Novel phosphate-based cements for clinical applications
Authors:   , Mestres Bea Gemma 
Published: October 2023

This Thesis aims at the development of two novel families of inorganic phosphate cements with suitable characteristics for clinical applications in hard tissue regeneration or replacement. It is organized in two distinct parts.
The first part focuses at the development of silicon-doped a-tricalcium phosphate and the subsequent preparation of a silicon-doped calcium phosphate cement for bone regeneration applications. For this purpose, silicon-doped a-tricalcium phosphate was synthesized by sintering a calcium-deficient hydroxyapatite at 1250ºC with different amounts of silicon oxide. The high temperature polymorph a-tricalcium phosphate was stabilized by the presence of silicon, which inhibited reversion of the b-a transformation, whereas in the Si-free a-tricalcium phosphate completely reverted to the b-polymorph. It was observed that the presence of Si did not alter the b-a transformation temperature. Both the Si-doped a-tricalcium phosphate and its Si-free counterpart were used as reactants in the formulation of calcium phosphate cements. While Si-doped a-tricalcium phosphate showed faster hydrolysis to calcium deficient hydroxyapatite, the composition, morphology and mechanical properties of both cements were similar upon completion of the reaction. When the samples were immersed in simulated body fluid, the Si-doped cement exhibited a faster deposition of an apatite layer on its surface than its Si-free counterpart, suggesting an enhanced bioactivity of the doped-cement. An in vitro cell culture study, in which osteoblast-like cells were exposed to a medium modified by the materials, showed a delay in cell proliferation and a stimulation of cell differentiation, the differentiation being more marked for the Si-containing cement. These results were attributed to the Ca depletion from the medium by both cements and to the continuous Si release detected for the Si-containing cement.
The second part of this Thesis is focused on the development of a new family of inorganic phosphate-based cements for biomedical applications, namely magnesium phosphate cements. The magnesium phosphate cements have been extensively used in civil engineering due to their fast setting, early strength acquisition and adhesive properties, properties that can be also of use for biomedical applications. However, there are some aspects that should be improved before they can be used in the human body, namely their high exothermic setting reaction and the release of potentially harmful ammonium ions. Therefore, a new family of magnesium phosphate cements was explored as candidate biomaterials for hard tissue applications. These cements were prepared by mixing magnesium oxide with either sodium dihydrogen phosphate, ammonium dihydrogen phosphate or an equimolar mixture of both. The exothermia and the setting kinetics of the new cement formulations were tailored. The ammonium-containing magnesium phosphate cements resulted in struvite as the major reaction product, whereas the magnesium phosphate cement prepared with sodium dihydrogen phosphate resulted in an amorphous product. The magnesium phosphate cements studied showed an early compressive strength substantially higher than that of conventional apatitic calcium phosphate cements. Moreover, they showed antimicrobial properties against bacteria present in dental infections, which were attributed to the synergistic effect of a high osmolarity and high pH of the cement extracts. These properties make magnesium phosphate cements good candidates for endodontic applications. It is with this latter point in mind that some of the most relevant physico-chemical properties were further optimized and characterized. Particularly, their radiopacity was enhanced by the addition of bismuth oxide. The sealing efficiency of the magnesium phosphate cements and their adhesion to dentin were shown to be comparable or even higher than those presented by other inorganic cements used for endodontic treatments.

Aquesta Tesi té com a objectiu el desenvolupament de dues noves famílies de ciments
inorgànics de base fosfat amb propietats adequades per a aplicacions clíniques en regeneració o
substitució de teixits durs. La Tesi està organitzada en dues parts.
La primera part està centrada en el desenvolupament de fosfat tricàlcic a dopat amb silici i
la subseqüent preparació de ciments de fosfat de calci dopats amb silici. Per a aquest objectiu, es
va obtenir fosfat tricàlcic a dopat amb silici mitjançant la sinterització d’una hidroxiapatita
deficient en calci amb diferents quantitats d’òxid de silici a 1250°C. La presència de silici va
estabilitzar el polimorf d’alta temperatura (fosfat tricàlcic a), inhibint-se la reversió de la
transformació b-a, mentre que el fosfat tricàlcic a sense silici va revertir completament a polimorf
b. La presència de silici no va alterar la temperatura de la transformació b-a. Tant el fosfat tricàlcic
a dopat amb silici com el seu homòleg sense silici van ser utilitzats com a reactius en la formulació
de ciments de fosfat de calci. Si bé el fosfat tricàlcic a dopat amb silici va mostrar en les fases
inicials una hidròlisi més ràpida a hidroxiapatita deficient en calci, un cop completada la reacció, la
composició, morfologia i propietats mecàniques d’ambdós ciments van ser similars. L’estudi de
bioactivitat mitjançant la immersió de les mostres en fluid corporal simulat va donar com a resultat
la formació d’una capa d’apatita a la superfície del ciment dopat amb silici, més ràpida que al seu
homòleg sense silici, fet que va suggerir una bioactivitat millorada del ciment dopat. L’estudi in
vitro, en el qual cèl·lules osteoblàstiques es van exposar a un medi de cultiu que havia estat
prèviament en contacte amb els ciments estudiats, va mostrar un retràs en la proliferació cel·lular i
un estímul de la diferenciació cel·lular, aquest últim més marcat pel ciment que contenia silici.
Aquests resultats es van atribuir a la reducció de calci en els medis en els quals estaven introduïts
els ciments i a l’alliberament continu d’ions silici per part del ciment que en contenia.