Multilevel surface engineering of nanostructured TiO2 on carbon-fiber-reinforced polyetheretherketone

A self-assembling graphene oxide coating for enhanced bactericidal and osteogenic properties of poly-ether-ether-ketone

Poly-ether-ether-ketone (PEEK) is a biomedical plastic that can be used for orthopedic implants, but it offers poor antibacterial properties and bioactivity. In this study, PEEK was sulfonated with the obtained porous structure adsorbing graphene oxide (GO). The surface microstructures and properties of the original PEEK, sulfonated PEEK (SPEEK), and GO-grafted PEEK (GO-SPEEK) were characterized. The results revealed that the GO-SPEEK surface is a 3D porous structure exhibiting superior hydrophilicity to the original PEEK. Although SPEEK was shown to possess antimicrobial properties against both Escherichia coli and Staphylococcus aureus, the bactericidal effect was even more significant for GO-SPEEK, at about 86% and 94%, respectively. In addition, the in vitro simulated-body-fluid immersion and cell experiments indicated that GO-SPEEK had much better hydroxyapatite (HA)-precipitation induction capacity and cell-material interactions (e.g., cell adhesion, proliferation, osteodifferentiation, and extracellular matrix mineralization. The tensile test revealed that the mechanical properties of PEEK were maintained after surface modification, as GO-SPEEK has comparable values of elastic modulus and tensile strength to PEEK. Our investigation sought a method to simultaneously endow PEEK with both good antimicrobial properties and bioactivity as well as mechanical properties, providing a theoretical basis for developing high-performance orthopedic implants in the clinic.

Role of Polyetheretherketone in Prosthodontics: A Literature Review

Implant prostheses and other fixed and removable metal prostheses have led to an increase in demand for the development of new and efficient materials such as high-performance polymers polyetheretherketone (PEEK) over titanium and other metals because of their further complications in the human body. PEEK is a polymer that is nontoxic and has a modulus of elasticity that is comparable to that of human bone. PEEK implants provide benefits over metal implants, such as reducing the stress shielding effect, simple processing, and color resemblance to natural teeth. And it is a fantastic alternative to titanium for dental and orthopedic implants. The current review is undertaken to understand the properties of this PEEK material to weigh its benefits and drawbacks for potential use in dental implants and other prostheses.

Construction of a layer-by-layer self-assembled rosemarinic acid delivery system on the surface of CFRPEEK implants for enhanced anti-inflammatory and osseointegration activities

Carbon fiber-reinforced polyether ether ketone (CFRPEEK) implants have attracted widespread attention in the field of clinical bone defect repair. However, the surface bioinertness confines the application of CFRPEEK implants. Inspired by the study of rosmarinic acid (RA)-promoted osteogenic differentiation, a self-assembly surface modification method based on electrostatic interactions, involving deposition of sodium carboxymethyl cellulose/chitosan and rosmarinic acid layer by layer on the surface of poly-L-lysine modified hydroxy CFRPEEK (SCPP/CC5@RA), is proposed to introduce RA on the surface of CFRPEEK for bioactivation. After layer-by-layer self-assembly (LBL), the surface of SCPP/CC5@RA exhibits weak electrophoresis (11.43 eV), suitable hydrophilicity, and bioactivity. The results of in vitro studies indicate that the RA release behavior of SCPP/CC5@RA effectively regulates the immune-inflammatory response and promotes the differentiation of osteoblasts. The rapid release of RA (0.17 μg mL-1) in the initial stage can downregulate the secretion of inflammation-related cytokines and significantly reduce oxidative stress levels; the sustained release of RA (0.06 μg mL-1) in the late stage can upregulate the expression of osteogenesis-related genes and induce mineralization of osteoblasts. Moreover, the rabbit tibia defect model demonstrates that the LBL technique can enhance the osseointegration of CFRPEEK implants. Compared with the control group, the bone trabecular thickness of the SCPP/CC5@RA group increases by 1.36 times, and the maximum pushing force increases by 2.67 times. In summary, this study provides a promising LBL based RA delivery system for the development of a dual-functional CFRPEEK implant in the field of bone implant biomaterials.

Methods to improve antibacterial properties of PEEK: A review

As a thermoplastic and bioinert polymer, polyether ether ketone (PEEK) serves as spine implants, femoral stems, cranial implants, and joint arthroplasty implants due to its mechanical properties resembling the cortical bone, chemical stability, and radiolucency. Although there are standards and antibiotic treatments for infection control during and after surgery, the infection risk is lowered but can not be eliminated. The antibacterial properties of PEEK implants should be improved to provide better infection control. This review includes the strategies for enhancing the antibacterial properties of PEEK in four categories: immobilization of functional materials and functional groups, forming nanocomposites, changing surface topography, and coating with antibacterial material. The measuring methods of antibacterial properties of the current studies of PEEK are explained in detail under quantitative, qualitative, andin vivomethods. The mechanisms of bacterial inhibition by reactive oxygen species generation, contact killing, trap killing, and limited bacterial adhesion on hydrophobic surfaces are explained with corresponding antibacterial compounds or techniques. The prospective analysis of the current studies is done, and dual systems combining osteogenic and antibacterial agents immobilized on the surface of PEEK are found the promising solution for a better implant design.

Research and Application of Medical Polyetheretherketone as Bone Repair Material

Polyetheretherketone (PEEK) can potentially be used for bone repair because its elastic modulus is similar to that of human natural bone and good biocompatibility and chemical stability. However, its hydrophobicity and biological inertness limit its application in the biomedical field. Inspired by the composition, structure, and function of bone tissue, many strategies are proposed to change the structure and functionality of the PEEK surface. In this review, the applications of PEEK in bone repair and the optimization strategy for PEEK's biological activity are reviewed, which provides a direction for the development of multifunctional bone repair materials in the future.

Enhancing cell adhesive and antibacterial activities of glass-fibre-reinforced polyetherketoneketone through Mg and Ag PIII

Glass-fibre-reinforced polyetherketoneketone (PEKK-GF) shows great potential for application as a dental implant restoration material; however, its surface bioinertness and poor antibacterial properties limit its integration with peri-implant soft tissue, which is critical in the long-term success of implant restoration. Herein, functional magnesium (Mg) and silver (Ag) ions were introduced into PEKK-GF by plasma immersion ion implantation (PIII). Surface characterization confirmed that the surface morphology of PEKK-GF was not visibly affected by PIII treatment. Further tests revealed that PIII changed the wettability and electrochemical environment of the PEKK-GF surface and enabled the release of Mg²⁺ and Ag⁺ modulated by Giavanni effect. In vitro experiments showed that Mg/Ag PIII-treated PEKK-GF promoted the proliferation and adhesion of human gingival fibroblasts and upregulated the expression of adhesion-related genes and proteins. In addition, the treated samples inhibited the metabolic viability and adhesion of Streptococcus mutans and Porphyromonas gingivalis on their surfaces, distorting bacterial morphology. Mg/Ag PIII surface treatment improved the soft tissue integration and antibacterial activities of PEKK-GF, which will further support and broaden its adoption in dentistry.

Amyloid-Mediated Nanoarchitectonics with Biomimetic Mineralization of Polyetheretherketone for Enhanced Osseointegration

Polyetheretherketone (PEEK), a widely used implant material, has attracted the attention of scientific researchers because of its bone-matched elastic modulus, radiolucency, and chemical resistance. However, the bioinert chemical properties of PEEK do not promote bone apposition once implanted. In this study, using a phase-transitioned lysozyme (PTL) nanofilm as a sandwiched layer, a robust hydroxyapatite (HAp) coating on PEEK (HAp@PTL@PEEK) is constructed. The PTL nanofilm shows strong adhesion to the PEEK surface and induces biomimetic mineralization to form a compact HAp coating on PEEK in simulated body fluids. This HAp coating not only shares a higher adhesion strength and better stability but can also be applied to implants with complex 3D structures. HAp@PTL@PEEK showed significantly enhanced osteogenic capacity when cultured with rat bone marrow mesenchymal stem cells by promoting initial cell adhesion, proliferation, and osteogenic differentiation in vitro. In vivo evaluations utilizing models of femoral condyle defects and skull defects confirm that the HAp coating substantially augments bone remodeling and osseointegration ability. Compared with the traditional method, our modified method is simpler, more environmentally friendly, and uses less hazardous components. Furthermore, the obtained HAp coating shares a higher adhesion strength to PEEK and a better osteogenic capacity. The study offers a novel method to improve the osseointegration of PEEK-based implants in biointerfaces and tissue engineering.

A novel injectable hydrogel containing polyetheretherketone for bone regeneration in the craniofacial region

Polyetheretherketone (PEEK) is an organic material introduced as an alternative for titanium implants. Injectable hydrogels are the most promising approach for bone regeneration in the oral cavity to fill the defects with irregular shapes and contours conservatively. In the current study, injectable Aldehyde-cellulose nanocrystalline/silk fibroin (ADCNCs/SF) hydrogels containing PEEK were synthesized, and their bone regeneration capacity was evaluated. Structure, intermolecular interaction, and the reaction between the components were assessed in hydrogel structure. The cytocompatibility of the fabricated scaffolds was evaluated on human dental pulp stem cells (hDPSCs). Moreover, the osteoinduction capacity of ADCNCs/SF/PEEK hydrogels on hDPSCs was evaluated using Real-time PCR, Western blot, Alizarin red staining and ALP activity. Bone formation in critical-size defects in rats' cranial was assessed histologically and radiographically. The results confirmed the successful fabrication of the hydrogel and its osteogenic induction ability on hDPSCs. Furthermore, in in vivo phase, bone formation was significantly higher in ADCNCs/SF/PEEK group. Hence, the enhanced bone regeneration in response to PEEK-loaded hydrogels suggested its potential for regenerating bone loss in the craniofacial region, explicitly surrounding the dental implants.

Biomimetic Mineralized Fiber Bundle-Inspired Scaffolding Surface on Polyetheretherketone Implants Promotes Osseointegration

The stress shielding effect caused by traditional metal implants is circumvented by using polyetheretherketone (PEEK), due to its excellent mechanical properties; however, the biologically inert nature of PEEK limits its application. Endowing PEEK with biological activity to promote osseointegration would increase its applicability for bone replacement implants. A biomimetic study is performed, inspired by mineralized collagen fiber bundles that contact bone marrow mesenchymal stem cells (BMMSCs) on the native trabecular bone surface. The PEEK surface (P) is first sulfonated with sulfuric acid to form a porous network structure (sP). The surface is then encapsulated with amorphous hydroxyapatite (HA) by magnetron sputtering to form a biomimetic scaffold that resembles mineralized collagen fiber bundles (sPHA). Amorphous HA simulates the composition of osteogenic regions in vivo and exhibits strong biological activity. In vitro results show that more favorable cell adhesion and osteogenic differentiation can be attained with the novelsurface of sPHA than with SP. The results of in vivo experiments show that sPHA exhibits osteoinductive and osteoconductive activity and facilitates bone formation and osseointegration. Therefore, the surface modification strategy can significantly improve the biological activity of PEEK, facilitate effective osseointegration, and inspire further bionic modification of other inert polymers similar to PEEK.

Antibacterial and Proliferative Effects of NaOH-Coated Titanium, Zirconia, and Ceramic-Reinforced PEEK Dental Composites on Bone Marrow Mesenchymal Stem Cells

Several metallic and polymer-based implants have been fabricated for orthopedic applications. For instance, titanium (Ti), zirconia (Zr), and polyetheretherketone (PEEK) are employed due to their excellent biocompatibility properties. Hence, the present study aimed to compare the functional and biological properties of these three biomaterials with surface modification. For this purpose, Ti, Zr, and ceramic-reinforced PEEK (CrPEEK) were coated with NaOH and tested for the biological response. Our results showed that the surface modification of these biomaterials significantly improved the water contact, protein adhesion, and bioactivity compared with uncoated samples. Among the NaOH-coated biomaterials, Ti and CrPEEK showed higher protein absorption than Zr. However, the mineral binding ability was higher in CrPEEK than in the other two biomaterials. Although the coating improved the functional properties, NaOH coating did not influence the antibacterial effect against E. coli and S. aureus in these biomaterials. Similar to the antibacterial effects, the NaOH coating did not contribute any significant changes in cell proliferation and cell loading, and CrPEEK showed better biocompatibility among the biomaterials. Therefore, this study concluded that the surface modification of biomaterials could potentially improve the functional properties but not the antibacterial and biocompatibility, and CrPEEK could be an alternative material to Ti and Zr with desirable qualities in orthopedic applications.

Treatment methods toward improving the anti-infection ability of poly(etheretherketone) implants for medical applications

Due to its favorable chemical stability, biocompatibility, and mechanical properties, Poly(etheretherketone) (PEEK) is a promising material for repairing bone and dental hard tissue defects. However, there are critical disadvantages: PEEK is biologically and chemically inert, which influences osseointegration of implants and bonding strength of prostheses, and its mechanical properties still cannot meet the requirements for some medical applications. Furthermore, bacterial infections and inflammatory reactions often accompany bone defects caused by trauma or inflammation or teeth loss caused by periodontitis. Previous studies mainly focused on enhancing PEEK's bioactivity and mechanical performance, but PEEK also lacks effective anti-infection ability. Thus, it is necessary to improve its anti-infection ability, and this is considered in this paper from two aspects. The first is to inhibit the attachment and growth of bacteria on the material, and the second is to endow the material with immunoregulatory ability, which means mobilizing the host immune system to protect tissue from inflammation. In this review, we analyze and discuss the existing treatment methods to improve the antibacterial and immunomodulatory abilities of PEEK addressing their limitations, relevant future challenges, and required research efforts.

Polymer–Metal Composite Healthcare Materials: From Nano to Device Scale

Metals have been investigated as biomaterials for a wide range of medical applications. At nanoscale, some metals, such as gold nanoparticles, exhibit plasmonics, which have motivated researchers’ focus on biosensor development. At the device level, some metals, such as titanium, exhibit good physical properties, which could allow them to act as biomedical implants for physical support. Despite these attractive features, the non-specific delivery of metallic nanoparticles and poor tissue–device compatibility have greatly limited their performance. This review aims to illustrate the interplay between polymers and metals, and to highlight the pivotal role of polymer–metal composite/nanocomposite healthcare materials in different biomedical applications. Here, we revisit the recent plasmonic engineered platforms for biomolecules detection in cell-free samples and highlight updated nanocomposite design for (1) intracellular RNA detection, (2) photothermal therapy, and (3) nanomedicine for neurodegenerative diseases, as selected significant live cell–interactive biomedical applications. At the device scale, the rational design of polymer–metallic medical devices is of importance for dental and cardiovascular implantation to overcome the poor physical load transfer between tissues and devices, as well as implant compatibility under a dynamic fluidic environment, respectively. Finally, we conclude the treatment of these innovative polymer–metal biomedical composite designs and provide a future perspective on the aforementioned research areas.

Wear Resistance and Biocompatibility of Co-Cr Dental Alloys Fabricated with CAST and SLM Techniques

Cobalt–chromium (Co-Cr) alloys have been widely used as dental-restoration materials for many years. This study sought to investigate whether selective laser melting (SLM) is a more appropriate process than traditional casting (CAST) for fabricating dental Co-Cr alloys. Metallurgical microscopy, X-ray photoelectron spectroscopy (XPS), Vickers hardness and nanoindentation tests, and friction and wear tests were used to evaluate the microstructure, surface compositions, mechanical properties, and wear resistance, respectively. Additionally, the biocompatibilities and cell adhesion of the alloys were evaluated with L-929 fibroblasts via CCK-8 assay, Live/Dead staining, flow cytometric analysis, scanning electron microscopy (SEM) observation and real-time PCR (RT-PCR) assay. The XPS results showed that the two alloys were all mainly comprised of Co, Cr, and O. The hardness in the CAST group equaled 7.15 ± 0.48 GPa, while in the SLM group, it equaled 9.06 ± 0.49 GPa. The friction coefficient of SLM alloys remained at approximately 0.46, but the CAST specimens fluctuated significantly. SLM alloys exhibited shallower wear scars and less wear debris compared with CAST alloys, simultaneously. Additionally, there were higher survival and expression of cell-adhesion-related genes on SLM alloys of L-929 cells, which meant that the deleterious effect on L-929 cells was significantly reduced compared with that for the CAST alloys. Overall, the wear resistances and biocompatibilities of the Co-Cr dental alloys were dramatically affected by the fabrication technique. The SLM technique is advantageous over the CAST technique for fabricating Co-Cr dental alloys.

Modification of polyether ether ketone for the repairing of bone defects

Bone damage as a consequence of disease or trauma is a common global occurrence. For bone damage treatment - bone implant materials are necessary across three classifications of surgical intervention (i.e. fixation, repair, and replacement). Many types of bone implant materials have been developed to meet the requirements of bone repair. Among them, polyether ether ketone (PEEK) has been considered as one of the next generation of bone implant materials, owing to its advantages related to good biocompatibility, chemical stability, X-ray permeability, elastic modulus comparable to natural bone, as well as the ease of processing and modification. However, as PEEK is a naturally bioinert material, some modification is needed to improve its integration with adjacent bones after implantation. Therefore, it has become a very hot topic of biomaterials research and various strategies for the modification of PEEK including blending, 3D printing, coating, chemical modification and the introduction of bioactive and/or antibacterial substances have been proposed. In this systematic review, the recent advances in modification of PEEK and its application prospect as bone implants are summarized, and the remaining challenges are also discussed.

The surface modification of long carbon fiber reinforced polyether ether ketone with bioactive composite hydrogel for effective osteogenicity

Long carbon fiber reinforced polyether ether ketone (LCFRPEEK) is fabricated using a three-dimensional (3D) needle-punched method in our previous work, which is considered as a potential orthopedic implant due to its high mechanical strength and isotropic properties, as well as having an elastic modulus similar to human cortical bone. However, the LCFRPEEK has inferior integration with bone tissue, limiting its clinical application. Thus, a facile surface modification method, using gelatin methacrylate/polyacrylamide composite hydrogel coating (GelMA/PAAM) loading with dexamethasone (Dex) on our newly-developed LCFRPEEK composite via concentrated sulfuric acid sulfonating and ultraviolet (UV) irradiation grafting methods, has been developed to tackle the problem. The results demonstrate that the GelMA/PAAM/Dex coating modified sulfonated LCFRPEEK (SCP/GP/Dex) has a hydrophilicity surface, a long-term Dex release capability and forms more bone-like apatite nodules in SBF. The SCP/GP/Dex also displays enhanced cytocompatibility and osteogenic differentiation in terms of rat bone marrow mesenchymal stem cells (rBMSCs) responses in vitro assay. The in vivo rat cranial defect assay confirms that SCP/GP/Dex boosts bone regeneration/osseointegration, which significantly improves osteogenic fixation between the implant and bone tissue. Therefore, the newly-developed LCFRPEEK modified via GelMA/PAAM/Dex bioactive coating exhibits improved biocompatibility and osteogenic integration capability, which has the basis for an orthopedic implant for clinical application.

Fabrication of Mg Coating on PEEK and Antibacterial Evaluation for Bone Application

Polyetheretherketone (PEEK) is an alternative biomedical polymer material to traditional metal and ceramic biomaterials. However, as a bioinert material, its wide application in the medical field is seriously restricted due to its lack of bioactivity. In this research, pure Mg was successfully deposited on a PEEK substrate by vapor deposition to improve the antibacterial properties of PEEK implants. The morphology and elemental composition of the coating were characterized by scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS). The higher the deposition temperature, the larger the Mg particle size. The Mg coating possesses a hydrophilic surface and a higher surface free energy that create its good biocompatibility. The Mg coating on a PEEK substrate withstands up to 56 days’ immersion. The antibacterial test showed that the antibacterial rate of coated PEEK is 99%. Mg-coated PEEK demonstrates promising antibacterial properties.

2D DNA nanoporous scaffold promotes osteogenic differentiation of pre-osteoblasts

Biofunctional materials with nanomechanical parameters similar to bone tissue may promote the adherence, migration, proliferation, and differentiation of pre-osteoblasts. In this study, deoxyribonucleic acid (DNA) nanoporous scaffold (DNA-NPS) was synthesized by the polymerization of rectangular and double-crossover (DX) DNA tiles. The diagonally precise polymerization of nanometer-sized DNA tiles (A + B) through sticky end cohesion gave rise to a micrometer-sized porous giant-sheet material. The synthesized DNA-NPS exhibited a uniformly distributed porosity with a size of 25 ± 20 nm. The morphology, dimensions, sectional profiles, 2-dimensional (2D) layer height, texture, topology, pore size, and mechanical parameters of DNA-NPS have been characterized by atomic force microscopy (AFM). The size and zeta potential of DNA-NPS have been characterized by the zeta sizer. Cell biocompatibility, proliferation, and apoptosis have been evaluated by flow cytometry. The AFM results confirmed that the fabricated DNA-NPS was interconnected and uniformly porous, with a surface roughness of 0.125 ± 0.08035 nm. The elastic modulus of the DNA-NPS was 22.45 ± 8.65 GPa, which was comparable to that of native bone tissue. DNA-NPS facilitated pre-osteoblast adhesion, proliferation, and osteogenic differentiation. These findings indicated the potential of 2D DNA-NPS in promoting bone tissue regeneration.

Metformin-Incorporated Gelatin/Hydroxyapatite Nanofiber Scaffold for Bone Regeneration

Tissue engineering and regenerative medicine has gradually evolved as a promising therapeutic strategy to the modern health care of aging and diseased population. In this study, we developed a novel nanofibrous scaffold and verified its application in the critical bone defect regeneration. The metformin-incorporated nano-gelatin/hydroxyapatite fibers (NGF) was produced by electrospinning, cross-linked, and then characterized by X-ray powder diffractometer and Fourier-transform infrared spectroscopy. Cytotoxicity, cell adhesion, cell differentiation, and quantitative osteogenic gene and protein expression were analyzed by bone marrow stem cells (BMSCs) from rat. Rat forearm critical bone defect model was performed for the in vivo study. The NGF were characterized by their porous structures with proper interconnectivity without significant cytotoxic effects; the adhesion of BMSCs on the NGF could be enhanced. The osteogenic gene and protein expression were upregulated. Postimplantation, the new regenerated bone in bone defect was well demonstrated in the NGF samples. We demonstrated that the metformin-incorporated NGF greatly improved healing potential on the critical-size bone defect. Although metformin-incorporated NGF had advantageous effectiveness during bone regeneration, further validation is required before it can be applied to clinical applications. Impact statement Bone is the structure that supports the rest of the human body. Critical-size bone defect hinders the regeneration of damaged bone tissues and compromises the mechanical strength of the skeletal system. Characterized by their porous structures with proper interconnectivity, the electrospinning nano-gelatin/hydroxyapatite fibrous scaffold developed in this study can greatly improve the healing potential on the critical-size bone defect. Further validation can validate its potential clinical applications.

Ambient temperature sulfonated carbon fiber reinforced PEEK with hydroxyapatite and reduced graphene oxide hydroxyapatite composite coating

30% carbon fiber reinforced polyetheretherketone (CFR-PEEK) has in recent times, become significant in the orthopedic industry because its elastic modulus can be engineered to match that of the human bone. But it is bioinert and does not integrate well with the immediate bone tissue environment. In this study, a combined surface modification technique involving ambient temperature sulfonation and surface coating of (hydroxyapatite (HA), 5%reduced graphene oxide hydroxyapatite(5%RGO/HA) and 10%reduced graphene oxide hydroxyapatite(10%RGO/HA) composites) on 30%CFR-PEEK was achieved with an appropriate temperature treatment at 345°C in nitrogen. The coatings adhered unto the surface of S30%CFR-PEEK with an improved hydrophilicity and bioactivity. With the sample S30%CFR-PEEK+HA, having the highest enhanced hydrophilicity from 112.5 ± 2.5° to 20 ± 2° and bioactivity. An improvement in hydrophilicity and bioactivity depicts a change in surface chemistry which will have a positive impact in the interaction of the materials surface with immediate bone environment for a successful application in the orthopedic industry.

Surface porous poly-ether-ether-ketone based on three-dimensional printing for load-bearing orthopedic implant

Poly-ether-ether-ketone (PEEK) possesses excellent biocompatibility and similar elastic modulus as bones but yet suffers from poor osseointegration. In order to balance PEEK's mechanical and osseointegration properties, a novel surface porous PEEK (SP-PEEK) is successfully fabricated by fused deposition modelling three-dimensional printing (FDM 3DP) and characterized by mechanical and osteogenesis in vitro tests. Moreover, the effects of pore diameter and pore layer number on the mechanical behaviors of SP-PEEK are investigated by theoretical model and numerical simulation. Comparison among experimental, theoretical and simulation results show good agreement. As pore diameter decreases, the equivalent strength and modulus become more sensitive to the decrease of pore layer number. In addition, the SP-PEEK exhibits the mechanical properties within the range of human trabecular bone and cortical bone, and thus can be tailored to mimic human bone by adjusting the pore diameter and pore layer number, which is benefit to mitigate stress shielding. The effects of pore diameter on the cell proliferation and osteogenic differentiation of SP-PEEK are tested by the co-culture of osteoblast precursor cells (MC3T3-E1) and SP-PEEK round discs. Results showcase that porous surface improves the osteogenesis in vitro, and the SP-PEEK group that the pore diameter is 0.6 mm exhibits optimal-performance osteogenesis in vitro.

Bioinspired Modifications of PEEK Implants for Bone Tissue Engineering

In recent years, polyetheretherketone (PEEK) has been increasingly employed as an implant material in clinical applications. Although PEEK is biocompatible, chemically stable, and radiolucent and has an elastic modulus similar to that of natural bone, it suffers from poor integration with surrounding bone tissue after implantation. To improve the bioactivity of PEEK, numerous strategies for functionalizing the PEEK surface and changing the PEEK structure have been proposed. Inspired by the components, structure, and function of bone tissue, this review discusses strategies to enhance the biocompatibility of PEEK implants and provides direction for fabricating multifunctional implants in the future.

Titanium-interlayer mediated hydroxyapatite coating on polyetheretherketone: a prospective study in patients with single-level cervical degenerative disc disease

BACKGROUND

Currently, there are limited reports regarding investigation of the biological properties of polyetheretherketone (PEEK) coated with titanium (Ti) and hydroxyapatite (HA) in human. The objective of this study is to evaluate the in vivo response of the PEEK cages coated with Ti and HA versus uncoated PEEK cages after anterior cervical discectomy and fusion (ACDF) in patients with single-level cervical degenerative disc disease (CDDD).

METHODS

Twenty-four patients with PEEK cages coated with Ti and HA (PEEK/Ti/HA group) were matched one-to-one with patients with uncoated PEEK cages (PEEK group) based on age, gender, and operative segment. All patients had been followed up for more than 2 years. Radiological assessments included intervertebral height (IH), C2-7 angle (C2-7a), segmental alignment (SA), and fusion rate. Clinical parameters included Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores.

RESULTS

There was no statistical difference in SA, IH, and C2-7a between the two groups before and after surgery and all these parameters were restored postoperatively. The fusion rate of PEEK/Ti/HA group was significantly higher than PEEK group at 3-month post-operation (87.5% vs. 62.5%). At the last follow-up, the fusion rate of the both groups achieved 100%. The VAS and JOA scores were comparable between two groups and improved postoperatively.

CONCLUSIONS

In patients with single-level ACDF, PEEK cage coated with Ti and HA provided a higher fusion rate than uncoated PEEK cage at 3-month post-operation, while both two cages could achieve solid osseous fusion at the last follow up. Compared with the uncoated PEEK cage, PEEK/Ti/HA cage yielded similar favorable segmental and overall cervical lordosis, IH, and clinical outcomes after the surgery.

In vitro and in vivo evaluation of structurally-controlled silk fibroin coatings for orthopedic infection and in-situ osteogenesis

Biomedical device-associated infections (BAI) and osteosynthesis are two main complications following the orthopedic implant surgery, especially while infecting bacteria form a mature biofilm, which can protect the organisms from the host immune system and antibiotic therapy. Comparing with the single antibiotics therapeutic method, the combination of silver nanoparticles (AgNPs) and conventional antibiotics exert a high level of antibacterial activity. Nevertheless, one major issue that extremely restricts the potential application of AgNP/antiviotics is the uncontrolled release. Moreover, the lack of osteogenic ability may cause the osteosynthesis. Thus, herein we fabricated a structure-controlled drug-loaded silk fibroin (SF) coating that can achieve the size and release control of AgNPs and high efficient osteogenesis. Three comparative SF-based coatings were fabricated: α-structured coating (α-helices 32.7%,), m-structured coating (β-sheets 28.3%) and β-structured coating (β-sheets 41%). Owning to the high content of α-helices structure and small AgNPs (20 nm), α-structured coating displayed better protein adsorption and hydrophilicity, as well as pH-dependent and long-lasting antibacterial performance. In vitro studies demonstrated that α coating showed biocompatibility (cellular attachment, spreading and proliferation), high ALP expression, collagen secretion and calcium mineralization. Moreover, after one month subcutaneous implantation in vivo, α-structured coating elicited minimal, comparable inflammatory response. Additionally, in a rabbit femoral defect model, α-structured coating displayed a significant improvement on the generation of new-born bone and bonding between the new bone and the tissue, implying a rapid and durable osteointegration. Expectedly, this optimized structure-controlled SF-based coating can be an alternative and prospective solution for the current challenges in orthopedics. STATEMENT OF SIGNIFICANCE: In this study, an AgNPs/Gentamycin-loaded structured-controlled silk fibroin coatings were constructed on Ti implant's surface to guarantee the success of implantation even in the face of bacterial infection. In comparison, the α-structured coating had the lowest content of β-sheets structure (19.0%) and the smallest particle size of AgNPs (~ 20 nm), and owned pH-responsive characteristic due to reversible α-helices structural. Thanks to pH-responsive release of Ag⁺, the α-structure coating could effectively inhibit adhesive bacteria and kill planktonic bacteria by releasing a large amount of reactive oxygen radicals. Through in vitro biological results (cell proliferation, differentiation and osteogenic gene expression) and in vivo rabbit femur implantation results, the α-structure coating had good biocompatible and osteogenic properties.

Design of dental implants at materials level: An overview

Due to the excellent restoration of masticatory function, satisfaction on aesthetics and other superiorities, dental implants represent an effective method to resolve tooth losing and damaging. Current dental implant systems still have problems waiting to be addressed, and problems are centralized on the materials of implant bodies. This review aims to summarize major developments in the field of dental implant materials, starting with an overview on structures, procedures of dental implants and challenges of implant materials. Next, implant materials are examined in three categories, that is, metals, ceramics, and polymers, their mechanical properties, biocompatibility, and bioactivity are summarized. And as an important aspect, strategies of surface modification are also reviewed, along with some finite element analysis to guiding the research direction of implant materials. Finally, the conclusive remarks are outlined to provide an outlook on the future research directions and prospects of dental implants.

Tuning the surface immunomodulatory functions of polyetheretherketone for enhanced osseointegration

The adverse macrophage-mediated immune response elicited by the surface of polyetheretherketone (PEEK) is responsible for the formation of fibrous encapsulation and resulting inferior osseointegration of PEEK implants in the dental and orthopedic fields. Therefore, endowing the PEEK surface with immunomodulatory ability is an appealing strategy to enhance implant-bone integration. Herein, a reliable and cost-effective method to construct adherent films with tunable nanoporous structures on PEEK is described. The functionalized surface not only suppresses the acute inflammatory response of macrophages, but also provides a favorable milieu for osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs). Whole genome expression analysis reveals that the suppression effect arises from synergistic inhibition of focal adhesion, Toll-like receptor, and NOD-like receptor signaling pathways, as well as the attenuating loop through the JAK-STAT and TNF signaling pathways in macrophages. Further in vivo studies confirm that the functionalized surface induces less fibrous capsule formation and an improved bone regeneration. The nanoporous films fabricated on PEEK harmonize the early macrophage-mediated inflammatory response and subsequent hBMSCs-centered osteogenic functions consequently yielding superior osseointegration.

An In Vitro Study of Osteoblast Response on Fused-Filament Fabrication 3D Printed PEEK for Dental and Cranio-Maxillofacial Implants

Polyetheretherketone (PEEK) is a prime candidate to replace metallic implants and prostheses in orthopedic, spine and cranio-maxillofacial surgeries. Fused-filament fabrication (FFF) is an economical and efficient three-dimensional (3D) printing method to fabricate PEEK implants. However, studies pertaining to the bioactivity of FFF 3D printed PEEK are still lacking. In this study, FFF 3D printed PEEK samples were fabricated and modified with polishing and grit-blasting (three alumina sizes: 50, 120, and 250 µm) to achieve varying levels of surface roughness. In vitro cellular response of a human osteosarcoma cell line (SAOS-2 osteoblasts, cell adhesion, metabolic activity, and proliferation) on different sample surfaces of untreated, polished, and grit-blasted PEEK were evaluated. The results revealed that the initial cell adhesion on different sample surfaces was similar. However, after 5 days the untreated FFF 3D printed PEEK surfaces exhibited a significant increase in cell metabolic activity and proliferation with a higher density of osteoblasts compared with the polished and grit-blasted groups (p < 0.05). Therefore, untreated FFF 3D printed PEEK with high surface roughness and optimal printing structures might have great potential as an appropriate alloplastic biomaterial for reconstructive cranio-maxillofacial surgeries.

Triple-functional polyetheretherketone surface with enhanced bacteriostasis and anti-inflammatory and osseointegrative properties for implant application

Polyetheretherketone (PEEK) is considered a potential orthopedic/dental material because of its excellent mechanical and chemical properties (e.g., similar elastic modulus to that of human bone). However, the poor bacteriostasis and anti-inflammatory and osseointegrative properties of bioinert PEEK impede its clinical application. We previously developed a facile and versatile surface modification method using dexamethasone plus minocycline-loaded liposomes (Dex/Mino liposomes) bonded by a mussel-inspired polydopamine coating, which effectively modulated cell inflammatory response and discouraged bacterial colonization in vitro. Herein, we report the application of this multifunctional surface modification method to improve bioinert PEEK, aimed at further studying the in vitro osteogenesis and in vivo properties of Dex/Mino liposome-modified PEEK to prevent bacterial contamination, attenuate the inflammatory response, and enhance ossification for physiologic osseointegration. Our study established that the Dex/Mino liposome-modified PEEK surface presented favorable stability and cytocompatibility. Compared with bare PEEK, improved osteogenic differentiation of human mesenchymal stem cells under both osteoinductive and osteoconductive conditions was found on the functionalized surface due to the liposomal Dex releasing. In vivo bacteriostasis assay confirmed that Mino released from the functionalized surface provided an effective antibacterial effect. Moreover, the subcutaneous foreign body reaction and beagle femur implantation models corroborated the enhanced anti-inflammatory and osteointegrative properties of the functionalized PEEK. Our findings indicate that the developed Dex/Mino liposome-modified PEEK with enhanced antibacterial, anti-inflammatory, and osseointegrative capacity has great potential as an orthopedic/dental implant material for clinical application.

Carbon Fiber Reinforced PEEK Composites Based on 3D-Printing Technology for Orthopedic and Dental Applications

Fused deposition modeling (FDM) is a rapidly growing three-dimensional (3D) printing technology and has great potential in medicine. Polyether-ether-ketone (PEEK) is a biocompatible high-performance polymer, which is suitable to be used as an orthopedic/dental implant material. However, the mechanical properties and biocompatibility of FDM-printed PEEK and its composites are still not clear. In this study, FDM-printed pure PEEK and carbon fiber reinforced PEEK (CFR-PEEK) composite were successfully fabricated by FDM and characterized by mechanical tests. Moreover, the sample surfaces were modified with polishing and sandblasting methods to analyze the influence of surface roughness and topography on general biocompatibility (cytotoxicity) and cell adhesion. The results indicated that the printed CFR-PEEK samples had significantly higher general mechanical strengths than the printed pure PEEK (even though there was no statistical difference in compressive strength). Both PEEK and CFR-PEEK materials showed good biocompatibility with and without surface modification. Cell densities on the "as-printed" PEEK and the CFR-PEEK sample surfaces were significantly higher than on the corresponding polished and sandblasted samples. Therefore, the FDM-printed CFR-PEEK composite with proper mechanical strengths has potential as a biomaterial for bone grafting and tissue engineering applications.

The Role of Polyether Ether Ketone (Peek) in Dentistry - A Review

This study is aimed to review the applications of Polyether Ether Ketone (PEEK) in dentistry. The increased demand for aesthetics, legislation in some developed countries, few drawbacks with existing materials and clinicians shifting their paradigms towards metal free restorations led space for the metal-free restorations in today's dental practice. An electronic literature search was conducted through Medline via PubMed, Wiley Online library, EBSCOhost, Science Direct, as well as the Google Scholar between January 2010 and March 2018 using the keywords: PEEK, modified PEEK, PEEK and Dental, advantages of PEEK, applications of PEEK in dentistry and PEEK Implants. A total of 103 articles were found in the literature search and out of these, 18 were not related to our study and hence were excluded. Finally, 85 articles were found to be relevant. PEEK has been explained for a number of applications in dental practice. The literature showed that the PEEK material has superior mechanical properties with different uses in various specialties of dentistry.

PEEK materials as an alternative to titanium in dental implants: A systematic review

PURPOSE

Evaluation of the available research on PEEK materials to find that whether PEEK material has favorable properties and can enhance osseointegration, so that they can be utilize as implants material.

MATERIALS AND METHODS

An electronic and structured systematic search was undertaken in May 2018, without any restrictions of time in the Medline/Pubmed, Sci-hub, Ebscohost, Cochrane, and Web of Science databases. To identify other related references further hand search was done. Articles related to PEEK and their applications in implants were only included. Articles not available in abstract form and article other than English language were excluded.

RESULTS

Initially, the search resulted in 153 papers. Independent screenings of the abstracts were done by the reviewers to identify the articles related to the question in focus. Sixty-two studies were selected out of which 10 were further excluded due to not in English language. Two additional papers were obtained after hand searching, and finally 54 articles were included in the review.

CONCLUSIONS

Surface modification of PEEK seems to enhance the cell adhesion, proliferation, biocompability, and osteogenic properties of PEEK implant materials. PEEK had also influence the biofilm structure and reduces the chances of periimplant inflammations. Further research and more number of controlled clinical trials on PEEK implant is required in near future so that it can replace titanium in future.

Dual Therapy Coating on Micro/Nanoscale Porous Polyetheretherketone to Eradicate Biofilms and Accelerate Bone Tissue Repair

Defective osteogenesis and latent infections continue to be two major issues in the therapy of bone tissue regeneration. In this study, a unique hierarchically micro/nanoscale-architecture is first proposed and produced on polyetheretherketone (PEEK). Besides, a "simvastatin-PLLA film-tobramycin microspheres" delivery system is subsequently fabricated to endow the PEEK implant with osteogenic and antibacterial capabilities. In vitro antibacterial evaluations confirm that the decorated PEEK scaffolds possess excellent resistance against planktonic/adherent bacteria. In vitro cell attachment/proliferation, lactate dehydrogenase (LDH) content, alkaline phosphatase (ALP) activity, calcium mineral deposition experiments, and real-time PCR analysis all exhibit that the superior proliferation rate and osteo-differentiation potential of MC3T3-E1 pre-osteoblasts are presented on the PEEK samples with dual functional decoration. In the mouse calvarial defect model, the micro-CT and histological results demonstrate that our scaffolds display a remarkable bone forming capability. Generally, the PEEK scaffolds co-endowed with simvastatin and tobramycin microspheres possess great potential in clinics.

Enhanced Bioactivity of Collagen Fiber Functionalized with Room Temperature Atomic Layer Deposited Titania

Surface modifications of a biomaterial like collagen are crucial in improving the surface properties and thus enhancing the functionality and performance of such a material for a variety of biomedical applications. In this study, a commercially available collagen membrane's surface was functionalized by depositing an ultrathin film of titania or titanium dioxide (TiO₂) using a room temperature atomic layer deposition (ALD) process. A novel titanium precursor-oxidizer combination was used for this process in a custom-made ALD reactor. Surface characterizations revealed successful deposition of uniform, conformal TiO₂ thin film on the collagen fibrillar surface, and consequently, the fibers became thicker making the membrane pores smaller. The in vitro bioactivity of the ALD-TiO₂ thin film coated collagen was investigated for the first time using cell proliferation and a calcium phosphate mineralization assay. The TiO₂-coated collagen demonstrated improved biocompatibility promoting higher growth and proliferation of human osteoblastic and mesenchymal stem cells when compared to that of noncoated collagen. A higher level of calcium phosphate or apatite formation was observed on ALD modified collagen surface as compared to that on noncoated collagen. Therefore, this novel material can be promising in bone tissue engineering applications.

Single-Phase, Antibacterial Trimagnesium Phosphate Hydrate Coatings on Polyetheretherketone (PEEK) Implants by Rapid Microwave Irradiation Technique

This Article reports the fabrication and evaluation of single-phase, silver-doped trimagnesium phosphate hydrate (Ag-TMPH) nanosheet coatings on polyetheretherketone (PEEK), a well-known material used to fabricate orthopedic and spinal implants. While PEEK has better biomechanical compatibility with bone compared to metallic implants, it is also quite inert. Therefore, it is a common practice to coat PEEK implants with conventional calcium phosphates (CaPs) to enhance cell attachment, proliferation and differentiation. As opposed to well-studied CaP compounds, relatively less-explored magnesium phosphates (MgPs) are also becoming interesting orthopedic biomaterials and is the prime focus in this research. The novel aspects of this paper are as follows. First, we report developing TMPH coatings within minutes with the help of microwave irradiation technology. Microwave irradiation plays an important role in the coating formation with accelerated kinetics. Scanning electron microscopy (SEM) confirmed the fabrication of approximately 650 nm thick TMPH coatings. The coatings resulted in submicron level surface roughness and in vitro cell studies confirmed enhanced MC3T3 cell adhesion within 4 h on such surfaces. The coatings also resulted in significant apatite formation after immersing in simulated body fluid for 7 days. Second, multifunctionality was achieved by doping TMPH coatings with Ag, thus rendering the coatings antibacterial. The antibacterial properties were evaluated against two most common infection-causing bacterial strains-Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus. The results indicated good bacterial resistance and bactericidal properties of the Ag-TMPH coatings. Third, in spite of Ag doping, the single-phase nature of the coatings were retained (without forming composite systems) with the help of the low-processing temperature of the microwave irradiation. The inductive coupled plasma technique confirmed that the doped single-phase TMPH coatings supported a uniform and controlled release of Ag⁺ ions over a period of 3 weeks. MTT assay evaluations and SEM micrographs confirmed no signs of cytotoxicity and healthy proliferation of cells in all cases. Quantitative real time PCR (qRT-PCR) indicated a significant rise in collagen (Col1) and osteocalcin (OCN) gene expression levels in the case of TMPH coated PEEK. Thus, microwave irradiation was successfully employed in forming multifunctional, that is, bioactive, cytocompatible, and antibacterial MgP coatings on PEEK.

Osteostimulation scaffolds of stem cells: BMP-7-derived peptide-decorated alginate porous scaffolds promote the aggregation and osteo-differentiation of human mesenchymal stem cells

The scaffolds for stem cell-based bone tissue engineering should hold the ability to guide stem cells osteo-differentiating. Otherwise, stem cells will differentiate into unwanted cell types or will form tumors in vivo. Alginate, a natural polysaccharide with great biocompatibility, was widely used in biomedical applications. However, the limited bioactivity and poor osteogenesis capability of pristine alginate hampered its further application in tissue engineering. In this work, a bone forming peptide-1 (BFP-1), derived from bone morphogenetic protein-7, was grafted to alginate polymer chains to prepare peptide-decorated alginate porous scaffolds (pep-APS) for promoting osteo-differentiation of human mesenchymal stem cells (hMSCs). SEM images of pep-APS exhibited porous structure with about 90% porosity (pore size 100-300 μm), which was appropriate for hMSCs ingrowth. The adhesion, proliferation and aggregation of hMSCs grown on pep-APS were enhanced in vitro. Moreover, pep-APS promoted the alkaline phosphatase (ALP) activity of hMSCs, and the osteo-related genes expression was obviously up-regulated. The immunochemical staining and western blot analysis results showed high expression level of OCN and Col1a1 in the hMSCs grown on pep-APS. This work provided a facile and valid strategy to endow the alginate polymers themselves with specific bioactivity and prepare osteopromoting scaffold with enhanced osteogenesis ability, possessing potential applications in stem cell therapy and regenerative medicine.

Biofunctional Mg coating on PEEK for improving bioactivity

High purity Mg was successfully coated on polyetheretherketone (PEEK) by vapor deposition method in order to improve the bioactivity including antibacterial property of PEEK implant. The morphology and elemental composition of the coating were characterized by scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS), showing that the coating was mainly composed of Mg at deposition temperature of 175 °C, 185 °C, 200 °C and 230 °C. The higher the substrate temperature was, the larger the Mg particle size was. The coating degraded and gradually peeled off from the surface of PEEK after up to 21 days' immersion. It was found that the degradation of Mg coating could strongly kill Staphylococcus aureus with antibacterial rate reaching to 99%. Mg can be expected to be coated on those bio-inert biomaterials to offer specific bioactivities.

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High purity Mg was coated on PEEK by vapor deposition method.

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The Mg coating degraded and gradually peeled off from the surface of PEEK after up to 21 days immersion.

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The degradation of Mg coating could strongly kill Staphylococcus aureus with antibacterial rate reaching to 99%.

Time-responsive osteogenic niche of stem cells: A sequentially triggered, dual-peptide loaded, alginate hybrid system for promoting cell activity and osteo-differentiation

The efficacy of stem cell-based bone tissue engineering has been hampered by cell death and limited fate control. A smart cell culture system with the capability of sequentially delivering multiple factors in specific growth stages, like the mechanism of the natural extracellular matrix modulating tissue formation, is attractive for enhancing cell activity and controlling cell fate. Here, a bone forming peptide-1 (BFP-1)-laden mesoporous silica nanoparticles (pep@MSNs) incorporated adhesion peptide, containing the arginine-glycine-aspartic acid (RGD) domain, modified alginate hydrogel (RA) system (pep@MSNs-RA) was developed to promote the activity and stimulate osteo-differentiation of human mesenchymal stem cells (hMSCs) in sequence. The survivability and proliferation of hMSCs were enhanced in the adhesion peptide modified hydrogel. Next, BFP-1 released from pep@MSNs induced hMSCs osteo-differentiation after the proliferation stage. Moreover, BFP-1 near the cells was self-captured by the additional cell-peptide cross-linked networks formed by the ligands (RGD) binding to receptors on the cell surface, leading to long-term sustained osteo-stimulation of hMSCs. The results suggest that independent and sequential stimulation in proliferation and osteo-differentiation stages could synergistically enhance the survivability, expansion, and osteogenesis of hMSCs, as compared to stimulating alone or simultaneously. Overall, this study provided a new and valid strategy for stem cell expansion and osteo-differentiation in 2D or 3D culture systems, possessing potential applications in 3D bio-printing and tissue regeneration.

Stimulation of cell responses and bone ingrowth into macro-microporous implants of nano-bioglass/polyetheretherketone composite and enhanced antibacterial activity by release of hinokitiol

Poor osteogenesis and bacterial infection lead to the failure of implants, thus enhancements of osteogenic activity and antibacterial activity of the implants have significances in orthopedic applications. In this study, macro-microporous bone implants of nano-bioglass (nBG) and polyetheretherketone (PK) composite (mBPC) were fabricated. The results indicated that the mBPC with the porosity of around 70% exhibited interconnected macropores (sizes of about 400 μm) and micropores (sizes of about 10 μm). The apatite mineralization ability of mBPC in simulated body fluid (SBF) was significantly improved compared with macroporous nBG/PK composite (BPC) without micropores and macroporous PK (mPK). Drug of hinokitiol (HK) was loaded into mBPC (dmBPC), which displayed excellent in vitro antibacterial activity against Staphylococcus aureus. The MC3T3-E1 cells proliferation and ALP activity were significantly promoted by mBPC and dmBPC as compared with BPC and mPK. The micro-CT and histological evaluation showed that both mBPC and dmBPC containing nBG and micropores induced higher new bone formation into porous implants than mPK and BPC. The immunohistochemistry analysis indicated that the expression of BMP-2 in mBPC and dmBPC exhibited obviously higher level than mPK and BPC. The results suggested that the incorporation of nBG and micropores in mBPC obviously improved the osteogenic activity, and mBPC load with HK also promoted osteogenesis, indicating good biocompatibility. The dmBPC with HK significantly enhanced osteogenesis and antibacterial activity, which had great potential as bone implant for hard tissue repair.

PEEK with Reinforced Materials and Modifications for Dental Implant Applications

Polyetheretherketone (PEEK) is a semi-crystalline linear polycyclic thermoplastic that has been proposed as a substitute for metals in biomaterials. PEEK can also be applied to dental implant materials as a superstructure, implant abutment, or implant body. This article summarizes the current research on PEEK applications in dental implants, especially for the improvement of PEEK surface and body modifications. Although various benchmark reports on the reinforcement and surface modifications of PEEK are available, few clinical trials using PEEK for dental implant bodies have been published. Controlled clinical trials, especially for the use of PEEK in implant abutment and implant bodies, are necessary.

Antimicrobial and Osseointegration Properties of Nanostructured Titanium Orthopaedic Implants

The surface design of titanium implants influences not only the local biological reactions but also affects at least the clinical result in orthopaedic application. During the last decades, strong efforts have been made to improve osteointegration and prevent bacterial adhesion to these surfaces. Following the rule of “smaller, faster, cheaper”, nanotechnology has encountered clinical application. It is evident that the hierarchical implant surface micro- and nanotopography orchestrate the biological cascades of early peri-implant endosseous healing or implant loosening. This review of the literature gives a brief overview of nanostructured titanium-base biomaterials designed to improve osteointegration and prevent from bacterial infection.

Enhanced Bioactivity and Bacteriostasis of Surface Fluorinated Polyetheretherketone

Although polyetheretherketone (PEEK) has been considered as a potential orthopedic and dental application material due to its similar elastic modulus as bones, inferior osseointegration and bacteriostasis of PEEK hampers its clinical application. In this work, fluorinated PEEK was constructed via plasma immersion ion implantation (PIII) followed by hydrofluoric acid treatment to ameliorate the osseointegration and antibacterial properties of PEEK. The surface microstructure, composition, and hydrophilicity of all samples were investigated. Rat bone mesenchymal stem cells (rBMSCs) were cultured on their surfaces to estimate bioactivity. The fluorinated PEEK can enhance the cell adhesion, cell spreading, proliferation, and alkaline phosphatase (ALP) activity compared to pristine PEEK. Furthermore, the fluorinated PEEK surface exhibits good bacteriostatic effect against Porphyromonas gingivalis, which is one of the major periodontal pathogens. In summary, we provide an effective route to introduce fluorine and the results reveal that the fluorinated PEEK can enhance the osseointegration and bacteriostasis, which provides a potential candidate for dental implants.

Nano-hydroxyapatite reinforced polyphenylene sulfide biocomposite with superior cytocompatibility and in vivo osteogenesis as a novel orthopedic implant

The design of novel functional biomaterials that possess similar mechanical attributes as human bones, accompanied with admirable osteogenesis to replace conventional metallic implants would be an intriguing accomplishment.

Applications of polyetheretherketone (PEEK) in oral implantology and prosthodontics

PURPOSE

Polyetheretherketone (PEEK) is a polymer that has many potential uses in dentistry. The aim of this review was to summarize the outcome of research conducted on the material for dental applications. In addition, future prospects of PEEK in the field of clinical dentistry have been highlighted.

STUDY SELECTION

An electronic search was carried out via the PubMed (Medline) database using keywords 'polyetheretherketone', 'dental' and 'dentistry' in combination. Original research papers published in English language in last fifteen year were considered. The studies relevant to our review were critically analyzed and summarized.

RESULTS

PEEK has been explored for a number of applications for clinical dentistry. For example, PEEK dental implants have exhibited lesser stress shielding compared to titanium dental implants due to closer match of mechanical properties of PEEK and bone. PEEK is a promising material for a number of removable and fixed prosthesis. Furthermore, recent studies have focused improving the bioactivity of PEEK implants at the nanoscale.

CONCLUSION

Considering mechanical and physical properties similar to bone, PEEK can be used in many areas of dentistry. Improving the bioactivity of PEEK dental implants without compromising their mechanical properties is a major challenge. Further modifications and improving the material properties may increase its applications in clinical dentistry.

Bioactivity and antibacterial effect of nitrogen plasma immersion ion implantation on polyetheretherketone

OBJECTIVE

We aimed to investigate the bioactivity and antibacterial effect of nitrogen plasma immersion ion implantation (PIII) on polyetheretherketone (PEEK).

METHODS

According to the different modified parameters, the PEEK specimens were randomly divided into four main groups (n=49/group): PEEK-C, PEEK-I, PEEK-L, and PEEK-H. Then, N₂-PIII surface modification was conducted using the corresponding parameters. The microstructure and composition of the modified PEEK surface was observed by scanning electron microscope (SEM), atomic force microscopy (AFM) and X-ray photoelectron spectroscopy (XPS). The water contact angle of the PEEK surface was also studied by contact angle meters. The bioactive ability of PEEK samples was evaluated by observing the attachment, proliferation, and differentiation of MG63 cells cultured on the PEEK samples. Antibacterial property of the samples against Staphylococcus aureus was detected with the plate colony-counting methods.

RESULTS

SEM and AFM analysis shows that PEEK-C surface is relatively smooth with the Ra value of 50.6±2.52nm. PEEK-I and PEEK-L surface is rough with the Ra value of 435.9±6.47nm and 443.23±5.49nm, respectively, and the PEEK-H surface is the most rough with the Ra value of 608.4±3.14nm. XPS element analysis demonstrated that nitrogen functional groups were successfully introduced into the surface of PIII-modified PEEK. Biological evaluation and the antibacterial results showed that nitrogen PIII treatment can significantly improve the biological activity of PEEK, and samples showed antibacterial properties against S. aureus.

SIGNIFICANCE

PEEK surface subjected to the N₂-PIII treatment showed better biological activity and antibacterial effect. Therefore, N₂-PIII-treated PEEK surface is promising in bone tissue engineering and dental applications.