Roughness response genes in osteoblasts

Improved Biocompatibility and Osseointegration of Nanostructured Calcium-Incorporated Titanium Implant Surface Treatment (XPEED®)

Surface treatment of implants facilitates osseointegration, with nanostructured surfaces exhibiting accelerated peri-implant bone regeneration. This study compared bone-to-implant contact (BIC) in implants with hydroxyapatite (HA), sand-blasted and acid-etched (SLA), and SLA with calcium (Ca)-coated (XPEED®) surfaces. Seventy-five disk-shaped grade 4 Ti specimens divided into three groups were prepared, with 16 implants per group tested in New Zealand white rabbits. Surface characterization was performed using X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), digital microscopy, and a contact angle analyzer. Cell viability, proliferation, and adhesion were assessed using MC3T3-E1 cells. Apatite formation was evaluated using modified simulated body fluid (m-SBF) incubation. After 4 weeks of healing, the outcomes reviewed were BIC, bone area (BA), removal torque tests, and histomorphometric evaluation. A microstructure analysis revealed irregular pores across all groups, with the XPEED group exhibiting a nanostructured Ca-coated surface. Surface characterization showed a crystalline CaTiO3 layer on XPEED surfaces, with evenly distributed Ca penetrating the implants. All surfaces provided excellent environments for cell growth. The XPEED and SLA groups showed significantly higher cell density and viability with superior osseointegration than HA (p < 0.05); XPEED exhibited the highest absorbance values. Thus, XPEED surface treatment improved implant performance, biocompatibility, stability, and osseointegration.

Zizyphus mauritiana seed extract: Paving the way for next-generation bone constructs with nano-fluorohydroxyapatite/carboxymethyl chitosan nanocomposite scaffold

This is the first study that explored the potential use of Zizyphus mauritiana seed extract (ZSE) to synthesize nano-fluorohydroxyapatite/carboxymethyl chitosan nanocomposite scaffolds at different concentrations (CFZ1, CFZ2 and CFZ3) using co-precipitation method. The proposed scaffolds showed presence of intermolecular H bonding interactions between the constituents, according to the FTIR. The mechanical studies revealed shore hardness of 72 ± 4.6 and optimal compressive modulus in case of CFZ3 [1654.48 ± 1.6 MPa], that was comparable with that of human cortical bone. The SEM, TEM and platelet adhesion images corroborated uniformly distributed needle like particles in case of CFZ3 with an average size ranging from 22 to 26 nm, linked rough morphology, and appropriate hemocompatibility. The markedly up regulation in the ALP activity and protein adsorption upon increasing ZSE concentration demonstrated that CFZ nanocomposite scaffolds were compatible with osteoblastic cells relative to CF nanocomposite. The cytotoxicity study indicated that CFZ nanocomposite do not induce toxicity over MG-63 and did not aggravate LDH leakage in contrast to CF. The histopathological investigations on albino rats confirmed significantly improved regeneration of bone in the repair of a critical-size [8 mm] calvarium defect. Therefore, CFZ3 nanocomposite scaffold represents a simple, off-the-shelf solution to the combined challenges associated with bone defects.

Effects of Surface Treatment Method Forming New Nano/Micro Hierarchical Structures on Attachment and Proliferation of Osteoblast-like Cells

Titanium (Ti) and Ti-based alloys are commonly used in dental implants, and surface modifications of dental implants are important for achieving osseointegration (i.e., direct connection between the implant surface and bone). This study investigated the effect of an eco-friendly etching solution-a hydrogen peroxide-sodium bicarbonate mixture-on the surface properties and contact angles of osteoblast adhesion and proliferation on Ti surfaces. Disk-shaped Ti specimens were prepared using different surface treatments (machining, sandblasting, and sandblasting/acid-etching), and they were immersed in the etching solution and ultrasonically cleaned. Surface characterization was performed using scanning electron microscopy, digital microscopy, contact angle analysis, and X-ray photoelectron spectroscopy. MG-63 osteoblasts were cultured on the specimens, and their adhesion to the specimen surface and proliferation were examined using staining and the MTT assay, respectively. Additional etching with the etching solution caused the formation of nano/micro hierarchical structures, increased surface roughness, and enhanced hydrophilicity. Osteoblast adhesion and proliferation were found to improve on the modified surfaces. The eco-friendly etching method has the potential to enhance the biological properties of Ti implant surfaces and thereby improve dental implant performance.

Enhanced human periodontal ligament stem cell viability and osteogenic differentiation on two implant materials: An experimental in vitro study

Background: Surface roughness of dental implants impacts the survival of adult periodontal stem cells and rate of differentiation. This research was conducted to test how human periodontal ligament stem cells behaved on yttria stabilized tetragonal zirconia polycrystals and polyetheretherketone (PEEK) discs with different surface topographies. Methods: Discs roughening was prepared by sandblasting. Stem cells were cultivated on zirconia discs with a polished surface, PEEK discs with a polished surface, sandblasted zirconia discs and sandblasted PEEK discs. Cells viability was assessed after 24, 48, 72 hours. Scanning electron microscopy was used to examine the adherence and attachment of cells. Osteoblastic differentiation capacity was studied by checking the mineralization clusters development through alizarin red S staining and alkaline phosphatase assay. ANOVA and the Tukey post hoc test were used for the statistical analysis. Results: Polished PEEK discs showed lower cell viability, whereas roughened sandblasted zirconia and PEEK discs showed the highest proliferation rates and cell viability percent. The osteogenic differentiation was enhanced for rough surfaces in comparison to polished surfaces. Sandblasted zirconia and PEEK discs showed a markedly increased mineralized nodule development and ALP enzyme activity compared to the polished surface and control. Conclusions: Micro- topographies creation on the PEEK implant surface enhances stem cell attachment, viability, and osteogenic differentiation.

Nanoscale Morphologies on the Surface of 3D-Printed Titanium Implants for Improved Osseointegration: A Systematic Review of the Literature

Three-dimensional (3D) printing is serving as the most promising approach to fabricate personalized titanium (Ti) implants for the precise treatment of complex bone defects. However, the bio-inert nature of Ti material limits its capability for rapid osseointegration and thus influences the implant lifetime in vivo. Despite the macroscale porosity for promoting osseointegration, 3D-printed Ti implant surface morphologies at the nanoscale have gained considerable attention for their potential to improve specific outcomes. To evaluate the influence of nanoscale surface morphologies on osseointegration outcomes of 3D-printed Ti implants and discuss the available strategies, we systematically searched evidence according to the PRISMA on PubMed, Embase, Web of Science, and Cochrane (until June 2022). The inclusion criteria were in vivo (animal) studies reporting the osseointegration outcomes of nanoscale morphologies on the surface of 3D-printed Ti implants. The risk of bias (RoB) was assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE's) tool. The quality of the studies was evaluated using the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. (PROSPERO: CRD42022334222). Out of 119 retrieved articles, 9 studies met the inclusion criteria. The evidence suggests that irregular nano-texture, nanodots and nanotubes with a diameter of 40-105nm on the surface of porous/solid 3D-printed Ti implants result in better osseointegration and vertical bone ingrowth compared to the untreated/polished ones by significantly promoting cell adhesion, matrix mineralization, and osteogenic differentiation through increasing integrin expression. The RoB was low in 41.1% of items, unclear in 53.3%, and high in 5.6%. The quality of the studies achieved a mean score of 17.67. Our study demonstrates that nanostructures with specific controlled properties on the surface of 3D-printed Ti implants improve their osseointegration. However, given the small number of studies, the variability in experimental designs, and lack of reporting across studies, the results should be interpreted with caution.

Plasma Electrolytic Oxidation for Dental Implant Surface Treatment

Current technologies of plasma electrolytic oxidation (PEO) for modifying the surfaces of dental implants made of the Grade IV titan alloy provide predictable long-term results in implant dentistry. The aim of the study is to evaluate the efficacy of PEO technology comparing two types of surface modification of dental implants made of VT1-0 medical titanium alloy.

Materials and Methods

50 IRIS dental implants (Scientific Production Company LICOSTOM, Russia), 10-mm long and 4 mm in diameter, were manufactured from the VT1-0 alloy. The implant surface was treated by two PEO methods: 1) in the aqueous solution of alkaline electrolyte without any additional modifiers (PEO-Ti); 2) in the aqueous solution of orthophosphoric acid-based electrolyte containing calcium carbonate (PEO-Ca). Implants made of VT1-0 alloy after milling and without additional treatment served as control samples. The implant surfaces were studied by electron microscopy and energy dispersive X-ray spectrometry. Some of the implants were installed in sheep, samples were obtained at 2, 4, and 8 weeks and studied by microcomputer tomography.

Results

Regardless of the electrolyte composition, a highly developed porous surface was formed in the samples with PEO-modified surfaces. The surface of the PEO-Ti samples in a simple unmodified electrolyte was characterized by a large number of open pores with a wide range of size distribution from 200 nm to 3 μm. The pore size distribution was of a monomodal character, with a maximum near 0.23 μm. The PEO samples in the Ca-containing electrolyte had pores also in a wide range from ~80 nm to ~7 μm. The pore distribution, in contrast to PEO-Ti, was bimodal in nature, with the main maximum in the region of 1.05 μm and the concomitant maximum near 2.45 μm.The obtained surfaces of both types (PEO with Ca and Ti) possessed high purity and optimal microroughness for osseointegration. Both types of PEO treatment (PEO with Ca and Ti) have demonstrated a similar osseointegrative potential, nevertheless, the surface of the PEO-Ca showed a better contact with the implant surface (49.8%) than PEO-Ti (42.4%) obviously due to the presence of calcium in its composition.

Conclusion

The PEO-formed implant surfaces demonstrate high osseointegrative properties after any variants of treatment and show the potential for application in osteoporosis.

The Effect of Microcosm Biofilm Decontamination on Surface Topography, Chemistry, and Biocompatibility Dynamics of Implant Titanium Surfaces

Since the inception of dental implants, a steadily increasing prevalence of peri-implantitis has been documented. Irrespective of the treatment protocol applied for the management of peri-implantitis, this biofilm-associated pathology, continues to be a clinical challenge yielding unpredictable and variable levels of resolution, and in some cases resulting in implant loss. This paper investigated the effect of microcosm biofilm in vitro decontamination on surface topography, wettability, chemistry, and biocompatibility, following decontamination protocols applied to previously infected implant titanium (Ti) surfaces, both micro-rough -Sandblasted, Large-grit, Acid-etched (SLA)-and smooth surfaces -Machined (M). Microcosm biofilms were grown on SLA and M Ti discs. These were treated with TiBrushes (TiB), combination of TiB and photodynamic therapy (PDT), combination of TiB and 0.2%CHX/1%NaClO, plus or minus Ultraviolet-C (UV-C) radiation. Surface topography was evaluated by Scanning Electron Microscopy (SEM) and Laser Surface Profilometry. Surface function was analysed through wettability analysis. Surface chemistry evaluation of the discs was performed under SEM/Energy-dispersive X-ray spectroscopy (EDX) and X-ray photoelectron spectroscopy (XPS). Biocompatibility was tested with the cytocompatibility assay using human osteoblast-like osteosarcoma cell line (MG-63) cells. Elemental analysis of the discs disclosed chemical surface alterations resulting from the different treatment modalities. Titanium, carbon, oxygen, sodium, aluminium, silver, were identified by EDX as the main components of all the discs. Based on the data drawn from this study, we have shown that following the decontamination of Ti surfaces the biomaterial surface chemistry and topography was altered. The type of treatment and Ti surface had a significant effect on cytocompatibility (p = 0.0001). Although, no treatment modality hindered the titanium surface biocompatibility, parameters such as the use of chemical agents and micro-rough surfaces had a higher cytotoxic effect in MG-63 cells. The use of smooth surfaces, and photofunctionalisation of the TiO₂ layer had a beneficial effect on cytocompatibility following decontamination.

Femtosecond laser optimization of PEEK: efficient bioactivity achieved by synergistic surface chemistry and structures

Poly-ether-ether-ketone (PEEK) is considered a potential orthopedic material due to the excellent mechanical properties and chemical resistance, but its biological inertness hampers its further clinical application. In this study, advanced femtosecond laser microfabrication technology was utilized to induce the change of the surface characteristics of PEEK to improve its bioactivity. Meanwhile, the mechanism of surface reaction and improved bioactivity was interpreted in detail from the perspective of material science. The surface physical-chemical characterization results showed that femtosecond laser etching could increase the surface energy, and the contents of active sites including amorphous carbon and carbon-hydroxyl on PEEK surfaces. In vitro validation experiments demonstrated that the samples etched with a femtosecond laser had a better ability to induce apatite deposition and cell proliferation than those treated with popular sulfonation modification, which would lead to better bioactivity and osteointegration. The current work fully presents the mechanism of the femtosecond laser low-temperature plasma effect on PEEK and the resulting surface characteristics, which could broaden the application of PEEK in the orthopedic field. Moreover, it has great potential in the surface design and modification of other biomaterials with enhanced bioactivity.

In-Vitro Phenotypic Response of Human Osteoblasts to Different Degrees of Titanium Surface Roughness

Objectives: This study aimed to investigate human osteoblast (HOB) responses towards different degrees of titanium (Ti) implant surface roughness. Methods: Four degrees of Ti surface roughness were investigated on a micrometer roughness scale: smooth (S: 0.08−0.1 µm), minimally rough (MM: 0.3−0.5 µm), moderately rough (MR: 1.2−1.4 µm), and rough (R: 3.3−3.7 µm). HOB cells were cultured, expanded, and maintained according to the supplier’s protocol. Cell proliferation and cytotoxicity were assessed at day 1, 3, 5, and 10 using alamarBlue and lactate dehydrogenase colorimetric assays. Data were analyzed with one-way ANOVA, two-way ANOVA, and Tukey’s post hoc test (p = 0.05 for all tests). Results: There was no significant difference in the cell proliferation or cytotoxicity of the HOB cells in contact with the different degrees of Ti surface roughness. There was, however, a significant time effect on cell proliferation (p < 0.0001) with different exposure durations for each roughness degree. Furthermore, a positive correlation (non-significant) between proliferation and cytotoxicity was observed for all investigated degrees of surface roughness. Conclusion: All investigated roughness degrees showed comparable HOB proliferation, with the MR surface presenting the highest percentage, followed by the R, MM, ad S, surfaces, respectively. The S surface showed the highest cytotoxic effect on HOBs; however, it did not reach the cytotoxic level suggested by the ISO for any medical device to be considered cytotoxic.

Additive Manufacturing: An Opportunity for the Fabrication of Near-Net-Shape NiTi Implants

Nickel–titanium (NiTi) is a shape-memory alloy, a type of material whose name is derived from its ability to recover its original shape upon heating to a certain temperature. NiTi falls under the umbrella of metallic materials, offering high superelasticity, acceptable corrosion resistance, a relatively low elastic modulus, and desirable biocompatibility. There are several challenges regarding the processing and machinability of NiTi, originating from its high ductility and reactivity. Additive manufacturing (AM), commonly known as 3D printing, is a promising candidate for solving problems in the fabrication of near-net-shape NiTi biomaterials with controlled porosity. Powder-bed fusion and directed energy deposition are AM approaches employed to produce synthetic NiTi implants. A short summary of the principles and the pros and cons of these approaches is provided. The influence of the operating parameters, which can change the microstructural features, including the porosity content and orientation of the crystals, on the mechanical properties is addressed. Surface-modification techniques are recommended for suppressing the Ni ion leaching from the surface of AM-fabricated NiTi, which is a technical challenge faced by the long-term in vivo application of NiTi.

Human Gingival Fibroblast Adhesion and Proliferation on Hydroxyapatite-Coated Zirconia Abutment Surfaces

Applying antibacterial coatings to dental implant materials seems reasonable but can have negative influences on desired cell adhesion and healing. In this study, zirconia abutment specimens interacting with gingival tissue were used. The aim was to compare the influence of machined or coated zirconia surfaces on the adhesion and proliferation of human gingival fibroblasts (HGF-1). Surface modifications were performed using atmospheric plasma coating with hydroxyapatite, zinc, and copper. Zirconia specimens were divided into four groups: hydroxyapatite, hydroxyapatite with zinc oxide (ZnO), hydroxyapatite with copper (Cu), and an untreated machined surface. After the characterization of the surface conditions, the morphology of adhered HGF-1 was determined by fluorescence staining and subjected to statistical evaluation. The visual analysis of cell morphology by SEM showed flat, polygonal, and largely adherent fibroblast cells in the untreated group, while round to partially flat cells were recorded in the groups with hydroxyapatite, hydroxyapatite + ZnO, and hydroxyapatite + Cu. The cell membranes in the hydroxyapatite + ZnO and hydroxyapatite + Cu groups appeared porous. The results show that HGF-1 adhere and proliferate well on machined zirconia, while plasma coating with hydroxyapatite or hydroxyapatite mixtures does not lead to increased adhesion or proliferation.

Effects of Titanium Implant Surface Topology on Bone Cell Attachment and Proliferation in vitro

Purpose

Titanium is commonly used for implants because of its corrosion resistance and osseointegration capability. It is well known that surface topology affects the response of bone tissue towards implants. In vivo studies have shown that in weeks or months, bone tissue bonds more efficiently to titanium implants with rough surfaces compared to smooth surfaces. In addition, stimulating early endosseous integration increases the long-term stability of bone-implants and hence their clinical outcome. Here, we evaluated the response of human MG-63 osteoblast-like cells to flat and solid, compared to rough and porous surface topologies in vitro 1–6 days post seeding. We compared the morphology, proliferation, and attachment of cells onto three smooth surfaces: tissue culture (TC) plastic or microscope cover glasses, machined polyether-ether-ketone (PEEK), and machined solid titanium, to cells on a highly porous (average R_a 22.94 μm) plasma-sprayed titanium surface (composite Ti-PEEK spine implants).

Methods

We used immuno-fluorescence (IF) and scanning electron microscopy (SEM), as well as Live/Dead and WST-1 cell proliferation assays.

Results

SEM analyses confirmed the rough topology of the titanium implant surface, compared to the smooth surface of PEEK, solid titanium, TC plastic and cover glasses. In addition, SEM analyses revealed that MG-63 cells seeded onto smooth surfaces (solid titanium, PEEK) adopted a flat, planar morphology, while cells on the rough titanium surface adopted an elongated morphology with numerous filopodial and lamellipodial extensions interacting with the substrate. Finally, IF analyses of focal adhesions (vinculin, focal adhesion kinase), as well as proliferation assays indicate that MG-63 cells adhere less and proliferate at a slower rate on the rough than on a smooth titanium surface.

Conclusion

These observations suggest that bone-forming osteoblasts adhere less strongly and proliferate slower on rough compared to smooth titanium surfaces, likely promoting cell differentiation, which is in agreement with other porous implant materials.

Promises of Functionally Graded Material in Bone Regeneration: Current Trends, Properties, and Challenges

Functionally graded materials (FGMs) are emerging materials systems, with structures and compositions gradually changing in a particular direction. Consequently, the properties of the materials gradually change in the desired direction to achieve particular nonhomogeneous service demands without abrupting the compositional and behavioral interface at the macroscale. FGMs have been found to have high potential as orthopedic implants; because the functional gradient can be adapted in such a manner that the core of FGM should be compatible with the density and strength of bone, interlayers can maintain the structural integrity and outermost layers would provide bioactivity and corrosion resistance, thus overall tailoring the stress shielding effect. This review article discusses the typical FGM systems existing in nature and the human body, focusing on bone tissue. Further, the reason behind the application of these FGMs systems in orthopedic implants is explored in detail, considering the physical and biological necessities. The substantial focus of the present critical review is devoted to two primary topics related to the usage of FGMs for orthopedic implants: (1) the synthesizing techniques currently available to produce FGMs for load-bearing orthopedic applications and (2) the properties, such as mechanical, structural, and biological behavior of the FGMs. This review article gives an insight into the potential of FGMs for orthopedic applications.

β-TCP/DCPD-PHBV (40%/60%): Biomaterial made from bioceramic and biopolymer for bone regeneration; investigation of intrinsic properties

In this study, a detailed physical, chemical, and mechanical investigation of bone substitute (β-TCP/DCPD-PHBV) was carried out. In fact, it is composed of biocompatible materials such as ceramic phosphocalcic, consisting of tricalcium phosphate (β-TCP) and dihydrated dicalcium phosphate (DCPD) and 3-hydroxybutyrate-co-3-hydroxyvalerate (PHBV) polymer having a weight fraction 40%/60%. For these analyses, diverse techniques were used, including SEM-EDS, mercury porosimeter, Fourier Transform Infrared Spectroscopy, and, finally, uniaxial compression test machine. A morphological investigation of biomaterials using MEB revealed uneven particle shape and size, as well as a rough surface with a porous and microcracked structure. In fact, this architecture promotes the development of bone within biomaterials. Compositional studies applying FTIR technology, also, revealed the existence of chemical components, comparable to those found in the mineral phase of bone (Ca²⁺, PO₄^3-, and HPO₄^2-). The following compounds prove the bioactivity of β-TCP/DCPD-PHBV. Furthermore, mechanical investigations revealed that this biomaterial has a satisfying mechanical strength (195.21 MPa), closer to bone. Nevertheless, another significant benefit of combining the two biocompatible materials used in this work is that the ductility of PHBV restricts the brittleness of β-TCP/DCPD-PHBV, compared to pure β-TCP/DCPD. The obtained results demonstrate the beneficial properties of β-TCP/DCPD-PHBV and approve the possibility of using this biomaterial as a viable material for future implantology applications.

Effectiveness of Biofunctionalization of Titanium Surfaces with Phosphonic Acid

Surface functionalization of dental implant surfaces has been a developing field in biomaterial research. This study aimed to obtain self-assembled monolayers (SAMs) using carboxyethylphosphonic acid on the surface of titanium (Ti) screws, and assessed the surface characteristics, biomechanical, and cellular behavior on the obtained specimens. This study had three groups, i.e., a control (untreated screws), a test group treated with phosphonic acid, and a third group with treated acid and bone morphogenetic protein (BMP-2) for in vitro analysis of cell lines. The assessed parameters included surface wettability, surface characteristics using scanning electron microscopy (SEM), protein immobilization, and cellular behavior of fibroblasts and mesenchymal stem cells of adipose tissue (MSCat cells). For surface wettability, a Welch test was performed to compare the contact angles between control (67 ± 1.83) and test (18.84 ± 0.72) groups, and a difference was observed in the mean measurements, but was not statistically significant. The SEM analysis showed significant surface roughness on the test screws and the cellular behavior of fibroblasts, and MSCat cells were significantly improved in this group, with fibroblasts having a polygonal shape with numerous vesicles and MSCat cells stable and uniformly coating the test Ti surface. Surface biofunctionalization of Ti surfaces with phosphonic acid showed promising results in this study, but remains to be clinically validated for its applications.

Current Concepts of Surface Topography of Implants: A Review

Both the rate of osseointegration and its extent depend upon the characteristics of the implant surface.1 2 3 4 5 Depending on the surface of the implant determination of implant–bone contact area, the rate of bone formation around the implant can be done.6 Hence, the implant surface plays an important part in multiple ways in the osseointegration process.

Application of femtosecond laser microfabrication in the preparation of advanced bioactive titanium surfaces

The surface activation of titanium plays a key role in the biological properties of titanium implants as bone repair materials. Improving the ability to induce apatite precipitation on the surface was a well-accepted titanium bioactivation route. In this study, advanced femtosecond laser microfabrication was applied to modify titanium surfaces, and the effect of femtosecond laser etching on apatite precipitation was investigated and compared with popular titanium modification methods. Meanwhile, the mechanism of apatite formation after femtosecond laser modification was interpreted from the point of materials science. The surface physical-chemical characterization results showed that femtosecond laser etching can improve the surface hydrophilicity and increase the surface energy. Compared with traditional abrasive paper and acid-alkali treatment, this method increased the contents of active sites including titanium oxide and titanium-hydroxyl on titanium surfaces. TiO2 on the surface was transformed to TiO after femtosecond laser treatment. The samples etched with 0.3 W and 0.5 W femtosecond lasers had a better ability to induce apatite deposition than those treated with traditional mechanical treatment and popular acid-alkali modification, which would lead to better bioactivity and osteointegration. Considering the technical advantages of femtosecond lasers in microfabrication, it provides a more efficient and controllable scheme for the bioactivation of titanium. This research would improve the application potential of femtosecond laser treatment, such as micropattern preparation and surface activation, in the field of biomaterials.

Zirconia Materials for Dental Implants: A Literature Review

Titanium is currently the most commonly used material for manufacturing dental implants. However, its potential toxic effects and the gray color have resulted in increasing requests for metal-free treatment options. Zirconia is a type of ceramic materials that has been extensively used in medicine field, such as implant abutments and various joint replacement appliances. Amounts of clinical evaluations have indicated good biocompatibility for zirconia products. Besides, its toothlike color, low affinity for plaque and outstanding mechanical and chemical properties have made it an ideal candidate for dental implants. The aim of this study is to review the laboratory and clinical papers about several kinds of zirconia materials and zirconia surface modification techniques. Although there are plenty of literatures on these topics, most of the researches focused on the mechanical properties of the materials or based on cell and animal experiments. Randomized clinical trials on zirconia materials are still urgently needed to validate their application as dental implants.

A review on diatom biosilicification and their adaptive ability to uptake other metals into their frustules for potential application in bone repair

Diatoms are unicellular eukaryotic algae that have a distinctive siliceous cell wall (frustule) with unique architectures. The nanotopography of the frustule is perfectly replicated between generations, offering a source of highly intricate and identical silica microparticles. In recent years, the ability to alter their cell wall chemistry both in terms of functionalisation with organic moieties or by incorporation of the metal ions in their frustules has increased interest in their utility for catalysis technologies, and semiconductor and biomedical applications. Herein we review the fundamental biological mechanisms in which diatoms produce their frustule and their ability to substitute different metal ions in their frustule fabrication process. The review focuses on the potential of diatom frustules as a naturally derived biomaterial in bone tissue engineering applications and how their cell walls, comprising biogenic silica, could either partially or fully incorporate other bone therapeutic metal ions, e.g., titanium or calcium, into their frustule. The use of diatom frustules in bone repair also potentially offers a 'greener', more environmentally friendly, biomaterial as they can naturally synthesise oxides of silicon and other metals into their frustules under ambient conditions at a relatively neutral pH. This process would negate the use of harsh organic chemicals and high-temperature processing conditions, often used in the fabrication of silica based biomaterials, e.g., bioactive glass.

Comparison of the Stability of Sandblasted, Large-Grit, and Acid-Etched Treated Mini-Screws With Two Different Surface Roughness Values: A Histomorphometric Study

PURPOSE

To evaluate the effects of 2 different surface roughness values produced by sandblasted, large-grit, and acid-etched treatments at different loading conditions on the stability of mini-screws.

MATERIAL AND METHODS

A total of 56 mini-screws (Group 1; 28 with Ra value of 1 μm, Group 2; 28 with Ra value of 1.5 μm) were inserted into the tibia of fourteen New Zealand rabbits. Surface analysis was performed before the placement of the miniscrews using multi-technique characterization. The mini-screws were loaded with 500 grf after different healing times: unloaded, immediate, 4 and 8 weeks. Resonance frequency analyses were performed immediately after mini-screw placement and at the end of loading. Biomechanical and histomorphometric analyses were also performed at the end of the loading period.

RESULTS

All mini-screws preserved their stability at the end of the loading period. However, the resonance frequency analyses showed higher implant stability quotient scores for 8-week group, unlike the immediate loading and unloaded groups (P < 0.05). According to the infinite focus microscopy results, prolongation of healing time resulted in a greater bone area on the loaded mini-screws in Group 2 (P < 0.05). Similarly, the histomorphometric analysis revealed higher bone-to-implant contact values in the 8-week group. There was no significant difference in the stability between the miniscrews with the Ra values of 1 and 1.5 μm.

CONCLUSIONS

Sandblasted, large-grit, and acid-etched treated mini-screws showed significantly higher stability with healing time under heavy forces. Sandblasted, large-grit, and acid-etched treated mini-screws can be removed without fracture of the screw or the bone surfaces.

Comparison of sandblasted and acid-etched surface implants and new hydrophilic surface implants in the posterior maxilla using a 3-month early-loading protocol: a randomized controlled trial

Objectives

In this prospective randomized controlled trial, we measured the primary and secondary stability of two surface-treated implants placed in the posterior maxilla, applied 3-month loading protocols, and compared and analyzed the short-term outcomes of the implants.

Patients and Methods From June 2018 to June 2019, patients with a residual bone height of 4 mm in the posterior maxilla were enrolled and randomly divided into two groups to place SA implants (Osstem Implants, Korea) in Group A and NH implants (Hiossen, USA) in Group B. Finally, 14 implants placed in 13 patients in Group A and 17 implants placed in 14 patients in Group B were analyzed. The measured primary and secondary stability of each implant was represented by implant stability quotient (ISQ), and treatment outcomes were evaluated.

Results

Group A consisted of patients with an average age of 62.2 years (range, 48-80 years), and Group B consisted of patients with an average age of 58.1 years (range, 35-82 years). Primary stability was 73.86±6.40 and 71.24±5.32 in Groups A and B, respectively (P=0.222). Secondary stability was 79.07±5.21 in Group A and 78.29±4.74 in Group B (P=0.667). A steep increase in ISQ during the healing period was observed in Group B, though it was not significant (P=0.265). The mean follow-up period was 378.5±164.6 days in Group A and 385.3±167.9 days in Group B. All implants in each group met the success criteria, and the success rate was 100%.

Conclusion

Two surface-treated implants placed in the posterior maxilla with greater than 4 mm alveolar bone height exhibited successful one-year treatment outcomes if a primary stability of 65 or higher ISQ was obtained and a 3-month early loading protocol was applied.

Ag- and Sr-enriched nanofibrous titanium phosphate phases as potential antimicrobial cement and coating for a biomedical alloy

Biomaterials and their surfaces regulate the biological response and ultimately the quality of healing at a possible site of implantation. The physical, chemical and topographical properties of implants' surfaces play a decisive role in the biological integration process for their immediate loading and long-term success. Since at this level of biological interaction nano-dimensionality is basically entailed, bio-functional nanostructured composites either as filling/cement or coating to metallic implants are required. This study shows the possibility of synthesizing two phases of nanostructured titanium phosphate (π and ρ polymorphs) and enriching them with silver nanoparticles and strontium. More importantly, Ag-Sr-enriched nanostructured π‑titanium phosphate is induced to grow on a commercially available titanium alloy (Ti-6Al-4V), widely used in orthopedic and dental implants, under highly controlled conditions. Structural and microscopic studies, using XRD, HRTEM and SEM altogether confirm the resultant phases and their enrichment with strontium and silver nanoparticles with an average particle size around 6 nm. Using confocal laser scanning microscopy, the surface roughness was measured and is found to lay at the interface between the nanosized and microsized topologies. Ion release assessments showed that the presence of strontium controlled the release rate of silver ions and this could be beneficial in terms of decreasing the accompanied cytotoxicity that is usually encountered at high concentrations of silver release. Antimicrobial and cell proliferation assays have proved that enriching titanium phosphate with strontium and silver nanoparticles has improved their antimicrobial properties, while the cytotoxicity could be controlled.

Comparison of the Migration Potential through Microperforated Membranes of CD146+ GMSC Population versus Heterogeneous GMSC Population

Background

Guided tissue regeneration (GTR) is a powerful modality for periodontal regeneration, but it blocks the periosteum and gingival stem cells (GMSCs), from supporting periodontal wound by the nutrients, growth factors, and regenerative cells. The microperforated membrane considered a rewarding solution for this major drawback; GMSCs can migrate through a GTR microperforated membrane toward a chemoattractant, with the blocking of other unfavorable epithelial cells and fibroblasts. In the absence of a sole marker for MSC, a homogeneous population of GMSC is difficult to isolate; using CD146 as confirmatory markers for MSC identification, testing the behaviour of such homogeneous population in migration dynamics was the question to answer in this study.

Materials and Methods

GMSCs from healthy crown lengthening tissue was isolated (n = 3), its stem cell nature was confirmed, CD146 and CD271 markers were confirmatory markers to confirm homogenous stem cell population, and magnetic sorting was used to isolate GMSC with CD146 markers. A homogenous CD146 population was compared to heterogeneous GMSCs of origin; the population doubling time and MTT test of the two populations were compared. Migration dynamics were examined in a transwell migration chamber through 8 μm perforated polycarbonic acid membrane, and 0.4 μm and 3 μm perforated collagen-coated polytetrafluoroethylene membrane (PTFE) and 10% fetal bovine serum (FBS) were the chemoattractants used in the lower compartment to induce cell migration, were incubated in a humidified environment for 24 hours, then migrated the cell in the lower compartment examined by a light and electron microscope.

Results

GMSCs fulfilled all the minimal criteria of stem cells and showed low signal 10% for CD146 on average and extremely low signal 2% for CD271 on average. Magnetic sorting optimized the signal of CD146 marker to 55%. GMSC CD146 population showed nonstatistically significant shorter population doubling time. CD146 homogeneous population migrated cell numbers were statistically significant compared to the heterogeneous population, through 0.4 μm and 3 μm perforated collagen membrane and 8 μm perforated polycarbonate membrane. Scanning electron microscopy proved the migration of the cells.

Conclusions

A subset of the isolated GMSC showed a CD146 marker, which is considered a dependable confirmatory marker for the stem cells. In terms of GMSC migration through the microperforated membrane, a homogeneous CD146 population migrates more statistically significant than a heterogeneous GMSC population.

In vitro characterization of hierarchical 3D scaffolds produced by combining additive manufacturing and thermally induced phase separation

This paper reports on the hybrid process we have used for producing hierarchical scaffolds made of poly(lactic-co-glycolic) acid (PLGA) and nanohydroxyapatite (nHA), analyzes their internal structures via scanning electron microscopy, and presents the results of our in vitro proliferation of MC3T3-E1 cells and alkaline phosphatase activity (ALP) for 0 and 21 days. These scaffolds were produced by combining additive manufacturing (AM) and thermally induced phase separation (TIPS) techniques. Slow cooling at a rate of 1.5 °C/min during the TIPS process was used to enable a uniform temperature throughout the scaffolds, and therefore, a relatively uniform pore size range. We produced ten different scaffold compositions and topologies in this study. These scaffolds had macrochannels with diameters of ∼300 µm, ∼380 µm, and ∼460 µm, generated by the extraction of embedded porous 3D-plotted polyethylene glycol (PEG) matrices. The other experimental factors included different TIPS temperatures (-20 °C, -10 °C, and 0 °C), as well as varying PLGA concentrations (8%, 10%, and 12% w/v) and nHA content (0%, 10%, and 20% w/w). Our results indicated that almost all these macro/microporous scaffolds supported cell growth over the period of 21 days. Nevertheless, significant differences were observed among some scaffolds in terms of their support of cell proliferation and differentiation. This paper presents the results of our in vitro cell culture for 0 and 21 days. Our optimal scaffold with a porosity of ∼90%, a modulus of ∼5.2 MPa, and a nHA content of 20% showed a cell adhesion of ∼29% on day 0 and maintained cell proliferation and ALP activity over the 21-day in vitro culture. Hence, the use of additive manufacturing and designed experiments to optimize the scaffold fabrication parameters resulted in superior mechanical properties that most other studies using TIPS.

The influence of laser frequency and groove distance on cell adhesion, cell viability, and antibacterial characteristics of Ti-6Al-4V dental implants treated by modern fiber engraving laser

OBJECTIVE

Micro-nano scale surface modification of Ti-6Al-4V was investigated through the fascinated modern fiber engraving laser method. The process was performed at a high laser speed of 2000mm/s, under different laser frequencies (20-160kHz) and groove distances (0.5-50μm).

METHODS

Topographic evaluations such as Atomic Force Microscopy (AFM) and Field Emission Scanning Electron Microscopy (FE-SEM) were used to identify the quality and regularity of patterns. The proliferation of human osteoblast-like osteosarcoma cells (MG63) was analyzed by MTT assay for up to 72h. Also, the plate counting method was used to quantify the viability potential of the modified surface against Escherichia coli bacteria.

RESULTS

The cellular viability of the sample modified at the laser frequency of 20kHz and grooving distance of 50μm increased up to 35 and 10% compared to the non-treated and control samples, respectively. In the case of the surface modification at lower grooving distances range between 0.5-50μm, the maximum laser frequency (160kHz) applied leads to lower pulse's energies and less bacterial adhesion. Otherwise, at groove distances more than 50μm, the minimum laser frequency (20kHz) applied reduces the laser pulse overlaps, increases the cell adhesion and antibacterial properties.

SIGNIFICANCE

Surface modification by the fiber engraving laser process significantly enhances the cell adhesion on the surface. As a result of such roughness and cell adhesion enhancement, the surface toxicity feature diminished, and its antibacterial properties improved.

Nanotubular Oxide Layer Formed on Helix Surfaces of Dental Screw Implants

Surface modification is used to extend the life of implants. To increase the corrosion resistance and improve the biocompatibility of metal implant materials, oxidation of the Ti-13Nb-13Zr titanium alloy was used. The samples used for the research had the shape of a helix with a metric thread, with their geometry imitating a dental implant. The oxide layer was produced by a standard electrochemical method in an environment of 1M H3PO4 + 0.3% HF for 20 min, at a constant voltage of 30 V. The oxidized samples were analyzed with a scanning electron microscope. Nanotubular oxide layers with internal diameters of 30–80 nm were found. An analysis of the surface topography was performed using an optical microscope, and the Sa parameter was determined for the top of the helix and for the bottom, where a significant difference in value was observed. The presence of the modification layer, visible at the bottom of the helix, was confirmed by analyzing the sample cross-sections using computed tomography. Corrosion tests performed in the artificial saliva solution demonstrated higher corrosion current and less noble corrosion potential due to incomplete surface coverage and pitting. Necessary improved oxidation parameters will be applied in future work.

Effect of Inflammation on Gingival Mesenchymal Stem/Progenitor Cells' Proliferation and Migration through Microperforated Membranes: An In Vitro Study

Background

In the field of periodontal guided tissue regeneration, microperforated membranes have recently proved to be very promising periodontal regenerative tissue engineering tools. Regenerative periodontal approaches, employing gingival mesenchymal stem/progenitor cells in combination with these novel membranes, would occur mostly in inflamed microenvironmental conditions intraorally. This in turn entails the investigation into how inflammation would affect the proliferation as well as the migration dynamics of gingival mesenchymal stem/progenitor cells. Materials and Methods. Clones of human gingival mesenchymal stem/progenitor cells (GMSCs) from inflamed gingival tissues were characterized for stem/progenitor cells' characteristics and compared to clones of healthy human GMSCs (n = 3), to be subsequently seeded on perforated collagen-coated poly-tetra-floro-ethylene (PTFE) membranes with a pore size 0.4 and 3 microns and polycarbonic acid membranes of 8 microns pore size in Transwell systems. The population doubling time and the MTT test of both populations were determined. Fetal bovine serum (FBS) was used as a chemoattractant in the culturing systems, and both groups were compared to their negative controls without FBS. Following 24 hours of incubation period, migrating cells were determined on the undersurface of microperforated membranes and the membrane-seeded cells were examined by scanning electron microscopy.

Results

GMSCs demonstrated all predefined stem/progenitor cell characteristics. GMSCs from inflamed gingival tissues showed significantly shorter population doubling times. GMSCs of inflamed and healthy tissues did not show significant differences in their migration abilities towards the chemoattractant, with no cellular migration observed in the absence of FBS. GMSCs from healthy gingival tissue migrated significantly better through larger micropores (8 microns). Scanning electron microscopic images proved the migratory activity of the cells through the membrane pores.

Conclusions

Inflammation appears to boost the proliferative abilities of GMSCs. In terms of migration through membrane pores, GMSCs from healthy as well as inflamed gingival tissues do not demonstrate a difference in their migration abilities through smaller pore sizes, whereas GMSCs from healthy gingival tissues appear to migrate significantly better through larger micropores.

Effects of calcium and phosphorus incorporation on the properties and bioactivity of TiO2 nanotubes

In this study, we investigate the formation of calcium and phosphorus-doped TiO₂ nanotubes, produced by potentiostatic anodization of Ti in viscous electrolyte-containing HF and Ca/P ions. Characterization of the produced oxide layer was conducted using scanning electron microscopy, glancing-angle X-ray diffraction, X-ray photoelectron spectroscopy, contact angle, and protein adsorption measurements. Adipose-derived stem cells were used to study material cytotoxicity, cell viability and proliferation, and cell morphology and growth. To evaluate the adipose-derived stem-cell differentiation, we investigated the expression of osteocalcin and osteopontin by cells as well as calcium mineralization. Results show that it was possible to produce a superhydrophilic titanium oxide nanotube layer with incorporation of Ca and P ions. The presence of Ca and P in the oxide layer not only improved the cell adhesion and proliferation but also stimulated the production of key marker proteins indicating differentiation of cells.

Customizable Implant-specific and Tissue-Specific Extracellular Matrix Protein Coatings Fabricated Using Atmospheric Plasma

Progression in implant science has benefited from ample amount of technological contributions from various disciplines, including surface biotechnology. In this work, we successfully used atmospheric plasma to enhance the biological functions of surgical implants by coating them with extracellular matrix proteins. The developed collagen and laminin coatings demonstrate advantageous material properties. Chemical analysis by XPS and morphological investigation by SEM both suggested a robust coating. Contact angle goniometry and dissolution study in simulated body fluid (SBF) elicited increased hydrophilicity and physiological durability. Furthermore, these coatings exhibited improved biological interactions with human mesenchymal and neural stem cells (NSCs). Cell adhesion, proliferation, and differentiation proved markedly refined as shown by enzymatic detachment, flow cytometry, and ELISA data, respectively. Most importantly, using the pathway-specific PCR array, our study discovered dozens of deregulated genes during osteogenesis and neurogenesis on our newly fabricated ECM coatings. The coating-induced change in molecular profile serves as a promising clue for designing future implant-based therapy. Collectively, we present atmospheric plasma as a versatile tool for enhancing surgical implants, through customizable implant-specific and tissue-specific coatings.

Nano-scale modification of titanium implant surfaces to enhance osseointegration

The main aim of this review study was to report the state of art on the nano-scale technological advancements of titanium implant surfaces to enhance the osseointegration process. Several methods of surface modification are chronologically described bridging ordinary methods (e.g. grit blasting and etching) and advanced physicochemical approaches such as 3D-laser texturing and biomimetic modification. Functionalization procedures by using proteins, peptides, and bioactive ceramics have provided an enhancement in wettability and bioactivity of implant surfaces. Furthermore, recent findings have revealed a combined beneficial effect of micro- and nano-scale modification and biomimetic functionalization of titanium surfaces. However, some technological developments of implant surfaces are not commercially available yet due to costs and a lack of clinical validation for such recent surfaces. Further in vitro and in vivo studies are required to endorse the use of enhanced biomimetic implant surfaces. STATEMENT OF SIGNIFICANCE: Grit-blasting followed by acid-etching is currently used for titanium implant modifications, although recent technological biomimetic physicochemical methods have revealed enhanced osteoconductive and anti-microbial outcomes. An improvement in wettability and bioactivity of titanium implant surfaces has been accomplished by combining micro and nano-scale modification and functionalization with protein, peptides, and bioactive compounds. Such morphological and chemical modification of the titanium surfaces induce the migration and differentiation of osteogenic cells followed by an enhancement of the mineral matrix formation that accelerate the osseointegration process. Additionally, the incorporation of bioactive molecules into the nanostructured surfaces is a promising strategy to avoid early and late implant failures induced by the biofilm accumulation.

Atypical Mesenchymal Stromal Cell Responses to Topographic Modifications of Titanium Biomaterials Indicate Cytoskeletal- and Genetic Plasticity-Based Heterogeneity of Cells

Titanium (Ti) is widely used as a biomaterial for endosseous implants due to its relatively inert surface oxide layer that enables implanted devices the ability of assembling tissue reparative components that culminate in osseointegration. Topographic modifications in the form of micro- and nanoscaled structures significantly promote osseointegration and enhance the osteogenic differentiation of adult mesenchymal stromal cells (MSCs). While the biological mechanisms central to the differential responses of tissues and cells to Ti surface modifications remain unknown, adhesion and morphological adaptation are amongst the earliest events at the cell-biomaterial interface that are highly influenced by surface topography and profoundly impact the regulation of stem cell fate determination. This study correlated the effects of Ti topographic modifications on adhesion and morphological adaptation of human MSCs with phenotypic change. The results showed that modified Ti topographies precluded the adhesion of a subset of MSCs while incurring distinct morphological constraints on adherent cells. These effects anomalously corresponded with a differential expression of stem cell pluripotency and Wnt signalling-associated markers on both modified surfaces while additionally differing between hydrophobic and hydrophilic surface modifications—though extent of osteogenic differentiation induced by both modified topographies yielded similarly significant higher levels of cellular mineralisation in contrast to polished Ti. These results suggest that in the absence of deposited proteins and soluble factors, both modified topographies incur the selective adhesion of a subpopulation of progenitors with relatively higher cytoskeletal plasticity. While the presence of deposited proteins and soluble factors does not significantly affect adherence of cells, nanotopographic modifications enhance expression of pluripotency markers in proliferative conditions, which are conversely overridden by both modified topographies in osteogenic inductive conditions. Further deciphering the mechanisms underlying cellular selectivity and Ti topographic responsiveness will improve our understanding of stem cell heterogeneity and advance the potential of MSCs in regenerative medicine.

Do the New Hydrophilic Surface Have Any Influence on Early Success Rate and Implant Stability during Osseointegration Period? Four-Month Preliminary Results from a Split-Mouth, Randomized Controlled Trial

OBJECTIVE

The objective of this study is to compare the implant stability of Hiossen ET III implants with its new hydrophilic (NH) surface and Hiossen ET III implants with the sandblasted and acid-etched (SA) surface.

MATERIALS AND METHODS

Patients required at least two teeth to be rehabilitated with a fixed, implant-supported restoration, consecutively enrolled. Patients randomly received SA surface implants (SA group) or SA implants with a newly developed bioabsorbable apatite nanocoating (NH group). Outcome measures were implant and prosthetic survival rate, complications, insertion torque, and implant stability quotient (ISQ) measured at implant placement and every week up to 8 weeks after implant placement. Comparison between groups was made by unpaired t-test, while the comparison between each follow-up will be made by paired t-tests to detect any change during the follow-up. Complications and failures were compared using Fisher's exact test.

RESULTS

A total of 14 patients were treated with 28 implants (14 SA and 14 NH). No implant and prosthesis failed 4 months after implant placement. No complications were experienced. At the 2nd week after implants placement, two implants in the SA group showed discontinuous measurements versus none in the NH group (p = 0.4815). Implants unscrewed during ISQ measurements and were rescrewed. Data recording stopped for 6 weeks. Both implants osseointegrated without any further complication. The NH implants did not show physiological ISQ decrease between 2nd and 4th week after implant placement, showing a more even pattern of ISQ values compared with SA implants (77.1 ± 4.6 vs. 72.9 ± 11.5; difference: 4.2 ± 12.1; p = 0.258). High ISQ values were found in both groups at each time point.

CONCLUSIONS

NH implants are a viable alternative to SA surface, as they seem to avoid the ISQ drop during the remodeling phase.

Effects of air abrasive decontamination on titanium surfaces: A systematic review of in vitro studies

BACKGROUND

Air abrasion (AA) is one of the decontamination methods that have demonstrated promising results in treating peri-implant diseases.

PURPOSE

This systematic review aimed at evaluating the in vitro effect of AA on surface change, cleaning efficacy, and biocompatibility of titanium surfaces and at comparing it with other decontamination methods.

MATERIALS AND METHODS

A comprehensive search was conducted up to April 2018 using PubMed, Scopus, and Google Scholar databases to identify studies on the decontamination effect of AA. All types of titanium surfaces, abrasive powders, contaminated surfaces, and measuring methods were included.

RESULTS

Overall, 1502 articles were identified. After screening the titles and abstracts, and carefully reading the full-texts, 48 articles published between 1989 and 2018 were selected. AA was considered almost safe, particularly for the nonmodified surfaces. Nevertheless, harder powders such as sodium bicarbonate tended to damage the surface more than glycine. AA resulted in surface change similar to plastic curettes and Er: YAG lasers. Regarding the cleaning efficacy, there was no significant difference between glycine and sodium bicarbonate, but different mixtures of calcium phosphate, hydroxyapatite, and erythritol were superior to glycine. AA was superior or equal to all other decontamination methods in cleaning. Regarding biocompatibility, AA was more successful in preserving biocompatibility for noncontaminated surfaces compared with contaminated surfaces and when used with erythritol and osteoinductive powders.

CONCLUSIONS

AA can efficiently remove contamination without serious damage to the surface. The main drawback of the AA method seems to be its limitation in restoring the biocompatibility of the surface.

Genome-wide DNA-methylation profiles in human bone marrow mesenchymal stem cells on titanium surfaces

The characteristics of titanium (Ti) have been shown to influence dental implant fixation. Treatment of surfaces using the sandblasted, large-grit, acid-etched (SLA) method is widely used to provide effective osseointegration. However, the DNA methylation-associated mechanism by which SLA surface treatment affects osseointegration of human bone marrow mesenchymal stem cells (hBMSCs) remains elusive. Genome-wide methylation profiling of hBMSCs on SLA-treated and machined smooth Ti was performed using Illumina Infinium Methylation EPIC BeadChip at day 7 of osteogenic induction. In total, 2,846 CpG sites were differentially methylated in the SLA group compared with the machined group. Of these sites, 1,651 (covering 1,066 genes) were significantly hypermethylated and 1,195 (covering 775 genes) were significantly hypomethylated. Thirty significant enrichment pathways were observed, with Wnt signaling being the most significant. mRNA expression was identified by microarray and combined with DNA-methylation profiles. Thirty-seven genes displayed negative association between mRNA expression and DNA-methylation level, with the osteogenesis-related genes insulin-like growth factor 2 (IGF2) and carboxypeptidase X, M14 Family Member 2 (CPXM2) showing significant up-regulation and down-regulation, respectively. In summary, our results demonstrate differences between SLA-treated and machined surfaces in their effects on genome-wide DNA methylation and enrichment of osteogenic pathways in hBMSCs. We provide novel insights into genes and pathways affected by SLA treatment in hBMSCs at the molecular level.

Biological and Physicochemical Assessment of Middle Ear Prosthesis

Polymers modified with bioactive nanoparticles are a promising solution for patients who need a tissue replacement. Modern implants, thanks to bioactive and bactericidal functions, facilitate the healing and regeneration process of the replaced tissue. The aim of this study was to assess whether silver nanoparticles (AgNPs) could support antibacterial function without cytotoxic effect and deterioration of biostability. This article describes biological and physiochemical aspects concerning a new polymeric middle ear implant (Otoimplant) enriched with silver nanoparticles. This kind of prosthesis is a promising implant for the reconstruction of ossicles in ossiculoplasty. We found that incorporation of silver nanoparticles into a polymeric matrix resulted in bactericidal efficacy against Gram-positive and Gram-negative bacteria, both resistant to antibiotics and basic strains. Our prostheses do not show cytotoxic effect and are a suitable biomaterial platform for effective culture of Saos2 and NHOst osteoblastic cells. The in vitro incubation of the samples in distilled water revealed that surface parameters, such as roughness, may slightly increase as a result of unveiling nanoparticles. However, the prolonged immersion does not change mechanical parameters. During one-year incubation, the prosthesis proved to retain stable values of Young's modulus, tensile strength, propagation of longitudinal ultrasonic waves, pH, and conductivity.

Validation of reference genes for real-time PCR of cord blood mononuclear cells, differentiating endothelial progenitor cells, and mature endothelial cells

In the last ten years, endothelial progenitor cells (EPCs) have gained interest as an attractive cell population in regenerative medicine for vascular applications. This population is defined as the precursor of endothelial mature cells (ECs) through a process of differentiation. To our knowledge, no single marker can be used to discriminate them from mature ECs. To effectively study their differentiation kinetics, gene expression must be assessed. Quantitative real-time PCR (RT-qPCR) is widely used to analyze gene expression. To minimize the impact of variances from RT-qPCR, a rigorous selection of reference genes must be performed prior to any experiments due to variations in experimental conditions. In this study, CD34+ mononuclear cells were extracted from human cord blood and differentiated into EPCs after seeding for a maximum period of 21 days. To choose the best combinations of reference genes, we compared the results of EPCs, CD34+ mononuclear cells, and mature endothelial cells to ensure that the differentiation kinetics did not affect the expression of our selected reference genes. The expression levels of seven genes, namely, YWHAZ, GAPDH, HPRT1, RPLP0, UBC, B2M, and TBP were thus compared. The algorithms geNorm, NormFinder, BestKeeper, and the Comparative ΔCt method were employed to assess the expression of each candidate gene. Overall results reveal that the expression stability of reference genes may differ depending on the statistical program used. YWHAZ, GAPDH, and UBC composed the optimal set of reference genes for the gene expression studies performed by RT-qPCR in our experimental conditions. This work can thus serve as a starting point for the selection of candidate reference genes to normalize the levels of gene expression in endothelial progenitor cell populations.

Osseointegration evaluation of laser-deposited titanium dioxide nanoparticles on commercially pure titanium dental implants

The nanotechnology field plays an important role in the improvement of dental implant surfaces. However, the different techniques used to coat these implants with nanostructured materials can differently affect cells, biomolecules and even ions at the nano scale level. The aim of this study is to evaluate and compare the structural, biomechanical and histological characterization of nano titania films produced by either modified laser or dip coating techniques on commercially pure titanium implant fixtures. Grade II commercially pure titanium rectangular samples measuring 35 × 12 × 0.25 mm length, width and thickness, respectively were coated with titania films using a modified laser deposition technique as the experimental group, while the control group was dip-coated with titania film. The crystallinity, surface roughness, histological feature, microstructures and removal torque values were investigated and compared between the groups. Compared with dip coating technique, the modified laser technique provided a higher quality thin coating film, with improved surface roughness values. For in vivo examinations, forty coated screw-designed dental implants were inserted into the tibia of 20 white New Zealand rabbits' bone. Biomechanical and histological evaluations were performed after 2 and 4 weeks of implantation. The histological findings showed a variation in the bone response around coated implants done with different coating techniques and different healing intervals. Modified laser-coated samples revealed a significant improvement in structure, surface roughness values, bone integration and bond strength at the bone-implant interface than dip-coated samples. Thus, this technique can be an alternative for coating titanium dental implants.

Effect of a biomimetic titania mesoporous coating doped with Sr on the osteogenic activity

Fabrication of titanium (Ti)-based biomedical implants with appropriate topography as well as capacity for drug delivery is highly pursued in the field of orthopedic and dental implants. In this study, a biomimetic mesoporous coating imbedded with strontium (MPs-Sr) is prepared by the high current anodization (HCA) and hydrothermal treatment (HT). This coating provides a more stable mechanical performance than the conventional nanotube arrays. The Sr loading is regulated by the HT reaction time and the Sr is released in a controllable manner from the MPs-Sr surface. The hydrophilic performance of MPs-Sr are significantly improved. Furthermore, it is showed that the attachment and spreading of preosteoblast MC3T3-E1 cells are significantly up-regulated by the nanoscale topology of MPs and the doped Sr. The improved collagen secretion and matrix mineralization levels of cells are closely related with the Sr release. The excellent osteogenic properties of MPs-Sr samples highlight their promising potential for use in clinical application.

Comparison of removal torques between laser-etched and modified sandblasted acid-etched Ti implant surfaces in rabbit tibias

PURPOSE

The purpose of this study was to analyze the effects of two different implant surface treatments on initial bone connection by comparing the Removal Torque Values (RTQs) at 7 and 10 days after chemically modified, sandblasted, large-grit and acid-etched (modSLA), and Laser-etched (LE) Ti implant placements.

MATERIALS AND METHODS

Twenty modSLA and 20 LE implants were installed on the left and right tibias of 20 adult rabbits. RTQs were measured after 7 and 10 days in 10 rabbits each. Scanning electron microscope (SEM) photographs of the two implants were observed by using Quanta FEG 650 from the FEI company (Hillsboro, OR, USA). Analyses of surface elements and components were conducted using energy dispersive spectroscopy (EDS, Horiba, Kyoto, Japan).

RESULTS

The mean RTQs were 12.29 ± 0.830 and 12.19 ± 0.713 Ncm after 7 days (P=.928) and 16.47 ± 1.324 and 16.17 ± 1.165 Ncm after 10 days (P=.867) for LE and modSLA, respectively, indicating no significant inter-group differences. Pore sizes in the LE were 40 µm and consisted of numerous small pores, whereas pore sizes in the modSLA were 5 µm. In the EDS analysis, Ti, O, and C were the only three elements found in the LE surfaces. Na, Ca, Cl, and K were also observed in modSLA, in addition to Ti, O, and C.

CONCLUSION

The implants showed no significant difference in biomechanical bond strength to bone in early-stage osseointegration. LE implant can be considered an excellent surface treatment method in addition to the modSLA implant and can be applied to the early loading of the prosthesis clinically.

Self-Assembled Monolayers for Dental Implants

Implant-based therapy is a mature approach to recover the health conditions of patients affected by edentulism. Thousands of dental implants are placed each year since their introduction in the 80s. However, implantology faces challenges that require more research strategies such as new support therapies for a world population with a continuous increase of life expectancy, to control periodontal status and new bioactive surfaces for implants. The present review is focused on self-assembled monolayers (SAMs) for dental implant materials as a nanoscale-processing approach to modify titanium surfaces. SAMs represent an easy, accurate, and precise approach to modify surface properties. These are stable, well-defined, and well-organized organic structures that allow to control the chemical properties of the interface at the molecular scale. The ability to control the composition and properties of SAMs precisely through synthesis (i.e., the synthetic chemistry of organic compounds with a wide range of functional groups is well established and in general very simple, being commercially available), combined with the simple methods to pattern their functional groups on complex geometry appliances, makes them a good system for fundamental studies regarding the interaction between surfaces, proteins, and cells, as well as to engineering surfaces in order to develop new biomaterials.

Osteoblastic cell behaviour on modified titanium surfaces

INTRODUCTION

The surfaces of endoosseous dental implants have been subjected to numerous modifications in order to create a surface which can provide rapid bone healing and fast implant loading. Each modification has involved changes to the chemical composition and topography of the surfaces which have resulted in various biological reactions to the implanted material.

AIM

The aim of this study was to evaluate the surface topography and chemistry of various modified titanium surfaces: (1) machined surface (MA), (2) alumina-blasted (Al2O3), (3) alumina-blasted and acid-etched (Al2O3 DE), (4) hydroxyapatite/tricalcium phosphate grit-blasted (HA/TCP) and (5) hydroxyapatite/tricalcium phosphate grit-blasted and acid-etched (HA/TCP DE) and to analyse the effects of surface roughness, and chemical composition on human osteoblast vitality, differentiation, morphology and orientation.

MATERIALS AND METHODS

The modified surfaces were subjected to topographic analysis using Scanning Electron Microscopy (SEM), optical profilometry, roughness analysis and chemical composition evaluation using Energy Dispersion Spectroscopy (EDS) analysis. The biological effects of the titanium modifications was analysed using human osteoblasts cell culture where the cell morphology, vitality (MTS assay) and differentiation (ALP activity) was analysed.

RESULTS

The machined surfaces were classified as anisotropic, smooth and composed of titanium and oxygen. The blasted surface samples along with the blasted and etched samples were found to be isotropic and rough. The grit-blasting procedure resulted in the incorporation of components from the blasting material. In the case of the blasted and etched samples, etching decreased the surface development as indicated by the Sdr and also reduced the amount of chemical compounds incorporated into the surfaces during the blasting procedure. The attached NHOst cells, proliferated the surfaces. With regard to the MA samples, the cells spread close to the titanium surface, with expanded cytoplasmic extensions and lamelipodia and were oriented in line with the groves left after machining. On the rough substrates, cells were less dispersed and exhibited numerous cytoplasmic extensions, filopodia and interconnections, they were not oriented with respect to the surfaces features. The cell viability of all samples except for Al2O3 decreased after the first day of culture. For all Al2O3, Al2O3 DE and HA samples the viability increased with culture time after an initial reduction. At the end of the culture period the ALP activity was slightly greater on Al2O3 and HA samples compared to the control with the HA DE sample having the same activity as the control. The Al2O3, HA and HA DE ALP samples showed comparable activity and were statistically different from MA and Al2O3 DE samples.

CONCLUSIONS

In this study, variously treated titanium surfaces were correlated with osteoblastic cell viability, morphology and differentiation in comparison with the plastic and smooth titanium. All examined surfaces were found to be biocompatible. Favourable cell reactions were observed for Al2O3 and HA blasted surfaces. The surface roughness patterns influenced the growth orientation while the surface topography influenced osteoblast morphology. Further animal studies are necessary to compare the in-vivo effect on osseointegration of these modified titanium surfaces.

Biomineralization of Fucoidan-Peptide Blends and Their Potential Applications in Bone Tissue Regeneration

Fucoidan (Fuc), a natural polysaccharide derived from brown seaweed algae, and gelatin (Gel) were conjugated to form a template for preparation of biomimetic scaffolds for potential applications in bone tissue regeneration. To the Fuc-Gel we then incorporated the peptide sequence MTNYDEAAMAIASLN (MTN) derived from the E-F hand domain, known for its calcium binding properties. To mimic the components of the extracellular matrix of bone tissue, the Fuc-Gel-MTN assemblies were incubated in simulated body fluid (SBF) to induce biomineralization, resulting in the formation of β-tricalcium phosphate, and hydroxyapatite (HAp). The formed Fuc-Gel-MTN-beta-TCP/HAP scaffolds were found to display an average Young's Modulus value of 0.32 GPa (n = 5) with an average surface roughness of 91 nm. Rheological studies show that the biomineralized scaffold exhibited higher storage and loss modulus compared to the composites formed before biomineralization. Thermal phase changes were studied through DSC and TGA analysis. XRD and EDS analyses indicated a biphasic mixture of β-tricalcium phosphate and hydroxyapatite and the composition of the scaffold. The scaffold promoted cell proliferation, differentiation and displayed actin stress fibers indicating the formation of cell-scaffold matrices in the presence of MT3C3-E1 mouse preosteoblasts. Osteogenesis and mineralization were found to increase with Fuc-Gel-MTN-beta-TCP/HAP scaffolds. Thus, we have developed a novel scaffold for possible applications in bone tissue engineering.

Towards modular bone tissue engineering using Ti–Co-doped phosphate glass microspheres: cytocompatibility and dynamic culture studies

The production of large quantities of functional vascularized bone tissue ex vivo still represent an unmet clinical challenge. Microcarriers offer a potential solution to scalable manufacture of bone tissue due to their high surface area-to-volume ratio and the capacity to be assembled using a modular approach. Microcarriers made of phosphate bioactive glass doped with titanium dioxide have been previously shown to enhance proliferation of osteoblast progenitors and maturation towards functional osteoblasts. Furthemore, doping with cobalt appears to mimic hypoxic conditions that have a key role in promoting angiogenesis. This characteristic could be exploited to meet the clinical requirement of producing vascularized units of bone tissue. In the current study, the human osteosarcoma cell line MG-63 was cultured on phosphate glass microspheres doped with 5% mol titanium dioxide and different concentrations of cobalt oxide (0%, 2% and 5% mol), under static and dynamic conditions (150 and 300 rpm on an orbital shaker). Cell proliferation and the formation of aggregates of cells and microspheres were observed over a period of two weeks in all glass compositions, thus confirming the biocompatibility of the substrate and the suitability of this system for the formation of compact micro-units of tissue. At the concentrations tested, cobalt was not found to be cytotoxic and did not alter cell metabolism. On the other hand, the dynamic environment played a key role, with moderate agitation having a positive effect on cell proliferation while higher agitation resulting in impaired cell growth. Finally, in static culture assays, the capacity of cobalt doping to induce vascular endothelial growth factor (VEGF) upregulation by osteoblastic cells was observed, but was not found to increase linearly with cobalt oxide content. In conclusion, Ti–Co phosphate glasses were found to support osteoblastic cell growth and aggregate formation that is a necessary precursor to tissue formation and the upregaulation of VEGF production can potentially support vascularization.

Biomedical applications of nanotechnology

The ability to investigate substances at the molecular level has boosted the search for materials with outstanding properties for use in medicine. The application of these novel materials has generated the new research field of nanobiotechnology, which plays a central role in disease diagnosis, drug design and delivery, and implants. In this review, we provide an overview of the use of metallic and metal oxide nanoparticles, carbon-nanotubes, liposomes, and nanopatterned flat surfaces for specific biomedical applications. The chemical and physical properties of the surface of these materials allow their use in diagnosis, biosensing and bioimaging devices, drug delivery systems, and bone substitute implants. The toxicology of these particles is also discussed in the light of a new field referred to as nanotoxicology that studies the surface effects emerging from nanostructured materials.