Bioactive Medical Ceramic Cement

Abstract

Bioactive, ceramic medical cements and methods for its use in treatment of bones and teeth in mammals are disclosed. This cement is non-exothermic and non-toxic, based upon setting of hydraulic ceramic compounds containing calcia, alumina, and silica phases. The self-hardening cement sets in vivo and in high humidity environments, and can be used in vivo without being easily washed out of the site. It also has dimensional stability, is resistant to acids present in an infection site or supragingivally, and has biocompatibility advantages of low inflammation and the formation of calcification layers in direct apposition to body tissue. Options include the addition of various radiopaque materials, and a variety of delivery systems including powder and liquid, capsule or pouch delivery, multiple pastes, or a unitary paste.

Claims

1. A biocompatible, osteogenic, bioactive, antimicrobial, and hydraulic self-setting ceramic cement composition for use in diverse medical, dental, and veterinary applications, including form restoration and device attachment, said cement composition characterized by: a fine ceramic powder phase having calcia, alumina, and silica compounds that are hydraulic, said ceramic powder phase having a maximum particle size less than 20 μm and a maximum median particle size of 9 μm; and a fine radiopaque powder, wherein when said fine ceramic powder phase is combined with said fine radiopaque powder into a powder mixture, and further wherein when said powder mixture is placed in contact with at least one aqueous fluid, said powder mixture begins to hydraulically set into a hardened cement mass while experiencing less than 0.1% linear expansion, has increased resistance to acids present at the site where it is applied, inherently forms calcific layers in direct apposition to body tissue at the site where it is applied, and sets at body temperature and room temperature without raising the local temperature of the site where it is applied during its hydraulic setting.

2. The ceramic cement composition of claim 1 further characterized by said alumina compound in said fine ceramic powder phase comprising monocalcium aluminate present in the range of 35% to 70% by weight.

3. The cement composition of claim 2 further characterized by formulations in which said monocalcium aluminate is adjusted within said range of 35% to 70% by weight for accelerated hydraulic setting into a hardened cement mass in teeth and bone cavity filling, vital and non-vital dental pulp therapy, securing prosthetic and orthodontic devices, root-end filling, post or device cementation, dental ridge augmentation, pulp capping, sealing, bone fixation, retention of separation of collapsed vertebrae, and replacement of missing bone.

4. The ceramic cement composition of claim 1 further characterized by said silica compound in said fine ceramic powder phase comprising tri/dicalcium silicate, with said tricalcium silicate present in the range of 45% to 75% by weight and said dicalcium silicate present in the range of 7% to 32% by weight.

5. The ceramic cement composition of claim 1 further characterized by said fine ceramic powder phase present in the range of 50% to 85% by weight.

6. The ceramic cement composition of claim 5 further characterized by said fine radiopaque powder present in the range of 20% to 60% by weight.

7. The cement composition of claim 6 further characterized by said fine radiopaque powder having a maximum particle size of 20 μm and said powder mixture experiencing less than 1% linear shrinkage after hydraulic setting into a hardened cement mass occurs.

8. A method of using the composition of claim 7 in dental, medical, and veterinary application sites, said method comprising the steps of: a) providing a needle having a minimum size of 30-gauge, a quantity of said claim 7 composition, a quantity of fluid, and an application site selected from a group consisting of dental, medical, and veterinary application sites; b) mixing at least some of said quantity of said claim 7 composition with at least some of said quantity of said provided fluid to create an unset cement mixture; c) selecting and placing at least some of said unset cement mixture into said needle; and d) using said needle to apply at least some of said unset cement mixture to said provided application site, wherein, after said application via said needle, hydraulic setting of said unset cement mixture occurs at said provided application site.

9. The ceramic cement composition of claim 1 further characterized by said powder mixture formulated with a non-aqueous liquid as a ready-to-use, single paste Tillable into and extruded from a syringe, said powder mixture present in the range of 60% to 85% by weight.

10. A method of using said ready-to-use, single, low-viscosity paste of claim 9 in an application site selected from a group consisting of medical, dental, and veterinary application sites, said method comprising the steps of: a) providing a needle having a minimum size of 30-gauge, a quantity of said claim 9 ready-to-use, single, low-viscosity paste, and a selected application site; b) selecting and placing at least some of said claim 9 ready-to-use, single, low-viscosity paste into said needle; and c) using said needle to apply at least some of said claim 9 ready-to-use, single, low-viscosity paste to said provided application site, wherein, after said application via said needle, hydraulic setting of said claim 9 ready-to-use, single, low-viscosity paste occurs.

11. The ceramic cement composition of claim 1 further characterized by formulation selected from a group consisting of said powder mixture, and at least one ready-to-use paste made with organic liquids, said fine ceramic powder phase of said formulation further characterized by nanoparticles of stabilizing agent providing a shelf life greater than one-year without refrigeration, said stabilizing agent selected from a group consisting of organic stabilizing agents and inorganic stabilizing agents.

12. A method of using said formulation of claim 11 in an application site selected from a group consisting of medical, dental, and veterinary application sites, said method comprising the steps of: a) providing a quantity of said claim 11 formulation, a quantity of viscosity-adjusting fluid, a selected application site, and a mechanical mixing and dispensing means adapted for mixing at least a portion of said quantity of said claim 11 formulation with at least a portion of said quantity of said viscosity-adjusting fluid to create an unset ceramic cement mixture, and then releasing at least a portion of said unset ceramic cement mixture so it can undergo hydraulic setting and create a hardened cement mass; b) associating at least some of said quantity of said claim 11 formulation with said mechanical mixing and dispensing means; c) also associating at least some of said quantity of said viscosity-adjusting fluid with said mechanical mixing and dispensing means; d) mixing said associated amounts of said claim 11 formulation and said viscosity-adjusting fluid to create an unset ceramic cement mixture; and e) using said mechanical mixing and dispensing means to apply at least some of said unset ceramic cement mixture to said provided application site, whereinafter said application hydraulic setting of said unset ceramic cement mixture occurs to create a hardened cement mass.

13. The method of claim 12 further characterized by said mechanical mixing and dispensing means being selected from a group consisting of mixing syringes, mixing tips for syringes, capsules, multi-compartment foil pouches, and trituration capsules.

14. The method of claim 12 further characterized by said steps b) and c) occurring off-site prior to receipt by a clinician of said claim 11 formulation, said quantity of viscosity-adjusting fluid, and said mechanical mixing and dispensing means, and said steps d) and e) being accomplished by said clinician to create said hardened cement mass.

15. The ceramic cement composition of claim 1 further characterized by formulations selected from a group consisting of a formulation comprising said powder mixture and said at least one fluid in contact with said powder mixture for hydraulic setting purposes being water, a formulation comprising said powder mixture and said at least one fluid in contact with said powder mixture for hydraulic setting purposes being at least one aqueous gel, a formulation for in vivo application comprising said powder mixture and said at least one fluid in contact with said powder mixture for hydraulic setting purposes being biological fluids, a formulation comprising said powder mixture prepared as a high-viscosity unitary paste and said at least one fluid in contact with said powder mixture for hydraulic setting purposes being water, a formulation comprising said powder mixture prepared as a unitary paste and said at least one fluid in contact with said powder mixture for hydraulic setting purposes being a water miscible liquid containing at least one polymer adjusting viscosity, flow, elasticity, and setting time of said paste, a formulation comprising said powder mixture prepared as at least two pastes that become mixed together prior to hydraulic setting, and formulations comprising said fine ceramic powder phase and said radiopaque powder provided alone and with other materials as two separately blended pastes, one hydraulic and one non-hydraulic, said two separately blended pastes mixed together prior to hydraulic setting.

16. The cement composition of claim 1 further characterized by said fine radiopaque powder selected from a group consisting of zinc oxide, zirconia, iodoform, calcium tungstate, cerium oxide, tantalum oxide, tungsten, barium sulfate, silver, gold, radiopaque silicate glasses containing a maximum amount of less than 60% by weight of baria or strontia, and radiopaque phosphate glasses containing a maximum amount of less than 60% by weight of baria or strontia.

17. The ceramic cement composition of claim 1 further characterized for minimized bubble formation by said at least one aqueous fluid placed in contact with said powder mixture having at least one water-soluble polymer with a maximum molecular weight of 50,000, at least one water-miscible organic liquid, and at least one defoaming salt.

18. The ceramic cement composition of claim 1 further characterized by said at least one fluid comprising at least one water-soluble polymer having a molecular weight greater than 50,000 and vigorous mixing of said at least one fluid with said powder mixture creating an unset cement mixture having stable bubbles ranging in size from 25 to 200 μm that remain in said unset cement mixture when applied in vivo to create interconnected porosity after hydraulic setting of said unset cement mixture into a hardened cement mass.

19. The ceramic cement composition of claim 1 further characterized by color stability upon exposure to visible light, medicaments containing sodium hypochlorite, and medicaments containing formalin.

20. The ceramic cement composition of claim 1 further characterized by said powder mixture and water forming an unset cement mixture, said unset cement mixture having resistance to washout when placed in an application site for hydraulic setting into a hardened cement mass, and said unset cement mixture also having an initial setting time in the range of 2 to 5 minutes when its powder-to-water ratio is in the range of 4:1 to 2:1.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0030] The sole illustration accompanying this disclosure is a simplified ceramic phase diagram adapted to show non-overlapping regions for Calcia, Alumina, and Silica where calcium silicate and calcium aluminate cements are stable. It was adapted from a more complex diagram used by Leif Hermansson whose publication is entitled: A Review of Nanostructured Ca-aluminate Based Biomaterials within Odontology and Orthopedics, Journal of the Korean Ceramic Society 2018; 55(2): 95-107. Visually, the cement phases used in the present invention are shown in this sole illustration where area 1 indicates the calcium silicate cement region and area 2 indicates the calcium aluminate cement region. It is important to note that these formula regions 1 and 2 are non-overlapping and distinct from one another.

DESCRIPTION OF EMBODIMENTS

Examples

[0031] The present disclosure of a hydraulic bioactive medical ceramic cement material herein includes a fine ceramic powder component, which is a combination of hydraulic cement powders. The hydraulic powders used in the present invention are distinctively different and involve the combination of hydraulic ceramic compounds: monocalcium aluminate cement, tricalcium silicate and dicalcium silicate. Such a ceramic powder component, further combined with radiopaque powders and other minor ingredients creates a versatile bioactive medical ceramic cement. This present invention material may be used to create a variety of products of low and high-viscosity (such as 100K cP and 2,500K cP) that can also set in vivo and be bioactive.

[0032] The generally accepted composition ranges for the two ceramic cements depicted in the sole illustration accompanying this invention disclosure are listed in Table 1 by chemical components and in Table 2 by phases. The phases present in calcium silicate hydraulic materials differ from those present in calcium aluminate powder.

TABLE-US-00001 TABLE 1 Comparisons of Hydraulic Cement Compositions Cement Calcium silicate Calcium aluminate Component notation Minimum Maximum Minimum Maximum CaO C 61 67 17 33 Al.sub.2O.sub.3 A 2.5 6 65 81 Na.sub.2O N 0 0.3 0 0.6 SiO.sub.2 S 19 23 0 0.8 Fe.sub.2O.sub.3 F 0 6 0 0.4 MgO M 0 0.4 0 0.4 Sulfate 1.5 4.5 0 0

TABLE-US-00002 TABLE 2 Phase composition (weight %) of Hydraulic Cements Cement Calcium Calcium Clinker notation silicate aluminate Tricalcium silicate (CaO).sub.3•SiO.sub.2 (alite) C.sub.3S 45-75 0 Dicalcium silicate (CaO).sub.2•SiO.sub.2 (belite) C.sub.2S  7-32  0-7 Tricalcium aluminate (CaO).sub.3•Al.sub.2O.sub.3 C.sub.3A  0-13 0 Tetracalcium aluminoferrite C.sub.4AF  0-18 0 Gypsum CaSO.sub.4•2 H.sub.2O  2-10 0 Monocalcium aluminate CaAl.sub.2O.sub.4 CA 0 35-70 Dodecacalcium heptaaluminate C.sub.12A.sub.7 0  0-10 Monocalcium dialuminate CaAl.sub.4O.sub.7 CA.sub.2 0  0-30 Alumina Al.sub.2O.sub.3 A 0  0-33 Gehlenite Ca.sub.2Al[AlSiO.sub.7] C.sub.2AS 0  1-11 Wüstite (FeO) F 0  0-7

[0033] A prior invention disclosure of the applicant/inventor herein, (Primus '342) mentioned the use of calcium aluminate and calcium silicate cement. Although calcium monoaluminate cement was mentioned, the examples only included tricalcium aluminate cement. Also, the final setting time in Primus '342 was noted to be about 2 hours for a combined cement, but not the 2 to 5 minutes for the initial setting time disclosed herein for the present invention; wherein, the setting time is variable depending on the powder-to-water ratio.

[0034] Calcium aluminate and calcium silicate cements are combined in the present invention to improve acid resistance and set faster. The combination also lowers the pH slightly, while remaining alkaline, which may reduce inflammation or cytotoxicity in contact with tissue, yet retain the bioactivity of cement to support healing responses. The acid resistance of the calcium aluminate cement may enhance the setting of these bioactive cements in the presence of infections encountered when placed in perforations in root walls or infected root tips. Faster setting is appreciated by medical professionals. The combination of ceramics providing the matrix of the present invention is useful because bone regeneration is assisted by the presence of silica, with reduced vulnerability to acid.

[0035] Ceramic cements for industrial uses with a low price are preferred, and are achieved by manufacture with less grinding, creating a coarser particle size. In medical devices, a fine powder is preferred. The particle size of the powder used as a part of the present invention is substantially reduced. Preferably, any auxiliary powders are as fine or finer than the ceramic cement powders, and may contain nanoparticles (<0.1 μm, 100 nm).

[0036] The components of powders in the present invention products (both cement and auxiliary powders) are all fine powders with a maximum particle size less than 20 μm and preferably less than 15 μm with a median particle size less than 9 pm and preferably less than 5 μm, and additionally with up to 10% nanoparticles. The fineness of the powder importantly increases the surface area, which increases the reactivity and speed of present invention setting, enables its penetration into bone or tooth architecture, makes dispensing of the present invention possible through 30-gauge syringe tips, reduces segregation of powder and liquid, and makes present invention pastes more homogeneous with a smooth feel to the paste.

[0037] The fineness of the present invention powders should include its radiopaque powder, which may include those compounds mentioned in paragraph [0043]. However, bismuth compounds are avoided because of the multiple oxidation states of bismuth that have colors ranging from yellow to dark brown. Oxidation of bismuth compounds are known to occur in the presence of formalin, sodium hypochlorite, and when exposed to light. Discoloration of prior inventions, such as Torabinejad '547 and '638, and Primus '342, has been observed when used within the primary teeth having thin enamel layers [Ref 9, Hutcheson]. Without the use of bismuth, discoloration of the present invention is avoided in dental applications. Many other ceramic or metal compounds provide radiopacity and are inert.

[0038] The powder formulas 1 through 6 in Table 3 are examples of bioactive ceramic cement powders contemplated by the present invention herein. These powders can be mixed with any water-based liquid and set, but were also mixed with a non-aqueous liquid noted in Table 4 to make pastes. The pastes in Table 4 are created for the convenience of the dentist or other medical professional to dispense without mixing. As the pastes set in vivo, the organic liquid is replaced by water from the body fluids to set the hydraulic cements. The powders hydrate and remain in the tooth as a hard mass; the organic liquid diffuses out of the treated area.

[0039] One example of a bioactive cement according to the present invention contains 40% tantalum oxide, 25% of a calcium aluminate cement, 25% calcium silicate cements, 9% of a fluidic stabilizing component and 1% of a salt. The fluidic stabilizing component may be inorganic or organic and include zeolite, chitosan, xanthan gum, polyacrylic acid, sodium polyacrylate, calcium lactate gluconate, and non-expansive clays. The fluidic stabilizing components create a dense cohesive paste when a liquid is mixed with the powder, and minimize the segregation of the fine powder and the liquid in bulk or in containers. Naturally occurring, water-soluble polymers which are preferred as a part of the present invention, but not limited thereto, include guar gum, pectin, xanthan gum, chitosan and its derivatives, carrageenan, cellulose ethers, hyaluronic acid (HA), albumin, and starch. Depending on the concentration, some of these polymers, such as polyacrylic acid and sodium polyacrylate have been blended with the ceramic powder for dissolution when a water-based liquid is added to the powder.

[0040] Many salts have been used to accelerate or retard the setting of calcium silicate cements [Ref 10, Taylor]. Salts have been included to reduce the foaming of the cement when it is mixed with liquids and may also accelerate the setting. Salts suitable for this invention include sodium carbonate, potassium carbonate, calcium nitrate and lithium nitrate.

[0041] Some polymers may be added to the present invention to introduce a slight expansion by being superabsorbent, that is absorbent of water or tissue fluids, and imparting a slight expansive characteristic. This expansion may be useful for filling the complex anatomy where the cement is placed, providing more interlocking of the cement and bone or tooth. Slight expansion is beneficial compared to polymerization shrinkage.

[0042] When a bioactive scaffold is needed, salts or polymeric additives that cause foaming may be added to cement mixtures. Foamed cements have been made for other industrial application such as U.S. Pat. No. 3,926,650 A (Lang et. al, 1975). A permeable cement may be suitable to fill a bone void with a porous material that can then be infiltrated by cells over time [Ref 11, Zhang et. al] and is disclosed in U.S. Pat. No. 5,149,368 (Liu et. al, 1992). Cells may resorb normally non-resorbable materials if porous. Other powders enhance resorption including a bioactive glass or calcium sulfate which are resorbable components that can create pathways for tissue engineering and cell in-growth in the cement as the additives are resorbed. Salts that cause foaming may also be used with the present invention for the same or similar purposes.

[0043] A preferred example of a bioactive cement, identified by the number 6 in Table 3 herein below, shows the present invention containing 25% of a calcium aluminate cement, 25% calcium silicate cement, 40% tantalum oxide, and 6% of a fluidic stabilizing component by weight.

TABLE-US-00003 TABLE 3 Example of Compositions of Bioactive Ceramic Cements (weight %) Powder Component 1 2 3 4 5 6 7 Tri/dicalcium silicate cement 30 24 24 24 23 25 24 Calcium aluminate cement 35 24 24 24 23 25 24 Radiopaque component: tantalite, 35 46 46 46 45 40 46 calcium tungstate or zirconia Halloysite 6 9 Xanthan gum 6 9 Zeolite 6 Sodium carbonate 1 Water-soluble polymer 6

[0044] The combination of calcium aluminate and calcium silicate cements in this preferred example of bioactive cement 6 reduced the initial setting time. The initial setting time is important to clinicians because they want to be sure the material is stably placed at the site, rinse the site, and close the opening. As a result, the present invention herein provides compositions wherein a certain degree of firmness can be developed at various times after mixing. The ceramic cement powder mixed with water at a ratio of 3:1 by weight has an initial set in 3 minutes, which is desirable in dentistry. In this configuration, the calcium silicate content is less than 20%.

[0045] The radiopaque component of the present invention may be any combination, but not limited to, the following powders: barium sulfate, calcium tungstate, cerium oxide, gold, iodoform, phosphate-based glass, silver, silicate glass, tantalum oxide, tungsten, zinc oxide, or zirconia. Any glass powder should contain baria or strontia for radiopacity. Usually the amount of radiopaque agent is kept to less than 60 weight percent and less than 50 mole percent, which is always less than the weight percent. The radiopacifier may have multiple purposes such as enhanced radiopacity, providing an antimicrobial effect, or contributing a color.

[0046] The ceramic powders of Table 3 can be inserted in the body to self-set in the presence of body fluids. Instruments for powder placement include but are not limited to a Dovgan carrier, an endo gun, a MAP system, or an amalgam carrier.

[0047] Alternatively, the biomedical cements of the present invention can be mixed with various liquids, water-based and non-aqueous, prepared at various consistencies, low or high viscosity, to harden and create a bioactive ceramic cement in vivo. This versatility is useful clinically. For instance, a material intended for bone fragment fixation or root-end filling requires a higher powder to liquid ratio and preferably a more viscous gel for a more putty-like consistency than one would need for cementing a tooth implant, an endodontic post or for a root canal sealer, which are desirably more fluid. The consistency of the present invention can range from a thin injectable paste that can be delivered through a 30-gauge or larger needle, to a thick clay-like consistency, depending on the preparation of the cement powder with liquid as a paste.

[0048] The present invention bioactive cement may be supplied with a separate container of liquid for mixing just before use. The simplest liquid that can be combined with a powder phase to form the present invention is water. This leads to a very fast setting cement, about 3 minutes, using a Gilmore needle apparatus per the ISO 6876:2012 (Endodontic Sealing Materials) method.

[0049] A water-based liquid may be supplied with present invention ceramic powder that includes various salts. Certain additives are known to accelerate or retard the setting of calcium cements and can be added to the ceramic cement powder or to an accompanying liquid. Accelerants may preferably include, but are not limited to: lithium salts, calcium hydroxide, potassium hydroxide or carbonate, potassium carbonate, and sodium hydroxide, carbonate, or sulfate. Other inorganic compounds may have a retarding effect [Ref 12, Lea] on setting.

[0050] A water-based liquid for the present invention ceramic cement may include organic water-miscible liquids, silica solutions, or water-soluble polymers. When mixed or dissolved in water, these additives can improve the handling and manipulation of the cement for the convenience of the clinician. The organic liquids may include glycerin, glycols, and fish or vegetable oils. Water-soluble synthetic polymers may include polyvinyl alcohol (PVA), polyvinyl pyrrolidone (PVP), polyethylene glycol (PEG), polyacrylic acid (PAA), polyacrylamides, N-(2-Hydroxypropyl) methacrylamide (HPMA), DIVinyl Ether-Maleic Anhydride (DIVEMA), polyoxazoline, polyphosphates, and polyphosphazenes. Such water-miscible liquids, solutions or water-soluble polymers may be included in a liquid to mix with the powder to create special features of flow, film thickness, working or setting time. A liquid to accompany the present invention cement may comprise naturally occurring, water-soluble polymers, including but not limited to guar gum, pectin, xanthan gum, chitosan and its derivatives, carrageenan, cellulose ethers, hyaluronic acid (HA), albumin, and starch. These liquids must be stable and not contain bioburden.

[0051] The molecular weight of the water-soluble polymers in gel form for use with the present invention bioactive cement may be selected to pinpoint the desired viscosity of the cement after mixing with a liquid. Higher molecular weights make more viscous solutions requiring less polymer and can be used to create a porous cement when set. The powder, when rapidly spatulated with viscous liquid can create a foamy material for implantation with bubbles that remain after setting. Such a porous structure may be suitable for resorption over time, such as required in bone replacement. Ideally, the bubble size should be on the scale of the bone site, greater than 100 μm with interconnected porosity [Ref .sup.13, Petrochenko]. The opposite is true for the lower molecular weight polymers. The lower molecular weight polymers lead to lower viscosity liquids that are less likely to form bubbles. High and low molecular weight polymers can be mixed and combined for use as a part of the present invention, including but not limited to polyvinyl alcohol, polyvinyl pyrrolidone, polyethylene glycol (PEG), polyacrylic acid (PAA), polyacrylamides, N-(2-Hydroxypropyl) methacrylamide (HPMA), DIVinyl Ether-Maleic Anhydride (DIVEMA), polyoxazoline, polyphosphates, and polyphosphazenes.

[0052] A low-viscosity liquid (less than 50,000 cP) that creates a long working time for the present invention bioactive cement and a highly elastic mixture will preferably contain <10% low volatility organic liquid, <5% of a defoaming salt or other material, <50% of a water soluble polymer of low molecular weight and water. The powder and liquid will be mixed at a ratio from 2:1 to 1:1, depending on the clinical preference.

[0053] A high-viscosity gel can be mixed to offer a shorter working time for the present invention bioactive cement and a clay-like consistency of the mixture, which will preferably contain <30% low volatility organic liquid, <50% water-soluble polymer, <5% of a defoaming salt, and water. Such water-soluble polymers may be a mixture of low, medium and high molecular weights. The powder and gel will be mixed at a ratio from 4:1 to 2:1, depending on the clinical preference.

[0054] Any of the liquids can be combined with the present invention bioactive cement in a capsule and mixed mechanically as in U.S. Pat. No. 5,394,980 (1995 Tsai). Alternatively, the powder and liquid can be packaged in a mixing syringe that is useful for the self-mixing therein, as in U.S. Pat. No. 8,454,558 B2 (2013 N. Jessop, et. al.). The powder and liquid can be packaged in a 2-compartment foil pouch and the barrier removed between the compartments for mixing just before use.

[0055] Unitary pastes having a long shelf life, >1 year shelf life, can be created with present invention bioactive ceramic cements. Such pastes set more slowly than the powder-water mixtures, but faster than other pastes based on only tri/dicalcium silicate cement. The bioactive powder of this invention may be blended with a non-aqueous liquid such as a glycerin or other organic liquids to create a biocompatible bioactive unitary paste. If the amount of liquid blended with the powder is about 60 to 75%, a low-viscosity paste (<50,000 cP) is formed that can be injected into a body cavity. In dentistry, such a paste would be useful for cementation of a prosthetic device, vertebral surgery, or non-surgical endodontic therapy using gutta percha points to obturate a root canal. If the powder percent is increased from 75 to about 85% powder, a high-viscosity (>500,000 cP), clay-like paste is created that can be used to pack into voids, and occlude openings in teeth either apically or coronally. Optionally, polymers may be dissolved in the non-aqueous liquid to adjust the setting time, viscosity, flow, or elasticity of the paste. Non-aqueous liquids are mixed with the ceramic powder to ensure a long-shelf life of the paste; otherwise the cement would quickly set.

TABLE-US-00004 TABLE 4 Examples of Bioactive Paste Compositions (weight %) High-viscosity paste, clay-like Low-viscosity paste Viscosity~1,000,000 cP Viscosity~200,000 cP Pastes # .fwdarw. 8 9 10 11 12 13 14 15 Tantalite or zirconia 35.9 35.9 35.9 35.1 31.3 31.3 31.3 30.6 Tri/dicalcium silicate 18.7 18.7 18.7 17.9 16.3 16.3 16.3 15.6 Calcium monoaluminate 18.7 18.7 18.7 17.9 16.3 16.3 16.3 15.6 Zeolite 4.7 0.0 0.0 0.0 4.1 0.0 0.0 0.0 Nano-clay 0.0 4.7 0.0 0.0 0.0 4.1 0.0 0.0 Xanthan gum 0.0 0.0 4.7 7.0 0.0 0.0 4.1 6.1 Water miscible organic liquid 22.0 22.0 22.0 22.0 32.0 32.0 32.0 32.0 TOTAL 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

[0056] The choice of liquid for making a unitary paste affects the shelf life of the paste. For instance, a commercial dental paste that contains tri- and dicalcium silicate but no alumina phase was compared to a high-viscosity unitary paste of the present invention. Both pastes were placed in small polytetrafluoroethylene molds at 37° C. and ambient humidity. The commercial paste had a shorter time before initial setting, 8 days, whereas the paste of the present invention did not undergo initial setting after 14 days. A longer working time, such as measured, is indicative of longer shelf life, with less evaporation of the organic liquid and less susceptibility to humidity.

[0057] A high-viscosity unitary paste was made of the present bioactive powder invention and compared to a commercial dental paste that contains no alumina phase but does contain tri/dicalcium silicate powder. Both the commercial and the paste of the present invention were placed in small polytetrafluoroethylene molds at 37° C. in a high humidity environment. The commercial paste did not set in 30 hours whereas the bioactive putty set initially in about 2:45 hr. and the final set was less than 9 hours. Although the setting time is significant for both materials, the complete setting is important to impart strength and sooner is better for healing. Therefore, the present invention has an apparent longer shelf life, but shorter setting time than other inventions.

[0058] The bioactive cement of this invention may be provided as a thick unitary paste in a syringe, with a second bottle or syringe of liquid. The clinician would dispense paste and if desired, add some of the supplied diluent liquid to reduce the viscosity just before use. If the diluent liquid is a water-based liquid, the mixed paste can begin to set immediately. If the diluent liquid is a non-aqueous liquid, the mixed paste, will have a longer working time and start setting when placed in vivo.

[0059] The bioactive medical ceramic cement powder of the present invention may be provided as multiple pastes, and the multiple pastes must be combined just before use. For instance, the radiopaque component may be combined with a water-based liquid in a paste in one syringe. The cement may be mixed with a non-aqueous liquid as a paste in a second syringe. The clinician would dispense paste from the two syringes, preferably in equal volumes, and mix the pastes just before use. Alternatively, the radiopaque component may be suspended in a water-based liquid and when mixed with the cement paste, the mixture may begin setting. If the radiopaque component is suspended in a non-aqueous liquid, the mixed paste from the two syringes will have a longer working time and start to set in vivo. The pastes may be packaged in two separate tubes or syringes, or the pastes can be packaged in a dual-barreled syringe and dispensed together by a common plunger, through a spiral, static mixing tip, which eliminates hand mixing.

[0060] Alternatively, the present invention of bioactive powder may be provided as more than two pastes, and the multiple pastes must be combined just before use. For instance, the radiopaque component may be combined with a non-aqueous liquid in one syringe as a very viscous paste. The present invention cement may be mixed with a non-aqueous liquid in a second syringe as a viscous paste. A third syringe or bottle containing a water-based gel may be combined with the other two pastes just before use to the viscosity desired. The combination of the three items would begin setting when mixed. Non-aqueous liquids ensure a long-shelf life of the cement-containing paste.

[0061] When a present invention low-viscosity bioactive cement mixture is manufactured, the ceramic medical cement can meet the requirements of international standards for dental materials, including those for endodontic sealers (ISO 6876:2012): flow greater than 17 mm, film thickness less than 50 μm, solubility less than 3%, and radiopacity more than 3 mm of equivalent aluminum. The dimensional stability of the cement is less than 0.1% expansion, and shrinkage less than 1% as required in ADA 57. The compressive strength after 28 days exceeds 35 MPa required in ADA 30:2013 for zinc oxide-eugenol for temporary cements, and the arsenic and lead contents are less than 2 and 100 ppm as required in ISO 9917-1 for water-based cements.

[0062] When powders, gels and pastes are made according to the present invention, the resulting material has enhanced properties over that of U.S. Pat. No. 7,892,342 B2 (Primus, 2011) as noted in Table 5. Furthermore, the resistance to washout is far superior compared to U.S. Pat. No. 7,892,342 B2 material. The pH is slightly lower, which contributed to the better biocompatibility with cells. The radiopacity was higher with more ceramic radiopaque powder.

TABLE-US-00005 TABLE 5 Physical Properties of Hydraulic Materials for Medical and Dental Uses Initial Loss after Dimensional Setting Film Washout stability Time Radiopacity thickness (weight (% linear Material (hr:mm) (mm of Al) (μm) %) change) Present Invention as 3:50 to 2:20 7.0 to 8.2 35 to 380  18 <0.2% unitary pastes (low and high-viscosity) Present invention as 0:03 7.2 350 Not tested <0.1% powder & water (2:1) Material of Primus ′342 2:55 5.0 350 100 <0.1%

[0063] For the sake of brevity, only certain ranges are explicitly disclosed herein. However, ranges from any lower limit may be combined with any upper limit to recite a range not explicitly recited, as well as, ranges from any lower limit may be combined with any other lower limit to recite a range not explicitly recited in this disclosure and in the same way, ranges from any upper limit may be combined with any other upper limit to recite a range not explicitly recited. Additionally, whenever a numerical range with a lower limit and an upper limit is disclosed, any number and any included range falling within the range are specifically disclosed. In particular, every range of values (of the form, “from about a to about b,” or, equivalently, “from approximately a to b,” or, equivalently, “from approximately a-b”) disclosed herein is to be understood to set forth every number and range encompassed within the broader range of values even if not explicitly recited. Thus, every point or individual value may serve as its own lower or upper limit combined with any other point or individual value or any other lower or upper limit, to recite a range not explicitly recited.

[0064] Although examples of the inventive compositions have been provided in the foregoing detailed descriptions, it should be understood that the invention is not limited only to the examples disclosed, but is intended to embrace any alternative, equivalent, modification, or rearrangement falling within the scope of the invention as defined by the following claims.

INDUSTRIAL APPLICABILITY

[0065] Industrially, a medical device may be manufactured using the present invention that is convenient, advantageous, and efficacious. The benefits include bioactivity, self-setting, biocompatibility, high pH, antimicrobial, improved acid resistance, faster setting, long life for premixed paste. This combination of features provides distinct and important advancement in the field.

[0066] The bioactive cement may be manufactured in a variety of versatile configurations and formats to address various needs for medical devices and supplied as kits to a clinician. One option is that the powder may be supplied alone. In vivo, the body fluids will be absorbed by the powder and setting will occur.

[0067] Another option is that the present invention bioactive ceramic cement may be provided as a two-part system with powder and water, or powder and a water-based liquid.

[0068] Furthermore, the present invention bioactive powder and a liquid may be packaged together in a capsule similar to capsules used for dispensing a unit-dose of dental amalgam such as shown in U.S. Pat. No. 5,394,980 (Tsai, 1995). In this capsule format, a barrier is used between the powder and liquid that is perforated just before use. After the barrier is broken powder and liquid can be mixed in a triturator, or dispensed for final mixing by hand. Alternatively, a capsule can be used for the present invention powder. Just before use, the capsule can be opened and liquid can be added to the powder in the capsule. The powder and liquid can be triturated in the capsule and then dispensed for placement.

[0069] Alternatively, a two-part foil pouch may be used with the present invention powder on one side and the liquid on the other. When a barrier is breached between the compartments, the powder and liquid can be mixed by hand in the pouch and then squeezed to dispense for placement in vivo.

[0070] Each of the formats has its own advantages depending on the indications for the clinical situations. For instance, a thick paste is especially suitable for in dental root-end filling and pediatric pulpotomy treatments, since time is especially important for treating children or in a root-end surgical operation. A thinner paste is needed for bone cement or root canal sealing with gutta percha. A paste with an intermediate viscosity is useful for filling uniting or aligning fractured bones or for placement of implants or an endodontic post.

[0071] The present invention ceramic medical cement can be used for permanent implantation with soft or hard tissue contact, particularly bone, pulpal or periradicular (root/bone) tissue. Resorption will not occur for the bioactive cement after setting, unless a foaming agent is used or if the material is mixed to such a thin consistency it would not set. The invention herein is suitable for use in the presence of blood or bodily fluids as the material is hydrophilic and sets in the presence of blood or fluid.

[0072] As described, the ceramic medical cement powder disclosed herein can be prepared in a variety of formats, but the powder is always biocompatible and bioactive when set because the setting reaction is the same: hydration of the two cement components forming a high pH cement that will elute calcium and hydroxide ions in water.

[0073] A benefit of the present invention cements is the dimensional stability of the ceramic materials after reaction with water. Neither shrinkage or expansion occurs. As a result the cement meets the ADA 57 standard for endodontic sealing materials of less than 1% linear shrinkage and less than 0.1% linear expansion. The dimensional stability is unlike polymers that generally shrink several percent and could allow bacteria ingress through the passage created by shrinkage. Expansion would also be deleterious as a material could create a hoop stress within the canal and fracture the root.

[0074] In dentistry, early childhood caries is a worldwide epidemic, and a global increase exists in dental caries prevalence in adults' permanent teeth. Performing pulpotomy treatment for deep caries is important for the primary teeth because caries are painful and interfere with nutritional intake. Furthermore, the premature loss of a tooth affects jaw bone development, speech, and the development and eruption of permanent teeth. Maintaining the vitality of the remaining pulp, after a pulpotomy, is especially important for immature, incompletely developed teeth in young adults. Enabling the roots of developing teeth to lengthen and the walls of the roots to thicken will provide a lifelong benefit. In adults, the preservation of tooth vitality via a pulpotomy is the lowest cost and least invasive approach. Pulpal or other endodontic treatment is often required for trauma, and a bioactive medicament is preferred. Thus, there is a continuing need for new products, such as the present invention bioactive medical ceramic cement that is versatile in meeting a wide variety of clinician needs.

[0075] Similar growing needs exist for orthopedics as the population ages with concomitant osteoporosis and other bone trauma or atrophy.

[0076] The bioactive ceramic cement of the present invention has the following characteristics: biocompatible (non-cytotoxic after setting, non-irritating, non-sensitizing, non-allergenic, and non-mutagenic), bioactive, antimicrobial, radiopacity, minimal expansion (less than 0.1%) and fine particle size for sealing, unaffected by moisture or blood, short setting time as a powder with water but adjustable depending on the liquid, easy to manipulate and place, washout resistant when mixed with liquids described, low heat of setting, sets under acidic better than calcium silicate cement alone, non-discoloring, having a bone or tooth-like color that does not change over time, and cost-effective for maintaining teeth in vivo.

REFERENCE SIGNS LIST

[0077] not applicable

REFERENCE TO DEPOSITED BIOLOGICAL MATERIALS

[0078] not applicable

SEQUENCE LISTING/SEQUENCE LISTING FREE TEXT

[0079] not applicable

CITATION LIST

PATENT LITERATURE

[0080] 1. U.S. Pat. No. 3,926,650 A, Dec. 16, 1975, Lange J, Schneider G, Zeh A; Foaming agent for plaster and cement compositions.
2. U.S. Pat. No. 5,394,980 Mar. 7, 1995, Tsai H; Multicompartment mixing capsule.
3. U.S. Pat. No. 5,149,368 Sep. 22, 1992, Liu S-T, Chung H H; Resorbable bioactive phosphate containing cements.
4. U.S. Pat. No. 5,415,547 B1 May 16, 1995, Torabinejad M, White D J; Tooth filling and method of use.
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7. U.S. Pat. No. 7,553,362 Jun. 30, 2009, Lu D, Zhou S. High strength biological cement composition and using the same.
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10. U.S. Pat. No. 8,454,558 B2 Jun. 4, 2013, Jessop N, McLean B S, Sheetz J; Syringe-in-syringe hollow inner barrel/plunger with integral seal and rupturable membrane and related kits, systems and methods.
11. U.S. Pat. No. 8,475,811 Jul. 2, 2003, Yang Q, Lu D, Premixed biological hydraulic cement paste composition and using the same .
12. U.S. Pat. No. 8,545,620 Oct. 1, 2013, Frenkenberger K, Kohler S, Heichele T, Hotzl K-D, Weiss P, Dressen A; Cement accelerator.
13. U.S. Pat. No. 8,658,712 Feb.25, 2014; U.S. Pat. No. 9,801,792 B2 Oct. 31, 2017; U.S. Pat. No. 9,925,125 B2 Mar. 27, 2018 Primus C M, Gutmann J L, Breuer M M, and Jefferies S R; Methods of treatment of the dental pulp and filling root canals using water-based material.
14. U.S. Pat. No. 9,101,436 B2 Aug. 11, 2015 Chow L C, Takagi S; Dental and endodontic filling materials and methods.
15. U.S. Pat. No. 9,259,439 B2 Feb. 16, 2016, Chow L C, Takagi S; Dual-phase cement precursor systems for bone repair.
16. U.S. Pat. No. 9,676,665 B2 Jun. 13, 2017, Engqvist H, Aberg J; Storage stable premixed hydraulic cement compositions, cements, methods and articles.
17. U.S. Pat. No. 10,154,945 B2 Dec. 18, 2018, Jang S W, Lim H N, Kim E S, and Oh S J; Single paste type hydraulic dental filling composition.

NON PATENT LITERATURE

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9 Hutcheson C, Seale N S, McWhorter A, Kerins C, Wright J. Multi-surface Composite vs Stainless Steel Crown Restorations After Mineral Trioxide Aggregate Pulpotomy: A Randomized Controlled Trial, Pediatr Dent.(2012)34(7):460-7.

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12 Lea's Chemistry of Cement and Concrete, 4th Edition, edited by Peter C. Hewlett (1998).

13 Petrochenko P, Narayan R J. Novel Approaches to Bone Grafting: Porosity, Bone Morphogenetic Proteins, Stem Cells, and the Periosteum, J Long Term Eff Med Implants. (2010)20(4): 303-315.