Graphene is an excellent filler for the development of reinforced composites. This study evaluated bone cement composites of graphene oxide (GO) and poly(methyl methacrylate) (PMMA) based on the proliferation of human bone marrow mesenchymal stem cells (hBMSCs), and the anabolic and catabolic effects of the incorporation of GO on osteoblast cells at a genetic level. Surface wettability and roughness were also evaluated at different GO concentrations (GO1: 0.024 wt% and GO2: 0.048 wt%) in the polymer matrix. Fabricated specimens were tested to (a) observe cell proliferation and (b) identify the effectiveness of GO on the expression of bone morphogenic proteins. Early osteogenesis was observed based on the activity of alkaline phosphatase and the genetic expression of the run-related transcription factor 2. Moreover, bone strengthening was determined by examining the collagen type 1 alpha–1 gene. The surface roughness of the substrate material increased following the addition of GO fillers to the resin matrix. It was found that over a period of ten days, the proliferation of hBMSCs on GO2 was significantly higher compared to the control and GO1. Additionally, quantitative colorimetric mineralization of the extracellular matrix revealed greater calcium phosphate deposition by osteoblasts in GO2. Furthermore, alizarin red staining analysis at day 14 identified the presence of mineralization in the form of dark pigmentation in the central region of GO2. The modified GO–PMMA composite seems to be promising as a bone cement type for the enhancement of the biological activity of bone tissue.

In this study, porous polyethylene scaffolds were examined as bone substitutes in vitro and in vivo in critical-sized calvarial bone defects in transgenic Sprague-Dawley rats. A microscopic examination revealed that the pores appeared to be interconnected across the material, making them suitable for cell growth. The creep recovery behavior of porous polyethylene at different loads indicated that the creep strain had two main portions. In both portions, strain increased with increased applied load and temperature. In terms of the thermographic behavior of the material, remarkable changes in melting temperature and heat fusion were revealed with increased the heating rates. The tensile strength results showed that the material was sensitive to the strain rate and that there was adequate mechanical strength to support cell growth. The in vitro cell culture results showed that human bone marrow mesenchymal stem cells attached to the porous polyethylene scaffold. Calcium sulfate–hydroxyapatite (CS–HA) coating of the scaffold not only improved attachment but also increased the proliferation of human bone marrow mesenchymal stem cells. In vivo, histological analysis showed that the study groups had active bone remodeling at the border of the defect. Bone regeneration at the border was also evident, which confirmed that the polyethylene acted as an osteoconductive bone graft. Furthermore, bone formation inside the pores of the coated polyethylene was also noted, which would enhance the process of osteointegration.

Cements for maxillofacial reconstruction of jaw defects through calcification of rotated muscle have been tested. The objective of this study was to investigate the visibility of loading of two types of commercially available cements, Cerament^™ Spine Support and Cerament Bone Void Filler with mesenchymal cells and cytokines (bone morphogenetic protein) to act as a biomimetic scaffolding for future clinical application. Determination of basic biocompatibility (cell viability) using methyl thiazolyl tetrazolium and live/dead assay was carried out using MG-63 cells at various time points. Next, in order to inform potential subsequent in vivo experiments, a collagen tissue mimic was used for characterization of rabbit mesenchymal stromal cells using immunofluorescent cytoskeleton staining, and simultaneous and then sequential injection of Cerament Spine Support cement and cells into collagen gels. Results indicated that Cerament Spine Support was more biocompatible and that sequential injection of cement and then rabbit mesenchymal stromal cells into the tissue mimics is an optimal approach for clinical applications.

The revascularization of grafted tissues is a complicated and non-straightforward process, which makes it challenging to perform reconstructive surgery for critical-sized bone defects. This challenge is combined with the low vascularity that results from radiotherapy. This low vascularity could result from ischemia–reperfusion injuries, also known as ischemia which may happen upon grafting. Ischemia may affect the hard tissue during reconstruction, and this can often cause resorption, infections, disfigurement, and malunion. This paper therefore reviews the clinical and experimental application of procedures that were employed to improve the reconstructive surgery process, which would ensure that the vascularity of the tissue is maintained or enhanced. It also presents the key strategies that are implemented to perform tissue engineering within the grafted sites aiming to optimize the microenvironment and to enhance the overall process of neovascularization and angiogenesis. This review reveals that the current strategies, according to the literature, are the seeding of the mature and progenitor cells, use of extracellular matrix (ECM), co-culturing of osteoblasts with the ECM, growth factors and the use of microcapillaries incorporated into the scaffold design. However, due to the unstable and regression-prone capillary structures in bone constructs, further research focusing on creating long-lasting and stable blood vessels is required. Graphical Abstract