], three new β type Ti alloys were designed, aiming at a unique combination of mechanical properties of high elastic admissible strain and high mechanical strength. Hafnium is a β stabilizer but there are only a few studies reporting the influences of hafnium in Ti alloys [65] to date. Therefore, further research on the effect of hafnium on the biocompatibility and mechanical properties of titanium alloys is highly pertinent. Itagaki et al. [66] investigated the β stabilizers, namely, Ta, hafnium, and Zr which are nonferromagnetic metals to develop new Ti alloying elements for stent materials applications.
Conventional metallic materials have been typically applied in the medicinal field, such as in dental applications, orthopedic implants, prosthetic heart valves, and intravascular stents. Compared with other biomaterials, metallic products possess superior mechanical properties, such as fracture toughness, fatigue strength, ductility, and yield strength, that are more suitable for load-bearing or permanent deformation. In fact, it is reported that gold plates were used to repair cleft-palate defects in early 1565. Later a large number of other metals and alloys such as platinum, silver, tantalum, palladium, nickel, copper, aluminium, zinc, iron, magnesium, carbon steel, stainless steel, cobalt–chromium alloys, titanium and its alloys have been used in the human body. However, the results have shown that the most of them are not compatible for implants in the human body owing to insufficient mechanical properties, inadequate biocompatibility, and inferior corrosion resistance.
Recently, new metallic biomaterials exhibiting better mechanical properties, excellent biocompatibility, and good corrosion resistance were observed. The examples are stainless steel, Ti and its alloys, Co–Cr alloys. The high chromium content develops a good resistance to a wide range of corrosive solutions. Due to the relatively low cost of stainless steel and availability it has been successfully demonstrated in the human body to have contact with tissues and bones for several decades. However, the wear resistance of stainless steel is very low, which shows minimum suitable application for artificial joints. Compared with stainless steel, Co–Cr alloys show a better wear resistance and excellent corrosion resistance even in chloride environments. The range of Co–Cr alloys in clinical applications used wrought and cast alloys. The elastic modulus is also similar to that of stainless steel and both of them exhibit higher cortical bone leading to stress shielding in the adjacent bone and finally results in the failure of the implantation. Compared with SS and Co–Cr alloys, Ti and its alloys demonstrate lower modulus of 55–110 GPa which is very close to the bone value. In addition, the passivation film of TiO2 gives excellent corrosion resistance. Hence, Ti and its alloys have been seen as the best among the aforementioned conventional metallic biomaterials due to their excellent combination of mechanical properties, biocompatibility, and corrosion resistance.
1.6.1 Metallic biomaterials—biofunctions
Two important characteristics of metallic biomaterials are biofunctionality and biocompatibility. Following this paradigm many of the metallic materials found in the human body have been restricted in the past few decades due to the insufficient biofunctionality and inferior biocompatibility characteristics. Revolutionizing metallic biomaterials not only should exhibit excellent biocompatibility but also specific biofunctioning to meet the various challenges. Hence the revolutionizing metallic biomaterials are being researched to develop the various biofunctions.
1.6.2 Antibacterial function
A serious complication found in implantation surgery is bacterial infection. Using the conventional metallic biomaterials it is difficult to expect the antibacterial function. Therefore, in the past decades, the bacterial colonization and antibacterial activity using metallic biomaterials have been reported under in vivo and in vitro studies. The antibacterial effect of alloying elements claims the antibacterial function. Recently, Ag- and Cu-based alloys have been reported for the fabrication of antibacterial metallic biomaterials. The silver and copper exhibited the antibacterial functions against the microorganisms. The medical application of Ag is in wound dressing and antibacterial coating for medical devices. However, in wound dressing Ag nanoparticles exhibited external infections, which is the inconvenience of using Ag on urinary catheters and endotracheal breathing tubes. However, Ag exhibits minimum toxicity and low risk is expected due to inhalation, dermal application, and also chronic intake of silver products can be deposited in the skin. The silver ions are bioactive and sufficient concentration can be used in vitro for antibacterial actions. Similarly, the antibacterial agents based on silver nanoparticles are found utilized in industrial and domestic applications.
Unlike Ag, Cu metal can be used for implants in the human body. Copper and its alloys also can be reported as natural antibacterial materials. So many antibacterial studies have exhibited that the copper alloy has natural intrinsic properties to destroy a wide range of bacteria, fungi, and viruses. It was proved that copper alloys kill more than 99% of disease-causing bacteria when cleaned periodically.
1.6.3 Promotion of osteogenesis
From the osteogenesis perspective the metallic biomaterials aforementioned are thought to be bioinert materials. Osseointegration means that the process of bone healing and new bone formation is the medicinal goal of implantation. The implant and bone cells are considered well osseointegrated when new bone cells form, proliferate, and differentiate on the implant. To find a strong binding material between the metallic implant and surrounding bone, a bioactive interface must be encouraged to give a better bone regeneration with expedited healing. Many studies are focused on the surface modifications to gain outstanding bone regeneration ability. Development of porosity on the surface, nanoceramic coating, hydroxyapatite coating, and thermal heat treatment are some of the strategies used to improve the bone integration with metallic implants.
The prototype technique and electrodeposition routes using Ti scaffolds with calcium phosphate coating were analyzed for their osteogenic behavior. The study described the possibility of using high-strength porous scaffold with suitable osteoconductive and osteogenic properties to design large skeletal parts in the maxillofacial and orthopedic fields. Using laser engineered net shaping the modulus of Ta can be modified by varying its porosity and the biocompatibility studies exhibited excellent adherence, growth, and abundant extracellular matrix formation over the porous Ta structure indicating a promotion in biological fixation. The microarc oxidation Ti implant surface has the ability of fast osteoid deposition with Ca, P, C, and N being found. And these materials are considered to exhibit good inducement capacity in vivo to accelerate bone tissue growth and minimize the osseointegration time.
The high mechanical stability of metallic biomaterials has attracted their use mainly to fabricate various medical devices such as bone plates, artificial hip joints, and dental implants. Specifically, different types of alloy materials have been considered in the medical field for their characteristics and various properties. Namely, stainless steel, cobalt–chromium–molybdenum alloy, and Ti alloys have been designed to find their applications in medical field.
1.7 Stainless steel
Stainless steel (SS) is the general name for a number of different steels used mainly because of its resistance to a wide range of corrosive agents [67]. SS is used to fabricate some prosthetic parts in fields such as dental implantology, prosthetic dentistry, and orthopedics [68]. It possesses good mechanical properties but suffers from poor biocompatibility. Infections and lack of osseointegration are the further existing drawbacks of these implants in the human body [69] Singh and Dahotre [70] initially reported that stainless steel implants are often degraded due to crevice, pitting, fretting corrosion fatigue, stress corrosion cracking, and galvanic corrosion in the body (Fig. 1.3).
Figure 1.3 (A) Stainless steel surgical device. (B) The stem of a total hip replacement, usually made from either stainless steel, cobalt, or titanium-based alloys.
Stainless steel implants are radiolucent to X-rays. Stainless steel alloy preparation is a method to increase implant radiopacity [71]. On the other hand, various materials including platinum, gold, and palladium additions to stainless steel increased the radiopacity and have been attempted for medical implantation. The practical route to shield the stainless steel alloys against corrosion is by protective coatings [72].
In this view, the surface properties of implanting biomaterials can be modified by plasma surface processes [73], the use of coatings [74], and structural modifications at the micro/nanoscales. On comparison with other techniques [75], the use of ultrafast lasers technique has been identified as an outstanding and effective technique to modify the surface topography at the micro- and nanorange in a well controlled manner.
The 18-8 grade stainless steel with molybdenum was the first stainless steel designed specifically to construct bone fracture plates and screws, for human use [47]. Because of its insufficient corrosion resistance, vanadium steel is limited in implants. Steels can be divided based on crystallographic structure into austenitic, ferritic, or martensitic stainless steel.
So, austenitic stainless steels, such as 316, 316L, and 302, are characterized by γ-faced centered cubic structure and are used in biomedical applications. However, 316L stainless steel may corrode inside the body [76]. 316L stainless steel is prone to corrode in chloride environment, particularly pitting corrosion. 316L stainless steel corrosion results in the release of metal ions such as nickel and chromium in the body and leads to allergies. Poor mechanical behavior of the implant is the product of localized corrosion.
Nanotechnology plays a significant role in the enhancement of the next generation of medical implants and now makes it possible to operate at the nanoscale range in medicine. This has the unique potential to positively target the cellular processes inside the body [14].
Decreasing the grain to microsize influences the reaction of the surface with environment while the nanostructures reduce the reaction of the surface to corrosive surroundings with good stability [77]. Moreover, the nanostructured stainless steel develops important nucleation sites allowing the design of more uniform passive film with greater corrosion resistance in sodium chloride solution compared to the microstructure biomaterials [51]. Severe plastic deformation has been identified as a filter of grain-sized metals and alloys which significantly only permits the nanometer range. Maleki-Ghaleh et al. [78] analyzed the effect of Equal Channel Angular Pressing technique on corrosion study of the 316L type austenitic stainless steel through eight passes. The results exhibited that after performing the eight stages of this technique, a well grained 316L stainless steel with a mean size of about 78 nm was obtained. It was noticed that this technique, effectively reduced the corrosion resistance of 316L stainless steel. Hajizadeh et al. [51] studied biological and corrosion performances of nanostructured 316L stainless steel using the same technique. They reported a considerable reduction in corrosion rate from 3.12 to 0.42 iA/cm². Moreover, the cell proliferation on nanostructured stainless steel surface steel appreciably improved compared to the conventional steel. The Young’s modulus study also provides integral information on structural modification on the volume of the nanomaterials. The fine textures developed during cold working results in an appreciable anisotropy of the Young’s modulus due to the strong change in orientation due to elastic behavior. Oberringer [79] performed osseointegration using nanotextured 316L steel to improve the endothelial and bone marrow mesenchymal stem cells. Dumas [80] analyzed the potential of femtosecond-structured surfaces to enhance osteogenesis and reduce adipogenesis of mesenchymal stem cells.
1.8 Cobalt-based implants
Cobalt alloys show an extremely high degree of corrosion resistance even in chloride surroundings due to the spontaneous creation of a chromium oxide (Cr2O3) passive layer within the human body [81]. These biomaterials possess superior mechanical properties such as greater resistance to fatigue and good wear resistance to corrosion. Due to 8% elongation performance of these materials, they are not brittle. These materials also exhibit a high elastic modulus (220–230 GPa) similar to that of stainless steel (~200 GPa) and superior to that of cortical bone (20–30 GPa) [7]. Ions such as Cr, Ni, and Co are specified to be released from the stainless steel and Co, Cr alloys suffer from the corrosion in the human body [82].
The cobalt-based alloys exhibit balance between biocompatibility and mechanical properties; both forms are somewhat better than stainless steel in corrosion resistance and strength but more costly to design. Cobalt-based alloys are better than stainless steel with regard to its corrosion stability. Cobalt–chromium alloys can be mainly divided into two types: (i) Co–Cr–Mo alloy; and (ii) Co–Ni–Cr–Mo alloy. The cast Co–Cr–Mo alloy has been applied in dentistry for longevity of artificial joints. Because of the high rate of work hardening required, it can’t be molded into a particular shape at surgery time. Therefore, this alloy is characteristically kept for implantable devices having a fixed configuration, such as total hip prosthesis, and the high abrasion resistance is occasionally utilized for bearing applications with metal-on-metal devices. Wrought Co–Ni–Cr–Mo alloy is used for manufacturing the stems of prostheses of heavily loaded joints, namely, the knee and hip. In annealed form the wrought alloy shows stress similar to the more brittle cast with improved ductility, and the tensile strength value is equal to heavily cold-worked SS. Additionally, with suitable working and annealing conditions, the wrought alloy can be brought to achieve a useful value of ductility and strength, exhibiting its versatile behavior as an implantable alloy. However, the wrought alloy suffers from higher crevice corrosion than the cast Co–Cr–Mo alloy. For fracture-fixation purposes this alloy is not used, due to its high cost compared to stainless steel. It has been reported that Cr, Ni, and Co are the most toxic ones. The corrosion products of Co–Cr–Mo are more toxic than those of stainless steel 316L. The electrochemical and mechanical behaviors of the biomaterial have been modified by thermal treatments to Co–Cr–Mo alloys [83]. The most utilized alloy for medical purposes is the cast version of Co28Cr6Mo (ASTM F75) and the wrought versions ASTM F799 and ASTM F1537 [84]. Patel et al. [85] have utilized the cobalt-based alloy via SPS to manufacture F75 composition and produced a microstructure which possesses hardness nearer to that of ceramic biomaterials utilized for hip replacement device fabrication. The superior fatigue and final tensile strength of the wrought Co–Ni–Cr–Mo alloy make it very appropriate for applications that need a long-lasting service without fracture or stress fatigue.
Cobalt alloys with minimal amount of nickel are named as F75 and F799, and alloys with more nickel content are called F90 and F562 [86]. The Co–Ni–Cr–Mo alloy typically called MP35N contains ~35% Co and Ni each. This alloy is more corrosion-resistant to sea water. The abrasive wear property of the wrought Co–Ni–Cr–Mo alloy is similar to that of cast Co–Cr–Mo alloy; wrought alloy is not found to be suitable for joint prosthesis-bearing surfaces because of the weak frictional properties with its composite materials. Interestingly, the better tensile strength fatigue of the wrought Co–Ni–Cr–Mo alloy makes it apt for applications which necessitate longevity of implants such as stems of hip joint prostheses. This unique behavior implant is used in femoral medullary canal replacement and also it is relatively hard to replace the failed implant. Also, the review of arthroplasty is difficult due to its poorer fixation of the implant. The microstructure of cobalt-based alloys possesses a cobalt-rich solid-solution medium having carbides (Cr7C3, and M23C6) in which W, Cr, Ta, Ni, Zr, Si, and Co may be found in a single carbide particle [87]. The manufacturing technique has the capacity to result in a minimum of three microstructural features which can strongly influence implant properties, depending on the casting technique [87]. The features include: (i) interdendritic regions formation that become solute (molybdenum, chromium, cobalt)-rich and possess carbides, while dendrites become drained in chromium and richer in cobalt; (ii) dendrite formation of large grain sizes which minimize the yield strength; and (iii) casting defects [87]. Even though the manufacture of cast materials may produce microscopic voids in their configuration, methods such as hot isostatic pressing can be suitable for densification of the material to enhance the mechanical properties [88]. Of late, low-carbon wrought routes of cobalt-based alloys have shown tremendous corrosion resistance and mechanical properties that are stronger than cast alloys [89].
1.9 Titanium-based implants
People made efforts to utilize titanium as a biomaterial from 1930 onwards and nearly 1000 ton of titanium-based alloys are used as biomaterials in patients worldwide every year. For orthopedic applications the focus over the past few decades has been to find a suitable metallic implant that forms an extremely firm passive layer of TiO2 on its surface. Ti is biocompatible and frequently shows direct bone apposition (Fig. 1.4). Further an advanced behavior of Ti is the low elastic modulus (two times lower compared to stainless steel and Co–Cr), which in turn exhibits less stress shielding and linked bone resorption around Ti orthopedic and dental implants. Moreover, Ti has lighter weight than other surgical biometals and demonstrates some artifacts on magnetic resonance imaging and computer tomography [90]. The mechanical properties of Ti can be improved by the addition of alloying materials, such as vanadium and aluminum. At higher concentrations the metal ions were observed in the tissues around the implants, in urine, in serum, and in remote tissue positions [91]. The slow deposition of Al and V ions and passive layer formation has long awakened concern about the longevity of Ti–6Al–4V implant alloys. Aluminum stimulates severe metabolic bone diseases such as osteomalacia and neurological disorders such as Alzheimer’s disease, while V ions are prone to be cytotoxic [92]. Additionally, the simultaneous action of wear and corrosion results in accelerated discharge of Al and V ions which leads to tribocorrosion behavior [93]. Hence as a result of inadequate wear resistance of Ti alloys, they are not used as sliding contact implants, such as in total joint replacements. In many clinical applications, such as stem/bone interface of cement less implants, femoral stem/ball contact of modular implants, and dental implant/bone interface, unwanted release of Al and V ions from Ti–6Al–4V alloy takes place due to tribocorrosion activity with micromotion. Therefore, great interest is focused toward the improvement of Ti-based alloys free from Al and V ions. [94]. To respond to this situation, Ti-nanostructured materials have been prepared. This approach eliminates the alloying concept and abandons the harmful ion release and finally improves the mechanical properties of pure Ti by the nanoscale size of the implanting material. In the same way the practicability of strengthening various metals for its implant purposes by nanostructuring has been performed in different analysis [95]. In addition to enhanced mechanical properties, a more desirable cell reaction to nanostructured implants compared to coarse grained Ti has been reported [96]. The most advantageous group of Ti alloys in clinical applications are Ni–Ti alloys, known as Nitinol which contains 54–60 wt.% Ni. Nitinol demonstrates the unique properties of superelasticity and shape memory which is used in guide wires, stents, peripheral vascular devices, and embolic protection filters [18]. Owing to the greater titanium composition, Nitinol alloy shows good corrosion resistance and biocompatibility in in vivo studies. However, the release of Ni ions causes carcinogenic, allergic effects and can also modify the cell behavior [97]. The severe plastic deformation technique has been used to design nanostructured Nitinol shape memory alloys that are ultrafine grained, which has resulted improved mechanical properties. It is also observed that the phase transformation temperature of Nitinol is affected when the grain refinement is changed to ultrafine [98] (Fig. 1.5). It is further reported that Ni–Ti alloys are found to exhibit high shape recovery and recovery stresses up to 10% [98], as well as reduced fracture strain and higher plateau stress. On the other hand, as an alternative to SPD technique, bulk nanostructured Ti and Ti alloys were produced from nanosized powders by the application of high pressure. In turn the cold sintering process results in severe plastic shear deformations of particles which are then combined into a dense bulk material [99]. Hence the formation of dense nanostructured Cu, Al, Ni, and Fe metals, as well as Cu–TiN and Ni–TiC nanocomposites by the cold sintering process of nanosized powders was demonstrated [100]. The most commonly utilized titanium biomaterials are pure Ti and Ti–6Al–4V. Because of its good mechanical and corrosion properties, Ti–6Al–4V alloy is used in orthopedic implants [101]. The modulus of elasticity of these biomaterials is ~110 GPa, which is half of the value of Co-based alloys. Ti alloys have the resistance similar to that of 316 stainless steel or the Co-based alloys; in comparison to specific strength, the Ti-based alloys beat other implant materials [102]. However Ti exhibits weak shear strength, making it less attractive in the design of bone screws, plates, and so on. Ti–Nb–Ta–Zr alloys with different concentrations could be used to obtain various deformation mechanisms in these alloys
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