Trends Biomater. Artif.

Organs, Vol 18 (1), pp 9-17 (2004)

http://www.sbaoi.org

Biological Evaluation of Bioceramic Materials - A Review

T. V. Thamaraiselvi and S. Rajeswari
Department of Analytical Chemistry
University of Madras
Guindy Campus, Chennai 600 025
The uses of bioceramics have been revolutionizing the biomedical field in deployment as implants for humans. Many
implant materials made of ceramics have been used for the past three decades. In the search to improve the
biocompatibility and mechanical strength of implant materials, attention has been directed towards the potential use of
ceramic/ceramic composites. The ceramic-based biomaterials have been accepted after biological evaluation through
several in vivo and in vitro tests. In this review an attempt has been made to elicit some of the in vivo and in vitro
studies performed on bioceramics, ceramic/ceramic composites and their applications as implants.

Introduction
The class of ceramics used for repair and
replacement of diseased and damaged parts
of musculoskeletal systems are termed
bioceramics. Bioceramics have become a
diverse class of biomaterials presently
including three basic types: bioinert high
strength ceramics, bioactive ceramics which
form direct chemical bonds with bone or
even with soft tissue of a living organism;
various bioresorbable ceramics that actively
participate in the metabolic processes of an
organism with the predictable results (1).
Alumina (Al2O3), Zirconia (ZrO2) and carbon
are termed bioinert. Bioglass and glass
ceramics are bioactive.
Calcium phosphate ceramics are categorized
as bioresorbable. Bioceramics became an
accepted group of materials for medical
applications, mainly for implants in
orthopaedics, maxillofacial surgery and for
dental implants. Table 1 elicits the
biomedical applications of bioceramics.
Bioceramics have been evaluated through
several in vitro and in vivo investigations.
The medical community has accepted the
bioceramics after a number of clinical tests.
In this review, the biological evaluations of
bioceramics are discussed from the
standpoint of cytotoxicity, tissue irritability,
bioceramics-tissue
interface
and
cell
adhesion to biomaterial surface.

Alumina (Al2O3)
Since 1975 alumina ceramic has proven its
bioinertness. An alumina ceramic has
characteristics of high hardness and high
abrasion resistance. The reasons for the
excellent wear and friction behavior of Al2O3
are associated with the surface energy and
surface smoothness of this ceramic. There is
only one thermodynamically stable phase,
i.e. Al2O3 that has a hexagonal structure with
aluminium ions at the octahedral interstitial
sites. The characteristic features of alumina
are depicted in Table 2 (2). Abrasion
resistance, strength and chemical inertness
of alumina have made it to be recognized as
a ceramic for dental and bone implants. The
biocompatibility of alumina ceramic has been
tested by many researchers. Noiri et al.,
evaluated the biocompatibility of aluminaceramic material histopathalogically for eight
weeks by implanting in the eye sockets of
albino rabbits. The results showed no signs
of implant rejection or prolapse of the
implanted piece. After a period of four weeks
of implantation, fibroblast proliferation and
vascular invasion were noted and by eighth
week, tissue growth was noted in the pores
of the implant (3).
Loosening is the most frequently observed
long-term
complication following joint

10

T. V. Thamaraiselvi and S. Rajeswari

Table 1: Biomedical Applications of Bioceramics

Devices
Function
Artificial total hip, knee,
Reconstruct arthritic or fractured joints
shoulder, elbow, wrist
Bone plates, screws, wires

Repair fractures

Intramedullary nails

Align fractures

Harrington rods

Correct chronic spinal curvature

Permanently implanted
artificial limbs
Vertebrae Spacers and
extensors
Spinal fusion

Replace missing extremities

Al2O3

Correct congenital deformity

Immobilize vertebrae to protect spinal
cord

Alveolar bone replacements,

mandibular reconstruction

Restore the alveolar ridge to improve

denture fit

End osseous tooth

replacement implants

Replace diseased, damaged or

loosened teeth
Provide posts for stress application
required to change deformities

Orthodontic anchors

Biomaterial
High-density alumina, metal bioglass
coatings
Bioglass-metal fiber composite,
Polysulfone-carbon fiber composite
Bioglass-metal fiber composite,
Polysulfone-carbon fiber composite
Bioglass-metal fiber composite,
Polysulfone-carbon fiber composite
Bioglass-metal fiber composite,
Polysulfone-carbon fiber composite

Table 2: Characteristic Features of Ceramic Biomaterials

Youngs
Compressive
Bond strength
Material
Modulus
Strength
(GPa)
(GPa)
(MPa)
Inert
380
4000
300-400
Al2O3
ZrO2 (PS)
150-200
2000
200-500

Bioglass
Polytetra fluro ethylene (PTFE) - carbon
composite, Porous Al2O3, Bioglass,
dense-apatite
Al2O3, Bioglass, dense hydroxyapatite,
vitreous carbon
Bioglass-coated Al2O3, Bioglass coated
vitallium

Hardness
2000-3000
(HV)
1000-3000
(HV)
NA

Density
3
g/cm
>3.9
6.0

Klc
1/2
(MPam )
5.0-6.0
4.0-12.0

Graphite
20-25
138
NA
1.5-1.9
NA
(LTI)
17-28
900
270-500
NA
1.7-2.2
NA
Pyrolitic
Carbon
Vitreous
150-200
24-31
172
70-207
1.4-1.6
NA
Carbon
(DPH)
Bioactive
73-117
600
120
350
3.1
<1
HAP
Bioglass
1000
50
NA
2.5
0.7
75
AW Glass
2
118
1080
215
680
2.8
Ceramic
Bone
3-30
130-180
60-160
NA
NA
NA
The variation in Young's Modulus noted for some of the materials listed is due to variation in density of test specimens.
PS - Partially Stabilized; HA - Hydroxyapatite; NA - Not Available; AW - Apatite-Wallastonite; HV - Vickers Hardness;
DPH - Diamond Pyramid Hardness

replacement. Its cause is thought to be

foreign-body reaction of the tissue against
wear particles of various biomaterials.
Relationship between the size and type of
biomaterials and tissue reaction has not
been clarified completely. When alumina
ceramic (Al2O3, 3.9 m) was surgically
inserted in the knee joints of Japanese white
rabbits, the consequent histological reaction
was examined. Alumina ceramic induced
weak tissue reaction (4). Ultrastructural
changes in the bone-alumina ceramics
interface were studied using transmission

electron microscope (TEM). Single crystal

alumina screws and pins were implanted in
the femoral bone of mature rabbits. Changes
in the implant-bone interface were observed.
Alumina was never in direct contact with the
bone and hemidesmosomes were not
observed in the interface (5).
The in vitro examination of blood
compatibility of biomaterials can predict the
immediate undesirable interactions of
materials with various blood components
such as activation of the coagulation system

Biological Evaluation of Bioceramic Materials - A Review

or alterations of platelets. Antithrombogenesis of alumina film by reactive sputtering

was tested in vitro. Several aluminal films
were deposited on glass substrates by
reactive sputtering and the interaction with
blood in vitro was examined. Activation of the
intrinsic coagulation system and reasonable
10% oxygen partial pressure in the platelet
reactivity were shown in the initial reaction
between artificial surfaces and components
of the blood (6). The blood compatibility of
sputter-deposited
alumina
films
was
investigated in vitro by Yuhta et al. The
platelet reaction to the alumina films and the
intrinsic coagulation factors XII activation by
the alumina films were examined. The
alumina films experienced an adhesion of
fewer platelets and slight morphological
changes were observed (7).
The cytotoxicity of single crystal alumina
ceramics was studied in L cell line culture.
They displayed the same colony formation
and survival rates as the controls showed
that they have no cytotoxicity and if
implanted in bone marrow they would not be
toxic to circumferential tissue (8).
Zirconia (ZrO2)
Zirconia is a biomaterial that has a bright
future because of its high mechanical
strength and fracture toughness. Zirconia
ceramics have several advantages over
other ceramic materials due to the
transformation
toughening
mechanisms
operating in their microstructure that can be
manifested in components made out of them.
The research on the use of zirconia ceramics
as biomaterials commenced about twenty
years ago and now zirconia is in clinical use
in total hip replacement (THR) but
developments are in progress for application
in other medical devices. Today's main
application of zirconia ceramics is in THR
ball heads.
The biocompatibility of polarized partially
stabilized zirconia (PSZ) ceramics were
examined using osteoblastic cell cultivation.
The proliferation of adhesive cells were
accelerated on the negative charge surface
and decelerated on the positive charge

11

surface (9). The osteointegration of zirconia

was investigated in normal and osteopenic
rats by means of histomorphometry. The
data showed that the tested material was
biocompatible in vitro and confirmed that
bone mineral density is a strong predictor of
the osteointegration of an orthopaedic
implant and that the use of pathological
animal models is necessary to completely
characterize biomaterials (10).
It is said that very small traces of
radioelements, which can be found even in
fully refined ceramics, have a negative effect
on organs and tissues. Zirconia contains
very small traces of radioelements. The
effects of traces of radioelements on organs
and tissue were investigated by means of
determining the massive activity of - rays
on the zirconia head (11). The cytotoxicity of
polycrystalline zirconia was speculated in L
cell line culture. The study revealed its
noncytotoxicity (8).
Carbon
Carbon is a versatile element and exists in a
variety of forms. Table 2 gives the
characteristic features of various types of
carbons used as biomaterial. Bokras et al.,
emphasized that the good compatibility of
carbonaceous materials with bone and other
tissue and the similarity of the mechanical
properties of carbon to those of bone
indicate that carbon is an exciting candidate
for orthopedic implants (12). Unlike metals,
polymers and other ceramics, these
carbonaceous materials do not suffer from
fatigue. However, their intrinsic brittleness
and low tensile strength limits their use in
major load bearing applications. It is used as
biomaterial particularly in contact with blood.
Hence it is important to evaluate its blood
compatibility.
Shi et al., studied the thromboembolic rates
in the mitral and aortic positions of omnicarbon valve constructed entirely of pyrolytic
carbon. It was found that total of 569 aortic
omnicarbon valves had thromboembolic
events of 0.5% and a total of 298 mitral
omnicarbon valves had a thromboembolic
rate of 1.6% (13). Zimmerman et al., studied

12

T. V. Thamaraiselvi and S. Rajeswari

the compatibility of filamentous carbon fibre.

It was speculated that it does not corrode
and elicit almost no foreign body response
and is also an efficient electrical conductor in
vivo (14).
Zhang et al., investigated the adhesion of
Staphylococous
auros,
Staphylococous
epidermidis, Escherichia coli, Psuedomonas
aeruginosa and Candida albicans to dacron
and pyrolite carbon in vitro with plate
counting. The experimental results showed
that the bacterials used in the experiment
have adhesion to prosthetic valve materials.
The bacterials have stronger adhesion to
dacron than to pyrolite carbon. The bacterial
adhesive capacity is significantly different
and is affected by mechanical and chemical
nature of biomaterials (15). In vitro tests
were conducted on diamond like carbon films
on germanium and various metals and
oxides that has been extended to coating
plastics used in medical and bioengineering
applications.
The
test
proved
its
biocompatibility and allowed cells to grow
without inflammatory response and with cell
integrity maintenance (16).
Mouse peritoneal macrophages and mouse
fibroblasts were grown on tissue culture
plates treated with diamond like carbon. The
investigation showed no adverse effects on
cells in culture and therefore merits further
investigation as a coating for biomedical use
(17). The mechanical bonding between the
carbon fiber reinforced carbon and host
tissue was investigated. The bonding
developed three months after intrabone
implantation and is accompanied by a
decrease. of the implant strength (18).
Bioglass & Glass Ceramic
Bioglasses are interesting versatile class of
materials and structurally all silica-based
glasses have the same basic building block SiO44-. Glasses of various compositions can
be obtained and they show very different
properties. Bioglasses have also found a
place in prosthetics. These bioglasses are
embedded in a biomaterial support to form
prosthetics for hard tissues. Such prosthetics
are
biocompatible,
show
excellent

mechanical properties and are useful for

orthopedic and dental prosthetics (19).
The biocompatibility of bioglass powders
were deduced from studies carried out both
in vivo and in vitro. Evidence for the lack of
toxicity of various bioglass formulations was
deduced from studies carried out both in vivo
and in vitro in several different centres.
Animal tests which involve rat peritoneal
macrophages in culture and a mouse
pulmonary biomaterial embolus model on
solid bioglass implants in soft tissues of rats
and rabbits over a duration of 8 weeks
indicated the biocompatibility of bioglass
powders (20).
Glass A bioactive glass ceramic materials
were the first to actively interact with tissues
and induce their intrinsic repair and
regenerative potential which involves control
over the cell cycle, molecular frame work that
controls cell proliferation and differentiation.
Depending upon the rate of resorption and
release of ions they can create chemical
gradients with specific biological actions over
cells and tissues (21). Glass ceramics for
use as a biomaterial comprises CaO-34.654.6,SiO2-24.2-44.8,P205-0-8.0,CaF2-0.1-1.0
and MgO-1.0-10.0 weight percentage and
the composition has a primary wallastonite
crystal phase and a secondary apatite crystal
phase. The glass ceramic has superior
mechanical properties, good biocompatibility,
bioactivity and no toxicity making it useful as
a biomaterial in artificial bone and dental
implants (22).
The bioactive glass ceramic containing two
main crystal phases, mica and apatite,
developed by Hoeland et al., showed a
calcium phosphate rich interface layer with
apatite crystals grown on solid state reaction
between glass ceramic and bone. The
interface reaction was interpreted as a
chemical process, which includes a slight
solubility of the glass ceramic and a solidstate reaction between the stable apatite
crystals in the glass ceramic and the bone
(23).
Gatti et aI., investigated the bioactivity of
bioactive glasses and glass ceramic by

Biological Evaluation of Bioceramic Materials - A Review

implanting as granules for 2 months in rabbit

muscle and for 5 months in sheep jaws in
order to study the influence of the biological
surrounding on the reactions of the
materials. Analytical studies showed that a
calcium and phosphorous rich surface layer
was formed on the glasses in the
implantation sites (24). The first report of
bone induction in soft tissues of animals by
glass ceramic that has long been recognized
as a bioactive (osteoconductive) biomaterial
was made by Yuan et aI. The porous glass
ceramic made from bioglass 45S5 was
implanted as cylinders in thigh muscles of
dogs for 3 months. Bone formation was
histologically found in pores of all implants
retrieved from 16 dogs (25).

13

temperature influence the stoichiometry of

Ca/P ratio and thus the nature of HAP. The
as dried powder has an amorphous
structure, while sintering at 900C produces
crystalline HAP. Both Ca2+ and P043- ions, as
well as the OH-group in HAP, can be
replaced by other ions, several of them
present in physiological surroundings. A wellknown ion is fluoride, leading to fluorapatites.
Ca10(PO4)6(OH)2-x F
O<X<2

The carbonate ion, when incorporated into

HAP yields carbonated apatites with various
chemical formulae.
Ca10(PO4)6(OH)2-2x(CO3)x
and Ca10-x+y(PO4)6-x(CO3)x(OH)2-x+2y

Calcium Phosphate Ceramics (CPC)

It has been known for more than twenty
years that ceramics made of calcium
phosphate salts can be used successfully for
replacing and augmenting bone tissue. The
most widely used calcium phosphate based
bioceramics are hydroxyapatite (HAP) and tricalcium phosphate (-TCP).
Hydroxyapatite has the chemical formula
Ca10(PO4)6(OH)2, the Ca/P ratio being 1.67
and possesses a hexagonal structure. It is
the most stable phase of various calcium
phosphates. It is stable in body fluid and in
dry or moist air upto 1200C and does not
decompose and has shown to be bioactive
due to its resorbable behaviour. Multiple
techniques have been used for preparation
of HAP powders. Two main ways of
preparation of HAP are wet methods and
solid-state reactions. There are also
alternative techniques for preparation of HAP
powders such as solgel, flux method,
electrocrystallisation , spray pyrolysis,
freeze-drying,
microwave
irradiation,
mechanochemical method or emulsion
processing. Wet chemical methods involve
the acid-base titration or co-precipitation
from aqueous solutions that contain calcium
nitrate
and
diammonium
hydrogen
phosphate, direct precipitation reaction
between orthophosphoric acid solution and
calcium hydroxide dispersed in water. The
rate of addition, pH and sintering

O<X<2
O<Y <1/2X

For biomedical purposes, the

apatite and fluorapatite are the
interest because of assumed
bony apatite and decreased
aqueous solutions respectively.

carbonated
materials of
similarity to
solubility in

-tricalcium
phosphate
(-TCP)
is
represented by the chemical formula
Ca3(PO4)2, the Ca/P ratio being 1.5. -TCP
shows an X ray pattern consistent with a
pure hexagonal crystal structure, although
the related -TCP is monoclinic. Singlephase TCP powders have also been
synthesized
successfully
by
many
researchers. -TCP turns into -TCP around
1200C; the latter phase is considered to be
stable in the range 700 to 1200C. -TCP is
highly soluble in body fluid. HAP is formed
on exposed surfaces of TCP by the following
reaction.
4Ca3(PO4)2(s)+ 2H2O Ca10(PO4)6(OH)2(surface) +Ca
2+2HPO4

2+

Thus, the solubility of a TCP surface

approaches the solubility of HAP and
decreases the pH of the solution, which
further increases the solubility of TCP and
enhances resorption. Many studies have
indicated that the dissolution of HAP in the
human body after implantation is too low to
achieve the optimal results. On the other

14

T. V. Thamaraiselvi and S. Rajeswari

hand, the dissolution rate of -TCP ceramic

is too fast for bone bonding. To achieve an
optimum resorbability of the material, studies
have mainly focused on the biphasic calcium
phosphate ceramics composed of HAP and
TCP. Several results suggest that the
resorbability of biphasic ceramics is largely
determined by the HAP/TCP ratio.
While considering the new genera of calcium
phosphate bioceramics, it is reasonable to
understand the analogy of the ceramic
biomaterials with bone mineral. Bone mineral
presents a more complex composition. It
contains calcium phosphate, hydrogen
phosphate ions, carbonate ions, magnesium,
sodium and numerous trace elements. It may
be tentatively represented by that of a
defectuous apatite;
Ca8.3+1.7(PO4)4.3 (CO3)1(HPO4)0.7(OH,CO3)0.3+1.7 =
Vacancy

The main differences with HAP are

carbonate
and
hydrogen
phosphate
substitution for phosphate and the important
amount of cationic and anionic vacancies.
The Ca/P+C ratio is constant. The only
changes observed are the relative amounts
of HPO42- and CO32-. The HPO42- content is
higher in bone of young animals than in that
of old animals. Several descriptions of bone
mineral structure can be given based on
several investigations using XRD, IR and
NMR. It may be described as a carbonate
apatite framework supporting nonapatitic,
labile environments.
The most important properties of calcium
phosphate
biomaterials
are
their
bioresorption
and
bioactivity.
These
phenomena are essentially dynamic and
strongly depend on biological parameters.
When calcium phosphate biomaterials are
put in contact with living tissues, several
interactions occur. As HAP and TCP have a
lower solubility product than the calcium
phosphate ionic product of body fluids, they
induce the formation on their surface, a
calcium phosphate apatite from ions present
in the fluids. The first stage is the interaction
with collagen and later accumulation of
proteins and cells on the surface of the
material followed by resorption of the

material
and
bone
formation.
The
composition of the crystals themselves is an
important factor and there is generally a
relationship between the resorption of
biomaterials and their solubility. Tricalcium
phosphate for instance is more easily
resorbed than stoichiometric apatites. The
nonstoichiometric apatites containing both
CO32-/HPO42- ions are very resorbable (26).
Bone mineral crystals are very tiny and
possess a very large surface area. On the
contrary, calcium phosphate biomaterials
present a low surface area and have strong
crystal bonds. It is speculated that resorption
results
from
two
processes;
the
disintegration of particles into crystals and
the dissolution of crystals. The dissolution
step involves cell activity, however some
insoluble calcium phosphates such as
apatite or calcium pyrophosphates cannot be
eliminated easily by cells and can manifest
phlogistic properties in other tissues than in
bone. It is argued that bioresorbability of
calcium phosphate differs due to the large
differences in the disaggregation rate owing
to the characteristics of the biomaterial and
the strength of crystal-to-crystal bonds
developed. Pure HAP sintered at high
temperature is nonresorbable or very slowly
resorbable, whereas the materials sintered at
lower temperature (900C) are resorbable.
Plasma spray of hydroxyapatite may induce
a partial decomposition into numerous
nonapatitic phases; high temperature
amorphous phosphate, calcium oxide,
calcium tetraphosphate and and tricalcium phosphate. These slight changes
in composition or impurities may modify
solubility. The behavior of calcium phosphate
based biomaterials in biological environment
determines how they can be used in vivo.
The prime requirement for calcium
phosphate materials to be bioactive and
bond to living bone is the formation of a bone
like apatite layer on their surface. This
phenomenon can be reproduced in vitro
using simulated body fluid, a protein-free
solution with ion concentrations similar to
those of human blood plasma(27). The
calcium phosphate biomaterials possess the
ability to attract osteoblast and osteoclasts

Biological Evaluation of Bioceramic Materials - A Review

(Chemotaxis).
Chemotaxis
involves
mediators present in bone matrix or in bone
fluid, which determine bone resorption or
formation. It is assumed that the first step of
chemotaxis is the adsorption of mediators
onto the mineral surface. Several factors
such as surface charge, microporosity,
composition and changes of molecular
composition, change the adsorption process.
Despite several uncertainties on the
mechanism of adsorption processes, HAP is
found to be a more efficient osteoblast
attractant than other calcium phosphates and
has been proposed as a support for
osteoblast cell cultures.
Ruan et al. evaluated the biocompatibility of
calcium phosphate based biomaterials by
tissue culture in vitro model. Biological
research results showed that human and
animal osteoblast cells anchor to the
materials surface in two hours in culture.
Confocal
laser
scanning
microscopy
demonstrated normal cell distribution and
proliferation on both of dense and porous
biomaterials. Hydroxyapatite and tricalcium
phosphate (TCP) stimulate cell proliferation
(28). With respect to the effect of material
factors on calcium phosphate induced
osteogenesis (the osteoinductive property of
HAP), macroporous implants with rough pore
walls containing abundant micropores and
porous implants with smooth macropore
walls composed of regularly aligned crystal
grains were investigated in dorsal muscles of
dogs. The result proved that calcium
phosphate ceramic can induce bone
formation in soft tissue and their
microstructure seemed to be an important
factor affecting the osteoinductive capacity of
calcium phosphate ceramics (29).
Yuan et al. investigated the osteoinduction of
various calcium phosphate biomaterials. The
osteoinductive potential varied in different
materials. Bone formation was only seen in
calcium
phosphate
biomaterials
with
micropores and was found in HAP ceramic,
TCP / HAP, -TCP ceramic and calcium
phosphate cement (30). An air pouch model
in rats was used by Maugars et al., for
evaluating articular phlogogenic capacity of
calcium phosphate ceramic. Histological

15

examinations after 48 hours revealed most

intense inflammatory reaction with biphasic
calcium phosphate. The thickness of the
superficial stratified layer of synoviocyte-like
cells doubled and interstitial fibrosis
occurred.
Neovascularization
with
polymorphous inflammatory infiltration was
seen. Hydroxyapatite also led to the same
effect but less intense. Despite good bone
tissue tolerance, intraarticularly these
biomaterials
can
lead
to
synovial
inflammation and such phlogogenic action
varies depending on the microcrystal injected
(31).
Ceramic/Ceramic Composite
Composite materials may be defined as
those materials that consist of two or more
fundamentally different components that are
able to act synergistically to give properties
superior to those provided by either
component alone. Composites made of
bioinert and bioactive ceramics are produced
to achieve two important features, bioactivity
and mechanical strength. Such composites
were biologically evaluated by scientists
through several animal tests. Alumina
ceramic
can
form
composites
with
hydroxyapatite that are bioactive. Animal
experiments of HAP/alumina composite
reveal that it can form tight osteointegration
with bone. It is bioactive with high strength
(32).
The biocompatibility of alumina-zirconia
composite was investigated by Konduk et al.
Tissue reactions of test materials were
performed using rats for two months
duration. X-ray diffraction studies showed
that alumina exists only in the form of
corundum. As the amount of zirconia
increased, mullite formation became visible
on the particle boundaries. Animal studies
revealed that these ceramic composites do
not have any adverse effect on the tissue
investigated histologically (33). The influence
of surface properties of ceramics on their
biocompatibility was examined in vitro by
using gingival fibroblasts. Al203 - Si02 - Ti02
ceramics with variable composition and
sufficient densities were produced by solgel
techniques. The biocompatibility of the

16

T. V. Thamaraiselvi and S. Rajeswari

ceramic was good without showing a direct

correlation between cell behavior and
material composition based on the interfaceenergy concept (34).
Zeng et al. developed a new type of gradient
ceramic biomaterial. ZrO2 was selected as
the substrate and Na20 - Si02 - B203 - CaO
system glass was chosen as a medium for
bonding HAP and ZrO2. After 3 month's
implantation in dog's leg bone, the gradient
bioactive implant bonded with the bone, the
bonding strength between the gradient
bioactive material implant and bone was
much higher than that between a pulse
titanium implant and bone (35). In vivo study
of carbon-carbon composites showed the
accumulation of platelets on the exposed
surface
material
with
any
surface
morphology, whereas platelet concentration
in blood remained constant (36).
Conclusion
Bioceramics are attractive as biological
implants for their biocompatibility. The
analysis of the results of animal experiments
and the evaluation of clinical follow up
studies show that alumina ceramic with high
mechanical strength show minimal or no
tissue reaction, nontoxic to tissues and blood
compatability tests were also satisfactory.
Zirconia ceramic revealed its bioinertness
and noncytotoxicity. Carbon with similar
mechanical properties of bone is an exciting
candidate, for it elicits blood compatibility, no
tissue reaction and nontoxicity to cells. None
of the three-bioinert ceramics exhibited
bonding with the bone. However, the
bioactivity of the bioinert ceramics can be

achieved by forming
bioactive ceramics.

composites

with

Bioglass and glass ceramics are nontoxic

and chemically bond to bone. Glass
ceramics elicit osteoinductive property.
Calcium
phosphate
ceramics
exhibit
nontoxicity to tissues, bioresorption and
osteoinductive property. The ceramic
particulate reinforcement has led to the
choice of more materials for implant
applications that include ceramic/ceramic,
ceramic/polymer, ceramic/metal composites.
Among these choice of composites
ceramic/polymer composites have found to
release toxic elements into the surrounding
tissues and possess the limitations of
organisation into definite shape. Metals face
corrosion related problems and ceramic
coatings on metallic implants degrade as the
time progress during long time applications.
Ceramic/ceramic
composites
enjoy
superiority due to similarity with bone
minerals, exhibiting biocompatibility and are
able to be shaped into definite size. Hence
the biological activity of bioceramics has to
be understood through various in vitro and in
vivo studies and the knowledge on
mechanical feature would join its hand to
play a key role for the choice of the
bioceramic in accord to the site of
implantation and their broad implication as
implants.
Acknowledgement
The authors are thankful to University Grants
Commission (UGC) for providing financial
assistance to support this work.

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