Preparation of bioactive Ti and its alloys via simple chemical surface treatment

Evaluation of baghdadite (Ca3ZrSi2O9) cements for the application as novel endodontic filling materials

OBJECTIVES

Baghdadite (Ca3ZrSi2O9) cements of various composition have been investigated in this study regarding an application as endodontic filling materials.

METHODS

Cements were either obtained by mixing mechanically activated baghdadite powder with water (maBag) or by subsequently substituting the ß-tricalcium phosphate (ß-TCP) component in a brushite forming calcium phosphate cement. The cements were analyzed for their mechanical performance, injectability, radiopacity, phase composition and antimicrobial properties.

RESULTS

The cements demonstrated sufficient mechanical performance with a compressive strength of ∼1 MPa (maBag) and 2.3 - 17.4 MPa (substituted calcium phosphate cement), good injectability > 80 % depending on the powder to liquid ratio and an intrinsic radiopacity of 1.13 - 2.05 mm aluminum equivalent. Immersion in artificial saliva proved their bioactivity by the formation of calcium phosphate and calcium silicate precipitates on the cement surface. The bacterial activity of Staphylococcus aureus cultured on the surface of the cements was found to be similar compared to clinical standard ProRoot MTA cement or even reduced by a factor of 3 for Streptococcus mutans.

SIGNIFICANCE

In combination with their antibacterial properties, baghdadite cements are thought to have the potential to fulfil the clinical requirements for endodontic filling materials.

Biological Surface Layer Formation on Bioceramic Particles for Protein Adsorption

In the biomedical fields of bone regenerative therapy, the immobilization of proteins on the bioceramic particles to maintain their highly ordered structures is significantly important. In this review, we comprehensively discussed the importance of the specific surface layer, which can be called "non-apatitic layer", affecting the immobilization of proteins on particles such as hydroxyapatite and amorphous silica. It was suggested that the water molecules and ions contained in the non-apatitic layer can determine and control the protein immobilization states. In amorphous silica particles, the direct interactions between proteins and silanol groups make it difficult to immobilize the proteins and maintain their highly ordered structures. Thus, the importance of the formation of a surface layer consisting of water molecules and ions (i.e., a non-apatitic layer) on the particle surfaces for immobilizing proteins and maintaining their highly ordered structures was suggested and described. In particular, chlorine-containing amorphous silica particles were also described, which can effectively form the surface layer of protein immobilization carriers. The design of the bio-interactive and bio-compatible surfaces for protein immobilization while maintaining the highly ordered structures will improve cell adhesion and tissue formation, thereby contributing to the construction of social infrastructures to support super-aged society.

Surface characteristics of additively manufactured CoCr and Ti6Al4V dental alloys: The effects of carbon and gold thin film coatings, and alkali-heat treatment

This study investigates the impact of surface modifications on additively manufactured CoCr and Ti6Al4V dental alloys, focusing on surface properties. Thin film carbon (C) and gold (Au) coatings, as well as alkali-heat treatment, were applied to the high- and low-polished specimens. Scanning electron microscopy (SEM) showed that thin film coatings retained the underlying surface topography, while the alkali-heat treatment induced distinct morphological changes. Energy-dispersive x-ray spectroscopy (EDS) analysis revealed that C-coating enriched surfaces with C, and Au-coating introduced detectable amounts of Au. Nevertheless, signs of coating delamination were observed in the high-polished specimens. Alkali-heat treatment led to the formation of a sodium titanate layer on Ti6Al4V surfaces, confirmed by sodium presence and Fourier transform infrared spectroscopy (FTIR) results showing carbonate bands. Surface roughness measurements with atomic force microscopy (AFM) showed that C-coating increased surface roughness in both high- and low-polished alloys. Au-coating slightly increased roughness, except for low-polished Au-coated Ti6Al4V, where a decrease in roughness was observed compared to low-polished bare Ti6Al4V, likely due to surface defects present in the latter resulting from the additive manufacturing process. Alkali-heat treatment led to a pronounced increase in roughness for both alloys, particularly for Ti6Al4V. Both thin film coatings decreased the water contact angles in all specimens in varying magnitudes, indicating an increase in wettability. However, the alkali-heat treatment caused a substantial decrease in contact angles, resulting in a highly hydrophilic state for Ti6Al4V. These findings underscore the substantial impact of surface modifications on additively manufactured dental alloys, potentially influencing their clinical performance. RESEARCH HIGHLIGHTS: Thin film coatings and chemical/heat treatment modify the surface properties of additively manufactured dental alloys. The surfaces of the alloys get rougher and more hydrophilic after alkali-heat treatment. Thin gold coatings exhibit potential adhesion challenges.

Titanium-based substrate modified with nanoenzyme for accelerating the repair of bone defect

Titanium (Ti) and titanium alloy are the most common metal materials in clinical orthopedic surgery. However, in the initial stage of surgery and implantation, the production of excessive reactive oxygen species (ROS) can induce oxidative stress (OS) microenvironment. OS will further inhibit the growth of new bone, resulting in surgical failure. In this study, based on the fact that nanoscale manganese dioxide (MnO2) can show H2O2-like enzyme activity, a MnO2 nanocoating was prepared on mciro-nano structured surface of Ti substrate via a two-step method of alkaline thermal and hydrothermal treatment. The results of scanning electron microscopy (SEM), X-ray diffractometer (XRD) and X-ray photoelectron spectroscopy (XPS) showed that the nano-MnO2 coating was successfully fabricated on the surface of Ti substrate. The results of measurement of H2O2, dissolved O2 and intracellular ROS in vitro showed that the treated Ti substrate could efficiently eliminate H2O2 and reduce ROS. Furthermore, the modified Ti substrate could promote the early adhesion, proliferation and osteogenic differentiation of MSCs, which was demonstrated by experimental results of cell morphology, cell viability, alkaline phosphatase, collagen, and mineralization deposition. The results of quantitative real-time polymerase chain reaction (qRT-PCR) of MSCs adhered the modified Ti substrate showed that the expression of genes related to osteogenic differentiation significantly increased. More importantly, the modified Ti implant could eliminate ROS at the injury site, reduce OS and promote the regeneration of bone tissue, which was demonstrated via hematoxylin/eosin, Masson's trichrome and immunohistochemical staining. In conclusion, the modified Ti implant presented here had the effect of reducing OS and promoting osseointegration. Relevant research ideas and results provide new methods for the research and development of functional implants, which have potential application value in the field of orthopedics.

Nano-topography and functionalization with the synthetic peptoid GN2-Npm9 as a strategy for antibacterial and biocompatible titanium implants

In recent years, antimicrobial peptides (AMPs) have attracted great interest in scientific research, especially for biomedical applications such as drug delivery and orthopedic applications. Since they are readily degradable in the physiological environment, scientific research has recently been trying to make AMPs more stable. Peptoids are synthetic N-substituted glycine oligomers that mimic the structure of peptides. They have a structure that does not allow proteolytic degradation, which makes them more stable while maintaining microbial activity. This structure also brings many advantages to the molecule, such as greater diversity and specificity, making it more suitable for biological applications. For the first time, a synthesized peptoid (GN2-Npm9) was used to functionalize a nanometric chemically pre-treated (CT) titanium surface for bone-contact implant applications. A preliminary characterization of the functionalized surfaces was performed using the contact angle measurements and zeta potential titration curves. These preliminary analyses confirmed the presence of the peptoid and its adsorption on CT. The functionalized surface had a hydrophilic behaviour (contact angle = 30°) but the hydrophobic tryptophan-like residues were also exposed. An electrostatic interaction between the lysine residue of GN2-Npm9 and the surface allowed a chemisorption mechanism. The biological characterization of the CT_GN2-Nmp9 surfaces demonstrated the ability to prevent surface colonization and biofilm formation by the pathogens Escherichia coli and Staphylococcus epidermidis thus showing a broad-range activity. The cytocompatibility was confirmed by human mesenchymal stem cells. Finally, a bacteria-cells co-culture model was applied to demonstrate the selective bioactivity of the CT_GN2-Nmp9 surface that was able to preserve colonizing cells adhered to the device surface from bacterial infection.

Alkali-treated titanium dioxide promotes formation of proteoglycan layer and altered calcification and immunotolerance capacity in bone marrow stem cell

Introduction

In this study, we report that a proteoglycans (PGs)-layer between the bone and titanium dioxide (TiO2) surface after osseointegration improved the calcification capacity and immunotolerance of human bone marrow mesenchymal stem cells (hBMSCs) on TiO2. Alkaline treatment of TiO2 is a method for promoting osteogenesis in hBMSCs. We hypothesized that promotion of osteogenesis due to alkaline treatment was caused by changing PGs-layer on TiO2.

Objective

This study aimed to analyze whether alkaline treatment of TiO2 affects PGs-layer formation and immunotolerance in hBMSCs.

Methods

The topology and wettability of the alkaline-treated titanium (Ti-Al) and unprocessed titanium (Ti-MS) surfaces were characterized. Initial cell attachment, cell proliferation, calcification capacity, alkaline phosphatase activity, PGs-layer formation, PGs function, and the expression of osteogenic and immunotolerance-related genes were analyzed. The conditioned medium (CM) from hBMSCs grown on Ti-Al and Ti-MS was added to macrophages (hMps) and Jurkat cells, and immunotolerance gene expression in these cells was analyzed.

Results

hBMSCs cultured on Ti-Al showed increased initial cell attachment, cell proliferation, PG-layer formation, and osteogenic capacity compared with hBMSCs on Ti-MS. Gene expression of indoleamine 2,3-dioxygenase (IDO) in the hBMSCs cultured on Ti-Al was higher than that in the hBMSCs on Ti-MS. CM from hBMSCs did not affect markers of M1 and M2 macrophages in hMps. CM from hBMSCs cultured on Ti-Al altered the gene expression of Foxp3 in Jurkat cells compared to that of CM from hBMSCs on Ti-MS.

Significance

These results suggest that alkaline treatment of TiO2 altered PGs-layer formation, and changed the osteogenesis and immunotolerance of hBMSCs.

Advanced surface engineering of titanium materials for biomedical applications: From static modification to dynamic responsive regulation

Titanium (Ti) and its alloys have been widely used as orthopedic implants, because of their favorable mechanical properties, corrosion resistance and biocompatibility. Despite their significant success in various clinical applications, the probability of failure, degradation and revision is undesirably high, especially for the patients with low bone density, insufficient quantity of bone or osteoporosis, which renders the studies on surface modification of Ti still active to further improve clinical results. It is discerned that surface physicochemical properties directly influence and even control the dynamic interaction that subsequently determines the success or rejection of orthopedic implants. Therefore, it is crucial to endow bulk materials with specific surface properties of high bioactivity that can be performed by surface modification to realize the osseointegration. This article first reviews surface characteristics of Ti materials and various conventional surface modification techniques involving mechanical, physical and chemical treatments based on the formation mechanism of the modified coatings. Such conventional methods are able to improve bioactivity of Ti implants, but the surfaces with static state cannot respond to the dynamic biological cascades from the living cells and tissues. Hence, beyond traditional static design, dynamic responsive avenues are then emerging. The dynamic stimuli sources for surface functionalization can originate from environmental triggers or physiological triggers. In short, this review surveys recent developments in the surface engineering of Ti materials, with a specific emphasis on advances in static to dynamic functionality, which provides perspectives for improving bioactivity and biocompatibility of Ti implants.

Dual-Action Effect of Gallium and Silver Providing Osseointegration and Antibacterial Properties to Calcium Titanate Coatings on Porous Titanium Implants

Previously, functional coatings on 3D-printed titanium implants were developed to improve their biointegration by separately incorporating Ga and Ag on the biomaterial surface. Now, a thermochemical treatment modification is proposed to study the effect of their simultaneous incorporation. Different concentrations of AgNO₃ and Ga(NO₃)₃ are evaluated, and the obtained surfaces are completely characterized. Ion release, cytotoxicity, and bioactivity studies complement the characterization. The provided antibacterial effect of the surfaces is analyzed, and cell response is assessed by the study of SaOS-2 cell adhesion, proliferation, and differentiation. The Ti surface doping is confirmed by the formation of Ga-containing Ca titanates and nanoparticles of metallic Ag within the titanate coating. The surfaces generated with all combinations of AgNO₃ and Ga(NO₃)₃ concentrations show bioactivity. The bacterial assay confirms a strong bactericidal impact achieved by the effect of both Ga and Ag present on the surface, especially for Pseudomonas aeruginosa, one of the main pathogens involved in orthopedic implant failures. SaOS-2 cells adhere and proliferate on the Ga/Ag-doped Ti surfaces, and the presence of gallium favors cell differentiation. The dual effect of both metallic agents doping the titanium surface provides bioactivity while protecting the biomaterial from the most frequent pathogens in implantology.

Cell osteogenic bioactivity mediated precisely by varying scaled micro-pits on ordered micro/nano hierarchical structures of titanium

Hierarchical surface structures with micro–nano scale play a crucial role in regulation of cell proliferation and osteogenic differentiation. It has been proven that cells are extremely sensitive to the nanoscaled structure and show multifarious phenotypes. Though a vital function of microstructure on osseointegration has been confirmed, the cell performances response to different microscaled structure is needed to be further dissected and in depth understood. In this work, the ordered micro–nano hierarchical structures with varying micro-scaled pits were precisely fabricated on titanium successfully by the combination of electrochemical, chemical etching and anodization as well. In vitro systematical assessments indicated that the micro–nano multilevel structures on titanium exhibited excellent cells adhesion and spreading ability, as well as steerable proliferation and osteogenic differentiation behaviors. It is shown that smaller micro-pits and lower roughness of the hierarchical structures enabled faster cell propagation. Despite cell growth was delayed on micro–nano titanium with relatively larger cell-match-size micro-pits and roughness, osteogenic-specific genes were significantly elevated. Furthermore, the alkaline phosphatase activity, collagen secretion and extracellular matrix mineralization of MC3T3-E1 on multi-scaled titanium were suppressed by a large margin after adding IWP-2 (an inhibitor of Wnt/β-catenin signal pathway), indicating this pathway played a crucial part in cell osteogenic differentiation modulated by micro–nano structures.

Metal Ion Augmented Mussel Inspired Polydopamine Immobilized 3D Printed Osteoconductive Scaffolds for Accelerated Bone Tissue Regeneration

Critical bone defects with a sluggish rate of auto-osteoconduction and imperfect reconstruction are motivators for the development of an alternate innovative approach for the regeneration of bone. Tissue engineering for bone regeneration signifies an advanced way to overcome this problem by creating an additional bone tissue substitute. Among different fabrication techniques, the 3D printing technique is obviously the most efficient and advanced way to fabricate an osteoconductive scaffold with a controlled porous structure. In the current article, the polycarbonate and polyester diol based polyurethane-urea (P12) was synthesized and 3D porous nanohybrid scaffolds (P12/TP-nHA) were fabricated using the 3D printing technique by incorporating the osteoconductive nanomaterial titanium phosphate adorned nanohydroxyapatite (TP-nHA). To improve the bioactivity, the surface of the fabricated scaffolds was modified with the immobilized biomolecule polydopamine (PDA) at room temperature. XPS study as well as the measurement of surface wettability confirmed the higher amount of PDA immobilization on TP-nHA incorporated nanohybrid scaffolds through the dative bone formation between the vacant d orbital of the incorporated titanium ion and the lone pair electron of the catechol group of dopamine. The incorporated titanium phosphate (TP) increased the tensile strength (53.1%) and elongation at break (96.8%) of the nanohybrid composite as compared to pristine P12. Moreover, the TP incorporated nanohybrid scaffold with calcium and phosphate moieties and a higher amount of immobilized active biomolecule improved the in vitro bioactivity, including the cell viability, cell proliferation, and osteogenic gene expression using hMSCs, of the fabricated nanohybrid scaffolds. A rat tibia defect model depicted that the TP incorporated nanohybrid scaffold with immobilized PDA enhanced the in vivo bone regeneration ability compared to the control sample without revealing any organ toxicity signifying the superior osteogenic bioactivity. Thus, a TP augmented polydopamine immobilized polyurethane-urea based nanohybrid 3D printed scaffold with improved physicochemical properties and osteogenic bioactivity could be utilized as an excellent advanced material for bone regeneration substitute.

Titanium alkalinization improves response of osteoblasts to zoledronic acid

This investigation is aimed to determine the effect of the modification of titanium surface with NaOH on the metabolism of osteoblasts treated with zoledronic acid (ZA). Machined and NaOH-treated titanium disks were used. Surfaces were characterized by scanning electron microscopy, confocal microscopy, and x-ray photoelectron spectroscopy (XPS) analysis. Human osteoblasts were seeded onto the disks. After 24 h, cells were treated with ZA at 5 μM for 7 days. At this point, cell viability, collagen synthesis, total protein production, alkaline phosphatase activity, and mineral nodule deposition were assessed. The results of surface roughness were descriptively and statistically analyzed (t-Student), while the XPS results were qualitatively described. Cell metabolism data were analyzed by the analysis of variance two-way and Tukey tests at a 5% significance level. The results demonstrated that NaOH-treatment increased surface roughness (p < .05) and confirmed the presence of sodium titanate and a pH switch on the NaOH-treated disks. This modification also resulted in higher cell viability, collagen synthesis, total protein production, and alkaline phosphatase by osteoblasts when compared to cells seeded onto machined disks (p < 0.05). In the presence of ZA, all cellular metabolism and differentiation parameters were significantly reduced for cells seeded on both surfaces (p < 0.05); however, the cells seeded onto modified surfaces showed higher values for these parameters, except for mineral nodule deposition (p < 0.05). NaOH modification improved cell adhesion and metabolism of osteogenic cells even in the presence of ZA. The surface modification of titanium with NaOH solution may be an interesting strategy to improve metabolism and differentiation of osteoblasts and accelerate osseointegration process, mainly for tissues exposed to ZA.

Bioactive and antimicrobial macro-/micro-nanoporous selective laser melted Ti-6Al-4V alloy for biomedical applications

Metal Additive Manufacturing (AM) technology is an emerging technology in biomedical field due to its unique ability to manufacture customized implants [Patients-specific Implants (PSIs)] replicating the complex bone structure from the relevant metal powders. PSIs could be developed through any AM technology, but the ultimate challenge lies in integrating the metallic implant with the living bone. Considering this aspect, in the present study, Ti alloy (Ti–6Al–4V) powder has been used to fabricate scaffolds of channel type macropores with 0–60% porosity using selective laser melting (SLM) and subsequent post-treatments paving way for surface microporosities. Surface chemical and subsequent heat treatments were carried out on thus developed Ti alloy scaffolds to improve its bioactivity, antibacterial activity and osteoblastic cell compatibility. NaOH and subsequent Ca(NO₃)₂/AgNO₃ treatment induced the formation of a nanoporous network structure decorated with Ca–Ag ions. Ag nanoparticles covering the entire scaffold provided antibacterial activity and the presence of Ca²⁺ ions with anatase TiO₂ layer further improved the bioactivity and osteoblastic cell compatibility of the scaffold. Therefore, SLM technology combined with heat treatment and surface modification could be effectively utilized to create macro-micro-nano structure scaffolds of Ti alloy that are bioactive, antibacterial, and cytocompatible.

On-Growth and In-Growth Osseointegration Enhancement in PM Porous Ti-Scaffolds by Two Different Bioactivation Strategies: Alkali Thermochemical Treatment and RGD Peptide Coating

A lack of primary stability and osteointegration in metallic implants may result in implant loosening and failure. Adding porosity to metallic implants reduces the stress shielding effect and improves implant performance, allowing the surrounding bone tissue to grow into the scaffold. However, a bioactive surface is needed to stimulate implant osteointegration and improve mechanical stability. In this study, porous titanium implants were produced via powder sintering to create different porous diameters and open interconnectivity. Two strategies were used to generate a bioactive surface on the metallic foams: (1) an inorganic alkali thermochemical treatment, (2) grafting a cell adhesive tripeptide (RGD). RGD peptides exhibit an affinity for integrins expressed by osteoblasts, and have been reported to improve osteoblast adhesion, whereas the thermochemical treatment is known to improve titanium implant osseointegration upon implantation. Bioactivated scaffolds and control samples were implanted into the tibiae of rabbits to analyze the effect of these two strategies in vivo regarding bone tissue regeneration through interconnected porosity. Histomorphometric evaluation was performed at 4 and 12 weeks after implantation. Bone-to-implant contact (BIC) and bone in-growth and on-growth were evaluated in different regions of interest (ROIs) inside and outside the implant. The results of this study show that after a long-term postoperative period, the RGD-coated samples presented higher quantification values of quantified newly formed bone tissue in the implant's outer area. However, the total analyzed bone in-growth was observed to be slightly greater in the scaffolds treated with alkali thermochemical treatment. These results suggest that both strategies contribute to enhancing porous metallic implant stability and osteointegration, and a combination of both strategies might be worth pursuing.

The response of bioactive titanium surfaces with different structure to UVC-irradiation to eliminate the negative effect on biological properties during aging time

The biological aging of titanium implants affects the service lifetime negatively in clinical applications, and UV irradiation is an applicable method to overcome the biological aging. This study investigated the changes in surface characteristics and biological properties of bioactive titanium surfaces with different structure and topography after UVC-irradiation. The bioactive titanium surfaces were prepared by anodizing (AO), sandblasting and acid-etching (SLA), acid-alkali etching (AA), alkali-heat etching (AH) methods. Samples were stored at dark for 7 weeks to simulate biological aging process and then irradiated by UVC for 2 hours. The results showed that the Ti-OH groups, which are crucial to enhance the biological properties, were easier to be generated on AO surfaces by UVC-irradiation, o owing to a mixture of anatase and rutile on surfaces. UVC-irradiation had the strongest effect on AO surfaces to enhance the bioactivity in bone-like apatite deposition and better biocompatibility in MSCs attachment and proliferation. Therefore, titanium surfaces with a mixture phase of anatase and rutile has the potential to effectively utilize the benefits of UVC-irradiation to overcome the negative effects of the biological aging and have a promising clinical application prospect.

Organotypic in vitro block culture model to investigate tissue-implant interface. An experimental study on pig mandible

In vitro studies of implant-tissue attachment are primarily based on two-dimensional cell culture models, which fail to replicate the three-dimensional native human oral mucosal tissue completely. Thus, the present study aimed to describe a novel tissue culture model using pig mandibular block including alveolar bone and gingival soft tissues to evaluate the tissue attachment to titanium implant provided with hydrothermally induced TiO₂ coating. Tissue attachment on TiO₂ coated and non-coated implants were compared. Ti-6Al-4V alloy posts were used to function as implants that were inserted in five pig mandibles. Implants were delivered with two different surface treatments, non-coated (NC) titanium and hydrothermal induced TiO₂ coated surfaces (HT). The tissue-implant specimens were cultured at an air/liquid interface for 7 and 14 days. The tissue-implant interface was analyzed by histological and immunohistochemical stainings. The microscopic evaluation suggests that pig tissue explants established soft and hard tissue attachment to both implant surfaces. The epithelial cells appeared to attach to the coated implant. The epithelium adjacent to the implant abutment starts to change its phenotype during the early days of the healing process. New bone formation was seen within small pieces of bone in close contact with the coated implant. In conclusion, this in vitro model maintains the viability of pig tissue and allows histologically and immunohistochemically evaluate the tissue-implant interface. HT-induced TiO₂ coating seems to have a favorable tissue response. Moreover, this organotypic tissue culture model is applicable for further studies with quantitative parameters to evaluate adhesion molecules present at the implant-tissue interface.

Mineralization of Titanium Surfaces: Biomimetic Implants

The surface modification by the formation of apatitic compounds, such as hydroxyapatite, improves biological fixation implants at an early stage after implantation. The structure, which is identical to mineral content of human bone, has the potential to be osteoinductive and/or osteoconductive materials. These calcium phosphates provoke the action of the cell signals that interact with the surface after implantation in order to quickly regenerate bone in contact with dental implants with mineral coating. A new generation of calcium phosphate coatings applied on the titanium surfaces of dental implants using laser, plasma-sprayed, laser-ablation, or electrochemical deposition processes produces that response. However, these modifications produce failures and bad responses in long-term behavior. Calcium phosphates films result in heterogeneous degradation due to the lack of crystallinity of the phosphates with a fast dissolution; conversely, the film presents cracks, which produce fractures in the coating. New thermochemical treatments have been developed to obtain biomimetic surfaces with calcium phosphate compounds that overcome the aforementioned problems. Among them, the chemical modification using biomineralization treatments has been extended to other materials, including composites, bioceramics, biopolymers, peptides, organic molecules, and other metallic materials, showing the potential for growing a calcium phosphate layer under biomimetic conditions.

Different Cell and Tissue Behavior of Micro-/Nano-Tubes and Micro-/Nano-Nets Topographies on Selective Laser Melting Titanium to Enhance Osseointegration

Background and Purpose

Micro-/nano-tubes (TNTs) and micro-/nano-nets (TNNs) are the common and sensible choice in the first step of combined modifications of titanium surface for further functionalization in the purpose of extended indications and therapeutic effect. It is important to recognize the respective biologic reactions of these two substrates for guiding a biologically based first-step selection.

Materials and Methods

TNTs were produced by anodic oxidation and TNNs were formed by alkali-heat treatment. The original selective laser melting (SLM) titanium surface was set as control. Surface characterization was evaluated by scanning electron microscopy, surface roughness, and water contact angle measurements. Osteoclastogenesis and osteogenesis were measured. MC3T3-E1 cells and RAW 264.7 cells were used for in vitro assay in terms of adhesion, proliferation, and differentiation. In vivo assessments were taken on Beagle dogs with micro-CT and histological analysis.

Results

TNN and TNT groups performed decreased roughness and increased hydrophilicity compared with SLM group. For biological detections, the highest ALP activity and osteogenesis-related genes expression were observed in TNT group followed by TNN group (P <0.05). Interestingly, when it comes to the osteoclastogenesis, TNNs displayed lowest TRAP activity and osteoclastogenesis-related genes expression and TNTs were lower than SLM but higher than TNNs (P <0.05). BV/TV around implants was highest in TNT group after 4 weeks (P <0.05). HE, ALP and TRAP staining showed that osteogenic and osteoclastic activity around TNTs were both higher than TNNs (P <0.05).

Conclusion

TNNs and TNTs have dual advantages in promotion of osteogenesis and inhibition of osteoclastogenesis. Furthermore, TNNs showed better capability in inhibiting osteoclast activity while TNTs facilitated stronger osteogenesis. Our results implied that TNT substrates would take advantage in early application after implantation, while diseases with inappropriate osteoclast activity would prefer TNN substrates, which will guide a biologically based first-step selection on combined modification for different clinical purposes.

Fabrication of bioactive glass coating on pure titanium by sol-dip method: Dental applications

This study aimed to assess the mechanical and biological properties of bioactive glass (BG) coating on titanium (Ti). Bioinert Ti substrates were coated by BG to induce bioactivity to the surface. The sol-gel derived BG 58S sol was successfully prepared and coated on the abraded and blasted Ti surface using the sol-dip method. The characterization and cell study for all substrates' surface was carried out. Adhesion test confirmed that a firmly adhered BG coating layer was formed on the abraded and blasted Ti. The measured bonding strength between the coating and the blasted Ti substrate was the highest among all samples, which was 41.03±2.31 MPa. In-vitro cell viability and alkaline phosphatase activity (ALP) tests results also showed that BG coating on the Ti substrate improved the biological properties of the surface. The BG sol-dip coating method could be used to fabricate Ti substrate with a bioactive surface.

Antibiofilm coatings based on protein-engineered polymers and antimicrobial peptides for preventing implant-associated infections

Implant-associated infections (IAIs) are one of the leading concerns in orthopedics and dentistry as they commonly lead to implant failure. The presence of biofilms and, increasingly frequently, drug-resistant bacteria further impairs the efficacy of conventional antibiotics. Immobilization of antimicrobial peptides (AMPs) on implant surfaces is a promising alternative to antibiotics for prevention of IAIs. In addition, the use of functional linkers for the AMP tethering enables to increase the antimicrobial potential and the bioactivities of the coating. In this study, an extracellular-matrix-mimicking system based on elastin-like recombinamers (ELRs) has been developed for the covalent anchoring of AMPs and investigated for use as a hybrid antibiofilm coating. A drip-flow biofilm reactor was used to simulate in vivo environmental dynamic conditions, thus showing that the presence of the AMPs in the hybrid coatings provided strong antibiofilm activity against monospecies and microcosm biofilm models of clinical relevance. These results, together with an excellent cytocompatibility towards primary gingival fibroblasts, encourage the use of ELRs as multivalent platforms for AMPs and open up a wide range of possibilities in the biofabrication of advanced coatings combining the antibiofilm potential of AMPs and the outstanding tunability and biomechanical properties of the ELRs.

Impacts of chemically different surfaces of implants on a biological activity of fibroblast growth factor-2-apatite composite layers formed on the implants

BACKGROUND

Implants coated with fibroblast growth factor-2 (FGF-2)-apatite composite layers were previously reported to enhance soft-tissue formation, bone formation, and angiogenesis around the implants owing to the biological activity of FGF-2. However, it is unclear whether the chemistries of the material and surface of implants have some impact on the retention of the biological activity of FGF-2 in FGF-2-apatite composite layers on them. Since magnitude of the impact should be evaluated for extensive application of the composite layer to coat various implants, following items were examined; (1) surface chemistries of six implants, (2) mitogenic activities of FGF-2 in FGF-2-apatite composite layers on the implants, and (3) improved synthesis method of the composite layer for retention of the mitogenic activity of FGF-2.

HYPOTHESIS

The biological activity of FGF-2 in the composite layer is affected by the chemistries of the material and surface of implants.

MATERIALS AND METHODS

Six commercial products of pins and screws having different surface chemistries were coated with FGF-2-apatite composite layers. The composite layers were quantitatively analyzed for calcium (Ca), phosphorus (P) and FGF-2, and also evaluated the mitogenic activities of FGF-2. Improvement of the synthesis method was then attempted using two pin products.

RESULTS

Each commercial product had a chemically and morphologically characteristic surface. FGF-2-apatite composite layers were formed on all the commercial products. Although the Ca, P, and FGF-2 contents (4.7±0.9μg/mm, 2.2±0.4μg/mm, and 21.1±3.7ng/mm, respectively) and the Ca/P molar ratios (1.69±0.01) of the composite layers were almost the same, rate of retention of the mitogenic activity of FGF-2 in the composite layers significantly decreased on some pin products (3/12-4/12). The decrease in rate of retention of the mitogenic activity of FGF-2 was prevented by a two-step synthesis method to form a composite layer on a precoating with calcium phosphate (9/12-12/12).

DISCUSSION

The chemistries of the implant surfaces had a significant impact on the retention of the mitogenic activity of FGF-2 in the composite layers formed on the implant. The two-step synthesis method was useful to retain mitogenic activity of FGF-2 regardless of the surface chemistries of the implants. The two-step synthesis method has potential to expand the applicability of FGF-2-apatite composite layers to a wider range of implants.

LEVEL OF EVIDENCE

III, Case control in vitro study.

In vitro investigation of the cell compatibility and antibacterial properties of titanium treated with calcium and ozone

The purpose of this study was to evaluate the surface modification of calcium ions on roughened titanium as a surface treatment of dental implants for cell attachment, growth, and initial bacterial adhesion. When a surface-roughened, pure titanium disk was immersed in a calcium chloride solution (100 mM) containing 20 ppm ozone for 24 h at 25ºC, calcium was detected on the surface by X-ray photoelectron spectroscopy. The calcium-modified, roughened titanium disk had a significantly greater concentration of the initially adhered cells as well as cells cultured over 7 days compared with titanium disks without surface modification. Furthermore, the initial bacterial adhesion on the calcium-ozone treated titanium disk was statistically less than on a pure titanium disk or titanium disk treated without ozone. Dissolved ozone was useful for modifying the surface of roughened titanium with calcium ions and the surface modification may be applicable for dental implants.

A Radiographic and Clinical Comparison of Immediate vs. Early Loading (4 Weeks) of Implants with a New Thermo-Chemically Treated Surface: A Randomized Clinical Trial

Background: Implant dentistry has evolved over time, resulting in better treatment outcomes for both patients and clinicians. The aim of this trial was to test whether the immediate loading of implants with a platform-switching design influences the marginal bone level, compared to four-week loading, after one year of follow-up. Moreover, a comparison of clinical data regarding implant survival, implant stability, and patient-reported outcome measures (PROMs) was conducted. Methods: Klockner^® VEGA^® implants with a ContacTi^® surface were placed in partially edentulous patients in the posterior areas. Group A received an immediately loaded prosthesis (one week) and Group B received an early-loaded prosthesis (four weeks). All abutments were placed at the time of surgery. Radiographic and clinical data were recorded. Results: Twenty-one patients were treated (35 implants). No implants were lost during the study. The final marginal bone level did not show differences between groups. The bone loss at 12 months at the implant level was 0.00 mm for both groups (median). The final implant quotient stability (ISQ) values did not differ between groups (median 73 and 70.25), nor did the other clinical parameters or PROMs. Conclusions: The results suggest that neither of the loading protocols with the implants used influenced the marginal bone level—not the osseointegration rate, clinical conditions, or PROMs.

3D-printed porous tantalum: recent application in various drug delivery systems to repair hard tissue defects

INTRODUCTION

The treatment of hard tissue defects, especially those of bone and cartilage, induced by infections or tumors remains challenging. Traditional methods, including debridement with systematic chemotherapy, have shortcomings owing to their inability to eliminate infections and high systematic toxicity.

AREA COVERED

This review comprehensively summarizes and discusses the current applications of 3D-printed porous tantalum (3D-P-p-Ta), a novel drug delivery strategy, in drug delivery systems to repair hard tissue defects, as well as the limitations of existing data and potential future research directions.

EXPERT OPINION

Drug delivery systems have advanced medical treatments, with the advantages of high local drug concentration, long drug-release period, and minimal systematic toxicity. Due to its excellent biocompatibility, ideal mechanical property, and anti-corrosion ability, porous tantalum is one of the most preferable loading scaffolds. 3D printing allows for freedom of design and facilitates the production of regular porous implants with high repeatability. There are several reports on the application of 3D-P-p-Ta in drug delivery systems for the management of infection- or tumor-associated bone defects, yet, to the best of our knowledge, no reviews have summarized the current research progress.

Compositional dependence of the apatite formation ability of Ti-Zr alloys designed for hard tissue reconstruction

Ti-Zr alloys are expected to be novel biomaterials with low stress shielding owing to their lower Young's moduli than pure Ti. The drawback of metallic biomaterials is that their bone-bonding abilities are relatively low. NaOH and heat treatments have been performed to provide Ti-50Zr with apatite-forming ability in the body environment, which is essential for bone bonding. However, the systematic compositional dependence of apatite formation has not been revealed. In the present study, NaOH treatment of Ti-Zr alloys with various compositions and bone-bonding abilities was assessed in vitro by apatite formation in simulated body fluid (SBF). The corrosion current density in NaOH aqueous solution and the amount of Na incorporated into the surface tended to decrease with increasing Zr content. The apatite-forming ability of the treated alloy significantly decreased when the Zr content was ≥60 atom%. This phenomenon is attributed to the (1) low OH content on the surface, (2) low Na incorporation into the treated alloy surface, which enhances apatite formation, and (3) low ability of P adsorption to the Ti-Zr alloy in SBF following Ca adsorption to trigger apatite nucleation. Although the adhesion of the titanate/zirconate layer formed on the surfaces to the substrates increased as Zr content increased, the adhesion between the apatite and the substrate was still low.

The Use of Simulated Body Fluid (SBF) for Assessing Materials Bioactivity in the Context of Tissue Engineering: Review and Challenges

Some special implantable materials are defined as “bioactive” if they can bond to living bone, forming a tight and chemically-stable interface. This property, which is inherent to some glass compositions, or can be induced by applying appropriate surface treatments on otherwise bio-inert metals, can be evaluated in vitro by immersion studies in simulated body fluid (SBF), mimicking the composition of human plasma. As a result, apatite coating may form on the material surface, and the presence of this bone-like “biomimetic skin” is considered predictive of bone-bonding ability in vivo. This review article summarizes the story and evolution of in vitro bioactivity testing methods using SBF, highlighting the influence of testing parameters (e.g., formulation and circulation of the solution) and material-related parameters (e.g., composition, geometry, texture). Suggestions for future methodological refinements are also provided at the end of the paper.

Improvement of hydroxyapatite formation ability of titanium-based alloys by combination of acid etching and apatite nuclei precipitation

The authors aimed to improve hydroxyapatite formation ability of Ti6Al4V, Ti-15Mo-5Zr-3Al alloy, Ti-12Ta-9Nb-6Zr-3V-O alloy (Gummetal®) and commercially pure Ti (cpTi) mesh by a combination of acid etching and apatite nuclei precipitation. Surfaces of specimens were etched with H₂SO₄ for pores formation on the specimens. Thus-etched specimens were soaked in an alkalinised simulated body fluid (SBF), which was adjusted at higher pH than that of conventional SBF and this solution was subsequently heated. By this treatment, apatite nuclei were precipitated in the pores of the specimens. By a soak in the conventional SBF to check hydroxyapatite formation ability, hydroxyapatite was covered the entire surfaces of the specimens within 1 day and high hydroxyapatite formation ability was successfully shown. The adhesion strength of the hydroxyapatite film formed in the above SBF test showed larger value as increasing the surface roughness of the specimens by adjusting the above acid etching condition depending on the kinds of Ti-based alloys. This is because the adhesion of the hydroxyapatite film occurred by the mechanical interlocking effect. In addition, this method showed shape selectivity of the materials because similar hydroxyapatite formation ability could be introduced to the cpTi mesh.

Surface Functionalization of Biomedical Ti-6Al-7Nb Alloy by Liquid Metal Dealloying

Surface functionalization is an effective approach to change the surface properties of a material to achieve a specific goal such as improving the biocompatibility of the material. Here, the surface of the commercial biomedical Ti-6Al-7Nb alloy was functionalized through synthesizing of a porous surface layer by liquid metal dealloying (LMD). During LMD, the Ti-6Al-7Nb alloy is immersed in liquid magnesium (Mg) and both materials react with each other. Particularly, aluminum (Al) is selectively dissolved from the Ti-6Al-7Nb alloy into liquid Mg while titanium (Ti) and niobium (Nb) diffuse along the metal/liquid interface to form a porous structure. We demonstrate that the porous surface layer in the Ti-6Al-7Nb alloy can be successfully tailored by LMD. Furthermore, the concentration of harmful Al in this porous layer is reduced by about 48% (from 5.62 ± 0.11 wt.% to 2.95 ± 0.05 wt.%) after 30 min of dealloying at 1150 K. The properties of the porous layer (e.g., layer thickness) can be tuned by varying the dealloying conditions. In-vitro tests suggest improved bone formation on the functionalized porous surface of the Ti-6Al-7Nb alloy.

Apatite formation and bacterial growth on raw silk fabric heated in argon gas

Raw silk has the potential to be a flexible, osteoconductive material because it forms bone-like apatite on its surface in acellular simulated body fluid with ion concentrations nearly 1.5 times greater than that of human plasma (1.5SBF). It has been reported that silk-which has many similarities to raw silk-develops antibacterial properties when heated in inert gas, which may be advantageous in preventing bacterial infection. Hence, raw silk heated in inert gas may be a flexible, osteoconductive material with antibacterial activity. Thus, we examined the effect of the heat treatment of raw silk fabric on its apatite-forming ability in 1.5SBF and on the growth of Escherichia coli. Raw silk fabric was heated in argon gas at several temperatures, to a maximum of 500 °C. The results of soaking tests in 1.5SBF indicate that the apatite-forming ability of raw silk decreases with increasing temperature. This may be because favourable structures for apatite formation, such as carboxyl groups, are thermally decomposed. The results of bacterial tests indicate that raw silk fabrics heated to 300 °C or 500 °C exhibit reduced bacterial growth compared to those that were not heated or were heated only to 100 °C. This might be because hydrophobic surfaces inhibit bacterial adhesion, or because the thermal decomposition of sericin-a component of raw silk-leads to a lack of available nutrients for the bacteria. Although this study did not demonstrate the expected material properties needed for clinical applications, this research contributes to a better understanding of silk biomaterials.

Layer-by-layer immobilizing of polydopamine-assisted ε-polylysine and gum Arabic on titanium: Tailoring of antibacterial and osteogenic properties

Bacterial infection has become a crucial reason that give rise to failure of medical implants in clinical applications. In this regard, various antibacterial surface modifications of implants have been developed in recent years. However, it remains a challenge to enable the implant surfaces with both suitable antibacterial and osteogenic properties. In this work, ε-polylysine and gum Arabic multilayer composite films were immobilized layer by layer (LBL) on anodized titanium with the assistance of polydopamine for the first time. In vitro antibacterial results showed that the bacteria numbers decreased with an increase in the loading amount of ε-polylysine. Furthermore, long-term antibacterial property up to 3 weeks against both gram-positive Staphylococcus aureus (S. aureus) and gram-negative Escherichia coli (E. coli) was obtained combined with the merits of covalent binding and LBL methods. Meanwhile, the cell proliferation and osteogenic differentiation of BMSCs on titanium dioxide nanotubes (TNTs) modified with composite films was significantly improved. Remarkably, a facile method to optimize anti-infective and osteogenic properties of medical titanium has been developed, and it was demonstrated that the ε-polylysine and gum Arabic multilayer composite films with assistance of polydopamine were able to endow the orthopedic implant materials both improved antibacterial property and excellent biocompatibility, which is of profound significance for practical application of titanium-based implants.

The development of novel bioactive porous titanium as a bone reconstruction material

Porous titanium fabricated by the resin-impregnated titanium substitute technique has good mechanical strength and osteoconduction. The alkali treatment of the titanium surface creates a bioactive surface. Alkali-treated porous titanium is expected to accelerate bone formation. The purpose of this study was to evaluate the bone reconstruction ability of alkali-treated porous titanium. Porous titanium (85% porosity) was treated with an alkali solution (5 N NaOH, 24 h). To assess material properties, we analyzed the surface structure by scanning electron microscopy (SEM) and mechanical strength testing. To assess bioactivity, each sample was soaked in a simulated body fluid (Hank's solution) for 7 days. Surface observations, weight change ratio measurement (after/before being soaked in Hank's solution) and surface elemental analysis were performed. We also designed an in vivo study with rabbit femurs. After 2 and 3 weeks of implantation, histological observations and histomorphometric bone formation ratio analysis were performed. All data were statistically analyzed using a Student's t-test (P < 0.05) (this study was approved by the Hiroshima University animal experiment ethics committee: A11-5-5). Non-treated porous titanium (control) appeared to have a smooth surface and the alkali-treated porous titanium (ATPT) had a nano-sized needle-like rough surface. ATPT had similar mechanical strength to that of the control. After soaking into the Hank's solution, we observed apatite-like crystals in the SEM image, weight gain, and high Ca and P contents in ATPT. There was significant bone formation at an early stage in ATPT compared with that in control. It was suggested that the alkali-treated porous titanium had a bioactive surface and induced bone reconstruction effectively. This novel bioactive porous titanium can be expected to be a good bone reconstruction material.

Porous titanium fabricated by the resin-impregnated titanium substitute technique has good mechanical strength and osteoconduction.

Bioactive glass coatings on metallic implants for biomedical applications

Metallic implant materials possess adequate mechanical properties such as strength, elastic modulus, and ductility for long term support and stability in vivo. Traditional metallic biomaterials, including stainless steels, cobalt-chromium alloys, and titanium and its alloys, have been the gold standards for load-bearing implant materials in hard tissue applications in the past decades. Biodegradable metals including iron, magnesium, and zinc have also emerged as novel biodegradable implant materials with different in vivo degradation rates. However, they do not possess good bioactivity and other biological functions. Bioactive glasses have been widely used as coating materials on the metallic implants to improve their integration with the host tissue and overall biological performances. The present review provides a detailed overview of the benefits and issues of metal alloys when used as biomedical implants and how they are improved by bioactive glass-based coatings for biomedical applications.

Poly (hexamethylene biguanide), adsorbed onto Ti-Al-V alloys, kills slime-producing Staphylococci and Pseudomonas aeruginosa without inhibiting SaOs-2 cell differentiation

Antimicrobial coating of implant material with poly(hexamethylene biguanide) hydrochloride (PHMB) may be an eligible method for preventing implant-associated infections. In the present study, an antibacterial effective amount of PHMB is adsorbed on the surface of titanium alloy after simple chemical pretreatment. Either oxidation with 5% H₂ O₂ for 24 hr or processing for 2 hr in 5 M NaOH provides the base for the subsequent formation of a relatively stable self-assembled PHMB layer. Compared with an untreated control group, adsorbed PHMB produces no adverse effects on SaOs-2 cells within 48 hr cell culture, but promotes the initial attachment and spreading of the osteoblasts within 15 min. Specimens were inoculated with slime-producing bacteria to simulate a perioperative infection. Adsorbed PHMB reacts bactericidally against Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa after surface contact. Adhered SaOs-2 cells differentiate and produce alkaline phosphatase and deposit calcium within 4 days in a mineralization medium on PHMB-coated Ti6Al4V surfaces, which have been precontaminated with S. epidermidis. The presented procedures provide a simple method for generating biocompatibly and antimicrobially effective implant surfaces that may be clinically important.

UV Treatment Improves the Biocompatibility and Antibacterial Properties of Crystallized Nanostructured Titanium Surface

This study describes the production of a new material composed of pure titanium (Ti) metal with a crystallized nanostructure and investigated whether heat treatment and ultraviolet (UV) irradiation improved its biocompatibility and antibacterial properties. We compared the performance of UV-irradiated and non-irradiated Ti nanosheets (TNS) formed by dark alkaline treatment and heating at 600 °C with that of untreated pure Ti nanostructure (positive control). In vitro and in vivo experiments to assess biocompatibility and effects on cell behavior were performed using human umbilical vein endothelial cells and rat bone marrow cells. The material surface was characterized by X-ray photoelectron spectroscopy (XPS). The antibacterial properties of the irradiated material were evaluated using Staphylococcus aureus, a common pathogenic bacterium. The UV-irradiated TNS exhibited high angiogenic capacity and promoted cell adherence and differentiation relative to the control. Further, surface analysis via XPS revealed a lower C peak for the UV-treated material, indicating a reduced amount of dirt on the material surface. Moreover, UV irradiation decreased the viability of S. aureus on the material surface by stimulating reactive oxygen species production. The biocompatibility and antibacterial properties of the TNS were improved by UV irradiation. Thus, TNS may serve as a useful material for fabrication of dental implants.

How alkali-activated Ti surfaces affect the growth of tethered PMMA chains: a close-up study on the PMMA thickness and surface morphology

The alkali-activation of titanium (Ti) surfaces performed in a heated sodium hydroxide (NaOH) aqueous solution, results in a porous layer rich in hydroxyl (OH) groups, the structure and porosity of which strongly depend on the reaction time and NaOH concentration used. In this study, a polymerization initiator is covalently grafted on the alkali-activated Ti substrates by using a phosphonic acid as coupling agent and the resulting surfaces are used as scaffolds to drive the growth of tethered poly(methyl methacrylate) (PMMA) chains via a surface initiated atom transfer radical polymerisation (SI-ATRP). A close-up investigation of how different treatment times (1 h, 3 h, 6 h, 12 h, and 24 h) and NaOH concentrations (0.1 M, 0.5 M, 1 M, 2 M, and 5 M) affect the final PMMA morphology and thickness are presented.

Assessment of characteristics and cytotoxic effects of 316L stainless steel coated with a new titanium oxide nano-structure coating method

In order to fabricate the TiO₂ nano-structure coating on the Ti-free stainless steel with good adhesion, commercially obtained 316L stainless steel (316L SS) plates were chemically treated by KOH aqueous solution including TiH₂ powder at 60ºC for 3 days in an oil bath shaker, and subsequently heated up to 550-800ºC under the air atmosphere. The crystal structure, color, adhesive strength and cytotoxic effects of coating were investigated. Fiber-like hydrogen titanate nano-structures were formed on the 316L SS surface and made a fine network. X-ray diffraction (XRD) patterns showed that hydrogen titanate phase converted to anatase and rutile after heat treatment above 550ºC. The heat treated sample at 800ºC for 1 h showed the highest adhesive strength and the lowest cytotoxicity. The alkali treatment method in this study is expected to be used on the other Ti-free metals with further research.

Enhanced Osteogenesis by Molybdenum Disulfide Nanosheet Reinforced Hydroxyapatite Nanocomposite Scaffolds

The advances in the arena of biomedical engineering enable us to fabricate novel biomaterials that provide a suitable platform for rapid bone regeneration. Herein, we have investigated the in vitro and in vivo osteogenic differentiation, proliferation, and bone regeneration capability of molybdenum disulfide nanosheets (MoS₂NSs) reinforced HAP nanocomposite scaffolds. The MG-63 cells were incubated with HAP and HAP/MoS₂NSs nanocomposite and followed for various cellular activities. The cells incubated with HAP@2 shows higher cell adhesion, cell proliferation, and alkaline phosphatase activity (ALP) in contrast to HAP. The in vivo and in vitro results of the increased ALP level confirm that HAP@2 promotes osteogenic differentiation. This improved osteogenesis was validated with upregulation of osteogenic marker viz. transcription factor, RUNX-2 (∼34 fold), collagen-1 (∼15 fold), osteopontin (∼11 fold), osteocalcin (∼20 fold), and bone morphogenetic protein-2 (∼12 fold) after 12 week postimplantation in comparison to drilled. The X-ray imaging demonstrates that HAP@2 implants promote rapid osteogenesis and bioresorbability than HAP and drilled. The outcomes of the present study provide a promising tool for the regeneration of bone deformities, without using any external growth factor.

Dental Implants with Anti-Biofilm Properties: A Pilot Study for Developing a New Sericin-Based Coating

Aim: several strategies have been tested in recent years to prevent bacterial colonization of dental implants. Sericin, one of the two main silk proteins, possesses relevant biological activities and also literature reports about its potential antibacterial properties, but results are discordant and not yet definitive. The aim of this study was to evaluate the effectiveness of different experimental protocols in order to obtain a sericin-based coating on medical grade titanium (Ti) able to reduce microbial adhesion to the dental implant surface. Materials and Methods: different strategies for covalent bonding of sericin to Ti were pursued throughout a multi-step procedure on Ti-6Al-4V disks. The surface of grade 5 Ti was initially immersed in NaOH solution to obtain the exposure of functional -OH groups. Two different silanization strategies were then tested using aminopropyltriethoxysilane (APTES). Eventually, the bonding between silanized Ti-6Al-4V and sericin was obtained with two different crosslinking processes: glutaraldehyde (GLU) or carbodiimide/N-Hydroxy-succinimide (EDC/NHS). Micro-morphological and compositional analyses were performed on the samples at each intermediate step to assess the most effective coating strategy able to optimize the silanization and bioconjugation processes. Microbiological tests on the coated Ti-6Al-4V disks were conducted in vitro using a standard biofilm producer strain of Staphylococcus aureus (ATCC 6538) to quantify the inhibition of microbial biofilm formation (anti-biofilm efficacy) at 24 hours. Results: both silanization techniques resulted in a significant increase of silicon (Si) on the Ti-6Al-4V surfaces etched with NaOH. Differences were found between GLU and EDC/NHS bioconjugation strategies in terms of composition, surface micro-morphology and anti-biofilm efficacy. Ti-6Al-4V samples coated with GLU-bound sericin after silanization obtained via vapor phase deposition proved that this technique is the most convenient and effective coating strategy, resulting in a bacterial inhibition of about 53% in respect to the uncoated Ti-6Al-4V disks. Conclusions: The coating with glutaraldehyde-bound sericin after silanization in the vapor phase showed promising bacterial inhibition values with a significant reduction of S. aureus biofilm. Further studies including higher number of replicates and more peri-implant-relevant microorganisms are needed to evaluate the applicability of this experimental protocol to dental implants.

Titanium-Tissue Interface Reaction and Its Control With Surface Treatment

Titanium (Ti) and its alloys are widely used for medical and dental implant devices-artificial joints, bone fixators, spinal fixators, dental implant, etc. -because they show excellent corrosion resistance and good hard-tissue compatibility (bone formation and bone bonding ability). Osseointegration is the first requirement of the interface structure between titanium and bone tissue. This concept of osseointegration was immediately spread to dental-materials researchers worldwide to show the advantages of titanium as an implant material compared with other metals. Since the concept of osseointegration was developed, the cause of osseointegration has been actively investigated. The surface chemical state, adsorption characteristics of protein, and bone tissue formation process have also been evaluated. To accelerate osseointegration, roughened and porous surfaces are effective. HA and TiO2 coatings prepared by plasma spray and an electrochemical technique, as well as alkalinization of the surface, are also effective to improve hard-tissue compatibility. Various immobilization techniques for biofunctional molecules have been developed for bone formation and prevention of platelet and bacteria adhesion. These techniques make it possible to apply Ti to a scaffold of tissue engineering. The elucidation of the mechanism of the excellent biocompatibility of Ti can provide a shorter way to develop optimal surfaces. This review should enhance the understanding of the properties and biocompatibility of Ti and highlight the significance of surface treatment.

Antimicrobial PHAs coatings for solid and porous tantalum implants

Biomaterial-associated infections (BAI) are the major cause of failure of indwelling medical devices. The risk of BAI can end dramatically in the surgical removal of the affected device. Therefore, a major effort must be undertaken to guarantee the permanence of the implant. In this regard, we have developed antimicrobial coatings for tantalum (Ta) implants, using polyhydroxyalkanoates (PHAs) as matrices for carrying an active principle. The dip-coating technique was successfully used for covering solid Ta discs. An original PHA emulsion flow process was developed for the coating of porous Ta structures, specially for the inner surfaces. The complete characterization of the biopolymer coatings, their antibacterial properties, toxicity and biointegration were analyzed. Thus, non-toxic, well-biointegrated homogeneous biopolymer coatings were attained, which showed antibacterial properties. By using biodegradable PHAs, the resulting drug delivery system assured the protection of Ta against bacterial infections for a period of time.

Effect of mussel adhesive protein coating on osteogenesis in vitro and osteointegration in vivo to alkali-treated titanium with nanonetwork structures

Purpose: On the basis of reasonable superposition of various surface treatment methods, alkali-treated titanium with nanonetwork structures (TNS) was coated with mussel adhesive protein (MAP) and named TNS-MAP. The aims were to optimize the biological properties of TNS, endue it with new properties, and enhance its utility in clinical dental applications. Methods: TNS disks were coated with MAP and the product surface was characterized. Its osteogenic properties were determined by evaluating its effects on cell adhesion, cell proliferation, the expression of osteogenesis-related genes, and in vivo experiments. Results: The treated materials showed excellent hydrophilicity, good surface roughness, and advantages of both TNS and MAP. TNS-MAP significantly promoted initial cell attachment especially after 15 mins and 30 mins. At every time point, cell adhesion and proliferation, the detection rate of osteogenesis-related markers in the extracellular matrix, and the expression of osteogenesis-related genes were markedly superior on TNS-MAP than the control. The in vivo experiments revealed that TNS-MAP promoted new bone growth around the implants and the bone-implant interface. Conclusion: We verified through in vitro and in vivo experiments that we successfully created an effective TNS-MAP composite implant with excellent biocompatibility and advantages of both its TNS and MAP parent materials. Therefore, the new biocomposite implant material TNS-MAP may potentially serve in practical dentistry and orthopedics.

Rapid evaluation of bioactive Ti-based surfaces using an in vitro titration method

The prediction of implant behavior in vivo by the use of easy-to-perform in vitro methods is of great interest in biomaterials research. Simulated body fluids (SBFs) have been proposed and widely used to evaluate the bone-bonding ability of implant materials. In view of its limitations, we report here a rapid in vitro method based on calcium titration for the evaluation of in vivo bioactivity. Using four different titanium surfaces, this method identifies that alkaline treatment is the key process to confer bioactivity to titanium whereas no significant effect from heat treatment is observed. The presence of bioactive titanium surfaces in the solution during calcium titration induces an earlier nucleation of crystalline calcium phosphates and changes the crystallization pathway. The conclusions from this method are also supported by the standard SBF test (ISO 23317), in vitro cell culture tests using osteoblasts and in vivo animal experiments employing a pelvic sheep model.

Indirect 3D printing technology for the fabrication of customised β-TCP/chitosan scaffold with the shape of rabbit radial head-an in vitro study

Background

With the development of indirect three-dimensional (3D) printing technology, it is possible to customise individual scaffolds to be used in bone transplantation and regeneration. In addition, materials previously limited to the 3D printing (3DP) process due to their own characteristics can also be used well in indirect 3DP. In this study, customised β-TCP/chitosan scaffolds with the shape of rabbit radial head were produced by indirect 3D printing technology.

Methods

Swelling ability, porosity, mechanical characterisation, and degradation rate analysis were performed, and in vitro studies were also implemented to evaluate the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells (MSCs) on the scaffolds. CCK8 cell proliferation assay kit and alkaline phosphatase (ALP) staining solution were used to study cell proliferation and early ALP content at the scaffold surface. Moreover, the osteogenic differentiation of MSCs on scaffolds was also evaluated through the scanning electron microscopy analysis.

Results

β-TCP/chitosan scaffold has good performance and degradation rate, and in vitro cell experiments also confirm that the scaffold has adequate cytocompatibility and bioactivity.

Conclusion

This study provides a promising new strategy for the design of customised scaffolds for the repair of complex damaged tissues.

Influence of MgO nanoparticles on the mechanical properties of coated hydroxyapatite nanocomposite scaffolds produced via space holder technique: Fabrication, characterization and simulation

In the current study, hydroxyapatite (HA)-MgO scaffolds are fabricated with the aid of the space holder technique using NaCl as the spacer type. After that, the fabricated samples are deposited in gelatin (GN) with ibuprofen (IBO) substitution to create GN-IBO thin surface coating. The samples are then synthesized chemically and the associated properties are studied using X-ray diffraction (XRD) and scan electron microscopy (SEM) equipped with the energy dispersive spectroscopy (EDS). The compressive strength, fracture toughness, hardness, porosity, bioactivity, degradation rate, wettability, and roughness of the manufactured HA-MgO bio-nanocomposite scaffolds containing different weight fractions of MgO nanoparticles are predicted. Accordingly, nonlinear mechanical behaviors including nonlinear free vibration and nonlinear vibrations associated with the prebuckling and postbuckling domains of an axially loaded plate-type bone implant made of the HA-MgO bio-nanocomposites coated with the GN-IBO thin layers are investigated analytically via a sandwich plate model. The obtained results reveal that magnesium has no considerable effect on the porosity, however it causes to enhance the compressive strength significantly. The presence of magnesium ions also leads to reduce the crystallinity of HA about 30-100 nm due to entering MgO nanoparticles into the network. The results related to the sample with 10 wt% MgO nanoparticles indicate that the microscopic structure of the fabricated bio-nanocomposite scaffold is three-dimensional with porous architecture. Also, it is shown that the solubility of the HA composed with MgO nanoparticles decreases with higher bioactivity.