1. GITAM DENTAL COLLEGE & HOSPITAL
VISAKHAPATNAM - 45
DEPARTMENT OF
ORAL & MAXILLOFACIAL SURGERY
SEMINAR ON
BIOMATERIALS IN ORAL AND MAXILLOFACIAL SURGERY
Presented by
Dr. M.PRUDHVI RAJ
III MDS

2. TABLE OF CONTENTS
 INTRODUCTION
 AIM & OBJECTIVE
 MATERIALS
 APPLICATIONS
 CONCLUSION
 BIBLIOGRAPHY

3. INTRODUCTION
Biomaterial is used to make devices to replace a part or a function of the body in
a safe, reliable, economic, and physiologically acceptable manner.
A variety of devices and materials presently used in the treatment of disease or
injury include such common place items as sutures, needles, catheters, plates,
tooth fillings, etc.
The use of biomaterials did not become practical until the advent of an aseptic
surgical technique developed by Dr. J. Lister in the 1860s. Earlier surgical
procedures, whether they involved biomaterials or not, were generally
unsuccessful as a result of infection. Problems of infection tend to be
exacerbated in the presence of biomaterials, since the implant can provide a
region inaccessible to the body’s immunologically competent cells. The earliest
successful implants, as well as a large fraction of modern ones, were in the
skeletal system.

4. Definitions of biomaterials :
1) A Biomaterial can be simply defined as a synthetic material used to
replace part of a living system or to function in intimate contact with living
tissue.
2) The Clemson University Advisory Board for Biomaterials has formally
defined a biomaterial to be “a systemically and pharmacologically inert
substance designed for implantation within or incorporation with living
systems.”
3) Black (1992) defined biomaterials as “a nonviable material used in a
medical device, intended to interact with biological systems”.
4) Bruck (1980) defined biomaterials as “materials of synthetic as well as of
natural origin in contact with tissue, blood, and biological fluids, and
intended for use for prosthetic, diagnostic, therapeutic, and storage
applications without adversely affecting the living organism and its
components”.
5) Williams (1987) defined the biomaterials as “any substance (other than
drugs) or combination of substances, synthetic or natural in origin, which
can be used for any period of time, as a whole or as a part of a system
which treats, augments, or replaces any tissue, organ, or function of the
body”.

5. Selection of Biomedical Materials
The process of material selection should ideally be for a logical sequence
involving:
1. Analysis of the problem;
2. Consideration of requirement;
3. Consideration of available material and their properties leading to:
4. Choice of material.
The choice of a specific biomedical material is now determined by consideration
of the following:
1. A proper specification of the desired function for the material;
2. An accurate characterization of the environment in which it must function,
and the effects that environment will have on the properties of the
material;
3. A delineation of the length of time the material must function;
4. A clear understanding of what is meant by safe for human use.
As the number of available materials increases, it becomes more and more
important to be protected from unsuitable products or materials, which haven't
been thoroughly evaluated. Most manufacturers of materials operate an
extensive quality assurance program and materials are thoroughly tested before
being released to the general practitioner.
1. Standard Specifications: Many standard specification tests of both
national and international standards organizations (ISO) are now available,
which effectively maintain quality levels. Such specifications normally give
details for:

6. (a) the testing of certain products,
(b) the method of calculating the results
(c) the minimum permissible result, which is acceptable.
2. Laboratory Evaluation: Laboratory tests, some of which are used in
standard specification, can be used to indicate the suitability of certain
materials. It is important that methods used to evaluate materials in
laboratory give results, which can be correlated with clinical experience.
3. Clinical Trials: Although laboratory tests can provide many important and
useful data on materials, the ultimate test is the controlled clinical trial and
verdict of practitioners after a period of use in general practice. Many
materials produce good results in the laboratory, only to be found lacking
when subjected to clinical use. The majority of manufacturers carry out
extensive clinical trials of new materials, normally in cooperation with a
university or hospital department, prior to releasing a product for use by
general practitioners.
TYPES OF BIOMATERIALS
The most common classes of materials used as biomedical materials are:
1. polymers,
2. metals
3. ceramics.
These three classes are used singly and in combination to form most of the
implantation devices available today.

7. I) Metallic biomaterials
Metals are used as biomaterials due to their excellent electrical and thermal
conductivity and mechanical properties. Since some electrons are independent in
metals, they can quickly transfer an electric charge and thermal energy. The
mobile free electrons act as the binding force to hold the positive metal ions
together. This attraction is strong, as evidenced by the closely packed atomic
arrangement resulting in high specific gravity and high melting points of most
metals. Since the metallic bond is essentially nondirectional, the position of the
metal ions can be altered without destroying the crystal structure resulting in a
plastically deformable solid.
The first metal alloy developed specifically for human use was the “vanadium
steel” which was used to manufacture bone fracture plates (Sherman plates) and
screws. Most metals such as iron (Fe), chromium (Cr), cobalt (Co), nickel (Ni),
titanium (Ti), tantalum (Ta), niobium (Nb), molybdenum (Mo), and tungsten (W)
that were used to make alloys for manufacturing implants can only be tolerated
by the body in minute amounts. Sometimes those metallic elements, in naturally
occurring forms, are essential in red blood cell functions (Fe) or synthesis of a
vitamin B 12 (Co), but cannot be tolerated in large amounts in the body [Black,
1992].The metallic systems most frequently used in the body are:
(a) Iron-base alloys of the 316L stainless steel
(b) Titanium and titanium-base alloys, such as
(i)Ti-6% Al-4%V, and commercially pure ≥ 98.9%
(ii) Ti-Ni (55% Ni and 45% Ti)

8. (c) Cobalt base alloys of four types
(i) Cr (27-30%), Mo (5-7%), Ni (2-5%)
(ii) Cr (19-21%), Ni (9-11%), W (14-16%)
(iii) Cr (18-22%), Fe (4-6%), Ni (15-25%), W (3-4%)
(iv)Cr (19-20%), Mo (9-10%), Ni (33-37%)
1) Stainless steel :
The first stainless steel utilized for implant fabrication was the 18-8 (type 302 in
modern classification), which is stronger and more resistant to corrosion than the
vanadium steel.
Later 18-8s Mo stainless steel was introduced which contains a small percentage
of molybdenum to improve the corrosion resistance in chloride solution (salt
water). This alloy became known as type 316 stainless steel.
In the 1950s the carbon content of 316 stainless steel was reduced from 0.08 to a
maximum amount of 0.03% (all are weight percent unless specified) for better
corrosion resistance to chloride solution and to minimize the sensitization, and
hence became known as type 316L stainless steel.
The minimum effective concentration of chromium is 11% to impart corrosion
resistance in stainless steels. The chromium is a reactive element, but it and its
alloys can be passivated by 30% nitric acid to give excellent corrosion resistance.

9. The austenitic stainless steels, especially types 316 and 316L , are most widely
used for implant fabrication. These cannot be hardened by heat treatment but
can be hardened by cold-working. This group of stainless steels is nonmagnetic
and possesses better corrosion resistance than any others. The inclusion of
molybdenum enhances resistance to pitting corrosion in salt water.
Compositions of 316L Stainless Steel
(American Society for Testing and Materials)
Element Composition (%)
Carbon 0.03 max
Manganese 2.00 max
Phosphorus 0.03 max
Sulfur 0.03 max
Silicon 0.75 max
Chromium 17.00–20.00
Nickel 12.00–14.00
Molybdenum 2.00–4.00

10. 2) Cobalt chromium ( Co Cr) alloys :
There are basically two types of cobalt-chromium alloys:
1) The castable CoCrMo alloy
2) The CoNiCrMo alloy which is usually Wrought by (hot) forging .
The castable CoCrMo alloy has been used for many decades in dentistry and,
relatively recently, in making artificial joints.
The wrought CoNiCrMo alloy is relatively new, now used for making the stems of
prosthesis for heavily loaded joints such as the knee and hip.
The ASTM lists four types of CoCr alloys which are recommended for surgical
implant applications:
1) cast CoCrMo alloy (F75)
2) wrought CoCrWNi alloy (F90)
3) wrought CoNiCrMo alloy (F562),
4) wrought CoNiCrMoWFe alloy (F563).
At the present time only two of the four alloys are used extensively in implant
fabrications, the castable CoCrMo and the wrought CoNiCrMo alloy.
The two basic elements of the CoCr alloys form a solid solution of up to 65% Co.
The molybdenum is added to produce finer grains which results in higher
strengths after casting or forging. The chromium enhances corrosion resistance
as well as solid solution strengthening of the alloy.

11. The CoNiCrMo alloy originally called MP35N (Standard Pressed Steel Co.) contains
approximately 35% Co and Ni each. The alloy is highly corrosion resistant to
seawater (containing chloride ions) under stress. However, there is a
considerable difficulty of cold working on this alloy, especially when making large
devices such as hip joint stems. Only hot-forging can be used to fabricate a large
implant with the alloy.
3) Titanium Alloys :
A) Pure Titanium and Ti6Al4V :
Titanium used for implant fabrication since 1930s.
Titanium’s lightness (4.5 g/cm3
) and good mechanochemical properties
are salient features for implant application.
There are four grades of unalloyed commercially pure (cp) titanium for surgical
implant applications.
The impurity contents separate them; oxygen, iron, and nitrogen should be
controlled carefully. Oxygen in particular has a great influence on the ductility
and strength.
The main alloying elements of the alloy are aluminum (5.5~6.5%) and vanadium
(3.5~4.5%).
Titanium is an allotropic material, which exists as a hexagonal close packed
structure up to 882°C and body-centered cubic structure above that
temperature. Titanium alloys can be strengthened and mechanical properties
varied by controlled composition and thermomechanical processing techniques.

12. The addition of alloying elements to titanium enables it to have a wide range of
properties:
(1) Aluminum tends to stabilize the alpha-phase, that is increase the
transformation temperature from alpha to beta -phase
(2) vanadium stabilizes the beta-phase by lowering the temperature of the
transformation from alpha to beta phase.
The alpha-alloy has a single-phase microstructure which promotes good
weldability. The stabilizing effect of the high aluminum content of these groups
of alloys makes excellent strength characteristics and oxidation resistance at high
temperature (300~600°C). These alloys cannot be heat treated for precipitation
hardening since they are single-phased.
The addition of controlled amounts of beta-stabilizers causes the higher strength
beta-phase to persist below the transformation temperature which results in the
two-phase system. The precipitates of beta-phase will appear by heat treatment
in the solid solution temperature and subsequent quenching, followed by aging
at a somewhat lower temperature.
The aging cycle causes the coherent precipitation of some fine alpha particles
from the metastable beta particles;
Imparting alpha structure may produce local strain field capable of absorbing
deformation energy. Cracks are stopped or deterred at the alpha particles, so
that the hardness is higher than for the solid solution.

13. The higher percentage of beta-stabilizing elements (13%V in Ti13V11Cr3Al alloy)
results in a microstructure that is substantially beta which can be strengthened
by heat treatment. Another Ti alloy (Ti13Nb13Zr) with 13% Nb and 13% Zr
showed martensite structure after being water quenched and aged, which
showed high corrosion resistance with low modulus (E = 79 MPa).
Formation of plates of martensite induces considerable elastic distortion in the
parent crystal structure and increases strength.
B) TiNi Alloys
The titanium–nickel alloys show unusual properties i.e., after it is deformed the
material can snap back to its previous shape following heating of the material.
This phenomenon is called shape memory effect (SME). The SME of TiNi alloy
was first observed by Buehler and Wiley at the U.S. Naval Ordnance Laboratory
[Buehler et al., 1963].
The equiatomic TiNi or NiTi alloy (Nitinol) exhibits an exceptional SME near room
temperature: if it is plastically deformed below the transformation temperature,
it reverts back to its original shape as the temperature is raised. The SME can be
generally related to a diffusionless martensitic phase transformation which is also
thermoelastic in nature, the thermoelasticity being attributed to the ordering in
the parent and martensitic phases [Wayman and Shimizu, 1972].
Another unusual property is the superelasticity. As can be seen, the stress does
not increase with increased strain after the initial elastic stress region and upon
release of the stress or strain the metal springs back to its original shape in
contrast to other metals such as stainless steel. The superlastic property is

14. utilized in orthodontic archwires since the conventional stainless steel wires are
too stiff and harsh for the tooth. In addition, the shape memory effect can also be
utilized.
Some possible applications of shape memory alloys are orthodontic dental
archwire, intracranial aneurysm clip, vena cava filters , contractile artificial
muscles for an artificial heart, vascular stent, catheter guide wire, and orthopedic
staple [Duerig et al., 1990]
4) Dental metals :
A. Dental amalgam
B. Gold and gold alloys
5) Other metals :
A. Tantalum
B. Platinum group metals (PGM) such as Pt, Pd, Rh, Ir, Ru, and Os
II) CERAMIC BIOMATERIALS
The most frequently used ceramic implant materials include aluminum oxides,
calcium phosphates, and apatites and graphite. Glasses have also been developed
for medical applications.
The use of ceramics was motivated by:
(i) their inertness in the body,
(ii) their formability into a variety of shapes and porosities,

15. (iii) their high compressive strength, and
(iv) some cases their excellent wear characteristics.
Applications of ceramics are in some cases limited by their generally poor
mechanical properties:
(a) in tension;
(b) load bearing, implant devices that are to be subjected to significant
tensile stresses must be designed and manufactured with great care if
ceramics are to be safely used.
Ceramics are used for the repair and restoration of diseased or damaged parts
of the musculo-skeletal system.
1) Nonabsorbable or Relatively Bioinert Bioceramics
A. Pyrolitic carbon-coated devices
B. Dense and nonporous aluminum oxides
C. Porous aluminum oxides
D. Zirconia ceramics
E. Dense hydroxyapatites
2) Biodegradable or Resorbable Ceramics
A. Aluminum–calcium–phosphorous oxides
B. Glass fibers and their composites
C. Corals
D. Calcium sulfates, including plaster of Paris

16. E. Ferric–calcium–phosphorous oxides
F. Hydroxyapatites
G. Tricalcium phosphate
H. Zinc–calcium–phosphorous oxides
I. Zinc–sulfate–calcium–phosphorous oxides
3) Bioactive or Surface-Reactive Ceramics
A. Bioglass and Ceravital
B. Dense and nonporous glasses
C. Hydroxyapatite
III) Polymeric Biomaterials
Polymers have assumed an important role in medical applications. In most
of these applications, polymers have little or no competition from other types of
materials. Their unique properties are:
1- Flexibility;
2- Resistance to biochemical attack;
3- Good biocompatibility;
4- Light weight;
5- Available in a wide variety of compositions with adequate physical and
mechanical properties;
6- Can be easily manufactured into products with the desired shape.
There are a large number of polymeric materials that have been used as implants
or part of implant systems. The polymeric systems include acrylics, polyamides,

17. polyesters, polyethylene, polysiloxanes, polyurethane, and a number of
reprocessed biological materials.
Some of the applications include the use of membranes of ethylene-vinyl-acetate
(EVA) copolymer for controlled release and the use of poly-glycolic acid for use as
a resorbable suture material.. As bioengineers search for designs of ever
increasing capabilities to meet the needs of medical practice, polymeric materials
alone and in combination with metals and ceramics are becoming increasingly
incorporated into devices used in the body.
1) Polyvinylchloride (PVC)
2) Polyethylene (PE)
3) Polypropylene (PP)
4) Polymethylmetacrylate (PMMA)
5) Polystyrene (PS)
6) Polyethylenterephthalate (PET)
7) Polytetrafluoroethylene (PTFE)
8) Polyurethane (PU)
9) Polyamide (nylon)
(PTFE) Polytetrafluoroethylene is a fluorocarbon–based polymer.
Commercially, the material is best known as Teflon. It is made by free-radical
polymerization of tetrafluoroethylene and has a carbon backbone chain, where
each carbon has two fluorine atoms attached to it.
Properties of PTFE
1-Hydrophobic (Water hating)
2- Biologically inert*
3- Non-biodegradable

18. 4- Has low friction characteristics
5- Excellent "Slipperiness"
6- Relatively lower wear resistance.
7- Highly crystalline (94%)
8- Very high density (2.2 kg.m-3)
9- Low modulus of elasticity (0.5MPa)
10- Low tensile strength (14MPa)
PTFE has many medical uses, including:
1- Arterial grafts (artificial vascular graft);
2- Catheters;
3- Sutures;
4- Uses in reconstructive and cosmetic facial surgery.
PTFE can be fabricated in many forms, such as:
1- Can be woven into a porous fabric like mesh. When implanted in the
body, this mesh allows tissue to grow into its pores, making it ideal for
medical devices, such as vascular grafts;
2- Pastes;
3- Tubes;
4- Strands;
5- Sheets.
Disadvantages of PTFE
PTFE has relatively low wear resistance. Under compression or in
solutions where rubbing or abrasion can occur, it can produce wear particles.
These can result in a chronic inflammatory reaction, an undesirable outcome.

19. Polyethylene, (PE)
It is chemically the simplest of all polymers and as a homochain polymer.
It is essentially:
1- Stable and suitable for long-time implantation under many
circumstances;
2- Relatively inexpensive;
3- Has good general mechanical properties.
So that it has become a versatile biomedical polymer with applications
ranging from catheters to joint-replacement.
Polypropylene, (PP)
Polypropylene is widely used in medical devices ranging from sutures to
finger joints and oxygenerators.
Poly (methyl methacrylate), PMMA
It is a hard brittle polymer that appears to be unsuitable for most clinical
applications, but it does have several important characteristics.
(a) It can be prepared under ambient conditions so that it can be
manipulated in the operating theater or dental clinic, explaining its
use in dentures and bone cement.
(b) The relative success of many joint prostheses is dependent on the
performance of the PMMA cement, which is prepared intraoperatively
by mixing powdered polymer with monomeric
methylmethacrylate, which forms a dough that can be placed in
the bone, where it then sets.

20. The disadvantages of PMMA
(a) The exotherm of polymerization;
(b) The toxicity of the volatile methylmethacrylate;
(c) The poor fracture toughness.
(But no better material has been developed to date)
Polyesters
Polyurathanes
MATERIALS IN MAXILLOFACIAL PROSTHETICS
Despite improvements in surgical and restorative techniques, the materials
used in maxillofacial prosthetics are far from ideal. An ideal material should be
inexpensive, biocompatible, strong, and stable. In addition, the material should
be skin-like in color and texture. Maxillofacial materials must exhibit resistance
to tearing and should be able to withstand moderate thermal and chemical
challenges. Currently, no material fulfills all of these requirements. A brief
description of maxillofacial materials is included in the following paragraphs:
LATEXES
Latexes are soft, inexpensive materials that may be used to create lifelike
prostheses. Unfortunately, these materials are weak, degenerate rapidly, exhibit

21. color instability and can cause allergic reactions. A recently developed synthetic
latex is a tripolymer of butylacrylate, methyl methacrylate, and methyl
metharylamide. This material is nearly transparent, but has limited applications.
VINYL PLASTISOLS
They are plasticized vinyl resin sometimes are used in maxillofacial applications.
Plastsols are thick liquids comprising small vinyl particles dispersed in a plasticizer.
Colorants are added to these materials to match individual skin tones.
Unfortunately, vinyl plastisols harden with age because plasticizer loss. Ultraviolet
light also has an adverse effect on these materials. For these reasons, the use of
vinyl is limited.
SILICONE RUBBERS
Both heat-vulcanizing and room temperature vulcanizing silicones are in use
today and both exhibit advantages and disadvantages. Room temperature
vulcanizing silicones are supplied as single- paste systems. These silicones are not
as strong as the heat-vulcanized silicones and generally are monochromatic.
Heat-vulcanizing silicone is supplied as a semi-solid material that requires milling,
packing under pressure, and 30-minute heat treatment application cycle at
180oC. Heat vulcanizing silicone displays better strength and color than room
temperature vulcanizing silicone.
POLYURETHANE POLYMERS
Polyurethane is the most recent of the materials used in maxillofacial prosthetics.
Fabrication of a polyurethane prosthesis requires accurate proportioning of three

22. materials. The material is placed in a stone or metal mold and allowed to
polymerize at room temperature. Although a polyurethane prosthesis has a
natural feel and appearance, it is susceptible to rapid deterioration. The loss of
natural teeth, through disease or trauma, has for many years been compensated
by the provision of artificial teeth in the form of bridges and dentures. These
essentially provide an aesthetic replacement of crown of the tooth but do nothing
to replace the root and its attachment to the bone of the jaw.
NATURAL POLYMERS
Natural polymers, or polymers, derived from living creatures, are of great
interest in the biomaterials field. In the area of tissue-engineering, for example,
scientists and engineers look for scaffold on which one may successfully grow
cells to replace damaged tissue.
Typically, it is desirable for these scaffolds to be:
(1) Biodegradable;
(2) Non-toxic/ non-inflammatory;
(3) Mechanically similar to the tissue to be replaced;
(4) Highly porous;
(5) Encouraging of cell attachments and growth;
(6) Easy and cheap to manufacture;
(7) Capable of attachment with other molecules ( to potentially increase
scaffold interaction with normal tissue)
Normal polymers often easily fulfill these expectations, as they are naturally
engineered to work well within the living beings from which they come. Three

23. examples of natural polymers that have been previously studied for use as
biomaterials are: collagen, chitosan, and alginate.
IV) COMPOSITE BIOMATERIALS
Composite materials have been extensively used in dentistry and prosthesis
designers are now incorporating these materials into other applications. Typically,
a matrix of ultrahigh-molecular-weight polyethylene (UHMWPE) is reinforced with
carbon fibers. These carbon fibers are made by pyrolizing acrylic fibers to obtain
oriented graphitic structure of high tensile strength and high modulus of
elasticity. The carbon fibers are 6-15mm in diameter, and they are randomly
oriented in the matrix. In order for the high modulus property of the reinforcing
fibers to strengthen the matrix, a sufficient interfacial bond between the fiber and
matrix must be achieved during the manufacturing process. Since the mechanical
properties of these composites with the proportion of carbon fibers in the
composites, it is possible to modify the material design flexibility to suit the
ultimate design of prostheses. Composites have unique properties and are usually
stronger than any of the single materials from which they are made. Workers in
this field have taken advantages of this fact and applied it to some difficult
problems where tissue in-growth is necessary.
- Deposited Al2O3 onto carbon;
- Carbon / PTFE;
- Al2O3 / PTFE;
- PLA-coated Carbon fibers.

24. Some applications of composites in biomaterial applications are:
(1) dental filling composites
(2) reinforced methyl methacrylate bone cement and ultra-high-molecular-
weight polyethylene
(3) orthopedic implants with porous surfaces.
V) BIODEGRADABLE POLYMERIC BIOMATERIALS
Another class of materials that is receiving increased attention is biodegradable
materials. Generally, when a material degrades in the body its properties change
from their original values leading to altered and less desirable performance. It is
possible, however, to design into an implant's performance the controlled
degradation of a material, such that natural tissue replaces the prosthesis and its
function.
Suture material that hold a wound together but resorb in the body as the wound
heals and gains strength. Another application of these materials occurs when they
are used to encourage natural tissue to grow. Certain wound dressings and
ceramic bone augmentation materials encourage tissue to grow into them by
providing a "scaffold". The scaffold material may or may not resorb over a period
of time but in each case, natural tissue has grown into the space, then by
restoring natural function. One final application of biodegradable materials is in
drug therapy, where it is possible to chemically bond certain drugs to the
biodegradable material, when these materials are placed within the body the

25. drug is released as the material degrades, thereby providing a localized, sustained
release of drugs over a predictable period of time.
1) Glycolide/Lactide-Based Biodegradable Linear Aliphatic polyesters
A. Glycolide-Based Biodegradable Homopolymer Polyesters
B. Glycolide-Based Biodegradable Copolyesters Having Aliphatic
Polyester-Based Co-Monomers
C. Glycolide-Based Biodegradable Copolyesters with Non-Aliphatic Polyester-
Based Co-Monomers
D. Glycolide-Derived Biodegradable Polymers Having Ether Linkage
E. Lactide Biodegradable Homopolymers and Copolymers
2) Non-Glycolide/Lactide-Based Linear Aliphatic Polyesters
3) Non-Aliphatic Polyesters Type Biodegradable Polymers
A. Aliphatic and Aromatic Polycarbonates
B. Poly(alkylene oxalates) and Copolymers
VI) BIOLOGIC BIOMATERIALS
1) Tissue-Derived Biomaterials (Collagen)
Collagen is the most widely found protein in mammals (25% of our protein
mass) and is the major provider of strength to tissue. A typical collagen
molecule consists of three interwined protein chains that form a helical structure
similar to a typical staircase). These molecules polymerize together to form

26. collagen fibers of varying length, thickness and interweaving pattern (some
collagen molecules will form ropelike structures, while others will form meshes
or networks). There are actually at least 15 different types of collagen, differing
in their structure, function, location, and other characteristics. The predominant
form used in biomedical applications, however, is type I collagen, which is a
"rope-forming" collagen and can be found almost everywhere in the body,
including skin and bone.
Collagen can be resorbed into the body, is non-toxic produces only a
minimal immune response, and is excellent for attachment and biological
interaction with cell. Collagen may also be processed into a variety of formats,
including porous sponges, gels and sheets, and can be cross-linked with
chemicals to make it stronger or to alter its degradation rate. The number of
biomedical applications in which collagen has been utilized is too high to count
here, it not only explored for use in various types of surgery, cosmetics, and
drug delivery, but in bio-prosthetic implants and tissue-engineering of multiple
organs as well. Cells grown in collagen often come close to behaving as they do
within the body, which is why collagen is so promising when one is trying to
duplicate natural tissue function and healing.
However, some disadvantages to using collagen as a cell substrate do
exist. Depending on how it is processed, collagen can potentially cause
alteration of cell behavior (e.g. changes in growth or movement), have
inappropriate mechanical properties, or undergo contraction (shrinkage).
Because cells interact so easily with collagen, cells can actually pull and
reorganize collagen fibers, causing scaffolds to lose their shape if they are not
properly stabilized by cross-linking or mixing with another less "vulnerable

27. material". Fortunately, collagen can be easily combined with other biological or
synthetic materials, to improve its mechanical properties or change the way cells
behave when grown upon it.
CHITOSAN
It is derived from chitin, a type of polysaccharide (sugar) that is present in
the hard exoskeletons of shellfish like shrimp and crab. Chitin has sparked
interest in the tissue-engineering field due to several desirable properties:
1- Minimal foreign body reaction;
2- Mild processing conditions (synthetic polymers often need to be
dissolved in harsh chemicals; chitosan will dissolve in water based on pH);
3- Controllable mechanical/biodegradation properties (such as scaffold
porosity);
4- Availability of chemical side groups for attachment to other molecules.
Chitosan has already been investigated for use in the engineering of
cartilage, nerve and liver tissues. Chitosan has also been studied for use in
wound healing and drug delivery. Current difficulties with using chitosan as a
polymer scaffold in tissue-engineering, however, include low strength and
inconsistent behavior with seeded cells. Fortunately, chitosan may be easily
combined with other materials in order to increase its strength and
cellattachment potential. Mixtures with synthetic polymers such as poly (vinyl
alcohol) and poly (ethylene glycol) or natural polymers such as collagen have
already been produced.

28. ALGINATE
It is a polysaccharide derived from brown seaweed. Like chitosan,
alginate can be processed easily in water and has been found to be fairly nontoxic
and non-inflammatory enough, so that it has been approved in some
countries for wound dressing and for use in food products. Alginate is
biodegradable, has controllable porosity, and may be linked to other biologically
active molecules. Interestingly, encapsulation of certain cell types into alginate
beads may actually enhance cell survival and growth. In addition, alginate has
been explored for use in liver, nerve, heart, and cartilage tissue-engineering.
Unfortunately, some drawbacks of alginate include mechanical weakness and
poor cell adhesion. Again, to overcome these limitations, the strength and cell
behavior of alginate have been enhanced by mixing with other materials,
including the natural polymers agarose and chitosan.
CONCLUSION
In the future, the practice of oral and maxillofacial surgery will be shaped by these
tools. The emerging fields of tissue engineering and biomaterials are truly
exciting. Products of the future, including those from genetically engineered
proteins all the way to tissue-engineered organs, are and will be in clinical trials in
the very near future. Our specialty will benefit from the development of many of
these biomaterials, and our future will be shaped by their use.