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International Journal of Emerging Technology and Advanced Engineering

Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 4, April 2012)

A Review on Biomaterials: Scope, Applications &


Human Anatomy Significance
Nitesh R. Patel1, Piyush P. Gohil2
1,2
Department of Mechanical Engineering, Faculty of Technology & Engineering Charotar University of Science &
Technology, Changa (Gujarat)
1
niteshpatel.me@charusat.ac.in
2
piyushgohil.me@charusat.ac.in
Abstract Biomaterials in the form of implants (sutures, In the early days all kinds of natural materials such as
bone plates, joint replacements, etc.) and medical devices wood, glue and rubber, and tissues from living forms, and
(pacemakers, artificial hearts, blood tubes, etc.) are widely manufactured materials such as iron, gold, zinc and glass
used to replace and/or restore the function of traumatized or were used as biomaterials. The host responses to these
degenerated tissues or organs, and thus improve the quality of
materials were extremely varied. Under certain conditions
life of the patients. The first and foremost requirement for the
choice of the biomaterial is its acceptability by the human (characteristics of the host tissues and surgical procedure)
body. A biomaterial used for implant should possess some some materials were tolerated by the body, whereas the
important properties in order to long-term usage in the body same materials were rejected in another situation. Over the
without rejection. The most common classes of materials used last 30 years considerable progress has been made in
as biomedical materials are Metals, Polymers, Ceramics, and understanding the interactions between the tissues and the
Composite. These four classes are used singly and in materials. It has been acknowledged that there are profound
combination to form most of the implantation devices differences between non-living (avital) and living (vital)
available today. This review should be of value to researchers materials.
who are interested in the state of the art of biomaterial
A wide range of materials encompassing all the classical
evaluation and selection of biomaterials.
KeywordsApplication, Biomaterials, Human Anatomy materials such as Metals (gold, tantalum, Ti6Al4V, 316L
stainless steel, Co-Cr Alloys, titanium alloys), Ceramics
I. INTRODUCTION (alumina, zirconia, carbon, titania, bioglass,
hydroxyapatite(HA)), Composite (Silica/SR,
The National Institutes of Health Consensus CF/UHMWPE, CF/PTFE, HA/PE, CF/epoxy, CF/PEEK,
Development Conference defined a biomaterial as Any CF/C, Al2O3/PTFE), Polymers (Ultra high molecular
substance (other than a drug) or combination of substances, weight polyethylene(UHMWPE), Polyurethane(PE),
synthetic or natural in origin, which can be used for any Polyurethane (PU), Polytetrafuoroethylene (PTFE),
period of time, as a whole or as a part of a system which Polyacetal (PA), Polymethylmethacrylate (PMMA),
treats, augments, or replaces any tissue, organ, or function Polyethylene Terepthalate (PET), Silicone Rubber (SR),
of the body (Boretos and Eden, 1984). Use of Polyetheretherketone (PEEK), Poly(lactic acid) (PLA),
biomaterials dates far back into ancient civilizations. Polysulfone (PS)) have been investigated as biomaterials.
Artificial eyes, ears, teeth, and noses were found on Researchers also classified materials into several types such
Egyptian mummies [1]. Chinese and Indians used waxes, as bioinert and bioactive, biostable and biodegradable, etc.
glues, and tissues in reconstructing missing or defective [4]. In broad terms, inert (more strictly, nearly inert)
parts of the body. Over the centuries, advancements in materials prohibited or minimal tissue response. Active
synthetic materials, surgical techniques, and sterilization materials encourage bonding to surrounding tissue with.
methods have permitted the use of biomaterials in many Degradable or resorbable materials are incorporated into
ways [2]. Medical practice today utilizes a large number of the surrounding tissue, or may even dissolve completely
devices and implants. Biomaterials in the form of implants over a period of time. Metals are typically inert, ceramics
(ligaments, vascular grafts, heart valves, intraocular lenses, may be inert, active or resorbable and polymers may be
dental implants, etc.) and medical devices (pacemakers, inert or resorbable [5]. Biomaterials must be nontoxic, non-
biosensors, artificial hearts, etc.) are widely used to replace carcinogenic, chemically inert, stable, and mechanically
and/or restore the function of traumatized or degenerated strong enough to withstand the repeated forces of a
tissues or organs, and thus improve the quality of life of the lifetime.
patients.

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International Journal of Emerging Technology and Advanced Engineering
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Newer biomaterials even incorporate living cells in order D. Functional Tissue Structure and Pathobiology:
to provide a true biological and mechanical match for the Biomaterials incorporated into medical devices are
living tissue. implanted into tissues and organs. Therefore, the key
principles governing the structure of normal and abnormal
II. SELECTION PARAMETERS FOR BIOMATERIALS cells, tissues or organs, the technique by which the
A Biomaterial used for implant should possess some structure and function of normal and abnormal tissues are
important properties in order to long-term usage in the studied, and the fundamental mechanisms of disease
body without rejection. The design and selection of processes are critical considerations to workers in the field
biomaterials depend on different properties which are [12].
characterized in this section. E. Toxicology:
A. Host Response: A biomaterial should not be toxic, unless it is
Host response is defined as the response of the host specifically engineered for such requirements (for example
organism (local and systemic) to the implanted material or a "smart" bomb" drug delivery system that targets cancer
device [6]. cells and destroy them). Toxicology for biomaterials deals
B. Biocompatibility: with the substances that migrate out of the biomaterials. It
is reasonable to say that a biomaterial should not give off
Researchers have coined the words `biomaterial' and anything from its mass unless it is specifically designed to
`biocompatibility' [7] to indicate the biological do so [12].
performance of materials. Materials that are biocompatible
are called biomaterials, and the biocompatibility is a F. Appropriate Design and Manufacturability:
descriptive term which indicates the ability of a material to Biomaterials should be machinable, moldable,
perform with an appropriate host response, in a specific extrudable. Finite element analysis is a powerful analytical
application [8]. In simple terms it implies compatibility or tool used in the design of any implants. Currently modern
harmony of the biomaterial with the living systems. manufacturing processes are necessary to guarantee the
Biocompatibility is the ability to exist in contact with quality needed in orthopaedic devices.
tissues of the human body without causing an unacceptable G. Mechanical Properties of Biomaterials:
degree of harm to the body. It is not only associated to Some of the most important properties of biomaterials
toxicity, but to all the adverse effects of a material in a that should be carefully studied and analysed in their
biological system [9, 10]. It must not adversely affect the applications are tensile strength, yield strength, elastic
local and systemic host environment of interaction (bone, modulus, corrosion and fatigue resistance, surface finish,
soft tissues, ionic composition of plasma, as well as intra creep, and hardness. Physical properties are also taking in
and extracellular fluids) [11]. It refers to a set of properties to account while selecting materials. The dialysis
that a material must have to be used safely in a biological membrane has a specified permeability. The articular cup
organism. It should be non-carinogenic, non-pyrogenic, of the hip joint has high lubricity. The intraocular lens has
non-toxic, non-allergenic, blood compatible, non- clarity and refraction requirements.
inflammatory. The operational definition of biocompatible
is "The patient is alive so it must be biocompatible". H. High corrosion resistance:
C. Biofunctionality[11]: Singh & Dahotre [13] did research on corrosion
resistance as is an important issue in selection of metallic
Biofunctionality is playing a specific function in biomaterials because the corrosion of metallic implants due
physical and mechanical terms. The material must satisfy to the corrosive body fluid is unavoidable. The implants
its design requirements in service: release undesirable metal ions which are non-
Load transmission and stress distribution (e.g. bone biocompatible. Corrosion can reduce the life of implant
replacement) device and consequently may impose revision surgery. In
Articulation to allow movement (e.g. artificial knee addition the human life may be decreased by the corrosion
joint) phenomenon. Okazaki & Gotoh [14] expressed the fact that
Control of blood and fluid flow (e.g. artificial heart) dissolved metal ions (corrosion product) either can
Space filling (e.g. cosmetic surgery) accumulate in tissues, near the implant or they may be
Electrical stimuli (e.g. pacemaker) transported to other parts of the body.
Light transmission (e.g. implanted lenses)
Sound transmission (e.g. cochlear implant)
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International Journal of Emerging Technology and Advanced Engineering
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I. High wear resistance: bone that may weaken the bone and deteriorate the
The low wear resistance or high coefficient of friction implant/bone interface, loosening and consequently failure
results in implant loosening [15, 16]. Wear debris are found of implant [9, 22]. The modulus is considered as a main
to be biologically active and make a severe inflammatory factor for selection of any biomaterials.
response that lead to the destruction of the healthy bone
which supports the actual implant. Corrosion caused by III. HUMAN ANATOMY
friction is a big concern since it releases non compatible The first and foremost requirement for the choice of the
metallic ions. It should be pointed out that mechanical biomaterial is its acceptability by the human body (Fig. 1).
loading also can result in corrosion fatigue and accelerated The success of a biomaterial or an implant is highly
wear processes [15]. dependent on three major factors (i) The properties
J. Long fatigue life: (mechanical, chemical and tribological) of the biomaterial
The fatigue strength is related to the response of the (ii) biocompatibility of the implant and (iii) the health
material to the repeated cyclic loads. Fatigue fracture leads condition of the recipient and the competency of the
some of major problems associated with implant loosening, surgeon [23].
stress-shielding and ultimate implant failure and it is Generally, tissues are grouped into hard and soft tissues.
frequently reported for hip prostheses [17]. Fatigue Bone and tooth are examples of hard tissues, and skin,
characteristics are strongly depends on the microstructures. blood vessels, cartilage and ligaments are a few examples
The microstructures of metallic biomaterials alter of soft tissues. As the names suggest, in general the hard
according to the processing and heat treatment employed tissues stiffer (elastic modulus) and stronger (tensile
[6]. strength) than the soft tissues (Tables 1 and 2). Considering
the structural or mechanical compatibility with tissues,
K. Adequate Strength: metals or ceramics are chosen for hard tissue applications,
Strength of materials from which the implants are and polymers for the soft tissue applications. One of the
fabricated has influence the fracture of artificial organ. In primary reasons that biomaterials are used is to physically
adequate strength can cause to fracture the implant. When replace hard or soft tissues that have become damaged or
the bone implant interface starts to fail, developing a soft destroyed through some pathological process [24]. Under
fibrous tissue at the interface can make more relative these circumstances, it may be possible to remove the
motion between the implant and the bone under loading diseased tissue and replace it with some suitable synthetic
[9]. This fact causes pain to the patient and after a certain material.
period, the pain becomes unbearable and the implant must
TABLE 1 MECHANICAL PROPERTIES OF HARD TISSUE [25]
be replaced, by a revision procedure [15].
L. Modulus equivalent to that of bone: Modulus Tensile Strength
Hard tissue
(GPa) (MPa)
For major applications such as total joint replacement, Cortical bone
higher yield strength is basically coupled with the 17.7 133
(longitudinal direction)
requirement of a lower modulus close to that of human Cortical bone
bones [19, 20]. The magnitude of bone modulus varies 12.8 52
(transverse direction)
from 4 to 30 GPa depending on the type of the bone and the Cancellous bone 0.4 7.4
measurement direction [21]. Large difference in the Enamel 84.3 10
Youngs modulus between implant material and the Dentine 11.0 39.3
surrounding bone can contribute to generation of severe
stress concentration, namely load shielding from natural TABLE 2 MECHANICAL PROPERTIES OF SOFT TISSUE [25]

Modulus Tensile Strength


Soft tissue
(MPa) (MPa)
Articular cartilage 10.5 27.5
Fibrocartilage 159.1 10.4
Ligament 303.0 29.5
Tendon 401.5 46.5
Skin 0.1-0.2 7.6
Intraocular lens 5.6 2.3
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International Journal of Emerging Technology and Advanced Engineering
Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 4, April 2012)

Dental Implants,
Dental Post, Arch
Cohlear Implants
Wire & Brackets,
Dental Bridges,
Intacts Dental Restorative
Material
Cardiovascular Shoulder Prosthesis
Implants (Vascular
Grafts)
Pacemaker

Abdominal Wall
Prosthesis Lumbar Disc
Replacement, Spine
Cage, Plate, Rods
Prosthetic and Screws
Arthroplasty
Total Hip
Intramedullary Nails Replacement,
Acetabular

Knee joint Bone Cement


Replacement, Tendon
/ Ligament, Cartilage
Replacement
Bone Fixation,
Bone Plates &
Screws

FIGURE 1: IMPLANTS FOR HUMAN ANATOMY SIGNIFICANCE

IV. IMPLANTABLE MATERIALS The main considerations in selecting metals and alloys
The science of biomedical materials involves a study of for biomedical applications are their excellent electrical and
the composition and properties of materials and the way in thermal conductivity, biocompatibility, appropriate
which they interact with the environment in which they are mechanical properties, corrosion resistance, and reasonable
placed. The most common classes of materials used as cost. It is very important to know the physical and chemical
biomedical materials are metals, polymers, ceramics, and properties of the different metallic materials used in any
composite. These four classes are used singly and in surgery as well as their interaction with the host tissue of
combination to form most of the implantation devices the human body.
available today. Stainless Steel:
Stainless steel was first used successfully as an
A. Metals and Alloys: important material in the surgical field. Stainless steel is the
Metals have been used almost exclusively for load- generic name for a number of different steels used
bearing implants, such as hip and knee prostheses and primarily because of their resistance to a wide range of
fracture fixation wires, pins, screws, and plates. Although corrosive agents [10, 15]. Stainless steel has been used for
pure metals are sometimes used, alloys frequently provide wide range of application due to easy availability, lower
improvement in material properties, such as strength and cost, excellent fabrication properties, accepted
corrosion resistance. Three material groups dominate biocompatibility and great strength.
biomedical metals: Stainless steel, cobalt-chromium-
molybdenum alloy, and titanium and titanium alloys.

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International Journal of Emerging Technology and Advanced Engineering
Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 4, April 2012)
Cobalt-Chrome: TABLE 3 MECHANICAL PROPERTIES OF METALLIC BIOMATERIALS [31]
Cobalt chromium alloys can be basically categorized
Tensile Fatigue
into two types; one is The CoCrMo alloy [ Cr (27-30%), Youngs Yield
Strength, Limit,
Mo (5-7%), Ni (2.5%)] has been used for many decades in Material
Modulus, Strength,
sUTS send
dentistry, and in making artificial joints and the second one E (GPa) sy (MPa)
(MPa) (MPa)
The CoNiCrMo alloy [Cr (19-21%), Ni (33-37%), and Mo
(9-11%)] has been used for making the stems of prostheses Stainless steel 190 2211,213 5861,351 241820
for heavily loaded joints, such as knee and hip [15]. Cobalt- Co-Cr alloys 210253 4481,606 6551,896 207950
based alloys are highly resistant to corrosion even in
chloride environment due to spontaneous formation of Titanium (Ti) 110 485 760 300
passive oxide layer within the human body environment Ti-6Al-4V 116 8961,034 9651,103 620
[10, 15, 16, 26, 27]. The thermal treatments used to Co-Cr-
Mo alloys modify the microstructure of the alloy and alters Cortical bone 1530 3070 70150
the electrochemical and mechanical properties of the
TABLE 4 APPLICATION OF METALS AS IMPLANTS USED IN HUMAN BODY
biomaterial [26]. The corrosion products of Co-Cr-Mo are
more toxic than those of stainless steel 316L. Types of Materials Applications
Titanium and its Alloys: Joint replacements (hip, knee), Bone
There are three structural types of titanium alloys: Alpha plate for fracture fixation, Dental implant
(), Alpha-Beta (-) or metastable and Beta ().The for tooth fixation, Heart valve, Spinal
phase in Ti alloys tends to exhibit a much lower modulus Stainless steel Instruments, Surgical Instruments,
Screws, dental root Implant, pacer,
than phase, and also it satisfies most of the other fracture plates, hip nails, Shoulder
necessities or requirements for orthopedic application [28, prosthesis
29]. Ti alloys due to the combination of its excellent
Bone plate for fracture fixation, Screws,
characteristics such as high strength, low density, high dental root implant, pacer, and Suture,
specific strength, good resistance to corrosion, complete Cobalt-chromium alloy dentistry, orthopedic prosthesis, Mini
inertness to body environment, enhanced biocompatibility, plates, Surgical tools, Bone and Joint
moderate elastic modulus of approximately 110 GPa are a replacements (hip, knee), dental implants
suitable choice for implantation. Long-term performance of Cochlear replacement, Bone and Joint
titanium and its alloys mainly Ti64 has raised some Replacements(hip, knee),Dental Implants
concerns because of releasing aluminum and vanadium [9, for tooth fixation, Screws, Suture, parts
10]. Both Al and V ions are associated with long term Titanium and its Alloys
for orthodontic surgery, bone fixation
health problems, like Alzheimer disease and neuropathy. devices like nails, screws and plates,
Furthermore when titanium is rubbed between itself or artificial heart valves and surgical
between other metals, it suffers from severe wear [30]. instruments, heart pacemakers, artificial
heart valves
The mechanical properties of materials are of great
importance when designing load-bearing orthopedic and B. Ceramics
dental implants. Some mechanical properties of metallic Ceramics are polycrystalline materials. The main
biomaterials are listed in Table 3. The mechanical characteristics of ceramic materials are hardness and
properties of a specific implant depend not only on the type brittleness, great strength and stiffness, resistance to
of metal but also on the processes used to fabricate the corrosion and wear, and low density. They work mainly on
material and device. The elastic moduli of the metals listed compression forces; on tension forces, their behavior is
in Table 3 are at least seven times greater than that of poor. Ceramics are typically electrical and thermal
natural bone. insulators. Ceramics are used in several different fields
such as dentistry, orthopedics, and as medical sensors. [32].
Overall, however, these biomaterials have been used less
extensively than either metals or polymers. Ceramics
typically fail with little, if any, plastic deformation, and
they are sensitive to the presence of cracks or other defects.

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International Journal of Emerging Technology and Advanced Engineering
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Ceramics have become a diverse class of biomaterials The osteointegration of zirconia was investigated in
presently including three basic types: bioinert, bioactive, normal and osteopenic rats by means of histomorphometry.
bioresorbable ceramics [33]. Alumina (Al2O3), Zirconia The data showed that the tested material was biocompatible
(ZrO2) and Pyrolytic carbon are termed bioinert. Bioglass in vitro and confirmed that bone mineral density is a strong
and glass ceramics are bioactive. Calcium phosphate predictor of the osteointegration of an orthopedic implant
ceramics are categorized as bioresorbable. and that the use of pathological animal models is necessary
Bioinert refers to a material that retains its structure in the to completely characterize biomaterials [38]. It is said that
body after implantation and does not induce any very small traces of radioelements, which can be found
immunologic host reactions. even in fully refined ceramics, have a negative effect on
Alumina (Al2O3): organs and tissues. Zirconia contains very small traces of
High density high purity (>99.5%) alumina (Al2O3) was radioelements [39]. The cytotoxicity of polycrystalline
the first ceramic widely used clinically. It is used in load- zirconia was speculated in L cell line culture. The study
bearing hip prostheses and dental implants, because of its revealed its noncytotoxicity [36].
combination of excellent corrosion resistance, good Pyrolytic Carbon:
biocompatibility, and high wear resistance, and high Carbon is a versatile element and exists in a variety of
strength. The reasons for the excellent wear and friction forms. Good compatibility of carbonaceous materials with
behavior of (Al2O3) are associated with the surface energy bone and other tissue and the similarity of the mechanical
and surface smoothness of this ceramic. The properties of carbon to those of bone indicate that carbon is
biocompatibility of alumina ceramic has been tested by an exciting candidate for orthopedic implants [40]. Unlike
many researchers. Noiri et al. [34] evaluated the metals, polymers and other ceramics, these carbonaceous
biocompatibility of alumina-ceramic material materials do not suffer from fatigue. However, their
histopathalogically for eight weeks by implanting in the intrinsic brittleness and low tensile strength limits their use
eye sockets of albino rabbits. The results showed no signs in major load bearing applications. The mechanical
of implant rejection or prolapse of the implanted piece. bonding between the carbon fiber reinforced carbon and
After a period of four weeks of implantation, fibroblast host tissue was investigated. The bonding developed three
proliferation and vascular invasion were noted and by months after intrabone implantation and is accompanied by
eighth week, tissue growth was noted in the pores of the a decrease of the implant strength [41].
implant [34]. Single crystal alumina screws and pins were Bioactive refers to materials that form direct chemical
implanted in the femoral bone of mature rabbits. Changes bonds with bone or even with soft tissue of a living
in the implant-bone interface were observed. Alumina was organism.
never in direct contact with the bone and hemidesmosomes Bioglass & Glass Ceramic:
were not observed in the interface [35]. The cytotoxicity of A common characteristic of such bioactive materials is a
single crystal alumina ceramics was studied in L cell line modification of the surface that occurs upon implantation.
culture. They displayed the same colony formation and Bonding to bone was first demonstrated for a range of
survival rates as the controls showed that they have no bioactive glasses, which contained specific amounts of
cytotoxicity and if implanted in bone marrow they would SiO2, CaO, and P2O5 [42]. This material has been widely
not be toxic to circumferential tissue [36]. used for filling bone defects. The porosity of bioglass is
Zirconia (ZrO2): beneficial for resorption and bioactivity [43]. The interface
Zirconia is a biomaterial that has a bright future because reaction was interpreted as a chemical process, which
of its high mechanical strength and fracture toughness. includes a slight solubility of the glass ceramic and a solid-
Zirconia ceramics have several advantages over other state reaction between the stable apatite crystals in the glass
ceramic materials due to the transformation toughening ceramic and the bone [44].
mechanisms operating in their microstructure that can be Bioresorbable refers to materials that degrade (by
manifested in components made out of them. The research hydrolytic breakdown) in the body while they are being
on the use of zirconia ceramics as biomaterials commenced replaced by regenerating natural tissue; the chemical by-
about twenty years ago and now zirconia is in clinical use products of the degrading materials are absorbed and
in total hip replacement (THR) but developments are in released via metabolic processes of the body.
progress for application in other medical devices. Today's Calcium phosphate ceramics:
main application of zirconia ceramics is in THR ball heads Different phases of calcium phosphate ceramics are used
[37]. depending upon whether a resorbable or bioactive material
is desired.
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Calcium phosphate (CaP) biomaterials are available in C. POLYMERIC BIOMATERIALS
various physical forms. One of their main characteristics is The development of polymeric biomaterials can be
their porosity. The ideal pore size for bioceramic is similar considered as an evolutionary process. Reports on the
to that of spongy bone [45]. The prime requirement for applications of natural polymers as biomaterials date back
calcium phosphate materials to be bioactive and bond to thousands of years [48]. Polymers are the most widely used
living bone is the formation of a bone like apatite layer on materials in biomedical applications. Polymers are organic
their surface [46]. materials that form large chains made up of many repeating
The major drawbacks to the use of ceramics and glasses units. The uses for polymeric materials are more diverse
as implants are their brittleness and poor tensile properties than for metallic implants, but their interchangeability is
(Table 5). Although they can have outstanding strength not as great. In most of applications, polymers have little or
when loaded in compression, ceramics and glasses fail at no competition from other types of materials. Their unique
low stress when loaded in tension or bending. Among properties are: Flexibility, Resistance to biochemical
biomedical ceramics, alumina has the highest mechanical attack, Good biocompatibility, Lightweight, Available in a
properties, but its tensile properties are still below those of wide variety of compositions with adequate physical and
metallic biomaterials. mechanical properties, Can be easily manufactured into
TABLE 5 MECHANICAL PROPERTIES OF CERAMIC BIOMATERIALS [47] products with the desired shape. A few of the major classes
of polymer are listed below:
Youngs Compressive Tensile Poly (methyl methacrylate), PMMA:
Modulus, Strength, Strength,
It is a hard brittle polymer that appears to be unsuitable
E (GPa) sUCS (MPa) sUTS (MPa)
for most clinical applications, but it does have several
Alumina 380 4500 350
important characteristics. It can be prepared under ambient
Zirconia 150-200 2000 200-500
conditions so that it can be manipulated in the operating
Pyrolytic
18-28 517 280-560 theater or dental clinic, explaining its use in dentures and
carbon
Bioglass-
bone cement. The relative success of many joint prostheses
22 500 56-83 is dependent on the performance of the PMMA cement,
ceramics
Calcium which is prepared intraoperatively by mixing powdered
40-117 510-896 69-193 polymer with monomeric methylmethacrylate, which forms
phosphates
dough that can be placed in the bone, where it then sets.
TABLE 6 APPLICATION OF CERAMICS AS IMPLANTS USED IN HUMAN
BODY
Silicone Rubbers:
Both heat-vulcanizing and room temperature vulcanizing
Types of Materials Applications silicones are in use today and both exhibit advantages and
Artificial total joint replacement, disadvantages. Room temperature vulcanizing silicones are
acetabular and femoral components, supplied as single- paste systems. Heat-vulcanizing silicone
Alumina vertebrae spacers and extensors, is supplied as a semi-solid material that requires milling,
orthodontic anchors, dental implant for
packing under pressure.
tooth fixation
Ultra High Molecular Weight Polyethylene (UHMWPE):
Replacement for hips, knees, teeth,
tendons and ligaments, repair for Much research is progressing in examining the wear
Zirconia properties of UHMWPE. The coefficient of friction
periodontal disease, bone fillers after
tumor surgery between polyethylene and cobalt-chromium alloy has been
Prosthetic heart valves, End osseous tooth reported to be between 0.03 and 0.16, with excellent wear
Pyrolytic carbon replacement implants, permanently rates. UHMWPE is used as the bearing surface in total joint
implanted artificial limbs arthroplasty, it has 90% success rates at 15 years with metal
Dental implants, middle ear implants, on polyethylene. Submicron particles found in
heart valves, artificial total joint periprosthetic tissues when polyethylene wear present.
Bioglass-ceramics replacement, bone plates, screws, wires, (But no better material has been developed to date)
intramedullary nails, spinal fusion, tooth The mechanical properties of polymers depend on
replacement implants several factors, including the composition and structure of
Skin treatments, dental implants, jawbone the macromolecular chains and their molecular weight.
reconstruction, orthopedics, facial
Calcium phosphates Table 7 lists some mechanical properties of selected
surgery, ear, nose and throat repair, dental
implant
polymeric biomaterials.

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Examples of current applications include vascular grafts, Bone itself achieves most of its mechanical properties as
heart valves, artificial hearts, breast implants, contact a natural composite material composed of calcium
lenses, intraocular lenses, components of extracorporeal phosphate ceramics in a highly organized collagen matrix.
oxygenators, dialyzers and plasmapheresis units, coatings Composite biomaterials are made with a filler
for pharmaceutical tablets and capsules, sutures, adhesives, (reinforcement) addition to a matrix material in order to
and blood substitutes, kidney, liver, pancreas, bladder, bone obtain properties that improve every one of the
cement, catheters, external and internal ear repairs, cardiac components. This means that the composite materials may
assist devices, implantable pumps, joint replacements, have several phases. Some matrix materials may be
pacemaker, encapsulations, soft-tissue replacement, combined with different types of fillers. Polymers
artificial blood vessels, artificial skin, Dentistry, Drug containing particulate fillers are known as particulate
delivery and targeting into sites of inflammation or tumors, composites. The first composite to come into general use,
Bags for the transport of blood plasma. initially made by an orthopedic surgeon, was the plaster of
TABLE 7 MECHANICAL PROPERTIES OF POLYMERS [49]
Paris bandage. This has been refined to fiberglass with a
polymeric matrix in the current synthetic casting materials.
Tensile Youngs A composite for internal prosthetic applications is based on
Polymer Strength Modulus, % the addition of chopped carbon fiber to improve the
SUTS(MPa) E(GPa) Elongation mechanical properties of polyethylene components [52].
Poly(methyl
Only carbon fiber is being studied for orthopedic
methacrylate) 30 2.2 1.4
(PMMA) applications [53]. Composite structures are typically
Nylon 6/6 76 2.8 90 produced from laminates. A laminate is a thin sheet of
Poly(ethylene composite material in which all the fibers run in one
53 2.14 300 direction and are held together by a thin coating of the
terephthalate)
Poly(lactic acid) 28-50 1.2-3 2-6 polymer matrix material. This laminate is combined with
Polypropylene 28-36 1.1-1.55 400-900 other laminates to form a bulk composite; the properties of
Polytetrafluoroethylene 17-28 0.5 120-350 this composite vary depending on the orientation of each
Silicone rubber 2.8 Up to 10 160 layer of the laminate [54]. None of these materials are
Ultra-high-molecular- currently in clinical use because of the inability to modify
weight the shapes of the implants intraoperatively to fit the bone;
>35 4-12 >300
polyethylene because of liberation of carbon fibers into the adjacent
(UHMWPE)
tissues; and because the difficulties of predicting the
D. BIOCOMPOSITE MATERIALS resorption of polymers in larger loadbearing implants, as
Biocomposites are composite materials composed of opposed to screws and pins, has thus far precluded their use
biodegradable matrix and biodegradable natural fibres as for these larger implants. No doubt, implants in this
reinforcement. The development of biocomposites has category will be available in the future, perhaps even
attracted great interest due to their environmental benefit containing bone inductive proteins.
and improved performance [50]. Plant-based fibers like TABLE 8 CONSTITUENTS OF BIOMEDICAL COMPOSITES
flax, jute, sisal and kenaf have been frequently used (Table
Particles Fibers Matrix
8). Most of studies concern biodegradable matrix based on Inorganic Polymers Thermosets
aliphatic polyesters reinforced with various vegetable Glass Aromatic Epoxy
fillers. With wide-ranging uses from environment-friendly Alumina Polyamides Polyacrylates
biodegradable composites to biomedical composites for (aramids) Polymethacrylates
drug/gene delivery, tissue engineering applications and UHMWPE Polyesters
cosmetic orthodontics. They often mimic the structures of Polyesters Silicones
the living materials involved in the process in addition to Polyolefins
the strengthening properties of the matrix that was used but PTFE
still providing biocompatibility. Those markets are Organic Resorbable Thermoplastics
significantly rising, mainly because of the increase in oil Polyacrylate polymers Polyolefins (PP,
price, and recycling and environment necessities [51]. Polymethacrylate Polylactide, and its PE)
copolymers with UHMWPE
polyglyocolide Polysulfones

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Silk Poly(ether ketones) V. CONCLUDING REMARKS
Collagen Polyesters
Inorganic Inorganic A biomaterial is any substance (other than drugs),
Carbon Hydroxyapatite natural or synthetic, that treats, augments, or replaces any
Glass Glass ceramics tissue, organ, and body function. Biomaterial selection is
Hydroxyapatite Calcium carbonate one of the most challenging issues due to crucial
Tricalcium ceramics requirements and biocompatibility, so it has been of major
phosphate Calcium phosphate interest to material designers in recent years. This review of
ceramics biomaterials has attempted to demonstrate the very
Carbon significant progress that has been made with the use of
Steel
advanced materials within the human body. The present
Titanium
Resorbable study reviewed the currently used biomaterials; metals,
polymers ceramics, polymers, and composite.
Polylactide, Metals are susceptible to degradation by corrosion, a
polyglycolide and process that can release by-products that may cause adverse
their copolymers biological responses. Ceramics are attractive as biological
Polydioxanone implants for their biocompatibility. The studies show that
TABLE 9 APPLICATION OF COMPOSITE AS IMPLANTS USED IN HUMAN alumina with high mechanical strength show minimal or no
BODY tissue reaction, nontoxic to tissues and blood compatibility
tests were also satisfactory. Carbon with similar
Applications Types of materials
mechanical properties of bone is an exciting candidate, for
CF/C, SiC/C,CF/Epoxy, GF/Polyester,
GF/PC, GF/PP, GF/Nylon, it elicits blood compatibility, no tissue reaction and
Dentistry GF/PMMA,UHMWPE/PMMA, nontoxicity to cells. The availability of a wide range of
CF/PMMA, GF/PMMA, KF/PMMA, polymers significantly influenced the growth of tissue
Silica/BIS-GMA engineering and controlled drug delivery technologies.
Cells/PTFE, Cells/PET, PET/Collagen, Innovations in the composite material design and
Vascular Grafts
PET/Gelation, PU/PU-PELA fabrication processes are raising the possibility of realizing
PET/PHEMA, KF/PMA, KF/PE, implants with improved performance. However, for
CF/PTFE,CF/PLLA, GF/PU, PET/PU, successful application, surgeons must be convinced with
Joint PTFE/PU, CF/PTFE, CF/C, the long term durability and reliability of composite
replacements CF/UHMWPE,UHMWPE/UHMWPE,
biomaterials.
CF/Epoxy, CF/PS, CF/PEEK,
CF/UHMWPE, CF/PE, In the past, success of materials in biomedical
Bone particles/PMMA, applications was not so much the outcome of meticulous
Titanium/PMMA, UHMWPE/PMMA, selection based on biocompatibility criteria but rather the
Bone cement result of serendipity, continuous refinement in fabrication
GF/PMMA, CF/PMMA, Bio-Glass/Bis-
GMA technology, and advances in material surface treatment. In
Bone
HA/PHB, HA/PEG-PHB, CF/PTFE, the present and future, election of a biomaterial for a
PET/PU, HA/HDPE, HA/PE, Bio- specific application must be based on several criteria.
Replacement
Glass/PE, Bio-Glass/PHB, Bio-Glass/PS, Biocompatibility is the paramount criterion that must be
Materials
HA/PLA met by every biomaterial. Medical research continues to
Spine Cage,
explore new scientific frontiers for diagnosing, treating,
Plate, Rods,
Screws, Disc, PET/PU, PET/Collagen, CF/LCP, curing, and preventing diseases at the molecular/genetic
Finger Joint, CF/PEEK, GF/PEEK, CF/Epoxy, CF/PS, level. This review should be of value to researchers who
Intramedullary Bio-glass/PU, Bio-glass/PS, PET/SR, are interested in the state of the art of biomaterial
Nails, PET/Hydrogel, CF/UHMWPE evaluation and selection of biomaterials.
Abdominal wall
Prosthesis,

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