Ceramics for Biomedical Applications

 Biomaterials

 Introduction
There are numerous materials that have been identified as being safe for use within the
human body. These materials are termed biomaterials. Biomaterials have been defined as
‘any material that is used to replace or restore function to a body tissue and is
continuously or intermittently in contact with body fluids. They include metals, polymers,
ceramics and also composite materials.
 Properties of Biomaterials

There are a number of important properties that a material must have in order for it to be
suitable for use in the body.
It should have a biocompatible chemical composition that does not induce adverse tissue
reaction. This means that it should be non-toxic, non-carcinogenic, non-allergic and
non-inflammatory.
It must also be bio-functional, with sufficient strength and wear resistance to withstand
the environment in which it is placed.
Depending on the application for which it is used, it may also need to be able to stable
over long periods, have specific degradation rates or encourage bone ingrowth.
 Types of Biomaterials
 Metals
Metals are used for a wide range of medical applications. These include orthopedic
implants, implants, plates and screws for oral and maxillofacial surgery, components for
devices used in cardiovascular surgery, e.g. pacemakers, valve replacements and stents.
Surgical and dental instruments are also made from metallic materials. Due to the
requirements for biocompatibility, relatively few metals are suitable for medical
applications. Those most widely used for structural applications are titanium, titanium
alloys, cobalt-base alloys and various grades of stainless steel.
Metals used for other applications include commercially pure titanium, shape memory
alloys (based on the nickel-titanium binary system), zirconium alloys, tantalum, niobium
and precious metals, such as silver.
Some examples of the metals used for various applications are given in table 1.
Table 1: Some bio-metallic materials and their applications
 Polymers
Polymers are long chain molecules derived from many repeating units called monomers.
They are typically classified into three groups, thermoplastics, thermosets and
elastomers.
Although all three groups are used for medical applications, thermoplastics are most
widely used.
Some of the polymers most commonly used for medical applications include silicone,
nylon, ultra-high molecular weight polyethylene, PVC and polyurethane.
They are used for a wide range of applications for example replacement joint
components, implants, such as facial and breast implants, heart valves, lenses, sutures,
cements and adhesives.
Some of these applications are detailed below in table 2.
Table 2: Some polymers and their applications
 Ceramics
Ceramics have been used for a long time in the medical industry. They have mainly
been used for dental and orthopedic applications. This is due to the chemical similarity
between the composition of certain ceramic materials and that of tissues such as bone and
teeth. Examples of the applications of various bioceramics are given in table 3.
Table 3: Some bioceramics and their applications
 Composites
A composite material is a physical mixture of two or more distinct constituents.
There is no chemical bonding or alloying between the constituents.
Composite materials have properties very different to the properties of their
constituents.
In general, a composite just consists of two constituents, a matrix phase, which forms the
bulk of the material, and a reinforcing phase, which generally provides strength.
For some applications bioactive particles, which encourage bone growth, are used as the
reinforcing phase.
Composite materials are widely used in medical applications.
Some examples of composite materials used for various applications are given in table 4.
Table 4: Some biocomposites and their applications
 Bioceramics
 Introduction
Ceramics are compounds between metallic and non-metallic elements; most
frequently oxides, nitrides and carbides. Ceramics tend to have a low energy state,
which means that they tend to be stable and may well be considered the most chemically
and biologically inert of all materials.
The wide range of materials that falls within this classification includes ceramics that are
composed of clay materials, cement and glass.
Unlike metals and polymers, ceramics are difficult to shear plastically due to the nature of
the ionic and covalent bonding holding them together and also the minimum number of slip
systems.
In the past properties such as their inherent brittleness, susceptibility to notches or
microcracks, low tensile strength and low impact strength has limited their use.
However, within the last 100 years, improvements in the techniques used for the
fabrication of ceramics have lead to their use as ‘high tech’ materials.
 More recently it has been recognized that the characteristic properties of hardness,
durability and chemical resistance displayed by ceramics mean that many can
withstand the hostile environment within the body.
Over the past forty years’ ceramics have been specifically designed for the repair and
reconstruction of diseased and worn out body parts. These ceramics are termed
‘bioceramics’.

 Classification of Bioceramics
No foreign material that is implanted into living tissue can be completely compatible. Any
material that is recognized as foreign elicits some form of response from living tissue.
Bioceramics can be classified according to the response that they initiate within the body.

There are three main classes; virtually inert, bioactive and resorbable bioceramics.
 Virtually Inert Ceramics

Virtually inert ceramics have minimal interaction with their surrounding tissue. They
therefore maintain their physical and mechanical properties while in the body and are also
resistant to corrosion and wear.
Examples include aluminium oxides, zirconia ceramics and single phase calcium
aluminates.
Virtually inert ceramics may be used for structural support, such as bone plates, bone
screws and femoral heads, and also non-structural support, such as drug delivery devices
and ventilation tubes.

 Compositional Classification of Bioceramics

Bioceramics can be classified according to their compositions. The major groups are
oxide ceramics, glasses and calcium phosphate bioceramics.
 Oxide Ceramics
The major types of oxide ceramics are alumina (Al2O3)-based ceramics and zirconia
(ZrO2)-based ceramics.

i. Alumina (Al2O3)-based ceramics

Alumina ceramics are reportedly the first bioceramics to be widely used clinically.
They have many favorable characteristics including good strength, high wear resistance,
good biocompatibility and excellent corrosion resistance.
They have good hardness with values ranging from 20 to 30GPa. Both single and polycrystalline
alumina have been used clinically.
The most stable phase is α-Al2O3. MgO, CaO and Y2O3 have been added to alumina in low
percentages to control its granular growth, and consequently the densification.
Because of its high wear resistance, alumina is currently used for the bearing surfaces in
joint replacements.
It is also used for other applications, such as porous coatings for femoral stems, porous bone
spacers, middle ear implants and for dental implants.
ii. Zirconia-based ceramics
Zirconia-based ceramics have become a popular alternative to alumina as a structural ceramic
because of their substantially higher fracture toughness.
They have better reliability, a higher flexural strength and a lower Young’s modulus than
alumina and can also be polished to a superior surface finish.
Zirconia-based ceramics also have excellent biocompatibility and, although they are not quite as hard as
alumina, they have excellent wear and friction resistance.
One disadvantage of these ceramics is the fact that zirconia undergoes a volume change of about 5%
during phase changes at high temperature, which can cause fracture.
Zirconia is therefore generally stabilized with a dopant, such as yttria (Y2O3) or magnesium oxide (MgO),
which promotes the formation of a more stable cubic phase.
Zirconia-based ceramics produced with the use of a stabilizer is referred to as partially stabilized zirconia.
Partially stabilized zirconia is used for the bearing surfaces in joint replacements.
Oxidized zirconia has also recently been introduced for this application. Zirconia dental implants have also
been produced although they are not widely used
 Carbons
The biocompatibility of carbon has long been recognized. It is available in numerous
different forms. These include pyrolitic carbon, crystalline diamond, graphite,
noncrystalline glassy carbon and carbon fibres.

Some carbons have been found to have excellent thrombo-resistance properties and are
used for applications such as artificial heart valves and pacemaker electrodes.
The main types used for this application are low temperature isotropic (LTI)
pyrolytic carbon, vitreous (glassy) carbon and ultra-low temperature isotropic (ULTI)
carbon.

Other carbons that are used in the medical industry include diamond-like carbons
and carbon fibres.
Diamonds-like carbons have high hardness, wear resistance, optical transparency,
chemical inertness, low friction and good adhesion properties.
 Calcium Phosphate Ceramics
Calcium phosphate can be crystallized into various calcium phosphate ceramics depending
on the Ca : P ratio, presence of water, impurities and temperature. Examples of phases formed
include tri-calcium phosphate, tetracalcium phosphate and hydroxyapatite.
Calcium phosphate ceramics have received a lot of research attention due to their chemical
similarity to calcified tissue (bones, teeth). They have been used in dentistry and medicine for
about thirty years.
Calcium phosphate ceramics can be used in block form for applications such as spinal fusion
and bone space filling, for example after the removal of a tumour.
They can also be used in granule form to help repair damaged bone in procedures such as
alveolar ridge augmentation and maxillofacial surgery.
In loading bearing applications their inherent brittleness requires them to be used as a coating
material on a tougher substrate. These coatings are used to encourage the ingrowth of bone
material and are used for the fixation of dental implants and joint replacement components.
More recently they have shown potential for use as percutaneous implants and as drug
release ceramics. Calcium phosphate can also be used for calcium phosphate cements (CPC).