Modification of Titanium Implant and Titanium Dioxide for Bone Tissue Engineering

Oxidative stress modulating nanomaterials and their biochemical roles in nanomedicine

Many pathological conditions are predominantly associated with oxidative stress, arising from reactive oxygen species (ROS); therefore, the modulation of redox activities has been a key strategy to restore normal tissue functions. Current approaches involve establishing a favorable cellular redox environment through the administration of therapeutic drugs and redox-active nanomaterials (RANs). In particular, RANs not only provide a stable and reliable means of therapeutic delivery but also possess the capacity to finely tune various interconnected components, including radicals, enzymes, proteins, transcription factors, and metabolites. Here, we discuss the roles that engineered RANs play in a spectrum of pathological conditions, such as cancer, neurodegenerative diseases, infections, and inflammation. We visualize the dual functions of RANs as both generator and scavenger of ROS, emphasizing their profound impact on diverse cellular functions. The focus of this review is solely on inorganic redox-active nanomaterials (inorganic RANs). Additionally, we deliberate on the challenges associated with current RANs-based approaches and propose potential research directions for their future clinical translation.

Reconstruction of Craniomaxillofacial Bone Defects with 3D-Printed Bioceramic Implants: Scoping Review and Clinical Case Series

Reconstruction of craniomaxillofacial bone defects using 3D-printed hydroxyapatite (HA) bioceramic patient-specific implants (PSIs) is a new technique with great potential. This study aimed to investigate the advantages, disadvantages, and clinical outcomes of these implants in craniomaxillofacial surgeries. The PubMed and Embase databases were searched for patients with craniomaxillofacial bone defects treated with bioceramic PSIs. Clinical outcomes such as biocompatibility, biomechanical properties, and aesthetics were evaluated and compared to those of commonly used titanium or poly-ether-ether-ketone (PEEK) implants and autologous bone grafts. Two clinical cases are presented to illustrate the surgical procedure and clinical outcomes of HA bioceramic PSIs. Literature review showed better a biocompatibility of HA PSIs than titanium and PEEK. The initial biomechanical properties were inferior to those of autologous bone grafts, PEEK, and titanium but improved when integrated. Satisfactory aesthetic results were found in our two clinical cases with good stability and absence of bone resorption or infection. Radiological signs of osteogenesis were observed in the two clinical cases six months postoperatively. HA bioceramic PSIs have excellent biocompatible properties and imitate natural bone biomechanically and radiologically. They are a well-suited alternative for conventional biomaterials in the reconstruction of load-sharing bone defects in the craniomaxillofacial region.

Polydopamine-curcumin coating of titanium for remarkable antibacterial activity via synergistic photodynamic and photothermal properties

Combined photothermal therapy (PTT) and photodynamic therapy (PDT) has emerged as a novel and effective antibacterial strategy. In order to endow titanium (Ti) with antibacterial properties, the Ti-PDA-Cur composite was prepared using the excellent adhesion properties of polydopamine (PDA) to load curcumin (Cur) on the surface of Ti. The Ti-PDA-Cur coating can produce singlet oxygen (1O2) and heat under 405 + 808 nm light irradiation, which can effectively kill Staphylococcus aureus and Escherichia coli. Moreover, the cytotoxicity and hemolysis rate of Ti-PDA-Cur were low, indicating its good biocompatibility. Therefore, this study provided a new strategy for the development of new Ti implants.

Influence of Ultrasound on the Characteristics of CaP Coatings Generated Via the Micro-arc Oxidation Process in Relation to Biomedical Engineering

Over the past decade, bone tissue engineering has been at the core of attention because of an increasing number of implant surgeries. The purpose of this study was to obtain coatings on titanium (Ti) implants with improved properties in terms of biomedical applications and to investigate the effect of ultrasound (US) on these properties during the micro-arc oxidation (MAO) process. The influence of various process parameters, such as time and current density, as well as US mode, on the properties of such coatings was evaluated. Novel porous calcium-phosphate-based coatings were obtained on commercially pure Ti. Their microstructure, chemical composition, topography, wettability, nanomechanical properties, thickness, adhesion to the substrate, and corrosion resistance were analyzed. In addition, cytocompatibility evaluation was checked with the human osteoblasts. The properties of the coatings varied significantly, depending on applied process parameters. The US application during the MAO process contributes to the increase of coating thickness, porosity, roughness, and skewness, as well as augmented calcium incorporation. The most advantageous coating was obtained at a current of 136 mA, time 450 s, and unipolar rectangular US, as it exhibits high porosity, adequate wettability, and beneficial skewness, which enabled increased adhesion and proliferation of osteoblasts during in vitro studies. Finally, the conducted research demonstrated the influence of various UMAO process parameters, which allowed for the selection of appropriate Ti implant modification for specific biomedical utilization.

Innovative Anodic Treatment to Obtain Stable Metallic Silver Micropatches on TiO2 Nanotubes: Structural, Electrochemical, and Photochemical Properties

Electrochemical modification of the Ti surface to obtain TiO2 nanotubes (NT-Ti) has been proposed to enhance osseointegration in medical applications. However, susceptibility to microbial adhesion, linked to biomaterial-associated infections, and the high TiO2 band gap energy, which allows light absorption almost exclusively in the ultraviolet (UV) region, limit its applications. Modifying the TiO2 semiconductor with metals such as Ag has been suggested both for antimicrobial purposes and for absorbing light in the visible region. The formation of NT-Ti with Ag micropatches (Ag-NT-Ti) is pursued with the objective of enhancing the stability of the deposits and preventing cytotoxic levels of Ag cellular uptake. The innovative process proposed here involves immersing NT-Ti in a AgNO3 solution as the initial step. Diverging from previously reported electrochemical methods, this process incorporates anodization within the TiO2 oxide formation region instead of cathodic reduction generally employed by other researchers. The final step encompasses an annealing treatment. The treatments result in the in situ Ag1+ reduction and formation of stable and active micropatches of metallic Ag on the NT-Ti surface. Scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), X-ray photoelectron spectroscopy (XPS), Raman, diffuse reflectance spectroscopy (DRS), wettability assessment, and electrochemical characterizations were conducted to evaluate the modified surfaces. The well-known properties of NT-Ti surfaces were enhanced, leading to improved photocatalytic activity across both visible and UV regions, significant stability against detachment, and controlled release of Ag1+ for promising antimicrobial effects.

Effect of Low-Temperature Oxygen Plasma Treatment of Titanium Alloy Surface on Tannic Acid Coating Deposition

In this study, the effect of low-temperature oxygen plasma treatment with various powers of a titanium alloy surface on the structural and morphological properties of a substrate and the deposition of a tannic acid coating was investigated. The surface characteristics of the titanium alloy were evaluated by X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), atomic force microscopy (AFM), and contact angle measurements. Following this, the tannic acid coatings were deposited on the titanium alloy substrates and the structural and morphological properties of the tannic acid coatings deposited were subject to characterization by XPS, SEM, and spectroscopic ellipsometry (SE) measurements. The results show that the low-temperature oxygen plasma treatment of titanium alloys leads to the formation of titanium dioxides that contain -OH groups on the surface being accompanied by a reduction in carbon, which imparts hydrophilicity to the titanium substrate, and the effect increases with the applied plasma power. The performed titanium alloy substrate modification translates into the quality of the deposited tannic acid coating standing out by higher uniformity of the coating, lower number of defects indicating delamination or incomplete bonding of the coating with the substrate, lower number of cracks, thinner cracks, and higher thickness of the tannic acid coatings compared to the non-treated titanium alloy substrate. A similar effect is observed as the applied plasma power increases.

Osteoimmune-modulating and BMP-2-eluting anodised 3D printed titanium for accelerated bone regeneration

3D printing of titanium (Ti) metal has potential to transform the field of personalised orthopaedics and dental implants. However, the impacts of controlled surface topographical features of 3D printed Ti implants on their interactions with the cellular microenvironment and incorporation of biological growth factors, which are critical in guiding the integration of implants with bone, are not well studied. In the present study, we explore the role of surface topological features of 3D printed Ti implants using an anodised titania nanotube (TiNT) surface layer in guiding their immune cell interaction and ability to deliver bioactive form of growth factors. TiNT layers with precisely controlled pore diameter (between 21and 130 nm) were anodically grown on 3D printed Ti surfaces to impart a nano-micro rough topology. Immune biomarker profiles at gene and protein levels show that anodised 3D Ti surfaces with smaller pores resulted in classical activation of macrophages (M1-like), while larger pores (i.e., >100 nm) promoted alternate activation of macrophages (M2-like). The in vitro bone mineralisation studies using the conditioned media from the immunomodulatory studies elucidate a clear impact of pore diameter on bone mineralisation. The tubular structure of TiNTs was utilised as a container to incorporate recombinant human bone morphogenetic protein-2 (BMP-2) in the presence of various sugar and polymeric cryoprotectants. Sucrose offered the most sustainable release of preserved BMP-2 from TiNTs. Downstream effects of released BMP-2 on macrophages as well as bone mineralisation were assessed showing bioactivity retention of the released rhBMP-2. Overall, the TiNT surface topography in combination with controlled, sustained, and local release of bioactive growth factors can potentially enhance the osseointegration outcomes of custom 3D printed Ti implants in the clinic.

Hydrogel-Loaded Exosomes: A Promising Therapeutic Strategy for Musculoskeletal Disorders

Clinical treatment strategies for musculoskeletal disorders have been a hot research topic. Accumulating evidence suggests that hydrogels loaded with MSC-derived EVs show great potential in improving musculoskeletal injuries. The ideal hydrogels should be capable of promoting the development of new tissues and simulating the characteristics of target tissues, with the properties matching the cell-matrix constituents of autologous tissues. Although there have been numerous reports of hydrogels loaded with MSC-derived EVs for the repair of musculoskeletal injuries, such as intervertebral disc injury, tendinopathy, bone fractures, and cartilage injuries, there are still many hurdles to overcome before the clinical application of modified hydrogels. In this review, we focus on the advantages of the isolation technique of EVs in combination with different types of hydrogels. In this context, the efficacy of hydrogels loaded with MSC-derived EVs in different musculoskeletal injuries is discussed in detail to provide a reference for the future application of hydrogels loaded with MSC-derived EVs in the clinical treatment of musculoskeletal injuries.

The effect of green synthesis of TiO2 nanoparticles/collagen/HA scaffold in bone regeneration: As an animal study

BACKGROUND

The bone defects cannot heal by themselves when their range exceeds the critical size defect (CSD). In clinical treatment, significant bone defects are often caused by trauma, developmental deformity, tumour resection and infection.

OBJECTIVES

The purpose of this study was to investigate the effect of green synthesis of TiO2 from propolis extract/collagen/HA (Hydroxyapatite) scaffolds on bone regeneration in rats.

METHODS

Water uptake, biodegradability, porosity and biodegradation of the scaffolds were evaluated after they were synthesised using freeze-dry method. Cell viability by MTT assay was then evaluated. During the 4, 8 and 12 weeks following the scaffold implantation, the bone regeneration was evaluated using macroscopic and microscopic tests to determine the effectiveness of green synthesis of TiO2 from propolis extract/collagen/HA scaffolds.

RESULTS

Compared to the HA/Coll scaffold, ProTiO2 /HA/Coll scaffold was reduced porosity, water absorption and degradability porosity. Based on in vitro tests, both synthetic scaffolds induced cell growth and were less toxic and stimulated cell growth. Based on histopathological testing, the ProTiO2 /HA/Coll scaffolds formed high levels of bone during 12 weeks in comparison with HA/Coll and control group.

CONCLUSIONS

ProTiO2 /HA/Coll composite can be used in regenerative medicine, bone fillers and scaffolds. As a result, this research suggests that ProTiO2 /HA/Coll composites could be promising candidates for bone regeneration.

Adipose-Derived Mesenchymal Stromal Cells: A Tool for Bone and Cartilage Repair

The osteogenic and chondrogenic differentiation ability of adipose-derived mesenchymal stromal cells (ASCs) and their potential therapeutic applications in bone and cartilage defects are reported in this review. This becomes particularly important when these disorders can only be poorly treated by conventional therapeutic approaches, and tissue engineering may represent a valuable alternative. Being of mesodermal origin, ASCs can be easily induced to differentiate into chondrocyte-like and osteocyte-like elements and used to repair damaged tissues. Moreover, they can be easily harvested and used for autologous implantation. A plethora of ASC-based strategies are being developed worldwide: they include the transplantation of freshly harvested cells, in vitro expanded cells or predifferentiated cells. Moreover, improving their positive effects, ASCs can be implanted in combination with several types of scaffolds that ensure the correct cell positioning; support cell viability, proliferation and migration; and may contribute to their osteogenic or chondrogenic differentiation. Examples of these strategies are described here, showing the enormous therapeutic potential of ASCs in this field. For safety and regulatory issues, most investigations are still at the experimental stage and carried out in vitro and in animal models. Clinical applications have, however, been reported with promising results and no serious adverse effects.

Recent advances on 3D-printed PCL-based composite scaffolds for bone tissue engineering

Population ageing and various diseases have increased the demand for bone grafts in recent decades. Bone tissue engineering (BTE) using a three-dimensional (3D) scaffold helps to create a suitable microenvironment for cell proliferation and regeneration of damaged tissues or organs. The 3D printing technique is a beneficial tool in BTE scaffold fabrication with appropriate features such as spatial control of microarchitecture and scaffold composition, high efficiency, and high precision. Various biomaterials could be used in BTE applications. PCL, as a thermoplastic and linear aliphatic polyester, is one of the most widely used polymers in bone scaffold fabrication. High biocompatibility, low cost, easy processing, non-carcinogenicity, low immunogenicity, and a slow degradation rate make this semi-crystalline polymer suitable for use in load-bearing bones. Combining PCL with other biomaterials, drugs, growth factors, and cells has improved its properties and helped heal bone lesions. The integration of PCL composites with the new 3D printing method has made it a promising approach for the effective treatment of bone injuries. The purpose of this review is give a comprehensive overview of the role of printed PCL composite scaffolds in bone repair and the path ahead to enter the clinic. This study will investigate the types of 3D printing methods for making PCL composites and the optimal compounds for making PCL composites to accelerate bone healing.

A novel implant surface modification mode of Fe3O4-containing TiO2 nanorods with sinusoidal electromagnetic field for osteoblastogenesis and angiogenesis

Implants made of Ti and its alloys are widely utilized in orthopaedic surgeries. However, insufficient osseointegration of the implants often causes complications such as aseptic loosening. Our previous research discovered that disordered titanium dioxide nanorods (TNrs) had satisfactory antibacterial properties and biocompatibility, but TNrs harmed angiogenic differentiation, which might retarded the osseointegration process of the implants. Magnetic nanomaterials have a certain potential in promoting osseointegration, electromagnetic fields within a specific frequency and intensity range can facilitate angiogenic and osteogenic differentiation. Therefore, this study used Fe₃O₄ to endow magnetism to TNrs and explored the regulation effects of Ti, TNrs, and Fe₃O₄-TNrs under 1 ​mT 15 ​Hz sinusoidal electromagnetic field (SEMF) on osteoblastogenesis, osseointegration, angiogenesis, and its mechanism. We discovered that after the addition of SEMF treatment to VR-EPCs cultured on Fe₃O₄-TNrs, the calcineurin/NFAT signaling pathway was activated, which then reversed the inhibitory effect of Fe₃O₄-TNrs on angiogenesis. Besides, Fe₃O₄-TNrs with SEMF enhanced osteogenic differentiation and osseointegration. Therefore, the implant modification mode of Fe₃O₄-TNrs with the addition of SEMF could more comprehensively promote osseointegration and provided a new idea for the modification of implants.

Predicting the toxicity of nanoparticles using artificial intelligence tools: a systematic review

Nanoparticles have been used extensively in different scientific fields. Due to the possible destructive effects of nanoparticles on the environment or the biological systems, their toxicity evaluation is a crucial phase for studying nanomaterial safety. In the meantime, experimental approaches for toxicity assessment of various nanoparticles are expensive and time-consuming. Thus, an alternative technique, such as artificial intelligence (AI), could be valuable for predicting nanoparticle toxicity. Therefore, in this review, the AI tools were investigated for the toxicity assessment of nanomaterials. To this end, a systematic search was performed on PubMed, Web of Science, and Scopus databases. Articles were included or excluded based on pre-defined inclusion and exclusion criteria, and duplicate studies were excluded. Finally, twenty-six studies were included. The majority of the studies were conducted on metal oxide and metallic nanoparticles. In addition, Random Forest (RF) and Support Vector Machine (SVM) had the most frequency in the included studies. Most of the models demonstrated acceptable performance. Overall, AI could provide a robust, fast, and low-cost tool for the evaluation of nanoparticle toxicity.

Harnessing electromagnetic fields to assist bone tissue engineering

Bone tissue engineering (BTE) emerged as one of the exceptional means for bone defects owing to it providing mechanical supports to guide bone tissue regeneration. Great advances have been made to facilitate the success of BTE in regenerating bone within defects. The use of externally applied fields has been regarded as an alternative strategy for BTE. Electromagnetic fields (EMFs), known as a simple and non-invasive therapy, can remotely provide electric and magnetic stimulation to cells and biomaterials, thus applying EMFs to assist BTE would be a promising strategy for bone regeneration. When combined with BTE, EMFs improve cell adhesion to the material surface by promoting protein adsorption. Additionally, EMFs have positive effects on mesenchymal stem cells and show capabilities of pro-angiogenesis and macrophage polarization manipulation. These advantages of EMFs indicate that it is perfectly suitable for representing the adjuvant treatment of BTE. We also summarize studies concerning combinations of EMFs and diverse biomaterial types. The strategy of combining EMFs and BTE receives encouraging outcomes and holds a promising future for effectively treating bone defects.

Dental Implants: Enhancing Biological Response Through Surface Modifications

Surface characteristics are an important factor for long-term clinical success of dental implants. Alterations of implant surface characteristics accelerate or improve osseointegration by interacting with the physiology of bone healing. Dental implant surfaces have been traditionally modified at the microlevel. Recently, researchers have actively investigated nano-modifications in dental implants. This review explores implant surface modifications that enhance biological response at the interface between a bone and the implant.

3D Printing of Bioinert Oxide Ceramics for Medical Applications

Three-dimensionally printed metals and polymers have been widely used and studied in medical applications, yet ceramics also require attention. Ceramics are versatile materials thanks to their excellent properties including high mechanical properties and hardness, good thermal and chemical behavior, and appropriate, electrical, and magnetic properties, as well as good biocompatibility. Manufacturing complex ceramic structures employing conventional methods, such as ceramic injection molding, die pressing or machining is extremely challenging. Thus, 3D printing breaks in as an appropriate solution for complex shapes. Amongst the different ceramics, bioinert ceramics appear to be promising because of their physical properties, which, for example, are similar to those of a replaced tissue, with minimal toxic response. In this way, this review focuses on the different medical applications that can be achieved by 3D printing of bioinert ceramics, as well as on the latest advances in the 3D printing of bioinert ceramics. Moreover, an in-depth comparison of the different AM technologies used in ceramics is presented to help choose the appropriate methods depending on the part geometry.

Current applications of adipose-derived mesenchymal stem cells in bone repair and regeneration: A review of cell experiments, animal models, and clinical trials

In the field of orthopaedics, bone defects caused by severe trauma, infection, tumor resection, and skeletal abnormalities are very common. However, due to the lengthy and painful process of related surgery, people intend to shorten the recovery period and reduce the risk of rejection; as a result, more attention is being paid to bone regeneration with mesenchymal stromal cells, one of which is the adipose-derived mesenchymal stem cells (ASCs) from adipose tissue. After continuous subculture and cryopreservation, ASCs still have the potential for multidirectional differentiation. They can be implanted in the human body to promote bone repair after induction in vitro, solve the problems of scarce sources and large damage, and are expected to be used in the treatment of bone defects and non-union fractures. However, the diversity of its differentiation lineage and the lack of bone formation potential limit its current applications in bone disease. Here, we concluded the current applications of ASCs in bone repair, especially with the combination and use of physical and biological methods. ASCs alone have been proved to contribute to the repair of bone damage in vivo and in vitro. Attaching to bone scaffolds or adding bioactive molecules can enhance the formation of the bone matrix. Moreover, we further evaluated the efficiency of ASC-committed differentiation in the bone in conditions of cell experiments, animal models, and clinical trials. The results show that ASCs in combination with synthetic bone grafts and biomaterials may affect the regeneration, augmentation, and vascularization of bone defects on bone healing. The specific conclusion of different materials applied with ASCs may vary. It has been confirmed to benefit osteogenesis by regulating osteogenic signaling pathways and gene transduction. Exosomes secreted by ASCs also play an important role in osteogenesis. This review will illustrate the understanding of scientists and clinicians of the enormous promise of ASCs’ current applications and future development in bone repair and regeneration, and provide an incentive for superior employment of such strategies.

Influence of Magnesium Content on the Physico-Chemical Properties of Hydroxyapatite Electrochemically Deposited on a Nanostructured Titanium Surface

The aim of this research was to obtain hydroxyapatite (HAp)-based coatings doped with different concentrations of Mg on a Ti nanostructured surface through electrochemical techniques and to evaluate the influence of Mg content on the properties of HAp. The undoped and doped HAp-based coatings were electrochemically deposited in galvanostatic pulsed mode on titania nanotubes with a diameter of ~72 nm, being designed to enhance the adhesion of the HAp coatings to the Ti substrate. The obtained materials were investigated by Scanning Electron Microscopy (SEM), Energy Dispersive Spectroscopy (EDS), X-Ray Diffraction (XRD), and Fourier-Transform Infra-Red spectroscopy (FTIR). The adhesion of the coatings to the substrate was also evaluated with the help of the “tape-test” and the micro-scratch test. The morphology (SEM) of all the coatings is made of very thin and narrow ribbon-like crystals, with some alterations with respect to the Mg amount in the coatings. Thus, a concentration of 1 mM of Mg in the electrolyte leads to wider and thicker ribbon-like crystals, while a concentration of 1.5 mM in the electrolyte generated a morphology that resembles the undoped HAp. Both phase composition (XRD) and chemical bonds (FTIR) analysis proved the formation of HAp in all coatings. Moreover, according to XRD, all coatings have a strong orientation toward the (002) plane. Irrespective of the Mg content, all coatings registered an average roughness between approx. 500 and 600 nm, while the coating thickness increased after addition of Mg, from a value of 9.6 μm, for the undoped HAp, to 11.3 μm and ~13.7 μm for H/Mg1 and H/Mg2, respectively. In terms of adhesion, it was shown that the coatings a H/Mg2 had a poorer adhesion when compared to H/Mg1 and the undoped HAp (H), which registered similar adhesion, indicating that a concentration of 1.5 mM of Mg in the electrolyte reduces the adhesion of the Hap-based coatings to the nanostructured surface. The obtained results indicated that Mg concentrations up to 1 mM in the electrolyte can enhance the properties of HAp-based coatings electrochemically deposited on a nanostructured surface, while even a slightly higher concentration of 1.5 mM can negatively impact the characteristics of HAp coatings.

A Bibliometric Analysis of Electrospun Nanofibers for Dentistry

Electrospun nanofibers have been widely used in dentistry due to their excellent properties, such as high surface area and high porosity, this bibliometric study aimed to review the application fields, research status, and development trends of electrospun nanofibers in different fields of dentistry in recent years. All of the data were obtained from the Web of Science from 2004 to 2021. Origin, Microsoft Excel, VOSviewer, and Carrot² were used to process, analyze, and evaluate the publication year, countries/region, affiliations, authors, citations, keywords, and journal data. After being refined by the year of publication, document types and research fields, a total of 378 publications were included in this study, and an increasing number of publications was evident. Through linear regression calculations, it is predicted that the number of published articles in 2022 will be 66. The most published journal about electrospun dental materials is Materials Science & Engineering C-Materials for Biological Applications, among the six core journals identified, the percent of journals with Journal Citation Reports (JCR) Q1 was 60%. A total of 17.60% of the publications originated from China, and the most productive institution was the University of Sheffield. Among all the 1949 authors, the most productive author was Marco C. Bottino. Most electrospun dental nanofibers are used in periodontal regeneration, and Polycaprolactone (PCL) is the most frequently used material in all studies. With the global upsurge in research on electrospun dental materials, bone regeneration, tissue regeneration, and cell differentiation and proliferation will still be the research hotspots of electrospun dental materials in recent years. Extensive collaboration and citations among authors, institutions and countries will also reach a new level.

Three interfaces of the dental implant system and their clinical effects on hard and soft tissues

Anatomically, the human tooth has structures both embedded within and forming part of the exterior surface of the human body. When a tooth is lost, it is often replaced by a dental implant, to facilitate the chewing of food and for esthetic purposes. For successful substitution of the lost tooth, hard tissue should be integrated into the implant surface. The microtopography and chemistry of the implant surface have been explored with the aim of enhancing osseointegration. Additionally, clinical implant success is dependent on ensuring that a barrier, comprising strong gingival attachment to an abutment, does not allow the infiltration of oral bacteria into the bone-integrated surface. Epithelial and connective tissue cells respond to the abutment surface, depending on its surface characteristics and the materials from which it is made. In particular, the biomechanics of the implant-abutment connection structure (i.e., the biomechanics of the interface between implant and abutment surfaces, and the screw mechanics of the implant-abutment assembly) are critical for both the soft tissue seal and hard tissue integration. Herein, we discuss the clinical importance of these three interfaces: bone-implant, gingiva-abutment, and implant-abutment.

Nanostructured Titanium Implant Surface Facilitating Osseointegration from Protein Adsorption to Osteogenesis: The Example of TiO2 NTAs

Titanium implants have been widely applied in dentistry and orthopedics due to their biocompatibility and resistance to mechanical fatigue. TiO₂ nanotube arrays (TiO₂ NTAs) on titanium implant surfaces have exhibited excellent biocompatibility, bioactivity, and adjustability, which can significantly promote osseointegration and participate in its entire path. In this review, to give a comprehensive understanding of the osseointegration process, four stages have been divided according to pivotal biological processes, including protein adsorption, inflammatory cell adhesion/inflammatory response, additional relevant cell adhesion and angiogenesis/osteogenesis. The impact of TiO₂ NTAs on osseointegration is clarified in detail from the four stages. The nanotubular layer can manipulate the quantity, the species and the conformation of adsorbed protein. For inflammatory cells adhesion and inflammatory response, TiO₂ NTAs improve macrophage adhesion on the surface and induce M2-polarization. TiO₂ NTAs also facilitate the repairment-related cells adhesion and filopodia formation for additional relevant cells adhesion. In the angiogenesis and osteogenesis stage, TiO₂ NTAs show the ability to induce osteogenic differentiation and the potential for blood vessel formation. In the end, we propose the multi-dimensional regulation of TiO₂ NTAs on titanium implants to achieve highly efficient manipulation of osseointegration, which may provide views on the rational design and development of titanium implants.

Improved cell adhesion to activated vapor silanization-biofunctionalized Ti-6Al-4V surfaces with ECM-derived oligopeptides

Titanium implants are widely used in traumatology and various orthopedic fields. Titanium and other metallic-based implants have limited structural and functional integration into the body, which translates into progressive prosthesis instability and the need for new surgical interventions that have enormous social and economic impacts. To enhance the biocompatibility of titanium implants, numerous biofunctionalization strategies have been developed. However, the problem persists, as more than 70% of implant failures are due to aseptic loosening. In this study we addressed the problem of improving the physiological engraftability and acceptability of titanium-based implants by applying a robust and versatile functionalization method based on the covalent immobilization of extracellular matrix (ECM)-derived oligopeptides on Ti-6Al-4V surfaces treated by activated vapor silanization (AVS). The feasibility of this technique was evaluated with two oligopeptides of different structures and compositions. These oligopeptides were immobilized on Ti-6Al-4V substrates by a combination of AVS and N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride/N-hydroxysuccinimide (EDC/NHS) crosslinking chemistry. The immobilization was shown to be stable and resistant to chemical denaturing upon sodium dodecyl sulfate treatment. On Ti-6Al-4V surfaces both peptides increased the attachment, spreading, rearrangement and directional growth of mesenchymal stem and progenitor cells (MSC) with chondro- and osteo-regenerative capacities. We also found that this biofunctionalization method (AVS-EDC/NHS) increased the attachment capacity of an immortalized cell line of neural origin with poor adhesive properties, highlighting the versatility and robustness of this method in terms of potential oligopeptides that may be used, and cell lineages whose anchorage to the biomaterial may be enhanced. Collectively, this novel functionalization strategy can accelerate the development of advanced peptide-functionalized metallic surfaces, which, in combination with host or exogenously implanted stem cells, have the potential to positively affect the osteoregenerative and osteointegrative abilities of metallic-based prostheses.

Converging 2D Nanomaterials and 3D Bioprinting Technology: State-of-the-Art, Challenges, and Potential Outlook in Biomedical Applications

The development of next-generation of bioinks aims to fabricate anatomical size 3D scaffold with high printability and biocompatibility. Along with the progress in 3D bioprinting, 2D nanomaterials (2D NMs) prove to be emerging frontiers in the development of advanced materials owing to their extraordinary properties. Harnessing the properties of 2D NMs in 3D bioprinting technologies can revolutionize the development of bioinks by endowing new functionalities to the current bioinks. First the main contributions of 2D NMS in 3D bioprinting technologies are categorized here into six main classes: 1) reinforcement effect, 2) delivery of bioactive molecules, 3) improved electrical conductivity, 4) enhanced tissue formation, 5) photothermal effect, 6) and stronger antibacterial properties. Next, the recent advances in the use of each certain 2D NMs (1) graphene, 2) nanosilicate, 3) black phosphorus, 4) MXene, 5) transition metal dichalcogenides, 6) hexagonal boron nitride, and 7) metal-organic frameworks) in 3D bioprinting technology are critically summarized and evaluated thoroughly. Third, the role of physicochemical properties of 2D NMSs on their cytotoxicity is uncovered, with several representative examples of each studied 2D NMs. Finally, current challenges, opportunities, and outlook for the development of nanocomposite bioinks are discussed thoroughly.

Compressive Strength of Conventional Glass Ionomer Cement Modified with TiO2 Nano-Powder and Marine-Derived HAp Micro-Powder

The aim of this research was to investigate the compressive strength (CS), breaking strength (BS), and compressive modulus (CM) of conventional glass ionomer cement (GIC) modified with TiO₂ nano particles, marine-derived hydroxyapatite (md-HAp) microparticles (<45 µm), and a combination of TiO₂ NP and md-HAp particles. The materials used in the study were conventional GIC Fuji IX GP Extra (GC Corporation, Tokyo, Japan), TiO₂ powder P25 (Degussa, Essen, Germany), and HAp synthesized from cuttlefish bone and ground in a mortar to obtain md-HAp powder. md-HAp was characterized using FTIR and SEM analysis. There were four groups of GIC samples: (i) Fuji IX control group, (ii) powder modified with 3 wt% TiO2, (iii) powder modified with 3 wt% HAp, and (iv) powder modified with 1.5 wt% TiO2 + 1.5 wt% HAp. Measurements were performed in a universal testing machine, and CS, BS, and CM were calculated. Statistical analysis was performed using ANOVA and Tukey’s tests. CS, BS, and CM differed significantly between the Fuji IX control group and all experimental groups while differences between the experimental groups were not statistically significant. The addition of TiO₂ NP, md-HAp micro-sized particles, and a combination of TiO₂ and md-HAp reduced the CS, BS, and CM of conventional GICs when mixed at the powder/liquid (p/l) ratio recommended by the manufacturer.

Toward Bactericidal Enhancement of Additively Manufactured Titanium Implants

Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.

Magnetron sputtering of strontium nanolayer on zirconia implant to enhance osteogenesis

The zirconia implants have a wide range of clinical applications, however, the biological inertness and lack of osteoinductive properties limit these applications. Strontium possesses superior biocompatibility and excellent osteogenic properties. To take advantage of these, the strontium titanate-coated zirconia implants were prepared in this study by sandblasting, acid etching, and magnetron sputtering, followed by the analysis of the biological behavior. Briefly, the zirconia sheets were polished and subjected to sandblasting and acid etching. Subsequently, a nano‑strontium titanate coating was developed on the sheets by magnetron sputtering. The specimens were characterized by scanning electron microscopy (SEM), water contact angle measurement (WCA) and EDS mapping, which confirmed the physical alternation and successful deposition of the strontium titanate coating. The in vitro experiments indicated that the majority of the filopodia and actin fibers of the MC3T3-E1 cells on SA-ZrO₂/Sr possessed an optimal osteogenic property to promote the osteogenic differentiation. Moreover, the RT-PCR results revealed that SA-ZrO₂/Sr significantly up-regulated the gene expression of Runx2, COL-1, ALP, OPG, OPN and OCN. Further, the in vivo evaluation confirmed that the SA-ZrO₂/Sr implants promoted the bone-implant osseointegration to the greatest extent as compared to SA-ZrO₂ and ZrO₂ implant. Overall, the SA-ZrO₂/Sr system was confirmed to be a promising implant, thus, providing new pathways for an effective implant design.

Role of MAPK/JNK signaling pathway on the regulation of biological behaviors of MC3T3‑E1 osteoblasts under titanium ion exposure

The oral cavity is a complex environment that is constantly undergoing remodeling. This provides a favorable electrolytic aqueous condition, which causes the corrosion of titanium implants and the release of titanium (Ti) ions. The accumulation of Ti ions in the peri-implant tissues may affect the osteogenesis process. Therefore, the present study aimed to investigate the possible effects of Ti ions on osteoblast physiology and its underlying mechanism, specifically the MAPK/JNK signaling pathway. In the present study, MC3T3-E1 osteoblasts were cultured the medium containing 10 ppm Ti ions. Confocal laser scanning microscopy was used to analyze cell morphology and adhesion. Alkaline phosphatase (ALP) activity assay and western blotting were performed to evaluate the expression of proteins associated with osteogenesis such as Runx2 and Osterix. Nuclear translocation of JNK, a key factor of the MAPK signaling pathway, was visualized and analyzed using immunofluorescence staining. The results showed that 10 ppm Ti ions exerted negative effects on the biological behaviors of MC3T3-E1 cells, which exhibited reduced adhesion, ALP activity and osteogenic differentiation. It was also found that 10 ppm Ti ions activated the MAPK/JNK signaling pathway by promoting the nuclear translocation of JNK via phosphorylation. In addition, the inhibitory effects of 10 ppm Ti ions on MC3T3-E1 cells was found to be reversed by the JNK inhibitor SP600125. In conclusion, the preset study suggests that the MAPK/JNK signaling pathway serves a key role in the molecular mechanism underlying the changes in osteoblast behavior following Ti ion exposure. These findings may serve as a valuable reference point for the further in-depth exploration of peri-implant bone loss.

Surface Modification Techniques of Titanium and its Alloys to Functionally Optimize Their Biomedical Properties: Thematic Review

Depending on the requirements of specific applications, implanted materials including metals, ceramics, and polymers have been used in various disciplines of medicine. Titanium and its alloys as implant materials play a critical role in the orthopedic and dental procedures. However, they still require the utilization of surface modification technologies to not only achieve the robust osteointegration but also to increase the antibacterial properties, which can avoid the implant-related infections. This article aims to provide a summary of the latest advances in surface modification techniques, of titanium and its alloys, specifically in biomedical applications. These surface techniques include plasma spray, physical vapor deposition, sol-gel, micro-arc oxidation, etc. Moreover, the microstructure evolution is comprehensively discussed, which is followed by enhanced mechanical properties, osseointegration, antibacterial properties, and clinical outcomes. Future researches should focus on the combination of multiple methods or improving the structure and composition of the composite coating to further enhance the coating performance.

Effect of Pore Size on the Physicochemical Properties and Osteogenesis of Ti6Al4V Porous Scaffolds with Bionic Structure

Ti6Al4V is widely used in implants in the fields of orthopedics and dentistry due to its high compressive strength and good biocompatibility. Nevertheless, Ti6Al4V has a certain degree of biological inertness and the elastic modulus of Ti6Al4V is much higher than the cortex and trabecular bone. In this study, we designed and printed a new type of pore size Ti6Al4V with like-trabecular structure scaffold (the pore size is 800/900/1000 μm, named P8/P9/P10, respectively) with electron beam melting (EBM). Its elastic modulus, compressive strength, and other physical and chemical properties, as well as cell adhesion, proliferation, and differentiation ability and in vitro biological properties were studied. The physical and chemical performance test results showed that as the pore size increased, the surface wettability increased and the elastic modulus decreased. As the pore size increased, F-actin and alkaline phosphatase (ALP) increased significantly, and osteogenesis-related genes including BMP2, OCN, RUNX2, and ALP were upregulated significantly. The reason may be that the components on the Ti6Al4V pore size may have an influence on intracellular signal conversion and then change the mode of cell proliferation and diffusion. In summary, the like-trabecular porous structure can effectively reduce the elastic modulus of metal materials, thereby avoiding stress concentration and promoting the adhesion and proliferation of osteoblasts. Porous materials with larger pores are more conducive to the proliferation and differentiation of osteoblasts. The irregular porous Ti6Al4V scaffold prepared by the EBM technology has good mechanical properties and the potential to promote adhesion, proliferation, and differentiation of osteoblasts, and has the possibility of application in the field of implantation.

Innovative Human Three-Dimensional Tissue-Engineered Models as an Alternative to Animal Testing

Animal testing has long been used in science to study complex biological phenomena that cannot be investigated using two-dimensional cell cultures in plastic dishes. With time, it appeared that more differences could exist between animal models and even more when translated to human patients. Innovative models became essential to develop more accurate knowledge. Tissue engineering provides some of those models, but it mostly relies on the use of prefabricated scaffolds on which cells are seeded. The self-assembly protocol has recently produced organ-specific human-derived three-dimensional models without the need for exogenous material. This strategy will help to achieve the 3R principles.

Nanomaterial-based scaffolds for bone tissue engineering and regeneration

The global incidence of bone tissue injuries has been increasing rapidly in recent years, making it imperative to develop suitable bone grafts for facilitating bone tissue regeneration. It has been demonstrated that nanomaterials/nanocomposites scaffolds can more effectively promote new bone tissue formation compared with micromaterials. This may be attributed to their nanoscaled structural and topological features that better mimic the physiological characteristics of natural bone tissue. In this review, we examined the current applications of various nanomaterial/nanocomposite scaffolds and different topological structures for bone tissue engineering, as well as the underlying mechanisms of regeneration. The potential risks and toxicity of nanomaterials will also be critically discussed. Finally, some considerations for the clinical applications of nanomaterials/nanocomposites scaffolds for bone tissue engineering are mentioned.

In vitro evaluation of a novel nanostructured Ti-36Nb-6Ta alloy for orthopedic applications

Aim: To evaluate the impact of a nanostructured surface created on β-titanium alloy, Ti-36Nb-6Ta, on the growth and differentiation of human mesenchymal stem cells. Materials & methods: The nanotubes, with average diameters 18, 36 and 46 nm, were prepared by anodic oxidation. Morphology, hydrophilicity and mechanical properties of the nanotube layers were characterized. The biocompatibility and osteogenic potential of the nanostructured surfaces were established using various in vitro assays, scanning electron microscopy and confocal microscopy. Results: The nanotubes lowered elastic modulus close to that of bone, positively influenced cell adhesion, improved ALP activity, synthesis of type I collagen and osteocalcin expression, but diminished early cell proliferation. Conclusion: Nanostructured Ti-36Nb-6Ta with nanotube diameters 36 nm was the most promising material for bone implantation.

Phase-Selective and Localized TiO2 Coating on Additive and Wrought Titanium by a Direct Laser Surface Modification Approach

Titanium has been the material of interest in biological implant applications due to its unique mechanical properties and biocompatibility. Their design is now growing rapidly due to the advent of additive manufacturing technology that enables the fabrication of complex and patient-customized parts. Titanium dioxides (TiO2) coatings with different phases (e.g., anatase, rutile) and morphologies have shown to be effective in enhancing osteointegration and antibacterial behavior. This enhanced antibacterial behavior stems from the photocatalytic activity generated from crystalline TiO2 coatings. Anatase has commonly been shown to be a more photocatalytic oxide phase compared to rutile despite its larger band gap. However, more recent studies have suggested that a synergistic effect leading to increased photocatalytic activity may be produced with a combination of oxides containing both anatase and rutile phases. Here, we demonstrate the selective and localized formation of TiO2 nanostructures on additive and wrought titanium parts with anatase, rutile, and mixed phases by a laser-induced transformation approach. Compared to conventional coating processes, this technique produces desired TiO2 phases simply by controlled laser irradiation of titanium parts in an oxygen environment, where needed. The effects of processing conditions such as laser power, scanning speed, laser pulse duration, frequency, and gas flow on the selective transformation were studied. The morphological and structural evolutions were investigated using various characterization techniques. This method is specifically of significant interest in creating phase-selective TiO2 surfaces on titanium-based bioimplants, including those fabricated by additive manufacturing technologies.

Toxicity of TiO2 Nanoparticles: Validation of Alternative Models

There are many studies concerning titanium dioxide (TiO₂) nanoparticles (NP) toxicity. Nevertheless, there are few publications comparing in vitro and in vivo exposure, and even less comparing air–liquid interface exposure (ALI) with other in vitro and in vivo exposures. The identification and validation of common markers under different exposure conditions are relevant for the development of smart and quick nanotoxicity tests. In this work, cell viability was assessed in vitro by WST-1 and LDH assays after the exposure of NR8383 cells to TiO₂ NP sample. To evaluate in vitro gene expression profile, NR8383 cells were exposed to TiO₂ NP during 4 h at 3 cm² of TiO₂ NP/cm² of cells or 19 μg/mL, in two settings—submerged cultures and ALI. For the in vivo study, Fischer 344 rats were exposed by inhalation to a nanostructured aerosol at a concentration of 10 mg/m³, 6 h/day, 5 days/week for 4 weeks. This was followed immediately by gene expression analysis. The results showed a low cytotoxic potential of TiO₂ NP on NR8383 cells. Despite the absence of toxicity at the doses studied, the different exposures to TiO₂ NP induce 18 common differentially expressed genes (DEG) which are involved in mitosis regulation, cell proliferation and apoptosis and inflammation transport of membrane proteins. Among these genes, we noticed the upregulation of Ccl4, Osm, Ccl7 and Bcl3 genes which could be suggested as early response biomarkers after exposure to TiO₂ NP. On the other hand, the comparison of the three models helped us to validate the alternative ones, namely submerged and ALI approaches.

Improved osteogenic differentiation of human amniotic mesenchymal stem cells on gradient nanostructured Ti surface

Titanium (Ti) and Ti-based alloys are widely used in the manufacture of dental and orthopedic implants. However, how to improve their osteogenic differentiation ability is still a key issue to be resolved. In this study, gradient nanostructured surface (GNS) samples were prepared by surface mechanical grinding treatment, and coarse-grained (CG) samples were obtained by recrystallization annealing, making sure that the two kinds of specimens had similar roughness. Then, human amniotic mesenchymal stem cells (hAMSCs) were cocultured with the two kinds of Ti to investigate the material effects on the cellular functions. The results demonstrated that the grains with size ~56 nm were formed on the surface of the GNS Ti, and the grain size gradually increases from the sample surface to interior. Compared to the CG samples, the GNS ones could make the adhesion effect of the hAMSCs better, and promote the cell proliferation and osteogenic differentiation more significantly, the preliminary mechanism of which might be due to their specific nanostructure, the thicker oxide layer formed on their surface and the enhanced hardness. Our results indicated that the gradient nanostructured Ti materials could enhance both osteogenic differentiation and mechanical properties, which may possess broader applications in bone tissue engineering and clinical implanting.

Icariin/Aspirin Composite Coating on TiO2 Nanotubes Surface Induce Immunomodulatory Effect of Macrophage and Improve Osteoblast Activity

Surface coating modification of titanium-based alloys is an efficient way to accelerate early osseointegration in dental implant fields. Icariin (ICA) is a traditional Chinese medicine that has bone activating functions, while aspirin (ASP) is a classical non-steroidal anti-inflammatory drug with good antipyretic and analgesic capabilities. Moreover, poly(lactic–co–glycolic acid) (PLGA) has attracted great attention due to its excellent biocompatibility and biodegradability. We superimposed an ASP/PLGA coating onto ICA loaded TiO2 nanotubes structure so as to establish an icariin/aspirin composite coating on TiO2 nanotubes surface. Scanning electron microscopy, X-ray photoelectron spectroscopy, a contact angle test and a drug release test confirmed the successful preparation of the NT–ICA–ASP/PLGA substrate, with a sustained release pattern of both ICA and ASP. Compared to those cultured on the Ti surface, macrophage cells on the NT-ICA-ASP/PLGA substrate displayed decreased M1 proinflammatory and enhanced M2 proregenerative genes and proteins expression, which implied activated immunomodulatory effect. Moreover, when cultured with conditioned medium from macrophages, osteoblast cells on the NT-ICA-ASP/PLGA substrate revealed improved cell proliferation, adhesion and osteogenic genes and proteins expression, compared with those on the Ti surface. The abovementioned results suggest that the established NT-ICA-ASP/PLGA substrate is a promising candidate for functionalized coating material in Ti implant surface modification.

Involvement of TGF-β and ROS in G1 Cell Cycle Arrest Induced by Titanium Dioxide Nanoparticles Under UVA Irradiation in a 3D Spheroid Model

Background

As one of the most widely produced engineered nanomaterials, titanium dioxide nanoparticles (nano-TiO₂) are used in biomedicine and healthcare products, and as implant scaffolds; therefore, the toxic mechanism of nano-TiO₂ has been extensively investigated with a view to guiding application. Three-dimensional (3D) spheroid models can simplify the complex physiological environment and mimic the in vivo architecture of tissues, which is optimal for the assessment of nano-TiO₂ toxicity under ultraviolet A (UVA) irradiation.

Methods and Results

In the present study, the toxicity of nano-TiO₂ under UVA irradiation was investigated in 3D H22 spheroids cultured in fibrin gels. A significant reduction of approximately 25% in spheroid diameter was observed following treatment with 100 μg/mL nano-TiO₂ under UVA irradiation after seven days of culture. Nano-TiO₂ under UVA irradiation triggered the initiation of the TGF-β/Smad signaling pathway, increasing the expression levels of TGF-β1, Smad3, Cdkn1a, and Cdkn2b at both the mRNA and protein level, which resulted in cell cycle arrest in the G1 phase. In addition, nano-TiO₂ under UVA irradiation also triggered the production of reactive oxygen species (ROS), which were shown to be involved in cell cycle regulation and the induction of TGF-β1 expression.

Conclusion

Nano-TiO₂ under UVA irradiation induced cell cycle arrest in the G1 phase and the formation of smaller spheroids, which were associated with TGF-β/Smad signaling pathway activation and ROS generation. These results reveal the toxic mechanism of nano-TiO₂ under UVA irradiation, providing the possibility for 3D spheroid models to be used in nanotoxicology studies.

Modifications of Dental Implant Surfaces at the Micro- and Nano-Level for Enhanced Osseointegration

This review paper describes several recent modification methods for biocompatible titanium dental implant surfaces. The micro-roughened surfaces reviewed in the literature are sandblasted, large-grit, acid-etched, and anodically oxidized. These globally-used surfaces have been clinically investigated, showing survival rates higher than 95%. In the past, dental clinicians believed that eukaryotic cells for osteogenesis did not recognize the changes of the nanostructures of dental implant surfaces. However, research findings have recently shown that osteogenic cells respond to chemical and morphological changes at a nanoscale on the surfaces, including titanium dioxide nanotube arrangements, functional peptide coatings, fluoride treatments, calcium–phosphorus applications, and ultraviolet photofunctionalization. Some of the nano-level modifications have not yet been clinically evaluated. However, these modified dental implant surfaces at the nanoscale have shown excellent in vitro and in vivo results, and thus promising potential future clinical use.

Waiting for Aπαταω: 250 Years Later

Scientific articles have been traditionally written from single points of view. In contrast, new knowledge is derived strictly from a dialectical process, through interbreeding of partially disparate perspectives. Dialogues, therefore, present a more veritable form for representing the process behind knowledge creation. They are also less prone to dogmatically disseminate ideas than monologues, alongside raising awareness of the necessity for discussion and challenging of differing points of view, through which knowledge evolves. Here we celebrate 250 years since the discovery of the chemical identity of the inorganic component of bone in 1769 by Johan Gottlieb Gahn through one such imaginary dialogue between two seasoned researchers and aficionados of this material. We provide the statistics on ups and downs in the popularity of this material throughout the history and also discuss important achievements and challenges associated with it. The shadow of Samuel Beckett's Waiting for Godot is cast over the dialogue, acting as its frequent reference point and the guide. With this dialogue presented in the format of a play, we provide hope that conversational or dramaturgical compositions of scientific articles - albeit virtually prohibited from the scientific literature of the day - may become more pervasive in the future.