Effect of ultraviolet light treatment on surface hydrophilicity and human gingival fibroblast response on nanostructured titanium surfaces

Saliva exposure reduces gingival keratinocyte growth on TiO2-coated titanium

Bioactive, nanoporous TiO2-coating has been shown to enhance cell attachment on titanium implant surface. The aim of this study was to evaluate, whether the saliva proteins affect the epithelial cell adhesion on TiO2-coated and non-coated titanium. Grade V titanium discs were polished. Half of the discs were provided with TiO2-coating produced in sol with polycondensation method. Half of the TiO2-coated and non-coated discs were treated with pasteurized saliva for 30 min. After saliva treatment, the total protein amounts on surfaces were measured. Next, the hydrophilicity of discs were measured with water contact angle measurements. Further, the gingival keratinocyte adhesion strength was measured after 2 and 6 h of cultivation using serial trypsinization. In addition, cell growth and proliferation were measured after 1, 3, and 7 days of cell culture. Finally, cell morphology, spreading and adhesion protein signals were detected with high resolution confocal microscopy. As a result, in sol coated TiO2-surface had significantly higher hydrophilicity when compared to non-coated titanium, meanwhile both non-coated and TiO2-coated surfaces with saliva treatment had a significant increase in hydrophilicity. Importantly, the amounts of adhered saliva proteins were equal between TiO2-coated and non-coated surfaces. Adhesion strength against enzymatic detachment was weakest on non-coated titanium after saliva exposure. Cell proliferation and cell spreading were highest on TiO2-coated titanium, but saliva exposure significantly decreased cell proliferation and spreading on TiO2-coated surface. To conclude, even though saliva exposure makes titanium surfaces more hydrophilic, it seems to neutralize the bioactive TiO2-coating and decrease cell attachment to TiO2-coated surface.

Effects of the application of low-temperature atmospheric plasma on titanium implants on wound healing in peri-implant connective tissue in rats

PURPOSE

This study aimed to clarify the effects of surface modification of titanium (Ti) implants by low-temperature atmospheric pressure plasma treatment on wound healing and cell attachment for biological sealing in peri-implant soft tissue.

METHODS

Hydrophilization to a Ti disk using a handheld low-temperature atmospheric pressure plasma device was evaluated by a contact angle test and compared with an untreated group. In in vivo experiments, plasma-treated pure Ti implants using a handheld plasma device (experimental group: PL) and untreated implants (control group: Cont) were placed into the rat upper molar socket, and samples were harvested at 3, 7 and 14 days after surgery. Histological evaluation was performed to assess biological sealing, collagen- and cell adhesion-related gene expression by reverse transcription quantitative polymerase chain reaction, collagen fiber detection by Picrosirius Red staining, and immunohistochemistry for integrins.

RESULTS

In in vivo experiments, increased width of the peri-implant connective tissue (PICT) and suppression of epithelial down growth was observed in PL compared with Cont. In addition, high gene expression of types I and XII collagen at 7 days and acceleration of collagen maturation was recognized in PL. Strong immunoreaction of integrin α2, α5, and β1 was observed at the implant contact area of PICT in PL.

CONCLUSIONS

The handheld low-temperature atmospheric pressure plasma device provided hydrophilicity on the Ti surface and maintained the width of the contact area of PICT to the implant surface as a result of accelerated collagen maturation and fibroblast adhesion, compared to no plasma application.

Effect of TiO2 Abutment Coatings on Peri-Implant Soft Tissue Behavior: A Systematic Review of In Vivo Studies

Establishing a proper soft tissue adhesion around the implant abutment is essential to prevent microbial invasion, inhibit epithelial downgrowth, and obtain an optimal healing process. This systematic review aims to evaluate the real potential of TiO2 coating on the behavior of peri-implant soft tissue health and maintenance. A specific aim was to evaluate clinically and histologically the effect of TiO2 abutment coating on epithelial and connective tissue attachment. Electronic database searches were conducted from 1990 to 2023 in MEDLINE/PubMed and the Web of Science databases. In total, 15 out of 485 publications were included. Eight studies involved humans, and seven were animal studies. Exposure time ranges from 2 days to 5 years. The peri-implant soft tissue evaluations included clinical assessment (plaque index (PI), peri-implant probing pocket depth (PPD), and bleeding on probing (BoP)), histological as well as histomorphometric analysis. The Office of Health Assessment and Translation (OHAT) Risk of Bias Rating Tool for Human and Animal Studies was used to evaluate the overall quality of the studies included in the review. The results showed some variation but remained within acceptable limits. Within the limitations of this systematic review, the present findings suggest that TiO2 coatings seem to influence soft tissue healing. TiO2-coated abutments with a roughness value between 0.2 and 0.5 μm enhance soft tissue health. Sol-gel-derived TiO2 coatings induced better soft tissue attachment than noncoated machined abutment surfaces. The anodized titanium abutments demonstrate comparable clinical and histological outcomes to conventional machined abutments. However, there was variation among the included studies concerning TiO2 coating characteristics and the measured outcomes used to evaluate the soft tissue response, and therefore, quantitative analysis was not feasible. Long-term in vivo studies with standardized soft tissue analysis and coating surface parameters are necessary before a definitive conclusion can be drawn. OSF Registration No.: 10.17605/OSF.IO/E5RQV.

Influence of Surface Characteristics of TiO2 Coatings on the Response of Gingival Cells: A Systematic Review of In Vitro Studies

The soft tissue-implant interface requires the formation of epithelium and connective tissue seal to hinder microbial infiltration and prevent epithelial down growth. Nanoporous titanium dioxide (TiO₂) surface coatings have shown good potential for promoting soft tissue attachment to implant surfaces. However, the impact of their surface properties on the biological response of gingival cells needs further investigation. This systematic review aimed to investigate the cellular behavior of gingival cells on TiO₂-implant abutment coatings based on in vitro studies. The review was performed to answer the question: "How does the surface characteristic of TiO₂ coatings influence the gingival cell response in in vitro studies?". A search in MEDLINE/PubMed and the web of science databases from 1990 to 2022 was performed using keywords. A quality assessment of the studies selected was performed using the SciRAP method. A total of 11 publications were selected from the 289 studies that fulfilled the inclusion criteria. The mean reporting and methodologic quality SciRAP scores were 82.7 ± 6.4/100 and 87 ± 4.2/100, respectively. Within the limitations of this in vitro systematic review, it can be concluded that the TiO₂ coatings with smooth nano-structured surface topography and good wettability improve gingival cell response compared to non-coated surfaces.

Focal adhesion formation of primary human gingival fibroblast on hydrothermally and in-sol-made TiO2 -coated titanium

Optimal cell adhesion of the gingival fibroblasts to dental implants is important for maintaining good implant integration. The aim of this study was to discover, if the nanoporous TiO₂ -coating on titanium alloy substrates is able to increase the cell adhesion of the human gingival fibroblasts (HGF). The study consisted of three differently produced titanium groups: hydrothermally produced TiO₂ -coating (HT), novel TiO₂ -coating made in sol (SOL), and noncoated control group. Primary HGF cells were initiated from gingival biopsies from patients having a third molar extraction. HGF were cultivated on titanium discs for 2 and 24 h to determine the initial attachment with confocal microscope. The cell spreading and adhesion protein signals were measured. In addition, expression of adhesion proteins vinculin, paxillin, and focal adhesion kinase (FAK) were measured after 3 days of cultivation by using Western Blotting. Higher protein levels of paxillin, vinculin, and FAK were induced on both coated discs compared to noncoated discs. The difference was statistically significant (p < 0.05) concerning expression of paxillin. The cell spreading was significantly larger on SOL discs after 2 and 24 h when comparing to noncoated controls. The confocal microscope analyses revealed significantly higher adhesion protein signals on both HT- and SOL-coated titanium compared to control group. This study showed, that both methods to produce TiO₂ -coatings are able to increase HGF adhesion protein expression and cell spreading on titanium surface. Accordingly, the coatings can potentially improve the gingival attachment to titanium implant surfaces.

Surface characteristics and in vitro biocompatibility of surface-modified titanium foils as a regenerative barrier membrane for guided bone regeneration

This study evaluated surface characteristics and biocompatibility of surface-modified thin titanium (Ti) foils as a regenerative barrier membrane for future application in guided bone regeneration (GBR) surgery to augment atrophic alveolar bone. Anodic oxidation and post-heat treatment were performed to prepare various Ti foil samples. Then, the in vitro soft and hard tissue compatibility of the samples was evaluated by examining the cell responses using primary human gingival fibroblasts (HGFs) and MG63 human osteoblast-like cells. Investigated Ti foil samples showed marked differences in physicochemical surface properties. Additional 400°C heat treatment applied to the anodized Ti surface led to formation of an anatase titanium dioxide structure and well-organized nanoscale protrusions, and significantly increased surface wettability. Anodization and heat treatment enhanced the growth of HGFs and MG63 cells in Ti foil samples. Additional heat treatment for 10 and 30 min further significantly improved the response of HGFs including spreading and proliferation, and upregulated the mRNA expression of cell adhesion- and maturation-related genes as well as the osteoblast differentiation of MG63 cells. Ti foil sample with thin oxide coating obtained by a 30 min heat treatment exhibited poor clinical plasticity as a regenerative barrier membrane, which showed complete coating failure in the bending test. Our results indicate that anatase Ti oxide coating of a specific film thickness with nanoscale surface protrusion morphology and hydrophilic characteristics obtained by anodization and post-heat treatment would be an effective approach as a biocompatible Ti regenerative membrane for inducing better regeneration of both gingival tissue and bone.

Epithelial cell attachment and adhesion protein expression on novel in sol TiO2 coated zirconia and titanium alloy surfaces

An adequate mucosal attachment is important when it comes to preventing peri-implant inflammation. The aim of this study was to compare epithelial cell adhesion and adhesion protein expression on in sol TiO₂ -coated and non-coated zirconia and titanium alloy surfaces. Fifty-six zirconia and titanium discs were cut, and half of them were coated with bioactive TiO₂ -coating. To study the epithelial cell attachment, human gingival keratinocytes were cultivated on discs for 1, 3, 6, and 24 h. The cell proliferation was detected by cultivating cells for 1, 3, and 7 days. In addition, the levels of adhesion proteins laminin y2, integrin α6, β4, vinculin, and paxillin were detected with Western Blot method. Furthermore, high-resolution imaging of the actin cytoskeleton and focal adhesion proteins was established. Longer-term cell culture (1-7 days) revealed higher cell numbers on the coated zirconia and titanium discs compared to non-coated discs. The difference was statistically significant (p < .05) after 24 h on coated zirconia and after 3 and 7 days on coated titanium discs compared to non-coated discs. Clear induction in the protein levels of laminin y2 and integrin α6 were detected on both coated samples, meanwhile integrin β4 were clearly induced on coated titanium alloy. The microscope evaluation showed significantly increased cell spreading on the coated discs. According to this study, the in sol induced TiO₂ -coating increases keratinocyte attachment and the expression of adhesion proteins on coated zirconia and titanium in vitro. Consequently, the coating has potential to enhance the mucosal attachment on implant surfaces.

Integration of collagen fibers in connective tissue with dental implant in the transmucosal region

Dental implants have been widely accepted as an ideal therapy to replace the missing teeth for its good performance in aspects of mechanical properties and aesthetic outcomes. Its restorative success is contributed by not only the successful osseointegration of the implant but also the tight soft tissue integration, especially the collagen fibers, in the transmucosal region. Soft tissue attaching to the dental implant/abutment is overall similar, but in some aspects distinct with that seen around natural teeth and soft tissue integration can be enhanced via several surface modification methods. This review is going to focus on the current knowledge of the transmucosal zone around the dental implants (compared with natural teeth), and latest strategies in use to fine-tune the collagen fibers assembly in the connective tissue, in an attempt to enhance soft tissue integration.

Thin flexible lab-on-a-film for impedimetric sensing in biomedical applications

Microfluidic cytometers based on coulter principle have recently shown a great potential for point of care biosensors for medical diagnostics. Here, we explore the design of an impedimetric microfluidic cytometer on flexible substrate. Two coplanar microfluidic geometries are compared to highlight the sensitivity of the device to the microelectrode positions relative to the detection volume. We show that the microelectrodes surface area and the geometry of the sensing volume for the cells strongly influence the output response of the sensor. Reducing the sensing volume decreases the pulse width but increases the overall pulse amplitude with an enhanced signal-to-noise ratio (~ max. SNR = 38.78 dB). For the proposed design, the SNR was adequate to enable good detection and differentiation of 10 µm diameter polystyrene beads and leukemia cells (~ 6–21 µm). Also, a systematic approach for irreversible & strong bond strength between the thin flexible surfaces that make up the biochip is explored in this work. We observed the changes in surface wettability due to various methods of surface treatment can be a valuable metric for determining bond strength. We observed permanent bonding between microelectrode defined polypropylene surface and microchannel carved PDMS due to polar/silanol groups formed by plasma treatment and consequent covalent crosslinking by amine groups. These experimental insights provide valuable design guidelines for enhancing the sensitivity of coulter based flexible lab-on-a-chip devices which have a wide range of applications in point of care diagnostics.

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.

Effects of surface roughness of ceria-stabilized zirconia/alumina nanocomposite on the morphology and function of human gingival fibroblasts

We evaluated the biological effects of implant abutments made from ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/Al₂O₃) with surface roughness variations using human gingival fibroblasts (HGF-1) in the transmucosal region. Two types of titanium (Ti) and Ce-TZP/Al₂O₃ disks with different surface roughness profiles were prepared (Ra0.9 and Ra0.02). Surface properties were evaluated using SEM, EDX, and wettability analysis. Biological parameters including cell adhesion, proliferation and morphology, collagen deposition, and inflammatory cytokine expression were evaluated for each disk. Surface morphology analysis of Ce-TZP/Al₂O₃ and Ti elucidated the uniform linear structures of Ra0.9 and the smooth and flat structures of Ra0.02. Cell morphology showed spindle-shaped and large, circular forms, respectively. Cell adhesion and proliferation and collagen deposition were significantly increased on Ce-TZP/Al₂O₃ Ra0.02 disk compared with the others, with no significant differences in cytokine expression among all the disks. The reduced surface roughness of Ce-TZP/Al₂O₃ was advantageous for promoting biological effects in the transmucosal region.

Time Dependency of Non-Thermal Oxygen Plasma and Ultraviolet Irradiation on Cellular Attachment and mRNA Expression of Growth Factors in Osteoblasts on Titanium and Zirconia Surfaces

Ultraviolet (UV) light and non-thermal plasma (NTP) are promising chair-side surface treatment methods to overcome the time-dependent aging of dental implant surfaces. After showing the efficiency of UV light and NTP treatment in restoring the biological activity of titanium and zirconia surfaces in vitro, the objective of this study was to define appropriate processing times for clinical use. Titanium and zirconia disks were treated by UV light and non-thermal oxygen plasma with increasing duration. Non-treated disks were set as controls. Murine osteoblast-like cells (MC3T3-E1) were seeded onto the treated or non-treated disks. After 2 and 24 h of incubation, the viability of cells on surfaces was assessed using an MTS assay. mRNA expression of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) were assessed using real-time reverse transcription polymerase chain reaction analysis. Cellular morphology and attachment were observed using confocal microscopy. The viability of MC3T3-E1 was significantly increased in 12 min UV-light treated and 1 min oxygen NTP treated groups. VEGF relative expression reached the highest levels on 12 min UV-light and 1 min NTP treated surfaces of both disks. The highest levels of HGF relative expression were reached on 12 min UV light treated zirconia surfaces. However, cells on 12 and 16 min UV-light and NTP treated surfaces of both materials had a more widely spread cytoskeleton compared to control groups. Twelve min UV-light and one min non-thermal oxygen plasma treatment on titanium and zirconia may be the favored times in terms of increasing the viability, mRNA expression of growth factors and cellular attachment in MC3T3-E1 cells.

Repeated Exposure of Nanostructured Titanium to Osteoblasts with Respect to Peri-Implantitis

Titanium offers excellent biocompatibility and extraordinary mechanical properties. As a result, it is used as a material for dental implants. Implants infected by peri-implantitis can be cleaned for successful re-osseointegration. Optimal surface properties, such as roughness and wettability, have a significant impact on cell adhesion. The aim of this study was to evaluate the adhesion and proliferation of osteoblasts on the surface of repeatedly cleaned nanostructured titanium samples. Human osteoblast-like cells MG-63 were seeded on nanostructured titanium specimens manufactured from rods produced by the equal channel angular pressing. For surface characterization, roughness and wettability were measured. Cell adhesion after 2 h as well as cell proliferation after 48 h from plating was assessed. We have found that this repeated cleaning of titanium surface reduced cell adhesion as well as proliferation. These events depend on interplay of surface properties, such as wettability, roughness and topography. It is difficult to distinguish which factors are responsible for these events and further investigations will be required. However, even after the several rounds of repeated cleaning, there was a certain rate of adhesion and proliferation recorded. Therefore the attempts to save failing implants by using in situ cleaning are promising.

Evaluation of a novel oral mucosa in vitro implantation model for analysis of molecular interactions with dental abutment surfaces

Background

Abutment surfaces are being designed to promote gingival soft tissue attachment and integration. This forms a seal around prosthetics and consequently ensures long‐term implant survival. New scalable and reproducible models are necessary to evaluate and quantify the performance of these surfaces.

Purpose

To evaluate a novel implantation model by histomorphometric and immunohistochemical characterization of the interactions between human oral gingival tissue and titanium abutments with either novel anodized or conventional machined surface.

Materials and Methods

Abutments were inserted into an organotypic reconstructed human gingiva (RHG) model consisting of differentiated gingival epithelium cells on a fibroblast populated lamina propria hydrogel following a tissue punch. Epithelial attachment, down‐growth along the abutment surface, and phenotype were assessed via histomorphology, scanning electron microscopy, and immunohistochemistry 10 days after implantation.

Results

The down‐growing epithelium transitioned from a gingival margin to a sulcular and junctional epithelium. The sulcus depth and junctional epithelial length were similar to previously reported pre‐clinical and clinical lengths. A collagen IV/laminin 5 basement membrane formed between the epithelium and the underlying connective tissue. The RHG expanded in thickness approximately 2‐fold at the abutment surface. The model allowed the evaluation of protein expression of adhering soft tissue cells for both tested abutments.

Conclusions

The RHG model is the first in vitro 3D model to enable the assessment of not only human epithelial tissue attachment to dental abutments but also the expression of protein markers involved in soft tissue attachment and integration. The two abutments showed no noticeable difference in epithelial attachment.

Early Biofilm Formation on UV Light Activated Nanoporous TiO2 Surfaces In Vivo

Purpose

To explore early S. mutans biofilm formation on hydrothermally induced nanoporous TiO₂ surfaces in vivo and to examine the effect of UV light activation on the biofilm development.

Materials and Methods

Ti-6Al-4V titanium alloy discs (n = 40) were divided into four groups with different surface treatments: noncoated titanium alloy (NC); UV treated noncoated titanium alloy (UVNC); hydrothermally induced TiO₂ coating (HT); and UV treated titanium alloy with hydrothermally induced TiO₂ coating (UVHT). In vivo plaque formation was studied in 10 healthy, nonsmoking adult volunteers. Titanium discs were randomly distributed among the maxillary first and second molars. UV treatment was administered for 60 min immediately before attaching the discs in subjects' molars. Plaque samples were collected 24h after the attachment of the specimens. Mutans streptococci (MS), non-mutans streptococci, and total facultative bacteria were cultured, and colonies were counted.

Results

The plaque samples of NC (NC + UVNC) surfaces showed over 2 times more often S. mutans when compared to TiO₂ surfaces (HT + UVHT), with the number of colonized surfaces equal to 7 and 3, respectively.

Conclusion

This in vivo study suggested that HT TiO₂ surfaces, which we earlier showed to improve blood coagulation and encourage human gingival fibroblast attachment in vitro, do not enhance salivary microbial (mostly mutans streptococci) adhesion and initial biofilm formation when compared with noncoated titanium alloy. UV light treatment provided Ti-6Al-4V surfaces with antibacterial properties and showed a trend towards less biofilm formation when compared with non-UV treated titanium surfaces.

Effects of Enhanced Hydrophilic Titanium Dioxide-Coated Hydroxyapatite on Bone Regeneration in Rabbit Calvarial Defects

The regeneration of bone defects caused by periodontal disease or trauma is an important goal. Porous hydroxyapatite (HA) is an osteoconductive graft material. However, the hydrophobic properties of HA can be a disadvantage in the initial healing process. HA can be coated with TiO₂ to improve its hydrophilicity, and ultraviolet irradiation (UV) can further increase the hydrophilicity by photofunctionalization. This study was designed to evaluate the effect of 5% TiO₂-coated HA on rabbit calvarial defects and compare it with that of photofunctionalization on new bone in the early stage. The following four study groups were established, negative control, HA, TiO₂-coated HA, and TiO₂-coated HA with UV. The animals were sacrificed and the defects were assessed by radiography as well as histologic and histomorphometric analyses. At 2 and 8 weeks postoperatively, the TiO₂-coated HA with UV group and TiO₂-coated HA group showed significantly higher percentages of new bone than the control group (p < 0.05). UV irradiation increased the extent of new bone formation, and there was a significant difference between the TiO₂-coated HA group and TiO₂-coated HA with UV group. The combination of TiO₂/HA and UV irradiation in bone regeneration appears to induce a favorable response.