Novel production method of porous surface Ti samples for biomedical application

A porous swelling copolymeric material for improved implant fixation to bone

Most metallic commercial bone anchors, such as screws and suture anchors achieve their fixation to bone through shear of the bone located between the threads. They have several deficiencies, potentially leading to failure, which are particularly evident in low-density bone. These include stress-shielding resulting from mechanical properties mismatch; lack of mechanically induced remodeling and osteointegration; and when the pullout force on the anchor, during functional activities, exceeds their pullout strength, catastrophic failure occurs leaving behind large bone defects that may be hard to repair. To overcome these deficiencies, we introduced in this study a porous swelling co-polymeric material and studied its swelling and compressive mechanical characteristics as bone anchor under different configurations. Porosity was achieved by adding a non-dissolvable agent (NaCl) during the process of polymerization, which was later dissolved in water, leaving behind a porous structure with adequate porosity for osteointegration. Three different groups of cylindrical samples of the swelling co-polymer were investigated. Solid, fully porous, and partially porous with a solid core and a porous outer layer. The results of the swelling and simple compression study show that the partially porous swelling co-polymer maintains excellent mechanical properties matching those of cancellous bone, quick swelling response, and an adequate porous outer layer for mechanically induced osteointegration. These suggest that this material may present an effective alternative to conventional bone anchors particularly in low-density bone.

Bioactivity of an Experimental Dental Implant with Anodized Surface

Background: Several studies proved that anodic oxidation improves osseointegration. This study aimed to optimize osseointegration through anodization in dental implants, obtaining anatase phase and controlled nanotopography. Methods: The division of the groups with 60 titanium implants was: control (CG); sandblasted (SG); anodized (AG): anodized pulsed current (duty cycle 30%, 30 V, 0.2 A and 1000 Hz). Before surgery, surface characterization was performed using Atomic Force Microscopy (AFM), Scanning Electron Microscopy (SEM), X-ray Dispersive Energy Spectroscopy (EDS) and Raman Spectroscopy. For in vivo tests, 10 New Zealand white rabbits received an implant from each group. The sacrifice period was 2 and 6 weeks (n = 5) and the specimens were subjected to computed microtomography (μCT) and reverse torque test. Results: AFM and SEM demonstrated a particular nanotopography on the surface in AG; the anatase phase was proved by Raman spectroscopy. In the μCT and in the reverse torque test, the AG group presented better results than the other groups. Conclusion: The chemical composition and structure of the TiO₂ film were positively affected by the anodizing technique, intensifying the biological characteristics in osseointegration.

Mineralization of Titanium Surfaces: Biomimetic Implants

The surface modification by the formation of apatitic compounds, such as hydroxyapatite, improves biological fixation implants at an early stage after implantation. The structure, which is identical to mineral content of human bone, has the potential to be osteoinductive and/or osteoconductive materials. These calcium phosphates provoke the action of the cell signals that interact with the surface after implantation in order to quickly regenerate bone in contact with dental implants with mineral coating. A new generation of calcium phosphate coatings applied on the titanium surfaces of dental implants using laser, plasma-sprayed, laser-ablation, or electrochemical deposition processes produces that response. However, these modifications produce failures and bad responses in long-term behavior. Calcium phosphates films result in heterogeneous degradation due to the lack of crystallinity of the phosphates with a fast dissolution; conversely, the film presents cracks, which produce fractures in the coating. New thermochemical treatments have been developed to obtain biomimetic surfaces with calcium phosphate compounds that overcome the aforementioned problems. Among them, the chemical modification using biomineralization treatments has been extended to other materials, including composites, bioceramics, biopolymers, peptides, organic molecules, and other metallic materials, showing the potential for growing a calcium phosphate layer under biomimetic conditions.

Gradient nanostructured titanium stimulates cell responses in vitro and enhances osseointegration in vivo

Background

Though titanium (Ti) is widely used as dental materials in the clinic, effective methods to treat Ti for higher surface biological activity still lack. Through Surface mechanical attrition treatment (SMAT) technology we could endow Ti with gradient nanostructured surface (GNS Ti). To investigate the biocompatibility of GNS Ti for its further application in dental implant field, we study the effects of GNS Ti on cell responses in vitro and osseointegration of the implant with surrounding bone tissues in vivo.

Methods

In this study, GNS Ti was fabricated by SMAT. In vitro experiment, we co-cultured GNS Ti with bone mesenchymal stem cells (BMSCs), surface characterization was detected by transmission electron microscope (TEM). Adhesion, proliferation and differentiation of BMSCs were evaluated by scanning electron microscope (SEM), MTT, flow cytometry (FCM), alkaline phosphatase (ALP) and osteocalcin (OCN) tests. In vivo experiment, the GNS Ti was implanted into the rabbit mandible. Osteogenesis and osseointegration were evaluated by Micro CT, toluidine blue staining, and immunohistochemical staining at 4, 8, and 12 weeks postoperatively.

Results

Both results showed that compared with the coarse grained (CG) Ti, the GNS Ti stimulated the adhesion, proliferation, and differentiation of BMSCs and improved osteogenesis and osseointegration.

Conclusions

This study indicates that gradient nanostructured Ti is a promising material for dental implant application.

Chitosan/hydroxyapatite composite coatings on porous Ti6Al4V titanium implants: in vitro and in vivo studies

Purpose

Titanium implants are widely used in the treatment of dentition defects; however, due to problems such as osseointegration failure, peri-implant bone resorption, and peri-implant inflammation, their application is subject to certain restrictions. The surface modification of titanium implants can improve the implant success rate and meet the needs of clinical applications. The goal of this study was to evaluate the effect of the use of porous titanium with a chitosan/hydroxyapatite coating on osseointegration.

Methods

Titanium implants with a dense core and a porous outer structure were prepared using a computer-aided design model and selective laser sintering technology, with a fabricated chitosan/hydroxyapatite composite coating on their surfaces. In vivo and in vitro experiments were used to assess osteogenesis.

Results

The quasi-elastic gradient and compressive strength of porous titanium implants were observed to decrease as the porosity increased. The in vitro experiments demonstrated that, the porous titanium implants had no biological toxicity; additionally, the porous structure was shown to be superior to dense titanium with regard to facilitating the adhesion and proliferation of osteoblast-like MC3T3-E1 cells. The in vivo experimental results also showed that the porous structure was beneficial, as bone tissue could grow into the pores, thereby exhibiting good osseointegration.

Conclusions

Porous titanium with a chitosan/hydroxyapatite coating promoted MC3T3-E1 cell proliferation and differentiation, and also improved osseointegration in vitro. This study has meaningful implications for research into ways of improving the surface structures of implants and promoting implant osseointegration.

Influence of Titanium Alloy Scaffolds on Enzymatic Defense against Oxidative Stress and Bone Marrow Cell Differentiation

Studies have been directed towards the production of new titanium alloys, aiming for the replacement of Ti-6 Aluminium-4 Vanadium (TiAlV) alloy in the future. Many mechanisms related to biocompatibility and chemical characteristics have been studied in the field of implantology, but enzymatic defenses against oxidative stress remain underexplored. Bone marrow stromal cells have been explored as source of cells, which have the potential to differentiate into osteoblasts and therefore could be used as cells-based therapy. The objective of this study was to evaluate the activity of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) in porous scaffolds of Ti-6 Aluminium-4 Vanadium (TiAlV), Ti-35 Niobium (TiNb), and Ti-35 Niobium-7 Zirconium-5 Tantalum (TiNbZrTa) on mouse bone marrow stromal cells. Porous titanium alloy scaffolds were prepared by powder metallurgy. After 24 hours, cells plated on the scaffolds were analyzed by scanning electron microscopy (SEM). The antioxidant enzyme activity was measured 72 hours after cell plating. Quantitative real time PCR (qRT-PCR) was performed after 3, 7, and 14 days, and Runx2 (Runt-related transcription factor2) expression was evaluated. The SEM images showed the presence of interconnected pores and growth, adhesion, and cell spreading in the 3 scaffolds. Although differences were noted for SOD and CAT activity for all scaffolds analyzed, no statistical differences were observed (p > 0.05). The osteogenic gene Runx2 presented high expression levels for TiNbZrTa at day 7, compared to the control group (TiAlV day 3). At day 14, all scaffolds had more than 2-fold induction for Runx2 mRNA levels, with statistically significant differences compared to the control group. Even though we were not able to confirm statistically significant differences to justify the replacement of TiAlV regarding antioxidant enzymes, TiNbZrTa was able to induce faster bone formation at early time points, making it a good choice for biomedical and tissue bioengineering applications.

Titanium alloys: in vitro biological analyzes on biofilm formation, biocompatibility, cell differentiation to induce bone formation, and immunological response

Biological effects of titanium (Ti) alloys were analyzed on biofilms of Candida albicans, Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus mutans, and Streptococcus sanguinis, as well as on osteoblast-like cells (MG63) and murine macrophages (RAW 264.7). Standard samples composed of aluminum and vanadium (Ti-6Al-4V), and sample containing niobium (Ti-35Nb) and zirconium (Ti-13Nb-13Zr) were analyzed. Monomicrobial biofilms were formed on the Ti alloys. MG63 cells were grown with the alloys and the biocompatibility (MTT), total protein (TP) level, alkaline phosphatase (ALP) activity, and mineralization nodules (MN) formation were verified. Levels of interleukins (IL-1β and IL-17), tumor necrosis factor alpha (TNF-α), and oxide nitric (NO) were checked, from RAW 264.7 cells supernatants. Data were statically analyzed by one-way analysis of variance (ANOVA) and Tukey's test, or T-test (P ≤ 0.05). Concerning the biofilm formation, Ti-13Nb-13Zr alloy showed the best inhibitory effect on E. faecalis, P. aeruginosa, and S. aureus. And, it also acted similarly to the Ti-6Al-4V alloy on C. albicans and Streptococcus spp. Both alloys were biocompatible and similar to the Ti-6Al-4V alloy. Additionally, Ti-13Nb-13Zr alloy was more effective for cell differentiation, as observed in the assays of ALP and MN. Regarding the stimulation for release of IL-1β and TNF-α, Ti-35Nb and Ti-13Nb-13Zr alloys inhibited similarly the synthesis of these molecules. However, both alloys stimulated the production of IL-17. Additionally, all Ti alloys showed the same effect for NO generation. Thus, Ti-13Nb-13Zr alloy was the most effective for inhibition of biofilm formation, cell differentiation, and stimulation for release of immune mediators.

In vitro and in vivo biological performance of porous Ti alloys prepared by powder metallurgy

Titanium (Ti) and Ti-6 Aluminium-4 Vanadium alloys are the most common materials in implants composition but β type alloys are promising biomaterials because they present better mechanical properties. Besides the composition of biomaterial, many factors influence the performance of the biomaterial. For example, porous surface may modify the functional cellular response and accelerate osseointegration. This paper presents in vitro and in vivo evaluations of powder metallurgy-processed porous samples composed by different titanium alloys and pure Ti, aiming to show their potential for biomedical applications. The porous surfaces samples were produced with different designs to in vitro and in vivo tests. Samples were characterized with scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and elastic modulus analyses. Osteogenic cells from newborn rat calvaria were plated on discs of different materials: G1—commercially pure Ti group (CpTi); G2—Ti-6Al-4V alloy; G3—Ti-13 Niobium-13 Zirconium alloy; G4—Ti-35 Niobium alloy; G5—Ti-35 Niobium-7 Zirconium-5 Tantalum alloy. Cell adhesion and viability, total protein content, alkaline phosphatase activity, mineralization nodules and gene expression (alkaline phosphatase, Runx-2, osteocalcin and osteopontin) were assessed. After 2 and 4 weeks of implantation in rabbit tibia, bone ingrowth was analyzed using micro-computed tomography (μCT). EDS analysis confirmed the material production of each group. Metallographic and SEM analysis revealed interconnected pores, with mean pore size of 99,5μm and mean porosity of 42%, without significant difference among the groups (p>0.05). The elastic modulus values did not exhibit difference among the groups (p>0.05). Experimental alloys demonstrated better results than CpTi and Ti-6Al-4V, in gene expression and cytokines analysis, especially in early experimental periods. In conclusion, our data suggests that the experimental alloys can be used for biomedical application since they contributed to excellent cellular behavior and osseointegration besides presenting lower elastic modulus.

3D bioprinting of GelMA scaffolds triggers mineral deposition by primary human osteoblasts

Due to its relatively low level of antigenicity and high durability, titanium has successfully been used as the major material for biological implants. However, because the typical interface between titanium and tissue precludes adequate transmission of load into the surrounding bone, over time, load-bearing implants tend to loosen and revision surgeries are required. Osseointegration of titanium implants requires presentation of both biological and mechanical cues that promote attachment of and trigger mineral deposition by osteoblasts. While many factors contribute to differentiation, the relative importance of the various cues is unclear. To substantially improve osseointegration of titanium implants, we generated a gelatin methacryloyl (GelMA) scaffold, using an extrusion-based 3D bioprinter, which can be directly printed on and grafted to the titanium implant surface. We demonstrate that this scaffold is able to trigger mineral deposition of both MG63 osteoblasts and primary normal human osteoblasts in the absence of any exogenous osteogenic factors. Films of the same formulation failed to promote mineral deposition suggesting that the three dimensional scaffold was able to tip the balance in favor of differentiation despite other potentially unfavorable differentiation cues of the material. We further show that these GelMA lattices can be directly grafted to titanium alloy and are secure in vitro over a period of seven weeks. When grafted within a groove system, the GelMA hydrogel is protected from shearing forces in a marrow implantation model. This prepares the way for osteogenic coatings to be directly manufactured on the implant surface and packaged for surgery.

In vivo testing of porous Ti-25Nb alloy serving as a femoral stem prosthesis in a rabbit model

The aim of the present study was to observe the performance of Ti-25Nb alloys with various porosities as femoral stem prostheses in a rabbit model, thus providing basic experimental evidence for the development of porous prostheses. The porous Ti-25Nb alloy prostheses were designed according to the morphology of the medullary cavity. These prostheses were placed into the femoral medullary cavities in 36 New Zealand white rabbits. Postoperative X-ray films, scanning electron microscopy (SEM) of the implant interface, energy-dispersive spectroscopy (EDS) analysis of the implant surface, pulling-out test and general observations were conducted. The specimens showed good biocompatibility; there was no obvious bone absorption in porous Ti-25Nb specimens with different porosities at different time points observed using X-ray films. Under SEM examination, calcium deposits were observed inside the pores and in the interface between bone and prostheses. The EDS analysis demonstrated that calcium deposits were present on the surface of the prostheses at the eight-week point postoperatively. The pulling-out test showed good bonding strength between bone and implant; after pulling out, the surface and inside the pores of the prostheses all presented bone mass. Porous Ti-25Nb alloy implants presents good biocompatibility as well as providing a biological fixation between the bone and implant. A porosity of 70% is more advantageous to the newborn bone ingrowth, combined with achieving a more solid bone-implant interface.

Titanium scaffold osteogenesis in healthy and osteoporotic rats is improved by the use of low-level laser therapy (GaAlAs)

The present study aimed to assess the effects of low-level laser therapy (GaAlAs) on the bone repair process within titanium scaffolds in the femurs of healthy and osteoporotic rats. Fifty-six rats were divided into four groups: group Sh: SHAM animals that received scaffolds; group LSh: SHAM animals that received scaffolds and were subjected to laser therapy; group OV: ovarietomized (OVX) animals that received scaffolds; and group LOV: OVX animals that received scaffolds and were subjected to laser therapy. Thirty days following ovariectomy or sham surgery, scaffolds were implanted in the left femurs of all animals in the study. Immediately after opening the surgical site, the inner part of the surgical cavity was stimulated with low-level laser (GaAlAs). In addition to this procedure, the laser group was also subjected to sessions of low-level laser therapy (LLLT) at 48-h intervals, with the first session performed immediately after surgery. The rats were sacrificed at 2 and 6 weeks, time in which femur fragments were submitted for histological and histomorphometric examination, and skin tissue above the scaffold was submitted to histological analysis. At the end of the study, greater bone formation was observed in the animals submitted to LLLT. At 2 and 6 weeks, statistically significant differences were observed between LSh and Sh groups (p = 0.009 and 0.0001) and LOV and OV (p = 0.0001 and 0.0001), respectively. No statistical difference was observed when assessing the estrogen variable. On the basis of our methodology and results, we conclude that LLLT improves and accelerates bone repair within titanium scaffolds in both ovariectomized and healthy rats, when compared to animals not subjected to radiation.

Porous titanium and Ti-35Nb alloy: effects on gene expression of osteoblastic cells derived from human alveolar bone

Tests on titanium alloys that possess low elastic modulus, corrosion resistance and minimal potential toxicity are ongoing. This study aimed to evaluate the behavior of human osteoblastic cells cultured on dense and porous Titanium (Ti) samples comparing to dense and porous Ti-35 Niobium (Ti-35Nb) samples, using gene expression analysis. Scanning electronic microscopy confirmed surface porosity and pore interconnectivity and X-ray diffraction showed titanium beta-phase stabilization in Ti-35Nb alloy. There were no differences in expression of transforming growth factor-β, integrin-β1, alkaline phosphatase, osteopontin, macrophage colony stimulating factor, prostaglandin E synthase, and apolipoprotein E regarding the type of alloy, porosity and experimental period. The experimental period was a significant factor for the markers: bone sialoprotein II and interleukin 6, with expression increasing over time. Porosity diminished Runt-related transcription factor-2 (Runx-2) expression. Cells adhering to the Ti-35Nb alloy showed statistically similar expression to those adhering to commercially pure Ti grade II, for all the markers tested. In conclusion, the molecular mechanisms of interaction between human osteoblasts and the Ti-35Nb alloy follow the principal routes of osseointegration of commercially pure Ti grade II. Porosity impaired the route of transcription factor Runx-2.

Titanium-35niobium alloy as a potential material for biomedical implants: In vitro study

Research on new titanium alloys and different surface topographies aims to improve osseointegration. The objective of this study is to analyze the behavior of osteogenic cells cultivated on porous and dense samples of titanium-niobium alloys, and to compare them with the behavior of such type of cells on commercial pure titanium. Samples prepared using powder metallurgy were characterized using scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), X-ray diffraction (XRD), and metallographic and profilometer analyses. Osteogenic cells from newborn rat calvaria were plated over different groups: dense or porous samples composed of Ti or Ti-35niobium (Nb). Cell adhesion, cell proliferation, MTT assay, cell morphology, protein total content, alkaline phosphatase activity, and mineralization nodules were assessed. Results from XRD and EDS analysis confirmed the presence of Ti and Nb in the test alloy. Metallographic analysis revealed interconnected pores, with pore size ranging from 138 to 150μm. The profilometer analysis detected the greatest rugosity within the dense alloy samples. In vitro tests revealed similar biocompatibility between Ti-35Nb and Ti; furthermore, it was possible to verify that the association of porous surface topography and the Ti-35Nb alloy positively influenced mineralized matrix formation. We propose that the Ti-35Nb alloy with porous topography constitutes a biocompatible material with great potential for use in biomedical implants.

Fabrication of Metallic Biomedical Scaffolds with the Space Holder Method: A Review

Bone tissue engineering has been increasingly studied as an alternative approach to bone defect reconstruction. In this approach, new bone cells are stimulated to grow and heal the defect with the aid of a scaffold that serves as a medium for bone cell formation and growth. Scaffolds made of metallic materials have preferably been chosen for bone tissue engineering applications where load-bearing capacities are required, considering the superior mechanical properties possessed by this type of materials to those of polymeric and ceramic materials. The space holder method has been recognized as one of the viable methods for the fabrication of metallic biomedical scaffolds. In this method, temporary powder particles, namely space holder, are devised as a pore former for scaffolds. In general, the whole scaffold fabrication process with the space holder method can be divided into four main steps: (i) mixing of metal matrix powder and space-holding particles; (ii) compaction of granular materials; (iii) removal of space-holding particles; (iv) sintering of porous scaffold preform. In this review, detailed procedures in each of these steps are presented. Technical challenges encountered during scaffold fabrication with this specific method are addressed. In conclusion, strategies are yet to be developed to address problematic issues raised, such as powder segregation, pore inhomogeneity, distortion of pore sizes and shape, uncontrolled shrinkage and contamination.

Trends in computer-aided manufacturing in prosthodontics: a review of the available streams

In prosthodontics, conventional methods of fabrication of oral and facial prostheses have been considered the gold standard for many years. The development of computer-aided manufacturing and the medical application of this industrial technology have provided an alternative way of fabricating oral and facial prostheses. This narrative review aims to evaluate the different streams of computer-aided manufacturing in prosthodontics. To date, there are two streams: the subtractive and the additive approaches. The differences reside in the processing protocols, materials used, and their respective accuracy. In general, there is a tendency for the subtractive method to provide more homogeneous objects with acceptable accuracy that may be more suitable for the production of intraoral prostheses where high occlusal forces are anticipated. Additive manufacturing methods have the ability to produce large workpieces with significant surface variation and competitive accuracy. Such advantages make them ideal for the fabrication of facial prostheses.

External mechanical microstimuli modulate the osseointegration of titanium implants in rat tibiae

Purpose. To assess the effect of external mechanical microstimuli of controlled magnitude on the microarchitecture of the peri-implant bone beds in rat tibiae. Materials and Methods. Tibiae of forty rats were fitted with two transcutaneous titanium cylinders. After healing, the implants were loaded to 1 to 3 N, five days/week for four weeks. These force levels translated into intraosseous strains of 700 ± 200 με, 1400 ± 400 με, and 2100 ± 600 με. After sacrifice, the implants' pullout strength was assessed. Second, the bone's microarchitecture was analyzed by microcomputed tomography (μCT) in three discrete regions of interest (ROIs). Third, the effect of loading on bone material properties was determined by nanoindentation. Results. The trabecular BV/TV significantly increased in an ROI of 0.98 mm away from the test implant in the 1 N versus the 3 N group with an opposite trend for cortical thickness. Pull-out strength significantly increased in the 2 N relatively to the nonstimulated group. Higher values of E-modulus and hardness were observed in the trabecular bone of the 2 N group. Conclusion. The in vivo mechanical loading of implants induces load-dependent modifications in bone microarchitecture and bone material properties in rat tibiae. In pull-out strength measurements, implant osseointegration was maximized at 2 N (1400 ± 400 με).

Properties of open-cell porous metals and alloys for orthopaedic applications

One shortcoming of metals and alloys used to fabricate various components of orthopaedic systems, such as the femoral stem of a total hip joint replacement and the tibial plate of a total knee joint replacement, is well-recognized. This is that the material modulus of elasticity (E') is substantially larger than that of the contiguous cancellous bone, a consequence of which is stress shielding which, in turn, has been postulated to be implicated in a cascade of events that culminates in the principal life-limiting phenomenon of these systems, namely, aseptic loosening. Thus, over the years, a host of research programs have focused on the synthesis of metallic biomaterials whose E' can be tailored to match that of cancellous bone. The present work is a review of the extant large volume of literature on these materials, which are called open-cell porous metals/alloys (or, sometimes, metal foams or cellular materials). As such, its range is wide, covering myriad aspects such as production methods, characterization studies, in vitro evaluations, and in vivo performance. The review also includes discussion of seven areas for future research, such as parametric studies of the influence of an assortment of process variables (such as the space holder material and the laser power in the space holder method and the laser-engineered net-shaping process, respectively) on various properties (notably, permeability, fatigue strength, and corrosion resistance) of a given porous metal/alloy, innovative methods of determining fatigue strength, and modeling of corrosion behavior.