Osteoblast adhesion to functionally graded hydroxyapatite coatings doped with silver

Silver-integrated EDM processing of TiAl6V4 implant material has antibacterial capacity while optimizing osseointegration

Periprosthetic joint infections (PJI) are a common reason for orthopedic revision surgeries. It has been shown that the silver surface modification of a titanium alloy (Ti-6Al-4V) by PMEDM (powder mixed electrical discharge machining) exhibits an antibacterial effect on Staphylococcus spp. adhesion. Whether the thickness of the silver-modified surface influences the adhesion and proliferation of bacteria as well as the ossification processes and in-vivo antibacterial capacity has not been investigated before. Therefore, the aim of this work is to investigate the antibacterial effect as well as the in vitro ossification process depending on the thickness of PMEDM silver modified surfaces. The attachment of S. aureus on the PMEDM modified surfaces was significantly lower than on comparative control samples, independently of the tested surface properties. Bacterial proliferation, however, was not affected by the silver content in the surface layer. We observed a long-term effect of antibacterial capacity in vitro, as well as in vivo. An induction of ROS, as indicator for oxidative stress, was observed in the bacteria, but not in osteoblast-like cells. No influence on the in vitro osteoblast function was observed, whereas osteoclast formation was drastically reduced on the silver surface. No changes in cell death, the metabolic activity and oxidative stress was measured in osteoblasts. We show that already small amounts of silver exhibit a significant antibacterial capacity while not influencing the osteoblast function. Therefore, PMEDM using silver nano-powder admixed to the dielectric represents a promising technology to shape and concurrently modify implant surfaces to reduce infections while at the same time optimizing bone ingrowth of endoprosthesis.

Surface competition between osteoblasts and bacteria on silver-doped bioactive titanium implant

The rapid integration in the bone tissue and the prevention of bacterial infection are key for the success of the implant. In this regard, a silver (Ag)-doped thermochemical treatment that generate an Ag-doped calcium titanate layer on titanium (Ti) implants was previously developed by our group to improve the bone-bonding ability and provide antibacterial activity. In the present study, the biological and antibacterial potential of this coating has been further studied. In order to prove that the Ag-doped layer has an antibacterial effect with no detrimental effect on the bone cells, the behavior of osteoblast-like cells in terms of cell adhesion, morphology, proliferation and differentiation was evaluated, and the biofilm inhibition capacity was assessed. Moreover, the competition by the surface between cell and bacteria was carried out in two different co-culture methods. Finally, the treatment was applied to porous Ti implants to study in vivo osteointegration. The results show that the incorporation of Ag inhibits the biofilm formation and has no effect on the performance of osteoblast-like cells. Therefore, it can be concluded that the Ag-doped surface is capable of preventing bone bacterial infection and providing suitable osseointegration.

Characterization and tribological behaviour of Indian clam seashell-derived hydroxyapatite coating applied on titanium alloy by plasma spray technique

Various hydroxyapatite (HA) powders synthesized at different temperatures are deposited on titanium alloy by using an atmospheric plasma spray process. These different HA powders were synthesized from Indian clam seashells through the hydrothermal technique at varying temperatures from 700 to 1000 °C for a 2 h time duration in our previous study. The synthesized HA powders are spray-dried to obtain agglomerated powders suitable for spraying during the coating application. Crystallite size, Ca/P ratio, and crystallinity of agglomerated HA powders and their respective coatings are estimated by standard methods. The microstructure and phases of the feedstock and coating materials are investigated by using a field-emission scanning electron microscope (FESEM) and X-ray diffractometer (XRD), respectively. Further, the HA coatings are characterized in terms of surface roughness, microhardness, porosity, adhesion strength, and wear resistance through the stylus profilometer, Vickers micro-hardness tester, image analysis technique, scratch tester, and ball-on-disc tribometer, respectively. The average surface roughness (R_a) and porosity of the coating are decreased with an increase in the synthesis temperature. The minimum R_a and porosity obtained for the 1000 °C coating sample suggest a high degree of melting of such powder particles. However, the highest adhesion strength noticed in the case of the 900 °C coating sample is due to the high compatibility of such coating material with Ti-alloy substrate in terms of thermal properties. The 900 °C coating sample has also shown the highest microhardness and wear-resistance properties due to its maximum crystallinity among all the HA coatings.

Role of Biomaterials Used for Periodontal Tissue Regeneration-A Concise Evidence-Based Review

Periodontal infections are noncommunicable chronic inflammatory diseases of multifactorial origin that can induce destruction of both soft and hard tissues of the periodontium. The standard remedial modalities for periodontal regeneration include nonsurgical followed by surgical therapy with the adjunctive use of various biomaterials to achieve restoration of the lost tissues. Lately, there has been substantial development in the field of biomaterial, which includes the sole or combined use of osseous grafts, barrier membranes, growth factors and autogenic substitutes to achieve tissue and bone regeneration. Of these, bone replacement grafts have been widely explored for their osteogenic potential with varied outcomes. Osseous grafts are derived from either human, bovine or synthetic sources. Though the biologic response from autogenic biomaterials may be better, the use of bone replacement synthetic substitutes could be practical for clinical practice. This comprehensive review focuses initially on bone graft replacement substitutes, namely ceramic-based (calcium phosphate derivatives, bioactive glass) and autologous platelet concentrates, which assist in alveolar bone regeneration. Further literature compilations emphasize the innovations of biomaterials used as bone substitutes, barrier membranes and complex scaffold fabrication techniques that can mimic the histologically vital tissues required for the regeneration of periodontal apparatus.

Effect of Doping Element and Electrolyte’s pH on the Properties of Hydroxyapatite Coatings Obtained by Pulsed Galvanostatic Technique

Hydroxyapatite (HAp) is the most widely used calcium phosphate as a coating on metal implants due to its biocompatibility and bioactivity. The aim of this research is to evaluate the effect of the pH’s electrolyte and doping element on the morphology, roughness, chemical, and phasic composition of hydroxyapatite-based coatings obtained by pulsed galvanostatic electrochemical deposition. As doping elements, both Sr and Ag were selected due to their good osseoinductive character and antibacterial effect, respectively. The electrolytes were prepared at pH 4 and 5, in which specific concentrations of Sr, Ag, and Sr + Ag were added. In terms of morphology, all coatings consist in ribbon-like crystals, which at pH 5 appear to be a little larger. Addition of Sr did not affect the morphology of HAp, while Ag addition has led to the formation of flower-like crystals agglomeration. When both doping elements were added, the flowers like agglomerations caused by the Ag have diminished, indicating the competition between Sr and Ag. X-Ray Diffraction analysis has highlighted that Sr and/or Ag have successfully substituted the Ca in the HAp structure. Moreover, at higher pH, the crystallinity of all HAp coatings was enhanced. Thus, it can be said that the electrolyte’s pH enhances to some extent the properties of HAp-based coatings, while the addition of Sr and/or Ag does not negatively impact the obtained features of HAp, indicating that by using pulsed galvanostatic electrochemical deposition, materials with tunable features dictated by the function of the coated medical device can be designed.

Hydrothermal synthesis of hydroxyapatite powders using Response Surface Methodology (RSM)

Hydroxyapatite (HAp)—[Ca₁₀ (PO₄)₆(OH) ₂] has a similar chemical composition to bone material, making it the main mineral supplement in bone-making. Due to its high biocompatibility, hydroxyapatite is widely used in the repair of bone deficiencies and in the production of dental or orthopedic implants. In this research, hydroxyapatite nanopowder was synthesized using a hydrothermal technique. Fourier Transform Infrared Spectroscopy (FTIR) and transmission electron microscopy (TEM) were used to investigate the chemical structure and morphology of the synthesized hydroxyapatite powder. X-ray diffraction (XRD) was used to evaluate the phase analysis of HAp nanopowder. In addition, bioactivity HAp assessment was conducted by scanning electron microscopy (SEM) attached with Energy Dispersive X-Ray Spectroscopy (EDX) analysis. Response Surface Methodology (RSM) with central composite design (CCD) was used in order to determine the optimal conditions for yield, size, and crystallinity. Three independent variables (pH, temperature, and hydrothermal treatment time) were investigated. The yield was observed to increase in alkaline conditions; pH showed the greatest influence on the yield, size, and crystallinity of the synthesized hydroxyapatite, based on Analysis of Variance. The results of bioactivity evaluation are showed high bioactivity due to the formation of apatite on the surface of the synthesized nanopowder.

Osteointegration, antimicrobial and antibiofilm activity of orthopaedic titanium surfaces coated with silver and strontium-doped hydroxyapatite using a novel blasting process

Poor integration of orthopaedic devices with the host tissue owing to aseptic loosening and device-associated infections are two of the leading causes of implant failure, which represents a significant problem for both patients and the healthcare system. Novel strategies have focused on silver to combat antimicrobial infections as an alternative to drug therapeutics. In this study, we investigated the impact of increasing the % substitution (12% wt) of silver and strontium in hydroxyapatite (HA) coatings to enhance antimicrobial properties and stimulate osteoblasts, respectively. Additionally, we prepared a binary substituted coating containing both silver and strontium (AgSrA) at 12% wt as a comparison. All coatings were deposited using a novel blasting process, CoBlast, onto biomedical grade titanium (V). Surface physicochemical properties, cytocompatibility and antimicrobial functionality were determined. The anticolonising properties of the coatings were screened using Staphylococcus aureus ATCC 1448, and thereafter, the AgA coating was evaluated using clinically relevant strains. Strontium-doped surfaces demonstrated enhanced osteoblast viability; however, a lower inhibition of biofilm formation was observed compared with the other surfaces. A co-substituted AgSrA surface did not show enhanced osteoblast or anticolonising properties compared with the SrA and AgA surfaces, respectively. Due to its superior anticolonising performance in preliminary studies, AgA was chosen for further studies. The AgA coated surfaces demonstrated good antibacterial activity (eluted and immobilised ion) against methicillin-resistant S. aureus followed by methicillin-sensitive Staphylococcus aureus clinical isolates; however, the AgA surface displayed poor impact against Staphylococcus epidermidis. In conclusion, herein, we demonstrate that HA can be substituted with a range of ions to augment the properties of HA coatings on orthopaedic devices, which offer promising potential to combat orthopaedic device-associated infections and enhance device performance.

Cationic Substitutions in Hydroxyapatite: Current Status of the Derived Biofunctional Effects and Their In Vitro Interrogation Methods

High-performance bioceramics are required for preventing failure and prolonging the life-time of bone grafting scaffolds and osseous implants. The proper identification and development of materials with extended functionalities addressing socio-economic needs and health problems constitute important and critical steps at the heart of clinical research. Recent findings in the realm of ion-substituted hydroxyapatite (HA) could pave the road towards significant developments in biomedicine, with an emphasis on a new generation of orthopaedic and dentistry applications, since such bioceramics are able to mimic the structural, compositional and mechanical properties of the bone mineral phase. In fact, the fascinating ability of the HA crystalline lattice to allow for the substitution of calcium ions with a plethora of cationic species has been widely explored in the recent period, with consequent modifications of its physical and chemical features, as well as its functional mechanical and in vitro and in vivo biological performance. A comprehensive inventory of the progresses achieved so far is both opportune and of paramount importance, in order to not only gather and summarize information, but to also allow fellow researchers to compare with ease and filter the best solutions for the cation substitution of HA-based materials and enable the development of multi-functional biomedical designs. The review surveys preparation and synthesis methods, pinpoints all the explored cation dopants, and discloses the full application range of substituted HA. Special attention is dedicated to the antimicrobial efficiency spectrum and cytotoxic trade-off concentration values for various cell lines, highlighting new prophylactic routes for the prevention of implant failure. Importantly, the current in vitro biological tests (widely employed to unveil the biological performance of HA-based materials), and their ability to mimic the in vivo biological interactions, are also critically assessed. Future perspectives are discussed, and a series of recommendations are underlined.

Synthesis of hydroxyapatite for biomedical applications

The current need for long lasting implants and bone substitutes characterized by biocompatibility, bioactivity and mechanical properties, without the immune rejection is a great challenge for scientists. These bone substitute structures should be prepared for individual patients with all details controlled on the micrometer level. Similarly, nontoxic, biocompatible targeted drug delivery systems which allow controlling the rate and time period of the drug delivery and simultaneously eliminating toxic and side effects on the healthy tissues, are of great interest. Extensive attempts have been made to develop a simple, efficient, and green method to form biofunctional scaffolds and implant coatings possessing the above mentioned significant biocompatibility, bioactivity and mechanical strength. Moreover, that could also serve as drug delivery systems. Hydroxyapatite (HA) which is a major mineral component of vertebrate bones and teeth is an excellent material for these purposes. In this literature review the biologically inspired scaffolds, bone substitutes, implants characterized by mechanical strength and biocompatibility, as well the drug delivery systems, based on hydroxyapatite are discussed.

Development of bio-composites with novel characteristics: Evaluation of phenol-induced antibacterial, biocompatible and biodegradable behaviours

This paper describes a laccase-assisted grafting of gallic acid (GA) and thymol (T) as functional entities onto the previously developed P(3HB)-g-EC composite. GA-g-P(3HB)-g-EC and T-g-P(3HB)-g-EC bio-composites were prepared by laccase-assisted free radical-induced graft polymerisation of GA and T onto the P(3HB)-g-EC based composite using surface dipping and incorporation technique. The results of the antibacterial evaluation for the prepared composites indicated that 15GA-g-P(3HB)-g-EC, 15T-g-P(3HB)-g-EC and 20T-g-P(3HB)-g-EC composites possessed the strongest bacteriostatic and bactericidal activities against Gram-positive Bacillus subtilis NCTC 3610 and Staphylococcus aureus NCTC 6571 and Gram-negative Escherichia coli NTCT 10418 and Pseudomonas aeruginosa NCTC 10662 strains. In this study, we have also tested GA-g-P(3HB)-g-EC and T-g-P(3HB)-g-EC bio-composites for their ability to support and maintain multilineage differentiation of human keratinocyte-like (HaCaT) skin cells in-vitro. From the cytotoxicity results, the tested composites showed 100% viability and did not induce any adverse effect on a HaCaT's morphology. Finally, in soil burial evaluation, a progressive increase in the degradation rate of GA-g-P(3HB)-g-EC and T-g-P(3HB)-g-EC bio-composites was recorded with the passage of time up to 6 weeks. In summary, our current findings suggest that GA-g-P(3HB)-g-EC and T-g-P(3HB)-g-EC bio-composites are promising candidates for biomedical type applications such as skin regeneration, multiphasic tissue engineering and/or medical implants.

Silver nanoparticles and their orthopaedic applications

Implant-associated infection is a major source of morbidity in orthopaedic surgery. There has been extensive research into the development of materials that prevent biofilm formation, and hence, reduce the risk of infection. Silver nanoparticle technology is receiving much interest in the field of orthopaedics for its antimicrobial properties, and the results of studies to date are encouraging. Antimicrobial effects have been seen when silver nanoparticles are used in trauma implants, tumour prostheses, bone cement, and also when combined with hydroxyapatite coatings. Although there are promising results with in vitro and in vivo studies, the number of clinical studies remains small. Future studies will be required to explore further the possible side effects associated with silver nanoparticles, to ensure their use in an effective and biocompatible manner. Here we present a review of the current literature relating to the production of nanosilver for medical use, and its orthopaedic applications.

Reduction of bacterial adhesion on dental composite resins by silicon-oxygen thin film coatings

Adhesion of bacteria on dental materials can be reduced by modifying the physical and chemical characteristics of their surfaces, either through the application of specific surface treatments or by the deposition of thin film coatings. Since this approach does not rely on the use of drugs or antimicrobial agents embedded in the materials, its duration is not limited by their possible depletion. Moreover it avoids the risks related to possible cytotoxic effects elicited by antibacterial substances released from the surface and diffused in the surrounding tissues. In this work, the adhesion of Streptococcus mutans and Streptococcus mitis was studied on four composite resins, commonly used for manufacturing dental prostheses. The surfaces of dental materials were modified through the deposition of a-SiO(x) thin films by plasma enhanced chemical vapor deposition. The chemical bonding structure of the coatings was analyzed by Fourier-transform infrared spectroscopy. The morphology of the dental materials before and after the coating deposition was assessed by means of optical microscopy and high-resolution mechanical profilometry, while their wettability was investigated by contact angle measurements. The sample roughness was not altered after coating deposition, while a noticeable increase of wettability was detected for all the samples. Also, the adhesion of S. mitis decreased in a statistically significant way on the coated samples, when compared to the uncoated ones, which did not occur for S. mutans. Within the limitations of this study, a-SiO(x) coatings may affect the adhesion of bacteria such as S. mitis, possibly by changing the wettability of the composite resins investigated.

Polyetheretherketone/nano-fluorohydroxyapatite composite with antimicrobial activity and osseointegration properties

Lack of antibacterial activity and binding ability to natural bone tissue has significantly limited polyetheretherketone (PEEK) for many challenging dental implant applications. Here, we have developed a polyetheretherketone/nano-fluorohydroxyapatite (PEEK/nano-FHA) biocomposite with enhanced antibacterial activity and osseointegration through blending method. Smooth and rough surfaces of PEEK/nano-FHA biocomposites were also prepared. Our results showed that in vitro initial cell adhesion and proliferation on the nano-FHA reinforced PEEK composite were improved. In addition, higher alkaline phosphatase activity and cell mineralization were also detected in cells cultured on PEEK/nano-FHA biocomposites, especially for rough PEEK/nano-FHA surfaces. More importantly, the as-prepared PEEK/nano-FHA biocomposite could effectively prevent the proliferation and biofilm formation of bacterial. For in vivo test, the newly formed bone volume of PEEK/nano-FHA group was higher than that of bare PEEK group based on 3D microcomputed tomography and 2D histomorphometric analysis. These reports demonstrate that the developed PEEK/nano-FHA biocomposite has increased biocompatibility and antibacterial activity in vitro, and promoted osseointegration in vivo, which suggests that it holds potential to be applied as dental implant material in dental tissue engineering applications.

Antibacterial polyetheretherketone implants immobilized with silver ions based on chelate-bonding ability of inositol phosphate: processing, material characterization, cytotoxicity, and antibacterial properties

We developed a novel antibacterial implant by forming a hydroxyapatite (HAp) film on polyetheretherketone (PEEK) substrate, and then immobilizing silver ions (Ag(+) ) on the HAp film based on the chelate-bonding ability of inositol phosphate (IP6). First, the PEEK surface was modified by immersion into concentrated sulfuric acid for 10 min. HAp film was formed on the acid-treated PEEK via the soft-solution process using simulated body fluid (SBF), urea, and urease. After HAp coating, specimens were immersed into IP6 solution, and followed by immersion into silver nitrite solution at concentrations of 0, 0.5, 1, 5 or 10 mM. Ag(+) ions were immobilized on the resulting HAp film due to the chelate-bonding ability of IP6. On cell-culture tests under indirect conditions by Transwell, MC3T3-E1 cells on the specimens derived from the 0.5 and 1 mM Ag(+) solutions showed high relative growth when compared with controls. Furthermore, on evaluation of antibacterial activity in halo test, elution of Ag(+) ions from Ag(+) -immobilized HAp film inhibited bacterial growth. Therefore, the above-mentioned results demonstrated that specimens had both biocompatibility and strong antibacterial activity. The present coating therefore provides bone bonding ability to the implant surface and prevents the formation of biofilms in the early postoperative period.

Processing and evaluation of bioactive coatings on polymeric implants

Polyetheretherketone (PEEK) is a high-performance polymer with advantages over metallic biomaterials for application in spinal implants. In this study, hydroxyapatite (HA) coatings were deposited onto PEEK substrates using radio-frequency magnetron sputtering for the purpose of improving bioactivity. An intermediate coating layer of yttria-stabilized zirconia (YSZ) was first deposited onto the PEEK substrates to provide heat shielding during subsequent post-deposition heat treatment to prevent degradation of PEEK substrates and coating/substrate interface. Plasma activation of the PEEK substrate surfaces before deposition resulted in a significant increase in coating adhesion strength. Post-deposition heat treatments of microwave and hydrothermal annealing were studied with the goal of forming crystalline HA without the use of high temperatures required in conventional annealing. Microstructural and compositional analyses by scanning electron microscopy (SEM) and X-ray diffraction revealed that the YSZ layer exhibited a crystalline structure as-deposited, with columnar grains oriented along the growth direction, whereas the HA layer was shown to be amorphous as-deposited. After microwave annealing, the HA coating exhibited a columnar crystalline microstructure, similar to that of the underlying YSZ crystalline layer; XRD analysis confirmed a crystalline HA phase in the coating. It is suggested that the existence of the crystalline YSZ layer aids in the formation of the HA layer upon heating, possibly lowering the activation energy for crystallization by providing nucleation sites for HA grain formation. Cell culture tests showed a significant increase in initial cell attachment and growth on the microwave-annealed coatings, compared with uncoated PEEK and amorphous HA surfaces.