A Review On Biomaterials: Scope, Applications & Human Anatomy Significance

International Journal of Emerging Technology and Advanced Engineering
Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 4, April 2012)
A Review on Biomaterials: Scope, Applications &

Human Anatomy Significance
Nitesh R. Patel1, Piyush P. Gohil2
1,2
Department of Mechanical Engineering, Faculty of Technology & Engineering Charotar University of Science &
Technology, Changa (Gujarat)
1
niteshpatel.me@charusat.ac.in
piyushgohil.me@charusat.ac.in
In the early days all kinds of natural materials such as

wood, glue and rubber, and tissues from living forms, and
manufactured materials such as iron, gold, zinc and glass
were used as biomaterials. The host responses to these
materials were extremely varied. Under certain conditions
(characteristics of the host tissues and surgical procedure)
some materials were tolerated by the body, whereas the
same materials were rejected in another situation. Over the
last 30 years considerable progress has been made in
understanding the interactions between the tissues and the
materials. It has been acknowledged that there are profound
differences between non-living (avital) and living (vital)
materials.
A wide range of materials encompassing all the classical
materials such as Metals (gold, tantalum, Ti6Al4V, 316L
stainless steel, Co-Cr Alloys, titanium alloys), Ceramics
(alumina,
zirconia,
carbon,
titania,
bioglass,
hydroxyapatite(HA)),
Composite
(Silica/SR,
CF/UHMWPE, CF/PTFE, HA/PE, CF/epoxy, CF/PEEK,
CF/C, Al2O3/PTFE), Polymers (Ultra high molecular
weight
polyethylene(UHMWPE),
Polyurethane(PE),
Polyurethane (PU), Polytetrafuoroethylene (PTFE),
Polyacetal (PA), Polymethylmethacrylate (PMMA),
Polyethylene Terepthalate (PET), Silicone Rubber (SR),
Polyetheretherketone (PEEK), Poly(lactic acid) (PLA),
Polysulfone (PS)) have been investigated as biomaterials.
Researchers also classified materials into several types such
as bioinert and bioactive, biostable and biodegradable, etc.
[4]. In broad terms, inert (more strictly, nearly inert)
materials prohibited or minimal tissue response. Active
materials encourage bonding to surrounding tissue with.
Degradable or resorbable materials are incorporated into
the surrounding tissue, or may even dissolve completely
over a period of time. Metals are typically inert, ceramics
may be inert, active or resorbable and polymers may be
inert or resorbable [5]. Biomaterials must be nontoxic, noncarcinogenic, chemically inert, stable, and mechanically
strong enough to withstand the repeated forces of a
lifetime.
Abstract Biomaterials in the form of implants (sutures,

bone plates, joint replacements, etc.) and medical devices
(pacemakers, artificial hearts, blood tubes, etc.) are widely
used to replace and/or restore the function of traumatized or
degenerated tissues or organs, and thus improve the quality of
life of the patients. The first and foremost requirement for the
choice of the biomaterial is its acceptability by the human
body. A biomaterial used for implant should possess some
important properties in order to long-term usage in the body
without rejection. The most common classes of materials used
as biomedical materials are Metals, Polymers, Ceramics, and
Composite. These four classes are used singly and in
combination to form most of the implantation devices
available today. This review should be of value to researchers
who are interested in the state of the art of biomaterial
evaluation and selection of biomaterials.
KeywordsApplication, Biomaterials, Human Anatomy
I. INTRODUCTION
The National Institutes of Health Consensus
Development Conference defined a biomaterial as Any
substance (other than a drug) or combination of substances,
synthetic or natural in origin, which can be used for any
period of time, as a whole or as a part of a system which
treats, augments, or replaces any tissue, organ, or function
of the body (Boretos and Eden, 1984). Use of
biomaterials dates far back into ancient civilizations.
Artificial eyes, ears, teeth, and noses were found on
Egyptian mummies [1]. Chinese and Indians used waxes,
glues, and tissues in reconstructing missing or defective
parts of the body. Over the centuries, advancements in
synthetic materials, surgical techniques, and sterilization
methods have permitted the use of biomaterials in many
ways [2]. Medical practice today utilizes a large number of
devices and implants. Biomaterials in the form of implants
(ligaments, vascular grafts, heart valves, intraocular lenses,
dental implants, etc.) and medical devices (pacemakers,
biosensors, artificial hearts, etc.) are widely used to replace
and/or restore the function of traumatized or degenerated
tissues or organs, and thus improve the quality of life of the
patients.
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Newer biomaterials even incorporate living cells in order
to provide a true biological and mechanical match for the
living tissue.
D. Functional Tissue Structure and Pathobiology:

Biomaterials incorporated into medical devices are
implanted into tissues and organs. Therefore, the key
principles governing the structure of normal and abnormal
cells, tissues or organs, the technique by which the
structure and function of normal and abnormal tissues are
studied, and the fundamental mechanisms of disease
processes are critical considerations to workers in the field
[12].
E. Toxicology:
A biomaterial should not be toxic, unless it is
specifically engineered for such requirements (for example
a "smart" bomb" drug delivery system that targets cancer
cells and destroy them). Toxicology for biomaterials deals
with the substances that migrate out of the biomaterials. It
is reasonable to say that a biomaterial should not give off
anything from its mass unless it is specifically designed to
do so [12].
F. Appropriate Design and Manufacturability:
Biomaterials should be machinable, moldable,
extrudable. Finite element analysis is a powerful analytical
tool used in the design of any implants. Currently modern
manufacturing processes are necessary to guarantee the
quality needed in orthopaedic devices.
G. Mechanical Properties of Biomaterials:
Some of the most important properties of biomaterials
that should be carefully studied and analysed in their
applications are tensile strength, yield strength, elastic
modulus, corrosion and fatigue resistance, surface finish,
creep, and hardness. Physical properties are also taking in
to account while selecting materials. The dialysis
membrane has a specified permeability. The articular cup
of the hip joint has high lubricity. The intraocular lens has
clarity and refraction requirements.
H. High corrosion resistance:
Singh & Dahotre [13] did research on corrosion
resistance as is an important issue in selection of metallic
biomaterials because the corrosion of metallic implants due
to the corrosive body fluid is unavoidable. The implants
release undesirable metal ions which are nonbiocompatible. Corrosion can reduce the life of implant
device and consequently may impose revision surgery. In
addition the human life may be decreased by the corrosion
phenomenon. Okazaki & Gotoh [14] expressed the fact that
dissolved metal ions (corrosion product) either can
accumulate in tissues, near the implant or they may be
transported to other parts of the body.
II. SELECTION PARAMETERS FOR BIOMATERIALS

A Biomaterial used for implant should possess some
important properties in order to long-term usage in the
body without rejection. The design and selection of
biomaterials depend on different properties which are
characterized in this section.
A. Host Response:
Host response is defined as the response of the host
organism (local and systemic) to the implanted material or
device [6].
B. Biocompatibility:
Researchers have coined the words `biomaterial' and
`biocompatibility' [7] to indicate the biological
performance of materials. Materials that are biocompatible
are called biomaterials, and the biocompatibility is a
descriptive term which indicates the ability of a material to
perform with an appropriate host response, in a specific
application [8]. In simple terms it implies compatibility or
harmony of the biomaterial with the living systems.
Biocompatibility is the ability to exist in contact with
tissues of the human body without causing an unacceptable
degree of harm to the body. It is not only associated to
toxicity, but to all the adverse effects of a material in a
biological system [9, 10]. It must not adversely affect the
local and systemic host environment of interaction (bone,
soft tissues, ionic composition of plasma, as well as intra
and extracellular fluids) [11]. It refers to a set of properties
that a material must have to be used safely in a biological
organism. It should be non-carinogenic, non-pyrogenic,
non-toxic, non-allergenic, blood compatible, noninflammatory. The operational definition of biocompatible
is "The patient is alive so it must be biocompatible".
C. Biofunctionality[11]:
Biofunctionality is playing a specific function in
physical and mechanical terms. The material must satisfy
its design requirements in service:
Load transmission and stress distribution (e.g. bone
replacement)
Articulation to allow movement (e.g. artificial knee
joint)
Control of blood and fluid flow (e.g. artificial heart)
Space filling (e.g. cosmetic surgery)
Electrical stimuli (e.g. pacemaker)
Light transmission (e.g. implanted lenses)
Sound transmission (e.g. cochlear implant)
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I. High wear resistance:
The low wear resistance or high coefficient of friction
results in implant loosening [15, 16]. Wear debris are found
to be biologically active and make a severe inflammatory
response that lead to the destruction of the healthy bone
which supports the actual implant. Corrosion caused by
friction is a big concern since it releases non compatible
metallic ions. It should be pointed out that mechanical
loading also can result in corrosion fatigue and accelerated
wear processes [15].
J. Long fatigue life:
The fatigue strength is related to the response of the
material to the repeated cyclic loads. Fatigue fracture leads
some of major problems associated with implant loosening,
stress-shielding and ultimate implant failure and it is
frequently reported for hip prostheses [17]. Fatigue
characteristics are strongly depends on the microstructures.
The microstructures of metallic biomaterials alter
according to the processing and heat treatment employed
[6].
K. Adequate Strength:
Strength of materials from which the implants are
fabricated has influence the fracture of artificial organ. In
adequate strength can cause to fracture the implant. When
the bone implant interface starts to fail, developing a soft
fibrous tissue at the interface can make more relative
motion between the implant and the bone under loading
[9]. This fact causes pain to the patient and after a certain
period, the pain becomes unbearable and the implant must
be replaced, by a revision procedure [15].
L. Modulus equivalent to that of bone:
For major applications such as total joint replacement,
higher yield strength is basically coupled with the
requirement of a lower modulus close to that of human
bones [19, 20]. The magnitude of bone modulus varies
from 4 to 30 GPa depending on the type of the bone and the
measurement direction [21]. Large difference in the
Youngs modulus between implant material and the
surrounding bone can contribute to generation of severe
stress concentration, namely load shielding from natural
bone that may weaken the bone and deteriorate the

implant/bone interface, loosening and consequently failure
of implant [9, 22]. The modulus is considered as a main
factor for selection of any biomaterials.
III. HUMAN ANATOMY
The first and foremost requirement for the choice of the
biomaterial is its acceptability by the human body (Fig. 1).
The success of a biomaterial or an implant is highly
dependent on three major factors (i) The properties
(mechanical, chemical and tribological) of the biomaterial
(ii) biocompatibility of the implant and (iii) the health
condition of the recipient and the competency of the
surgeon [23].
Generally, tissues are grouped into hard and soft tissues.
Bone and tooth are examples of hard tissues, and skin,
blood vessels, cartilage and ligaments are a few examples
of soft tissues. As the names suggest, in general the hard
tissues stiffer (elastic modulus) and stronger (tensile
strength) than the soft tissues (Tables 1 and 2). Considering
the structural or mechanical compatibility with tissues,
metals or ceramics are chosen for hard tissue applications,
and polymers for the soft tissue applications. One of the
primary reasons that biomaterials are used is to physically
replace hard or soft tissues that have become damaged or
destroyed through some pathological process [24]. Under
these circumstances, it may be possible to remove the
diseased tissue and replace it with some suitable synthetic
material.
TABLE 1 MECHANICAL PROPERTIES OF HARD TISSUE [25]
Hard tissue
Cortical bone
(longitudinal direction)
Cortical bone
(transverse direction)
Cancellous bone
Enamel
Dentine
Modulus
(GPa)
Tensile Strength
(MPa)
17.7
133
12.8
52
0.4
84.3
11.0
7.4
10
39.3
TABLE 2 MECHANICAL PROPERTIES OF SOFT TISSUE [25]
Soft tissue
Articular cartilage
Fibrocartilage
Ligament
Tendon
Skin
Intraocular lens
93
Modulus
(MPa)
10.5
159.1
303.0
401.5
0.1-0.2
5.6
Tensile Strength
(MPa)
27.5
10.4
29.5
46.5
7.6
2.3

Dental Implants,
Dental Post, Arch
Wire & Brackets,
Dental Bridges,
Dental Restorative
Material
Cohlear Implants
Intacts
Cardiovascular
Implants (Vascular
Grafts)
Shoulder Prosthesis
Pacemaker
Abdominal Wall
Prosthesis
Lumbar Disc
Replacement, Spine
Cage, Plate, Rods
and Screws
Prosthetic
Arthroplasty
Total Hip
Replacement,
Acetabular
Intramedullary Nails
Knee joint
Replacement, Tendon
/ Ligament, Cartilage
Replacement
Bone Cement
Bone Fixation,
Bone Plates &
Screws
FIGURE 1: IMPLANTS FOR HUMAN ANATOMY SIGNIFICANCE
The main considerations in selecting metals and alloys

for biomedical applications are their excellent electrical and
thermal conductivity, biocompatibility, appropriate
mechanical properties, corrosion resistance, and reasonable
cost. It is very important to know the physical and chemical
properties of the different metallic materials used in any
surgery as well as their interaction with the host tissue of
the human body.
Stainless Steel:
Stainless steel was first used successfully as an
important material in the surgical field. Stainless steel is the
generic name for a number of different steels used
primarily because of their resistance to a wide range of
corrosive agents [10, 15]. Stainless steel has been used for
wide range of application due to easy availability, lower
cost,
excellent
fabrication
properties,
accepted
biocompatibility and great strength.
IV. IMPLANTABLE MATERIALS

The science of biomedical materials involves a study of
the composition and properties of materials and the way in
which they interact with the environment in which they are
placed. The most common classes of materials used as
biomedical materials are metals, polymers, ceramics, and
composite. These four classes are used singly and in
combination to form most of the implantation devices
available today.
A. Metals and Alloys:
Metals have been used almost exclusively for loadbearing implants, such as hip and knee prostheses and
fracture fixation wires, pins, screws, and plates. Although
pure metals are sometimes used, alloys frequently provide
improvement in material properties, such as strength and
corrosion resistance. Three material groups dominate
biomedical metals: Stainless steel, cobalt-chromiummolybdenum alloy, and titanium and titanium alloys.
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TABLE 3 MECHANICAL PROPERTIES OF METALLIC BIOMATERIALS [31]
Cobalt-Chrome:
Cobalt chromium alloys can be basically categorized
into two types; one is The CoCrMo alloy [ Cr (27-30%),
Mo (5-7%), Ni (2.5%)] has been used for many decades in
dentistry, and in making artificial joints and the second one
The CoNiCrMo alloy [Cr (19-21%), Ni (33-37%), and Mo
(9-11%)] has been used for making the stems of prostheses
for heavily loaded joints, such as knee and hip [15]. Cobaltbased alloys are highly resistant to corrosion even in
chloride environment due to spontaneous formation of
passive oxide layer within the human body environment
[10, 15, 16, 26, 27]. The thermal treatments used to Co-CrMo alloys modify the microstructure of the alloy and alters
the electrochemical and mechanical properties of the
biomaterial [26]. The corrosion products of Co-Cr-Mo are
more toxic than those of stainless steel 316L.
Titanium and its Alloys:
There are three structural types of titanium alloys: Alpha
(), Alpha-Beta (-) or metastable and Beta ().The
phase in Ti alloys tends to exhibit a much lower modulus
than phase, and also it satisfies most of the other
necessities or requirements for orthopedic application [28,
29]. Ti alloys due to the combination of its excellent
characteristics such as high strength, low density, high
specific strength, good resistance to corrosion, complete
inertness to body environment, enhanced biocompatibility,
moderate elastic modulus of approximately 110 GPa are a
suitable choice for implantation. Long-term performance of
titanium and its alloys mainly Ti64 has raised some
concerns because of releasing aluminum and vanadium [9,
10]. Both Al and V ions are associated with long term
health problems, like Alzheimer disease and neuropathy.
Furthermore when titanium is rubbed between itself or
between other metals, it suffers from severe wear [30].
The mechanical properties of materials are of great
importance when designing load-bearing orthopedic and
dental implants. Some mechanical properties of metallic
biomaterials are listed in Table 3. The mechanical
properties of a specific implant depend not only on the type
of metal but also on the processes used to fabricate the
material and device. The elastic moduli of the metals listed
in Table 3 are at least seven times greater than that of
natural bone.
Youngs
Modulus,
E (GPa)
Yield
Strength,
sy (MPa)
Tensile
Strength,
sUTS
(MPa)
Fatigue
Limit,
send
(MPa)
Stainless steel
190
2211,213
5861,351
241820
Co-Cr alloys
210253
4481,606
6551,896
207950
Titanium (Ti)
110
485
760
300
Ti-6Al-4V
116
8961,034
9651,103
620
1530
3070
70150
Material
Cortical bone
TABLE 4 APPLICATION OF METALS AS IMPLANTS USED IN HUMAN BODY
Types of Materials
Stainless steel
Cobalt-chromium alloy
Titanium and its Alloys
Applications
Joint replacements (hip, knee), Bone
plate for fracture fixation, Dental implant
for tooth fixation, Heart valve, Spinal
Instruments, Surgical Instruments,
Screws, dental root Implant, pacer,
fracture plates, hip nails, Shoulder
prosthesis
Bone plate for fracture fixation, Screws,
dental root implant, pacer, and Suture,
dentistry, orthopedic prosthesis, Mini
plates, Surgical tools, Bone and Joint
replacements (hip, knee), dental implants
Cochlear replacement, Bone and Joint
Replacements(hip, knee),Dental Implants
for tooth fixation, Screws, Suture, parts
for orthodontic surgery, bone fixation
devices like nails, screws and plates,
artificial heart valves and surgical
instruments, heart pacemakers, artificial
heart valves
B. Ceramics
Ceramics are polycrystalline materials. The main
characteristics of ceramic materials are hardness and
brittleness, great strength and stiffness, resistance to
corrosion and wear, and low density. They work mainly on
compression forces; on tension forces, their behavior is
poor. Ceramics are typically electrical and thermal
insulators. Ceramics are used in several different fields
such as dentistry, orthopedics, and as medical sensors. [32].
Overall, however, these biomaterials have been used less
extensively than either metals or polymers. Ceramics
typically fail with little, if any, plastic deformation, and
they are sensitive to the presence of cracks or other defects.
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Ceramics have become a diverse class of biomaterials
presently including three basic types: bioinert, bioactive,
bioresorbable ceramics [33]. Alumina (Al2O3), Zirconia
(ZrO2) and Pyrolytic carbon are termed bioinert. Bioglass
and glass ceramics are bioactive. Calcium phosphate
ceramics are categorized as bioresorbable.
Bioinert refers to a material that retains its structure in the
body after implantation and does not induce any
immunologic host reactions.
Alumina (Al2O3):
High density high purity (>99.5%) alumina (Al2O3) was
the first ceramic widely used clinically. It is used in loadbearing hip prostheses and dental implants, because of its
combination of excellent corrosion resistance, good
biocompatibility, and high wear resistance, and high
strength. The reasons for the excellent wear and friction
behavior of (Al2O3) are associated with the surface energy
and surface smoothness of this ceramic. The
biocompatibility of alumina ceramic has been tested by
many researchers. Noiri et al. [34] evaluated the
biocompatibility
of
alumina-ceramic
material
histopathalogically for eight weeks by implanting in the
eye sockets of albino rabbits. The results showed no signs
of implant rejection or prolapse of the implanted piece.
After a period of four weeks of implantation, fibroblast
proliferation and vascular invasion were noted and by
eighth week, tissue growth was noted in the pores of the
implant [34]. Single crystal alumina screws and pins were
implanted in the femoral bone of mature rabbits. Changes
in the implant-bone interface were observed. Alumina was
never in direct contact with the bone and hemidesmosomes
were not observed in the interface [35]. The cytotoxicity of
single crystal alumina ceramics was studied in L cell line
culture. They displayed the same colony formation and
survival rates as the controls showed that they have no
cytotoxicity and if implanted in bone marrow they would
not be toxic to circumferential tissue [36].
Zirconia (ZrO2):
Zirconia is a biomaterial that has a bright future because
of its high mechanical strength and fracture toughness.
Zirconia ceramics have several advantages over other
ceramic materials due to the transformation toughening
mechanisms operating in their microstructure that can be
manifested in components made out of them. The research
on the use of zirconia ceramics as biomaterials commenced
about twenty years ago and now zirconia is in clinical use
in total hip replacement (THR) but developments are in
progress for application in other medical devices. Today's
main application of zirconia ceramics is in THR ball heads
[37].
The osteointegration of zirconia was investigated in

normal and osteopenic rats by means of histomorphometry.
The data showed that the tested material was biocompatible
in vitro and confirmed that bone mineral density is a strong
predictor of the osteointegration of an orthopedic implant
and that the use of pathological animal models is necessary
to completely characterize biomaterials [38]. It is said that
very small traces of radioelements, which can be found
even in fully refined ceramics, have a negative effect on
organs and tissues. Zirconia contains very small traces of
radioelements [39]. The cytotoxicity of polycrystalline
zirconia was speculated in L cell line culture. The study
revealed its noncytotoxicity [36].
Pyrolytic Carbon:
Carbon is a versatile element and exists in a variety of
forms. Good compatibility of carbonaceous materials with
bone and other tissue and the similarity of the mechanical
properties of carbon to those of bone indicate that carbon is
an exciting candidate for orthopedic implants [40]. Unlike
metals, polymers and other ceramics, these carbonaceous
materials do not suffer from fatigue. However, their
intrinsic brittleness and low tensile strength limits their use
in major load bearing applications. The mechanical
bonding between the carbon fiber reinforced carbon and
host tissue was investigated. The bonding developed three
months after intrabone implantation and is accompanied by
a decrease of the implant strength [41].
Bioactive refers to materials that form direct chemical
bonds with bone or even with soft tissue of a living
organism.
Bioglass & Glass Ceramic:
A common characteristic of such bioactive materials is a
modification of the surface that occurs upon implantation.
Bonding to bone was first demonstrated for a range of
bioactive glasses, which contained specific amounts of
SiO2, CaO, and P2O5 [42]. This material has been widely
used for filling bone defects. The porosity of bioglass is
beneficial for resorption and bioactivity [43]. The interface
reaction was interpreted as a chemical process, which
includes a slight solubility of the glass ceramic and a solidstate reaction between the stable apatite crystals in the glass
ceramic and the bone [44].
Bioresorbable refers to materials that degrade (by
hydrolytic breakdown) in the body while they are being
replaced by regenerating natural tissue; the chemical byproducts of the degrading materials are absorbed and
released via metabolic processes of the body.
Calcium phosphate ceramics:
Different phases of calcium phosphate ceramics are used
depending upon whether a resorbable or bioactive material
is desired.
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Calcium phosphate (CaP) biomaterials are available in
various physical forms. One of their main characteristics is
their porosity. The ideal pore size for bioceramic is similar
to that of spongy bone [45]. The prime requirement for
calcium phosphate materials to be bioactive and bond to
living bone is the formation of a bone like apatite layer on
their surface [46].
The major drawbacks to the use of ceramics and glasses
as implants are their brittleness and poor tensile properties
(Table 5). Although they can have outstanding strength
when loaded in compression, ceramics and glasses fail at
low stress when loaded in tension or bending. Among
biomedical ceramics, alumina has the highest mechanical
properties, but its tensile properties are still below those of
metallic biomaterials.
C. POLYMERIC BIOMATERIALS
The development of polymeric biomaterials can be
considered as an evolutionary process. Reports on the
applications of natural polymers as biomaterials date back
thousands of years [48]. Polymers are the most widely used
materials in biomedical applications. Polymers are organic
materials that form large chains made up of many repeating
units. The uses for polymeric materials are more diverse
than for metallic implants, but their interchangeability is
not as great. In most of applications, polymers have little or
no competition from other types of materials. Their unique
properties are: Flexibility, Resistance to biochemical
attack, Good biocompatibility, Lightweight, Available in a
wide variety of compositions with adequate physical and
mechanical properties, Can be easily manufactured into
products with the desired shape. A few of the major classes
of polymer are listed below:
Poly (methyl methacrylate), PMMA:
It is a hard brittle polymer that appears to be unsuitable
for most clinical applications, but it does have several
important characteristics. It can be prepared under ambient
conditions so that it can be manipulated in the operating
theater or dental clinic, explaining its use in dentures and
bone cement. The relative success of many joint prostheses
is dependent on the performance of the PMMA cement,
which is prepared intraoperatively by mixing powdered
polymer with monomeric methylmethacrylate, which forms
dough that can be placed in the bone, where it then sets.
Silicone Rubbers:
Both heat-vulcanizing and room temperature vulcanizing
silicones are in use today and both exhibit advantages and
disadvantages. Room temperature vulcanizing silicones are
supplied as single- paste systems. Heat-vulcanizing silicone
is supplied as a semi-solid material that requires milling,
packing under pressure.
Ultra High Molecular Weight Polyethylene (UHMWPE):
Much research is progressing in examining the wear
properties of UHMWPE. The coefficient of friction
between polyethylene and cobalt-chromium alloy has been
reported to be between 0.03 and 0.16, with excellent wear
rates. UHMWPE is used as the bearing surface in total joint
arthroplasty, it has 90% success rates at 15 years with metal
on polyethylene. Submicron particles found in
periprosthetic tissues when polyethylene wear present.
(But no better material has been developed to date)
The mechanical properties of polymers depend on
several factors, including the composition and structure of
the macromolecular chains and their molecular weight.
Table 7 lists some mechanical properties of selected
polymeric biomaterials.
TABLE 5 MECHANICAL PROPERTIES OF CERAMIC BIOMATERIALS [47]
Alumina
Zirconia
Pyrolytic
carbon
Bioglassceramics
Calcium
phosphates
Youngs
Modulus,
E (GPa)
380
150-200
Compressive
Strength,
sUCS (MPa)
4500
2000
Tensile
Strength,
sUTS (MPa)
350
200-500
18-28
517
280-560
22
500
56-83
40-117
510-896
69-193
TABLE 6 APPLICATION OF CERAMICS AS IMPLANTS USED IN HUMAN

BODY
Types of Materials
Alumina
Zirconia
Pyrolytic carbon
Bioglass-ceramics
Calcium phosphates
Applications
Artificial total joint replacement,
acetabular and femoral components,
vertebrae spacers and extensors,
orthodontic anchors, dental implant for
tooth fixation
Replacement for hips, knees, teeth,
tendons and ligaments, repair for
periodontal disease, bone fillers after
tumor surgery
Prosthetic heart valves, End osseous tooth
replacement implants, permanently
implanted artificial limbs
Dental implants, middle ear implants,
heart valves, artificial total joint
replacement, bone plates, screws, wires,
intramedullary nails, spinal fusion, tooth
replacement implants
Skin treatments, dental implants, jawbone
reconstruction, orthopedics, facial
surgery, ear, nose and throat repair, dental
implant
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Examples of current applications include vascular grafts,
heart valves, artificial hearts, breast implants, contact
lenses, intraocular lenses, components of extracorporeal
oxygenators, dialyzers and plasmapheresis units, coatings
for pharmaceutical tablets and capsules, sutures, adhesives,
and blood substitutes, kidney, liver, pancreas, bladder, bone
cement, catheters, external and internal ear repairs, cardiac
assist devices, implantable pumps, joint replacements,
pacemaker, encapsulations, soft-tissue replacement,
artificial blood vessels, artificial skin, Dentistry, Drug
delivery and targeting into sites of inflammation or tumors,
Bags for the transport of blood plasma.
Bone itself achieves most of its mechanical properties as

a natural composite material composed of calcium
phosphate ceramics in a highly organized collagen matrix.
Composite biomaterials are made with a filler
(reinforcement) addition to a matrix material in order to
obtain properties that improve every one of the
components. This means that the composite materials may
have several phases. Some matrix materials may be
combined with different types of fillers. Polymers
containing particulate fillers are known as particulate
composites. The first composite to come into general use,
initially made by an orthopedic surgeon, was the plaster of
Paris bandage. This has been refined to fiberglass with a
polymeric matrix in the current synthetic casting materials.
A composite for internal prosthetic applications is based on
the addition of chopped carbon fiber to improve the
mechanical properties of polyethylene components [52].
Only carbon fiber is being studied for orthopedic
applications [53]. Composite structures are typically
produced from laminates. A laminate is a thin sheet of
composite material in which all the fibers run in one
direction and are held together by a thin coating of the
polymer matrix material. This laminate is combined with
other laminates to form a bulk composite; the properties of
this composite vary depending on the orientation of each
layer of the laminate [54]. None of these materials are
currently in clinical use because of the inability to modify
the shapes of the implants intraoperatively to fit the bone;
because of liberation of carbon fibers into the adjacent
tissues; and because the difficulties of predicting the
resorption of polymers in larger loadbearing implants, as
opposed to screws and pins, has thus far precluded their use
for these larger implants. No doubt, implants in this
category will be available in the future, perhaps even
containing bone inductive proteins.
TABLE 7 MECHANICAL PROPERTIES OF POLYMERS [49]
Polymer
Poly(methyl
methacrylate)
(PMMA)
Nylon 6/6
Poly(ethylene
terephthalate)
Poly(lactic acid)
Polypropylene
Polytetrafluoroethylene
Silicone rubber
Ultra-high-molecularweight
polyethylene
(UHMWPE)
Tensile
Strength
SUTS(MPa)
Youngs
Modulus,
E(GPa)
%
Elongation
30
2.2
1.4
76
2.8
90
53
2.14
300
28-50
28-36
17-28
2.8
1.2-3
1.1-1.55
0.5
Up to 10
2-6
400-900
120-350
160
>35
4-12
>300
D. BIOCOMPOSITE MATERIALS
Biocomposites are composite materials composed of
biodegradable matrix and biodegradable natural fibres as
reinforcement. The development of biocomposites has
attracted great interest due to their environmental benefit
and improved performance [50]. Plant-based fibers like
flax, jute, sisal and kenaf have been frequently used (Table
8). Most of studies concern biodegradable matrix based on
aliphatic polyesters reinforced with various vegetable
fillers. With wide-ranging uses from environment-friendly
biodegradable composites to biomedical composites for
drug/gene delivery, tissue engineering applications and
cosmetic orthodontics. They often mimic the structures of
the living materials involved in the process in addition to
the strengthening properties of the matrix that was used but
still providing biocompatibility. Those markets are
significantly rising, mainly because of the increase in oil
price, and recycling and environment necessities [51].
TABLE 8 CONSTITUENTS OF BIOMEDICAL COMPOSITES
98
Particles
Inorganic
Glass
Alumina
Fibers
Polymers
Aromatic
Polyamides
(aramids)
UHMWPE
Polyesters
Polyolefins
PTFE
Matrix
Thermosets
Epoxy
Polyacrylates
Polymethacrylates
Polyesters
Silicones
Organic
Polyacrylate
Polymethacrylate
Resorbable
polymers
Polylactide, and its
copolymers with
polyglyocolide
Thermoplastics
Polyolefins (PP,
PE)
UHMWPE
Polysulfones

Silk
Collagen
Inorganic
Carbon
Glass
Hydroxyapatite
Tricalcium
phosphate
Poly(ether ketones)
Polyesters
Inorganic
Hydroxyapatite
Glass ceramics
Calcium carbonate
ceramics
Calcium phosphate
ceramics
Carbon
Steel
Titanium
Resorbable
polymers
Polylactide,
polyglycolide and
their copolymers
Polydioxanone
V. CONCLUDING REMARKS
A biomaterial is any substance (other than drugs),
natural or synthetic, that treats, augments, or replaces any
tissue, organ, and body function. Biomaterial selection is
one of the most challenging issues due to crucial
requirements and biocompatibility, so it has been of major
interest to material designers in recent years. This review of
biomaterials has attempted to demonstrate the very
significant progress that has been made with the use of
advanced materials within the human body. The present
study reviewed the currently used biomaterials; metals,
ceramics, polymers, and composite.
Metals are susceptible to degradation by corrosion, a
process that can release by-products that may cause adverse
biological responses. Ceramics are attractive as biological
implants for their biocompatibility. The studies show that
alumina with high mechanical strength show minimal or no
tissue reaction, nontoxic to tissues and blood compatibility
tests were also satisfactory. Carbon with similar
mechanical properties of bone is an exciting candidate, for
it elicits blood compatibility, no tissue reaction and
nontoxicity to cells. The availability of a wide range of
polymers significantly influenced the growth of tissue
engineering and controlled drug delivery technologies.
Innovations in the composite material design and
fabrication processes are raising the possibility of realizing
implants with improved performance. However, for
successful application, surgeons must be convinced with
the long term durability and reliability of composite
biomaterials.
In the past, success of materials in biomedical
applications was not so much the outcome of meticulous
selection based on biocompatibility criteria but rather the
result of serendipity, continuous refinement in fabrication
technology, and advances in material surface treatment. In
the present and future, election of a biomaterial for a
specific application must be based on several criteria.
Biocompatibility is the paramount criterion that must be
met by every biomaterial. Medical research continues to
explore new scientific frontiers for diagnosing, treating,
curing, and preventing diseases at the molecular/genetic
level. This review should be of value to researchers who
are interested in the state of the art of biomaterial
evaluation and selection of biomaterials.
TABLE 9 APPLICATION OF COMPOSITE AS IMPLANTS USED IN HUMAN

BODY
Applications
Dentistry
Vascular Grafts
Joint
replacements
Bone cement
Bone
Replacement
Materials
Spine Cage,
Plate, Rods,
Screws, Disc,
Finger Joint,
Intramedullary
Nails,
Abdominal wall
Prosthesis,
Types of materials
CF/C, SiC/C,CF/Epoxy, GF/Polyester,
GF/PC, GF/PP, GF/Nylon,
GF/PMMA,UHMWPE/PMMA,
CF/PMMA, GF/PMMA, KF/PMMA,
Silica/BIS-GMA
Cells/PTFE, Cells/PET, PET/Collagen,
PET/Gelation, PU/PU-PELA
PET/PHEMA, KF/PMA, KF/PE,
CF/PTFE,CF/PLLA, GF/PU, PET/PU,
PTFE/PU, CF/PTFE, CF/C,
CF/UHMWPE,UHMWPE/UHMWPE,
CF/Epoxy, CF/PS, CF/PEEK,
CF/UHMWPE, CF/PE,
Bone particles/PMMA,
Titanium/PMMA, UHMWPE/PMMA,
GF/PMMA, CF/PMMA, Bio-Glass/BisGMA
HA/PHB, HA/PEG-PHB, CF/PTFE,
PET/PU, HA/HDPE, HA/PE, BioGlass/PE, Bio-Glass/PHB, Bio-Glass/PS,
HA/PLA
PET/PU, PET/Collagen, CF/LCP,

CF/PEEK, GF/PEEK, CF/Epoxy, CF/PS,
Bio-glass/PU, Bio-glass/PS, PET/SR,
PET/Hydrogel, CF/UHMWPE
99

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