Introduo cincia dos

biomateriais
Luiz Henrique Catalani
Laboratrio de Biomateriais Polimricos
http://www2.iq.usp.br/docente/lhc/
Bibliografia
Biomaterials Science, B. D. Ratner, A. S. Hoffman, F. J.
Schoene J.E. Lemons, Elsevier, 2nd Ed. 2004.
Biomateriais, Fundamentos e Aplicaes, R.L. Orfice, M.M.
Pereira, H.S. Mansur, 1a Ed. Cultura Mdica, 2006.
Polymer Chemistry, C.E. Carraher Jr., Marcel Dekker, 6th Ed. Polymer Chemistry, C.E. Carraher Jr., Marcel Dekker, 6th Ed.
2003.
Textbook of Polymer Science, F.W. Billmeyer Jr., Wiley, 3
rd
Ed., 1984.
O que um Biomaterial?
Quais reas devem ser incluidas no Quais reas devem ser incluidas no
estudo de Biomaterials?
Seis definies de um Biomaterial
1. non-viable material used in a medical device, intended
to interact with biological systems.
ESB Consensus Conference I
2. material intended to interface with biological systems to
evaluate, treat, augment or replace any tissue, organ or
function of the body
ESB Consensus Conference II - Note Esta uma verso
refinada que exclue materiais no-viveis
3. synthetic, natural or modified natural material intended
to be in contact and interact with the biological system
ISO no recomendada pois implica que tecidos so biomateriais
e devido a ambiguidade da frase em contato
4. any substance (other than a drug), synthetic or natural,
that can be used as a system or part of a system that
treats, augments, or replaces any tissue, organ, or treats, augments, or replaces any tissue, organ, or
function of the body.
Dorland Medical no recomendada pois no faz referncias
interfaces
5. solid materials which occur in and are made by living
organisms, such as chitin, fibrin or bone.
Larousse Science no recomendada pois limita a origen biolgica
6. a systemically and pharmacologically inert substance
designed for implantation within or in corporation with designed for implantation within or in corporation with
living systems
The Clemson University Advisory Board for Biomaterials
quando biomateriais era visto como algo inerte para atingir
biocompatibilidade, o que no mais o caso.
Biomateriais so substncias das quais
podem ser fabricados dispositivos que
interagem com sistemas biolgicos
1. Dispositivo algo conceitualizado e fabricado para
uma funo particular.
2. A substncia tem propriedades ideais para o correto 2. A substncia tem propriedades ideais para o correto
funcionamento do dispositivo.
3. A substncia no deve (idealmente) degradar o
sistema biolgico.
4. O estudo de biomateriais a descrio e predio
do comportamento de tais substncias no contexto
do funcionamento do dispositivo e o ambiente
biolgico a que se insere.
Duas reas genricas que abrangem
Biomateriais
Materials Disciplines
Chemistry
Physics
Thermodynamics
Surface science
Metallurgy
Biological Disciplines
Anatomy
Surgery
Orthopedics
Dentistry
Physiology Metallurgy
Ceramics
Polymer Science
Composites
Hydrogels
Physical testing
Mechanical eng.
Design eng.
--
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Physiology
Toxicology
Molecular biology
Cellular biology
Biochemistry
Immunology
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Biomateriais necessrio em vista da inabilidade
de tratar condies a no ser atravs de
substituio, insero ou regenerao
1. Substituio de parte do corpo que perdeu sua
funo (quadril/fmur, joelho, corao) funo (quadril/fmur, joelho, corao)
2. Corrigir anormalidades (leso da mesula espinhal)
3. Assitir a uma funo (marca-passo, stent)
4. Assistir a cura (estrutural, sutura, liberao
controlada de frmacos)
5. Materiais para engenharia de tecidos
O comportamento do biomaterial depender
do ambiente no qual o dispositivo deve
funcionar
MEDICAL DEVICE EXAMPLES ANNUAL #(U.S.)
Sutures (temporary or bioresorbable) 250 M**
Catheters (fluid transport tubes) 200 M
Blood Bags 40 M
Contact Lenses 30 M Contact Lenses 30 M
Intraocular Lenses 2.5 M
Knee and Hip Prostheses 0.5 M
Breast Prostheses (cancer or cosmetic) 0.25 M
Dental Implants 0.9 M
Renal Dialyzers (patients) 0.3 M
Oxygenators/CPBs (cardiopulmonary bypass 0.3 M
system - facilitates open heart surgery)
Vascular Grafts 0.3 M
Pacemakers (pulse generators) 0.4 M
Mercado global em 2003 ( bUS$)
Biomateriais uma ideia
antiga antiga
On this 3000 year old
mummy, there is evidence
that an ancient Egyptian
physician crafted this
prostheses to help an ailing prostheses to help an ailing
patient--in this case, a 5060
year old woman whose toe
had been amputated or lost
in an accident. The
biomaterial that he used
was wood.
Historicamente, biomateriais eram comuns
para mdicos e sacerdotes
1. Ouro foi usado como reparo dental por chineses,
astecas e romanos a at 2000 atrs.
2. J em 1775, ferro e lato foram eram usados para
reparo de fmur fraturado. reparo de fmur fraturado.
3. O primeiro olho de vidro foi produzido em 1832 pelo
vidreiroLudwig Mller-Uri em Lauscha, Alemanha.
4. Indgenas da America central e Africa utulizavam
pinas de formigas para costura de ferimentos.
5. George Washington (1732-1799) tinha dentes de
marfim.
Portrait of George Washington by
American artist Gilbert Stuart
George Washingtons false
teeth on view in New York
have teeth set in jointed
metal frames, operated with
a spring loaded opening
mechanism. (Treasures from
Mount Vernon: George Mount Vernon: George
Washington Revealed, NY
1999). One of the teeth is
Washington's own. The
others were carved from
biomaterials, cow's tooth
and hippopotamus ivory, by
his dentist Doctor John
Greenwood in 1793
It is said that George Washington appears
uncomfortable on the US dollar because of the
pain caused by his false teeth. It is currently
speculated that the spring mechanism required
GW to forcibly hold his mouth closed, which
accounts for the expression on his face.
Biomateriais Projetados
A falha dos primeiros materiais ocorreu
porque no foi dada ateno
adequabilidade biolgica dos materiais
A abordagem contempornea o A abordagem contempornea o
desenvolvimento racional de materiais para
fabricao de dispositivos mdicos baseados
em um melhor entendimento da sua funo e
da interface entre o material e o ambiente no
qual o dispositivo deve funcionar.
Dados sobre o ambiente biolgico
Value Location
pH 6.8 Intracellular
7.0 Interstitial
7.15-7.35 Blood
pO
2
2-40 Interstitial (mm Hg)
40 Venous
100 Arterial
Temperature 37 Normal Core Temperature 37 Normal Core
28 Normal Skin
Mechanical Stress 4x10
7
N m
-2
Muscle (peak stress)
4x10
8
N m
-2
Tendon (peak stress)
Stress Cycles (per year) 3x10
5
Peristalsis
5x10
6
- 4x10
7
Heart muscle contraction

Nm
-2
unidade de tenso mecnica
O ambiente in vivo no esttico
A vida no uma condio estvel.
um processo dinmico metaestvel
constantemente trocando energia e material
com o mundo externo para produzir trabalho.
Um dispositivo efetivo deve ser fabricado de
um material que no desordene o processo
metaestvel nem a performande do
dispositivo.
Biocompatibilidade
a habilidade do material de atuar com uma
resposta apropriada do hospedeiro em uma
aplicao especfica.
A interao de contato do biomaterial com o
ambiente biolgico ocorre na interface do
material. A biocompatibilidade ser
determinada pelas interaes que ocorrem determinada pelas interaes que ocorrem
nesta interface.
Onde a clula faz a ligao
(ancoragem) depender das
propriedades especficas da
rea.
Um exemplo histrico
Artroplastia total de quadril
(total hip replacement: THP)
Ao longo dos sculos, o tratamento de
disfuno das juntas do quadril desenvolveu- disfuno das juntas do quadril desenvolveu-
se como uma das intervenes cirurgicas
mais bem sucedidas da histria.
O objetivo restaurar a funo, alinhamento da junta e
reduzir a dor.
Existem dois tipos de interveno:
Seo da junta com remoo de parte do osso
enrijecido, criando um vazio preenchido por tecido
Artroplastia
http://www.healthline.com/galecontent/arthroplasty?utm_term=arthroplasty%20&utm_medium=mw&utm_campaign=article
cicatrizante (junta menos estvel)
Reconstruo interposicional: cirurgia para
reformatao da junta e uso de prtese de
recobertura (plstico, metal, tecido biolgico etc).
Em caso de falha, h necessidade de substituio da
junta por prtese total (artroplastia).
1. Anterior superior iliac spine
2. Ilium
3. Anterior inferior iliac spine
4. Pelvic brim
5. Acetabular fossa
6. Head of femur
7. Fovea
8. Superior ramus of pubis
9. Obturator foramen
10. Inferior ramus of pubis
11. Pubic symphysis
12. Ischium
13. Lesser trochanter
14. Intertrochanteric crest
15. Greater trochanter
16. Neck of femur
1700s: exciso da junta praticada como reao ao
grande nmero de amputaes.
Anthony White (1782-1849) primeira artroplastia.
John Rhea Barton (1826) primeir a osteotomia
(joelho) em Filadelfia.
Themistocles Glck (alemo, 1891) desenvolveu Themistocles Glck (alemo, 1891) desenvolveu
uma bola e soquete de marfim fixados ao osso com
parafusos de nquel.
Sir Robert Jones usou uma tira de folha de ouro
para reconstruir cabeas femurais
Total Hip Replacement
In 1938, Phillip Wiles (1899-1966) of
the Middlesex Hospital in London
described the first total hip arthroplasty
(THA) using precisely fitted stainless
steel ball on the femur which was fixed
to the bone with screws and bolts, with
a stainless steel acetabulum lining. a stainless steel acetabulum lining.
Many of the surgical records for this
procedure were lost during WW II.
Unfortunately, however, this design and
these materials did not achieve
satisfactory results. Poor corrosion
resistance of the material along with
high stress concentrations on the short
stem caused this system to fail.
THR Improvements
Inspired by the stem, improvements in
material and design were made by G.
K. McKee, a trainee with Wiles. In
collaboration with J. Farrar, they
developed the McKee-Farrar device.
This THR had chrome cobalt metal on
metal articulation, and both the metal articulation, and both the
acetabular and femoral components
were fixed with cement.
Modern Prototype
Professor Sir John Charnley was convinced that
the metal on metal articulation of the McKee joint
was unsatisfactory. He felt that a high frictional
torque would eventually loosen the fixation of the
McKee components in their bony bed. He began a
search for self-lubricating bearings, and this search
took him into the field of polymers and his first
attempt at hip arthroplasty in the early 1950's was a
Teflon on Teflon bearing used as a resurfacing for Teflon on Teflon bearing used as a resurfacing for
the arthritic femoral head and acetabulum.
Unfortunately the Teflon on Teflon bearings wore
out within two years.
In 1960 he introduced what is considered the
prototype of the modern hip THR device, a metal
femoral component with an acetabular cup made of
ultra-high molecular weight polyethylene
(UHMWPE).
Sir John Charnley was a master
surgeon, innovator and bio-engineer. He
invented the low friction hip replacement
in the early 1960s at the Center for Hip
Surgery at Wrightington, England.
Surgeons from all over the world made
their way to Wrightington to learn his
techniques.
http://www.hipsandknees.com/hip/charnley.htm
Today, THR is the most successful
prosthetic implant surgery. Failure of
below 1% per year is observed when
surgery performed by specialist. THR
has proven very successful for mature
and elderly group, however it has not
performed as well in the younger more
active group.
Further THR Development
Understandably, surgeons and design engineers have
tried to improve the conventional hip replacement
particularly for use in more active patients. These
alterations in design have focused on improving fixation of
components, improving wear of the articulating parts and
improving the mechanical transition from the natural bone
to the implant. These are basic biomaterials questions
UHMWPE is the primary biomaterial
used to replace cartilage
Wear particle generation in
UHMWPE leads to inflammation,
osteolysis, loosening
Reduction of wear will greatly enhance
U!tra HIgh Mn!ccu!ar
WcIght Pn!ycthy!cnc
Reconstruo de menisco:
33
Reduction of wear will greatly enhance
component life
Understanding underlying degradation
mechanisms is key to future solutions
Improved surface properties could
preserve the desirable bulk properties
while reducing friction and wear
Reconstruo de ligamento:
e-PTFE Anterior Cruciate Ligament
34
Reparo de cartilagem: crescimento
celular sobre suportes de PLA
35
Wyre et al. (2000)
5 m
chondrocytes on PEMA/THFMA
Vlvulas cardiacas artificiais
36
Tratamento de doenas
vasculares: STENTS
37
38
Artifical Heart
LVAS: left ventricular assist system
Pump Drive Unit
39
Stored energy propels pusher plates of blood sac
When solenoid is de-energized, pump passively refills
Balanced, symmetrical drive system eliminates torque
Reconstruo odontolgica
40
Biomateriais em oftalmologia
Plpebra: retrao, perda Fios, tubos, placas, Silicone, nylon, tefron, dracon, polietileno
41
Plpebra: retrao, perda
de tecido periorbitrio
Fios, tubos, placas,
lminas, esponjas
Silicone, nylon, tefron, dracon, polietileno
poroso, PLLA, HAp, PMMA, enxerto
autlogo
Vias lacrimais Plugs, inserts, tubos
e stents
Silicone, celulose, vidro pyrex, malha de
ao
Orbita: fraturas,
cavidades anolftlmicas
Fios, gel, placas,
folhas, lminas ,
parafusos, esferas
Ao, titnio, silicone, PTFE, HAp,
biocermicas, enxerto dermoadiposo
autlogo
Lentes intra-oculares Lente tica Silicone, acrlicos, hidrogis, collamer
Outros: vitreo, crnea,
retina, esclera
vrios