A Perspective on Titanium Biocompatibility

Biocompatibility Evolves: Phenomenology to Toxicology to Regeneration

The word "biocompatibility," is inconsistent with the observations of healing for so-called biocompatible biomaterials. The vast majority of the millions of medical implants in humans today, presumably "biocompatible," are walled off by a dense, avascular, crosslinked collagen capsule, hardly suggestive of life or compatibility. In contrast, one is now seeing examples of implant biomaterials that lead to a vascularized reconstruction of localized tissue, a biological reaction different from traditional biocompatible materials that generate a foreign body capsule. Both the encapsulated biomaterials and the reconstructive biomaterials qualify as "biocompatible" by present day measurements of biocompatibility. Yet, this new generation of materials would seem to heal "compatibly" with the living organism, where older biomaterials are isolated from the living organism by the dense capsule. This review/perspective article will explore this biocompatibility etymological conundrum by reviewing the history of the concepts around biocompatibility, today's standard methods for assessing biocompatibility, a contemporary view of the foreign body reaction and finally, a compendium of new biomaterials that heal without the foreign body capsule. A new definition of biocompatibility is offered here to address advances in biomaterials design leading to biomaterials that heal into the body in a facile manner.

Local Cellular Responses to Titanium Dioxide from Orthopedic Implants

We evaluated recently published articles relevant to the biological effects of titanium dioxide (TiO₂) particles on local endogenous cells required for normal bone homeostasis, repair, and implant osseointegration. Structural characteristics, size, stability, and agglomeration of TiO₂ particles alter the viability and behavior of multiple bone-related cell types. Resulting shifts in bone homeostasis may increase bone resorption and lead to clinical incidents of osteolysis, implant loosening, and joint pain. TiO₂ particles that enter cells (through endocytosis or Trojan horse mechanism) may further disrupt implant retention. We propose that cellular responses to titanium-based nanoparticles contribute to pathological mechanisms underlying the aseptic loosening of titanium-based metal implants.

Fabrication mechanism of nanostructured HA/TNTs biomedical coatings: an improvement in nanomechanical and in vitro biological responses

In this paper, a mechanism for fabrication of nanostructured hydroxyapatite coating on TiO2 nanotubes is presented. Also, the physical, biological, and nanomechanical properties of the anodized Ti6Al4V alloy consisting TiO2 nanotubes, electrodeposited hydroxyapatite, and the hydroxyapatite/TiO2 nanotubes double layer coating on Ti6Al4V alloy implants are compared. Mean cell viability of the samples being 84.63 % for uncoated plate, 91.53 % for electrodeposited hydroxyapatite, and 94.98 % for hydroxyapatite/TiO2 nanotubes coated sample were in the acceptable range. Merely anodized prototype had the highest biocompatibility of 110 % with respect to the control sample. Bonding strength of hydroxyapatite deposit to the substrate increased from 12 ± 2 MPa to 25.4 ± 2 MPa using intermediate TiO2 nanotubes layer. Hardness and elastic modulus of the anodized surface were 956 MPa and 64.7 GPa, respectively. The corresponding values for hydroxyapatite deposit were approximately measured 44.3 MPa and 0.66 GPa, respectively, while the average obtained values for hardness (159.3 MPa) and elastic modulus (2.25 GPa) of the hydroxyapatite/TiO2 nanotubes double coating improved more than 30 % of the pure hydroxyapatite deposit. Friction coefficient (ξ) of the anodized surface was 0.32 ± 0.02. The calculated friction coefficient enhanced from 0.65 ± 0.04 for sole hydroxyapatite layer to the 0.46 ± 0.02 for hydroxyapatite/TiO2 nanotubes due to presence of nanotubular TiO2 intermediate layer.

In situ modification of cell-culture scaffolds by photocatalytic decomposition of organosilane monolayers

We demonstrate a novel application of TiO2 photocatalysis for modifying the cell affinity of a scaffold surface in a cell-culture environment. An as-deposited octadecyltrichlorosilane self-assembled monolayer (OTS SAM) on TiO2 was found to be hydrophobic and stably adsorbed serum albumins that blocked subsequent adsorption of other proteins and cells. Upon irradiation of ultraviolet (UV) light, OTS molecules were decomposed and became permissive to the adhesion of PC12 cells via adsorption of an extracellular matrix protein, collagen. Optimal UV dose was 200 J cm(-2) for OTS SAM on TiO2. The amount of collagen adsorption decreased when excessive UV light was irradiated, most likely due to the surface being too hydrophilic to support its adsorption. This UV-induced modification required TiO2 to be present under the SAM and hence is a result of TiO2 photocatalysis. The UV irradiation for surface modification can be performed before cell plating or during cell culture. We also demonstrate that poly(ethylene glycol) SAM can also be patterned with this method, indicating that it is applicable to both hydrophobic and hydrophilic SAMs. This method provides a unique tool for fabricating cell microarrays and studying dynamical properties of living cells.

Preparation and analysis of chemically gradient functional bioceramic coating formed by pulsed laser deposition

Bioactive ceramic coatings based on calcium phosphates yield better functionality in the human body for a variety of metallic implant devices including orthopaedic and dental prostheses. In the present study chemically and hence functionally gradient bioceramic coating was obtained by pulsed laser deposition method. Calcium phosphate bioactive ceramic coatings based on hydroxyapatite (HA) and tricalcium phosphate (TCP) were deposited over titanium substrate to produce gradation in physico-chemical characteristics and in vitro dissolution behaviour. Sintered targets of HA and α-TCP were deposited in a multi target laser deposition system. The obtained deposits were characterized by X-ray diffraction, fourier transform infrared spectroscopy, scanning electron microscopy and energy dispersive X-ray analysis. Inductively coupled plasma spectroscopy was used to estimate the in vitro dissolution behaviour of coatings. The variation in mechanical property of the gradient layer was evaluated through scratch test and micro-indentation hardness. The bioactivity was examined in vitro with respect to the ability of HA layer to form on the surface as a result of contact with simulated body fluid. It could be inferred that chemically gradient functional bioceramic coating can be produced by laser deposition of multiple sintered targets with variable chemical composition.

Functionalization of titanium based metallic biomaterials for implant applications

Surface immobilization with active functional molecules (AFMs) on a nano-scale is a main field in the current biomaterial research. The functionalization of a vast number of substances and molecules, ranging from inorganic calcium phosphates, peptides and proteins, has been investigated throughout recent decades. However, in vitro and in vivo results are heterogeneous. This may be attributed partially to the limits of the applied immobilization methods. Therefore, this paper highlights the advantages and limitations of the currently applied methods for the biological nano-functionalization of titanium-based biomaterial surfaces. The second part describes a newer immobilization system, using the nanomechanical fixation of at least partially single-stranded nucleic acids (NAs) into an anodic titanium oxide layer as an immobilization principle and their hybridization ability for the functionalization of the surface with active functional molecules conjugated to the respective complementary NA strands.

Imaging modalities for localization of an iStent(®)

The iStent (Glaukos Corporation, Laguna Hills, CA) is a 1-mm, titanium trabecular bypass stent implanted across the inner wall of Schlemm's canal under direct gonioscopy. This study was designed to determine the best modality to identify iStent placement when gonioscopic visualization is not possible. In this in vitro study on a human cadaver eye, ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (AS-OCT), and B-scan ultrasonography were done to visualize and precisely locate two intentionally misplaced iStents. UBM could localize both intentionally misplaced stents, whereas AS-OCT could not visualize the iStent that was lodged in the sulcus. B-scan ultrasonography was unable to detect either of the stents. UBM may be a useful imaging modality to identify iStent in the anterior or posterior chamber, whereas AS-OCT is limited to detection of stents in the anterior chamber alone. B-scan ultrasonography is unable to identify iStent in either the anterior or posterior chamber.

Biological nano-functionalization of titanium-based biomaterial surfaces: a flexible toolbox

Surface functionalization with bioactive molecules (BAMs) on a nanometre scale is a main field in current biomaterial research. The immobilization of a vast number of substances and molecules, ranging from inorganic calcium phosphate phases up to peptides and proteins, has been investigated throughout recent decades. However, in vitro and in vivo results are heterogeneous. This may be at least partially attributed to the limits of the applied immobilization methods. Therefore, this paper highlights, in the first part, advantages and limits of the currently applied methods for the biological nano-functionalization of titanium-based biomaterial surfaces. The second part describes a new immobilization system recently developed in our groups. It uses the nanomechanical fixation of at least partially single-stranded nucleic acids (NAs) into an anodic titanium oxide layer as an immobilization principle and their hybridization ability for the functionalization of the surface with BAMs conjugated to the respective complementary NA strands.

Reference biomaterials for biological evaluation

The variability associated with most of the biological evaluation studies is relatively large and hence experimental controls are frequently employed to ensure that the results are reliable. These experimental controls, either positive or negative controls, could be considered as reference materials in the context of biological evaluation. Currently, reference biomaterial needs across the world are not addressed satisfactorily. Affordability and lack of availability of certified reference materials necessitates the development and the use of laboratory developed RMs. A well defined characterization strategy is essential for the successful development of in house reference materials. This article provides an overview of the current international status in the area of reference biomaterials and enumerates the steps involved in the development of an in house reference material. The production and characterization of commercially pure titanium pins for use as negative controls during muscle implantation studies is presented as a case study.

About oxygen, cytochrome p450 and titanium: learning from Ron Estabrook

We learned from Ron Estabrook to consider the complexity of the cytochrome P450 system and to appreciate insights coming from other fields. Two issues from different fields are comparatively discussed which both have formally in common to reflect the response of the human body on foreign compounds and materials. The former ones are environmental pollutants and drugs, while the latter are solid materials such as titanium, used for orthopedic implants. It will be reviewed that both show rich oxygen chemistry as catalysts and are involved in complex biochemical responses at different regulatory levels in foreign body reactions.

Surface modification of titanium-based alloys with bioactive molecules using electrochemically fixed nucleic acids

A new method of surface modification for titanium (alloys) with bioactive molecules was developed with the intention of providing a new basis of implant adaptation for particular requirements of certain medical indications. Nucleic acid single strands are fixed electrochemically via their termini (regiospecifically) by growing an oxide layer on Ti6Al7Nb anodically. It could be shown that they are accessible to subsequent hybridization with complementary strands at physiological pH. Amount of nucleic acids immobilized and hybridized were determined radioanalytically using 32P-labelled nucleic acids. Stable fixation was attained at and above potentials of 4 V(SCE). Up to 4 pmol/cm2 of nucleic acid single strands could be immobilized and hybridization efficiencies up to 1.0 were reached. Hybridization efficiency was found to depend on surface density of immobilized oligonucleotides, while hybridization rates increased when MgCl2 was added. A conjugate consisting of an oligonucleotide complementary to the immobilized strand and the hexapeptide GRGDSP with RGD as an integrin recognition site was synthesized. This conjugate was able to bind to integrins on osteoblasts. It was shown that this conjugate binds to the anchor strand fixed on Ti6Al7Nb to an extent comparable with the unconjugated complementary strand.

Is surface chemical composition important for orthopaedic implant materials?

Ti-6Al-7Nb (NS) in its 'standard' implant form has been previously shown to be detrimental to fibroblast growth and colonisation on its surface. Specific aspects of the NS topography have been implicated, however, the contribution of its unique surface chemistry to the cell behaviour was unknown. By evaporating either gold or titanium on the surface of standard NS, two different model surface chemistries could be studied with the same characteristic standard NS topography. Two other 'standard' orthopaedic topographies, that of stainless steel (SS) and of 'commercially pure' titanium (TS) were also treated in a similar manner. All materials elicited behaviour similar to their uncoated counterparts. For coated SS and TS, cell proliferation was observed, cells were well spread and displayed mature focal adhesion sites, and associated cytoskeletal components. For coated NS, cell proliferation was compromised, cells remained rounded, filopodia attached and seemed to probe the surface, especially the beta -phase particles, and both the focal adhesion sites and the microtubule network were disrupted by the presence of these particles. These results confirmed, that in the instance of NS, the topography was the primary cause for the observed stunted cell growth. For biomaterials studies, the standardisation of surface chemistry used here is a valuable tool in allowing vastly different materials and surface finishes to be compared solely on the basis of their topography.

The initial attachment and subsequent behavior regulation of osteoblasts by dental implant surface modification

The aim of this study was to investigate the influence of hydrophobic acid-etched (A) and coarse-blasted large-grit and acid-etched (SLA) surfaces as well as hydrophilic modified acid-etched (modA) and modified coarse-blasted large-grit and acid-etched (modSLA) surfaces on the behavior of MG63 cells grown on these surfaces through determination of cell attachment and cell proliferation, time-lapse microscopy of fluorescence-labeled cells, and determination of gene expression by reverse transcription-polymerase chain reaction (RT-PCR). No significant difference of cell attachment on various titanium surfaces was found. Increased cell proliferation was observed on the A surface and the SLA surface compared with the modA surface and the modSLA surface. After 2 days of incubation, on modSLA and modA surfaces a tendency of formation of cell clusters has been observed, which was most pronounced on modSLA surface. On the A and the SLA surface, cell cluster formation started after longer incubation periods. The expression level of the bone-associated genes (alkaline phosphatase, osteocalcin, type-I-collagen, osteoprotegerin, and glyceraldehyde-3-phosphate-dehydrogenase) detected by RT-PCR was highest on the modSLA surface. In conclusion it has been demonstrated that the modSLA surface results in an enhanced cluster formation of osteoblasts grown on this surface and in an increased expression of key osteogenic regulatory genes in osteoblasts.

Biomedical interfaces: titanium surface technology for implants and cell carriers

Titanium and its alloys have become key materials for biomedical applications, mainly owing to their compatibility with human tissues and their mechanical strength. Effects of surface topography on cell and tissue response have been investigated extensively in the past, while (bio)chemical surface modification and its combination with designed topographies have remained largely unexplored. The following report describes some of the strategies used or intended to modify titanium surfaces, based on biological principles, with a focus on ultrathin biomimetic adlayers. One of the visions behind such approaches is to achieve improved healing and integration responses after implantation for patients, especially for those suffering from deficiencies, for example, diabetes or osteoporosis, two diseases that have increased drastically in our society during the last century.

Enhanced bone apposition around biofunctionalized sandblasted and acid-etched titanium implant surfaces. A histomorphometric study in miniature pigs

Microrough titanium (Ti) surfaces of dental implants have demonstrated more rapid and greater bone apposition when compared with machined Ti surfaces. However, further enhancement of osteoblastic activity and bone apposition by bio-functionalizing the implant surface with a monomolecular adsorbed layer of a co-polymer - i.e., poly(L-lysine)-graft-poly(ethylene glycol) (PLL-g-PEG) and its derivatives (PLL-g-PEG/PEG-peptide) - has never been investigated. The aim of the present study was to examine early bone apposition to a modified sandblasted and acid-etched (SLA) surface coated with an Arg-Gly-Asp (RGD)-peptide-modified polymer (PLL-g-PEG/PEG-RGD) in the maxillae of miniature pigs, and to compare it with the standard SLA surface. Test and control implants had the same microrough topography (SLA), but differed in their surface chemistry (polymer coatings). The following surfaces were examined histomorphometrically: (i) control - SLA without coating; (ii) (PLL-g-PEG); (iii) (PLL-g-PEG/PEG-RDG) (RDG, Arg-Asp-Gly); and (iv) (PLL-g-PEG/PEG-RGD). At 2 weeks, RGD-coated implants demonstrated significantly higher percentages of bone-to-implant contact as compared with controls (61.68% vs. 43.62%; P < 0.001). It can be concluded that the (PLL-g-PEG/PEG-RGD) coatings may promote enhanced bone apposition during the early stages of bone regeneration.