Bactericidal properties of a titanium-peroxy gel obtained from metallic titanium and hydrogen peroxide

Effect of a Nanostructured Titanium Surface on Gingival Cell Adhesion, Viability and Properties against P. gingivalis

OBJECTIVES

The transgingival part of titanium implants is either machined or polished. Cell-surface interactions as a result of nano-modified surfaces could help gingival fibroblast adhesion and support antibacterial properties by means of the physico-mechanical aspects of the surfaces. The aim of the present study was to determine how a nanocavity titanium surface affects the viability and adhesion of human gingival fibroblasts (HGF-1). Additionally, its properties against Porphyromonas gingivalis were tested.

MATERIAL AND METHODS

Two different specimens were evaluated: commercially available machined titanium discs (MD) and nanostructured discs (ND). To obtain ND, machined titanium discs with a diameter of 15 mm were etched with a 1:1 mixture of 98% H₂SO₄ and 30% H₂O₂ (piranha etching) for 5 h at room temperature. Surface topography characterization was performed via scanning electron microscopy (SEM) and atomic force microscopy (AFM). Samples were exposed to HGF-1 to assess the effect on cell viability and adhesion, which were compared between the two groups by means of MTT assay, immunofluorescence and flow cytometry. After incubation with P. gingivalis, antibacterial properties of MD and ND were determined by conventional culturing, live/dead staining and SEM. Results: The present study successfully created a nanostructured surface on commercially available machined titanium discs. The etching process created cavities with a 10-20 nm edge-to-edge diameter. MD and ND show similar adhesion forces equal to about 10-30 nN. The achieved nanostructuration reduced the cell alignment along machining structures and did not negatively affect the proliferation of gingival fibroblasts when compared to MD. No differences in the expression levels of both actin and vinculin proteins, after incubation on MD or ND, were observed. However, the novel ND surface failed to show antibacterial effects against P. gingivalis.

CONCLUSION

Antibacterial effects against P. gingivalis cannot be achieved with nanocavities within a range of 10-20 nm and based on the piranha etching procedure. The proliferation of HGF-1 and the expression levels and localization of the structural proteins actin and vinculin were not influenced by the surface nanostructuration. Further studies on the strength of the gingival cell adhesion should be performed in the future.

CLINICAL RELEVANCE

Since osseointegration is well investigated, mucointegration is an important part of future research and developments. Little is known about how nanostructures on the machined transgingival part of an implant could possibly influence the surrounding tissue. Targeting titanium surfaces with improved antimicrobial properties requires extensive preclinical basic research to gain clinical relevance.

Synthesis of Nanoporous TiO2 with the Use of Diluted Hydrogen Peroxide Solution and Its Application in Gas Sensing

The chemical routes of metal oxidation in presence of hydrogen peroxide solutions are tailor-made for the synthesis of biocompatible metal oxide surfaces with clean intermediate and end products, such as oxides, hydroxides, hydrogen and water. The hydrolysis of titanium in hydrogen peroxide solutions is particularly interesting for medical applications, forming micro- and nanoscale titania surfaces. In this paper, the content of the hydrolysis solution is revised, allowing the fabrication of gas sensor devices based on nanoporous titania. Nanopore and microcrack formations were discussed in detail by monitoring the structural changes on the thin film surface with field-emission scanning electron microscopy (FE-SEM). A stable rutile crystalline phase was detected by glancing incidence X-ray diffraction (GI-XRD) measurement after repetitive hydrothermal processes. Electrical conductance measurements were carried out at high temperatures (400–600 °C) under humid airflow (40% RH@20 °C) with the injection of various concentrations of a wide set of test compounds (C2H3N, CO, H2, NO2, C2H6O), to observe the sensing capabilities of the material. Furthermore, the humidity effects on the sensing properties toward H2, CO, and C2H6O have been discussed.

Thromboinflammation as bioactivity assessment of H2O2-alkali modified titanium surfaces

The release of growth factors from platelets, mediated by the coagulation and the complement system, plays an important role in the bone formation around implants. This study aimed at exploring the thromboinflammatory response of H₂O₂-alkali soaked commercially pure titanium grade 2 discs exposed to whole human blood, as a way to assess the bioactivity of the discs. Commercially pure titanium grade 2 discs were modified by soaking in H₂O₂, NaOH and Ca(OH)₂. The platelet aggregation, coagulation activation and complement activation was assessed by exposing the discs to fresh whole blood from human donors. The platelet aggregation was examined by a cell counter and the coagulation and complement activation were assessed by ELISA-measurements of the concentration of thrombin-antithrombin complex, C3a and terminal complement complex. The modified surface showed a statistically significant increased platelet aggregation, coagulation activation and complement activation compared to unexposed blood. The surface also showed a statistically significant increase of coagulation activation compared to PVC. The results of this study showed that the H₂O₂-alkali soaked surfaces induced a thromboinflammatory response that indicates that the surfaces are bioactive.

Antibacterial Surface Coating for Bone Scaffolds Based on the Dark Catalytic Effect of Titanium Dioxide

Biomaterials which promote tissue integration and resist microbial colonisation are required in bone tissue engineering to prevent biomaterial-associated infections. Surface modification of established materials for bone tissue engineering, such as TiO₂, have emerged as promising anti-infective strategies. Interestingly, the antibacterial activity of TiO₂ in the form of particles can be enhanced by combining it with H₂O₂, even in the absence of irradiation. However, it remains unknown whether TiO₂ surfaces elicit a similar effect. In this study, the antibacterial effect of porous TiO₂ scaffolds generated by the catalytic decomposition of H₂O₂ in the absence of light (dark catalysis) was investigated. Porous ceramic foams were fabricated and sol-gel coated for high catalytic activity. Degradation of methylene blue in the presence of 3% H₂O₂ increased by 80% for the sol-gel-coated surfaces. The degradation kinetics indicate that intermediate free radicals that form at the liquid-TiO₂ interface are responsible for the oxidative behavior of the surface. TiO₂ surfaces were further pretreated with 30% H₂O₂ for prolonged oxidative behavior. The biological response toward such surfaces was assessed in vitro. S. epidermidis biofilms formed on modified surfaces showed reduced viability compared to nonmodified surfaces. Further, the same surface modification showed no cytotoxic effects on MC3T3 preosteoblasts. However, the results from the conducted genotoxicity assay were inconclusive, and further studies are needed to exclude ROS-mediated DNA damage. To conclude, this study provides evidence that a simple surface modification based on the dark catalytic effect of TiO₂ can be used to create antibacterial surface properties for ceramic bone scaffolds.

Synergetic inactivation of Staphylococcus epidermidis and Streptococcus mutansin a TiO2/H2O2/UV system

TiO 2 photocatalysis can be used to kill surface adherent bacteria on biomaterials, and is particularly interesting for use with percutaneous implants and devices. Its efficiency and safety, however, depend on the activation energy required. This in vitro study investigates synergetic effects against the clinically relevant strains S. epidermidis and S. mutans when combining photocatalytic surfaces with H2O2. After 20 min exposure to 0.1 wt% H2O2 and UV light on TiO2 surfaces, viabilities of S. epidermidis and S. mutans were reduced by 99.7% and 98.9%, respectively. Without H2O2 the corresponding viability reduction was 86% for S. epidermidis and 65% for S. mutans. This study indicates that low concentrations of H2O2 can enhance the efficiency of photocatalytic TiO2 surfaces, which could potentially improve current techniques used for decontamination and debridement of TiO2 coated biomedical implants and devices.

Chemical nature of implant-derived titanium(IV) ions in synovial fluid

Previous investigations have indicated a deleterious leakage of Ti(III) and/or Ti(IV) species from Ti-Al-V alloy joint prostheses into adjacent tissue, synovium or synovial fluid (SF) in vivo. In view of the importance of the particular chemical nature of such complexes in determining their biological activity, we have employed high field proton (1H) NMR spectroscopy to "speciate" Ti(IV) in inflammatory SF. Treatment of osteoarthritic SF samples with increasing concentrations of Ti(IV) (0.10-1.03 mM [TiO(C2O4)2]2-) gave rise to a specific broadening of the citrate proton resonances, indicating that this bioavailable oxygen-donor ligand plays an important role in complexing implant-derived Ti(IV). 1H NMR analysis of Ti(IV)-loaded SF samples subsequently treated with a large excess of ascorbate (0.05 M) showed that this added Ti(IV) chelator was only poorly effective in removing this metal ion from Ti(IV)-citrate/Ti(IV)-oxycitrate complexes. The results obtained here provide evidence for complexation of the low-molecular-mass (non-protein-bound) fraction of implant-derived Ti(IV) by citrate in vivo.

Anti-inflammatory effects of a titanium-peroxy gel: role of oxygen metabolites and apoptosis

Polymorphonuclear neutrophils (PMN) are among the first inflammatory cells to arrive at an implant interface, where they encounter with the foreign material and may produce reactive oxygen species (ROS). During the interaction between titanium and ROS, titanium-peroxy (Ti-peroxy) compounds may be formed. We used a Ti-peroxy gel, made from titanium and hydrogen peroxide, to study the effects of Ti-peroxy compounds on PMN. In the absence of serum, the Ti-peroxy gel decreased the oxidative response of PMN to yeast and PMA and reduced PMN apoptosis without inducing necrosis. These effects could not be ascribed to the release of hydrogen peroxide from the Ti-peroxy gel, because a steady-state hydrogen peroxide producing system failed to mimic the effects of the gel. The effects were similarly unaffected when PMN were preincubated with beta(2)-integrin antibodies, questioning the involvement of adhesion molecules. Nevertheless, when a filter was used to separate the Ti-peroxy gel from the cells, the gel effect on PMN life span was abolished, pointing to a contact-dependent mechanism. In the presence of serum, the Ti-peroxy gel had no effect on the PMN oxidative response and life span, but appeared rather inert. In summary, this study demonstrates that the Ti-peroxy gel has potentially anti-inflammatory properties through a combined peroxide and physical contact effect, supporting the notion that interactions between titanium and inflammatory cells are responsible for the good performance of titanium in vivo.

Proteoglycans at the bone-implant interface

The widespread success of clinical implantology stems from bone's ability to form rigid, load-bearing connections to titanium and certain bioactive coatings. Adhesive biomolecules in the extracellular matrix are presumably responsible for much of the strength and stability of these junctures. Histochemical and spectroscopic analyses of retrievals have been supplemented by studies of osteoblastic cells cultured on implant materials and of the adsorption of biomolecules to titanium powder. These data have often been interpreted to suggest that proteoglycans permeate a thin, collagen-free zone at the most intimate contact points with implant surfaces. This conclusion has important implications for the development of surface modifications to enhance osseointegration. The evidence for proteoglycans at the interface, however, is somewhat less than compelling due to the lack of specificity of certain histochemical techniques and to possible sectioning artifacts. With this caveat in mind, we have devised a working model to explain certain observations of implant interfaces in light of the known physical and biological properties of bone proteoglycans. This model proposes that titanium surfaces accelerate osseointegration by causing the rapid degradation of a hyaluronan meshwork formed as part of the wound-healing response. It further suggests that the adhesive strength of the thin, collagen-free zone is provided by a bilayer of decorin proteoglycans held in tight association by their overlapping glycosaminoglycan chains.

Effects of Ca and H2O2 added to RPMI on the fretting corrosion of Ti6Al4V

Titanium and its alloys have demonstrated considerable success in various surgical procedures including orthopedic, dental, and cardiovascular surgery. However, particulate debris from corrosion and wear is present in a considerable quantity in tissue local to the implant. This study evaluated the effect of Ca, since it is present in both serum and bone, and H2O2, since it is produced through local inflammation, on the amount of titanium release. Four sets of Ti6Al4V plates and Ti6Al4V screws were used. Each set was designated to one of four solutions: RPMI (cell culture growth media), RPMI with CaCl2, RPMI with CaCO3, and RPMI with H2O2. A fretter was used to cause corrosion by creating micromotion between two screws and a two-hole plate of Ti6Al4V. After fretting for 72 h, weight loss of the plate and screws and the amount of Ti and vanadium (V) in solution was used to assess the amount of fretting corrosion which had occurred. Results of weight loss and Ti in solution indicated that the presence of H2O2 increased the amount of particulate debris produced in RPMI as compared with RPMI alone. The addition of CaCl2 to RPMI also increased both weight loss and Ti in solution compared with RPMI alone. The addition of CaCO2, however, did not give values significantly different from RPMI alone. Comparison of weight loss and Ti in solution indicated that the increase in fretting corrosion was not different between RPMI with CaCl2 and RPMI with H2O2. The particulate wear debris from the four solutions was black in color and the size of the particulate produced was compared using a Coulter Multisizer. The results indicated that particles produced in the four solutions were not different, with mean values between 1.324 and 1.100 microns, and they were similar in size to the particulate found in tissues surrounding failed total hip replacements. In order to better understand the role of Ca in the fretting corrosion of Ti6Al4V, energy dispersive x-ray analysis (EDXA) using SEM was used to determine elemental composition of one countersink surface of a plate which had been run four times in RPMI with CaCl2. The presence of Ca in the bulk was not significant (% composition < 0.5%). However, Ca was present in two surface particles which were examined at a magnification of 55,000, with a Ca% composition of 63.2% and 19.2%. While results from this study indicate that both soluble Ca(CaCl2) and H2O2 increase the fretting corrosion of Ti6Al4V, the insoluble form of Ca, which would be found in bone and hydroxyapatite, has no effect. These data indicate that it is important to specify the media used in corrosion, dissolution, and elution experiments.

Effect of titanium on selected oral bacterial species in vitro

Titanium granules were tested for their antibacterial effect on strains of Streptococcus sanguis, Streptococcus mitis, Actinomyces naeslundii, Haemophilus parainfluenzae, Fusobacterium spp. and Prevotella intermedia in comparison with amalgam and two of its components, copper and tin. Glass beads were used as controls. The number of viable bacteria was estimated in samples exposed to the various materials for 1, 3, 6 and 24 h, respectively, and the viable counts were related to the baseline value. Titanium showed low antibacterial effect on the species tested. Copper and amalgam showed an expressed toxicity to all species and differed significantly from titanium and glass particles. Gram positive Streptococcus spp. and A. naeslundii showed a lower susceptibility to the metals than the Gram negative species. The antibacterial effect of copper and amalgam test particles on S. sanguis and P. intermedia was significantly decreased in the presence of serum. This study showed that some metals have a toxic effect in vitro on oral bacteria, a fact that may play a role in plaque formation when these materials are used for dental restorations. Titanium did not have a similar antibacterial effect.

Infection adjacent to titanium and bone cement implants: an experimental study in rabbits

A pure titanium cylinder or a piece of bone cement was implanted in each upper tibial metaphysis of 20 rabbits. After 4 months radiograms were taken and 10(4), 10(6), or 10(8) Staphylococcus aureus were injected into each leg through central holes in the implants in three groups of animals. Four weeks later new radiograms, bacteriological and histological biopsies were obtained. Three animals died before the end of the experiment. In animals which received 10(6) or 10(8) S. aureus radiographic signs of infection were found in 11/22 legs with both titanium and bone cement implants. No radiolucent zones developed around the implants. Bacteriological cultures from bone close to the implants were negative in all legs with titanium implants and positive in four legs with cement implants. Seven cultures were negative in spite of radiographic changes. It is concluded that after a proper time for wound healing the bone around unloaded implants of both titanium and bone cement is fairly resistant to infection. In some cases, healing of an infection in the surrounding bone seems possible.

Human cell culture studies with dental metallic materials

The compatibility of cast non-alloyed titanium and eight dental castable alloys (precious, low noble, non-precious) was determined by means of human primary oral fibroblasts derived from the attached gingiva and the periodontium. Furthermore, cast non-alloyed Ti was tested in a human permanent cell culture (MOLT 4). All investigated metallic materials showed cytotoxic properties in primary cultures. The differences in cytotoxicity between the various materials were statistically significant. The best results were found for one noble alloy and for non-alloyed titanium, whereas all non-precious alloys almost completely inhibited cell growth. The cytotoxic potential of the investigated materials might contribute to the irritating effect of dental cast restorations adjacent to the gingiva and the periodontium.

Physico-chemical considerations of titanium as a biomaterial

Physico-chemical properties of titanium are discussed. Special attention is paid to those of amorphous TiO 2 that contact tissues in vivo. In aqueous environments TiO 2. (aq) has low ion-formation tendency and low reactivity with macromolecules. This is accompanied by low toxicity. Titanium does not facilitate reactive oxygen radical generation during inflammatory conditions as observed in in-vitro experiments. The outermost layers of the oxide are in the Ti(IV) oxidation state, although using electron spin resonance (ESR) techniques, formation of Ti(III) is observed at atmospheric conditions. The impact of similarities between water and TiO 2 is speculated upon, and the physico-chemical properties of titanium are tentatively linked to some in-vivo consequences.