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International Journal of Bioprinting Osteogenic, antibacterial CpTi-MgOCu implants

the in vivo performance of an implant is greatly influenced such as hydroxyapatite . Mg ions play a crucial role in
2+
[20]
by the chemistry of the implant surface upon contact with bone metabolism, aiding osteogenesis by regulating local
the physiological environment, researchers have explored pH, which enhances osteoblast recruitment, proliferation,
the use of calcium phosphate (CaP) coatings added with and differentiation [21,22] . Mg ions also aid in regulating
2+
dopants, such as MgO, SiO , and ZnO, on bulk Ti to gene expressions in stem cell differentiation of osteoblastic
2
enhance osseointegration [8-10] . However, the weak metal- cells to stimulate formation of bone matrix proteins and
ceramic interface in these coatings has led to challenges, enhance bone formation [23,24] . Numerous studies have
including some coating failures due to delamination. demonstrated the efficacy of Mg ions in bioactive ceramic
matrices, significantly enhancing cell proliferation in
The long-term stability of the implant is severely affected [25,26]
by polymicrobial infections at the implant site, eventually vitro [8,27] and osteogenesis and bone mineralization in
leading to implant loosening and prosthetic joint infection vivo .
[11]
(PJI) . Addressing such polymicrobial infections involves A major concern associated with cemented implants
long-term antibiotic administration, revision surgeries is aseptic loosening due to delamination of the ceramic
involving debridement of infected tissues with implant coating on the titanium implant under loading conditions,
retention, or implant replacement, the latter being the leading to implant failure [28-31] . A recent survey study on
most effective in eradicating the infection [12-14] . However, the aseptic loosening of cemented implants post-total
revision surgeries in patients with compromised bone knee arthroplasty surgeries from 2009 to 2017 reported
health pose significant risks to their overall well-being and an alarming 6% failure rate due to cement debonding in
increase the probability of early mortality. A report on PJI the tibial implant . Such a high failure rate necessitates
[32]
indicated that 25% of patients treated for PJI died within a search for suitable cemented implant substitutes.
5 years . Moreover, a recent survey by the World Health Instead of using Mg-doped hydroxyapatite or calcium
[15]
Organization highlights 700,000 annual deaths due to phosphate cemented onto titanium implants, we propose
microbial infections, with projections of 10 million deaths incorporating MgO into the Ti matrix. Limited studies
by 2050 . The seriousness of the situation prompted a call have been conducted on incorporating MgO into the metal
[16]
to action at the United Nations General Assembly in 2017, matrix to enhance osteogenesis . The challenges posed by
[25]
aiming to reduce the mortality caused by antimicrobial the difference in melting points between Ti (1668°C) and
resistance down by 200,000 deaths . Without adequate MgO (2852°C) have been overcome by utilizing additive
[18]
intervention, the number of deaths from polymicrobial manufacturing (AM) for fabricating this composition. AM
infections may rise exponentially in the coming decades. allows the manufacturing of metal-ceramic composites
with greater flexibility and enables the incorporation of
Despite titanium’s established position as the ultimate
metallic material for implant applications worldwide, its designed porosities that aid in enhanced osseointegration
bio-inertness remains a significant drawback [17,18] . The early in vivo, a feat not achievable by other manufacturing
[33]
stage of osseointegration, which is crucial for a patient’s methods . However, to prevent brittleness of the metal-
healing period post-surgery and the long-term stability ceramic composites and ensure successful AM fabrication,
in vivo, can be severely affected by a prolonged healing we have restricted the addition of MgO dopant to 1 wt.%
in Ti . Copper (Cu) has also been extensively studied due
[34]
process at the implant site, particularly in individuals
with compromised bone health. Given that the implant’s to its antibacterial properties in Ti-Cu alloys. Nevertheless,
surface is constantly in contact with the physiological concerns regarding toxicity resulting from higher amounts
environment, its role in biological performance, including of Cu in the human body limit its use in significant
quantities. This study added small amounts of Cu (3 wt.%)
osseointegration and integration with surrounding bone to the Ti-MgO composition.
tissue, is vital. Numerous strategies have been employed to
enhance bone–tissue integration on titanium surfaces, such Given these issues, we added MgO and Cu to CpTi
as introducing surface porosities and calcium phosphate matrix to enhance its osteogenic potential and imbue
coatings with dopant additions. One prominent dopant inherent bactericidal capabilities. There lies a research
addition is magnesium oxide (MgO), which enhances gap in exploring the effect of MgO incorporation into
osteogenesis in bone-remodeling processes. Magnesium Ti matrix. The novelty of this study lies in investigating
(Mg) is the fourth main cation found in the human body; the synergistic osteogenic and antibacterial potential of
an adult body contains approximately 25 g of Mg, with the CpTi-MgO-Cu material design. This Ti-MgO-Cu
50–60% present in the bony intracellular matrix . Mg, material chemistry is expected to enhance early-stage
[19]
a biodegradable material in vivo with poor corrosion osseointegration due to osteogenic MgO and prevent
resistance, is usually incorporated in a biomaterial matrix polymicrobial infection incidence at the implant site,

Volume 9 Issue 6 (2023) 553 https://doi.org/10.36922/ijb.1167