in a report by habibovic and coworkers [ biomaterials , 29 , 944 ( 2008 ], it was noted that ( 1 ) in the search for a synthetic biomaterial that is able to successfully replace autografting , the “ gold - standard ” in orthopedic and craniofacial surgery , a range of materials have been developed in the past four decades ; ( 2 ) motives influencing the design of synthetic bone graft substitutes are often based upon mimicking one or more properties of natural bone since this is the intended tissue to be repaired or augmented ; ( 3 ) various types of calcium - phosphate biomaterials , which resemble either the composition of bone mineral or its precursors have been developed , such as hydroxyapatite -, α - and β - tricalcium phosphate , octacalcium phosphate , and dicalcium phosphate in the form of ceramics , cements , and thin coatings — many relatively insoluble calcium - phosphate materials are osteoconductive and in some cases , even able to induce new bone formation in extra - skeletal sites ; ( 4 ) in the case of large or dense bone graft substitutes , biodegradation is important for allowing simultaneous replacement of the material with new bone — this process prevents stress shielding and disadvantageous resorption of neighboring bone ; ( 5 ) although calcium - phosphate materials can be degraded through cell - mediated processes ( resorption ), chemical dissolution is the main pathway of biodegradation — dissolution of calcium - phosphate materials is largely dependent on their chemical composition ; and ( 6 ) for both dense and macroporous materials , the rate of resorption should ideally be the same as the rate of new bone formation in order to obtain a constantly stabilized repair and eventually a fully repaired bone defect without remnants of the synthetic material . these remarks and earlier reports dealing with absorbable bone substitutes and the distantly related absorbable cyanoacrylate tissue adhesives were analyzed prior to conceiving the novel combinations of the inorganic bone graft materials with the adhesive materials to yield the different , unexpected and unobvious properties contained in the parent application of this invention and the new systems subject of the instant invention . while the parent application of this invention introduced the novel approach of integrating the adhesive and thermoplastic properties of absorbable polycyanoacrylates with the osteogenic and structural properties of selected inorganic phosphate - containing materials to yield unique self - setting , absorbable , composite bone cement / fillers , the present invention focuses on exploiting the main attributes of these composites to maximize their clinical applicability through carefully tailored value - added features . the latter include those noted below : 1 . combining the liquid cyanoacrylate component with bioactive , solid microparticles , or soluble bioactive polymers , such as ( a ) certain phosphate - based microparticles or their mixtures with casio 3 microparticles that are known for being osteoconductive and can be further activated by immobilizing specific bioactive agents to , in part , render them osteoinductive as well , and / or impart antimicrobial activities ; and ( b ) c - succinylated , absorbable copolyesters or polyether - esters carrying succinic acid side groups capable of ionic conjugation with basic bioactive agents , such as antimicrobials and cell growth - promoting agents . 2 . introducing specific compounds to accelerate or modulate the anionic polymerization of the cyanoacrylate monomer ( s ), as in the case of ( a ) pyrophosphoric acid to slow - down the anionic polymerization when the filler itself can cause polymerization ; ( b ) hydroxy - terminated polyglycolide ( pg - h ) to initiate and accelerate the polymerization ; and / or ( c ) a specific combination of the pg - h and pyrophosphoric acid to modulate the curing time to meet the application site requirements . this allows ease of handling and modulates the curing time to be in concert with the specific surgical site and procedure . 3 . using ionic conjugates of basic bioactive agents , ionically immobilized on or within carboxyl - bearing microparticles or cyanoacrylate - soluble c - succinylated polyether - esters — the basic agents can be selected from among those known to have ( a ) antimicrobial activities to prevent post - surgical infection ; ( b ) cell growth - promoting effects to promote tissue regeneration ; and / or ( c ) specific effects to increase the rate of ossification . 4 . adding casio 3 to the phosphate component of self - setting cyanoacrylate - based absorbable composites to increase the rate of absorption ( or dissolution ) of the overall phosphate / silicate mixture and improve the composite osteogenic effect . this will accelerate the directed bone regeneration process . 5 . incorporating fibrous reinforcing components to increase the modulus and / or toughness as well as fatigue properties , such as using ( a ) chitosan chopped fibers and chitosan knitted mesh made of multifilament yarn ; ( b ) chopped multifilament or monofilament yarns of absorbable , slow - and / or fast - absorbing copolyesters and polyether - esters ; ( c ) woven or knitted meshes ( both weft - and warp - knitted ) monofilaments and / or one or more type of multifilament yarn made of fast - or slow - absorbing copolyesters or polyether - esters . reinforcing the self - setting , absorbable , bioactive composite facilitates their use in correcting major defects , such as those encountered in maxillofacial and cranial bones as well as long bones where , for instance , the mesh is used as a scaffold for applying a partially cured paste of the cyanoacrylate - based composite . furthermore , using fast - absorbing fibers or mesh will result in generating interconnected channels , as they absorb , in the bone cement / filler to render it osteoconductive . acids generated as by - products of the degrading absorbable meshes or fibers will accelerate the absorption or dissolution of the phosphate - based and casio 3 components of the composite ; and ( d ) bi - or multicomponent weft - or warp - knitted meshes comprising fast - and slow - absorbing yarn will lead to two or more strength retention profiles that , in turn , allow a gradual or multistage load - transfer to the natural bone and hence , accelerate bone regeneration . 6 . using surface - activated reinforcing , fibrous constructs to immobilize bioactive agents or agents that can accelerate absorption or modulate the dissolution of the composite constituents . these include ( a ) partially base - hydrolyzed surfaces of the fibrous components to yield negatively charged substrates for binding basic bioactive agents and basic amino acids ; ( b ) chitosan fiber with inherently basic surfaces for binding positively charged bioactive agents or amino acids — binding acids such as aspartic and citric acids on chitosan can assist in degrading absorbable polyester components of the composite ; and ( c ) silk fibers with pendant functional side groups for osteoblast attachment . 7 . coating the mesh reinforcing component of the self - setting cyanoacrylate - based composites will allow the application of different absorbable coatings that , in turn , can be used ( a ) to modulate the absorption and strength retention of the mesh through using amine - bearing polymers or carboxyl - bearing polymers that are neutralized with lysine or arginine ; ( b ) as controlled release vehicles for the predetermined release of bioactive agents , including those known for their antimicrobial and cell growth - promoting and osteogenic activities ; and ( c ) as carriers for basic chemical compounds or basic components capable of initiating and accelerating the polymerization of acrylate monomer ( s ) at the mesh fibrous components to maximize the mesh / matrix adhesive joint and hence , the mechanical properties of the reinforced composite . 8 . in vitro curing of unreinforced and fiber - or mesh - reinforced self - setting composites for use as machinable blocks . composites describe in items 1 through 7 can be prepared as fully cured blocks suitable for machining or micromachining into solid orthopedic absorbable devices useful in ( a ) repairing different types of bone defects , including those of the limbs and feet where bone guided bone regeneration is sought ; and ( b ) substituting part of the maxillofacial and cranial bones where natural bone will eventually replace the absorbable composites . further illustrations of the present invention are provided by the following examples : preparation and in vitro testing of a self - setting composite , scc - p1 from 50 / 50 ( weight / volume ) of ( 95 / 5 cahpo 4 / pg - h )/ methoxypropyl cyanoacrylate hydroxy - terminated polyglycolide ( pg - h ) microparticles are dried at 110 ° c . for at least 6 hours under reduced pressure ( the microparticulate , pg - h , was made previously at poly - med , inc ., anderson , s . c .). a batch of cahpo 4 microparticles is dried for at least 6 hours at 130 ° c . a dry 5 g mixture of 95 / 5 cahpo 4 / pg - h microparticles is added , while stirring , using a teflon - coated stirrer , under dry nitrogen atmosphere to 5 ml of mpc at room temperature . after mixing , the resulting paste is transferred to a two - part teflon mold designed to produce cured 3 × 1 × 0 . 19 cm test specimens ( for the 3 - point bend method ). the closed mold is heated at 37 ° c . until full curing is achieved — the approximate curing time is predetermined during a few pilot runs . the cured composition is removed and evaluated for mechanical properties using the 3 - point bend method and an mts minibionix universal tester to record the peak stress , modulus and breaking elongation . a few of the cured specimens are cut into 10 × 10 × 1 . 9 mm samples for determining the composite absorption under accelerated conditions in deionized water at 50 ° c ., in terms of mass loss after 10 days of incubation . to determine the molecular weight of the polymerized mpc ( pmpc ) the composition is extracted with chloroform . after removing the solvent , the molecular weight of the pmpc is determined by gpc using methylene chloride as the mobile phase . the preparation and testing for scc - p2 and scc - p3 are conducted as described for scc - p1 in example 1 with the exception of using 97 / 3 ( by weight ) cahop 4 / pg - h . key data on the composite preparation and in vitro testing are summarized in table i . the preparation and testing of scc - p4 and scc - p5 are conducted as described for scc - p1 with the exception of using 40 / 60 ( 95 / 5 cahpo 4 / pg - h )/ methoxypropyl cyanoacrylate and 40 / 60 ( 95 / 5 cahpo 4 / k 2 hpo 4 )/ methoxypropyl cyanoacrylate for scc - p4 and scc - p5 , respectively . key data on the preparation and in vitro testing are summarized in table i . preparation and in vitro testing of self - setting composites based on phosphate / silicate microparticles and methoxypropyl cyanoacrylate ( mpc ), scc - ps1 to scc - ps3 preparation of scc - ps1 to scc - ps3 is conducted as described for scc - p1 ( example 1 ) with the exception of substituting 10 to 30 weight percent of the cahpo 4 with casio 3 . similarly , the cured composites are tested as noted in example 1 for scc - p1 . key data for the composite preparation and in vitro testing are summarized in table ii . a tested using 3 - point bend method with 3 × 1 × 0 . 19 cm test specimen ; t = sample thickness , p . s . = peak stress , mod . = flexural modulus , b . e . = breaking elongation . d using 20 ml of deionized water and 10 × 10 × 1 . 9 mm test specimen . a scc - p3 = self - setting , methoxypropyl cyanoacrylate - based / phosphate composite from example 3 ; scc - ps2 = self setting methoxypropyl cyanoacrylate - based / phosphate / silicate from example 6 . b single - component mesh = warp - knitted mesh constructed from slow - absorbing multifilament yarn , say of example 7 ; bicomponent mesh = warp - knitted mesh constructed from say and a fast absorbing multifilament yarn , fay of example 8 . c on a 3 × 1 cm test specimen having an approximately 1 . 9 mm thickness , using a 3 - point bend method to determine the peak stress ( p . s . ), flexural modulus ( mod .) and breaking elongation ( b . e .). t = approximate thickness 1 . 9 . although the present invention has been described in connection with the preferred embodiments , it is to be understood that modifications and variations may be utilized without departing from the principles and scope of the invention , as those skilled in the art will readily understand . accordingly , such modifications may be practiced within the scope of the following claims . moreover , applicants hereby disclose all subranges of all ranges disclosed herein . these subranges are also useful in carrying out the present invention .
self - setting , absorbable bioactive polycyanoacrylate - based composites include at least one inorganic phosphate salt or a combination of at least one inorganic phosphate salt and calcium silicate in a cyanoacrylate matrix . the composites can be reinforced with single - or multicomponent absorbable , warp - knitted mesh , thus producing a broad range of absorbable , bioactive biomaterials suitable for use not only as preferred absorbable alternatives to the commercial non - absorbable polymethyl methacrylate bone cements , but also for repairing or replacing cranial and maxillofacial bone defects and other complex defects through guided bone regeneration .