Biocompatibility of titanium implants modified by microarc oxidation and hydroxyapatite coating

Hydroxyapatite-based coatings on Mg and Ti-based implants: A detailed examination of various coating methodologies

Metallic implants have been considered as promising alternatives to traditional implants due to their biocompatibility and favorable biodegradability properties. However, one of the major challenges in using these implants is the relatively fast degradation rate of metal alloys in the body's electrolyte environment, which can lead to early loss of performance and the release of undesirable degradation products. Applying appropriate coatings with suitable performance on the surface of metal implants can be an effective solution to control the rate of deterioration and increase their stability in the body environment. In this comprehensive study, various methods of coating metal implants with calcium phosphate or hydroxyapatite structures, including sol-gel, chemical deposition (such as hydrothermal deposition), and thermal spraying (such as plasma spray) methods have been fully investigated. The benefits and drawbacks of each of these techniques in relation to the properties of the resulting coating such as surface morphology, chemical composition, adhesion to the substrate, porosity and crystal structure, anti-corrosion performance, their impact on the biological performance of the implant in terms of biocompatibility, degradation rate control, and mechanical properties, as well as limitations related to the coating process are described. The results of this comprehensive study provide valuable and key guidance for choosing the most suitable coating and coating method according to the type of medical application considered for metal implants.

Antibacterial Properties and Biocompatibility of Multicomponent Titanium Oxides: A Review

The simple oxides like titania, zirconia, and ZnO are famous with their antibacterial (or even antimicrobial) properties as well as their biocompatibility. They are broadly used for air and water filtering, in food packaging, in medicine (for implants, prostheses, and scaffolds), etc. However, these application fields can be broadened by switching to the composite multicomponent compounds (for example, titanates) containing in their unit cell, together with oxygen, several different metallic ions. This review begins with a description of the synthesis methods, starting from wet chemical conversion through the manufacturing of oxide (nano)powders toward mechanosynthesis methods. The morphology of these multicomponent oxides can also be very different (like thin films, complicated multilayers, or porous scaffolds). Further, we discuss in vitro tests. The antimicrobial properties are investigated with Gram-positive or Gram-negative bacteria (like Escherichia coli or Staphylococcus aureus) or fungi. The cytotoxicity can be studied, for example, using mouse mesenchymal stem cells, MSCs (C3H10T1/2), or human osteoblast-like cells (MG63). Other human osteoblast-like cells (SaOS-2) can be used to characterize the cell adhesion, proliferation, and differentiation in vitro. The in vitro tests with individual microbial or cell cultures are rather far away from the real conditions in the human or animal body. Therefore, they have to be followed by in vivo tests, which permit the estimation of the real applicability of novel materials. Further, we discuss the physical, chemical, and biological mechanisms determining the antimicrobial properties and biocompatibility. The possible directions of future developments and novel application areas are described in the concluding section of the review.

The Applicability of Polyetheretherketone and Titanium Mesh in Cranioplasty: A Retrospective Comparative Analysis

OBJECTIVE

To compare the clinical application effect and safety of polyetheretherketone (PEEK) and titanium mesh (TM) in cranioplasty.

METHODS

Four-year retrospective comparison of patients (96 cases) undergoing synthetic cranioplasty with PEEK or TM. The patients were divided into the PEEK group (24 cases) and the TM group (72 cases) according to the implants, and the patient demographics, general conditions before the operation, postoperative complications, length of postoperative hospital stay, total costs, satisfaction with shaping and long-term complications were compared between the 2 groups.

RESULTS

Patients in the PEEK group were younger than those in the TM group (P=0.019). Hospitalization costs were significantly higher in the PEEK group than in the TM group (P<0.001). The incidence of postoperative subcutaneous effusion was 33% in the PEEK group and 6.9% in the TM group, which suggests that patients in the PEEK group had a higher risk of postoperative subcutaneous effusion (P=0.001). There was no significant difference in the incidence of long-term complications and cosmetic satisfaction between the 2 groups at 4 years postoperatively.

CONCLUSIONS

In this study, both titanium mesh and PEEK are reliable implants for cranioplasty. Titanium mesh is widely used in cranioplasty due to its cost-effective performance. PEEK has gradually gained recognition due to the characteristics of the material and surgical procedure, but the price needs to be further reduced, and attention should be paid to the occurrence and treatment of early postoperative subcutaneous effusion.

Surface-modified titanium and titanium-based alloys for improved osteogenesis: A critical review

As implantable materials, titanium, and its alloys have garnered enormous interest from researchers for dental and orthopedic procedures. Despite their success in wide clinical applications, titanium, and its alloys fail to stimulate osteogenesis, resulting in poor bonding strength with surrounding bone tissue. Optimizing the surface topology and altered compositions of titanium and titanium-based alloys substantially promotes peri-implant bone regeneration. This review summarizes the utilization and importance of various osteogenesis components loaded onto titanium and its alloys. Further, different surface-modification methods and the release efficacy of loaded substances are emphasized. Finally, we summarize the article with prospects. We believe that further investigation studies must focus on identifying novel loading components, exploring various innovative, optimized surface-modification methods, and developing a sustained-release system on implant surfaces to improve peri-implant bone formation.

Mussel-inspired biomaterials: From chemistry to clinic

After several billions of years, nature still makes decisions on its own to identify, develop, and direct the most effective material for phenomena/challenges faced. Likewise, and inspired by the nature, we learned how to take steps in developing new technologies and materials innovations. Wet and strong adhesion by Mytilidae mussels (among which Mytilus edulis-blue mussel and Mytilus californianus-California mussel are the most well-known species) has been an inspiration in developing advanced adhesives for the moist condition. The wet adhesion phenomenon is significant in designing tissue adhesives and surgical sealants. However, a deep understanding of engaged chemical moieties, microenvironmental conditions of secreted proteins, and other contributing mechanisms for outstanding wet adhesion mussels are essential for the optimal design of wet glues. In this review, all aspects of wet adhesion of Mytilidae mussels, as well as different strategies needed for designing and fabricating wet adhesives are discussed from a chemistry point of view. Developed muscle-inspired chemistry is a versatile technique when designing not only wet adhesive, but also, in several more applications, especially in the bioengineering area. The applications of muscle-inspired biomaterials in various medical applications are summarized for future developments in the field.

Nanostructural control of transparent hydroxyapatite nanoparticle films using a citric acid coordination technique

Hydroxyapatite (HA), as the main mineral component in hard tissues, has good biocompatibility. In particular, HA films are widely used as bioactive coatings for artificial bones and dental implants in biomedical fields. However, it is currently difficult to prepare a nanostructure-controlled HA film by a wet process for further applications. Herein, we report the synthesis of HA nanoparticles coordinated by citric acid (Cit/HA) based on the interactions between carboxylate and calcium ions to control the sizes and shapes of the hybrid nanoparticles, to improve their dispersibility in water and to eventually form uniform transparent films with nanospaces, and investigated the film formation mechanism. As compared with the well-known rod-like HA nanoparticles (size: 48 × 15 nm²), we successfully synthesized spherical and negatively charged Cit/HA nanoparticles (size: 25 × 23 nm²) to achieve highly transparent Cit/HA films using the spin-coating technique. The Cit/HA films had uniform and crack-free appearance. About the nanostructures, we found that the Cit/HA film surfaces had meso-scaled nanospaces with a diameter of 4.2 nm based on the regular arrangement of spherical nanoparticles, instead of the HA film with a nanospace diameter of 24.5 nm formed by non-uniform accumulation. Therefore, we successfully achieved the control of the nanospace sizes of the films with the nanoparticle arrangement and realized transparent nanoparticle film formation in a very simple way, which will provide more convenient bioceramic films for biomedical applications.

Assessment of the Functional Properties of 316L Steel Alloy Subjected to Ion Implantation Used in Biotribological Systems

Clinical trials conducted in many centres worldwide indicate that, despite advances made in the use of biomaterials for medical applications, tribocorrosive wear remains a significant issue. The release of wear residue into body fluids can cause inflammation and, as a result, implant failure. Surface modification is one of the methods used to improve the mechanical, tribological, and fatigue properties of biomaterials. In this article, the authors investigated the impact of ion implantation on improving the functional properties of implant surfaces. This paper presents morphology, geometric surface structure, hardness, and tribological test results for layers obtained by ion implantation with nitrogen and oxygen ions on alloy 316L. The surface morphology and thickness of the implanted layer were examined using scanning microscopy. Atomic force microscopy was used to evaluate the geometric structure of the surface. Instrumented indentation was used to measure nanohardness. Model tribo tests were carried out for reciprocating motion under conditions of dry friction and lubricated friction with Ringer’s solution. The tribological tests showed that the implanted samples had a lower wear than the reference samples. Nitrogen ion implantation increased the hardness of 316L steel by about 45% and increased it by about 15% when oxygen ions were used.

Early Bone Healing on Hydroxyapatite-Coated and Chemically-Modified Hydrophilic Implant Surfaces in an Ovine Model

Implant topography affects early peri-implant bone healing by changing the osteoconduction rate in the surrounding biological environment. Implant surfaces have been designed to promote faster and stronger bone formation for rapid and stable prosthesis loading. Early peri-implant bone healing has been observed with a sandblasted, acid-etched implant that was chemically modified to be hydrophilic (cmSLA). The present study investigates whether early peri-implant bone healing extends to a rough surface implant with a high crystalline hydroxyapatite surface (TSV MP-1 HA). Three implants were randomly placed in porous trabecular bone within both medial femoral condyles of 10 sheep. Early peri-implant bone stability was measured at 3- and 6-weeks healing time following implant insertion. Results indicated a similar implant stability quotient between the implants at insertion and over time. The significant increase over time of reverse torque values with respect to insertion torque (p < 0.001) did not differ between the implants. However, the bone-to-implant contact of TSV MP-1 HA was significantly higher than that of cmSLA implants at 6 weeks (p < 0.01). These data validate previous findings of a hydrophilic implant surface and extend the observation of early osseointegration to a rough surface implant in porous trabecular bone.

Surface Characterization and Biocompatibility of Hydroxyapatite Coating on Anodized TiO2 Nanotubes via PVD Magnetron Sputtering

Hydroxyapatite (HA) coating has received significant attention in the scientific community for the development of implants, and HA coating on titanium oxide (TiO₂) nanotubes has shown potential benefits in the improvement of cell proliferation, adhesion, and differentiation. In this study, a HA coating on a TiO₂ nanotubular surface was developed to improve the biocompatibility of the titanium (Ti) surface via magnetron sputtering. Scanning electron microscopy (SEM), surface profilometry, and water contact goniometry revealed that HA-coated TiO₂ nanotubes influenced the surface roughness (R_a) and hydrophilicity. The XRD and FTIR peaks indicated the presence of crystalline phases of TiO₂ (anatase) and HA-coated TiO₂ nanotubes after annealing at 500 °C for 120 min. The HA-coated TiO₂ nanotubes showed significantly increased R_a and decreased water contact angle (θ) compared to the as-anodized TiO₂ nanotubular and bare CP-Ti surfaces. MTS assay using osteoblast-like cells confirmed that the HA-coated TiO₂ nanotubular surface provided an enhanced cell attachment and growth when compared to as-anodized TiO₂ nanotubular and pure CP-Ti surfaces.

Characterization of Titanium Surface Modification Strategies for Osseointegration Enhancement

As biocompatible metallic materials, titanium and its alloys have been widely used in the orthopedic field due to their superior strength, low density, and ease of processing. However, further improvement in biological response is still required for rapid osseointegration. Here, various Ti surface-treatment technologies were applied: hydroxyapatite blasting, sand blasting and acid etching, anodic oxidation, and micro-arc oxidation. The surface characteristics of specimens subjected to these techniques were analyzed in terms of structure, elemental composition, and wettability. The adhesion strength of the coating layer was also assessed for the coated specimens. Biocompatibility was compared via tests of in vitro attachment and proliferation of pre-osteoblast cells.

Current Challenges and Innovative Developments in Hydroxyapatite-Based Coatings on Metallic Materials for Bone Implantation: A Review

Biomaterials are in use for the replacement and reconstruction of several tissues and organs as treatment and enhancement. Metallic, organic, and composites are some of the common materials currently in practice. Metallic materials contribute a big share of their mechanical strength and resistance to corrosion properties, while organic polymeric materials stand high due to their biocompatibility, biodegradability, and natural availability. To enhance the biocompatibility of these metals and alloys, coatings are frequently applied. Organic polymeric materials and ceramics are extensively utilized for this purpose due to their outstanding characteristics of biocompatibility and biodegradability. Hydroxyapatite (HAp) is the material from the ceramic class which is an ultimate candidate for coating on these metals for biomedical applications. HAp possesses similar chemical and structural characteristics to normal human bone. Due to the bioactivity and biocompatibility of HAp, it is used for bone implants for regenerating bone tissues. This review covers an extensive study of the development of HAp coatings specifically for the orthopaedic applications that include different coating techniques and the process parameters of these coating techniques. Additionally, the future direction and challenges have been also discussed briefly in this review, including the coating of HAp in combination with other calcium magnesium phosphates that occur naturally in human bone.

Development of tantalum with highly hydrophilic surface and antimicrobial properties obtained by micro-arc oxidation process

Tantalum (Ta) and its application in biomaterials has been attracting more and more attention recently. It can be considered as a material for hard tissue implants. This study focuses on antimicrobial and surface characterization of micro-arc oxidized (MAO) nanocrystalline Ta compared with its microcrystalline equivalent. For the purposes of the investigation, x-ray diffractometry (XRD), scanning electron microscopy (SEM), atomic force microscopy (AFM), wetting analysis, optical profilometry, corrosion resistance measurement, and antimicrobial tests were performed. Nanocrystalline Ta was fabricated using high-energy ball milling (HEBM) and pulse plasma sintering (PPS). The MAO process done at 250 V results in the formation of a porous oxide surface. An XRD analysis confirmed the presence of a Ta₂ O₅ oxide layer. Based on the SEM pictures, the obtained oxide layer was approximately 3-4 μm thick for nanocrystalline Ta substrate. For microcrystalline Ta, the oxide layer was thinner, in the range of 0.3-0.6 μm. The analysis of polarization curves showed a significant improvement of corrosion resistance for MAO nanocrystalline Ta (2.62 × 10^-8 A/cm² ) versus not oxidized nanocrystalline Ta (1.20 × 10^-5 A/cm² ). The surface roughness of MAO nanocrystalline Ta proved to be several times higher than that of unoxidized Ta. Wetting analysis showed that the oxide layer on the nanocrystalline substrate is hydrophilic. This research provides detailed information about MAO microcrystalline and MAO nanocrystalline Ta antimicrobial activity against Staphylococcus aureus and Pseudomonas aeruginosa. A significant decrease of S. aureus for MAO nanocrystalline Ta (control 10,435 ± 981 vs. sample 3,453 ± 130) was noticed. No significant difference was noticed for MAO microcrystalline and nanocrystalline Ta tested for P. aeruginosa.

In Vitro and In Vivo Biocompatibility Studies of a Cast and Coated Titanium Alloy

The biocompatibility of a cast porous and with a calcium titanate reaction layer functionalized titanium alloy (Ti-6Al-7Nb) was tested by means of cell culture, and a small (rat) and large animal (sheep) model. The uncoated titanium material served as a control. In-vitro tests included the validation of osteoblast-like cells attached to the surface of the material with scanning electron microscopy and immunofluorescence of cytoskeletal actin as well as their osteogenic development, the ability to mineralize, and their vitality. Following the in-vitro tests a small animal (rat) and big animal (sheep) model were accomplished by inserting a cylindrical titanium implant into a drill hole defect in the femoral condyle. After 7, 14, and 30 days (rat) and 6 months (sheep) the condyles were studied regarding histological and histomorphometrical characteristics. Uncoated and coated material showed a good biocompatibility both in cell culture and animal models. While the defect area in the rat is well consolidated after 30 days, the sheep show only little bone inside the implant after 6 months, possibly due to stress shielding. None of the executed methods indicated a statistically significant difference between coated and uncoated material.

Time-Transient Effects of Silver and Copper in the Porous Titanium Dioxide Layer on Antibacterial Properties

Recently, silver (Ag) and copper (Cu) have been incorporated into a titanium (Ti) surface to realize their antibacterial property. This study investigated both the durability of the antibacterial effect and the surface change of the Ag- and Cu-incorporated porous titanium dioxide (TiO2) layer. Ag- and Cu-incorporated TiO2 layers were formed by micro-arc oxidation (MAO) treatment using the electrolyte with Ag and Cu ions. Ag- and Cu-incorporated specimens were incubated in saline during a period of 0-28 days. The changes in both the concentrations and chemical states of the Ag and Cu were characterized using X-ray photoelectron spectroscopy (XPS). The durability of the antibacterial effects against Escherichia coli (E. coli) were evaluated by the international organization for standardization (ISO) method. As a result, the Ag- and Cu-incorporated porous TiO2 layers were formed on a Ti surface by MAO. The chemical state of Ag changed from Ag2O to metallic Ag, whilst that of Cu did not change by incubation in saline for up to 28 days. Cu existed as a stable Cu2O compound in the TiO2 layer during the 28 days of incubation in saline. The concentrations of Ag and Cu were dramatically decreased by incubation for up to 7 days, and remained a slight amount until 28 days. The antibacterial effect of Ag-incorporated specimens diminished, and that of Cu was maintained even after incubation in saline. Our study suggests the importance of the time-transient effects of Ag and Cu on develop their antibacterial effects.

Biodegradation behavior of micro-arc oxidation coating on magnesium alloy-from a protein perspective

Protein exerts a critical influence on the degradation behavior of absorbable magnesium (Mg)-based implants. However, the interaction mechanism between protein and a micro-arc oxidation (MAO) coating on Mg alloys remains unclear. Hereby, a MAO coating was fabricated on AZ31 Mg alloy. And its degradation behavior in phosphate buffer saline (PBS) containing bovine serum albumin (BSA) was investigated and compared with that of the uncoated alloy. Surface morphologies and chemical compositions were studied using Field-emission scanning electron microscope (FE-SEM), Fourier transform infrared spectrophotometer (FT-IR) and X-ray diffraction (XRD). The degradation behavior of the bare Mg alloy and its MAO coating was studied through electrochemical and hydrogen evolution tests. Cytotoxicity assay was applied to evaluate the biocompatibility of Mg alloy substrate and MAO coating. Results indicated that the presence of BSA decreased the degradation rate of Mg alloy substrate because BSA (RCH(NH₂)COO‾) molecules combined with Mg²⁺ ions to form (RCH(NH₂)COO)₂Mg and thus inhibited the dissolution of Mg(OH)₂ by impeding the attack of Cl‾ ions. In the case of MAO coated Mg alloy, the adsorption of BSA on MAO coating and the formation of (RCH(NH₂)COO)₂Mg exhibited a synergistic effect and enhanced the corrosion resistance of the coated alloy significantly. Furthermore, cell bioactive assay suggested that the MAO coating had good viability for MG63 cells due to its high surface area.

•

BSA reduces degradation of Mg substrate due to the formation of (RCH(NH₂)COO)₂Mg.

•

BSA inhibits degradation of MAO coating by acting as a protective layer.

•

MAO coating promotes cell proliferation due to higher surface area.

•

Cells were rounded shaped on MAO coating owing to the rough surface.

Controlled release of BMP-2 from titanium with electrodeposition modification enhancing critical size bone formation

In this study, a porous Ti-alloy based implant with an interconnected channel structure (MAO-CaP-BMP2) is fabricated using a method combining 3D printing, microarc oxidation (MAO) treatment, and co-precipitation of Ca,P layer with BMP-2 technique. The macroporous structure with pore size of 600 μm made by 3D printing not only enhances the ingrowth of cells but also allows the formation of blood vessels inside the implant. As a result, the new bond formation is promoted. In addition, the microporous dioxide layer formed on the implant surface by MAO provides the sites for co-precipitation of Ca,P layer with BMP-2. The microstructure allows the prolonged release of BMP-2. Our results show that a sustained release of BMP-2 over 35 days is achieved for MAO-CaP-BMP2 group longer than Ti without MAO modification group and without Ca,P electrochemical deposition group. The slow release of BMP-2 at the bone/implant interface for a long period of time leads to enhancement of the osseointegration between the implant and surrounding bones. This result indicates that MAO-CaP-BMP2 is a good candidate of growth factor carrier. Successful regeneration of bone requires the concomitant processes of osteogenesis and neovascularization. MAO-CaP-BMP2 modified Ti-alloy implant is both osteoinductive and osteoconductive which can create better osteogenesis and angiogenesis. As a result, it can enhance bone formation.

Multilayered composite coatings of titanium dioxide nanotubes decorated with zinc oxide and hydroxyapatite nanoparticles: controlled release of Zn and antimicrobial properties against Staphylococcus aureus

Purpose: This study aimed to decorate the surface of TiO₂ nanotubes (TiO₂ NTs) grown on medical grade Ti-6Al-4V alloy with an antimicrobial layer of nano zinc oxide particles (nZnO) and then determine if the antimicrobial properties were maintained with a final layer of nano-hydroxyapatite (HA) on the composite.

Methods: The additions of nZnO were attempted at three different annealing temperatures: 350, 450 and 550 °C. Of these temperatures, 350°C provided the most uniform and nanoporous coating and was selected for antimicrobial testing.

Results: The LIVE/DEAD assay showed that ZnCl₂ and nZnO alone were >90% biocidal to the attached bacteria, and nZnO as a coating on the nanotubes resulted in around 70% biocidal activity. The lactate production assay agreed with the LIVE/DEAD assay. The concentrations of lactate produced by the attached bacteria on the surface of nZnO-coated TiO₂ NTs and ZnO/HA-coated TiO₂ NTs were 0.13±0.03 mM and 0.37±0.1 mM, respectively, which was significantly lower than that produced by the bacteria on TiO₂ NTs alone, 1.09±0.30 mM (Kruskal–Wallis, P<0.05, n=6). These biochemical measurements were correlated with electron micrographs of cell morphology and cell coverage on the coatings.

Conclusion: nZnO on TiO₂ NTs was a stable and antimicrobial coating, and most of the biocidal properties remained in the presence of nano-HA on the coating.

Ion-substituted calcium phosphate coatings by physical vapor deposition magnetron sputtering for biomedical applications: A review

Coatings based on ion-substituted calcium phosphate (Ca-P) have attracted great attention in the scientific community over the past decade for the development of biomedical applications. Among such Ca-P based structures, hydroxyapatite (HA) has shown significant influence on cell behaviors including cell proliferation, adhesion, and differentiation. These cell behaviors determine the osseointegration between the implant and host bone and the biocompatibility of implants. This review presents a critical analysis on the physical vapor deposition magnetron sputtering (PVDMS) technique that has been used for ion-substituted Ca-P based coatings on implants materials. The effect of PVDMS processing parameters such as discharge power, bias voltage, deposition time, substrate temperature, and post-heat treatment on the surface properties of ion-substituted Ca-P coatings is elucidated. Moreover, the advantages, short comings and future research directions of Ca-P coatings by PVDMS have been comprehensively analyzed. It is revealed that the topography and surface chemistry of amorphous HA coatings influence the cell behavior, and ion-substituted HA coatings significantly increase cell attachment but may result in a cytotoxic effect that reduces the growth of the cells attached to the coating surface areas. Meanwhile, low-crystalline HA coatings exhibit lower rates of osteogenic cell proliferation as compared to highly crystalline HA coatings developed on Ti based surfaces. PVDMS allows a close reproduction of bioapatite characteristics with high adhesion strength and substitution of therapeutic ions. It can also be used for processing nanostructured Ca-P coatings on polymeric biomaterials and biodegradable metals and alloys with enhanced corrosion resistance and biocompatibility. STATEMENT OF SIGNIFICANCE: Recent studies have utilized the physical vapor deposition magnetron sputtering (PVDMS) for the deposition of Ca-P and ion-substituted Ca-P thin film coatings on orthopedic and dental implants. This review explains the effect of PVDMS processing parameters, such as discharge power, bias voltage, deposition time, substrate temperature, and post-heat treatment, on the surface morphology and crystal structure of ion-substituted Ca-P and ion-substituted Ca-P thin coatings. It is revealed that coating thickness, surface morphology and crystal structure of ion-substituted Ca-P coatings via PVDMS directly affect the biocompatibility and cell responses of such structures. The cell responses determine the osseointegration between the implant and host bone and eventually the success of the implants.

Bibliographic review on the state of the art of strontium and zinc based regenerative therapies. Recent developments and clinical applications

This review brings up to date the state of the art of strontium and zinc based regenerative therapies, both having a promoting effect on tissue formation and a role inhibiting resorption in musculoskeletal disorders.

Cellular Response of Anodized Titanium Surface by Poly(Lactide-co-Glycolide)/Bone Morphogenic Protein-2

Background

The purpose of this study is to examine physical characteristics of and initial biological properties to anodized titanium treated with poly(d,l-lactide-co-glycolide) (PLG) mixed with recombinant human bone morphogenic protein-2 (rhBMP-2).

Methods

Titanium specimens were prepared in groups of four as follows: group NC was anodized under 300 V as control; group PC was anodized then dropped and dried with solution 0.02 ml PLG; group D was anodized then dropped and dried with solution 0.02 ml PLG/rhBMP-2 (3.75 μg per disc); and group E was anodized then coated with 0.02 ml PLG/rhBMP-2 (3.75 μg per disc) by electrospray. Human osteoblastic-like sarcoma cells were cultured. Cell proliferation and alkaline phosphatase (ALP) activity test were carried out. Runx-2 gene was investigated by the reverse transcription-polymerase chain reaction. Immunofluorescence outcome of osteogenic proteins was observed.

Results

After 3 days, there were significantly higher proliferations compared rhBMP-2 loaded titanium discs with rhBMP-2 unloaded discs. The ALPase activity on rhBMP-2 loaded titanium discs was significantly higher than in rhBMP-2 unloaded discs. The expression level of Runx2 mRNA presented the highest on the PLG/rhBMP-2-coated surface.

Conclusion

PLG polymers mixed with rhBMP-2 might improve proliferation, differentiation and osteogenic protein formation of cells on the anodized titanium.

Hybrid micro/nanostructural surface offering improved stress distribution and enhanced osseointegration properties of the biomedical titanium implant

OBJECTIVES

The aim of the present study was to investigate the surface characteristic, biomechanical behavior, hemocompatibility, bone tissue response and osseointegration of the optimal micro-arc oxidation surface-treated titanium (MST-Ti) dental implant.

MATERIALS AND METHODS

The surface characteristic, biomechanical behavior and hemocompatibility of the MST-Ti dental implant were performed using scanning electron microscope, finite element method, blood dripping and immersion tests. The mini-pig model was utilized to evaluate the bone tissue response and osseointegration of the MST-Ti dental implant in vivo. Data were analyzed by analysis of variance using the Student's t-test (P ≤ 0.05).

RESULTS

The hybrid volcano-like micro/nanoporous structure was formed on the surface of the MST-Ti dental implant. The hybrid volcano-like micro/nanoporous surface played an important role to improve the stress transfer between fixture, cortical bone and cancellous bone for the MST-Ti dental implant. Moreover, the MST-Ti implant was considered to have the outstanding hemocompatibility. In vivo testing results showed that the bone-to-implant contact (BIC) ratio significantly altered as the implant with micro/nanoporous surface. After 12 weeks of implantation, the MST-Ti dental implant group exhibited significantly higher BIC ratio than the untreated dental implant group. In addition, the MST-Ti dental implant group also presented an enhancing osseointegration, particularly in the early stages of bone healing.

CONCLUSION

It can be concluded that the micro-arc oxidation approach induced the formation of micro/nanoporous surface is a promising and reliable alternative surface modification for Ti dental implant applications.

A bioactive coating with submicron-sized titania crystallites fabricated by induction heating of titanium after tensile deformations

Thermal oxidation technology was widely investigated as one of effective surface modification method for improving the bioactivity and biocompatibility of titanium and its alloys. In this work, the induction heat oxidization method, a fast, efficient, economical and environmental protective technology, was applied to prepare the submicron-morphological oxide coating with variable rutile TiO₂ equiaxed crystallites on the surface of pure Ti substrates after cold-drawing with 10-20% deformations. The results showed the plastic-deformed Ti cylinders recrystallized during induction heating treatment (IHT) for 10-20s which resulted in evolution of microstructures as well as slight improvement of microhardness. The surface characteristics of TiO₂ crystallites in oxidation layers were determined by the microstructural evolutions of Ti substrate in terms of the nucleation and growth of TiO₂ crystallites. Specially, the oxidized surface with 50-75nm roughness and more uniform and finer equiaxed oxide grains remarkablely improved the apatite deposition after bioactive evaluation in 1.5 × SBF for 7 days. This work provided a potential method to create controlled bioactive oxide coatings with submicro-/nano-scaled TiO₂ crystallites on titanium substrate in terms of the role of metallographic microstructure in the formation process of titanium oxides.

Mechanical properties of anodic titanium films containing ions of Ca and P submitted to heat and hydrothermal treatment

Anodic oxidation is a technique widely used to improve the bioactivity of Ti surface. In this study, micro-arc oxidation (MAO) was used to obtain an anodic film incorporating Ca and P ions to evaluate the effect of heat and hydrothermal treatment on the mechanical and in vitro bioactivity properties of these new layers. The MAO process was carried out using (CH3COO)2Ca·H2O and NaH2PO4·2H2O electrolytes under galvanostatic mode (150mA/cm(2)). The thermal treatments were made at 400°C and 600°C in air atmosphere while hydrothermal treatment was made in an alkaline water solution at 130°C. These surfaces presented desired mechanical properties for biomedical applications owing to the rutile and anatase phases in the anodic film that are more crystalline after thermal treatments; which provided an increase in hardness values and lower elastic modulus. The dry sliding wear resistance increased by performing thermal treatments on the surfaces with one condition still maintaining the film after the test. Bioactivity was investigated by immersion in simulated body fluid during 21 days and hydroxyapatite was formed on all samples. Finally, lower values of contact angle were obtained for heat treated samples.

Deposition of hydroxyapatite–incorporated TiO2 coating on titanium using plasma electrolytic oxidation coupled with electrophoretic deposition

K₂[TiO(C₂O₄)₂] is decomposed by micro-arcs on the anode producing TiO₂ while hydroxyapatite particles are incorporated into TiO₂ coating during electrophoretic deposition.

Patient-specific implants compared with stored bone grafts for patients with interval cranioplasty

Interval cranioplasty after craniectomy carries the risk of infection and failure. There is no consensus regarding the choice of reconstruction technique. In addition to the replacement of the stored autogenous bone graft, the use of patient-specific implants (PSIs) has become popular. We conducted a retrospective study comparing 17 patients who underwent reconstruction with PSIs (titanium and polyether ether ketone) (follow-up, 43 months [range, 3-93]) with 16 control subjects who had their stored bone grafts reimplanted (follow-up, 32 months [range, 5-92]) based on success rate, complication rate, operative time, and duration of hospitalization. Complication rate and the rate of necessary reoperation were significantly lower, and the hospital stay was shorter in the PSI group. We did not find any significant differences concerning operative time. In our patient groups, interval reconstruction after craniectomy with a PSI was a safer procedure based on complication and success rates than reconstruction with stored autogenous bone grafts. In patients with interval cranioplasty who have a higher risk for complication or failure, the use of PSIs should be the treatment of choice.

Calcium orthophosphate deposits: Preparation, properties and biomedical applications

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

Alternative antimicrobial approach: nano-antimicrobial materials

Despite numerous existing potent antibiotics and other antimicrobial means, bacterial infections are still a major cause of morbidity and mortality. Moreover, the need to develop additional bactericidal means has significantly increased due to the growing concern regarding multidrug-resistant bacterial strains and biofilm associated infections. Consequently, attention has been especially devoted to new and emerging nanoparticle-based materials in the field of antimicrobial chemotherapy. The present review discusses the activities of nanoparticles as an antimicrobial means, their mode of action, nanoparticle effect on drug-resistant bacteria, and the risks attendant on their use as antibacterial agents. Factors contributing to nanoparticle performance in the clinical setting, their unique properties, and mechanism of action as antibacterial agents are discussed in detail.

Surface properties and biocompatibility of nanostructured TiO2 film deposited by RF magnetron sputtering

Nanostructured TiO2 films are deposited on a silicon substrate using 150-W power from the RF magnetron sputtering at working pressures of 3 to 5 Pa, with no substrate bias, and at 3 Pa with a substrate bias of -50 V. X-ray diffraction (XRD) analysis reveals that TiO2 films deposited on unbiased as well as biased substrates are all amorphous. Surface properties such as surface roughness and wettability of TiO2 films, grown in a plasma environment, under biased and unbiased substrate conditions are reported according to the said parameters of RF power and the working pressures. Primary rat osteoblasts (MC3T3-E1) cells have been cultured on nanostructured TiO2 films fabricated at different conditions of substrate bias and working pressures. The effects of roughness and hydrophilicity of nanostructured TiO2 films on cell density and cell spreading have been discussed.

Characteristics of multi-layer coating formed on commercially pure titanium for biomedical applications

An innovative multi-layer coating comprising a bioactive compound layer (consisting of hydroxyapatite and calcium titanate) with an underlying titanium oxide layer (in the form of anatase and rutile) has been developed on Grade 4 quality commercially pure titanium via a single step micro-arc oxidation process. Deposition of a multi-layer coating on titanium enhanced the bioactivity, while providing antibacterial characteristics as compared its untreated state. Furthermore, introduction of silver (4.6wt.%) into the multi-layer coating during micro-arc oxidation process imposed superior antibacterial efficiency without sacrificing the bioactivity.

Interval cranioplasty with patient-specific implants and autogenous bone grafts--success and cost analysis

Different options exist for the reconstruction of craniectomy defects following interval cranioplasty. The standard procedure is still based on the re-implantation of autogenous bone specimen which can be stored in the abdominal wall or be cryopreserved. Alternatively patient-specific implants (PSIs) can be used. We conducted a retrospective study based on 50 consecutive patients with skull bone defects of 100 cm(2) or more being operated on by the same team of surgeons. Thirty-three patients agreed to take part in the study. Seventeen patients who underwent reconstruction with PSIs (titanium and polyether ether ketone, PEEK) (follow-up, 43 months [range, 3-93]) were compared with 16 control subjects who had autogenous bone grafts re-implanted (follow-up, 32 months [range, 5-92]). Criteria analyzed were the success and complication rates, operation time, duration of hospitalization and the treatment costs. Complication rate and the rate of reoperation were significantly lower, and the hospital stay was shorter in the PSI group. The treatment costs for reconstruction with autogenous bone were considerably lower than skull bone reconstruction based on PSIs (average costs: 10849.91 €/patient versus 15532.08 €/patient with PSI). Due to biological reasons some of the autogenous bone implants fail due to infection and resorption and the patients have to undergo another operation with implantation of a PSI in a secondary attempt. For those patients the highest overall treatment costs must be calculated (average costs: 26086.06 €/patient with secondary stage PSI versus 15532.08 €/patient with primary stage PSI).

CONCLUSION

High success rates and reliability of PSIs may change the treatment strategy in patients undergoing interval cranioplasty.

Biocompatibility and Surface Properties of TiO₂ Thin Films Deposited by DC Magnetron Sputtering

We present the study of the biocompatibility and surface properties of titanium dioxide (TiO₂) thin films deposited by direct current magnetron sputtering. These films are deposited on a quartz substrate at room temperature and annealed with different temperatures (100, 300, 500, 800 and 1100 °C). The biocompatibility of the TiO₂ thin films is analyzed using primary cultures of dorsal root ganglion (DRG) of Wistar rats, whose neurons are incubated on the TiO₂ thin films and on a control substrate during 18 to 24 h. These neurons are activated by electrical stimuli and its ionic currents and action potential activity recorded. Through X-ray diffraction (XRD), the surface of TiO₂ thin films showed a good quality, homogeneity and roughness. The XRD results showed the anatase to rutile phase transition in TiO₂ thin films at temperatures between 500 and 1100 °C. This phase had a grain size from 15 to 38 nm, which allowed a suitable structural and crystal phase stability of the TiO₂ thin films for low and high temperature. The biocompatibility experiments of these films indicated that they were appropriated for culture of living neurons which displayed normal electrical behavior.

Effects of titanium surface anodization with CaP incorporation on human osteoblastic response

In this study we investigated whether anodization with calcium phosphate (CaP) incorporation (Vulcano®) enhances growth factors' secretion, osteoblast-specific gene expression, and cell viability, when compared to acid etched surfaces (Porous®) and machined surfaces (Screw®) after 3 and 7days. Results showed significant cell viability for Porous and Vulcano at day 7, when compared with Screw (p=0.005). At the same time point, significant differences regarding runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP) and bone sialoprotein (BSP) expression were found for all surfaces (p<0.05), but with greater fold induction for Porous and Vulcano. The secretion of transforming growth factor β1 (TGF-β1) and bone morphogenetic protein 2 (BMP-2) was not significantly affected by surface treatment in any experimental time (p>0.05). Although no significant correlation was found for growth factors' secretion and Runx2 expression, a significant positive correlation between this gene and ALP/BSP expression showed that their strong association is independent on the type of surface. The incorporation of CaP affected the biological parameters evaluated similar to surfaces just acid etched. The results presented here support the observations that roughness also may play an important role in determining cell response.

Plasma electrolytic oxidation of titanium and improvement in osseointegration

Reducing the osseointegration time for biomedical titanium implants in surgical patients is an important goal. However, a huge controversy exists over the effectiveness of osseointegration of the surface layer by plasma electrolytic oxidation (PEO), which is a widely favored surface modification for titanium-based implants. In this study, various surface coatings, including anatase-TiO2 (A-TiO2 ), rutile-TiO2 (R-TiO2 ), hydroxyapatite (HAp), strontium-containing hydroxyapatite (Sr-HAp), and dual-phase HAp-TiO2 were synthesized on titanium implants by PEO. A comparative study of osseointegration performance (both in vitro and in vivo) and bone/implant adhesion strength conducted using push-out thrust tests were demonstrated. The in vitro experimental test results agree strongly with the in vivo test results: the dual-phase HAp-TiO2 coating exhibits the superior cell adhesion and differentiation condition among all of the coatings in the in vitro tests and therefore has the highest push-out bonding strength of 5.37 MPa after 12 wk of implantation in the in vivo test. The HAp-containing coatings benefit from its bioactivity and therefore perform the others in terms of long-term osteocyte growth (from the in vitro results) and the extent of osseointegration (from the in vivo results). The dual-phase HAp-TiO2 coating provides the advantages of both the bioactive HAp and structural enhancement by the TiO2 , effectively promoting osseointegration.

Enhancement of biomechanical behavior on osseointegration of implant with SLAffinity

The purpose of this study was to investigate stresses resulting from different thicknesses of hydroxyapatite- and titanium dioxide (TiO(2))-treated layers at the interface between temporomandibular joint (TMJ) implants and bones using three-dimensional finite element models. For ensuring osseointegration of implant treatment, one must examine the stresses of interface between implant and bone tissue. Treated layers on TMJ implants are a very important factor in clinical application. Several studies have investigated finite element models for TMJs, but few have examined a model for TMJ implants with treated layers. In this study, TMJ models were reconstructed using computer tomography data, and the effects of treated layer thickness on the stress field during jaw movement were investigated; this index has not yet been reported with respect to TMJ implant. The maximum stresses in the bone occurred at the position of the first screw. Data analysis indicated a greater decrease in this stress in the case of using TMJ implants with TiO(2)-treated layers, and the stresses decreased with increasing layer thicknesses. Results confirmed that the treated layers improve biomechanical properties of the TMJ implants and release abnormal stress concentration in them. The results of our study offer the potential clinical benefit of inducing superior biomechanical behavior in TMJ implants.

Hydroxyapatite/poly(ɛ-caprolactone) double coating on magnesium for enhanced corrosion resistance and coating flexibility

Hydroxyapatite was deposited on pure magnesium (Mg) with a flexible poly(ɛ-caprolactone) interlayer to reduce the corrosion rate of Mg and enhance coating flexibility. The poly(ɛ-caprolactone) interlayer was uniformly coated on Mg by a spraying method, followed by hydroxyapatite deposition on the poly(ɛ-caprolactone) using an aerosol deposition method. In scanning electron microscopy observations, inorganic/organic composite-like structure was observed between the hydroxyapatite and poly(ɛ-caprolactone) layers, resulting from the collisions of hydroxyapatite particles into the poly(ɛ-caprolactone) matrix at the initial stage of the aerosol deposition. The corrosion resistance of the coated Mg was examined using potentiodynamic polarization tests. The hydroxyapatite/poly(ɛ-caprolactone) double coating remarkably improved the corrosion resistance of Mg in Hank’s solution. In the in vitro cell tests, the coated Mg showed better cell adhesion compared with the bare Mg due to the reduced corrosion rate and enhanced biocompatibility. The stability and flexibility of hydroxyapatite/poly(ɛ-caprolactone) double coating was investigated by scanning electron microscopy inspections after the coated Mg was deformed. The hydroxyapatite coating on the poly(ɛ-caprolactone) interlayer revealed enhanced coating stability and flexibility without cracking or delamination during bending and stretching compared with the hydroxyapatite single coating. These results demonstrated that the hydroxyapatite/poly(ɛ-caprolactone) double coating significantly improved the surface corrosion resistance of Mg and enhanced coating flexibility for use of Mg as a biodegradable implant.

Effect of micro-arc oxidation surface modification on the properties of the NiTi shape memory alloy

In this paper, the effects of micro-arc oxidation (MAO) surface modification (alumina coatings) on the phase transformation behavior, shape memory characteristics, in vitro haemocopatibility and cytocompatibility of the biomedical NiTi alloy were investigated respectively by differential scanning calorimetry, bending test, hemolysis ratio test, dynamic blood clotting test, platelet adhesion test and cytotoxicity testing by human osteoblasts (Hobs). The results showed that there were no obvious changes of the phase transformation temperatures and shape memory characteristics of the NiTi alloy after the MAO surface modification and the coating could withstand the thermal shock and volume change caused by martensite-austenite phase transformation. Compared to the uncoated NiTi alloys, the MAO surface modification could effectively improve the haemocopatibility of the coated NiTi alloys by the reduced hemolysis ratio, the prolonged dynamic clotting time and the decreased number of platelet adhesion; and the rough and porous alumina coatings could obviously promote the adherence, spread and proliferation of the Hobs with the significant increase of proliferation number of Hobs adhered on the surface of the coated NiTi alloys (P < 0.05).

Formation of High Corrosion Resistant Nanotubular Layers on Titanium Alloy Ti13Nb13Zr

This paper presents results of oxidation tests and corrosion investigations of titanium alloy Ti13Nb13Zr performed at different conditions. The oxide layers have been formed by electrochemical method in 2M H3PO4 + 0.3% HF solution for 30 min. and 1 h at 20 V constant voltage. The corrosion tests have been made by potentiodynamic method in Ringer`s solution at pH ranged between 3 and 7. It has been shown that the nanooxide films, which improve corrosion resistance of titanium alloy Ti13Nb13Zr even if acidic environment, have appeared.