The influence of titania-zirconia-zirconium titanate nanotube characteristics on osteoblast cell adhesion

Study on the influence of scaffold morphology and structure on osteogenic performance

The number of patients with bone defects caused by various bone diseases is increasing yearly in the aging population, and people are paying increasing attention to bone tissue engineering research. Currently, the application of bone tissue engineering mainly focuses on promoting fracture healing by carrying cytokines. However, cytokines implanted into the body easily cause an immune response, and the cost is high; therefore, the clinical treatment effect is not outstanding. In recent years, some scholars have proposed the concept of tissue-induced biomaterials that can induce bone regeneration through a scaffold structure without adding cytokines. By optimizing the scaffold structure, the performance of tissue-engineered bone scaffolds is improved and the osteogenesis effect is promoted, which provides ideas for the design and improvement of tissue-engineered bones in the future. In this study, the current understanding of the bone tissue structure is summarized through the discussion of current bone tissue engineering, and the current research on micro-nano bionic structure scaffolds and their osteogenesis mechanism is analyzed and discussed.

Hip reconstruction using a customized intercalary prosthesis with the rhino horn-designed uncemented stem for ultrashort proximal femur segments following tumor resection: a combined biomechanical and clinical study

Background

Hip-preserved reconstruction for patients with ultrashort proximal femur segments following extensive femoral diaphyseal tumor resection is a formidable undertaking. A customized intercalary prosthesis with a rhino horn-designed uncemented stem was developed for the reconstruction of these extensive skeletal defects.

Methods

This study was designed to analyze and compare the differences in the biomechanical behavior between the normal femur and the femur with diaphyseal defects reconstructed by an intercalary prosthesis with different stems. The biomechanical behavior under physiological loading conditions is analyzed using the healthy femur as the reference. Five three-dimensional finite element models (healthy, customized intercalary prosthesis with four different stems implemented, respectively) were developed, together with a clinical follow-up of 12 patients who underwent intercalary femoral replacement.

Results

The biomechanical results showed that normal-like stress and displacement distribution patterns were observed in the remaining proximal femur segments after reconstructions with the rhino horn-designed uncemented stems, compared with the straight stem. Stem A showed better biomechanical performance, whereas the fixation system with Stem B was relatively unstable. The clinical results were consistent with the FEA results. After a mean follow-up period of 32.33 ± 9.12 months, osteointegration and satisfactory clinical outcomes were observed in all patients. Aseptic loosening (asymptomatic) occurred in one patient reconstructed by Stem B; there were no other postoperative complications in the remaining 11 patients.

Conclusion

The rhino horn-designed uncemented stem is outstanding in precise shape matching and osseointegration. This novel prosthesis design may be beneficial in decreasing the risk of mechanical failure and aseptic loosening, especially when Stem A is used. Therefore, the customized intercalary prosthesis with this rhino horn-designed uncemented stem might be a reasonable alternative for the reconstruction of SSPF following extensive tumor resection.

Advancing dental implants: Bioactive and therapeutic modifications of zirconia

Zirconium-based implants have gained popularity in the dental implant field owing to their corrosion resistance and biocompatibility, attributed to the formation of a native zirconia (ZrO₂) film. However, enhanced bioactivity and local therapy from such implants are desirable to enable the earlier establishment and improved long-term maintenance of implant integration, especially in compromised patient conditions. As a result, surface modification of zirconium-based implants have been performed using various physical, chemical and biological techniques at the macro-, micro-, and nano-scales. In this extensive review, we discuss and detail the development of Zr implants covering the spectrum from past and present advancements to future perspectives, arriving at the next generation of highly bioactive and therapeutic nano-engineered Zr-based implants. The review provides in-depth knowledge of the bioactive/therapeutic value of surface modification of Zr implants in dental implant applications focusing on clinical translation.

Review on synthesis, properties and multifarious therapeutic applications of nanostructured zirconia in dentistry

Amongst dental ceramics, nano zirconia (ZrNp) has shown exceptional developments in the field of dentistry in recent years. Zirconia is an oxide that possess superior optical, mechanical, and biological properties. As a novel nanoparticle, it has been widely used in various fields of dentistry due to its improved mechanical properties, biocompatibility, and stable structure. Provision of metal free solutions is one of the prime requirements in dental materials. Many metal alloys used extensively possess unaesthetic colors and display chemical interactions in the oral cavity encouraging use of zirconia for dental use. Use of ZrNp based ceramics has increased due to its resistance to corrosion, superior color matching that enhances esthetics and improved strength compared to conventional biomaterials. This review discusses the recent scientific literature on the synthesis, properties and types, applications, and toxicity of ZrNp in the field of dentistry.

Micro + Nano: Conserving the Gold Standard Microroughness to Nanoengineer Zirconium Dental Implants

Zirconium has achieved popularity as a biomaterial for dental and orthopedic implants; however, its bioinertness can compromise implant-tissue integration, especially in compromised patient conditions. More recently, various nanoengineering strategies have been explored to enhance the bioactivity of Ti-based implants; however, nanoengineering of Zr-based implants has not been adequately explored. In this pioneering attempt, we report on the optimized fabrication of various nanostructures on microrough Zr surfaces and explore the influence of the underlying surface topography. In-depth optimization of electrochemical anodization (EA) is performed by tuning various parameters, including substrate topography, voltage/current and time, onto microrough (micromachined) and extremely rough Zr substrates, which represent clinically relevant implant surfaces. Variations of EA factors yielded various nanotopographies, including nanotubes, nanograss and nanotemplates, offering different topographical and chemical combinations. EA optimization and precise current-voltage recording was performed to arrive at clinically translatable and reproducible nanostructures on Zr surfaces. This study will pave the way toward the fabrication of the next generation of nanoengineered Zr-based orthopedic and dental implants.

Surface Characterization and Biocompatibility of Hydroxyapatite Coating on Anodized TiO2 Nanotubes via PVD Magnetron Sputtering

Hydroxyapatite (HA) coating has received significant attention in the scientific community for the development of implants, and HA coating on titanium oxide (TiO₂) nanotubes has shown potential benefits in the improvement of cell proliferation, adhesion, and differentiation. In this study, a HA coating on a TiO₂ nanotubular surface was developed to improve the biocompatibility of the titanium (Ti) surface via magnetron sputtering. Scanning electron microscopy (SEM), surface profilometry, and water contact goniometry revealed that HA-coated TiO₂ nanotubes influenced the surface roughness (R_a) and hydrophilicity. The XRD and FTIR peaks indicated the presence of crystalline phases of TiO₂ (anatase) and HA-coated TiO₂ nanotubes after annealing at 500 °C for 120 min. The HA-coated TiO₂ nanotubes showed significantly increased R_a and decreased water contact angle (θ) compared to the as-anodized TiO₂ nanotubular and bare CP-Ti surfaces. MTS assay using osteoblast-like cells confirmed that the HA-coated TiO₂ nanotubular surface provided an enhanced cell attachment and growth when compared to as-anodized TiO₂ nanotubular and pure CP-Ti surfaces.

Orchestrating soft tissue integration at the transmucosal region of titanium implants

Osseointegration at the bone-implant interface and soft tissue integration (STI) at the trans-mucosal region are crucial for the long-term success of dental implants, especially in compromised patient conditions. The STI quality of conventional smooth and bio-inert titanium-based implants is inferior to that of natural tissue (i.e. teeth), and hence various surface modifications have been suggested. This review article compares and contrasts the various modification strategies (physical, chemical and biological) utilized to enhance STI of Ti implants. It also details the STI challenges associated with conventional Ti-based implants, current surface modification strategies and cutting-edge nano-engineering solutions. The topographical, biological and therapeutic advances achievable via electrochemically anodized Ti implants with TiO₂ nanotubes/nanopores are highlighted. Finally, the status and future directions of such nano-engineered implants is discussed, with emphasis on bridging the gap between research and clinical translation.

Electrochemical Oxidation of Ti15Mo Alloy-The Impact of Anodization Parameters on Surface Morphology of Nanostructured Oxide Layers

It is well-known that the structure and composition of the material plays an important role in the processes occurring at the surface. In this paper, a surface morphology of nanostructured oxide layers electrochemically grown on Ti15Mo, tuned by applying different anodization parameters, was investigated in detail. The one-step anodization of Ti15Mo alloy was performed at room temperature in an ethylene glycol-based electrolyte containing 0.11 M NH4F and 1.11 M H2O. Different anodization times (ranging from 5 to 60 min) and applied potentials (40-100 V) were tested, and the surface morphology, elemental content, and crystalline structure were monitored by scanning electron microscopy (SEM), energy dispersive X-ray spectrometry (EDS), and X-ray diffractometry (XRD), respectively. The results showed that contrary to the multistep anodization of titanium foil, the surface morphology of anodic oxide obtained via the one-step process contains the nanoporous outer layer covering the nanotubular structure. What is more, the pore diameter (Dp) and interpore distance (Dint) of such layers exhibit different trends than those observed for anodization of pure titanium. In particular, at a certain potential range, a decrease in both Dp and Dint with increasing potential was observed. However, independently on the used anodization conditions, the elemental content of oxide layers remained similar, showing the amount of molybdenum at c.a. 15 wt.%. Finally, the amorphous nature of as-anodized layers was confirmed, and their optical band-gap was determined from the diffuse reflectance UV-Vis spectra. It was found that Eg is tunable to some extent by changing the anodizing potential. However, further thermal treatment in air at 400 °C resulted in the anatase phase formation that was accompanied by a significant Eg reduction. Therefore, we believe that the presented results will greatly contribute to the understanding of anodic formation of nanostructured functional oxide layers with tunable properties that can be applied in various fields.

Effect of TiO2 Nanotube Pore Diameter on Human Mesenchymal Stem Cells and Human Osteoblasts

The pore diameter of uniformly structured nanotubes can significantly change the behaviour of cells. Recent studies demonstrated that the activation of integrins is affected not by only the surface chemistry between the cell-material interfaces, but also by the features of surface nanotopography, including nanotube diameter. While research has been carried out in this area, there has yet to be a single systemic study to date that succinctly compares the response of both human stem cells and osteoblasts to a range of TiO₂ nanotube pore diameters using controlled experiments in a single laboratory. In this paper, we investigate the influence of surface nanotopography on cellular behaviour and osseointegrative properties through a systemic study involving human mesenchymal stem cells (hMSCs) and human osteoblasts (HOBs) on TiO₂ nanotubes of 20 nm, 50 nm and 100 nm pore diameters using in-vitro assessments. This detailed study demonstrates the interrelationship between cellular behaviour and nanotopography, revealing that a 20 nm nanotube pore diameter is preferred by hMSCs for the induction of osteogenic differentiation, while 50 nm nanotubular structures are favourable by HOBs for osteoblastic maturation.

Multi-Scale Surface Treatments of Titanium Implants for Rapid Osseointegration: A Review

The propose of this review was to summarize the advances in multi-scale surface technology of titanium implants to accelerate the osseointegration process. The several multi-scaled methods used for improving wettability, roughness, and bioactivity of implant surfaces are reviewed. In addition, macro-scale methods (e.g., 3D printing (3DP) and laser surface texturing (LST)), micro-scale (e.g., grit-blasting, acid-etching, and Sand-blasted, Large-grit, and Acid-etching (SLA)) and nano-scale methods (e.g., plasma-spraying and anodization) are also discussed, and these surfaces are known to have favorable properties in clinical applications. Functionalized coatings with organic and non-organic loadings suggest good prospects for the future of modern biotechnology. Nevertheless, because of high cost and low clinical validation, these partial coatings have not been commercially available so far. A large number of in vitro and in vivo investigations are necessary in order to obtain in-depth exploration about the efficiency of functional implant surfaces. The prospective titanium implants should possess the optimum chemistry, bionic characteristics, and standardized modern topographies to achieve rapid osseointegration.

The Trends of TiZr Alloy Research as a Viable Alternative for Ti and Ti16 Zr Roxolid Dental Implants

Despite many discussions about Ti versus Zr, Ti remains the golden standard for dental implants. With the extended use of implants, their rejection in peri-implantitis due to material properties is going to be an important part of oral health problems. Extended use of implants leading to a statistical increase in implant rejection associated with peri-implantitis raises concerns in selecting better implant materials. In this context, starting in the last decade, investigation and use of TiZr alloys as alternatives for Ti in oral dentistry became increasingly more viable. Based on existing new results for Ti16Zr (Roxolid) implants and Ti50Zr alloy behaviour in oral environments, this paper presents the trends of research concerning the electrochemical stability, mechanical, and biological properties of this alloy with treated and untreated surfaces. The surface treatments were mostly performed by anodizing the alloy in various conditions as a non-sophisticated and cheap procedure, leading to nanostructures such as nanopores and nanotubes. The drug loading and release from nanostructured Ti50Zr as an important perspective in oral implant applications is discussed and promoted as well.

Effect of Anodized TiO2-Nb2O5-ZrO2 Nanotubes with Different Nanoscale Dimensions on the Biocompatibility of a Ti35Zr28Nb Alloy

Some important factors in the design of biomaterials are surface characteristics such as surface chemistry and topography, which significantly influence the relationship between the biomaterial and host cells. Therefore, nanotubular oxide layers have received substantial attention for biomedical applications due to their potential benefits in the improvement of the biocompatibility of the substrate. In this study, a nanotubular layer of titania-niobium pentoxide-zirconia (TiO₂-Nb₂O₅-ZrO₂) was developed via anodization on a β-type Ti35Zr28Nb alloy surface with enhanced biocompatibility. Scanning electron microscopy (SEM) and surface profilometry analysis of the anodized nanotubes indicated that the inner diameter (D_i) and wall thicknesses (W_t) increased with an increase in the water content of electrolyte and the applied voltage during anodization, while the nanotube length (L_n) increased with increasing the anodization time. TiO₂-Nb₂O₅-ZrO₂ nanotubes with different D_i, W_t, and L_n showed different surface roughnesses (R_a) and surface energies (γ), which affected the biocompatibility of the base alloy. MTS assay results showed that the TiO₂-Nb₂O₅-ZrO₂ nanotubes with the largest inner diameter (D_i) of 75.9 nm exhibited the highest cell viability of 108.55% due to the high γ of the surface, which led to high adsorption of proteins on the top surface of the nanotubes. The second highest cell viability was observed on the nanotubular surface with D_i of 33.3 nm, which is believed to result from its high γ as well as the optimum spacing between nanotubes. R_a did not appear to be clearly linked to cellular response; however, there may exist a threshold value of surface energy of ∼70 mJ/m², below which the cell response is less sensitive and above which the cell viability increases with increasing γ. This indicates that the TiO₂-Nb₂O₅-ZrO₂ nanotubes provided a suitable environment for enhanced attachment and growth of osteoblast-like cells as compared to the bare Ti35Zr28Nb alloy surface.

Antibacterial and osteogenesis performances of LL37-loaded titania nanopores in vitro and in vivo

Background: Many studies have shown that the size of nanotube (NT) can significantly affect the behavior of osteoblasts on titanium-based materials. But the weak bonding strength between NT and substrate greatly limits their application. Purpose: The objective of this study was to compare the stability of NT and nanopore (NP) coatings, and further prepare antibacterial titanium-based materials by loading LL37 peptide in NP structures. Methods: The adhesion strength of NT and NP layers was investigated using a scratch tester. The proliferation and differentiation of MC3T3-E1 cells on different substrates were evaluated in vitro by CCK8, alkaline phosphatase activity, mineralization and polymerase chain reaction assays. The antibacterial rates of NP and NP/LL37 were also measured by spread plate method. Moreover, the osteogenesis around NP and NP/LL373 in vivo was further evaluated using uninfected and infected models. Results: Scratch test proved that the NP layers had stronger bonding strength with the substrates due to their continuous pore structures and thicker pipe walls than the independent NT structures. In vitro, cell results showed that MC3T3-E1 cells on NP substrates had better early adhesion, spreading and osteogenic differentiation than those of NT group. In addition, based on the drug reservoir characteristics of porous materials, the NP substrates were also used to load antibacterial LL37 peptide. After loading LL37, the antibacterial and osteogenic induction abilities of NP were further improved, thus significantly promoting osteogenesis in both uninfected and infected models. Conclusion: We determined that the NP layers had stronger bonding strength than NT structures, and the corresponding NP materials might be more suitable than NT for preparing drug-device combined titanium implants for bone injury treatment.

Synergistic effects of titania nanotubes and silicon to enhance the osteogenic activity

In this study, titania nanotubes (TNTs) incorporating silicon (Si) were formed on Ti disks using anodization and electron beam evaporation (EBE) technology to improve the osteogenic activity. The amount of Si was exquisitely adjusted by controlling the duration of EBE to optimize the biofunctionality. As the Si was incorporated, the samples exhibited hydrophilic surfaces. Long lasting and controllable Si release was observed from the EBE-modified samples without cytotoxicity. Moreover, initial cell adhesion, spreading, proliferation and osteogenic differentiation of MC3T3-E1 cells were evaluated. The results showed a notable enhancement of spreading, osteogenesis and differentiation of cells on silicon-coated TNTs (Si-TNTs). In particular, samples with highest amount of silicon (∼5.93% Si) displayed greatest augmentation of ALP activity, osteogenic-related gene expression and mineralization compared to the others in the present study. It was indicated that the modification with TNTs and appropriated Si content resulted in enhanced osteoblastic spreading, proliferation and differentiation, and therefore has the potential for future applications in the field of orthopedics.

Progress in TiO2 nanotube coatings for biomedical applications: a review

Titanium dioxide nanotubes (TNTs) have drawn wide attention and been extensively applied in the field of biomedicine, due to their large specific surface area, good corrosion resistance, excellent biocompatibility, and enhanced bioactivity. This review describes the preparation of TNTs and the surface modification that entrust the nanotubes with better antibacterial property and enhanced osteoblast adhesion, proliferation, and differentiation. Considering the contact between TNTs' surface and surrounding tissues after implantation, the interactions between TNTs (with properties including their diameter, length, wettability, and crystalline phase) and proteins, platelets, bacteria, and cells are illustrated. The state of the art in the applications of TNTs in dentistry, orthopedic implants, and cardiovascular stents are introduced. In particular, the application of TNTs in biosensing has attracted much attention due to its ability for the rapid diagnosis of diseases. Finally, the difficulties and challenges in the practical application of TNTs are also discussed.

Biofunctional Sr- and Si-loaded titania nanotube coating of Ti surfaces by anodization-hydrothermal process

BACKGROUND

Two frequent problems associated with titanium (Ti) surfaces of bone/dental implants are their corrosion and lack of native tissue integration.

METHODS

Here, we present an anodization-hydrothermal method for coating Ti surfaces with a layer of silicon (Si)- and strontium (Sr)-loaded titania nanotubes (TNs). The Ti surfaces coated with such a layer (Si-Sr-TNs) were characterized with different techniques.

RESULTS

The results indicate that the Si4+ and Sr2+ ions were evenly incorporated into the TNs and that the Si-Sr-TN layer provides good protection against corrosive media like simulated body fluid. The excellent cytocompatibility of the coating was confirmed in vitro by the significant growth and differentiation of MC3T3-E1 osteoblastic cells.

CONCLUSION

Being easily and economically fabricated, the Si-Sr-TN surfaces may find their niche in clinical applications, thanks to their excellent biological activity and corrosion resistance.

Classification and Effects of Implant Surface Modification on the Bone: Human Cell-Based In Vitro Studies

Implant surfaces are continuously being improved to achieve faster osseointegration and a stronger bone to implant interface. This review will present the various implant surfaces, the parameters for implant surface characterization, and the corresponding in vitro human cell-based studies determining the strength and quality of the bone-implant contact. These in vitro cell-based studies are the basis for animal and clinical studies and are the prelude to further reviews on how these surfaces would perform when subjected to the oral environment and functional loading.

Silicon-Doped Titanium Dioxide Nanotubes Promoted Bone Formation on Titanium Implants

While titanium (Ti) implants have been extensively used in orthopaedic and dental applications, the intrinsic bioinertness of untreated Ti surface usually results in insufficient osseointegration irrespective of the excellent biocompatibility and mechanical properties of it. In this study, we prepared surface modified Ti substrates in which silicon (Si) was doped into the titanium dioxide (TiO₂) nanotubes on Ti surface using plasma immersion ion implantation (PIII) technology. Compared to TiO₂ nanotubes and Ti alone, Si-doped TiO₂ nanotubes significantly enhanced the expression of genes related to osteogenic differentiation, including Col-I, ALP, Runx2, OCN, and OPN, in mouse pre-osteoblastic MC3T3-E1 cells and deposition of mineral matrix. In vivo, the pull-out mechanical tests after two weeks of implantation in rat femur showed that Si-doped TiO₂ nanotubes improved implant fixation strength by 18% and 54% compared to TiO₂-NT and Ti implants, respectively. Together, findings from this study indicate that Si-doped TiO₂ nanotubes promoted the osteogenic differentiation of osteoblastic cells and improved bone-Ti integration. Therefore, they may have considerable potential for the bioactive surface modification of Ti implants.

Bio-inspired synthesis of hybrid tube-like structures based on CaCO3 and type I-collagen

Tube-like hybrid particles based on calcium carbonate, a biocompatible mineral, and collagen, enhance osteoblasts viability.

The diameter of nanotubes formed on Ti-6Al-4V alloy controls the adhesion and differentiation of Saos-2 cells

Ti-6Al-4V-based nanotubes were prepared on a Ti-6Al-4V surface by anodic oxidation on 10 V, 20 V, and 30 V samples. The 10 V, 20 V, and 30 V samples and a control smooth Ti-6Al-4V sample were evaluated in terms of their chemical composition, diameter distribution, and cellular response. The surfaces of the 10 V, 20 V, and 30 V samples consisted of nanotubes of a relatively wide range of diameters that increased with the voltage. Saos-2 cells had a similar initial adhesion on all nanotube samples to the control Ti-6Al-4V sample, but it was lower than on glass. On day 3, the highest concentrations of both vinculin and talin measured by enzyme-linked immunosorbent assay and intensity of immunofluorescence staining were on 30 V nanotubes. On the other hand, the highest concentrations of ALP, type I collagen, and osteopontin were found on 10 V and 20 V samples. The final cellular densities on 10 V, 20 V, and 30 V samples were higher than on glass. Therefore, the controlled anodization of Ti-6Al-4V seems to be a useful tool for preparing nanostructured materials with desirable biological properties.

Improving the osteointegration of Ti6Al4V by zeolite MFI coating

Osteointegration is crucial for success in orthopedic implantation. In recent decades, there have been numerous studies aiming to modify titanium alloys, which are the most widely used materials in orthopedics. Zeolites are solid aluminosilicates whose application in the biomedical field has recently been explored. To this end, MFI zeolites have been developed as titanium alloy coatings and tested in vitro. Nevertheless, the effect of the MFI coating of biomaterials in vivo has not yet been addressed. The aim of the present work is to evaluate the effects of MFI-coated Ti6Al4V implants in vitro and in vivo. After surface modification, the surface was investigated using field emission scanning electron microscopy (FE-SEM) and energy dispersive spectroscopy (EDS). No difference was observed regarding the proliferation of MC3T3-E1 cells on the Ti6Al4V (Ti) and MFI-coated Ti6Al4V (M-Ti) (p > 0.05). However, the attachment of MC3T3-E1 cells was found to be better in the M-Ti group. Additionally, ALP staining and activity assays and quantitative real-time RT-PCR indicated that MC3T3-E1 cells grown on the M-Ti displayed high levels of osteogenic differentiation markers. Moreover, Van-Gieson staining of histological sections demonstrated that the MFI coating on Ti6Al4V scaffolds significantly enhanced osteointegration and promoted bone regeneration after implantation in rabbit femoral condylar defects at 4 and 12 weeks. Therefore, this study provides a method for modifying Ti6Al4V to achieve improved osteointegration and osteogenesis.