Porous zirconia blocks for bone repair: an integrative review on biological and mechanical outcomes

Abstract

The aim of this study was to conduct an integrative review of the biological and mechanical outcomes of porous zirconia structures for extensive bone repair. An electronic search was performed on the PubMed database using a combination of the following scientific terms: porous, scaffold, foam, zirconia, bone regeneration, bone repair, bone healing. Articles published in the English language up to December 2021 and related to porosity, pore interconnectivity, biocompatibility and strength of the material, and the manufacturing methods of zirconia porous structures were included. Randomized controlled trials and prospective cohort studies were also evaluated. The research identified 145 studies, of which 23 were considered relevant. A high percentage of pores and the size and interconnectivity of pores are key factors for cell migration, attachment, proliferation, and differentiation. In addition, pore interconnectivity allows for the exchange of nutrients between cells and formation of blood vessels. However, a decrease in strength of the porous structures was noted with an increase in the number and size of pores. Therefore, yttria-stabilized zirconia tetragonal polycrystal (Y-TZP) has mechanical properties that make it suitable for the manufacture of highly porous structures or implants for extensive bone repair. Additionally, the porous structures can be coated with bioactive ceramics to enhance the cell response and bone ingrowth without compromising pore networking. Porous structures and mesh implants composed of zirconia have become a strategy for extensive bone repair since the material and the pore network provide the desired biological response and bone volume maintenance.