By Primasari Cahya Wardhani SPECIAL TOPICS OF BIOMATERIALS

TEXTURED AND
POROUS MATERIALS
 TEXTURED AND POROUS MATERIALS

POROUS MATERIALS
Porous materials contain many pores.

POROUS MATERIALS ARE MADE :

SOLID PHASE (BASIC) + A FLUID OR FLUID CONSIST
GASE PHASE THAT PORE FORM IN THE SOLID

LOW and MIDLLE HIGH POROSITY

POROSITY
Can all materials with pore be referred to be porous ? Figure :
NO , because POROUS MATERIALS : This Figure from Porous
Three dimensional
composite oxide ceramics,
reticulated foamed
which is a low porosity
material, shown as a cross- materials.
sectional image.

Have closed pores which

behave like a phase of
impurity

 TEXTURED AND POROUS MATERIALS
TEXTURED MATERIALS

WHY TEXTURED MATERIALS BE IMPORTANT ??????

Strength and stress corrosion

deformation cracking
behavior resistance

chemical reactivity
and resistance to Weldability and
radiation damage magnetic
susceptibility

They are material properties can be highly dependent on the materials texture and related changes in
microstructure.
 TEXTURED AND POROUS MATERIALS
TEXTURED MATERIALS

Failures can correlate with the crystalline textures formed during

fabrication or use of that component. Consequently, consideration of
textures that are present in and that could form in engineered
components while in use can be a critical when making decisions about
the selection of some materials and methods employed to manufacture
parts with those materials. When parts fail during use or abuse,
understanding the textures that occur within those parts can be crucial
to meaningful interpretation of failure analysis.
TEXTURED AND POROUS MATERIALS

IN THIS CASE WILL BE DISCUSSED ABOUT TEXTURED WITH

POROUS IN MATERIALS

Device function and placement in the body dictates what

material would be most suitable for a particular application
WHY TEXTURED AND POROUS MATERIALS BE IMPORTANT ????
TISSSUE INGROWTH : to promote tissue ingrowth for
improved tissue implant stabilization
Other important effects incited by implant texturing include
disruption of fibrous encapsulation, improved tissue healing,
and increased vascularization of the tissue surrounding the
implant.
Difference in cellular and tissue response around
polyvinyl alcohol (PVA) implanted in rat
subcutaneous tissue after 3 weeks:
(a) porous PVA (300 m pores) promoted fibro
vascular ingrowth (arrows denote capillaries)
(b) smooth PVA developed dense avascular capsule
adjacent to material surface. (From Koschwanez, H.
E. (2004). Unpublished data.)
TEXTURED AND POROUS MATERIALS Numerous materials (metals, ceramics, natural and synthetic
polymers) can be textured or rendered porous using a wide
variety of techniques
Summary of Methods Developed for Fabricating Porous Three-Dimensional Biodegradable
Scaffolds for Tissue Engineering (Chen et al., 2002; Hutmacher, 2000; Yang et al., 2001)
Processing
Method Description Merits of Method Challenges
Time
Gas foaming * (Mooney High pressure CO 2 gas ~ 2 days Tuneable porosity and pore Closed pore architecture
et al., 1996) dissolved in polymer to structure Non-porous surface
create pores No organic solvents
Fiber bonding (Mikos Physical bonding non-woven ~ 4 days Interconnecting, open pore Lack of mechanical
et al., 1993) polymer fibers to create architecture strength
interconnecting mesh Large surface area for cell Difficulty controlling
attachment porosity
Amenable to only certain
polymers and solvents
Three-dimensional Computer controlled solvent > 7 days Open pore architecture Lack of mechanical
printing (Wu et al., application to sequential Complex 3D scaffolds strength
1996a,b) layers of powdered possible User and technique
polymer, creating a porous Incorporation of bioactive sensitive
scaffold compounds Instrument requirements
Phase separation Sublimation of solvent Open pore architecture Difficult to control scaffold
(Schugens et al., in polymer to form Can incorporate bioactive morphology
1996a,b) macropores molecules
Emulsion freeze-drying Polymer, solvent and water (all Open pore architecture Difficult to control scaffold
(Whang et al., 1995) immiscible) homogenized, Can incorporate bioactive morphology
quenched in liquid N 2 , then molecules User and technique
freeze-dried to form pores sensitive
Porogen leaching Dissolution of salt in polymer Open pore architecture Lack of mechanical
(Mikos et al., 1994) to form pores Tuneable pore size and strength
porosity Possible solvent residue
Can not incorporate
bioactive molecules
Visible surface skin
 TEXTURED AND POROUS MATERIALS

Numerous materials (metals, ceramics, natural and Common Materials used in Orthopedic and Dental Applications for Fabricating Porous Coatings or Porous Scaffolds
Common Methods
synthetic polymers) can be textured or rendered Ceramics
MATERIAL
Hydroxyapatite (HA)
to render Porous
Plasma-spray
Advantages Disadvantages
Similar composition and Coatings: Long-term
porous using a wide variety of techniques (Sun et al., 2001;
Karageorgiou and
Natural coral
Calcium phosphate
(coating)
Sinter (scaffold)
structure to natural bone stability (i.e. resportion,
Enhanced delamination)
Kaplan, 2005; based material osseointegration using Scaffolds: Brittle, slow
Simske et al., 1997) Amorphous glasses apatite-like materials degradation
Biocompatible Not amenable to
Easy to render porous machining
Low corrosion Difficult to control pore
sizes of naturally
occurring ceramics

Metals (Sun et al., 2001; Titanium (Ti) and Ti Plasma spray Bioinert Corrosion related
Karageorgiou and alloys Sinter Excellent mechanical complications
Kaplan, 2005; Simske Cobalt-chromium Grit-blast properties (i.e. less Stress shielding
et al., 1997; Ryan et al., (Co-Cr) and Co-Cr Wire mesh susceptible to fatigue complications from
2006; Bobyn et al., 1999) alloys Combustion than ceramics, polymers) significantly higher
Tantalum synthesis Youngs modulus than
Vapor deposition bone

Natural Polymers Collagen Freeze-drying Biocompatible Lack mechanical

(Karageorgiou and Hyaluronic acid Salt leaching Naturally biodegradable strength
Kaplan, 2005) Silk fibroin Gas foaming Amicable for growth Rapid degradation rates
Crosslinking factor incorporation, Chemical modifications
supporting cells can reduce
biocompatibility

Synthetic Polymers Poly lacticide (PLA) Salt leaching Scaffolds can easily Lack mechanical
(Karageorgiou and Poly glycolide (PGA) Gas foaming be tailored to meet strength
Kaplan, 2005; Simske Poly ethylene glycol Electrospinning application
et al., 1997; Ryan et al., (PEG) Sintering Amicable for growth
2006) Polyvinyl alcohol factor incorporation,
(PVA) supporting cells
Polyethylene
terephthalate (PET)
polyurethane
 The Benefit And Challenges Used of Textured and Porous Materials

STIMULATING TISSUE INGROWTH

- Porosity to Promote Bone regeneration and Implant Fixation -

BONE GROWTH
POROUS MATERIALS Naturally porous of bone, pore
size 1 100m
FOR JOIN REPLACEMENT Latest study required pore
size from porous materials
less than 100m

WHY IMMPORTANT ? Osteointegration

Bone Growth Dependent Porous materials help increased
with pore size Osteointegration (Implant with
Reduce Latent complication host bone )
of prothesis loosening
 The Benefit And Challenges Used of Textured and Porous Materials
STIMULATING TISSUE INGROWTH
- Porosity to Promote Bone regeneration and Implant Fixation -

CELL TYPE FROM HOST STIFFER IMPANT MATERIAL

Different cell type have POROUS METAL (most widely
preverential pore size. employed for loadbearing
applications) stiffer than bone host.
Bone becomes weakened and
susceptible to fracture and implant
loosening.
CHALLENGES

REDUCE DINAMIC FATIGUE STRENGTH &

HIGHER CORROSION RATE FIBROUS TISSUE
the pores may create stress This fibrotic tissue may inhibit bone
concentration sites for micro fractures, formation or prevent bony ingrowth
compounding implant fatigue from the host tissue, ultimately
reducing implant fixation strength
 The Benefit And Challenges Used of Textured and Porous Materials

STIMULATING TISSUE INGROWTH

- Texturing to Improve healing and restore Motion in Eye Implants -

EYE PROBLEM a. Examples of

porous
Severe Trauma, intraocular cancer or removal of hydroxyapatite
a blind and painful eye. This pobrlem (left) and
compensated with an ORBITAL IMPLANT. polyethylene
(right) orbital
implants

b. Sagittal view
of human orbit
showing
placement of
WHY TEXTURED AND POROUS MATERIALS ? orbital implant.
ORBITAL IMPLANT have important consideration
include : fit, optimized prosthesis motility, and
minimized long-term complications, such as
implant exposure, extrusion, migration, and
infection
 The Benefit And Challenges Used of Textured and Porous Materials
STIMULATING TISSUE INGROWTH
- Texturing to Improve healing and restore Motion in Eye Implants -

Hydroxyapatite (HA)
Good biocompability, , suturing this to the
extraocular muscles is difficult, roughness of
HA also makes more challenging.
Porous polyethylene (PPE)
CHALLENGES : flexible, easily molded, relatively inexpensive, and can
Porous orbital materials are stiffer in relation be sutured to surrounding tissue. PPE appears to incite
less inflammation and fibrosis than HA.
to the conjunctiva and surrounding tissue
Aluminum oxide (AO)
robust, biocompatible, easy to manufacture, and
less expensive than HA, is the newest porous
material used in orbital implants, with only one
commercially available implant
 The Benefit And Challenges Used of Textured and Porous Materials

DISRUPTING FIBROSIS
- Texturing to Disrupt Capsular Contracture of Breast Prostheses -
BREAST AUGMENTATION
All breast implants are constructed with a smoothed or textured shell of silicone elastomer, a
material pervasively used in medical devices
.
01 PROBLEM IN BREAST AUGMENTATION
Most common complication in breast augmentation surgery, with longterm contracture
02 incidence reported at 1525%.
FACTORS CONTRIBUTE TO BREAST IMPLANT CAPSULAR CONTRACTURE
03 including implant surface, implant placement, implant shape, bacterial infection, bleeding,
surgical technique, post-operative care, and patient health.

04 TEXTURED AND POROUS MATERIALS

Hypthotheses are that the tissue integration promoted by the
textured surface may be either reducing micromotion
05 PORE SIZE OPTIMUM
One clinical study comparing saline-filled silicone implants textured with
either 75150 m or 600800 m pore size concluded that both
morphologies were effective in reducing capsular contracture
 The Benefit And Challenges Used of Textured and Porous Materials
DISRUPTING FIBROSIS
- Texturing to Disrupt Capsular Contracture of Breast Prostheses -

CHALLENGES
Texturing reduces contracture incidence or
01 simply delays contracture onset

CHALLENGES
Disrupting the smooth surface with texturing
02 influences collagen arrangement and structure,
macrophage population, micromotion, and risk of
infection

CHALLENGES
Patient preference suggests that breast firmness
is not a definitive factor in deciding which type of
03 breast implant is preferred. Textured implants
often have an unnatural feel, because textured
implant shells lack flexibility
 The Benefit And Challenges Used of Textured and Porous Materials
- Texturing to Minimize Fibrotic Encapsulation of Glaucoma Drainage Devices-
GLAUCOMA DRAINAGE DEVICE
Schematic of glaucoma drainage
device placement in eye.
(Ahmed Glaucoma Valve
glaucoma drain, New
World Medical, Inc.)
DISRUPTING FIBROSIS
GLAUCOMA DRAINAGE DEVICE
Glaucoma is the obstruction of
aqueous drainage that causes the
intraocular pressure (IOP) to
increase to the point of nerve
damage
Glaucoma drainage devices (GDDs)
are silicone tubes inserted into the
anterior chamber of the eye.
Attached to the tube is a plate that
is sutured beneath the conjunctiva.
Over two to four years, a thick
fibrous capsule forms around the
device, causing the filtering bleb to
fail at least 20% of the time
WHY TEXTURED AND
POROUS MATERIALS ?
Implant material, rigidity,
flexibility, and shape are potential
contributors to long-term device
failure. Micromotion of a smooth,
rigid plate against the scleral
surface has also been attributed
to exacerbating scar tissue
formation by causing constant,
low-grade inflammation.
To Reduce micromotion using a
POROUS PLATE (50m pore size
silicone attached to smooth
plate).
 The Benefit And Challenges Used of Textured and Porous Materials
DISRUPTING FIBROSIS
- Texturing to Minimize Fibrotic Encapsulation of Glaucoma Drainage Devices-

LIMITING BLEB ELEVATION PORE SIZE

COMPARED WITH SMOOTH DESIGNS
The smaller pores within the
inner layer prevent cells from
infiltrating the device lumen and
valve or restricting aqueous
HIGHER INCIDENCES OF humor outflow.
DIPLOPIA (DOUBLE VISION)
CHALLENGES
The larger outer pore layer
stimulates tissue integration
and blood vessel formation
adjacent to the device, as well
as reducing capsule thickness
 The Benefit And Challenges Used of Textured and Porous Materials

PROMOTING ANGIOGENESIS
- Improving Long-Term Performance of Vascular Grafts -

SYNTHETIC VASCULAR GRAFTS

Repair damaged or occluded blood vessels
Challenged to create synthetic grafts that mimic physiological function
Graft material porosity is related to graft healing and is critical as part of the
strategy to form a stable, endothelium lined lumen to provide an anti
thrombotic surface that is similar to native vessels

TEXTURED AND POROUS MATERIALS

Numerous studies conclude that high porosity (60 m pores) ePTFE small diameter
grafts have superior graft healing compared to low porosity (30 m pores) grafts in
terms of patency as well as the rate, stability, and completeness of luminal
endothelialization.
Optimal pore size for achieving stable luminal endothelium coverage in small diameter
grafts is 60m
Example material is ePTFE and Dacron
 The Benefit And Challenges Used of Textured and Porous Materials
PROMOTING ANGIOGENESIS
- Minimizing Infection and Epithelial Downgrowth -

PERCUTANEOUS DEVICES
Provides route to infection
and increases complications EXCEPT METODE (NOT
associated with wound non- USED POROUS
closure
MATERIALS)
antibiotics

Infection and Epithelial

Downgrowth (PERCUTANEOUS TEXTURED AND
INFECTION) POROUS MATERIALS
Ranges between 80,000 and Several porous and
250,000 annually in the USA textured biomaterials have
been investigated to
improve percutaneous
device performance and
longevity
 The Benefit And Challenges Used of Textured and Porous Materials
PROMOTING ANGIOGENESIS
- Minimizing Infection and Epithelial Downgrowth -

AVULATION AND MARZUPILATION topological properties

when epidermis surrounding the implant irregular topologies may be more prone to
grows parallel to the implant surface and harboring bacteria (Chehroudi and Brunette,
unites under the implant, surrounding the 2002). Bacteria may out compete tissue cells
implant in an epidermal pocket. in adhering to an implant surface, thus
preventing tissue integration and promoting
infection.

CHALLENGES
smooth surface implants Perimigration
parallel collagen fibers against smooth Competition between macrophages, giant cells, and
surfaces create poorly integrated, avascular fibroblasts within the pores prevents connective
capsules prone to separation from the tissue maturation and scar tissue formation
implant during wound contracture (Kim et
al.,2006).

avascularity of the fibrotic tissue

has been reported to encourage bacterial
attachment in the tissue surrounding the
catheter
 The Benefit And Challenges Used of Textured and Porous Materials
PROMOTING ANGIOGENESIS
- Porous Coatings to Improve Glucose and Oxygen Transport to Implanted Sensors -

Why Textured And Porous Materials

To improve long-term Percutaneous The Last Result
glucose sensors were performed using sensors
From in vitro test porous materials covered with a porous
create the ideal environment angiogenic and bioprotective
ePTFE membrane,
unfortunately inflammation
within the angiogenic layer in
Percutaneous glucose sensors 80% of sensors
The foreign-body response
ultimately causes impedance of
glucose and oxygen transport to
the sensor, resulting in sensor
signal deterioration, and frequently
sensor failure
 The Benefit And Challenges Used of Textured and Porous Materials
PROMOTING ANGIOGENESIS
- Porous Coatings to Improve Glucose and Oxygen Transport to Implanted Sensors -

Topographical approaches
Topographical approaches for improving long-term sensor performance were first proposed by Woodward (1982), who
suggested that the best coating for an implanted glucose sensor was a sponge that encourages tissue ingrowth and disrupts
fibrosis

Example of a: (a) Medtronic Mini Med SOF-SENSOR TM glucose sensor; and (b) an experimental porous poly-L-lactic
acid (PLLA) coating applied to the sensor tip for investigational purposes. Inset: environmental scanning electron
microscope image of porous PLLA coating fabricated using salt-leaching/gas foaming with ammonium bicarbonate
(NH4 HCO3). (Koschwanez, H. E. (2006). Unpublished data.) Courtesy of John Wiley and Sons.
 The Benefit And Challenges Used of Textured and Porous Materials
PROMOTING ANGIOGENESIS
- Porous Coatings to Improve Glucose and Oxygen Transport to Implanted Sensors -
 The Benefit And Challenges Used of Textured and Porous Materials
PROMOTING ANGIOGENESIS
- Porous Coatings to Improve Glucose and Oxygen Transport to Implanted Sensors -
A Variations in pore size and pore structure
B Sensor failure in vivo
Increasing collagen deposition within the
C sponge implant
Mechanical stresses imposed by the
D percutaneously implanted sensor
CHALLENGES
Variations in pore size and pore
structure
Limit the conclusions that can be drawn about how
A
pore size influences tissue response
Sensor failure in vivo
B fibrotic capsule that forms around glucose
sensors
Increasing collagen deposition within
C the sponge implant
Failing sensor sensitivity was found to correlate
with increasing collagen deposition within the
sponge implant
D
Mechanical stresses imposed by the
percutaneously implanted sensor
may have overshadowed the angiogenic-inducing,
collagen-reducing properties of porous
coatings
Longterm Effect Of Optimum Pore Size Between Titanium Implants And
Combination Ti/PEEK On The Posterior Interbody Lumbar Spine

Effect of pore size on bone
ingrowth into porous titanium
implants fabricated by additive
manufacturing: An in vivo
experiment
In this study, we evaluated the effect
of pore size with constant porosity
on in vivo bone ingrowth in rabbits
into porous titanium implants
manufactured by SLM.
Combination Ti/PEEK ALIF cage
for anterior lumbar interbody
fusion: Early clinical and
radiological results
In this study, the clinical and
radiological outcomes of a
combination titanium/
polyetheretherketone (Ti/PEEK) ALIF
cages in one, two and three-level
surgery were evaluated
Porous Titanium-6 Aluminum-4
Vanadium Cage Has Better
Osseointegration and Less
Micromotion Than a Poly-Ether-
Ether-Ketone Cage in Sheep
Vertebral Fusion
In this study, we developed a porous
Ti cage using electron beam melting
(EBM) technique to reduce its elastic
modulus and compared its spinal
fusion efficacy with a PEEK cage in a
preclinical sheep anterior cervical
fusion model.
 Longterm Effect Of Optimum Pore Size Between Titanium Implants And
Combination Ti/PEEK On The Posterior Interbody Lumbar Spine
Effect of pore size on bone ingrowth into
porous titanium implants fabricated by
additive manufacturing: An in vivo
experiment
Three porous titanium implants (with an
intended porosity of 65% and pore sizes
of 300, 600, and 900 m, designated the
P300, P600, and P900 implants,
respectively) were manufactured by SLM,
were evaluated and verified using
microfocus X-ray computed tomography.
Bone ingrowth was evaluated by their
implantation as cylindrical porous
titanium implants into the cancellous
bone of the rabbit femur for 2, 4, and 8
weeks.
Combination Ti/PEEK ALIF cage for
anterior lumbar interbody fusion: Early
clinical and radiological results
In this study, we have found that utilizing
Ti/PEEK interbody cages containing
Allograft and BMP-2, in one, two and
three-level ALIF procedures, proved to be
an effective treatment for Lumbar
spondylotic radiculopathy and back pain.
There were no patients with lucency or
halo adjacent to the titanium endplates at
the 3-month postoperative mark,
consistent with bone/Titanium
incorporation.
Porous Titanium-6 Aluminum-4
Vanadium Cage Has Better
Osseointegration and Less Micromotion
Than a Poly-Ether-Ether-Ketone Cage in
Sheep Vertebral Fusion
In the sheep anterior spinal fusion model, the
implantation of porous Ti cages fabricated by
electron beam melting can achieve rapid bone
ingrowth. In addition, they have better bone-
material integration and mechanical stability
than PEEK cages. The Ti cage eliminates the
need for autografting to fill up the cage, which
greatly simplifies the surgical procedure and
makes it very suitable for patients with
insufficient auto-grafts. This new cage has great
clinical potential.
Longterm Effect Of Optimum Pore Size Between Titanium Implants And
Combination Ti/PEEK On The Posterior Interbody Lumbar Spine

MATERIALS (Tittanium & PEEK) TISSUE INGROWTH

Most commonly used in
PORE SIZE & POROSITY
Rate of bone growth into a
porous material is highly
dependent on pore size
(Klawitter et al., 1976) and pore
connectivity (Hing et al., 2004
Porous surfaces promote
biomedical aplication ( Join tissue ingrowth that minimizes
Replacement ) OSSEINTEGRATION interfacial cell necrosis
from mechanical shear forces,
Osteointegration will not occur if fibrous tissue that in turn results in less
ingrowth precedes first. Fibrous ingrowth has
inflammation and reduced
been shown to occur with pores smaller than 15 capsule thickness (Rosengren
m (Simske et al., 1997) or larger than 1000 m
et al., 1999).
(Ryan et al., 2006), suggesting different cell types
have preferential pore sizes.
Fr eePower PointTemp
lat es
Long-term Effect Of Optimum Pore Size Between Titanium Implants And
Combination Ti/PEEK On The Posterior Interbody Lumbar Spine
FROM 3 PAPER ABOVE WE CAN GET :
Optimum pore size using Titanium is 600m
Tittanium better than PEEK
Ti/PEEK proved to be an effective treatment for Lumbar spondylotic
radiculopathy and back pain.

The aim and advantageous of this research:

- Improving the ability of long term spinal device,
- To determine the influence of pore size when combined
material (Ti / PEEK),
- To determine optimal pore size of each of the materials
when will be applied in spinal device,
- Ensure material which is better able to whether the
combination Ti and PEEK replaces the function Ti which
have been the best choice.
THANK YOU
2017