## 13 Summary of Quantitative Comparisons of Different PMMA Formulations  
Modifications in PMMA compositions are aimed at optimizing its properties, such as the peak temperature, handling time, porosity, and mechanical strength, to address the clinical challenges and enhance its performance in medical applications. These modifications include adding PCM nanoparticles or pre-cooling the cement before use (Table 7) [24; 50; 81; 86]. Standard PMMA demonstrates high mechanical strength (70-100 MPa), while PMMA with nanoparticles achieves the highest strength among the options (20-50% increase from standard PMMA). PMMA with PCMs and pre-cooled PMMA show a mechanical strength comparable to the standard PMMA, indicating that these modifications do not significantly alter the material's mechanical properties (Figure 6) [50,81,86]. The highest peak temperature values are exhibited by standard PMMA (90-120 \({}^{\circ}\)C), which poses a risk of thermal damage. PMMA with nanoparticles (60-80 \({}^{\circ}\)C), PMMA \begin{table}
\begin{tabular}{p{113.8 pt} p{113.8 pt} p{113.8 pt} p{113.8 pt} p{113.8 pt} p{113.8 pt}} \hline \hline
**Parameter** & **Standard PMMA** & **PMMA with PCMs** & **PMMA with Nanoparticles** & **Pre-cooled PMMA** \\ \hline Peak Temperature (\({}^{\circ}\)C) & - & Generates high peak temperatures during polymerization, which can cause thermal damage to surrounding tissues (0–120 \({}^{\circ}\)C) & Incorporation of PCMs & - & The addition of nanoparticles like temperature by absorbing heat during (75-100 \({}^{\circ}\)C) & Pre-cooling significantly reduces the peak polymerization & - & Pre-cooling significantly reduces the peak polymerization & - \\ Handling Time (min) & - & Has a relatively short working time, which can be a limitation in clinical settings (5–8 min) & - & Incorporation of PCMs can extend the working time by moderating the exothermic reaction (10-30\% increase from standard) & - & The addition of nanoparticles can extend the prolong the working time by slowing down the polymerization process (15-20 min) \\ \hline Porosity & - & Typically has low porosity, which is beneficial for mechanical strength but can limit biological integration (3\%) & - & The addition of nanoparticles can affect possibly, but specific change the porosity of PMMA (3\%) & - & The addition of energy deposits depend on the temperature and amount of nanoparticles (3\%) \\ \hline Mechanical Strength (MPa) & - & High mechanical strength, but can be excessively stiff (70-100 MPa) & - & The addition of phase-change materials (PCMs) does not significantly alter strength of PMMA (20-50\% increase from standard) & - & Significantly increases faster strength and & - & Pre-cooling does not significantly affect the normalized to standard PMMA (70-100 MPa) \\ \hline \hline \end{tabular}
\end{table} 
Table 7: Quantitative comparisons of different PMMA formulations. Figure 6: Differences in mechanical strength of PMMA bone cement based on the composition. with PCMs (75-100 \({}^{\circ}\)C), and pre-cooled PMMA all show reduced peak temperatures, with PMMA with nanoparticles and pre-cooled PMMA achieving the lowest values (60-80 \({}^{\circ}\)C). These modifications effectively mitigate the exothermic heat release during polymerization, enhancing safety for clinical applications (Figure 7) [24; 50; 86]. Another characteristic of PMMA being affected by composition is the working time. Standard PMMA has the shortest working time (5-8 min), limiting its handling flexibility. PMMA with nanoparticles (10-30% increase from standard) and PMMA with PCMs show moderate increases in working time (10-12 min). Pre-cooled PMMA exhibits the longest working time (15-20 min), significantly enhancing its usability in clinical settings by slowing the polymerization process (Figure 8) [24; 50; 81]. No significant difference was observed in the porosity levels of different PMMA formulations.