Calcium carbonate: Adored and ignored in bioactivity assessment

The title of this article could sound a bit curious to some readers since a layer of apatite - and not calcium carbonate - is well-known to form on the surface of bioactive glasses upon immersion in simulated body fluids. However, calcium carbonate (commonly reported as calcite crystals) can form on the surface of bioactive glasses as well, instead of or in competition with hydroxyapatite, during in vitro tests. Major factors that govern calcium carbonate formation are a high concentration of Ca²⁺ ions in the testing solution - and, in this regard, glass composition/texture and type of medium play key roles - along with the volume of solution used during in vitro tests. To date, this phenomenon has received relatively little attention and is still partly unexplored. This article provides a critical overview of the available literature on this topic in order to stimulate constructive discussion among biomaterials scientists and further research for better understanding the mechanisms involved in glass bioactivity. STATEMENT OF SIGNIFICANCE: A literature search indicates that a layer of apatite - and not calcium carbonate - is well known to form on the surface of biomaterials during the bioactivity assessment. However, calcium carbonate can form on the surface as well, instead of or in competition with apatite. To date, this phenomenon has received relatively little attention and is still partly unexplored. This review provides a critical overview of the available literature on this topic in order to stimulate constructive discussions that can be further useful for clinical success.