Osseointegration of sintered porous-surfaced and plasma spray-coated implants: An animal model study of early postimplantation healing response and mechanical stability

In vitro and in vivo studies of alkali- and heat-treated Ti-6Al-7Nb and Ti-5Al-2Nb-1Ta alloys for orthopedic implants

In vitro studies of Ti-6Al-7Nb and Ti-5Al-2Nb-1Ta alloys were carried out by treating the specimens with 10 M NaOH at 60 degrees C for 24 h and subsequently heat-treated at 600 degrees C for 1 h. After the alkali and heat treatments, and on subsequent soaking in simulated body fluid (SBF), the morphological and compositional changes on the surface of the specimens were examined using scanning electron microscope attached with an energy-dispersive electron probe X-ray analyzer. The results revealed a dense and uniform bonelike apatite layer on the surface of treated substrates immersed in SBF solution. In vivo studies were carried out in rats to evaluate osteoconduction of Ti-6Al-7Nb and Ti-5Al-2Nb-1Ta alloys surface after alkali and heat treatments compared with untreated titanium alloys as the control. The following titanium implants were prepared from these species: (1) control without implant; (2) untreated titanium implant; (3) alkali- and heat-treated implant--the implants were immersed in 10 M NaOH solution at 60 degrees C for 24 h and subsequently heated at 600 degrees C for 1 h. The specimens were inserted into the medial side of each tibia of rats. Histologically, direct bone contact with the implant surface was significantly higher in the alkali heat-treated implants than the untreated titanium implants.

Porous titanium and silicon-substituted hydroxyapatite biomodification prepared by a biomimetic process: characterization and in vivo evaluation

Porous titanium with a pore size of 150-600 microm and a porosity of 67% was prepared by fiber sintering. The porous titanium had a complete three-dimensional (3D) interconnected structure and a high yield strength of 100 MPa. Si-substituted hydroxyapatite (Si-HA) was coated on the surface by a biomimetic process to improve the surface bioactivity. X-ray diffraction results showed that Si-HA coating was not well crystallized. New bone tissue was found in the uncoated porous titanium after 2 weeks of implantation and a significant increase (p<0.05) in the bone ingrowth rate (BIR) was found after 4 weeks of implantation, indicating the good osteoconductivity of the porous structure. The HA-coated and Si-HA-coated porous titanium exhibited a significantly higher BIR than the uncoated titanium at all intervals, highlighting the better surface bioactivity and osteoconductivity of the HA- and Si-HA coatings. Also, the Si-HA-coated porous titanium demonstrated a significantly higher BIR than the HA-coated porous titanium, showing that silicon plays an active role in the surface bioactivity. For Si-HA-coated porous titanium, up to 90% pore area was covered by new bone tissue after 4 weeks of implantation in cortical bone. In the bone marrow cavity, the pore spaces were filled with bone marrow, displaying that the interconnected pore structure could provide a channel for body fluid. It was concluded that both the 3D interconnected pore structure and the Si-HA coating contributed to the high BIR.

Influence of the positioning of a cementless glenoid prosthesis on its interface micromotions

The positioning of the glenoid component in total shoulder arthroplasty is complicated by the limited view during operation. Malalignment and/or motion of the glenoid component with respect to the bone can be a cause of, or contribute to, failure of the implant. The aim of this paper is to determine the effect of the positioning of a cementless glenoid component on the micromotions between the implant and the bone during normal loading after surgery. For this study a three-dimensional finite element model of a complete scapula with a cementless glenoid component was used. In total, eight positions of the upper arm in both abduction and anteflexion were chosen to represent the patient's arm movement post-operatively. A previously published musculoskeletal model was used to determine the joint and muscle forces on the scapula with implant in each arm position. Five different alignments of the glenoid component (neutral, anterior, inferior, posterior, and superior inclinations), two different implantation depths (‘optimal’ and ‘deeper’ implantations), and two bone qualities (healthy and rheumatoid arthritis (RA) bone) were considered. Inclinations of 10° with respect to a neutral alignment did not affect the overall interface micromotions in the optimal implantation depth. However, when the implantation depth was 3 mm deeper, anterior and inferior inclinations were more favourable than a neutral alignment and other inclinations. Micromotions in RA bone were always larger than in healthy bone.

Computational mechanobiology to study the effect of surface geometry on peri-implant tissue differentiation

The geometry of an implant surface to best promote osseointegration has been the subject of several experimental studies, with porous beads and woven mesh surfaces being among the options available. Furthermore, it is unlikely that one surface geometry is optimal for all loading conditions. In this paper, a computational method is used to simulate tissue differentiation and osseointegration on a smooth surface, a surface covered with sintered beads (this simulated the experiment (Simmons, C., and Pilliar, R., 2000, Biomechanical Study of Early Tissue Formation Around Bone-Interface Implants: The Effects of Implant Surface Geometry," Bone Engineering, J. E. Davies, ed., Emsquared, Chap. A, pp. 369-379) and established that the method gives realistic results) and a surface covered by porous tantalum. The computational method assumes differentiation of mesenchymal stem cells in response to fluid flow and shear strain and models cell migration and proliferation as continuum processes. The results of the simulation show a higher rate of bone ingrowth into the surfaces with porous coatings as compared with the smooth surface. It is also shown that a thicker interface does not increase the chance of fixation failure.

Osseointegration of zirconia implants: an SEM observation of the bone-implant interface

Background

The successful use of zirconia ceramics in orthopedic surgery led to a demand for dental zirconium-based implant systems. Because of its excellent biomechanical characteristics, biocompatibility, and bright tooth-like color, zirconia (zirconium dioxide, ZrO₂) has the potential to become a substitute for titanium as dental implant material. The present study aimed at investigating the osseointegration of zirconia implants with modified ablative surface at an ultrastructural level.

Methods

A total of 24 zirconia implants with modified ablative surfaces and 24 titanium implants all of similar shape and surface structure were inserted into the tibia of 12 Göttinger minipigs. Block biopsies were harvested 1 week, 4 weeks or 12 weeks (four animals each) after surgery. Scanning electron microscopy (SEM) analysis was performed at the bone implant interface.

Results

Remarkable bone attachment was already seen after 1 week which increased further to intimate bone contact after 4 weeks, observed on both zirconia and titanium implant surfaces. After 12 weeks, osseointegration without interposition of an interfacial layer was detected. At the ultrastructural level, there was no obvious difference between the osseointegration of zirconia implants with modified ablative surfaces and titanium implants with a similar surface topography.

Conclusion

The results of this study indicate similar osseointegration of zirconia and titanium implants at the ultrastructural level.

Histodynamics of bone tissue formation around immediately loaded cylindrical implants in the rabbit

OBJECTIVES

The local mechanical environment influences early peri-implant tissue formation. It is still unclear whether immediate loading limits or promotes peri-implant osteogenesis and which mechanical parameters are important herein. The present study evaluated the influence of well-controlled mechanical stimuli on the tissue response around immediately loaded cylindrical turned titanium implants at two different observation periods.

MATERIAL AND METHODS

A repeated sampling bone chamber, consisting of dual-structure perforated hollow cylinders with a cylindrical implant, was installed in the tibia of 14 rabbits and used to conduct three displacement-controlled immediate loading experiments: (i) 30 microm - 400 cycles/day - 1 Hz frequency - 2 x/week - 6 weeks; (ii) 30 microm - 400 cycles/day - 1 Hz - 2 x/week - 6 weeks, followed by another 6 weeks with a 50 microm - 800 cycles/day - 1 Hz - 2 x/week loading protocol; and (iii) 0 microm implant displacement for 12 weeks. A linear mixed model and logistic mixed model with alpha=5% were conducted on the data set.

RESULTS

The tissue area fraction was significantly the highest after 12 weeks of loading. The bone area fraction was significantly different between all three loading conditions, with the highest values for the 12-week loading experiment. Twelve-week stimulation resulted in a significantly higher mineralized bone fraction than 6 weeks. Loading did have a significantly positive effect on the mineralized bone fraction. The incidence of osteoid-to-implant and bone-to-implant contact increased significantly when loading the implant for 12 weeks.

CONCLUSION

Immediate loading had a positive effect on the tissue differentiation and bone formation around cylindrical turned titanium implants. Controlled implant micro-motion up to 50 microm had a positive effect on the bone formation at its interface.

Influence of different implant surfaces on peri-implant osteogenesis: histomorphometric analysis in sheep

BACKGROUND

The present study investigated peri-implant osteogenesis and implant biologic fixation in different zirconia sandblasted endosseous titanium surfaces (SLA-60 and SLA-120) and a turned titanium surface (T) 2 and 4 weeks after surgery.

METHODS

Seventy-two implant screws were implanted in tibia of six sheep. Histologic sections of implants (2 and 4 weeks after surgery) were analyzed with light microscopy for histomorphometric analysis of bone-to-implant contact (BIC), bone ingrowth (BI), and bone surface (BS/BV). Histologic blocks were used to perform bone microhardness studies next to the implants. Some implants were also observed with scanning electron microscopy (SEM) and transmission electron microscopy (TEM).

RESULTS

In general, the highest values of BIC, BI, BS/BV, and Vickers hardness number (HV) were measured in SLA-60 samples, followed by SLA-120 and T implants. Two weeks after surgery, all the implants appeared biologically fixed by a newly formed woven bone arranged in thin bone trabeculae and filling the gap between implant and host bone. Four weeks after implantation, the thickness of the woven bone trabeculae had increased, especially around the SLA-60 and SLA-120 implants by a gradual deposition of parallel-fiber bone.

CONCLUSIONS

Our results suggest that, in the early period of peri-implant healing, the implant surface morphology that seemed to influence the increase of peri-implant osteogenesis, bone turnover, and peri-implant bone maturation was SLA-60. We suggest that this surface, characterized by moderately deep titanium cavities very similar to the osteocyte lacunae, could act as a microscopic scaffold for mesenchymal and/or osteoblast-like cells adhesion.

In vitro and in vivo performance of a novel surface treatment to enhance osseointegration of endosseous implants

OBJECTIVE

This article shows the in vitro and in vivo characterization of a new biomimetic treatment developed to enhance the osseointegration of titanium dental implants.

STUDY DESIGN

A novel biomimetic treatment of titanium was developed. Its physicochemical properties and biologic and in vivo performance were considered and studied. Mineralization capability was assessed by soaking test in simulated body fluid solution, and cytocompatibility was assessed using osteoblast-like MG63 cell culture. Histomorphometric analysis was performed at 3 time points using a sheep animal model.

RESULTS

In vitro tests confirmed the biomimetic potential of the considered novel treatment. Histomorphometric analysis indicated its potential for rapid and good-quality osseointegration.

CONCLUSION

The in vitro and in vivo test results indicated that the proposed novel treatment possesses a significant potential to increase the rate of osteointegration of titanium for endosseous dental implants.

Influence of controlled immediate loading and implant design on peri-implant bone formation

AIM

Tissue formation at the implant interface is known to be sensitive to mechanical stimuli. The aim of the study was to compare the bone formation around immediately loaded versus unloaded implants in two different implant macro-designs.

MATERIAL AND METHODS

A repeated sampling bone chamber with a central implant was installed in the tibia of 10 rabbits. Highly controlled loading experiments were designed for a cylindrical (CL) and screw-shaped (SL) implant, while the unloaded screw-shaped (SU) implant served as a control. An F-statistic model with alpha=5% determined statistical significance.

RESULTS

A significantly higher bone area fraction was observed for SL compared with SU (p<0.0001). The mineralized bone fraction was the highest for SL and significantly different from SU (p<0.0001). The chance that osteoid- and bone-to-implant contact occurred was the highest for SL and significantly different from SU (p<0.0001), but not from CL. When bone-to-implant contact was observed, a loading (SL versus SU: p=0.0049) as well as an implant geometry effect (SL versus CL: p=0.01) was found, in favour of the SL condition.

CONCLUSIONS

Well-controlled immediate implant loading accelerates tissue mineralization at the interface. Adequate bone stimulation via mechanical coupling may account for the larger bone response around the screw-type implant compared with the cylindrical implant.

Effect of Modified Pectin Molecules on the Growth of Bone Cells

The aim of this study was to investigate molecular candidates for bone implant nanocoatings, which could improve biocompatibility of implant materials. Primary rat bone cells and murine preosteoblastic MC3T3-E1 cells were cultured on enzymatically modified hairy regions (MHR-A and MHR-B) of apple pectins. MHRs were covalently attached to tissue culture polystyrene (TCPS) or glass. Uncoated substrata or bone slices were used as controls. Cell attachment, proliferation, and differentiation were investigated with fluorescence and confocal microscopy. Bone cells seem to prefer MHR-B coating to MHR-A coating. On MHR-A samples, the overall numbers as well as proportions of active osteoclasts were diminished compared to those on MHR-B, TCPS, or bone. Focal adhesions indicating attachment of the osteoblastic cells were detected on MHR-B and uncoated controls but not on MHR-A. These results demonstrate the possibility to modify surfaces with pectin nanocoatings.

Mineralization at the interface of implants

Osseointegration of implants is crucial for the long-term success of oral implants. Mineralization of the bone's extracellular matrix as the ultimate step of a mature bone formation is closely related to implant osseointegration. Osteogenesis at oral implants is a complex process, driven by cellular and acellular phenomena. The biological process of the maintenance and emergence of minerals in the vicinity of oral implants is influenced to a great extent by biophysical parameters. Implant-related structural and functional factors, as well as patient-specific factors, govern the features of osteogenesis. To understand the influence of these factors in peri-implant bone mineralization, it is important to consider the basic biological processes. Biological and crystallographic investigations have to be applied to evaluate mineralization at implant surfaces at the different hierarchical levels of analysis. This review gives insight into the complex theme of mineral formation around implants. Special focus is given to new developments in implant design and loading protocols aimed at accelerating osseointegration of dental implants.

Report of a Case Receiving Full-Arch Rehabilitation in Both Jaws Using Immediate Implant Loading Protocols: A 1-Year Resonance Frequency Analysis Follow-Up

BACKGROUND

Immediate occlusal implant loading has been documented as a viable treatment option for various indications. However, documentations related to full-arch rehabilitation are usually limited to treatment of one jaw at a time, thereby leaving the opposing dentition unchanged. Furthermore, clinical documentation using traditional, well-accepted measuring techniques may not be adequate when it comes to short-term evaluation of the success or failure of implants subjected to immediate occlusal loading.

PURPOSE

The purpose of this case report is to (1) present an implant stability follow-up of a patient receiving an immediate, implant-supported full-arch rehabilitation in both jaws and (2) evaluate the patient's acceptance of this rehabilitation.

MATERIALS AND METHODS

A 68-year-old patient scheduled for implant treatment was selected for an immediate implant loading protocol in both jaws. During two surgical events 3 weeks apart, eight maxillary and four mandibular Brånemark System Mk IV TiUnite fixtures (Nobel Biocare AB, Göteborg, Sweden) were inserted and subsequently used to immediately support a cross-arch fixed prosthesis in the maxilla and a bar-retained overdenture in the mandible. Implant stability was recorded from the day of surgery periodically during a 1-year follow-up using resonance frequency analysis (RFA).

RESULTS

At the 1-year follow-up, based on clinical, RFA, and radiographic evaluations, all implants and the reconstructions were classified as successful. All maxillary implants showed a decrease in the implant stability quotient (ISQ) value from the measurement at the time of surgery to the first follow-up, whereas two of four mandibular implants revealed an initial drop in stability. Irrespective of a specific ISQ level measured at implant surgery (ISQ range 53-74) and despite an initial decrease in stability, measurements recorded at the 12-month follow-up indicated similar stability levels for all maxillary implants (ISQ range 64-68) or the group of mandibular implants (ISQ range 72-75) but with a higher ISQ level for mandibular implants. Furthermore, the patient's acceptance of the immediate full-arch rehabilitation in both jaws was high.

CONCLUSIONS

The present case report demonstrates that a slightly staged approach for full-arch rehabilitation in both jaws using immediate implant loading protocols is a realistic treatment option. Furthermore, RFA follow-up indicates that immediately occlusally loaded implants placed in reduced bone quality and quantity are more prone to loose stability in the early healing period compared with implants placed in dense bone quality.

Peri-implant osteogenesis in health and osteoporosis

Long-term clinical success of endosseous dental implants is critically related to a wide bone-to-implant direct contact. This condition is called osseointegration and is achieved ensuring a mechanical primary stability to the implant immediately after implantation. Both primary stability and osseointegration are favoured by micro-rough implant surfaces which are obtained by different techniques from titanium implants or coating the titanium with different materials. Host bone drilled cavity is comparable to a common bone wound. In the early bone response to the implant, the first tissue which comes into contact with the implant surface is the blood clot, with particular attention to platelets and fibrin. Peri-implant tissue healing starts with an inflammatory response as the implant is inserted in the bone cavity, but an early afibrillar calcified layer comparable to the lamina limitans or incremental lines in bone is just observable at the implant surface both in vitro than in vivo conditions. Just within the first day from implantation, mesenchymal cells, pre-osteoblasts and osteoblasts adhere to the implant surface covered by the afibrillar calcified layer to produce collagen fibrils of osteoid tissue. Within few days from implantation a woven bone and then a reparative trabecular bone with bone trabeculae delimiting large marrow spaces rich in blood vessels and mesenchymal cells are present at the gap between the implant and the host bone. The peri-implant osteogenesis can proceed from the host bone to the implant surface (distant osteogenesis) and from the implant surface to the host bone (contact osteogenesis) in the so called de novo bone formation. This early bone response to the implant gradually develops into a biological fixation of the device and consists in an early deposition of a newly formed reparative bone just in direct contact with the implant surface. Nowadays, senile and post-menopausal osteoporosis are extremely diffuse in the population and have important consequences on the clinical success of endosseous dental implants. In particular the systemic methabolic and site morphological conditions are not favorable to primary stability, biological fixation and final osseointegration. An early good biological fixation may allow the shortening of time before loading the implant, favouring the clinical procedure of early or immediate implant loading. Trabecular bone in implant biological fixation is gradually substituted by a mature lamellar bone which characterizes the implant ossoeintegration. As a final consideration, the mature lamellar bone observed in osseointegrated implants is not always the same as a biological turnover occurs in the peri-implant bone up to 1mm from the implant surface, with both osteogenesis and bone reabsorption processes.

The design and production of Co–Cr alloy implants with controlled surface topography by CAD–CAM method and their effects on osseointegration

Improved fixation and increased longevity are still important performance criteria in the development of orthopaedic prostheses. The osseointegration of a series of implant designs made of conventional cobalt-chromium alloy was investigated, the shape of each implant being the critical variable. The shape was defined by computer-aided design with a view to maximising interdigitation of new bone with the implant. Two different process routes, conventional casting and selective laser sintering were employed, each process yielded implants that had identical surface topology but different microstructures. Hydroxyapatite (HA) was used to coat some samples by plasma spraying. Bone formation associated with each implant design was delineated through the administration of fluorescent vital dyes at three time points following their implantation into New Zealand white rabbits. After one month, specimens were harvested, resin embedded, serial sectioned and examined under fluorescent light microscopy. The amount of bone growth was quantified using image analysis. Plasma spray HA-coated samples promoted better osteogenesis and integration than uncoated samples. The extent of bone growth associated with identically shaped specimens fabricated by the SLS route was markedly greater, attributed to the microstructure of these implants.

Positive effect of early loading on implant stability in the bi-cortical guinea-pig model

Loading, early after implant placement, has gained rapid interest in dentistry. Primary implant stability, as e.g. defined by resonance frequency instrumentation, has been isolated as a predicator when immediate and early implant loading is applied. The aim of this study was to investigate the effect of early (after 7 days) mechanical loading on the establishment of osseointegration by means of resonance frequency analysis (RFA). Percutaneous titanium implants were installed in both tibiae of 10 guinea-pigs. One week after implant installation, one implant (test) was loaded daily for 6 weeks, while the contra-lateral served as the unloaded one (control). A sinusoidally varying bending moment was applied at a frequency of 3 Hz and a force amplitude of 5 N, for 1800 cycli. Resonance frequency was measured at implant installation and from then on weekly using the RFA-device (Osstell). Contrary to control implants, that showed a decrease in stability 1 week after installation, reaching a minimum at 3 weeks (-200 Hz), test implants showed a progressive increase in stability over time. After 6 weeks, the mean resonance frequency of test and control implants reached the same values. As confirmed by recent literature, early loading does not have to endanger the establishment of osseointegration of titanium implants. On the contrary, controlled loading is beneficial to maintain the implant stability during the early critical healing period as determined by RFA-measurements.

Biomechanical and histomorphometric study on the bone-screw interface of bioactive ceramic-coated titanium screws

The purpose of this study was to compare the osseointegration of 4 different kinds of bioactive ceramic-coated screws with uncoated screws by biomechanical and histomorphometric analysis. Calcium pyrophosphate (CPP), apatite-wollastonite 1:3 glass ceramic (W3G), apatite-wollastonite 1:1 glass ceramic (WAG) and bioactive CaO-SiO2-B2O3 glass ceramic (CSG) coatings were prepared and coated by the dipping method. Coated and uncoated titanium screws were inserted into the tibia of 18 adult mongrel male dogs for 2, 4, and 8 weeks. The insertion torques, radiographs, undecalcified histology, histomorphometric analysis, and extraction torques were evaluated. No difference of insertion torque was found among the five screw types. At 2 and 4 weeks after implantation, the extraction torque of ceramic-coated screws was significantly higher than that of uncoated screws (p < or = 0.0001). At 8 weeks, the extraction torques of CPP-, W3G-, and WAG-coated screws were significantly higher than those of CSG-coated and uncoated screws (p<0.0001). At 2, 4, and 8 weeks, the extraction torques of 4 different ceramic-coated screws were significantly higher than the corresponding insertion torque. Strong fixation was observed even at 2 weeks in the CPP-, W3G- and WAG-coated screws. The bone-screw contacts of the 4 different coated screws at 2 and 4 weeks were statistically higher than that of the uncoated screws, and the bone-screw contacts of the CPP-, W3G- and WAG-coated screws at 8 weeks were also statistically higher than that of the uncoated screws. The fixation strength was increased by the presence of osteoconductive coating materials, such as CPP, W3G, and WAG, which enabled to achieve higher fixation strength even as early as 2-8 weeks after the insertion.

Comparative study of osteoconduction on micromachined and alkali-treated titanium alloy surfaces in vitro and in vivo

This study sought to evaluate osteoconduction of Ti-6Al-4V surfaces under various conditions, including micro-patterned, alkali-treated, micro-patterned plus alkali-treated, and surfaces without any treatment as the control. The through-mask electrochemical micromachining (EMM) was used to fabricate micro-hole arrays on the titanium alloy surface. In vitro calcium phosphate formation on titanium surfaces was in static and dynamic simulated body fluid (SBF). In vivo comparison was conducted in the medullary cavity of dog femur using the implant cages which could provide the same physiological environment for specimens with different surface conditions. In vitro experiments indicate good conduction of calcium phosphate on the alkali-treated surfaces, and also better calcium phosphate deposition on the micro-hole surface than on the flat surfaces in dynamic SBF. In vivo experiments confirm the beneficial effect of alkaline treatment on osteoconduction. The results of in vivo experiments also indicate a synergistic effect of the alkaline treatment and the topographic pattern on osteoconduction.

Synthesis and Characterization of a Novel Chitosan−Gelatin Bioconjugate with Fluorescence Emission

Polysaccharide-protein conjugations have generated increasing interests for biomedical applications in recent years. A naturally occurring cross-linking reagent, genipin, which has been used in herbal medicine, was employed to cross-link chitosan and gelatin for the preparation of a novel chitosan-gelatin conjugate. The primary amine groups on chitosan and gelatin were covalently linked with genipin, leading to the formation of a chitosan-gelatin conjugate with nitrogen-containing heterocycle units, the pyrindine-like derivatives. The FT-IR and UV-vis studies revealed that chitosan could react with genipin via a nucleophilic ring-opening reaction to construct more sufficient and extensive cross-link networks, as compared with its gelatin counterpart. The UV-vis absorption properties of the chitosan-gelatin conjugates were strongly related to the chitosan-to-gelatin weight ratio in the compositions. It is worth noting that the conjugation process endows the special emission properties of the chitosan-gelatin conjugates, which depends on the cross-linking reaction and the formation of hydrogen bonding involved chitosan-gelatin complex. Fluorescence quenching or enhancement was observed from the chitosan-gelatin conjugates upon coordinated with a wide variety of heavy metal ions (Ag+, Cu2+, Fe2+, and Co2+). This study also examined the possibility of covalent coupling the capture chelator (chitosan) with bioactive protein (e.g., albumin, alpha-globulin, and fibrinogen) to create fluorescence emission. These findings may provide a novel way to deliver therapeutic radionuclides for immuno-targeting purposes in the future.

Histomorphometrische Evaluation poröser Titanprobenkörper anhand eines computergestützten Bildanalysesystems / Histomorphometric evaluation of bone ingrowth of porous titanium by a computer-assisted analyzing system

The objective of this study was to evaluate the bone ingrowth of a new vacuum plasma sprayed titanium surface (vps-ti) in comparison to cs-titanium implants in a göttinger minipig model. Fifteen göttinger minipigs each received the two implants, vacuum plasma sprayed titanium with a porosity of 50% and a pore size of 200 microm (vps-ti) and an implant with a similar porosity but a different pore size 500 microm (cs-ti), at the proximal femur metaphysis by press-fit technique. The pigs were euthanized at three different postsurgical periods: 4, 8 and 12 weeks. Each femur was harvested and qualitative (macroscopic and microscopic) and quantitative (histomorphometric) histological analysis was done on histological slides. The results indicated that there was a difference in bone ingrowth between the two implants, whereas the bone ingrowth of vps-ti was superior to cs-ti after 4 and 8 weeks healing time. 12 weeks post implantationem no statistiscal difference was evident. The pore size of 200 microm seemed superior to a pore size of 500 microm. Whether or not these effects lead to a better mechanical stability remains unanswered.

A novel porous Ti6Al4V: Characterization and cell attachment

For the first time, a highly porous strong Ti6Al4V was produced by using a "polymeric sponge replication" method. A polymeric sponge, impregnated with a Ti6Al4V slurry prepared from Ti6Al4V powders and binders, was subjected to drying and pyrolyzing to remove the polymeric sponge and binders. After sintering at a high temperature and under high vacuum, a porous Ti6Al4V was produced. Optical microscopical observation, environmental scanning electron microscopy observation (with energy-dispersive micro X-ray analysis), mechanical tests, and metallurgical analyses were performed on the obtained porous Ti6Al4V with regard to the porous structure (both macropores and micropores), mechanical properties, chemical composition, phase compositions, and cell attachment behavior. The porous Ti6Al4V made by this method had a three-dimensional trabecular porous structure with interconnected pores mainly ranging from 400 to 700 microm and a total porosity of about 90%. The compressive strength was 10.3 +/- 3.3 MPa and the elastic constant 0.8 +/- 0.3 GPa. MC3T3-E1 cells attached and spread well in the inner surface of pores. Being similar to cancellous bone with regard to both interconnected porous structure and mechanical properties, the resulting porous Ti6Al4V is expected to be a promising biomaterial for biomedical applications.

Cementless implant fixation--toward improved reliability

Cementless implants offer the advantage of fixation by direct bone-to-implant osseointegration, thereby avoiding the use of a synthetic intermediary material (such as acrylic bone cement) of limited mechanical strength. Successful osseointegration, however, depends on several conditions being satisfied during the peri-implant bone healing period, including the need for limited early loading resulting in minimal relative movement at the implant-bone interface. Sintered porous- and plasma spray-coated implants represent the most common cementless orthopedic implants in current clinical use, although novel cast structures also are being investigated. All stand to benefit from surface modifications currently being explored to enhance osteoconductive or osteoinductive characteristics of the implants. The faster osseointegration that such modified surface designs potentially might offer would result in more reliable and convenient (from the patient perspective) cementless implants. Encouraging results of early animal-based studies exploring such modifications have been reported.

Calcium phosphate sol–gel-derived thin films on porous-surfaced implants for enhanced osteoconductivity. Part II: Short-term in vivo studies

Osseointegration rates of porous-surfaced Ti6Al4V implants with control (unmodified sintered coatings) were compared to porous-surfaced implants modified through the addition of either an Inorganic or Organic Route-formed-Ca-P film. Implants were placed in distal femoral rabbit condyle sites and, following a 9-day healing period, implant fixation strength was evaluated using a pull-out test. Three groups of ten rabbits each were evaluated. Inorganic Route Ca-P-coated implants were compared with control implants in Group I. Organic Route Ca-P-coated implants with control implants in Group II, and Inorganic- with Organic Route-Ca-P-coated implants in Group III. Maximum pull-out force and interface stiffness were compared while selected extracted implants were examined by SEM to characterise failure surfaces. Both types of Ca-P coatings significantly enhanced the early rate of bone ingrowth and fixation as evidenced by higher pull-out force and interface stiffness compared with controls. However, there was no significant difference between Ca-P-coated implants prepared using the two different methods. The enhanced osteoconductivity observed with the Organic Route-formed films despite the absence of any obvious new surface topographic features introduced with the films suggests that the increased rate of bone ingrowth was due primarily to altered surface chemistry rather than changes in topography, at least for these sintered porous-surfaced implants.

Osteointegration of biomimetic apatite coating applied onto dense and porous metal implants in femurs of goats

Biomimetic calcium phosphate (Ca-P) coatings were applied onto dense titanium alloy (Ti6Al4V) and porous tantalum (Ta) cylinders by immersion into simulated body fluid at 37 degrees C and then at 50 degrees C for 24 h. As a result, a homogeneous bone-like carbonated apatitic (BCA) coating, 30 microm thick was deposited on the entire surface of the dense and porous implants. Noncoated and BCA-coated implants were press-fit implanted in the femoral diaphysis of 14 adult female goats. Bone contact was measured after implantation for 6, 12, and 24 weeks, and investigated by histology and backscattered electron microscopy (BSEM). After 6 weeks, bone contact of the BCA-coated Ti6Al4V implants was about 50%. After 12 and 24 weeks, bone contact was lower in comparison with the 6-week implantations at, respectively 24 and 39%. Regarding the BCA-coated porous Ta implants, bone contacts were 17, 30, and 18% after 6, 12, and 24 weeks, respectively. However, bone contact was always found significantly higher for BCA-coated dense Ti6Al4V and porous Ta cylinders than the corresponding noncoated implants. The results of this study show that the BCA coating enhances the bone integration as compared to the noncoated implants.

Activity of plasma sprayed yttria stabilized zirconia reinforced hydroxyapatite/Ti–6Al–4V composite coatings in simulated body fluid

Hydroxyapatite (HA)/yttria stabilized zirconia/Ti-6Al-4V bio-composite coatings deposited onto Ti-6Al-4V substrate through a plasma spray technique were immersed in simulated body fluid (SBF) to investigate their behavior in vitro. Surface morphologies and structural changes in the coatings were analyzed by scanning electron microscopy, thin-film X-ray diffractometer, and X-ray photoelectron spectroscopy. The tensile bond strength of the coatings after immersion was also conducted through the ASTM C-633 standard for thermal sprayed coatings. Results showed that carbonate-containing hydroxyapatite (CHA) layer formed on the surface of composite coatings after 4 weeks immersion in SBF solution, indicating the composite coating possessed excellent bioactivity. The mechanical properties were found to decrease with immersion duration of maximum 56 days. However, minimal variation in mechanical properties was found subsequent to achieving supersaturation of the calcium ions, which was attained with the precipitation of the calcium phosphate layers. The mechanical properties of the composite coating were found to be significantly higher than those of pure HA coatings even after immersion in the SBF solution, indicating the enhanced mechanical properties of the composite coatings.

Ultrastructural characterization of the implant/bone interface of immediately loaded dental implants

Primary stability and an optimized load transfer are assumed to account for an undisturbed osseointegration process of implants. Immediate loaded newly designed titanium dental implants inserted in the mandible of minipigs were used for the characterization of the interfacial area between the implant surface and the surrounding bone tissue during the early healing phase. Histological and electron microscopical studies were performed from implant containing bone specimens. Two different load regimens were applied to investigate the load related tissue reaction. Histological and electron microscopical analysis revealed a direct bone apposition on the implant surfaces, as well as the attachment of cells and matrix proteins in the early loading phase. A striking finding of the ultrastructural immunocytochemical investigations was the synthesis and deposition of bone related proteins (osteonectin, fibronectin, fibronectin receptor) by osteoblasts from day one of bone/biomaterial interaction. Calcium-phosphate needle-like crystallites were newly synthesized in a time-related manner directly at the titanium surface. No difference in the ultrastructural appearance of the interface was found between the two loading groups. Our experimental data suggest that loading of specially designed implants can be performed immediately after insertion without disturbing the biological osseointegration process.

Influence of pores created by laser superfinishing on osseointegration of titanium alloy implants

The aim of this study was to assess the osseointegration of copper vapor laser-superfinished titanium alloy (Ti6Al4V) implants with pore sizes of 25, 50, and 200 microm in a rabbit intramedullary model. Control implants were prepared by corundum blasting. Each animal received all four different implants in both femora and humeri. Using static and dynamic histomorphometry, the bone-implant interface and the peri-implant bone tissue were examined 3, 6, and 12 weeks postimplantation. Among the laser-superfinished implants, total bone-implant contact was smallest for the 25-microm pores, and was similar for 50- and 200-microm pore sizes at all time points. However, all laser-superfinished surfaces were inferior to corundum-blasted (CB) control implants in terms of bone-implant contact. Within the 12-week study period, remodeling of woven bone initially formed within pores occurred only in the implants with 200-microm pores. Implants with 25-microm pores showed the highest amount of peri-implant bone volume at all time points, indicating that the amount of peri-implant bone was not correlated with the quality of the bone-implant interface. At 3 and 6 weeks postsurgery, we did not find any differences in mineral apposition rates or bone formation rates between the various implant surfaces. However, the peri-implant bone formation rate at the end of the trial was 70 and 62% higher in implants with 50- and 200-microm pores compared with CB implants, respectively. We conclude that, although laser-superfinished implants were not superior to CB control implants in terms of osseointegration, our study has provided further insights into the mechanisms of bone remodeling within pores of various sizes, and may form a basis for future experiments to design optimal implant surfaces with the help of modern laser technology.

In vivo behavior and mechanical stability of surface-modified titanium implants by plasma spray coating and chemical treatments

The geometric design and chemical compositions of an implant surface may have an important part in affecting early implant stabilization and influencing tissue healing. In this study, in vivo behavior and mechanical stability in implants of three surface designs, which were smooth surface (SS), rough titanium (Ti) surface by plasma spray coating (PSC), and alkali- and heat-treated (AHT) Ti surface after plasma spray coating, were compared by histological and mechanical analyses. Surface morphologies of the implants were observed by optical microscopy and scanning electron microscopy. Chemical compositional surface changes were investigated by energy dispersive spectroscopy. The implants were inserted transversely in a dog thighbone and evaluated at 4 weeks of healing. At 4 weeks of healing after implantation in bone, the healing tissue was more extensively integrated with an AHT implant than with the implants of smooth (SS) and/or rough Ti surfaces (PSC). The bone bonding strength (pull-out force) between living bone and implant was observed by a universal testing machine. At 4 weeks' healing after implant placement in bone, the pull-out forces of the SS, PSC, and AHT implants were 235 (+/-34.25), 710 (+/-142.25), and 823 (+/-152.22) N, respectively. Histological and mechanical data demonstrate that appropriate surface design selection can improve early bone growth and induce an acceleration of the healing response, thereby improving the potential for implant osseointegration.

Osteogenecity of octacalcium phosphate coatings applied on porous metal implants

The biomimetic route allows the homogeneous deposition of calcium phosphate (Ca-P) coatings on porous implants by immersion in simulated physiologic solution. In addition, various Ca-P phases, such as octacalcium phosphate (OCP) or bone-like carbonated apatite (BCA), which are stable only at low temperatures, can be deposited. In this pilot study, experiments were designed with a twofold-purpose: (1) to investigate the osteoinduction of OCP-coated and noncoated porous tantalum cylinders and of dense titanium alloy cylinders (5 mm in diameter and 10 mm in length) in the back muscle of goats at 12 and 24 weeks (n = 4); and (2) to compare the osteogenic potentials of BCA-coated, OCP-coated, and bare porous tantalum cylinders in a gap of 1 mm created in the femoral condyle of a goat at 12 weeks (n = 2). In the goat muscle, after 12 weeks the OCP-coated porous cylinder had induced ectopic bone as well as bone within the cavity of the OCP-coated dense titanium cylinder. In the femoral condyle, bone did not fill the gap in any of the porous implants. In contrast with the two other groups, OCP-coated porous cylinders exhibited bone formation in the center of the implant. The nature of the Ca-P coating, via its microstructure, its dissolution rate, and its specific interactions with body fluids, may influence the osteogenecity of the Ca-P biomaterial.

Mechanical and histomorphometric evaluations of titanium implants with different surface treatments inserted in sheep cortical bone

Improvement of the implant-bone interface is still an open problem and the interest in chemical modification of implant surfaces for cementless fixation has grown steadily over the past decade. Mechanical and histomorphometric investigations were performed at different times on implants inserted into sheep femoral cortical bone to compare the in vivo osseointegration of titanium screws ( X 3.5 x 7 mm length) with different surface treatments. After 8 weeks of implantation, the push-out force of anodized and hydrothermally treated implants (ANODIC) was significantly higher than that of machined implants (MACH) (36%, p<0.0005), whereas a decrease of 39% was observed for acid-etched implants (HF) when compared to other surface treatments. After 12 weeks of implantation, the push-out force values of HF implants were still significantly lower than those observed for MACH (-19%, p<0.01) and hydroxyapatite vacuum plasma-sprayed implants (HAVPS, -25%, p<0.0005), and the highest push-out force was found in HAVPS (p<0.001) implants. After 8 and 12 weeks of implantation, the AI of HF implants was significantly (p<0.05) lower ( approximately -25%) than that of MACH, HAVPS and ANODIC implants. In conclusion, results appear to confirm that there are no specific differences between ANODIC and HAVPS implants in terms of behavior. Moreover, although MACH implants show some surface contaminating agents, they appear to ensure good osseointegration within 12 weeks both mechanically and histomorphometrically, as do ANODIC and HAVPS implants. However, further studies are required to investigate bone hardness and mineralization around implants.

In vitro studies of plasma-sprayed hydroxyapatite/Ti-6Al-4V composite coatings in simulated body fluid (SBF)

The bioactivity of plasma-sprayed hydroxyapatite (HA)/Ti-6Al-4V composite coatings was studied by soaking the coatings in simulated body fluid (SBF) for up to 8 weeks. This investigation was aimed at elucidating the biological behaviour of plasma-sprayed HA/Ti-6Al-4V composite coatings by analyzing the changes in chemistry, and crystallinity of the composite coating in a body-analogous solution. Phase composition, microstructure and calcium ion concentration were analyzed before, and after immersion. The mechanical properties, such as tensile bond strength, microhardness and Young's modulus were appropriately measured. Results demonstrated that the tensile bond strength of the composite coating was significantly higher than that of pure HA coatings even after soaking in the SBF solution over an 8-weeks period. Dissolution of Ca-P phases in SBF was evident after 24h of soaking, and, a layer of carbonate-apatite covered the coating surface after 2 weeks of immersion. The mechanical properties were found to diminish with soaking duration. However, slight variation in mechanical properties was found after supersaturation of the calcium ions was attained with the precipitation of the calcium phosphate layers.

Trabecular bone response to surface roughened and calcium phosphate (Ca-P) coated titanium implants

The influence of calcium phosphate (Ca-P) coating and surface roughness on the trabecular bone response of titanium implants was investigated. Four types of titanium implants, i.e. blasted with titanium powder, sintered with titanium beads, titanium powder blasted and provided with an additional Ca-P coating, and titanium beads with Ca-P coating, were prepared. The Ca-P coating was deposited by ion beam dynamic mixing method. The Ca-P coating was rapid heat-treated with infrared radiation at 700 degrees C. The implants were inserted into the trabecular bone of the left and right femoral condyles of 16 rabbits. After implantation periods of 2, 3, 4 and 12 weeks, the bone-implant interface was evaluated histologically and histomorphometrically. Histological evaluation revealed new bone formation around different implant materials after already 3 weeks of implantation. After 12 weeks, mature trabecular bone surrounded all implants. At 3 and 4 weeks of implantation, no difference existed in bone contact to the various implant materials. On the other hand, after 12 weeks of implantation the highest percentage of bone contact was found around the Ca-P coated beads implants. Supported by the results, we concluded that the combination of surface geometry and Ca-P coating benefits the implant-bone response during the healing phase.

Hydroxyapatite coating on titanium by thermal substrate method in aqueous solution

A new hydrocoating method (the thermal substrate method) is proposed for coating calcium phosphates such as hydroxyapatite (HA), on titanium substrates in an aqueous solution. Several factors (e.g., the type of ion source, the heating time and temperature, and the surface roughness of the substrate) affected the characteristics of the precipitate formed by this method. The solution used included 3 mmol dm(-3) Ca(H(2)PO(4))(2) and 7 mmol dm(-3) CaCl(2), and its pH was adjusted to 6.5. The experimental studies were conducted under the following conditions: temperature 45-160 degrees C, heating time 10-20 min, and surface roughness of substrate #120-#2000 grid ground using energy paper. A high quality of precipitate, whose predominant component was HA, was obtained on titanium substrates by the thermal substrate method in an aqueous solution. No significant difference in the precipitates was found with the type of ion source. The amount of HA precipitate increased with increasing temperature and with increasing heating time. The features of the precipitate were different, depending on the surface roughtness of the substrate: HA regularly nucleated along the grooves of the rough surface (#120 and #400 grid), and in the case of the fine surface (#1200-#2000 grid), a uniform precipitation occurred.

Platelet interactions with titanium: modulation of platelet activity by surface topography

Endosseous implants initially come into contact with blood. Thus, the nature of the interactions between blood and implanted endosseous implants may influence subsequent bone healing events in the peri-implant healing compartment. We conducted studies to address the following question: Does implant surface microtexture modulate platelet activity? We used commercially pure Ti (cpTi) disks with four different surface finishes: dual acid-etched (DAE), 320 grit (320G) abraded, machined, and p1200 polished cpTi. Surfaces were characterized by scanning electron microscopy (SEM) and optical profilometry. The DAE and 320G surfaces presented more complex microtextures than the machined or polished surfaces. Platelet activities were measured by quantifying platelet adherence, platelet-derived microparticle (MP) formation, and P-selectin expression as function of surface type. Platelet adhesion, measured using a lactate dehydrogenase (LDH) assay. was increased on DAE and 320G surfaces compared to machined and polished surfaces (p < 0.05). M P formation and P-selectin expression, assayed by flow cytometry, also showed increased activation of platelets on DAE and 320G surfaces. Because increased activation of platelets may lead to up-regulation of osteogenic responses during bone healing, these results may explain the enhanced osteoconductivity known to occur with DAE cpTi surfaces in comparison with machined cpTi surfaces.

Mechanical regulation of localized and appositional bone formation around bone-interfacing implants

The local mechanical environment around bone-interfacing implants determines, in large part, whether bone formation leading to functional osseointegration will occur. Previous attempts to relate local peri-implant tissue strains to tissue formation have not accounted for implant surface geometry, which has been shown to influence early tissue healing in vivo. Furthermore, the process by which mechanically regulated peri-implant bone formation occurs has not been considered previously. In the current study, we used a unit cell approach and the finite element method to predict the local tissue strains around porous-surfaced and plasma-sprayed implants, and compared the predictions to patterns of bone formation reported in earlier in vivo experiments. Based on the finite element predictions, we determined that appositional bone formation occurred when the magnitudes of the strain components at the tissue-host bone interface were <8%. Localized, de novo bone formation occurred when the distortional tissue strains were less than approximately 3%. Based on these threshold tissue strains, we propose a mechanoregulatory model to relate local tissue strains to the process of peri-implant bone formation. The mechanoregulatory model is novel in that it predicts both appositional and localized bone formation and its predictions are dependent on implant surface geometry. The model provides initial criteria with which the osseointegration potential of bone-interfacing implants may be evaluated, particularly under conditions of immediate or early loading.

Differences in osseointegration rate due to implant surface geometry can be explained by local tissue strains

Experimental evidence indicates that the surface geometry of bone-interfacing implants influences the nature and rate of tissues formed around implants. In a previously reported animal model study, we showed that non-functional, press-fitted porous-surfaced implants placed in rabbit femoral condyle sites osseointegrated more rapidly than plasma-sprayed implants. We hypothesized that the accelerated osseointegration observed with the porous-surfaced design was the result of this design providing a local mechanical environment that was more favourable for bone formation. In the present study, we tested this hypothesis using finite element analysis and homogenization methods to predict the local strains in the pre-mineralized tissues formed around porous-surfaced and plasma-sprayed implants. We found that, for loading perpendicular to the implant interface, the porous surface structure provided a large region that experienced low distortional and volumetric strains, whereas the plasma-sprayed implant provided little local strain protection to the healing tissue. The strain protected region, which was within the pores of the sintered porous surface layer. corresponded to the region where the difference in the amount of mineralization between the two implant designs was the greatest. Low distortional and volumetric strains are believed to favour osteogenesis, and therefore the model results provide initial support for the hypothesis that the porous-surfaced geometry provides a local mechanical environment that favours more rapid bone formation in certain situations.