Bone bonding bioactivity of Ti metal and Ti-Zr-Nb-Ta alloys with Ca ions incorporated on their surfaces by simple chemical and heat treatments

Enhancement of in vitro antibacterial activity and bioactivity of iodine-loaded titanium by micro-scale regulation using mixed-acid treatment

Postoperative infection and subsequent device loss are serious complications in the use of titanium dental implants and plates for jawbone reconstruction. We have previously reported that NaOH-CaCl2 -thermal-ICl3 -treated titanium (NaCaThIo) has a nano-scale surface and exhibits antibacterial activity against Staphylococcus aureus. The present study examined the surface properties of mixed-acid treated and then iodine-treated titanium (MA-NaCaThIo), and evaluated oral antibacterial activity and cytotoxicity compared with the results obtained with NaCaThIo. MA-NaCaThIo formed a surface layer with a nano-scale network structure having microscale irregularities, and both the thickness of the surface layer (1.49 ± 0.16 μm) and the average surface roughness (0.35 ± 0.03 μm) were significantly higher than those of NaCaThIo. Furthermore, MA-NaCaThIo maintained high hydrophilicity with a contact angle of 7.5 ± 1.7° even after 4 weeks, as well as improved apatite formation, iodine ion release, and antibacterial activity against Prevotella intermedia compared to NaCaThIo. Cell culture test revealed that MA-NaCaThIo exhibited no cytotoxicity against MG-63 and Vero cells, while increased cell proliferation, ALP activity and mineralization of MG-63 compared to NaCaThIo. This treated titanium is expected to be useful for the development of next-generation titanium devices having both bone-bonding and antibacterial properties.

Mechanical, bioactive, and long-lasting antibacterial properties of a Ti scaffold with gradient pores releasing iodine ions

The ideal bone implant would effectively prevent aseptic as well as septic loosening by minimizing stress shielding, maximizing bone ingrowth, and preventing implant-associated infections. Here, a novel gradient-pore-size titanium scaffold was designed and manufactured to address these requirements. The scaffold features a larger pore size (900 μm) on the top surface, gradually decreasing to small sizes (600 μm to 300 μm) towards the center, creating a gradient structure. To enhance its functionality, the additively manufactured scaffolds were biofunctionalized using simple chemical and heat treatments so as to incorporate calcium and iodine ions throughout the surface. This unique combination of varying pore sizes with a biofunctional surface provides highly desirable mechanical properties, bioactivity, and notably, long-lasting antibacterial activity. The target mechanical aspects, including low elastic modulus, high compression, compression-shear, and fatigue strength, were effectively achieved. Furthermore, the biofunctional surface exhibits remarkable in vitro bioactivity and potent antibacterial activity, even under conditions specifically altered to be favorable for bacterial growth. More importantly, the integration of small pores alongside larger ones ensures a sustained high release of iodine, resulting in antimicrobial activity that persisted for over three months, with full eradication of the bacteria. Taken together, this gradient structure exhibits obvious superiority in combining most of the desired properties, making it an ideal candidate for orthopedic and dental implant applications.

Advanced surface engineering of titanium materials for biomedical applications: From static modification to dynamic responsive regulation

Titanium (Ti) and its alloys have been widely used as orthopedic implants, because of their favorable mechanical properties, corrosion resistance and biocompatibility. Despite their significant success in various clinical applications, the probability of failure, degradation and revision is undesirably high, especially for the patients with low bone density, insufficient quantity of bone or osteoporosis, which renders the studies on surface modification of Ti still active to further improve clinical results. It is discerned that surface physicochemical properties directly influence and even control the dynamic interaction that subsequently determines the success or rejection of orthopedic implants. Therefore, it is crucial to endow bulk materials with specific surface properties of high bioactivity that can be performed by surface modification to realize the osseointegration. This article first reviews surface characteristics of Ti materials and various conventional surface modification techniques involving mechanical, physical and chemical treatments based on the formation mechanism of the modified coatings. Such conventional methods are able to improve bioactivity of Ti implants, but the surfaces with static state cannot respond to the dynamic biological cascades from the living cells and tissues. Hence, beyond traditional static design, dynamic responsive avenues are then emerging. The dynamic stimuli sources for surface functionalization can originate from environmental triggers or physiological triggers. In short, this review surveys recent developments in the surface engineering of Ti materials, with a specific emphasis on advances in static to dynamic functionality, which provides perspectives for improving bioactivity and biocompatibility of Ti implants.

A dual functional Ti-Ga alloy: inhibiting biofilm formation and osteoclastogenesis differentiation via disturbing iron metabolism

BACKGROUND

Although biomedical implants have been widely used in orthopedic treatments, two major clinical challenges remain to be solved, one is the bacterial infection resulting in biofilm formation, and the other is aseptic loosening during implantation due to over-activated osteoclastogenesis. These factors can cause many clinical issues and even lead to implant failure. Thus, it is necessary to endow implants with antibiofilm and aseptic loosening-prevention properties, to facilitate the integration between implants and bone tissues for successful implantation. To achieve this goal, this study aimed to develop a biocompatible titanium alloy with antibiofilm and anti-aseptic loosening dual function by utilizing gallium (Ga) as a component.

METHODS

A series of Ti-Ga alloys were prepared. We examined the Ga content, Ga distribution, hardness, tensile strength, biocompatibility, and anti-biofilm performance in vitro and in vivo. We also explored how Ga³⁺ ions inhibited the biofilm formation of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) and osteoclast differentiation.

RESULTS

The alloy exhibited outstanding antibiofilm properties against both S. aureus and E. coli in vitro and decent antibiofilm performance against S. aureus in vivo. The proteomics results demonstrated that Ga³⁺ ions could disturb the bacterial Fe metabolism of both S. aureus and E. coli, inhibiting bacterial biofilm formation. In addition, Ti-Ga alloys could inhibit receptor activator of nuclear factor-κB ligand (RANKL)-dependent osteoclast differentiation and function by targeting iron metabolism, then suppressing the activation of the NF-κB signaling pathway, thus, showing their potential to prevent aseptic loosening.

CONCLUSION

This study provides an advanced Ti-Ga alloy that can be used as a promising orthopedic implant raw material for various clinical scenarios. This work also revealed that iron metabolism is the common target of Ga³⁺ ions to inhibit biofilm formation and osteoclast differentiation.

Physical, morphological and bioactive properties of Co-Cr-W-Ta alloys: Influence of insertion of tantalum and surface thermochemical treatment on bioactivity

The development of bioactivity in bioinert metallic alloys is a field of interest aiming to improve some aspects of these materials for implant applications. New Co₆₃ Cr₂₈ W_9-x Ta_x alloys with different Ta concentrations (x = 0, 2, 4, 6, and 9% w/w) were synthesized in the work reported here. The alloys were characterized by x-ray diffraction, volumetric density, Vickers microhardness, atomic force microscopy, scanning electron microscopy (SEM), and energy-dispersion x-ray spectroscopy (EDS). Bioactivity properties were evaluated by in vitro tests with simulated body fluid (SBF). In vivo assays were performed to assess biocompatibility. The influence of surface thermochemical treatment and Ta insertion on the bioactive properties of the alloys was investigated. The results showed that the alloy structure comprises εCo and αCo phases, with cobalt as a matrix with Cr, W, and Ta as a solid solution. TaCo₂ phase is observed in the alloys with 4, 6, and 9% w/w of Ta, and its amount increase as Ta concentration increases. Volumetric density is reduced (from 8.78 ± 0.06 to 8.56 ± 0.09 g/cm³ ) as Ta concentration increases (from 0% to 9% w/w) mainly due to the lower density of the tantalum compared to the tungsten metal. On the other hand, the TaCo₂ phase contributes to the increase of Vickers's hardness by ~17.6% for the alloy with 9% Ta (394.7 ± 8.1 HV) compared with Co₆₃ Cr₂₈ W₉ (336 ± 5 HV). The topographic analysis showed increased roughness and adhesion due to the nucleation of Ta_1.1 O_1.05 and Ca₂ Ta₂ O₇ crystals after surface thermochemical treatment. The roughness and adhesion increase from 16.9 ± 0.6 nm and 8.3 ± 1.8 nN (untreated surface) to 255.7 ± 17.7 nm and 24.1 ± 12.6 nN (treated surface), respectively, for the Co₆₃ Cr₂₈ Ta₉ alloy. These results suggest that thermochemical treatment provides surface conditions favorable to hydroxyapatite (HA) nucleation. The SEM and EDS data showed the nucleation of spongy structures, consistent with HA, composed mainly of Ca and P, indicating that oxides tantalum promoted a bioactive response on the sample's surface. The biological assay corroborated the alloy's safety and applicability, highlighting its potential in biomedical application since no harmful effects were observed.

Bioactivity and antibacterial activity of iodine-containing calcium titanate against implant-associated infection

Developing antimicrobial biomaterials is a major challenge in the fields of orthopaedic and dental implants. In this study, we evaluated the bone-bonding ability and antibacterial activity of a novel biomaterial for preventing implant-associated infections. We have previously reported that NaOH heat treatment improved the bone-bonding ability of titanium, which was later modified to release target ions from the calcium titanate surface. Iodine, an essential nutrient, exhibits broad-spectrum antimicrobial activity; hence, we designed a calcium titanate that releases iodine ions (Ca-I-Ti). The material was prepared from a simple solution using heat treatments as well as inexpensive devices and chemical agents. MC3T3-E1 cells seeded on Ca-I-Ti displayed high degrees of bioactivity and viability, and Ca-I-Ti exhibited antibacterial activity against methicillin-susceptible Staphylococcus aureus. In vivo biomechanical and histological experiments showed that Ca-I-Ti had excellent bone-bonding ability at 8 weeks after implantation. In a subcutaneous infection model in rats, methicillin-susceptible Staphylococcus aureus on the implant was reduced by approximately 95% compared to that on commercially pure titanium, indicating that Ca-I-Ti has antibacterial effects in vivo. In addition, no local or systemic complications were observed, and active infection in the surrounding tissues was histologically inhibited. Thus, iodine-containing calcium titanate is a safe biomaterial with excellent bioactivity and antibacterial properties, indicating its potential in preventing implant-associated infections.

Drug-Releasing Gelatin Coating Reinforced with Calcium Titanate Formed on Ti–6Al–4V Alloy Designed for Osteoporosis Bone Repair

Ti–6Al–4V alloy has been widely used in the orthopedic and dental fields owing to its high mechanical strength and biocompatibility. However, this alloy has a poor bone-bonding capacity, and its implantation often causes loosening. Osteoporosis increases with the aging of the population, and bisphosphonate drugs such as alendronate and minodronate (MA) are used for the medical treatment. Reliable and multifunctional implants showing both bone bonding and drug releasing functions are desired. In this study, we developed a novel organic-inorganic composite layer consisting of MA-containing gelatin and calcium-deficient calcium titanate (cd–CT) with high bone-bonding and scratch resistance on Ti–6Al–4V alloy. The alloy with the composite layer formed apatite within 7 days in a simulated body fluid and exhibited high scratch resistance of an approximately 50 mN, attributable to interlocking with cd ± CT. Although the gelatin layer almost completely dissolved in phosphate-buffered saline within 6 h, its dissolution rate was significantly suppressed by a subsequent thermal crosslinking treatment. The released MA was estimated at more than 0.10 μmol/L after 7 days. It is expected that the Ti alloy with the MA-containing gelatin and cd–CT composite layer will be useful for the treatment of osteoporosis bone.

A comprehensive review on metallic implant biomaterials and their subtractive manufacturing

There is a tremendous increase in the demand for converting biomaterials into high-quality industrially manufactured human body parts, also known as medical implants. Drug delivery systems, bone plates, screws, cranial, and dental devices are the popular examples of these implants - the potential alternatives for human life survival. However, the processing techniques of an engineered implant largely determine its preciseness, surface characteristics, and interactive ability with the adjacent tissue(s) in a particular biological environment. Moreover, the high cost-effective manufacturing of an implant under tight tolerances remains a challenge. In this regard, several subtractive or additive manufacturing techniques are employed to manufacture patient-specific implants, depending primarily on the required biocompatibility, bioactivity, surface integrity, and fatigue strength. The present paper reviews numerous non-degradable and degradable metallic implant biomaterials such as stainless steel (SS), titanium (Ti)-based, cobalt (Co)-based, nickel-titanium (NiTi), and magnesium (Mg)-based alloys, followed by their processing via traditional turning, drilling, and milling including the high-speed multi-axis CNC machining, and non-traditional  abrasive water jet machining (AWJM), laser beam machining (LBM), ultrasonic machining (USM), and electric discharge machining (EDM) types of subtractive manufacturing techniques. However, the review further funnels down its primary focus on Mg, NiTi, and Ti-based alloys on the basis of the increasing trend of their implant applications in the last decade due to some of their outstanding properties. In the recent years, the incorporation of cryogenic coolant-assisted traditional subtraction of biomaterials has gained researchers' attention due to its sustainability, environment-friendly nature, performance, and superior biocompatible and functional outcomes fitting for medical applications. However, some of the latest studies reported that the medical implant manufacturing requirements could be more remarkably met using the non-traditional subtractive manufacturing approaches. Altogether, cryogenic  machining among the traditional routes and EDM among the non-traditional means along with their variants, were identified as some of the most effective subtractive manufacturing techniques for achieving the dimensionally accurate and biocompatible metallic medical implants with significantly modified surfaces.

Coinciding significance of the crystallographic orientation and nanostructuring on the biocompatibility of TZNT-Ag1 .5 alloy deformed by the cold rolling process

In this study, the simultaneous significance of the crystallographic texture and nanostructuring on the cytocompatibility of as-cast (Ti₅₅ Zr₂₅ Nb₁₀ Ta₁₀ )_98.5 -Ag_1.5 alloy (at. %, TZNT-Ag_1.5 ), subjected to cold rolling up to 90% reduction, along with the changes of Young's modulus and hardness under cold rolling were investigated. For this purpose, the as-cast and cold-rolled TZNT-Ag_1.5 alloy test specimens were analyzed by XRD, TEM, HRTEM, SEM, contact angle, nanoindentation, and OM techniques. Moreover, to evaluate the effect of severe cold deformation on the biocompatibility, MG-63 osteoblastic cell was cultured on the surface of 90% cold-rolled and as-cast test specimens of TZNT-Ag_1.5 alloy. The results showed that severe cold deformation was led to fast grain refinement of β grains of the as-cast TZNT-Ag_1.5 alloy in the range of 50-100 nm. In addition to the nanostructuring, upon severe cold deformation, the <gamma>-fiber (<111>// normal direction) texture was formed and after 90% reduction, the (111)<1 1 ¯ 0 > γ_-fiber component was strengthened. The micro-hardness and reduced Young's modulus are 235 ± 5.29, 246 ± 1.73, 271 ± 4.0, and 283 ± 6.25 (HV); and 73.725 ± 1.70, 83.98 ± 5.10, 81.26 ± 6.55, and 88.66 ± 7.16 (GPa) for TZNT-Ag_1.5 (as-cast), TZNT-Ag_1.5 (20%CR), TZNT-Ag_1.5 (50%CR), and TZNT-Ag_1.5 (90%CR) test specimens, respectively. Further, with increasing the cold deformation degree, the dislocation density of TZNT-Ag_1.5 alloy increased as this parameter is 2.79 × 10¹⁵ (m^-2 ) for the 90%CR test specimen. On the other hand, the values of the contact angle for the 90%CR test specimen (46.2 ± 3.5°) exhibit a higher hydrophilic and wettable surface as compared to the other studied test specimens. After 5 days of incubation, osteoblastic cells on the surface of the 90% cold-rolled TZNT-Ag_1.5 test specimens revealed significant differences in cell proliferation and differentiation as compared to the as-cast alloy test specimens and/or CP-Ti. Finally, because the maximum orientation intensities were generally <3, it was deduced that grain refinement rather than the crystallographic texture plays a significant role in improving the surface biocompatibility of the new TZNT-Ag_1.5 alloy.

Iodine-Loaded Calcium Titanate for Bone Repair with Sustainable Antibacterial Activity Prepared by Solution and Heat Treatment

In the orthopedic and dental fields, simultaneously conferring titanium (Ti) and its alloy implants with antibacterial and bone-bonding capabilities is an outstanding challenge. In the present study, we developed a novel combined solution and heat treatment that controllably incorporates 0.7% to 10.5% of iodine into Ti and its alloys by ion exchange with calcium ions in a bioactive calcium titanate. The treated metals formed iodine-containing calcium-deficient calcium titanate with abundant Ti-OH groups on their surfaces. High-resolution XPS analysis revealed that the incorporated iodine ions were mainly positively charged. The surface treatment also induced a shift in the isoelectric point toward a higher pH, which indicated a prevalence of basic surface functionalities. The Ti loaded with 8.6% iodine slowly released 5.6 ppm of iodine over 90 days and exhibited strong antibacterial activity (reduction rate >99%) against methicillin-resistant Staphylococcus aureus (MRSA), S. aureus, Escherichia coli, and S. epidermidis. A long-term stability test of the antibacterial activity on MRSA showed that the treated Ti maintained a >99% reduction until 3 months, and then it gradually decreased after 6 months (to a 97.3% reduction). There was no cytotoxicity in MC3T3-E1 or L929 cells, whereas apatite formed on the treated metal in a simulated body fluid within 3 days. It is expected that the iodine-carrying Ti and its alloys will be particularly useful for orthopedic and dental implants since they reliably bond to bone and prevent infection owing to their apatite formation, cytocompatibility, and sustainable antibacterial activity.

Osteoconductivity of bioactive Ti-6Al-4V implants with lattice-shaped interconnected large pores fabricated by electron beam melting

Additive manufacturing has facilitated the fabrication of orthopedic metal implants with interconnected pores. Recent reports have indicated that a pore size of 600 μm is beneficial for material-induced osteogenesis. However, the complete removal of the metal powder from such small pores of implants is extremely difficult especially in electron beam melting (EBM). We therefore developed a new type of Ti-6Al-4V implant with lattice-shaped interconnected pores measuring 880-1400 μm, which allowed for the easy removal of metal powder. This implant was fabricated by EBM and treated with NaOH, CaCl₂, heat, and water (ACaHW treatment) to render the metal surface bioactivity. In the present study, the mechanical and chemical property of the implants and the biocompatibility were evaluated. The SEM and micro-CT images demonstrated the 3D interconnectivity of the porous structures. The average porosity of the porous titanium implant was 57.5%. The implant showed maximum compressive load of 78.9 MPa and Young's modulus of 3.57 GPa which matches that of human cortical bone. ACaHW treatment of the porous Ti-6Al-4V implants induced apatite formation in simulated body fluid in vitro. The ACaHW-treated porous implants harvested from rabbit femoral bone showed direct bonding of bone to the metal surface without interposition of fibrous tissue. The porous ACaHW-treated implant had a higher affinity to the bone than the untreated one. The mechanical strength of implant fixation assessed using the push-out test was significantly higher in the ACaHW-treated implant than in untreated one. FE-SEM analysis and EDX mapping after push-out test of solid implants showed a lot of bone tissue patches on the surface of the ACaHW-treated implant. These results suggest that the new ACaHW-treated Ti-6Al-4V implant with lattice-shaped interconnected pores is a superior alternative to conventional materials for medical application.

Design and development of metallic biomaterials with biological and mechanical biocompatibility

In the present article, the recent trends in the research and development of metallic biomaterials are discussed with focus on the results obtained by the author's group. The design of biocompatible metallic biomaterials possessing excellent biological and mechanical properties, including titanium alloys with low Young's modulus, is reviewed with focus on Young's modulus, fatigue strength, and peculiar behavior. The evaluation of biological compatibility including cell viability and living tissue compatibility using animal models and surface modifications using bioactive ceramic and blood-compatible polymers are summarized. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 944-954, 2019.

Porous titanium cervical interbody fusion device in the treatment of degenerative cervical radiculopathy; 1-year results of a prospective controlled trial

BACKGROUND CONTEXT

Anterior cervical discectomy with an interbody cage (ACDF) to obtain fusion is a common procedure in cervical spine surgery. Presently, polyetheretherketone (PEEK) with (auto) graft is frequently used for interbody fusion although alternative implant technology like 3-D printing titanium has been introduced recently.

PURPOSE

Reporting the clinical and quantitative radiological outcome of a prospective cohort of 3-D printed porous titanium implants.

STUDY DESIGN/SETTING

Prospective study of patients with single level ACDF using 3-D printed porous titanium cervical implants. These data were compared with 48 patients from the PEEK with autograft group of the previously performed CAncellous Structured Ceramic Arthrodesis DEvice trial.

PATIENT SAMPLE

Fourty-nine patients were included.

OUTCOME MEASURES

Neck disability index (NDI), visual analog scale (VAS), self-reported perceived recovery, and fusion status.

METHODS

The clinical outcomes and fusion rates were documented at 3, 6, and 12 months. Dynamic X-rays were analyzed to determine range of motion (ROM) of the operated level. Fusion was defined as rotation ≤4° and ≤1.25 mm translation on flexion-extension films.

RESULTS

The mean NDI improved from 41.2 preoperatively to 19.4 at 12 months postoperatively. Both VAS arm and VAS neck improved significantly after surgery and 77.1% of the patients reported complete or nearly complete recovery at 12 months. The mean ROM of the affected disc level decreased from 8.7° (range 2.6-21.4) before surgery to 1.6° (0.0-4.6°) after 12 months. The fusion rate at 3, 6, and 12 months was 84%, 89%, and 91% respectively, compared with 67%, 72%, and 90%, in the PEEK group.

CONCLUSIONS

3-D printed porous titanium cervical implants resulted in significant clinical improvement after surgery. The fusion rate of porous titanium compared with PEEK with autograft at 12 months was similar, although porous titanium resulted in faster consolidation. In addition, one level anterior cervical fusion can be successfully achieved without additional plating.

The effect of nano-size second precipitates on the structure, apatite-inducing ability and in-vitro biocompatibility of Ti-29Nb-14Ta-4.5Zr alloy

The apatite formation and in-vitro biocompatibility of Ti-29Nb-14Ta-4.5Zr (TNTZ) alloy reinforced by various nano-sized phases of α″, α, and ω in the β matrix have been studied. The electrochemical performances of the elaborated microstructures have been assessed through potentiodynamic polarization in the simulated body fluid (SBF) and interestingly, the β + ω specimen exhibited an extraordinary corrosion resistance compared to the others. This was attributed to the uniform distribution, spherical morphology and coherent interface of the ω nano-precipitates. The polarization tests in simulated body fluid showed the high tendency of apatite formation on the surface of the β- matrix contained ω precipitates. The in-vitro cytotoxicity analysis employing MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay showed >85% cell viability of the TNTZ alloy reinforced by nano-ω precipitations. Since this specimen showed the highest cell adhesion as well, it introduces this structure as a promising high potential candidate for biomedical applications due to its high corrosion resistance, biocompatibility, ultra-low cytotoxicity, and good cell adhesion.

Tri-Functional Calcium-Deficient Calcium Titanate Coating on Titanium Metal by Chemical and Heat Treatment

The main problem of orthopedic and dental titanium (Ti) implants has been poor bone-bonding to the metal. Various coatings to improve the bone-bonding, including the hydroxyapatite and titania, have been developed, and some of them have been to successfully applied clinical use. On the other hand, there are still challenges to provide antibacterial activity and promotion of bone growth on Ti. It was shown that a calcium-deficient calcium titanate coating on Ti and its alloys exhibits high bone-bonding owing to its apatite formation. In this study, Sr and Ag ions, known for their promotion of bone growth and antibacterial activity, were introduced into the calcium-deficient calcium titanate by a three-step aqueous solution treatment combined with heat. The treated metal formed apatite within 3 days in a simulated body fluid and exhibited antibacterial activity to Escherichia coli without showing any cytotoxicity in MC3T3-E1 preosteoblast cells. Furthermore, the metal slowly released 1.29 ppm of Sr ions. The Ti with calcium-deficient calcium titanate doped with Sr and Ag will be useful for orthopedic and dental implants, since it should bond to bone because of its apatite formation, promote bone growth due to Sr ion release, and prevent infection owing to its antibacterial activity.

Simulated body fluid and the novel bioactive materials derived from it

Professor Larry Hench first reported that certain glasses are able to spontaneously bond to living bone in 1970. This discovery stimulated research into new kinds of bone-bonding materials. However, there were no guiding principles for this purpose, and many animals were sacrificed in the effort to establish them. The present authors proposed in 1991 that the bone-bonding capacity of a material could be evaluated by examining apatite formation on its surface in an acellular simulated body fluid (SBF), without the need of performing any animal experiments. Various kinds of novel bone-bonding bioactive materials based on Ti metal and its alloys with a number of different functions have been developed using SBF. Some of these have entered clinical use as important bone-repairing materials. Without the method of SBF evaluation, these novel materials would not have been developed. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 968-977, 2019.

Ca-Ag coexisting nano-structured titania layer on Ti metal surface with enhanced bioactivity, antibacterial and cell compatibility

A nano-structured titanate layer encapsulated with Ca²⁺ and Ag⁺ ions was successfully grown over commercially pure (CP) Ti metal by chemical treatment with H₂O₂ and subsequent treatment with Ca (NO₃)₂/AgNO₃ solutions. Heat treatment at 600 °C, further transformed this nano-structured titanate layer into titania containing Ca²⁺ and Ag⁺ ions. Thus modified Ti metal showed significant enhancement in apatite-forming ability when soaked in simulated body fluid (SBF). Presence of Ag⁺ ions showed good antimicrobial activity against pathogenic Staphylococcus aureus, and, Ca²⁺ ions being a major component of bone mineral accelerated the apatite-forming ability over Ti metal in SBF. Further, Ca²⁺and Ag⁺ ions proportion over Ti metal surface could be optimised in order to have minimum Ag concentration that can have not only antibacterial activity and also cell compatibility against MG 63 osteoblast-like cells. Therefore, the proposed surface modification approach presented here is expected to be useful in orthopaedic implants that necessitate enhanced bioactivity, antibacterial activity and cell compatibility.

A critical review of multifunctional titanium surfaces: New frontiers for improving osseointegration and host response, avoiding bacteria contamination

Evolution of metal implants progressively shifted the focus from adequate mechanical strength to improved biocompatibility and absence of toxicity and, finally, to fast osseointegration. Recently, new frontiers and challenges of Ti implants have been addressed to improvement of bioactivity, fighting of bacterial infection and biofilm formation, as well as modulation of inflammation. This is closely related to the clinical demand of multifunctional implants able to simultaneously have a number of specific responses with respect to body fluids, cells (osteoblasts, fibroblasts, macrophages) and pathogenic agents (bacteria, viruses). This complex system of multiple biological stimuli and surface responses is a major arena of the current research on biomaterials and biosurfaces. This review covers the strategies explored to this purpose since 2010 in the case of Ti and Ti alloys, considering that the number of related papers doubled about in the last seven years and no review has comprehensively covered this engaging research area yet. The different approaches followed for producing multifunctional Ti-based surfaces involve the use of thick and thin inorganic coatings, chemical surface treatments, and functionalization strategies coupled with organic coatings.

STATEMENT OF SIGNIFICANCE

According to the clinical demand of multifunctional implants able to simultaneously have a number of specific responses with respect to body fluids, cells and pathogenic agents, new frontiers of Ti implants have been addressed to improvement of bioactivity, fighting of bacterial infection and biofilm formation, as well as modulation of inflammation. Literature since 2010 is here reviewed. Several strategies for getting bioactive and antibacterial actions on Ti surfaces have been suggested, but they still need to be optimized with respect to several concerns. A further step will be to combine on the same surface a proven ability of modulation of inflammatory response. The achievement of multifunctional surfaces able to modulate inflammation and to promote osteogenesis is a grand challenge.

Fully Depleted Ti-Nb-Ta-Zr-O Nanotubes: Interfacial Charge Dynamics and Solar Hydrogen Production

Poor kinetics of hole transportation at the electrode/electrolyte interface is regarded as a primary cause for the mediocre performance of n-type TiO₂ photoelectrodes. By adopting nanotubes as the electrode backbone, light absorption and carrier collection can be spatially decoupled, allowing n-type TiO₂, with its short hole diffusion length, to maximize the use of the available photoexcited charge carriers during operation in photoelectrochemical (PEC) water splitting. Here, we presented a delicate electrochemical anodization process for the preparation of quaternary Ti-Nb-Ta-Zr-O mixed-oxide (denoted as TNTZO) nanotube arrays and demonstrated their utility in PEC water splitting. The charge-transfer dynamics for the electrodes was investigated using time-resolved photoluminescence, electrochemical impedance spectroscopy, and the decay of open-circuit voltage analysis. Data reveal that the superior photoactivity of TNTZO over pristine TiO₂ originated from the introduction of Nd, Ta, and Zr elements, which enhanced the amount of accessible charge carriers, modified the electronic structure, and improved the hole injection kinetics for expediting water splitting. By modulating the water content of the electrolyte employed in the anodization process, the wall thickness of the grown TNTZO nanotubes can be reduced to a size smaller than that of the depletion layer thickness, realizing a fully depleted state for charge carriers to further advance the PEC performance. Hydrogen evolution tests demonstrate the practical efficacy of TNTZO for realizing solar hydrogen production. Furthermore, with the composition complexity and fully depleted band structure, the present TNTZO nanotube arrays may offer a feasible and universal platform for the loading of other semiconductors to construct a sophisticated heterostructure photoelectrode paradigm, in which the photoexcited charge carriers can be entirely utilized for efficient solar-to-fuel conversion.

Improved bioactivity of GUMMETAL®, Ti59Nb36Ta2Zr3O0.3, via formation of nanostructured surfaces

The leading reason for implant revision surgery globally is lack of implant integration with surrounding bone. A new titanium alloy GUMMETAL^® (Ti₅₉Nb₃₆Ta₂Zr₃O_0.3) is currently used in biomedical devices and has a Young’s modulus that is better matched to bone. The surface was subject to NaOH, CaCl₂, heat and water treatment (BioGum) after which the surfaces were evaluated using atomic force microscope, scanning electron microscope, X-ray diffractometer and elemental analysis using energy dispersive X-ray. To demonstrate enhanced bone bonding ability and cytocompatibility, apatite formation in simulated body fluid and in vitro stem cell attachment, proliferation and cytoskeleton organisation were examined. The formation of a ~200 nm nanoscale needle-like calcium titanate network on the surface following treatment was revealed and upon soaking in simulated body fluid, the formation of a ~5 µm layer of apatite. Metabolic activity of rat bone marrow stem cells on BioGum was increased in comparison to control and the cell number appeared greater, with more elongated morphology as early as 2 h post-seeding. This positions the modification as a simple and potentially universal technology for the improvement of implant integration.

Bioactive pedicle screws prepared by chemical and heat treatments improved biocompatibility and bone-bonding ability in canine lumbar spines

Background

Titanium (Ti)-6Al-4V alloy, which is widely used in spinal instrumentation with a pedicle screw (PS) system. However, significant clinical problems, including loosening and back-out of PSs, persist. During the last decade, a novel technology that produces bioactive Ti from chemical and heat treatments has been reported that induces the spontaneous formation of a hydroxyapatite (HA) layer on the surface of Ti materials. The purpose of this study was to study the effect of bioactivation of Ti-6Al-4V PSs on the ability of HA formation in vitro and its biocompatibility and bone-bonding ability in vivo.

Methods

Ti-6V-4Al alloy PSs were prepared and bioactivated by NaOH-CaCl₂-heat-water treatments. The HA-forming ability of bioactive PSs in simulated body fluid (SBF) was evaluated by field emission scanning electron microscopy (FE-SEM) and energy dispersive X-ray analysis (EDX). Six 11-month-old female beagle dogs were used for the in vivo study. Bioactive and control (without bioactivation) PSs were left and right randomly placed from L1 to L6. One and three months after surgery, lumbar spines were removed for biomechanical and histological analyses.

Results

In vitro: The surface analysis of bioactive PSs by FE-SEM and EDX showed substantial HA deposits over the entire surface. In vivo: The mean extraction torque was significantly higher for bioactive PSs compared to controls PSs (P<0.01); there was no significant difference in pull-out strength between control and bioactive PSs. Histologically, the contact area between bone tissue and screw surface showed no significant trend to be greater in bioactive PSs compared to control PSs (P = 0.06).

Conclusions

Bioactive PSs prepared by chemical and heat treatments formed layers of HA on the surface of screws in vitro that improved biocompatibility and bonding ability with bone in vivo. Bioactive PSs may reduce screw loosening to overcome the obstacles confronted in spinal instrumentation surgery.

In vivo osteoconductivity of surface modified Ti-29Nb-13Ta-4.6Zr alloy with low dissolution of toxic trace elements

Simulated Body Fluid (SBF) has served as a useful standard to check the bioactivity of implant materials for years. However, it is not perfectly able to imitate human serum; sometimes disparities between the SBF test and animal test were confirmed. Therefore, to ensure the reliability of the results of the SBF test obtained from our previous study, an animal study was performed to check osteoconductivity of surface modified implant materials. Three types of solution processes, hydrothermal (H), electrochemical (E), and hydrothermal-electrochemical (HE), were performed on the Ti-29Nb-13Ta-4.6Zr alloy (TNTZ) to improve its bioactivity, and their bioactivities were measured in vivo using bone-implant contacts (BICs). BICs of the HE- and H-treated samples were significantly higher than that of the control. Metal ion diffusion towards the bone was also evaluated to examine the adverse effect of metal ions. No metal ion diffusion was observed, indicating the safety of our solution processed implant materials.

Strontium and magnesium ions released from bioactive titanium metal promote early bone bonding in a rabbit implant model

We have previously developed the "alkali and heat treatment" method to confer bioactivity (bone-bonding ability) to titanium metal (Ti). As strontium (Sr) and magnesium (Mg) ions reportedly promote osteoblastic cell proliferation and differentiation and accelerate bone formation, we improved this method to induce the release of Sr (Sr-Ti) or Mg (Mg-Ti) ions from Ti in a previous study. Here, we evaluated the bioactivity of these novel surface treatments, Sr-Ti and Mg-Ti. In vitro evaluation of cell viability, expression of integrin β1, β catenin, and cyclin D1, osteogenic gene expression, alkaline phosphatase activity, and extracellular mineralization using MC3T3-E1 cells revealed that Sr-Ti and Mg-Ti enhanced proliferation and osteogenic differentiation. In rabbit in vivo studies, Sr-Ti and Mg-Ti also provided greater biomechanical strength and bone-implant contact than the positive control Ti (Ca-Ti), especially at the early stage (4-8weeks), and maintained these properties for a longer period (16-24weeks). Advantages of the improved method include process simplicity, applicability for any implant shape, and lack of adverse effects on implant composition and structure. Therefore, our treatment is promising for clinical applications to achieve early bone bonding.

STATEMENT OF SIGNIFICANCE

Implantation into osteoporotic bone constitutes a challenging problem because of early migration or loosening of the implant, which is primarily due to insufficient initial fixation in porotic bone. Therefore, it is desirable to provide implants with a capacity for early bone bonding. We have achieved conferring early bone bonding ability to titanium metal by releasing strontium ions or magnesium ions. Our treatment is promising for clinical applications to achieve early bone bonding of orthopedic or dental Ti-based implants.

Impact of Surface Potential on Apatite Formation in Ti Alloys Subjected to Acid and Heat Treatments

Titanium metal (Ti) and its alloys are widely used in orthopedic and dental fields. We have previously shown that acid and heat treatment was effective to introduce bone bonding, osteoconduction and osteoinduction on pure Ti. In the present study, acid and heat treatment with or without initial NaOH treatment was performed on typical Ti-based alloys used in orthopedic and dental fields. Dynamic movements of alloying elements were developed, which depended on the kind of treatment and type of alloy. It was found that the simple acid and heat treatment enriched/remained the alloying elements on Ti-6Al-4V, Ti-15Mo-5Zr-3Al and Ti-15Zr-4Nb-4Ta, resulting in neutral surface charges. Thus, the treated alloys did not form apatite in a simulated body fluid (SBF) within 3 days. In contrast, when the alloys were subjected to a NaOH treatment prior to an acid and heat treatment, alloying elements were selectively removed from the alloy surfaces. As a result, the treated alloys became positively charged, and formed apatite in SBF within 3 days. Thus, the treated alloys would be useful in orthopedic and dental fields since they form apatite even in a living body and bond to bone.

Two-in-One Biointerfaces-Antimicrobial and Bioactive Nanoporous Gallium Titanate Layers for Titanium Implants

The inhibitory effect of gallium (Ga) ions on bone resorption and their superior microbial activity are attractive and sought-after features for the vast majority of implantable devices, in particular for implants used for hard tissue. In our work, for the first time, Ga ions were successfully incorporated into the surface of titanium metal (Ti) by simple and cost-effective chemical and heat treatments. Ti samples were initially treated in NaOH solution to produce a nanostructured sodium hydrogen titanate layer approximately 1 μm thick. When the metal was subsequently soaked in a mixed solution of CaCl₂ and GaCl₃, its Na ions were replaced with Ca and Ga ions in a Ga/Ca ratio range of 0.09 to 2.33. 8.0% of the Ga ions were incorporated into the metal surface when the metal was soaked in a single solution of GaCl₃ after the NaOH treatment. The metal was then heat-treated at 600 °C to form Ga-containing calcium titanate (Ga–CT) or gallium titanate (GT), anatase and rutile on its surface. The metal with Ga–CT formed bone-like apatite in a simulated body fluid (SBF) within 3 days, but released only 0.23 ppm of the Ga ions in a phosphate-buffered saline (PBS) over a period of 14 days. In contrast, Ti with GT did not form apatite in SBF, but released 2.96 ppm of Ga ions in PBS. Subsequent soaking in hot water at 80 °C dramatically enhanced apatite formation of the metal by increasing the release of Ga ions up to 3.75 ppm. The treated metal exhibited very high antibacterial activity against multidrug resistant Acinetobacter baumannii (MRAB12). Unlike other antimicrobial coating on titanium implants, Ga–CT and GT interfaces were shown to have a unique combination of antimicrobial and bioactive properties. Such dual activity is essential for the next generation of orthopaedic and dental implants. The goal of combining both functions without inducing cytotoxicity is a major advance and has far reaching translational perspectives. This unique dual-function biointerfaces will inhibit bone resorption and show antimicrobial activity through the release of Ga ions, while tight bonding to the bone will be achieved through the apatite formed on the surface.

Synergistic effect of nanotopography and bioactive ions on peri-implant bone response

Both bioactive ion chemistry and nanoscale surface modifications are beneficial for enhanced osseointegration of endosseous implants. In this study, a facile synthesis approach to the incorporation of bioactive Ca²⁺ ions into the interlayers of nanoporous structures (Ca-nano) formed on a Ti6Al4V alloy surface was developed by sequential chemical and heat treatments. Samples with a machined surface and an Na⁺ ion-incorporated nanoporous surface (Na-nano) fabricated by concentrated alkali and heat treatment were used in parallel for comparison. The bone response was investigated by microcomputed tomography assessment, sequential fluorescent labeling analysis, and histological and histomorphometric evaluation after 8 weeks of implantation in rat femurs. No significant differences were found in the nanotopography, surface roughness, or crystalline properties of the Ca-nano and Na-nano surfaces. Bone–implant contact was better in the Ca-nano and Na-nano implants than in the machined implant. The Ca-nano implant was superior to the Na-nano implant in terms of enhancing the volume of new bone formation. The bone formation activity consistently increased for the Ca-nano implant but ceased for the Na-nano implant in the late healing stage. These results suggest that Ca-nano implants have promising potential for application in dentistry and orthopedics.

Bioactivity and mechanical stability of Ti-6Al-4V implants superplastically embedded with hydroxyapatite in rats

In this in vivo study, Sprague Dawley (SD) rats were used to investigate the bioactivity as well as the microstructural and mechanical properties of Ti-6Al-4V samples embedded with hydroxyapatite (HA) using two different coating methods-superplastic embedment (SPE) and superplastic deformation (SPD). The HA layer thickness for the SPE and SPD samples increased from 249.1  ±  0.6 nm to 874.8  ±  13.7 nm, and from 206.1  ±  5.8 nm to 1162.7  ±  7.9 nm respectively, after 12 weeks of implantation. The SPD sample exhibited much faster growth of newly formed HA compared to SPE. The growth of the newly formed HA was strongly dependent on the degree of HA crystallinity in the initial HA layer. After 12 weeks of implantation, the surface hardness value of the SPE and SPD samples decreased from 661  ±  0.4 HV to 586  ±  1.3 HV and from 585  ±  6.6 HV to 425  ±  86.9 HV respectively. The decrease in surface hardness values was due to the newly formed HA layer that was more porous than the initial HA layer. However, the values were still higher than the substrate surface hardness of 321  ±  28.8 HV. Wear test results suggest that the original HA layers for both samples were still strongly intact, and to a certain extent the newly grown HA layers also were strongly bound with the original HA layers. This study confirms the bioactivity and mechanical stability of the HA layer on both samples in vivo.

Novel bioactive materials developed by simulated body fluid evaluation: Surface-modified Ti metal and its alloys

Until the discovery of the bone-bonding activity of Bioglass by Hench et al. in the early 1970s, it had not been demonstrated that a synthetic material could bond to living bone without eliciting a foreign body reaction. Since then, various kinds of materials based on calcium phosphate, such as sintered hydroxyapatite and β-tricalcium phosphate have also been shown to bond to living bone. Until the discovery of the bone-bonding activity of Ti metal formed with a sodium titanate surface layer by the present authors in 1996, it had not been shown that a metallic material could bond to living bone. Since then, various kinds of surface-modified Ti metal and its alloys have been found to bond to living bone. Until the discovery of the osteoinduction of porous hydroxyapatite by Yamasaki in 1990, it was unknown whether a synthetic material could induce bone formation even in muscle tissue. Since then, various kinds of porous calcium phosphate ceramics have been shown to induce osteoinduction. Until the discovery of osteoinduction induced by a porous Ti metal formed with a titanium oxide surface layer by Fujibayashi et al. in 2004, it had been unclear whether porous metals would be able to induce osteoinduction. These novel bioactive materials have been developed by systematic research into the apatite formation that occurs on surface-modified Ti metal and its related materials in an acellular simulated body fluid (SBF) having ion concentrations almost equal to those of human blood plasma. Some of the novel bioactive materials based on Ti metal are already in clinical use or clinical trials, such as artificial hip joints and spinal fusion devices. In the present paper, we review how these novel bioactive materials based on Ti metal have been developed based on an evaluation of apatite formation in SBF. Without the SBF evaluation, these novel bioactive materials would most likely never have been developed.

STATEMENT OF SIGNIFICANCE

On the basis of systematic study of apatite formation on a material in a simulated body fluid, various kinds of novel bioactive materials possessing not only bone-bonding activity and but also various other functions such as bone growth promotion, antibacterial activity and osteoinduction have been developed. Some of them are already successfully applied to clinical applications or trials for artificial hip joints and spinal fusion devices. It is shown in the present paper how these novel bioactive materials have been developed.

Osseointegration behavior of novel Ti-Nb-Zr-Ta-Si alloy for dental implants: an in vivo study

This study aimed to evaluate the effects of Ti-Nb-Zr-Ta-Si alloy implants on mineral apposition rate and new BIC contact in rabbits. Twelve Ti-Nb-Zr-Ta-Si alloy implants were fabricated and placed into the right femur sites in six rabbits, and commercially pure titanium implants were used as controls in the left femur. Tetracycline and alizarin red were administered 3 weeks and 1 week before euthanization, respectively. At 4 weeks and 8 weeks after implantation, animals were euthanized, respectively. Surface characterization and implant-bone contact surface analysis were performed by using a scanning electron microscope and an energy dispersive X-ray detector. Mineral apposition rate was evaluated using a confocal laser scanning microscope. Toluidine blue staining was performed on undecalcified sections for histology and histomorphology evaluation. Scanning electron microscope and histomorphology observation revealed a direct contact between implants and bone of all groups. After a healing period of 4 weeks, Ti-Nb-Zr-Ta-Si alloy implants showed significantly higher mineral apposition rate compared to commercially pure titanium implants (P < 0.05), whereas there was no significant difference between Ti-Nb-Zr-Ta-Si alloy implants and commercially pure titanium implants (P > 0.05) at 8 weeks. No significant difference of bone-to-implant contact was observed between Ti-Nb-Zr-Ta-Si alloy implants and commercially pure titanium implants implants after a healing period of 4 weeks and 8 weeks. This study showed that Ti-Nb-Zr-Ta-Si alloy implants could establish a close direct contact comparedto commercially pure titanium implants implants, improved mineral matrix apposition rate, and may someday be an alternative as a material for dental implants.

Synergistic effects of bioactive ions and micro/nano-topography on the attachment, proliferation and differentiation of murine osteoblasts (MC3T3)

Surface topography and chemical nature of biological materials play an important role in regulating cell behaviors. For the intention of improving the biological performance of Ti6Al4V, the hierarchical micro/nano-topographies containing bioactive ions (Ca(2+) and Mg(2+)) were fabricated in this study. Briefly, the hierarchical micro/nano-topography was constructed on Ti6Al4V surface via sandblasting, acid etching and alkali-hydrothermal treatment. Then Na(+) existing in the nano-topography was replaced by Ca(2+) and Mg(2+) through hydrothermal reaction. The surface topographies and chemical nature of native and treated samples were characterized using laser scanning microscope, X-ray Photoelectron Spectroscopy and field emission scanning electron microscopy with the energy-dispersive spectroscopy. Surface wettability was measured with a contact angle goniometer. A series of biological tests were carried out to evaluate the synergistic effects of bioactive ions and micro/nano-topography on the attachment, proliferation and differentiation of murine osteoblastic MC3T3 cells. The results of in vitro tests indicated that Ca(2+) and Mg(2+) in the titanium alloy surface had an affirmative effect on cells attachment, proliferation and differentiation. Cells grown onto micro/nano-structured surface with Ca(2+) implantation exhibited significantly higher differentiation levels of alkaline phosphatase activity and mineralization compared to that on micro/nano-structured surface with Mg(2+) implantation. This study provided a novel method to construct a favorable biological environment between tissues and implants.

Osteoanabolic Implant Materials for Orthopedic Treatment

Osteoporosis is becoming more prevalent due to the aging demographics of many populations. Osteoporotic bone is more prone to fracture than normal bone, and current orthopedic implant materials are not ideal for the osteoporotic cases. A newly developed strontium phosphate (SrPO4 ) coating is reported herein, and applied to Ti-29Nb-13Ta-4.6Zr (wt%), TNTZ, an implant material with a comparative Young's modulus to that of natural bone. The SrPO4 coating is anticipated to modulate the activity of osteoblast (OB) and osteoclast (OC) cells, in order to promote bone formation. TNTZ, a material with excellent biocompatibility and high bioinertness is pretreated in a concentrated alkaline solution under hydrothermal conditions, followed by a hydrothermal coating growth process to achieve complete SrPO4 surface coverage with high bonding strength. Owing to the release of Sr ions from the SrPO4 coating and its unique surface topography, OB cells demonstrate increased proliferation and differentiation, while the cellular responses of OC are suppressed, compared to the control case, i.e., bare TNTZ. This TNTZ implant with a near physiologic Young's modulus and a functional SrPO4 coating provides a new direction in the design and manufacture of implantable devices used in the management of orthopedic conditions in osteoporotic individuals.

New Ti-Alloys and Surface Modifications to Improve the Mechanical Properties and the Biological Response to Orthopedic and Dental Implants: A Review

Titanium implants are widely used in the orthopedic and dentistry fields for many decades, for joint arthroplasties, spinal and maxillofacial reconstructions, and dental prostheses. However, despite the quite satisfactory survival rates failures still exist. New Ti-alloys and surface treatments have been developed, in an attempt to overcome those failures. This review provides information about new Ti-alloys that provide better mechanical properties to the implants, such as superelasticity, mechanical strength, and corrosion resistance. Furthermore, in vitro and in vivo studies, which investigate the biocompatibility and cytotoxicity of these new biomaterials, are introduced. In addition, data regarding the bioactivity of new surface treatments and surface topographies on Ti-implants is provided. The aim of this paper is to discuss the current trends, advantages, and disadvantages of new titanium-based biomaterials, fabricated to enhance the quality of life of many patients around the world.

Topological design and additive manufacturing of porous metals for bone scaffolds and orthopaedic implants: A review

One of the critical issues in orthopaedic regenerative medicine is the design of bone scaffolds and implants that replicate the biomechanical properties of the host bones. Porous metals have found themselves to be suitable candidates for repairing or replacing the damaged bones since their stiffness and porosity can be adjusted on demands. Another advantage of porous metals lies in their open space for the in-growth of bone tissue, hence accelerating the osseointegration process. The fabrication of porous metals has been extensively explored over decades, however only limited controls over the internal architecture can be achieved by the conventional processes. Recent advances in additive manufacturing have provided unprecedented opportunities for producing complex structures to meet the increasing demands for implants with customized mechanical performance. At the same time, topology optimization techniques have been developed to enable the internal architecture of porous metals to be designed to achieve specified mechanical properties at will. Thus implants designed via the topology optimization approach and produced by additive manufacturing are of great interest. This paper reviews the state-of-the-art of topological design and manufacturing processes of various types of porous metals, in particular for titanium alloys, biodegradable metals and shape memory alloys. This review also identifies the limitations of current techniques and addresses the directions for future investigations.

In vivo study of the early bone-bonding ability of Ti meshes formed with calcium titanate via chemical treatments

Alkali and heat (AH) treatment forming sodium titanate has been shown to connect bioinert Ti metal and bone tissue. Artificial joints treated with this method have achieved extensive clinical application. Recently a new chemical treatment of Alkali-Calcium-Heat-Water (ACaHW) treatment forming calcium titanate was proposed. Notably, the apatite-forming ability of this treatment is greater than that of AH treatment, as verified in vitro. However, the early bone-bonding abilities of the two treatments have not been compared in vivo. To simulate clinical application, we treated a commercially pure Ti (Cp-Ti) mesh implant with AH or ACaHW. Then, using mechanical and histological methods, we compared the bone-bonding abilities of the two treatments early during the implantation process (2-4 weeks); untreated Cp-Ti mesh was used as a control. Because the mesh structure might influence bone-bonding ability, we compared these bonding abilities with values obtained at 4 and 8 weeks using a Cp-Ti implant with a plate structure. In the mesh group, histological comparisons at 2 and 3 weeks indicated that ACaHW treatment resulted in a bone-bonding ability similar to that of AH treatment; ACaHW exhibited a greater bonding ability than AH at 4 weeks. However, in tests of the plate group at later time points, such differences were not apparent. The results obtained here indicate that during the early stage of embedment, ACaHW treatment of Cp-Ti mesh implants yields a higher bone-bonding ability than AH treatment, thus providing a positive reference for future clinical applications.

A Strontium-Modified Titanium Surface Produced by a New Method and Its Biocompatibility In Vitro

OBJECTIVE

To present a new and effective method of producing titanium surfaces modified with strontium and to investigate the surface characteristics and in vitro biocompatibility of titanium (Ti) surfaces modified with strontium (Sr) for bone implant applications.

MATERIALS AND METHODS

Sr-modified Ti surfaces were produced by sequential treatments with NaOH, strontium acetate, heat and water. The surface characteristics and the concentration of the Sr ions released from the samples were examined. Cell adhesion, morphology and growth were investigated using osteoblasts isolated from the calvaria of neonatal Sprague-Dawley rats. Expression of osteogenesis-related genes and proteins was examined to assess the effect of the Sr-modified Ti surfaces on osteoblasts.

RESULTS

The modified titanium surface had a mesh structure with significantly greater porosity, and approximately5.37±0.35at.% of Sr was incorporated into the surface. The hydrophilicity was enhanced by the incorporation of Sr ions and water treatment. The average amounts of Sr released from the Sr-modified plates subjected to water treatment were slight higher than the plates without water treatment. Sr promoted cellular adhesion, spreading and growth compared with untreated Ti surfaces. The Sr-modified Ti plates also promoted expression of osteogenesis-related genes,and expression of OPN and COL-І by osteoblasts. Ti plates heat treated at 700°C showed increased bioactivity in comparison with those treated at 600°C. Water treatment upregulated the expression of osteogenesis-related genes.

CONCLUSIONS

These results show that Sr-modification of Ti surfaces may improve bioactivity in vitro. Water treatment has enhanced the response of osteoblasts. The Sr-modified Ti heat-treated at 700°C exhibited better bioactivity compared with that heated at 600°C.

Growth of Novel Ceramic Layers on Metals via Chemical and Heat Treatments for Inducing Various Biological Functions

The present authors' systematic studies on growth of novel ceramic layers on Ti metal and its alloys by chemical and heat treatments for inducing bone-bonding bioactivity and some other biological functions are reviewed. Ti metal formed an apatite on its surface in a simulated body fluid, when heat-treated after exposure to strong acid solutions to form rutile surface layer, or to strong alkali solutions to form sodium titanate surface layer. Both types of Ti metal tightly bonded to the living bone. The alkali and heat treatment was applied to the surface Ti metal of an artificial hip joint and successfully used in the clinic since 2007. The acid and heat treatments was applied to porous Ti metal to induce osteoconductivity as well as osteoinductivity. The resulting product was successfully used in clinical trials for spinal fusion devices. For the Ti-based alloys, the alkali and heat treatment was little modified to form calcium titanate surface layer. Bone-growth promoting Mg, Sr, and Zn ions as well as the antibacterial Ag ion were successfully incorporated into the calcium titanate layer.

Novel artificial hip joint: A layer of alumina on Ti-6Al-4V alloy formed by micro-arc oxidation

In many hip replacement surgeries, monolithic alumina is used as a femoral head due to its high wear resistance. However, it is liable to fracture under load bearing operations in artificial joints. We propose a promising way to overcome this limitation by forming a dense alumina layer onto a relatively tough substrate such as Ti-6Al-4V alloy to obtain high wear resistance on a material that can sustain relatively high toughness. For this purpose, Al metal powders were deposited onto Ti-6Al-4V alloy by cold spraying in N2 atmosphere. Interfacial adhesion between Al and the Ti alloy was improved by the formation of a reaction layer of Al3Ti between them by heating at 640 °C for 1h in air. Subsequently, micro-arc oxidation treatment was performed to oxidize Al. The oxidized layer was composed of an outer porous layer of γ-alumina and inner-most dense layer of α-alumina. The α-alumina layer was almost fully densified and exhibited high Vickers hardness almost equal to that of alumina ceramics used as the femoral head. Thus, the newly developed dense alumina/Ti alloy can be potentially used to produce the reliable bearing surfaces of artificial hip joint.

Bioactive titanate layers formed on titanium and its alloys by simple chemical and heat treatments

To reveal general principles for obtaining bone-bonding bioactive metallic titanium, Ti metal was heat-treated after exposure to a solution with different pH. The material formed an apatite layer at its surface in simulated body fluid when heat-treated after exposure to a strong acid or alkali solution, because it formed a positively charged titanium oxide and negatively charged sodium titanate film on its surface, respectively. Such treated these Ti metals tightly bonded to living bone. Porous Ti metal heat-treated after exposure to an acidic solution exhibited not only osteoconductive, but also osteoinductive behavior. Porous Ti metal exposed to an alkaline solution also exhibits osteoconductivity as well as osteoinductivity, if it was subsequently subjected to acid and heat treatments. These acid and heat treatments were not effective for most Ti-based alloys. However, even those alloys exhibited apatite formation when they were subjected to acid and heat treatment after a NaOH treatment, since the alloying elements were removed from the surface by the latter. The NaOH and heat treatments were also not effective for Ti-Zr-Nb-Ta alloys. These alloys displayed apatite formation when subjected to CaCl₂ treatment after NaOH treatment, forming Ca-deficient calcium titanate at their surfaces after subsequent heat and hot water treatments. The bioactive Ti metal subjected to NaOH and heat treatments has been clinically used as an artificial hip joint material in Japan since 2007. A porous Ti metal subjected to NaOH, HCl and heat treatments has successfully undergone clinical trials as a spinal fusion device.

Composition and Modifications of Dental Implant Surfaces

Since Brånemark discovered the favorable effects of titanium in bone healing in 1965, titanium has emerged as the gold standard bulk material for present-time dental implantology. In the course of years researchers aimed for improvement of the implants performance in bone even at compromised implant sites and multiple factors were investigated influencing osseointegration. This review summarizes and clarifies the four factors that are currently recognized being relevant to influence the tissue-implant contact ratio: bulk materials and coatings, topography, surface energy, and biofunctionalization. The macrodesigns of bulk materials (e.g., titanium, zirconium, stainless steel, tantalum, and magnesium) provide the mechanical stability and their influence on bone cells can be additionally improved by surface treatment with various materials (calcium phosphates, strontium, bioglasses, diamond-like carbon, and diamond). Surface topography can be modified via different techniques to increase the bone-implant contact, for example, plasma-spraying, grit-blasting, acid-etching, and microarc oxidation. Surface energy (e.g., wettability and polarity) showed a strong effect on cell behavior and cell adhesion. Functionalization with bioactive molecules (via physisorption, covalent binding, or carrier systems) targets enhanced osseointegration. Despite the satisfying clinical results of presently used dental implant materials, further research on innovative implant surfaces is inevitable to pursuit perfection in soft and hard tissue performance.

Promoting bone-like apatite formation on titanium alloys through nanocrystalline tantalum nitride coatings

The study aims to advance the applicability of titanium alloys as bone implant materials by tackling some important aspects of surface robustness and bioactivity.

A comparison in mechanical properties of cermets of calcium silicate with Ti-55Ni and Ti-6Al-4V alloys for hard tissues replacement

This study investigated the impact of calcium silicate (CS) content on composition, compressive mechanical properties, and hardness of CS cermets with Ti-55Ni and Ti-6Al-4V alloys sintered at 1200°C. The powder metallurgy route was exploited to prepare the cermets. New phases of materials of Ni₁₆Ti₆Si₇, CaTiO₃, and Ni₃₁Si₁₂ appeared in cermet of Ti-55Ni with CS and in cermet of Ti-6Al-4V with CS, the new phases Ti₅Si₃, Ti₂O, and CaTiO₃, which were emerged during sintering at different CS content (wt%). The minimum shrinkage and density were observed in both groups of cermets for the 50 and 100 wt% CS content, respectively. The cermets with 40 wt% of CS had minimum compressive Young's modulus. The minimum of compressive strength and strain percentage at maximum load were revealed in cermets with 50 and 40 wt% of CS with Ti-55Ni and Ti-6Al-4V cermets, respectively. The cermets with 80 and 90 wt% of CS showed more plasticity than the pure CS. It concluded that the composition and mechanical properties of sintered cermets of Ti-55Ni and Ti-6Al-4V with CS significantly depend on the CS content in raw cermet materials. Thus, the different mechanical properties of the cermets can be used as potential materials for different hard tissues replacements.

Antibacterial and bioactive calcium titanate layers formed on Ti metal and its alloys

An antibacterial and bioactive titanium (Ti)-based material was developed for use as a bone substitute under load-bearing conditions. As previously reported, Ti metal was successively subjected to NaOH, CaCl2, heat, and water treatments to form a calcium-deficient calcium titanate layer on its surface. When placed in a simulated body fluid (SBF), this bioactive Ti formed an apatite layer on its surface and tightly bonded to bones in the body. To address concerns regarding deep infection during orthopedic surgery, Ag(+) ions were incorporated on the surface of this bioactive Ti metal to impart antibacterial properties. Ti metal was first soaked in a 5 M NaOH solution to form a 1 μm-thick sodium hydrogen titanate layer on the surface and then in a 100 mM CaCl2 solution to form a calcium hydrogen titanate layer via replacement of the Na(+) ions with Ca(2+) ions. The Ti material was subsequently heated at 600 °C for 1 h to transform the calcium hydrogen titanate into calcium titanate. This heat-treated titanium metal was then soaked in 0.01-10 mM AgNO3 solutions at 80 °C for 24 h. As a result, 0.1-0.82 at.% Ag(+) ions and a small amount of H3O(+) ions were incorporated into the surface calcium titanate layers. The resultant products formed apatite on their surface in an SBF, released 0.35-3.24 ppm Ag(+) ion into the fetal bovine serum within 24 h, and exhibited a strong antibacterial effect against Staphylococcus aureus. These results suggest that the present Ti metals should exhibit strong antibacterial properties in the living body in addition to tightly bonding to the surrounding bone through the apatite layer that forms on their surfaces in the body.

Controlled release of strontium ions from a bioactive Ti metal with a Ca-enriched surface layer

A nanostructured sodium hydrogen titanate layer ∼1μm in thickness was initially produced on the surface of titanium metal (Ti) by soaking in NaOH solution. When the metal was subsequently soaked in a mixed solution of CaCl2 and SrCl2, its Na ions were replaced with Ca and Sr ions in an Sr/Ca ratio in the range 0.18-1.62. The metal was then heat-treated at 600°C to form strontium-containing calcium titanate (SrCT) and rutile on its surface. The treated metal did not form apatite in a simulated body fluid (SBF) even after 7days. When the metal formed with SrCT was subsequently soaked in water at 80°C, the treated metal formed bone-like apatite on its surface within 1day in SBF since the Ca ions were partially replaced with H3O(+) ions. However, it released only 0.06ppm of Sr ions even after 7days in phosphate-buffered saline. When the metal was soaked after the heat treatment in 1M SrCl2 solution instead of water, the treated metal released 0.92ppm of Sr ions within 7days while maintaining its apatite-forming ability. The Ti formed with this kind of bioactive SrCT layer on its surface is expected to be highly useful for orthopedic and dental implants, since it should be able to promote bone growth by releasing Sr ions and tightly bond to the bone through the apatite formed on its surface.

Bone bonding ability of a chemically and thermally treated low elastic modulus Ti alloy: gum metal

The gum metal with composition Ti-36Nb-2Ta-3Zr-0.3O, is free from cytotoxic elements and exhibits a low elastic modulus as well as high mechanical strength. We have previously demonstrated that this gum metal, once subjected to a series of surface treatments--immersion in 1 M NaOH (alkali treatment) and then 100 mM CaCl2, before heating at 700 °C (sample: ACaH-GM), with an optional final hot water immersion (sample: ACaHW-GM)--has apatite-forming ability in simulated body fluid. To confirm the in vivo bioactivity of these treated alloys, failure loads between implants and bone at 4, 8, 16, and 26 weeks after implantation in rabbits' tibiae were measured for untreated gum metal (UT-GM), ACaH-GM and ACaHW-GM, as well as pure titanium plates after alkali and heat treatment (AH-Ti). The ACaH-GM and UT-GM plates showed almost no bonding, whereas ACaHW-GM and AH-Ti plates showed successful bonding by 4 weeks, and their failure loads subsequently increased with time. The histological findings showed a large amount of new bone in contact with the surface of ACaHW-GM and AH-Ti plates, suggesting that the ACaHW treatment could impart bone-bonding bioactivity to a gum metal in vivo. Thus, with this improved bioactive treatment, these advantageous gum metals become useful candidates for orthopedic and dental devices.