Selective cell affinity of biomimetic micro-nano-hybrid structured TiO2 overcomes the biological dilemma of osteoblasts

Beyond microroughness: novel approaches to navigate osteoblast activity on implant surfaces

Considering the biological activity of osteoblasts is crucial when devising new approaches to enhance the osseointegration of implant surfaces, as their behavior profoundly influences clinical outcomes. An established inverse correlation exists between osteoblast proliferation and their functional differentiation, which constrains the rapid generation of a significant amount of bone. Examining the surface morphology of implants reveals that roughened titanium surfaces facilitate rapid but thin bone formation, whereas smooth, machined surfaces promote greater volumes of bone formation albeit at a slower pace. Consequently, osteoblasts differentiate faster on roughened surfaces but at the expense of proliferation speed. Moreover, the attachment and initial spreading behavior of osteoblasts are notably compromised on microrough surfaces. This review delves into our current understanding and recent advances in nanonodular texturing, meso-scale texturing, and UV photofunctionalization as potential strategies to address the "biological dilemma" of osteoblast kinetics, aiming to improve the quality and quantity of osseointegration. We discuss how these topographical and physicochemical strategies effectively mitigate and even overcome the dichotomy of osteoblast behavior and the biological challenges posed by microrough surfaces. Indeed, surfaces modified with these strategies exhibit enhanced recruitment, attachment, spread, and proliferation of osteoblasts compared to smooth surfaces, while maintaining or amplifying the inherent advantage of cell differentiation. These technology platforms suggest promising avenues for the development of future implants.

Nanofeatured surfaces in dental implants: contemporary insights and impending challenges

Dental implant therapy, established as standard-of-care nearly three decades ago with the advent of microrough titanium surfaces, revolutionized clinical outcomes through enhanced osseointegration. However, despite this pivotal advancement, challenges persist, including prolonged healing times, restricted clinical indications, plateauing success rates, and a notable incidence of peri-implantitis. This review explores the biological merits and constraints of microrough surfaces and evaluates the current landscape of nanofeatured dental implant surfaces, aiming to illuminate strategies for addressing existing impediments in implant therapy. Currently available nanofeatured dental implants incorporated nano-structures onto their predecessor microrough surfaces. While nanofeature integration into microrough surfaces demonstrates potential for enhancing early-stage osseointegration, it falls short of surpassing its predecessors in terms of osseointegration capacity. This discrepancy may be attributed, in part, to the inherent "dichotomy kinetics" of osteoblasts, wherein increased surface roughness by nanofeatures enhances osteoblast differentiation but concomitantly impedes cell attachment and proliferation. We also showcase a controllable, hybrid micro-nano titanium model surface and contrast it with commercially-available nanofeatured surfaces. Unlike the commercial nanofeatured surfaces, the controllable micro-nano hybrid surface exhibits superior potential for enhancing both cell differentiation and proliferation. Hence, present nanofeatured dental implants represent an evolutionary step from conventional microrough implants, yet they presently lack transformative capacity to surmount existing limitations. Further research and development endeavors are imperative to devise optimized surfaces rooted in fundamental science, thereby propelling technological progress in the field.

Optimizing implant osseointegration, soft tissue responses, and bacterial inhibition: A comprehensive narrative review on the multifaceted approach of the UV photofunctionalization of titanium

Titanium implants have revolutionized restorative and reconstructive therapy, yet achieving optimal osseointegration and ensuring long-term implant success remain persistent challenges. In this review, we explore a cutting-edge approach to enhancing implant properties: ultraviolet (UV) photofunctionalization. By harnessing UV energy, photofunctionalization rejuvenates aging implants, leveraging and often surpassing the intrinsic potential of titanium materials. The primary aim of this narrative review is to offer an updated perspective on the advancements made in the field, providing a comprehensive overview of recent findings and exploring the relationship between UV-induced physicochemical alterations and cellular responses. There is now compelling evidence of significant transformations in titanium surface chemistry induced by photofunctionalization, transitioning from hydrocarbon-rich to carbon pellicle-free surfaces, generating superhydrophilic surfaces, and modulating the electrostatic properties. These changes are closely associated with improved cellular attachment, spreading, proliferation, differentiation, and, ultimately, osseointegration. Additionally, we discuss clinical studies demonstrating the efficacy of UV photofunctionalization in accelerating and enhancing the osseointegration of dental implants. Furthermore, we delve into recent advancements, including the development of one-minute vacuum UV (VUV) photofunctionalization, which addresses the limitations of conventional UV methods as well as the newly discovered functions of photofunctionalization in modulating soft tissue and bacterial interfaces. By elucidating the intricate relationship between surface science and biology, this body of research lays the groundwork for innovative strategies aimed at enhancing the clinical performance of titanium implants, marking a new era in implantology.

The Effects of a Biomimetic Hybrid Meso- and Nano-Scale Surface Topography on Blood and Protein Recruitment in a Computational Fluid Dynamics Implant Model

The mechanisms underlying bone-implant integration, or osseointegration, are still incompletely understood, in particular how blood and proteins are recruited to implant surfaces. The objective of this study was to visualize and quantify the flow of blood and the model protein fibrinogen using a computational fluid dynamics (CFD) implant model. Implants with screws were designed with three different surface topographies: (1) amorphous, (2) nano-trabecular, and (3) hybrid meso-spikes and nano-trabeculae. The implant with nano-topography recruited more blood and fibrinogen to the implant interface than the amorphous implant. Implants with hybrid topography further increased recruitment, with particularly efficient recruitment from the thread area to the interface. Blood movement significantly slowed at the implant interface compared with the thread area for all implants. The blood velocity at the interface was 3- and 4-fold lower for the hybrid topography compared with the nano-topography and amorphous surfaces, respectively. Thus, this study for the first time provides insights into how different implant surfaces regulate blood dynamics and the potential advantages of surface texturization in blood and protein recruitment and retention. In particular, co-texturization with a hybrid meso- and nano-topography created the most favorable microenvironment. The established CFD model is simple, low-cost, and expected to be useful for a wide range of studies designing and optimizing implants at the macro and micro levels.

Impact of nano-scale trabecula size on osteoblastic behavior and function in a meso-nano hybrid rough biomimetic zirconia model

PURPOSE

A novel implant model consisting of meso-scale cactus-inspired spikes and nano-scale bone-inspired trabeculae was recently developed to optimize meso-scale roughness on zirconia. In this model, the meso-spike dimension had a significant impact on osteoblast function. To explore how different nano-textures impact this model, here we examined the effect of different nano-trabecula sizes on osteoblast function while maintaining the same meso-spike conformation.

METHODS

Zirconia disks with meso-nano hybrid surfaces were created by laser etching. The meso-spikes were fixed to 40 μm high, whereas the nano-texture was etched as large and small trabeculae of average Feret diameter 237.0 and 134.1 nm, respectively. A polished surface was also prepared. Rat bone marrow-derived and human mesenchymal stromal cell-induced osteoblasts were cultured on these disks.

RESULTS

Hybrid rough surfaces, regardless of nano-trabecula dimension, robustly promoted the osteoblastic differentiation of both rat and human osteoblasts compared to those on polished surfaces. Hybrid surfaces with small nano-trabeculae further enhanced osteoblastic differentiation compared with large nano-trabeculae. However, the difference in osteoblastic differentiation between small and large nano-trabeculae was much smaller than the difference between the polished and hybrid rough surfaces. The nano-trabecula size did not influence osteoblast attachment and proliferation, or protein adsorption. Both hybrid surfaces were hydro-repellent. The atomic percentage of surface carbon was lower on the hybrid surface with small nano-trabeculae.

CONCLUSIONS

Small nano-trabeculae promoted osteoblastic differentiation more than large nano-trabeculae when combined with meso-scale spikes. However, the biological impact of different nano-trabeculae was relatively small compared with that of different dimensions of meso-spikes.

A Novel Cell Delivery System Exploiting Synergy between Fresh Titanium and Fibronectin

Delivering and retaining cells in areas of interest is an ongoing challenge in tissue engineering. Here we introduce a novel approach to fabricate osteoblast-loaded titanium suitable for cell delivery for bone integration, regeneration, and engineering. We hypothesized that titanium age influences the efficiency of protein adsorption and cell loading onto titanium surfaces. Fresh (newly machined) and 1-month-old (aged) commercial grade 4 titanium disks were prepared. Fresh titanium surfaces were hydrophilic, whereas aged surfaces were hydrophobic. Twice the amount of type 1 collagen and fibronectin adsorbed to fresh titanium surfaces than aged titanium surfaces after a short incubation period of three hours, and 2.5-times more fibronectin than collagen adsorbed regardless of titanium age. Rat bone marrow-derived osteoblasts were incubated on protein-adsorbed titanium surfaces for three hours, and osteoblast loading was most efficient on fresh titanium adsorbed with fibronectin. The number of osteoblasts loaded using this synergy between fresh titanium and fibronectin was nine times greater than that on aged titanium with no protein adsorption. The loaded cells were confirmed to be firmly attached and functional. The number of loaded cells was strongly correlated with the amount of protein adsorbed regardless of the protein type, with fibronectin simply more efficiently adsorbed on titanium surfaces than collagen. The role of surface hydrophilicity of fresh titanium surfaces in increasing protein adsorption or cell loading was unclear. The hydrophilicity of protein-adsorbed titanium increased with the amount of protein but was not the primary determinant of cell loading. In conclusion, the osteoblast loading efficiency was dependent on the age of the titanium and the amount of protein adsorption. In addition, the efficiency of protein adsorption was specific to the protein, with fibronectin being much more efficient than collagen. This is a novel strategy to effectively deliver osteoblasts ex vivo and in vivo using titanium as a vehicle.

Ultraviolet Treatment of Titanium to Enhance Adhesion and Retention of Oral Mucosa Connective Tissue and Fibroblasts

Peri-implantitis is an unsolved but critical problem with dental implants. It is postulated that creating a seal of gingival soft tissue around the implant neck is key to preventing peri-implantitis. The objective of this study was to determine the effect of UV surface treatment of titanium disks on the adhesion strength and retention time of oral connective tissues as well as on the adherence of mucosal fibroblasts. Titanium disks with a smooth machined surface were prepared and treated with UV light for 15 min. Keratinized mucosal tissue sections (3 × 3 mm) from rat palates were incubated for 24 h on the titanium disks. The adhered tissue sections were then mechanically detached by agitating the culture dishes. The tissue sections remained adherent for significantly longer (15.5 h) on the UV-treated disks than on the untreated control disks (7.5 h). A total of 94% of the tissue sections were adherent for 5 h or longer on the UV-treated disks, whereas only 50% of the sections remained on the control disks for 5 h. The adhesion strength of the tissue sections to the titanium disks, as measured by tensile testing, was six times greater after UV treatment. In the culture studies, mucosal fibroblasts extracted from rat palates were attached to titanium disks by incubating for 24, 48, or 96 h. The number of attached cells was consistently 15–30% greater on the UV-treated disks than on the control disks. The cells were then subjected to mechanical or chemical (trypsinization) detachment. After mechanical detachment, the residual cell rates on the UV-treated surfaces after 24 and 48 h of incubation were 35% and 25% higher, respectively, than those on the control surfaces. The remaining rate after chemical detachment was 74% on the control surface and 88% on the UV-treated surface for the cells cultured for 48 h. These trends were also confirmed in mouse embryonic fibroblasts, with an intense expression of vinculin, a focal adhesion protein, on the UV-treated disks even after detachment. The UV-treated titanium was superhydrophilic, whereas the control titanium was hydrophobic. X-ray photoelectron spectroscopy (XPS) chemical analysis revealed that the amount of carbon at the surface was significantly reduced after UV treatment, while the amount of TiOH molecules was increased. These ex vivo and in vitro results indicate that the UV treatment of titanium increases the adhesion and retention of oral mucosa connective tissue as a result of increased resistance of constituent fibroblasts against exogenous detachment, both mechanically and chemically, as well as UV-induced physicochemical changes of the titanium surface.

Osteoblast Attachment Compromised by High and Low Temperature of Titanium and Its Restoration by UV Photofunctionalization

Titanium implants undergo temperature fluctuations during manufacturing, transport, and storage. However, it is unknown how this affects their bioactivity. Herein, we explored how storage (six months, dark conditions) and temperature fluctuations (5-50 °C) affected the bioactivity of titanium implants. Stored and fresh acid-etched titanium disks were exposed to different temperatures for 30 min under wet or dry conditions, and their hydrophilicity/hydrophobicity and bioactivity (using osteoblasts derived from rat bone marrow) were evaluated. Ultraviolet (UV) treatment was evaluated as a method of restoring the bioactivity. The fresh samples were superhydrophilic after holding at 5 or 25 °C under wet or dry conditions, and hydrophilic after holding at 50 °C. In contrast, all the stored samples were hydrophobic. For both fresh and stored samples, exposure to 5 or 50 °C reduced osteoblast attachment compared to holding at 25 °C under both wet and dry conditions. Regression analysis indicated that holding at 31 °C would maximize cell attachment (p < 0.05). After UV treatment, cell attachment was the same or better than that before temperature fluctuations. Overall, titanium surfaces may have lower bioactivity when the temperature fluctuates by ≥20 °C (particularly toward lower temperatures), independent of the hydrophilicity/hydrophobicity. UV treatment was effective in restoring the temperature-compromised bioactivity.

Biomimetic Zirconia with Cactus-Inspired Meso-Scale Spikes and Nano-Trabeculae for Enhanced Bone Integration

Biomimetic design provides novel opportunities for enhancing and functionalizing biomaterials. Here we created a zirconia surface with cactus-inspired meso-scale spikes and bone-inspired nano-scale trabecular architecture and examined its biological activity in bone generation and integration. Crisscrossing laser etching successfully engraved 60 μm wide, cactus-inspired spikes on yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) with 200–300 nm trabecular bone-inspired interwoven structures on the entire surface. The height of the spikes was varied from 20 to 80 μm for optimization. Average roughness (Sa) increased from 0.10 μm (polished smooth surface) to 18.14 μm (80 μm-high spikes), while the surface area increased by up to 4.43 times. The measured dimensions of the spikes almost perfectly correlated with their estimated dimensions (R² = 0.998). The dimensional error of forming the architecture was 1% as a coefficient of variation. Bone marrow-derived osteoblasts were cultured on a polished surface and on meso- and nano-scale hybrid textured surfaces with different spike heights. The osteoblastic differentiation was significantly promoted on the hybrid-textured surfaces compared with the polished surface, and among them the hybrid-textured surface with 40 μm-high spikes showed unparalleled performance. In vivo bone-implant integration also peaked when the hybrid-textured surface had 40 μm-high spikes. The relationships between the spike height and measures of osteoblast differentiation and the strength of bone and implant integration were non-linear. The controllable creation of meso- and nano-scale hybrid biomimetic surfaces established in this study may provide a novel technological platform and design strategy for future development of biomaterial surfaces to improve bone integration and regeneration.

The toxicity of SiO2 NPs on cell proliferation and cellular uptake of human lung fibroblastic cell line during the variation of calcination temperature and its modeling by artificial neural network

Less attention had been paid to cell toxicity of the various synthesis methods of nanoparticles, this study investigated the effect of the calcination temperature(CT) on the crystallization of SiO2 nanoparticles(NPs), cell proliferation(CP), and cellular uptake(CU) in MRC-5. In this study, parameters were adjusted as CT(70-1000 °C), calcination time(2, 12, and 24 h), and catalyst feed rate(0.01, 0.05, and 0.1 mL.min1). CP was determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) test after a 24-h exposure. The CU was achieved using ICP-MS. Results were analyzed using MATLAB2018. Results revealed that the size of synthesized particles was lower than 50 nm and, the XRD peak varied from 21 to 30° during the increase in CT. FTIR spectra confirmed the existence of Si-O and Si-Cl bonds. The maximum level of crystallization was at 1000 °C. CP decreased with the rise in the concentration of NPs(p < 0.05), as well as an increase in feed rate. A positive relationship between increased crystallization and decreased CP(R = 0.78) was seen, while such a trend was not observed in calcination time. The suggested structure in this study was 4:10:1 with Rall = 0.97, Rtest = 0.97, RMSE = 0.25, and MSE = 0.003. Furthermore, the CU rate increased with the rise in CT and calcination time. The maximum and minimum CU levels were related to NPs calcinated in 1000 °C-24 h and 350 °C-2 h, respectively. As a consequence, the most toxicity of SiO2 NPs was related to the crystalline NP. Therefore, the increase in CT and the calcination time were significant factors affecting on crystallization of SiO2 NPs, CP of lung cell, as well as CU of SiO2.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40201-021-00663-4.

Laser Ablated Periodic Nanostructures on Titanium and Steel Implants Influence Adhesion and Osteogenic Differentiation of Mesenchymal Stem Cells

Metal implants used in trauma surgeries are sometimes difficult to remove after the completion of the healing process due to the strong integration with the bone tissue. Periodic surface micro- and nanostructures can directly influence cell adhesion and differentiation on metallic implant materials. However, the fabrication of such structures with classical lithographic methods is too slow and cost-intensive to be of practical relevance. Therefore, we used laser beam interference ablation structuring to systematically generate periodic nanostructures on titanium and steel plates. The newly developed laser process uses a special grating interferometer in combination with an industrial laser scanner and ultrashort pulse laser source, allowing for fast, precise, and cost-effective modification of metal surfaces in a single step process. A total of 30 different periodic topologies reaching from linear over crossed to complex crossed nanostructures with varying depths were generated on steel and titanium plates and tested in bone cell culture. Reduced cell adhesion was found for four different structure types, while cell morphology was influenced by two different structures. Furthermore, we observed impaired osteogenic differentiation for three structures, indicating reduced bone formation around the implant. This efficient way of surface structuring in combination with new insights about its influence on bone cells could lead to newly designed implant surfaces for trauma surgeries with reduced adhesion, resulting in faster removal times, reduced operation times, and reduced complication rates.

A Newly Created Meso-, Micro-, and Nano-Scale Rough Titanium Surface Promotes Bone-Implant Integration

Titanium implants are the standard therapeutic option when restoring missing teeth and reconstructing fractured and/or diseased bone. However, in the 30 years since the advent of micro-rough surfaces, titanium’s ability to integrate with bone has not improved significantly. We developed a method to create a unique titanium surface with distinct roughness features at meso-, micro-, and nano-scales. We sought to determine the biological ability of the surface and optimize it for better osseointegration. Commercially pure titanium was acid-etched with sulfuric acid at different temperatures (120, 130, 140, and 150 °C). Although only the typical micro-scale compartmental structure was formed during acid-etching at 120 and 130 °C, meso-scale spikes (20–50 μm wide) and nano-scale polymorphic structures as well as micro-scale compartmental structures formed exclusively at 140 and 150 °C. The average surface roughness (Ra) of the three-scale rough surface was 6–12 times greater than that with micro-roughness only, and did not compromise the initial attachment and spreading of osteoblasts despite its considerably increased surface roughness. The new surface promoted osteoblast differentiation and in vivo osseointegration significantly; regression analysis between osteoconductivity and surface variables revealed these effects were highly correlated with the size and density of meso-scale spikes. The overall strength of osseointegration was the greatest when the acid-etching was performed at 140 °C. Thus, we demonstrated that our meso-, micro-, and nano-scale rough titanium surface generates substantially increased osteoconductive and osseointegrative ability over the well-established micro-rough titanium surface. This novel surface is expected to be utilized in dental and various types of orthopedic surgical implants, as well as titanium-based bone engineering scaffolds.

Disproportionate Effect of Sub-Micron Topography on Osteoconductive Capability of Titanium

Titanium micro-scale topography offers excellent osteoconductivity and bone-implant integration. However, the biological effects of sub-micron topography are unknown. We compared osteoblastic phenotypes and in vivo bone and implant integration abilities between titanium surfaces with micro- (1-5 µm) and sub-micro-scale (0.1-0.5 µm) compartmental structures and machined titanium. The calculated average roughness was 12.5 ± 0.65, 123 ± 6.15, and 24 ± 1.2 nm for machined, micro-rough, and sub-micro-rough surfaces, respectively. In culture studies using bone marrow-derived osteoblasts, the micro-rough surface showed the lowest proliferation and fewest cells attaching during the initial stage. Calcium deposition and expression of osteoblastic genes were highest on the sub-micro-rough surface. The bone-implant integration in the Sprague-Dawley male rat femur model was the strongest on the micro-rough surface. Thus, the biological effects of titanium surfaces are not necessarily proportional to the degree of roughness in osteoblastic cultures or in vivo. Sub-micro-rough titanium ameliorates the disadvantage of micro-rough titanium by restoring cell attachment and proliferation. However, bone integration and the ability to retain cells are compromised due to its lower interfacial mechanical locking. This is the first report on sub-micron topography on a titanium surface promoting osteoblast function with minimal osseointegration.

Rapid nano-scale surface modification on micro-arc oxidation coated titanium by microwave-assisted hydrothermal process

Nano to submicron scaled surface possesses excellent biological affinity and several processes have been undertaken to develop titanium implant with specific surface chemical and phase composition and nano-scale features. A simple process was used to modify the nano topographies on a micro-arc-oxidation (MAO) surface which shortens the time for the conventional hydrothermal process (HT). Nano-scaled anatase precipitates on the MAO surface with different crystallinities and morphologies were regulated via microwave-assisted hydrothermal in pure water (MWDD) or in pH conditioned mediums containing calcium and phosphorus ions (MWCP, MWCP9, MWCP11). The surface morphologies and structures were investigated by SEM, XRD, FTIR, and TEM. Anatase crystals as nano-spikes along [001] direction were observed on the surface of the MWDD and MWCP groups. Increasing the pH of the conditioned medium leads the precipitate to lose its crystallinity; the surface of MWCP11 is covered with amorphous anatase which has a 3D nano-sheet architecture. The MW treated surfaces possess superior hydrophilicity can adsorb more proteins (fibronectin and bovine serum albumin), and the osteoblasts-like MG63 cells on these surfaces have higher spreading ratios than on the MAO and HT groups. The cell viabilities in the MW groups were significantly higher than in the MAO and HT groups on the 7th day (P < 0.05), although their cell viabilities were similar on the first day. MWCP and MWCP11 have higher alkaline phosphatase activity on days 7 and 14 compared to other groups (P < 0.05). The MW treatment produces different nanomorphologies on the MAO surface and retains the original micro/submicron pores and surface calcium and phosphorus contents, thus it is expected to promote osseointegration without compromising the bond strength.

Micro/nano hierarchical structured titanium treated by NH4OH/H2O2 for enhancing cell response

In this paper, two kinds of titanium surfaces with novel micro/nano hierarchical structures, namely Etched (E) surface and Sandblast and etched (SE) surface, were successfully fabricated by NH4OH and H2O2 mixture. And their cellular responses of MG63 were investigated compared with Sandblast and acid-etching (SLA) surface. Scanning electron microscope (SEM), Surface profiler, X-ray photoelectron spectroscopy (XPS), and Contact angle instrument were employed to assess the surface morphologies, roughness, chemistry and wettability respectively. Hierarchical structures with micro holes of 10-30 μm in diameter and nano pits of tens of nanometers in diameter formed on both E and SE surfaces. The size of micro holes is very close to osteoblast cell, which makes them wonderful beds for osteoblast. Moreover, these two kinds of surfaces possess similar roughness and superior hydrophilicity to SLA. Reactive oxygen species were detected on E and SE surface, and thus considerable antimicrobial performance and well fixation can be speculated on them. The cell experiments also demonstrated a boost in cell attachment, and that proliferation and osteogenic differentiation were achieved on them, especially on SE surface. The results indicate that the treatment of pure titanium with H2O2/NH4OH is an effective technique to improve the initial stability of implants and enhance the osseointegration, which may be a promising surface treatment to titanium implant.

3D bioprinting of GelMA scaffolds triggers mineral deposition by primary human osteoblasts

Due to its relatively low level of antigenicity and high durability, titanium has successfully been used as the major material for biological implants. However, because the typical interface between titanium and tissue precludes adequate transmission of load into the surrounding bone, over time, load-bearing implants tend to loosen and revision surgeries are required. Osseointegration of titanium implants requires presentation of both biological and mechanical cues that promote attachment of and trigger mineral deposition by osteoblasts. While many factors contribute to differentiation, the relative importance of the various cues is unclear. To substantially improve osseointegration of titanium implants, we generated a gelatin methacryloyl (GelMA) scaffold, using an extrusion-based 3D bioprinter, which can be directly printed on and grafted to the titanium implant surface. We demonstrate that this scaffold is able to trigger mineral deposition of both MG63 osteoblasts and primary normal human osteoblasts in the absence of any exogenous osteogenic factors. Films of the same formulation failed to promote mineral deposition suggesting that the three dimensional scaffold was able to tip the balance in favor of differentiation despite other potentially unfavorable differentiation cues of the material. We further show that these GelMA lattices can be directly grafted to titanium alloy and are secure in vitro over a period of seven weeks. When grafted within a groove system, the GelMA hydrogel is protected from shearing forces in a marrow implantation model. This prepares the way for osteogenic coatings to be directly manufactured on the implant surface and packaged for surgery.

The response of osteoblastic MC3T3-E1 cells to micro- and nano-textured, hydrophilic and bioactive titanium surfaces

The aim of the present work was to investigate the morphology and activity of the murine osteoblastic cell line MC3T3 on control smooth (Machined), commercially available rough (ZT) titanium discs, and on titanium samples obtained by modifying the ZT treatment protocol, and herein labelled as ZTF, ZTM and ZTFM. Cells were evaluated at SEM and immunofluorescence for morphology and cell-to-cell interactions and by MTT assay and real time PCR for cell growth and function. Microscopy showed that ZT modified protocols could differently affect cell shape and distribution. All the tested surfaces showed good biocompatibility by viability assay. However, cells on smoother surfaces appeared to express higher levels of transcript for Collagen 1a1, the main component of extracellular matrix, by real time PCR. Expression of the early differentiation marker Alkaline Phosphatase was higher on ZTF surfaces and ZTM enhanced the expression of later osteoblastic markers Osteoprotegerin and Osteocalcin. Noteworthy, the expression of Connexin 43, a component of cell-to-cell contacts and hemichannels, followed a similar pattern to differentiation marker genes and was higher in cells on ZTM surfaces, consistently with the microscopic observation of cell clusters. Taken together, this data showed that ZTF and ZTM treatment protocols appeared to improve the basal sand-blasting/acid-etching ZT procedure with ZTM surfaces promoting the most mature stage of differentiation.

Osseointegration of titanium implants with SLAffinity treatment: a histological and biomechanical study in miniature pigs

PURPOSE

Electrochemical oxidation following sandblasting and acid-etching (SLA) treatment has received interest as a surface modification procedure for titanium (Ti) implants (denoted as an SLAffinity surface); however, little information is available on its impacts on the in vivo performance of SLAffinity-Ti implants. The present study evaluated the osseointegration and biomechanical bone-tissue response to SLAffinity-Ti implants with micro- and nanoporous oxide layers.

MATERIALS AND METHODS

The interaction between blood and the tested implants was examined. In total, 144 implants with the following surfaces were used: a standard machined (M-Ti), an SLA-Ti, and an SLAffinity-Ti surface. For each animal, four implants (one M-Ti, one SLA-Ti, and two SLAffinity-Ti) were inserted into the mandibular canine-premolar area for histomorphometric observations and another four implants were inserted into the flat surface on the anteromedial aspect of the rear tibia for removal torque (RT) tests. After 2, 4, and 8 weeks of implantation, histomorphometric and RT tests were conducted.

RESULTS

Interactions between blood and implants were better for implants with the SLAffinity-Ti surface. RT tests showed a significant improvement in fixation strength for SLAffinity-Ti implants (84.5 ± 8.7 N-cm) after 8 weeks compared to M-Ti (62.95 ± 11.5 N-cm) and SLAffinity-Ti (76.1 ± 6.6 N-cm) implants. A histological evaluation showed that osseous integration had occurred with all implants after 8 weeks. SLAffinity-Ti implants exhibited 28.5 ± 6.2 % bone-to-implant contact (BIC) at 2 weeks and 84.3 ± 8.1 % at 8 weeks. M-Ti implants exhibited BIC levels of 17.0 ± 5.4 and 76.5 ± 6.3 %, whereas SLA-Ti implants exhibited BIC levels of 28.5 ± 6.2 and 81.1 ± 8.4 % at corresponding time intervals. In terms of the peri-implant bone area (BA), values for SLAffinity-Ti implants ranged from 29.5 ± 4.1 to 88.3 ± 3.0 %. For M-Ti implants, values ranged from 20.3 ± 5.5 to 81.7 ± 4.2 %. For SLA-Ti implants, values ranged from 23.0 ± 3.5 to 84.0 ± 3.6 %.

CONCLUSIONS

Electrochemical oxidation increased the oxide layers and improved the blood interaction with SLAffinity-Ti implants, resulting in significantly higher bone apposition with the SLAffinity-Ti implants after 2 and 8 weeks of healing. An increase in resistance for the RT of SLAffinity-Ti implants over the 8-week healing period was also observed.

CLINICAL RELEVANCE

The use of SLAffinity-Ti implants has potential for improvement of early osseointegration.

Effect of Octacalcium-Phosphate-Modified Micro/Nanostructured Titania Surfaces on Osteoblast Response

Surface structures and properties of titanium implants play a vital role in successful bone replacement. To mimic the natural bone structure, some strategies have recently focused on the preparation of multiscaled morphology on medical titanium and shown some promising results; however, relatively few efforts have been made for further enhancing the biocompatibility of such a hierarchical hybrid structure without compromising the superior bioactivity of the starting micro/nano roughness. In this study, a thin ribbonlike octacalcium phosphate (OCP) coating was electrodeposited on a hierarchically structured titania surface, maintaining its micro/nanospongelike morphology. It is indicated that the micro/nanostructured surface with deposited OCP showed an improved biomineralization ability, in comparison to that without OCP modification, when immersed in simulated body fluid (SBF). Further evaluations of cellular activities demonstrated that the introduction of OCP to the micro/nano spongelike-structured surface remarkably enhanced MC3T3-E1 cell proliferation, alkaline phosphatase activity, and extracellular matrix mineralization compared to that of cells on the micro/nanospongelike titania surface during 14 days of culturing. Meanwhile, the OCP-deposited micro/nanostructured surface displayed much a smaller passive current density and lower current response to the applied potential, resulting in the improvement of corrosion resistance. All of the evaluations suggested that the modification of the OCP coating on the prepared micro/nanospongelike titania is of superior chemical stability, biomineralization, and osteoblast activities, which indicates a favorable implant microenvironment for osseointegration in vivo.

MULTIFUNCTIONAL TITANIUM: SURFACE MODIFICATION PROCESS AND BIOLOGICAL RESPONSE

A proper stimulation of the cell activity is the last request to the new biomaterials, intended for bone substitution and osseointegration. In this regard, the scientific literature suggests that the surface modification on a nanoscale is a major source of innovation. The nano features and multiscale topographies can stimulate cell differentiation and activity. Moreover, the presence of specific biological molecules grafted onto the biosurfaces can properly stimulate cells to tissue regeneration. The final aim is to promote a fast and physiological bone healing, at the implant site. In order to be suitable for implantation, the modified surfaces must sustain the implantation and working load/friction without damages. Two different innovative surface modifications of the Ti6Al4V alloy were tested in this research. The first one is an inorganic modification and it is aimed at inducing in vivo apatite precipitation (inorganic bioactivity) and cell interaction through nano features. The modified surface shows a complex topography (micro and nanoroughness), a modified surface chemistry (high density of hydroxyls groups), high wettability and protein absorption. Moreover, an additional biological modification by grafting of alkaline phosphatase (ALP) was tested. The modified surfaces were compared with the traditional polished and blasted ones, in terms of osteoblast adhesion, proliferation and morphology. A significant increase in the cell proliferation rate was observed on the modified materials. Moreover, the osteoblasts showed a more differentiated aspect and filopodia exploring the nanotextures on both the treated materials.

Micro-topography and reactivity of implant surfaces: an in vitro study in simulated body fluid (SBF)

The creation of micro-textured dental implant surfaces possessing a stimulating activity represents a challenge in implant dentistry; particularly, the formation of a thin, biologically active, calcium-phosphate layer on their surface could help to strengthen the bond to the surrounding bone. The aim of the present study was to characterize in terms of macrostructure, micro-topography and reactivity in simulated body fluid (SBF), the surface of titanium (Ti) implants blasted with TiO2 particles, acid etched with hydrofluoric acid, and activated with Ca and Mg-containing nanoparticles. Sandblasted and acid-etched implants were analyzed by ESEM-EDX (environmental scanning electron microscope with energy dispersive X-ray system) to study the micromorphology of the surface and to perform elemental X-ray microanalysis (microchemical analyses) and element mapping. ESEM-EDX analyses were performed at time 0 and after a 28-day soaking period in SBF Hank's balanced salt solution (HBSS) following ISO 23317 (implants for surgery—in vitro evaluation for apatite-forming ability of implant materials). Microchemical analyses (weight % and atomic %) and element mapping were carried out to evaluate the relative element content, element distribution, and calcium/phosphorus (Ca/P) atomic ratio. Raman spectroscopy was used to assess the possible presence of impurities due to manufacturing and to investigate the phases formed upon HBSS soaking. Micro-morphological analyses showed a micro-textured, highly rough surface with microgrooves. Microchemical analyses showed compositional differences among the apical, middle, and distal thirds. The micro-Raman analyses of the as-received implant showed the presence of amorphous Ti oxide and traces of anatase, calcite, and a carbonaceous material derived from the decomposition of an organic component of lipidic nature (presumably used as lubricant). A uniform layer of Ca-poor calcium phosphates (CaPs) (Ca/P ratio <1.47) was observed after soaking in HBSS; the detection of the 961 cm⁻¹ Raman band confirms this finding. These implants showed a micro-textured surface supporting the formation of CaPs when immersed in SBF. These properties may likely favor bone anchorage and healing by stimulation of mineralizing cells.

Titanium surfaces with nanostructures influence on osteoblasts proliferation: a systematic review

Objectives

Nanothechnology found to be increasingly implemented in implantology sphere over the recent years and it shows encouraging effect in this field. The aim of present review is to compare, based on the recent evidence, the influence of various nanostructure surface modifications of titanium for implants, on osteoblasts proliferation.

Material and Methods

A literature review of English articles was conducted by using MEDLINE database restricted to 2009 - 2014 and constructed according PRISMA guidelines. Search terms included “Titanium implant”, “Titanium surface with nanostructure”, “Osteoblast”. Additional studies were identified in bibliographies. Only in vitro and/or in vivo studies on nano structured implant surfaces plus control sample, with specific evaluation method for osteoblasts proliferation and at least one Ti sample with nanostructure, were included in the review.

Results

32 studies with 122 groups of examined samples were selected for present review. Each study conducted in vitro experiment, two studies conducted additional in vivo experiments. All studies were dispensed by type of surface modification into two major groups; “Direct ablative titanium implant surface nano-modifications” with 19 studies and ”Nanocomposite additive implant surface modifications” with 13 studies. Overall 24 studies reporting on positive effect of nanostructured surface, 2 studies found no significant advantage and 6 studies reported on negative effect compared to other structure scales.

Conclusions

From examination of selected articles we can notice marked advantage in implementation of various nanostructures onto implant surface. Yet for discovering the ultimate implant surface nanostructure, further comparable investigations of Ti surface nanostructures need to be done.

Investigation of the interfacial effects of small chemical-modified TiO2 nanotubes on 3T3 fibroblast responses

In order to gain insight into how interfacial effects influence cell responses, chemically modified anodized TiO2 nanotubes (ATNs) were used to simultaneously investigate the effects of nanoscale substrate structure and angstrom-scale chemicals on cell morphological change and cell growth. Two small chemicals were used to modify the ATNs, namely, 3-aminopropyltrimethoxysilane (APTMS) and 3-mercaptopropyltrimethoxysilane (MPTMS), resulting in APTMS-modified ATNs (APTMS-ATNs) and MPTMS-modified ATNs (MPTMS-ATNs), respectively. In our in vitro observation of NIH/3T3 fibroblasts, cells thrived on both unmodified and modified ATNs. Quantitative analyses of cell numbers exhibited that APTMS-ATNs effectively facilitated cell proliferation and directed cell orientation owing to full cell-substrate contact caused by positively charged amino groups (-NH3(+)) on the surface. In addition, scanning electron microscopy and fluorescence images showed different cell morphologies on APTMS-ATNs and MPTMS-ATNs. APTMS-ATNs resulted in flat spreading of fibroblasts, while MPTMS-ATNs resulted in fibroblasts with a three-dimensional solid shape and clear contours. The results indicate that the synergistic effects of nanotube surface topology and small chemical modification and, to a lesser extent, surface hydrophilicity, alter the interfacial interactions between cells and substrates, significantly affecting cell morphology, attachment, and growth. Using ATNs with different interfacial effects from various small chemicals, orientation of cells into various patterns can be achieved and investigation of cell fates, such as proliferation or stem cell differentiation, can be performed for future advanced medical or biological applications.

Biological performance of titania containing phosphate-based glasses for bone tissue engineering applications

The interplay between glass chemistry, structure, degradation kinetics, and biological activity provides flexibility for the development of scaffolds with highly specific cellular response. The aim of this study was therefore to investigate the role of titania inclusion into the phosphate-based glass on its ability to stimulate osteoblast-like human osteosarcoma (HOS) cells to adhere, proliferate and differentiate. In depth morphological and biochemical characterisation was performed on HOS cells cultured on the surface of glass discs. Cell proliferation was also studied in the presence of the glass extract. Cell differentiation, through osteoblast phenotype genes, alkaline phosphatase (ALP) activity and osteocalcin production, was carried out using normal or osteogenic media. Both Thermanox® and titania free glass were used as controls. The data demonstrated that titania inclusion provides desired cytocompatible surface that supported initial cell attachment, sustained viability, and increased cell proliferation similar or significantly higher than Thermanox®. The modified glasses regulated osteoblastic cell differentiation as detected by osteoblast phenotype gene transcription and upregulated ALP and osteocalcin expression. Using osteogenic media had no significant effect on ALP activity and osteocalcin expression. Therefore, titania modified phosphate glasses may have future use as bone tissue engineering scaffolds.

Where bone meets implant: the characterization of nano-osseointegration

The recent application of electron tomography to the study of biomaterial interfaces with bone has brought about an awareness of nano-osseointegration and, to a further extent, demanded increasingly advanced characterization methodologies. In this study, nanoscale osseointegration has been studied via laser-modified titanium implants. The micro- and nano-structured implants were placed in the proximal tibia of New Zealand white rabbits for six months. High-resolution transmission electron microscopy (HRTEM), analytical microscopy, including energy dispersive X-ray spectroscopy (EDXS) and energy-filtered TEM (EFTEM), as well as electron tomography studies were used to investigate the degree of nano-osseointegration in two- and three-dimensions. HRTEM indicated the laser-modified surface encouraged the formation of crystalline hydroxyapatite in the immediate vicinity of the implant. Analytical studies suggested the presence of a functionally graded interface at the implant surface, characterized by the gradual intermixing of bone with oxide layer. Yet, the most compelling of techniques, which enabled straightforward visualization of nano-osseointegration, proved to be segmentation of electron tomographic reconstructions, where thresholding techniques identified bone penetrating into the nanoscale roughened surface features of laser-modified titanium. Combining high-resolution, analytical and three-dimensional electron microscopy techniques has proven to encourage identification and understanding of nano-osseointegration.

Increased preosteoblast adhesion and osteogenic gene expression on TiO2 nanotubes modified with KRSR

TiO2 anodized nanotubelayers are potentially useful for orthopedic and dental implants because they promotes bone formation. Peptide sequences, such as lysine-arginine-serine-arginine (KRSR), are often used to modify biomaterial surfaces for the selective adhesion of bone cells. The objective of this study was to functionalize TiO2 nanotube layers with KRSR to examine the responses of mouse preosteoblasts (MC3T3-E1) to this new material in vitro. SEM, AFM, XPS were used to characterize the materials. Immunofluorescence staining, SEM, ALP, RT-PCR, Wb analysis were used to detect the preosteoblast adhesion, spreading and osteogenic differentiation. KRSR peptides could be immobilized on the TiO2 nanotube layers by silane coupling. Immobilized KRSR increased preosteoblast adhesion and spreading on TiO2 nanotube layers. Moreover, osteogenic differentiation increased on the KRSR-modified TiO2 nanotube layers. KRSR-modified TiO2 nanotube layers have satisfactory biological properties and should be further investigated as medical implant materials.

Osteointegration of titanium implant is sensitive to specific nanostructure morphology

An important aspect of orthopedic implant integration is the enhancement of functional activity of osteoblasts at the tissue-implant interface without any fibrous tissue intervention. Nanostructured implant surfaces are known to enhance osteoblast activity. Previously, we have reported a simple hydrothermal method for the fabrication of non-periodic nanostructures (nanoscaffold, nanoleaves and nanoneedles) on titanium implants showing good biocompatibility and a distinct osteoblast response in vitro in terms of osteoblast adhesion to the surface. In the present work, these nanostructures have been evaluated for their detailed in vitro cellular response as well as in vivo osteointegration. Our studies showed that a specific surface nanomorphology, viz. nanoleaves, which is a network of vertically aligned, non-periodic, leaf-like structures with thickness in the nanoscale, provided a distinct increase in osteoblast cell proliferation, alkaline phosphatase (ALP) activity and collagen synthesis compared to several other types of nanomorphology, such as nanotubes, nanoscaffold and nanoneedles (rods). Gene expression analysis of ALP, osteocalcin, collagen, decorin and Runx2 showed ~20- to 40-fold up-regulation on the leaf-like topography. Cytoskeletal arrangement studies on this substrate again revealed a unique response with favorable intracellular protein expressions of vinculin, FAK and src. In vivo osteointegration study over 12 weeks on rat model (Sprague-Dawley) showed early-stage bone formation (60% bone contact by week 2 and ~85% by week 8, p<0.01) in the leaf-like nanopattern, without any inflammatory cytokine production.

Bone integration capability of nanopolymorphic crystalline hydroxyapatite coated on titanium implants

The mechanism by which hydroxyapatite (HA)-coated titanium promotes bone–implant integration is largely unknown. Furthermore, refining the fabrication of nano-structured HA to the level applicable to the mass production process for titanium implants is challenging. This study reports successful creation of nanopolymorphic crystalline HA on microroughened titanium surfaces using a combination of flame spray and low-temperature calcination and tests its biological capability to enhance bone–implant integration. Sandblasted microroughened titanium implants and sandblasted + HA-coated titanium implants were subjected to biomechanical and histomorphometric analyses in a rat model. The HA was 55% crystallized and consisted of nanoscale needle-like architectures developed in various diameters, lengths, and orientations, which resulted in a 70% increase in surface area compared to noncoated microroughened surfaces. The HA was free from impurity contaminants, with a calcium/phosphorus ratio of 1.66 being equivalent to that of stoichiometric HA. As compared to microroughened implants, HA-coated implants increased the strength of bone–implant integration consistently at both early and late stages of healing. HA-coated implants showed an increased percentage of bone–implant contact and bone volume within 50 μm proximity of the implant surface, as well as a remarkably reduced percentage of soft tissue intervention between bone and the implant surface. In contrast, bone volume outside the 50 μm border was lower around HA-coated implants. Thus, this study demonstrated that the addition of pure nanopolymorphic crystalline HA to microroughened titanium not only accelerates but also enhances the level of bone–implant integration and identified the specific tissue morphogenesis parameters modulated by HA coating. In particular, the nanocrystalline HA was proven to be drastic in increasing osteoconductivity and inhibiting soft tissue infiltration, but the effect was limited to the immediate microenvironment surrounding the implant.

Bone integration capability of alkali- and heat-treated nanobimorphic Ti-15Mo-5Zr-3Al

The role of nanofeatured titanium surfaces in a number of aspects of in vivo bone-implant integration, and, in particular, their potential advantages over microfeatured titanium surfaces, as well as their specific contribution to osteoconductivity, is largely unknown. This study reports the creation of a unique nanobimorphic titanium surface comprised of nanotrabecular and nanotuft-like structures and determines how the addition of this nanofeature to a microroughened surface affects bone-implant integration. Machined surfaces without microroughness, sandblasted microroughened surfaces, and micro-nano hybrid surfaces created by sandblasting and alkali and heat treatment of Ti-15Mo-5Zr-3Al alloy were subjected to biomechanical, interfacial and histological analyses in a rat model. The presence of microroughness enabled accelerated establishment of biomechanical implant fixation in the early stages of healing compared to the non-microroughened surfaces; however, it did not increase the implant fixation at the late stages of healing. The addition of nanobimorphic features to the microroughened surfaces further increased the implant fixation by as much as 60-100% over the healing time. Bone area within 50 μm of the implant surface, but not beyond this distance, was significantly increased by the presence of nanobimorphic features. Although the percentage of bone-implant contact was also significantly increased by the addition of nanobimorphic features, the greatest improvement was found in the soft tissue intervention between the bone and the implant, which was reduced from >30% to <5%. Mineralized tissue densely deposited with calcium-binding globular proteins was observed in an extensive area of nanobimorphic surfaces after biomechanical testing. This study clearly demonstrates the nanofeature-enhanced osteoconductivity of titanium by an alkali- and heat-treated nanobimorphic surface compared to that by microfeatured surfaces, which results not only in an acceleration but also an improvement of bone-implant integration. The identified biological parameters that successfully detect the advantages of nanofeatures over microfeatures will be useful in evaluating new implant surfaces in future studies.

Stimulated osteoblastic proliferation by mesoporous silica xerogel with high specific surface area

Specific surface area is a critical parameter of mesoporous silica-based biomaterials, however, little is known about its effects on osteoblast responses in vitro. In the present study, mesoporous silica xerogels (MSXs) with different surface area (401, 647 and 810 m(2)/g, respectively) were synthesized by a sol-gel process. Surface silanol contents decreased with the increase of surface area with which protein adsorption capability positively correlated. And the apatite-like surface seemed to form faster on MSXs with higher surface area determined by XRD analysis. Using MG63 osteoblast-like cells as models, it was found that cell proliferations were promoted on MSXs with higher surface area, based on the premise that the effects of Si released from materials on osteoblast viability were excluded by real-time Transwell(®) assay. RT-PCR results indicated cell adhesion-related integrin subunits α5 were up-regulated by higher surface area at day 1, which was further confirmed by flow cytometry analysis. The data suggest that increasing SSA of MSXs could promote surface cellular affinity by adsorbing serum proteins and accelerating apatite-like layer formation, which results in promoted osteoblastic proliferation via integrin subunit α5 at initial adhesion stage. Regulating SSA, an effective approach in designing mesoporous silica-based materials, provides an alternative method to obtain desirable tissue-response in bone regeneration and drug-delivery system.