Titanium Oxide Antibacterial Surfaces in Biomedical Devices

Synergetic inactivation of Staphylococcus epidermidis and Streptococcus mutansin a TiO2/H2O2/UV system

TiO 2 photocatalysis can be used to kill surface adherent bacteria on biomaterials, and is particularly interesting for use with percutaneous implants and devices. Its efficiency and safety, however, depend on the activation energy required. This in vitro study investigates synergetic effects against the clinically relevant strains S. epidermidis and S. mutans when combining photocatalytic surfaces with H2O2. After 20 min exposure to 0.1 wt% H2O2 and UV light on TiO2 surfaces, viabilities of S. epidermidis and S. mutans were reduced by 99.7% and 98.9%, respectively. Without H2O2 the corresponding viability reduction was 86% for S. epidermidis and 65% for S. mutans. This study indicates that low concentrations of H2O2 can enhance the efficiency of photocatalytic TiO2 surfaces, which could potentially improve current techniques used for decontamination and debridement of TiO2 coated biomedical implants and devices.

Suspension thermal spraying of hydroxyapatite: microstructure and in vitro behaviour

In cementless fixation of metallic prostheses, bony ingrowth onto the implant surface is often promoted by osteoconductive plasma-sprayed hydroxyapatite coatings. The present work explores the use of the innovative High Velocity Suspension Flame Spraying (HVSFS) process to coat Ti substrates with thin homogeneous hydroxyapatite coatings. The HVSFS hydroxyapatite coatings studied were dense, 27-37μm thick, with some transverse microcracks. Lamellae were sintered together and nearly unidentifiable, unlike conventional plasma-sprayed hydroxyapatite. Crystallinities of 10%-70% were obtained, depending on the deposition parameters and the use of a TiO2 bond coat. The average hardness of layers with low (<24%) and high (70%) crystallinity was ≈3.5GPa and ≈4.5GPa respectively. The distributions of hardness values, all characterised by Weibull modulus in the 5-7 range, were narrower than that of conventional plasma-sprayed hydroxyapatite, with a Weibull modulus of ≈3.3. During soaking in simulated body fluid, glassy coatings were progressively resorbed and replaced by a new, precipitated hydroxyapatite layer, whereas coatings with 70% crystallinity were stable up to 14days of immersion. The interpretation of the precipitation behaviour was also assisted by surface charge assessments, performed through Z-potential measurements. During in vitro tests, HA coatings showed no cytotoxicity towards the SAOS-2 osteoblast cell line, and surface cell proliferation was comparable with proliferation on reference polystyrene culture plates.

Antimicrobial activity and cytocompatibility of Ag plasma-modified hierarchical TiO2 film on titanium surface

To improve the antimicrobial ability and cytocompatibility of biomedical titanium implants, many efforts have been made to modify their surface topography and chemical composition. In this work, Ag plasma-modified hierarchical TiO2 film was fabricated on titanium surface via acid etching to produce micropit, hydrothermal treatment to generate TiO2 nanorod and subsequent plasma immersion ion implantation process to impregnate Ag into TiO2 surface. In view of the potential clinical applications, their antimicrobial activity, bioactivity and cytocompatibility were systematically evaluated. The hierarchical TiO2 film showed enhanced bioactivity and bacteriostatic effect on both microbes due to more negative zeta potential, constructing the first defense line against microbial adhesion by electrostatic repulsion. Addition of embedded Ag remarkably enhanced the antimicrobial efficiency toward both microbes based on Schottky contact without Ag(+) release, establishing the second defense line targeting microbial membrane. Furthermore, the addition of Ag degraded the bioactivity very little and exerted nearly no adverse or even promoted effect on MG63 cell functions, including adhesion, spreading and proliferation. This work illustrates a two-defense-line antimicrobial activity in darkness with both prior electrostatic repulsion to inhibit most microbes adhesion and posterior biocidal action to kill residual ones that luckily infiltrated through the first defense line, and provide proof of concept using both clinically relevant human pathogens. In conclusion, the Ag-embedded hierarchical TiO2 film with excellent antimicrobial activity, bioactivity and cytocompatibility provides a promising candidate for orthopedic and dental implants.

From Koch's postulates to biofilm theory. The lesson of Bill Costerton

The clinical diagnoses of implant infections pose insurmountable difficulties for cultural methods because of their frequent failure when bacteria are growing in biofilms. In 1978 Bill Costerton warned that chronic infections in patients with indwelling medical devices were caused by bacteria growing in well-developed glycocalyx-enclosed biofilms and that bacteria within biofilms resist antibiotic therapies and immune host defenses. Costerton's "biofilm theory" opened two lines of scientific endeavor: the study of the biochemistry and genetics of biofilm formation and function; and, on the other side, the search for new methods for medical diagnosis and treatment of biofilm-centered implant infections. This Editorial and the entire 2012 issue "Focus on Implant Infections" are dedicated to the memory of Bill Costerton, recognized worldwide as the Father of Biofilms for his innovation and body of work on infections caused by sessile bacteria. Bill Costerton was a great scientist, heedful both to the biological aspects of biofilms and to the medical challenges of new diagnostic methods and modern therapeutic approaches to implant infections. But, most of all, he was a charming Maestro for the large number of colleagues and students whose enthusiasm for the science he was able to nourish. Bill passed away on May 12th, 2012 and the entire science community mourns the death of a friend and a leader.

A novel antibacterial modification treatment of titanium capable to improve osseointegration

BACKGROUND

Among the different causes of orthopedic and dental implant failure, infection remains the most serious and devastating complication associated with biomaterial devices.

PURPOSE

The aim of this study was to develop an innovative osteointegrative and antibacterial biomimetic coating on titanium and to perform a chemical-physical and in vitro biological characterization of the coating using the SAOS-2 cell line. We also studied the antibacterial properties of the coating against both Gram-positive and Gram-negative bacteria strains.

METHODS

An electrochemical solution containing silicon, calcium, phosphorous, sodium, and silver nanoparticles was used to obtain the antibacterial by Anodic Spark Deposition (ASD) treatment. Surface morphology was characterized using SEM and laser profilometry. A qualitative analysis of the chemical composition of the coating was assessed by EDS. The adhesion properties of the coating to the titanium bulk were performed with a 3-point bending test. SAOS-2 osteoblastic cell line spreading and morphology and viability were investigated. The bacterial adhesion and the antibacterial properties were investigated after 3 h and 24 h of incubation with Streptococcus mutans, Streptococcus epidermidis, and Escherichia coli bacterial strains.

RESULTS

The proposed anodization treatment created a chemically and morphologically modified, adherent titanium oxide layer, characterized by a microporous morphology enriched by calcium, silicon, phosphorous, and silver. The preliminary biological characterization showed optimal SAOS-2 cell adhesion and proliferation as well as a strong antibacterial effect.

CONCLUSIONS

Based on the results of this study, we believe that this novel biomimetic and antibacterial treatment hold promise for enhancing osteointegration while conferring strong antibacterial properties to titanium.

A review of the biomaterials technologies for infection-resistant surfaces

Anti-infective biomaterials need to be tailored according to the specific clinical application. All their properties have to be tuned to achieve the best anti-infective performance together with safe biocompatibility and appropriate tissue interactions. Innovative technologies are developing new biomaterials and surfaces endowed with anti-infective properties, relying either on antifouling, or bactericidal, or antibiofilm activities. This review aims at thoroughly surveying the numerous classes of antibacterial biomaterials and the underlying strategies behind them. Bacteria repelling and antiadhesive surfaces, materials with intrinsic antibacterial properties, antibacterial coatings, nanostructured materials, and molecules interfering with bacterial biofilm are considered. Among the new strategies, the use of phages or of antisense peptide nucleic acids are discussed, as well as the possibility to modulate the local immune response by active cytokines. Overall, there is a wealth of technical solutions to contrast the establishment of an implant infection. Many of them exhibit a great potential in preclinical models. The lack of well-structured prospective multicenter clinical trials hinders the achievement of conclusive data on the efficacy and comparative performance of anti-infective biomaterials.

Self-disinfecting surfaces: review of current methodologies and future prospects

Methods to improve disinfection of environmental surfaces in hospital rooms include improving cleaning/disinfection by environmental service workers through education and feedback on cleaning effectiveness (eg, use of fluorescent dyes), "no-touch" methods (eg, UV-C light), and self-disinfecting surfaces. Self-disinfecting surfaces can be created by impregnating or coating surfaces with heavy metals (eg, silver or copper), germicides (eg, triclosan), or miscellaneous methods (eg, light-activated antimicrobials). These methods are under active investigation but to date have not been assessed for their ability to reduce health care-associated infections.

Electron storage mediated dark antibacterial action of bound silver nanoparticles: smaller is not always better

Size tunable silver nanoparticles (Ag NPs) are synthesized and incorporated into titanium oxide coatings (TOCs) by manipulating the atomic-scale heating effect of silver plasma immersion ion implantation (Ag PIII). The resulting Ag NPs/TOC composite coatings possess electron storage capability that gives rise to both controlled antibacterial activity and excellent compatibility with mammalian cells. The precipitation behavior of these Ag NPs is qualitatively constrained by the classical nucleation theory. Both photoluminescence (PL) spectra and fluorescence microscopy results demonstrate that larger Ag NPs (5-25 nm) are better at reserving electrons than smaller ones (∼4 nm). The antibacterial activities of the as-sprayed and Ag PIII treated TOCs show that Ag NPs with a different size act distinctively to bacteria: large particles induce serious cytosolic content leakage and lysis of both Staphylococcus aureus and Escherichia coli cells while small ones do not. The excellent activity of larger Ag NPs against bacteria is highly related to their stronger electron storage capability, which can induce accumulation of adequate valence-band holes (h⁺) at the titanium oxide side, arousing oxidation reactions to bacterial cells in the dark. Moreover, the in vitro cell culture assay (using both MG63 and MC3T3 cells) reveals no significant cytotoxicity and even good cytocompatibility on the Ag PIII treated samples. Our results show that, by taking advantage of the boundary property between Ag NP and titanium oxide, the antibacterial activity of Ag NPs can be accurately controlled. This study provides a distinct criterion for the design of nanostructured surfaces such that their osteoblast functions and antibacterial activity are perfectly balanced.

New advances in titanium-mediated free radical reactions

Titanium complexes have been widely used as catalysts for C‑C bond-forming processes via free-radical routes. Herein we provide an overview of some of the most significant contributions in the field, that covers the last decade, emphasizing the key role played by titanium salts in the promotion of selective reactions aimed at the synthesis of multifunctional organic compounds, including nucleophilic radical additions to imines, pinacol and coupling reactions, ring opening of epoxides and living polymerization.

Biofilm Formation on Composite Resins for Dental Restorations: An in Situ Study on the Effect of Chlorhexidine Mouthrinses

Purpose

Biofilm formation on the surface of dental restorative materials by oral bacteria is considered an important step in the development of secondary caries. The aim of this study was to evaluate the in situ effect of a chlorhexidine (CHX)-containing mouthrinse on the biofilm formation occurring on the surface of human enamel and of two resin-based commercially available materials: a silorane-based material (Filtek Silorane®) and a methacrylate-based material (Filtek Supreme XT®).

Methods

53 disks were obtained for each of the two composites and 37 disks for enamel. The surface was characterized by determining the surface roughness and the surface free energy of 5 samples for each of the three materials tested, then the remaining samples were mounted on splints worn by 16 volunteers. The participants were randomly divided into two groups: an experimental group that used 0.12% CHX-based mouthrinse and a control group that used a placebo mouthrinse. Biofilm formation on the different surfaces after a 24 h period was assessed using MTT assay.

Results

The two composites in the group treated with the placebo mouthrinse showed a similar biofilm formation, which was significantly higher than that occurring on enamel surfaces. The CHX-based mouthrinse significantly reduced biofilm formation on the surfaces of the two resin-based materials when compared with the placebo mouthrinse. The reduction was particularly relevant on the Filtek Silorane surfaces.

Conclusions

The new silorane-based material seems to interact with CHX in a promising way from the point of view of biofilm formation control.

Improving Indoor Air Quality by Using the New Generation of Corrugated Cardboard-Based Filters

Purpose

Indoor Air Quality (IAQ) is strictly affected by the concentration of Total suspended particulate matter (TSP). Air filtration is by far the most feasible suggestion to improve IAQ. Unfortunately, highly effective HEPA filters also have a few major weaknesses that have hindered their widespread use. There is therefore a renewed interest in developing novel, cost-effective filtration systems. We have recently reported the development of cardboard-based filters for bacterial removal that were further implemented and tested herein.

Methods

A parallelepiped filter manufactured by aligning strips of corrugated cardboard and surrounded by a cardboard frame was specifically designed with an internal pocket holding a partially cut antistatic pleated fabric (HP). This filter, together with its parent version (CTRL) and a commercially sourced specimen (CAF), were assessed comparatively in a longtime test to assess their effectiveness on TSP removal.

Results

We found that the TSP abatement efficiency (E%) of the HP filter was relatively high and invariable over the 93 days of test and the pressure drop (PD%) decrease because of filter clogging was moderate. Most important, the HP filter was the most effective if assessed in terms of overall yield (Y%) and its performance was quite constant over the entire period considered.

Conclusions

This work disclosed this novel class of corrugated cardboard-based filters as promising tools to ameliorate IAQ in light of their good TSP removal properties that endure over time. Moreover, cardboard is a lightweight, inexpensive, and eco-friendly material and corrugated cardboard-based air filters are very easy to shape and mount on and/or replace in existing ventilation systems

Decreased bacteria activity on Si₃N₄ surfaces compared with PEEK or titanium

A significant need exists for orthopedic implants that can intrinsically resist bacterial colonization. In this study, three biomaterials that are used in spinal implants – titanium (Ti), polyether-ether-ketone (PEEK), and silicon nitride (Si₃N₄) – were tested to understand their respective susceptibility to bacterial infection with Staphylococcus epidermidis, Staphlococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Enterococcus. Specifically, the surface chemistry, wettability, and nanostructured topography of respective biomaterials, and the effects on bacterial biofilm formation, colonization, and growth were investigated. Ti and PEEK were received with as-machined surfaces; both materials are hydrophobic, with net negative surface charges. Two surface finishes of Si₃N₄ were examined: as-fired and polished. In contrast to Ti and PEEK, the surface of Si₃N₄ is hydrophilic, with a net positive charge. A decreased biofilm formation was found, as well as fewer live bacteria on both the as-fired and polished Si₃N₄. These differences may reflect differential surface chemistry and surface nanostructure properties between the biomaterials tested. Because protein adsorption on material surfaces affects bacterial adhesion, the adsorption of fibronectin, vitronectin, and laminin on Ti, PEEK, and Si₃N₄ were also examined. Significantly greater amounts of these proteins adhered to Si₃N₄ than to Ti or PEEK. The findings of this study suggest that surface properties of biomaterials lead to differential adsorption of physiologic proteins, and that this phenomenon could explain the observed in-vitro differences in bacterial affinity for the respective biomaterials. Intrinsic biomaterial properties as they relate to resistance to bacterial colonization may reflect a novel strategy toward designing future orthopedic implants.

Electrochemically Deposited Gentamicin-Loaded Calcium phosphate Coatings for Bone Tissue Integration

Purpose

Despite improvements in operative environment and surgical techniques, post-operative infections remain one of the most devastating complications in total joint replacement prostheses. Several efforts have been made to modify the surface of materials in order to prevent bacterial adhesion and colonization. Here, we show a one-pot electrochemical surface modification process for co-deposition of calcium phosphate and gentamicin, with the aim of triggering specific biological responses and imparting antibacterial properties on titanium alloy prostheses.

Methods

Gentamicin-loaded calcium phosphate coatings were deposited on Ti specimens via cathodic polarization in an electrochemical bath containing different amounts of the antibiotic salt (1–10 mg mL–1). Coatings were evaluated in terms of chemico-physical properties, via SEM/EDX, XRD, and ICP analysis, and antibacterial activity, via agar disc diffusion test on Staphylococcus aureus 8325–4 and Staphylococcus aureus SA113.

Results

An effective incorporation of gentamicin was achieved without any major effect on the morphology and structure. Morphology resulted in a typical plate-like brushite structure, confirmed by chemical composition and crystallographic structure. Gentamicin-loaded coatings showed an antibacterial efficacy on both staphlococcal strains, with a dose-dependent activity.

Conclusions

Electrochemical technology can be advantageously exploited in order to obtain coatings for bone-contact prostheses with tailored antibacterial properties.

Biofilm formation in Staphylococcus implant infections. A review of molecular mechanisms and implications for biofilm-resistant materials

Implant infections in orthopaedics, as well as in many other medical fields, are chiefly caused by staphylococci. The ability of growing within a biofilm enhances the chances of staphylococci to protect themselves from host defences, antibiotic therapies, and biocides. Advances in scientific knowledge on structural molecules (exopolysaccharide, proteins, teichoic acids, and the most recently described extracellular DNA), on the synthesis and genetics of staphylococcal biofilms, and on the complex network of signal factors that intervene in their control are here presented, also reporting on the emerging strategies to disrupt or inhibit them. The attitude of polymorphonuclear neutrophils and macrophages to infiltrate and phagocytise biofilms, as well as the ambiguous behaviour exhibited by these innate immune cells in biofilm-related implant infections, are here discussed. Research on anti-biofilm biomaterials is focused, reviewing materials loaded with antibacterial substances, or coated with anti-adhesive/anti-bacterial immobilized agents, or surfaced with nanostructures. Latter approaches appear promising, since they avoid the spread of antibacterial substances in the neighbouring tissues with the consequent risk of inducing bacterial resistance.

Titanium Oxide Antibacterial Surfaces in Biomedical Devices

Titanium oxide is a heterogeneous catalyst whose efficient photoinduced activity, related to some of its allotropic forms, paved the way for its widespread technological use. Here, we offer a comparative analysis of the use of titanium oxide as coating for materials in biomedical devices. First, we introduce the photoinduced catalytic mechanisms of TiO2 and their action on biological environment and bacteria. Second, we overview the main physical and chemical technologies for structuring suitable TiO2 coatings on biomedical devices. We then present the approaches for in vitro characterization of these surfaces. Finally, we discuss the main aspects of TiO2 photoactivated antimicrobial activity on medical devices and limitations for these types of applications.