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Materials Today: Proceedings 4 (2017) 35343541 www.materialstoday.com/proceedings

5th International Conference of Materials Processing and Characterization (ICMPC 2016)

Advanced Application of Polymer based Biomaterials

Deepen Banoriyaa, Rajesh Purohita*, R.K.Dwivedia
a
Department of Mechanical Engineering, MANIT, Bhopal

Abstract

This paper includes the brief review regarding the applications of various biomedical field associated with polymer based
biomaterials. They are used in the form of implants and medical devices to replace and restore the function of distressed or
disintegrated 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 adequacy by the human body. A biomaterial used for implant should possess some important
properties in order to long term usage in the body without refutation. An outline of various biomedical applications of polymer
based biomaterials with different types that are already in use or investigated are presented in this paper.

2017 Elsevier Ltd. All rights reserved.

Selection and peer-review under responsibility of Conference Committee Members of 5th International Conference of Materials Processing and
Characterization (ICMPC 2016).

Keywords:Biomaterials, Implants, Polymer, Biocompatibility.

1. Introduction

The term Biomaterials have alternately been used to describe materials derived from biological sources or to
describe materials used for therapies in the human body. The focus of this paper is biomedical applications of
polymers, with an emphasis on emerging new applications driving an expansion of the polymer based biomaterials.
The use of polymers in medicine earlier gives birth to the field of polymer science, virtually every early synthetic
polymer found its way into experimental surgical studies soon after its invention and many endured to become
staples of clinical practice.

* Corresponding author. Tel.: +09479953671

E-mail address:rpurohit73@gmail.com

2214-78532017 Elsevier Ltd. All rights reserved.

Selection and peer-review under responsibility of Conference Committee Members of 5th International Conference of Materials Processing and
Characterization (ICMPC 2016).
 Deepen et. al/ Materials Today: Proceedings 4 (2017) 35343541 3535

Nomenclature

BIS-GMA bis-phenol A glycidyl methacrylate PET polyethylene terepthalate

C carbon PGA poly(glycolic acid)
CF carbon fibers PHB polyhydroxybutyrate
GF glass fibers PHEMA poly(HEMA) or poly (2-
HA hydroxyapatite/hydroxylapatite methacrylate) hydroxyethyl
HDPE high density polyethylene PLA poly (lactic acid)
KF Kevlar fiber PLDLA poly (L-DL-lactic acid)
LCP liquid crystalline polymer PLLA poly (L-lactic acid)
LDPE low density polyethylene PMA polymethylacrylate
MMA methylmethacrylate PMMA polymethylmethacrylate
PA polyacetal POLYGLACTIN copolymer of PLA and PGA
PBT polybutylene terephthalate PP polypropylene
PC polycarbonate PS polysulfone
PCL polycaprolactone PTFE polytetrafluroethylene
PE polyethylene PU polyurethane
PEA polyethylacrylate PVC polyvinylchloride
PEEK polyetheretherketone SR silicone rubber
PEG polyethylene glycol THFM tetrahydrofurfuryl methacrylate
PELA block copolymer of lactic acid and UHMWPE ultra high molecular weight poly-
polyethylene glycol ethylene

The polymers remain important in clinical medicine as essential components of permanent prosthetic devices
including hip implants, artificial lenses, large diameter vascular grafts, catheters, etc., and research continues to
optimize the stability and performance of these materials in vivo. Whereas the original uses of polymers in surgery
centered primarily on replacements for connective tissues, a host of new applications are emerging as a result of
major advances in the sciences of molecular cell biology and developmental biology. An array of new protein and
nucleic acid based drugs, which cannot be taken in classical pill form, are providing impetus for new implantable
polymers for controlled drug delivery and gene therapy. Applications in the relatively new field of tissue
engineering, where polymers are used to assist regeneration of three-dimensional tissue and organ structures, are
more promising and are more assimilated with biological demands [1].
A large number of polymers such as polyethylene (PE), polyurethane (PU), polytetrafluoroethylene (PTFE),
polyacetal (PA), polymethylmethacrylate (PMMA), polyethyleneterepthalate (PET), silicone rubber (SR),
polysulfone (PS), polyetheretherketone (PEEK), poly lactic acid (PLA), and poly glycolic acid (PGA) are also used
in various biomedical applications. HA/PE, silica/SR, carbon fiber/ultrahigh molecular weight polyethylene
(CF/UHMWPE), carbon fiber/ epoxy (CF/epoxy), and CF/PEEK are few examples of polymer composite
biomaterials [2].
The application of polymeric materials for medical purposes is growing very fast. Polymers have found
applications in such diverse bio-medical fields as tissue engineering, implantation of medical devices and artificial
organs, prostheses, ophthalmology, dentistry, bone repair, and many other medical fields. Polymer-based delivery
systems enable controlled slow release of drugs into the body. The application of synthetic polymers for gene
therapy has also been investigated. They may provide a safer way of gene delivery than use of viruses as vectors.
Polymeric materials have also extensively been used for biosensors, in testing devices, and for bio-regulation.
Polymeric material suitable for a biomedical application must be biocompatible, at least on its surface. Strictly
speaking many polymeric systems used for implantation of medical devices into the body are considered to be
biocompatible, though after implantation they become isolated from the tissues of the body by collagenous
encapsulation. An implanted polymeric material may be considered to be biocompatible, if its insertion into the
body does not provoke an adverse reaction. A thrombus is formed very fast when polymers contact blood cells.
Materials with non-thrombogenic blood compatible surfaces must, therefore, be used in contact with the blood
3536 Deepen et. al/ Materials Today: Proceedings 4 (2017) 35343541

stream. Truly biocompatible polymers, used for medical purposes, should be able to recognize and cooperate in
harmony with bio-assemblies and living cells without any non-specific interactions [3]. Mechanical properties of typical
polymeric biomaterialsare shown in table 1.

Table 1: Mechanical properties of typical polymeric biomaterials [4]

Material Youngs Modulus (GPa) Tensile strength (MPa)
Polyethylene(PE) 0.88 35
Polyurethane(PU) 0.02 35
Polytetrafiuoroethylene(PTFE) 0.5 27.5
Polyacetal(PA) 2.1 67
Polymethylmethacrylate(PMMA) 2.55 59
Polyethyleneterepthalate(PET) 2.85 61
Polyetheretherketone(PEEK) 8.3 139
Siliconerubber(SR) 0.008 7.6
Polysulfone(PS) 2.65 75

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:
1) The properties (mechanical, chemical and tribological) of the biomaterial.
2) Biocompatibility of the implant.
3) The health condition of the recipient and the competency of the surgeon.

Fig.1: Significance of Implants for Human Anatomy [5]

A composite material made of a vital (non-living) matrix and reinforcement phases, is called
'avital/avitalcomposite'. Alternatively, a composite material comprising of vital (living) and avital (non-
living) materials is called 'vital/avital composite'. The avital/avital composites are analogous to polymer
composites known to engineers. The avital/avital composites are further divided into non resorbable, partially
resorbable and fully resorbable composite biomaterials. The non resorbable composites are designed not to
degrade in the in vivo (inside the body) environment. They are particularly promising for long term implants
such as total joint replacements, bone cement, spine rods, fusion cages, discs, plates, dental posts, and hernia
patches. They are also proposed for short term applications such as bone plates, rods, screws, ligaments, and
catheters. On the other hand, the resorbable composites are intended to lose their mechanical integrity in in-
 Deepen et. al/ Materials Today: Proceedings 4 (2017) 35343541 3537

vivo conditions. They are particularly promising as short term or transient implants namely bone plates, screws,
pins, rods, ligaments, tendons, bone replacement, vascular grafts, and artificial skin [6].
As shown in Fig.1, over the years a wide variety of polymer based biomaterials have been developed for various
biomedical applications. The following sections present details of polymer composite biomaterials in terms of
applications. In each section, general information regarding structure and function of tissues, purpose and type of
implants or devices, and various other materials used are also briefly presented. classificaztion of polymers is shown
in figure 2 with a flow chart.
Polymer Composite
Biomaterials

Vital/Avital Composites Avital/Avital Composites

Ex: Fibroblasts/PGA
Endothelial/PET

Non-resorbable Composites Partially Resorbable Fully Resorbable

Composites Composites
Alumina/PMMA
Bioglass/PS CF/PGA PLA-PGA/PLA
Bioglass/PU CF/PLA PLLA/PLDLLA
Bone/PMMA CF/PLLA
CF/C HA/ALGINATE
CF/Epoxy HA/PBT
CF/Nylon HA/PEG-PHB
CF/PBT HA/PLA
CF/PEEK PET/COLLAGEN
CF/PMMA PET/PHEMA
CF/PP PU/PU-PELA
CF/PS
CF/PTFE
CF/UHMWPE
GF/bis-GMA
GF/PMMA
GF/PP
GF/PU
HA/HDPE
HA/UHMWPE
KF/PC
KF/PMA
PE/PMMA
PET/PU
PTFE/PU
SILICA/bis-GMA
SILICA/SR
UHMWPE/bis-GMA

Fig.2: Classification of Polymer Composite Biomaterials

2. Applications in biomedical field as:

Polymers have assumed an important role in medical applications. In most of these applications, polymers have
little or no competition from other types of materials. Their unique properties are:
1. Flexibility.
2. Resistance to biochemical attack.
3. Good biocompatibility.
4. Light in weight.
3538 Deepen et. al/ Materials Today: Proceedings 4 (2017) 35343541

5. Available in a wide variety of compositions with adequate physical and mechanical properties.
6. Can be easily manufactured into products with the desired shape.

2.1 Tissue engineering

Biomaterials play a critical role in engineering of tissue constructs, working as an artificial extracellular matrix
and three dimensional support environment for cells (entrained in vitro or migrating in vivo from the host tissue) to
regenerate a wound site [7]. Due to their mechanical versatility and similarity to the structural characteristics of
tissue, polymers are the most popular biomaterials in tissue engineering [8]. Polymeric biomaterials are currently
dominated by thermoplastic polyesters such as poly lactic acid (PLA), poly glycolic acid (PGA), poly caprolactone
(PCL) and their blends or copolymers. Polyester is a category of polymers that contain the ester functional group in
their main chain. Esters are chemical compounds derived from a carboxylic acid (COOH group) and a hydroxyl
(OH) compound, usually an alcohol. Many esters, such as fatty acids, are endogenous to human metabolism and
thus biocompatible. Many polyesters can break down to natural metabolic products by simple hydrolysis. Although
these biomaterials have been well characterized and fabricated to match the biochemical properties of soft tissues,
there is generally a lack of mechanical compatibility between thermoplastic polymer implants and living tissues [9].

2.2 Implantation of medical devices

Synthetic biodegradable polymers have attracted considerable attention for applications in medical devices, and
will play an important role in the design and function of medical devices. Drug Eluting Stents (DES) have been
widely used as a default treatment for patients with coronary artery disease. Biodegradable polymers are always
used as a biodegradable and bio resorbable coatings on stents to control the release of drugs [10]. Besides being used
as biodegradable coatings, biodegradable polymers are also candidate materials for fully biodegradable stents
because of their suitable properties for controlled drug release and good mechanical performance to prevent stents
from deforming or fracturing [11]. Orthopaedic devices made from biodegradable materials have advantages over
metal or non-degradable materials. They can transfer stress over time to the damaged area as it heals, allowing of the
tissues, and there is no need of a second surgery to remove the implanted devices. Many commercial orthopaedic
fixation devices such as pins and rods for bone fracture fixation, and screws and plates for maxillofacial repair are
made of PLLA, poly glycolide and other biodegradable polymers [12,13]. Many disposable medical devices, such as
syringes, injection pipes, surgical gloves, pads, etc., are usually made of non degradable plastics, resulting in serious
environmental and economic issues. PLA, poly glycolide, poly d,l-(lactide-co-glycolide) and PCL are all
biodegradable. Therefore, they are promising materials for use in disposable medical devices meeting environmental
friendly requirements. These biodegradable polymers have been used to prepare some disposable medical devices
and will likely have a widening commercial application [14].

2.3 Joint Prostheses

Joints enable the movement of the body and its parts. Many joints in the body are synovial types, which permit
free movement. Hence, we are able to do various physical activities such as walk, jog, run, jump, turn, bend, bow,
stand, and sit in our daily life. Hip, knee, shoulder, and elbow area few common examples of synovial joints [2].
Total Hip Replacement (THR) is the most common artificial joint in human beings. A typical (THR) consists of
a cup type acetabular component, and a femoral component whose head is designed to fit into the acetabular cup,
thus enabling joint articulations. The shaft of the femoral component (also called femoral stem) is tapered such that
it can be fixed into a reamed medullary canal of the femur. Subsequently acetabular cups made of UHMWPE were
developed and found to be successful. The UHMWPE cups are usually supported with a metal backing. It would be
suggested that creep deformation, plastic distortion, and high wear or erosion of UHMWPE is possible. Although
the short term function of UHMWPE acetabular cups is satisfactory, their long term performance has been a concern
for many years [15].
The Total Knee Replacement has a more complicated geometry and biomechanics of movements than the hip
joint. The incidence of knee injuries and degeneration is higher than most other joints. A typical (TKR) mainly
consists of femora and tibia components. The tibia component is made of UHMWPE polymer supported by a
metallic tibia tray. It should be emphasized that the composite by itself may not be suitable for low friction bearing
 Deepen et. al/ Materials Today: Proceedings 4 (2017) 35343541 3539

but a combination of a UHMWPE surface and a composite substrate appears to offer some advantages. Other joint
replacements include ankle, toe, shoulder, elbow, wrist, and finger joints. The success rate of these joint
replacements is limited due to loosening of prostheses and hence they are used less commonly compared with THR
and TKR. Some designs use CF/UHMWPE instead of UHMWPE to provide higher strength and creep resistance. In
certain types (space filler design) of finger joint replacements, silicone rubber (SR) is considered. Tearing off at the
junction of prosthesis and roughened arthritic bone is a major concern. In order to improve the tear strength and
flexural properties. It is reinforced with PET fabrics. It is reported that the composite prosthesis also successful in
decreasing pain, improving stability, increasing hand function, and in providing an adequate range of motion [16].

2.4 Dentistry

Dental treatment is one of the most frequent medical treatments performed upon human beings. Dental
treatment ranges from filling cavities (also called 'dental caries') to replacing fractured or decayed teeth. A large
variety of materials are used in the dental treatments such as cavity lining, cavity filling, fluting, endodontic, crown
and bridge, prosthetic, preventive, orthodontic, and periodontal treatment of teeth. These materials are also generally
described as biomaterials.
The choice of material is dependent on its ability to resemble the physical, mechanical and esthetic properties of
natural tooth structure. Dental composite resins, which are translucent with a refractive index matching that of the
enamel, have virtually replaced these materials and are very commonly used to restore posterior teeth as well as
anterior teeth. The dental composite resin comprises of BIS-GMA as the matrix polymer and quartz, barium glass,
and colloidal silica as fillers. Polymerization can be initiated by a thermo chemical initiator such as benzoyl
peroxide, or by a photochemical initiator (benzoin alkyl ether) that generates free radicals when subjected to
ultraviolet light from a lamp used by the dentist. The dental implant may be designed to enter the jaw bone or to fit
on to the bone surface. The types of dental implants available are numerous. For example, certain root form shave
threads, which facilitate to secure the root form into the jaw bone, where as in some other designs, the surface is
coated with porous bioactive materials, which allow bone growth and Osseo integration. They are made of a wide
range of materials such as metals (Co-Cr-Mo alloys, Ti alloys, stainless steel, platinum, silver), ceramics (zirconia,
alumina, glass, and carbon), polymers (UHMPE, PMMA, PTFE, PS, and PET) and composites (SiC/carbon and
CF/carbon) [17,18].
A bridge is a partial denture (false teeth) used to replace one or more tooth completely. The high cost and time
consuming preparation of current gold bridges has led to the development of relatively inexpensive and easy to use
CF/PMMA, KF/PMMA, UHMWPE/PMMA and GF/PMMA composite bridges and dentures. Orthodontic arch
wires (approximately 0.5mm diameter) are used to correct the alignment of teeth. This is facilitated by bonding
orthodontic brackets onto the teeth [19]. It is proposed GF/PC, GF/Nylon, GF/PP, and GF/PMMA composite
materials for arch wires. The stated advantages of using composite arch wires include aesthetics, easy forming in the
clinic, and the possibility of varying stiffness without changing component dimensions [20].

2.5 Bone repair

Bone is a structural composite composed of collagen fibres with hydroxy apatite nano crystals precipitated along
the collagen fibrils[21]. Bone also contains other constituents such as mucopolysaccharides, blood vessels, and bone
cells. The low elastic modulus collagen fibers are aligned in bone along the main stress directions. The high elastic
modulus hydroxy apatite mineral comprises approximately 70% of the dry bone mass and contributes significantly
to the bone stiffness.
Bone is an anisotropic material because its properties are directionally dependent. Bone fractures are treated
(anatomic reduction) in different ways and they may be grouped into two types namely external fixation and internal
fixation. The external fixation does not require opening the fractures where as the internal fixation requires opening
of the fracture site. Casting materials or plaster bandages are used to form splints, casts or braces [22]. The casting
material essentially is a composite material made of woven cotton fabrics (woven gauze) and Plaster of Paris matrix
(calcium sulphate) and other reinforcements include fabrics of glass and polyester fibres. Recently, casts made of
glass or polyester fabrics, and water activated polyurethanes are gaining popularity. An ideal cast material should be
easy to handle, light weight, conformable to anatomical shape, strong, water proof, radiolucent, and easy to remove.
External fixators constructed from CF/epoxy composite materials are gaining acceptance owing to their light weight
3540 Deepen et. al/ Materials Today: Proceedings 4 (2017) 35343541

yet sufficient strength and stiffness [23].

Polymers such as PA, PTFE, and polyester for bone plate applications, the materials proposed for bone plate
application must also possess sufficiently high fatigue strength (comparable to stainless steel), as the orthopaedic
devices are subjected to extremely high cyclic loads, and must not lead to largest rains at the fracture site, which
may affect the bone union. Polymer composite materials offer desired high strength and bone like elastic
properties[24]. The non resorbable composite plates are made of either thermoset polymer composites or
thermoplastic composite materials. CF/epoxy, GF/epoxy are few examples of non resorbable thermoset composites
[25]. As the technology for making good quality thermoplastic composites made available, researchers developed
CF/PMMA, CF/PP, CF/PS, CF/PE, CF/nylon, CF/PBT, and CF/PEEK non resorbable thermoplastic composite bone
plates. Among various materials investigated, the CF/PEEK is reportedly biocompatible and has good resistance to
hydrolysis and radiation (a sterilization method) degradation [26, 27]. The other promising properties include high
strength, fatigue resistance, and biological inertness with no mutagenicity or carcinogenicity[28].

2.6 Drug delivery system

A new dimension for the use of polymeric materials as drug delivery devices involves incorporation of
biodegradability into the system. A number of degradable polymers are potentially useful for this purpose, including
a variety of synthetic and natural substances. The use of intentionally degradable polymers in medicine has been
brought into prominence with new innovations in drug delivery systems. The limitations of conventional methods of
drug delivery, by tablet or injection for example, are well known. One of the most prominent approaches is that in
which the drug is contained within a polymer membrane or otherwise encapsulated in a polymer matrix and where
the drug diffuses out into the tissues following implantation. In some cases, erosion or dissolution of the polymer
contributes to the release mechanism. Degradable polymers such as poly lactic acid and poly orthoesters, are used
for drug delivery systems [29]. Chitosan has been effectively used in drug delivery as a hydrogel system, drug
conjugate, biodegradable release system, and PEC for many components. Chitosan based systems are used for the
delivery of proteins/peptides, growth factors, anti inammatory drugs, antibiotics, as well as, in gene therapy and
bio imaging applications. Chitosan particles or poly electrolytes complexes have been studied for nasal delivery of
therapeutic proteins have been done. It was found that insulin loaded chitosan nano particles enhanced nasal
absorption of proteins to a greater extent than relevant chitosan solutions [30,31].
Heparin is widely used as an anticoagulant and anti platelet agent. Since systemic administration of heparin
elevates the risk for hemorrhage, site specific delivery of heparin to injured vessels provides a favorable alternative
to systemic delivery. By mixing heparin powder in the polymer melt, they were able to test the effect of heparin
loading within rat endothelial injuries. In vitro release studies showed full recovery of loaded heparin, indicating that
heparin did not react during polymerization. The results shows the promise of using heparin within polymeric
devices for local drug delivery [32].

3. Conclusion

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. The present
study reviewed the currently used polymers based biomaterials. The availability of a wide range of polymers
significantly influenced the growth of tissue engineering and controlled drug delivery technologies. However, for
successful application, surgeons must be convinced with the long term durability and reliability of polymer
composite based biomaterials. The use of polymer composite materials for biomedical applications offers many new
options and possibilities for implants design. As a matter of fact, polymer based composite materials and
components can be designed to obtain a wide range of mechanical and biological properties. In many biomedical
applications, the research and the testing of polymer based composites has been introduced and highly developed,
but only in a very few cases an industrial production and commercial distribution of medical devices partially or
entirely made of composites has started. 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.
 Deepen et. al/ Materials Today: Proceedings 4 (2017) 35343541 3541

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