Osteoblast differentiation and phenotype expressions on chitosan-coated Ti-6Al-4V

A Comprehensive Review of the Contemporary Methods for Enhancing Osseointegration and the Antimicrobial Properties of Titanium Dental Implants

Titanium dental implants with various restorative options are popular for replacing missing teeth due to their comfortable fit, excellent stability, natural appearance, and impressive track record in clinical settings. However, challenges such as potential issues with osseointegration, peri-implant bone loss, and peri-implantitis might lead to implant failure, causing concern for patients and dental staff. Surface modification has the potential to significantly enhance the success rate of titanium implants and meet the needs of clinical applications. This involves the application of various physical, chemical, and bioactive coatings, as well as adjustments to implant surface topography, offering significant potential for enhancing implant outcomes in terms of osseointegration and antimicrobial properties. Many surface modification methods have been employed to improve titanium implants, showcasing the diversity of approaches in this field including sandblasting, acid etching, plasma spraying, plasma immersion ion implantation, physical vapor deposition, electrophoretic deposition, electrochemical deposition, anodization, microarc oxidation, laser treatments, sol-gel method, layer-by-layer self-assembly technology, and the adsorption of biomolecules. This article provides a comprehensive overview of the surface modification methods for titanium implants to address issues with insufficient osseointegration and implant-related infections. It encompasses the physical, chemical, and biological aspects of these methods to provide researchers and dental professionals with a robust resource to aid them in their study and practical use of dental implant materials, ensuring they are thoroughly knowledgeable and well-prepared for their endeavors.

Electrospun polycaprolactone-chitosan nanofibers on a zinc mesh as biodegradable guided bone-regeneration membranes with enhanced mechanical, antibacterial, and osteogenic properties for alveolar bone-repair applications

Guided bone-regeneration membrane (GBRM) is commonly used in bone-repair surgery because it blocks fibroblast proliferation and provides spatial support in bone-defect spaces. However, the need for removal surgery and the lack of antibacterial properties of conventional GBRM limit its therapeutic applicability for alveolar bone defects. Here we developed a GBRM for alveolar bone-repair and -regeneration applications through double-sided electrospinning of polycaprolactone and chitosan layers on a Zn mesh surface (denoted DSZM). The DSZM showed a UTS of ∼25.6 MPa, elongation of ∼16.1%, strength-elongation product of ∼0.413 GPa%, and ultrahigh spatial maintenance ability, and the UTS was over 6 times higher than that of commercial Bio-Gide membrane. The DSZM exhibited a corrosion rate of ∼17 µm/y and a Zn ion concentration of ∼0.23 µg/ml after 1 month of immersion in Hanks' solution. The DSZM showed direct and indirect cytocompatibility with exceptional osteogenic differentiation and calcium deposition toward MC3T3-E1 cells. Further, the DSZM showed strongly sustained antibacterial activity against S. aureus and osteogenesis in a rat critical-sized maxillary defect model. Overall, the DSZM fits the requirements for alveolar bone-repair and -regeneration applications as a biodegradable GBRM material due to its spatial support, suitable degradability, cytocompatibility, and antibacterial and osteogenic capabilities. STATEMENT OF SIGNIFICANCE: This work reports the mechanical properties, antibacterial ability and osteogenic properties of electrospun PCL-CS nanofiber on Zn mesh as biodegradable guided bone-regeneration membrane for alveolar bone-repair applications. Our findings demonstrate that the DSZM prepared by double-sided electrospinning of PCL-CS layers on Zn mesh showed a UTS of ∼25.6 MPa, elongation of ∼16.1%, strength-elongation product of ∼0.413 GPa%, and ultrahigh spatial maintenance ability, and the UTS was over 6 times greater than that of commercial Bio-Gide® membrane. The DSZM showed direct and indirect cytocompatibility with exceptional osteogenic differentiation and calcium deposition toward MC3T3-E1 cells. Further, the DSZM showed strongly sustained antibacterial activity against S. aureus and osteogenesis in a rat critical-sized maxillary defect model.

The integration of peri-implant soft tissues around zirconia abutments: Challenges and strategies

Stable soft tissue integration around the implant abutment attenuates pathogen penetration, protects underlying bone tissue, prevents peri-implantitis and is essential in maintaining long-term implant stability. The desire for "metal free" and "aesthetic restoration" has favored zirconia over titanium abutments, especially for implant restorations in the anterior region and for patients with thin gingival biotype. Soft tissue attachment to the zirconia abutment surface remains a challenge. A comprehensive review of advances in zirconia surface treatment (micro-design) and structural design (macro-design) affecting soft tissue attachment is presented and strategies and research directions are discussed. Soft tissue models for abutment research are described. Guidelines for development of zirconia abutment surfaces that promote soft tissue integration and evidence-based references to inform clinical choice of abutment structure and postoperative maintenance are presented.

Surface functionalization of chitosan as a coating material for orthopaedic applications: A comprehensive review

Metallic implants have dominated the biomedical implant industries for the past century for load-bearing applications, while the polymeric implants have shown great promise for tissue engineering applications. The surface properties of such implants are critical as the interaction of implant surfaces, and the body tissues may lead to unfavourable reactions. Desired implant properties are biocompatibility, corrosion resistance, and antibacterial activity. A polymer coating is an efficient and economical way to produce such surfaces. A lot of research has been carried out on chitosan (CS)-modified metallic and polymer scaffolds in the last decade. Different methods such as electrophoretic deposition, sol-gel methods, dip coating and spin coating, electrospinning, etc. have been utilized to produce CS coatings. However, a systematic review of chitosan coatings on scaffolds focussing on widely employed techniques is lacking. This review surveys literature concerning the current status of orthopaedic applications of CS for the purpose of coatings. In this review, the various preparation methods of coating, and the role of the surface functionalities in determining the efficiency of coatings are discussed. Effect of nanoparticle additions on the polymeric interfaces and in regulating the properties of surface coatings are also investigated in detail.

Electrophoretic deposition of Bioactive glass - Chitosan nanocomposite coatings on Ti-6Al-4V for orthopedic applications

Chitosan-Bioactive glass (CS-BG) nanocomposite coatings were developed on the Ti-6Al-4 V alloy to investigate the effect of the BG content on the adhesion strength, bioactivity, bio-corrosion, wettability and roughness. For this purpose, BG nanoparticles were synthesized using a sol-gel process. Three nanocomposite coatings with different concentrations of BG (0.5, 1 and 1.5 g/L) were fabricated through cathodic electrophoretic deposition (EPD). The surface morphology and composition of the coatings revealed the formation of compact coatings with a uniform distribution of BG nanoparticles. Increasing the BG content enhanced the deposition rate of CS-BG nanocomposite coatings and raised the coating thickness. Moreover, the CS-BG coating containing 1.5 g/L BG showed the best corrosion performance owing to the more uniform distribution of BG nanoparticles and its higher thickness. Also, increasing the BG concentration improved the adhesion strength, raised the roughness, and promoted wettability. Further, in-vitro bioactivity evaluation of the coated and uncoated specimens in SBF revealed that the formation of bone-like apatite was significantly encouraged on the surface of CS-BG coatings, as compared to the Ti-6Al-4 V uncoated sample. So, the apatite-forming ability of the coatings was improved by increasing the BG content. For in vitro investigation, osteoblast-like cell line MG63 were cultured on Ti-6Al-4 V substrate coated with CS-BG and cellular behavior was evaluated. Results demonstrated good cell attachment with no significant levels of cytotoxicity during 5 days of culture. Therefore, the electrophoretic deposition of the CS-1.5 g/L BG coating could successfully enhance the adhesion strength, bioactivity, corrosion and cellular performance of the substrate.

[Advances in titanium dental implant surface modification]

Titanium dental implants have wide clinical application due to their many advantages, including comfort, aesthetics, lack of damage to adjacent teeth, and significant clinical effects. However, the failure of osseointegration, bone resorption, and peri-implantitis limits their application. Physical-chemical and bioactive coatings on the surface of titanium implants could improve the successful rate of dental implants and meet the clinical application requirements. This paper reviews the characteristics of surface modification of titanium implants from the aspects of physics, chemistry, and biology. Results provide information for research and clinical application of dental implant materials.

Composite biopolymers for bone regeneration enhancement in bony defects

For the past century, various biomaterials have been used in the treatment of bone defects and fractures. Their role as potential substitutes for human bone grafts increases as donors become scarce. Metals, ceramics and polymers are all materials that confer different advantages to bone scaffold development. For instance, biocompatibility is a highly desirable property for which naturally-derived polymers are renowned. While generally applied separately, the use of biomaterials, in particular natural polymers, is likely to change, as biomaterial research moves towards mixing different types of materials in order to maximize their individual strengths. This review focuses on osteoconductive biocomposite scaffolds which are constructed around natural polymers and their performance at the in vitro/in vivo stages and in clinical trials.

Bioinspired titanium coatings: self-assembly of collagen–alginate films for enhanced osseointegration

Achieving long term osseointegration is fundamental to the development of successful bone implants.

Quaternised chitosan coating on titanium provides a self-protective surface that prevents bacterial colonisation and implant-associated infections

The Ti rod-treated group showed radiographic signs of osseous destruction, osteolytic lesions and consecutive deformity after 14 days, while the HTi rod-treated group were free of radiographic signs of infection.

Silver nanoparticles and growth factors incorporated hydroxyapatite coatings on metallic implant surfaces for enhancement of osteoinductivity and antibacterial properties

Research on incorporation of both growth factors and silver (Ag) into hydroxyapatite (HA) coatings on metallic implant surfaces for enhancing osteoinductivity and antibacterial properties is a challenging work. Generally, Ag nanoparticles are easy to agglomerate and lead to a large increase in local Ag concentration, which could potentially affect cell activity. On the other hand, growth factors immobilization requires mild processing conditions so as to maintain their activities. In this study, bone morphology protein-2 (BMP-2) and Ag nanoparticle contained HA coatings were prepared on Ti surfaces by combining electrochemical deposition (ED) of Ag and electrostatic immobilization of BMP-2. During the ED process, chitosan (CS) was selected as the stabilizing agent to chelate Ag ions and generate Ag nanoparticles that are uniformly distributed in the coatings. CS also reduces Ag toxicity while retaining its antibacterial activity. Afterwards, a BMP/heparin solution was absorbed on the CS/Ag/HA coatings. Consequently, BMP-2 was immobilized on the coatings by the electrostatic attraction between CS, heparin, and BMP-2. Sustained release of BMP-2 and Ag ions from HA coatings was successfully demonstrated for a long period. Results of antibacterial tests indicate that the CS/Ag/HA coatings have high antibacterial properties against both Staphylococcus epidermidis and Escherichia coli. Osteoblasts (OB) culture reveals that the CS/Ag/HA coatings exhibit good biocompatibility. Bone marrow stromal cells (BMSCs) culture indicates that the BMP/CS/Ag/HA coatings have good osteoinductivity and promote the differentiation of BMSCs. Ti bars with BMP/CS/Ag/HA coatings were implanted into the femur of rabbits to evaluate the osteoinductivity of the coatings. Results indicate that BMP/CS/Ag/HA coatings favor bone formation in vivo. In summary, this study presents a convenient and effective method for the incorporation of growth factors and antibacterial agents into HA coatings. This method can be utilized to modify a variety of metallic implant surfaces.