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Use of PEMF to Promote Bone Responses to Biomaterials

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Publication Title | Use of PEMF to Promote Bone Responses to Biomaterials

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International Journal of Biomaterials Volume 2018, Article ID 8935750, 15 pages
Review Article
The Use of Pulsed Electromagnetic Fields to Promote Bone Responses to Biomaterials In Vitro and In Vivo
Carlo Galli ,1 Giuseppe Pedrazzi,1 Monica Mattioli-Belmonte ,2 and Stefano Guizzardi1
1 Dep. of Medicine and Surgery, University of Parma, Italy
2DISCLIMO, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
Correspondence should be addressed to Carlo Galli;
Received 23 May 2018; Accepted 9 August 2018; Published 3 September 2018
Academic Editor: Esmaiel Jabbari
Copyright © 2018 Carlo Galli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Implantable biomaterials are extensively used to promote bone regeneration or support endosseous prosthesis in orthopedics and dentistry. Their use, however, would benefit from additional strategies to improve bone responses. Pulsed Electromagnetic Fields (PEMFs) have long been known to act on osteoblasts and bone, affecting their metabolism, in spite of our poor understanding of the underlying mechanisms. Hence, we have the hypothesis that PEMFs may also ameliorate cell responses to biomaterials, improving their growth, differentiation, and the expression of a mature phenotype and therefore increasing the tissue integration of the implanted devices and their clinical success. A broad range of settings used for PEMFs stimulation still represents a hurdle to better define treatment protocols and extensive research is needed to overcome this issue. The present review includes studies that investigated the effects of PEMFs on the response of bone cells to different classes of biomaterials and the reports that focused on in vivo investigations of biomaterials implanted in bone.
1. Biomaterials and Bone Regeneration
Biomaterials play an important role in bone regenerative strategies [1] in both orthopedics and dentistry as scaffolds [2] or as a support for prosthesis, e.g., hip or dental implants [3]. In all these clinical situations the challenge biomaterials must face is to integrate in the host and promote bone healing along its surfaces [4], albeit with noticeable differences. Most scaffolds are made of resorbable materials, because common opinion dictates that scaffolds should progressively be replaced by native tissue [5], whereas prostheses are mostly permanent implants and their purpose is to last and function as long as possible in patients, usually while withstanding relevant mechanical forces in the process [6]. Thus, most scaffolds currently used in bone are made of bioceramics, predominantly calcium phosphates, because of their chemical similarity to the inorganic matrix of bone [7], which makes them osteoconductive [8, 9]. Furthermore, bioceramics are rigid and their mechanical properties have been shown to positively affect cell differentiation along the osteoblastic lineage [10, 11]. Last but not least, this class of biomaterials
is usually very biocompatible and resorbable within a time span that appears to quite closely meet the requirements for implantation into natural bone [8]. Although bioceramics can be loaded with biologically active ions [12] or biomolecules [13] to improve bone formation, they are not as versatile and customizable as polymers, whose structure can be modified almost ad libitum, enabling researchers to add functional groups and control their polymerization, their chemical behavior, their mechanical properties, and resorbability [14– 16]. Polymers have opened up hitherto unexplored possibili- ties, such as injection of photopolymerizable compounds [17] or easy 3D printing [18].
In contrast, implantable prostheses are still mostly made of titanium and its alloys, although novel and highly resistant ceramics, i.e., zirconia, could represent a viable alternative [19, 20]. Titanium is a very biocompatible metal, which has been shown to represent an efficient material for ortho- pedic and dental implants [21]. A lot of effort has gone into investigating optimal surface treatments to optimize bone response and speed up tissue healing after surgery [4, 22]. What bioceramics, most polymers, and metals still

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