Tailoring of antibacterial Ag nanostructures on TiO2 nanotube layers by magnetron sputtering

TiO2 nanotubes as an antibacterial nanotextured surface for dental implants: Systematic review and meta-analysis

OBJECTIVES

Nanotechnology is constantly advancing in dental science, progressing several features aimed at improving dental implants. An alternative for surface treatment of dental implants is electrochemical anodization, which may generate a nanotubular surface (TiO2 nanotubes) with antibacterial potential and osteoinductive features. This systematic review and meta-analysis aims to elucidate the possible antibacterial properties of the surface in question compared to the untreated titanium surface.

SOURCES

For that purpose, was performed a systematic search on the bases PubMed, Lilacs, Embase, Web Of Science, Cinahl, and Cochrane Central, as well as, manual searches and gray literature.

STUDY SELECTION

The searches resulted in 742 articles, of which 156 followed for full-text reading. Then, 37 were included in the systematic review and 8 were included in meta-analysis.

RESULTS

Fifteen studies revealed significant antibacterial protection using TiO2 nanotube surfaces, while 15 studies found no statistical difference between control and nanotextured surfaces. Meta-analysis of in vitro studies demonstrated relevant bacterial reduction only for studies investigating Staphylococcus aureus in a period of 6 h. Meta-analysis of in vivo studies revealed three times lower bacterial adhesion and proliferation on TiO2 nanotube surfaces.

CONCLUSIONS

TiO2 nanotube topography as a surface for dental implants in preclinical research has demonstrated a positive relationship with antibacterial properties, nevertheless, factors such as anodization protocols, bacteria strains, and mono-culture methods should be taken into consideration, consequently, further studies are necessary to promote clinical translatability.

Surface modification techniques of titanium and titanium alloys for biomedical orthopaedics applications: A review

Biomedical alloys have an important share in orthopedic applications. Among them, titanium and its titanium alloys are widely used as implant materials because of their excellent mechanical properties and non-cytotoxicity. However, its disadvantages such as its biological inertness and poor antibacterial properties inhibit its further development. Therefore, the surface properties of titanium are crucial in the implantation process and determine the success of the implant. The main purpose of this review is to provide a comprehensive and detailed description of the modification techniques used for the surface modification of titanium implants. In this paper, the corresponding technical methods are introduced systematically from four aspects: mechanical method, physical surface modification, chemical surface modification and electrochemical technique to understand the experimental mechanism of each modification technique, and the above methods can indeed improve the various properties of titanium and its alloys. With the increasing demand for implants in the future, the requirements for surface properties will also increase. Therefore, the development of new coating materials with higher performance by combining various advantages of existing modification technologies is the main trend of future research on surface modification of titanium alloys.

Effect of nanopackaging on the quality of edible mushrooms and its action mechanism: A review

With higher demands for food packaging and the development of nanotechnology, nanopackaging is becoming a research hotspot in the field of food packaging because of its superb preservation effect, and it can effectively resist oxidation and regulates energy metabolism to maintain the quality and prolong the shelf life of mushrooms. Furthermore, under the background of SARS-CoV-2 pandemic, nanomaterials could be a potential tool to prevent virus transmission because of their excellent antiviral activities. However, the investigation and application of nanopackaging are facing many challenges including costs, environmental pollution, poor in-depth genetic research for mechanisms and so on. This article reviews the preservation effect and mechanisms of nanopackaging on the quality of mushrooms and discusses the trends and challenges of using these materials in food packaging technologies with the focus on nanotechnology and based on recent studies.

Characterization and investigation of electrochemical and biological properties of antibacterial silver nanoparticle-deposited TiO2 nanotube array surfaces

The one of main reasons of the premature failure of Ti-based implants is infections. The metal- and metal oxide-based nanoparticles have very high potential on controlling of infections. In this work, the randomly distributed AgNPs-deposited onto well-ordered TiO₂ nanotube surfaces were fabricated on titanium by anodic oxidation (AO) and electrochemical deposition (ED) processes. AgNPs-deposited nanotube surfaces, which is beneficial for bone tissue growth exhibited hydrophilic behaviors. Moreover, the AgNPs-deposited nanotube surfaces, which prevent the leaching of metallic Ti ions from the implant surface, indicated great corrosion resistance under SBF conditions. The electrochemical corrosion resistance of AgNPs-deposited nanotube surfaces was improved up to about 145% compared to bare Gr2 surface. The cell viability of AgNPs-deposited nanotube surfaces was improved. Importantly, the AgNPs-deposited nanotube surfaces exhibited antibacterial activity for Gram-positive and Gram-negative bacteria. Eventually, it can be concluded that the AgNPs-deposited nanotube surfaces possess high stability for long-term usage of implant applications.

Nile Tilapia Skin Impregnated with Antibacterial Silver/Titanium Dioxide Compounds

The development of alternative (and free-of-antibiotics) antibacterial and antibiofilm agents is an important strategy to circumvent the resistance of bacteria to antibiotics. Herein, we explore the production of mixed oxides by incorporating silver nanoparticles in titanium dioxide as a silver concentration-dependent antibacterial agent that is further incorporated in Tilapia fish skin (a promising prototype of xenograft), integrating the antibacterial activity of mixed oxide into the intrinsic properties of Tilapia skin. The antibiofilm activity of samples prepared with high concentrations of silver (10 wt% of precursor AgNO3) has been considered a good antibiofilm response. The influence of silver content is also observed with respect to the minimum bactericidal concentration, which is reduced to 3.13 mg/mL with a characteristic kill time in the order of 30 min that is associated with antibiofilm activity in biofilm-forming strains of Staphylococcus aureus. These results indicate that modified Tilapia fish skin acquires antibacterial behavior and can be explored for xenografts with prospective applications in the light-dependent actuation of TiO2-based compounds.

The race for the optimal antimicrobial surface: perspectives and challenges related to plasma electrolytic oxidation coating for titanium-based implants

Plasma electrolytic oxidation (PEO) is a low-cost, structurally reliable, and environmentally friendly surface modification method for orthopedic and dental implants. This technique is successful for the formation of porous, corrosion-resistant, and bioactive coatings, besides introducing antimicrobial compounds easily. Given the increase in implant-related infections, antimicrobial PEO-treated surfaces have been widely proposed to surmount this public health concern. This review comprehensively discusses antimicrobial implant surfaces currently produced by PEO in terms of their in vitro and in vivo microbiological and biological properties. We present a critical [part I] and evidence-based [part II] review about the plethora of antimicrobial PEO-treated surfaces. The mechanism of microbial accumulation on implanted devices and the principles of PEO technology to ensure antimicrobial functionalization by one- or multi-step processes are outlined. Our systematic literature search showed that particular focus has been placed on the metallic and semi-metallic elements incorporated into PEO surfaces to facilitate antimicrobial properties, which are often dose-dependent, without leading to cytotoxicity in vitro. Meanwhile, there are concerns over the biocompatibility of PEO and its long-term antimicrobial effects in animal models. We clearly highlight the importance of using clinically relevant infection models and in vivo long-term assessments to guarantee the rational design of antimicrobial PEO-treated surfaces to identify the 'finish line' in the race for antimicrobial implant surfaces.

The Antibacterial and Cytotoxic Effects of Silver Nanoparticles Coated Titanium Implants: A Narrative Review

Nanotechnology has become an emerging research field with numerous biomedical scientific applications. Silver possesses bactericidal activities that have been harnessed for centuries; however, there is a concern about the toxic effects of silver nanoparticles. This paper aims to provide an overview of silver-treated dental implants and discuss their potential to reduce the prevalence of peri-implant diseases. An electronic search was performed using PubMed. After screening, data extraction was performed on the 45 remaining articles using inclusion and exclusion criteria. Most of the articles demonstrated that silver nanoparticles embedded in a coating layer and/or on surface-treated titanium exhibit sound antibacterial effects and biocompatibility. Most of the reviewed studies revealed that silver nanoparticles on dental implant surfaces reduced cytotoxicity but provided a prolonged antibacterial effect. The cytotoxicity and antibacterial effect are closely linked to how the silver nanoparticles are released from the titanium surfaces, where a slower release increases cell viability and proliferation. However, to improve the clinical translation, there is still a need for more studies, especially evaluating the long-term systemic effects and studies recreating the conditions in the oral cavity.

Low voltage environmentally friendly plasma electrolytic oxidation process for titanium alloys

Plasma electrolytic oxidation (PEO) is a surface-treatment process extensively used to protect the surfaces of light metals such as Mg, Al, and Ti. Here, we report an environmentally friendly PEO process that uses nitrogen-containing electrolytes and low voltages (120 V) to form ~ 12 micron thick, uniform, adherent and porous oxide coatings on T1 titanium alloy surfaces. We evaluated the influence of nitrogenation by comparing the coatings to alloys treated in PEO baths without nitrogen-containing compounds. Both sets of samples exhibited basalt-like morphologies with distinct variation in the pore structures. The composition analyses showed that the coatings were primarily composites of titanium oxides and silicates. The T1 Ti alloys treated with nitrogen-containing electrolytes also contained TiC and TiN. This is the first ever report of producing Ti_xO_y, Ti–Si–O, TiC, and TiN composite coatings using a single PEO bath without carbide/nitride nanoparticles. The bandgaps of the coatings suggested visible light functionality. The use of nitrogen-based compounds in the PEO baths improved the hardness of the oxide layers but introduced stress-induced cracking which are potentially responsible for the reduction in corrosion resistance of the nitride and carbide containing coatings.

Influence of laser and alkali treatment on an Ag/TiO2nanotube based dopamine sensor

Herein, TiO₂nanotubes (T-NTs) arrays were subjected to two types of treatment followed by a simple metal deposition technique to significantly enhance the performances of T-NTs based electrochemical sensing of dopamine. The first type of treatment was done by soaking T-NTs in sodium hydroxide solution for an optimal time to enhance the conductivity and charge carrier density. The second type of treatment employed was laser irradiation, which induces crystallinity disorder and forms rutile TiO₂, promoting active analyte adsorption sites. Afterward, silver (Ag) was electro-deposited on the T-NTs as a dopamine sensing catalyst to form T-NTs/Ag nanohybrids. The dual-treated T-NTs based sensor showed 3-fold enhancement in sensitivity (from 8.2μA mM^-1cm^-2to 32μA mM^-1cm^-2), reduced charge transfer resistance (from 38 × 10^-6Ω to 0.7 × 10^-6Ω), above 2 order higher donor charge density (from 3.58 × 10¹⁸cm^-3to 1.41 × 10²¹cm^-3), and reduced limit of detection (from 32.3μM to 2.8μM) in comparison to plain T-NTs based sensor. In addition, the sensitivity reported here is significantly higher than most of the previously reported TiO₂based dopamine sensors. Perspective-wise, the dual treatment approach is a promising technique and is highly desirable for enhancing the performances of T-NTs and other nanomaterial based electrochemical sensors.

Antimicrobial Properties of the Ag, Cu Nanoparticle System

Microbes, including bacteria and fungi, easily form stable biofilms on many surfaces. Such biofilms have high resistance to antibiotics, and cause nosocomial and postoperative infections. The antimicrobial and antiviral behaviors of Ag and Cu nanoparticles (NPs) are well known, and possible mechanisms for their actions, such as released ions, reactive oxygen species (ROS), contact killing, the immunostimulatory effect, and others have been proposed. Ag and Cu NPs, and their derivative NPs, have different antimicrobial capacities and cytotoxicities. Factors, such as size, shape and surface treatment, influence their antimicrobial activities. The biomedical application of antimicrobial Ag and Cu NPs involves coating onto substrates, including textiles, polymers, ceramics, and metals. Because Ag and Cu are immiscible, synthetic AgCu nanoalloys have different microstructures, which impact their antimicrobial effects. When mixed, the combination of Ag and Cu NPs act synergistically, offering substantially enhanced antimicrobial behavior. However, when alloyed in Ag-Cu NPs, the antimicrobial behavior is even more enhanced. The reason for this enhancement is unclear. Here, we discuss these results and the possible behavior mechanisms that underlie them.

Visible-Light Active Titanium Dioxide Nanomaterials with Bactericidal Properties

This article provides an overview of current research into the development, synthesis, photocatalytic bacterial activity, biocompatibility and cytotoxic properties of various visible-light active titanium dioxide (TiO2) nanoparticles (NPs) and their nanocomposites. To achieve antibacterial inactivation under visible light, TiO2 NPs are doped with metal and non-metal elements, modified with carbonaceous nanomaterials, and coupled with other metal oxide semiconductors. Transition metals introduce a localized d-electron state just below the conduction band of TiO2 NPs, thereby narrowing the bandgap and causing a red shift of the optical absorption edge into the visible region. Silver nanoparticles of doped TiO2 NPs experience surface plasmon resonance under visible light excitation, leading to the injection of hot electrons into the conduction band of TiO2 NPs to generate reactive oxygen species (ROS) for bacterial killing. The modification of TiO2 NPs with carbon nanotubes and graphene sheets also achieve the efficient creation of ROS under visible light irradiation. Furthermore, titanium-based alloy implants in orthopedics with enhanced antibacterial activity and biocompatibility can be achieved by forming a surface layer of Ag-doped titania nanotubes. By incorporating TiO2 NPs and Cu-doped TiO2 NPs into chitosan or the textile matrix, the resulting polymer nanocomposites exhibit excellent antimicrobial properties that can have applications as fruit/food wrapping films, self-cleaning fabrics, medical scaffolds and wound dressings. Considering the possible use of visible-light active TiO2 nanomaterials for various applications, their toxicity impact on the environment and public health is also addressed.

Enhanced antibacterial properties of orthopedic implants by titanium nanotube surface modification: a review of current techniques

Prosthesis-associated infections are one of the main causes of implant failure; thus it is important to enhance the long-term antibacterial ability of orthopedic implants. Titanium dioxide nanotubes (TNTs) are biomaterials with good physicochemical properties and biocompatibility. Owing to their inherent antibacterial and drug-loading ability, the antibacterial application of TNTs has received increasing attention. In this review, the process of TNT anodizing fabrication is summarized. Also, the mechanism and the influencing factors of the antibacterial property of bare TNTs are explored. Furthermore, different antibacterial strategies for carrying drugs, as well as modifications to prolong the antibacterial effect and reduce drug-related toxicity are discussed. In addition, antibacterial systems based on TNTs that can automatically respond to infection are introduced. Finally, the currently faced problems are reviewed and potential solutions are proposed. This review provides new insight on TNT fabrication and summarizes the most advanced antibacterial strategies involving TNTs for the enhancement of long-term antibacterial ability and reduction of toxicity.

Surface treatments on titanium implants via nanostructured ceria for antibacterial and anti-inflammatory capabilities

Peri-implantitis is the most common risk factor for dental implant failure. Nanostructured ceria (nano-CeO₂) has anti-inflammatory and antibacterial functions, and different shapes of ceria enclosed by specific crystal planes could be an effective approach to enhance intrinsic catalysis. In the present study, the authors developed a novel implant surface-modification strategy by coating different shapes of nano-CeO₂ onto titanium (Ti) surfaces to enhance their antibacterial and anti-inflammatory properties. The objectives of the study were to: (1) develop novel Ti surfaces modified with different shapes of nano-CeO₂ (nanorod, nanocube and nano-octahedron) for peri-implantitis prevention; (2) investigate and compare the inhibition efficacy of different shapes of CeO₂-modified surfaces against biofilms of peri-implantitis-related pathogens; and (3) evaluate the different CeO₂-modified surfaces on cell inflammatory response in vitro and in vivo. The results showed that nanorod CeO₂-modified Ti had more bacteria attachment of Streptococcus sanguinis in the early stage, compared with other CeO₂-modified Ti (p < 0.05). They all exhibited similarly substantial CFU reductions against peri-implantitis-related biofilms (p > 0.1). Nanocube and nano-octahedron CeO₂-modified Ti exerted much better anti-inflammatory effects and ROS-scavenging ability than nanorod CeO₂in vitro (p < 0.05). In vivo, the mean mRNA expression of TNF-α, IL-6 and IL-1β in the tissues around Ti was decreased by the three shapes of nano-CeO₂; nano-octahedron CeO₂ showed the strongest anti-inflammatory effect among all groups (p < 0.05). In conclusion, all three types of CeO₂-modified Ti exerted equally strong antibacterial properties; nano-octahedron CeO₂-modified Ti had the best anti-inflammatory effect. Therefore, CeO₂-modified Ti surfaces are highly promising for enhancing antimicrobial functions for dental implants. Novel nano-octahedron CeO₂ coating on Ti had great therapeutic potential for alleviating and eliminating peri-implantitis. STATEMENT OF SIGNIFICANCE: Peri-implantitis is the most common risk factor for dental implant failure. Nanostructured ceria (nano-CeO₂) has anti-inflammatory and antibacterial functions, and different shapes of ceria enclosed by specific crystal planes could be an effective approach to enhance intrinsic catalysis. In the present study, we developed a novel implant surface-modification strategy by coating different shapes of nano-CeO₂ onto titanium surfaces to enhance their antibacterial and anti-inflammatory properties for dental implants. In addition, we found that the nano-octahedron CeO₂ coating on titanium would have great therapeutic potential for alleviating and eliminating peri-implantitis.

Antibacterial potential associated with drug-delivery built TiO2 nanotubes in biomedical implants

The fast evolution of surface treatments for biomedical implants and the concern with their contact with cells and microorganisms at early phases of bone healing has boosted the development of surface topographies presenting drug delivery potential for, among other features, bacterial growth inhibition without impairing cell adhesion. A diverse set of metal ions and nanoparticles (NPs) present antibacterial properties of their own, which can be applied to improve the implant local response to contamination. Considering the promising combination of nanostructured surfaces with antibacterial materials, this critical review describes a variety of antibacterial effects attributed to specific metals, ions and their combinations. Also, it explains the TiO2 nanotubes (TNTs) surface creation, in which the possibility of aggregation of an active drug delivery system is applicable. Also, we discuss the pertinent literature related to the state of the art of drug incorporation of NPs with antibacterial properties inside TNTs, along with the promising future perspectives of in situ drug delivery systems aggregated to biomedical implants.

Potential antibacterial mechanism of silver nanoparticles and the optimization of orthopedic implants by advanced modification technologies

Infection, as a common postoperative complication of orthopedic surgery, is the main reason leading to implant failure. Silver nanoparticles (AgNPs) are considered as a promising antibacterial agent and always used to modify orthopedic implants to prevent infection. To optimize the implants in a reasonable manner, it is critical for us to know the specific antibacterial mechanism, which is still unclear. In this review, we analyzed the potential antibacterial mechanisms of AgNPs, and the influences of AgNPs on osteogenic-related cells, including cellular adhesion, proliferation, and differentiation, were also discussed. In addition, methods to enhance biocompatibility of AgNPs as well as advanced implants modifications technologies were also summarized.

Overcoming the biological aging of titanium using a wet storage method after ultraviolet treatment

We evaluated whether the biological activity of the surface of titanium, when stored in an aqueous solution after ultraviolet (UV) treatment, is comparable to that of the surface immediately after UV treatment. We subjected Grade IV titanium discs with machined surfaces to UV radiation for 15 min and then tested them immediately and after storage for 28 days, with and without distilled H₂O (dH₂O). We evaluated the surface characteristics using surface profiling, contact angle analysis, X-ray photoelectron spectroscopy, and in terms of the surface zeta-potential. We determined the level of biological activity by analysing albumin adsorption, MC3T3-E1 and human mesenchymal cell adhesion and cytoskeleton development, as well as the production of intracellular reactive oxygen species between groups. The surface characteristics produced by the UV irradiation were maintained in dH₂O for 28 days. We found that titanium stored in dH₂O for 28 days after UV treatment exhibited enhanced protein adsorption, cell attachment, and cytoskeleton development. Titanium stored in dH₂O for 28 days after UV irradiation exhibited a lower level of oxidative stress, comparable to that of the titanium immediately after UV treatment. UV treatment combined with wet storage can be used as a means of overcoming the biological aging of titanium.

Extracellular Electron Transfer from Aerobic Bacteria to Au-Loaded TiO2 Semiconductor without Light: A New Bacteria-Killing Mechanism Other than Localized Surface Plasmon Resonance or Microbial Fuel Cells

Titania loaded with noble metal nanoparticles exhibits enhanced photocatalytic killing of bacteria under light illumination due to the localized surface plasmon resonance (LSPR) property. It has been shown recently that loading with Au or Ag can also endow TiO2 with the antibacterial ability in the absence of light. In this work, the antibacterial mechanism of Au-loaded TiO2 nanotubes (Au@TiO2-NT) in the dark environment is studied, and a novel type of extracellular electron transfer (EET) between the bacteria and the surface of the materials is observed to cause bacteria death. Although the EET-induced bacteria current is similar to the LSPR-related photocurrent, the former takes place without light, and no reactive oxygen species (ROS) are produced during the process. The EET is also different from that commonly attributed to microbial fuel cells (MFC) because it is dominated mainly by the materials' surface, but not the bacteria, and the environment is aerobic. EET on the Au@TiO2-NT surface kills Staphylococcus aureus, but if it is combined with special MFC bacteria, the efficiency of MFC may be improved significantly.

Time-dependent effects of ultraviolet and nonthermal atmospheric pressure plasma on the biological activity of titanium

Here, we evaluated time-dependent changes in the effects of ultraviolet (UV) and nonthermal atmospheric pressure plasma (NTAPPJ) on the biological activity of titanium compared with that of untreated titanium. Grade IV machined surface titanium discs (12-mm diameter) were used immediately and stored up to 28 days after 15-min UV or 10-min NTAPPJ treatment. Changes of surface characteristics over time were evaluated using scanning electron microscopy, surface profiling, contact angle analysis, X-ray photoelectron spectroscopy, and surface zeta-potential. Changes in biological activity over time were as determined by analysing bovine serum albumin adsorption, MC3T3-E1 early adhesion and morphometry, and alkaline phosphatase (ALP) activity between groups. We found no differences in the effects of treatment on titanium between UV or NTAPPJ over time; both treatments resulted in changes from negatively charged hydrophobic (bioinert) to positively charged hydrophilic (bioactive) surfaces, allowing enhancement of albumin adsorption, osteoblastic cell attachment, and cytoskeleton development. Although this effect may not be prolonged for promotion of cell adhesion until 4 weeks, the effects were sufficient to maintain ALP activity after 7 days of incubation. This positive effect of UV and NTAPPJ treatment can enhance the biological activity of titanium over time.

Controlled release of drugs in electrosprayed nanoparticles for bone tissue engineering

Generating porous topographic substrates, by mimicking the native extracellular matrix (ECM) to promote the regeneration of damaged bone tissues, is a challenging process. Generally, scaffolds developed for bone tissue regeneration support bone cell growth and induce bone-forming cells by natural proteins and growth factors. Limitations are often associated with these approaches such as improper scaffold stability, and insufficient cell adhesion, proliferation, differentiation, and mineralization with less growth factor expression. Therefore, the use of engineered nanoparticles has been rapidly increasing in bone tissue engineering (BTE) applications. The electrospray technique is advantageous over other conventional methods as it generates nanomaterials of particle sizes in the micro/nanoscale range. The size and charge of the particles are controlled by regulating the polymer solution flow rate and electric voltage. The unique properties of nanoparticles such as large surface area-to-volume ratio, small size, and higher reactivity make them promising candidates in the field of biomedical engineering. These nanomaterials are extensively used as therapeutic agents and for drug delivery, mimicking ECM, and restoring and improving the functions of damaged organs. The controlled and sustained release of encapsulated drugs, proteins, vaccines, growth factors, cells, and nucleotides from nanoparticles has been well developed in nanomedicine. This review provides an insight into the preparation of nanoparticles by electrospraying technique and illustrates the use of nanoparticles in drug delivery for promoting bone tissue regeneration.

Metal-Based Antibacterial Substrates for Biomedical Applications

The interest in nanotechnology and the growing concern for the antibiotic resistance demonstrated by many microorganisms have recently stimulated many efforts in designing innovative biomaterials and substrates with antibacterial properties. Among the implemented strategies to control the incidence of infections associated with the use of biomedical device and implants, interesting routes are represented by the incorporation of bactericidal agents onto the surface of biomaterials for the prevention of bacterial adhesion and biofilm growth. Natural products and particularly bioactive metals such as silver, copper and zinc represent an interesting alternative for the development of advanced biomaterials with antimicrobial properties. This review presents an overview of recent progress in the modification of biomaterials as well as the most attractive techniques for the deposition of antimicrobial coatings on different substrates for biomedical application. Moreover, some research activities and results achieved by the authors in the development of antibacterial materials are also presented and discussed.

Reactive combinatorial synthesis and characterization of a gradient Ag-Ti oxide thin film with antibacterial properties

The growing demand for orthopedic and dental implants has spurred researchers to develop multifunctional coatings, combining tissue integration with antibacterial features. A possible strategy to endow titanium (Ti) with antibacterial properties is by incorporating silver (Ag), but designing a structure with adequate Ag(+) release while maintaining biocompatibility has been shown difficult. To further explore the composition-structure-property relationships between Ag and Ti, and its effects against bacteria, this study utilized a combinatorial approach to manufacture and test a single sample containing a binary Ag-Ti oxide gradient. The sample, sputter-deposited in a reactive (O2) environment using a custom-built combinatorial physical vapor deposition system, was shown to be effective against Staphylococcus aureus with viability reductions ranging from 17 to above 99%, depending on the amount of Ag(+) released from its different parts. The Ag content along the gradient ranged from 35 to 62 wt.%, but it was found that structural properties such as varied porosity and degree of crystallinity, rather than the amount of incorporated Ag, governed the Ag(+) release and resulting antibacterial activity. The coating also demonstrated in vitro apatite-forming abilities, where structural variety along the sample was shown to alter the hydrophilic behavior, with the degree of hydroxyapatite deposition varying accordingly. By means of combinatorial synthesis, a single gradient sample was able to display intricate compositional and structural features affecting its biological response, which would otherwise require a series of coatings. The current findings suggest that future implant coatings incorporating Ag as an antibacterial agent could be structurally enhanced to better suit clinical requirements.

Cellular attachment and differentiation on titania nanotubes exposed to air- or nitrogen-based non-thermal atmospheric pressure plasma

The surface topography and chemistry of titanium implants are important factors for successful osseointegration. However, chemical modification of an implant surface using currently available methods often results in the disruption of topographical features and the loss of beneficial effects during the shelf life of the implant. Therefore, the aim of this study was to apply the recently highlighted portable non-thermal atmospheric pressure plasma jet (NTAPPJ), elicited from one of two different gas sources (nitrogen and air), to TiO₂ nanotube surfaces to further improve their osteogenic properties while preserving the topographical morphology. The surface treatment was performed before implantation to avoid age-related decay. The surface chemistry and morphology of the TiO₂ nanotube surfaces before and after the NTAPPJ treatment were determined using a field-emission scanning electron microscope, a surface profiler, a contact angle goniometer, and an X-ray photoelectron spectroscope. The MC3T3-E1 cell viability, attachment and morphology were confirmed using calcein AM and ethidium homodimer-1 staining, and analysis of gene expression using rat mesenchymal stem cells was performed using a real-time reverse-transcription polymerase chain reaction. The results indicated that both portable nitrogen- and air-based NTAPPJ could be used on TiO₂ nanotube surfaces easily and without topographical disruption. NTAPPJ resulted in a significant increase in the hydrophilicity of the surfaces as well as changes in the surface chemistry, which consequently increased the cell viability, attachment and differentiation compared with the control samples. The nitrogen-based NTAPPJ treatment group exhibited a higher osteogenic gene expression level than the air-based NTAPPJ treatment group due to the lower atomic percentage of carbon on the surface that resulted from treatment. It was concluded that NTAPPJ treatment of TiO₂ nanotube surfaces results in an increase in cellular activity. Furthermore, it was demonstrated that this treatment leads to improved osseointegration in vitro.

Antibacterial surface treatment for orthopaedic implants

It is expected that the projected increased usage of implantable devices in medicine will result in a natural rise in the number of infections related to these cases. Some patients are unable to autonomously prevent formation of biofilm on implant surfaces. Suppression of the local peri-implant immune response is an important contributory factor. Substantial avascular scar tissue encountered during revision joint replacement surgery places these cases at an especially high risk of periprosthetic joint infection. A critical pathogenic event in the process of biofilm formation is bacterial adhesion. Prevention of biomaterial-associated infections should be concurrently focused on at least two targets: inhibition of biofilm formation and minimizing local immune response suppression. Current knowledge of antimicrobial surface treatments suitable for prevention of prosthetic joint infection is reviewed. Several surface treatment modalities have been proposed. Minimizing bacterial adhesion, biofilm formation inhibition, and bactericidal approaches are discussed. The ultimate anti-infective surface should be “smart” and responsive to even the lowest bacterial load. While research in this field is promising, there appears to be a great discrepancy between proposed and clinically implemented strategies, and there is urgent need for translational science focusing on this topic.