Argon-based atmospheric pressure plasma enhances early bone response to rough titanium surfaces

Nonthermal Atmospheric Pressure Plasma Treatment of Endosteal Implants for Osseointegration and Antimicrobial Efficacy: A Comprehensive Review

The energy state of endosteal implants is dependent on the material, manufacturing technique, cleaning procedure, sterilization method, and surgical manipulation. An implant surface carrying a positive charge renders hydrophilic properties, thereby facilitating the absorption of vital plasma proteins crucial for osteogenic interactions. Techniques to control the surface charge involve processes like oxidation, chemical and topographical adjustments as well as the application of nonthermal plasma (NTP) treatment. NTP at atmospheric pressure and at room temperature can induce chemical and/or physical reactions that enhance wettability through surface energy changes. NTP has thus been used to modify the oxide layer of endosteal implants that interface with adjacent tissue cells and proteins. Results have indicated that if applied prior to implantation, NTP strengthens the interaction with surrounding hard tissue structures during the critical phases of early healing, thereby promoting rapid bone formation. Also, during this time period, NTP has been found to result in enhanced biomechanical fixation. As such, the application of NTP may serve as a practical and reliable method to improve healing outcomes. This review aims to provide an in-depth exploration of the parameters to be considered in the application of NTP on endosteal implants. In addition, the short- and long-term effects of NTP on osseointegration are addressed, as well as recent advances in the utilization of NTP in the treatment of periodontal disease.

Effects of Argon Gas Plasma Treatment on Biocompatibility of Nanostructured Titanium

In this study, we applied argon plasma treatment to titanium surfaces with nanostructures deposited by concentrated alkali treatment and investigated the effects on the surface of the material and the tissue surrounding an implant site. The results showed that the treatment with argon plasma removed carbon contaminants and increased the surface energy of the material while the nanoscale network structure deposited on the titanium surface remained in place. Reactive oxygen species reduced the oxidative stress of bone marrow cells on the treated titanium surface, creating a favorable environment for cell proliferation. Good results were observed in vitro evaluations using rat bone marrow cells. The group treated with argon plasma exhibited the highest apatite formation in experiments using simulated body fluids. The results of in vivo evaluation using rat femurs revealed that the treatment improved the amount of new bone formation around an implant. Thus, the results demonstrate that argon plasma treatment enhances the ability of nanostructured titanium surfaces to induce hard tissue differentiation and supports new bone formation around an implant site.

Cold physical plasma treatment optimization for improved bone allograft processing

In musculoskeletal surgery, the treatment of large bone defects is challenging and can require the use of bone graft substitutes to restore mechanical stability and promote host-mediated regeneration. The use of bone allografts is well-established in many bone regenerative procedures, but is associated with low rates of ingrowth due to pre-therapeutic graft processing. Cold physical plasma (CPP), a partially ionized gas that simultaneously generates reactive oxygen (O2) and nitrogen (N2) species, is suggested to be advantageous in biomedical implant processing. CPP is a promising tool in allograft processing for improving surface characteristics of bone allografts towards enhanced cellularization and osteoconduction. However, a preclinical assessment regarding the feasibility of pre-therapeutic processing of allogeneic bone grafts with CPP has not yet been performed. Thus, this pilot study aimed to analyze the bone morphology of CPP processed allografts using synchrotron radiation-based microcomputed tomography (SR-µCT) and to analyze the effects of CPP processing on human bone cell viability and function. The analyzes, including co-registration of pre- and post-treatment SR-µCT scans, revealed that the main bone morphological properties (total volume, mineralized volume, surface area, and porosity) remained unaffected by CPP treatment if compared to allografts not treated with CPP. Varying effects on cellular metabolic activity and alkaline phosphatase activity were found in response to different gas mixtures and treatment durations employed for CPP application. It was found that 3 min CPP treatment using a He + 0.1% N2 gas mixture led to the most favourable outcome regarding a significant increase in bone cell viability and alkaline phosphatase activity. This study highlights the promising potential of pre-therapeuthic bone allograft processing by CPP prior to intraoperative application and emphasizes the need for gas source and treatment time optimization for specific applications.

Non-Thermal Plasma Treatment of Poly(tetrafluoroethylene) Dental Membranes and Its Effects on Cellular Adhesion

Non-resorbable dental barrier membranes entail the risk of dehiscence due to their smooth and functionally inert surfaces. Non-thermal plasma (NTP) treatment has been shown to increase the hydrophilicity of a biomaterials and could thereby enhance cellular adhesion. This study aimed to elucidate the role of allyl alcohol NTP treatment of poly(tetrafluoroethylene) in its cellular adhesion. The materials (non-treated PTFE membranes (NTMem) and NTP-treated PTFE membranes (PTMem)) were subjected to characterization using scanning electron microscopy (SEM), contact angle measurements, X-ray photoelectron spectroscopy (XPS), and electron spectroscopy for chemical analysis (ESCA). Cells were seeded upon the different membranes, and cellular adhesion was analyzed qualitatively and quantitatively using fluorescence labeling and a hemocytometer, respectively. PTMem exhibited higher surface energies and the incorporation of reactive functional groups. NTP altered the surface topography and chemistry of PTFE membranes, as seen through SEM, XPS and ESCA, with partial defluorination and polymer chain breakage. Fluorescence labeling indicated significantly higher cell populations on PTMem relative to its untreated counterparts (NTMem). The results of this study support the potential applicability of allyl alcohol NTP treatment for polymeric biomaterials such as PTFE-to increase cellular adhesion for use as dental barrier membranes.

Optimized Gingiva Cell Behavior on Dental Zirconia as a Result of Atmospheric Argon Plasma Activation

Several physico-chemical modifications have been developed to improve cell contact with prosthetic oral implant surfaces. The activation with non-thermal plasmas was one option. Previous studies found that gingiva fibroblasts on laser-microstructured ceramics were hindered in their migration into cavities. However, after argon (Ar) plasma activation, the cells concentrated in and around the niches. The change in surface properties of zirconia and, subsequently, the effect on cell behavior is unclear. In this study, polished zirconia discs were activated by atmospheric pressure Ar plasma using the kINPen^®09 jet for 1 min. Surfaces were characterized by scanning electron microscopy, X-ray photoelectron spectroscopy (XPS), and water contact angle. In vitro studies with human gingival fibroblasts (HGF-1) focused on spreading, actin cytoskeleton organization, and calcium ion signaling within 24 h. After Ar plasma activation, surfaces were more hydrophilic. XPS revealed decreased carbon and increased oxygen, zirconia, and yttrium content after Ar plasma. The Ar plasma activation boosted the spreading (2 h), and HGF-1 cells formed strong actin filaments with pronounced lamellipodia. Interestingly, the cells' calcium ion signaling was also promoted. Therefore, argon plasma activation of zirconia seems to be a valuable tool to bioactivate the surface for optimal surface occupation by cells and active cell signaling.

Improvement implant osseointegration through nonthermal Ar/O2 plasma

This study investigated the effects of nonthermal Ar/O₂ plasma on the osseointegration of titanium implants. Through 8 weeks' in vivo evaluation of implants inserted into femoral bones of male Sprague-Dawley rats, the new bone mineralization apposition rate (MAR) is increased by 1.87 and 2.14 times for implants of smooth machined (SM) and sand-blasted and acid-etched (SLA) after plasma treatment. The bone volume fraction (bone volume/total volume, BV/TV) and bone-implant contact (BIC) ratios are improved by 1.31, 1.26 times and 1.35, 1.15 times after 90 s plasma treatment. The improved hydrophilicity rather than implant surface morphology is believed to play a critical role for the osseointegration improvement.

Dental Implants and Implant Coatings: A Focus on Their Toxicity and Safety

Dental implants are medical devices that are surgically inserted into the patient's jawbone by an orthodontist to act as roots of missing teeth. After the implantation, the maxilla or mandible integrates with the surface of the dental implant. This process, called "osseointegration," is an important period to ensure the long-term use of dental implants and prevent implant failures. Metal implants are the most used implant materials. However, they have disadvantages such as corrosion, metal ion release from metal implant surfaces and associated toxicity. To avoid these adverse effects and improve osseointegration, alternative dental implant materials such as ceramics, polymers, composites, and novel surface modification technologies have been developed. The safety of these materials are also of concern for toxicologists. This review will give general information about dental implant materials, osseointegration and successful implantation process. Moreover, we will focus on the new surface coatings materials for of dental implants and their toxicity and safety concerns will be discussed.

Effect of argon plasma pre-treatment of healing abutments on peri-implant microbiome and soft tissue integration: a proof-of-concept randomized study

PURPOSE

Biofilm-free implant surface is ultimate prerequisite for successful soft and bone tissue integration. Objective of the study was to estimate the effects of argon plasma healing abutment pre-treatment (PT) on peri-implant soft-tissue phenotype (PiSP), inflammation, plaque accumulation and the microbiome (PiM) between non-treated (NPT) and treated (PT) abutments following 3-months healing period. The hypothesis was that cell-conductive and antimicrobial properties of PT would yield optimal conditions for soft tissue integration.

MATERIAL AND METHODS

Two months following second-phase surgery, microbiological and clinical parameters were assessed around thirty-six healing abutments with two types of microtopography, smooth surface (MACHINED) and ultrathin threaded microsurface (ROUGH). A two level randomization schema was used to achieve equal distribution and abutments were randomly divided into rough and machined groups, and then divided into PT and NPT groups. PiM was assessed using next-generation DNA sequencing.

RESULTS

PiM bacterial composition was highly diverse already two months post-implantation, consisting of key-stone pathogens, early and late colonizers, while the mycobiome was less diverse. PT was associated with lower plaque accumulation and inflammation without significant impact on PiSP, while in NPT clinical parameters were increased and associated with periopathogens. NPT mostly harbored late colonizers, while PT exerted higher abundance of early colonizers suggesting less advanced plaque formation. Interaction analysis in PT demonstrated S. mitis co-occurrence with pro-healthy Rothia dentocariosa and co-exclusion with Parvimonas micra, Porphyromonas endodontalis and Prevotella oris. PiSP parameters were generally similar between the groups, but significant association between PiM and keratinized mucosa width was observed in both groups, with remarkably more expressed diversity in NPT compared to PT. PT resulted in significantly lower BOP and PI around rough and machined abutments, respectively, without specific effect on PiM and PiSP.

CONCLUSIONS

PT contributed to significantly the less advanced biofilm accumulation and inflammation without specific effects on PiSP.

In-Vitro Biofilm Removal Efficacy Using Water Jet in Combination with Cold Plasma Technology on Dental Titanium Implants

Peri-implantitis-associated inflammation can lead to bone loss and implant failure. Current decontamination measures are ineffective due to the implants' complex geometry and rough surfaces providing niches for microbial biofilms. A modified water jet system (WaterJet) was combined with cold plasma technology (CAP) to achieve superior antimicrobial efficacy compared to cotton gauze treatment. Seven-day-old multi-species-contaminated titanium discs and implants were investigated as model systems. The efficacy of decontamination on implants was determined by rolling the implants over agar and determining colony-forming units supported by scanning electron microscopy image quantification of implant surface features. The inflammatory consequences of mono and combination treatments were investigated with peripheral blood mononuclear cell surface marker expression and chemokine and cytokine release profiles on titanium discs. In addition, titanium discs were assayed using fluorescence microscopy. Cotton gauze was inferior to WaterJet treatment according to all types of analysis. In combination with the antimicrobial effect of CAP, decontamination was improved accordingly. Mono and CAP-combined treatment on titanium surfaces alone did not unleash inflammation. Simultaneously, chemokine and cytokine release was dramatically reduced in samples that had benefited from additional antimicrobial effects through CAP. The combined treatment with WaterJet and CAP potently removed biofilm and disinfected rough titanium implant surfaces. At the same time, non-favorable rendering of the surface structure or its pro-inflammatory potential through CAP was not observed.

An in vivo preclinical study assessing biocompatibility of Pd-based bulk metallic glass

BACKGROUND: The bulk metallic glass (BMG), Pd79Ag3.5P6Si9.5Ge2, has a high fracture toughness and has been found to accommodate post-yield stress, unlike most other BMG. Moreover, due to its greater noble gas composition it has a intrinsic corrosion resistance, ideal for dental and orthopedic implants. OBJECTIVE: This present study aimed to evaluate the in vivo application of Pd79Ag3.5P6Si9.5Ge2 in a large translational sheep model to assess its efficacy to be utilized as an endosteal device. METHODS: Twelve implants in the form of cylindrical rods (3 mm in diameter) were produced through rapid quenching. Each sheep (n = 12) received one osteotomy in the mandibular region using rotary instrumentation, which was subsequently filled with Pd79Ag3.5P6Si9.5Ge2. After 6- and 24-weeks the animals were euthanized, and samples collected en bloc to conduct histomorphometric analysis. The level/degrees of osseointegration were assessed through bone-to-implant contact (BIC). RESULTS: Favorable BIC was observed with fibrous connective tissue layers at both 6- and 24-weeks. Bone along with interfacial remodeling was observed in proximity with the metallic glass surface at 6 weeks with higher degrees of bone organization being observed at the later healing time, 24 weeks. CONCLUSIONS: The introduced BMG revealed potential to serve as an alternative biomaterial to commonly used Ti alloys given its unique combination of toughness and strength.

Surface coating of orthopedic implant to enhance the osseointegration and reduction of bacterial colonization: a review

The use of orthopedic implants in surgical technology has fostered restoration of physiological functions. Along with successful treatment, orthopedic implants suffer from various complications and fail to offer functions correspondent to native physiology. The major problems include aseptic and septic loosening due to bone nonunion and implant site infection due to bacterial colonization. Crucial advances in material selection in the design and development of coating matrixes an opportunity for the prevention of implant failure. However, many coating materials are limited in in-vitro testing and few of them thrive in clinical tests. The rate of implant failure has surged with the increasing rates of revision surgery creating physical and sensitive discomfort as well as economic burdens. To overcome critical pathogenic activities several systematic coating techniques have been developed offering excellent results that combat infection and enhance bone integration. This review article includes some more common implant coating matrixes with excellent in vitro and in vivo results focusing on infection rates, causes, complications, coating materials, host immune responses and significant research gaps. This study provides a comprehensive overview of potential coating technology, with functional combination coatings which are focused on ultimate clinical practice with substantial improvement on in-vivo tests. This includes the development of rapidly growing hydrogel coating techniques with the potential to generate several accurate and precise coating procedures.

Efficiency of biofilm removal by combination of water jet and cold plasma: an in-vitro study

Background

Peri-implantitis therapy is a major problem in implantology. Because of challenging rough implant surface and implant geometry, microorganisms can hide and survive in implant microstructures and impede debridement. We developed a new water jet (WJ) device and a new cold atmospheric pressure plasma (CAP) device to overcome these problems and investigated aspects of efficacy in vitro and safety with the aim to create the prerequisites for a clinical pilot study with these medical devices.

Methods

We compared the efficiency of a single treatment with a WJ or curette and cotton swab (CC) without or with adjunctive use of CAP (WJ + CAP, CC + CAP) to remove biofilm in vitro from rough titanium discs. Treatment efficacy was evaluated by measuring turbidity up to 72 h for bacterial re-growth or spreading of osteoblast-like cells (MG-63) after 5 days with scanning electron microscopy. With respect to application safety, the WJ and CAP instruments were examined according to basic regulations for medical devices.

Results

After 96 h of incubation all WJ and CC treated disks were turbid but 67% of WJ + CAP and 46% CC + CAP treated specimens were still clear. The increase in turbidity after WJ treatment was delayed by about 20 h compared to CC treatment. In combination with CAP the cell coverage significantly increased to 82% (WJ + CAP) or 72% (CC + CAP), compared to single treatment 11% (WJ) or 10% (CC).

Conclusion

The newly developed water jet device effectively removes biofilm from rough titanium surfaces in vitro and, in combination with the new CAP device, biologically acceptable surfaces allow osteoblasts to grow. WJ in combination with CAP leads to cleaner surfaces than the usage of curette and cotton swabs with or without subsequent plasma treatment. Our next step will be a clinical pilot study with these new devices to assess the clinical healing process.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02195-1.

Disinfection of implant abutment connection using antimicrobial photodynamic therapy and 0.2% chlorhexidine gel applications immediately before prosthesis delivery: Clinical and radiographic status at 1-year of follow-up

OBJECTIVE

The aim of this 1-year follow-up randomized control trial was to compare the clinicoradiographic status of implants that were disinfected with antimicrobial photodynamic therapy (aPDT) and 0.2% chlorhexidine gel immediately before prosthesis delivery.

METHODS

Forty-five partially edentulous patients with implants placed in the region of missing mandibular first molars and a history of periodontal diseases were included. Immediately before prosthesis delivery, patients were divided into three groups. In groups 1 and 2, implant abutment disinfection (IAD) was performed using aPDT and 0.2% chlorhexidine immediately before prosthesis delivery. In Group-3, IAD was performed using a steaming protocol. Peri-implant modified plaque index (mPI), modified gingival index (mGI), probing depth (PD) and crestal bone loss (CBL) were assessed at 1 year of follow-up. Power analysis was done and group comparisons were done. Logistic regression analysis was done to corelate clinical parameters with demographic variables. P<0.01 was considered statistically significant.

RESULTS

In total, 15, 15, and 15 implants were present among patients in groups 1, 2 and 3, respectively. There was no statistically significant difference in peri-implant mPI, mBoP, PD and CBL in all groups (Table 2). None of the patients had periodontal disease and there was no statistically significant correlation between peri-implant clinicoradiographic parameters with age, toothbrushing and flossing habits, and duration of implants in function. Eighty percent, 86.7% and 100% individuals in groups 1, 2 and 3, respectively reported that they were brushing teeth twice daily. Flossing of interproximal spaces once daily was reported by 66.7%, 73.3% and 66.7% individuals in groups 1, 2 and 3, respectively.

CONCLUSION

As long as oral hygiene is stringently maintained after implant prosthesis delivery, IAD can be performed using aPDT, 0.2% CHX gel or steam-disinfection.

Human osteoblast and fibroblast response to oral implant biomaterials functionalized with non-thermal oxygen plasma

Plasma-treatment of oral implant biomaterials prior to clinical insertion is envisaged as a potential surface modification method for enhanced implant healing. To investigate a putative effect of plasma-functionalized implant biomaterials on oral tissue cells, this investigation examined the response of alveolar bone osteoblasts and gingival fibroblasts to clinically established zirconia- and titanium-based implant surfaces for bone and soft tissue integration. The biomaterials were either functionalized with oxygen-plasma in a plasma-cleaner or left untreated as controls, and were characterized in terms of topography and wettability. For the biological evaluation, the cell adhesion, morphogenesis, metabolic activity and proliferation were examined, since these parameters are closely interconnected during cell-biomaterial interaction. The results revealed that plasma-functionalization increased implant surface wettability. The magnitude of this effect thereby depended on surface topography parameters and initial wettability of the biomaterials. Concerning the cell response, plasma-functionalization of smooth surfaces affected initial fibroblast morphogenesis, whereas osteoblast morphology on rough surfaces was mainly influenced by topography. The plasma- and topography-induced differential cell morphologies were however not strong enough to trigger a change in proliferation behaviour. Hence, the results indicate that oxygen plasma-functionalization represents a possible cytocompatible implant surface modification method which can be applied for tailoring implant surface wettability.

Effect of Argon-Based Atmospheric Pressure Plasma Treatment on Hard Tissue Formation on Titanium Surface

In this paper, we suggest that the atmospheric pressure plasma treatment of pure titanium metal may be useful for improving the ability of rat bone marrow cells (RBMCs) to induce hard tissue differentiation. Previous studies have reported that the use of argon gas induces a higher degree of hard tissue formation. Therefore, this study compares the effects of plasma treatment with argon gas on the initial adhesion ability and hard tissue differentiation-inducing ability of RBMCs. A commercially available titanium metal plate was used as the experimental material. A plate polished using water-resistant abrasive paper #1500 was used as the control, and a plate irradiated with argon mixed with atmospheric pressure plasma was used as the experimental plate. No structural change was observed on the surface of the titanium metal plate in the scanning electron microscopy results, and no change in the surface roughness was observed via scanning probe microscopy. X-ray photoelectron spectroscopy showed a decrease in the carbon peak and the formation of hydroxide in the experimental group. In the distilled water drop test, a significant decrease in the contact angle was observed for the experimental group, and the results indicated superhydrophilicity. Furthermore, the bovine serum albumin adsorption, initial adhesion of RBMCs, alkaline phosphatase activity, calcium deposition, and genetic marker expression of rat bone marrow cells were higher in the experimental group than those in the control group at all time points. Rat distal femur model are used as in vivo model. Additionally, microcomputed tomography analysis showed significantly higher results for the experimental group, indicating a large amount of the formed hard tissue. Histopathological evaluation also confirmed the presence of a prominent newly formed bone seen in the images of the experimental group. These results indicate that the atmospheric pressure plasma treatment with argon gas imparts superhydrophilicity, without changing the properties of the pure titanium plate surface. It was also clarified that it affects the initial adhesion of bone marrow cells and the induction of hard tissue differentiation.

Effect of Plasma Treatment on Titanium Surface on the Tissue Surrounding Implant Material

Early osseointegration is important to achieve initial stability after implant placement. We have previously reported that atmospheric-pressure plasma treatment confers superhydrophilicity to titanium. Herein, we examined the effects of titanium implant material, which was conferred superhydrophilicity by atmospheric-pressure plasma treatment, on the surrounding tissue in rat femur. Control and experimental groups included untreated screws and those irradiated with atmospheric-pressure plasma using piezobrush, respectively. The femurs of 8-week-old male Sprague-Dawley rats were used for in vivo experiments. Various data prepared from the Micro-CT analysis showed results showing that more new bone was formed in the test group than in the control group. Similar results were shown in histological analysis. Thus, titanium screw, treated with atmospheric-pressure plasma, could induce high hard tissue differentiation even at the in vivo level. This method may be useful to achieve initial stability after implant placement.

Cold atmospheric plasma as an interface biotechnology for enhancing surgical implants

Cold atmospheric plasma (CAP) has been intensively researched for direct treatment of living cells and tissues. Significant attention is now being given to its indirect applications in plasma medicine. Surgical implant is an exemplary conveyor to deliver the therapeutic effects of plasma to patients. There is a constant drive to enhance the clinical performance of surgical implants, targeting at the implant-tissue interface. As a versatile and potent tool, CAP is capable of ameliorating surgical implants using various strategies of interface biotechnology, such as surface modification, coating deposition, and drug delivery. Understanding the chemical, physical, mechanical, electrical, and pharmacological processes occurring at the implant-tissue interface is crucial to effective application of CAP as an interface biotechnology. This preclinical review focuses on the recent advances in CAP-assisted implant-based therapy for major surgical specialties. The ultimate goal here is to elicit unique opportunities and challenges for translating implant science to plasma medicine.

Bone healing at collagenated bicortically installed implants: an experimental study in rabbits

PURPOSE

To study the healing at collagenated bicortically installed implants.

METHODS

Twenty albino New Zealand rabbits were used for implant installation. Two implants with a double acid etched surface, coated with a collagen type I or left uncoated, were installed bicortically in the metaphysis and in the diaphysis of each tibia. Ten rabbits were euthanized after 2 weeks and ten after 6 weeks after installation. Ground sections were prepared for histological analyses that were performed both in the cortical layers and in the marrow regions.

RESULTS

After 2 weeks of healing, highest amounts of new bone were found at the collagenated implants (43.2 ± 6.0%) compared to the standard implants (33.9 ± 6.1%; p = 0.022). After 6 weeks of healing, similar percentages of new bone were observed, being 51.8 ± 7.3% and 50.9 ± 9.6% (p = 0.678) for the standard and collagenated surfaces, respectively.

CONCLUSIONS

A coated surface with collagen type I promoted bone apposition in the earliest periods of healing. However, the effect vanished over time so that similar results were obtained after 6 weeks of healing.

Anatase Forming Treatment without Surface Morphological Alteration of Dental Implant

The osseointegration of titanium implants is allowed by the TiO₂ layer that covers the implants. Titania can exist in amorphous form or in three different crystalline conformations: anatase, rutile and brookite. Few studies have characterized TiO₂ covering the surface of dental implants from the crystalline point of view. The aim of the present study was to characterize the evolution of the TiO₂ layer following different surface treatments from a crystallographic point of view. Commercially pure titanium and Ti-6Al-4V implants subjected to different surface treatments were analyzed by Raman spectroscopy to evaluate the crystalline conformation of titania. The surface treatments evaluated were: machining, sandblasting, sandblasting and etching and sandblasting, etching and anodization. The anodizing treatment evaluated in this study allowed to obtain anatase on commercially pure titanium implants without altering the morphological characteristics of the surface.

Review of Innovative Physical Therapy Methods: Introduction to the Principles of Cold Physical Plasma

The principles of physics and precision engineering have allowed many technologies to enter standard treatment regimens for a range of diseases. Recently, a new type of technology has been accredited as safe and efficient routine procedure in dermatology in Europe: cold physical plasma. Several accredited devices successfully restrain the powerful energy of plasmas to make them available for therapeutic purposes. Herein, we introduce an introduction to the concept of cold physical plasmas and highlight some fields of their medical applications.

Comprehensive biomedical applications of low temperature plasmas

The main component of plasma medicine is the use of low-temperature plasma (LTP) as a powerful tool for biomedical applications. LTP generates high reactivity at low temperatures and can be activated with noble gases with molecular mixtures or compressed air. LTP reactive species are quickly produced, and are a remarkably good source of reactive oxygen and nitrogen species including singlet oxygen (O₂), ozone (O₃), hydroxyl radicals (OH), nitrous oxide (NO), and nitrogen dioxide (NO₂). Its low gas temperature and highly reactive non-equilibrium chemistry make it appropriate for the alteration of inorganic surfaces and delicate biological systems. Treatment of oral biofilm-related infections, treatment of wounds and skin diseases, assistance in cancer treatment, treatment of viruses' infections (e.g. herpes simplex), and optimization of implants surfaces are included among the extensive plasma medicine applications. Each of these applications will be discussed in this review article.

Osteoconductive and Osteoinductive Surface Modifications of Biomaterials for Bone Regeneration: A Concise Review

The main aim of bone tissue engineering is to fabricate highly biocompatible, osteoconductive and/or osteoinductive biomaterials for tissue regeneration. Bone implants should support bone growth at the implantation site via promotion of osteoblast adhesion, proliferation, and formation of bone extracellular matrix. Moreover, a very desired feature of biomaterials for clinical applications is their osteoinductivity, which means the ability of the material to induce osteogenic differentiation of mesenchymal stem cells toward bone-building cells (osteoblasts). Nevertheless, the development of completely biocompatible biomaterials with appropriate physicochemical and mechanical properties poses a great challenge for the researchers. Thus, the current trend in the engineering of biomaterials focuses on the surface modifications to improve biological properties of bone implants. This review presents the most recent findings concerning surface modifications of biomaterials to improve their osteoconductivity and osteoinductivity. The article describes two types of surface modifications: (1) Additive and (2) subtractive, indicating biological effects of the resultant surfaces in vitro and/or in vivo. The review article summarizes known additive modifications, such as plasma treatment, magnetron sputtering, and preparation of inorganic, organic, and composite coatings on the implants. It also presents some common subtractive processes applied for surface modifications of the biomaterials (i.e., acid etching, sand blasting, grit blasting, sand-blasted large-grit acid etched (SLA), anodizing, and laser methods). In summary, the article is an excellent compendium on the surface modifications and development of advanced osteoconductive and/or osteoinductive coatings on biomaterials for bone regeneration.

Photo and Plasma Activation of Dental Implant Titanium Surfaces. A Systematic Review with Meta-Analysis of Pre-Clinical Studies

Background: Ultraviolet (UV) and non-thermal plasma functionalization are surface treatment modalities that seem able to improve osseointegration. The aim of this systematic review and meta-analysis is to assess the effect of the two methods and possible differences. Materials and Methods: The systematic research of pre-clinical animal studies was conducted up to May 2020 in the databases PubMed/Medline, Scopus and the Cochrane Lybrary. A meta-analysis was performed by using the DerSimonian–Laird estimator in random-effects models. Results: Through the digital search, 518 articles were identified; after duplicate removal and screening process 10 papers were included. Four studies evaluating UV treatment in rabbits were included in the meta-analysis. The qualitative evaluation of the included studies showed that both UV photofunctionalization and non-thermal plasma argon functionalization of titanium implant surfaces might be effective in vivo to improve the osseointegration. The meta-analysis on four studies evaluating UV treatment in rabbits showed that bone to implant contact values (expressed as standardized mean differences and raw mean differences) were significantly increased in the bio-activated groups when follow-up times were relatively homogeneous, although a high heterogeneity (I² > 75%) was found in all models. Conclusions: The present systematic review and meta-analysis on pre-clinical studies demonstrated that chair-side treatment of implants with UV or non-thermal plasma appear to be effective for improving osseointegration. This systematic review supports further clinical trials on this topic.

The Emerging Role of Cold Atmospheric Plasma in Implantology: A Review of the Literature

In recent years, cold atmospheric plasma (CAP) technologies have received increasing attention in the field of biomedical applications. The aim of this article is to review the currently available literature to provide an overview of the scientific principles of CAP application, its features, functions, and its applications in systemic and oral diseases, with a specific focus on its potential in implantology. In this narrative review, PubMed, Medline, and Scopus databases were searched using key words like “cold atmospheric plasma”, “argon plasma”, “helium plasma”, “air plasma”, “dental implants”, “implantology”, “peri-implantitis”, “decontamination”. In vitro studies demonstrated CAP’s potential to enhance surface colonization and osteoblast activity and to accelerate mineralization, as well as to determine a clean surface with cell growth comparable to the sterile control on both titanium and zirconia surfaces. The effect of CAP on biofilm removal was revealed in comparative studies to the currently available decontamination modalities (laser, air abrasion, and chlorhexidine). The combination of mechanical treatments and CAP resulted in synergistic antimicrobial effects and surface improvement, indicating that it may play a central role in surface “rejuvenation” and offer a novel approach for the treatment of peri-implantitis. It is noteworthy that the CAP conditioning of implant surfaces leads to an improvement in osseointegration in in vivo animal studies. To the best of our knowledge, this is the first review of the literature providing a summary of the current state of the art of this emerging field in implantology and it could represent a point of reference for basic researchers and clinicians interested in approaching and testing new technologies.

The effect of macrophages on an atmospheric pressure plasma-treated titanium membrane with bone marrow stem cells in a model of guided bone regeneration

Guided bone regeneration (GBR) is an established treatment. However, the mechanisms of GBR are not fully understood. Recently, a GBR membrane was identified that acts as a passive barrier to regenerate bone via activation and migration of macrophages (Mps) and bone marrow stem cells (BMSCs). Atmospheric pressure plasma treatment of the titanium membrane (APP-Ti) activated macrophages. The purpose of this study was to analyze whether macrophages attached to an APP-Ti membrane affected differentiation of BMSCs in a GBR model. Human THP-1 macrophages (hMps) were cultured on non-treated Ti (N-Ti) and APP-Ti membrane. Macrophage polarization was analyzed by RT-PCR and immunocytochemistry. Secreted proteins from hMps on N-Ti and APP-Ti were detected by LC/MS/MS. hBMSCs were co-cultured with hMps on N-Ti or APP-Ti and analyzed by osteogenic differentiation, Alizarin red S staining, and alkaline phosphatase (ALP) activity. N-Ti and APP-Ti membrane were also implanted into bone defects of rat calvaria. hMps on APP-Ti were polarized M2-like macrophages. hMps on N-Ti secreted plasminogen activator inhibitor-1 and syndecan-2, but hMps on APP-Ti did not. hBMSCs co-cultured with hMps on APP-Ti increased cell migration and gene expression of osteogenic markers, but suppressed mineralization, while ALP activity was similar to that of hMps on N-Ti in vitro. The volume of newly formed bone was not significantly different between N-Ti and APP-Ti membrane in vivo. M2 polarized hMps on APP-Ti suppressed osteogenic induction of hBMSCs in vitro. The indirect role of hMps on APP-Ti in newly formed bone was limited.

Single-cell adhesion of human osteoblasts on plasma-conditioned titanium implant surfaces in vitro

OBJECTIVES

This study aimed to demonstrate the effect of treating titanium-implant surfaces with plasma from two different sources on wettability and initial single-cell adhesion of human osteoblasts and to investigate whether aging affects treatment outcomes.

METHODS

Titanium disks with sandblasted and acid-etched (SLA) surfaces were treated with atmospheric pressure plasma (APP) and low-pressure plasma (LPP). For wetting behavior of the specimens after plasma treatment, the water contact angle was measured. The single-cell detachment force and amount of work of detachment of human osteoblasts were determined with single-cell force spectroscopy (SCFS). To evaluate the aging effect in APP-treated specimens, SCFS was conducted 10 and 60 min after treatment.

RESULTS

Significantly higher hydrophilicity was observed in the APP and LPP treatment groups than in the control group, but no significant difference was observed between the APP and LPP groups. No significant difference in cell-detachment force or work of detachment was observed, and there were no significant differences according to the conditioning mechanisms and storage time.

SIGNIFICANCE

Conditioning of the titanium surfaces with APP or LPP was not a significant influencing factor in the initial adhesion of the osteoblasts.

Surface bio-functionalization using plasma of argon could alter microbiological and topographic surface analysis of dental implants?

BACKGROUND

Plasma of argon was demonstrated to improve protein and cell adhesion on implant surface. On the other hand, increased surface energy and hydrophilicity could potentially amplify the risks of implant surface contamination during clinical phases, risks that have not yet been evaluated in Literature. The aim of the present in vitro study was to verify if Plasma treatment could alter the implant surface characteristics and its ability to remain sterile.

MATERIALS AND METHODS

Implants from 9 brands were collected (n=11). One implant for each company was used for SEM surface analysis. To perform the microbiological analysis, ten implants from each company were used and randomly split by allocation either in test or control group. To replicate the surgical work flow, both test and control samples were left 60s in clinical environment. Bacterial growth analysis was performed. Optical density at 600nm was measured as readout of bacterial growth and colony forming unit (CFU) after 24h was evaluated. Statistical analysis was performed by using the Wilcoxon Mann Whitney test. A p-value lower than 0.05 was considered significant.

RESULTS

SEM analysis revealed different categories of implant surface roughness. The optical density confirmed a readout of bacterial growth between 4 and 7 with no significant differences within groups. The number of CFU/ml for each measured sample (test and control) was lower than 102 and failed to present significant differences.

CONCLUSION

Surface activation using plasma of argon did not affect the degree of implant contamination, allowing to maintain a substantial sterility of the implant independently of its morphology. This may allow in the next future the use of bioactivation through plasma of argon to exploit the superhydrophilicity deriving from this biophysical process.

Bioactive Effects of Low-Temperature Argon-Oxygen Plasma on a Titanium Implant Surface

Although titanium is the most commonly used dental implant material, its biological aging directly leads to a lower rate of osseointegration. The aim of this study is to treat aged titanium disc surfaces using low-temperature argon-oxygen plasma (LTAOP) to obtain a more hydrophilic surface in order to enhance biological activities of osteoblasts on dental implant materials. In this study, smooth-machined titanium (SM Ti) and sandblasted and acid-etched titanium (SLA Ti) substrates were used. Aged titanium discs (SM and SLA Ti) were activated by LTAOP and the surface properties were analyzed. Osteoblasts were then seeded onto the aged and LTAOP-treated surfaces. Cell morphology, viability, and features of osteogenesis were examined. We showed that after the LTAOP treatment, the surfaces of both SM and SLA titanium substrates become more hydrophilic with a larger active oxygen species composition, whereas no obvious morphological changes were observed. Osteoblasts were found to be attached and stretched well on the surfaces of LTAOP treatment specimens. Moreover, the proliferation and osteocalcin secretion of osteoblasts on the plasma-activated titanium samples were superior to the untreated counterparts. LTAOP activation can enhance the attachment, proliferation, and mineralization of osteoblasts on the surfaces of the aged titanium substrates. This research provides a new strategy to modify the surface of titanium dental implants for improved biological functions.

Microplasma Cross-Linked Graphene Oxide-Gelatin Hydrogel for Cartilage Reconstructive Surgery

Herein, we report the cartilage tissue engineering application of nanographene oxide (NGO)-reinforced gelatin hydrogel fabricated by utilizing a microplasma-assisted cross-linking method. NGO sheets with surface functionalities were introduced to enhance the mechanical and biomedical properties of gelatin-based hydrogels. Highly energetic reactive radicals were generated from the nonthermal plasma (NTP), which is used to facilitate the cross-linking and polymerization during the polymeric hydrogel fabrication. The NTP treatment substantially reinforced a small amount (1 wt %) of NGO into the gelatin hydrogel. Systematic material characterization thus shows that the fabricated hydrogel possessed unique properties such as moderate surface roughness and adhesiveness, suitable pores sizes, temperature-dependent viscoelasticity, and controllable degradability. In vitro studies demonstrated that the as-fabricated hydrogel exhibited excellent cell-material interactions with SW 1353 cells, bone marrow-derived mesenchymal stem cells, and a rat chondrocyte cell line, thereby exhibiting appropriate cytocompatibility for cartilage tissue engineering applications. Furthermore, an in vivo study indicated that the formation of a healthy hyaline cartilage after the microfracture was enhanced by the fabricated hydrogel implant, offering a potential biocompatible platform for microfracture-based cartilage reconstructive surgery.

Effects of argon plasma treatment on the osteoconductivity of bone grafting materials

BACKGROUND

The osteoconductive properties of bone grafting materials represent one area of research for the management of bony defects found in the fields of periodontology and oral surgery. From a physico-chemical aspect, the wettability of the graft has been demonstrated to be one of the most important factors for new bone formation. It is also well-known that argon plasma treatment (PAT) and ultraviolet irradiation (UV) may increase the surface wettability and, consequently, improve the regenerative potential of the bone grafts. Therefore, the aim of the present in vitro study was to evaluate the effect of PAT and UV treatment on the osteoconductive potential of various bone grafts.

MATERIALS AND METHODS

The following four frequently used bone grafts were selected for this study: synthetic hydroxyapatite (Mg-HA), biphasic calcium phosphate (BCP), cancellous and cortical xenogenic bone matrices (CaBM, CoBM). Sixty-six serially numbered disks 10 mm in diameter were used for each graft material and randomly assigned to the following three groups: test 1 (PAT), test 2 (UV), and control (no treatment). Six samples underwent topographic analysis using SEM pre- and post-treatments to evaluate changes in surface topography/characteristics. Additionally, cell adhesion and cell proliferation were evaluated at 2 and 72 h respectively following incubation in a three-dimensional culture system utilizing a bioreactor. Furthermore, the effects of PAT and UV on immune cells were assessed by measuring the viability of human macrophages at 24 h.

RESULTS

The topographic analysis showed different initial morphologies of the commercial biomaterials (e.g., Mg-HA and BCP showed flat morphology; BM samples were extremely porous with high roughness). The surface analysis following experimental treatments did not demonstrate topographical difference when compared with controls. Investigation of cells demonstrated that PAT treatment significantly increased cell adhesion of all 4 evaluated bone substitutes, whereas UV failed to show any statistically significant differences. The viability test revealed no differences in terms of macrophage adhesion on any of the tested surfaces.

CONCLUSION

Within their limitations, the present results suggest that treatment of various bone grafting materials with PAT appears to enhance the osteoconductivity of bone substitutes in the early stage by improving osteoblast adhesion without concomitantly affecting macrophage viability.

CLINICAL RELEVANCE

Treatment of bone grafts with PAT appears to result in faster osseointegration of the bone grafting materials and may thus favorably influence bone regeneration.

Dielectric Barrier Discharge High Voltage Cold Atmospheric Plasma: An Innovative Nonthermal Technology for Extending the Shelf-Life of Asian Sea Bass Slices

Impact of dielectric barrier discharge high-voltage cold atmospheric plasma (DBD-HVCAP) generated with the mixture of oxygen and argon (10:90) for various treatment times (2.5 to 10 min) on the qualities of Asian sea bass slices during 4 °C storage was investigated. Microbial load of slices treated with DBD-HVCAP were lower than the control. The efficacy of bacteria reduction by DBD-HVCAP was dependent on the treatment times (P < 0.05). Total viable bacteria count (TVBC) was more than 6.0 Log CFU/g at day 6 for the control kept in air. Slices treated with DBD-HVCAP for all treatment times used had TVBC lower than the limit at day 12. Total volatile nitrogen base content (TVNB) as well as trimethylamine (TMA) content in slices treated with DBD-HVCAP were lower than that of the control throughout the storage. TVNB as well as TMA contents were lower in HVCAP treated slices in a treatment time-dependent manner. Nevertheless, lipid oxidation in samples treated with DBD-HVCAP was higher than that of the control. Polyunsaturated fatty acids were decreased in slices treated with DBD-HVCAP for more than 5 min after 12 days of storage. Therefore DBD-HVCAP treatment for 5 min was demonstrated to be potential means for increasing the shelf-life of Asian sea bass slices with minimal negative effect on chemical and sensory properties, in which they could be stored longer than 12 days at 4 °C. PRACTICAL APPLICATION: Microbial inactivation capacity of dielectric barrier discharge high-voltage cold atmospheric plasma (DBD-HVCAP) has been documented with limited information on its application in extending the shelf-life of foods. DBD-HVCAP was demonstrated as an innovative technology for extending the shelf-life of Asian sea bass slices, which could be implemented in seafood industries for assuring safety and extending shelf-life of products. The shelf-life of the slices treated with DBD-HVCAP was extended to 12 days of storage at 4 °C as compared to the 6 days of the untreated counterpart.

Human Osteoblast Cell Behaviour on Titanium Discs Treated with Argon Plasma

(1) Background. Titanium is characterized by its biocompatibility and resistance to stress and fatigue. Treatment with argon plasma may favour growth of human osteoblasts with respect to cell adhesion and proliferation. The aim of this study was to analyse the behaviour of human osteoblasts (MG-63) on Grade IV and V titanium possessing a sand-blasted, acid-etched (SLA) surface. SLA is a widely used surface treatment to create micro- and macroretentions to enhance osteoconductive properties on the surface. (2) Methods. One group of each grade of titanium was decontaminated with argon plasma and compared. On each disc, 20 × 10⁴ cells were cultivated for morphological analysis, study of cell viability (regarding a negative control [100% viability]) and mitochondrial energy balance. (3) Results. At 24 h titanium treated with SLA showed a higher percentage of cell viability (47.3 ± 8.1%) compared to titanium IV treated with argon plasma, which presented a percentage of 79.1 ± 1.1%. Grade V titanium treated with argon plasma presented a higher viability percentage 91.3 ± 3.0% whereas nontreated Grade V titanium presented 53.3 ± 4.0%. Cells cultivated on the surfaces with an argon-plasma treatment were enlarged in comparison to non-treated discs. The cells with smaller circularity with a greater spread and spindle shape were the ones cultivated on the Grade V titanium surface. Cells seeded on treated titanium IV and titanium V, treated or not, showed higher mitochondrial activity over nontreated titanium IV. (4) Conclusions. Cells cultivated on those Grade V titanium discs that were decontaminated with argon plasma presented higher levels of cell adhesion and proliferation, lower mitochondrial damage and a higher mean cell area compared to those not decontaminated with argon plasma.

Side effects by oral application of atmospheric pressure plasma on the mucosa in mice

Cold atmospheric pressure plasma (CAP) has been investigated with promising results for peri-implant diseases treatment. However, prior to in-vivo applications of CAP sources in humans, short-term harmful mucosal damage or other unwanted side effects have to be reviewed. 180 male mice (B6C3F1) were divided into twelve treatment groups (n = 15). The right buccal cheek mucosa was treated with CAP. The first and second group each received continuous 10 sec irradiation with 2 different plasma sources (kINPen09, PS-MWM). The third group was treated with the kINPen09 for one minute. Control groups were treated with a corresponding dose of ultraviolet light for 8 seconds or 48 seconds and the other one was left untreated. The animals were weighed before and after treatment. The animals were sacrificed one day or one week after exposure. Stained tissue samples were histologically examined for tissue damage independently by two experienced pathologists. One day after CAP treatment histological analysis showed focal mucosal erosion with superficial ulceration and necrosis accompanied by a mild inflammatory reaction. One week after CAP treatment, the mucosal defects were completely re-epithelialized, associated with remnants of granulation tissue in the stroma irrespective of treatment duration. Furthermore, no cytological atypia was found and no severe weight loss occurred. The control groups did not show any alterations at all. CAP treatment led to a superficial mucosal damage that healed within few days. Nonetheless, further long-term experiments are necessary to exclude undesirable side effects after longer observation time. Particularly, potential carcinogenic effects must be ruled out prior to the application of CAP treatment in daily dental practice.

Effect of Plasma of Argon Treated Implants on Bone Density: A Randomized, Controlled, Histomorphometric Study in Dogs

Background:

Altering surface characteristics by increasing its energy and hydrophilicity will accelerate the interaction between cells and implant surface. Energy and hydrophilicity tend to disappear over a short time. The implant surface may be reactivated by the use of argon plasma

Objective:

To assess bone density at cleaned and activated titanium implants using argon plasma.

Methods:

Mandibular premolars and first molars were extracted bilaterally in eight Beagle dogs. After three months, four implants, two treated with argon plasma (test; plasma) and two left without treatment (control), were randomly installed in one side of the mandible. Abutments were applied on the implants and a non-submerged healing was allowed. After one month, the same surgical procedures were adopted on the opposite side of the mandible. The animals were euthanized after one month and ground sections representing the healing after 1 and 2 months were obtained for histological examination.

Results:

No statistically significant differences were found between test and control sites (p < 0.05). After 1 month of healing, new bone was 32.5 ± 12.2% and 33.8 ± 8.8% at the plasma and control sites, respectively. After 2 months, the respective values were 50.8 ± 21.5% and 47.6 ± 15.6%.

Conclusion:

The treatment of the implant surface with argon plasma did not have a significant effect on bone density around implants.

Plasma Activation of a Breast Implant Shell in Conjunction With Antibacterial Irrigants Enhances Antibacterial Activity

BACKGROUND

Infection and capsular contracture are two of the most significant complications of breast-implant surgery. Both complications are associated with bacterial contamination of the implant surface. Plasma activation of the surface of a silicone breast implant changes its surface properties from water repelling (hydrophobic) to water absorbing (hydrophilic), thus making it possible for antibacterial irrigants to temporarily adsorb onto the implant surface.

OBJECTIVES

To support our hypothesis that by changing the surface properties we could render antibacterial irrigation more effective in inhibiting bacterial growth on a breast implant shell.

METHODS

An in vitro study using silicone discs cut from a textured silicone breast implant shell was performed by treating some of the discs with plasma activation and then exposing the discs to contamination with either Staphylococcus aureus or Pseudomonas aeruginosa and then variously treating the discs with 10% povidone iodine, Cefazolin, or Gentamicin. Bacterial contamination was verified and counted using contact plates as well as culture media.

RESULTS

Plasma activation changed the wetting properties of the disc's surface from hydrophobic to hydrophilic. Nonplasma activated contaminated discs demonstrated clear bacterial growth both in the untreated group and in the antibacterial-treated group. Combining antibacterial treatment with plasma activation resulted in complete inhibition of bacterial growth in each of the groups treated with antibacterial irrigants.

CONCLUSIONS

Combining plasma activation with topical antibacterial irrigants can inhibit the growth of bacteria on implant shell discs. By changing the properties of the surface from hydrophobic to hydrophilic, the adsorption of the antibacterial irrigants is enhanced.

A review of nanostructured surfaces and materials for dental implants: surface coating, patterning and functionalization for improved performance

The emerging field of nanostructured implants has enormous scope in the areas of medical science and dental implants. Surface nanofeatures provide significant potential solutions to medical problems by the introduction of better biomaterials, improved implant design, and surface engineering techniques such as coating, patterning, functionalization and molecular grafting at the nanoscale. This review is of an interdisciplinary nature, addressing the history and development of dental implants and the emerging area of nanotechnology in dental implants. After a brief introduction to nanotechnology in dental implants and the main classes of dental implants, an overview of different types of nanomaterials (i.e. metals, metal oxides, ceramics, polymers and hydrides) used in dental implant together with their unique properties, the influence of elemental compositions, and surface morphologies and possible applications are presented from a chemical point of view. In the core of this review, the dental implant materials, physical and chemical fabrication techniques and the role of nanotechnology in achieving ideal dental implants have been discussed. Finally, the critical parameters in dental implant design and available data on the current dental implant surfaces that use nanotopography in clinical dentistry have been discussed.

Hard and soft tissue changes around implants activated using plasma of argon: A histomorphometric study in dog

OBJECTIVE

To histologically assess the hard and soft tissue changes after insertion of cleaned and activated titanium implants using plasma of argon.

MATERIALS AND METHODS

Eight dogs were included in this study. The mandibular premolars and first molars were extracted. For each hemi-mandible, four implants, 7 mm long and 3.3 mm of diameter, with a ZirTi surface were used. The surface of two implants was randomly treated with argon plasma (test), while the other two implants were left untreated (control). After 1 month, the same procedure was performed in the contralateral hemi-mandible. The amount of old bone, new bone, overall value of old bone plus new bone, and soft tissue was histologically evaluated.

RESULTS

After 1 month of healing, high percentages of new bone in close contact with the implant surface were found at both the treated (60.1% ± 15.6%; 95% CI 56.5%-78.0%) and untreated (57.2% ± 13.1%; 95% CI 49.3%-67.5%) implants. Low percentages of old bone were found at this stage of healing, at both the treated (4.4% ± 3.0%; 95% CI 1.2%-5.4%) and untreated (3.4% ± 3.1%; 95% CI 0.6%-4.9%) implants. Not statistically significant differences were found between groups (p > .05). After 2 months of healing, treated implants presented a significantly higher (p = .012) new bone formation (72.5% ± 12.4%; 95% CI 69.6%-86.8%) compared to untreated sites (64.7% ± 17.3%; 95% CI 59.4%-83.3%). Controversially, no difference (p = .270) in terms of old bone was present between treated (3.1% ± 1.7%, 95% CI 1.8%-4.2%) and untreated implants (3.8% ± 1.9%, 95% CI 3.2%-5.8%). Significant differences (p = .018) in terms of total mineralized bone were found between treated (75.6% ± 13.0%, 95% CI 73.3%-91.3%) and untreated implants (68.4% ± 16.8%; 95% CI 64.2%-87.6%).

CONCLUSIONS

Implants treated using plasma of argon was demonstrated to reach a higher bone-to-implant contact when compared to untreated implants.

Changes in surface characteristics of titanium and zirconia after surface treatment with ultraviolet light or non-thermal plasma

Positive effects of irradiation with ultraviolet (UV) light or treatment with non-thermal plasma on titanium and zirconia surfaces have been described in various studies. The aim of this study was to assess and compare the changes in the physicochemical surface conditions of titanium and zirconia surfaces after a short treatment with UV light or with non-thermal plasmas of argon or oxygen. Titanium and zirconia samples with moderately rough surfaces were treated for 12 min either in a UV-light oven or in a non-thermal plasma reactor that generates non-thermal plasmas of oxygen or argon. Changes in surface conditions were assessed by confocal microscopy, dynamic contact angle measurement, and X-ray photoelectron spectroscopy (XPS). No changes in roughness occurred. Ultraviolet irradiation and non-thermal plasma significantly increased the wettability of the titanium and zirconia surfaces. X-ray photoelectron spectroscopy showed an increase of oxygen and a significant decrease of carbon after treatment with either method. Thus, ultraviolet light and non-thermal plasma were found to be able to improve the chemical surface conditions of titanium and zirconia following a short exposure time. However, further in vitro and in vivo studies are needed to determine the relevance of the results.

Photofunctionalization and non-thermal plasma activation of titanium surfaces

OBJECTIVE

The aim of this study was to compare UV light and non-thermal plasma (NTP) treatment regarding the improvement of physical material characteristics and cell reaction on titanium surfaces in vitro after short-term functionalization.

MATERIALS AND METHODS

Moderately rough (Ra 1.8-2.0 μm) sandblasted and acid-etched titanium disks were treated by UV light (0.05 mW/cm² at λ = 360 nm and 2 mW/cm² at λ = 250 nm) or by NTP (24 W, -0.5 mbar) of argon or oxygen for 12 min each. Surface structure was investigated by scanning electron microscopy, confocal microscopy and X-ray photoelectron spectroscopy (XPS). Hydrophilicity was assessed by dynamic contact angle measurement. Cell attachment, viability, cell proliferation and cytotoxicity were assessed in vitro using murine osteoblast-like cells.

RESULTS

UV irradiation or NTP treatment of titanium surfaces did not alter the surface structure. XPS analysis revealed a significantly increased oxidation of the surface and a decrease of carbon after the use of either method. NTP and UV light led to a significant better cell attachment of murine osteoblasts; significantly more osteoblasts grew on the treated surfaces at each time point (p < 0.001).

CONCLUSIONS

UV light as well as NTP modified the surface of titanium and significantly improved the conditions for murine osteoblast cells in vitro. However, results indicate a slight advantage for NTP of argon and oxygen in a short time interval of surface functionalization compared to UV.

CLINICAL RELEVANCE

UV light and NTP are able to improve surface conditions of dental implants made of titanium.

Hydrothermal Sterilization Improves Initial Osteoblast Responses on Sandpaper-Polished Titanium

Hydrocarbon contamination accumulated on titanium (Ti) implant surfaces during storage and sterilization is unavoidable and difficult to remove. It impairs the bioactivity of implants, restricts initial interactions between implants and the surrounding biological environment, and has become a common challenge for Ti implants. To overcome this problem, sterilization was considered as the final surface modification and a novel method, hydrothermal sterilization (HS), was proposed. Briefly, stored sandpaper-polished Ti specimens were sterilized in a glass container with pure water at 121 °C for 20 min and kept in the same water until utilization. As a control, another group of specimens was sterilized with conventional autoclaving (AC) at 121 °C for 20 min and stored in sterilization pouches after being dried at 60 °C. Compared with AC, HS deposited numerous nano-sized particles on the substrates, reduced the atomic percentage of the surface carbon, and transformed the Ti surface to a super hydrophilic status. HS also increased the attachment rate, spread, proliferation, and the mineralized nodule areas of rat bone marrow-derived osteoblasts. These results suggest that HS enhances the bioactivity of Ti implants for osteoblasts, and that this biofunctionalization was attributed to nanostructure construction, hydrophilic conversion, and the effective removal of hydrocarbons. Hydrothermal sterilization is proposed to be used as a universal sterilization method for all kinds of titanium implants without apatite coating.

Behavior of Human Bone Marrow-Derived Mesenchymal Stem Cells on Various Titanium-Based Coatings

The chemical composition and texture of titanium coatings can influence the growth characteristics of the adhered cells. An enhanced proliferation of the human mesenchymal stem cells (hMSCs) would be beneficial. The present study was aimed to investigate whether titanium deposited at different atmospheres would affect the cell growth properties, cellular morphology, and expression of surface markers of hMSCs. Titanium-based coatings were deposited on silicon wafers under oxygen, nitrogen, or argon atmospheres by ultra-short pulsed laser deposition using two different gas pressures followed by heating at 400 °C for 2 h. The characteristics of the coated surfaces were determined via contact angle, zeta potential, and scanning electron microscopy (SEM) techniques. Human MSCs were cultivated on differently coated silicon wafers for 48 h. Subsequently, the cell proliferation rates were analyzed with an MTT assay. The phenotype of hMSCs was checked via immunocytochemical stainings of MSC-associated markers CD73, CD90, and CD105, and the adhesion, spreading, and morphology of hMSCs on coated materials via SEM. The cell proliferation rates of the hMSCs were similar on all coated silicon wafers. The hMSCs retained the MSC phenotype by expressing MSC-associated markers and fibroblast-like morphology with cellular projections. Furthermore, no significant differences could be found in the size of the cells when cultured on all various coated surfaces. In conclusion, despite certain differences in the contact angles and the zeta potentials of various titanium-based coatings, no single coating markedly improved the growth characteristics of hMSCs.

Plasma of Argon Affects the Earliest Biological Response of Different Implant Surfaces: An In Vitro Comparative Study

The aim of this in vitro study was to evaluate the early cell response and protein adsorption elicited by the argon plasma treatment of different commercially available titanium surfaces via a chair-side device. Sterile disks made of grade 4 titanium (n= 450, 4-mm diameter) with 3 surface topographies (machined, plasma sprayed, and zirconia blasted and acid etched) were allocated to receive 4 testing treatments (2% and 10% protein adsorption and cell adhesion with MC3T3-E1 and MG-63). Furthermore, the specimens were divided to undergo 1) argon plasma treatment (10 W, 1 bar for 12 min) in a plasma reactor, 2) ultraviolet (UV) light treatment for 2 h (positive control group), or 3) no treatment (control group). Pretreatment surface analyses based on a scanning electron microscope and profilometer images were also performed. Profilometric analysis demonstrated that the evaluated specimens perfectly suit the standard parameters. The use of argon plasma was capable of affecting the quantity of proteins adsorbed on the different surfaces, notwithstanding their roughness or topographic features at a low fetal bovine serum concentration (2%). UV light treatment for 2 h attained similar results. Moreover, both the plasma of argon and the UV light demonstrated a significant increase in the number of osteoblasts adherent at 10 min in all tested surfaces. Within its limitations, this in vitro study highlights the potential biological benefits of treating implant surfaces with plasma of argon or UV, irrespective of the roughness of the titanium surface. However, in vivo experiments are needed to confirm these preliminary data and settle the rationale of a treatment that might be clinically relevant in case of bone-reparative deficiencies.