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Canullo L, Penarrocha Oltra D, Pesce P, Zarauz C, Lattanzio R, Penarrocha Diago M, Iezzi G. Soft tissue integration of different abutment surfaces: An experimental study with histological analysis. Clin Oral Implants Res 2021; 32:928-940. [PMID: 34036644 DOI: 10.1111/clr.13782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/21/2021] [Accepted: 05/12/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate whether abutment surface and surface bio-activation have an effect on soft tissue morphogenesis. MATERIALS AND METHODS 36 patients (36 implants) were included. Abutments were randomly divided into 4 groups (n = 9): Smooth Surface-MAChined (MAC), Ultrathin Threaded Microsurface (UTM), MAC Plasma of Argon activated (Plasma-MAC), and UTM Plasma of Argon activated (Plasma-UTM). After 2 months of healing, soft tissue samples were collected and prepared for histological analysis. The margin of the peri-implant mucosa (PM), the apical extension of the barrier epithelium (aJE), and the apical location of the abutment (AM) were identified. Significances of differences among groups were tested by means of the Kruskal-Wallis test and between pairs of results by means of the Mann-Whitney test. RESULTS The mean (SD) vertical dimension of the mucosa was 2.5mm (1.0), including a connective tissue portion (CTP) of 0.8mm (0.8) in the MAC group; 3.6mm (0.2) with a CTP of 1.6mm (0.4) in the Plasma-MAC group; 3.2mm (1.0), with a CPT of 0.5mm (0.6) in the UTM; and 3.3mm (0.8), with a CPT of 0.9mm (0.7) in the Plasma-UTM group. Statistically significant differences were observed in the aJE-AM height and PM-aJE profile among the four experimental groups (p = .042 and p = .039, respectively). The Mann-Whitney test indicated differences between the Plasma-abutments and the untreated abutments both for PM-AM (p = .025) and AjE-AM (p = .021). The differences appeared more evident when the preoperative soft tissue thickness was ≤2mm. CONCLUSIONS Within its limits, the study demonstrated a favorable effect of the plasma treatment on the connective tissue portion tissues. Plasma-MAC group highlighted the best performance. This behavior appeared strictly correlated with the soft tissue thickness.
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Affiliation(s)
- Luigi Canullo
- Department of Oral Surgery and Implants, University of Valencia, Valencia, Spain
| | | | - Paolo Pesce
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Cristina Zarauz
- Department of Fixed Prosthodontics, University of Geneva, Geneva, Switzerland
| | - Rossano Lattanzio
- Department of Innovative Technologies in Medicine & Dentistry, Center for Advanced Studies and Technology (CAST), 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | | | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
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Innovative Coatings of Metallic Alloys Used as Bioactive Surfaces in Implantology: A Review. COATINGS 2021. [DOI: 10.3390/coatings11060649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Metallic implants are widely used in the field of implantology, but there are still problems leading to implant failures due to weak osseointegration, low mechanical strength for the implant, inadequate antibacterial properties, and low patient satisfaction. Implant failure can be caused by bacterial infections and poor osteointegration. To improve the implant functionalization, many researchers focus on surface modifications to prepare the proper physical and chemical conditions able to increase biocompatibility and osteointegration between implant and bone. Improving the antibacterial performance is also a key factor to avoid the inflammation in the human body. This paper is a brief review for the types of coatings used to increase osseointegration and biocompatibility for the successful use of metal alloys in the field of implantology.
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Evaluation of metal concentrations in hair and nails after dental implant placement. J Prosthet Dent 2021; 128:625-631. [PMID: 33712311 DOI: 10.1016/j.prosdent.2020.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM The accumulation of the elements contained in Ti6Al4V, the mostly used titanium alloy for dental implants, in epithelial extensions requires investigation. Studies evaluating the metals in dental implants in the hair and nails of patients with dental implants are lacking. PURPOSE The purpose of this clinical research was to measure the levels of titanium (Ti), aluminum (Al), and vanadium (V) in the hair and nails of patients treated with grade 5 Ti alloy dental implants. MATERIAL AND METHODS Ti, Al, and V elemental levels in the hair and nail samples of 33 participants treated with grade 5 Ti alloy dental implants were measured by using an inductively coupled plasma mass spectrometer. RESULTS The results revealed a statistically significant increase in the amount of Ti in nail samples after implant surgery (P=.01), but no statistically significant increases in the amounts of Al or V in nail samples (P=.48, P=.645). In hair samples, the increase in Ti, Al, and V was not statistically significant (P=.728, P=.221, P=.376). The correlation between the amount of change in the elements in implants and the contact areas was weak for hair (Al, r=0.114; Ti, r=0.361; V, r=0.377) and for nails (Al, r=0.127; Ti, r=0.116; V, r=0.058). CONCLUSIONS After the placement of dental implants made of grade 5 Ti alloy, minimal Al and V accumulated in hair and nails.
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Prati C, Zamparini F, Botticelli D, Ferri M, Yonezawa D, Piattelli A, Gandolfi MG. The Use of ESEM-EDX as an Innovative Tool to Analyze the Mineral Structure of Peri-Implant Human Bone. MATERIALS 2020; 13:ma13071671. [PMID: 32260166 PMCID: PMC7178284 DOI: 10.3390/ma13071671] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 12/24/2022]
Abstract
This study aimed to investigate the mineralization and chemical composition of the bone–implant interface and peri-implant tissues on human histological samples using an environmental scanning electron microscope as well as energy-dispersive x-ray spectroscopy (ESEM-EDX) as an innovative method. Eight unloaded implants with marginal bone tissue were retrieved after four months from eight patients and were histologically processed and analyzed. Histological samples were observed under optical microscopy (OM) to identify the microarchitecture of the sample and bone morphology. Then, all samples were observed under ESEM-EDX from the coronal to the most apical portion of the implant at 500x magnification. A region of interest with bone tissue of size 750 × 500 microns was selected to correspond to the first coronal and the last apical thread (ROI). EDX microanalysis was used to assess the elemental composition of the bone tissue along the thread interface and the ROI. Atomic percentages of Ca, P, N, and Ti, and the Ca/N, P/N and Ca/P ratios were measured in the ROI. Four major bone mineralization areas were identified based on the different chemical composition and ratios of the ROI. Area 1: A well-defined area with low Ca/N, P/N, and Ca/P was identified as low-density bone. Area 2: A defined area with higher Ca/N, P/N, and Ca/P, identified as new bone tissue, or bone remodeling areas. Area 3: A well-defined area with high Ca/N, /P/N, and Ca/P ratios, identified as bone tissue or bone chips. Area 4: An area with high Ca/N, P/N, and Ca/P ratios, which was identified as mature old cortical bone. Bone Area 2 was the most represented area along the bone–implant interface, while Bone Area 4 was identified only at sites approximately 1.5 mm from the interface. All areas were identified around implant biopsies, creating a mosaic-shaped distribution with well-defined borders. ESEM-EDX in combination with OM allowed to perform a microchemical analysis and offered new important information on the organic and inorganic content of the bone tissue around implants.
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Affiliation(s)
- Carlo Prati
- Endodontic Clinical Section, School of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy;
- Correspondence:
| | - Fausto Zamparini
- Endodontic Clinical Section, School of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy;
- Laboratory of Biomaterials and Oral Pathology, School of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy;
| | | | - Mauro Ferri
- Corporación Universitária Rafael Núñez, Cartagena de Indias 130014, Colombia;
| | - Daichi Yonezawa
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8102, Japan;
| | - Adriano Piattelli
- Department of Medical Oral and Biotechnological Sciences, University of Chieti Pescara, 66100 Chieti, Italy;
| | - Maria Giovanna Gandolfi
- Laboratory of Biomaterials and Oral Pathology, School of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy;
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Canullo L, Menini M, Santori G, Rakic M, Sculean A, Pesce P. Titanium abutment surface modifications and peri-implant tissue behavior: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:1113-1124. [PMID: 31955269 DOI: 10.1007/s00784-020-03210-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/09/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the effect of various titanium abutment modifications on the behaviour of peri-implant soft tissue healing, inflammation and maintenance. MATERIAL AND METHODS An electronic database research until 30 April 2019 was performed. A meta-analysis (MA) for each outcome parameter was performed by using the random-effects models with the DerSimonian-Laird estimator. RESULTS Ten studies were included in the present review. Four studies with a long follow-up (5-6 years) reported the outcomes in a heterogeneous way and were suitable for MA. Six studies (4 RCT, 2 CCT) including 118 patients and 182 implants dealing with a modified healing abutment surface and short follow-up were selected for MA. The MA for PI and BoP as outcome showed no significant differences between surfaces (PI: P = 0.091; BoP: P = 0.099). The MA for PD as outcome showed no significant differences between surfaces (P = 0.488). No statistical significance was found by evaluating each mixed-effects model for potential moderators (type of study, study design, number of implants, follow-up length). The other four studies with a longer follow-up (5-6 years) reported contradictory results depending on the surface treatment investigated. CONCLUSIONS Within their limits, the present findings suggest that peri-implant soft tissue may not be affected by the surface treatment of titanium abutments on the short term. Contrasting results are reported in longer follow-up periods depending on the technique used to modify the abutment. CLINICAL RELEVANCE Clinicians should carefully evaluate the use of a modified titanium surface in their practice. Even if no differences in terms of inflammation are present at short term, these findings need to be validated in long-term studies.
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Affiliation(s)
| | - Maria Menini
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Mia Rakic
- University Complutense de Madrid, Madrid, Spain
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Paolo Pesce
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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Palmquist A. A multiscale analytical approach to evaluate osseointegration. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:60. [PMID: 29736606 PMCID: PMC5938308 DOI: 10.1007/s10856-018-6068-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/18/2018] [Indexed: 06/08/2023]
Abstract
Osseointegrated implants are frequently used in reconstructive surgery, both in the dental and orthopedic field, restoring physical function and improving the quality of life for the patients. The bone anchorage is typically evaluated at micrometer resolution, while bone tissue is a dynamic composite material composed of nanoscale collagen fibrils and apatite crystals, with defined hierarchical levels at different length scales. In order to understand the bone formation and the ultrastructure of the interfacial tissue, analytical strategies needs to be implemented enabling multiscale and multimodal analyses of the intact interface. This paper describes a sample preparation route for successive analyses allowing assessment of the different hierarchical levels of interest, going from macro to nano scale and could be implemented on single samples. Examples of resulting analyses of different techniques on one type of implant surface is given, with emphasis on correlating the length scale between the different techniques. The bone-implant interface shows an intimate contact between mineralized collagen bundles and the outermost surface of the oxide layer, while bone mineral is found in the nanoscale surface features creating a functionally graded interface. Osteocytes exhibit a direct contact with the implant surface via canaliculi that house their dendritic processes. Blood vessels are frequently found in close proximity to the implant surface either within the mineralized bone matrix or at regions of remodeling.
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Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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Early Healing Evaluation of Commercially Pure Titanium and Ti-6Al-4V Presenting Similar Surface Texture. IMPLANT DENT 2017; 26:338-344. [DOI: 10.1097/id.0000000000000591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clinical, Morphological, and Molecular Evaluations of Bone Regeneration With an Additive Manufactured Osteosynthesis Plate. J Craniofac Surg 2017; 27:1899-1904. [PMID: 27513773 DOI: 10.1097/scs.0000000000002939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
There is limited information on the biological status of bone regenerated with microvascular fibula flap combined with biomaterials. This paper describes the clinical, histological, ultrastructural, and molecular picture of bone regenerated with patient-customized plate, used for mandibular reconstruction in combination with microvascular osteomyocutaneous fibula flap. The plate was virtually planned and additively manufactured using electron beam melting. This plate was retrieved from the patient after 33 months. Microcomputed tomography, backscattered-scanning electron microscopy, histology, and quantitative-polymerase chain reaction were employed to evaluate the regenerated bone and the flap bone associated with the retrieved plate. At retrieval, the posterior two-thirds of the plate were in close adaptation with the underlying flap, whereas soft tissue was observed between the native mandible and the anterior one-third. The histological and structural analyses showed new bone regeneration, ingrowth, and osseointegration of the posterior two-thirds. The histological observations were supported by the gene expression analysis showing higher expression of bone formation and remodeling genes under the posterior two-thirds compared with the anterior one-third of the plate. The observation of osteocytes in the flap indicated its viability. The present data endorse the suitability of the customized, additively manufactured plate for the vascularized fibula mandibular reconstruction. Furthermore, the combination of the analytical techniques provides possibilities to deduce the structural and molecular characteristics of bone regenerated using this procedure.
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Shah FA, Johansson ML, Omar O, Simonsson H, Palmquist A, Thomsen P. Laser-Modified Surface Enhances Osseointegration and Biomechanical Anchorage of Commercially Pure Titanium Implants for Bone-Anchored Hearing Systems. PLoS One 2016; 11:e0157504. [PMID: 27299883 PMCID: PMC4907497 DOI: 10.1371/journal.pone.0157504] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/31/2016] [Indexed: 12/24/2022] Open
Abstract
Osseointegrated implants inserted in the temporal bone are a vital component of bone-anchored hearing systems (BAHS). Despite low implant failure levels, early loading protocols and simplified procedures necessitate the application of implants which promote bone formation, bone bonding and biomechanical stability. Here, screw-shaped, commercially pure titanium implants were selectively laser ablated within the thread valley using an Nd:YAG laser to produce a microtopography with a superimposed nanotexture and a thickened surface oxide layer. State-of-the-art machined implants served as controls. After eight weeks' implantation in rabbit tibiae, resonance frequency analysis (RFA) values increased from insertion to retrieval for both implant types, while removal torque (RTQ) measurements showed 153% higher biomechanical anchorage of the laser-modified implants. Comparably high bone area (BA) and bone-implant contact (BIC) were recorded for both implant types but with distinctly different failure patterns following biomechanical testing. Fracture lines appeared within the bone ~30-50 μm from the laser-modified surface, while separation occurred at the bone-implant interface for the machined surface. Strong correlations were found between RTQ and BIC and between RFA at retrieval and BA. In the endosteal threads, where all the bone had formed de novo, the extracellular matrix composition, the mineralised bone area and osteocyte densities were comparable for the two types of implant. Using resin cast etching, osteocyte canaliculi were observed directly approaching the laser-modified implant surface. Transmission electron microscopy showed canaliculi in close proximity to the laser-modified surface, in addition to a highly ordered arrangement of collagen fibrils aligned parallel to the implant surface contour. It is concluded that the physico-chemical surface properties of laser-modified surfaces (thicker oxide, micro- and nanoscale texture) promote bone bonding which may be of benefit in situations where large demands are imposed on biomechanically stable interfaces, such as in early loading and in compromised conditions.
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Affiliation(s)
- Furqan A. Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
| | - Martin L. Johansson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
- Oticon Medical AB, Askim, Sweden
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
| | - Hanna Simonsson
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
- Oticon Medical AB, Askim, Sweden
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
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Shah FA, Trobos M, Thomsen P, Palmquist A. Commercially pure titanium (cp-Ti) versus titanium alloy (Ti6Al4V) materials as bone anchored implants - Is one truly better than the other? MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 62:960-6. [PMID: 26952502 DOI: 10.1016/j.msec.2016.01.032] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/10/2015] [Accepted: 01/14/2016] [Indexed: 01/17/2023]
Abstract
Commercially pure titanium (cp-Ti) and titanium alloys (typically Ti6Al4V) display excellent corrosion resistance and biocompatibility. Although the chemical composition and topography are considered important, the mechanical properties of the material and the loading conditions in the host have, conventionally, influenced material selection for different clinical applications: predominantly Ti6Al4V in orthopaedics while cp-Ti in dentistry. This paper attempts to address three important questions: (i) To what extent do the surface properties differ when cp-Ti and Ti6Al4V materials are manufactured with the same processing technique?, (ii) Does bone tissue respond differently to the two materials, and (iii) Do bacteria responsible for causing biomaterial-associated infections respond differently to the two materials? It is concluded that: (i) Machined cp-Ti and Ti6Al4V exhibit similar surface morphology, topography, phase composition and chemistry, (ii) Under experimental conditions, cp-Ti and Ti6Al4V demonstrate similar osseointegration and biomechanical anchorage, and (iii) Experiments in vitro fail to disclose differences between cp-Ti and Ti6Al4V to harbour Staphylococcus epidermidis growth. No clinical comparative studies exist which could determine if long-term, clinical differences exist between the two types of bulk materials. It is debatable whether cp-Ti or Ti6Al4V exhibit superiority over the other, and further comparative studies, particularly in a clinical setting, are required.
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Affiliation(s)
- Furqan A Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Göteborg, Sweden.
| | - Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Göteborg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Göteborg, Sweden
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Göteborg, Sweden
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Parton AL, Duncan WJ, Oliveira ME, Key O, Farella M. Implant-based three-dimensional superimposition of the growing mandible in a rabbit model. Eur J Orthod 2015; 38:546-52. [PMID: 26609073 DOI: 10.1093/ejo/cjv085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The reliable assessment of craniofacial morphological changes during growth requires invariant regions for image registration. As these regions have not yet been identified in three dimensions, intra-osseous implants are required as fiducial markers for the reliable assessment of three-dimensional (3D) mandibular growth changes. The objective of this study was to develop an animal model for the assessment of the 3D morphological changes of the mandible during growth, using implants as fiducial markers. MATERIALS AND METHODS Titanium implants were placed in the body of the mandible of six New Zealand White rabbits. Cone beam computed tomography (CBCT) scans were taken 1-week following implant placement and after an additional 8-weeks of growth. Segmentations of CBCT images were exported into custom-made scripts, implant centroids were identified, implant stability during growth calculated, and the segmented mandibles were registered on the implant centroids. RESULTS The buccal cortical bone of the body of the mandible was stable during growth and suitable for fiducial marker placement. Bilateral implants resulted in more accurate rigid registration of the growing rabbit mandible than only unilateral implants. 3D mandibular growth changes were visualised by means of semi-transparencies. CONCLUSIONS This animal model appears to be feasible for the assessment of the 3D morphological changes occurring during mandibular growth. To the best of our knowledge this is the first time that the implant superimposition method has been combined with 3D imaging to accurately reveal mandibular growth changes.
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Affiliation(s)
- Andrew L Parton
- *Department of Oral Sciences, University of Otago, Dunedin, New Zealand and
| | - Warwick J Duncan
- *Department of Oral Sciences, University of Otago, Dunedin, New Zealand and
| | - Marcelo E Oliveira
- **Robotic System Laboratory (LSRO), Swiss Federal Institute of Technology in Lausanne (EPFL), Lausanne, Switzerland
| | - Oscar Key
- *Department of Oral Sciences, University of Otago, Dunedin, New Zealand and
| | - Mauro Farella
- *Department of Oral Sciences, University of Otago, Dunedin, New Zealand and
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Stenlund P, Omar O, Brohede U, Norgren S, Norlindh B, Johansson A, Lausmaa J, Thomsen P, Palmquist A. Bone response to a novel Ti-Ta-Nb-Zr alloy. Acta Biomater 2015; 20:165-175. [PMID: 25848727 DOI: 10.1016/j.actbio.2015.03.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/20/2015] [Accepted: 03/31/2015] [Indexed: 11/15/2022]
Abstract
Commercially pure titanium (cp-Ti) is regarded as the state-of-the-art material for bone-anchored dental devices, whereas the mechanically stronger alloy (Ti-6Al-4V), made of titanium, aluminum (Al) and vanadium (V), is regarded as the material of choice for high-load applications. There is a call for the development of new alloys, not only to eliminate the potential toxic effect of Al and V but also to meet the challenges imposed on dental and maxillofacial reconstructive devices, for example. The present work evaluates a novel, dual-stage, acid-etched, Ti-Ta-Nb-Zr alloy implant, consisting of elements that create low toxicity, with the potential to promote osseointegration in vivo. The alloy implants (denoted Ti-Ta-Nb-Zr) were evaluated after 7 days and 28 days in a rat tibia model, with reference to commercially pure titanium grade 4 (denoted Ti). Analyses were performed with respect to removal torque, histomorphometry and gene expression. The Ti-Ta-Nb-Zr showed a significant increase in implant stability over time in contrast to the Ti. Further, the histological and gene expression analyses suggested faster healing around the Ti-Ta-Nb-Zr, as judged by the enhanced remodeling, and mineralization, of the early-formed woven bone and the multiple positive correlations between genes denoting inflammation, bone formation and remodeling. Based on the present experiments, it is concluded that the Ti-Ta-Nb-Zr alloy becomes osseointegrated to at least a similar degree to that of pure titanium implants. This alloy is therefore emerging as a novel implant material for clinical evaluation.
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Affiliation(s)
- Patrik Stenlund
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Sweden; Department of Chemistry, Materials and Surfaces, SP Technical Research Institute of Sweden, Box 857, SE-501 15 Borås, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Göteborg, Sweden.
| | - Omar Omar
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Göteborg, Sweden
| | - Ulrika Brohede
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Sweden; Sandvik Coromant R&D, SE-126 80 Stockholm, Sweden
| | - Susanne Norgren
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Sweden; Sandvik Coromant R&D, SE-126 80 Stockholm, Sweden; Department of Engineering Sciences, Ångström Laboratory, Uppsala University, Sweden
| | - Birgitta Norlindh
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Göteborg, Sweden
| | - Anna Johansson
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Göteborg, Sweden
| | - Jukka Lausmaa
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Sweden; Department of Chemistry, Materials and Surfaces, SP Technical Research Institute of Sweden, Box 857, SE-501 15 Borås, Sweden
| | - Peter Thomsen
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Göteborg, Sweden
| | - Anders Palmquist
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Göteborg, Sweden
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13
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Shah FA, Wang X, Thomsen P, Grandfield K, Palmquist A. High-Resolution Visualization of the Osteocyte Lacuno-Canalicular Network Juxtaposed to the Surface of Nanotextured Titanium Implants in Human. ACS Biomater Sci Eng 2015; 1:305-313. [DOI: 10.1021/ab500127y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Xiaoyue Wang
- Department
of Materials Science and Engineering, McMaster University, Hamilton, ON L8S 4L7, Canada
| | | | - Kathryn Grandfield
- Department
of Materials Science and Engineering, McMaster University, Hamilton, ON L8S 4L7, Canada
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German MJ, Osei-Bempong C, Knuth CA, Deehan DJ, Oldershaw RA. Investigating the biological response of human mesenchymal stem cells to titanium surfaces. J Orthop Surg Res 2014; 9:135. [PMID: 25496535 PMCID: PMC4269958 DOI: 10.1186/s13018-014-0135-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/01/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND We have investigated the behaviour of a newly characterised population of haemarthrosis fluid-derived human mesenchymal stem cells (HF-hMSCs) with titanium (Ti) surfaces. METHODS HF-hMSCs were seeded onto round cannulated interference (RCI; Smith and Nephew) screws or control Ti discs and cultured under pro-osteogenic conditions. RESULTS Electron microscopy showed the attachment and spreading of HF-hMSCs across both Ti surfaces during the early stages of osteogenic culture; however, cells were exclusively localised to the basal regions within the vertex of the Ti screws. In the later stages of culture, an osteoid matrix was deposited on the Ti surfaces with progressive culture expansion and matrix deposition up the sides and the top of the Ti Screws. Quantification of cellular content revealed a significantly higher number of cells within the Ti screw cultures; however, there was no difference in the cellular health. Conversely, alizarin red staining used as both a qualitative and quantitative measure of matrix calcification was significantly increased in Ti disc cultures compared to those of Ti screws. CONCLUSIONS Our results suggest that the gross topography of the metal implant is able to create microenvironment niches that have an influence on cellular behaviour. These results have implications for the design of advanced tissue engineering strategies that seek to use cellular material to enhance biological remodelling and healing following tissue reconstruction.
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Affiliation(s)
- Matthew J German
- Centre for Oral Health Research, School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4BW, UK.
| | - Charles Osei-Bempong
- Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Times Square, Newcastle upon Tyne, NE1 4EP, UK.
| | - Callie A Knuth
- North East England Stem Cell Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Times Square, Newcastle upon Tyne, NE1 4EP, UK.
| | - David J Deehan
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne NHS Hospitals Foundation Trust, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
| | - Rachel A Oldershaw
- North East England Stem Cell Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Times Square, Newcastle upon Tyne, NE1 4EP, UK. .,Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK.
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15
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Shah FA, Johansson BR, Thomsen P, Palmquist A. Ultrastructural evaluation of shrinkage artefacts induced by fixatives and embedding resins on osteocyte processes and pericellular space dimensions. J Biomed Mater Res A 2014; 103:1565-76. [PMID: 25046613 DOI: 10.1002/jbm.a.35287] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/30/2014] [Accepted: 07/18/2014] [Indexed: 11/06/2022]
Abstract
The integrity of the interface between the osteocyte (Ot) process and the canalicular wall was investigated in terms of change in the lateral dimensions of the Ot process in relation to the canalicular width, i.e., widening of the pericellular space. This has been interpreted as shrinkage of the Ot process relative to the canalicular wall during sample preparation stages of fixation, dehydration, and resin embedding. Sprague-Dawley rat tibial cross-sections were prepared for transmission electron microscopy (TEM). Four different fixative preparations: paraformaldehyde (PF), modified Karnovsky's (MK), glutaraldehyde (GRR) with ruthenium red (GRR), and zinc formalin (ZF); and two different embedding resins: LR Gold (LRG) and Epon812 (Epon) were evaluated. It was found that for LRG embedding, formalin-only fixatives (PF and ZF) induced lower shrinkage than GRR-containing fixatives (MK and GRR). In contrast, for Epon embedding, MK showed the highest shrinkage, while no differences were found between the remaining fixatives (PF, ZF, and GRR). All formalin-containing fixatives (MK, PF, and ZF) induced similar shrinkage in both embedding media. The most dramatic difference was for GRR fixation, which in combination with LRG embedding showed ∼ 62% more shrinkage than with Epon embedding, suggesting that the combination of GRR fixation and LRG embedding synergistically amplifies Ot shrinkage. These differences likely suggest a role of the resin in secondarily influencing the tissue structure following fixation. Further, the work confirms LRG as a poor embedding medium for bone specimens, as it causes large variations in shrinkage depending on fixation.
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Affiliation(s)
- Furqan A Shah
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Göteborg, Sweden
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16
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Palmquist A, Windahl SH, Norlindh B, Brånemark R, Thomsen P. Retrieved bone-anchored percutaneous amputation prosthesis showing maintained osseointegration after 11 years-a case report. Acta Orthop 2014; 85:442-5. [PMID: 24798110 PMCID: PMC4105779 DOI: 10.3109/17453674.2014.919559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg,BIOMATCELL VINN Excellence Center for Biomaterials and Cell Therapy
| | - Sara H Windahl
- Center for Bone and Arthritis Research, Department of Internal Medicine, Sahlgrenska Academy at University of Gothenburg
| | - Birgitta Norlindh
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg,BIOMATCELL VINN Excellence Center for Biomaterials and Cell Therapy
| | - Rickard Brånemark
- BIOMATCELL VINN Excellence Center for Biomaterials and Cell Therapy,Department of Orthopaedics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg,BIOMATCELL VINN Excellence Center for Biomaterials and Cell Therapy
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Thorfve A, Lindahl C, Xia W, Igawa K, Lindahl A, Thomsen P, Palmquist A, Tengvall P. Hydroxyapatite coating affects the Wnt signaling pathway during peri-implant healing in vivo. Acta Biomater 2014; 10:1451-62. [PMID: 24342040 DOI: 10.1016/j.actbio.2013.12.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/12/2013] [Accepted: 12/09/2013] [Indexed: 01/09/2023]
Abstract
Owing to its bio- and osteoconductivity, hydroxyapatite (HA) is a widely used implant material, but its osteogenic properties are only partly evaluated in vitro and in vivo. The present study focused on bone healing adjacent to HA-coated titanium (Ti) implants, with or without incorporated lithium ions (Li(+)). Special attention was given to the Wnt signaling pathway. The implants were inserted into rat tibia for 7 or 28 days and analyzed ex vivo, mainly by histomorphometry and quantitative real-time polymerase chain reaction (qPCR). HA-coated implants showed, irrespective of Li(+) content, bone-implant contact (BIC) and removal torque values significantly higher than those of reference Ti. Further, the expression of OCN, CTSK, COL1A1, LRP5/6 and WISP1 was significantly higher in implant-adherent cells of HA-coated implants, with or without Li(+). Significantly higher β-catenin expression and significantly lower COL2A1 expression were observed in peri-implant bone cells from HA with 14 ng cm(-2) released Li(+). Interestingly, Ti implants showed a significantly larger bone area (BA) in the threads than HA with 39 ng cm(-2) released Li(+), but had a lower BIC than any HA-coated implant. This study shows that HA, with or without Li(+), is a strong activator of the Wnt signaling pathway, and may to some degree explain its high bone induction capacity.
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Affiliation(s)
- A Thorfve
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden; BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, The Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden.
| | - C Lindahl
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, The Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden; Department of Engineering Sciences, Angstrom Laboratory, Uppsala University, Box 534, SE-751 21 Uppsala, Sweden
| | - W Xia
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, The Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden; Department of Engineering Sciences, Angstrom Laboratory, Uppsala University, Box 534, SE-751 21 Uppsala, Sweden
| | - K Igawa
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, The Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden; Department of Oral and Maxillofacial Surgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, 71-15 Yatsuyamada Koriyama, Fukushima 9638-563, Japan
| | - A Lindahl
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, The Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden; Department of Clinical Chemistry and Transfusion Medicine, The Sahlgrenska Academy, University of Gothenburg, Bruna Straket 16, SE-413 45 Gothenburg, Sweden
| | - P Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden; BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, The Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden
| | - A Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden; BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, The Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden
| | - P Tengvall
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden; BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, The Sahlgrenska Academy at University of Gothenburg, Box 412, SE-405 30 Gothenburg, Sweden
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Dérand P, Rännar LE, Hirsch JM. Imaging, virtual planning, design, and production of patient-specific implants and clinical validation in craniomaxillofacial surgery. Craniomaxillofac Trauma Reconstr 2013; 5:137-44. [PMID: 23997858 DOI: 10.1055/s-0032-1313357] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 11/15/2011] [Indexed: 10/28/2022] Open
Abstract
The purpose of this article was to describe the workflow from imaging, via virtual design, to manufacturing of patient-specific titanium reconstruction plates, cutting guide and mesh, and its utility in connection with surgical treatment of acquired bone defects in the mandible using additive manufacturing by electron beam melting (EBM). Based on computed tomography scans, polygon skulls were created. Following that virtual treatment plans entailing free microvascular transfer of fibula flaps using patient-specific reconstruction plates, mesh, and cutting guides were designed. The design was based on the specification of a Compact UniLOCK 2.4 Large (Synthes(®), Switzerland). The obtained polygon plates were bent virtually round the reconstructed mandibles. Next, the resections of the mandibles were planned virtually. A cutting guide was outlined to facilitate resection, as well as plates and titanium mesh for insertion of bone or bone substitutes. Polygon plates and meshes were converted to stereolithography format and used in the software Magics for preparation of input files for the successive step, additive manufacturing. EBM was used to manufacture the customized implants in a biocompatible titanium grade, Ti6Al4V ELI. The implants and the cutting guide were cleaned and sterilized, then transferred to the operating theater, and applied during surgery. Commercially available software programs are sufficient in order to virtually plan for production of patient-specific implants. Furthermore, EBM-produced implants are fully usable under clinical conditions in reconstruction of acquired defects in the mandible. A good compliance between the treatment plan and the fit was demonstrated during operation. Within the constraints of this article, the authors describe a workflow for production of patient-specific implants, using EBM manufacturing. Titanium cutting guides, reconstruction plates for fixation of microvascular transfer of osteomyocutaneous bone grafts, and mesh to replace resected bone that can function as a carrier for bone or bone substitutes were designed and tested during reconstructive maxillofacial surgery. A clinically fit, well within the requirements for what is needed and obtained using traditional free hand bending of commercially available devices, or even higher precision, was demonstrated in ablative surgery in four patients.
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Affiliation(s)
- Per Dérand
- Department of Oral and Maxillofacial Surgery, Lund University, Lund, Sweden
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19
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Ragamouni S, Kumar JM, Mushahary D, Nemani H, Pande G. Histological analysis of cells and matrix mineralization of new bone tissue induced in rabbit femur bones by Mg-Zr based biodegradable implants. Acta Histochem 2013; 115:748-56. [PMID: 23628266 DOI: 10.1016/j.acthis.2013.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 02/22/2013] [Accepted: 02/27/2013] [Indexed: 10/26/2022]
Abstract
The biological efficacy of bone inducing implant materials in situ can be assessed effectively by performing histological analysis. We studied the peri-implant bone regeneration around two types of biodegradable magnesium-zirconium alloys, Mg-5Zr and Mg-Zr-2Sr, using histological, histochemical and immunohistochemical methods in the femur of New Zealand White strain rabbits. Our study includes three animal groups: (a) Mg-5Zr, (b) Mg-Zr-2Sr and (c) control. In each group three animals were used and in groups 'a' and 'b' the respective alloys were implanted in cavities made at the distal ends of the femur; control animals were left without implants to observe natural bone healing. Qualitative assessment of the cellularity and matrix mineralization events of the newly formed bone tissue was done at three months after implantation by histological methods in methyl methacrylate embedded tissue without decalcifying the bone. Quantitative mineral content and density of the new bone (NB) were evaluated by the statistical analysis of dual energy X-ray absorptiometry (DXA) data obtained from three animals in each experimental group. Based on our analysis we conclude that Mg-Zr-2Sr alloy showed better osseointegration of the newly formed bone with the implant surface. Our methodology of studying peri-implant osteoinduction of degradable implants using low temperature methyl methacrylate embedding resin can be useful as a general method for determining the bio-efficacy of implant materials.
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20
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Palmquist A, Snis A, Emanuelsson L, Browne M, Thomsen P. Long-term biocompatibility and osseointegration of electron beam melted, free-form–fabricated solid and porous titanium alloy: Experimental studies in sheep. J Biomater Appl 2013. [DOI: 10.1177/0731684411431857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of the present study was to evaluate the long-term osseointegration and biocompatibility of electron beam melted (EBM) free-form–fabricated (FFF titanium grade 5 (Ti6Al4V) implants. Porous and solid machined cylindrical and disk-shaped implants were prepared by EBM and implanted bilaterally in the femur and subcutaneously in the dorsum of the sheep. After 26 weeks, the implants and surrounding tissue were retrieved. The tissue response was examined qualitatively and quantitatively using histology and light microscopic (LM) morphometry. Selected bone implants specimens were evaluated by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and micro-computed tomography (mCT). The results showed that both porous and solid implants were osseointegrated and high bone–implant contact was observed throughout the porous implant. In the soft tissue, the porous implants showed thinner fibrous encapsulation while no signs of intolerance were observed for either implant type. Taken together, the present experimental results show that FFF Ti6Al4V with and without porous structures demonstrate excellent long-term soft tissue biocompatibility and a high degree of osseointegration. The present findings extend earlier, short-term experimental observations in bone and suggest that EBM, FFF Ti6Al4V implants possess valuable properties in bone and soft tissue applications.
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Affiliation(s)
- A Palmquist
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg Göteborg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy Göteborg, Sweden
| | - A Snis
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy Göteborg, Sweden
- Arcam AB Mölndal, Sweden
| | - L Emanuelsson
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg Göteborg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy Göteborg, Sweden
| | - M Browne
- Bioengineering Group, School of Engineering Sciences, University of Southampton UK
| | - P Thomsen
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg Göteborg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy Göteborg, Sweden
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21
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Svensson S, Suska F, Emanuelsson L, Palmquist A, Norlindh B, Trobos M, Bäckros H, Persson L, Rydja G, Ohrlander M, Lyvén B, Lausmaa J, Thomsen P. Osseointegration of titanium with an antimicrobial nanostructured noble metal coating. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2013; 9:1048-56. [PMID: 23639678 DOI: 10.1016/j.nano.2013.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 03/15/2013] [Accepted: 04/15/2013] [Indexed: 12/31/2022]
Abstract
UNLABELLED Nanometer scale surface features on implants and prostheses can potentially be used to enhance osseointegration and may also add further functionalities, such as infection resistance, to the implant. In this study, a nanostructured noble metal coating consisting of palladium, gold and silver, never previously used in bone applications, was applied to machined titanium screws to evaluate osseointegration after 6 and 12 weeks in rabbit tibiae and femurs. Infection resistance was confirmed by in vitro adhesion test. A qualitatively and quantitatively similar in vivo bone response was observed for the coated and uncoated control screws, using histology, histomorphometry and electron microscopy. The bone-implant interface analysis revealed an extensive bone formation and direct bone-implant contact. These results demonstrate that the nanostructured noble metal coating with antimicrobial properties promotes osseointegration and may therefore be used to add extra implant functionality in the form of increased resistance to infection without the use of antibiotics. FROM THE CLINICAL EDITOR The authors of this paper demonstrate that nanostructured noble metal coating of implants and prostheses used in orthopedic procedures promotes osseointegration and may be used to add extra implant functionality in the form of increased resistance to infection without the use of antibiotics.
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Affiliation(s)
- Sara Svensson
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Göteborg, Sweden; Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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22
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Mg ion implantation on SLA-treated titanium surface and its effects on the behavior of mesenchymal stem cell. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2012; 33:1554-60. [PMID: 23827608 DOI: 10.1016/j.msec.2012.12.061] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/16/2012] [Accepted: 12/17/2012] [Indexed: 12/17/2022]
Abstract
Magnesium (Mg) is one of the most important ions associated with bone osseointegration. The aim of this study was to evaluate the cellular effects of Mg implantation in titanium (Ti) surfaces treated with sand blast using large grit and acid etching (SLA). Mg ions were implanted into the surface via vacuum arc source ion implantation. The surface morphology, chemical properties, and the amount of Mg ion release were evaluated by scanning electron microscopy (SEM), Auger electron spectroscopy (AES), Rutherford backscattering spectroscopy (RBS), and inductively coupled plasma-optical emission spectrometer (ICP-OES). Human mesenchymal stem cells (hMSCs) were used to evaluate cellular parameters such as proliferation, cytotoxicity, and adhesion morphology by MTS assay, live/dead assay, and SEM. Furthermore, osteoblast differentiation was determined on the basis of alkaline phosphatase (ALP) activity and the degree of calcium accumulation. In the Mg ion-implanted disk, 2.3×10(16) ions/cm(2) was retained. However, after Mg ion implantation, the surface morphology did not change. Implanted Mg ions were rapidly released during the first 7 days in vitro. The MTS assay, live/dead assay, and SEM demonstrated increased cell attachment and growth on the Mg ion-implanted surface. In particular, Mg ion implantation increased the initial cell adhesion, and in an osteoblast differentiation assay, ALP activity and calcium accumulation. These findings suggest that Mg ion implantation using the plasma source ion implantation (PSII) technique may be useful for SLA-treated Ti dental implants to improve their osseointegration capacity.
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Titanium as a Reconstruction and Implant Material in Dentistry: Advantages and Pitfalls. MATERIALS 2012. [PMCID: PMC5449026 DOI: 10.3390/ma5091528] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Commercial pure titanium (cpTi) has been the material of choice in several disciplines of dentistry due to its biocompatibility, resistance to corrosion and mechanical properties. Despite a number of favorable characteristics, cpTi as a reconstruction and oral implant material has several shortcomings. This paper highlights current knowledge on material properties, passive oxidation film formation, corrosion, surface activation, cell interactions, biofilm development, allergy, casting and machining properties of cpTi for better understanding and potential improvement of this material for its clinical applications.
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de Peppo GM, Palmquist A, Borchardt P, Lennerås M, Hyllner J, Snis A, Lausmaa J, Thomsen P, Karlsson C. Free-form-fabricated commercially pure Ti and Ti6Al4V porous scaffolds support the growth of human embryonic stem cell-derived mesodermal progenitors. ScientificWorldJournal 2012; 2012:646417. [PMID: 22262956 PMCID: PMC3259715 DOI: 10.1100/2012/646417] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 10/15/2011] [Indexed: 12/14/2022] Open
Abstract
Commercially-pure titanium (cp-Ti) and the titanium-aluminum-vanadium alloy (Ti6Al4V) are widely used as reconstructive implants for skeletal engineering applications, due to their good mechanical properties, biocompatibility and ability to integrate with the surrounding bone. Electron beam melting technology (EBM) allows the fabrication of customized implants with tailored mechanical properties and high potential in the clinical practice. In order to augment the interaction with the biological tissue, stem cells have recently been combined with metallic scaffolds for skeletal engineering applications. We previously demonstrated that human embryonic stem cell-derived mesodermal progenitors (hES-MPs) hold a great potential to provide a homogeneous and unlimited supply of cells for bone engineering applications. This study demonstrates the effect of EBM-fabricated cp-Ti and Ti6Al4V porous scaffolds on hES-MPs behavior, in terms of cell attachment, growth and osteogenic differentiation. Displaying different chemical composition but similar surface properties, EBM-fabricated cp-Ti and Ti6Al4V scaffolds supported cell attachment and growth, and did not seem to alter the expression of genes involved in osteogenic differentiation and affect the alkaline phosphatase activity. In conclusion, interfacing hES-MPs to EBM-fabricated scaffolds may represent an interesting strategy for design of third-generation biomaterials, with the potential to promote implant integration in clinical conditions characterized by poor bone quality.
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Affiliation(s)
- G M de Peppo
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, P.O. Box 412, 41346 Göteborg, Sweden.
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Palmquist A, Snis A, Emanuelsson L, Browne M, Thomsen P. Long-term biocompatibility and osseointegration of electron beam melted, free-form-fabricated solid and porous titanium alloy: experimental studies in sheep. J Biomater Appl 2011; 27:1003-16. [PMID: 22207608 DOI: 10.1177/0885328211431857] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of the present study was to evaluate the long-term osseointegration and biocompatibility of electron beam melted (EBM) free-form-fabricated (FFF titanium grade 5 (Ti6Al4V) implants. Porous and solid machined cylindrical and disk-shaped implants were prepared by EBM and implanted bilaterally in the femur and subcutaneously in the dorsum of the sheep. After 26 weeks, the implants and surrounding tissue were retrieved. The tissue response was examined qualitatively and quantitatively using histology and light microscopic (LM) morphometry. Selected bone implants specimens were evaluated by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and micro-computed tomography (mCT). The results showed that both porous and solid implants were osseointegrated and high bone-implant contact was observed throughout the porous implant. In the soft tissue, the porous implants showed thinner fibrous encapsulation while no signs of intolerance were observed for either implant type. Taken together, the present experimental results show that FFF Ti6Al4V with and without porous structures demonstrate excellent long-term soft tissue biocompatibility and a high degree of osseointegration. The present findings extend earlier, short-term experimental observations in bone and suggest that EBM, FFF Ti6Al4V implants possess valuable properties in bone and soft tissue applications.
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Affiliation(s)
- A Palmquist
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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Stráský J, Janeček M, Harcuba P, Bukovina M, Wagner L. The effect of microstructure on fatigue performance of Ti–6Al–4V alloy after EDM surface treatment for application in orthopaedics. J Mech Behav Biomed Mater 2011; 4:1955-62. [DOI: 10.1016/j.jmbbm.2011.06.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/24/2011] [Accepted: 06/21/2011] [Indexed: 11/29/2022]
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27
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Chai WL, Brook IM, Emanuelsson L, Palmquist A, van Noort R, Moharamzadeh K. Ultrastructural analysis of implant-soft tissue interface on a three dimensional tissue-engineered oral mucosal model. J Biomed Mater Res A 2011; 100:269-77. [DOI: 10.1002/jbm.a.33245] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 11/06/2022]
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Palmquist A, Emanuelsson L, Brånemark R, Thomsen P. Biomechanical, histological and ultrastructural analyses of laser micro- and nano-structured titanium implant after 6 months in rabbit. J Biomed Mater Res B Appl Biomater 2011; 97:289-98. [PMID: 21394900 DOI: 10.1002/jbm.b.31814] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 11/25/2010] [Accepted: 12/19/2010] [Indexed: 11/08/2022]
Abstract
Short-term, experimental studies of partly laser-modified implants with nano-scale surface topographical features have recently shown a considerable increase in the biomechanical anchorage to bone. The aim of this study is to evaluate the biomechanical and bone-bonding ability of partly laser-modified implants compared with machined implants after a healing period of 6 months in a rabbit model. The results showed a 170% increase in removal torque. Histology and scanning electron microscopy demonstrated osseointegration for both implant types, but also revealed a different fracture pattern at the interface and in the bone. Transmission electron microscopy and chemical analysis showed coalescence between mineralized tissue and the nano-structured surface of the laser modified implant. Taken together, the results indicate that nano-structured surfaces promote in vivo long-term bone bonding and interface strength.
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Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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Lamers E, Walboomers XF, Domanski M, McKerr G, O'Hagan BM, Barnes CA, Peto L, Luttge R, Winnubst LAJA, Gardeniers HJGE, Jansen JA. Cryo DualBeam Focused Ion Beam-Scanning Electron Microscopy to Evaluate the Interface Between Cells and Nanopatterned Scaffolds. Tissue Eng Part C Methods 2010; 17:1-7. [PMID: 20594113 DOI: 10.1089/ten.tec.2010.0251] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
With the advance of nanotechnology in biomaterials science and tissue engineering, it is essential that new techniques become available to observe processes that take place at the direct interface between tissue and scaffold materials. Here, Cryo DualBeam focused ion beam-scanning electron microscopy (FIB-SEM) was used as a novel approach to observe the interactions between frozen hydrated cells and nanometric structures in high detail. Through a comparison of images acquired with transmission electron microscopy (TEM), conventional FIB-SEM operated at ambient temperature, and Cryo DualBeam FIB-SEM, the advantages and disadvantages of each technique were evaluated. Ultrastructural details of both (extra)cellular components and cell organelles were best observe with TEM. However, processing artifacts such as shrinkage of cells at the substrate interface were introduced in both TEM and conventional FIB-SEM. In addition, the cellular contrast in conventional FIB-SEM was low; consequently, cells were difficult to distinguish from the adjoining substrate. Cryo DualBeam FIB-SEM did preserve (extra)cellular details like the contour, cell membrane, and mineralized matrix. The three described techniques have proven to be complementary for the evaluation of processes that take place at the interface between tissue and substrate.
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Affiliation(s)
- Edwin Lamers
- 1 Department of Biomaterials, Radboud University Nijmegen Medical Centre , Nijmegen, The Netherlands
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Palmquist A, Omar OM, Esposito M, Lausmaa J, Thomsen P. Titanium oral implants: surface characteristics, interface biology and clinical outcome. J R Soc Interface 2010; 7 Suppl 5:S515-27. [PMID: 20591849 DOI: 10.1098/rsif.2010.0118.focus] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bone-anchored titanium implants have revolutionized oral healthcare. Surface properties of oral titanium implants play decisive roles for molecular interactions, cellular response and bone regeneration. Nevertheless, the role of specific surface properties, such as chemical and phase composition and nanoscale features, for the biological in vivo performance remains to be established. Partly, this is due to limited transfer of state-of-the-art preparation techniques to complex three-dimensional geometries, analytical tools and access to minute, intact interfacial layers. As judged by the available results of a few randomized clinical trials, there is no evidence that any particular type of oral implant has superior long-term success. Important insights into the recruitment of mesenchymal stem cells, cell-cell communication at the interface and high-resolution imaging of the interface between the surface oxide and the biological host are prerequisites for the understanding of the mechanisms of osseointegration. Strategies for development of the next generation of material surface modifications for compromised tissue are likely to include time and functionally programmed properties, pharmacological modulation and incorporation of cellular components.
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Affiliation(s)
- Anders Palmquist
- BIOMATCELL Vinn Excellence Center for Biomaterials and Cell Therapy, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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