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Ermawan R, Corrigan H, Wiyono N. Current update and trend of 3D printing in spinal surgery: A bibliometric analysis and review of literature. J Orthop 2024; 50:22-28. [PMID: 38162258 PMCID: PMC10755500 DOI: 10.1016/j.jor.2023.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/19/2023] [Indexed: 01/03/2024] Open
Abstract
Incorporation of three-dimensional (3D) printing technology into the field of spinal surgery is on the rise. A bibliometric analysis of the current topic was carried out to elaborate the trend and to navigate future research. A Scopus database search was conducted with keywords related to 3D printing, spine, and surgery. The final 792 articles were extracted and further analyzed with VOSviewer 1.6.19 and Biblioshiny. The first published article was in 2002. A notable increase in articles in 2014 might be attributable to the availability of cheaper 3D printers which rose significantly on a global scale in 2011. China leads in terms of published research on 3D printing in spinal surgery, followed by the US, Australia, and India. The author's keyword co-occurrence analysis reveals 8 theme clusters, including preoperative and intraoperative measures, biomodelling, spinal neoplasms, biomechanics of 3D-printed materials, degenerative spinal diseases, minimally invasive surgery, and bioprinting. The top 15 of the most recently cited keywords are listed to provide future researchers to produce impactful articles. Two strategic diagrams of 2 periods (2002-2018 and 2018-2023) show the theme's evolution. We found 6 consistent themes in keyword co-occurrence analysis and the strategic diagram analysis, that are promising subjects for future research. Overall, this bibliographic study indicates the expanding importance of 3D printing in spinal surgery and suggests several critical themes and impactful keywords for future researchers.
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Affiliation(s)
- Rieva Ermawan
- Department of Orthopaedic and Traumatology Dr. Moewardi General Province Hospital, Surakarta, Indonesia
- Department of Orthopaedic, Faculty of Medicine Sebelas Maret University Surakarta, Central Java, Indonesia
| | - Hubertus Corrigan
- Department of Orthopaedic and Traumatology Dr. Moewardi General Province Hospital, Surakarta, Indonesia
- Department of Orthopaedic, Faculty of Medicine Sebelas Maret University Surakarta, Central Java, Indonesia
- Department of Anatomy, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Nanang Wiyono
- Department of Anatomy, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
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2
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Yang S, Jiang W, Ma X, Wang Z, Sah RL, Wang J, Sun Y. Nanoscale Morphologies on the Surface of 3D-Printed Titanium Implants for Improved Osseointegration: A Systematic Review of the Literature. Int J Nanomedicine 2023; 18:4171-4191. [PMID: 37525692 PMCID: PMC10387278 DOI: 10.2147/ijn.s409033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023] Open
Abstract
Three-dimensional (3D) printing is serving as the most promising approach to fabricate personalized titanium (Ti) implants for the precise treatment of complex bone defects. However, the bio-inert nature of Ti material limits its capability for rapid osseointegration and thus influences the implant lifetime in vivo. Despite the macroscale porosity for promoting osseointegration, 3D-printed Ti implant surface morphologies at the nanoscale have gained considerable attention for their potential to improve specific outcomes. To evaluate the influence of nanoscale surface morphologies on osseointegration outcomes of 3D-printed Ti implants and discuss the available strategies, we systematically searched evidence according to the PRISMA on PubMed, Embase, Web of Science, and Cochrane (until June 2022). The inclusion criteria were in vivo (animal) studies reporting the osseointegration outcomes of nanoscale morphologies on the surface of 3D-printed Ti implants. The risk of bias (RoB) was assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE's) tool. The quality of the studies was evaluated using the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. (PROSPERO: CRD42022334222). Out of 119 retrieved articles, 9 studies met the inclusion criteria. The evidence suggests that irregular nano-texture, nanodots and nanotubes with a diameter of 40-105nm on the surface of porous/solid 3D-printed Ti implants result in better osseointegration and vertical bone ingrowth compared to the untreated/polished ones by significantly promoting cell adhesion, matrix mineralization, and osteogenic differentiation through increasing integrin expression. The RoB was low in 41.1% of items, unclear in 53.3%, and high in 5.6%. The quality of the studies achieved a mean score of 17.67. Our study demonstrates that nanostructures with specific controlled properties on the surface of 3D-printed Ti implants improve their osseointegration. However, given the small number of studies, the variability in experimental designs, and lack of reporting across studies, the results should be interpreted with caution.
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Affiliation(s)
- Shiyan Yang
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Weibo Jiang
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Xiao Ma
- Department of Orthopedics, the China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Zuobin Wang
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun, Jilin, 130000, People's Republic of China
| | - Robert L Sah
- Department of Bioengineering, University of California-San Diego, La Jolla, CA, 92037, USA
- Center for Musculoskeletal Research, Institute of Engineering in Medicine, University of California-San Diego, La Jolla, CA, 92037, USA
| | - Jincheng Wang
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Yang Sun
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
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Calazans Neto JV, Reis ACD, Valente MLDC. Osseointegration in additive-manufactured titanium implants: A systematic review of animal studies on the need for surface treatment. Heliyon 2023; 9:e17105. [PMID: 37484223 PMCID: PMC10361303 DOI: 10.1016/j.heliyon.2023.e17105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
The objective of the systematic review is to find an answer to a question: "Do surface treatments on titanium implants produced by additive manufacturing improve osseointegration, compared to untreated surfaces?". This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA 2020) and was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022321351). Searches were performed in PubMed, Scopus, Science Direct, Embase, and Google Scholar databases on March 22nd, 2022. Articles were chosen in 2 steps by 2 blinded reviewers based on previously selected inclusion criteria: articles in animals that addressed the influence of surface treatments on osseointegration in implants produced by additive manufacturing. Articles were excluded that (1) did not use titanium surface, 2) that did not evaluate surface treatments, 3) that did not described osseointegration, 4) Studies with only in vitro analyses, clinical studies, systematic reviews, book chapters, short communications, conference abstracts, case reports and personal opinions.). 1003 articles were found and, after applying the eligibility criteria, 17 were used for the construction of this review. All included studies found positive osseointegration results from performing surface treatments on titanium. The risk of bias was analyzed using the SYRCLE assessment tool. Surface treatments are proposed to promote changes in the microstructure and composition of the implant surface to favor the adhesion of bone cells responsible for osseointegration. It is observed that despite the benefits generated by the additive manufacturing process in the microstructure of the implant surface, surface treatments are still indispensable, as they can promote more suitable characteristics for bone-implant integration. It can be concluded that the surface treatments evaluated in this systematic review, performed on implants produced by additive manufacturing, optimize osseointegration, as it allows the creation of a micro-nano-textured structure that makes the surface more hydrophilic and allows better contact bone-implant.
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Affiliation(s)
| | | | - Mariana Lima da Costa Valente
- Corresponding author. Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, FORP-USP. Av. Do Café, s/n, 14040Ribeirão Preto, Brazil.
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Matsko A, Shaker N, Fernandes ACBCJ, Haimeur A, França R. Nanoscale Chemical Surface Analyses of Recycled Powder for Direct Metal Powder Bed Fusion Ti-6Al-4V Root Analog Dental Implant: An X-ray Photoelectron Spectroscopy Study. Bioengineering (Basel) 2023; 10:bioengineering10030379. [PMID: 36978770 PMCID: PMC10045388 DOI: 10.3390/bioengineering10030379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Over the past couple of decades, additive manufacturing and the use of root-analogue-printed titanium dental implants have been developed. Not all powder particles are sintered into the final product during the additive manufacturing process. Reuse of the remaining powder could reduce the overall implant manufacturing cost. However, Ti-6Al-4V powder particles are affected by heat, mechanical factors, and oxidization during the powder bed fusion manufacturing process. Degradation of the powder may harm the final surface composition and decrease the biocompatibility and survival of the implant. The uncertainty of the recycled powder properties prevents implant fabrication facilities from reusing the powder. This study investigates the chemical composition of controlled, clean, and recycled titanium alloy powder and root-analogue implants (RAI) manufactured from these powders at three different depths. The change in titanium's quantity, oxidization state, and chemical composition in powder and RAI implants have been demonstrated and analyzed. While not identical, the surface chemical composition of the recycled powder implant and the implant manufactured from unused powder are similar. The results also indicate the presence of TiO2 on all surfaces. Many studies confirmed that titanium dioxide on the implant's surface correlates with better osteointegration, reduced bacterial infection, and increased corrosion resistance. Considering economic and environmental aspects, surface chemical composition comparison of clean and reused powder is crucial for the future manufacturing of cost-effective and biocompatible implants.
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Affiliation(s)
- Anastasia Matsko
- Biomedical Engineering Program, Faculty of Engineering University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Nader Shaker
- Department of Restorative Dentistry, College of Dentistry, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
| | - Ana Carla B C J Fernandes
- Department of Oral Biology, College of Dentistry, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
| | - Asmaa Haimeur
- Department of Restorative Dentistry, College of Dentistry, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
| | - Rodrigo França
- Department of Restorative Dentistry, College of Dentistry, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
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Dias Corpa Tardelli J, Duarte Firmino AC, Ferreira I, Cândido dos Reis A. Influence of the roughness of dental implants obtained by additive manufacturing on osteoblastic adhesion and proliferation: A systematic review. Heliyon 2022; 8:e12505. [PMID: 36643331 PMCID: PMC9834751 DOI: 10.1016/j.heliyon.2022.e12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/29/2022] [Accepted: 12/13/2022] [Indexed: 12/26/2022] Open
Abstract
Objective Critically analyzed the existing literature to answer the question "What is the influence of roughness of surfaces for dental implants obtained by additive manufacturing compared to machined on osteoblastic cell adhesion and proliferation?" Design This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the Open Science Framework. The personalized search strategy was applied to Embase, Pub Med, Scopus, and Science Direct databases and Google Scholar and ProQuest grey literature. The selection process was carried out in two stages independently by two reviewers according to the eligibility criteria. The risk of bias was analyzed using a checklist of important parameters to be considered. Results When applying the search strategy on databases 223 articles were found, after removing the duplicates, 171 were analyzed by title and abstract of which 25 were selected for full reading, of these, 6 met the eligibility criteria. 2 studies were included from the reference list totaling 8 articles included in this systematic review and none were included from the Grey Literature. 7 had a low risk of bias and 1 moderate. Conclusions 1) Roughness is a property that must be analyzed and correlated with the chemical composition, intrinsic to the alloy and resulting from the surface treatment; morphology of topographic peaks and valleys; printing technique and its parameters; 2) Need for more studies on the biomolecular level to elucidate the mechanism by which the roughness and the morphology of topographical peaks and valleys descriptive of roughness influence osteoblastic adhesion and proliferation.
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Alipour S, Nour S, Attari SM, Mohajeri M, Kianersi S, Taromian F, Khalkhali M, Aninwene GE, Tayebi L. A review on in vitro/ in vivo response of additively manufactured Ti-6Al-4V alloy. J Mater Chem B 2022; 10:9479-9534. [PMID: 36305245 DOI: 10.1039/d2tb01616h] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bone replacement using porous and solid metallic implants, such as Ti-alloy implants, is regarded as one of the most practical therapeutic approaches in biomedical engineering. The bone is a complex tissue with various mechanical properties based on the site of action. Patient-specific Ti-6Al-4V constructs may address the key needs in bone treatment for having customized implants that mimic the complex structure of the natural tissue and diminish the risk of implant failure. This review focuses on the most promising methods of fabricating such patient-specific Ti-6Al-4V implants using additive manufacturing (AM) with a specific emphasis on the popular subcategory, which is powder bed fusion (PBF). Characteristics of the ideal implant to promote optimized tissue-implant interactions, as well as physical, mechanical/chemical treatments and modifications will be discussed. Accordingly, such investigations will be classified into 3B-based approaches (Biofunctionality, Bioactivity, and Biostability), which mainly govern native body response and ultimately the success in implantation.
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Affiliation(s)
- Saeid Alipour
- Department of Materials Science and Engineering, Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Shirin Nour
- Tissue Engineering Group, Department of Biomedical Engineering, University of Melbourne, VIC 3010, Australia.,Polymer Science Group, Department of Chemical Engineering, University of Melbourne, VIC 3010, Australia
| | - Seyyed Morteza Attari
- Department of Material Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Mohammad Mohajeri
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, TX, USA
| | - Sogol Kianersi
- CÚRAM, SFI Centre for Research in Medical Devices, Biomedical Sciences, University of Galway, Galway, Ireland
| | - Farzaneh Taromian
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Mohammadparsa Khalkhali
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - George E Aninwene
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California-Los Angeles, Los Angeles, California, USA.,Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, California, USA.,California NanoSystems Institute (CNSI), University of California-Los Angeles, Los Angeles, California, USA
| | - Lobat Tayebi
- School of Dentistry, Marquette University, Milwaukee, Wisconsin, USA.
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In Vitro and In Vivo Studies of Hydrogenated Titanium Dioxide Nanotubes with Superhydrophilic Surfaces during Early Osseointegration. Cells 2022; 11:cells11213417. [DOI: 10.3390/cells11213417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Titanium-based implants are often utilized in oral implantology and craniofacial reconstructions. However, the biological inertness of machined titanium commonly results in unsatisfactory osseointegration. To improve the osseointegration properties, we modified the titanium implants with nanotubular/superhydrophilic surfaces through anodic oxidation and thermal hydrogenation and evaluated the effects of the machined surfaces (M), nanotubular surfaces (Nano), and hydrogenated nanotubes (H-Nano) on osteogenesis and osseointegration in vitro and in vivo. After incubation of mouse bone marrow mesenchymal stem cells on the samples, we observed improved cell adhesion, alkaline phosphatase activity, osteogenesis-related gene expression, and extracellular matrix mineralization in the H-Nano group compared to the other groups. Subsequent in vivo studies indicated that H-Nano implants promoted rapid new bone regeneration and osseointegration at 4 weeks, which may be attributed to the active osteoblasts adhering to the nanotubular/superhydrophilic surfaces. Additionally, the Nano group displayed enhanced osteogenesis in vitro and in vivo at later stages, especially at 8 weeks. Therefore, we report that hydrogenated superhydrophilic nanotubes can significantly accelerate osteogenesis and osseointegration at an early stage, revealing the considerable potential of this implant modification for clinical applications.
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Reis TAD, Borges GCS, Zancopé K, Neves FDD. Influence of diameter on mechanical behavior of morse taper narrow implants. BRAZILIAN JOURNAL OF ORAL SCIENCES 2022. [DOI: 10.20396/bjos.v21i00.8666036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Dental implants could give back function, esthetics and quality of life to patients. The correct choice of the implant, especially in borderline cases, is essential for a satisfactory result. Aim: Thus, the objective of this study was to evaluate the mechanical behavior of Morse taper implants with two different prosthetic interfaces. Methods: Twenty self-locking Morse taper implants, 2.9 mm in diameter (FAC), and 20 Morse taper implants, 3.5 mm in diameter (CM) were divided into two groups (n=10), and submitted to strength to failure test, optical microscopic evaluation of fracture, metallographic analysis of the alloy, finite element analysis (FEA) and strain gauge test. A Student’s t test (α = 0.05) was made for a statistical analysis. Results: For the strength to failure test, a statistically difference was observed (p <0.001) between FAC (225.0 ± 19.8 N) and CM (397.3 ± 12.5 N). The optical microscopic evaluation demonstrated a fracture pattern that corroborated with FEA´s results. The metallographic analysis determined that the implants of the FAC group have titanium-aluminum-vanadium alloy in their composition. In the strain gauge test, there was no statistical difference (p = 0.833) between CM (1064.8 ± 575.04 μS) and FAC (1002.2 ± 657.6 μS) groups. Conclusion: Based on the results obtained in this study, ultra-narrow implants (FAC) should ideally be restricted to areas with low masticatory effort.
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A Review of Biomimetic Topographies and Their Role in Promoting Bone Formation and Osseointegration: Implications for Clinical Use. Biomimetics (Basel) 2022; 7:biomimetics7020046. [PMID: 35466263 PMCID: PMC9036271 DOI: 10.3390/biomimetics7020046] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/20/2022] Open
Abstract
The use of metallic and polymeric materials for implants has been increasing over the past decade. This trend can be attributed to a variety of factors including a significant increase in basic science research focused on implant material characteristics and how various surface modifications may stimulate osseointegration and, ultimately, fusion. There are many interbody fusion devices and dental implants commercially available; however, detailed information about their surface properties, and the effects that various materials and surface modifications may have on osteogenesis, is lacking in the literature. While the concept of bone-implant osseointegration is a relatively recent addition to the spine fusion literature, there is a comparatively large body of literature related to dental implants. The purpose of this article is to summarize the science of surface modified bone-facing implants, focusing on biomimetic material chemistry and topography of titanium implants, to promote a better understanding of how these characteristics may impact bone formation and osseointegration. This manuscript has the following aspects: highlights the role of titanium and its alloys as potent osteoconductive bioactive materials; explores the importance of biomimetic surface topography at the macro-, micro- and nano-scale; summarizes how material surface design can influence osteogenesis and immune responses in vitro; focuses on the kinds of surface modifications that play a role in the process. Biomimetic surface modifications can be varied across many clinically available biomaterials, and the literature supports the hypothesis that those biomaterial surfaces that exhibit physical properties of bone resorption pits, such as roughness and complex hierarchical structures at the submicron and nanoscale, are more effective in supporting osteoblast differentiation in vitro and osteogenesis in vivo.
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Hou C, An J, Zhao D, Ma X, Zhang W, Zhao W, Wu M, Zhang Z, Yuan F. Surface Modification Techniques to Produce Micro/Nano-scale Topographies on Ti-Based Implant Surfaces for Improved Osseointegration. Front Bioeng Biotechnol 2022; 10:835008. [PMID: 35402405 PMCID: PMC8990803 DOI: 10.3389/fbioe.2022.835008] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/08/2022] [Indexed: 12/24/2022] Open
Abstract
Titanium and titanium alloys are used as artificial bone substitutes due to the good mechanical properties and biocompatibility, and are widely applied in the treatment of bone defects in clinic. However, Pure titanium has stress shielding effect on bone, and the effect of titanium-based materials on promoting bone healing is not significant. To solve this problem, several studies have proposed that the surface of titanium-based implants can be modified to generate micro or nano structures and improve mechanical properties, which will have positive effects on bone healing. This article reviews the application and characteristics of several titanium processing methods, and explores the effects of different technologies on the surface characteristics, mechanical properties, cell behavior and osseointegration. The future research prospects in this field and the characteristics of ideal titanium-based implants are proposed.
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Affiliation(s)
- Chuang Hou
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Jing An
- Nursing Teaching and Research Department, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Duoyi Zhao
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiao Ma
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Weilin Zhang
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Wei Zhao
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Meng Wu
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiyu Zhang
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Zhiyu Zhang, ; Fusheng Yuan,
| | - Fusheng Yuan
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Zhiyu Zhang, ; Fusheng Yuan,
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Shaikh MQ, Nath SD, Akilan AA, Khanjar S, Balla VK, Grant GT, Atre SV. Investigation of Patient-Specific Maxillofacial Implant Prototype Development by Metal Fused Filament Fabrication (MF 3) of Ti-6Al-4V. Dent J (Basel) 2021; 9:dj9100109. [PMID: 34677171 PMCID: PMC8534331 DOI: 10.3390/dj9100109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
Additive manufacturing (AM) and related digital technologies have enabled several advanced solutions in medicine and dentistry, in particular, the design and fabrication of patient-specific implants. In this study, the feasibility of metal fused filament fabrication (MF3) to manufacture patient-specific maxillofacial implants is investigated. Here, the design and fabrication of a maxillofacial implant prototype in Ti-6Al-4V using MF3 is reported for the first time. The cone-beam computed tomography (CBCT) image data of the patient’s oral anatomy was digitally processed to design a 3D CAD model of the hard tissue and fabricate a physical model by stereolithography (SLA). Using the digital and physical models, bone loss condition was analyzed, and a maxillofacial implant initial design was identified. Three-dimensional (3D) CAD models of the implant prototypes were designed that match the patient’s anatomy and dental implant requirement. In this preliminary stage, the CAD models of the prototypes were designed in a simplified form. MF3 printing of the prototypes was simulated to investigate potential deformation and residual stresses. The patient-specific implant prototypes were fabricated by MF3 printing followed by debinding and sintering using a support structure for the first time. MF3 printed green part dimensions fairly matched with simulation prediction. Sintered parts were characterized for surface integrity after cutting the support structures off. An overall 18 ± 2% shrinkage was observed in the sintered parts relative to the green parts. A relative density of 81 ± 4% indicated 19% total porosity including 11% open interconnected porosity in the sintered parts, which would favor bone healing and high osteointegration in the metallic implants. The surface roughness of Ra: 18 ± 5 µm and a Rockwell hardness of 6.5 ± 0.8 HRC were observed. The outcome of the work can be leveraged to further investigate the potential of MF3 to manufacture patient-specific custom implants out of Ti-6Al-4V.
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Affiliation(s)
- Mohammad Qasim Shaikh
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
| | - Subrata Deb Nath
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
| | - Arulselvan Arumugam Akilan
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
| | - Saleh Khanjar
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
| | - Vamsi Krishna Balla
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
- Bioceramics and Coating Division, CSIR-Central Glass and Ceramic Research Institute, 196 Raja S.C. Mullick Road, Kolkata 700 032, India
| | | | - Sundar Vedanarayanan Atre
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
- Correspondence:
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Shu T, Zhang Y, Sun G, Pan Y, He G, Cheng Y, Li A, Pei D. Enhanced Osseointegration by the Hierarchical Micro-Nano Topography on Selective Laser Melting Ti-6Al-4V Dental Implants. Front Bioeng Biotechnol 2021; 8:621601. [PMID: 33490056 PMCID: PMC7817818 DOI: 10.3389/fbioe.2020.621601] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/30/2020] [Indexed: 12/19/2022] Open
Abstract
Currently, selective laser melting (SLM) has been thriving in implant dentistry for on-demand fabricating dental implants. Based on the coarse microtopography of SLM titanium surfaces, constructing nanostructure to form the hierarchical micro-nano topography is effective in enhancing osseointegration. Given that current nanomodification techniques of SLM implants, such as anodization and hydrothermal treatment, are facing the inadequacy in costly specific apparatus and reagents, there has been no recognized nanomodified SLM dental implants. The present study aimed to construct hierarchical micro-nano topography on self-made SLM dental implants by a simple and safe inorganic chemical oxidation, and to evaluate its contribution on osteoblastic cells bioactivity and osseointegration. The surface chemical and physical parameters were characterized by FE-SEM, EDS, profilometer, AFM, and contact angle meter. The alteration on bioactivity of MG-63 human osteoblastic cells were detected by qRT-PCR. Then the osseointegration was assessed by implanting implants on the femur condyle of New Zealand Rabbits. The hierarchical micro-nano topography was constituted by the microrough surface of SLM implants and nanoneedles (diameter: 20∼50 nm, height: 150∼250 nm), after nanomodifying SLM implants in 30% hydrogen peroxide and 30% hydrochloride acid (volume ratio 1:2.5) at room temperature for 36 h. Low chemical impurities content and high hydrophilicity were observed in the nanomodified group. Cell experiments on the nanomodified group showed higher expression of mitophagy related gene (PINK1, PARKIN, LC3B, and LAMP1) at 5 days and higher expression of osteogenesis related gene (Runx2 and OCN) at 14 days. In the early stage of bone formation, the nanomodified SLM implants demonstrated higher bone-to-implant contact. Intriguingly, the initial bone-to-implant contact of nanomodified SLM implants consisted of more mineralized bone with less immature osteoid. After the cessation of bone formation, the bone-to-implant contact of nanomodified SLM implants was equal to untreated SLM implants and marketable TixOs implants. The overall findings indicated that the inorganic chemical oxidized hierarchical micro-nano topography could enhance the bioactivity of osteoblastic cells, and consequently promote the peri-implant bone formation and mineralization of SLM dental implants. This study sheds some light on improvements in additive manufactured dental implants.
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Affiliation(s)
- Tianyu Shu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.,State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Yuchen Zhang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Guo Sun
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Yang Pan
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Gang He
- Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yilong Cheng
- School of Chemistry, Xi'an Jiaotong University, Xi'an, China
| | - Ang Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.,Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Dandan Pei
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.,Department of Prosthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
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13
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Sabino RM, Mondini G, Kipper MJ, Martins AF, Popat KC. Tanfloc/heparin polyelectrolyte multilayers improve osteogenic differentiation of adipose-derived stem cells on titania nanotube surfaces. Carbohydr Polym 2021; 251:117079. [PMID: 33142622 PMCID: PMC7717535 DOI: 10.1016/j.carbpol.2020.117079] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/22/2020] [Accepted: 09/07/2020] [Indexed: 01/11/2023]
Abstract
In this study, a surface modification strategy using natural biopolymers on titanium is proposed to improve bone healing and promote rapid and successful osseointegration of orthopedic implants. Titania nanotubes were fabricated via an anodization process and the surfaces were further modified with polyelectrolyte multilayers (PEMs) based on Tanfloc (a cationic tannin derivative) and glycosaminoglycans (heparin and hyaluronic acid). Scanning electron microscopy (SEM), water contact angle measurements, and X-ray photoelectron spectroscopy were used to characterize the surfaces. Adipose-derived stem cells (ADSCs) were seeded on the surfaces, and the cell viability, adhesion, and proliferation were investigated. Osteogenesis was induced and osteogenic differentiation of human ADSCs on the surfaces was evaluated via mineralization and protein expression assays, immunofluorescent staining, and SEM. The Tanfloc/heparin PEMs on titania nanotubes improved the rate of osteogenic differentiation of ADSCs as well as the bone mineral deposition, and is therefore a promising approach for use in orthopedic implants.
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Affiliation(s)
- Roberta M Sabino
- School of Advanced Materials Discovery, Colorado State University, USA
| | - Gabriela Mondini
- Department of Biological Sciences, Pontifícia Universidade Católica do Paraná, Brazil
| | - Matt J Kipper
- School of Advanced Materials Discovery, Colorado State University, USA; School of Biomedical Engineering, Colorado State University, USA; Department of Chemical and Biological Engineering, Colorado State University, USA.
| | - Alessandro F Martins
- Department of Chemical and Biological Engineering, Colorado State University, USA; Laboratory of Materials, Macromolecules and Composites, Federal University of Technology, Brazil; Group of Polymers and Composite Materials, Chemical Department, State University of Maringá, Brazil
| | - Ketul C Popat
- School of Advanced Materials Discovery, Colorado State University, USA; School of Biomedical Engineering, Colorado State University, USA; Department of Mechanical Engineering, Colorado State University, USA.
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14
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Liu Y, Xie D, Zhou R, Zhang Y. 3D X-ray micro-computed tomography imaging for the microarchitecture evaluation of porous metallic implants and scaffolds. Micron 2020; 142:102994. [PMID: 33341436 DOI: 10.1016/j.micron.2020.102994] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 01/11/2023]
Abstract
As an advanced microscopy technology with strong sample adaptability and non-destructive three-dimensional (3D) characteristics, X-ray micro-computed tomography (Micro-CT) can establish the overall connection between various microarchitecture parameters and accelerate the research process of porous metallic implants and scaffolds. In this review, the Micro-CT based quantitative evaluation methods of microarchitecture and bone formation are investigated. To ensure reliability of the results, the Micro-CT setup is discussed briefly and the essential image processing algorithms are introduced in detail. The significance and limitations of Micro-CT are analyzed in the context of research on porous metallic implants. We also discuss the future development of Micro-CT technology in the field of biological tissue engineering.
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Affiliation(s)
- Yuchuan Liu
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China; Engineering Research Center of Industrial Computed Tomography Nondestructive Testing, Ministry of Education, Chongqing University, Chongqing 400044, China
| | - Dongyang Xie
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China; Engineering Research Center of Industrial Computed Tomography Nondestructive Testing, Ministry of Education, Chongqing University, Chongqing 400044, China
| | - Rifeng Zhou
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China; Engineering Research Center of Industrial Computed Tomography Nondestructive Testing, Ministry of Education, Chongqing University, Chongqing 400044, China; State Key Laboratory of Mechanical Transmissions, Chongqing University, Chongqing 400044, China.
| | - Yuxin Zhang
- State Key Laboratory of Mechanical Transmissions, Chongqing University, Chongqing 400044, China; College of Materials Science and Engineering, Chongqing University, Chongqing 400044, China.
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15
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Kim J, Kim HY, Kim WH, Kim JW, Kim MJ. Effect of PTH and corticotomy on implant movement under mechanical force. BMC Oral Health 2020; 20:315. [PMID: 33172437 PMCID: PMC7653691 DOI: 10.1186/s12903-020-01310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Osseointegrated implants are considered as clinically non-movable. Parathyroid hormone (PTH) is known to play a significant role in the regulation of bone remodeling and in intermittent, low doses, result in osteoanabolic effects. This study aimed to investigate the effects of PTH and corticotomy, both under traction force, on osseointegrated implants. Methods Four implants—two in each hemimandible—were placed in each of the three study mongrels. Each mongrels were designated as control, normal dose PTH (PTH-1), and high dose PTH (PTH-2) groups, with each groups further subdivided into non-surgery implant and surgery implant. After osseointegration, mechanical force with NiTi closed coil springs (500 g) was applied around each implants. Corticotomy was performed around one of four implants in each mongrels. Parathyroid hormone was administered locally on a weekly basis for 20 weeks. Clinical movement of the implants were evaluated with the superimposed 3D- scanned data, bone- microarchitectural and histologic examinations. Results Superimposition analysis showed continuous movement of the non-surgery implant of PTH-1 group. Movement was further justified with lowest bone implant contact (adjusted BIC; 44.77%) in histomorphometric analysis. Upregulation of bone remodeling around the implant was observed in the normal dose PTH group. In the surgery implants, the remarkably higher adjusted BIC compared to the non-surgery implants indicated increased bone formation around the implant surface. Conclusion The results indicate that the catabolic and anabolic balance of osseointegrated implants in terms of bone remodeling can be shifted via various interventions including pharmacological, surgical and mechanical force. Clinical relevance Upregulated bone remodeling by PTH and corticotomy under continuous mechanical force showed the possible implications for the movement of osseointegrated dental implant.
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Affiliation(s)
- Jiyeon Kim
- School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Heon-Young Kim
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Anyangcheon-ro 1071, Yangcheon-gu, Seoul, 158-710, South Korea
| | - Won-Ho Kim
- Department of Orthodontics, School of Medicine, Ewha Womans University, Anyangcheon-ro 1071, Yangcheon-gu, Seoul, 158-710, South Korea
| | - Jin-Woo Kim
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Anyangcheon-ro 1071, Yangcheon-gu, Seoul, 158-710, South Korea.
| | - Min-Ji Kim
- Department of Orthodontics, School of Medicine, Ewha Womans University, Anyangcheon-ro 1071, Yangcheon-gu, Seoul, 158-710, South Korea.
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16
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Analysis of the mechanical and physicochemical properties of
Ti‐6Al‐4 V
discs obtained by selective laser melting and subtractive manufacturing method. J Biomed Mater Res B Appl Biomater 2020; 109:420-427. [DOI: 10.1002/jbm.b.34710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 07/16/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022]
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17
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Revilla‐León M, Sadeghpour M, Özcan M. A Review of the Applications of Additive Manufacturing Technologies Used to Fabricate Metals in Implant Dentistry. J Prosthodont 2020; 29:579-593. [DOI: 10.1111/jopr.13212] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Marta Revilla‐León
- Comprehensive Dentistry Department, College of DentistryTexas A&M University Dallas TX
- Gradute Prosthodontics, Department of Restorative Dentistry, School of DentistryUniversity of Washington Seattle WA
| | - Mehrad Sadeghpour
- Revilla Research Center Madrid Spain
- Private practice in Dallas Dallas TX
| | - Mutlu Özcan
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center for Dental and Oral MedicineUniversity of Zurich Zürich Switzerland
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18
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Berger MB, Jacobs TW, Boyan BD, Schwartz Z. Hot isostatic pressure treatment of 3D printed Ti6Al4V alters surface modifications and cellular response. J Biomed Mater Res B Appl Biomater 2020; 108:1262-1273. [PMID: 31469519 PMCID: PMC7048629 DOI: 10.1002/jbm.b.34474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/26/2019] [Accepted: 08/06/2019] [Indexed: 11/05/2022]
Abstract
Additive manufacturing can be used to create personalized orthopedic and dental implants with varying geometries and porosities meant to mimic morphological properties of bone. These qualities can alleviate stress shielding and increase osseointegration through bone ingrowth, but at the expense of reduced fatigue properties compared to machined implants, and potential for loose build particle erosion. Hot isostatic pressure (HIP) treatment is used to increase fatigue resistance; implant surface treatments like grit-blasting and acid-etching create microroughness and reduce the presence of loose particles. However, it is not known how HIP treatment affects surface treatments and osseointegration of the implant to bone. We manufactured two titanium-aluminum-vanadium constructs, one with simple through-and-through porosity and one possessing complex trabecular bone-like porosity. We observed HIP treatment varied in effect and was dependent on architecture. Micro/meso/nano surface properties generated by grit-blasting and acid-etching were altered on biomimetic HIP-treated constructs. Human mesenchymal stem cells (MSCs) were cultured on constructs fabricated +/- HIP and subsequently surface-treated. MSCs were sensitive to 3D-architecture, exhibiting greater osteogenic differentiation on constructs with complex trabecular bone-like porosity. HIP-treatment did not alter the osteogenic response of MSCs to these constructs. Thus, HIP may provide mechanical and biological advantages during implant osseointegration and function.
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Affiliation(s)
- Michael B. Berger
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond VA 23284, USA
| | - Thomas W. Jacobs
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond VA 23284, USA
| | - Barbara D. Boyan
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond VA 23284, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Zvi Schwartz
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond VA 23284, USA
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
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19
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Cohen DJ, Scott KM, Kulkarni AN, Wayne JS, Boyan BD, Schwartz Z. Acellular mineralized allogenic block bone graft does not remodel during the 10 weeks following concurrent implant placement in a rabbit femoral model. Clin Oral Implants Res 2019; 31:37-48. [PMID: 31545532 DOI: 10.1111/clr.13544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/22/2019] [Accepted: 09/08/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Due to bone loss, endosseous implants often require addition of a bone graft to support adequate primary fixation, bone regeneration, and osseointegration. The aim of this study was to compare effectiveness of autogenic and allogenic bone grafts when used during simultaneous insertion of the implant. MATERIALS AND METHODS 4-mm-diameter rabbit diaphyseal bone autografts or allografts (n = 16/group) with a 3.2-mm pre-drilled hole in the center were placed into a 4 mm defect in the proximal femur of 3.5 kg male New Zealand White rabbits. Machined 3.2 × 10 mm grit-blasted, acid-etched titanium-aluminum-vanadium (Ti6Al4V) implants were placed. Control implants were placed into progressively drilled 3.2-mm holes in the contralateral limbs. Post-insertion day 70, samples were analyzed by micro-CT and calcified histology, or by mechanical torque and push-out testing followed by decalcified histology. RESULTS Both grafts were integrated with the native bone. Micro-CT showed less bone volume (BV) and bone volume/total volume (BV/TV) in the allograft group, but histology showed no differences in BV or BV/TV between groups. Allograft lacked living cells, whereas autograft was cellularized. No difference was found in maximum removal torque between groups. Compressive loading at the graft-to-bone interface was significantly lower in allograft compared with autograft groups. CONCLUSIONS There was less bone in contact with the implant and significantly less maximum compressive load in the allograft group compared with autograft. The allograft remained acellular as demonstrated by empty lacunae. Taken together, block allograft implanted simultaneously with an implant produces a poorer quality bone compared with autograft.
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Affiliation(s)
- D Joshua Cohen
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Kayla M Scott
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Aniket N Kulkarni
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer S Wayne
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Barbara D Boyan
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Zvi Schwartz
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA.,Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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20
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Puisys A, Schlee M, Linkevicius T, Petrakakis P, Tjaden A. Photo-activated implants: a triple-blinded, split-mouth, randomized controlled clinical trial on the resistance to removal torque at various healing intervals. Clin Oral Investig 2019; 24:1789-1799. [PMID: 31512072 DOI: 10.1007/s00784-019-03041-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Hydrophilic implant surfaces promote faster osseointegration of dental implants with a higher bone-implant contact (BIC) rate. Animal and in vitro studies proved that ultraviolet (UV) irradiation of titanium implants regains hydrophilicity. Clinical impact is still unclear. The objective of this RCT was to assess the removal torque (RT) required to unfix a surface-treated implant (test group) versus the original surface implant (control group) performed at various points in time. The null hypothesis stated that test and control implants will show the same deliberation force at specific time points. MATERIAL AND METHODS One hundred eighty partially edentulous patients were randomly assigned to six groups. In single-stage surgery, each patient received one test and one control implant. In total, 180 test and 180 control implants were placed epicrestally. Test implants received a surface treatment with UV irradiation prior to insertion, in order to reduce carbon and enhance hydrophilicity and thus wettability. Maximum RT values for test and control implants were recorded with a torque measuring device at implant placement (T1), after 1 (group 1), 2 (group 2), 3 (group 3), 4 (group 4), 6 (group 5) (T2), and 8 weeks (group 6) of healing. Subsequently, implants were returned to their original position for the continuation of the healing process. RESULTS No implant was lost. Age, gender, smoking, implant position, and bone quality could be excluded as confounding factors because of the lack of statistical significance. At T2, RT values were higher for test implants compared with those for control implants, being statistically significant in groups 2, 3, 4, and 6 (p < 0.05). CONCLUSIONS Our data support rejection of the null hypothesis. CLINICAL RELEVANCE Photo-activation of the surface of titanium implants leads to higher resistance to RT forces compared with that of non-treated implants, indicating improved healing and implant stability especially in the early healing phase.
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21
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Oliveira TT, Reis AC. Fabrication of dental implants by the additive manufacturing method: A systematic review. J Prosthet Dent 2019; 122:270-274. [PMID: 30928226 DOI: 10.1016/j.prosdent.2019.01.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
STATEMENT OF PROBLEM Placement of dental implants depends, among other factors, on anatomic conditions such as sufficient bone height and thickness. Thus, individualized dental implants seem to offer benefits for patients with alveolar bone resorption. Additive manufacturing has allowed for the fabrication of custom implants with microscale resolution and, although the efficiency of the process is unclear, is a potential process for manufacturing dental implants. PURPOSE The purpose of this systematic review was to evaluate the current situation of additive manufacturing techniques for fabricating dental implants. MATERIAL AND METHODS An electronic search was performed in the databases PubMed, Lilacs, Cochrane Library, and Science Direct, with the terms "additive manufacturing" AND "dental implants," "rapid prototyping" AND "dental implants," "3 D printing" AND "dental implants," "electron beam melting" AND "dental implants," "selective laser melting" AND "dental implants." The articles were screened, and the final selection of articles was obtained by using the inclusion and exclusion criteria. RESULTS The database search resulted in 1322 articles, which were screened for title and/or summary according to the inclusion criteria. From the selected 38 articles, 30 remained after applying the exclusion criteria. These were read completely, resulting in a selection of 13 articles for this systematic review. Owing to the great variety of articles with different objectives, the results were based on a descriptive analysis of the following topics: additive manufacturing technique and material, printed structure and implant design, implant characteristics, mechanical analysis, surface treatment, and osseointegration. CONCLUSIONS Additive manufacturing is a new technology that may solve many problems in diverse fields. In dentistry, however, further studies are needed to improve the method for manufacturing custom dental implants because no standard methodology is available. Moreover, the advantages and disadvantages of the process are not yet clearly defined.
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Affiliation(s)
- Thaisa T Oliveira
- Postgraduate student, Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Andréa C Reis
- Associate Professor, Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry, University of São Paulo (USP), Ribeirão Preto, Brazil.
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22
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Cheng A, Schwartz Z, Kahn A, Li X, Shao Z, Sun M, Ao Y, Boyan BD, Chen H. Advances in Porous Scaffold Design for Bone and Cartilage Tissue Engineering and Regeneration. TISSUE ENGINEERING. PART B, REVIEWS 2019; 25:14-29. [PMID: 30079807 PMCID: PMC6388715 DOI: 10.1089/ten.teb.2018.0119] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022]
Abstract
IMPACT STATEMENT Challenges in musculoskeletal tissue regeneration affect millions of patients globally. Scaffolds for tissue engineering bone and cartilage provide promising solutions that increase healing and decrease need for complicated surgical procedures. Porous scaffolds have emerged as an attractive alternative to traditional scaffolds. However, the success of advanced materials, use of biological factors, and manufacturing techniques can vary depending on use case. This review provides perspective on porous scaffold manufacturing, characterization and application, and can be used to inform future scaffold design.
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Affiliation(s)
- Alice Cheng
- Department of Biomedical Engineering, Peking University, Beijing, China
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
- Department of Periodontology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Adrian Kahn
- Department of Oral and Maxillofacial Surgery, University of Tel Aviv, Tel Aviv, Israel
| | - Xiyu Li
- Department of Biomedical Engineering, Peking University, Beijing, China
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Zhenxing Shao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Muyang Sun
- Department of Biomedical Engineering, Peking University, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Barbara D. Boyan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Haifeng Chen
- Department of Biomedical Engineering, Peking University, Beijing, China
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Harun W, Manam N, Kamariah M, Sharif S, Zulkifly A, Ahmad I, Miura H. A review of powdered additive manufacturing techniques for Ti-6al-4v biomedical applications. POWDER TECHNOL 2018. [DOI: 10.1016/j.powtec.2018.03.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Chan YH, Lew WZ, Lu E, Loretz T, Lu L, Lin CT, Feng SW. An evaluation of the biocompatibility and osseointegration of novel glass fiber reinforced composite implants: In vitro and in vivo studies. Dent Mater 2018; 34:470-485. [DOI: 10.1016/j.dental.2017.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/16/2017] [Accepted: 12/08/2017] [Indexed: 01/21/2023]
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25
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Early cell response of osteogenic cells on differently modified implant surfaces: Sequences of cell proliferation, adherence and differentiation. J Craniomaxillofac Surg 2017; 46:453-460. [PMID: 29325889 DOI: 10.1016/j.jcms.2017.12.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Osseointegration of dental implants is a crucial prerequisite for long-term survival. Therefore, surface modifications are needed to interact with the extracellular environment and to trigger osteogenic cell responses such as cell proliferation, adherence, and differentiation. The purpose of this study was to investigate different surface modifications in vitro over 2 weeks. MATERIALS AND METHODS Commercially available cells from a human osteogenic cell line (HHOB-c) were cultivated on the following surfaces: titanium with smooth surfaces (polished titanium (P), machined titanium (M), polyetheretherketone (Peek)), titanium with rough and hydrophilised surfaces (acid etched titanium (A), sandblasted acid etched titanium (SA and SA2), sandblasted acid etched hydrophilised (SAH), titanium plasma painted titanium (TPS)), titanium with calcium phosphate-containing surfaces (titanium plasma painted calcium phosphate modified titanium (TPS-CaP), sandblasted calcium phosphate modified titanium (S-CaP), sandblasted acid etched calcium phosphate modified titanium (SA-CaP)), and zirconium-oxide (yttrium amplified zirconium (Z), yttrium amplified Ca2+ delivering zirconium (Z-Ca)). Tissue culture polystyrene (TCPS) served as a control. Cell count was assessed after 24 h, 48 h, 72 h, 7 d, and 14 d; osteogenic cell adherence and differentiation were analysed by using cellular Quantitative Immuno-Cytochemistry (QIC) assay for alkaline phosphatase (AP), osteocalcin (OC), integrin alpha V (ITGAV), and talin (T). RESULTS All tested surfaces showed a positive influence on the differentiation and adherence of osteogenic cells, especially P, M, A, TCPS, and Peek. After 48 h, the surfaces M, SA and SAH had induced a positive influence on adherence, whereas SA2, SA, and SAH triggered proliferation after 14 d. CONCLUSIONS Rough and hydrophilised surface modifications, such as SAH, trigger osteogenic cell responses. These in vitro results highlight the potential use of SAH surface modifications of dental implants and indicate further clinical studies are warranted.
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Boyan BD, Lotz EM, Schwartz Z. * Roughness and Hydrophilicity as Osteogenic Biomimetic Surface Properties. Tissue Eng Part A 2017; 23:1479-1489. [PMID: 28793839 DOI: 10.1089/ten.tea.2017.0048] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Successful dental and orthopedic implant outcomes are determined by the degree of osseointegration. Over the last 60 years, endosseous implants have evolved to stimulate osteogenesis without the need for exogenous biologics such as bone morphogenetic proteins. An understanding of the interaction between cells and the physical characteristics of their environments has led to development of bioactive implants. Implant surfaces that mimic the inherent chemistry, topography, and wettability of native bone have shown to provide cells in the osteoblast lineage with the structural cues to promote tissue regeneration and net new bone formation. Studies show that attachment, proliferation, differentiation, and local factor production are sensitive to these implant surface characteristics. This review focuses on how surface properties, including chemistry, topography, and hydrophilicity, modulate protein adsorption, cell behavior, biological reactions, and signaling pathways in peri-implant bone tissue, allowing the development of true biomimetics that promote osseointegration by providing an environment suitable for osteogenesis.
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Affiliation(s)
- Barbara D Boyan
- 1 Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University , Richmond, Virginia.,2 Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology , Atlanta, Georgia
| | - Ethan M Lotz
- 1 Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University , Richmond, Virginia
| | - Zvi Schwartz
- 1 Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University , Richmond, Virginia.,3 Department of Periodontics, University of Texas Health Science Center at San Antonio , San Antonio, Texas
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27
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Cheng A, Chen H, Schwartz Z, Boyan BD. Imaging analysis of the interface between osteoblasts and microrough surfaces of laser-sintered titanium alloy constructs. J Microsc 2017; 270:41-52. [PMID: 28960365 DOI: 10.1111/jmi.12648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/07/2017] [Accepted: 09/07/2017] [Indexed: 11/30/2022]
Abstract
Previous work using focused ion beam (FIB) analysis of osteoblasts on smooth and microrough Ti surfaces showed that the average cell aspect ratio and distance from the surface are greater on the rough surface. In order to better interrogate the relationship between individual cells and their substrate using multiple imaging modalities, we developed a method that tracks the same cell across confocal laser scanning microscopy (CLSM) to correlate surface microroughness with cell morphology and cytoskeleton; scanning electron microscopy (SEM) to provide higher resolution for observation of nanoroughness as well as chemical mapping via energy dispersive X-ray spectroscopy; and transmission electron microscopy (TEM) for high-resolution imaging. FIB was used to prepare thin sections of the cell-material interface for TEM, or for three-dimensional electron tomography. Cells were cultured on laser-sintered Ti-6Al-4V substrates with polished or etched surfaces. Direct cell to surface attachments were observed across surfaces, though bridging across macroscale surface features occurred on rough substrates. Our results show that surface roughness, cell cytoskeleton and gross morphology can be correlated with the cell-material cross-sectional interface at the single cell level across multiple high-resolution imaging modalities. This work provides a platform method for further investigating mechanisms of the cell-material interface.
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Affiliation(s)
- A Cheng
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, U.S.A.,Department of Biomedical Engineering, Peking University, Beijing, China
| | - H Chen
- Department of Biomedical Engineering, Peking University, Beijing, China
| | - Z Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, U.S.A.,Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - B D Boyan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, U.S.A.,Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, U.S.A
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Hartjen P, Nada O, Silva TG, Precht C, Henningsen A, Holthaus MGRO, Gulow N, Friedrich RE, Hanken H, Heiland M, Zwahr C, Smeets R, Jung O. Cytocompatibility of Direct Laser Interference-patterned Titanium Surfaces for Implants. ACTA ACUST UNITED AC 2017; 31:849-854. [PMID: 28882950 DOI: 10.21873/invivo.11138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 12/18/2022]
Abstract
In an effort to generate titanium surfaces for implants with improved osseointegration, we used direct laser interference patterning (DLIP) to modify the surface of pure titanium grade 4 of four different structures. We assessed in vitro cytoxicity and cell attachment, as well as the viability and proliferation of cells cultured directly on the surfaces. Attachment of the cells to the modified surfaces was comparably good compared to that of cells on grit-blasted and acid-etched reference titanium surfaces. In concordance with this, viability and proliferation of the cells directly cultured on the specimens were similar on all the titanium surfaces, regardless of the laser modification, indicating good cytocompatibility.
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Affiliation(s)
- Philip Hartjen
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ola Nada
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thiago Gundelwein Silva
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Clarissa Precht
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anders Henningsen
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Hanken
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité University Hospital, Berlin, Germany
| | - Christoph Zwahr
- Institute of Manufacturing Technology, TU Dresden, Dresden, Germany.,Fraunhofer Institute for Material and Beam Technology, Dresden, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ole Jung
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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29
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Xie P, Ouyang H, Deng Y, Yang Y, Xu J, Huang W. Comparison of conventional reconstruction plate versus direct metal laser sintering plate: an in vitro mechanical characteristics study. J Orthop Surg Res 2017; 12:128. [PMID: 28865455 PMCID: PMC5581440 DOI: 10.1186/s13018-017-0628-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 08/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Additive manufacturing (AM) technology has helped to achieve several advances in the medical field, particularly as far as fabrication of implants is concerned. But the application of direct metal laser sintering (DMLS) bone plate is quite limited due to the indeterminate mechanical property. The purposes of this study were to characterize the biomechanical properties of the polished DMLS reconstruction plate and to compare these with the properties of commonly applied implants and to find whether the mechanical performance of DMLS plate meets the requirements for clinical application. METHODS In this study, we fabricated two groups of plates by DMLS and computer numerical control (CNC) techniques. After that, we polished all samples and investigated their roughness, components, hardness, static bending, and torsional performance. Moreover, cyclic bending tests and fractographic analysis were conducted. Statistical comparisons of the group by means of monotonic test data were made, and a qualitative comparison was performed to assess failures in fatigue. RESULTS We found no differences in surface roughness or components after polishing, but the DMLS plate hardness is 7.42% (p < 0.01) greater than that of the CNC plates. Compared with the CNC plates, the DMLS plate static bending and torsional performance were significantly greater. In a dynamic test, the DMLS plates survived 106, 106, 32,731, and 33,264 cycles under 0.6, 0.8, 0.9, and 1 kN cyclic loads, respectively, while the CNC plates survived 106, 106, 106, and 283,714 cycles. CONCLUSIONS These results indicate that the mechanical performances of the DMLS plate are stronger, and the strength under fatigue tests is sufficient. DMLS implant has great potential and may become a better choice for clinical use in the future. However, direct application of these AM instruments in the operating room requires further validation including animal and clinical experiment.
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Affiliation(s)
- Pusheng Xie
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Hanbin Ouyang
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Yuping Deng
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Yang Yang
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Jing Xu
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Wenhua Huang
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
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30
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Gorler O, Saygin AG. Comparative Evaluation of Effects of Laser Modalities on Shear Bond Strengths of Veneering Porcelains to Laser Sintered Substructures: An In Vitro Study. Photomed Laser Surg 2017; 35:338-344. [PMID: 28590838 DOI: 10.1089/pho.2017.4299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Laser modalities and direct metal laser sintering (DMLS) have a potential to enhance micromechanical bonding between dental super- and infrastructures. However, the effect of different manufacturing methods on the metal-ceramic bond strength needs further evaluation. We investigated the effect of surface treatment with Er:YAG, Nd:YAG, and Ho:YAG lasers on the shear bond strength (SBS) of high-fusion dental porcelains (Vita and G-Ceram) to infrastructures prepared with DMLS in vitro settings. MATERIALS AND METHODS Study specimens (n = 128) were randomly divided into study subsets (n = 8), considering treatment types applied on the surface of infrastructures, including sandblasting and selected laser modalities; infrastructure types as direct laser sintered (DLS) and Ni-Cr based; and superstructure porcelains as Vita and G-Ceram. The SBS test was performed to assess the effectiveness of surface modifications that were also examined with a stereo microscope. RESULTS Considering laser procedure types, the highest SBS values were obtained by Er:YAG laser, followed by, with a decreasing efficiency, Ho:YAG laser and sandblasting procedures, and Nd:YAG laser procedure (p < 0.05). Nd:YAG laser decreases the bonding of Vita and G-Ceram in all the infrastructures compared with sandblasting. Considering porcelains, the highest SBS values were obtained by Vita (p < 0.05). Considering infrastructures, the highest SBS values were obtained by DMLS procedure (p < 0.05). The laser procedures caused surface irregularities as revealed by the stereo microscopic examination. CONCLUSIONS In current experimental settings, Er:YAG laser applied to DLS infrastructure veneered with Vita porcelain increases bonding strength more distinctly, and Nd:YAG laser applied to Ni-Cr-based infrastructure veneered with G-Ceram porcelain alters bonding strength unfavorably.
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Affiliation(s)
- Oguzhan Gorler
- Department of Prosthodontics, Cumhuriyet University Faculty of Dentistry , Sivas, Turkey
| | - Aysegul Goze Saygin
- Department of Prosthodontics, Cumhuriyet University Faculty of Dentistry , Sivas, Turkey
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31
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Cohen DJ, Cheng A, Sahingur K, Clohessy RM, Hopkins LB, Boyan BD, Schwartz Z. Performance of laser sintered Ti-6Al-4V implants with bone-inspired porosity and micro/nanoscale surface roughness in the rabbit femur. ACTA ACUST UNITED AC 2017; 12:025021. [PMID: 28452335 DOI: 10.1088/1748-605x/aa6810] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Long term success of bone-interfacing implants remains a challenge in compromised patients and in areas of low bone quality. While surface roughness at the micro/nanoscale can promote osteogenesis, macro-scale porosity is important for promoting mechanical stability of the implant over time. Currently, machining techniques permit pores to be placed throughout the implant, but the pores are generally uniform in dimension. The advent of laser sintering provides a way to design and manufacture implants with specific porosity and variable dimensions at high resolution. This approach enables production of metal implants that mimic complex geometries found in biology. In this study, we used a rabbit femur model to compare osseointegration of laser sintered solid and porous implants. Ti-6Al-4V implants were laser sintered in a clinically relevant size and shape. One set of implants had a novel porosity based on human trabecular bone; both sets had grit-blasted/acid-etched surfaces. After characterization, implants were inserted transaxially into rabbit femora; mechanical testing, micro-computed tomography (microCT) and histomorphometry were conducted 10 weeks post-operatively. There were no differences in pull-out strength or bone-to-implant contact. However, both microCT and histomorphometry showed significantly higher new bone volume for porous compared to solid implants. Bone growth was observed into porous implant pores, especially near apical portions of the implant interfacing with cortical bone. These results show that laser sintered Ti-6Al-4V implants with micro/nanoscale surface roughness and trabecular bone-inspired porosity promote bone growth and may be used as a superior alternative to solid implants for bone-interfacing implants.
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Affiliation(s)
- David J Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States of America
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32
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Cheng A, Cohen DJ, Kahn A, Clohessy RM, Sahingur K, Newton JB, Hyzy SL, Boyan BD, Schwartz Z. Laser Sintered Porous Ti-6Al-4V Implants Stimulate Vertical Bone Growth. Ann Biomed Eng 2017; 45:2025-2035. [PMID: 28409291 DOI: 10.1007/s10439-017-1831-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/04/2017] [Indexed: 12/25/2022]
Abstract
The objective of this study was to examine the ability of 3D implants with trabecular-bone-inspired porosity and micro-/nano-rough surfaces to enhance vertical bone ingrowth. Porous Ti-6Al-4V constructs were fabricated via laser-sintering and processed to obtain micro-/nano-rough surfaces. Male and female human osteoblasts were seeded on constructs to analyze cell morphology and response. Implants were then placed on rat calvaria for 10 weeks to assess vertical bone ingrowth, mechanical stability and osseointegration. All osteoblasts showed higher levels of osteocalcin, osteoprotegerin, vascular endothelial growth factor and bone morphogenetic protein 2 on porous constructs compared to solid laser-sintered controls. Porous implants placed in vivo resulted in an average of 3.1 ± 0.6 mm3 vertical bone growth and osseointegration within implant pores and had significantly higher pull-out strength values than solid implants. New bone formation and pull-out strength was not improved with the addition of demineralized bone matrix putty. Scanning electron images and histological results corroborated vertical bone growth. This study indicates that Ti-6Al-4V implants fabricated by additive manufacturing to have porosity based on trabecular bone and post-build processing to have micro-/nano-surface roughness can support vertical bone growth in vivo, and suggests that these implants may be used clinically to increase osseointegration in challenging patient cases.
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Affiliation(s)
- Alice Cheng
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.,Department of Biomedical Engineering, Peking University, Beijing, China
| | - David J Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian Kahn
- Department of Oral Surgery, University of Tel-Aviv, Tel Aviv, Israel
| | - Ryan M Clohessy
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Kaan Sahingur
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Joseph B Newton
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Sharon L Hyzy
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Barbara D Boyan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA. .,Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA. .,School of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA.
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA.,Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Biological and Mechanical Effects of Micro-Nanostructured Titanium Surface on an Osteoblastic Cell Line In vitro and Osteointegration In vivo. Appl Biochem Biotechnol 2017; 183:280-292. [PMID: 28321783 DOI: 10.1007/s12010-017-2444-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Abstract
Hybrid micro-nanostructure implant surface was produced on titanium (Ti) surface by acid etching and anodic oxidation to improve the biological and mechanical properties. The biological properties of the micro-nanostructure were investigated by simulated body fluid (SBF) soaking test and MC3T3-E1 cell co-culture experiment. The cell proliferation, spreading, and bone sialoprotein (BSP) gene expression were examined by MTT, SEM, and reverse transcription-polymerase chain reaction (RT-PCR), respectively. In addition, the mechanical properties were evaluated by instrumented nanoindentation test and friction-wear test. Furthermore, the effect of the micro-nanostructure surface on implant osteointegration was examined by in vivo experiment. The results showed that the formation of bone-like apatite was accelerated on the micro-nanostructured Ti surface after immersion in simulated body fluid, and the proliferation, spreading, and BSP gene expression of the MC3T3-E1 cells were also upregulated on the modified surface. The micro-nanostructured Ti surface displayed decreased friction coefficient, stiffness value, and Young's modulus which were much closer to those of the cortical bone, compared to the polished Ti surface. This suggested much better mechanical match to the surrounding bone tissue of the micro-nanostructured Ti surface. Furthermore, the in vivo animal experiment showed that after implantation in the rat femora, the micro-nanostructure surface displayed higher bonding strength between bone tissues and implant; hematoxylin and eosin (H&E) staining suggested that much compact osteoid tissue was observed at the interface of Micro-nano-Ti-bone than polished Ti-bone interface after implantation. Based on these results mentioned above, it was concluded that the improved biological and mechanical properties of the micro-nanostructure endowed Ti surface with good biocompatibility and better osteointegration, implying the enlarged application of the micro-nanostructure surface Ti implants in future.
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Cheng A, Cohen DJ, Boyan BD, Schwartz Z. Laser-Sintered Constructs with Bio-inspired Porosity and Surface Micro/Nano-Roughness Enhance Mesenchymal Stem Cell Differentiation and Matrix Mineralization In Vitro. Calcif Tissue Int 2016; 99:625-637. [PMID: 27501817 DOI: 10.1007/s00223-016-0184-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/28/2016] [Indexed: 12/17/2022]
Abstract
Direct metal laser sintering can produce porous Ti-6Al-4V orthopedic and dental implants. The process requires reduced resources and time and can provide greater structural control than machine manufacturing. Implants in bone are colonized by mesenchymal stem cells (MSCs), which can differentiate into osteoblasts and contribute to osseointegration. This study examined osteoblast differentiation and matrix mineralization of human MSCs cultured on laser-sintered Ti-6Al-4V constructs with varying porosity and at different time scales. 2D solid disks and low, medium and high porosity (LP, MP, and HP) 3D constructs based on a human trabecular bone template were laser sintered from Ti-6Al-4V powder and further processed to have micro- and nanoscale roughness. hMSCs exhibited greater osteoblastic differentiation and local factor production on all 3D porous constructs compared to 2D surfaces, which was sustained for 9 days without use of exogenous factors. hMSCs cultured for 8 weeks on MP constructs in osteogenic medium (OM), OM supplemented with BMP2 or collagen-coated MP constructs in OM exhibited bone-like extracellular matrix mineralization. Use of bio-inspired porosity for the 3D architecture of additively manufactured Ti-6Al-4V enhanced osteogenic differentiation of hMSCs beyond surface roughness alone. This study suggests that a 3D architecture may enhance the osseointegration of orthopedic and dental implants in vivo.
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Affiliation(s)
- Alice Cheng
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive NW, Atlanta, GA, 30313, USA
- Department of Biomedical Engineering, Peking University, Peking University Hospital Building A503, Haidian District, Beijing, 100871, China
| | - David J Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
| | - Barbara D Boyan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive NW, Atlanta, GA, 30313, USA.
- Department of Biomedical Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA.
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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