Zhang Jinkai, Zhuang Yu, Sheng Ruilong, Tomás Helena, Rodrigues João, Yuan Guangyin, Wang Xudong, Lin Kaili
Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China.
CQM-Centro de Quimica da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105, Funchal, Madeira, Portugal.
Mater Horiz. 2024 Jan 2;11(1):12-36. doi: 10.1039/d3mh01260c.
With the increasing and aging of global population, there is a dramatic rise in the demand for implants or substitutes to rehabilitate bone-related disorders which can considerably decrease quality of life and even endanger lives. Though titanium and its alloys have been applied as the mainstream material to fabricate implants for load-bearing bone defect restoration or temporary internal fixation devices for bone fractures, it is far from rare to encounter failed cases in clinical practice, particularly with pathological factors involved. In recent years, smart stimuli-responsive (SSR) strategies have been conducted to functionalize titanium implants to improve bone regeneration in pathological conditions, such as bacterial infection, chronic inflammation, tumor and diabetes mellitus, SSR implants can exert on-demand therapeutic and/or pro-regenerative effects in response to externally applied stimuli (such as photostimulation, magnetic field, electrical and ultrasound stimulation) or internal pathology-related microenvironment changes (such as decreased pH value, specific enzyme secreted by bacterial and excessive production of reactive oxygen species). This review summarizes recent progress on the material design and fabrication, responsive mechanisms, and and evaluations for versatile clinical applications of SSR titanium implants. In addition, currently existing limitations and challenges and further prospective directions of these strategies are also discussed.
随着全球人口的增长和老龄化，用于修复与骨骼相关疾病的植入物或替代品的需求急剧上升，这些疾病会显著降低生活质量甚至危及生命。尽管钛及其合金已被用作制造用于承重骨缺损修复的植入物或用于骨折的临时内固定装置的主流材料，但在临床实践中遇到失败病例并不罕见，尤其是涉及病理因素时。近年来，已经开展了智能刺激响应（SSR）策略，以使钛植入物功能化，从而在诸如细菌感染、慢性炎症、肿瘤和糖尿病等病理条件下改善骨再生。SSR植入物可以响应外部施加的刺激（如光刺激、磁场、电刺激和超声刺激）或内部病理相关的微环境变化（如pH值降低、细菌分泌的特定酶和活性氧的过量产生）发挥按需治疗和/或促再生作用。本综述总结了SSR钛植入物在材料设计与制造、响应机制以及通用临床应用评估方面的最新进展。此外，还讨论了这些策略目前存在的局限性和挑战以及进一步的前瞻性方向。
