The bone-titanium interface in vitro

Reactivity of Titanium Dental Implant Surfaces in Simulated Body Fluid

Osseointegration of titanium (Ti) implants in bone is crucial for dental implant treatment. Bacterial challenge possibly leading to peri-implantitis threatens long-term success. For the improvement of osseointegration, an understanding of materials and tissue intervention is needed. This in vitro study analyzed changes of different implant surfaces exposed to simulated body fluid (SBF). Implants were analyzed by scanning electron microscopy/X-ray photoelectron spectroscopy. Supernatants (SNs) were assessed using inductively coupled plasma-mass spectrometry (ICP-MS). Additional calcium (Ca) and phosphate (P) crystals developed (Hank's buffered salt solution (HBSS)) on implants with layered surfaces. ICP of SN demonstrated a decreased Ca/P ratio. After incubation with human serum (HS), layers appeared flattened containing <1% Ca/P. The etched/machined implants showed the formation of a surface transformation layer or coating consisting of crystalline Ca/P precipitations and a decrease in the Ca/P ratio in the supernatant. Incubation in HS induced noncrystalline coverage, and increased Ti/Ca/P was detected in supernatants. HBSS induced crystals on surfaces of modified implants and crystalline covers on nonmodified implants containing Ca/P. The serum did not show the development of HA-like structures but showed dissolving effects. Titanium surfaces show completely altered behavior when incubated in serum-containing SBF.

Antibacterial Property and Biocompatibility of Silver, Copper, and Zinc in Titanium Dioxide Layers Incorporated by One-Step Micro-Arc Oxidation: A Review

Titanium (Ti) and its alloys are commonly used in medical devices. However, biomaterial-associated infections such as peri-implantitis and prosthetic joint infections are devastating and threatening complications for patients, dentists, and orthopedists and are easily developed on titanium surfaces. Therefore, this review focuses on the formation of biofilms on implant surfaces, which is the main cause of infections, and one-step micro-arc oxidation (MAO) as a coating technology that can be expected to prevent infections due to the implant. Many researchers have provided sufficient data to prove the efficacy of MAO for preventing the initial stages of biofilm formation on implant surfaces. Silver (Ag), copper (Cu), and zinc (Zn) are well used and are incorporated into the Ti surface by MAO. In this review, the antibacterial properties, cytotoxicity, and durability of these elements on the Ti surface incorporated by one-step MAO will be summarized. This review is aimed at enhancing the importance of the quantitative control of Ag, Cu, and Zn for their use in implant surfaces and the significance of the biodegradation behavior of these elements for the development of antibacterial properties.

Titanium-Tissue Interface Reaction and Its Control With Surface Treatment

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

A New Chemical Etching Process to Improve Endosseous Implant Osseointegration: In Vitro Evaluation on Human Osteoblast-Like Cells

The development of novel mechanical and chemical surface modification treatments to improve the osteointegration properties of osseointegrated dental implants is nowadays a topic of great applicative interest. The aim of the present study was to analyse the role of surface topography and chemistry of four different surface treatments on titanium by an in vitro human osteosarcoma immortalised cell line model (MG63). The surface treatments considered were (a) machined titanium, (b) chemical etched on machined titanium, (c) sandblasted titanium and (d) chemical etching on sandblasted titanium.

Chemical and physical surface properties were investigated by Scanning Electron Microscopy, Thin Film-X ray Diffraction and by Laser Profilometry. The in vitro biological response was characterised using the MG63 cell line by elution cytotoxicity tests, cell morphology, adhesion, proliferation activity, alkaline phosphatase activity and total DNA content in order to show a relationship between osteoblast response and surface features.

Chemical and physical characterisation showed that the considered treatments differently modify the surface morphology in the micro and sub-micrometric scale. Although some differences in alkaline phosphatase activity were observed in the biological characterisation, depending on the specific material's surface finishing, the results showed that cells were well responsive on all the tested materials and grew and differentiated with similar proliferation rate.

Formation of hydroxyapatite on titanium implants in vivo precedes bone-formation during healing

The bone material interface has been an area of intense study over many decades, where studies of the healing process ranging from simple mineral deposition in vitro to actual healing in vivo have given important clues to the importance of calcium minerals in the bone/implant interface. Here, the authors use a combination of in vitro cell culture methods and in vivo implantation to study how the role of the spontaneously formed hydroxyapatite layer on Ti-implants for the in vivo-healing into the bone tissue of rat tibia. Initial experiments were made in reduced systems by incubation of TiO₂ in cell culture medium and analysis by time of flight secondary ion mass spectrometry (ToF-SIMS) and energy-dispersive x-ray spectroscopy followed by subsequent exposure of human embryological stem cells analyzed by von Kossa staining and environmental scanning electron microsopy. In vivo studies of the bone-material interface was analyzed by ToF-SIMS depth profiling using both C₆₀⁺ ions as well as a gas cluster ion source beam, Ar₁₅₀₀⁺ as sputter source. The low ion yield of the Ar₁₅₀₀⁺ for inorganics allowed the inorganic/organic interface of the implant to be studied avoiding the erosion of the inorganic materials caused by the conventional C₆₀⁺ beam.

SEM imaging of the stimulatory response of RAW264.7 cells against Porphyromonas gingivalis using a simple technique employing new conductive materials

In the medical biology, it is essential to understand not only biological morphology but also the interaction between biological materials and agents. To study these, electron microscopy (EM) is often utilized. However, sample preparation techniques for EM require a high level of skill and a considerable time. Here, we conducted EM using a simple technique employing a conductive liquid, BEL-1, and compared the results with another simple technique employing an ionic liquid, 1-butyl-3-methylimidazolium tetrafluoroborate ([BMIM][BF₄ ]). BEL-1 was used for sample pretreatment, and the morphologies of the mouse RAW 264.7 cell line, Porphyromonas gingivalis, and the RAW 264.7 cell line were stimulated via co-incubation with P. gingivalis and observed using field emission scanning EM (FE-SEM). In the present study, the inflammation-induced system of P. gingivalis was successfully established. FE-SEM results revealed the fine morphology of the RAW 264.7 cell line and P. gingivalis and confirmed a morphological change in the RAW 264.7 cell line caused by P. gingivalis stimulation. Using the developed sample preparation technique employing BEL-1, high-contrast and high-resolution observations of deformable biological materials were conducted without any difficulty or the necessity for complicated technique. This morphological information and the developed techniques can contribute to reveal the interaction between biological materials and agents and thereby accelerate drug formulation and disease treatment. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1280-1285, 2018.

Mineralization at Titanium Surfaces is a Two-Step Process

Mapping the initial reaction of implants with blood or cell culture medium is important for the understanding of the healing process in bone. In the present study, the formation of low crystalline carbonated hydroxyapatite (CHA) onto commercially pure titanium (Ti) implants from cell culture medium and blood, is described as an early event in bone healing at implants. The Ti-implants were incubated with cell culture medium (DMEM) or whole blood and the surface concentration of Ca, P and HA was analyzed by XPS, EDX and Tof-SIMS. After incubation with DMEM for 16 h and 72 h, EDX and XPS analysis showed stable levels of Ca and P on the Ti-surface. ESEM images showed an even distribution of Ca and P. Further analysis of the XPS results indicated that CHA was formed at the implants. Analysis with ToF-SIMS yielded high m.w. fragments of HA, such as Ca₂PO4 at m/z 174.9 and Ca₃PO₅ at m/z 230.8, as secondary ions at the Ti-surfaces. Analysis of implants incubated in blood for 16 h, with ToF-SIMS, showed initial formation of CHA yielding CaOH as secondary ion. The results indicate that early mineralization at Ti-surfaces is an important step in the healing of implants into bone.

Ultrastructure of the Mineralized Tissue/Calcium Phosphate Interface in Vitro

An in vitro rat bone marrow cell (RBMC) system was used to examine the structure of the interface established between calcium phosphates (Ca-P) and mineralized tissue. The Ca-P used, varied either in chemical structure or crystallinity. Therefore, not only the influence of chemical composition, but also the effect of degradation of Ca-P ceramics could be studied. The interfaces were examined with scanning and transmission electron microscopy (SEM and TEM).

SEM showed that deposition of mineralized extracellular matrix on the different materials examined varied both in time and morphology. Mineralization started with the formation of afibrillar globules with which collagen fibres became integrated. With TEM, three distinctly different interfacial structural arrangements were observed which were dependent on the presence or absence of an electron dense layer and/or an amorphous zone. The former was considered to be at least partially caused by protein adsorption, which would precede biological mineralization events, whereas the latter was considered to represent partial degradation of the ceramic surfaces.

The results of this study showed that interfacial reactions were not only influenced by the chemical structure, but also by the crystallinity of Ca-P ceramics. Thus, characterisation of Ca-P implant materials is of critical importance in achieving a better understanding of the phenomena that occur at the bone-biomaterial interface.

UV-killed Staphylococcus aureus enhances adhesion and differentiation of osteoblasts on bone-associated biomaterials

Titanium alloys (Ti) are the preferred material for orthopedic applications. However, very often, these metallic implants loosen over a long period and mandate revision surgery. For implant success, osteoblasts must adhere to the implant surface and deposit a mineralized extracellular matrix (ECM). Here, we utilized UV-killed Staphylococcus aureus as a novel osteoconductive coating for Ti surfaces. S. aureus expresses surface adhesins capable of binding to bone and biomaterials directly. Furthermore, interaction of S. aureus with osteoblasts activates growth factor-related pathways that potentiate osteogenesis. Although UV-killed S. aureus cells retain their bone-adhesive ability, they do not stimulate significant immune modulator expression. All of the abovementioned properties were utilized for a novel implant coating so as to promote osteoblast recruitment and subsequent cell functions on the bone-implant interface. In this study, osteoblast adhesion, proliferation, and mineralized ECM synthesis were measured on Ti surfaces coated with fibronectin with and without UV-killed bacteria. Osteoblast adhesion was enhanced on Ti alloy surfaces coated with bacteria compared to uncoated surfaces, while cell proliferation was sustained comparably on both surfaces. Osteoblast markers such as collagen, osteocalcin, alkaline phosphatase activity, and mineralized nodule formation were increased on Ti alloy coated with bacteria compared to uncoated surfaces.

The effect of titanium particles on rat bone marrow stem cells in vitro

In arthroplasty prostheses and dental implant, titanium is an excellent biocompatible material for its advanced physical qualities and better biocompatibility. However, it was reported that high ratios of titanium particles can be liberated due to the continual loading or articulation cycles of the implant. Because bone marrow stem cells (BMSCs) located adjacent to the implant are critical contributors to osseous tissue integrity, this study researched the influence of titanium particles on BMSCs' viability, proliferation, and cell skeleton. In addition, the phagocytosis of titanium particles by BMSCs and expression of tumor suppressor protein p53 were also examined. It was found that exposure of BMSCs to titanium particles disrupted their viability and proliferation in vitro, which may due to the phagocytosis of titanium particles by BMSCs. Moreover, cell skeleton was destroyed and the p53 protein level increased as the titanium particles were added. For these results, it was concluded that titanium particles had a cytotoxic effect on BMSCs in vitro and would inhibit the bone formation around the implant.

Effect of pH on the interaction between zwitterions and titanium oxide

The isoelectric points (IEPs) of two zwitterions, glycine and both-terminals-terminated poly(ethylene glycol) (NH(2)-PEG-COOH), were determined from the titration curves, and the thicknesses of zwitterion layers immobilized on titanium (Ti) with immersion and electrodeposition at various pH based on IEPs were evaluated with ellipsometry to investigate the effect of pH and the immobilization technique on the interactions between the zwitterions and the Ti surface. From the titration curves, pK(1), pK(2), and the IEP of glycine were determined as 2.8, 8.9, and 5.9, respectively, and pK(1), pK(2), and the IEP of NH(2)-PEG-COOH were determined as 2.1, 11.7, and 6.9, respectively. At a certain specific pH, (+)H(3)N-CH(2)-COO(-) or (+)H(3)N-PEG-COO(-) was formed by hydrolysis of glycine or NH(2)-PEG-COOH. In addition, the Ti surface was negatively charged at this pH. As a result, for immersion, the electrostatic reactivity between terminal groups of zwitterions and hydroxyl groups on the Ti surface was the highest and the thickness of the immobilized layer was significantly the largest at pH 12. For electrodeposition, glycine, with its lower molecular weight, was more easily attracted to the Ti surface than NH(2)-PEG-COOH, which has a higher molecular weight, while the thickness of the immobilized layer was the greatest at pH 12 in both zwitterions.

Histomorphometric evaluation of implants coated with enamel or dentine derived fluoride-substituted apatite

OBJECTIVES

The aim of this study was to compare osseous healing characteristics of titanium implants coated with enamel-derived fluoride-substituted apatite (EFSA) or dentin-derived fluoride-substituted apatite (DFSA).

METHODS

Fluoride-substituted apatite was derived from extracted human teeth with calcination method at 850 degrees C. DFSA and EFSA were separated and carefully ground with a blade grinder. Twenty-four titanium implants were prepared from a 99.99% pure titanium bar. EFSA and DFSA powders were sprayed separately on implants. As control group, unsprayed and sandblasted pure titanium implants were used. Eight adult rams were used in the study. One EFSA coated, 1 DFSA coated and 1 control implants were placed into right tibia of each rams. The rams were sacrificed after 6 months of healing. Undecalcified sections were prepared according to Donath's method and histomorphometric evaluation of implants was made.

RESULTS

The mean bone contact percentage of DFSA-coated, EFSA-coated and control implants was 89.88%+/-2.34, 70.19%+/-13.11 and 53.12%+/-5.76 respectively. This study suggests that DFSA-coated implants achieved better bone contact than EFSA-coated implants (P<0.05). Also study groups presented better bone contact than control group (P<0.05).

CONCLUSIONS

The results of this study show that although DFSA-coated implants achieved better bone contact, both DFSA and EFSA can be considered as appropriate coating materials.

Formation of calcium phosphates on titanium implants with four different bioactive surface preparations. An in vitro study

The aim of the present study was to compare the nucleating and growing behaviour on four types of bioactive surfaces by using the simulated body fluid (SBF) model. Titanium discs were blasted and then prepared by alkali and heat treatment, anodic oxidation, fluoridation, or hydroxyapatite coating. The discs were immersed in SBF for 1, 2, 4 and 6 weeks. Calcium phosphates were found on all specimens, as analysed with scanning electron microscopy/energy dispersive X-ray analysis (SEM/EDX). After 1 and 2 weeks of SBF immersion more titanium was accessible with SEM/EDX on the blasted surfaces than the four bioactive surface types, indicating a difference in coverage by calcium phosphates. The Ca/P mean ratio of the surfaces was approximately 1.5 after 1 week, in contrast to the fluoridated specimens which displayed a Ca/P mean ratio of approximately 2. Powder X-ray diffraction (P-XRD) analyses showed the presence of hydroxyapatite on all types of surfaces after 4 and 6 weeks of immersion. The samples immersed for 6 weeks showed a higher degree of crystallinity than the samples immersed for 4 weeks. In conclusion, differences appeared at the early SBF immersion times of 1 and 2 weeks between controls and bioactive surface types, as well as between different bioactive surface types.

Influence of different implant surfaces on peri-implant osteogenesis: histomorphometric analysis in sheep

BACKGROUND

The present study investigated peri-implant osteogenesis and implant biologic fixation in different zirconia sandblasted endosseous titanium surfaces (SLA-60 and SLA-120) and a turned titanium surface (T) 2 and 4 weeks after surgery.

METHODS

Seventy-two implant screws were implanted in tibia of six sheep. Histologic sections of implants (2 and 4 weeks after surgery) were analyzed with light microscopy for histomorphometric analysis of bone-to-implant contact (BIC), bone ingrowth (BI), and bone surface (BS/BV). Histologic blocks were used to perform bone microhardness studies next to the implants. Some implants were also observed with scanning electron microscopy (SEM) and transmission electron microscopy (TEM).

RESULTS

In general, the highest values of BIC, BI, BS/BV, and Vickers hardness number (HV) were measured in SLA-60 samples, followed by SLA-120 and T implants. Two weeks after surgery, all the implants appeared biologically fixed by a newly formed woven bone arranged in thin bone trabeculae and filling the gap between implant and host bone. Four weeks after implantation, the thickness of the woven bone trabeculae had increased, especially around the SLA-60 and SLA-120 implants by a gradual deposition of parallel-fiber bone.

CONCLUSIONS

Our results suggest that, in the early period of peri-implant healing, the implant surface morphology that seemed to influence the increase of peri-implant osteogenesis, bone turnover, and peri-implant bone maturation was SLA-60. We suggest that this surface, characterized by moderately deep titanium cavities very similar to the osteocyte lacunae, could act as a microscopic scaffold for mesenchymal and/or osteoblast-like cells adhesion.

Cytocompatibility and electrochemical properties of Ti–Au alloys for biomedical applications

The purpose of this study was to develop Ti-Au alloys with a higher resistant to corrosion, better biocompatibility, and better mechanical properties than the commercially pure titanium and its alloys. Ti-Au alloys were designed with a gold content that ranged from 0 to 5.0 at % in steps of 1.0 at %. Properties of the alloys including chemical composition, microstructure, phase, hardness, electrochemical properties, and the cytotoxicity were investigated. Only the alpha phase existed in the Ti-Au alloys. The addition of gold to the titanium decreased the alpha to beta transformation temperature. The acicular alpha phase became thinner and the hardness value increased with increasing gold content. In the electrochemical tests, Ti-Au alloys had a higher resistant to corrosion than had pure titanium and did not exhibit pitting corrosion in artificial saliva. The cytotoxicities of the Ti-Au alloys were similar to that of pure titanium. Therefore, Ti-Au alloys could be used as biomaterials in the medical and dental fields.

Influence of surface pretreatment of titanium- and cobalt-based biomaterials on covalent immobilization of fibrillar collagen

Collagen type-I is a major component of the extracellular matrix of most tissues and it is increasingly utilized for surface engineering of biomaterials to accelerate receptor-mediated cell adhesion. In the present study, coatings with layers of fibrillar type-I collagen were prepared on titanium, titanium alloy, and cobalt alloy to improve initial osteoblast adhesion and implant-tissue integration. To suppress the quick in vivo degradation rate of collagen the deposited layers were covalently immobilized at the metal surfaces as well as chemically cross-linked. The application of different oxidation techniques to the metallic substrates resulted in surfaces with varying hydroxyl group contents, which directly influenced the amount of immobilized silane coupling agents. It was found that a high density of surface-bound coupling agents increased the stability of the covalently linked collagen layers. After coating of metallic biomaterials with a cross-linked collagen layer, an improved cellular response of human osteoblast-like cells (MG-63) in vitro could be recognized.

Osteogenic potential of cultured bone/ceramic construct: comparison with marrow mesenchymal cell/ceramic composite

Osteogenesis occurs in porous hydroxyapatite (HA) when porous HA blocks combined with marrow mesenchymal cells are grafted in vivo. In vitro bone formation occurs in HA pores when HA combined with marrow cells is cultured in osteogenic medium containing dexamethasone. This cultured bone/HA construct possesses higher osteogenic ability when it is grafted in vivo. In the present study, we compared the osteogenic potential of a cultured bone/HA construct with that of a marrow mesenchymal cell/HA composite. Marrow cells were obtained from the femoral bone shaft of 7-week-old, male Fischer 344 rats and were cultured in T-75 flasks. Cells were concentrated, then frozen and stored in liquid nitrogen for 6 months. The cryopreserved cells were then thawed and prepared for subculture in porous HA (5 x 5 x 5 mm, Interpore 500) and for implantation with porous HA. After 2 weeks of subculture, three cultured bone/HA constructs were separately implanted in the right side of the back of each syngeneic 7-week-old male Fischer rat, and three thawed cell/HA composites (without subculture) were separately implanted in the left side. These implants were harvested at 2 or 4 weeks postimplantation, and prepared for histological, biochemical, and genetic analysis. Alkaline phosphatase activity and osteocalcin content of cultured bone/HA constructs were much higher than those of the cell/HA composites at 2 and 4 weeks postimplantation. Histological examination and gene expression data agreed with these findings. The culture technique discussed herein should facilitate the development of biosynthetic bone implants with higher osteogenic capacity.

Physical and biological characterizations of a novel multiphase anodic spark deposition coating to enhance implant osseointegration

The present study assessed in vitro the short-term cellular response to surface physico-chemical properties of a new, purposed bioactive surface treatment called BioSpark performed on simply machined and on sand-blasted titanium. Material characterisation was carried out using scanning electron microscopy, energy dispersion spectroscopy, laser profilometry, and thin film X-ray diffraction. The in vitro biological study showed a suitable cellular response with adhesion and spreading level comparable for all the tested specimens. The proliferation analysis demonstrated that all the surfaces successfully supported cellular colonisation; in particular, higher cellular proliferation activity was observed on the BioSpark-treated materials, with values higher than machined titanium. The results suggest that the BioSpark treatment represents a smart way to enhance osteoblastic cellular colonisation and thus improve osteointegration processes of machined and sandblasted titanium for orthopaedic and dental implants.

Osteoblasts generate harder, stiffer, and more delamination-resistant mineralized tissue on titanium than on polystyrene, associated with distinct tissue micro- and ultrastructure

This study revealed that osteoblasts generate harder, stiffer, and more delamination-resistant mineralized tissue on titanium than on the tissue culture polystyrene, associated with modulated gene expression, uniform mineralization, well-crystallized interfacial calcium-phosphate layer, and intensive collagen deposition. Knowledge of this titanium-induced alteration of osteogenic potential leading to enhanced intrinsic biomechanical properties of mineralized tissue provides novel opportunities and implications for understanding and improving bone-titanium integration and engineering physiomechanically tolerant bone.

INTRODUCTION

Bone-titanium integration is a biological phenomenon characterized by continuous generation and preservation of peri-implant bone and serves as endosseous anchors against endogenous and exogenous loading, of which mechanisms are poorly understood. This study determines the intrinsic biomechanical properties and interfacial strength of cultured mineralized tissue on titanium and characterizes the tissue structure as possible contributing factors in biomechanical modulation.

MATERIALS AND METHODS

Rat bone marrow-derived osteoblastic cells were cultured either on a tissue culture-grade polystyrene dish or titanium-coated polystyrene dish having comparable surface topography. Nano-indentation and nano-scratch tests were undertaken on mineralized tissues cultured for 28 days to evaluate its hardness, elastic modulus, and critical load (force required to delaminate tissue). Gene expression was analyzed using RT-PCR. The tissue structural properties were examined by scanning electron microscopy (SEM), collagen colorimetry and localization with Sirius red stain, mineral quantification, and localization with von Kossa stain and transmission electron microscopy (TEM).

RESULTS

Hardness and elastic modulus of mineralized tissue on titanium were three and two times greater, respectively, than those on the polystyrene. Three times greater force was required to delaminate the tissue on titanium than that on the polystyrene. SEM of the polystyrene culture displayed a porous structure consisting of fibrous and globular components, whereas the titanium tissue culture appeared to be uniformly solid. Cell proliferation was remarkably reduced on titanium. Microscopic observations revealed that the mineralized tissue on titanium was composed of uniform collagen-supported mineralization from the titanium interface to the outer surface, with intensive collagen deposition at tissue-titanium interface. In contrast, tissue on the polystyrene was characterized by collagen-deficient mineralization at the polystyrene interface and calcium-free collagenous matrix formation in the outer tissue area. Such characteristic microstructure of titanium-associated tissue was corresponded with upregulated gene expression of collagen I and III, osteopontin, and osteocalcin mRNA. Cross-sectional TEM revealed the apposition of a high-contrast and well-crystallized calcium phosphate layer at the titanium interface but not at the polystyrene interface.

CONCLUSIONS

Culturing osteoblasts on titanium, compared with polystyrene, enhances the hardness, elastic modulus, and interfacial strength of mineralized tissue to a higher degree. Titanium per se possesses an ability to alter cellular phenotypes and tissue micro- and ultrastructure that result in enhanced intrinsic biomechanical properties of mineralized tissue.

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.

Maxillary sinus augmentation with Bio-Oss particles: a light, scanning, and transmission electron microscopy study in man

Biological interactions occurring at the bone-biomaterial interface are critical for long-term clinical success. Bio-Oss is a deproteinized, sterilized bovine bone that has been extensively used in bone regeneration procedures. The aim of the present study was a comparative light, scanning, and electron microscopy evaluation of the interface between Bio-Oss and bone in specimens retrieved after sinus augmentation procedures. Under light microscopy, most of the particles were surrounded by newly formed bone, while in a few cases, at the interface of some particles it was possible to observe marrow spaces and biological fluids. Under scanning electron microscopy, in most cases, the particle perimeter appeared lined by bone that was tightly adherent to the biomaterial surface. Transmission electron microscopy showed that the bone tissue around the biomaterial showed all the phases of the bone healing process. In some areas, randomly organized collagen fibers were present, while in other areas, newly formed compact bone was present. In the first bone lamella collagen fibers contacting the Bio-Oss surface were oriented at 243.73 +/- 7.12 degrees (mean +/- SD), while in the rest of the lamella they were oriented at 288.05 +/- 4.86 degrees (mean +/- SD) with a statistically significant difference of 44.32 degrees (p < 0.001). In the same areas the intensity of gray value was 172.56 +/- 18.15 (mean +/- SD) near the biomaterial surface and 158.71 +/- 21.95 (mean +/- SD) in the other part of the lamella with an unstatistically significant difference of 13.79 (p = 0.071). At the bone-biomaterial interface there was also an electron-dense layer similar to cement lines. This layer had a variable morphology being, in some areas, a thin line, and in other areas, a thick irregular band. The analyses showed that Bio-Oss particles do not interfere with the normal osseous healing process after sinus lift procedures and promote new bone formation. In conclusion, this study serves as a better understanding of the morphologic characteristics of Bio-Oss and its interaction with the surrounding tissues.

In Vitro Bone Formation Induced by Immunosuppressive Agent Tacrolimus Hydrate (FK506)

When rat bone marrow cells were cultured with an immunosuppressive agent, tacrolimus hydrate (FK506), as well as with beta-glycerophosphate and vitamin C, numerous cell clusters became positive for alkaline phosphatase activity. Scanning electron microscopy revealed mineralized bone matrix in the cell clusters, which was identical to that of living bone. High levels of alkaline phosphatase (ALP), indicating osteoblastic activity, and high levels of osteocalcin (Oc) and calcium were found in the mature bone matrix of the cultures. There was significantly increased expression of mRNAs for ALP and Oc. These results indicate that the cultures contained both bone matrix and high osteoblastic activity, suggesting that FK506 induces ossification.

Enhanced mineralized tissue adhesion to titanium over polystyrene assessed by the nano-scratch test

The critical load determined by the scratch test is regarded to be a representative measure of coating adhesion in the field of engineering. This study aimed to evaluate the method for its usefulness for assessing the mineralized tissue-titanium interface strength. Osteoblastic cells derived from rat bone marrow were cultured on polystyrene, titanium-coated polystyrene, and titanium disks with either a machined or dual-acid etched surface. Nano-scratch testing was performed on mineralized tissue specimens at culture day 28. The scratch path was monitored by light microscopy until complete delamination of mineralized tissue from the substrate occurred, and the required force was recorded as the critical load. Energy-dispersive spectroscopic analysis was used to verify the delamination. The mean critical load values (+/- standard deviations) were as follows: polystyrene 31 mN (+/-1), titanium-coated polystyrene 67 mN (+/-4), machined titanium 76 mN (+/-4), DAE titanium 107 mN (+/-3), with statistical differences (P < 0.05; ANOVA). No elemental calcium and phosphorous were observed in the delaminated areas. The nano-scratch test applied to cultured mineralized tissue differentiated the critical load from various culture conditions: polystyrene vs. titanium; titanium with different surface topographies. Culturing mineralized tissue on titanium, especially on roughened surfaces, increased the tissue critical load. The nano-scratch test may be useful to evaluate mineralized tissue adhesion properties in titanium cultures.

Corrosion resistance of titanium-silver alloys in an artificial saliva containing fluoride ions

Dental gels and rinses for caries prophylactic contain fluoride at concentrations ranging from 0.1 to 1%. In addition, many types of fluoride-releasing materials have been used in dental applications. The purpose of the study was to investigate the addition effect of fluoride into artificial saliva on the corrosion resistance of pure titanium and titanium-silver alloys. Titanium and titanium-silver alloys were arc melted, homogenized at 950 degrees C for 72 h, hot rolled, and solution heat treated and quenched. In order to investigate the effect of the fluoride ions on the corrosion resistance, potentiodynamic polarization testing, potentiostatic testing, and open-circuit potential measurements were performed in plain artificial saliva and 0.1 and 1% NaF-added artificial saliva. The passive current densities of titanium and titanium-silver alloys increased with increasing fluoride-ion concentration. Ti2.0Ag and Ti3.0Ag exhibited a low current density relatively and showed a stable behavior compared to titanium. The open-circuit potential of titanium decreased and current density at 250 mV (SCE) potentiostatic testing reacted sensitively with increasing fluoride concentration. On the other hand, the open-circuit potential of titanium-silver alloys with a high silver content (3.0-4.0 at %) reacted less sensitively to the fluoride-ion concentration. Among titanium-silver alloys, Ti3.0Ag alloy had a higher resistance against the attack of fluoride ions and showed a more stable open-circuit potential and current density than titanium in the fluoride-containing solution. It is concluded that they are electrochemically stable and maintained good corrosion resistance in fluoride-containing artificial saliva.

Properties of titanium-silver alloys for dental application

The purpose of this study was to develop titanium-silver alloys with biocompatibility, high corrosion resistance, and low ion-release rate, and to evaluate the electrochemical properties of titanium-silver alloys in artificial saliva. Titanium-silver alloys with silver contents ranging from 0 to 4.5 at % in steps of 0.5 at % were designed. The alloys were arc melted, homogenized at 950 degrees C for 72 h, hot rolled to 2 mm in thickness, and finally solution heat treated at 950 degrees C for 1 h and quenched in water. Chemical compositions, phases, hardnesses, electrochemical properties, and the cytotoxicity of the alloys were investigated. The purity of titanium-silver alloys was maintained above 99.9%, because few impurities were introduced through their manufacture. In the case of alloys containing silver in the range 2.0-4.0 at %, the formation of an acicular alpha phase was observed inside the beta phase. The acicular phase got thinner with increasing amounts of silver. This means that silver is a beta-phase stabilizing element in titanium-silver alloys. The hardness value tended to rise with increasing silver content and increased largely over 3.5 at %, and the increase of the hardness value versus pure titanium was about 33%. It is believed that the substantial increases in hardness was due to the effects of solid solution strengthening and of alpha-beta phase transition. Moreover, titanium-silver alloys had higher corrosion resistances than pure titanium. These results mean that silver additions to titanium can improve alloy corrosion resistance. Passive current densities in the potentiodynamic polarization curves were dependent on the chemical compositions of the titanium-silver alloys. However, they did not show a linear relationship with respect to silver contents. Titanium-silver alloys did not show pitting corrosion in artificial saliva. It is believed that silver addition to titanium strengthened the passive film due to titanium dissolution induced by the different electromotive forces of titanium and silver. In the agar overlay test, the cytotoxicity of the titanium-silver alloys and of titanium were none or mild. In summary, titanium-silver alloys had higher mechanical properties and corrosion resistance than titanium, and toxicities that were similar to titanium. Therefore, it is recommended that titanium-silver alloys be adopted cautiously by the biomedical and dental fields.

Effects of topography and composition of titanium surface oxides on osteoblast responses

To investigate the roles of composition and characteristics of titanium surface oxides in cellular behaviour of osteoblasts, the surface oxides of titanium were modified in composition and topography by anodic oxidation in two kinds of electrolytes, (a) 0.2 M H(3)PO(4), and (b) 0.03 M calcium glycerophosphate (Ca-GP) and 0.15 M calcium acetate (CA), respectively. Phosphorus (P: ca.10at%) or both calcium (Ca: 1-6at%) and phosphorus (P: 3-6at%) were incorporated into the anodized surfaces in the form of phosphate and calcium phosphate. Surface roughness was slightly decreased or enhanced (R(a) in the range of 0.1-0.5 microm) on the anodized surfaces. The geometry of the micro-pores in the anodized surfaces varied with diameters up to 0.5 microm in 0.2 M H(3)PO(4) and to 2 microm in 0.03 M Ca-GP and 0.15 M CA, depending on voltages and electrolyte. Contact angles of all the anodic oxides were in the range of 60-90 degrees. Cell culture experiments demonstrated absence of cytotoxicity and an increase of osteoblast adhesion and proliferation by the anodic oxides. Cells on the surfaces with micro-pores showed an irregular and polygonal growth and more lamellipodia, while osteoblasts on the titanium surface used as a control or on anodic oxides formed at low voltages showed many thick stress fibres and intense focal contacts. Alkaline phosphatase (ALP) activity of the cells did not show any correlation with surface characteristics of anodic oxides.

Nucleation of calcium phosphate by surface-bound extracellular matrix

The native extracellular matrix (ECM) laid down on silicon and titanium surfaces by osteoblast-like SAOS-2 cells was exposed by selective removal of cells. This type of material surface ECM-Si, ECM-Ti was shown to promote the nucleation of calcium phosphate from a simulated body fluid (SBF). Microscopic and spectroscopic results revealed the effect was associated with a collagen fiber-free extracellular matrix.

Osteogenic Differentiation of Human Bone Marrow Stromal Cells on Partially Demineralized Bone Scaffoldsin Vitro

Tissue engineering has been used to enhance the utility of biomaterials for clinical bone repair by the incorporation of an osteogenic cell source into a scaffold followed by the in vitro promotion of osteogenic differentiation before host implantation. In this study, three-dimensional, partially demineralized bone scaffolds were investigated for their ability to support osteogenic differentiation of human bone marrow stromal cells (BMSCs) in vitro. Dynamic cell seeding resulted in homogeneous cell attachment and infiltration within the matrix and produced significantly higher seeding efficiencies when compared with a conventional static seeding method. Dynamically seeded scaffolds were cultured for 7 and 14 days in the presence of dexamethasone and evaluated on biochemical, molecular, and morphological levels for osteogenic differentiation. Significant elevation in alkaline phosphatase activity was observed versus controls over the 14-day culture, with a transient peak indicative of early mineralization on day 7. On the basis of RT-PCR, dexamethasone-treated samples showed elevations in alkaline phosphatase and osteocalcin expression levels at 7 and 14 days over nontreated controls, while bone sialoprotein was produced only in the presence of dexamethasone at 14 days. Scanning electron microscopy evaluation of dexamethasone-treated samples at 14 days revealed primarily cuboidal cells indicative of mature osteoblasts, in contrast to nontreated controls displaying a majority of cells with a fibroblastic cell morphology. These results demonstrate that partially demineralized bone can be successfully used with human BMSCs to support osteogenic differentiation in vitro. This osseous biomaterial may offer new potential benefits as a tool for clinical bone replacement.

Osseous healing characteristics of three different implant types

The macroscopic and especially microscopic properties of implant surfaces play a major role in the osseous healing of dental implants. The aim of this study was to perform a histologic and histomorphometric comparison of the healing characteristics of anodically modified, machined and hydroxyapatite (HA)-coated implant types. A total of 24 machined surface implants (MSI), 24 HA-coated implants (HCI) and 24 anodized titanium surface implants (ASI) were inserted into the mandibles of 12 adult mini-pigs after extracting all mandibular premolars. Four animals each were killed after covered healing for 3, 6 and 12 weeks. Undecalcified ground sections were subjected to histologic and histomorphometric examinations. Primary effects and interactions were statistically evaluated and least square means (Tukey test) were compared. Histologic evaluations showed broad-based bone apposition to HA-coated and anodically roughened surfaces as well as narrow bone contacts to the machined surface. Localized resorption was only observed with the HA-coated implants. Overall, histomorphometric evaluation of bone-to-implant contact percentages for all observation periods showed significant differences between MSI (19.39% +/- 4.53) and HCI (39.05% +/- 4.53; P = 0.0092) and between MSI and ASI (42.72% +/- 4.20; P = 0.0011). In conclusion, the results of this study show that an anodically roughened implant may provide a similar rate of bone-to-implant contact as a HA-coated implant. In the presence of bone quality II to IV, according to Lekholm & Zarb (1985, in: Tissue-Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago: Quintessence Publishing), this may be of particular benefit, possibly because of higher stability, in maintaining pre-implantation functional strength after implant healing.

In vitro investigation of titanium and hydroxyapatite dental implant surfaces using a rat bone marrow stromal cell culture system

In this study, rat bone marrow cells (RBM) were used to evaluate different titanium and hydroxyapatite dental implant surfaces. The implant surfaces investigated were: a titanium surface having a porous titanium plasma-sprayed coating (sample code Ti-TPS), a titanium surface with a deep profile structure (sample code Ti-DPS), an uncoated titanium substrate with a machined surface (sample code Ti-ma) and a machined titanium substrate with a porous hydroxyapatite plasma-sprayed coating (sample code Ti-HA). RBM cells were cultured on the disc-shaped test substrates for 14 days. The culture medium was changed daily and examined for calcium and phosphate concentrations. After 14 days specimens were examined by light microscopy, scanning electron microscopy, energy dispersive X-ray analysis and morphometry of the cell-covered substrate surface. All test substrates facilitated RBM growth of extracellular matrix formation. Ti-DPS and Ti-TPS to the highest degree, followed by Ti-ma and Ti-HA. Ti-DPS and Ti-TPS displayed the highest cell density and thus seem to be well suited for the endosseous portion of dental implants. RBM cells cultured on Ti-HA showed a delayed growth pattern. This may be related to its high phosphate ion release.

Effect of surface chemistries and characteristics of Ti6Al4V on the Ca and P adsorption and ion dissolution in Hank's ethylene diamine tetra-acetic acid solution

This study examined the influence of chemistries and surface characteristics of Ti6Al4V on the adsorption of Ca and P species and ion dissolution behavior of the material exposed in Hank's solution with 8.0 mM ethylene diamine tetra-acetic acid at 37 degrees C. The variation of chemistries of the alloy and nano-surface characteristics (chemistries of nano-surface oxides, amphoteric OH group adsorbed on oxides, and oxide thickness) was effected by surface modification and three passivation methods (34% nitric acid passivation. 400 degrees C heated in air, and aged in 100 degrees C water). X-ray photoelectron spectroscopy and Auger electron spectroscopy were used for surface analyses. The chemistries of nano-surface oxides in a range studied should not change the capability of Ca and P adsorption. Nor is the capability affected significantly by amphoteric OH group and oxide thickness. However, passivations influence the surface oxide thickness and the early stage ion dissolution rate of the alloy. The rate-limiting step of the rate can be best explained by metal-ion transport through the oxide film, rather than hydrolysis of the film. Variation of the chemistries of titanium alloy alters the electromotive force potential of the metal, thereby affecting the corrosion and ion dissolution rate.

Interaction of spiral ganglion neuron processes with alloplastic materials in vitro(1)

The cochlear implant (CI) involves the introduction of alloplastic materials into the cochlea. While current implants interact with cochlear neurons at a distance, direct interactions between spiral ganglion (SG) neurites and implants could be fostered by appropriate treatment with neurotrophic factors. The interactions of fibroblasts and osteoblasts with alloplastic materials have been well studied in vitro and in vivo. However, interactions of inner ear neurons with such alloplastic materials have yet to be described. To investigate survival and growth behavior of SG neurons on different materials, SG explants from post-natal day 5 rat SG were cultured for 72 h in the presence of neurotrophin-3 (10 ng/ml) on titanium, gold, stainless steel, platinum, silicone and plastic surfaces that had been coated with laminin and poly-L-lysine. Neurite outgrowth was investigated after immunohistological staining for neurofilament, by image analysis to determine neurite extension and directional changes. Neurite morphology and adhesion to the alloplastic material were also evaluated by scanning electron microscopy (SEM). On titanium, SG neurites reached the highest extent of outgrowth, with an average length of 662 microm and a mean of 31 neurites per explant, compared to 568 microm and 21 neurites on gold, 574 microm and 24 neurites on stainless steel, 509 microm and 16 neurites on platinum, 281 microm and 12 neurites on silicone and 483 microm and 31 neurites on plastic. SEM revealed details of adhesion of neurites and interaction with non-neuronal cells. The results of this study indicate that the growth of SG neurons in vitro is strongly influenced by alloplastic materials, with titanium exhibiting the highest degree of biocompatibility with respect to neurite extension. The knowledge of neurite interaction with different alloplastic materials is of clinical interest, as development in CI technology leads to closer contact of implanted electrodes with surviving inner ear neurons.

Role of surface roughness of titanium versus hydroxyapatite on human bone marrow cells response

This study was designed to assess human bone marrow cell response and particularly cell adhesion, proliferation, and differentiation, when cultured in vitro on titanium alloy and hydroxyapatite with different values of surface roughness. A further aim was to compare the cell response on the two materials, currently used in spinal surgery. Cell adhesion was determined after 0.5, 2, 4, and 18 hours of incubation; proliferation after 8, 11, 14, and 16 days of culture; and differentiation was evaluated with the expression of alkaline phosphatase activity after 8 and 16 days of culture. This study showed that bone marrow cells grew faster on titanium alloy than on hydroxyapatite, although fewer cells attached to titanium, compared to those attached to hydroxyapatite. No statistically significant difference was observed as the expression of alkaline phosphatase activity on hydroxyapatite and titanium alloy of the same roughness. Cell adhesion, proliferation, and differentiation are dependent on surface roughness of the biomaterial, and all three increased as the roughness of titanium alloy increased. Conclusively, surface roughness of titanium and hydroxyapatite significantly influences bone marrow cell response, and therefore these biomaterials should be used with rough outer surface, if a significant cell response on them is desired. These advantages of titanium and hydroxyapatite theoretically seem to be of particular importance in the following situations: long fusions, lumbosacral fusion, revision surgery with poor bone bank, neuropathic scoliosis associated with few bone graft reserves, and adult patients with severe osteoporosis.