Titanium for Orthopedic Applications: An Overview of Surface Modification to Improve Biocompatibility and Prevent Bacterial Biofilm Formation

Osteointegration of Ti Bone Implants: A Study on How Surface Parameters Control the Foreign Body Response

The integration of titanium (Ti)-based implants with bone is limited, resulting in implant failure. This lack of osteointegration is due to the foreign body response (FBR) that occurs after the implantation of biodevices. The process begins with protein adsorption, which is governed by implant surface properties, e.g., chemistry, charge, wettability, and/or topography. The distribution and composition of the protein layer in turn influence the recruitment, differentiation, and modulation of immune and bone cells. The subsequent events that occur at the bone-material interface will ultimately determine whether the implant is encapsulated or will integrate with bone. Despite the numerous studies evaluating the influence of surface properties in the various stages of the FBR, the factors that affect tissue-material interactions are often studied in isolation or in small correlations due to the technical challenges involved in assessing them in vitro or in vivo. Consequently, the influence of protein conformation on the Ti bone implant surface design remains an unresolved research question. The objective of this review is to comprehensively evaluate the existing literature on the effect of surface parameters of Ti and its alloys in the stages of FBR, with a particular focus on protein adsorption and osteoimmunomodulation. This evaluation aims to systematically describe these effects on bone formation.

Layer-by-Layer Construction of Antibacterial and Anticoagulant Blood Contacting Materials

Vascular transplantation is a common treatment for Cardiovascular disease (CVD). However, the mismatch of mechanical, structural, or microenvironmental properties of materials limits the clinical application. Therefore, the functional construction of artificial vessels or other blood contact materials remains an urgent challenge. In this paper, the composite nanofibers of polycaprolactone (PCL) with dopamine and polyethylenimine (PEI) coating are first prepared, which are further self-assembled by anticoagulant hirudin (rH) and antimicrobial peptide (AMP) of HHC36 through layer-by-layer (LBL) method. The results of FTIR and XPS analysis show that hirudin and AMP are successfully loaded on PEI-PDA/PCL nanofibers and the hydrophilicity is improved. They also show good mechanical properties that the ultimate tensile strength and elongation at break are better than natural blood vessels. The antibacterial results show that the antibacterial effect is still 93% against E. coli on the fifth day because of the stable and continuous release of HHC36 and rH. The performance of anticoagulant activity also exhibited the same results, which APTT is even 9.7s longer in the experimental group than the control group on the fifth day. The novel materials would be effectively solve the formation of thrombosis around artificial blood vessel grafts and the treatment of inflammation.

Friend or foe? Inflammation and the foreign body response to orthopedic biomaterials

The use of biomaterials and implants for joint replacement, fracture fixation, spinal stabilization and other orthopedic indications has revolutionized patient care by reliably decreasing pain and improving function. These surgical procedures always invoke an acute inflammatory reaction initially, that in most cases, readily subsides. Occasionally, chronic inflammation around the implant develops and persists; this results in unremitting pain and compromises function. The etiology of chronic inflammation may be specific, such as with infection, or be unknown. The histological hallmarks of chronic inflammation include activated macrophages, fibroblasts, T cell subsets, and other cells of the innate immune system. The presence of cells of the adaptive immune system usually indicates allergic reactions to metallic haptens. A foreign body reaction is composed of activated macrophages, giant cells, fibroblasts, and other cells often distributed in a characteristic histological arrangement; this reaction is usually due to particulate debris and other byproducts from the biomaterials used in the implant. Both chronic inflammation and the foreign body response have adverse biological effects on the integration of the implant with the surrounding tissues. Strategies to mitigate chronic inflammation and the foreign body response will enhance the initial incorporation and longevity of the implant, and thereby, improve long-term pain relief and overall function for the patient. The seminal research performed in the laboratory of Dr. James Anderson and co-workers has provided an inspirational and driving force for our laboratory's work on the interactions and crosstalk among cells of the mesenchymal, immune, and vascular lineages, and orthopedic biomaterials. Dr. Anderson's delineation of the fundamental biologic processes and mechanisms underlying acute and chronic inflammation, the foreign body response, resolution, and eventual functional integration of implants in different organ systems has provided researchers with a strategic approach to the use of biomaterials to improve health in numerous clinical scenarios.

Osseointegration of minimally invasive sacroiliac joint fixation implants-A human retrieval study

Minimally invasive sacroiliac joint fusion has become increasingly prevalent and is described to reduce pain and improve function. In some patients, pain can recur several months after primary surgery. Lack of early implant osseointegration might be a cause of pain and hence an indication for revision surgery. Triangular titanium implants are the most documented implant for minimally invasive sacroiliac joint fusion. There is, however, no knowledge of how triangular titanium implants osseointegrate in humans and whether fusion is induced over the sacroiliac joint. During planned revision surgery due to recurrent pain, six triangular titanium implants were retrieved from six different patients at median 9 months from primary surgery. All six implants were scanned using microcomputed tomography. The presence or absence of bone in-growth, on-growth, and through-growth of the implants was evaluated as an indication of implant osseointegration. Three of six implants showed no or minor signs of osseointegration. Of the three remaining implants, one showed partial osseointegration and two implants showed high degrees of osseointegration. This study showed that triangular titanium implants can osseointegrate into host bone in humans. When osseointegration occurs, triangular titanium implants can give fusion across the sacroiliac joint.

Global Trends in Orthopedic Biofilm Research: A Bibliometric Analysis of 1994-2022

Objective

Bibliometric analysis is commonly used to visualize the knowledge foundation, trends, and patterns in a specific scientific field by performing a quantitative evaluation of the relevant literature. The purpose of this study was to perform a bibliometric analysis of recent studies in the field of orthopedic biofilm research and identify its current trends and hotspots.

Methods

Research studies were retrieved from the Web of Science Core Collection and Scopus databases and analyzed in bibliometrix with R package (4.2.2).

Results

A total of 2426 literature were included in the study. Journal of orthopaedic research and Clinical orthopaedics and related research ranked first in terms of productivity and impact, with 57 published articles and 32 h-index, respectively. Trampuz A, Ohio State Univ and the United States ranked as the most productive authors, institutions, and countries. Biofilm formation, role of sonication, biomaterial mechanism and antibiotic loading have been investigated as the trend and hotspots in the field of orthopedic biofilm research.

Conclusion

This study provides a thorough overview of the state of the art of current orthopedic biofilm research and offers valuable insights into recent trends and hotspots in this field.

Fabrication and characterization of sodium alginate-silicon nitride-PVA composite biomaterials with damping properties

Silicon nitride is utilized clinically as a bioceramic for spinal fusion cages, owing to its high strength, osteoconductivity, and antibacterial effects. Nevertheless, silicon nitride exhibits suboptimal damping properties, a critical factor in mitigating traumatic bone injuries and fractures. In fact, there is a scarcity of spinal implants that simultaneously demonstrate proficient damping performance and support osteogenesis. In our study, we fabricated a novel sodium alginate-silicon nitride/poly(vinyl alcohol) (SA-SiN/PVA) composite scaffold, enabling enhanced energy absorption and rapid elastic recovery under quasi-static and impact loading scenarios. Furthermore, the study demonstrated that the incorporation of physical and chemical cross-linking significantly improved stiffness and recoverable energy dissipation. Concerning the interaction between cells and materials, our findings suggest that the addition of silicon nitride stimulated osteogenic differentiation while inhibiting Staphylococcus aureus growth. Collectively, the amalgamation of ceramics and tough hydrogels facilitates the development of advanced composites for spinal implants, manifesting superior damping, osteogenic potential, and antibacterial properties. This approach holds broader implications for applications in bone tissue engineering.

Sideritis raeseri-Modified Coatings on Ti-6Al-4V as a Carrier for Controlled Delivery Systems of Active Substances

The search for the ideal metallic material for an implant is still a difficult challenge for scientists due to the phenomenon of corrosion and the consequent disruption of the implant structure. Prevention is the application of coatings that protect the implant, activate the tissues for faster regeneration, and also prevent inflammation through antibacterial and antiviral effects. The present study focuses on the selection of components for a Ti-6Al-4V alloy coating. These days, researchers are taking an intense interest in extracts of natural origin. It was decided to take a look at Sideritis raeseri, which contains vitamins and valuable elements and is rich in polyphenols, as well as antioxidants. The composition of coatings based on a PEG polymer reinforced with brushite and the S. raeseri extract with the proteins L-carnosine, fibroin, or sericin was developed. The samples were subjected to detailed physiochemical analysis, including potentiometry and electrical conductivity analysis, Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), X-ray diffraction (XRD) analysis, and UV-VIS spectroscopy. The study demonstrated that polyphenols were successfully released from the coatings during incubation in vitro. The osteointegration process can be supported by a number of factors, such as the release of polyphenols from implant coatings to prevent bacterial, viral, and fungal infections. Subjecting the samples to 14 days of incubation demonstrated their interactions with the incubation fluids, an ion exchange between the medium and the materials. An analysis of the surface morphology exhibited the presence of brushite crystals and their increased number after incubation, indicating the bioactivity of the formed coatings.

Enhanced Hemocompatibility and Cytocompatibility of Stainless Steel

The present study introduces an advanced surface modification approach combining electrochemical anodization and non-thermal plasma treatment, tailored for biomedical applications on stainless steel grade 316L (SS316L) surfaces. Nanopores with various diameters (100-300 nm) were synthesized with electrochemical anodization, and samples were further modified with non-thermal oxygen plasma. The surface properties of SS316L surfaces were examined by scanning electron microscopy, atomic force microscopy, X-ray photoemission spectroscopy, and Water contact angle measurements. It has been shown that a combination of electrochemical anodization and plasma treatment significantly alters the surface properties of SS316L and affects its interactions with blood platelets and human coronary cells. Optimal performance is attained on the anodized specimen featuring pores within the 150-300 nm diameter range, subjected to subsequent oxygen plasma treatment; the absence of platelet adhesion was observed. At the same time, the sample demonstrated good endothelialization and a reduction in smooth muscle cell adhesion compared to the untreated SS316L and the sample with smaller pores (100-150 nm). This novel surface modification strategy has significant implications for improving biocompatibility and performance of SS316L in biomedical applications.

Ion-incorporated titanium implants for staged regulation of antibacterial activity and immunoregulation-mediated osteogenesis

Antibacterial properties and osteogenic activity are considered as two crucial factors for the initial healing and long-term survivability of orthopedic implants. For decades, various drug-loaded implants to enhance biological activities have been investigated extensively. More importantly, to control the drug release timing is equally significant due to the sequential biological processes after implantation. Hence, developing a staged regulation system on the titanium surface is practically significant. Here, we prepared TiO2 nanotubes (TiO2 NTs) on the titanium surface by anodization, followed by the incorporation of zinc (Zn) and strontium (Sr) sequentially through a hydrothermal process. Surface characterization confirmed the successful fabrication of Zn and Sr-incorporated TiO2 NTs (Zn-Sr/TiO2) on the titanium surface. The ion release results exhibited the differential release characteristic of Zn and Sr, which meant the early-stage release of Zn and the long-term release of Sr. It was exactly in accord with  the biological process after implantation, laying the basis of staged regulation after implantation. Zn-Sr/TiO2 showed favorable anti-early infection properties both in vitro and in vivo. Its inhibition effect on bacterial biofilm formation was attributed to the resistance against bacteria's initial adhesion and the killing effect on planktonic bacteria. Additionally, the release of Sr could alleviate infection-induced damage via immunoregulation. The biocompatibility and osteogenic activity mediated by M2 macrophage activation were confirmed with in vitro and in vivo studies. Therefore, it exhibited great potential in staged regulation for antibacterial activity in the early stage and the M2 activation-mediated osteogenic activity in the late stage. The staged regulation process was based on the differential release of Zn and Sr to achieve the early antibacterial effect and the long-term immune-induced osteogenic activity, to prevent implant-related infection and achieve better osseointegration. These two kinds of ions played their roles synergistically and complement mutually. This work is expected to provide an innovative idea for realizing sequential regulation after implantation.

Bamboo-Inspired Porous Scaffolds for Advanced Orthopedic Implants: Design, Mechanical Properties, and Fluid Characteristics

In orthopedic implant development, incorporating a porous structure into implants can reduce the elastic modulus to prevent stress shielding but may compromise yield strength, risking prosthesis fracture. Bamboo's natural structure, with its exceptional strength-to-weight ratio, serves as inspiration. This study explores biomimicry using bamboo-inspired porous scaffolds (BISs) resembling cortical bone, assessing their mechanical properties and fluid characteristics. The BIS consists of two 2D units controlled by structural parameters α and β. The mechanical properties, failure mechanisms, energy absorption, and predictive performance are investigated. BIS exhibits mechanical properties equivalent to those of natural bone. Specifically, α at 4/3 and β at 2/3 yield superior mechanical properties, and the destruction mechanism occurs layer by layer. Besides, the Gibson-Ashby models with different parameters are established to predict mechanical properties. Fluid dynamics analysis reveals two high-flow channels in BISs, enhancing nutrient delivery through high-flow channels and promoting cell adhesion and proliferation in low-flow regions. For wall shear stress below 30 mPa (ideal for cell growth), α at 4/3 achieves the highest percentage (99.04%), and β at 2/3 achieves 98.46%. Permeability in all structural parameters surpasses that of human bone. Enhanced performance of orthopedic implants through a bionic approach that enables the creation of pore structures suitable for implants.

Investigation on bacterial capture and antibacterial properties of acid-treated Ti surface

OBJECTIVES

Utilizing Ti and Ti alloys as dental materials established a huge spurt in the field of dentistry. Since implantation is an invasive procedure that involves tissue penetration, infection control is mandatory for increasing the success rate of the implant treatment. In this study, we aimed to assess the impact of the surface physicochemical properties of acid-treated Ti on microorganisms specifically bacteria.

METHODS

After investigating the surface morphology and characteristics of acid-treated and untreated Ti sheets, we evaluated their potential to capture Escherichia coli (E. coli.) as well as the latter's survival on the surface of both types of sheets. Finally, we assessed the efficiency of the antibacterial properties exhibited by Ti against the oral microflora.

RESULTS

SEM images revealed surface roughening of the acid-treated Ti represented by significantly irregular shape. Moreover, the acid-treated Ti exhibited remarkable hydrophobicity. A quantitative evaluation confirmed that acid-treated Ti has higher bacterial capture and antibacterial properties than untreated Ti. Further experiments showed similar effects of both types of Ti not only on E. coli but also on oral microflora.

SIGNIFICANCE

Results suggest that acid treatment of Ti surface is a potent technique for enhancing the antibacterial properties of Ti-derived materials.

Unprecedented Multifunctionality in Novel Monophase Micro/Nanostructured Ti-Zn Alloy

It is always challenging to integrate multiple functions into one material system. However, those materials/devices will address society's critical global challenges and technological demands if achieved with innovative design strategies and engineering. Here, one such material with a broader spectrum of desired properties appropriate for seven applications is identified and explored, and a glucose-sensing-triggered energy-storage mechanism is demonstrated. To date, the Titanium (Ti)-Zinc (Zn) binary alloys are investigated only as mixed phases and for a maximum of three applications. In contrast, the novel single phase of structurally stable 50 Ti-50 Zn (Ti0.5 Zn0.5 ) is synthesized and proven suitable for seven emerging applications. Interestingly, it is thermally stable up to 750 °C and possesses excellent mechanical, tribological properties and corrosion resistance. While exceptional biocompatibility is evident even up to a concentration of 500 µg mL-1 , the antibacterial activity against E. coli is also seen. Further, rapid detection and superior selectivity for glucose, along with supercabattery behavior, unambiguously demonstrate that this novel monophase is a remarkable multifunctional material than the existing mixed-phase Ti-Zn compounds. The coin-cell supercapacitor shows outstanding stability up to 30 000 cycles with >100% retention capacity. This allows us to prototype a glucose-sensing-triggered energy-storage-device system for wearable point-of-care diagnostic applications.

Electrophoretically deposited titanium and its alloys in biomedical engineering: Recent progress and remaining challenges

Over the past decade, titanium implants have gained popularity as the number of performed implantation operations has significantly increased. There are a number of methods for modifying the surface of biomaterials, which are aimed at extending the life of titanium implants. The developments in this field in recent years have required a comprehensive discussion of all the properties of electrophoretically deposited coatings on titanium and its alloys, taking into account their bioactivity. The development that took place in this field in recent years required a comprehensive discussion of all the properties of coatings electrophoretically deposited on titanium and its alloys, with particular emphasis on their bioactivity. Herein, we attempt to assess the influence of the electrophoretic deposition (EPD) process parameters on these coatings' biological and mechanical properties. Particular attention has been addressed to the in-vitro and in-vivo studies conducted hitherto. We have seen an increased interest in using titanium alloys without the addition of toxic compounds and gaps in the EPD field such as the uncommon endeavors to develop a "Design of experiments" approach as well as the lack of assessment of the surface free energy and detailed topography of electrophoretically deposited coatings. The exact correlation of coating properties with EPD process parameters still seems explicitly not understood, necessitating more future investigations. Ipso facto, the exact mechanism of particle agglomeration and Hamaker's law need to be fathomable.

The role of stiffness-matching in avoiding stress shielding-induced bone loss and stress concentration-induced skeletal reconstruction device failure

It is well documented that overly stiff skeletal replacement and fixation devices may fail and require revision surgery. Recent attempts to better support healing and sustain healed bone have looked at stiffness-matching of these devices to the desired role of limiting the stress on fractured or engrafted bone to compressive loads and, after the reconstructed bone has healed, to ensure that reconstructive medical devices (implants) interrupt the normal loading pattern as little as possible. The mechanical performance of these devices can be optimized by adjusting their location, integration/fastening, material(s), geometry (external and internal), and surface properties. This review highlights recent research that focuses on the optimal design of skeletal reconstruction devices to perform during and after healing as the mechanical regime changes. Previous studies have considered auxetic materials, homogeneous or gradient (i.e., adaptive) porosity, surface modification to enhance device/bone integration, and choosing the device's attachment location to ensure good osseointegration and resilient load transduction. By combining some or all of these factors, device designers work hard to avoid problems brought about by unsustainable stress shielding or stress concentrations as a means of creating sustainable stress-strain relationships that best repair and sustain a surgically reconstructed skeletal site. STATEMENT OF SIGNIFICANCE: Although standard-of-care skeletal reconstruction devices will usually allow normal healing and improved comfort for the patient during normal activities, there may be significant disadvantages during long-term use. Stress shielding and stress concentration are amongst the most common causes of failure of a metallic device. This review highlights recent developments in devices for skeletal reconstruction that match the stiffness, while not interrupting the normal loading pattern of a healthy bone, and help to combat stress shielding and stress concentration. This review summarises various approaches to achieve stiffness-matching: application of materials with modulus close to that of the bone; adaptation of geometry with pre-defined mechanical properties; and/or surface modification that ensures good integration and proper load transfer to the bone.

Biomedical Applications of Titanium Alloys: A Comprehensive Review

Titanium alloys have emerged as the most successful metallic material to ever be applied in the field of biomedical engineering. This comprehensive review covers the history of titanium in medicine, the properties of titanium and its alloys, the production technologies used to produce biomedical implants, and the most common uses for titanium and its alloys, ranging from orthopedic implants to dental prosthetics and cardiovascular devices. At the core of this success lies the combination of machinability, mechanical strength, biocompatibility, and corrosion resistance. This unique combination of useful traits has positioned titanium alloys as an indispensable material for biomedical engineering applications, enabling safer, more durable, and more efficient treatments for patients affected by various kinds of pathologies. This review takes an in-depth journey into the inherent properties that define titanium alloys and which of them are advantageous for biomedical use. It explores their production techniques and the fabrication methodologies that are utilized to machine them into their final shape. The biomedical applications of titanium alloys are then categorized and described in detail, focusing on which specific advantages titanium alloys are present when compared to other materials. This review not only captures the current state of the art, but also explores the future possibilities and limitations of titanium alloys applied in the biomedical field.

Porosity modeling in a TiNbTaZrMo high-entropy alloy for biomedical applications

High-entropy alloys (HEAs) have attracted great attention for many biomedical applications. However, the nature of interatomic interactions in this class of complex multicomponent alloys is not fully understood. We report, for the first time, the results of theoretical modeling for porosity in a large biocompatible HEA TiNbTaZrMo using an atomistic supercell of 1024 atoms that provides new insights and understanding. Our results demonstrated the deficiency of using the valence electron count, quantification of large lattice distortion, validation of mechanical properties with available experimental data to reduce Young's modulus. We utilized the novel concepts of the total bond order density (TBOD) and partial bond order density (PBOD) via ab initio quantum mechanical calculations as an effective theoretical means to chart a road map for the rational design of complex multicomponent HEAs for biomedical applications.

Nanotextured porous titanium scaffolds by argon ion irradiation: Toward conformal nanopatterning and improved implant osseointegration

Stress shielding and osseointegration are two main challenges in bone regeneration, which have been targeted successfully by chemical and physical surface modification methods. Direct irradiation synthesis (DIS) is an energetic ion irradiation method that generates self-organized nanopatterns conformal to the surface of materials with complex geometries (e.g., pores on a material surface). This work exposes porous titanium samples to energetic argon ions generating nanopatterning between and inside pores. The unique porous architected titanium (Ti) structure is achieved by mixing Ti powder with given amounts of spacer NaCl particles (vol % equal to 30%, 40%, 50%, 60%, and 70%), compacted and sintered, and combined with DIS to generate a porous Ti with bone-like mechanical properties and hierarchical topography to enhance Ti osseointegration. The porosity percentages range between 25% and 30% using 30 vol % NaCl space-holder (SH) volume percentages to porosity rates of 63%-68% with SH volume of 70 vol % NaCl. Stable and reproducible nanopatterning on the flat surface between pores, inside pits, and along the internal pore walls are achieved, for the first time on any porous biomaterial. Nanoscale features were observed in the form of nanowalls and nanopeaks of lengths between 100 and 500 nm, thicknesses of 35-nm and heights between 100 and 200 nm on average. Bulk mechanical properties that mimic bone-like structures were observed along with increased wettability (by reducing contact values). Nano features were cell biocompatible and enhanced in vitro pre-osteoblast differentiation and mineralization. Higher alkaline phosphatase levels and increased calcium deposits were observed on irradiated 50 vol % NaCl samples at 7 and 14 days. After 24 h, nanopatterned porous samples decreased the number of attached macrophages and the formation of foreign body giant cells, confirming nanoscale tunability of M1-M2 immuno-activation with enhanced osseointegration.

Low-Fouling and Antibacterial Polymer Brushes via Surface-Initiated Polymerization of a Mixed Zwitterionic and Cationic Monomer

The use of surface-grafted polymer brushes with combined low-fouling and antibacterial functionality is an attractive strategy to fight biofilm formation. This report describes a new styrene derivative combining a quaternary ammonium group with a sulfobetaine group in one monomer. Surface-initiated polymerization of this monomer on titanium and a polyethylene (PE) base material gave bifunctional polymer brush layers. Grafting was achieved via surface-initiated atom transfer radical polymerization from titanium or heat-induced free-radical polymerization from plasma-activated PE. Both techniques gave charged polymer layers with a thickness of over 750 nm, as confirmed by ToF-SIMS-SPM measurements. The chemical composition of the brush polymers was confirmed by XPS and FT-IR analysis. The surface charge, characterized by the ζ potential, was positive at different pH values, and the number of solvent-accessible excess ammonium groups was found to be ∼1016 N+/cm2. This led to strong antibacterial activity against Gram-positive and Gram-negative bacteria that was superior to a structurally related contact-active polymeric quaternary ammonium brush. In addition to this antibacterial activity, good low-fouling properties of the dual-function polymer brushes against Gram-positive and Gram-negative bacteria were found. This dual functionality is most likely due to the combination of antibacterial quaternary ammonium groups with antifouling sulfobetaines. The combination of both groups in one monomer allows the preparation of bifunctional brush polymers with operationally simple polymerization techniques.

Nanotechnology development in surgical applications: recent trends and developments

This paper gives a detailed analysis of nanotechnology's rising involvement in numerous surgical fields. We investigate the use of nanotechnology in orthopedic surgery, neurosurgery, plastic surgery, surgical oncology, heart surgery, vascular surgery, ophthalmic surgery, thoracic surgery, and minimally invasive surgery. The paper details how nanotechnology helps with arthroplasty, chondrogenesis, tissue regeneration, wound healing, and more. It also discusses the employment of nanomaterials in implant surfaces, bone grafting, and breast implants, among other things. The article also explores various nanotechnology uses, including stem cell-incorporated nano scaffolds, nano-surgery, hemostasis, nerve healing, nanorobots, and diagnostic applications. The ethical and safety implications of using nanotechnology in surgery are also addressed. The future possibilities of nanotechnology are investigated, pointing to a possible route for improved patient outcomes. The essay finishes with a comment on nanotechnology's transformational influence in surgical applications and its promise for future breakthroughs.

Research Progress of Titanium-Based Alloys for Medical Devices

Biomaterials are currently a unique class of materials that are essential to improving the standard of human life and extending it. In the assent of the appearance of biomaterials that contain non-toxic elements, in this study, we examine a system of Ti25Mo7Zr15TaxSi (x = 0, 0.5, 0.75, 1 wt.%) for future medical applications. The alloys were developed in a vacuum electric arc furnace and then studied from a structural, mechanical and in vivo assessment (on rabbits) perspective. The effect of the silicon addition was clearly seen in both the structural and the mechanical characteristics, standing out as beta alloys with a dendritic structure and lowering the mechanical properties as a result of the silicon addition. In experimental rabbits, the proliferation of mesenchymal stem cells was observed in the periosteum and peri-implant area, differentiating into osteoblasts and then into osteocytes. Osteoclasts were discovered within the cartilaginous islands that provide structural support to newly formed bone, playing a primary role in bone remodeling. The newly formed spongy tissue adhered to the fibrous capsule that surrounds the alloy, ensuring good osseointegration of metallic implants. The overexpression of Osteopontin, Metalloproteinase-2 (also known as gelatinase A), and Metallopeptidase-9 (also known as gelatinase B) underscores the processes of osteogenesis, bone mineralization, and normal bone remodeling.

Biocompatible quaternary pullulan functionalized 2D MoS2 glycosheet-based non-leaching and infection-resistant coatings for indwelling medical implants

Medical implants are frequently used in medicine and reconstructive surgery to treat various pathological and anatomical conditions. However, over time, biofilm formation on the surface of these implants can cause recurrent infections and subsequent inflammatory responses in the host, resulting in tissue damage, necrosis, and re-hospitalization. To address these implant-associated infections, the best approach is to create antimicrobial coatings. Here, we report the fabrication of a biocompatible, non-leaching, and contact-based antibacterial coating for implants using quaternary pullulan functionalized MoS2 (MCP) glycosheets. The cationic MCP glycosheets were coated on the surfaces of polydopamine-modified stainless steel and polyvinyl fluoride substrates through a simple process of electrostatic interaction. The developed coating showed excellent antibacterial activity (>99.5%) against E. coli and S. aureus that remained stable over 30 days without leaching out of the substrates and retained its antibacterial activity. MCP-coated implants did not induce any acute or sub-chronic toxicity to mammalian cells, both in vitro and in vivo. Furthermore, MCP coating prevented S. aureus colonization on stainless steel implants in a mouse model of implant-associated infection. The MCP coating developed in this study represents a simple, safe, and effective antibacterial coating for preventing implant-associated infections.

The Impact of Al2O3 Particles from Grit-Blasted Ti6Al7Nb (Alloy) Implant Surfaces on Biocompatibility, Aseptic Loosening, and Infection

For the improvement of surface roughness, titanium joint arthroplasty (TJA) components are grit-blasted with Al2O3 (corundum) particles during manufacturing. There is an acute concern, particularly with uncemented implants, about polymeric, metallic, and corundum debris generation and accumulation in TJA, and its association with osteolysis and implant loosening. The surface morphology, chemistry, phase analysis, and surface chemistry of retrieved and new Al2O3 grit-blasted titanium alloy were determined with scanning electron microscopy (SEM), X-ray energy-dispersive spectroscopy (EDS), transmission electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS) and confocal laser fluorescence microscopy, respectively. Peri-prosthetic soft tissue was studied with histopathology. Blasted retrieved and new stems were exposed to human mesenchymal stromal stem cells (BMSCs) for 7 days to test biocompatibility and cytotoxicity. We found metallic particles in the peri-prosthetic soft tissue. Ti6Al7Nb with the residual Al2O3 particles exhibited a low cytotoxic effect while polished titanium and ceramic disks exhibited no cytotoxic effect. None of the tested materials caused cell death or even a zone of inhibition. Our results indicate a possible biological effect of the blasting debris; however, we found no significant toxicity with these materials. Further studies on the optimal size and properties of the blasting particles are indicated for minimizing their adverse biological effects.

[Progress in antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants]

Objective

To review antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants, so as to provide reference for subsequent research.

Methods

The related research literature on antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants in recent years was reviewed, and the research progress was summarized based on different kinds of antibacterial substances and osteogenic active substances.

Results

At present, the antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants includes: ① Combined coating strategy of antibiotics and osteogenic active substances. It is characterized in that antibiotics can be directly released around titanium-based implants, which can improve the bioavailability of drugs and reduce systemic toxicity. ② Combined coating strategy of antimicrobial peptides and osteogenic active substances. The antibacterial peptides have a wide antibacterial spectrum, and bacteria are not easy to produce drug resistance to them. ③ Combined coating strategy of inorganic antibacterial agent and osteogenic active substances. Metal ions or metal nanoparticles antibacterial agents have broad-spectrum antibacterial properties and various antibacterial mechanisms, but their high-dose application usually has cytotoxicity, so they are often combined with substances that osteogenic activity to reduce or eliminate cytotoxicity. In addition, inorganic coatings such as silicon nitride, calcium silicate, and graphene also have good antibacterial and osteogenic properties. ④ Combined coating strategy of metal organic frameworks/osteogenic active substances. The high specific surface area and porosity of metal organic frameworks can effectively package and transport antibacterial substances and bioactive molecules. ⑤ Combined coating strategy of organic substances/osteogenic active substancecs. Quaternary ammonium compounds, polyethylene glycol, N-haloamine, and other organic compounds have good antibacterial properties, and are often combined with hydroxyapatite and other substances that osteogenic activity.

Conclusion

The factors that affect the antibacterial and osteogenesis properties of titanium-based implants mainly include the structure and types of antibacterial substances, the structure and types of osteogenesis substances, and the coating process. At present, there is a lack of clinical verification of various strategies for antibacterial/osteogenesis dual-functional surface modification of titanium-based implants. The optimal combination, ratio, dose-effect mechanism, and corresponding coating preparation process of antibacterial substances and bone-active substances are needed to be constantly studied and improved.

Research progress on antibacterial activity of medical titanium alloy implant materials

Titanium and its alloys are the preferred materials for medical implants. However, easy infection is a fatal shortcoming of Ti implants. Fortunately, the ongoing development of antibacterial implant materials is a promising solution, and Ti alloys with antibacterial properties hold immense potential for medical applications. In this review, we briefly outline the mechanisms of bacterial colonization and biofilm formation on implants; discuss and classify the major antimicrobials currently in use and development, including inorganic and organic antimicrobials; and describe the important role of antimicrobials in the development of implant materials for clinical applications. Strategies and challenges related to improving the antimicrobial properties of implant materials as well as the prospects of antibacterial Ti alloys in the medical field are also discussed.

Ternary nanocomposite potentiates the lysophosphatidic acid effect on human osteoblast (MG63) maturation

Aim: This study aimed to investigate the potential of ternary nanocomposite (TNC) to support MG63 osteoblast maturation to EB1089-(3S)1-fluoro-3-hydroxy-4-(oleoyloxy)butyl-1-phosphonate (FHBP) cotreatment. Materials & methods: Binary (P25/reduced graphene oxide [rGO]) nanocomposite was prepared, and silver (Ag) nanoparticles were loaded onto the surface to form TNC (P25/rGO/Ag). The influence of TNC on proliferation, alkaline phosphatase activity and osteogenic gene expression was evaluated in a model of osteoblast maturation wherein MG63 were costimulated with EB1089 and FHBP. Results: TNC had no cytotoxic effect on MG63. The addition of TNC to EB1089-FHBP cotreatment enhanced the maturation of MG63, as supported by the greater alkaline phosphatase activity and OPN and OCN gene expression. Conclusion: TNC could serve as a promising carrier for FHBP, opening up possibilities for its application in bone regeneration.

Evolution and New Generation of Dual Mobility Cups

Although total hip arthroplasty (THA) is considered a successful procedure, hip dislocation remains the main cause of early failure. Dual mobility cups (DMCs) have been shown to significantly reduce the dislocation rate in both primary and revision THAs. During the past several decades, DMCs have evolved in design and fixation interface. There have been three generations of DMCs. This article addresses the rationale for a new cementless highly porous titanium DMC to improve component fixation and implant biocompatibility. [Orthopedics. 2023;46(5):e273-e280.].

Improving Pure Titanium's Biological and Mechanical Characteristics through ECAP and Micro-Arc Oxidation Processes

Pure titanium is limited to be used in biomedical applications due to its lower mechanical strength compared to its alloy counterpart. To enhance its properties and improve medical implants feasibility, advancements in titanium processing technologies are necessary. One such technique is equal-channel angular pressing (ECAP) for its severe plastic deformation (SPD). This study aims to surface modify commercially pure titanium using micro-arc oxidation (MAO) or plasma electrolytic oxidation (PEO) technologies, and mineral solutions containing Ca and P. The composition, metallography, and shape of the changed surface were characterized using X-ray diffraction (XRD), digital optical microscopy (OM), and scanning electron microscope (SEM), respectively. A microhardness test is conducted to assess each sample's mechanical strength. The weight % of Ca and P in the coating was determined using energy dispersive spectroscopy (EDS), and the corrosion resistance was evaluated through potentiodynamic measurement. The behavior of human dental pulp cell and periodontal cell behavior was also studied through a biomedical experiment over a period of 1-, 3-, and 7-days using culture medium, and the cell death and viability can be inferred with the help of enzyme-linked immunosorbent assay (ELISA) since it can detect proteins or biomarkers secreted by cells undergoing apoptosis or necrosis. This study shows that the mechanical grain refinement method and surface modification might improve the mechanical and biomechanical properties of commercially pure (CP) titanium. According to the results of the corrosion loss measurements, 2PassMAO had the lowest corrosion rate, which is determined to be 0.495 mmpy. The electrode potentials for the 1-pass and 2-pass coated samples are 1.44 V and 1.47 V, respectively. This suggests that the coating is highly effective in reducing the corrosion rate of the metallic CP Ti sample. Changes in the grain size and the presence of a high number of grain boundaries have a significant impact on the corrosion resistance of CP Ti. For ECAPED and surface-modified titanium samples in a 3.6% NaCl electrolyte solution, electrochemical impedance spectroscopy (EIS) properties are similar to Nyquist and Bode plot fitting. In light of ISO 10993-5 guidelines for assessing in vitro cytotoxicity, this study contributes valuable insights into pulp and periodontal cell behavior, focusing specifically on material cytotoxicity, a critical factor determined by a 30% decrease in cell viability.

Corrosion Products from Metallic Implants Induce ROS and Cell Death in Human Motoneurons In Vitro

Due to advances in surgical procedures and the biocompatibility of materials used in total joint replacement, more and younger patients are undergoing these procedures. Although state-of-the-art joint replacements can last 20 years or longer, wear and corrosion is still a major risk for implant failure, and patients with these implants are exposed for longer to these corrosive products. It is therefore important to investigate the potential effects on the whole organism. Released nanoparticles and ions derived from commonly used metal implants consist, among others, of cobalt, nickel, and chromium. The effect of these metallic products in the process of osteolysis and aseptic implant loosening has already been studied; however, the systemic effect on other cell types, including neurons, remains elusive. To this end, we used human iPSC-derived motoneurons to investigate the effects of metal ions on human neurons. We treated human motoneurons with ion concentrations regularly found in patients, stained them with MitoSOX and propidium iodide, and analyzed them with fluorescence-assisted cell sorting (FACS). We found that upon treatment human motoneurons suffered from the formation of ROS and subsequently died. These effects were most prominent in motoneurons treated with 500 μM of cobalt or nickel, in which we observed significant cell death, whereas chromium showed fewer ROS and no apparent impairment of motoneurons. Our results show that the wear and corrosive products of metal implants at concentrations readily available in peri-implant tissues induced ROS and subsequently cell death in an iPSC-derived motoneuron cell model. We therefore conclude that monitoring of neuronal impairment is important in patients undergoing total joint replacement.

Contact-Biocide TiO2 Surfaces by Surface-Initiated Atom Transfer Radical Polymerization with Chemically Stable Phosphonate Initiators

Surface-initiated atom transfer radical polymerization (SI-ATRP) is a powerful tool for grafting functional polymers from metal surfaces. It depends on the immobilization of suitable initiators on the surface before radical polymerization. Herein, we report a set of bifunctional initiators bearing a phosphonic acid group for surface binding and a bromoisobutyramide moiety for SI-ATRP. We have analyzed the impact of the connecting alkyl spacers on the grafting process of (vinylbenzyl)trimethylammonium chloride (VBTAC) from titanium as a base material. The thickness of the grafted polymer increased with the spacer length of the initiator. We obtained chemically stable polycationic surfaces with high charge densities of ∼10¹⁶ N⁺/cm² leading to efficient contact activity of modified titanium coupons against S. aureus. Notably, SI-ATRP grafting was efficient with VBTAC as a styrene-derived ammonium compound. Thus, the reported protocol avoids post-grafting quaternization with toxic alkylating reagents.

Engineering Antioxidant Surfaces for Titanium-Based Metallic Biomaterials

Prolonged inflammation induced by orthopedic metallic implants can critically affect the success rates, which can even lead to aseptic loosening and consequent implant failure. In the case of adverse clinical conditions involving osteoporosis, orthopedic trauma and implant corrosion-wear in peri-implant region, the reactive oxygen species (ROS) activity is enhanced which leads to increased oxidative stress. Metallic implant materials (such as titanium and its alloys) can induce increased amount of ROS, thereby critically influencing the healing process. This will consequently affect the bone remodeling process and increase healing time. The current review explores the ROS generation aspects associated with Ti-based metallic biomaterials and the various surface modification strategies developed specifically to improve antioxidant aspects of Ti surfaces. The initial part of this review explores the ROS generation associated with Ti implant materials and the associated ROS metabolism resulting in the formation of superoxide anion, hydroxyl radical and hydrogen peroxide radicals. This is followed by a comprehensive overview of various organic and inorganic coatings/materials for effective antioxidant surfaces and outlook in this research direction. Overall, this review highlights the critical need to consider the aspects of ROS generation as well as oxidative stress while designing an implant material and its effective surface engineering.

Preparation and Functionalization of Polymers with Antibacterial Properties-Review of the Recent Developments

The presence of antibiotic-resistant bacteria in our environment is a matter of growing concern. Consumption of contaminated drinking water or contaminated fruit or vegetables can provoke ailments and even diseases, mainly in the digestive system. In this work, we present the latest data on the ability to remove bacteria from potable water and wastewater. The article discusses the mechanisms of the antibacterial activity of polymers, consisting of the electrostatic interaction between bacterial cells and the surface of natural and synthetic polymers functionalized with metal cations (polydopamine modified with silver nanoparticles, starch modified with quaternary ammonium or halogenated benzene). The synergistic effect of polymers (N-alkylaminated chitosan, silver doped polyoxometalate, modified poly(aspartic acid)) with antibiotics has also been described, allowing for precise targeting of drugs to infected cells as a preventive measure against the excessive spread of antibiotics, leading to drug resistance among bacteria. Cationic polymers, polymers obtained from essential oils (EOs), or natural polymers modified with organic acids are promising materials in the removal of harmful bacteria. Antimicrobial polymers are successfully used as biocides due to their acceptable toxicity, low production costs, chemical stability, and high adsorption capacity thanks to multi-point attachment to microorganisms. New achievements in the field of polymer surface modification in order to impart antimicrobial properties were summarized.

Titanium surface polyethylene glycol hydrogel and gentamicin-loaded cross-linked starch microspheres release system for anti-infective drugs

OBJECTIVE

To design and construct a hydrogel drug-controlled release system loaded with gentamicin on a titanium surface, and to evaluate the in vitro drug release behaviour and antibacterial properties and biocompatibility of the controlled release system.

METHODS

Titanium (Ti) surface was coated with poly dopamine (PDA) substrate, and then polyethylene glycol (PEG) was attached to PDA. The composite drug microsphere controlled release layer formed by gentamicin (GEN) and cross-linked starch (CSt) were subsequently covered with poly lactic⁃co⁃glycolic acid (PLGA) as a barrier to construct a Ti-GEN-Cst-PLGA anti-infective drug controlled release system.

RESULTS

The hydrogel drug release system was successfully constructed. The results of in vitro anti-staphylococcus aureus (SAU) assay, anti-staphylococcus epidermidis (SEP) assay and anti-Escherichia coli (ECO) assay showed that Ti-GEN-Cst-PLGA could effectively inhibit the growth of three bacteria. Assay in the New Zealand rabbit found that Ti-GEN-Cst-PLGA could promote wound healing at the 3rd week after implantation, and the pathology assay found that the Ti-GEN-Cst-PLGA group had less inflammatory reactions and significant tissue proliferation at the endophyte contact surface.

CONCLUSION

Ti-GEN-Cst-PLGA can effectively inhibit the inflammatory response and promote wound healing, or may be a potential treatment for orthopaedic endophytes.

In Situ and Ex Situ Raman Studies of Cysteine’s Behavior on a Titanium Surface in Buffer Solution

In this paper, surface-enhanced Raman spectroscopy (SERS) was used to investigate the adsorption process of cysteine (Cys). Studies were carried out in the presence of phosphate-buffered saline solution (PBS), at pH 7.4, and acidified to pH 5, 3, and 1, on the surface of Ti for implant application. In situ SERS spectra obtained for the Cys/Ti solution system, after 24 h of immersion time, indicated that the buffer solution strongly influences the adsorption behavior of Cys on the Ti surface. This results in a decrease in Cys adsorption on the Ti surface, in the range of pH 7.4 to 3. The strong interaction between a sulfur atom of Cys and a Ti surface was observed only at pH = 1, under strongly acidic conditions. In contrast, ex situ SERS spectra recorded for the same samples but in a dried Cys/Ti system show a completely different behavior of Cys on the Ti surface. Formation of a disulfide (S-S) bond has occurred as a result of the dimerization or aggregation of Cys molecules on the Ti surface. Detailed analysis of the adsorption behavior of Cys on the Ti surface can be very important in the preparation of bioactive materials (i.e., coated by organic layers).

Existing and Novel Biomaterials for Bone Tissue Engineering

The treatment of bone defects remains one of the major challenges in modern clinical practice. Nowadays, with the increased incidence of bone disease in an aging population, the demand for materials to repair bone defects continues to grow. Recent advances in the development of biomaterials offer new possibilities for exploring modern bone tissue engineering strategies. Both natural and synthetic biomaterials have been used for tissue repair. A variety of porous structures that promote cell adhesion, differentiation, and proliferation enable better implant integration with increasingly better physical properties. The selection of a suitable biomaterial on which the patient's new tissue will grow is one of the key issues when designing a modern tissue scaffold and planning the entire treatment process. The purpose of this article is to present a comprehensive literature review of existing and novel biomaterials used in the surgical treatment of bone tissue defects. The materials described are divided into three groups-organic, inorganic, and synthetic polymers-taking into account current trends. This review highlights different types of existing and novel natural and synthetic materials used in bone tissue engineering and their advantages and disadvantages for bone defects regeneration.

Key Challenges in Diamond Coating of Titanium Implants: Current Status and Future Prospects

Over past years, the fabrication of Ti-based permanent implants for fracture fixation, joint replacement and bone or tooth substitution, has become a routine task. However, it has been found that some degradation phenomena occurring on the Ti surface limits the life or the efficiency of the artificial constructs. The task of avoiding such adverse effects, to prevent microbial colonization and to accelerate osteointegration, is being faced by a variety of approaches in order to adapt Ti surfaces to the needs of osseous tissues. Among the large set of biocompatible materials proposed as an interface between Ti and the hosting tissue, diamond has been proven to offer bioactive and mechanical properties able to match the specific requirements of osteoblasts. Advances in material science and implant engineering are now enabling us to produce micro- or nano-crystalline diamond coatings on a variety of differently shaped Ti constructs. The aim of this paper is to provide an overview of the research currently ongoing in the field of diamond-coated orthopedic Ti implants and to examine the evolution of the concepts that are accelerating the full transition of such technology from the laboratory to clinical applications.

Experimental Research on New Developed Titanium Alloys for Biomedical Applications

The mechanical properties and electrochemical behavior of two new titanium alloys, Ti20Mo7Zr and Ti20Mo7Zr0.5Si, are investigated in this paper. The alloys have been manufactured by vacuum arc remelting (VAR) technique and studied to determine their microstructure, corrosion behavior, and mechanical properties. Metallographic observations and quantitative microanalysis by optical microscopy, scanning electron microscopy SEM, and energy dispersive X-rays spectroscopy EDX were performed. Data about the three-point bending test and microhardness are presented. For electrochemical properties, three different environments were used: Ringer solution at 25 °C, Ringer solution at 40 °C simulating fever condition, and 3.5% NaCl solution. Metallographic investigation revealed the biphasic and dendritic structure of both samples when the procedures were performed. Electrochemical testing in body simulation fluid, fever conditions, and saline medium showed that the lower the proportion of silicon in the samples, the higher the corrosion resistance. The formation of a titanium oxide layer on the surface of both samples was noticed using quantitative EDX analysis. The three-point bending test for the two samples revealed that the presence of silicon decreases the modulus of elasticity; the surface of the samples displayed soft and hard phases in the microhardness test. Electrochemical impedance spectroscopy (EIS) measurements were carried out at different potentials, and the obtained spectra exhibit a two-time constant system, attesting double-layer passive film on the samples.

Curcumin-Based Universal Grafting of Poly(OEGMA) Brushes and Their Antibacterial Applications

Catechol and/or pyrogallol groups are recognized as crucial for the formation of polyphenol coatings on various substrates. Meanwhile, studies on polyphenolic molecules that do not contain such groups are relatively rare. The key molecule in turmeric-based universal (i.e., substrate-independent) coatings is curcumin, which contains no catechol or pyrogallol groups. As chemically reactive hydroxyl groups would remain after curcumin coating, it is hypothesized that curcumin coating can serve as a reactive layer for controlling interfacial properties. In this study, a curcumin-based surface modification method is developed to graft polymer brushes from various substrates, including titanium dioxide, gold, glass, stainless steel, and nylon. α-Bromoisobutyryl bromide, a polymerization initiator, is introduced to the curcumin-coated substrates via esterification; subsequently, poly(oligo(ethylene glycol) methacrylate) (poly(OEGMA)) is grafted from the surfaces. Compared to the control surfaces, poly(OEGMA)-grafted surfaces significantly suppress bacterial adhesion by up to 99.4%, demonstrating their antibacterial properties. Considering its facile and versatile surface modification, curcumin-based polymer grafting can be an efficient method for controlling the chemical/physical properties of surfaces in a substrate-independent manner.

Bioactive Inorganic Materials for Dental Applications: A Narrative Review

Over time, much attention has been given to the use of bioceramics for biomedical applications; however, the recent trend has been gaining traction to apply these materials for dental restorations. The bioceramics (mainly bioactive) are exceptionally biocompatible and possess excellent bioactive and biological properties due to their similar chemical composition to human hard tissues. However, concern has been noticed related to their mechanical properties. All dental materials based on bioactive materials must be biocompatible, long-lasting, mechanically strong enough to bear the masticatory and functional load, wear-resistant, easily manipulated, and implanted. This review article presents the basic structure, properties, and dental applications of different bioactive materials i.e., amorphous calcium phosphate, hydroxyapatite, tri-calcium phosphate, mono-calcium phosphate, calcium silicate, and bioactive glass. The advantageous properties and limitations of these materials are also discussed. In the end, future directions and proposals are given to improve the physical and mechanical properties of bioactive materials-based dental materials.

Cellular responses to nanoscale substrate topography of TiO2 nanotube arrays: cell morphology and adhesion

Nanotopographical features can be beneficial in augmenting cell functions and increasing osteogenic potential. However, the relationships between surface topographies and biological responses are difficult to establish due to the difficulty in controlling the surface topographical features at a low-nanometre scale. Herein, we report the fabrication of well-defined controllable titanium dioxide (TiO₂) nanotube arrays with a wide range of pore sizes, 30-175 nm in diameter, and use of the electrochemical anodization method to assess the effect of surface nanotopographies on cell morphology and adhesion. The results show that TiO₂ nanotube arrays with pore sizes of 30 and 80 nm allowed for cell spreading of bone marrow-derived mesenchymal stem cells with increased cell area coverage. Additionally, cell adhesion was significantly enhanced by controlled nanotopographies of TiO₂ nanotube arrays with 80 nm pore size. Our results demonstrate that surface modification at the nano-scale level with size tunability under controlled chemical/physical properties and culture conditions can greatly impact cell responses. These findings point to a new direction of material design for bone-tissue engineering in orthopaedic applications.

Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances

Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.

Early Osteogenic Marker Expression in hMSCs Cultured onto Acid Etching-Derived Micro- and Nanotopography 3D-Printed Titanium Surfaces

Polyetheretherketone (PEEK) titanium composite (PTC) is a novel interbody fusion device that combines a PEEK core with titanium alloy (Ti6Al4V) endplates. The present study aimed to investigate the in vitro biological reactivity of human bone-marrow-derived mesenchymal stem cells (hBM-MSCs) to micro- and nanotopographies produced by an acid-etching process on the surface of 3D-printed PTC endplates. Optical profilometer and scanning electron microscopy were used to assess the surface roughness and identify the nano-features of etched or unetched PTC endplates, respectively. The viability, morphology and the expression of specific osteogenic markers were examined after 7 days of culture in the seeded cells. Haralick texture analysis was carried out on the unseeded endplates to correlate surface texture features to the biological data. The acid-etching process modified the surface roughness of the 3D-printed PTC endplates, creating micro- and nano-scale structures that significantly contributed to sustaining the viability of hBM-MSCs and triggering the expression of early osteogenic markers, such as alkaline phosphatase activity and bone-ECM protein production. Finally, the topography of 3D-printed PTC endplates influenced Haralick's features, which in turn correlated with the expression of two osteogenic markers, osteopontin and osteocalcin. Overall, these data demonstrate that the acid-etching process of PTC endplates created a favourable environment for osteogenic differentiation of hBM-MSCs and may potentially have clinical benefit.

Fabrication of an ordered micro-/nanotextured titanium surface to improve osseointegration

Ordered microscale titanium (Ti) surface topography with homogeneous cell-sized microholes (20 µm in diameter) was fabricated using simple electrochemical etching. The as-prepared surface imposed with uniform titania nanotubes (TNTs, 70 nm in diameter) through electrochemical anodization showed no considerable change in the initial microscale morphology. Bone marrow mesenchymal stem cells (BMSCs) were used in evaluating the bioactivity. Compared with polished Ti and unordered microtextured Ti, the ordered microtextured Ti formed by electrochemical etching remarkably promoted cell attachment, alkaline phosphatase activity, collagen secretion, extracellular matrix mineralization, and osteogenesis-related gene expression but considerably inhibited cell proliferation. After TNTs were introduced to the ordered microtextured Ti, cell attachment and osteogenic differentiation indexes were further enhanced, and cell proliferation recovered over time. The ordered micro-/nanotextured Ti surface was more conducive to the cell attachment, proliferation, and osteogenesis of BMSCs than polished Ti with and without TNTs, unordered microtextured Ti with and without TNTs, and unitary ordered microtextured Ti. Thus, the novel ordered bio-inspired micro-/nanotextured structure composed of cell-sized microholes and TNTs on the Ti surface possessed a favorable interfacial environment that improved osseointegration, potentially optimizing Ti implant surface topography.

Recent Advancements in Materials and Coatings for Biomedical Implants

Metallic materials such as stainless steel (SS), titanium (Ti), magnesium (Mg) alloys, and cobalt-chromium (Co-Cr) alloys are widely used as biomaterials for implant applications. Metallic implants sometimes fail in surgeries due to inadequate biocompatibility, faster degradation rate (Mg-based alloys), inflammatory response, infections, inertness (SS, Ti, and Co-Cr alloys), lower corrosion resistance, elastic modulus mismatch, excessive wear, and shielding stress. Therefore, to address this problem, it is necessary to develop a method to improve the biofunctionalization of metallic implant surfaces by changing the materials' surface and morphology without altering the mechanical properties of metallic implants. Among various methods, surface modification on metallic surfaces by applying coatings is an effective way to improve implant material performance. In this review, we discuss the recent developments in ceramics, polymers, and metallic materials used for implant applications. Their biocompatibility is also discussed. The recent trends in coatings for biomedical implants, applications, and their future directions were also discussed in detail.

Nanostructured Titanium Implant Surface Facilitating Osseointegration from Protein Adsorption to Osteogenesis: The Example of TiO2 NTAs

Titanium implants have been widely applied in dentistry and orthopedics due to their biocompatibility and resistance to mechanical fatigue. TiO₂ nanotube arrays (TiO₂ NTAs) on titanium implant surfaces have exhibited excellent biocompatibility, bioactivity, and adjustability, which can significantly promote osseointegration and participate in its entire path. In this review, to give a comprehensive understanding of the osseointegration process, four stages have been divided according to pivotal biological processes, including protein adsorption, inflammatory cell adhesion/inflammatory response, additional relevant cell adhesion and angiogenesis/osteogenesis. The impact of TiO₂ NTAs on osseointegration is clarified in detail from the four stages. The nanotubular layer can manipulate the quantity, the species and the conformation of adsorbed protein. For inflammatory cells adhesion and inflammatory response, TiO₂ NTAs improve macrophage adhesion on the surface and induce M2-polarization. TiO₂ NTAs also facilitate the repairment-related cells adhesion and filopodia formation for additional relevant cells adhesion. In the angiogenesis and osteogenesis stage, TiO₂ NTAs show the ability to induce osteogenic differentiation and the potential for blood vessel formation. In the end, we propose the multi-dimensional regulation of TiO₂ NTAs on titanium implants to achieve highly efficient manipulation of osseointegration, which may provide views on the rational design and development of titanium implants.

Surface co-deposition of polypyrrole nanoparticles and tannic acid for photothermal bacterial eradication

Bacterial infections on implantable materials can cause severe complications for affected patients, posing a serious threat to human health. Therefore, the development of appropriate surface modification strategies to construct the antibacterial platforms on medical implants are urgently needed. In this work, the poly(vinyl alcohol) (PVA)-stabilized polypyrrole nanoparticles (PVA-PPy NPs) were prepared by oxidative polymerization using FeCl₃ as the oxidant. Subsequent mixing of the PVA-PPy NPs solution mixture with tannic acid (TA) was facilitated by hydrogen bonding. The as-formed TA/PVA-PPy NPs can be deposited with good adhesion onto solid materials in a substrate-independent manner. The hydrophilic TA/PVA-PPy NPs-deposited titanium (Ti-TPP) surface can reduce the adhesion of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). In addition, the Ti-TPP surface had photothermal property under 808 nm near-infrared (NIR) irradiation, which can kill the adhered bacteria via the hyperthermal effect. Upon exposure to NIR, the respective survival rates of S. aureus and E. coli on the Ti-TPP surfaces were only 1.66% and 2.78%, in comparison to those on the pristine Ti surfaces. Furthermore, the Ti-TPP surface could prevent the formation of early-stage biofilm under NIR irradiation. The TA/PVA-PPy NPs composites can be utilized as a contact-photoactive antibacterial coating for biomedical applications.