Benign response to particles of diamond and SiC: bone chamber studies of new joint replacement coating materials in rabbits

Friend or foe? Inflammation and the foreign body response to orthopedic biomaterials

The use of biomaterials and implants for joint replacement, fracture fixation, spinal stabilization and other orthopedic indications has revolutionized patient care by reliably decreasing pain and improving function. These surgical procedures always invoke an acute inflammatory reaction initially, that in most cases, readily subsides. Occasionally, chronic inflammation around the implant develops and persists; this results in unremitting pain and compromises function. The etiology of chronic inflammation may be specific, such as with infection, or be unknown. The histological hallmarks of chronic inflammation include activated macrophages, fibroblasts, T cell subsets, and other cells of the innate immune system. The presence of cells of the adaptive immune system usually indicates allergic reactions to metallic haptens. A foreign body reaction is composed of activated macrophages, giant cells, fibroblasts, and other cells often distributed in a characteristic histological arrangement; this reaction is usually due to particulate debris and other byproducts from the biomaterials used in the implant. Both chronic inflammation and the foreign body response have adverse biological effects on the integration of the implant with the surrounding tissues. Strategies to mitigate chronic inflammation and the foreign body response will enhance the initial incorporation and longevity of the implant, and thereby, improve long-term pain relief and overall function for the patient. The seminal research performed in the laboratory of Dr. James Anderson and co-workers has provided an inspirational and driving force for our laboratory's work on the interactions and crosstalk among cells of the mesenchymal, immune, and vascular lineages, and orthopedic biomaterials. Dr. Anderson's delineation of the fundamental biologic processes and mechanisms underlying acute and chronic inflammation, the foreign body response, resolution, and eventual functional integration of implants in different organ systems has provided researchers with a strategic approach to the use of biomaterials to improve health in numerous clinical scenarios.

The Gemstone Cyborg: How Diamond Films Are Creating New Platforms for Cell Regeneration and Biointerfacing

Diamond is a promising material for the biomedical field, mainly due to its set of characteristics such as biocompatibility, strength, and electrical conductivity. Diamond can be synthesised in the laboratory by different methods, is available in the form of plates or films deposited on foreign substrates, and its morphology varies from microcrystalline diamond to ultrananocrystalline diamond. In this review, we summarise some of the most relevant studies regarding the adhesion of cells onto diamond surfaces, the consequent cell growth, and, in some very interesting cases, the differentiation of cells into neurons and oligodendrocytes. We discuss how different morphologies can affect cell adhesion and how surface termination can influence the surface hydrophilicity and consequent attachment of adherent proteins. At the end of the review, we present a brief perspective on how the results from cell adhesion and biocompatibility can make way for the use of diamond as biointerface.

Silicon Carbide Nanostructures as Potential Carbide Material for Electrochemical Supercapacitors: A Review

Silicon carbide (SiC) is a very promising carbide material with various applications such as electrochemical supercapacitors, photocatalysis, microwave absorption, field-effect transistors, and sensors. Due to its enticing advantages of high thermal stability, outstanding chemical stability, high thermal conductivity, and excellent mechanical behavior, it is used as a potential candidate in various fields such as supercapacitors, water-splitting, photocatalysis, biomedical, sensors, and so on. This review mainly describes the various synthesis techniques of nanostructured SiC (0D, 1D, 2D, and 3D) and its properties. Thereafter, the ongoing research trends in electrochemical supercapacitor electrodes are fully excavated. Finally, the outlook of future research directions, key obstacles, and possible solutions are emphasized.

Influence of surface termination of ultrananocrystalline diamond films coated on titanium on response of human osteoblast cells: A proteome study

Successful osseointegration, i.e. the fully functional connection of patient's bone and artificial implant depends on the response of the cells to the direct contact with the surface of the implant. The surface properties of the implant which trigger cell responses leading to its integration into the surrounding bone can be tailored by surface modifications or coating with thin layers. One potential material for such applications is ultrananocrystalline diamond (UNCD). It combines the exceptional mechanical properties of diamond with good biocompatibility and possibility of coating as thin uniform films on different substrates of biological interest. In the current work we firstly deposited UNCD films on titanium-coated substrates and applied oxygen or ammonia plasma to modify their surface properties. The as-grown and modified UNCD exhibited relatively smooth surfaces with topography dominated by rounded features. The modifications induced oxygen- or amino-terminated surfaces with increased hydrophilicity. In addition, the UNCD coatings exhibited very low coefficient of friction when diamond was used as a counterpart. As-grown and modified UNCD samples were applied to study the responses of human osteoblast MG63 cells triggered by surfaces with various terminations assessed by proteomic analysis. The results revealed that the coating of Ti with UNCD as well as the plasma modifications resulting in O- or NH₂-terminated UNCD induced upregulation of proteins specific for cytoskeleton, cell membrane, and extracellular matrix (ECM) involved in the cell-ECM-surface interactions. Proteins from each of these groups, namely, vimentin, cadherin and fibronectin were further studied immunocytochemically and the results confirmed their increased abundance leading to improved cell-to-surface adhesion and cell-to-cell interactions. These findings demonstrate the potential of implant coating with UNCD and its surface modifications for better osseointegration and bone formation.

In Vitro Biocompatibility of Titanium Oxide for Prosthetic Devices Nanostructured by Low Pressure Metal-Organic Chemical Vapor Deposition

Metal-Organic Chemical Vapor Deposition (MOCVD) has recently been proposed to coat orthopedic and dental prostheses with metal nanostructured oxide films through the decomposition of oxygenated compounds (single-source precursors) or the reaction of oxygen-free metal compounds with oxygenating agents. The present study was carried out to assess the in vitro biocompatibility in terms of cell proliferation and activation, of commercially pure Ti (control material: TI/MA) coated with nanostructured TiO2 film by MOCVD (Ti/MOCVD) using osteoblast-like cell cultures (MG-63). Evaluations were performed at 3, 7 and 14 days. Cell proliferation showed a similar trend for Ti/MA and Ti/MOCVD compared to polystyrene; cell number increased with time from seeding to day 7 (p < 0.005), and then decreased progressively until day 14 (ranging from −14% to −47%). The ALP level and OC production showed no significant differences between Ti/MOCVD and Ti/MA at each experimental time. Significantly higher ALP levels were found in Ti/MA at 3 days and in Ti/MOCVD at 7 and 14 days when compared to the polystyrene group. OC production decreased over time and the highest values were observed at 3 days, when it was significantly higher in the Ti/MA than in the polystyrene group (50%, p < 0.05). CICP synthesis was positively affected by the presence of Ti/MOCVD and was higher in Ti/MOCVD than in the polystyrene group. No significant differences were found between Ti/MOCVD and Ti/MA in terms of IL-6 and TGF-ß1 synthesis at any experimental time. In conclusion, the current findings demonstrate that the nanostructured TiO2 coating positively affects the osteoblast-like cell behavior in terms of cell proliferation and activity, thus confirming its high level of in vitro biocompatibility in accordance with expectations.

Diamond thin films: giving biomedical applications a new shine

Progress made in the last two decades in chemical vapour deposition technology has enabled the production of inexpensive, high-quality coatings made from diamond to become a scientific and commercial reality. Two properties of diamond make it a highly desirable candidate material for biomedical applications: first, it is bioinert, meaning that there is minimal immune response when diamond is implanted into the body, and second, its electrical conductivity can be altered in a controlled manner, from insulating to near-metallic. In vitro, diamond can be used as a substrate upon which a range of biological cells can be cultured. In vivo, diamond thin films have been proposed as coatings for implants and prostheses. Here, we review a large body of data regarding the use of diamond substrates for in vitro cell culture. We also detail more recent work exploring diamond-coated implants with the main targets being bone and neural tissue. We conclude that diamond emerges as one of the major new biomaterials of the twenty-first century that could shape the way medical treatment will be performed, especially when invasive procedures are required.

Biological evaluation of ultrananocrystalline and nanocrystalline diamond coatings

Nanostructured biomaterials have been investigated for achieving desirable tissue-material interactions in medical implants. Ultrananocrystalline diamond (UNCD) and nanocrystalline diamond (NCD) coatings are the two most studied classes of synthetic diamond coatings; these materials are grown using chemical vapor deposition and are classified based on their nanostructure, grain size, and sp³ content. UNCD and NCD are mechanically robust, chemically inert, biocompatible, and wear resistant, making them ideal implant coatings. UNCD and NCD have been recently investigated for ophthalmic, cardiovascular, dental, and orthopaedic device applications. The aim of this study was (a) to evaluate the in vitro biocompatibility of UNCD and NCD coatings and (b) to determine if variations in surface topography and sp³ content affect cellular response. Diamond coatings with various nanoscale topographies (grain sizes 5-400 nm) were deposited on silicon substrates using microwave plasma chemical vapor deposition. Scanning electron microscopy and atomic force microscopy revealed uniform coatings with different scales of surface topography; Raman spectroscopy confirmed the presence of carbon bonding typical of diamond coatings. Cell viability, proliferation, and morphology responses of human bone marrow-derived mesenchymal stem cells (hBMSCs) to UNCD and NCD surfaces were evaluated. The hBMSCs on UNCD and NCD coatings exhibited similar cell viability, proliferation, and morphology as those on the control material, tissue culture polystyrene. No significant differences in cellular response were observed on UNCD and NCD coatings with different nanoscale topographies. Our data shows that both UNCD and NCD coatings demonstrate in vitro biocompatibility irrespective of surface topography.

Porcine adipose-derived stem cells from buccal fat pad and subcutaneous adipose tissue for future preclinical studies in oral surgery

Introduction

Adipose-derived stem cells (ASCs) are progenitor cells used in bone tissue engineering and regenerative medicine. Despite subcutaneous adipose tissue being more abundant, the buccal fat pad (BFP) is easily accessible for dentists and maxillofacial surgeons. For this reason, considering the need for preclinical study and the swine as an optimal animal model in tissue engineering applications, we compared the features of porcine ASCs (pASCs) from both tissue-harvesting sites.

Methods

ASCs were isolated from interscapular subcutaneous adipose tissue (ScI) and buccal fat pads of six swine. Cells were characterized for their stemness and multipotent features. Moreover, their osteogenic ability when cultured on titanium disks and silicon carbide-plasma-enhanced chemical vapor-deposition fragments, and their growth in the presence of autologous and heterologous serum were also assessed.

Results

Independent of the harvesting site, no differences in proliferation, viability, and clonogenicity were observed among all the pASC populations. Furthermore, when induced toward osteogenic differentiation, both ScI- and BFP-pASCs showed an increase of collagen and calcified extracellular matrix (ECM) production, alkaline phosphatase activity, and osteonectin expression, indicating their ability to differentiate toward osteoblast-like cells. In addition, they differentiated toward adipocyte-like cells, and chondrogenic induced pASCs were able to increase glycosaminoglycans (GAGs) production over time. When cells were osteoinduced on synthetic biomaterials, they significantly increased the amount of calcified ECM compared with control cells; moreover, titanium showed the osteoinductive effect on pASCs, also without chemical stimuli. Finally, these cells grew nicely in 10% FBS, and no benefits were produced by substitution with swine serum.

Conclusions

Swine buccal fat pad contains progenitor cells with mesenchymal features, and they also osteo-differentiate nicely in association with synthetic supports. We suggest that porcine BFP-ASCs may be applied in preclinical studies of periodontal and bone-defect regeneration.

An all-diamond, hermetic electrical feedthrough array for a retinal prosthesis

The interface between medical implants and the human nervous system is rapidly becoming more and more complex. This rise in complexity is driving the need for increasing numbers of densely packed electrical feedthrough to carry signals to and from implanted devices. This is particularly crucial in the field of neural prosthesis where high resolution stimulating or recording arrays near peripheral nerves or in the brain could dramatically improve the performance of these devices. Here we describe a flexible strategy for implementing high density, high count arrays of hermetic electrical feedthroughs by forming conducting nitrogen doped nanocrystalline diamond channels within an insulating polycrystalline diamond substrate. A unique feature of these arrays is that the feedthroughs can themselves be used as stimulating electrodes for neural tissue. Our particular application is such a feedthrough, designed as a component of a retinal implant to restore vision to the blind. The hermeticity of the feedthroughs means that the array can also form part of an implantable capsule which can interface directly with internal electronic chips. The hermeticity of the array is demonstrated by helium leak tests and electrical and electrochemical characterisation of the feedthroughs is described. The nitrogen doped nanocrystalline diamond forming the electrical feedthroughs is shown to be non-cyctotoxic. New fabrication strategies, such as the one described here, combined with the exceptional biostability of diamond can be exploited to generate a range of biomedical implants that last for the lifetime of the user without fear of degradation.

Evaluation of silicon nitride as a wear resistant and resorbable alternative for total hip joint replacement

Many of the failures of total joint replacements are related to tribology, i.e., wear of the cup, head and liner. Accumulation of wear particles at the implants can be linked to osteolysis which leads to bone loss and in the end aseptic implant loosening. Therefore it is highly desirable to reduce the generation of wear particles from the implant surfaces. Silicon nitride (Si(3)N(4)) has shown to be biocompatible and have a low wear rate when sliding against itself and is therefore a good candidate as a hip joint material. Furthermore, wear particles of Si(3)N(4) are predicted to slowly dissolve in polar liquids and they therefore have the potential to be resorbed in vivo, potentially reducing the risk for aseptic loosening. In this study, it was shown that α-Si(3)N(4)-powder dissolves in PBS. Adsorption of blood plasma indicated a good acceptance of Si(3)N(4) in the body with relatively low immune response. Si(3)N(4) sliding against Si(3)N(4) showed low wear rates both in bovine serum and PBS compared with the other tested wear couples. Tribofilms were built up on the Si(3)N(4) surfaces both in PBS and in bovine serum, controlling the friction and wear characteristics.

Osteogenic differentiation on DLC-PDMS-h surface

The hypothesis was that anti-fouling diamond-like carbon polydimethylsiloxane hybrid (DLC-PDMS-h) surface impairs early and late cellular adhesion and matrix-cell interactions. The effect of hybrid surface on cellular adhesion and cytoskeletal organization, important for osteogenesis of human mesenchymal stromal cells (hMSC), where therefore compared with plain DLC and titanium (Ti). hMSCs were induced to osteogenesis and followed over time using scanning electron microscopy (SEM), time-of-flight secondary ion mass spectrometry (ToF-SIMS), immunofluorescence staining, quantitative real-time polymerase chain reaction (qRT-PCR), and hydroxyapatite (HA) staining. SEM at 7.5 hours showed that initial adherence and spreading of hMSC was poor on DLC-PDMS-h. At 5 days some hMSC were undergoing condensation and apoptotic fragmentation, whereas cells on DLC and Ti grew well. DAPI-actin-vinculin triple staining disclosed dwarfed cells with poorly organized actin cytoskeleton-focal complex/adhesion-growth substrate attachments on hybrid coating, whereas spread cells, organized microfilament bundles, and focal adhesions were seen on DLC and in particular on Ti. Accordingly, at day one ToF-SIMS mass peaks showed poor protein adhesion to DLC-PDMS-h compared with DLC and Ti. COL1A1, ALP, OP mRNA levels at days 0, 7, 14, 21, and/or 28 and lack of HA deposition at day 28 demonstrated delayed or failed osteogenesis on DLC-PDMS-h. Anti-fouling DLC-PDMS-h is a poor cell adhesion substrate during the early protein adsorption-dependent phase and extracellular matrix-dependent late phase. Accordingly, some hMSCs underwent anoikis-type apoptosis and failed to complete osteogenesis, due to few focal adhesions and poor cell-to-ECM contacts. DLC-PDMS-h seems to be a suitable coating for non-integrating implants/devices designed for temporary use.

SiC nanocrystals: high-rate deposition and nano-scale control by thermal plasma

SiC nanocrystals were fabricated at a high rate with SiCl₄ as the Si source by using thermal-plasma-enhanced chemical vapor deposition through the assembly of precursor atoms.

Diamond as a scaffold for bone growth

Diamond is an attractive material for biomedical implants. In this work, we investigate its capacity as a bone scaffold. It is well established that the bioactivity of a material can be evaluated by examining its capacity to form apatite-like calcium phosphate phases on its surface when exposed to simulated body fluid. Accordingly, polycrystalline diamond (PCD) and ultrananocrystalline diamond (UNCD) deposited by microwave plasma chemical vapour deposition were exposed to simulated body fluid and assessed for apatite growth when compared to the bulk silicon. Scanning electron microscopy and X-ray photoelectron spectroscopy showed that both UNCD and PCD are capable of acting as a bone scaffold. The composition of deposited apatite suggests that UNCD and PCD are suitable for in vivo implantation with UNCD possible favoured in applications where rapid osseointegration is essential.

Nanostructured diamond coatings for orthopaedic applications

With increasing numbers of orthopaedic devices being implanted, greater emphasis is being placed on ceramic coating technology to reduce friction and wear in mating total joint replacement components, in order to improve implant function and increase device lifespan. In this chapter, we consider ultra-hard carbon coatings, with emphasis on nanostructured diamond, as alternative bearing surfaces for metallic components. Such coatings have great potential for use in biomedical implants as a result of their extreme hardness, wear resistance, low friction and biocompatibility. These ultra-hard carbon coatings can be deposited by several techniques resulting in a wide variety of structures and properties.

Highly bright tunable blue-violet photoluminescence in SiC nanocrystal-sodium dodecyl sulfonate crosslinked network

We report strong photoluminescence in an ultra-small surface oxidized SiC quantum dot-sodium dodecyl sulfonate crosslinked network. The peak emission wavelength is tunable spanning a wide blue-violet spectral region showing clear quantum confinement effects. The photoluminescence decay exhibits triple recombination dynamics with an average lifetime of 13.65 ns.

In vitro studies on the effect of particle size on macrophage responses to nanodiamond wear debris

Nanostructured diamond coatings improve the smoothness and wear characteristics of the metallic component of total hip replacements and increase the longevity of these implants, but the effect of nanodiamond wear debris on macrophages needs to be determined to estimate the long-term inflammatory effects of wear debris. The objective was to investigate the effect of the size of synthetic nanodiamond particles on macrophage proliferation (BrdU incorporation), apoptosis (Annexin-V flow cytometry), metabolic activity (WST-1 assay) and inflammatory cytokine production (qPCR). RAW 264.7 macrophages were exposed to varying sizes (6, 60, 100, 250 and 500 nm) and concentrations (0, 10, 50, 100 and 200 μg ml(-1)) of synthetic nanodiamonds. We observed that cell proliferation but not metabolic activity was decreased with nanoparticle sizes of 6-100 nm at lower concentrations (50 μg ml(-1)), and both cell proliferation and metabolic activity were significantly reduced with nanodiamond concentrations of 200 μg ml(-1). Flow cytometry indicated a significant reduction in cell viability due to necrosis irrespective of particle size. Nanodiamond exposure significantly reduced gene expression of tumor necrosis factor-α, interleukin-1β, chemokine Ccl2 and platelet-derived growth factor compared to serum-only controls or titanium oxide (anatase 8 nm) nanoparticles, with variable effects on chemokine Cxcl2 and vascular endothelial growth factor. In general, our study demonstrates a size and concentration dependence of macrophage responses in vitro to nanodiamond particles as possible wear debris from diamond-coated orthopedic joint implants.

Adhesion, Growth and Differentiation of Osteoblasts on Surface-Modified Materials Developed for Bone Implants

This review briefly outlines the history and possibilities of bone reconstruction using various types of artificial materials, which allow interaction with cells only on the surface of the implant or enable ingrowth of cells inside the material. Information is also provided on the most important properties of bone cells taking part in bone tissue development, and on diseases and regeneration. The most common cell types used for testing cell-material interaction in vitro are listed, and the most commonly used approaches to this testing are also mentioned. A considerable part of this review is dedicated to the physical and chemical properties of the material surface, which are decisive for the cell-material interaction, and also to modifications to the surface of the material aimed at integrating it better with the surrounding bone tissue. Special attention is paid to the effects of nanoscale and microscale surface roughness on cell behaviour, to material surface patterning, which allows regionally-selective adhesion and growth of cells, and also to the surface chemistry. In addition, coating the materials with bioactive layers is examined, particularly those created by deposition of fullerenes, hybrid metal-fullerene composites, carbon nanotubes, nanocrystalline diamond films, diamond-like carbon, and nanocomposite hydrocarbon plasma polymer films enriched with metals.

Enhanced growth and osteogenic differentiation of human osteoblast-like cells on boron-doped nanocrystalline diamond thin films

Intrinsic nanocrystalline diamond (NCD) films have been proven to be promising substrates for the adhesion, growth and osteogenic differentiation of bone-derived cells. To understand the role of various degrees of doping (semiconducting to metallic-like), the NCD films were deposited on silicon substrates by a microwave plasma-enhanced CVD process and their boron doping was achieved by adding trimethylboron to the CH₄:H₂ gas mixture, the B∶C ratio was 133, 1000 and 6700 ppm. The room temperature electrical resistivity of the films decreased from >10 MΩ (undoped films) to 55 kΩ, 0.6 kΩ, and 0.3 kΩ (doped films with 133, 1000 and 6700 ppm of B, respectively). The increase in the number of human osteoblast-like MG 63 cells in 7-day-old cultures on NCD films was most apparent on the NCD films doped with 133 and 1000 ppm of B (153,000±14,000 and 152,000±10,000 cells/cm², respectively, compared to 113,000±10,000 cells/cm² on undoped NCD films). As measured by ELISA per mg of total protein, the cells on NCD with 133 and 1000 ppm of B also contained the highest concentrations of collagen I and alkaline phosphatase, respectively. On the NCD films with 6700 ppm of B, the cells contained the highest concentration of focal adhesion protein vinculin, and the highest amount of collagen I was adsorbed. The concentration of osteocalcin also increased with increasing level of B doping. The cell viability on all tested NCD films was almost 100%. Measurements of the concentration of ICAM-1, i.e. an immunoglobuline adhesion molecule binding inflammatory cells, suggested that the cells on the NCD films did not undergo significant immune activation. Thus, the potential of NCD films for bone tissue regeneration can be further enhanced and tailored by B doping and that B doping up to metallic-like levels is not detrimental for cells.

Single-Crystal Silicon Carbide: A Biocompatible and Hemocompatible Semiconductor for Advanced Biomedical Applications

Crystalline silicon carbide (SiC) and silicon (Si) biocompatibility was evaluated in vitro by directly culturing three skin and connective tissue cell lines, two immortalized neural cell lines, and platelet-rich plasma (PRP) on these semiconducting substrates. The in vivo biocompatibility was then evaluated via implantation of 3C-SiC and Si shanks into a C57/BL6 wild type mouse. The in vivo results, while preliminary, were outstanding with Si being almost completely enveloped with activated microglia and astrocytes, indicating a severe immune system response, while the 3C-SiC film was virtually untouched. The in vitro experiments were performed specifically for the three adopted SiC polytypes, namely 3C-, 4H- and 6H-SiC, and the results were compared to those obtained for Si crystals. Cell proliferation and adhesion quality were studied using MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assays and fluorescent microscopy. The neural cells were studied via atomic force microscopy (AFM) which was used to quantify filopodia and lamellipodia extensions on the surface of the tested materials. Fluorescent microscopy was used to assess platelet adhesion to the semiconductor surfaces where significantly lower values of platelet adhesion to 3C-SiC was observed compared to Si. The reported results show good indicators that SiC is indeed a more biocompatible substrate than Si. While there were some differences among the degree of biocompatibility of the various SiC polytypes tested, SiC appears to be a highly biocompatible material in vitro that is also somewhat hemocompatible. This extremely intriguing result appears to put SiC into a unique class of materials that is both bio- and hemo-compatible and is, to the best of our knowledge, the only semiconductor with this property.

Group IV nanoparticles: synthesis, properties, and biological applications

In this review, the emerging roles of group IV nanoparticles including silicon, diamond, silicon carbide, and germanium are summarized and discussed from the perspective of biologists, engineers, and medical practitioners. The synthesis, properties, and biological applications of these new nanomaterials have attracted great interest in the past few years. They have gradually evolved into promising biomaterials due to their innate biocompatibility; toxic ions are not released when they are used in vitro or in vivo, and their wide fluorescence spectral regions span the near-infrared, visible, and near-ultraviolet ranges. Additionally, they generally have good resistance against photobleaching and have lifetimes on the order of nanoseconds to microseconds, which are suitable for bioimaging. Some of the materials possess unique mechanical, chemical, or physical properties, such as ultrachemical and thermal stability, high hardness, high photostability, and no blinking. Recent data have revealed the superiority of these nanoparticles in biological imaging and drug delivery.

Plasma-sprayed hydroxyapatite coating on carbon/carbon composite scaffolds for bone tissue engineering and related tests in vivo

The bioactive hydroxyapatite (HA) coatings were successfully prepared on carbon/carbon composites (C/C) by means of sand-blasting pretreatment and plasma-spraying technology. X-ray diffraction was employed to analyze the phase constitute of the coatings. Meanwhile, the bond strength between the HA coatings and C/C substrates was determined via shear test. Experimental results show that the coatings constitute HA, CaO, and other amorphous phosphates. The post heat treatment could effectively increase crystallization and purity of the coatings. Through observation and analysis by electron microprobe and scanning electron microscopy, it is concluded that the bond strength of the plasma-sprayed HA coatings on C/C is mainly determined by the interface structure and can be further improved by the post heat treatment. Meanwhile, the implantation in vivo was carried out in hybrid goats. The histological observation revealed that the osteoplaque gradually grew on the surface of the HA coatings and the pure C/C surface was covered by the fibrous tissues. No inflammation symptoms were found in the bone tissue around the implants.

Nanoscale topography of nanocrystalline diamonds promotes differentiation of osteoblasts

The excellent mechanical, tribological and biochemical properties of diamond coatings are promising for improving orthopedic or stomatology implants. A crucial prerequisite for such applications is an understanding and control of the biological response of the diamond coatings. This study concentrates on the correlation of diamond surface properties with osteoblast behavior. Nanocrystalline diamond (NCD) films (grain size up to 200 nm, surface roughness 20 nm) were deposited on silicon substrates of varying roughnesses (1, 270 and 500 nm) and treated by oxygen plasma to generate a hydrophilic surface. Atomic force microscopy was used for topographical characterization of the films. As a reference surface, tissue culture polystyrene (PS) was used. Scanning electron microscopy and immunofluorescence staining was used to visualize cell morphological features as a function of culture time. Metabolic activity, alkaline phosphatase activity, and calcium and phosphate deposition was also monitored. The results show an enhanced osteoblast adhesion as well as increased differentiation (raised alkaline phosphatase activity and mineral deposition) on NCD surfaces (most significantly on RMS 20 nm) compared to PS. This is attributed mainly to the specific surface topography as well as to the biocompatible properties of diamond. Hence the controlled (topographically structured) diamond coating of various substrates is promising for preparation of better implants, which offer faster colonization by specific cells as well as longer-term stability.

Cytotoxicity evaluation of nanocrystalline diamond coatings by fibroblast cell cultures

The cytotoxicity profile of nanocrystalline diamond (NCD) coatings on a Si(3)N(4) ceramic was investigated. This material is envisaged to have biomedical dental applications such as burrs and surgical instruments. Two fibroblast cell culture systems were used to address the cytotoxicity of NCD-coated samples: L929 cells (a mouse permanent cell line) and human gingival fibroblasts. Cell behavior was evaluated in terms of cell adhesion, cell viability/proliferation (mitochondrial function, MTT assay) and the pattern of cell growth. Fibroblast cell behavior on standard polystyrene culture plates was used as control, as Si(3)N(4) substrates have previously been shown to be biocompatible. NCD coatings provided a suitable surface for cell attachment, spreading and proliferation. Human gingival cells showed a homogeneous cytoplasm spreading, a flattened elongated morphology and a typical parallel alignment on confluent cultures. In comparison, L929 cells denoted a lower cytoplasm expansion, a heterogeneous spreading but a higher proliferation rate. For both cells, after few days, the NCD coating was completely covered with continuous cell layers. As compared to standard polystyrene culture plates, no deleterious or cytotoxic responses were observed with L929 and human fibroblast cell cultures, and in both a slight enhancement in cell proliferation was observed. In addition, the seeded NCD film allowed reproduction of the typical features of the two cell culture systems tested, further suggesting the lack of cytotoxicity of this coating.

Load-bearing biomedical applications of diamond-like carbon coatings - current status

The current status of diamond-like carbon (DLC) coatings for biomedical applications is reviewed with emphasis on load-bearing coatings. Although diamond-like carbon coating materials have been studied for decades, no indisputably successful commercial biomedical applications for high load situations exist today. High internal stress, leading to insufficient adhesion of thick coatings, is the evident reason behind this delay of the break-through of DLC coatings for applications. Excellent adhesion of thick DLC coatings is of utmost importance for load-bearing applications. According to this review superior candidate material for articulating implants is thick and adherent DLC on both sliding surfaces. With the filtered pulsed arc discharge method, all the necessary requirements for the deposition of thick and adherent DLC are fulfilled, provided that the substrate material is selected properly.

What other biologic and mechanical factors might contribute to osteolysis?

An overwhelming consensus exists that wear particles are the primary driving force in aseptic loosening of orthopaedic implants. Nonetheless, considerable evidence has emerged demonstrating that various other factors can modulate the biologic activity of orthopaedic wear particles. Two of the most studied modulating factors are bacterial endotoxins and implant motion.

Destination of titanium particles detached from titanium plasma sprayed implants

Small titanium particles may detach from titanium plasma sprayed (TPS) implants during implant insertion, when no preliminary tapping is used, probably for the frictional force between titanium coating and host bone. Aim of this study was to investigate the destination of these titanium particles observed in the peri-implant environment. Twenty-four TPS screws were implanted in tibiae of two sheep. Fourteen and 90 days after implantation the implants with the surrounding bone were removed and processed to be analyzed by light microscope and scanning electron microscope (secondary electron and back-scattered electron probes). Small titanium particles detached from the unloaded TPS implants were observed both in the newly-formed bone matrix and in marrow tissue. Histomorphometric analysis showed that both at 14 and 90 days after implantation the titanium particles appeared more concentrated in marrow tissue than in calcified bone matrix, decreasing by 66.4% over time. In particular, smaller particles (<250 microm(2)) decreased by 81.5%, whereas the larger ones (250-2000 microm(2)) did not show any significant variations over time, suggesting that most of the smaller particles may undergo to ionic dissolution, probably migrating into the peri-implant marrow lacunae. A slight migration of titanium particles from the implant surface towards the more distant peri-implant tissues was also demonstrated over time.

Nanodiamond

This chapter discusses various methods of surface modification for the development of functionalized diamond nanoparticles for biomedical applications. To be used in biomedical applications, nanoparticles must be biocompatible, non-toxic, non-detective by immune systems, and should not induce side effects. Size control of particles is a prerequisite for biomedical applications. Carbon nanostructures span the same length scale as bio-compounds, ranging from subnanometer-size nucleotides to tens and hundreds of nanometer-sized organelles and viruses, and up to micron-sized cell sizes. The chapter also summarizes different approaches to the surface functionalization of nanodiamonds (ND) particles—that is, the key in successful biomedical applications followed by a discussion of modification of diamond surfaces with nucleic acids and proteins. Both current and potential applications of diamond films and particles in the area of biosensing are addressed.

Peri-implant osteogenesis in health and osteoporosis

Long-term clinical success of endosseous dental implants is critically related to a wide bone-to-implant direct contact. This condition is called osseointegration and is achieved ensuring a mechanical primary stability to the implant immediately after implantation. Both primary stability and osseointegration are favoured by micro-rough implant surfaces which are obtained by different techniques from titanium implants or coating the titanium with different materials. Host bone drilled cavity is comparable to a common bone wound. In the early bone response to the implant, the first tissue which comes into contact with the implant surface is the blood clot, with particular attention to platelets and fibrin. Peri-implant tissue healing starts with an inflammatory response as the implant is inserted in the bone cavity, but an early afibrillar calcified layer comparable to the lamina limitans or incremental lines in bone is just observable at the implant surface both in vitro than in vivo conditions. Just within the first day from implantation, mesenchymal cells, pre-osteoblasts and osteoblasts adhere to the implant surface covered by the afibrillar calcified layer to produce collagen fibrils of osteoid tissue. Within few days from implantation a woven bone and then a reparative trabecular bone with bone trabeculae delimiting large marrow spaces rich in blood vessels and mesenchymal cells are present at the gap between the implant and the host bone. The peri-implant osteogenesis can proceed from the host bone to the implant surface (distant osteogenesis) and from the implant surface to the host bone (contact osteogenesis) in the so called de novo bone formation. This early bone response to the implant gradually develops into a biological fixation of the device and consists in an early deposition of a newly formed reparative bone just in direct contact with the implant surface. Nowadays, senile and post-menopausal osteoporosis are extremely diffuse in the population and have important consequences on the clinical success of endosseous dental implants. In particular the systemic methabolic and site morphological conditions are not favorable to primary stability, biological fixation and final osseointegration. An early good biological fixation may allow the shortening of time before loading the implant, favouring the clinical procedure of early or immediate implant loading. Trabecular bone in implant biological fixation is gradually substituted by a mature lamellar bone which characterizes the implant ossoeintegration. As a final consideration, the mature lamellar bone observed in osseointegrated implants is not always the same as a biological turnover occurs in the peri-implant bone up to 1mm from the implant surface, with both osteogenesis and bone reabsorption processes.

Improvement of arthroscopic cartilage stiffness probe using amorphous diamond coating

During arthroscopic evaluation of articular cartilage unstable contact and even slipping of the measurement instrument on the tissue surface may degrade the reproducibility of the measurement. The main aim of the present study was to achieve more stable contact by controlling the friction between articular cartilage surface and the arthroscopic cartilage stiffness probe (Artscan 200, Artscan Oy, Helsinki, Finland) using amorphous diamond (AD) coating. In order to obtain surfaces with different average roughnesses (R(a)), polished stainless steel disks were coated with AD by using the filtered pulsed arc-discharge (FPAD) method. Dynamic coefficient of friction (mu) between the articular cartilage (n = 8) and the coated plates along one non-coated plate was then determined. The friction between AD and cartilage could be controlled over a wide range (mu = 0.027-0.728, p < 0.05, Wilcoxon test) by altering the roughness. Possible deterioration of cartilage was investigated by measuring surface roughness after friction tests and comparing it with the roughness of the adjacent, untested samples (n = 8). Importantly, even testing with the roughest AD (R(a) = 1250 nm) did not damage articular surface. On the basis of the friction measurements, a proper AD coating was selected for the stiffness probe. The performance of coated and non-coated probe was compared by measuring bovine osteochondral samples (n = 22) with both instruments. The reproducibility of the stiffness measurements was significantly better with the AD-coated probe (CV% = 4.7) than with the uncoated probe (CV% = 8.2). To conclude, AD coating can be used to safely control dynamic friction with articular surface. Sufficient friction between articular surface and reference plate of the arthroscopic probe improves significantly reproducibility of the stiffness measurements.

In vitro studies on the effect of delaminated a-C:H film fragments on bone marrow cell cultures

Amorphous hydrogenated carbon (a-C:H) films have many outstanding properties required for a protective coating material on load bearing medical implants. Recently, titanium doped a-C:H films have been evaluated regarding their effects on bone marrow cell cultures. But many materials that are well-tolerated in bulk form are able to induce toxic reaction if present particulate form. In order to further assess biocompatibility aspects of these two coatings, film delamination has been mimicked in exposure to fluids. In the present study, particles from a-C:H, a-C:H/Ti and a-C:H-a-C:H/Ti bilayer films were added to bone marrow cell cultures in vitro. The results showed that plain a-C:H and to a certain extent a-CH/Ti particles were inert. Both kinds of particles did not significantly stimulate the osteoclast-related enzyme tartrate resistant acid phosphatase (TRAP). A slight increase in cell proliferation and total culture TRAP was found in cultures treated by a-C:H-a-C:H/Ti bilayer films. Latter effect can probably be traced back by the relative high percentage of small particles of a size of around 2 microm. However, if corrected by the cell number also no differences between particle-treated and untreated control cultures could be found, indicating the absence of a toxic effect from delaminated a-C:H coatings.

Micro/nanoscale mechanical and tribological characterization of SiC for orthopedic applications

Micro/nanomechanical and tribological characterization of SiC has been carried out. For comparison, measurements on SiC, CoCrMo, Ti-6Al-4V, and stainless steel have also been made. Hardness and elastic modulus of these materials were measured by nanoindentation using a nanoindenter. The nanoindentation impressions were imaged using an atomic force microscope (AFM). Scratch, friction, and wear properties were measured using an accelerated microtribometer. Scratch and wear damages were studied using a scanning electron microscope (SEM). It is found that SiC exhibits higher hardness, elastic modulus, scratch resistance as well as lower friction with fewer and smaller debris particles compared to other materials. These results show that SiC possesses superior mechanical and tribological properties that make it an ideal material for use in orthopedic and other biomedical applications.

Evaluation of MEMS materials of construction for implantable medical devices

Medical devices based on microelectro-mechanical systems (MEMS) platforms are currently being proposed for a wide variety of implantable applications. However, biocompatibility data for typical MEMS materials of construction and processing, obtained from standard tests currently recognized by regulatory agencies, has not been published. Likewise, the effects of common sterilization techniques on MEMS material properties have not been reported. Medical device regulatory requirements dictate that materials that are biocompatibility tested be processed and sterilized in a manner equivalent to the final production device. Material, processing, and sterilization method can impact the final result. Six candidate materials for implantable MEMS devices, and one encapsulating material, were fabricated using typical MEMS processing techniques and sterilized. All seven materials were evaluated using a baseline battery of ISO 10993 physicochemical and biocompatibility tests. In addition, samples of these materials were evaluated using a scanning electron microscope (SEM) pre- and post-sterilization. While not addressing all facets of ISO 10993 testing, the biocompatibility and SEM data indicate few concerns about use of these materials in implant applications.

An in vitro investigation of diamond-like carbon as a femoral head coating

Wear of polyethylene acetabular components of hip implants is a significant clinical problem. In prosthetic hip surgery, polyethylene wear is identified as a factor that limits the life of the implant; it is known that the production of debris can cause adverse tissue reactions that may lead to extensive bone loss around the implant, and consequently loosening of the fixation. A new class of so-called Diamond-Like Carbon coatings, applied to titanium femoral heads was compared to ceramic and metallic heads in terms of wear behavior against UHMWPE using a hip joint simulator with a bovine calf serum lubricant. A thin film of Diamond-Like Carbon was deposited directly onto titanium (Ti6Al4V) head using chemical vapor deposition. The wear of polyethylene coupled with Diamond-Like Carbon coated femoral heads was comparable to that obtained with the polyethylene coupled with commercial alumina femoral heads.