Effects of fluoride-ion-implanted titanium surface on the cytocompatibility in vitro and osseointegatation in vivo for dental implant applications

Anodic Production and Characterization of Biomimetic Oxide Layers on Grade 4 Titanium for Medical Applications

Biomaterials are the basis for the development of medicine because they allow safe contact with a living organism. The aim of this work was to produce innovative oxide layers with a microporous structure on the surface of commercially pure titanium Grade 4 (CpTi G4) and to characterize their properties as drug carriers. The anodization of the CpTi G4 subjected to mechanical grinding and electrochemical polishing was carried out in a solution of 1M ethylene glycol with the addition of 40 g of ammonium fluoride at a voltage of 20 V for 2, 18, 24, and 48 h at room temperature. It was found that the longer the anodization time, the greater the number of pores formed on the CpTi G4 surface as revealed using the FE-SEM method, and the greater the surface roughness determined in profilometric tests. As the anodizing time increases, the amount of the drug in the form of gentamicin sulfate incorporated into the resulting pores decreases. The most favorable drug release kinetics profile determined via UV-VIS absorption spectroscopy was found for the CpTi G4 anodized for 2 h.

Fluoride anodic films on stainless-steel fomites to reduce transmission infections

The growing concern arising from viruses with pandemic potential and multi-resistant bacteria responsible for hospital-acquired infections and outbreaks of food poisoning has led to an increased awareness of indirect contact transmission. This has resulted in a renewed interest to confer antimicrobial properties to commonly used metallic materials. The present work provides a full characterization of optimized fluoride anodic films grown in stainless steel 304L as well as their antimicrobial properties. Antibacterial tests show that the anodic film, composed mainly of chromium and iron fluorides, reduces the count and the percentage of the area covered by 50% and 87.7% for Pseudomonas aeruginosa and Stenotrophomonas maltophilia, respectively. Virologic tests show that the same treatment reduces the infectivity of the coronavirus HCoV-229E-GFP, in comparison with the non-anodized stainless steel 304L.IMPORTANCEThe importance of environmental surfaces as a source of infection is a topic of particular interest today, as many microorganisms can survive on these surfaces and infect humans through direct contact. Modification of these surfaces by anodizing has been shown to be useful for some alloys of medical interest. This work evaluates the effect of anodizing on stainless steel, a metal widely used in a variety of applications. According to the study, the fluoride anodic layers reduce the colonization of the surfaces by both bacteria and viruses, thus reducing the risk of acquiring infections from these sources.

Fluoride-modified implant surfaces improves osseointegration in the tibias of rats with induced diabetes

This study evaluated the influence of a fluoride-modified titanium surface on osseointegration in rats with induced diabetes. One hundred and eighty rats were randomly allocated into 3 groups with 60 animals each: Control group (C): Animals without diabetes; Diabetes Group (D): Animals with uncontrolled induced diabetes; Controlled Diabetes Group (CD): Animals with diabetes induced controlled by the insulin administration. Diabetes was induced by streptozotocin injection. Each animal received 2 implants in the proximal tibial metaphysis, one with the machined surface (M) and the other one with a fluoride-modified titanium surface (F), after 4 weeks of induction of diabetes. The animals were submitted to euthanasia 2, 4, and 6 weeks after the implant placement (n = 20 animals/group). The osseointegration was evaluated by the implant removal torque test and the histometric analysis of the non-decalcified histological sections: 1) Contact bone/implant (%BIC); 2) Bone tissue area between implant threads (%BBT). Implants with F surface showed a higher removal torque than implants with surface M in all groups. There was no difference in %BIC between the groups regardless of the surface used. The F surface showed a tendency to present higher %BBT values for the 3 evaluation periods in the D group. The fluoride-modified implant surface has no impact on the %BIC and %BBT. However, the fluoride-modified implant surface increases the locking of the implants with the bone. The hyperglycemia was associated with lower removal torque values despite the surfaces of the implant used.

Antibacterial performance of a porous Cu-bearing titanium alloy by laser additive manufacturing

Porphyromonas gingivalis (P. gingivalis) is the most common species that causes peri-implantitis. It forms an irreversible dense biofilm and causes inflammation. A novel 3D-printed porous TC4-6Cu alloy was fabricated using selective laser melting (SLM) technology for the dental implant, which is anticipated to inhibit biofilm formation. We attempted to investigate the antibacterial ability and antibacterial mechanism of the 3D-printed porous TC4-6Cu alloy against P. gingivalis. This work used scanning electron microscopy (SEM) and laser confocal microscopy (CLSM) to detect the antimicrobial ability of the alloy against sessile P. gingivalis. The results indicated that the 3D-printed porous TC4-6Cu alloy could cause bacterial fragmentation and deformation. Plate antimicrobial counting experiments showed that the antibacterial rates of the alloy against adherent bacteria and planktonic bacteria after 24 h were 98.05% and 73.92%, respectively. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of Cu2+ were tested to appraise the antibacterial property of the alloy against planktonic P. gingivalis. The relationship between the antibacterial mechanism of the alloy with oxidative stress was evaluated through ROS fluorescence intensity and protein leakage concentration. The results revealed that the alloy significantly eliminated adherent bacteria and inhibited biofilm formation. Moreover, 3D-printed porous TC4-6Cu alloy demonstrated significant bactericidal ability by inducing the production of reactive oxygen species (ROS), which could result in protein leakage from the bacterial cell membrane. This research may open a new perspective on the development and biomedical applications for dental implantation.

Preparation and properties of composite manganese/fluorine coatings on metallic titanium

Titanium is widely used in implants because of its good mechanical properties and biocompatibility. However, titanium has no biological activity and is prone to causing implant failure after implantation. In this study, we prepared a manganese- and fluorine-doped titanium dioxide coating on a titanium surface by microarc oxidation technology. The surface characteristics of the coating were evaluated by field emission scanning electron microscopy, X-ray diffraction, X-ray photoelectron spectroscopy, and atomic force microscopy and profiler, and the corrosion resistance and wear resistance of the coating were also evaluated. The bioactivity of the coating on bone marrow mesenchymal stem cells was evaluated by in vitro cell experiments, and the antibacterial properties of the coating were evaluated by in vitro bacterial experiments. The results confirmed that the manganese- and fluorine-doped titanium dioxide coating was successfully prepared on the titanium surface, and manganese and fluorine were successfully introduced into the coating. The doping of manganese and fluorine did not change the surface morphology of the coating, and the coating had good corrosion resistance and wear resistance. The results of the in vitro cell experiment showed that the titanium dioxide coating with manganese and fluoride could promote the proliferation, differentiation and mineralization of bone marrow mesenchymal stem cells. The results of the bacterial experiment in vitro showed that the coating material could inhibit the propagation of Staphylococcus aureus and had a good antibacterial effect. Conclusion: it is feasible to prepare a manganese- and fluorine-doped titanium dioxide coating on titanium surfaces by microarc oxidation. The coating not only has good surface characteristics but also has good bone-promoting and antibacterial properties and has potential for clinical application.

A systematic review on the effect of inorganic surface coatings in large animal models and meta-analysis on tricalcium phosphate and hydroxyapatite on periimplant bone formation

The aim of the present systematic review was to analyse studies using inorganic implant coatings and, in a meta‐analysis, the effect of specifically tricalcium phosphate (TCP) and hydroxyapatite (HA) implant surface coatings on bone formation according to the PRISMA criteria. Inclusion criteria were the comparison to rough surfaced titanium implants in large animal studies at different time points of healing. Forty studies met the inclusion criteria for the systematic review. Fifteen of these analyzed the bone‐to‐implant contact (BIC) around the most investigated inorganic titanium implant coatings, namely TCP and HA, and were included in the meta‐analysis. The results of the TCP group show after 14 days a BIC being 3.48% points lower compared with the reference surface. This difference in BIC decreases to 0.85% points after 21–28 days. After 42–84 days, the difference in BIC of 13.79% points is in favor of the TCP‐coatings. However, the results are not statistically significant, in part due to the fact that the variability between the studies increased over time. The results of the HA group show a significant difference in mean BIC of 6.94% points after 14 days in favor of the reference surface. After 21–28 days and 42–84 days the difference in BIC is slightly in favor of the test group with 1.53% points and 1.57% points, respectively, lacking significance. In large animals, there does not seem to be much effect of TCP‐coated or HA‐coated implants over uncoated rough titanium implants in the short term.

Multilayered coating of titanium implants promotes coupled osteogenesis and angiogenesis in vitro and in vivo

We used surface-modified titanium (Ti) substrates with a multilayered structure composed of chitosan-catechol (Chi-C), gelatin (Gel) and hydroxyapatite (HA) nanofibers, which were previously shown to improve osteogenesis, as a platform to investigate the interaction of osteogenesis and angiogenesis during bone healing. Combined techniques of Transwell co-culture, wound healing assay, enzyme linked immunosorbent assay (ELISA), quantitative real-time polymerase chain reaction (qRT-PCR), western blotting and immunohistochemical staining were used to evaluate adhesion, morphology and migration of adipose-derived mesenchymal stem cells (Ad-MSCs) and human umbilical vein endothelial cells (HUVECs) grown on different Ti substrates. We investigated the effect of substrates on the osteogenic differentiation of Ad-MSCs and reciprocal paracrine effects of Ad-MSCs on HUVECs or vice versa. The multilayered Ti substrates directly regulated the cellular functions of Ad-MSCs and angiogenic HUVECs and mediated communication between them by enhancing paracrine effects via cell-matrix interactions in vitro. The in vivo results showed that the change of microenvironment induced by surface-modified Ti implants promoted the adhesion, recruitment and proliferation of MSCs and facilitated coupled osteogenesis and angiogenesis in bone healing. The study proved that multilayer-film-coated Ti substrates positively mediated cellular biological function in vitro and improved bone healing in vivo.

STATEMENT OF SIGNIFICANCE

Recent studies have revealed that osteogenesis and angiogenesis are coupled, and that communication between osteoblasts and endothelial cells is essential for bone healing and remodeling processes; however, these conclusions only result from in vitro studies or in vivo studies using transgenic murine models. Relatively little is known about the communication between osteoblasts and endothelial cells in peri-implants during bone healing processes. Our results revealed the cellular/molecular mechanism of how multilayered Ti substrates mediate reciprocal paracrine effects between adipose-derived mesenchymal stem cells and human umbilical vein endothelial cells; moreover, the interactions between the cell-matrix and peri-implant was proven in vivo with enhanced bone healing. This study contributes to our understanding of the fundamental mechanisms of angiogenesis and osteogenesis that affect peri-implantation, and thus, provides new insights into the design of future high-quality orthopedic implants.

Comparing the effect of strontium-functionalized and fluoride-modified surfaces on early osseointegration

BACKGROUND

Studies have shown that medical devices comprising strontium contribute to bone healing and osseointegration. The aim of this study was to evaluate the in vivo performance of surface-functionalized implants (Ti-Sr-O) showing predictable release characteristics of strontium and compare it to performance a commercially available fluoride-modified surface.

METHODS

Ti-Sr-O functionalized, fluoride-modified,  Grade 4 titanium implants were inserted in the femoral condyle of adult male New Zealand white rabbits. Atomic absorption spectrometry (AAS) was utilized to monitor strontium blood serum levels. Two weeks after insertion, histomorphometric evaluation was performed with respect to bone-to-implant contact (BIC%) and bone formation (BF%) using defined regions of interest.

RESULTS

Mean values for BIC% showed a comparable degree of osseointegration for Ti-Sr-O and the fluoride-modified surface, while BF% revealed a significant difference in increased BF with Ti-Sr-O. AAS measurements did not indicate any influence of the Ti-Sr-O modified implants on the strontium blood serum concentrations.

CONCLUSIONS

Within the limitations of this study, it was shown that the Ti-Sr-O coating, with sustained release characteristics of strontium, enhanced bone apposition and, thus, could find practical applications, e.g., within the field of medical implantology.