Surface analysis of failed oral titanium implants

The Effect of an Er, Cr: YSGG Laser Combined with Implantoplasty Treatment on Implant Surface Roughness and Morphologic Analysis: A Pilot In Vitro Study

Although laser irradiation and implantoplasty (IP) are both treatment options for peri-implantitis, no studies have yet combined these two treatment solutions. The aim of this study was to identify the effect of an Er, Cr: YSGG laser on the IP surface. In experiment 1, TiUnite anodized surface implants were treated with an Er, Cr: YSGG laser at 0.5 to 2 W on the panel energy setting and 20 Hz under water irrigation. In experiment 2, all implant surfaces were treated with the IP procedure first, then irradiated with the Er, Cr: YSGG laser. All samples were analyzed by stereomicroscopy, scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and surface topography. Stereomicroscopy and SEM revealed no obvious surface change at any energy setting once the surface was polished with the IP procedure, whereas damage was caused to the TiUnite original implant surface when the Er, Cr: YSGG laser panel energy was set at 1 W or higher. EDS showed no significant difference in element composition once the surface was polished with the IP procedure, while a compositional change was detected when the Er, Cr: YSGG laser panel energy was set to 0.5 W or higher to irradiate the original TiUnite surface. Surface roughness may be related to laser irradiation energy, but no significant changes occurred following IP. These results indicated that the Er, Cr: YSGG laser may have little effect on the post-IP surface compared with the virgin TiUnite surface.

Biocompatibility of titanium from the viewpoint of its surface

Among metals, Ti and majority of its alloys exhibit excellent biocompatibility or tissue compatibility. Although their high corrosion resistance is a factor in the biocompatibility of Ti and Ti alloys, it is clear that other factors exist. In this review, the corrosion resistance and passive film of Ti are compared to those of other metallic biomaterials, and their band gap energies, E_gs, are compared to discuss the role of E_g in the reactivity with living tissues. From the perspective of the material's surface, it is possible to explain the excellent biocompatibility of Ti by considering the following factors: Ti ions are immediately stabilized not to show toxicity if it is released to body fluids; good balance of positive and negative charges by the dissociation of surface hydroxyl groups on the passive film; low electrostatic force of the passive film inducing a natural adsorption of proteins maintaining their natural conformation; strong property as n-type semiconductor; lower band gap energy of the passive film on Ti generating optimal reactivity; and calcium phosphate formation is caused by this reactivity. The results suggest that due to the passive oxide film, the optimal balance between high corrosion resistance and appropriate reactivity of Ti is the predominate solution for the excellent biocompatibility of Ti.

Analysis of acute sinusitis-related early failed implant surface: a combined histological, electron microscopy, and X-ray spectroscopy approach

Background

Even though dental implants are a reliable choice for dental rehabilitation, implant failures due to various etiologies have been reported. Early implant failures account for 2 to 6% of installed implants and are reported to have a higher rate than late failures, regardless of loading time. We herein report three cases of acute sinusitis and early implant failure with implants that failed within 1 month after installation. The aim of this study was to evaluate the surface properties of early failed implants and peri-implant tissue to determine the early osseointegration pattern in acute sinusitis-related failed implants as well as the possible role of surface contamination in the failure of osseointegration.

Results

A combined histological, electron microscopy, and X-ray spectroscopy approach was used to characterize the surface of non-osseointegrated titanium implants and the surrounding biological tissues. Morphologic scanning electron microscopy revealed a heterogeneous surface and irregular osseointegration. The implant surface was covered mostly by carbon- and oxygen-rich organic matter. Energy-dispersive X-ray spectroscopy surface analysis of three implants showed the incorporation of some contaminants in both the upper and apical regions. Carbon, nitrogen, sodium, silicon, chlorine, sulfur, gold, and zirconium were detected on the surface of one or more failed implants. Fibrosis, lymphocytic, and macrophage infiltrates and a high activation of osteoclasts surrounding the bone graft particles were detected in the surrounding tissues.

Conclusions

The etiology and mechanism of early implant failure, especially in sinus-related cases, as well as the proper management interventions to minimize the rate of early implant failures, are of great concern. No matter how confident and accurate the surgeon’s operation, there may be unknown errors in the whole procedure that no one knows about. Rather than errors related to the implant surface, it is expected that there were invisible problems during the evaluation of the patient’s own unique sinus mucosal inflammation or the operator’s own procedure. Furthermore, well-designed researches are necessary to reveal the effect of material-related factors on acute sinus complication and early implant failure.

Benefits of Residual Aluminum Oxide for Sand Blasting Titanium Dental Implants: Osseointegration and Bactericidal Effects

OBJECTIVES

The purpose of this work was to determine the influence of residual alumina after sand blasting treatment in titanium dental implants. This paper studied the effect of alumina on physico-chemical surface properties, such as: surface wettability, surface energy. Osseointegration and bacteria adhesion were determined in order to determine the effect of the abrasive particles.

MATERIALS AND METHODS

Three surfaces were studied: (1) as-received, (2) rough surface with residual alumina from sand blasting on the surface and (3) with the same roughness but without residual alumina. Roughness was determined by white light interferometer microscopy. Surface wettability was evaluated with a contact angle video-based system and the surface free energy by means of Owens and Wendt equation. Scanning electron microscopy equipped with microanalysis was used to study the morphology and determine the chemical composition of the surfaces. Bacteria (Lactobacillus salivarius and Streptococcus sanguinis) were cultured in each surface. In total, 110 dental implants were placed into the bone of eight minipigs in order to compare the osseointegration. The percentage of bone-to-implant contact was determined after 4 and 6 weeks of implantation with histometric analysis.

RESULTS

The surfaces with residual alumina presented a lower surface free energy than clean surfaces. The in vivo studies demonstrated that the residual alumina accelerated bone tissue growth at different implantation times, in relation to clean dental implants. In addition, residual alumina showed a bactericidal effect by decreasing the quantity of bacteria adhering to the titanium.

CONCLUSIONS

It is possible to verify the benefits that the alumina (percentages around 8% in weight) produces on the surface of titanium dental implants.

CLINICAL RELEVANCE

Clinicians should be aware of the benefits of sand-blasted alumina due to the physico-chemical surface changes demonstrated in in vivo tests.

Bone Micromorphology and Material Attrition After Sonic, Ultrasonic and Conventional Osteotomies

BACKGROUND/AIM

Osteotomy as the first step in surgery, provides access to the field and its application could influence the outcome. Nowadays, the conventional burr reduction is being challenged by newer sonic and ultrasonic methods. We investigated the bone structural integrity and metal attrition residues both in bone and the irrigation fluid.

MATERIALS AND METHODS

Bovine ribs were cut using three methods. Bone cuts were studied using Environmental Scanning Electron Microscopy (ESEM) for tissue discrepancies and Scanning Electron Microscopy/Energy Dispersion X-Ray Microanalysis (SEM/EDX) for organic and inorganic debris.

RESULTS

Better preservation of bone architecture was seen in piezo and sono surgery while metal attrition was not conclusive (p>0.05). Unlike in bone analyses, both bur and ultrasonic osteotomies showed statistically significant higher median inorganic detection per analysis (p=0.021 and p=0.037, respectively).

CONCLUSION

Sono and piezo surgery proved to be less invasive while attrition properties were the same.

Energy-Dispersive X-ray Spectroscopic Investigation of Failed Dental Implants Associated with Odontogenic Maxillary Sinusitis

The failed dental implant associated with maxillary sinusitis is a multifactorial phenomenon and should be investigated thoroughly. The inflammatory process induced by accumulated biofilm and wear debris may increase mucous secretion and mucous thickening, which finally may lead to severe complications such as maxillary sinusitis. The inflammatory cytokines might compromise the long-term osseointegration of the related implant. In this study, implants retrieved from three patients who experienced implant failure relating to maxillary sinusitis were investigated using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy. SEM analysis of the implant apical region revealed a less-compact bone structure, indicating the high bone turnover due to an inflammatory process. The ratio of calcium (Ca) and phosphorus (P) was negligible in all specimens. Detection of fluorine (F), sodium (Na), silicon (Si), gold (Au), aluminum (Al), and magnesium (Mg) confirmed the contamination. The selected cases presented different biological aspects that might play the central role in the failed dental implants associated with maxillary sinusitis: the contamination of potentially toxic elements, microorganism infection, and long perforation of implant apex into the sinus. Each of the above phenomena needs to be confirmed with further clinical study with a larger number of failed implants and accompanying tissue samples.

Time Transient of Calcium and Phosphate Ion Adsorption by Rutile Crystal Facets in Hanks' Solution Characterized by XPS

For the elucidation of the mechanism of calcium phosphate formation on commercially pure titanium (CP Ti) in the human body, rutile TiO₂ single crystal plates with (001), (110), and (111) facets, namely, TiO₂(001), TiO₂(110), and TiO₂(111), and polycrystalline plates (TiO₂(poly)) were immersed in a simulated body fluid, Hanks' solution (Hanks), for 10⁰-10⁵ s, and the adsorption of calcium and phosphate ions was precisely characterized employing X-ray photoelectron spectroscopy (XPS). Previously published CP Ti data were used for comparison. Prior to immersion in Hanks, oxygen content was more than twice as high as that of titanium due to the existence of hydroxyl groups and water on the oxides. After immersion in Hanks, the composition and chemical state of the TiO₂ substrates remained unchanged. Among the electrolytes contained in Hanks, only calcium and phosphate ions were adsorbed by and incorporated onto TiO₂ surfaces. Adsorption of calcium ions onto rutile did not exhibit any systematic increase of calcium with immersion time except TiO₂(poly). Adsorption of phosphate ions was initially constant, followed by an increase with the logarithm of immersion time. The adsorption rate of phosphate ions decreased in the following order: TiO₂(001), TiO₂(poly), TiO₂(111), CP Ti, and TiO₂(110). The coordination number and band gap of each crystal facet of rutile is important for the adsorption and incorporation of phosphate ions. Regular calcium phosphate formation on CP Ti is possibly enabled by the surface oxide film, which consists chiefly of amorphous TiO₂. However, calcium phosphate formation kinetics on CP Ti differed from those on the TiO₂ crystalline phase. These findings may further the understanding of CP Ti hard tissue compatibility.

Changes in the surface topography and element proportion of clinically failed SLA implants after in vitro debridement by different methods

OBJECTIVE

To evaluate the surface topography and element proportion changes in clinically failed implants after different modalities in vitro debridement and to compare the cleaning effect of different method combinations.

MATERIAL AND METHODS

Thirty clinical failed implants were treated by different debridement methods in vitro as follows: Group 1: physiologic saline irrigation; Group 2: glycine powder air polishing; Group 3: glycine powder air polishing + ethylenediaminetetraacetic acid (EDTA); Group 4: polyetheretherketone (PEEK) tip ultrasonic scaling; and Group 5: PEEK tip ultrasonic scaling + EDTA. The relative contaminated area reduction (RCAR), visual analogue scale (VAS, the higher value means, the better cleaning effect) and surface roughness were assessed using scanning electron microscopy (SEM), stereoscopic microscopy (SM) and white light interferometry (WLI). Surface chemistry was determined by energy dispersive spectroscopy (EDS).

RESULTS

Group 4 and Group 5 showed higher RCARs (82.90%, 82.89%), VAS scores (2.61, 2.33) and roughness reductions (-0.85 μm, -1.80 μm). Group 3 attained the highest decrease of C% (carbon, -26.67%), O% (oxygen, -13.71%) and N% (nitrogen, -5.66%), and the highest increase of Ti% (titanium, 49.67%). PEEK remnants were detected on the implant surface of Groups 4 and 5.

CONCLUSION

Within the limitation of the present in vitro design, PEEK tip ultrasonic scaling was more effective in eliminating visible contamination, while glycine powder air polishing combined with EDTA treatment was more conducive to expose the original surface element distribution. Both methods have their own advantages in decontamination, but none of them could reconstruct the surface as the pristine implant.

Xeno-Hybrid Bone Graft Releasing Biomimetic Proteins Promotes Osteogenic Differentiation of hMSCs

Bone defect is a noteworthy health problem and is the second most transplanted tissue after blood. Numerous bone grafts are designed and applied in clinics. Limitations, however, from different aspects still exist, including limited supply, mechanical strength, and bioactivity. In this study, two biomimetic peptides (P2 and P6) are incorporated into a composite bioactive xeno hybrid bone graft named SmartBonePep®, with the aim to increase the bioactivity of the bone graft. The results, which include cytotoxicity, proliferation rate, confocal microscopy, gene expression, and protein qualification, successfully prove that the SmartBonePep® has multi-modal biological effects on human mesenchymal stem cells from bone marrow. The effective physical entrapment of P6 into a composite xeno-hybrid bone graft, withstanding manufacturing processes including exposure to strong organic solvents and ethylene oxide sterilization, increases the osteogenic potential of the stem cells as well as cell attachment and proliferation. P2 and P6 both show a strong biological potential and may be future candidates for enhancing the clinical performance of bone grafts.

Characterization of the in Vitro Osteogenic Response to Submicron TiO2 Particles of Varying Structure and Crystallinity

Titanium oxide (TiO2) nano-/microparticles have been widely used in orthopedic and dental sciences because of their excellent mechanical properties, chemical stability, and ability to promote the osseointegration of implants. However, how the structure and crystallinity of TiO2 particles may affect their osteogenic activity remains elusive. Herein, we evaluated the osteogenic response to submicron amorphous, anatase, and rutile TiO2 particles with controlled size and morphology. First, the ability of TiO2 particles to precipitate apatite was assessed in an acellular medium by using a simulated body fluid (SBF). Three days after the addition to SBF, anatase and rutile TiO2 particles induced the precipitation of aggregates of nanoparticles with a platelike morphology, typical for biomimetic apatite. Conversely, amorphous TiO2 particles induced the precipitation of particles with poor Ca/P atomic ratio only after 14 days of exposure to SBF. Next, the osteogenic response to TiO2 particles was assessed in vitro by incubating MC3T3-E1 preosteoblasts with the particles. The viability and mineralization efficiency of osteoblastic cells were maintained in the presence of all the tested TiO2 particles despite the differences in the induction of apatite precipitation in SBF by TiO2 particles with different structures. Analysis of the particles' surface charge and of the proteins adsorbed onto the particles from the culture media suggested that all the tested TiO2 particles acquired a similar biological identity in the culture media. We posited that this phenomenon attenuated potential differences in osteoblast response to amorphous, anatase, and rutile particles. Our study provides an important insight into the complex relationship between the physicochemical properties and function of TiO2 particles and sheds light on their safe use in medicine.

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.

Fabrication of multifunctional titanium surfaces by producing hierarchical surface patterns using laser based ablation methods

Textured implant surfaces with micrometer and sub-micrometer features can improve contact properties like cell adhesion and bacteria repellency. A critical point of these surfaces is their mechanical stability during implantation. Therefore, strategies capable to provide both biocompatibility for an improved implant healing and resistance to wear for protecting the functional surface are required. In this work, laser-based fabrication methods have been used to produce hierarchical patterns on titanium surfaces. Using Direct Laser Writing with a nanosecond pulsed laser, crater-like structures with a separation distance of 50 µm are produced on unpolished titanium surfaces. Directly on this texture, a hole-like pattern with 5 µm spatial period is generated using Direct Laser Interference Patterning with picosecond pulses. While the smaller features should reduce the bacterial adhesion, the larger geometry was designed to protect the smaller features from wear. On the multifunctional surface, the adherence of E. Coli bacteria is reduced by 30% compared to the untreated reference. In addition, wear test performed on the multiple-scale patterns demonstrated the possibility to protect the smaller features by the larger craters. Also, the influence of the laser treatment on the growth of a titanium oxide layer was evaluated using Energy Dispersive X-Ray Spectroscopy analysis.

The role of bacterial biofilm and mechanical forces in modulating dental implant failures

Currently many assume that bacteria are the primary etiological factor associated with failure of titanium dental implants. However, emerging data indicates a possible role for mechanical forces in implant failure. This study is based on the hypothesis that the synergistic effect of mechanical forces and bacterial biofilm can lead to surface damage resulting in in vivo release of metallic particles. The primary aim of the study was to develop a dynamic fatigue test method for dental implants immersed in wet environments such as; (i) 0.01 M phosphate buffer saline (PBS); (ii) lactic acid (pH = 5); (iii) bacterial polyculture. Four dental implants each were subjected to fatigue loading from 45 N to 450 N at 4 Hz for 2 million cycles while immersed in (i) PBS (negative control); (ii) bacterial culture (test); and (iii) lactic acid (positive control). Post-testing, optical microscopy, x-ray photoelectron spectroscopy, and electrochemical corrosion tests were performed to evaluate the surface morphology, chemistry, and potential, respectively, of titanium implants. Post-testing, surface discoloration was evident in all three groups. However, the surface damage was further established in XPS analyses of test specimens, which showed that the interplay of bacterial biofilm and mechanical forces resulted in thinning of the TiO₂. Lower corrosion potential (Ecorr) of the test specimens compared to positive and negative controls also illustrated damage to the oxide layer. However, other electrochemical parameters such as linear polarization resistance (LPR) and corrosion rate (CR) were comparable among the groups indicating the corrosion resistance post-testing. The synergistic effect of cyclic occlusal loading and bacteria biofilm could negatively affect the surface of titanium dental implants.

Targeted Drug Delivery from Titanium Implants: A Review of Challenges and Approaches

Titanium implants are considered the gold standard of treatment for dental and orthopedic applications. Biocompatibility, low elasticity, and corrosion resistance are some of the key properties of these metallic implants. Nonetheless, a long-term clinical failure of implants may occur due to inadequate osseointegration. Poor osseointegration induces mobility, inflammation, increased bone resorption, and osteolysis; hence, it may result in painful revision surgeries. Topographical modifications, improvement in hydrophilicity, and the development of controlled-release drug-loading systems have shown to improve cellular adhesion, proliferation, and differentiation. Surface modifications, along with drug coating, undoubtedly demonstrate better osseointegration, especially in challenged degenerative conditions, such as osteoporosis, osteoarthritis, and osteogenesis imperfecta. Anabolic bone-acting drugs, such as parathyroid hormone peptides, simvastatin, prostaglandin-EP4-receptor antagonist, vitamin D, strontium ranelate, and anti-catabolic bone-acting drugs, such as calcitonin, bisphosphonates, and selective estrogen receptor modulators, expedite the process of osseointegration. In addition, various proteins, peptides, and growth factors may accessorize the idea of localized therapy. Loading these substances on modified titanium surfaces is achieved commonly by mechanisms such as direct coating, adsorption, and incorporating in biodegradable polymers. The primary approach toward the optimum drug loading is a critical trade-off between factors preventing release of a drug immediately and those allowing slow and sustained release. Recent advances broaden the understanding of the efficacy of adsorption, hydrogel coating, and electrospinning layer-by-layer coating facilitated by differential charge on metallic surface. This review discusses the existing approaches and challenges for the development of stable and sustained drug delivery systems on titanium implants, which would promote faster and superior osseointegration.

Surface damage of dental implant systems and ions release after exposure to fluoride and hydrogen peroxide

OBJECTIVE

The aim of this study was to evaluate surface changes on dental implant systems and ions release after immersion in fluoride and hydrogen peroxide.

METHODS

Ten implant-abutment assemblies were embedded in acrylic resin and cross-sectioned along the implant vertical axis. Samples were wet ground and polished. Delimited areas of groups of samples were immersed in 1.23% sodium fluoride gel (F) or in 35% hydrogen peroxide (HP) for 16 min. Gels (n = 3) were collected from the implant surfaces and analyzed by inductively coupled plasma mass spectrometry (ICP-MS), to detect the concentration of metallic ions released from the implant systems. Selected areas of the abutment and implant (n = 15) were analyzed by atomic force microscopy (AFM) and scanning electron microscopy (SEM).

RESULTS

SEM images revealed surface topographic changes on implant-abutment joints after immersion in fluoride. Implants showed excessive oxidation within loss of material, while abutment surfaces revealed intergranular corrosion after immersion in fluoride. ICP-MS results revealed a high concentration of Ti, Al, V ions in fluoride after contact with the implant systems. Localized corrosion of implant systems could not be detected by SEM after immersion in hydrogen peroxide although the profilometry showed increase in roughness. ICP-MS showed the release of metallic ions in hydrogen peroxide medium after contact with dental implants.

CONCLUSION

Therapeutical substances such as fluorides and hydrogen peroxide can promote the degradation of titanium-based dental implant and abutments leading to the release of toxic ions.

Cleaning effect of osteoconductive powder abrasive treatment on explanted human implants and biofilm-coated titanium discs

The aim of this study is to test the cleaning effect and surface modification of a new implant surface treatment on explanted dental implants and titanium discs. It is a modified air powder abrasive (APA) treatment applied using osteoconductive powders. Twenty-eight in vitro Ca-precipitated organic film-coated titanium discs and 13 explanted dental implants were treated. In a 2-step approach, 3 powders were used: hydroxylapatite (HA) and biomimetic calcium phosphate (BioCaP), which are osteoconductive, and erythritol, which is not. APA treatment was applied. (Air pressure: 2.4 bar; water flow for cleaning: 41.5 ml/min, for Coating 1: 2.1 ml/min, and for Coating 2: 15.2 ml/min.) The test groups were as follows: Group 1: HA cleaning + BioCaP Coating 1; Group 2: HA cleaning + BioCaP Coating 2; Group 3: erythritol cleaning + BioCaP Coating 1; Group 4: erythritol cleaning + BioCaP Coating 2; Group 5: HA cleaning; Group 6: erythritol cleaning; and control: no powder. Cleaned areas were calculated by point counting method. Surface changes and chemical content were evaluated using light microscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Cleaning effect between groups was compared by a pairwise Student's t test. The significance level was fixed at p < .05. Cleaning effect on the discs was 100% in all test groups and 5% in the control. Powder particles in varying size and shape were embedded on the surface. All HA- or CaP-treated surfaces showed Ca and P content but no surface damage. Calcified biofilm remnants were removed from the implant surface by the test groups, whereas in control groups, they remained. APA treatment with CaP and HA powders under clinically applicable pressure settings gives positive results in vitro; therefore, they could be promising when used in vivo.

Inverse response of osteoblasts and fibroblasts to growth on carbon-deposited titanium surfaces

Titanium implant surfaces may serve as attachment substrates for various cell types. Since carbon adsorption on titanium is inevitable, this study examined the negative/positive biological reaction of osteoblasts and fibroblasts on carbon-deposited titanium surfaces. Osteogenic MC3T3-E1 and fibrogenic NIH/3T3 cells were separately cultured on titanium disks on which carbon deposition was experimentally regulated to achieve titanium/carbon ratios of 6.5, 0.02, 0.005, and 0. The initial attachment of cells demonstrated that the quantity of attached osteoblasts on Ti/C (0.005) surfaces was 20% lower than that on Ti/C (6.5) surfaces at 4 h of culture. A 40% reduction in cell attachment at 24 h transferring from Ti/C (6.5) to Ti/C (0.005) surfaces highlighted the negative effect of carbon deposition on osteoblast attachment. However, the initial attachment of fibroblasts, which depended on carbon deposition, increased, and the quantity of cells on Ti/C (0.005) surfaces was almost twice that on Ti/C (6.5) surfaces at 4 h of culture. The levels of common differentiation markers of collagen synthesis were also differentially carbon-dependent as total collagen deposition on Ti/C (0.005) decreased by > 30% compared to that on Ti/C (6.5) in osteoblasts after 7 days of culture. In contrast, collagen synthesis in fibroblasts markedly increased as was evident by the increase in carbon deposition. These inverse effects indicate that carbon deposition on a titanium surface would likely be a disadvantage for bone formation, but might represent an effective option for achieving better wound healing and soft tissue sealing around the surface of an implant-neck region. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1869-1877, 2018.

In vivo degradation of orthodontic miniscrew implants: surface analysis of as-received and retrieved specimens

This study investigated in vivo degradation of Ti-6Al-4V alloy miniscrew implants. Miniscrew implants were placed in patients, and the surfaces were studied upon retrieval by scanning electron microscopy, microscale X-ray photoelectron spectroscopy, elastic recoil detection analysis and nanoindentation testing. Bone-like structures were formed on the retrieved specimens. The hardness and elastic modulus of the surfaces of the retrieved specimens were significantly lower than the as-received specimens, although no statistically significant differences were observed for the hardness and elastic modulus in the bulk region. Thick organic over-layer containing carbon, oxygen, and nitrogen, with the thickness greater than 50 nm, covered the retrieved specimens, and higher concentrations of hydrogen were detected in the retrieved specimens compared with the as-received specimens. Minimal degradation of the bulk mechanical properties of miniscrew implants was observed after clinical use, although precipitation of bone-like structures, formation of a carbonaceous contamination layer, and hydrogen absorption were observed on the surfaces of miniscrew implants.

Titanium allergy: a literature review

Titanium has gained immense popularity and has successfully established itself as the material of choice for dental implants. In both medical and dental fields, titanium and its alloys have demonstrated success as biomedical devices. Owing to its high resistance to corrosion in a physiological environment and the excellent biocompatibility that gives it a passive, stable oxide film, titanium is considered the material of choice for intraosseous use. There are certain studies which show titanium as an allergen but the resources to diagnose titanium sensivity are very limited. Attention is needed towards the development of new and precise method for early diagnosis of titanium allergy and also to find out the alternative biomaterial which can be used in place of titanium. A review of available articles from the Medline and PubMed database was done to find literature available regarding titanium allergy, its diagnosis and new alternative material for titanium.

Corrosion Behavior of Titanium in Artificial Saliva by Lactic Acid

As one of the main products produced by oral microorganisms, the role of lactic acid in the corrosion of titanium is very important. In this study, the corrosion behavior of titanium in artificial saliva with and without lactic acid were investigated by open-circuit potentials (OCPs), polarization curves and electrochemical impedance spectroscopy (EIS). OCP firstly increased with the amount of lactic acid from 0 to 3.2 g/L and then tended to decrease from 3.2 to 5.0 g/L. The corrosion of titanium was distinctly affected by lactic acid, and the corrosion rate increased with increasing the amount of lactic acid. At each concentration of lactic acid, the corrosion rate clearly increased with increasing the immersing time. Results of scanning electron microscopy (SEM) also indicated that lactic acid accelerated the pitting corrosion in artificial saliva. A probable mechanism was also proposed to explain the experimental results.

Attachment and proliferation of human osteoblast-like cells (MG-63) on laser-ablated titanium implant material

Demand is increasing for shortening the long (3-6 months) osseointegration period to rehabilitate patients' damaged chewing apparatus in as short a time as possible. For dental implants, as for biomaterials in general, the bio- and osseointegration processes can be controlled at molecular and cellular levels by modification of the implant surface. One of the most promising of such surface modifications is laser ablation, as demonstrated by our previous results [46]. Commercially pure (CP4) sand-blasted, acid-etched titanium disks (Denti® System Ltd., Hungary) were irradiated with a KrF excimer laser (248 nm, fluence 0.4 J/cm(2), FWHM 18 ns, 2000 pulses), or with a Nd:YAG laser (532 nm, 1.3 J/cm(2), 10 ns, 200 pulses) then examined by SEM, AFM, and XPS. In vitro attachment (24 h) and proliferation (72 h) of MG-63 osteoblast cells were investigated via dimethylthiazol-diphenyl tetrazolium bromide (MTT), alamarBlue (AB) assays alkaline phosphatase quantification (ALP) and SEM. SEM and AFM revealed significant changes in morphology and roughness. XPS confirmed the presence of TiO2 on each sample; after Nd:YAG treatment a reduced state of Ti (Ti(3+)) was also observed. MTT, AB and ALP measurements detected an increase in the number of cells between the 24- and 72 hour observations; however, laser treatment did not affect cell attachment and proliferation significantly.

Effect of cleaning and sterilization on titanium implant surface properties and cellular response

Titanium (Ti) has been widely used as an implant material due to the excellent biocompatibility and corrosion resistance of its oxide surface. Biomaterials must be sterile before implantation, but the effects of sterilization on their surface properties have been less well studied. The effects of cleaning and sterilization on surface characteristics were bio-determined using contaminated and pure Ti substrata first manufactured to present two different surface structures: pretreated titanium (PT, Ra=0.4 μm) (i.e. surfaces that were not modified by sandblasting and/or acid etching); (SLA, Ra=3.4 μm). Previously cultured cells and associated extracellular matrix were removed from all bio-contaminated specimens by cleaning in a sonicator bath with a sequential acetone-isopropanol-ethanol-distilled water protocol. Cleaned specimens were sterilized with autoclave, gamma irradiation, oxygen plasma, or ultraviolet light. X-ray photoelectron spectroscopy (XPS), contact angle measurements, profilometry, and scanning electron microscopy were used to examine surface chemical components, hydrophilicity, roughness, and morphology, respectively. Small organic molecules present on contaminated Ti surfaces were removed with cleaning. XPS analysis confirmed that surface chemistry was altered by both cleaning and sterilization. Cleaning and sterilization affected hydrophobicity and roughness. These modified surface properties affected osteogenic differentiation of human MG63 osteoblast-like cells. Specifically, autoclaved SLA surfaces lost the characteristic increase in osteoblast differentiation seen on starting SLA surfaces, which was correlated with altered surface wettability and roughness. These data indicated that recleaned and resterilized Ti implant surfaces cannot be considered the same as the first surfaces in terms of surface properties and cell responses. Therefore, the reuse of Ti implants after resterilization may not result in the same tissue responses as found with never-before-implanted specimens.

Bone response to laser-induced micro- and nano-size titanium surface features

This study explored whether laser-induced, site-specific implant surface modifications with micro- and nano-scale topography were able to promote bone formation. The aim was to evaluate the biomechanical and histological response to partly laser-modified titanium implants in comparison with machined implants. After an early 8-week healing period in rabbit tibia and femur, a 250% increase in removal torque was demonstrated for the partly laser-modified surface. Further, different fracture mechanisms were demonstrated for the two surfaces. Histologically, significantly more bone was found in direct contact with the laser-modified surface for the implants in the tibia sites, and a similar amount of bone tissue was observed in contact with the implant in the femoral sites. In conclusion, an improved bone-implant interface anchorage was promoted by an increase in micro- and nano-scale implant surface topography and surface oxide induced by topological laser treatment.

FROM THE CLINICAL EDITOR

Nanosized grooves in titanium implants markedly improve bone-implant anchorage by increasing the amount of bone formed in direct contact with the metal prosthesis.

In vitro scanning electron microscopic comparison of inner surface of exposed and unexposed nonresorbable membranes

OBJECTIVE

The purpose of this study was to analyze the attached tissues and the membrane surface condition according to barrier membrane exposure.

STUDY DESIGN

The selected patients underwent implant surgery with guided bone regeneration, then were surgically reentered to remove the membrane when the membrane was exposed early or when the second surgery of implant was done. The membranes used in the study included titanium mesh (Jeil Medical Co., Seoul, Korea), Frios titanium shield (Dentsply Friadent, Mannheim, Germany), and TR-Goretex membrane (W. L. Gore & Associates, CA, USA). Group 1 included 9 cases that had membranes that were exposed during an early period. Each membrane was removed in 3-6 weeks. Group 2 included 8 cases that had membranes that were not exposed and each membrane was removed in 12-24 weeks during the second surgery period of implants. Removed membrane samples were observed with scanning electron microscopy.

RESULTS

The membrane surface condition and the observed tissues were significantly different between the exposed membrane group and the unexposed membrane group (P < .05). In the majority of the cases of early exposed membranes, organic film and soft tissues were observed beneath the membrane. Bony debris was observed in only 1 sample from the exposed group. In the exposed group, the degree of membrane damage was more severe than in the unexposed group. The membrane surface condition and the observed tissues had no significant difference among the 3 kinds of membranes (P > .05).

CONCLUSION

The observed tissues and the membrane surface condition were affected by the membrane exposure. If the membrane is exposed, the soft tissue and organic film interfere with direct contact to the bone, and this affects the barrier membrane surface condition and bony tissues.

The peri-implantitis: implant surfaces, microstructure, and physicochemical aspects

There are two ways of looking at secondary failures of osseointegration; one is to reflect on possible causes for the failure, the other focuses on the pathology per se. In the first case, background factors such as mechanical trauma (adverse loading) or inflammations/infections are being discussed as the cause of failure. Then peri-implantitis is a term reserved for implant disturbance due to inflammation/infections only. However, irrespective of the original reason for the failure being adverse loading or inflammation/infection, the end result with bone resorption and inflammation may be very similar. Hence, in the present article, an alternative outlook has been chosen. Trigerring factors for peri-implantitis are generally gathered under four categories: lesions of peri-implant attachment, presence of aggressive bacteria, excessive mechanical stress, and corrosion. If only one of these factors would start a chain reaction leading to lesions, then the other factors may combine to worsen the condition. With other words, peri-implantitis is a general term dependent on a synergy of several factors, irrespective of the precise reason for first triggering off symptoms.

Titanium allergy in dental implant patients: a clinical study on 1500 consecutive patients

BACKGROUND

In dentistry, allergic reactions to Ti implants have not been studied, nor considered by professionals. Placing permanent metal dental implants in allergic patients can provoke type IV or I reactions. Several symptoms have been described, from skin rashes and implant failure, to non-specific immune suppression.

OBJECTIVE

Our objective was to evaluate the presence of titanium allergy by the anamnesis and examination of patients, together with the selective use of cutaneous and epicutaneous testing, in patients treated with or intending to receive dental implants of such material.

MATERIAL AND METHODS

Thirty-five subjects out of 1500 implant patients treated and/or examined (2002-2004) were selected for Ti allergy analysis. Sixteen presented allergic symptoms after implant placement or unexplained implant failures [allergy compatible response group (ACRG)], while 19 had a history of other allergies, or were heavily Ti exposed during implant surgeries or had explained implant failures [predisposing factors group (PFG)]. Thirty-five controls were randomly selected (CG) in the Allergy Centre. Cutaneous and epicutaneous tests were carried out.

RESULTS

Nine out of the 1500 patients displayed positive (+) reactions to Ti allergy tests (0.6%): eight in the ACRG (50%), one in the PFG (5.3%)(P=0.009) and zero in the control group. Five positives were unexplained implant failures (five out of eight).

CONCLUSIONS

Ti allergy can be detected in dental implant patients, even though its estimated prevalence is low (0.6%). A significantly higher risk of positive allergic reaction was found in patients showing post-op allergy compatible response (ACRG), in which cases allergy tests could be recommended.

Implant Surface Analysis and Microbiologic Evaluation of Failed Implants Retrieved From Smokers

The aim of this study was to evaluate the microbiota and surface of failed titanium dental implants from 4 manufacturers. Twelve mobile dental implants were retrieved from 10 smokers after 3 to 10 years of functional loading. Before implant removal, microbial samples were taken and evaluated using polymerase chain reaction. After implant removal, analyses of the failed implant surfaces were performed using scanning electron microscopy and energy-dispersive spectrometer x-ray. Periodontal pathogens such as Aggregactibacter actinomycetemcomitans, Campylobacter rectus, Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola were detected in all implants in different proportions. Surface analysis showed varying degrees of surface roughness between the samples and the presence of proteinaceous material, appearing mainly as dark stains. Foreign carbon, oxygen, sodium, calcium, aluminum, and silicon elements were also found. Although no material-related causes of implant failure were detected, several periodontal pathogens were identified independently of the surface topography or manufacturer.

Corrosion degradation and prevention by surface modification of biometallic materials

Metals, in addition to ceramics and polymers, are important class of materials considered for replacement of non-functional parts in the body. Stainless steel 316, titanium and titanium alloys, Co-Cr, and nitinol shape memory alloys are the most frequently used metallic materials. These alloys are prone to corrosion in various extents. This review briefly discusses the important biomaterials, their properties, and the physiological environment to which these materials are exposed. Corrosion performance of currently used metallic materials has been assessed and threat to the biocompatibility from corrosion products/metal ions is discussed. The possible preventive measures to improve corrosion resistance by surface modification and to increase the bioactivity of the metallic surfaces have also been discussed. Importance of the formation of oxide layers on the metal surface, another aspect of corrosion process, has been correlated with the host response. The gap areas and future direction of research are also outlined in the paper.

Biological responses of anodized titanium implants under different current voltages

The oxide layer of a titanium surface is very stable, and seems to result in excellent biocompatibility and successful osseointegration. The purpose of this study was to investigate the effects of high anodic oxidation voltages on the surface characteristics of titanium implants and the biologic response of rabbit tibiae. Bone tissue responses were evaluated by removal torque tests and histomorphometric analysis. Screw-shaped implants with microthreads were made of commercially pure titanium (Grade II). We prepared anodized implants under 300 V (group I), 400 V (group II), 500 V (group III) and 550 V (group IV). The surface characteristics of specimens were inspected according to three categories: surface morphology, surface roughness and oxide layer thickness. The screw-shaped implants were installed in rabbit tibiae. The removal torque values were measured and histomorphometric analysis was done after 1- and 3-month healing periods. Data indicate that as anodic oxidation voltage increased above 300 V, oxide layer thickness increased rapidly and pore size also increased. The roughness values of the implants increased with voltage up to 500 V, but decreased at 550 V. In the removal torque test, group III showed higher values than groups I and II at a statistically significant level (P < 0.05) after a 1-month healing period. In histomorphometric analysis, groups III and IV, after a 3-month healing period, showed greater bone to implant contact ratios for the total implant surface than did group I (P < 0.05).

Electrochemical properties of 316L stainless steel with culturing L929 fibroblasts

Potentiodynamic polarization and impedance tests were carried out on 316L stainless steel with culturing murine fibroblast L929 cells to elucidate the corrosion behaviour of 316L steel with L929 cells and to understand the electrochemical interface between 316L steel and cells, respectively. Potential step test was carried out on 316L steel with type I collagen coating and culturing L929 cells to compare the effects of collagen and L929 cells. The open-circuit potential of 316L steel slightly shifted in a negative manner and passive current density increased with cells, indicating a decrease in the protective ability of passive oxide film. The pitting potential decreased with cells, indicating a decrease in the pitting corrosion resistance. In addition, a decrease in diffusivity at the interface was indicated from the decrease in the cathodic current density and the increase in the diffusion resistance parameter in the impedance test. The anodic peak current in the potential step test decreased with cells and collagen. Consequently, the corrosion resistance of 316L steel decreases with L929 cells. In addition, collagen coating would provide an environment for anodic reaction similar to that with culturing cells.

Lethal photosensitization and guided bone regeneration in treatment of peri-implantitis: an experimental study in dogs

The purpose of this study was to evaluate the effect of lethal photosensitization and guided bone regeneration (GBR) on the treatment of ligature-induced peri-implantitis in different implant surfaces. The treatment outcome was evaluated by clinical and histometric methods. A total of 40 dental implants with four different surface coatings (10 commercially pure titanium surface (cpTi); 10 titanium plasma-sprayed (TPS); 10 acid-etched surface; 10 surface-oxide sandblasted) were inserted into five mongrel dogs. After 3 months, the animals with ligature-induced peri-implantitis were subjected to surgical treatment using a split-mouth design. The controls were treated by debridment and GBR, while the test side received an additional therapy with photosensitization, using a GaAlAs diode laser, with a wavelength of 830 nm and a power output of 50 mW for 80 s (4 J/cm2), and sensitized toluidine blue O (100 microg/ml). The animals were sacrificed 5 months after therapy. The control sites presented an earlier exposition of the membranes on all coating surfaces, while the test group presented a higher bone height gain. Re-osseointegration ranged between 41.9% for the cpTi surface and 31.19% for the TPS surface in the test sites; however differences were not achieved between the surfaces. The lethal photosensitization associated with GBR allowed for better re-osseointegration at the area adjacent to the peri-implant defect regardless of the implant surface.

Influence of fluoride, hydrogen peroxide and lactic acid on the corrosion resistance of commercially pure titanium

Titanium is widely used in dental implantology and orthopaedics due to its excellent corrosion resistance and mechanical properties. However, it has been reported that Ti is sensitive to F(-), H(2)O(2) and lactic acid. Atomic force microscopy (AFM) and scanning electron microscopy (SEM) were used to investigate the corrosion resistance of CP-Ti disks after 9 days immersion in different test solutions, based on artificial saliva containing F(-) (0.5% and 2.5%), H(2)O(2) (0.1% and 10%) and/or lactic acid. Because activated macrophages and bacteria can also release locally some of these oxidative compounds, we investigated the role of these cells when plated onto titanium disks. The surface roughness (R(a)) was highly increased when titanium disks were immersed in artificial saliva containing F(-), H(2)O(2) and lactic acid. After 21 days of cell culture, R(a) was significantly increased on disks incubated with activated-J774.2 cells or Streptococcus mitis. AFM appeared to be more sensitive than SEM in evaluating the corrosion of the titanium. Chemical species, either environmental or those released by macrophages and bacteria, can provoke a marked attack of the titanium surface.

Analysis of Failed Commercially Pure Titanium Dental Implants: A Scanning Electron Microscopy and Energy-Dispersive Spectrometer X-Ray Study

BACKGROUND

The failure of osseointegration in oral rehabilitation has gained importance in current literature and in clinical practice. The integration of titanium dental implants in alveolar bone has been partly ascribed to the biocompatibility of the implant surface oxide layer. The aim of this investigation was to analyze the surface topography and composition of failed titanium dental implants in order to determine possible causes of failure.

METHODS

Twenty-one commercially pure titanium (cpTi) implants were retrieved from 16 patients (mean age of 50.33 +/- 11.81 years). Fourteen implants were retrieved before loading (early failures), six after loading (late failures), and one because of mandibular canal damage. The failure criterion was lack of osseointegration characterized as dental implant mobility. Two unused implants were used as a control group. All implant surfaces were examined by scanning electron microscopy (SEM) and energy-dispersive spectrometer x-ray (EDS) to element analysis. Evaluations were performed on several locations of the same implant.

RESULTS

SEM showed that the surface of all retrieved implants consisted of different degrees of organic residues, appearing mainly as dark stains. The surface topography presented as grooves and ridges along the machined surface similar to control group. Overall, foreign elements such as carbon, oxygen, sodium, calcium, silicon, and aluminum were detected in failed implants. The implants from control group presented no macroscopic contamination and clear signs of titanium.

CONCLUSION

These preliminary results do not suggest any material-related cause for implant failures, although different element composition was assessed between failed implants and control implants.

Surface modification of surface sol–gel derived titanium oxide films by self-assembled monolayers (SAMs) and non-specific protein adsorption studies

Biological events occurring at the implant-host interface, including protein adsorption are mainly influenced by surface properties of the implant. Titanium alloys, one of the most widely used implants, has shown good biocompatibility primarily through its surface oxide. In this study, a surface sol-gel process based on the surface reaction of metal alkoxides with a hydroxylated surface was used to prepare ultrathin titanium oxide (TiOx) coatings on silicon wafers. The oxide deposited on the surface was then modified by self-assembled monolayers (SAMs) of silanes with different functional groups. Interesting surface morphology trends and protein adhesion properties of the modified titanium oxide surfaces were observed as studied by non-specific protein binding of serum albumin. The surface properties were investigated systematically using water contact angle, ellipsometry, X-ray photoelectron spectroscopy (XPS), and atomic force microscopy (AFM) measurements. Results showed that the surface sol-gel process predominantly formed homogeneous, but rough and porous titanium oxide layers. The protein adsorption was dependent primarily on the silane chemistry, packing of the alkyl chains (extent of van der Waals interaction), morphology (porosity and roughness), and wettability of the sol-gel oxide. Comparison was made with a thermally evaporated TiOx-Ti/Si-wafer substrate (control). This method further extends the functionalization of surface sol-gel derived TiOx layers for possible titanium alloy bioimplant surface modification.

Treatment of ligature-induced peri-implantitis by lethal photosensitization and guided bone regeneration: a preliminary histologic study in dogs

BACKGROUND

The purpose of this pilot study was to evaluate the healing potential and reosseointegration in ligature-induced peri-implantitis defects adjacent to various dental implant surfaces following lethal photosensitization.

METHODS

A total of 36 dental implants with 4 different surface coatings (9 commercially pure titanium surface [CPTi]; 9 titanium plasma-sprayed [TPS]; 9 hydroxyapatite [HA]; and 9 acid-etched [AE]) were inserted in 6 male mongrel dogs 3 months after extraction of mandibular premolars. After a 2-month period of ligature-induced peri-implantitis and 12 months of natural peri-implantitis progression, only 19 dental implants remained. The dogs underwent surgical debridement of the remaining dental implant sites and lethal photosensitization by combination of toluidine blue O (100 microg/ml) and irradiation with diode laser. All exposed dental implant surfaces and bone craters were meticulously cleaned by mechanical means, submitted to photodynamic therapy, and guided bone regeneration (GBR) using expanded polytetrafluoroethylene (ePTFE) membranes. Five months later, biopsies of the implant sites were dissected and prepared for ground sectioning and analysis.

RESULTS

The percentage of bone fill was HA: 48.28 +/- 15.00; TPS: 39.54 +/- 12.34; AE: 26.88 +/- 22.16; and CPTi: 26.70 +/- 16.50. The percentage of reosseointegration was TPS: 25.25 +/- 11.96; CPTi: 24.91 +/- 17.78; AE: 17.30 +/- 15.41; and HA: 15.83 +/- 9.64.

CONCLUSION

These data suggest that lethal photosensitization may have potential in the treatment of peri-implantitis.

Fracture of dental implants: literature review and report of a case

Fracture of dental implants is a rare phenomenon with severe clinical results. In this article, the literature is reviewed and various causative factors that may lead to fracture are presented. Galvanic activity has not been mentioned before as a possible cause for implant fracture, yet, it can occur at the level of contact with the superstructure. This is illustrated by the case of a titanium implant restored with a non-precious porcelain-fused-to-metal cemented crown that fractured 4 years after loading. The radiographs show alveolar bone resorption around the fixture. Metallurgical analysis of the implant indicated that the fracture was caused by metal fatigue and that the crown metal, a nickel-chromium-molybdenum alloy, exhibited corrosion. These findings suggest a new explanation for implant fractures; cytotoxic nickel ions, leaching from the base metal alloy may cause bone resorption. This in turn leads to increased mobility, facilitating washout of the luting cement. Contact of the base metal with titanium in the presence of oral fluids produces galvanic currents that hasten corrosion and leaching out of nickel ions, thus leading to further bone resorption. Loss of bone support allows lateral bending moments that cause metal fatigue, eventually leading to fracture. Therefore, good treatment planning and appropriate case selection might have prevented this fracture. Furthermore, the use of nonprecious metal alloy for the crown's infrastructure had further contribution to the chain of events that led to the implant's fracture.