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Abstract
The manner in which a mutually acceptable co-existence of biomaterials and tissues
is developed and sustained has been the focus of attention in biomaterials science
for many years, and forms the foundation of the subject of biocompatibility. There
are many ways in which materials and tissues can be brought into contact such that
this co-existence may be compromised, and the search for biomaterials that are able
to provide for the best performance in devices has been based upon the understanding
of all the interactions within biocompatibility phenomena. Our understanding of the
mechanisms of biocompatibility has been restricted whilst the focus of attention has
been long-term implantable devices. In this paper, over 50 years of experience with
such devices is analysed and it is shown that, in the vast majority of circumstances,
the sole requirement for biocompatibility in a medical device intended for long-term
contact with the tissues of the human body is that the material shall do no harm to
those tissues, achieved through chemical and biological inertness. Rarely has an attempt
to introduce biological activity into a biomaterial been clinically successful in
these applications. This essay then turns its attention to the use of biomaterials
in tissue engineering, sophisticated cell, drug and gene delivery systems and applications
in biotechnology, and shows that here the need for specific and direct interactions
between biomaterials and tissue components has become necessary, and with this a new
paradigm for biocompatibility has emerged. It is believed that once the need for this
change is recognised, so our understanding of the mechanisms of biocompatibility will
markedly improve.