Nano-scale modification of titanium implant surfaces to enhance osseointegration

Nanointeraction: The profound influence of nanostructured and nano-drug delivery biomedical implant surfaces on cell behavior

Nanostructured surfaces feature promising biological properties on biomaterials attracting large interest at basic research, implant industry development, and bioengineering applications. Thou, nanoscale interactions at a molecular and cellular level are not yet completely understood and its biological and clinical implications need to be further elucidated. As follows, the aim of this comprehensive review was to evaluate nanostructured surfaces at biomedical implants focusing on surface development, nanostructuration, and nanoengineered drug delivery systems that can induce specific cell interactions in all relevant aspects of biological, reparative, anti-bacterial, anti-inflammatory and clinical processes. The methods and the physio-chemical properties involved in nanotopography performance, the main cellular characteristics involved at surface/cell interaction, and a summary of results and outlooks reported in studies applying nanostructured surfaces and nano-drug delivery systems is presented. The future prospects and commercial translation of this developing field, particularly concerning multifunctional nanostructured surfaces and its clinical implications are further discussed. At a cellular level, nanostructured biomedical implant surfaces can enhance osteogenesis by targeting osteoblasts, osteocytes, and mesenchymal cells, stimulate fibroblast/epithelial cells proliferation and adherence, inhibit bacterial cell proliferation and biofilm accumulation, and act as immune-modulating surfaces targeting macrophages and reducing pro-inflammatory cytokine expression. Moreover, several methodological options to create drug-delivery systems on metallic implant surfaces are available, however, the clinical translation is yet incomplete. The efficiency of which nanostructured/nano-delivery surfaces may target specific cell interactions and favor clinical outcomes needs to be further elucidated in pre-clinical and clinical studies, along with engineering solutions for commercial translation and approval of controlling agencies.

Evaluation of annealed titanium oxide nanotubes on titanium: From surface characterization to in vivo assays

The entire route from anodic oxidation and surface characterization, including in vitro experiments and finally in vivo osseointegration assays were performed with the aim to evaluate nanotubular and crystalline annealed titanium oxides as a suitable surface for grade 2 titanium permanent implants. Polished titanium (T0) was compared with anodized surfaces obtained in acidic media with fluoride, leading to an ordered nanotubular structure of titanium oxide on the metal surface, characterized by tube diameter of 89 ± 24 nm (Tnts). Samples were thermally treated in air (TntsTT) to increase the anatase crystalline phase on nanotubes, with minor alteration of the structure. Corrosion tests were performed to evaluate the electrochemical response after 1, 14, and 28 days of immersion in simulated body fluid. Based on the in vitro results, heat-treated titanium nanotubes (TntsTT) were selected as a promissory candidate to continue with the osseointegration in vivo assays. The in vivo results showed no major improvement in the osseointegration process when compared with untreated Ti after 30 days of implantation and there also was a lower increase in the development of new osseous tissue.

Chondroitin-4-sulfate transferase-1 depletion inhibits formation of a proteoglycan-rich layer and alters immunotolerance of bone marrow mesenchymal stem cells on titanium oxide surfaces

Successful osseointegration is essential for dental implants. However, the complete molecular mechanism of osseointegration remains to be elucidated. In this study, we focused on the proteoglycan (PG)-rich layer between titanium oxides (TiOx) and bone, and chondroitin-4-sulfate transferase-1 (C4ST-1), which forms the sugar chain in PGs. Human bone marrow mesenchymal stem cells (hBMSCs) depleted of C4ST-1 were cultured on titanium (Ti) plates, and the interface between hBMSCs and TiOx was analyzed using transmission electron microscopy. Immunotolerance, proliferation, initial adhesion, and calcification of the cells were analyzed in vitro. At 14 days of cultivation, a PG-rich layer was observed between hBMSCs and TiOx. However, the PG-rich layer was reduced in C4ST-1-depleted hBMSCs on TiOx. Real-time RT-PCR showed that conditioned media increased the levels of expression of M1-macrophage markers in human macrophages. However, depletion of C4ST-1 did not affect calcification, cell proliferation, or initial cell adhesion on Ti plates. These results suggested that C4ST-1 in hBMSCs affects their immunotolerance and alters the formation of PG-rich layer formation on TiOx.

Mechanical and Corrosion Properties of Laser Surface-Treated Ti13Nb13Zr Alloy with MWCNTs Coatings

Titanium and its alloys is the main group of materials used in prosthetics and implantology. Despite their popularity and many advantages associated with their biocompatibility, these materials have a few significant disadvantages. These include low biologic activity—which reduces the growth of fibrous tissue and allows loosening of the prosthesis—the possibility of metallosis and related inflammation or other allergic reactions, as well as abrasion of the material during operation. Searching for the best combinations of material properties for implants in today′s world is not only associated with research on new alloys, but primarily with the modification of their surface layers. The proposed laser modification of the Ti13Nb13Zr alloy with a carbon nanotube coating is aimed at eliminating most of the problems mentioned above. The carbon coating was carried out by electrophoretic deposition (EPD) onto ground and etched substrates. This form of carbon was used due to the confirmed biocompatibility with the human body and the ability to create titanium carbides after laser treatment. The EPD-deposited carbon nanotube coating was subjected to laser treatment. Due to high power densities applied to the material during laser treatment, non-equilibrium structures were observed while improving mechanical and anti-corrosive properties. An electrophoretically deposited coating of carbon nanotubes further improved the effects of laser processing through greater strengthening, hardness or Young′s modulus similar to that required, as well as led to an increase in corrosion resistance. The advantage of the presented laser modification of the Ti13Nb13Zr alloy with a carbon coating is the lack of surface cracks, which are difficult to eliminate with traditional laser treatment of Ti alloys. All samples tested showed contact angles between 46° and 82° and thus, based on the literature reports, they have hydrophilic surfaces suitable for cell adhesion.

Extension of hydrophilicity stability by reactive plasma treatment and wet storage on TiO2 nanotube surfaces for biomedical implant applications

Micro and nanoscale changes allow the optimization of physico-chemical properties of titanium implant surfaces. Recently UV and plasma treatments have allowed surface hydrophilicity to take increased prominence; however, this beneficial effect is short-lived. The aim of this study is to investigate methodologies post-anodizing treatment to generate and maintain high surface hydrophilicity along with high biocompatibility. Anodized surfaces were characterized regarding physical-chemical properties. Then, surface wettability with nanomorphology was evaluated at different times and with distinct post-treatments: as deposited, with a reactive plasma and UV-light post-treatment, stored in air or deionized (DI) water. Adhesion, alkaline phosphatase (ALP) activity and bone cell viability tests were executed after the incremental treatments. The anodizing process generated a surface with TiO2 nanotubes morphology and micro-roughness. Plasma-treated surfaces resulted in the most hydrophilic samples and this property was maintained for a longer period when those were stored in DI water (angle variation of 7° to 12° in 21 days). Furthermore, plasma post-treatment changed the titanium surface crystalline phase from amorphous to anatase. Anodized surfaces modified by reactive plasma and stored in DI water suggest better hydrophilicity stability, biocompatibility, ALP activity and achievement of crystalline phase alteration, indicating future potential use on biomedical implants.

TiO2 nanoparticles synergize with substrate mechanics to improve dental pulp stem cells proliferation and differentiation

Multiple studies exist on the influence of TiO₂ nanoparticle uptake on cell behavior. Yet little is known about the lingering influence of nanoparticles accumulation within the external environment which is particularly important to stem cell differentiation. Herein, dental pulp stem cells were cultured on hard and soft polybutadiene substrates, where 0.1 mg/mL rutile TiO₂ nanoparticles were introduced once, 24 h after plating. In the absence of TiO₂, the doubling time on soft substrate is significantly longer, while addition of TiO₂ decreases it to the same level as on the hard substrate. FACS analysis indicates particle uptake initially at 25% is reduced to 2.5% after 14 days. In the absence of TiO₂, no biomineralization on the soft and snowflake-like hydroxyapatite deposits on the hard substrate are shown at week 4. With the addition of TiO₂, SEM/EDAX reveals copious mineral deposition templated on large banded collagen fibers on both substrates. The mineral-to-matrix ratios analyzed by Raman spectroscopy are unremarkable in the absence of TiO₂. However, with addition of TiO₂, the ratios are consistent with native bone on the hard and dentin on the soft substrates. This is further confirmed by RT-PCR, which showed upregulation of markers consistent with osteogenesis and odontogenesis, respectively.

Protruding Nanostructured Surfaces for Antimicrobial and Osteogenic Titanium Implants

Protruding nanostructured surfaces have gained increasing interest due to their unique wetting behaviours and more recently their antimicrobial and osteogenic properties. Rapid development in nanofabrication techniques that offer high throughput and versatility on titanium substrate open up the possibility for better orthopaedic and dental implants that deter bacterial colonisation while promoting osteointegration. In this review we present a brief overview of current problems associated with bacterial infection of titanium implants and of efforts to fabricate titanium implants that have both bactericidal and osteogenic properties. All of the proposed mechano-bactericidal mechanisms of protruding nanostructured surfaces are then considered so as to explore the potential advantages and disadvantages of adopting such novel technologies for use in future implant applications. Different nanofabrication methods that can be utilised to fabricate such nanostructured surfaces on titanium substrate are briefly discussed.

Demonstration of a SiC Protective Coating for Titanium Implants

To mitigate the corrosion of titanium implants and improve implant longevity, we investigated the capability to coat titanium implants with SiC and determined if the coating could remain intact after simulated implant placement. Titanium disks and titanium implants were coated with SiC using plasma-enhanced chemical vapor deposition (PECVD) and were examined for interface quality, chemical composition, and coating robustness. SiC-coated titanium implants were torqued into a Poly(methyl methacrylate) (PMMA) block to simulate clinical implant placement followed by energy dispersive spectroscopy to determine if the coating remained intact. After torquing, the atomic concentration of the detectable elements (silicon, carbon, oxygen, titanium, and aluminum) remained relatively unchanged, with the variation staying within the detection limits of the Energy Dispersive Spectroscopy (EDS) tool. In conclusion, plasma-enhanced chemical vapor deposited SiC was shown to conformably coat titanium implant surfaces and remain intact after torquing the coated implants into a material with a similar hardness to human bone mass.

Magnesium Doped Hydroxyapatite-Based Coatings Obtained by Pulsed Galvanostatic Electrochemical Deposition with Adjustable Electrochemical Behavior

The aim of this study was to adapt the electrochemical behavior in synthetic body fluid (SBF) of hydroxyapatite-based coatings obtained by pulsed galvanostatic electrochemical deposition through addition of Mg in different concentrations. The coatings were obtained by electrochemical deposition in a typical three electrodes electrochemical cell in galvanic pulsed mode. The electrolyte was obtained by subsequently dissolving Ca(NO3)2·4H2O, NH4H2PO4, and Mg(NO3)2·6H2O in ultra-pure water and the pH value was set to 5. The morphology consists of elongated and thin ribbon-like crystals for hydroxyapatite (HAp), which after the addition of Mg became a little wider. The elemental and phase composition evidenced that HAp was successfully doped with Mg through pulsed galvanostatic electrochemical deposition. The characteristics and properties of hydroxyapatite obtained electrochemically can be controlled by adding Mg in different concentrations, thus being able to obtain materials with different properties and characteristics. In addition, the addition of Mg can lead to the control of hydroxyapatite bioactive ceramics in terms of dissolution rate.

Graphene–Chitosan Hybrid Dental Implants with Enhanced Antibacterial and Cell-Proliferation Properties

Dental implants are widely used tooth replacement tools owing to their good oral rehabilitation and reconstruction capacities. Since dental implants are designed as a replacement for natural teeth, multi-functional abilities are desired to achieve successful implant treatment with improved osseointegration through promotion of mammalian cell activity and prevention of bacterial cell activity. In this study, we developed a graphene–chitosan hybrid dental implant (GC hybrid implant) using various concentrations of graphene, which demonstrated the different surface properties including increased wettability and roughness. Importantly, the GC hybrid implant under the optimal condition (i.e., 1% GC hybrid implant) could significantly promote osteoblast proliferation while reducing biofilm formation and bacterial activity. Our study demonstrates the potential of using this GC hybrid implant as a new type of dental implant, which can offer an effective design for the fabrication of advanced dental implants.

Biofunctional and Tribomechanical Behavior of Porous Titanium Substrates Coated with a Bioactive Glass Bilayer (45S5-1393)

The porous substrates of commercially pure titanium have been coated with a novel bilayer of bioactive glasses (BGs), 45S5 and 1393, to improve the osseointegration and solve the stress-shielding phenomenon of titanium partial implants. The porosity of the substrates and the scratch resistance and bioactivity of the coating have been evaluated. Results are discussed in terms of stiffness and yield strength of the substrates, as well as the chemical composition, thickness, and design of the bioglass coating (monolithic vs bilayer). The role of the pores was a crucial issue in the anchoring of the coating, both in porosity percentage (30 and 60 vol %) and in pore range size (100-200 and 355-500 μm). The study was focused on the adhesion and infiltration of a 1393 bioglass layer (in contact with a porous titanium substrate), in combination with the biofunctionality of the 45S5 bioglass layer (surrounded by the host bone tissue), as 1393 bioglass enhances the adherence, while 45S5 bioglass promotes higher bioactivity. This bioactivity of the raw powder was initially estimated by nuclear magnetic resonance, through the evaluation of the chemical environments, and confirmed by the formation of hydroxyapatite when immersed in a simulated body fluid. The results revealed that the substrate with 30 vol % of porosity and a range of 355-500 μm pore size, coated with this novel BG bilayer, presented the best combination in terms of mechanical and biofunctional properties.

Influence of surface pre-treatment with mechanical polishing, chemical, electrochemical and ion sputter etching on the surface properties, corrosion resistance and MG-63 cell colonization of commercially pure titanium

The impact of four pre-treatment techniques on the surface morphology and chemistry, residual stress, mechanical properties, corrosion resistance in a physiological saline solution and cell colonization of commercially pure titanium is examined in detail. Mechanical polishing, electrochemical etching, chemical etching in Kroll's reagent, and ion sputter etching with argon ions were applied. Surface morphologies reflect the nature of surface layer removal. Significant roughening of the surface and a characteristic microtopology become apparent as a result of the sensitivity of chemical and ion sputter etching to the grain orientation. The hardness in the near surface region was controlled by the amount of residual stress. Etching of the stressed surface layer led to a reduction in residual stress and surface hardness. A compact passivation layer composed of TiO, TiO₂ and Ti₂O₃ native oxides imparted high corrosion resistance to the surface after mechanical polishing, chemical and electrochemical etching. The ion sputter etched surface showed substantially reduced corrosion resistance, where the corrosion process was controlled by electron transfer. The specific topology affected the adhesion of the cell to the surface rather than the cell area coverage. The cell area coverage increased with the corrosion stability of the surface.

Electrophoretic Deposition and Characterization of Chitosan/Eudragit E 100 Coatings on Titanium Substrate

Currently, a significant problem is the production of coatings for titanium implants, which will be characterized by mechanical properties comparable to those of a human bone, high corrosion resistance, and low degradation rate in the body fluids. This paper aims to describe the properties of novel chitosan/Eudragit E 100 (chit/EE100) coatings deposited on titanium grade 2 substrate by the electrophoretic technique (EPD). The deposition was carried out for different parameters like the content of EE100, time of deposition, and applied voltage. The microstructure, surface roughness, chemical and phase composition, wettability, mechanical and electrochemical properties, and degradation rate at different pH were examined in comparison to chitosan coating without the addition of Eudragit E 100. The applied deposition parameters significantly influenced the morphology of the coatings. The chit/EE100 coating with the highest homogeneity was obtained for Eudragit content of 0.25 g, at 10 V, and for 1 min. Young’s modulus of this sample (24.77 ± 5.50 GPa) was most comparable to that of human cortical bone. The introduction of Eudragit E 100 into chitosan coatings significantly reduced their degradation rate in artificial saliva at neutral pH while maintaining high sensitivity to pH changes. The chit/EE100 coatings showed a slightly lower corrosion resistance compared to the chitosan coating, however, significantly exceeding the substrate corrosion resistance. All prepared coatings were characterized by hydrophilicity.

Multi-Scale Surface Treatments of Titanium Implants for Rapid Osseointegration: A Review

The propose of this review was to summarize the advances in multi-scale surface technology of titanium implants to accelerate the osseointegration process. The several multi-scaled methods used for improving wettability, roughness, and bioactivity of implant surfaces are reviewed. In addition, macro-scale methods (e.g., 3D printing (3DP) and laser surface texturing (LST)), micro-scale (e.g., grit-blasting, acid-etching, and Sand-blasted, Large-grit, and Acid-etching (SLA)) and nano-scale methods (e.g., plasma-spraying and anodization) are also discussed, and these surfaces are known to have favorable properties in clinical applications. Functionalized coatings with organic and non-organic loadings suggest good prospects for the future of modern biotechnology. Nevertheless, because of high cost and low clinical validation, these partial coatings have not been commercially available so far. A large number of in vitro and in vivo investigations are necessary in order to obtain in-depth exploration about the efficiency of functional implant surfaces. The prospective titanium implants should possess the optimum chemistry, bionic characteristics, and standardized modern topographies to achieve rapid osseointegration.

Scalable fabrication of tunable titanium nanotubes via sonoelectrochemical process for biomedical applications

Titanium does not react well with the human tissues and due to its bio-inert nature the surface modification has yet to be well-studied. In this study, the sonoelectrochemical process has been carried out to generate TiO₂ nanotube arrays on implantable Ti 6-4. All the prepared nanotubes fill with the vancomycin by immersion and electrophoresis method. Drug-releasing properties, antibacterial behavior, protein adsorption and cell attachment of drug-modified nanotubes are examined by UV-vis, flow cytometry, modified disc diffusion, BSA adsorption, and FESEM, respectively. The most uniform morphology, appropriate drug release, cell viability behavior and antibacterial properties can be achieved by samples anodized in the range of 60-75 V. Also improves the adsorption of BSA protein in bone healing and promotes osteoblast activity and osseointegration. Drug loading efficiency increases up to 60% via electrophoresis comparing the immersion method for anodized sample in 75 V. While electrophoresis does not affect the amount of vancomycin adsorption for lower voltages. Besides, the present study indicates that an anodized sample without drug loading has no antibacterial activity. Moreover, 28-days drug releasing from nanotubes is investigated by mathematical formula according to Fickian's law to find an effective dose of loaded drug.

Surface modification of small intestine submucosa in tissue engineering

With the development of tissue engineering, the required biomaterials need to have the ability to promote cell adhesion and proliferation in vitro and in vivo. Especially, surface modification of the scaffold material has a great influence on biocompatibility and functionality of materials. The small intestine submucosa (SIS) is an extracellular matrix isolated from the submucosal layer of porcine jejunum, which has good tissue mechanical properties and regenerative activity, and is suitable for cell adhesion, proliferation and differentiation. In recent years, SIS is widely used in different areas of tissue reconstruction, such as blood vessels, bone, cartilage, bladder and ureter, etc. This paper discusses the main methods for surface modification of SIS to improve and optimize the performance of SIS bioscaffolds, including functional group bonding, protein adsorption, mineral coating, topography and formatting modification and drug combination. In addition, the reasonable combination of these methods also offers great improvement on SIS surface modification. This article makes a shallow review of the surface modification of SIS and its application in tissue engineering.

Laser-Based Ablation of Titanium-Graphite Composite for Dental Application

Biocompatible materials with excellent mechanical properties as well as sophisticated surface morphology and chemistry are required to satisfy the requirements of modern dental implantology. In the study described in this article, an industrial-grade fibre nanosecond laser working at 1064 nm wavelength was used to micromachine a new type of a biocompatible material, Ti-graphite composite prepared by vacuum low-temperature extrusion of hydrogenated-dehydrogenated (HDH) titanium powder mixed with graphite flakes. The effect of the total laser energy delivered to the material per area on the machined surface morphology, roughness, surface element composition and phases transformations was investigated and evaluated by means of scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), confocal laser-scanning microscopy (CLSM) and X-ray diffraction analysis (XRD). The findings illustrate that the amount of thermal energy put to the working material has a remarkable effect on the machined surface properties, which is discussed from the aspect of the contact properties of dental implants.

Enhanced Osseointegration and Bio-Decontamination of Nanostructured Titanium Based on Non-Thermal Atmospheric Pressure Plasma

Alkali-treated titanate layer with nanonetwork structures (TNS) is a promising surface for improving osseointegration capacity in implants. Nevertheless, there is a risk of device failure as a result of insufficient resistance to biofilm contamination. This study tested whether treatment using a handheld non-thermal plasma device could efficiently eliminate biofilm contamination without destroying the surface nanostructure while re-establishing a surface that promoted new bone generation. TNS specimens were treated by a piezoelectric direct discharge (PDD) plasma generator. The effect of decontamination was performed utilizing Staphylococcus aureus. The evaluation of initial cell attachment with adhesion images, alkaline phosphatase activity, extracellular matrix mineralization, and expression of genes related to osteogenesis was performed using rat bone marrow mesenchymal stem cells, and the bone response were evaluated in vivo using a rat femur model. Nanotopography and surface roughness did not significantly differ before and after plasma treatments. Cell and bone formation activity were improved by TNS plasma treatment. Furthermore, plasma treatment effectively eliminated biofilm contamination from the surface. These results suggested that this plasma treatment may be a promising approach for the treatment of nanomaterials immediately before implantation and a therapeutic strategy for peri-implantitis.

Biomedical Applications of TiO2 Nanostructures: Recent Advances

Titanium dioxide (TiO2) nanostructures are one of the most plentiful compounds that have emerged in various fields of technology such as medicine, energy and biosensing. Various TiO2 nanostructures (nanotubes [NTs] and nanowires) have been employed in photoelectrochemical (PEC) biosensing applications, greatly enhancing the detection of targets. TiO2 nanostructures, used as reinforced material or coatings for the bare surface of titanium implants, are excellent additive materials to compensate titanium implants deficiencies-like poor surface interaction with surrounding tissues-by providing nanoporous surfaces and hierarchical structures. These nanostructures can also be loaded by diversified drugs-like osteoporosis drugs, anticancer and antibiotics-and used as local drug delivery systems. Furthermore, TiO2 nanostructures and their derivatives are new emerging antimicrobial agents to overcome human pathogenic microorganisms. However, like all other nanomaterials, toxicity and biocompatibility of TiO2 nanostructures must be considered. This review highlights recent advances, along with the properties and numerous applications of TiO2-based nanostructure compounds in nano biosensing, medical implants, drug delivery and antibacterial fields. Moreover, in the present study, some recent advances accomplished on the pharmaceutical applications of TiO2 nanostructures, as well as its toxicity and biocompatibility, are presented.

A Newly Created Meso-, Micro-, and Nano-Scale Rough Titanium Surface Promotes Bone-Implant Integration

Titanium implants are the standard therapeutic option when restoring missing teeth and reconstructing fractured and/or diseased bone. However, in the 30 years since the advent of micro-rough surfaces, titanium’s ability to integrate with bone has not improved significantly. We developed a method to create a unique titanium surface with distinct roughness features at meso-, micro-, and nano-scales. We sought to determine the biological ability of the surface and optimize it for better osseointegration. Commercially pure titanium was acid-etched with sulfuric acid at different temperatures (120, 130, 140, and 150 °C). Although only the typical micro-scale compartmental structure was formed during acid-etching at 120 and 130 °C, meso-scale spikes (20–50 μm wide) and nano-scale polymorphic structures as well as micro-scale compartmental structures formed exclusively at 140 and 150 °C. The average surface roughness (Ra) of the three-scale rough surface was 6–12 times greater than that with micro-roughness only, and did not compromise the initial attachment and spreading of osteoblasts despite its considerably increased surface roughness. The new surface promoted osteoblast differentiation and in vivo osseointegration significantly; regression analysis between osteoconductivity and surface variables revealed these effects were highly correlated with the size and density of meso-scale spikes. The overall strength of osseointegration was the greatest when the acid-etching was performed at 140 °C. Thus, we demonstrated that our meso-, micro-, and nano-scale rough titanium surface generates substantially increased osteoconductive and osseointegrative ability over the well-established micro-rough titanium surface. This novel surface is expected to be utilized in dental and various types of orthopedic surgical implants, as well as titanium-based bone engineering scaffolds.

Modifications of Dental Implant Surfaces at the Micro- and Nano-Level for Enhanced Osseointegration

This review paper describes several recent modification methods for biocompatible titanium dental implant surfaces. The micro-roughened surfaces reviewed in the literature are sandblasted, large-grit, acid-etched, and anodically oxidized. These globally-used surfaces have been clinically investigated, showing survival rates higher than 95%. In the past, dental clinicians believed that eukaryotic cells for osteogenesis did not recognize the changes of the nanostructures of dental implant surfaces. However, research findings have recently shown that osteogenic cells respond to chemical and morphological changes at a nanoscale on the surfaces, including titanium dioxide nanotube arrangements, functional peptide coatings, fluoride treatments, calcium–phosphorus applications, and ultraviolet photofunctionalization. Some of the nano-level modifications have not yet been clinically evaluated. However, these modified dental implant surfaces at the nanoscale have shown excellent in vitro and in vivo results, and thus promising potential future clinical use.

Antibacterial, Antibiofilm, and Antiadhesive Properties of Different Quaternized Chitosan Derivatives

In the era of antimicrobial resistance, the identification of new antimicrobials is a research priority at the global level. In this regard, the attention towards functional antimicrobial polymers, with biomedical/pharmaceutical grade, and exerting anti-infective properties has recently grown. The aim of this study was to evaluate the antibacterial, antibiofilm, and antiadhesive properties of a number of quaternized chitosan derivatives that have displayed significant muco-adhesive properties and wound healing promotion features in previous studies. Low (QAL) and high (QAH) molecular weight quaternized chitosan derivatives were synthetized and further modified with thiol moieties or pendant cyclodextrin, and their antibacterial activity evaluated as minimal inhibitory concentrations (MIC) and minimal bactericidal concentrations (MBC). The ability of the derivatives to prevent biofilm formation was assessed by crystal violet staining. Both QAL and QAH derivatives exerted a bactericidal and/or inhibitory activity on the growth of P. aeruginosa and S. epidermidis. The same compounds also showed marked dose-dependent anti-biofilm activity. Furthermore, the high molecular weight derivative (QAH) was used to functionalize titanium plates. The successful functionalization, demonstrated by electron microscopy, was able to partially inhibit the adhesion of S. epidermidis at 6 h of incubation. The shown ability of the chitosan derivatives tested to both inhibit bacterial growth and/or biofilm formation of clinically relevant bacterial species reveals their potential as multifunctional molecules against bacterial infections.

Properties of Nanohydroxyapatite Coatings Doped with Nanocopper, Obtained by Electrophoretic Deposition on Ti13Zr13Nb Alloy

Nowadays, hydroxyapatite coatings are the most common surface modification of long-term implants. These coatings are characterized by high thickness and poor adhesion to the metallic substrate. The present research is aimed at characterizing the properties of nanohydroxyapatite (nanoHAp) with the addition of copper nanoparticle (nanoCu) coatings deposited on the Ti13Zr13Nb alloy by an electrophoresis process. The deposition of coatings was carried out for various amounts of nanoCu powder and various average particle sizes. Microstructure, topography, phase, and chemical composition were examined with scanning electron microscopy, atomic force microscopy, and X-ray diffraction. Corrosion properties were determined by potentiodynamic polarization technique in simulated body fluid. Nanomechanical properties were determined based on nanoindentation and scratch tests. The wettability of coatings was defined by the contact angle. It was proven that nanoHAp coatings containing nanocopper, compared to nanoHAp coatings without nanometals, demonstrated smaller number of cracks, lower thickness, and higher nanomechanical properties. The influence of the content and the average size of nanoCu on the quality of the coatings was observed. All coatings exhibited hydrophilic properties. The deposition of nanohydroxyapatite coatings doped with nanocopper may be a promising way to improve the antibacterial properties and mechanical stability of coatings.

Synthetic bone: Design by additive manufacturing

A broad range of synthetic trabecular-like metallic lattices are 3D printed, to study the extra design freedom conferred by this new manufacturing process. The aim is to propose new conceptual types of implant structures for superior bio-mechanical matching and osseo-integration: synthetic bone. The target designs are 3D printed in Ti-6Al-4V alloy using a laser-bed process. Systematic evaluation is then carried out: (i) their accuracy is characterised at high spatial resolution using computed X-ray tomography, to assess manufacturing robustness with respect to the original geometrical design intent and (ii) the mechanical properties - stiffness and strength - are experimentally measured, evaluated, and compared. Finally, this new knowledge is synthesised in a conceptual framework to allow the construction of so-called implant design maps, to define the processing conditions of bone tailored substitutes, with focus on spine fusion devices. The design criteria emphasise the bone stiffness-matching, preferred range of pore structure for bone in-growth, manufacturability of the device and choice of inherent materials properties which are needed for durable implants. Examples of the use of such maps are given with focus on spine fusion devices, emphasising the stiffness-matching, osseo-integration properties and choice of inherent materials properties which are needed for durable implants. STATEMENT OF SIGNIFICANCE: We present a conceptual bio-engineering design methodology for new biomedical lattices produced by additive manufacturing, which addresses some of the critical points in currently existing porous implant materials. Amongst others: (i) feasibility and accuracy of manufacturing, (ii) design to the elastic properties of bone, and (iii) sensible pores sizes for osseointegration. This has inspired new and novel geometrical latticed designs which aim at improving the properties of intervertebral fusion devices. In their fundamental form, these structures are here fabricated and tested. When integrated into medical devices, these concepts could offer superior medical outcomes.