The role of implant surface characteristics in the healing of bone

The bases for using a particular occlusal design in tooth and implant-borne reconstructions and complete dentures

OBJECTIVES

A systematic review identified randomised and other trials (1966-2006) of studies of occlusal design of crowns, complete (CRP) and partial (PRP) removable prostheses and implant-borne reconstructions, and whether occlusal design influenced diet, quality of life, bruxism and attrition.

METHODS

The search primarily included Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, Database of Abstracts of Reviews of Effectiveness, Ovid Medline and PreMedline.

RESULTS

The search yielded 1315 studies: 20 on CRP--1 RCT, one systematic review, four clinical trials, 10 case series; 22 on PRP - one cohort study, two experimental studies, 15 case reports or case series, three clinical trials; 23 on implant superstructures, and 24 reports on implant failure, 37 on oral health related quality of life, eight on attrition; and four studies on masticatory function.

CONCLUSIONS

CRP--Studies of occlusal form and tooth arrangements, included balanced, lingualised and monoplane arrangements--lingualised posterior occlusion was preferred. Early studies on CRP design were observational as case reports, however data suggested that optimum function is achieved by modification of the maxillary occlusion, irrespective of the opposing mandibular occlusion. PRP--Edentulous ridge resorption is patient-specific, has a multifactorial aetiology and there is no objective data to confirm that mechanical factors cause bone loss; oral hygiene management is crucial for long-term health. Studies on distal extension PDs confirmed a link between bite force and masticatory function; preservation of two functioning posterior tooth units ipsilateral to the distal extension optimises function. Data indicate that patient-specific factors, rather than PD design-specific features, influence long-term PD outcomes. Implant superstructures--There is little scientific evidence specifying occlusal and superstructure design for fixed prostheses for teeth or implants. Occlusal scheme design and occlusal form have evolved through clinical experience, but there is no evidence to indicate that a particular design is superior. Complex neurophysiological mechanisms allow the jaw muscle system to accommodate to oral and dental changes.

Enhancement ofin vitro osteogenesis on titanium by chemically produced nanotopography

The surface characteristics of biomaterials can influence protein adsorption, cellular functions, and ultimately tissue formation. Controlled chemical oxidation of titanium-based surfaces with a mixture of H(2)SO(4)/H(2)O(2) creates a nanopatterned surface that has been shown to affect early osteogenic events. The objective of this study was to evaluate the effect over time of this nanopattern on various key parameters of osteogenesis, and determine whether these effects ultimately translate into more mineralized matrix production. Osteogenic cells were obtained by enzymatic digestion of newborn rat calvaria and grown on treated and untreated titanium discs for periods of up to 14 days. Alkaline phosphatase activity peaked earlier and cell number was higher as of day 7 on the nanopatterned discs. Immunofluorescence showed that the treated surface favored early bone sialoprotein and osteopontin secretion, and fibronectin accumulation. Alizarin red staining revealed that, at days 10 and 14, there were significantly more mineralized nodules on treated than on untreated discs. These results demonstrate that simple chemical treatment of titanium with H(2)SO(4)/H(2)O(2) accelerates the in vitro osteogenic potential of calvaria-derived cells. They also suggest that this treatment may represent an advantageous approach for producing "intelligent surfaces" that stimulate bone formation and enhance bone-implant contact.

A physical vapor deposition method for controlled evaluation of biological response to biomaterial chemistry and topography

The purpose of this study was to characterize a technique to effectively mask surface chemistry without modifying surface topography. A thin layer of titanium was deposited by physical vapor deposition (PVD) onto different biomaterial surfaces. Commercially pure titanium disks were equally divided into three groups. Disks were either polished to a mirror finish, grit blasted with alumina particles, or grit blasted and subsequently plasma sprayed with a commercial grade of hydroxyapatite (HA). A subgroup of each of these treatment types was further treated by masking the entire disk surface with a thin layer of commercially pure titanium deposited by PVD. A comparison of surface topography and chemical composition was carried out between disks within each treatment group. Canine marrow cells were seeded on all disk surfaces to determine the stability of the PVD Ti mask under culture conditions. The PVD process did not significantly alter the surface topography of any samples. The thin titanium layer completely masked the underlying chemistry of the plasma sprayed HA surface and the chemistry of the plasma vapor deposited titanium layer did not differ from that of the commercially pure titanium disks. Aliquots obtained from the media during culture did not indicate any significant differences in Ti concentration amongst the Ti and Ti-masked surfaces. The PVD application of a Ti layer on HA coatings formed a stable, durable, and homogenous layer that effectively masked the underlying surface chemistry without altering the surface topography.

A Pilot Study of Complete Edentulous Rehabilitation with Immediate Function Using a New Implant Design: Case Series

BACKGROUND

The current investigation focuses on new implant designs for increased predictability in clinically demanding situations. Microtextured implant surfaces create favorable conditions for enhanced osseointegration of dental implants compared to implants with a smooth surface, and the macroscopic implant design may influence implant stability.

PURPOSE

The aim of the present study was to retrospectively evaluate the clinical performance of a novel implant design in the rehabilitation of completely edentulous jaws and in combination with an immediate function protocol.

MATERIALS AND METHODS

Forty-six consecutive patients received 189 study implants (NobelSpeedy concept implant, Nobel Biocare AB, Göteborg, Sweden) supporting 53 full-arch all-acrylic prostheses (44 maxilla, 9 mandible). The majority (66%) of the reconstructions were supported by four implants, of which the two posterior implants were tilted. All patients were followed for a minimum of 1 year. Radiographic assessment of the marginal bone level was performed.

RESULTS

Two implants were lost in two patients, rendering a 1-year cumulative clinical survival rate of 98.9%. The marginal bone level was, on average, situated 1.2 +/- 0.7 mm below the implant-abutment interface after 1 year of loading. Good soft tissue health and overall esthetic outcome was reported.

CONCLUSIONS

The results of the present pilot study indicate that fully edentulous jaws with various types of bone can be treated with high success and good esthetics using immediately loaded implants with the presented design, and that favorable marginal bone levels can be maintained.

Proliferation and osteoblastic differentiation of human bone marrow-derived stromal cells on akermanite-bioactive ceramics

In the present study, the effects of a calcium magnesium silicate bioactive ceramic (akermanite) on proliferation and osteoblastic differentiation of human bone marrow stromal cells (hBMSC) have been investigated and compared with the classical ceramic (beta-tricalcium phosphate, beta-TCP). Akermanite and beta-TCP disks were seeded with hBMSC and kept in growth medium or osteogenic medium for 10 days. Proliferation and osteoblastic differentiation were evaluated on day 1, 4, 7 and 10. The data from the Alamar Blue assay and lactic acid production assay showed that hBMSC proliferated more significantly on akermanite than on beta-TCP. The analysis of osteoblast-related genes, including alkaline phosphatase (ALP), osteopontin (OPN), bone sialoprotein (BSP) and osteocalcin (OC), indicated that akermanite ceramics enhanced the expression of osteoblast-related genes, but type I collagen (COL I) showed no noticeable difference among akermanite and beta-TCP ceramics. Furthermore, this stimulatory effect was observed not only in osteogenic medium, but also in normal growth medium without osteogenic reagents such as l-ascorbic acid, glycerophosphate and dexamethasone. This result suggests that akermanite can promote osteoblastic differentiation of hBMSC in vitro even without osteogenic reagents, and may be used as a bioactive material for bone regeneration and tissue engineering applications.

Implant surfaces

Available in many shapes, sizes, and lengths, dental implants are also crafted from different materials with different surface proper-ties. Among the most desired characteristics of an implant are those that ensure that the tissue-implant interface will be established quickly and then will be firmly maintained. Because many variables affect oral implants, it is sometimes difficult to reliably predict the likelihood of an implant's success. It is especially difficult to assess whether the various modifications in the latest implants deliver improved performance. This article focuses primarily on important surface characteristics and their potential effects on the performance of dental implants.

Enhancing surface free energy and hydrophilicity through chemical modification of microstructured titanium implant surfaces

Roughness-induced hydrophobicity, well-known from natural plant surfaces and intensively studied toward superhydrophobic surfaces, has currently been identified on microstructured titanium implant surfaces. Studies indicate that microstructuring by sandblasting and acid etching (SLA) enhances the osteogenic properties of titanium. The undesired initial hydrophobicity, however, presumably decelerates primary interactions with the aqueous biosystem. To improve the initial wettability and to retain SLA microstructure, a novel surface modification was tested. This modification differs from SLA by its preparation after acid etching, which was done under protective gas conditions following liquid instead of dry storage. We hypothesized that this modification should have increased wettability due to the prevention of contaminations that occurs during air contact. The main outcome of dynamic wettability measurements was that the novel modification shows increased surface free energy (SFE) and increased hydrophilicity with initial water contact angles of 0 degrees compared to 139.9 degrees for SLA. This hydrophilization was kept even after any drying. Reduced hydrocarbon contaminations were identified to play a possible role in altered surface thermodynamics. Such surfaces aim to retain the hydrophilicity and natural high surface energy of the Ti dioxide surface until surgical implants' insertion and are compared in this in vitro study with structural surface variants of titanium to compare roughness and chemically induced wettability.

Photocoupling of fibronectin to titanium surfaces influences keratinocyte adhesion, pellicle formation and thrombogenicity

OBJECTIVES

Coating of implant surfaces with biomolecules can influence basic host responses and enhance subsequent tissue integration. The biological factors have to be immobilized on the implant material. Human fibronectin (Fn) was used as a model protein and covalently coupled to titanium (Ti) surfaces via silanization and an anthraquinone linker. The impact on several aspects of initial host/biomaterial interactions (keratinocyte adhesion, platelet interactions and pellicle formation) was studied.

METHODS

Coupling efficiency was characterized by immunological techniques. The effects of coupled Fn on initial host/biomaterial interactions were assessed. Cell adhesion and spreading were investigated by fluorescent staining, pellicle formation by an acoustic sensor system (quartz crystal microbalance with dissipation, QCM-D), and platelet adhesion as one parameter mediating the inflammatory response by scanning electron microscopy (SEM) and immunological assays.

RESULTS

Coupling efficiency was related to irradiation time used for photochemical coupling of the UV-activated anthraquinone to the silanized Ti surface. With an optimized protocol, the amount of Fn coupled to the surface could be almost doubled compared to standard dip-coating methods. On the anthraquinone-coupled Fn coatings, cell adhesion and spreading of human keratinocytes was significantly enhanced. Online detection of pellicle formation revealed strong reversibility of saliva protein adhesion on Fn coated surfaces compared to the pure Ti surface. Furthermore, the Fn coated Ti showed a low thrombogenicity.

SIGNIFICANCE

This study suggests that anthraquinone-coupled biological coatings may be useful for biofunctionalization of Ti dental implants by enhancement of soft tissue re-integration (restoration of the epithelial seal) combined with diminished pellicle formation.

Regulation of Osteoblast Gene Expression and Phenotype by Polylactide-fatty Acid Surfaces

Cell function is influenced by surface structure and molecules. Molecules that enhance cellular differentiation can be applied to tissue scaffold surfaces to stimulate endogenous tissue regeneration. The application of this approach to bone implants yields surfaces coated with factors (proteins, peptides, etc...) that promote the differentiation of osteoblasts, the cells that make bone. Increased bone formation leads to increased healing and union of the implant with endogenous bone. To obtain better control over surface coating we developed PLLA copolymers with allyl (PLLA-co-DAG) and 3-hydroxypropyl (PLLA-co-HP) side chains to which we can attach functional groups. Given the potential of fatty acids being able to incorporate into lipid bilayers and/or influence gene expression, we grafted different fatty acid side chains to PLLA-co-HP by esterifying the corresponding fatty acids with the PLLA-co-HP 3-hydroxypropyl side chains. The effects of the polymer modifications on osteoblasts were then evaluated. While cellular morphology differed between surface coatings, they did not reflect changes in cellular phenotype. Changes in gene expression were most evident with arachidonate and 3-hydroxypropyl side-chains which exhibited osteoblast differentiating capabilities. Linoleate, myristate, oleate, and stearate ester side-chains did not have a significant influence on osteoblast phenotype. Growth characteristics of osteoblasts did not differ between the fatty acid copolymer films, although cells grown on PLLA-co-HP exhibited a trend toward increased growth. Taken together our findings demonstrate that surface fatty acid composition can impact osteoblast phenotype.

Comparison of osteoblast spreading on microstructured dental implant surfaces and cell behaviour in an explant model of osseointegration

OBJECTIVES

To compare interactions between rat calvarial osteoblasts and titanium dental implants with different microstructured surfaces.

MATERIAL AND METHODS

Seven commercially available implants were used. Surfaces included plasma-sprayed, grit-blasted and/or acid-etched, smooth-machined and anodised titanium. Two methods were used to compare cell behaviour: (1) A cell-spreading assay in which percentages of cells at four different stages of attachment were identified by scanning electron microscopy and quantified within a 30 min attachment period. (2) Implants were placed in 'pocket culture' within nylon mesh sacs in contact with explanted calvarial bone fragments for 2 and 4 weeks.

RESULTS

Surfaces combining grit blasting and acid etching, of microporous topography, showed significantly enhanced rates of cell spreading in comparison with the others. Differential cell morphology was observed in both suspension assays and pocket cultures. In the latter, cells migrated onto all surfaces. Multicellular layers with extracellular matrix (ECM) were present between the layers and on the material surfaces after 2 weeks. After 4 weeks, cell layers were more consolidated, and microstructures were obscured by layers of cells and ECM. Mineralised tissue was seen in association with ECM on grit-blasted surfaces of rough and smooth microtopography.

CONCLUSIONS

The two methods provided complementary information: a rough surface of porous microstructure may enhance the rate of cell spreading. Differentiation and calcification occurred on surfaces of both rough and smooth microstructure.

Effects of Different Titanium Alloys and Nanosize Surface Patterning on Adhesion, Differentiation, and Orientation of Osteoblast-Like Cells

To test nanosize surface patterning for application as implant material, a suitable titanium composition has to be found first. Therefore we investigated the effect of surface chemistry on attachment and differentiation of osteoblast-like cells on pure titanium prepared by pulsed laser deposition (TiPLD) and different Ti alloys (Ti6Al4V, TiNb30 and TiNb13Zr13). Early attachment (30 min) and alkaline phosphatase (ALP) activity (day 5) was found to be fastest and highest, respectively, in cells grown on TiPLD and Ti6Al4V. Osteoblasts seeded on TiPLD produced most osteopontin (day 10), whereas expression of this extracellular matrix protein was an order of magnitude lower on the TiNb30 surface. In contrast, expression of the corresponding receptor, CD44, was not influenced by surface chemistry. Thus, TiPLD was used for further experiments to explore the influence of surface nanostructures on osteoblast adhesion, differentiation and orientation. By laser-induced oxidation, we produced patterns of parallel Ti oxide lines with different widths (0.2-10 microm) and distances (2-20 and 1,000 microm), but a common height of only 12 nm. These structures did not influence ALP activity (days 5-9), but had a positive effect on cell alignment. Two days after plating, the majority of the focal contacts were placed on the oxide lines. The portion of larger focal adhesions bridging two lines was inversely related to the line distance (2-20 microm). In contrast, the portion of aligned cells did not depend on the line distance. On average, 43% of the cells orientated parallel towards the lines, whereas 34% orientated vertically. In the control pattern (1,000 microm line distance), cell distribution was completely at random. Because a significant surplus of the cells preferred a parallel alignment, the nanosize difference in height between Ti surface and oxide lines may be sufficient to orientate the cells by contact guiding. However, gradients in electrostatic potential and surface charge density at the Ti/Ti oxide interface may additionally influence focal contact formation and cell guidance.

Adsorption of serum fetuin to hydroxylapatite does not contribute to osteoblast phenotype modifications

Osteoblasts exhibit enhanced differentiation and altered gene profiles when cultured on hydroxyapatite (HA) compared to plastic surfaces. To begin determining mechanisms for this response, we used proteomics to identify proteins predominantly found in osteoblasts on HA but not plastic surfaces. Two-dimensional gel electrophoresis and Western analyses indicate that fetuin is abundant in extracts from HA, but not plastic surfaces. Incubation of HA and plastic surfaces with cell culture medium (containing 10% serum) under cell-free conditions shows that fetuin is predominantly derived from the culture medium serum and readily adsorbs to the HA surface. However, we did detect low levels of fetuin B mRNA in osteoblasts. Serum albumin, actin-beta, apolipoprotein-AI, and vimentin also adsorbed to HA. To determine the role of fetuin in the HA-induced osteoblast phenotype changes, osteoblasts were seeded onto fetuin-coated or uncoated HA under serum-free conditions. Osteoblast morphology was similar on both HA surfaces, suggesting that HA alone (without adsorbed serum proteins) is sufficient for cell attachment and spreading. Similarly, genes previously reported to be modulated by HA (glvr-1, DMP-1, osteoglycin, and proliferin 3) were modulated even in the absence of fetuin or other serum proteins. These data show that HA surface can be enriched selectively with fetuin from serum; however, neither fetuin or other serum proteins are required to mediate HA-induced osteoblast attachment, spreading, or changes in expression of genes examined. This finding suggests that factors intrinsic to HA are required for the response.

In Vitro Biocompatibility of a New Titanium-29Niobium-13Tantalum-4.6Zirconium Alloy With Osteoblast-Like MG63 Cells

BACKGROUND

Titanium-29niobium-13tantalum-4.6zirconium (TiNb) has recently been developed as a new implant material. TiNb is composed of non-toxic elements and has a lower modulus of elasticity than the other titanium alloys. However, its biocompatibility has not been adequately characterized. The aim of this study was to evaluate the biocompatibility of TiNb using an osteoblast-titanium co-culture system.

METHODS

MG63 cells were cultured on three kinds of titanium disks: TiNb, pure titanium (pTi), and titanium-6aluminum-4vanadium (TiAl), prepared with two different surfaces, a polished and acid-etched surface and a machined-grooved surface. The surface topography and roughness were evaluated by scanning electron microscopy (SEM). After 48 hours culture, the number of proliferating cells and prostaglandin E2 (PGE2) production in the culture supernatant were determined.

RESULTS

There was no significant difference in surface roughness among the three titanium disks with a polished and acid-etched surface. After 48 hours of culture, the number of cells was significantly reduced on pTi and TiAl compared to TiNb and the control. PGE2 production was significantly higher on pTi than on TiAl, TiNb, and the control. We further examined the effect of surface roughness on PGE2 production using machine-grooved titanium disks. While pTi and TiAl stimulated the production of PGE2 depending on surface roughness, roughened TiNb did not affect PGE2 production.

CONCLUSIONS

These results suggest that TiNb may exhibit favorable biocompatibility because it has an efficient surface topography for cell proliferation, and the level of PGE2 production does not depend on surface roughness. We conclude that TiNb may be useful as an implant material.

Cellular Reactions of Osteoblasts to Micron- and Submicron-Scale Porous Structures of Titanium Surfaces

Osteoblast reactions to topographic structures of titanium play a key role in host tissue responses and the final osseointegration. Since it is difficult to fabricate micro- and nano-scale structures on titanium surfaces, little is known about the mechanism whereby the topography of titanium surfaces exerts its effects on cell behavior at the cellular level. In the present study, the titanium surface was structured in micron- and submicron-scale ranges by anodic oxidation in either 0.2 M H3PO4 or 0.03 M calcium glycerophosphate with 0.15 calcium acetate. The average dimensions of pores in the structured surface were about 0.5 and 2 microm in diameter, with roughness averaging at 0.2 and 0.4 microm, respectively. Enhanced attachment of cells (SaOS-2) was shown on micron- and submicron-scale structures. Initial cell reactions to different titanium surfaces, e.g. the development of the actin-containing structures, are determined by the different morphology of the surfaces. It is demonstrated that on either micron- or submicron-structured surfaces, many well-developed filopodia were observed to be primary adhesion structures in cell-substrate interactions, and some of them entered pores using their distinct tips or points along their length for initial attachment. Therefore, porous structures at either micro- or submicrometre scale supply positive guidance cues for anchorage-dependent cells to attach, leading to enhanced cell attachment. In contrast, the cells attached to a smooth titanium surface by focal contacts around their periphery as predominant adhesion structures, since repulsive signals from the environment led to retraction of the filopodia back to the cell bodies. These cells showed well-organized stress fibres, which exert tension across the cell body, resulting in flattened cells.

Morphologic, functional and behavioral effects of titanium dioxide exposure on nerves

OBJECTIVES

The purpose of this study was to explore morphologic, functional, and behavioral effects of titanium dioxide (TiO(2)) on nerves.

MATERIAL AND METHODS

A total of 17 albino rats were used for nerve conduction experiments, hot-plate tests, and histological evaluation. TiO(2) was implanted unilaterally on the sciatic nerves of five rats. Ten days after surgery, test and control nerves were dissected and their signal transduction speeds were quantified by suction electrodes in a bath containing a Tyrode solution. Twelve rats were divided into three equal groups resulting in equal number of nerves (n=8) for TiO(2) implantation, surgical exposure of the nerves, and for use as controls. One week after surgery, hot-plate tests were undertaken for 10 consecutive days to determine response latencies of the nerves. At the termination of the experiments, the nerves were harvested, processed, and examined under a microscope.

RESULTS

The signal transduction speeds of TiO(2)-implanted nerves was similar to control specimens (P>0.05). The avoidance responses of TiO(2)-implanted, surgically exposed, and control nerves were comparable (P>0.05). At the cellular level, TiO(2) did not lead to any signs of adverse reactions on nerves.

CONCLUSIONS

TiO(2), the main oxide surrounding endosseous titanium implants, does not alter the structure and the function of myelinated nerves.

Cellular biocompatibility and stimulatory effects of calcium metaphosphate on osteoblastic differentiation of human bone marrow-derived stromal cells

In the present study, the in vitro biocompatibility of calcium metaphosphate (CMP) with human bone marrow stromal cells (HBMSCs) and its effect on osteoblastic differentiation have been investigated. Powder and disk forms of CMP do not exert a cytotoxic effect on the HBMSCs undergoing osteoblastic differentiation. In addition, the HBMSCs adhere to the surface of the CMP disk as successfully as to the culture plate or hydroxyapatite (HA) disk. The HBMSCs adhered to either the HA or CMP disk display an undistinguishable actin arrangement and cellular phenotypes, indicating that the CMP does not disrupt normal cellular responses. An analysis of the differentiation of the HBMSCs cultured on culture plate, the HA and the CMP disk shows that three matrices are capable of supporting osteoblastic differentiation of the HBMSCs as accessed by alkaline phosphatase (ALP) staining. Further molecular analysis of osteoblastic differentiation of HBMSCs reveals that the CMP disk has a better ability than the HA disk to induce an expression of osteoblast-related genes, including ALP, osteoprotegerin (OPG), a decoy receptor for RANK ligand, and osteopontin (OPN), a non-collagenous bone matrix protein. The results demonstrate that, in addition to favorable biocompatibility, the CMP can stimulate osteoblastic differentiation of the HBMSCs in vitro.

In vivo mechanisms of hydroxyapatite ceramic degradation by osteoclasts: fine structural microscopy

In the present study the in vivo mechanism of calcium-phosphate (CaP) ceramic degradation has been investigated by means of transmission electron microscopy. The results revealed osteoclast-mediated degradation of hydroxyapatite ceramic implanted into sheep bone by simultaneous resorption and phagocytosis. After 6 weeks of implantation, osteoclasts were localized immediately beneath the ceramic surface. They had formed resorption lacunae and exhibited typical ultrastructural features, such as the ruffled border, the clear zone, and the dorsal microvilli. Their resorption capacity also had become evident by alterations of the electron density and the shape of the CaP crystals localized within the acidic microenvironment of the ruffled border. Moreover, the osteoclasts simultaneously were capable of phagocytosing the resorbed CaP crystals. The formation of endophagosomes was performed (1) by the uptake of particles into large intracellular vacuoles, which were generated by deep invagination of the membranes of the osteoclastic ruffled border, and (2) by the encircling of particles due to the development of pseudopodia-like plasmaprotrusions of the ruffled border. The formation of endophagosomes was followed by the in situ fragmentation of the inclusion material, which subsequently was released into the extracellular space and phagocytosed by macrophages.

Force transmission of one- and two-piece morse-taper oral implants: a nonlinear finite element analysis

PURPOSE

To compare force transmission behaviors of one-piece (1-P) and two-piece (2-P) morse-taper oral implants.

MATERIAL AND METHODS

A three-dimensional finite element model of a morse-taper oral implant and a solid abutment was constructed separately. The implant-abutment complex was embedded in a phi 1.5 cm x 1.5 cm acrylic resin cylinder. Vertical and oblique forces of 50 N and 100 N were applied on the abutment and solved by two different analyses. First, contact analysis was performed in the implant-abutment complex to evaluate a 2-P implant. Then, the components were bonded with a separation force of 10(20) N to analyze a 1-P implant.

RESULTS

Von Mises stresses in the implant, principal stresses, and displacements in the resin were the same for both designs under vertical loading. Under oblique loading, principal stresses and displacement values in the resin were the same, but the magnitudes of Von Mises stresses were higher in the 2-P implant. The principal stress distributions around both implants in the acrylic bone were similar under both loading conditions.

CONCLUSION

2-P implants experience higher mechanical stress under oblique loading. Nevertheless, the 1-P- or 2-P morse-taper nature of an implant is not a decisive factor for the magnitude and distribution of stresses, and displacements in supporting tissues.

Effects of topography and composition of titanium surface oxides on osteoblast responses

To investigate the roles of composition and characteristics of titanium surface oxides in cellular behaviour of osteoblasts, the surface oxides of titanium were modified in composition and topography by anodic oxidation in two kinds of electrolytes, (a) 0.2 M H(3)PO(4), and (b) 0.03 M calcium glycerophosphate (Ca-GP) and 0.15 M calcium acetate (CA), respectively. Phosphorus (P: ca.10at%) or both calcium (Ca: 1-6at%) and phosphorus (P: 3-6at%) were incorporated into the anodized surfaces in the form of phosphate and calcium phosphate. Surface roughness was slightly decreased or enhanced (R(a) in the range of 0.1-0.5 microm) on the anodized surfaces. The geometry of the micro-pores in the anodized surfaces varied with diameters up to 0.5 microm in 0.2 M H(3)PO(4) and to 2 microm in 0.03 M Ca-GP and 0.15 M CA, depending on voltages and electrolyte. Contact angles of all the anodic oxides were in the range of 60-90 degrees. Cell culture experiments demonstrated absence of cytotoxicity and an increase of osteoblast adhesion and proliferation by the anodic oxides. Cells on the surfaces with micro-pores showed an irregular and polygonal growth and more lamellipodia, while osteoblasts on the titanium surface used as a control or on anodic oxides formed at low voltages showed many thick stress fibres and intense focal contacts. Alkaline phosphatase (ALP) activity of the cells did not show any correlation with surface characteristics of anodic oxides.

Biologic significance of surface microroughing in bone incorporation of porous bioactive glass implants

A novel chemical etching method was recently developed to create a controlled microrough surface on porous bioactive glass implants. Our earlier in vitro studies showed enhanced attachment of osteoblast-like MG63 cells on a microrough bioactive glass surface. The purpose of our current study was to confirm the in vivo significance of surface microroughening for bone bonding of bioactive glass. Porous bioactive glass cones made of sintered microspheres were surgically implanted in the anterior cortex of rabbit femurs. Peripheral quantitative computed tomography (pQCT), biomechanical push-out testing, histomorphometry, and electron microscopy (BEI-SEM) were used to analyze bone ingrowth and osseointegration at 7, 10, 14, 28, 56, and 84 days after implantation. The results showed that microroughening of the bioactive glass surface significantly enhanced the bone-bonding response of the biomaterial. The positive response was seen in one of the three bioactive glass compositions studied. The affinity index of new bone on the glass surface was significantly (p = 0.02) increased with a trend (p = 0.10) toward improved mechanical incorporation. New bone formation was dependent on the glass composition, and it was found to occur not only through the mechanism of bone ingrowth but also based on in situ osteogenesis within implant interstices. Based on these results, the procedure of microroughening could enhance the osteopromotive properties of certain bioactive glass compositions.

Vascular response to titanium dioxide: A study on the rat carotid artery

The purpose of this study was to explore the effects of titanium dioxide (TiO(2)) on vascular smooth muscle contractility with the use of the rat carotid-artery model. TiO(2) powder was implanted on right carotid arteries of five albino rats, the left arteries of which were left intact and served as controls. Fourteen days after placement, bilateral carotid arteries were removed and contraction/relaxation of isolated vessel rings were measured for dose-dependent epinephrine and acetylcholine administrations by a force displacement transducer. The data of each tissue specimen were collected with the use of a computerized system and corresponding software at a sample rate of 1000 kHz, and were expressed as contraction force. Contraction forces of control and TiO(2)-implanted vessel rings were similar (P > 0.05). TiO(2) does not appear to have adverse effects on vascular contractility.

Osteoblasts and osteocytes express MMP2 and -8 and TIMP1, -2, and -3 along with extracellular matrix molecules during appositional bone formation

Our previous studies suggested that a part of bone extracellular matrix (ECM) molecules are degraded and remodeled during embryonic bone formation. In contrast, little is known about ECM remodeling in postnatal appositional bone formation. The present study was designed to investigate expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) during experimentally initiated appositional bone formation in rats. Expressions of ECM molecules, MMPs, and TIMPs were examined using in situ hybridization. Osteoblasts and osteocytes expressed MMP2 and -8, TIMP1, -2, and -3, as well as type I collagen, osteopontin, and osteocalcin in the course of the appositional bone formation, while they showed few transcripts of MMP13. The results indicated that while osteoblasts and osteocytes in the apposed bone produce ECM molecules, they degrade ECM molecules with MMPs and regulate the degradation by inhibiting the activity of MMPs using TIMPs. Osteoblasts and osteocytes may reorganize the ECM composition to mature the bone matrix in appositional bone formation.

THE EFFECT OF SURFACE PORE SIZE ON THE DIFFERENTIATION OF RAT BONE MARROW CELLS: MORPHOLOGICAL OBSERVATIONS AND EXPRESSION OF BONE RELATED PROTEIN mRNA

The purpose of this study was to investigate the behavior of rat bone marrow cells (RBM) growing on surfaces with different pore sizes. RBM behavior on Millipore filters (MF-Millipore membrane filter) made from cellulose mixed esters with 5 different pore surfaces (0.45 microm, 1.2 microm, 3.0 microm, 5.0 microm and 8.0 microm) were compared in terms of morphological changes on the different pore sizes. Furthermore, the expressions of osteopontin and osteocalcin mRNAs were investigated. On the 1.2 microm and 3.0 microm pore surfaces, RBM attached to the substrate well, but cells on the 5.0 microm and 8.0 microm pore surfaces invaded deeply into the pores. Higher levels of both osteopontin and osteocalcin mRNA expression were always observed in cells cultured on the 1.2 microm filter. These results suggest that the 1.2 microm Millipore filter pore size is the most suitable for inducing RBM to differentiate into an osteoblastic phenotype among these surfaces and is probably related to production of the ECM but not to the phenomenon of cell spreading.

Three-Dimensional Topographic and Metrologic Evaluation of Dental Implants by Confocal Laser Scanning Microscopy

BACKGROUND

Surface topography of dental implants has changed during the past few years; however, the last systematic study on this topic is dated 1993.

PURPOSE

The aim of this study was to correlate dental implants by surface analysis.

MATERIALS AND METHODS

A microtopographic analysis of 35 dental implants was performed using confocal laser scanning microscopy. Roughness value (Sa) and developed surface area (ratio, Sdr) were calculated. Implants were grouped according to their surface treatment: "minimally rough" with no further surface treatment (n = 2); ablative structured using etching or blasting (n = 17); titanium plasma spray coated (TPS; n = 9); coated with hydroxyapatite (HA; n = 7).

RESULTS

Most implants (n =16) showed Sa values between 3.0 and 5.0 microm. The developed surface area has a mean value of 13.5 and an SD of 6.52. Minimally rough implant surfaces show the lowest Sa values (mean 0.5 microm). Implants with ablative surface treatment have mean Sa values of 3.1 microm. Both groups with additive surface treatment (TPS and HA) present similar roughness values with a mean of 6.0 microm and 5.8 microm, respectively. Ratio Sdr ranges from 3.1 for the minimally rough implants to 11.4 for the ablative treated implants and 14.3 for TPS-coated and 18.4 for HA-coated implants. There is a significant difference between the roughness and ratio values of the different groups. The topographic images show a typical surface according to the underlying surface treatment.

CONCLUSIONS

We can confirm the "classic" grouping of dental implants by type of surface treatment into the groups minimally rough, ablative, TPS coated, and HA coated as these treatments lead to different ascending Sas; however, the additional value of the ratio Sdr including both spatial and amplitude aspects of the surface could not be confirmed in this study. Functional parameters describing the topographic differences are still lacking.

Control of surface mineralization using collagen fibrils

Surface structure in the form of roughness and organized patterning can affect osteoblastic adhesion and proliferation. This study investigates the effect of reconstituted collagen fibrils on the deposition pattern of a homogeneous inorganic mineral (sodium chloride). The patterns were monitored from nanometer to millimeter scales using atomic force and light microscopies. Initially, mineral deposits formed blocks following the contour of the collagen fibrils. At later times, dendritic structures formed. This demonstrates that collagen fibrils can affect the surface deposition pattern of saline minerals. It is also shown that collagen fibril diameter and the stoichiometry of the inorganic and organic phases effect the surface distribution of minerals.

In vitro MC3T3 osteoblast adhesion with respect to surface roughness of Ti6Al4V substrates

This work investigates the role of the surface roughness of Ti6Al4V on the cell morphology, proliferation and adhesion, and in particular on the variation of the expression of cell adhesion proteins. Standardised test samples with five different surface preparations are used: sandblasted, 80, 1200, and 4000 grade polished, mirror polished. Surface roughness is analysed by Scanning Electron Microscopy and LASER Confocal Microscopy. Cell culture experiments are performed with MC3T3-E1 mouse osteoblasts after 3 days culture: proliferation rate, morphology and adhesion are assessed. The variations of expression of cell adhesion proteins are evidenced by indirect immune fluorescence method: actin from the cytoskeleton, vinculin from the focal adhesion complex, fibronectin and collagen I from the extracellular matrix. The results reveal a clear influence of surface roughness of Ti6Al4V on cell proliferation, morphology and adhesion. A significant correlation is established between surface roughness and cell growth. More the surface is smooth more the osteoblasts proliferate and appear spread out on the test samples. In addition, the expression of adhesion proteins varies with respect to the surface roughness. These results indicate a direct relationship between the decrease of cell adhesion and the increase of cell proliferation on mirror polished materials.

Enhanced bone integration of implants with increased surface roughness: a long term study in the sheep

OBJECTIVES

This study evaluated the quality and the remodeling of bone around commercially pure titanium implants after 3, 6, 12 and 18 month implantation periods in the sheep.

METHODS

Twelve animals were implanted in the cortico-trabecular areas of both femurs. Each femur received four implants with a rough surface (type 1) in the right femur and four with a smooth surface (type 2) in the left one. Bone blocks containing the implants were studied by histomorphometry on undecalcified specimens. The amount of bone around implants was measured (bone volume, fractional woven bone volume, bone thickness, contact interface) together with osteoblastic activity (mineral apposition rates, bone formation rates) and resorption activity (eroded surfaces).

RESULTS

No significant differences could be observed for the two types of implants between 3 and 6 months. At 12 and 18 months, bone volume and contact interface were still increasing and there was always a tendency for type 1 implants to be associated with higher values. On the contrary, mineral apposition rate, bone formation rates and eroded surfaces decreased in the referent area in contact with the implant; this phenomenon of 'return to the normal' was more evident with type 1 implants. The remodeling process appears to increase bone quality and bone-titanium interface around implants in long term periods.

CONCLUSIONS

The net bone quantity necessary to immobilize implants is obtained rapidly but the adapting process to mechanical strength can lead to a small but persistent increase in bone volume around implants. Although the differences between type 1 and type 2 implants were often small or statistically insignificant, the rougher type 1 implants seemed to be associated with stronger bone response.

Grooves affect primary bone marrow but not osteoblastic MC3T3-E1 cell cultures

To elucidate the influence of microtextures on bone cell performance, primary adult rat bone marrow cells (RBMC) and osteoblastic MC3T3-E1 cells were cultured on tissue culture pretreated plates to which grooves at different density were applied. RBMC cells were found to be significantly affected by grooves in the substratum in contrast to osteoblastic MC3T3-E1 cells, taking culture morphology, total cell number, cell mass, and cell activity (MTT-dehydrogenase), parameter for differentiation of osteoblast progenitor cells into (pre-)osteoblasts (alkalinephosphatase activity, ALP) and tartrate-resistant acid phosphatase (TRAP) activity as indices. TRAP is located in lysosomes and secretory granules mainly although not solely in osteoclasts. By applying grooves to and/or by chemical treatment of unpretreated pure polysterene plates it could be concluded that the effects on RBMC cells were evoked not only by the presence of grooves but also by the surface chemistry of the grooved and ungrooved surface areas.

Validation of three-dimensional surface characterising methods: scanning electron microscopy and confocal laser scanning microscopy

Surface characteristics of enosseous titanium implants have been known to influence the quality of osseointegration. Parameters recommended for metrical analysis should be supplemented by a topographical description. In this study, Ra values obtained by established tactile and optical profilometric methods are correlated with those obtained by stereo scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). As test specimens, standardised CVD diamond-coated titanium alloys with different microwave coating power ranging from 2,000 to 3,000 W were used. A non-CVD-coated corund grit-blasted specimen (NC) was used as reference. After coating with a CVD, power of 2,000 W Ra ranges from 4.33 to 5.69 microm depending on the method used. With increasing power of the coating process, the amplitude of the surface roughness is significantly increased to 4.53 to 6.89 microm. Ra values of the same sample obtained by different methods are also significantly different (p = 0.001). Compared with the established methods of tactile and optical profilometry, SEM and CLSM offer valid data on the surface roughness accompanied by a topographical imaging. In future studies, the underlying method should be specified to interpret roughness values correctly, as not every method is suitable for each specimen and values obtained by different methods vary extremely.

[Implantation of flakes of castor oil resin in rat dental alveolus]

The purposes of the present study were: 1) to investigate the biocompatibility of a natural resin (made of fatty acids extracted from Ricinus communis) implanted in the dental alveolus of rats and 2) to verify any possible interference of that material in the osseous healing following tooth extraction. The resin (AUG-EX, Poliquil Araraquara Polímeros Químicos LTDA, Araraquara--SP) was placed inside de alveoli immediately after extraction of the upper right incisors. The animals were sacrificed 1, 2, 3 and 6 weeks after extraction or extraction + implantation. The hemi-maxillae were decalcified and processed for paraffin embedding. Longitudinal 6-micrometer-thick semi-serial sections stained with hematoxylin and eosin were obtained. Histologic examination showed particles of irregular shape and variable size (700-1200 microns) localized in the medium/cervical alveolar thirds, with a scanty but persistent foreign body reaction. From the second week on, as the relative volume of bone trabeculae increased, it was seen in close contact with the surface of the implanted material in some regions. Histometric analysis (differential point counting method), used to quantify the healing process in the apical third, showed a small but significant decrease (13%-20%) in new bone formation in the implanted rats. In conclusion, the results show that, in spite of its biocompatible nature, the studied resin hinders the post-extration healing process.

Hydrogen desorption from sand-blasted and acid-etched titanium surfaces after glow-discharge treatment

Hydrogen desorption from argon plasma-treated titanium implants with a high surface roughness was studied. Implants with a high surface roughness have shown an increase in mechanical stability in bone tissue and a different behavior of osteoblasts in vitro. High surface roughness was produced by grit blasting and acid etching, resulting in an increase of the sub-surface hydrogen concentration and the formation of a titanium hydride. After an argon plasma treatment the surface oxide, which always covers titanum surfaces exposed to an oxygen-containing environment, and some of the hydrogen were sputtered away, decreasing the hydrogen concentration in the sub-surface region. Nuclear reaction analysis was used to determine the hydrogen concentration as a function of depth. The total amount of sub-surface (down to a depth of < or = 2 microm) hydrogen remaining after plasma treatment decreased with increasing plasma intensity to below the levels observed in non-acid-etched samples (approximately 1-2%). Thermal desorption spectroscopy was used for desorption studies and investigation of H(2) desorption activation energies. With a surface oxide present, the onset of hydrogen desorption is at ca 400 degrees C, which is the oxide decomposition temperature in vacuum, with an activation energy of ca 2 eV/molecule of H(2). After plasma treatment, that is, without surface oxide present, the onset of desorption was observed at ca 300 degrees C and with an activation energy of ca 0.8 eV/molecule of H(2), indicating a bulk diffusion-limited desorption.

Substrate dependent differences in morphology and elasticity of living osteoblasts investigated by atomic force microscopy

We have used the atomic force microscope (AFM) as a tool for testing the biocompatibility of implant materials by investigating the adhesion behavior of osteoblast cells in vitro. This technique allowed the investigation of cytomorphology and cytomechanical properties of living cells on a submicrometer scale. Cell adhesion was investigated on Cobalt-Chromium (CoCr), Titanium (Ti) and Titanium-Vanadium (TiV) substrates, which are of great interest in the field of implant research. The elastic properties and the morphology of living osteoblasts on the metallic substrates were compared with those of osteoblasts cultured on glass and tissue culture polystyrene (PS). Furthermore, a characterization of the surface roughness of the substrates was performed and the surface coverage of proteins after incubation with cell culture medium on the substrates was observed with the AFM.

Surface roughness modulates the response of MG63 osteoblast-like cells to 1,25-(OH)(2)D(3) through regulation of phospholipase A(2) activity and activation of protein kinase A

Implant surface roughness influences osteoblast proliferation, differentiation, and local factor production. Moreover, the responsiveness of osteoblasts to systemic hormones such as 1, 25-(OH)(2)D(3) is altered by the effects of surface roughness; on the roughest Ti surfaces the effects of roughness and 1, 25-(OH)(2)D(3) are synergistic. Prostaglandin E(2) (PGE(2)) appears to be involved in mediating the effects of surface roughness on the cells, as well as in the response to 1,25-(OH)(2)D(3). However, it is not yet known through which signaling pathways surface roughness exerts its effects on the response of osteoblasts to 1, 25-(OH)(2)D(3). The present study examined the potential role of protein kinase A (PKA), phospholipase A(2)(PLA(2)), and protein kinase C (PKC) in this process. MG63 osteoblast-like human osteosarcoma cells were cultured on cpTi disks with R(a) values of 0. 54 microm (PT), 4.14 microm (SLA), or 4.92 microm (TPS). PKA was inhibited by adding H8 to the cultures; similarly, PLA(2) was inhibited with quinacrine or activated with melittin, and PKC was inhibited with chelerythrine. Inhibitors or activators were included in the culture media through the entire culture period or for the last 24 h of culture. In addition, cultures were treated for 24 h with inhibitors or activators in the presence of 1,25-(OH)(2)D(3). The effects on cell number and alkaline phosphatase specific activity were determined after 24 h; PKC activity was determined after 9 min and at 24 h. Cell number was reduced on rough surfaces, and alkaline phosphatase activity was increased. 1,25-(OH)(2)D(3) had a synergistic effect with surface roughness on alkaline phosphatase. However, neither surface roughness nor 1,25-(OH)(2)D(3) had an effect on PKC. H8 treatment for 24 h inhibited cell number and alkaline phosphatase on all surfaces; however, when it was present throughout the culture period, the PKA inhibitor had no effect on cell number, but decreased alkaline phosphatase-specific activity. H8 reduced the 1,25-(OH)(2)D(3)-mediated effect on cell number and alkaline phosphatase. Quinacrine inhibited cell proliferation and alkaline phosphatase on all surfaces and further reduced the 1,25-(OH)(2)D(3)-dependent decreases in both parameters. Melittin had no effect when applied for 24 h and did not modify the 1,25-(OH)(2)D(3) effect; however, when present throughout the culture period, it caused a decrease in proliferation and an increase in enzyme activity. Chelerythrine, the PKC inhibitor, only inhibited cell proliferation when it was present throughout the entire culture period. However, it decreased alkaline phosphatase in cultures treated for 24 h, but increased enzyme activity when it was present for the entire culture period. The results indicate that surface roughness and 1,25-(OH)(2)D(3) both mediate their effects through PLA(2) which catalyzes the rate-limiting step in PGE(2) production. Further downstream, PGE(2) activates PKA. Surface roughness-dependent effects are also mediated through PKC, but only after the cells have reached confluence and are undergoing phenotypic maturation. The effect of surface roughness on responsiveness to 1,25-(OH)(2)D(3) is mediated through PLA(2)/PKA and not through PKC.

Ellipsometric Study of Bovine Serum Albumin Adsorbed onto Ti/TiO(2) Electrodes

The adsorption of bovine serum albumin (BSA) onto relatively hydrophobic TiO(2) surfaces was studied by ellipsometry as a function of pH and BSA concentration. Titanium oxide layers were electrochemically grown on Ti disc electrodes. When fast attachment of BSA onto TiO(2) takes place, the adsorption can be considered as occurring in two different steps. The first step is fast and is the result of the direct adsorption of the protein molecules that attach to the surface without changing their conformation. The second process is slow and lasts for several hours. In this process, the adsorbed amount remains constant, whereas the thickness of the layer increases and its refractive index decreases with time. The changes in this second step are due mainly to rearrangements in the adsorbed layer produced by variations in the conformation and structure of the adsorbed molecules. The main conformational changes take place in the direction normal to the surface because lateral molecule-molecule interactions impede significant lateral expansion. Adsorption from BSA solutions of low concentration does not appear to lead to significant reconformation of the protein layer. Comparison with adsorption on powdered TiO(2) indicates that the adsorbed amount and the effective area occupied by an adsorbed BSA molecule can remain about constant even when strong surface reconformation takes place. Copyright 1999 Academic Press.

The effects of the surface topography of micromachined titanium substrata on cell behavior in vitro and in vivo

Surface properties, including topography and chemistry, are of prime importance in establishing the response of tissues to biomaterials. Microfabrication techniques have enabled the production of precisely controlled surface topographies that have been used as substrata for cells in culture and on devices implanted in vivo. This article reviews aspects of cell behavior involved in tissue response to implants with an emphasis on the effects of topography. Microfabricated grooved surfaces produce orientation and directed locomotion of epithelial cells in vitro and can inhibit epithelial downgrowth on implants. The effects depend on the groove dimensions and they are modified by epithelial cell-cell interactions. Fibroblasts similarly exhibit contact guidance on grooved surfaces, but fibroblast shape in vitro differs markedly from that found in vivo. Surface topography is important in establishing tissue organization adjacent to implants, with smooth surfaces generally being associated with fibrous tissue encapsulation. Grooved topographies appear to have promise in reducing encapsulation in the short term, but additional studies employing three-dimensional reconstruction and diverse topographies are needed to understand better the process of connective-tissue organization adjacent to implants. Microfabricated surfaces can increase the frequency of mineralized bone-like tissue nodules adjacent to subcutaneously implanted surfaces in rats. Orientation of these nodules with grooves occurs both in culture and on implants. Detailed comparisons of cell behavior on micromachined substrata in vitro and in vivo are difficult because of the number and complexity of factors, such as population density and micromotion, that can differ between these conditions.

Proteoglycans at the bone-implant interface

The widespread success of clinical implantology stems from bone's ability to form rigid, load-bearing connections to titanium and certain bioactive coatings. Adhesive biomolecules in the extracellular matrix are presumably responsible for much of the strength and stability of these junctures. Histochemical and spectroscopic analyses of retrievals have been supplemented by studies of osteoblastic cells cultured on implant materials and of the adsorption of biomolecules to titanium powder. These data have often been interpreted to suggest that proteoglycans permeate a thin, collagen-free zone at the most intimate contact points with implant surfaces. This conclusion has important implications for the development of surface modifications to enhance osseointegration. The evidence for proteoglycans at the interface, however, is somewhat less than compelling due to the lack of specificity of certain histochemical techniques and to possible sectioning artifacts. With this caveat in mind, we have devised a working model to explain certain observations of implant interfaces in light of the known physical and biological properties of bone proteoglycans. This model proposes that titanium surfaces accelerate osseointegration by causing the rapid degradation of a hyaluronan meshwork formed as part of the wound-healing response. It further suggests that the adhesive strength of the thin, collagen-free zone is provided by a bilayer of decorin proteoglycans held in tight association by their overlapping glycosaminoglycan chains.