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Nanomaterials 2018, 8, 681 8 of 25 by AgNPs and the impressive interest oriented toward their application in wound therapy and medical-device coatings, their biocompatibility and safety aspects must be thoroughly clarified [187]. 7. Silver Nanoparticles for Bone Healing Every year, millions of people worldwide are affected by distinctive and complex bone-related pathologies, including infectious diseases, degenerative and genetic conditions, cancers, and fractures [188]. Unfortunately, the opportunistic contamination and colonization of orthopedic implants represent major concerns in osseous-tissue replacement strategies, since the related infections are associated with high morbidity [189]. Bone is an active tissue that undergoes regenerative and restorative processes through the intrinsic and complex bone-remodeling mechanism [190]. Bone grafts are usually implanted to replace or restore severe defects that irremediably affect osseous tissue, such as genetic malformations, tumors, or traumas [191]. Orthopedic and bone-implant-related infections are usually associated with highly inflammatory processes and subsequent implant loss and bone-destruction phenomena [192]. Previous studies reported that AgNPs naturally improve the differentiation process of MC3T3-1 pre-osteoblast cells and subsequent bone-like tissue mineralization, when compared with other NPs [193]. Currently, silver-coated prostheses represent an unconventional approach during the prophylaxis of tumor-related infections and extensive trauma-related infections. However, no clinical studies comparing the long-term clinical impact of nanosilver-coated implants for revision arthroplasty are reported as of yet [194]. The self-repairing capability of bone can be limited when bacterial activity occurs in bone defects. Compared with usual antibiotics, AgNPs possess intrinsic antibacterial activity with a broader spectrum. Also, the bacterial resistance to AgNP activity is an uncommon phenomenon, thus emphasizing that the bactericidal mechanisms of nanosilver act in synergy. Thanks to this peculiar property, AgNPs have the capability to inhibit or impair biofilm development or mature biofilm, respectively, in the case of antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus [195]. Human bone, dentin, and dental enamel are mainly composed of crystallized hydroxyapatite (HA), which is a calcium-phosphate salt [196]. Given the specific biocompatibility of biosynthesized and synthetic HA, this material and its derivatives are extensively explored for the development of unconventional osseous-related restorative and regenerative strategies, either as artificial bone grafts or as coating materials for metallic implants [197]. With regards to the superficial modification of various metallic implant surfaces, biocompatible HA integrated with silver (either in metallic or ionic form) represents a suitable choice for the fabrication of bioactive and antimicrobial bone implants [198]. The antimicrobial efficiency of HA-based coatings embedded with nanosilver was evidenced against Gram-positive [199–201] and Gram-negative [202–204] bacterial strains. In terms of bone-replacement procedures, AgNPs are normally used as doping materials for synthetic and bio-inspired bone scaffolds, with relevant results being recently reported [205,206]. In order to induce antibacterial properties in HA coatings, several experimental techniques proved suitable for the incorporation of nanosilver within calcium-phosphate materials, such as laser-assisted deposition, electrochemical deposition, magnetron sputtering, ion-beam-assisted deposition, sol-gel technology, and microarc oxidation [207]. Previous studies showed that AgNP-implanted titanium displayed improved antibacterial ability, as well as excellent compatibility with osteoblasts, thanks to the micro-galvanic effects produced between the implanted AgNPs and the titanium substrate [208]. Many studies investigated the feasibility and clinical potential of adjusting acrylic cements with AgNPs, in order to provide unconventional and functionally improved biomaterials for orthopedic applications. While previous studies explored different acrylics modified with AgNPs, a significant part of the previous work is limited, since vital material characteristics and mechanical properties were not thoroughly analyzed [159,209–211].PDF Image | Biomedical Applications of Silver Nanoparticles
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