Osteogenic activity and antibacterial effect of zinc ion implanted titanium

Elements in trace amount with a significant role in human physiology: a tumor pathophysiological and diagnostic aspects

Cancer has a devastating impact globally regardless of gender, age, and community, which continues its severity to the population due to the lack of efficient strategy for the cancer diagnosis and treatment. According to the World Health Organisation report, one out of six people dies due to this deadly cancer and we need effective strategies to regulate it. In this context, trace element has a very hidden and unexplored role and require more attention from investigators. The variation in concentration of trace elements was observed during comparative studies on a cancer patient and a healthy person making them an effective target for cancer regulation. The percentage of trace elements present in the human body depends on environmental exposure, food habits, and habitats and could be instrumental in the early diagnosis of cancer. In this review, we have conducted inclusive analytics on trace elements associated with the various types of cancers and explored the several methods involved in their analysis. Further, intricacies in the correlation of trace elements with prominent cancers like prostate cancer, breast cancer, and leukaemia are represented in this review. This comprehensive information on trace elements proposes their role during cancer and as biomarkers in cancer diagnosis.

Fabrication and performance of Zinc-based biodegradable metals: From conventional processes to laser powder bed fusion

Zinc (Zn)-based biodegradable metals (BMs) fabricated through conventional manufacturing methods exhibit adequate mechanical strength, moderate degradation behavior, acceptable biocompatibility, and bioactive functions. Consequently, they are recognized as a new generation of bioactive metals and show promise in several applications. However, conventional manufacturing processes face formidable limitations for the fabrication of customized implants, such as porous scaffolds for tissue engineering, which are future direction towards precise medicine. As a metal additive manufacturing technology, laser powder bed fusion (L-PBF) has the advantages of design freedom and formation precision by using fine powder particles to reliably fabricate metallic implants with customized structures according to patient-specific needs. The combination of Zn-based BMs and L-PBF has become a prominent research focus in the fields of biomaterials as well as biofabrication. Substantial progresses have been made in this interdisciplinary field recently. This work reviewed the current research status of Zn-based BMs manufactured by L-PBF, covering critical issues including powder particles, structure design, processing optimization, chemical compositions, surface modification, microstructure, mechanical properties, degradation behaviors, biocompatibility, and bioactive functions, and meanwhile clarified the influence mechanism of powder particle composition, structure design, and surface modification on the biodegradable performance of L-PBF Zn-based BM implants. Eventually, it was closed with the future perspectives of L-PBF of Zn-based BMs, putting forward based on state-of-the-art development and practical clinical needs.

Multifunctional Bionic Periosteum with Ion Sustained-Release for Bone Regeneration

In this study, a novel bionic periosteum (BP)-bioactive glass fiber membrane (BGFM) is designed. The introduction of magnesium ion (Mg2+) and zinc ion (Zn2+) change the phase separation during the electrospinning (ES) jet stretching process. The fiber's pore structure transitions from connected to closed pores, resulting in a decrease in the rapid release of metal ions while also improving degradation via reducing filling quality. Additionally, the introduction of magnesium (Mg) and zinc (Zn) lead to the formation of negative charged tetrahedral units (MgO4 2- and ZnO4 2-) in the glass network. These units effectively trap positive charged metal ions, further inhibiting ion release. In vitro experiments reveal that the deigned bionic periosteum regulates the polarization of macrophages toward M2 type, thereby establishing a conducive immune environment for osteogenic differentiation. Bioinformatics analysis indicate that BP enhanced bone repair via the JAK-STAT signaling pathway. The slow release of metal ions from the bionic periosteum can directly enhance osteogenic differentiation and vascularization, thereby accelerating bone regeneration. Finally, the bionic periosteum exhibits remarkable capabilities in angiogenesis and osteogenesis, demonstrating its potential for bone repair in a rat calvarial defect model.

Surface Functionalization of 3D-Printed Scaffolds with Seed-Assisted Hydrothermally Grown ZnO Nanoarrays for Bone Tissue Engineering

Bioactive metal-based nanostructures, particularly zinc oxide (ZnO), are promising materials for bone tissue engineering. However, integrating them into 3D-printed polymers using traditional blending methods reduces the cell performance. Alternative surface deposition techniques often require extreme conditions that are unsuitable for polymers. To address these issues, we propose a metal-assisted hydrothermal synthesis method to modify 3D printed polycaprolactone (PCL) scaffolds with ZnO nanoparticles (NPs), facilitating the growth of ZnO nanoarrays (NAs) at a low-temperature (55 °C). Physicochemical characterizations revealed that the ZnO NPs form both physical and chemical bonds with the PCL surface; chemical bonding occurs between the carboxylate groups of PCL and Zn(OH)2 during seed deposition and hydrothermal synthesis. The ZnO NPs and NAs grown for a longer time (18 h) on the surface of PCL scaffolds exhibit significant proliferation and early differentiation of osteoblast-like cells. The proposed method is suitable for the surface modification of thermally degradable polymers, opening up new possibilities for the deposition of diverse metals.

Efficacy of sintered Zinc-doped fluorapatite scaffold as an antimicrobial regenerative bone filler for dental applications

OBJECTIVES

The objective of this study was to assess whether zinc-doped fluorapatite (ZnFA) could serve as an effective antimicrobial dental bone filler for bone regeneration compared to autografts.

METHODS

FA and 2 % zinc-doped FA (2ZnFA) were synthesized and characterized in-house. Compressed and sintered FA and 2ZnFA disks were incubated with bacteria to assess antimicrobial properties. Adipose-derived stem cells were cultured on these discs to evaluate the surfaces' ability to support cell growth and promote osteogenic differentiation. Surfaces exhibiting the highest expressions of the bone markers osteopontin and osteocalcin were selected for an in vivo study in a rat mandibular defect model. Twenty rats were divided into 5 groups, equally, and a 5 mm surgical defect of the jaw was left untreated or filled with 2ZnFA, FA, autograft, or demineralized bone matrix (DBM). At 12 weeks, the defects and surrounding tissues were harvested and subjected to microCT and histological evaluations.

RESULTS

Standard techniques such as FTIR, ICP-MS, fluoride probe, and XRD revealed the sintered FA and ZnFA's chemical compositions and structures. Bacterial studies revealed no significant differences in surface bacterial adhesion properties between FA and 2ZnFA, but significantly fewer bacterial loads than control titanium discs (p < 0.05). Cell culture data confirmed that both surfaces could support cell growth and promote the osteogenic differentiation of stem cells. MicroCT analysis confirmed statistical similarities in bone regeneration within FA, 2ZnFA, and autograft groups.

CONCLUSION

The data suggests that both FA and 2ZnFA could serve as alternatives to autograft materials, which are the current gold standard. Moreover, these bone fillers outperformed DBM, an allograft material commonly used as a dental bone void filler.

CLINICAL SIGNIFICANCE

The use of FA or 2ZnFA for treating mandibular defects led to bone regeneration statistically similar to autograft repair and significantly outperformed the widely used dental bone filler, DBM. Additional translational research may confirm FA-based materials as superior substitutes for existing synthetic bone fillers, ultimately enhancing patient outcomes.

Osteogenesis or Apoptosis-Twofold Effects of Zn2+ on Bone Marrow Mesenchymal Stem Cells: An In Vitro and In Vivo Study

Zinc (Zn) is a bioabsorbable metal that shows great potential as an implant material for orthopedic applications. Suitable concentrations of zinc ions promote osteogenesis, while excess zinc ions cause apoptosis. As a result, the conflicting impacts of Zn2+ concentration on osteogenesis could prove to be significant problems for the creation of novel materials. This study thoroughly examined the cell viability, proliferation, and osteogenic differentiation of rat bone marrow mesenchymal stem cells (rBMSCs) cultured in various concentrations of Zn2+ in vitro and validated the osteogenesis effects of zinc implantation in vivo. The effective promotion of cell survival, proliferation, migration, and osteogenic differentiation of bone marrow mesenchymal stem cell (BMSCs) may be achieved at a low concentration of Zn2+ (125 μM). The excessively high concentration of zinc ions (>250 μM) not only reduces BMSCs' viability and proliferation but also causes them to suffer apoptosis due to the disturbed zinc homeostasis and excessive Zn2+. Moreover, transcriptome sequencing was used to examine the underlying mechanisms of zinc-induced osteogenic differentiation with particular attention paid to the PI3K-AKT and TGF-β pathways. The present investigation elucidated the dual impacts of Zn2+ microenvironments on the osteogenic characteristics of rBMSCs and the associated processes and might offer significant insights for refining the blueprint for zinc-based biomaterials.

Biosurfactant-Assisted Cu Doping of Brushite Coatings: Enhancing Structural, Electrochemical, and Biofunctional Properties

Stainless steel (316L SS) has been widely used in orthopedic, cardiovascular stents, and other biomedical implant applications due to its strength, corrosion resistance, and biocompatibility. To address the weak interaction between steel implants and tissues, it is a widely adopted strategy to enhance implant performance through the application of bioactive coatings. In this study, Cu-doped brushite coatings were deposited successfully through pulse electrodeposition on steel substrates facilitated with a biosurfactant (BS) (i.e., surfactin). Further, the combined effect of various concentrations of Cu ions and BS on the structural, electrochemical, and biological properties was studied. The X-ray diffraction (XRD) confirms brushite composition with Cu substitution causing lattice contraction and a reduced crystallite size. The scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) studies reveal the morphological changes of the coatings with the incorporation of Cu, which is confirmed by X-ray photoelectron spectroscopy (XPS) and elemental mapping. The Fourier transform infrared (FTIR) and Raman spectroscopy confirm the brushite and Cu doping in the coatings, respectively. Increased surface roughness and mechanical properties of Cu-doped coatings were analyzed by using atomic force microscopic (AFM) and nanohardness tests, respectively. Electrochemical assessments demonstrate corrosion resistance enhancement in Cu-doped coatings, which is further improved with the addition of biosurfactants. In vitro biomineralization studies show the Cu-doped coating's potential for osseointegration, with added stability. The cytocompatibility of the coatings was analyzed using live/dead and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assays; cell adhesion, proliferation, and migration studies were evaluated using SEM. Antibacterial assays highlight significant improvement in the antibacterial properties of Cu-doped coatings with BS. Thus, the developed Cu-doped brushite coatings with BS demonstrate their potential in the realm of biomedical implant technologies, paving the way for further exploration.

Advancements in incorporating metal ions onto the surface of biomedical titanium and its alloys via micro-arc oxidation: a research review

The incorporation of biologically active metallic elements into nano/micron-scale coatings through micro-arc oxidation (MAO) shows significant potential in enhancing the biological characteristics and functionality of titanium-based materials. By introducing diverse metal ions onto titanium implant surfaces, not only can their antibacterial, anti-inflammatory and corrosion resistance properties be heightened, but it also promotes vascular growth and facilitates the formation of new bone tissue. This review provides a thorough examination of recent advancements in this field, covering the characteristics of commonly used metal ions and their associated preparation parameters. It also highlights the diverse applications of specific metal ions in enhancing osteogenesis, angiogenesis, antibacterial efficacy, anti-inflammatory and corrosion resistance properties of titanium implants. Furthermore, the review discusses challenges faced and future prospects in this promising area of research. In conclusion, the synergistic approach of micro-arc oxidation and metal ion doping demonstrates substantial promise in advancing the effectiveness of biomedical titanium and its alloys, promising improved outcomes in medical implant applications.

Surface-modified titanium and titanium-based alloys for improved osteogenesis: A critical review

As implantable materials, titanium, and its alloys have garnered enormous interest from researchers for dental and orthopedic procedures. Despite their success in wide clinical applications, titanium, and its alloys fail to stimulate osteogenesis, resulting in poor bonding strength with surrounding bone tissue. Optimizing the surface topology and altered compositions of titanium and titanium-based alloys substantially promotes peri-implant bone regeneration. This review summarizes the utilization and importance of various osteogenesis components loaded onto titanium and its alloys. Further, different surface-modification methods and the release efficacy of loaded substances are emphasized. Finally, we summarize the article with prospects. We believe that further investigation studies must focus on identifying novel loading components, exploring various innovative, optimized surface-modification methods, and developing a sustained-release system on implant surfaces to improve peri-implant bone formation.

Zeolite imidazolate framework-8 in bone regeneration: A systematic review

Zeolite imidazolate framework-8 (ZIF-8) is a biomaterial that has been increasingly studied in recent years. It has several applications such as bone regeneration, promotion of angiogenesis, drug loading, and antibacterial activity, and exerts multiple effects to deal with various problems in the process of bone regeneration. This systematic review aims to provide an overview of the applications and effectiveness of ZIF-8 in bone regeneration. A search of papers published in the PubMed, Web of Science, Embase, and Cochrane Library databases revealed 532 relevant studies. Title, abstract, and full-text screening resulted in 39 papers being included in the review, including 39 in vitro and 22 animal studies. Appropriate concentrations of nano ZIF-8 can promote cell proliferation and osteogenic differentiation by releasing Zn2+ and entering the cell, whereas high doses of ZIF-8 are cytotoxic and inhibit osteogenic differentiation. In addition, five studies confirmed that ZIF-8 exhibits good vasogenic activity. In all in vivo experiments, nano ZIF-8 promoted bone formation. These results indicate that, at appropriate concentrations, materials containing ZIF-8 promote bone regeneration more than materials without ZIF-8, and with characteristics such as promoting angiogenesis, drug loading, and antibacterial activity, it is expected to show promising applications in the field of bone regeneration. STATEMENT OF SIGNIFICANCE: This manuscript reviewed the use of ZIF-8 in bone regeneration, clarified the biocompatibility and effectiveness in promoting bone regeneration of ZIF-8 materials, and discussed the possible mechanisms and factors affecting its promotion of bone regeneration. Overall, this study provides a better understanding of the latest advances in the field of bone regeneration of ZIF-8, serves as a design guide, and contributes to the design of future experimental studies.

Effects of Aging on Osteosynthesis at Bone-Implant Interfaces

Joint replacement is a common surgery and is predominantly utilized for treatment of osteoarthritis in the aging population. The longevity of many of these implants depends on bony ingrowth. Here, we provide an overview of current techniques in osteogenesis (inducing bone growth onto an implant), which is affected by aging and inflammation. In this review we cover the biologic underpinnings of these processes as well as the clinical applications. Overall, aging has a significant effect at the cellular and macroscopic level that impacts osteosynthesis at bone-metal interfaces after joint arthroplasty; potential solutions include targeting prolonged inflammation, preventing microbial adhesion, and enhancing osteoinductive and osteoconductive properties.

Multifunctional nanocoating for enhanced titanium implant osseointegration

Preventing bacterial infection and promoting osseointegration are essential for the long-term success of titanium (Ti) implants. In this study, we developed a multifunctional nanocoating on Ti mini-implants to simultaneously address these challenges. The nanocoating consists of self-assembled antimicrobial peptides GL13K and silver nanoparticles, referred to as Ag-GL. Our results showed that the Ag-GL coating did not alter the surface morphology of the mini-implants. Ag-GL coated mini-implants demonstrated a two orders of magnitude reduction in colony-forming unit (CFU) values compared to the noncoated eTi group, resulting in minimal inflammation and no apparent bone destruction in a bacterial infection in vivo model. When evaluating osseointegration properties, micro-CT analysis, histomorphometric analysis, and pull-out tests revealed that the Ag-GL coating significantly enhanced osseointegration and promoted new bone formation in vivo.

Carnosine, Zinc and Copper: A Menage a Trois in Bone and Cartilage Protection

Dysregulated metal homeostasis is associated with many pathological conditions, including arthritic diseases. Osteoarthritis and rheumatoid arthritis are the two most prevalent disorders that damage the joints and lead to cartilage and bone destruction. Recent studies show that the levels of zinc (Zn) and copper (Cu) are generally altered in the serum of arthritis patients. Therefore, metal dyshomeostasis may reflect the contribution of these trace elements to the disease's pathogenesis and manifestations, suggesting their potential for prognosis and treatment. Carnosine (Car) also emerged as a biomarker in arthritis and exerts protective and osteogenic effects in arthritic joints. Notably, its zinc(II) complex, polaprezinc, has been recently proposed as a drug-repurposing candidate for bone fracture healing. On these bases, this review article aims to provide an overview of the beneficial roles of Cu and Zn in bone and cartilage health and their potential application in tissue engineering. The effects of Car and polaprezinc in promoting cartilage and bone regeneration are also discussed. We hypothesize that polaprezinc could exchange Zn for Cu, present in the culture media, due to its higher sequestering ability towards Cu. However, future studies should unveil the potential contribution of Cu in the beneficial effects of polaprezinc.

Incorporating zinc ion into titanium surface promotes osteogenesis and osteointegration in implantation early phase

The objective of this study is to further investigate the feasibility of Zinc-Titanium implant as a potential implantable material in oral application in aspects of osteoblast biocompatibility, osteogenesis and osseointegration ability. First, we used plasma immersion ion implantation and deposition (PIIID) technology to introduce Zinc ion into pure Titanium surface, then we used X-ray photoelectron spectroscopy to analyze the chemical composition of modified surface layer; next, we used in vitro studies including immunological fluorescence assay and western blotting to determine responses between MG-63 osteoblast-like cell and implant. In vivo studies adopted pig model to check the feasibility of Zn-Ti implant. Results showed that in vitro and in vivo were consistent, showing that Zn ion was successfully introduced into Ti surface by PIIID technique. The chemical and physical change on modified plant resulted in the more active expressions of mRNA and protein of Type I collagen in MG-63 cells compared with non-treated implant, and the better integration ability of bones with modified implant. We confirmed the Zn-Ti implant owns the ability in promoting osteogenesis and osteointegration in early phase of implantation and is a qualified candidate in dentistry. The overview of our study can be depicted as follows.

The changes and potential effects of zinc homeostasis in periodontitis microenvironment

Zinc is a very important and ubiquitous element, which is present in oral environment, daily diet, oral health products, dental restorative materials, and so on. However, there is a lack of attention to the role of both extracellular or intracellular zinc in the progression of periodontitis and periodontal regeneration. This review summarizes the characteristics of immunological microenvironment and host cells function in several key stages of periodontitis progression, and explores the regulatory effect of zinc during this process. We find multiple evidence indicate that zinc may be involved and play a key role in the stages of immune defense, inflammatory response and bone remodeling. Zinc supplementation in an appropriate dose range or regulation of zinc transport proteins can promote periodontal regeneration by either enhancing immune defense or up-regulating local cells proliferation and differentiation functions. Therefore, zinc homeostasis is essential in periodontal remodeling and regeneration. More attention is suggested to be focused on zinc homeostasis regulation and consider it as a potential strategy in the studies on periodontitis treatment, periodontal-guided tissue regeneration, implant material transformation, and so on.

Chemoselective Coatings of GL13K Antimicrobial Peptides for Dental Implants

Dental implant-associated infection is a clinical challenge which poses a significant healthcare and socio-economic burden. To overcome this issue, developing antimicrobial surfaces, including antimicrobial peptide coatings, has gained great attention. Different physical and chemical routes have been used to obtain these biofunctional coatings, which in turn might have a direct influence on their bioactivity and functionality. In this study, we present a silane-based, fast, and efficient chemoselective conjugation of antimicrobial peptides (Cys-GL13K) to coat titanium implant surfaces. Comprehensive surface analysis was performed to confirm the surface functionalization of as-prepared and mechanically challenged coatings. The antibacterial potency of the evaluated surfaces was confirmed against both Streptococcus gordonii and Streptococcus mutans, the primary colonizers and pathogens of dental surfaces, as demonstrated by reduced bacteria viability. Additionally, human dental pulp stem cells demonstrated long-term viability when cultured on Cys-GL13K-grafted titanium surfaces. Cell functionality and antimicrobial capability against multi-species need to be studied further; however, our results confirmed that the proposed chemistry for chemoselective peptide anchoring is a valid alternative to traditional site-unspecific anchoring methods and offers opportunities to modify varying biomaterial surfaces to form potent bioactive coatings with multiple functionalities to prevent infection.

In vivo evaluation of bone regeneration using ZIF8-modified polypropylene membrane in rat calvarium defects

AIM

The profound potential of zeolitic imidazolate framework 8 (ZIF8) thin film for inducing osteogenesis has been previously established under in vitro conditions. As the next step towards the clinical application of ZIF8-modified substrates in periodontology, this in vivo study aimed to evaluate the ability of the ZIF8 crystalline layer to induce bone regeneration in an animal model defect.

MATERIALS AND METHODS

Following the mechanical characterization of the membranes and analysing the in vitro degradation of the ZIF8 layer, in vivo bone regeneration was evaluated in a critical-sized (5-mm) rat calvarial bone defect model. For each animal, one defect was randomly covered with either a polypropylene (PP) or a ZIF8-modified membrane (n = 7 per group), while the other defect was left untreated as a control. Eight weeks post surgery, bone formation was assessed by microcomputed tomography scanning, haematoxylin and eosin staining and immunohistochemical analysis.

RESULTS

The ZIF8-modified membrane outperformed the PP membrane in terms of mechanical properties and revealed a trace Zn+2 release. Results of in vivo evaluation verified the superior barrier function of the ZIF8-coated membrane compared with pristine PP membrane. Compared with the limited marginal bone formation in the control and PP groups, the defect area was almost filled with mature bone in the ZIF8-coated membrane group.

CONCLUSIONS

Our results support the effectiveness of the ZIF8-coated membrane as a promising material for improving clinical outcomes of guided bone regeneration procedures, without using biological components.

Surface characterization, electrochemical properties and in vitro biological properties of Zn-deposited TiO2 nanotube surfaces

In this work, to improve antibacterial, biocompatible and bioactive properties of commercial pure titanium (cp-Ti) for implant applications, the Zn-deposited nanotube surfaces were fabricated on cp-Ti by using combined anodic oxidation (AO) and physical vapor deposition (PVD-TE) methods. Homogenous elemental distributions were observed through all surfaces. Moreover, Zn-deposited surfaces exhibited hydrophobic character while bare Ti surfaces were hydrophilic. Due to the biodegradable behavior of Zn on the nanotube surface, Zn-deposited nanotube surfaces showed higher corrosion current density than bare cp-Ti surface in SBF conditions as expected. In vitro biological properties such as cell viability, ALP activity, protein adsorption, hemolytic activity and antibacterial activity for Gram-positive and Gram-negative bacteria of all surfaces were investigated in detail. Cell viability, ALP activity and antibacterial properties of Zn-deposited nanotube surfaces were significantly improved with respect to bare cp-Ti. Moreover, hemolytic activity and protein adsorption of Zn-deposited nanotube surfaces were decreased. According to these results; a bioactive, biocompatible and antibacterial Zn-deposited nanotube surfaces produced on cp-Ti by using combined AO and PVD techniques can have potential for orthopedic and dental implant applications.

Facile and versatile strategy for fabrication of highly bacteriostatic and biocompatible SLA-Ti surfaces with the regulation of Mg/Cu coimplantation ratio for dental implant applications

The low bactericidal activity and poor osteogenic activity of Ti limit the use of this metal in dental implants by increasing the risk of their periimplantitis-induced failure. To address this problem, we herein surface-modify biomedical Ti through the plasma immersion coimplantation of Mg and Cu ions and examine the physicochemical properties and bio-/hemocompatibility of the resulting materials as well as their activity against periimplantitis-causing bacteria, namely Streptococcus mutans and Porphyromonas gingivalis. The reactive oxygen species release (ROS) was assessed via the 2'7'-dichlorodihydrofluorescein diacetate (DCFH-DA) assay. The best-performing sample Mg/Cu（8/10）-Ti promotes cell proliferation and initial cell adhesion while exhibiting high hydrophilicity, outstanding activity against the aforementioned pathogens, and good bio-/hemocompatibility. Additionally, higher levels of cellular ROS generation in S. mutans and P. gingivalis could provide insight into the antibacterial mechanisms involved in Mg/Cu（8/10）-Ti. Thus, Mg/Cu coimplantation is concluded to endow the Ti surface with high bacteriostatic activity and biocompatibility, paving the way to the widespread use of Ti-based dental implants.

Dynamically evolving piezoelectric nanocomposites for antibacterial and repair-promoting applications in infected wound healing

Wound healing from bacterial infections is one of the major challenges in the biomedical field. The traditional single administration methods are usually accompanied with side effects or unsatisfactory efficacy. Herein, we design dynamically evolving antibacterial and repair-promoting nanocomposites (NCs) by in situ self-assembling of zeolitic imidazolate framework-8 (ZIF-8) on the surface of barium titanate (BTO), and further loading with a small amount of ciprofloxacin (CIP). The new strategy of combining pH-stimulated drug delivery and ultrasound-controlled sonodyamics has the potential to dynamically evolve in infected wound sites, offering a multifunctional therapy. In vitro study demonstrates that the enhancement generation of reactive oxygen species through the sonodynamic process due to the heterostructures and a small amount of CIP released in an acidic environment are synergistically antibacterial, and the inhibition rate was >99.9%. In addition, reduced sonodynamic effect and Zn²⁺ generated along with the gradual degradation of ZIF-8 simultanously promote cell migration and tissue regeneration. The in vivo study of full-thickness skin wounds in mouse models demonstrate a healing rate of 99.3% could be achieved under the treatment of BTO@ZIF-8/CIP NCs. This work provides a useful improvement in rational design of multi-stimulus-responsive nanomaterials for wound healing. STATEMENT OF SIGNIFICANCE: A novel piezoelectric nanocomposite was proposed to realize sonodynamic therapy and pH-stimulated drug releasing simultaneously in wound healing treatment. The dynamically evolving structure of the piezoelectric nanocomposite in acidic microenvironment has been theoretically and experimentally verified to contribute to a continuous variation of sonodymanic strength, which accompanied with the gradual releasing of drug and biocompatible Zn²⁺effectively balanced antibacterial and repair-promoting effects. Both of the in vitro and in vivo study demonstrated that the strategy could significantly accelerate wound healing, inspiring researchers to optimize the design of multi-stimulus-responsive nanomaterials for various applications in biomedical and biomaterial fields.

Effect of Zinc Oxide Incorporation on the Antibacterial, Physicochemical, and Mechanical Properties of Pit and Fissure Sealants

This study aimed to evaluate the antibacterial, physicochemical, and mechanical properties of pit and fissure sealants containing different weight percentages of zinc oxide nanoparticles (ZnO NPs). The following amounts of ZnO NPs were added to a commercially available pit and fissure sealant (BeautiSealant, Shofu, Japan) to prepare the experimental materials: 0 wt.% (commercial control (CC)), 0.5 wt.% (ZnO 0.5), 1 wt.% (ZnO 1.0), 2 wt.% (ZnO 2.0), and 4 wt.% (ZnO 4.0). The antibacterial effect against S. mutans was confirmed by counting the colony-forming units (CFUs) and observing live/dead bacteria. In addition, ion release, depth of cure, water sorption and solubility, and flexural strength tests were conducted. When compared with the CC, the experimental groups containing ZnO NPs showed zinc ion emission and significantly different CFUs (p < 0.05) with fewer live bacteria. ZnO NP addition reduced the depth of cure and water solubility and increased water sorption in comparison with the CC (p < 0.05). However, all groups showed similar flexural strength (p > 0.05). The pit and fissure sealants containing ZnO NPs exhibited antibacterial activity against S. mutans with no negative effects on physicochemical and mechanical properties, and thus, these sealants can be ideal secondary caries prevention material.

Engineering Three-Dimensional-Printed Bioactive Polylactic Acid Alginate Composite Scaffolds with Antibacterial and In Vivo Osteoinductive Capacity

Although fused deposition modeling (FDM) has made it possible to create reproducible three-dimensional poly(lactic acid) (PLA) scaffolds, their efficacy for tissue engineering applications is limited by their lack of osteoinductive properties and antibacterial functions. Building on the success of the FDM constructs capable of supporting bone regeneration, we report here on the development of PLA scaffolds infused with sodium alginate cross-linked with both calcium and zinc divalent cations. Zn²⁺ cations were used to confer antibacterial and osteoinductive properties to enhance the performance of nontoxic PLA-alginate. Both the PLA and alginate polymers have been approved by the US Food and Drug Administration. In vivo bone regeneration capacity was demonstrated on a rabbit model by tomography and histological analysis. The scaffolds exhibited antibacterial activity against Gram-positive methicillin-resistant Staphylococcus epidermidis and Gram-negative Pseudomonas aeruginosa, while the control scaffolds could not resist the two microbial species tested. The scaffolds' physical properties were evaluated by field emission scanning electron microscopy with energy-disperse X-ray spectroscopy, Fourier transform infrared spectroscopy, water absorption, porosity measurements, and compression tests in dry and swollen states at body temperature. Their superior compressive properties, water uptake, and osteoinductive and antibacterial activities thus make them promising candidates for bone tissue regeneration.

Strategies to improve bioactive and antibacterial properties of polyetheretherketone (PEEK) for use as orthopedic implants

Polyetheretherketone (PEEK) has gradually become the mainstream material for preparing orthopedic implants due to its similar elastic modulus to human bone, high strength, excellent wear resistance, radiolucency, and biocompatibility. Since the 1990s, PEEK has increasingly been used in orthopedics. Yet, the widespread application of PEEK is limited by its bio-inertness, hydrophobicity, and susceptibility to microbial infections. Further enhancing the osteogenic properties of PEEK-based implants remains a difficult task. This article reviews some modification methods of PEEK in the last five years, including surface modification of PEEK or incorporating materials into the PEEK matrix. For surface modification, PEEK can be modified by chemical treatment, physical treatment, or surface coating with bioactive substances. For PEEK composite material, adding bioactive filler into PEEK through the melting blending method or 3D printing technology can increase the biological activity of PEEK. In addition, some modification methods such as sulfonation treatment of PEEK or grafting antibacterial substances on PEEK can enhance the antibacterial performance of PEEK. These strategies aim to improve the bioactive and antibacterial properties of the modified PEEK. The researchers believe that these modifications could provide valuable guidance on the future design of PEEK orthopedic implants.

Does the incorporation of zinc into TiO2 on titanium surfaces increase bactericidal activity? A systematic review and meta-analysis

STATEMENT OF PROBLEM

Infections associated with bacterial biofilm formation are an important cause of early implant failure. With the growing number of antibiotic-resistant bacteria, the incorporation of zinc into TiO2 coatings of titanium implants has emerged to promote osseointegration and inhibit bacterial proliferation. However, a systematic assessment of its efficacy is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to assess the bactericidal effect of zinc-modified TiO2 coatings on titanium or Ti-6Al-4V alloy.

MATERIAL AND METHODS

The review was structured based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist and the peer review of electronic search strategies (PRESS) guidelines. The search was performed in Science Direct, SCOPUS, Web of Science, and PubMed databases, including experimental in vitro studies that used titanium or Ti-6Al-4V as a control group and performed bacterial assays. Meta-analysis was performed by using the standardized mean differences of antibacterial effects.

RESULTS

A total of 2519 articles were collected after duplicate removal. Then, eligibility criteria and a manual search were applied to select 20 studies for qualitative analysis and 16 studies for statistical analysis. The risk of bias revealed low-quality evidence. The meta-analysis showed that zinc positively affected the bactericidal activity of TiO2 coatings (-8.79, CI95%=-11.01 to -6.57, P<.001), with a high degree of heterogeneity (I2=78%). Subgroup analysis with TiO2 nanotubes produced by anodization and ZnO nanoparticles by hydrothermal synthesis reduced heterogeneity to 43%, with the removal of outliers (I2=46%), with a favorable antibacterial effect for zinc incorporation into TiO2.

CONCLUSIONS

Bactericidal activity was identified for zinc incorporated into TiO2 coatings, making it an interesting option for titanium dental implants.

Electrophoretic-deposited MXene titanium coatings in regulating bacteria and cell response for peri-implantitis

Background: Two-dimensional(2D)MXenes have continued to receive increasing interest from researchers due to their graphene-like properties, in addition to their versatile properties for applications in electronic devices, power generation, sensors, drug delivery, and biomedicine. However, their construction and biological properties as titanium coatings to prevent peri-implantitis are still unclear.

Materials and methods: In this work, few-layer Ti₃C₂T_x MXene coatings with different thicknesses at varied depositing voltages (30, 40, and 50 V) were constructed by anodic electrophoretic deposition without adding any electrolytic ions. In vitro cytocompatibility assay was performed on preosteoblasts (MC3T3-E1) cell lines after the characterization of the coating. Meanwhile, the antibacterial activity against bacteria which are closely related to peri-implantitis including Staphylococcus aureus (S. aureus) and its drug-resistant strain MRSA was further investigated.

Results: MXene-coated titanium models with different thicknesses were successfully assembled by analyzing the results of characterization. The compounding of Ti₃C₂T_x could significantly improve the initial adhesion and proliferation of MC3T3-E1 cells. Moreover, the coating can effectively inhibit the adhesion and cell activity of S. aureus and MRSA, and MRSA expressed greater restricting behavior than S. aureus. The ability to promote antibacterial activity is proportional to the content of Ti₃C₂T_x. Its antioxidant capacity to reduce ROS in the culture environment and bacterial cells was first revealed.

Conclusion: In summary, this work shows a new avenue for MXene-based nano-biomaterials under the clinical problem of multiple antibiotic resistance.

Bioinductive and anti-inflammatory properties of Propolis and Biodentine on SHED

Objectives

This study aimed to evaluate and compare the cell viability, differentiation potential and anti-inflammatory potential of propolis and Biodentine™ on stem cells isolated from human exfoliated deciduous teeth (SHED).

Materials and methods

SHED were segregated and cultured from the dental pulp of children after therapeutic extraction. Microculture Tetrazolium Assay (MTT) assay was carried out for assessing cell proliferation potential of propolis and Biodentine at different concentrations. As per the results from cell proliferation assay, cell differentiation potential of SHED was evaluated at concentration of 12.5 μg/ml using Alizarin Red staining. The anti-inflammatory potential of test materials was evaluated using gelatin zymography by detecting MMP-2 and MMP-9.

Results

The maximum cell proliferation percentage of SHED treated with propolis and Biodentine was observed at a concentration of 12.5 μg/ml, on day 7, 14 and 21 with Biodentine having maximum cell proliferation potential followed by propolis. SHED treated with Biodentine showed maximum cell differentiation on day 7 (107.16), 14 (106.29) and 21 (107.72). However, anti-inflammatory activity against MMP-2 was 95 % with propolis and 85 % with Biodentine and whereas, against MMP-9 it was 65 % for propolis and 47 % for Biodentine.

Conclusion

Propolis shows comparable cell viability, cell proliferation and differentiation potential on SHED when compared to Biodentine. It also exhibits better invitro anti-inflammatory activity on SHED compared to Biodentine. Further studies are warranted to validate the application of propolis as an effective and economical alternative biocompatible agent to Biodentine for vital pulp therapies.

A superlattice composite of Zn-Fe layered double hydroxide and graphene oxide for antitumor application

A superlattice composite of Zn-Fe layered double hydroxide and graphene oxide was fabricated on the titanium surface and showed lamellar morphology. It was found for the first time that this superlattice composite could inhibit cell adhesion and proliferation, and cause cell death of the cholangiocarcinoma cell line RBE cells in vitro and show tumor inhibition effect in vivo.

Chemical Nature of Metals and Metal-Based Materials in Inactivation of Viruses

In response to the enormous threat to human survival and development caused by the large number of viruses, it is necessary to strengthen the defense against and elimination of viruses. Metallic materials have been used against viruses for thousands of years due to their broad-spectrum antiviral properties, wide sources and excellent physicochemical properties; in particular, metal nanoparticles have advanced biomedical research. However, researchers in different fields hold dissimilar views on the antiviral mechanisms, which has slowed down the antiviral application of metal nanoparticles. As such, this review begins with an exhaustive compilation of previously published work on the antiviral capacity of metal nanoparticles and other materials. Afterwards, the discussion is centered on the antiviral mechanisms of metal nanoparticles at the biological and physicochemical levels. Emphasis is placed on the fact that the strong reducibility of metal nanoparticles may be the main reason for their efficient inactivation of viruses. We hope that this review will benefit the promotion of metal nanoparticles in the antiviral field and expedite the construction of a barrier between humans and viruses.

Antibacterial Designs for Implantable Medical Devices: Evolutions and Challenges

The uses of implantable medical devices are safer and more common since sterilization methods and techniques were established a century ago; however, device-associated infections (DAIs) are still frequent and becoming a leading complication as the number of medical device implantations keeps increasing. This urges the world to develop instructive prevention and treatment strategies for DAIs, boosting the studies on the design of antibacterial surfaces. Every year, studies associated with DAIs yield thousands of publications, which here are categorized into four groups, i.e., antibacterial surfaces with long-term efficacy, cell-selective capability, tailored responsiveness, and immune-instructive actions. These innovations are promising in advancing the solution to DAIs; whereas most of these are normally quite preliminary “proof of concept” studies lacking exact clinical scopes. To help identify the flaws of our current antibacterial designs, clinical features of DAIs are highlighted. These include unpredictable onset, site-specific incidence, and possibly involving multiple and resistant pathogenic strains. The key point we delivered is antibacterial designs should meet the specific requirements of the primary functions defined by the “intended use” of an implantable medical device. This review intends to help comprehend the complex relationship between the device, pathogens, and the host, and figure out future directions for improving the quality of antibacterial designs and promoting clinical translations.

Antimicrobial potential and osteoblastic cell growth on electrochemically modified titanium surfaces with nanotubes and selenium or silver incorporation

Titanium nanotube surfaces containing silver, zinc, and copper have shown antimicrobial effects without decreasing osteoblastic cell growth. In this in-vitro study we present first results on the biological evaluation of surface modifications by incorporating selenium and silver compounds into titanium-dioxide (TiO₂) nanotubes by electrochemical deposition. TiO₂-nanotubes (TNT) and Phosphate-doped TNT (pTNT) were grown on the surface of Ti6Al4V discs by anodization. Hydroxyapatite (HA), selenium (Se) and silver (Ag) compounds were incorporated by electrochemical deposition. Colony forming units of Staphylococcus epidermidis (DSM 3269) were significantly decreased in SepTNT (0.97 ± 0.18 × 10⁶ CFU/mL), SepTNT-HA (1.2 ± 0.39 × 10⁶ CFU/mL), AgpTNT (1.36 ± 0.42 × 10⁶ CFU/mL) and Ag₂SepTNT (0.999 ± 0.12 × 10⁶ CFU/mL) compared to the non-modified control (2.2 ± 0.21 × 10⁶ CFU/mL). Bacterial adhesion was calculated by measuring the covered area after fluorescence staining. Adhesion was lower in SepTNT (37.93 ± 12%; P = 0.004), pTNT (47.3 ± 6.3%, P = 0.04), AgpTNT (24.9 ± 1.8%; P < 0.001) and Ag₂SepTNT (14.9 ± 4.9%; P < 0.001) compared to the non-modified control (73.7 ± 11%). Biofilm formation and the growth of osteoblastic cells (MG-63) was observed by using Crystal Violet staining. Biofilm formation was reduced in SepTNT (22 ± 3%, P = 0.02) and Ag₂SepTNT discs (23 ± 11%, P = 0.02) compared to the non-modified control (54 ± 8%). In comparison with the non-modified control the modified SepTNT-HA and pTNT surfaces showed a significant higher covered area with osteoblastic MG-63-cells. Scanning electron microscope (SEM) images confirmed findings regarding bacterial and osteoblastic cell growth. These findings show a potential synergistic effect by combining selenium and silver with titanium nanotubes.

Inhibition of Inflammatory Response and Promotion of Osteogenic Activity of Zinc-Doped Micro-Arc Titanium Oxide Coatings

An early and sustained immune response can lead to chronic inflammation after the implant is placed in the body. The implantable materials with immunomodulatory effects can reduce the body's immune response and promote the formation of ideal osseointegration between the implants and bone tissue. In this study, zinc-coated titanium micro-arc oxide coating was prepared on titanium surface by micro-arc oxidation. The physical properties, anti-inflammation, and osteogenesis of the material were evaluated. We have physically characterized the surface structure of the coatings by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and atomic force microscopy (AFM) and detected the release of Zn²⁺ from the coating surface by inductively coupled optical plasma emission spectrometry (ICP-OES). The BMSCs were inoculated on the surface of the coating, and the biocompatibility of the coating was evaluated by CCK-8 analysis and living and dead cell staining. The osteogenic effect of the layer on BMSCs was evaluated by alkaline phosphatase (ALP) assays, osteocalcin (OCN) immunofluorescence, and quantitative polymerase chain reaction (q-PCR). The survival status of RAW264.7 on the coating surface and the mRNA expression of the associated proinflammatory markers, tumor necrosis factor-α (TNF-α), cluster of differentiation 86 (CD86), and inducible nitric oxide (INOS) were detected by CCK-8 analysis and q-PCR. In parallel, the cell counting kit-8 (CCK-8) analysis and q-PCR screened and evaluated the effective concentration of Zn²⁺ anti-inflammatory in vitro. The results show that the coating has good physical characterization, and Zn is uniformly bound to the surface of titanium and shows stable release and good biocompatibility to BMSCs, downregulating the expression of inflammation-related genes promoting the bone formation of BMSCs. We have successfully prepared zinc-coated micro-arc titanium oxide coating on the titanium surface, which has good osteogenesis and great anti-inflammatory potential and provides a new way for osseointegration in the implant.

Effects of Zinc Ions Released From Ti-NW-Zn Surface on Osteogenesis and Angiogenesis In Vitro and in an In Vivo Zebrafish Model

Zinc-modified titanium materials have been widely applied in oral implants. Among them, our previous studies have also successfully prepared a novel acid-etched microstructured titanium surface modified with zinc-containing nanowires (Ti-NW-Zn) and proved its excellent biocompatibility. It is well known that the functional regulation between angiogenesis and osteogenesis is of great importance for bone remodeling around implants. However, there are few reports concerning the biological safety of zinc ions released from materials and the appropriate concentration of released zinc ions which was more conducive to angiogenesis and bone regeneration. In this study, we investigated the effects of zinc ions released from Ti-NW-Zn surfaces on angiogenesis and osteogenesis using the zebrafish model and revealed the relationship between angiogenesis and osteogenesis via HUVECs and MC3T3-E1s in vitro. We found that the zinc ions released from Ti-NW-Zn surfaces, with a concentration lower than median lethal concentrations (LCs) of zebrafish, were biologically safe and promote osteogenesis and angiogenesis in vivo. Moreover, the proper concentration of zinc ions could induce the proliferation of HUVECs and osteogenic differentiation. The positive effects of the appropriate concentration of zinc ions on osteoblast behaviors might be regulated by activating the MAPK/ERK signaling pathway. These aspects may provide new sights into the mechanisms underlying zinc-modified titanium surfaces between osteogenesis and angiogenesis, to lay the foundation for further improving the materials, meanwhile, promoting the applications in dentistry.

Antibacterial Activity of Silver and Gold Particles Formed on Titania Thin Films

Metal-based nanoparticles with antimicrobial activity are gaining a lot of attention in recent years due to the increased antibiotics resistance. The development and the pathogenesis of oral diseases are usually associated with the formation of bacteria biofilms on the surfaces; therefore, it is crucial to investigate the materials and their properties that would reduce bacterial attachment and biofilm formation. This work provides a systematic investigation of the physical-chemical properties and the antibacterial activity of TiO2 thin films decorated by Ag and Au nanoparticles (NP) against Veillonella parvula and Neisseria sicca species associated with oral diseases. TiO2 thin films were formed using reactive magnetron sputtering by obtaining as-deposited amorphous and crystalline TiO2 thin films after annealing. Au and Ag NP were formed using a two-step process: magnetron sputtering of thin metal films and solid-state dewetting. The surface properties and crystallographic nature of TiO2/NP structures were investigated by SEM, XPS, XRD, and optical microscopy. It was found that the higher thickness of Au and Ag thin films results in the formation of the enlarged NPs and increased distance between them, influencing the antibacterial activity of the formed structures. TiO2 surface with AgNP exhibited higher antibacterial efficiency than Au nanostructured titania surfaces and effectively reduced the concentration of the bacteria. The process of the observation and identification of the presence of bacteria using the deep learning technique was realized.

Hybrid nanocoatings of self-assembled organic-inorganic amphiphiles for prevention of implant infections

Antimicrobial coatings are one of the most promising strategies to prevent bacterial infections in orthopedic and dental implants. Combining antimicrobial agents with different antimicrobial mechanisms might have synergistic effects and be more potent. Others have shown that nanocomposites of silver nanoparticles (AgNPs) decorated with antimicrobial peptides (AMPs) show increased potency as free agents in solution. However, similar nanocomposites have not been explored to coat biomaterials through cooperative weak electrostatic attraction forces between AMP, AgNPs and substrates in need of protection against infection. In this work, we synthesized self-assembled antimicrobial amphiphiles of an AMP, GL13K. Then, we decorated the AMP nanostructures with AgNPs, which were finally used to coat etched Ti (eTi) surfaces. The strong hydrogen bonding between the AMP amphiphiles and the polar eTi yielded a robust and stable coating. When compared to single AgNP or single AMP coatings, our hybrid nanocoatings had notably higher in vitro antimicrobial potency against multiple bacteria strains related to implant infection. The hybrid coating also showed relevant antimicrobial activity in an in vivo subcutaneous infection model in rats. This work advances the application of AgNP/AMP nanocomposites as effective coatings for prevention of implant infections. STATEMENT OF SIGNIFICANCE: High morbidity, mortality and elevated costs are associated with orthopedic and dental implant infections. Conventional antibiotic treatment is ineffective due to barrier-like extracellular polymeric substances in biofilms and the increasing threat from antibiotic resistance. Antimicrobial coatings are one of the most promising strategies, but the performance is usually unsatisfactory, especially when tested in vivo. Here, we present a hybrid nanocoating with different modes of action to prevent implant infections using self-assembled antimicrobial peptide (AMP) amphiphiles decorated with silver nanoparticles (AgNPs). When compared to single AgNP or AMP coatings, our hybrid nanocoatings showed significant increases in antimicrobial potency against multiple implant infection-related bacterial strains in vitro and in an in vivo rat subcutaneous infection model.

Megaprosthesis anti-bacterial coatings: A comprehensive translational review

Periprosthetic joint infections (PJI) are catastrophic complications for patients with implanted megaprostheses and pose significant challenges in the management of orthopaedic oncology patients. Despite various preventative strategies, with the increasing rate of implanted orthopaedic prostheses, the number of PJIs may be increasing. PJIs are associated with a high rate of amputation. Therefore, novel strategies to combat bacterial colonization and biofilm formation are required. A promising strategy is the utilization of anti-bacterial coatings on megaprosthetic implants. In this translational review, a brief overview of the mechanism of bacterial colonization of implants and biofilm formation will be provided, followed by a discussion and classification of major anti-bacterial coatings currently in use and development. In addition, current in vitro outcomes, clinical significance, economic importance, evolutionary perspectives, and future directions of anti-bacterial coatings will also be discussed. Megaprosthetic anti-bacterial coating strategies will help reduce infection rates following the implantation of megaprostheses and would positively impact sarcoma care. STATEMENT OF SIGNIFICANCE: This review highlights the clinical challenges and a multitude of potential solutions to combating peri-prosthetic join infections in megaprotheses using anti-bacterial coatings. Reducing infection rates following the implantation of megaprostheses would have a major impact on sarcoma care and major trauma surgeries that require reconstruction of large skeletal defects.

The Role of Zinc in Bone Mesenchymal Stem Cell Differentiation

Zinc is an essential trace element for bone growth and bone homeostasis in the human body. Bone mesenchymal stem cells (BMSCs) are multipotent progenitors existing in the bone marrow stroma with the capability of differentiating along multiple lineage pathways. Zinc plays a paramount role in BMSCs, which can be spurred differentiating into osteoblasts, chondrocytes, or adipocytes, and modulates the formation and activity of osteoclasts. The expression of related genes also changed during the differentiation of various cell phenotypes. Based on the important role of zinc in BMSC differentiation, using zinc as a therapeutic approach for bone remodeling will be a promising method. This review explores the role of zinc ion in the differentiation of BMSCs into various cell phenotypes and outlines the existing research on their molecular mechanism.

Calcium Phosphate-Coated and Strontium-Incorporated Mesoporous Silica Nanoparticles Can Effectively Induce Osteogenic Stem Cell Differentiation

Ceramic (nano)materials are promising materials for bone regeneration applications. The addition of bioinorganics such as strontium (Sr) and zinc (Zn) is a popular approach to further improve their biological performance. However, control over ion delivery is important to prevent off-target effects. Mesoporous silica nanoparticles (MSNs) are popular nanomaterials that can be designed to incorporate and controllably deliver multiple ions to steer specific regenerative processes. In this work, MSNs loaded with Sr (MSN_Sr ) and surface coated with a pH-sensitive calcium phosphate (MSN_Sr -CaP) or calcium phosphate zinc layer (MSN_Sr -CaZnP) are developed. The ability of the MSNs to promote osteogenesis in human mesenchymal stromal cells (hMSCs) under basic cell culture conditions is explored and compared to ion administration directly to the cell culture media. Here, it is shown that MSN-CaPs can effectively induce alkaline phosphatase (ALP) levels and osteogenic gene expression in the absence of other osteogenic stimulants, where an improved effect is observed for MSNs surface coated with multiple ions. Moreover, comparatively lower ion doses are needed when using MSNs as delivery vehicles compared to direct ion administration in the medium. In summary, the MSNs developed here represent promising vehicles to deliver (multiple) bioinorganics and promote hMSC osteogenesis in basic conditions.

iTRAQ-based proteomic analysis reveals potential osteogenesis-promoted role of ATM in strontium-incorporated titanium implant

The present study aims to reveal the osteogenic roles played by DNA damage response biomarkers through implementing isobaric tags for relative and absolute quantitation (iTRAQ) technique. First, sandblasted large-grit double acid-etched (SLA) titanium implant and strontium-incorporated (SLA-Sr) titanium implant were used for inserting in the tibiae of rats. iTRAQ technique was used to detect protein expression changes and identify differentially expressed proteins (DEPs). In total, 19,343 peptides and 4280 proteins were screened out. Among them, 91 and 138 DEPs were identified in the SLA-Sr group after implantation for 3 and 7 days, respectively. Ataxia-telangiectasia mutated (ATM) protein up-regulated on the 3rd day showed a trend of further up-regulation on the 7th day. Moreover, functional enrichment analyses were also conducted to explore the biological function of DEPs during the initial stage of osseointegration in vivo, which revealed that the biological functions of the DEPs on the 7th day were mainly related to "mismatch repair" and "mitotic G1 DNA damage checkpoint." Analysis of the Reactome signaling pathway showed that ATM was associated with TP53's regulation and activation. Finally, DNA damage repair related genes were selected for validation at mRNA and protein expression levels. Real-time reverse transcription-polymerase chain reaction and immunohistochemistry validation results demonstrated that mRNA expression level of ATM was higher in SLA-Sr group. In conclusion, SLA-Sr titanium implant could initiate DNA damage repair by activating expression levels of ATM. This study was striving to reveal new faces of better osseointegration and shedding light on the biological function and underlying mechanisms of this important procedure.

A versatile multicomponent mesoporous silica nanosystem with dual antimicrobial and osteogenic effects

In this manuscript, we propose a simple and versatile methodology to design nanosystems based on biocompatible and multicomponent mesoporous silica nanoparticles (MSNs) for infection management. This strategy relies on the combination of antibiotic molecules and antimicrobial metal ions into the same nanosystem, affording a significant improvement of the antibiofilm effect compared to that of nanosystems carrying only one of these agents. The multicomponent nanosystem is based on MSNs externally functionalized with a polyamine dendrimer (MSN-G3) that favors internalization inside the bacteria and allows the complexation of multiactive metal ions (MSN-G3-Mⁿ⁺). Importantly, the selection of both the antibiotic and the cation may be done depending on clinical needs. Herein, levofloxacin and Zn²⁺ ion, chosen owing to both its antimicrobial and osteogenic capability, have been incorporated. This dual biological role of Zn²⁺ could have and adjuvant effect thought destroying the biofilm in combination with the antibiotic as well as aid to the repair and regeneration of lost bone tissue associated to osteolysis during infection process. The versatility of the nanosystem has been demonstrated incorporating Ag⁺ ions in a reference nanosystem. In vitro antimicrobial assays in planktonic and biofilm state show a high antimicrobial efficacy due to the combined action of levofloxacin and Zn²⁺, achieving an antimicrobial efficacy above 99% compared to the MSNs containing only one of the microbicide agents. In vitro cell cultures with MC3T3-E1 preosteoblasts reveal the osteogenic capability of the nanosystem, showing a positive effect on osteoblastic differentiation while preserving the cell viability. STATEMENT OF SIGNIFICANCE: A simple and versatile methodology to design biocompatible and multicomponent MSNs based nanosystems for infection management is proposed. These nanosystems, containing two antimicrobial agents, levofloxacin and Zn²⁺, have been synthetized by external functionalization of MSNs with a polycationic dendrimer (MSNs-G3), which favours its internalization inside the bacteria and lead the complexation with metal ions through the amines of the dendrimer. The nanosystems offer a notable improvement of the antibiofilm effect (above 99%) than both components separately as well as osteogenic capability with positive effect on the osteoblastic differentiation and preserved cell viability.

Fabrication and characterization of biodegradable zinc matrix composites reinforced by uniformly dispersed beta-tricalcium phosphate via graphene oxide-assisted hetero-agglomeration

The development of biodegradable Zn matrix composites has been considered a promising approach to achieving enhanced mechanical properties, controllable degradation rate, good biocompatibility, and good osseointegration as orthopedic implants. However, scant literature regarding Zn matrix composites has been reported because of the great difficulty in dispersing the nano-sized bioactive reinforcements uniformly within the Zn matrix. In the present study, a novel and effective method were employed to obtain Zn matrix composites reinforced by uniformly dispersed beta-tricalcium phosphate (β-TCP) via graphene oxide (GO)-assisted hetero-agglomeration and subsequent spark plasma sintering process. A very low-content (0.04 vol%) few-layered GO was used as a coupling reagent to connect the Zn matrix and nano-sized TCP particles. In an appropriate polarity solvent, the negatively charged GO sheets could combine with both the positively charged Zn powder and TCP particles by electrostatic attraction and charge neutralization. Due to the nature of hetero-agglomeration, the flexible GO sheet could adhere to the large Zn powder and attracted a certain amount of TCP particles to form a Zn/GO/TCP sandwich structure by charge neutralization thereby forming a uniform dispersion of TCP particles within Zn matrix. After the spark plasma sintering (SPS) process, the TCP particles incorporated with very thin ZnO layers (thickness of a few dozen nanometers) formed a homogeneous and unique 3D network-like distribution in as-sintered TCP/Zn composites. A unique "snap pea"-like structure was confirmed at the grain boundary of α-Zn grains, which consisted of the TCP particles as "pea" and thin ZnO layer as "pod". Due to the uniform dispersion of bioactive TCP particles and unique structure of the TCP incorporating grain boundary, as-sintered 3TCP/Zn matrix composites possessed yield strength (YS) of 140.8 ± 7.7 MPa, failure strain of 36.0 ± 2.8%, the moderate degradation rate of 19.1 ± 3.3 μm·y^-1 and good cytocompatibility to MC3T3-E1 cells. Moreover, osteogenic differentiation activity evaluation revealed that the addition of TCP could significantly improve the expressions of the osteogenic differentiation-related gene (ALP) in MC3T3-E1 cells, thereby resulting in improved osteogenic capability. Therefore, biodegradable 3TCP/Zn matrix composites fabricated by GO-assisted hetero-agglomeration and subsequent SPS process could be a promising material as orthopedic implants.

Antibacterial metals and alloys for potential biomedical implants

Metals and alloys, including stainless steel, titanium and its alloys, cobalt alloys, and other metals and alloys have been widely used clinically as implant materials, but implant-related infection or inflammation is still one of the main causes of implantation failure. The bacterial infection or inflammation that seriously threatens human health has already become a worldwide complaint. Antibacterial metals and alloys recently have attracted wide attention for their long-term stable antibacterial ability, good mechanical properties and good biocompatibility in vitro and in vivo. In this review, common antibacterial alloying elements, antibacterial standards and testing methods were introduced. Recent developments in the design and manufacturing of antibacterial metal alloys containing various antibacterial agents were described in detail, including antibacterial stainless steel, antibacterial titanium alloy, antibacterial zinc and alloy, antibacterial magnesium and alloy, antibacterial cobalt alloy, and other antibacterial metals and alloys. Researches on the antibacterial properties, mechanical properties, corrosion resistance and biocompatibility of antibacterial metals and alloys have been summarized in detail for the first time. It is hoped that this review could help researchers understand the development of antibacterial alloys in a timely manner, thereby could promote the development of antibacterial metal alloys and the clinical application.

Magnetron sputtering of strontium nanolayer on zirconia implant to enhance osteogenesis

The zirconia implants have a wide range of clinical applications, however, the biological inertness and lack of osteoinductive properties limit these applications. Strontium possesses superior biocompatibility and excellent osteogenic properties. To take advantage of these, the strontium titanate-coated zirconia implants were prepared in this study by sandblasting, acid etching, and magnetron sputtering, followed by the analysis of the biological behavior. Briefly, the zirconia sheets were polished and subjected to sandblasting and acid etching. Subsequently, a nano‑strontium titanate coating was developed on the sheets by magnetron sputtering. The specimens were characterized by scanning electron microscopy (SEM), water contact angle measurement (WCA) and EDS mapping, which confirmed the physical alternation and successful deposition of the strontium titanate coating. The in vitro experiments indicated that the majority of the filopodia and actin fibers of the MC3T3-E1 cells on SA-ZrO₂/Sr possessed an optimal osteogenic property to promote the osteogenic differentiation. Moreover, the RT-PCR results revealed that SA-ZrO₂/Sr significantly up-regulated the gene expression of Runx2, COL-1, ALP, OPG, OPN and OCN. Further, the in vivo evaluation confirmed that the SA-ZrO₂/Sr implants promoted the bone-implant osseointegration to the greatest extent as compared to SA-ZrO₂ and ZrO₂ implant. Overall, the SA-ZrO₂/Sr system was confirmed to be a promising implant, thus, providing new pathways for an effective implant design.

Loading Gentamicin and Zn2+ on TiO2 Nanotubes to Improve Anticoagulation, Endothelial Cell Growth, and Antibacterial Activities

Titanium and its alloys are widely used in blood-contacting implantable and interventional medical devices; however, their biocompatibility is still facing great challenges. In the present study, in order to improve the biocompatibility and antibacterial activities of titanium, TiO2 nanotubes were firstly in situ prepared on the titanium surface by anodization, followed by the introduction of polyacrylic acid (PAA) and gentamicin (GS) on the nanotube surface by layer-by-layer assembly, and finally, zinc ions were loaded on the surface to further improve the bioactivities. The nanotubes displayed excellent hydrophilicity and special nanotube-like structure, which can selectively promote the albumin adsorption, enhance the blood compatibility, and promote the growth of endothelial cells to some degree. After the introduction of PAA and GS, although the superhydrophilicity cannot be achieved, the results of platelet adhesion, cyclic guanosine monophosphate (cGMP) activity, hemolysis rate, and activated partial thromboplastin time (APTT) showed that the blood compatibility was improved, and the blood compatibility was further enhanced after zinc ion loading. On the other hand, the modified surface showed good cytocompatibility to endothelial cells. The introduction of PAA and zinc ions not only promoted the adhesion and proliferation of endothelial cells but also upregulated expression of vascular endothelial growth factor (VEGF) and nitric oxide (NO). The slow and continuous release of GS and Zn2+ over 14 days can significantly improve the antibacterial properties. Therefore, the present study provides an effective method for the surface modification of titanium-based blood-contacting materials to simultaneously endow with good blood compatibility, endothelial growth behaviors, and antibacterial properties.

Additive manufacturing of Ti6Al4V alloy via electron beam melting for the development of implants for the biomedical industry

Additive Manufacturing (AM) or rapid prototyping technologies are presented as one of the best options to produce customized prostheses and implants with high-level requirements in terms of complex geometries, mechanical properties, and short production times. The AM method that has been more investigated to obtain metallic implants for medical and biomedical use is Electron Beam Melting (EBM), which is based on the powder bed fusion technique. One of the most common metals employed to manufacture medical implants is titanium. Although discovered in 1790, titanium and its alloys only started to be used as engineering materials for biomedical prostheses after the 1950s. In the biomedical field, these materials have been mainly employed to facilitate bone adhesion and fixation, as well as for joint replacement surgeries, thanks to their good chemical, mechanical, and biocompatibility properties. Therefore, this study aims to collect relevant and up-to-date information from an exhaustive literature review on EBM and its applications in the medical and biomedical fields. This AM method has become increasingly popular in the manufacturing sector due to its great versatility and geometry control.

Research status of biodegradable metals designed for oral and maxillofacial applications: A review

The oral and maxillofacial regions have complex anatomical structures and different tissue types, which have vital health and aesthetic functions. Biodegradable metals (BMs) is a promising bioactive materials to treat oral and maxillofacial diseases. This review summarizes the research status and future research directions of BMs for oral and maxillofacial applications. Mg-based BMs and Zn-based BMs for bone fracture fixation systems, and guided bone regeneration (GBR) membranes, are discussed in detail. Zn-based BMs with a moderate degradation rate and superior mechanical properties for GBR membranes show great potential for clinical translation. Fe-based BMs have a relatively low degradation rate and insoluble degradation products, which greatly limit their application and clinical translation. Furthermore, we proposed potential future research directions for BMs in the oral and maxillofacial regions, including 3D printed BM bone scaffolds, surface modification for BMs GBR membranes, and BMs containing hydrogels for cartilage regeneration, soft tissue regeneration, and nerve regeneration. Taken together, the progress made in the development of BMs in oral and maxillofacial regions has laid a foundation for further clinical translation.

Zinc- and strontium- co-incorporated nanorods on titanium surfaces with favorable material property, osteogenesis, and enhanced antibacterial activity

Early infection and peri-implantitis after implant restoration are major reasons for dental implant failure. Implant-associated infections are majorly attributed to biofilm formation. In this study, co-incorporated zinc- (Zn-) and strontium- (Sr-) nanorod coating on sandblasted and acid-etched (SLA) titanium (SLA-Zn/Sr) was fabricated by hydrothermal synthesis. It was aimed at promoting osteogenesis while inhibiting biofilm formation. The nanorod-like particles (φ 30-50 nm) were found to be evenly formed on SLA-Zn/Sr (Zn: 1.49 ± 0.16 wt%; Sr: 21.69 ± 2.74 wt%) that was composed of well-crystallized ZnTiO₃ and SrTiO₃ phases. With a sufficient interface bonding strength (42.00 ± 3.00 MPa), SLA-Zn/Sr enhanced the corrosion resistance property of titanium. Besides, SLA-Zn/Sr promoted the cellular initial adhesion, proliferation and osteogenic differentiation of rBMSCs in vitro while inhibiting the adhesion of Staphylococcus aureus and Porphyromonas gingivalis . In addition, through down-regulating icaA gene expression, this novel surface reduced the secretion of polysaccharide intercellular adhesion (reduced by 87.9% compared to SLActive) to suppress the S. aureus biofilm formation. We, therefore, propose a new chemical modification on titanium for multifunctional implant material development. Due to the Zn/Sr co-doping in coating, material properties, early osteogenic effect and antibacterial ability of titanium can be simultaneously enhanced, which has the potential to be applied in dental implantation in the future.

Impact of exogenous metal ions on peri-implant bone metabolism: a review

The development of effective methods to promote the osseointegration of dental implants by surface modification is an area of intense research in dental materials science. Exogenous metal ions present in the implant and surface modifications are closely related to the bone metabolism around the implant. In the complex oral microenvironment, the release of metal ions caused by continuous corrosion of dental implants has an unfavorable impact on the surrounding tissue, and then affects osseointegration, leading to bad results such as loosening and falling off in the late stage of the implant. Besides, these ions can even be distributed in distant tissues and organs. Currently, surface modification techniques are being developed that involve different processing technologies including the introduction of exogenous metal ions with different properties onto the surface of implants to improve performance. However, most metal elements have some level of biological toxicity and can only be used within a safe concentration range to exert the optimum biological effects on recipients. In this paper, we review the adverse effects of metal ions on osseointegration and highlight the emerging applications for metal elements in improving the performance of dental implants.

Antibacterial activity of an NIR-induced Zn ion release film

Photothermal therapy originated from using gold nanorods (GNRs) and near-infrared (NIR) irradiation has been widely used in the antibacterial field. Zn element exhibits antimicrobial activity against various bacterial and fungal strains. In this study, a bilayer film, consisting of GNRs as the inner layer and a polydopamine layer containing Zn element (PDA@Zn) as the outer layer, was deposited on the Ti surface. The results testified that all the GNR-modified surfaces had the same photothermal conversion efficiency. The Ti surface modified with GNR and PDA@Zn layers had better antibacterial activity against E. coli and S. aureus due to the GNR-induced photothermal effect and the antibacterial Zn element. Moreover, the accelerated release of Zn ions from the PDA@Zn layer was attributed to the GNR-induced high temperature under the NIR irradiation, which caused the concentration of Zn ions to be high enough to kill the surrounding bacteria. This study illustrates that a composite surface possessing both the contact and heat-responsive antibacterial property was constructed on titanium for potential clinical applications.

Biological Roles and Delivery Strategies for Ions to Promote Osteogenic Induction

Bone is the most studied tissue in the field of tissue regeneration. Even though it has intrinsic capability to regenerate upon injury, several pathologies and injuries could hamper the highly orchestrated bone formation and resorption process. Bone tissue engineering seeks to mimic the extracellular matrix of the tissue and the different biochemical pathways that lead to successful regeneration. For many years, the use of extrinsic factors (i.e., growth factors and drugs) to modulate these biological processes have been the preferred choice in the field. Even though it has been successful in some instances, this approach presents several drawbacks, such as safety-concerns, short release profile and half-time life of the compounds. On the other hand, the use of inorganic ions has attracted significant attention due to their therapeutic effects, stability and lower biological risks. Biomaterials play a key role in such strategies where they serve as a substrate for the incorporation and release of the ions. In this review, the methodologies used to incorporate ions in biomaterials is presented, highlighting the osteogenic properties of such ions and the roles of biomaterials in controlling their release.