Locally engineered acrylic bone cement with ZrO₂ and natural antibacterials: Effect of stirring temperature and dmot accelerator on cranioplasty applications

Cranioplasty procedures often rely on imported bone cement materials that may not be optimized for local clinical needs or cost-effective for widespread use. This study addresses the need for a standardized, locally engineered alternative by synthesizing acrylic bone cement based on poly(methyl methacrylate) (PMMA), enhanced with ZrO₂ for radiopacity and Aloe vera and Calendula extracts as natural antibacterial agents. The novelty of this research lies in exploring the combined effects of stirring temperature (45°C and 60°C) and accelerator concentration (0.5%, 1.5%, 2.6% DmoT) on the cement's mechanical, thermal, and biological performance—an area rarely investigated in previous formulations. Comprehensive characterization was conducted using FTIR, SEM-EDX, mechanical testing, and antibacterial assays. Results showed that stirring temperature and DmoT concentration did not significantly affect morphology, which remained homogeneous across samples. The formulation with 2.6% DmoT at 45°C achieved optimal performance, with a setting time of 18 min 27 s, setting temperature of 60°C, and compressive strength of 156.77 MPa—meeting ASTM F451-21 standards. The highest compressive strength (167.50 MPa) was observed at 0.5% DmoT. Radiopacity was confirmed with an average light intensity of 94.84%, and Aloe vera demonstrated superior antibacterial efficacy against Staphylococcus aureus , with a 16.23 mm inhibition zone. These findings demonstrate the feasibility of developing cost-effective, biocompatible bone cement tailored for cranioplasty, offering a promising substitute for imported materials in the Indonesian healthcare context.