The effect of plasma-sprayed calcium phosphate ceramic coatings on the metal ion release from porous titanium and cobalt-chromium alloys

There Are over 60 Ways to Produce Biocompatible Calcium Orthophosphate (CaPO4) Deposits on Various Substrates

A The present overview describes various production techniques for biocompatible calcium orthophosphate (abbreviated as CaPO4) deposits (coatings, films and layers) on the surfaces of various types of substrates to impart the biocompatible properties for artificial bone grafts. Since, after being implanted, the grafts always interact with the surrounding biological tissues at the interfaces, their surface properties are considered critical to clinical success. Due to the limited number of materials that can be tolerated in vivo, a new specialty of surface engineering has been developed to desirably modify any unacceptable material surface characteristics while maintaining the useful bulk performance. In 1975, the development of this approach led to the emergence of a special class of artificial bone grafts, in which various mechanically stable (and thus suitable for load-bearing applications) implantable biomaterials and artificial devices were coated with CaPO4. Since then, more than 7500 papers have been published on this subject and more than 500 new publications are added annually. In this review, a comprehensive analysis of the available literature has been performed with the main goal of finding as many deposition techniques as possible and more than 60 methods (double that if all known modifications are counted) for producing CaPO4 deposits on various substrates have been systematically described. Thus, besides the introduction, general knowledge and terminology, this review consists of two unequal parts. The first (bigger) part is a comprehensive summary of the known CaPO4 deposition techniques both currently used and discontinued/underdeveloped ones with brief descriptions of their major physical and chemical principles coupled with the key process parameters (when possible) to inform readers of their existence and remind them of the unused ones. The second (smaller) part includes fleeting essays on the most important properties and current biomedical applications of the CaPO4 deposits with an indication of possible future developments.

Thermally Sprayed Functional Coatings and Multilayers: A Selection of Historical Applications and Potential Pathways for Future Innovation

Thermal spray coatings are material systems with unique structures and properties that have enabled the growth and evolution of key modern technologies (i.e., gas turbines, structurally integrated components, etc.). The inherent nature of these sprayed coatings, such as their distinctive thermal and mechanical properties, has been a driving force for maintaining industrial interest. Despite these benefits and proven success in several fields, the adoption of thermal spray technology in new applications (i.e., clean energy conversion, semiconductor thermally sprayed materials, biomedical applications, etc.) at times, however, has been hindered. One possible cause could be the difficulty in concurrently maintaining coating design considerations while overcoming the complexities of the coatings and their fabrication. For instance, a coating designer must consider inherent property anisotropy, in-flight decomposition of molten material (i.e., loss of stoichiometry), and occasionally the formation of amorphous materials during deposition. It is surmisable for these challenges to increase the risk of adoption of thermal spray technology in new fields. Nevertheless, industries other than those already mentioned have benefited from taking on the risk of implementing thermal spray coatings in their infrastructure. Benefits can be quantified, for example, based on reduced manufacturing cost or enhanced component performance. In this overview paper, a historical presentation of the technological development of thermal spray coatings in several of these industries is presented. Additionally, emerging industries that have not yet attained this level of thermal spray maturation will also be discussed. Finally, where applicable, the utility and benefits of multilayer functional thermal spray coating designs will be demonstrated.

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

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

Are clinical findings of systemic titanium dispersion following implantation explained by available in vitro evidence? An evidence-based analysis

Although the presence of titanium wear particles released into tissues is known to induce local inflammation following the therapeutic implantation of titanium devices into humans, the role that titanium ions play in adverse tissue responses has received little attention. Support that ongoing titanium ion release occurs is evidenced by the presence of ionic titanium bound to transferrin in blood, and ongoing excretion in the urine of patients with titanium devices. However, as reports documenting the presence of titanium within tissues do not distinguish between particulate and ionic forms due to technical challenges, the degree to which ionic titanium is released into tissues is unknown. To determine the potential for titanium ion release into tissues, this study evaluates available in vitro evidence relating to the release of ionic titanium under physiological conditions. This is a systematic literature review of studies reporting titanium ion release into solutions from titanium devices under conditions replicating the interstitial pH and constituents. Inclusion and exclusion criteria were defined. Of 452 articles identified, titanium ions were reported in nine media relevant to human biology in seventeen studies. Only one study, using human serum replicated both physiological pH and the concentration of constituents while reporting the presence of titanium ions. While there is insufficient information to explain the factors that contribute to the presence of titanium ions in serum of humans implanted with titanium devices, currently available information suggests that areas of future inquiry include the role of transferrin and organic acids.

In vitro performance of Ag-incorporated hydroxyapatite and its adhesive porous coatings deposited by electrostatic spraying

Bacterial infection of implanted materials is a significant complication that might require additional surgical operations for implant retrieval. As an antibacterial biomaterial, Ag-containing hydroxyapatite (HA) may be a solution to reduce the incidences of implant associated infections. In this study, pure, 0.2mol% and 0.3mol% Ag incorporated HA powders were synthesized via a precipitation method. Colloidal precursor dispersions prepared from these powders were used to deposit porous coatings onto titanium and stainless steel substrates via electrostatic spraying. The porous coating layers obtained with various deposition times and heat treatment conditions were characterized by X-ray diffraction (XRD) and scanning electron microscopy (SEM). Scratch tests were conducted to assess the adhesion strength of the coating. Antibacterial activity of Ag-incorporated HA was tested towards Escherichia coli (E. coli) at various incubation times. Osteoblast adhesion on Ag-incorporated HA was evaluated to assess biocompatibility. Improvement in adhesion strength of the coating layer was observed after the heat treatment process due to mutual ionic diffusion at the interface. The Ag-incorporated HA killed all viable E. coli after 24h of incubation, whereas no antibacterial activity was detected with pure HA. In addition, in vitro cell culture tests demonstrated osteoblast adhesion similar to pure HA, which indicated good cytocompatibility. In summary, results of this study provided significant promise for the future study of Ag-incorporated HA for numerous medical applications.

In vitro evaluation of hydroxyapatite coatings with (002) crystallographic texture deposited by micro-plasma spraying

Hydroxyapatite (HA) coatings are usually deposited on the metallic implant to increase the biocompatibility and protect the bloodstream from harmful metal ions. Atmospheric plasma spray (APS) is known as a cost effective deposition method. However, the low crystallinity of APS deposited coating accelerates its dissolution in body fluid. We used micro-plasma spray (MPS) to develop chemically stable HA coatings, and performed APS as reference. Results showed that MPS deposited coatings exhibited (002) crystallographic texture while the reference sample did not. The texture intensity and crystallinity were improved by shortening stand-off distance. These suggested that different formation procedures of HA coatings were involved and three mechanisms were proposed by sketching typical splats. To evaluate the chemical stability of the coatings in a physiological environment, in vitro experiments were performed in Hanks' solution. Well crystallized (~100%) HA coating with the strongest crystallographic texture exhibited superior stability up to 14days. Crystals with (002) orientation was more stable than that with (211) orientation. Hence columnar structure with nanopores emerged on the coating surface after incubation, and this may facilitate the future osteoblast growth. Furthermore, HA coating with weak and no crystallographic texture induced apatite layer. However, vertical cracks and cleavage at coating-apatite interface may cause coating separation.

Fabrication of strongly attached hydroxyapatite coating on titanium by hydrothermal treatment of Ti-Zn-PO4 coated titanium in CaCl 2 solution

Hydroxyapatite (HAp) coating was formed on zinc phosphate (Ti-Zn-PO4) coated Ti plates by hydrothermal treatment in CaCl2 solution at 200 °C for 12 h. Uniform surface coverage of the fabricated HAp coating was obtained by this method. SEM-EDX analysis of the adhesion test area showed that the presence of fractures only occurred in HAp crystals. On the other words cohesive fracture was seen in HAp coating layer formed on the Ti-Zn-PO4. The measured strength was around 42.3 ± 17 MPa. Rat bone marrow (RBM) mesenchymal stem cells were cultured and differentiation-induced on each sample (Ti plate, Ti-Zn-PO4 coated and HAp coated), and cell calcification properties were examined. Apparent differences in morphology and extension of the RBM cells were obtained, while the Ti-Zn-PO4 coated samples showed the highest cell number among all samples. After differentiation-induction, HAp coated samples showed the highest amount of alkaline phosphatase activity, and the highest level of cell calcification. Therefore, the hard tissue compatibility of Ti is improved by hydrothermally HAp coating of samples.

Calcium orthophosphate deposits: Preparation, properties and biomedical applications

Since various interactions among cells, surrounding tissues and implanted biomaterials always occur at their interfaces, the surface properties of potential implants appear to be of paramount importance for the clinical success. In view of the fact that a limited amount of materials appear to be tolerated by living organisms, a special discipline called surface engineering was developed to initiate the desirable changes to the exterior properties of various materials but still maintaining their useful bulk performances. In 1975, this approach resulted in the introduction of a special class of artificial bone grafts, composed of various mechanically stable (consequently, suitable for load bearing applications) implantable biomaterials and/or bio-devices covered by calcium orthophosphates (CaPO4) to both improve biocompatibility and provide an adequate bonding to the adjacent bones. Over 5000 publications on this topic were published since then. Therefore, a thorough analysis of the available literature has been performed and about 50 (this number is doubled, if all possible modifications are counted) deposition techniques of CaPO4 have been revealed, systematized and described. These CaPO4 deposits (coatings, films and layers) used to improve the surface properties of various types of artificial implants are the topic of this review.

Biomimetic approaches in bone tissue engineering: Integrating biological and physicomechanical strategies

The development of responsive biomaterials capable of demonstrating modulated function in response to dynamic physiological and mechanical changes in vivo remains an important challenge in bone tissue engineering. To achieve long-term repair and good clinical outcomes, biologically responsive approaches that focus on repair and reconstitution of tissue structure and function through drug release, receptor recognition, environmental responsiveness and tuned biodegradability are required. Traditional orthopedic materials lack biomimicry, and mismatches in tissue morphology, or chemical and mechanical properties ultimately accelerate device failure. Multiple stimuli have been proposed as principal contributors or mediators of cell activity and bone tissue formation, including physical (substrate topography, stiffness, shear stress and electrical forces) and biochemical factors (growth factors, genes or proteins). However, optimal solutions to bone regeneration remain elusive. This review will focus on biological and physicomechanical considerations currently being explored in bone tissue engineering.

Calcium orthophosphate coatings, films and layers

In surgical disciplines, where bones have to be repaired, augmented or improved, bone substitutes are essential. Therefore, an interest has dramatically increased in application of synthetic bone grafts. As various interactions among cells, surrounding tissues and implanted biomaterials always occur at the interfaces, the surface properties of the implants are of the paramount importance in determining both the biological response to implants and the material response to the physiological conditions. Hence, a surface engineering is aimed to modify both the biomaterials, themselves, and biological responses through introducing desirable changes to the surface properties of the implants but still maintaining their bulk mechanical properties. To fulfill these requirements, a special class of artificial bone grafts has been introduced in 1976. It is composed of various mechanically stable (therefore, suitable for load bearing applications) biomaterials and/or bio-devices with calcium orthophosphate coatings, films and layers on their surfaces to both improve interactions with the surrounding tissues and provide an adequate bonding to bones. Many production techniques of calcium orthophosphate coatings, films and layers have been already invented and new promising techniques are continuously investigated. These specialized coatings, films and layers used to improve the surface properties of various types of artificial implants are the topic of this review.

Mechanical insertion properties of calcium-phosphate implant coatings

OBJECTIVES

To investigate the influence of protein incorporation on the resistance of biomimetic calcium-phosphate coatings to the shear forces that are generated during implant insertion.

MATERIALS AND METHODS

Thirty-eight standard (5 × 13 mm) Osseotite® implants were coated biomimetically with a layer of calcium phosphate, which either lacked or bore a co-precipitated (incorporated) depot of the model protein bovine serum albumin (BSA). The coated implants were inserted into either artificial bone (n=18) or the explanted mandibles of adult pigs (n=12). The former set-up was established for the measurement of torque and of coating losses during the insertion process. The latter set-up was established for the histological and histomorphometric analysis of the fate of the coatings after implantation.

RESULTS

BSA-bearing coatings had higher mean torque values than did those that bore no protein depot. During the insertion process, less material was lost from the former than from the latter type of coating. The histological and histomorphometric analysis revealed fragments of material to be sheared off from both types of coating at vulnerable points, namely, at the tips of the threads. The sheared-off fragments were retained within the peri-implant space.

CONCLUSION

The incorporation of a protein into a biomimetically prepared calcium-phosphate coating increases its resistance to the shear forces that are generated during implant insertion. In a clinical setting, the incorporated protein would be an osteogenic agent, whose osteoinductive potential would not be compromised by the shearing off of coating material, and the osteoconductivity of an exposed implant surface would not be less than that of a coated one.

Role of phosphatidyl-serine in bone repair and its technological exploitation

In the 1970s, morphological evidence collected by electron microscopy linked mineral deposition (“calcification” or “mineralization”) in newly-forming bone to membrane-encapsulated particles of a diameter of approximately 100 nm (50–200 nm) that were called “matrix vesiscles”. As the characterisation of these vesicles progressed towards their biochemical composition, the role of lipids in the biomineralization process appeared to be crucial. In particular, a group of cell-membrane phospholipids were identified as major players in the crystal formation process. Indeed, in the 1980s it became clear that phosphatidylserine, together with proteins of the annexin family, was among the most important molecules in binding calcium ions and that this phospholipid was involved in the regulation of the early stages of mineralization in vivo. During the same period of time, the number of surgical implantations of orthopaedic, dental and maxilo-facial devices requiring full integration with the treated bone prompted the study of new functionalisation molecules able to establish a stable bonding with the mineral phase of the host tissue. In the late 1990s studies started that aimed at exploiting the potential of calcium-binding phospholipids and, in particular, of the phosphatidylserine as functionalisation molecules to improve the osteointegration of artificial implants. Later, papers have been published that show the potential of the phophatidylserine and phosphatidylserine-mimicking coating technology to promote calcification both in vitro and in vivo. The promising results support the future clinical application of these novel osteointegrative biomaterials.

Surface characteristics and bioactivity of oxide film on titanium metal formed by thermal oxidation

In this study, we characterized the surface of oxide film formed on titanium metal through the use of thermal treatment and investigated the effect of surface characteristics on the bioactivity of titanium. The as-received sample group was prepared by polishing and cleaning CP-Ti as a control group, and thermally oxidized sample groups were prepared by heat treating at 530, 600, 700, 800, 900, and 1000 degrees C respectively. Micro-morphology, crystalline structure, chemical composition, and binding state were evaluated using FE-SEM, XRD, and XPS. The bioactivity of sample groups was investigated by observing the degree of calcium phosphate formation from immersion testing in MEM. The surface characterization tests showed that hydroxyl group content in titanium oxide film was increased, as the density of titanium atoms was high and the surface area was large. In MEM immersion test, initial calcium phosphate formation was dependent upon the thickness of titanium oxide, and resultant calcium phosphate formation depended on the content of the hydroxyl group of the titanium oxide film surface.

In Situ Characterization of Degradation Behavior of Plasma-Sprayed Coatings on Orthopedic and Dental Implants

Plasma-sprayed ‘HA’ coatings on commercial orthopedic and dental implants were developed to combine the strength of the metal (Ti or Ti alloy) and the bioactivity of the hydroxyapatite (HA). Several studies have shown that ‘HA’-coated implants provided greater amount of bone attachment, higher bone-implant interfacial strength and accelerated skeletal attachment. However, some reports on implant failures have been attributed to coating delamination and coating early resorption of the plasma sprayed ‘HA’ coating. This paper reviews studies on characterization and degradation of plasma-sprayed ‘HA’ coatings on orthopedic and dental implants and offers alternatives to plasma-spray method of providing calcium phosphate coating. X-ray diffraction analyses showed that plasma-sprayed HA coating consists principally of HA and amorphous calcium phosphate (ACP) with minor amounts of other resorbable calcium phosphates (α- or β-tricalcium phosphates, tetracalcium phosphate), sometimes calcium oxide. The HA/ACP ratios were found to range from 20HA/80ACP to 70HA/30ACP in coated implants from different manufacturers. In vitro initial dissolution rates in acidic buffer (pH 6, 37oC) increased with decreasing HA/ACP ratios in the coating because of the preferential dissolution of the ACP phase. These results suggest that coating with very low HA/ACP ratio may result in the premature resorption of the coating before the bone can attach to the implant thus causing loosening and eventual failure of the implant. Alternatives to plasma-sprayed ‘HA’ are implant surface modifications and low temperature calcium phosphate coatings using electrochemical deposition method or precipitation method.

In vivo assessment of the osteointegrative potential of phosphatidylserine-based coatings

The successful implantation of titanium-based implants for orthopaedic and dental applications is often hindered because of their mobility, which arises because of a lack of direct binding of the metal surface to the mineral phase of the surrounding bone. Ceramic coatings, although ensuring the integration of the implant within the tissue, are unstable and carry risks of delamination and of failure. Recently, a novel biomimetic approach has been developed where porous titanium implants are coated with calcium-binding phospholipids able to catalyse the nucleation of discrete apatite crystals after only 30 min incubation in simulated body fluids. The present work assesses the osteointegrative potential of this new class of coatings in an in vivo rabbit model and compares its performance with those of bare porous titanium and hydroxyapatite-coated titanium. The data obtained show that phosphatidylserine-based coatings, whilst resorbing, drive the growing bone into apposition with the metal surface. This is in contrast to the case of bare titanium.

Silicon-substituted hydroxyapatite thin films: Effect of annealing temperature on coating stability and bioactivity

The effect of annealing temperature on the physicochemical and biological characteristics of magnetron cosputtered silicon-substituted hydroxyapatite (SiHA) thin coatings was studied. Annealing is required to transform as-sputtered amorphous films into crystalline coatings. A nanocrystalline, single-phase apatite structure was achieved for coatings heated to 600 or 700 degrees C and, with increasing annealing temperature, the crystallite size increased. Small crystallites were found to be more soluble in the physiological environment but, at the same time, were able to induce early formation of a new apatite layer. A human osteoblast-like (HOB) cell model was used to evaluate the performance of these annealed SiHA coatings. HOB cells attached and grew well on coatings and, after 42 days in culture, a mineralization process was observed to be taking place, with evidence of calcium phosphate minerals throughout the extracellular matrix. Our findings indicated that an annealing temperature of 600 degrees C is sufficient to achieve crystalline SiHA coatings and exhibiting good chemical stability and bioactivity.

Decreased bacterial adhesion to surface-treated titanium

Osteointegrative dental implants are widely used in implantology for their well-known excellent performance once implanted in the host. Remarkable bacterial colonization along the transgingival region may result in a progressive loss of adhesion at gum-implant interface and an increase of the bone area exposed to pathogens. This phenomenon may negatively effect the osteointegration process and cause, in the most severe cases, implant failure. The presence of bacteria at implant site affect the growth of new bone tissue and consequently, the achievement of a mechanically stable bone-implant interface, key parameters for a suitable implant osteointegration. In the present work, a novel surface treatment has been developed and optimized in order to convert the amorphous titanium oxide in a crystalline layer enriched in anatase capable of providing not only antibacterial properties but also of stimulating the precipitation of apatite when placed in simulated body fluid. The collected data have shown that the tested treatment results in a crystalline anatase-type titanium oxide layer able to provide a remarkable decrease in bacterial attachment without negatively effecting cell metabolic activity. In conclusion, the surface modification treatment analyzed in the present study might be an elegant way to reduce the risk of bacterial adhesion and increase the lifetime of the transgingival component in the osteointegrated dental implant.

Peri-implant osteogenesis in health and osteoporosis

Long-term clinical success of endosseous dental implants is critically related to a wide bone-to-implant direct contact. This condition is called osseointegration and is achieved ensuring a mechanical primary stability to the implant immediately after implantation. Both primary stability and osseointegration are favoured by micro-rough implant surfaces which are obtained by different techniques from titanium implants or coating the titanium with different materials. Host bone drilled cavity is comparable to a common bone wound. In the early bone response to the implant, the first tissue which comes into contact with the implant surface is the blood clot, with particular attention to platelets and fibrin. Peri-implant tissue healing starts with an inflammatory response as the implant is inserted in the bone cavity, but an early afibrillar calcified layer comparable to the lamina limitans or incremental lines in bone is just observable at the implant surface both in vitro than in vivo conditions. Just within the first day from implantation, mesenchymal cells, pre-osteoblasts and osteoblasts adhere to the implant surface covered by the afibrillar calcified layer to produce collagen fibrils of osteoid tissue. Within few days from implantation a woven bone and then a reparative trabecular bone with bone trabeculae delimiting large marrow spaces rich in blood vessels and mesenchymal cells are present at the gap between the implant and the host bone. The peri-implant osteogenesis can proceed from the host bone to the implant surface (distant osteogenesis) and from the implant surface to the host bone (contact osteogenesis) in the so called de novo bone formation. This early bone response to the implant gradually develops into a biological fixation of the device and consists in an early deposition of a newly formed reparative bone just in direct contact with the implant surface. Nowadays, senile and post-menopausal osteoporosis are extremely diffuse in the population and have important consequences on the clinical success of endosseous dental implants. In particular the systemic methabolic and site morphological conditions are not favorable to primary stability, biological fixation and final osseointegration. An early good biological fixation may allow the shortening of time before loading the implant, favouring the clinical procedure of early or immediate implant loading. Trabecular bone in implant biological fixation is gradually substituted by a mature lamellar bone which characterizes the implant ossoeintegration. As a final consideration, the mature lamellar bone observed in osseointegrated implants is not always the same as a biological turnover occurs in the peri-implant bone up to 1mm from the implant surface, with both osteogenesis and bone reabsorption processes.

In vitro assessment of the osteointegrative potential of a novel multiphase anodic spark deposition coating for orthopaedic and dental implants

Hydroxyapatite coatings have been proven to improve the osteointegration of metal implants through a tight binding to the bone mineral phase as well as through favorable osteoblast adhesion and proliferation onto the implant surface. However, hydroxyapatite coatings are not stable and they tend to delaminate from the metal surface when challenged by the mechanical stresses experienced by the implant. Recently, a new multiphase anodic spark deposition (ASD) method has been optimized where the formation of a thick oxide film is followed by the deposition of a calcium phosphate mineral phase and its etching by alkali. The data in this paper demonstrate that this novel type of coating, BioSpark, improves the material osteointegration potential when compared to conventional ASD while offering more mechanical stability. A faster mineralization was obtained by incubation in simulated body fluids and osteoblasts showed better adhesion, proliferation, differentiation, and collagen production. These performances were related to the surface morphology, to the film calcium/phosphate ratio and its surface oxygen content, as well as to a preferential binding of structural proteins such as fibronectin.

Adherent apatite coating on titanium substrate using chemical deposition

Plasma-sprayed "HA" coatings on commercial orthopedic and dental implants consist of mixtures of calcium phosphate phases, predominantly a crystalline calcium phosphate phase, hydroxyapatite (HA) and an amorphous calcium phosphate (ACP) with varying HA/ACP ratios. Alternatives to the plasma-spray method are being explored because of some of its disadvantages. The purpose of this study was to deposit an adherent apatite coating on titanium substrate using a two-step method. First, titanium substrates were immersed in acidic solution of calcium phosphate resulting in the deposition of a monetite (CaHPO4) coating. Second, the monetite crystals were transformed to apatite by hydrolysis in NaOH solution. Composition and morphology of the initial and final coatings were identified using X-ray diffraction (XRD), Scanning Electron Microscopy, and Energy Dispersive Spectroscopy (EDS). The final coating was porous and the apatite crystals were agglomerated and followed the outline of the large monetite crystals. EDS revealed the presence of calcium and phosphorous elements on the titanium substrate after removing the coating using tensile or scratching tests. The average tensile bond of the coating was 5.2 MPa and cohesion failures were observed more frequently than adhesion failures. The coating adhesion measured using scratch test with a 200-microm-radius stylus was 13.1N. Images from the scratch tracks demonstrated that the coating materials were squashed without fracturing inside and/or at the border of the tracks until the failure point of the coating. In conclusion, this study showed the potential of a chemical deposition method for depositing a coating consisting of either monetite or apatite. This method has the advantage of producing a coating with homogenous composition on even implants of complex geometry or porosity. This method involves low temperatures and, therefore, can allow the incorporation of growth factors or biogenic molecules.

Osseointegration of a hydroxyapatite-coated multilayered mesh stem

A new type of porous coating for hip prostheses called "multilayered mesh" was tested under weight-bearing conditions. The surface of the stem is constructed of titanium mesh produced by etching. The hip stems of hydroxyapatite (HA)-coated multilayered mesh and conventional beads were implanted into canine right hips, and animals were killed 3, 6 and 10 weeks and 6 and 12 months after implantation. Shear strength between the implant and the bone was evaluated by the push-out test. Bone ingrowth was calculated from backscattered electron imaging-scanning electron microscopy (BEI-SEM) images of transverse sections. Toluidine blue stained sections and the BEI-SEM images were evaluated histologically. The break sites of the specimens after the push-out test were evaluated on BEI-SEM images of longitudinal sections. The mean push-out strength of the HA-coated multilayered mesh samples was greater than that of the beads-coated samples every time tested, and the HA-coated multilayered mesh implants had significantly stronger push-out strength at 3 and 6 weeks (p<0.05). The strength of the HA-coated multilayered mesh implants was even greater at 6 and 12 months, whereas the strength of the beads-coated samples decreased. The HA-coated multilayered mesh implants showed significantly higher percentages of bone ingrowth than the beads-coated implants every time tested, except at 6 months (p<0.05). At 6 and 12 months, the bone ingrowth data for the HA-coated multilayered mesh implants increased, whereas it decreased for the beads-coated implants. The new bone formation had reached the bottom of the porous area of the HA-coated multilayered mesh surface by 3 weeks, but not had reached the bottom of the conventional beads surface. At 6 and 12 months, the smaller pores of the bead surface stopped the thickening of trabecular bone, and at 12 months, the break sites were at the bone-implant interface of the bead surface, whereas they were on the bone side of the HA-coated multilayered mesh surface. The difference between the break sites was significant at 12 months (p<0.05). The HA-coated multilayered mesh stem provided faster, stronger, and more durable osseointegration than the conventional bead stem.

Hydroxylapatite and titanium: interfacial reactions

The chemical reactions between hydroxylapatite (HA) and titanium were studied in three different kinds of experiments to increase understanding of how to bond HA to titanium for implant materials. HA powder was bonded to a titanium rod with hot isostatic pressing. Interdiffusion of the HA elements and titanium was found in concentration profiles measured in the electron microprobe. Titanium was vapor-deposited on sintered HA discs and heated in air; perovskite (CaTiO(3)) was found on the HA surface with Rutherford backscattering and X-ray diffraction measurements. Powder composites of HA and titanium and TiO(2) were sintered at 1100 degrees C; again, perovskite was a reaction product, as well as beta-Ca(3)(PO(4))(2), from decomposition of the HA. These results demonstrate chemical reactions and interdiffusion between HA and TiO(2) during sintering, resulting in chemical bonding between HA and titanium. Thus, cracks and weakness at HA-titanium interfaces probably result from mismatch between the coefficients of thermal expansion of these materials. HA composites with other ceramics and different alloys should lead to better thermal matching and better bonding at the interface.

Material fundamentals and clinical performance of plasma-sprayed hydroxyapatite coatings: a review

The clinical use of plasma-sprayed hydroxyapatite (HA) coatings on metal implants has aroused as many controversies as interests over the last decade. Although faster and stronger fixation and more bone growth have been revealed, the performance of HA-coated implants has been doubted. This article will initially address the fundamentals of the material selection, design, and processing of the HA coating and show how the coating microstructure and properties can be a good predictor of the expected behavior in the body. Further discussion will clarify the major concerns with the clinical use of HA coatings and introduce a comprehensive review concerning the outcomes experienced with respect to clinical practice over the past 5 years. A reflection on the results indicates that HA coatings can promote earlier and stronger fixation but exhibit a durability that can be related to the coating quality. Specific relationships between coating quality and clinical performance are being established as characterization methods disclose more information about the coating.

Effect of mechanical surface pretreatment on metal ion release

The degree of metal ion dissolution from Ti-6Al-4V alloy hip replacement stems subjected to various mechanical and chemical surface pretreatments was analysed in vitro. High-dissolution rates were observed for nitric acid passivated samples that had been mechanically surface treated to increase the implant surface area. Significantly lower ion release levels were observed for mechanically treated samples which had been aged in de-ionised water. The application of an hydroxyapatite coating decreased the metal ion release from the nitric acid passivated samples (compared to the uncoated sample) and increased the metal ion dissolution from the aged samples. The dissolution behaviour of the samples is explained in terms of the diffusion processes occurring at the stem/solution interface and the morphological and chemical characteristics of the surface treated stems.

Characterization of hydroxyapatite film with mixed interface by Ar+ ion beam enhanced deposition

Ar+ ion beam enhanced deposition (IBED) was used to produce a hydroxyapatite (HA) film on polished titanium substrates. In this study, the HA ceramic target was sputtered by an argon-ion beam with an energy of 1.5 KeV, and the sputtered film was intermittently bombarded by energetic argon-ions at 60 KeV. An effective Ca-Ti mixed layer produced by the energetic argon-ion bombardment was confirmed by using Auger electron spectroscopy. The characteristics of the deposited films were evaluated by Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses. XRD analysis revealed that the as-deposited film was amorphous, and a hydroxyapatite-type structure was obtained from the post-heat treatment of the deposited films. SEM observations showed that no distinct difference in surface morphology was found between the as-deposited and heat-treated samples for Ar+ IBED films, suggesting a strongly bonded HA film on the titanium substrate. In comparison with the HA target, some chemistry alterations were brought about in the deposited films, such as the incorporation of CO3, the loss of the OH groups and some distortion of the phosphate lattice.

Effect of different surface finishing and of hydroxyapatite coatings on passive and corrosion current of Ti6Al4V alloy in simulated physiological solution

Direct and alternating current electrochemical tests were carried out on Ti6Al4V with different surface finishing and with hydroxyapatite (HA) coatings. Sand-blasting and rough titanium deposits obtained by vacuum plasma spraying (VPS) bring about an increase of passive and corrosion current density (c.d.) with respect to smooth Ti6Al4V, as a consequence of the augmentation of the real surface. The presence of HA deposits obtained by VPS causes an increase of passive and corrosion c.d. of the metallic substrate of about one order of magnitude and this should be taken into account in view of human body applications.

Adaptive crystal formation in normal and pathological calcifications in synthetic calcium phosphate and related biomaterials

Mineralization and crystal deposition are natural phenomena widely distributed in biological systems from protozoa to mammals. In mammals, normal and pathological calcifications are observed in bones, teeth, and soft tissues or cartilage. We review studies on the adaptive apatite crystal formation in enamel compared with those in other calcified tissues (e.g., dentin, bone, and fish enameloids) and in pathological calcifications, demonstrating the adaptation of these crystals (in terms of crystallinity and orientation) to specific tissues that vary in functions or vary in normal or diseased conditions. The roles of minor elements, such as carbonate, magnesium, fluoride, hydrogen phosphate, pyrophosphate, and strontium ions, on the formation and transformation of biologically relevant calcium phosphates are summarized. Another adaptative process of crystals in biology concerns the recent development of calcium phosphate ceramics and other related biomaterials for bone graft. Bone graft materials are available as alternatives to autogeneous bone for repair, substitution, or augmentation. This paper discusses the adaptive crystal formation in mineralized tissues induced by calcium phosphate and related bone graft biomaterials during bone repair.

Carcinogenicity of CoCrMo (F-75) implants in the rat

A long-term study was conducted in rats to assess the contribution of the surface area of CoCrMo devices to carcinogenesis. Groups consisting of 104 rats each (52 male, 52 female) were either implanted with metal cylinders fixed on the left, lateral femur (groups 1-3) or injected with a suspension of metal microspheres in the dorsal subcutis (group 4). Group 1 (control) received solid Ti6Al4V cylinders [surface area to body weight (SA/BW) ratio measuring 1.35 times that of human total hip prosthesis (HTHP)]. Group 2 was implanted with solid CoCrMo (SA/BW ratio: identical to implants of group 1). Group 3 received sintered-porous CoCrMo devices (SA/BW ratio: 30 x HTHP). Group 4 was injected with a suspension of CoCrMO microspheres (SA/BW ratio: 135 x HTHP). Implant-associated tumors (IATs) were observed in 23, 14, 3, and 15 rats of groups 1, 2, 3, and 4, respectively. Within groups 1 and 2, 34 IATs were associated with loose implants, three with undetermined implant fixation status, and none with fixed implants. A significantly increased accumulation of chronic inflammatory tissues around loose rather than fixed implants suggested a foreign-body reaction as the primary mechanism of carcinogenesis. A secondary role in carcinogenesis was ascribed to the increased CoCrMo implant SA/BW ratios as indicated by a 14.6% IAT incidence in group 4 versus 3% in group 3. These results support the notion that early intervention in the removal of loose metal devices is warranted to mitigate against foreign body-induced carcinogenesis, at least in this animal model.

Effect of hydroxyapatite thickness on metal ion release from Ti6Al4V substrates

The electrochemical dissolution behaviour of Ti6Al4V alloy coated with hydroxyapatite (HA) by plasma spraying was studied in Hank's balanced salt solution (HBSS) and compared with that of polished and grit-blasted passivated surfaces. Two different nominal thicknesses of HA (50 and 200 micro m) were used. Taking a polished passivated surface as reference, grit blasting of the substrate increased the electrical charge used in the oxidation of Ti6Al4V alloy at constant potential, as a result of increased surface area. However, only HA coatings with a thickness of 200 micro m were capable of reducing the charge to values lower than those measured for polished surfaces. Electrochemical impedance spectroscopy has also shown that only 200 micro m thick coatings are effective in reducing the oxidation rate of the substrate. Furthermore, in potentiostatic experiments the 50 micro m thick coating detached from the substrate, which did not occur with the 200 micro m thick coating. However, after 6 months immersion in HBSS, detachment occurred in some regions of both coatings. No titanium, aluminium or vanadium were detected in solution by electrothermal atomic absorption spectroscopy. These data indicate that HA is an effective barrier to metal ion release, even for the thinner coatings, due to formation of metal phosphates or to incorporation of metal ions in the HA structure.

Changes in phases and crystallinity of plasma-sprayed hydroxyapatite coatings under heat treatment: a quantitative study

With three kinds of plasma-sprayed hydroxyapatite coatings (HACs) prepared, the objectives of this study were (1) to establish the calibration methods for quantitatively measuring the concentration of impurity phases and the degree of crystallinity of the HACs, and (2) to explore the effects of postheat treatments at various temperatures in vacuo on the changes of phases and crystallinity of the HACs. By the internal standard method used, the concentrations of impurity phases, such as alpha-TCP, beta-TCP, and TP, of the assprayed HACs were significantly higher than those measured by the direct intensity-ratio method, and the CaO phase was lower than the direct intensity-ratio method. When the HACs were heat treated in the temperature interval 630-850 degrees C, the concentrations of impurity phases obviously decreased, and the coating crystallinity apparently increased. After annealing at 850 degrees C, an HAC consisting of at least 95% crystallinity with few impurity phases was obtained. As the annealing temperatures in the interval 850-1000 degrees C were applied, however, the HA phase seriously decomposed, resulting in the appearance of a large number (higher than 20 wt%) of impurity phases in the HACs. This work suggests that the optimum heat treatment conditions in vacuo for maximizing crystallinity and minimizing impurity phases of the HACs do not occur at the same temperature.

Interface mechanics and histomorphometric analysis of hydroxyapatite-coated and porous glass-ceramic implants in canine bone

A canine study was performed to make a histological and biomechanical evaluation of the interface between bone and two different bioceramic implants. A newly developed glass-ceramic formed by P2O5, CaO, SiO2, and Al2O3, giving a crystal phase composed of CaP2O6-AlPO4-SiP2O7, was compared to hydroxyapatite (HA) coated Ti-6Al-4V implants. A total of 24 implants were inserted into the femoral condyle of 15 adult female golden retriever dogs weighing 20-25 kg. There was a 12 week follow-up. Implants were examined by mechanical testing, histology, histomorphometry, microradiograpic methods, and EDAX analysis. The ultimate shear strength for the HA-coated implants was significantly higher than in the glass-ceramic group. When these values were related to the histomorphometric measurements, the difference could be explained by the tissue-to-implant contact. The glass-ceramic showed direct contact only with nonmineralized, osteoid bone. The HA-coated implants, however, were integrated into the bone. The study indicated that porous glass-ceramic containing AlPO4 causes local osteomalacia and might not be suitable for clinical purposes.

Development of calcium phosphate based functional gradient bioceramics

A functional gradient bioceramic that can function gradually with respect to body tissue was studied by changing the composition of calcium phosphate gradually from the surface to the inside. Diamond powder was spread on the surface of compact hydroxyapatite (HA) powder and fired at 1280 degrees C under reduced pressure, followed by firing under atmospheric conditions. The sintered body thus prepared was dense and alpha-tricalcium phosphate (alpha-TCP: alpha-Ca3(PO4)2) was found on its surface. The content of alpha-TCP gradually decreased with increasing depth from the surface. In contrast, the content of HA increased with increasing depth from the surface. The gradient ratio of alpha-TCP and HA depends on the firing time for each condition, i.e. reduced or atmospheric pressure. The alpha-TCP formation was ascribed to the decomposition of HA due to the spontaneous combustion of diamond powder.

Two-year outcome of hydroxyapatite-coated prostheses. Two femoral prostheses retrieved at autopsy

We performed a histological study of the bone-implant interface on 2 human femurs implanted with a hydroxyapatite-coated self-locking stem for 2 years. Extensive bone formation with no intervening fibrous tissue was noted around the entire circumference of the 2 prostheses. The newly-formed bone had 2 morphotypes: an alveolar disposition with a continuous contact between bone and hydroxyapatite, and a digitiform one where distinct bony trabeculae were in contact with the ceramic coating or with the bone marrow. Partial or even total resorption of the hydroxyapatite coating was clearly identified, these areas showing bone in contact with the metal.

Strategies to affect bone remodeling: osteointegration

Osteointegration was defined as a "direct structural and functional connection between ordered living bone and the surface of a load-carrying implant." Although osteointegration was meant originally to describe a biologic fixation of the titanium dental implants, it is now used to describe the attachment of other materials used for dental and orthopedic applications as well. Analyses of material-bone interface showed that osteointegrated implants can have an intervening fibrous layer or direct bone apposition characterized by bone-bonding depending on the composition and surface properties of the biomaterial. This article reviews biologic (host tissue properties and response), biomechanical, and biomaterial factors affecting osteointegration. Biologic factors include the quality of bone. Biomaterial factors include the effect of material composition on the bone-material interface. Suggested areas for future research include determining the correlation between oral bone status and osteoporosis, the effect of gender, age, and endocrine status (e.g., osteoporosis) on implant success or failure, the effect of calcium phosphate coating composition and crystallinity on in vivo performance of implants, the factors contributing to accelerated osteointegration, and development of osteoinductive implants.

The shear strength and the failure mode of plasma-sprayed hydroxyapatite coating to bone: the effect of coating thickness

Plasma-sprayed hydroxyapatite coated (HAC) 50 and 200 microns thick on Ti-6Al-4V cylinders was transcortically implanted in the femora of canines to evaluate in detail the effect of coating thickness on the pushout shear strength and failure mode examined under scanning electron microscope after the periods of 4, 6, 8, and 12 weeks. The HAC coating exhibited higher shear strength at 50 microns than at 200 microns. Its failure mode was conclusively at or near the HAC-bone interface, and the slight attack of body fluid had not degraded the implant to the extent that failure occurred at the HAC-Ti alloy interface after 12 weeks of observation. For 200 microns-HAC, failure was found at the HAC-bond interface, inside the HAC lamellar splat layer and at the HAC-Ti alloy substrate interface, depending on the period of implantation. It was also deduced that the variation of failure mode of 200 microns-HAC with time could not be accounted for by the attack of body fluid alone; the degradation must be a synergetic adverse result of residual stress in the HAC and the attack of body fluid.

Hydroxyapatite ceramic coating for bone implant fixation. Mechanical and histological studies in dogs

The success of bone ingrowth into porous coated implants depends on several factors which can be separated into five main groups: implant related factors, such as design of implant, surface structure and pore characteristics. status of host bone bed, such as underlying disease (rheumatoid arthritis, osteoporosis), available bone stock, use of drugs and surgical technique. mechanical stabilization and loading conditions applied on the implant. adjuvant therapies such as bone grafting and HA coating which might enhance the amount of bone ingrowth. remodeling of periprosthetic bone. Once bone ingrowth has occurred, maintenance of bony anchorage depends on bone remodeling at the interface. The present series of studies were performed in order to investigate the effect of some of these factors on bone ingrowth in relation to hydroxyapatite (HA) and titanium alloy (Ti) coating when subjected to pathological and mechanical conditions mimicking the clinical situation. HA- and Ti-coated implants were inserted into the femoral condyles of mature dogs. The observation period ranged from 4 to 16 weeks, and the results were evaluated by mechanical push-out testing, histomorphometric analysis, polarized light microscopy, UV fluorescence microscopy, collagen analysis and transmission electron microscopy (microanalysis). There were no complications related to the operative procedures and all dogs were terminated according to the original time schedule. Host bone related factors were studied in the initial experiments. First, the effect of a gap between bone and implant was studied and compared with press-fit insertion. The HA-coating yielded superior effect on bone ingrowth compared to Ti in situations where the implant was surrounded by a gap and also where the implants were inserted in press-fit. Gaps of 1 mm and 2 mm around the implant were bridged by bone around HA implants whereas significantly less amounts of bone filled the gap around Ti implants. The gap-healing capacity of bone was increased even at a relatively great distance (400 microns) from the HA surface. This finding indicates that the osteoconductive effect of HA is not limited to the bone forming capacity on the surface of the implant. A positive gradient of newly formed bone was found towards the HA-coating, this gradient not being found towards the Ti-coating. In order to investigate the significance of arthritic bone changes (osteopenia) on fixation of porous coated implants we adopted the Carragheenin-induced gonarthritis model resulting in substantial bone loss as determined by CT-scanning.(ABSTRACT TRUNCATED AT 400 WORDS)

Biocompatibility studies on plasma polymerized interface materials encompassing both hydrophobic and hydrophilic surfaces

The biocompatibility of radiofrequency plasma polymerized films (less than 100 nm thick) deposited on biomedical polymer supports has been characterized by in vitro and in vivo methods. The polymer interface materials covered a wide range of elemental composition and surface properties, and were prepared from N-vinyl-2-pyrrolidone, gamma-butyrolactone, n-hexane, and hexamethyldisilazane (PPHMDSZ). The biocompatibility studies showed that the interface materials were noncytotoxic to mouse and human fibroblasts, as shown by morphologic evaluation, and by determination of extracellular LDH; and they did not stimulate interleukin-1-like production from human monocytes, as indicated by a thymocyte proliferation assay. The human fibroblast proliferation assay showed that three of the polymers supported cell growth at levels comparable to, or greater than, polymer controls, while the hydrophobic PPHMDSZ inhibited both cell attachment and proliferation. The response to subcutaneous implantation for all test materials was indicative of biocompatibility, with rapid resolution of the acute phase response and normal wound healing. The wide range of composition and surface properties for the plasma polymerized films evaluated in this study suggest that this general class of materials is likely to exhibit excellent biocompatibility.

Hydroxyapatite coating modifies implant membrane formation. Controlled micromotion studied in dogs

We studied the influence of controlled micromovements between bone and porous titanium alloy implants with and without hydroxyapatite coating. A dynamically loaded unstable device producing approximately 150-microns axial translation of knee implants during each gait cycle was developed. Stable implants served as controls. Matched stable and unstable implants with either porous titanium (Ti) or hydroxyapatite (HA) coating surrounded by a gap of 0.75 mm were inserted into the weight-bearing regions of the medial femoral condyles in 14 mature dogs. Histologic analysis after 4 weeks showed a fibrous membrane surrounding both types of implants subjected to micromovements, whereas various amounts of bone ingrowth was obtained in the stable implants. The membrane around unstable HA implants was thinner than that around unstable Ti implants. Islands of fibrocartilaginous tissue characterized the membrane around unstable HA implants, whereas fibrous connective tissue surrounded unstable Ti implants. The collagen concentration of the fibrous membranes was higher around unstable HA implants compared with Ti implants. Instability reduced the shear strength of the implants. However, the shear strength of unstable HA implants exceeded that of the Ti implants, both unstable and stable. The greatest shear strength was obtained by stable HA implants, i.e., tenfold greater than that of stable Ti implants. The gap-healing capacity around stable HA implants increased toward the HA surface, and was greater than that around Ti implants. Our study demonstrates that micromovements between bone and implant inhibit bone ingrowth and lead to the development of a fibrous membrane. The superior fixation of unstable HA implants compared with unstable Ti implants may be ascribed to the presence of fibrocartilage, a higher collagen concentration, and radiating orientation of collagen fibers in the membrane. The strongest mechanical anchorage and the greatest amount of bone ingrowth was obtained by stable implants coated with hydroxyapatite.

The mechanisms of passive dissolution of titanium in a model physiological environment

The surface chemistry, oxidation, and disolution kinetics of titanium were measured to establish the mechanisms of passive dissolution in physiological environments. Titanium thin films were immersed in 8.0 mM ethylenediamine-tetraacetic acid in simulated interstitial electrolyte (EDTA/SIE) and maintained at 37 degrees C, 10% O2, 5% CO2 and 7.2 pH for periods of time up to 3200 h (133 days). Two immersion schemes were employed: the integral sequentially determined the titanium released into a solution of accumulated dissolution products; and the differential continuously replenished the test solution. The solutions were analyzed for titanium by electrothermal atomic absorption spectrometry (EAAS), and the sample surfaces were analyzed by Auger electron spectroscopy (AES) and x-ray photoelectron spectroscopy (XPS) to determine oxide composition, stoichiometry, and thickness. Prior to immersion two types of hydroxyl (OH) groups were distinguished on the TiO2 surface. Upon immersion, the chemistry of the surface changed as a function of immersion: the presence of OH groups increased and P (nonelemental) was detected at the surface. The dissolution kinetics obeyed a two-phase logarithmic model, where the transition between phases occurred simultaneously with the adsorption of the P-containing species. The dissolution kinetics depended on surface reactions, electric field strength, and molecular diffusion. These mechanisms explain the observed dependence of dissolution kinetics on the properties of the surface oxide and solution ligands.

Hydration and preferential molecular adsorption on titanium in vitro

Surface sensitive spectroscopies, Auger electron and X-ray photoelectron (XPS), were used to determine changes in titanium oxide composition, oxide stoichiometry, and adsorbed surface species as a function of exposure to human serum in a balanced electrolyte (serum/SIE) and 8.0 mM ethylenediaminetetraacetic acid in a balanced electrolyte (EDTA/SIE) at 37 degrees C. Before immersion, the oxide was near ideal TiO2, covered by two types of hydroxyl groups: acidic OH(s) with oxygens doubly coordinated to titanium, and basic Ti-OH groups singly coordinated. After extended exposure to both solutions, up to 5000 h (ca. 208 d), the surface concentration of OH groups increased and non-elemental P appeared. The P LVV Auger transition and P 2p spectra indicated the peak positions were similar to reference phosphate compounds. The adsorbed phosphate species were presumed to be either Ti-H2PO4 or Ti-HPO4-. The XPS data suggested that a lipoprotein and/or glycolipid film was adsorbed to the specimens exposed to serum/SIE. Analysis of the preferential lipoprotein/glycolipid adsorption using electrostatic bonding concepts contributed to the refinement of the hierarchical model for the Ti-tissue interface. The salient features are that Ti metal is not in direct contact with the biological milieu, rather there is a gradual transition from the bulk metal, near-stoichiometric oxide, Ca and P substituted hydrated oxide, adsorbed lipoproteins and glycolipids, proteoglycans, collagen filaments and bundles to cells.