A review of the bioactivity of hydraulic calcium silicate cements.
OBJECTIVE
In tissue regeneration research, the term "bioactivity" was initially used to describe the resistance to removal of a biomaterial from host tissues after intraosseous implantation. Hydraulic calcium silicate cements (HCSCs) are putatively accepted as bioactive materials, as exemplified by the increasing number of publications reporting that these cements produce an apatite-rich surface layer after they contact simulated body fluids.


METHODS
In this review, the same definitions employed for establishing in vitro and in vivo bioactivity in glass-ceramics, and the proposed mechanisms involved in these phenomena are used as blueprints for investigating whether HCSCs are bioactive.


RESULTS
The literature abounds with evidence that HCSCs exhibit in vitro bioactivity; however, there is a general lack of stringent methodologies for characterizing the calcium phosphate phases precipitated on HCSCs. Although in vivo bioactivity has been demonstrated for some HCSCs, a fibrous connective tissue layer is frequently identified along the bone-cement interface that is reminiscent of the responses observed in bioinert materials, without accompanying clarifications to account for such observations.


CONCLUSIONS
As bone-bonding is not predictably achieved, there is insufficient scientific evidence to substantiate that HCSCs are indeed bioactive. Objective appraisal criteria should be developed for more accurately defining the bioactivity profiles of HCSCs designed for clinical use.
Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, China.
Li-Na
LN
Niu
Department of Oral Anatomy and Physiology and TMD, School of Stomatology, Fourth Military Medical University, Xi'an, China.
Kai
K
Jiao
Department of Prosthodontics, School of Stomatology, Peking University, Beijing, China.
Tian-da
TD
Wang
Department of Stomatology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
Wei
W
Zhang
Department of Restorative Dentistry, Faculty of Dental Surgery, University of Malta, Malta.
Josette
J
Camilleri
Department of Endodontics, College of Dental Medicine, Georgia Regents University, Augusta, GA, USA.
Brian E
BE
Bergeron
Department of Prosthodontics, School of Stomatology, Peking University, Beijing, China.
Hai-Lan
HL
Feng
Department of Stomatology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
Jing
J
Mao
Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, China. Electronic address: jhchen@fmmu.edu.cn.
Ji-Hua
JH
Chen
College of Graduate Studies, Georgia Regents University, Augusta, GA, USA.
David H
DH
Pashley
Department of Endodontics, College of Dental Medicine, Georgia Regents University, Augusta, GA, USA; College of Graduate Studies, Georgia Regents University, Augusta, GA, USA. Electronic address: ftay@gru.edu.
Franklin R
FR
Tay
D001031:Apatites / Q000737:chemistry; D001672:Biocompatible Materials / Q000737:chemistry*; D001843:Bone Cements / Q000737:chemistry; D001842:Bone and Bones / Q000033:anatomy & histology; D017610:Calcium Compounds / Q000737:chemistry*; D002130:Calcium Phosphates / Q000737:chemistry; D011232:Chemical Precipitation; D003238:Connective Tissue / Q000033:anatomy & histology; D006801:Humans; D012823:Silicate Cement / Q000737:chemistry*; D017640:Silicates / Q000737:chemistry*
D001031:Apatites; D001672:Biocompatible Materials; D001843:Bone Cements; D017610:Calcium Compounds; D002130:Calcium Phosphates; D017640:Silicates; D012823:Silicate Cement; C020243:calcium phosphate; C031293:calcium silicate
Bioactivity; Calcium silicate; Hydraulic cement; In vitro; In vivo