Effect of Ca/P coating resorption and surgical fit on the bone/implant interface

Real-Time Protein and Cell Binding Measurements on Hydroxyapatite Coatings

Although a lot of in vitro and in vivo assays have been performed during the last few decades years for hydroxyapatite bioactive coatings, there is a lack of exploitation of real-time in vitro interaction measurements. In the present work, real-time interactions for a plasma sprayed hydroxyapatite coating were measured by a Multi-Parametric Surface Plasmon Resonance (MP-SPR), and the results were compared with standard traditional cell viability in vitro assays. MP-SPR is proven to be suitable not only for measurement of molecule-molecule interactions but also molecule-material interaction measurements and cell interaction. Although SPR is extensively utilized in interaction studies, recent research of protein or cell adsorption on hydroxyapatite coatings for prostheses applications was not found. The as-sprayed hydroxyapatite coating resulted in 62.4% of crystalline phase and an average thickness of 24 ± 6 μm. The MP-SPR was used to measure lysozyme protein and human mesenchymal stem cells interaction to the hydroxyapatite coating. A comparison between the standard gold sensor and Hydroxyapatite (HA)-plasma coated sensor denoted a clearly favourable cell attachment on HA coated sensor as a significantly higher signal of cell binding was detected. Moreover, traditional cell viability and proliferation tests showed increased activity with culture time indicating that cells were proliferating on HA coating. Cells show homogeneous distribution and proliferation along the HA surface between one and seven days with no significant mortality. Cells were flattened and spread on rough surfaces from the first day, with increasing cytoplasmatic extensions during the culture time.

A study of the physical, chemical and biological properties of TiO2 coatings produced by micro-arc oxidation in a Ca-P-based electrolyte

In this work, a porous and homogeneous titanium dioxide layer was grown on commercially pure titanium substrate using a micro-arc oxidation (MAO) process and Ca-P-based electrolyte. The structure and morphology of the TiO2 coatings were characterized by X-ray diffraction, scanning electron microscopy (SEM), transmission electron microscopy, and profilometry. The chemical properties were studied using electron dispersive X-ray spectroscopy (SEM-EDS) and X-ray photoelectron spectroscopy. The wettability of the coating was evaluated using contact angle measurements. During the MAO process, Ca and P ions were incorporated into the oxide layer. The TiO2 coating was composed of a mixture of crystalline and amorphous structures. The crystalline part of the sample consisted of a major anatase phase and a minor rutile phase. A cross-sectional image of the coating-substrate interface reveals the presence of voids elongated along the interface. An osteoblast culture was performed to verify the cytocompatibility of the anodized surface. The results of the cytotoxicity tests show satisfactory cell viability of the titanium dioxide films produced in this study.

Effects of serum protein on ionic exchange between culture medium and microporous hydroxyapatite and silicate-substituted hydroxyapatite

It has been proposed that one of the underlying mechanisms contributing to the bioactivity of osteoinductive or osteoconductive calcium phosphates involves the rapid dissolution and net release of calcium and phosphate ions from the matrix as alternatively a precursor to subsequent re-precipitation of a bone-like apatite at the surface and/or to facilitate ion exchange in biochemical processes. In order to confirm and evaluate ion release from sintered hydroxyapatite (HA) and to examine the effect of silicate substitution into the HA lattice on ion exchange under physiological conditions we monitored Ca(2+), PO(4)(3-) and SiO(4)(4-) levels in Earl's minimum essential medium (E-MEM) in the absence (serum-free medium, SFM) or presence (complete medium, C-MEM) of foetal calf serum (FCM), with both microporous HA or 2.6 wt% silicate-substituted HA (SA) sintered discs under both static and semi-dynamic (SD) conditions for up to 28 days. In SFM, variation in Ca(2+) ion concentration was not observed with either disc chemistry or culture conditions. In C-MEM, Ca(2+) ions were released from SA under static and SD conditions whereas with HA Ca(2+) was depleted under SD conditions. PO(4)(3-) depletion occurred in all cases, although it was greater in C-MEM, particularly under SD conditions. SiO(4)(4-) release occurred from SA irrespective of medium or culture conditions but a sustained release only occurred in C-MEM under SD conditions. In conclusion we showed that under physiological conditions the reservoir of exchangeable ions in both HA and SA in the absence of serum proteins is limited, but that the presence of serum proteins facilitated greater ionic exchange, particularly with SA. These observations support the hypothesis that silicate substitution into the HA lattice facilitates a number of ionic interactions between the material and the surrounding physiological environment, including but not limited to silicate ion release, which may play a key role in determining the overall bioactivity and osteoconductivity of the material. However, significant net release of Ca(2+) and PO(4)(3-) was not observed, thus rapid or significant net dissolution of the material is not necessarily a prerequisite for bioactivity in these materials.

Bone reaction to a biomimetic third-generation hydroxyapatite coating and new surface treatment for the Symax hip stem

Four uncemented Symax hip stems were extracted at three weeks and nine, 13 and 32 months, respectively, for reasons other than loosening. The reasons for implant removal were infection in two cases, recurrent dislocation in one and acetabular fracture in one. They were analysed to assess the effect and behaviour of an electrochemically deposited, completely resorbable biomimetic BONIT-hydroxyapatite (HA) coating (proximal part) and a DOTIZE surface treatment (distal part) using qualitative histology, quantitative histomorphometry and scanning electron microscopy (SEM). Early and direct bone-implant bonding with signs of active remodelling of bone and the HA coating were demonstrated by histology and SEM. No loose BONIT-HA particles or delamination of the coating were observed, and there was no inflammation or fibrous interposition at the interface.

Histomorphometry showed bone-implant contact varying between 26.5% at three weeks and 83.5% at 13 months at the HA-coated implant surface. The bone density in the area of investigation was between 24.6% at three weeks and 41.1% at 32 months. The DOTIZE surface treatment of the distal part of the stem completely prevented tissue and bone apposition in all cases, thereby optimising proximal stress transfer.

The overall features of this implant, in terms of geometry and surface texture, suggest a mechanically stable design with a highly active biomimetic coating, resulting in rapid and extensive osseo-integration, exclusively in the metaphyseal part of the stem. Early remodelling of the HA coating does not seem to have a detrimental effect on short-term bone-implant coupling. There were no adverse effects identified from either the BONIT-HA coating or the DOTIZE surface treatment.

Nanostructured tantala as a template for enhanced osseointegration

The goal of current dental and orthopedic biomaterials research is to design implants that induce controlled and guided tissue growth, and rapid healing. In addition to acceleration of normal wound healing phenomena, these implants should result in the formation of a characteristic interfacial layer with adequate biomechanical properties. To achieve these goals, however, a better understanding of events at the bone-material interface is needed, as well as the development of new materials and approaches that promote osseointegration. Here we present novel nanostructured nanoarrays from tantala that can promote cell adhesion and differentiation. Our results suggest that tantala nanotube arrays enhance osteoblast cell adhesion, proliferation and differentiation. The routes of fabrication of tantala nanotube arrays are flexible and cost-effective, enabling realization of desired platform topologies on existing non-planar orthopedic implants.

Osteoblast proliferation and maturation on bioactive fiber-reinforced composite surface

The objective of this study was to evaluate the proliferation and osteogenic potential of bone-marrow derived osteoblast-like cells on fiber-reinforced composite (FRC) substrates with and without bioactive glass surface modification. Three FRC materials were fabricated for the study: (a) grit-blasted FRC, (b) grit-blasted FRC with bidirectional net reinforcement and (c) FRC with bioactive glass (BAG) coating. Rat bone-marrow derived osteoblast-like cells were harvested and cultured on experimental material plates and on cp. titanium plates (control) for 21 days. The materials' surfaces were characterized by roughness testing and scanning electron microscopy. Cell growth and differentiation kinetics were subsequently investigated by evaluating proliferation, alkaline phosphatase (ALP) activity, osteocalcin (OC) and bone sialoprotein (BSP) production. On day 14, the cell proliferation was significantly lower (P<0.05) on FRC-BAG than on titanium and FRC. The proliferation on the other three materials was equal throughout the experiment. The maximal ALP activities on FRC, FRC-Net, and titanium were observed on day 21, whereas FRC-BAG had already reached the maximal level on day 14. Expression of osteoblastic markers (OC, BSP) indicates that the fastest osteogenic differentiation takes place on FRC after 7 days. In contrast, a slower differentiation process was observed on titanium than on any other tested material (P<0.015) at 21 days, as was confirmed by increased mRNA expression of OC and BSP. It can be concluded that the proliferation and maturation of osteoblast-like cells on FRC appears to be comparable to titanium. Presence of BAG enhances cell maturation.

Preparation and characterization of selenium incorporated anodic conversion coatings on titanium surfaces for biomedical applications

An anodic spark deposition process was used for preparation of inorganic, glass-ceramic like conversion coatings. The microstructure of the layers was characterized by surface and solid state techniques such as scanning electron microscopy, electron probe microanalysis and Raman spectroscopy. The porous coatings, typically up to 8 mum thick, consist mainly of titanium oxides and amounts of incorporated electrolyte constituents like Se, Ca or P. Beside nano crystalline anatase phases, a mostly amorphous structure is proposed in which network-forming [PO(4)] tetrahedras and [TiO(6)] octahedras in various degrees of condensation are connected. A drastic modification of the film structure was observed when selenium was incorporated into the glassy oxide structure of the coating. In these cases no nano crystalline phases of titanium oxides or other chemical compounds were detected. First cell culture investigations show a significant improvement of the biological properties. Cell proliferation and TGF-beta-expression of these coatings in comparison with commercial pure titanium (CPT) with native titanium oxide films were examined.

XPS study on the use of 3-aminopropyltriethoxysilane to bond chitosan to a titanium surface

Chitosan, a biopolymer found in the exoskeletons of shellfish, has been shown to be antibacterial, biodegradable, osteoconductive, and has the ability to promote organized bone formation. These properties make chitosan an ideal material for use as a bioactive coating on medical implant materials. In this study, coatings made from 86.4% de-acetylated chitosan were bound to implant-quality titanium. The chitosan films were bound through a three-step process that involved the deposition of 3-aminopropyltriethoxysilane (APTES) in toluene, followed by a reaction between the amine end of APTES with gluteraldehyde, and finally, a reaction between the aldehyde end of gluteraldehyde and chitosan. Two different metal treatments were examined to determine if major differences in the ability to bind chitosan could be seen. X-ray photoelectron spectroscopy (XPS) was used to examine the surface of the titanium metal and to study the individual reaction steps. The changes to the titanium surface were consistent with the anticipated reaction steps, with significant changes in the amounts of nitrogen, silicon, and titanium that were present. It was demonstrated that more APTES was bound to the piranha-treated titanium surface as compared to the passivated titanium surface, based on the amounts of titanium, carbon, nitrogen, and silicon that were present. The metal treatments did not affect the chemistry of the chitosan films. Using toluene to bond APTES on titanium surfaces, rather than aqueous solutions, prevented the formation of unwanted polysiloxanes and increased the amount of silane on the surface for forming bonds to the chitosan films. Qualitatively, the films were more strongly attached to the titanium surfaces after using toluene, which could withstand the ultrahigh vacuum environment of XPS, as compared to the aqueous solutions, which were removed from the titanium surface when exposed to the ultrahigh vacuum environment of XPS.

Preparation of poly(lactic acid) composite hollow spheres containing calcium carbonates

Poly(lactic acid) composite hollow spheres containing calcium carbonate were prepared by oil-in-water emulsion evaporation to develop injectable bone substitutes incorporated with cells. The spheres were approximately 1.2mm in diameter and had a shell with a thickness in the range of 50-150microm. The hollow in the spheres was presumed to be formed by CO(2) gas generated by the decomposition of vaterite used as a starting material. An open channel approximately 800microm in diameter was formed in the spheres by chemical etching utilizing the rapid dissolution of poly(lactic acid) at the thin portion of the shell. Cells could migrate into the hollow spheres through the open channel and attach to the inner surface.

Bone tissue engineering on amorphous carbonated apatite and crystalline octacalcium phosphate-coated titanium discs

Poor fixation of bone replacement implants, e.g. the artificial hip, in implantation sites with inferior bone quality and quantity may be overcome by the use of implants coated with a cultured living bone equivalent. In this study, we tested, respectively, amorphous carbonated apatite (CA)- and crystalline octacalcium phosphate (OCP)-coated discs for their use in bone tissue engineering. Subcultured rat bone marrow cells were seeded on the substrates and after 7 days of culture, the implants were subcutaneously implanted in nude mice for 4 weeks. After 7 days of culture, the cells had formed a continuous multi-layer that covered the entire surface of the substrates. The amount of cells was visually higher on the crystalline OCP-coated discs compared to the amorphous CA-coated discs. Furthermore, the amorphous CA-coated discs exhibited a visually higher amount of mineralized extracellular matrix compared to the crystalline OCP-coated discs. After 4 weeks of implantation, clear de novo bone formation was observed on all discs with cultured cells. The newly formed bone on the crystalline OCP-coated discs was more organized and revealed a significantly higher volume compared to the amorphous CA-coated discs. The percentage of bone contact with the discs was also significantly higher on the OCP-coated discs. Overall, the results suggest that a crystalline OCP coating is more suitable for bone tissue engineering than an amorphous CA coating.

Osteointegration of femoral stem prostheses with a bilayered calcium phosphate coating

Our purpose was to evaluate the osteointegration of bilayered calcium phosphate (CaP)-coated femoral hip stems in a canine model. A first layer of hydroxyapatite (HA) 20 microm thick and a superficial layer of Biphasic Calcium Phosphate (BCP) 30 microm thick were plasma-sprayed on to the proximal region of sandblasted Ti6Al4V prostheses. Bilayered CaP-coated and non-coated canine femoral stems were implanted bilaterally under general anesthesia in 6 adult female Beagle dogs. After 6 and 12 months, a significant degradation of the bilayered coating occurred with a remainder of 33.1+/-12.4 and 23.6+/-9.2 microm in thickness, respectively. Lamellar bone apposition was observed on bilayered coated implants while fibrous tissue encapsulation was observed on non-coated femoral stems. The bone-implant contacts (BIC) were 91+/-3% and 81+/-8% for coated and 7+/-8% and 8+/-12% for non-coated implants, at 6 and 12 months, respectively. Our study supports the concept of a direct relationship between the biodegradation of CaP coating and the enhanced osteointegration of titanium prostheses. A bilayered CaP coating might therefore enhance bone apposition in the early stages because of the superior bioactivity of the BCP layer while the more stable HA layer might sustain bone bonding over long periods.

Effect of hydroxyapatite coating crystallinity on dissolution and osseointegrationin vivo

Hydroxyapatite (HA) coating with different crystallinities were deposited by plasma spraying and vapor-flame treatment process. Their crystallinities are about 55 and 98%, respectively. These coatings were implanted in cortical bone, muscle, and marrow of dogs. The dissolution and osseointegration behavior were evaluated by scanning electron microscope (SEM) observation histological analysis. The results obtained indicated that after implanted in muscle, a bone-like apatite layer was formed on the surface of as-sprayed coating, which was not observed on the surface of the treated coating. The as-sprayed coating has the ability to induce new bone formation on its surface after implanted in marrow. In contrast, the treated coating displays a limited bone bioactivity. The vapor-flame process diminishes the short-term osseointegration properties of the HA coating, but no significant affection was found after three months implantation. Either in muscle or in cortical bone, treated coating exhibits higher stability than the as-sprayed coating, in some conditions.

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.

In vitro bioactivity of silicon-substituted hydroxyapatites

Silicon-containing hydroxyapatites were synthesized by the controlled crystallization method. Chemical analysis, N(2) adsorption, Hg porosimetry, X-ray diffraction, scanning electron microscopy-energy-dispersive X-ray spectroscopy, and X-ray photoelectron spectroscopy (XPS) were used to characterize the hydroxyapatite and to monitor the development of a calcium phosphate layer onto the surface of the substrate immersed in a simulated body fluid, that is, in vitro bioactivity tests. The influence of the silicon content and the nature of the starting calcium and phosphorus sources on the in vitro bioactivity of the resulting materials were studied. A sample of silicocarnotite, whose structure is related to that of hydroxyapatite and contains isolated SiO(4) (4-) anions that isomorphically substitute some PO(4) (3-) anions, was prepared and used as reference material for XPS studies. An increase of the unit cell parameters with the Si content was observed, which indicated that SiO(4) (4-) units are present in lattice positions, replacing some PO(4) (3-) groups. By using XPS it was possible to assess the presence of monomeric SiO(4) (4-) units in the surface of apatite samples containing 0.8 wt % of silicon, regardless the nature of the starting raw materials, either Ca(NO(3))(2)/(NH(4))(2)HPO(4)/Si(OCOCH(3))(4) or Ca(OH)(2)/H(3)PO(4)/Si(OCOCH(3))(4). However, an increase of the silicon content up to 1.6 wt % leads to the polymerization of the silicate species at the surface. This technique shows silicon enrichment at the surface of the three samples. The in vitro bioactivity assays showed that the formation of an apatite-like layer onto the surface of silicon-containing substrates is strongly enhanced as compared with pure silicon-free hydroxyapatite. The samples containing monomeric silicate species showed higher in vitro bioactivity than that of silicon-rich sample containing polymeric silicate species. The use of calcium and phosphate salts as precursors lead to materials with higher bioactivity.

In vitro osteoblast response to anodized titanium and anodized titanium followed by hydrothermal treatment

In this study, Titanium (Ti) surfaces were modified using anodization. The electrolyte used for anodization was a mixture of calcium glycerophosphate and calcium acetate. The anodized surfaces were divided into three groups. Hydrothermal treatments were performed on two of the anodized groups for either 2 or 4 h. In vitro osteoblast response to anodized oxide and the hydrothermal treated oxide after anodization was evaluated in this study. Calcium and phosphorus ions were deposited on the Ti oxide during anodization. Anodized surfaces following a 4-h hydrothermal treatment were observed to promote the growth apatite-like crystals as compared with anodized surfaces after a 2-h hydrothermal treatment. Cellular function and onset of mineralization, as indicated by protein production and osteocalcin production, respectively, also were observed as enhanced on hydrothermal-treated surfaces. It was thus concluded from this study that calcium phosphate and apatite-like crystals could be deposited on Ti surfaces using anodization and a combination of anodization and hydrothermal treatment. It was also concluded that the phenotypic expression of osteoblast was enhanced by the presence of calcium phosphate or apatite-like crystals on anodized or hydrothermally treated Ti surfaces.

Injectable calcium phosphate cement as a filler for bone defects around oral implants: an experimental study in goats

The aim of this study was to evaluate the clinical applicability and biological behavior of a newly developed injectable calcium phosphate (Ca-P) cement as bone filler for gaps around oral implants. Twenty-four step-like implants, creating gaps of 1 and 2 mm, were inserted into the trabecular bone of the medial femoral condyles of six goats. Four different situations were tested: (1) implant + gaps; (2) implant + gaps, but covered with a polylactic acid membrane; (3) implant + gaps that were filled with Ca-P cement; and (4) implant + gaps that were filled with Ca-P cement and covered with a membrane. All implants were left in place for 12 weeks. Histological and quantitative histomorphometrical measurements demonstrated that implants + gaps had generally poor bone contact at the implant base. Furthermore, fibrous encapsulation was observed in the gap part. In contrast, the presence of a membrane promoted bone ingrowth into the gap and also the bone contact at the implant base. Injection of Ca-P cement resulted in an almost complete filling of the gaps around the implant. The cement surface was completely covered by bone. Active resorption and remodeling of cement particles was observed, suggesting a pattern of slow resorption associated with full replacement with newly formed bone. Additional use of a membrane did not result in adjunctive benefits. Bone-to-implant contact at the implant base was comparable with the implants provided only with a membrane. In conclusion, the Ca-P cement used here showed excellent clinical handling properties combined with a superior bone behavior. On the other hand, the degradation rate of the material was still very slow. This current characteristic can hamper the final clinical applicability of the material as gap filler for periimplant or periodontal defects.

Osteoblast growth on titanium foils coated with hydroxyapatite by pulsed laser ablation

Pulsed laser ablation is a new method for deposition of thin layers of hydroxyapatite (HA) on to biomaterial surfaces. In this paper, we report activity and morphology of osteoblasts grown on HA surfaces fabricated using different laser conditions. Two sets of films were deposited from dense HA targets, at three different laser fluences: 3, 6 and 9 Jcm(-2). One set of the surfaces was annealed at 575 degrees C to increase the crystallinity of the deposited films. Primary human osteoblasts were seeded onto the material surfaces and cytoskeletal actin organisation was examined using confocal laser scanning microscopy. The annealed surfaces supported greater cell attachment and more defined cytoskeletal actin organisation. Cell activity, measured using the alamar Blue assay, was also found to be significantly higher on the annealed samples. In addition, our results show distinct trends that correlate with the laser fluence used for deposition. The cell activity increases with increasing fluence. This pattern was repeated for alkaline phosphatase production by the cells. Differences in cell spreading were apparent which were correlated with the fluence used to deposit the HA. The optimum surface for initial attachment and spreading of osteoblasts was one of the HA films deposited using 9 J cm(-2) laser fluence and subsequently annealed at 575 degrees C.

A methodological study for the analysis of apatite-coated dental implants retrieved from humans

The stability of thermally processed hydroxyapatite coatings for oral and orthopedic bioprostheses has been questioned. Information on the chemical changes, which occur with hydroxyapatite biomaterials post-implantation in humans, is lacking. The purpose of this investigation was to begin to examine post-implantation surface changes of hydroxyapatite-coated implants using scanning electron microscopy (SEM), x-ray microanalysis (EDAX), Fourier transform infrared spectroscopy (FTIR), and x-ray diffraction (XRD). Three retrieved dental implant specimens from humans following clinical failure due to peri-implantitis were examined. Unimplanted cylinders served as controls. Clinically, the retrieved specimens were all enveloped by a fibrous tissue capsule with bone present at the apical extent of the implant. SEM analysis showed that the retrieved surfaces were coated with both calcified and proteinaceous deposits. EDAX scans of the retrieved specimens demonstrated evidence of hydroxyapatite coating loss reflected by increasing titanium and aluminum signals. Other foreign ions such as sodium, chloride, sulfur, silica, and magnesium were detected. XRD of the control specimens showed that the samples were predominantly apatite; however, two peaks were detected in the diffraction pattern, which are not characteristic of hydroxyapatite, indicating that small amounts of one or more other crystalline phases were also present. The retrieved specimens showed slightly larger average crystal size relative to the control sample material, and the non-apatite lines were not present. FTIR evaluation of the retrieved specimens revealed the incorporation of carbonate and organic matrix on or into the hydroxyapatite. Narrowing of and increased detail in the phosphate peaks indicated an increase in average crystal size and/or perfection relative to the controls, as did the XRD results. Based on these results, we conclude that chemical changes may occur within the coating, with the incorporation of carbonate and concomitant reduction in hydroxyapatite coating thickness. Thermodynamic dissolution-reprecipitation of the coating itself and subsequent surface insult by bacterial and local inflammatory components may be involved with these changes.

Organoapatite growth on an orthopedic alloy surface

We report here a method to coat orthopedic metals with the artificial bone material organoapatite. The growth of organoapatite on titanium alloy surfaces of foils and porous cylinders involves sequential preadsorption of poly(L-lysine) and poly(L-glutamic acid) on metal, followed by exposure to organoapatite-precipitating solutions. The organoapatite characterization of the coating was carried out by transmission electron microscopy, electron diffraction, scanning electron microscopy, energy-dispersive X-ray scattering, powder X-ray diffraction, FT-IR, and elemental analysis. The preadsorbed poly(amino acids) in the form of a self-assembled bilayer of oppositely charged macromolecules can lead to a surface coverage of titanium alloy in the range of 70-90%. The deposition mechanisms could involve the surface capture of embryonic crystals and the nucleation of apatite on the bilayer. Bioabsorbable organoapatite could serve as a tissue-engineering scaffold for bone regeneration into porous implants.

Chemical characterization of silicon-substituted hydroxyapatite

Bioceramic specimens have been prepared by incorporating a small amount of silicon (0.4 wt %) into the structure of hydroxyapatite [Ca10(PO4)6(OH)2, HA] via an aqueous precipitation reaction to produce a silicon-substituted hydroxyapatite (Si-HA). The results of chemical analysis confirmed the proposed substitution of the silicon (or silicate) ion for the phosphorus (or phosphate) ion in hydroxyapatite. The Si-HA was produced by first preparing a silicon-substituted apatite (Si-Ap) by a precipitation process. A single-phase Si-HA was obtained by heating/calcining the as-prepared Si-Ap to temperatures above 700 degrees C; no secondary phases, such as tricalcium phosphate (TCP), tetracalcium phosphate (TeCP), or calcium oxide (CaO), were observed by X-ray diffraction analysis. Although the X-ray diffraction patterns of Si-HA and stoichiometric HA appeared to be identical, refinement of the diffraction data revealed some small structural differences between the two materials. The silicon substitution in the HA lattice resulted in a small decrease in the a axis and an increase in the c axis of the unit cell. This substitution also caused a decrease in the number of hydroxyl (OH) groups in the unit cell, which was expected from the proposed substitution mechanism. The incorporation of silicon in the HA lattice resulted in an increase in the distortion of the PO4 tetrahedra, indicated by an increase in the distortion index. Analysis of the Si-HA by Fourier transform infrared (FTIR) spectroscopy indicated that although the amount of silicon incorporated into the HA lattice was small, silicon substitution appeared to affect the FTIR spectra of HA, in particular the P-O vibrational bands. The results demonstrate that phase-pure silicon-substituted hydroxyapatite may be prepared using a simple precipitation technique.

Histomorphological and biomechanical characterization of calcium phosphates in the osseous environment

The standardization of characterization techniques is becoming increasingly important for bone replacement materials as it becomes apparent that, for the field to advance, testing must be developed to allow the biocompatibility or bioactivity of a new material to be assessed and directly compared with existing materials. Currently there are many forms of biocompatibility test for materials destined for the osseous environment, ranging from immersion in simulated body fluid to implantation into living bone. However, the variety of ways in which the data from these tests may be acquired and interpreted, as a result of changes in parameters such as surgical technique and mechanical test conditions, means that much of the published data within the field is not comparable. This paper will introduce the concept of biocompatibility by considering calcium phosphate bioceramics, and discusses some aspects of in vivo experimental design, including simple histomorphometry techniques, in addition to considering practical methods for the assessment of the biomechanical characteristics of an osseointegrated implant.

Healing of large (2 mm) gaps around calcium phosphate-coated bone implants: a study in goats with a follow-up of 6 months

Plasma-sprayed hydroxylapatite (HA) coatings are known for their ability to demonstrate osseointegration with bone. Recently it was found that the amount of bone apposition was strongly reduced 6 weeks after implantation in a goat model if gaps of two millimeters between bone and apatite coating existed. Stability of the apatite coatings examined did not influence the gap-healing ability. This study investigated whether a longer follow-up period of 24 weeks would be sufficient for the restoration of bone apposition on apatite coatings in an identical surgical model with 2 mm gaps, and whether bone apposition on the apatite coatings is influenced by the coating stability. Three coatings were investigated: 25-30% crystalline HA (aHA), 60-63% crystalline HA (cHA), and 85-90% crystalline fluorapatite (FA). Uncoated Ti-6A1-4V implants were used as controls. Implants were inserted in the femoral condyles of both femora of eight goats. Each goat received four implants. Histology revealed that bone formation on each of the apatite coatings remained low and did not increase with an extended follow-up period of 24 weeks. The coatings showed significantly (P < 0.01) more bone contact than the uncoated control implants. The three different coatings did not show significant differences in bone apposition. The aHA coating in most cases had disappeared completely after 24 weeks. Despite the disappearance of the aHA coating, bone contact was seen on the substrate surface without fibrous tissue interposition. The cHA coating showed minor signs of degradation while the FA coatings showed no visible degradation. It is concluded that non-press-fit implantation of apatite-coated implants leads to more bone apposition as compared to uncoated Ti-6A1-4V implants. However, it is suggested by these results that the upper limit of gaps around apatite implants is 2 millimeters in a non-weight-bearing model in goats. Bone apposition will not increase by extending the follow-up period more than six weeks, nor will it be altering the stability of the apatite coatings used.

Bone cell behavior on Matrigel-coated Ca/P coatings of varying crystallinities

Rat calvarial cell mitogenic behavior was investigated on various biomaterials coated with Matrigel, a basement membrane matrix containing growth factors. Low (20-40%) and high (70-90%) crystallinity hydroxyapatite (rHA and cHA), rough titanium (Ti), and tissue culture polystyrene (TP) surfaces were compared. Surface chemistry and calcium resorption of HA coatings, alkaline phosphatase activity (APA), and growth of cells were measured for Matrigel-coated and uncoated surfaces at 2, 7, and 14 days. Gene expression for four noncollagenous bone-related proteins (osteonectin, osteopontin, alkaline phosphatase, and osteocalcin) was also investigated by reverse transcription and polymerase chain reaction up to 28 days. Ca concentration in incubating solutions increased with time for the two types of HA coatings and was always greater for rHA than cHA. Surface chemistry and coating dissolution rates were not affected by the presence of Matrigel or cells throughout the study. APA of cells on the two HA-coated surfaces was comparably enhanced in the presence of Matrigel and was greater than on Ti surfaces. Only HA surfaces showed an increased APA of cells with time in the presence of Matrigel. Cell growth peaked at 7 days and was greatest for cells on the two HA surfaces and without Matrigel. At 14 days, cell growth was comparable on the four surfaces. The presence of HA and Matrigel enhanced cell-specific APA at 14 days. Gene expression for all four proteins investigated showed no differences between surfaces after 7 days. At 2 and 7 days, gene expression was indicative of proliferation for Ti, and of proliferation, differentiation, and mineralization for HA and TP more so without Matrigel. The addition of this matrix significantly enhanced mitogenicity of calvarial cells on HA only after 14 days. Matrigel eliminated differences seen between the two HA coatings. Gene expression was not enhanced or inhibited by the presence of Matrigel.

Resorption of hydroxyapatite and fluorapatite ceramic coatings on weight-bearing implants: a quantitative and morphological study in dogs

Resorption (defined as loss of ceramic coating because of cellular activity or dissolution) of ceramic coatings is a matter of concern for the long-term performance of ceramic-coated implants. A new fluorine-containing coating, fluorapatite (FA), has been shown to be more stable than hydroxyapatite (HA) in unloaded models. In a weight-bearing model in trabecular bone, we evaluated loss (defined as reduction of coating irrespective of type of mechanism) of HA and FA coatings during 25 weeks of implantation. Eight mature dogs had HA- or FA-coated implants inserted bilaterally into the weight-bearing region of the medial femoral condyle. Quantified loss of ceramic coating was estimated at the light microscopic level using stereological methods. The experiment showed significant loss of both types of coatings. However, no statistical difference in loss of ceramic coating was found regarding surface area implant coverage, volume, and thickness (p = 0.77, p = 0.13, p = 0.56, p = 0.23, respectively). Completely resorbed HA coating was replaced by 36 +/- 6.0% (range: 26-42) bone in direct contact with the implant surface compared with 29 +/- 16.0% (range: 12-59) for FA (p = 0.40), suggesting that the implant was firmly fixed despite loss of the ceramic coating. Transmission electron microscopy in combination with electron energy spectroscopy and electron spectroscopic imaging showed that osteclast-like cells, osteocytes, macrophage-like cells, and fibroblasts had phagocytosed calcium-containing fragments, indicating cell-mediated resorption of the ceramic coating.

Improved fixation of porous-coated versus grit-blasted surface texture of hydroxyapatite-coated implants in dogs

We inserted, in 8 dogs, implants with either porous-coated or grit-blasted titanium surface and coated with hydroxyapatite (HA) into trabecular bone in the proximal humerus, using a 1 mm gap model. After 25 weeks, push-out tests showed that energy absorption for porous-coated implants was twice that of grit-blasted implants, whereas shear stiffness was reduced by one fifth, indicating a stronger fixation of porous-coated implants. Macroscopically, all grit-blasted implants had delamination of the HA coating, whereas porous implants failed mostly at the HA-tissue interface. Porous-coated implants had 47% bone ingrowth and grit-blasted implants 70% (p = 0.02), however, no difference in absolute surface area was found. Part of the HA coating was resorbed during the implantation period as regards volume and thickness. HA coverage was more reduced on porous-coated than on grit-blasted implants (p = 0.01). No foreign-body reaction or osteolysis was seen. An important finding was that one fifth of the surface with complete resorption of HA coating was replaced by newly formed bone.

Healing of gaps around calcium phosphate-coated implants in trabecular bone of the goat

Hydroxylapatite coatings are under clinical investigation in orthopaedics and dentistry. Bone formation on apatite coatings in the presence of gaps is important for clinical applications. The importance of the stability of the coating is not known at present. By varying the plasma-spray parameters, and by the addition of fluoride, the crystallinity and stability of calcium phosphates can be changed. It is suggested that bone formation is enhanced by dissolution of the apatite coating. We studied apatite coatings of varying stability with regard to their gap-healing characteristics, and we examined what the maximum gap would be that can be bridged if a coating is applied. Ti-6A1-4V implants coated with 62% crystalline hydroxylapatite, 30% crystalline hydroxylapatite or fluorapatite, or noncoated Ti-6A1-4V were implanted in 16 goats. The implants were surrounded by gaps of 1 or 2 mm, and the follow-up period was 6 weeks. Histological examination and histometry revealed that gaps of 1 mm can be bridged by bone if an apatite coating is applied. However, only a minimal amount of bone contact was seen on the apatite coatings with 2 mm gaps. Uncoated implants demonstrated no bone contact at all. Among the three different coatings there were no differences in gap healing. It can be concluded that in the goat, gaps of 2 or more mm between coated implants and host bone tissue inhibit bone deposition on the coating (p < 0.05), but the stability of the coating does not influence gap-healing characteristics.

Role of different loading conditions on resorption of hydroxyapatite coating evaluated by histomorphometric and stereological methods

The role of different loading conditions on resorption of plasma-sprayed hydroxyapatite coating was investigated in an experimental study. Resorption of hydroxyapatite was quantified by histomorphometric and stereological methods on backscattered scanning electron images. Hydroxyapatite-coated titanium implants were inserted unilaterally into the medial femoral condyle of the knee in 14 mature dogs. Initially, all implants were subjected to controlled micromotion of 150 microns. After 4 weeks, the dogs were randomly assigned either to have the implant surgically immobilized to prevent further micromovement or to have a sham operation. Sixteen weeks after the first operation, the implants were analyzed. Six noninserted implants served as controls. The surface area and volume of the hydroxyapatite coating were reduced on the immobilized implants by 53 and 67% (p < 0.05), respectively, and were further significantly reduced on the continuously loaded implants by 83 and 87%, respectively, compared with the control implants. The hydroxyapatite coating was significantly thinner on immobilized (15 microns) and continuously loaded (15 microns) implants as compared with control implants (23 microns), but no difference between the inserted implants was found. Areas not covered with hydroxyapatite had 29 and 24% bone coverage on the immobilized and continuously loaded implants (not significant). Resorption of hydroxyapatite coating did occur in vivo. Continuous loading of the implants accelerated resorption significantly compared with immobilization of the implants. It is suggested that completely resorbed hydroxyapatite was partly replaced by bone in direct contact with the metal implant surface.

Differences of bone bonding ability and degradation behaviour in vivo between amorphous calcium phosphate and highly crystalline hydroxyapatite coating

Three types of calcium phosphate coating were formed on polyethersulphone (PES) rectangular plates using a biomimetic method: a 20 microns thick amorphous calcium phosphate (ACP 20) coating, a 50 microns thick amorphous calcium phosphate (ACP 50) coating, and a 50 microns thick highly crystalline hydroxyapatite (hHA 50) coating. Uncoated PES plates were used as a control group. These materials were implanted in the tibiae of rabbits and subcutaneously in rats, and the samples were harvested 8 and 16 weeks thereafter, and were examined histologically. The tensile failure loads at the bone-implant interfaces were determined using the detaching test. Each ACP coating was more degradable than the hHA 50 coating. However, newly formed bone came into direct contact with underlying materials as the coating degraded. No coating degraded in subcutaneous tissue. Soft tissue intervening was seen in uncoated samples. Failure load of ACP 20-, ACP 50- and hHA 50-coated samples were all relatively higher than that of the uncoated samples at each period. Significant increase of failure load was seen in hHA 50-coated samples by 16 weeks, however, no increase was seen in either the uncoated or ACP-coated samples. If coating longevity is desired, then the hHA coating is preferable. However, if only the osteoconducive property of calcium phosphate coating is desired for initial fixation of porous materials, the ACP coating may be advantageous.

Biomechanical and histological analysis of an HA coated, arc deposited CPTi canine hip prosthesis

The interfacial shear strength and bone tissue response was investigated for an arc deposited (AD) commercially pure titanium implant surface, with (AD/HA) and without (AD) plasma-sprayed hydroxyapatite (HA) coating. Ten purpose bred coonhounds received bilateral femoral stem implantation (AD and AD/HA) in the proximal femurs (hemiarthroplasty). The femoral prosthesis consisted of a modular CoCr alloy head, modular Ti-6Al-4V neck, and a 10-mm diameter cylindrical Ti-6Al-4V femoral stem. The AD surface had 30-35% greater surface roughness than the AD/HA surface. The HA coating had a purity greater than 90% and a crystallinity greater than 65%. After 6, 12, and 24 weeks, the implants were retrieved and analyzed with mechanical testing, qualitative and quantitative histology, and electron microscopy. The AD/HA implants had equivalent interfacial shear strengths to the AD implants at all time periods. The AD/HA implants had significantly greater linear bone contact than the AD implants. The 6-week implants had significantly thicker cortical bone than the 12- and 24-week implants. The HA coating was very stable in vivo, evidenced by no thickness reduction at any time period. Qualitatively, the AD/HA implants primarily had bone contacting the implant surface with little fibrous tissue present, and the AD implants had bone and fibrous tissue contacting the implant surface. The electron microscopy analysis showed that the mechanically tested implants exhibited a mixed failure mode at the bone, HA coating, and titanium interfaces.