Poly(methyl methacrylate) bone cement, its rise, growth, downfall and future

Abstract

Poly(methyl methacrylate) (PMMA)-based bone cements (BCs) can be defined as a family of materials that consist of powder and liquid phases which after mixing form a plastic paste that can self-set once implanted in the human body. PMMA-based BCs are easily molded and adapted to complex bone cavities or used in orthodontic applications to restore dental damage. The main advantages of the use of cement are the excellent primary fixation between bone and implant and, therefore, the faster recovery of the patient. Despite the initial success rate of implant fixation with BCs, they have some disadvantages such as local tissue damage due to exothermic polymerization reactions, mechanical mismatch between native bone and cement, lack of bone regeneration and bioactivity and poor mechanical properties which may cause the failure of the BCs. BCs are still considered as a top option for bone repair. Due to the disadvantages highlighted, research has focused on alternative materials used with PMMA-based BCs. This review aims to critically review the BCs and emerging materials used in combination with PMMA-based BCs. These materials include titania, apatite–wollastonite (A-W), glass ceramic (GC) and hydroxyapatite (HA). The review discusses the properties of these materials and their pathway to clinical study. Among the various kinds of reinforcement, HA has been extensively used. So, in this review, we compare the effects of HA as reinforcement in PMMA-based BCs. Upcoming study of PMMA-based BCs should concentrate on trialing combinations of these reinforcing agents as this might improve beneficial characteristics.