Effect of surface treatments on the fatigue life of titanium for biomedical applications

Advances in implants and bone graft types for lumbar spinal fusion surgery

The increasing prevalence of spinal disorders worldwide necessitates advanced treatments, particularly interbody fusion for severe cases that are unresponsive to non-surgical interventions. This procedure, especially 360° lumbar interbody fusion, employs an interbody cage, pedicle screw-and-rod instrumentation, and autologous bone graft (ABG) to enhance spinal stability and promote fusion. Despite significant advancements, a persistent 10% incidence of non-union continues to result in compromised patient outcomes and escalated healthcare costs. Innovations in lumbar stabilisation seek to mimic the properties of natural bone, with evolving implant materials like titanium (Ti) and polyetheretherketone (PEEK) and their composites offering new prospects. Additionally, biomimetic cages featuring precisely engineered porosities and interconnectivity have gained traction, as they enhance osteogenic differentiation, support osteogenesis, and alleviate stress-shielding. However, the limitations of ABG, such as harvesting morbidities and limited fusion capacity, have spurred the exploration of sophisticated solutions involving advanced bone graft substitutes. Currently, demineralised bone matrix and ceramics are in clinical use, forming the basis for future investigations into novel bone graft substitutes. Bioglass, a promising newcomer, is under investigation despite its observed rapid absorption and the potential for foreign body reactions in preclinical studies. Its clinical applicability remains under scrutiny, with ongoing research addressing challenges related to burst release and appropriate dosing. Conversely, the well-documented favourable osteogenic potential of growth factors remains encouraging, with current efforts focused on modulating their release dynamics to minimise complications. In this evidence-based narrative review, we provide a comprehensive overview of the evolving landscape of non-degradable spinal implants and bone graft substitutes, emphasising their applications in lumbar spinal fusion surgery. We highlight the necessity for continued research to improve clinical outcomes and enhance patient well-being.

The Effect of Implantoplasty on the Fatigue Behavior and Corrosion Resistance in Titanium Dental Implants

Implantoplasty is a technique increasingly used to remove the biofilm that causes peri-implantitis on dental implants. This technique of mechanization of the titanium surface makes it possible to eliminate bacterial colonies, but it can generate variations in the properties of the implant. These variations, especially those in fatigue resistance and electrochemical corrosion behavior, have not been studied much. In this work, fatigue tests were performed on 60 dental implants without implantoplasty, namely 30 in air and 30 in Hank's solution at 37 °C, and 60 with implatoplasty, namely 30 in air and 30 in Hank's solution at 37 °C, using triaxial tension-compression and torsion stresses simulating human chewing. Mechanical tests were performed with a Bionix servo-hydraulic testing machine and fracture surfaces were studied by scanning electron microcopyElectrochemical corrosion tests were performed on 20 dental implants to determine the corrosion potentials and corrosion intensity for control implants and implantoplasty implants. Studies of titanium ion release to the physiological medium were carried out for each type of dental implants by Inductively Coupled-Plasma Mass Spectrometry at different immersion times at 37 °C. The results show a loss of fatigue caused by the implantoplasty of 30%, observing that the nucleation points of the cracks are in the areas of high deformation in the areas of the implant neck where the mechanization produced in the treatment of the implantoplasty causes an exaltation of fatigue cracks. It has been observed that tests performed in Hank's solution reduce the fatigue life due to the incorporation of hydrogen in the titanium causing the formation of hydrides that embrittle the dental implant. Likewise, the implantoplasty causes a reduction of the corrosion resistance with some pitting on the machined surface. Ion release analyses are slightly higher in the implantoplasted samples but do not show statistically significant differences. It has been observed that the physiological environment reduces the fatigue life of the implants due to the penetration of hydrogen into the titanium forming titanium hydrides which embrittle the implant. These results should be taken into account by clinicians to determine the convenience of performing a treatment such as implantoplasty that reduces the mechanical behavior and increases the chemical degradation of the titanium dental implant.

Fatigue properties of plasma nitriding for dental implant application

STATEMENT OF PROBLEM

Fatigue failure of implant components is a common clinical problem. Plasma nitriding, an in situ surface-strengthening method, may improve fatigue properties of dental implants.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of plasma nitriding on the fatigue behavior of implant systems.

MATERIAL AND METHODS

The preload and friction coefficient of plasma nitrided abutment screws, as well as settlement of the implant-abutment interface, were measured. Then, the reverse torque values and pullout force were evaluated after cyclic loading. Finally, the fatigue properties of the implant system were investigated with static fracture and dynamic fatigue life tests, and the morphology of the fracture on the surface of the implant system was observed.

RESULTS

The plasma nitriding treatment reduced the friction coefficient; increased the preload, settlement value, reverse torque values, pullout force, and static fracture load; and prolonged fatigue life. Furthermore, abutment screws with plasma nitriding treatment showed a different fatigue fracture mode.

CONCLUSIONS

Plasma nitriding improved mechanical performance and may be a suitable way to optimize the fatigue behavior of dental implants.

Genetic-Based Optimization of 3D Burch–Schneider Cage With Functionally Graded Lattice Material

A Burch–Schneider (BS) cage is a reinforcement device used in total hip arthroplasty (THA) revision surgeries to bridge areas of acetabular loss. There have been a variety of BS cages in the market, which are made of solid metal. However, significant differences in structural configuration and mechanical behavior between bone and metal implants cause bone resorption and interface loosening, and hence lead to failure of the implant in the long term. To address this issue, an optimal design framework for a cellular BS cage was investigated in this study by genetic algorithm and topology optimization, inspired by porous human bone with variable holes. In this optimization, a BS cage is constructed with functionally graded lattice material which gradually evolves to achieve better mechanical behavior by natural selection and natural genetics. Clinical constraints that allow adequate bone ingrowth and manufacturing constraint that ensures the realization of the optimized implant are considered simultaneously. A homogenization method is introduced to calculate effective mechanical properties of octet-truss lattice material in a given range of relative density. At last, comparison of the optimum lattice BS cage with a fully solid cage and a lattice cage with identical element density indicates the validity of the optimization design strategy proposed in this article.

Low Cycle Fatigue Performance of Additively Processed and Heat-Treated Ti-6Al-7Nb Alloy for Biomedical Applications

In biomedical engineering, laser powder bed fusion is an advanced manufacturing technology, which enables, for example, the production of patient-customized implants with complex geometries. Ti-6Al-7Nb shows promising improvements, especially regarding biocompatibility, compared with other titanium alloys. The biocompatible features are investigated employing cytocompatibility and antibacterial examinations on Al2O3-blasted and untreated surfaces. The mechanical properties of additively manufactured Ti-6Al-7Nb are evaluated in as-built and heat-treated conditions. Recrystallization annealing (925 °C for 4 h), β annealing (1050 °C for 2 h), as well as stress relieving (600 °C for 4 h) are applied. For microstructural investigation, scanning and transmission electron microscopy are performed. The different microstructures and the mechanical properties are compared. Mechanical behavior is determined based on quasi-static tensile tests and strain-controlled low cycle fatigue tests with total strain amplitudes εA of 0.35%, 0.5%, and 0.8%. The as-built and stress-relieved conditions meet the mechanical demands for the tensile properties of the international standard ISO 5832-11. Based on the Coffin–Manson–Basquin relation, fatigue strength and ductility coefficients, as well as exponents, are determined to examine fatigue life for the different conditions. The stress-relieved condition exhibits, overall, the best properties regarding monotonic tensile and cyclic fatigue behavior.

Harbor and coastal structures: A review of mechanical fatigue under random wave loading

Harbor and coastal structures are essential in maritime connections. Additionally, some offshore structures near the coast are important for supplying energy as a material or transforming the natural resources into energy, as in wind turbines. One of the main issues that needs to be overcome in terms of these structures is mechanical fatigue due to the loads of the structure by its function and waves, wind, the current seawater level, and ice. Structural design has to meet high target loads to ensure that structures can endure extreme marine conditions under the assumption of the probability of loads and based on marine conditions, can mask damage where component immersions are not available for inspection. In this work, the wave loads and fatigue damage under random processes are reviewed.

Fatigue properties of UFG Ti grade 2 dental implant vs. conventionally tested smooth specimens

Complicated geometry in combination with surface treatment strongly deteriorates fatigue resistance of metallic dental implants. Mechanical properties of pure Ti grade 2, usually used for dental implant production, were shown to be significantly improved due to intensive grain refinement via Conform SPD. The increase of the tensile strength properties was accompanied by a significant increase in the fatigue resistance and fatigue endurance limit. However, the SLA treatment usually used for the implants' surface roughening, resulted in the fatigue properties and endurance limit decrease, while this effect was more pronounced for the ultrafine-grained comparing to the coarse-grained material when tested under tensile-tensile loading mode. The testing of the implants is usually provided under the bending mode. Even though different testing condition for the conventional specimens tests and implants testing was adopted, a numerical study revealed their comparable fatigue properties. The fatigue limit determined for the implants was 105% higher than the one for coarse-grained and only by 4 % lower than the one for ultrafine-grained Ti grade 2. Based on the obtained results, conventional specimens testing can be used for the prediction of the fatigue limit of the implants.

The rationale behind implant coatings to promote osteointegration, bone healing or regeneration

Implant loosening, bone healing failure, implant-associated infections, and large bony defects remain challenges in orthopedic surgery. Implant surface modifications and coatings are being developed to promote osteointegration, prevent colonization by bacteria, and release bioactive factors. The following mini-review briefly discusses the clinical problem, explains the four "osteos", presents examples of coatings used for different orthopedic indications, and finally raises awareness of the coating and translational requirements.

Hydrothermally grown TiO2-nanorods on surface mechanical attrition treated Ti: Improved corrosion fatigue and osteogenesis

Current bioactive modifications of Ti-based materials for promoting osteogenesis often decrease corrosion fatigue strength (σ_cf) of the resultant implants, thereby shortening their service lifespan. To solve this issue and accelerate the osteogenesis process, in the present study, a TiO₂ nanorods (TNR)-arrayed coating was hydrothermally grown on optimal surface mechanical attrition treated (SMATed) titanium (S-Ti). The microstructure, bond integrity, residual stress distribution, and corrosion fatigue of TNR-coated S-Ti (TNR/S-Ti) and the response of macrophages and bone marrow-derived mesenchymal stem cells (BMSCs) to TNR/S-Ti were investigated and compared with those of mechanically polished Ti (P-Ti), S-Ti, and TNR-coated P-Ti (TNR/P-Ti). S-Ti showed a nanograined layer and an underlying grain-deformed region with residual compressive stress, which was sustained even when it was hydrothermally coated with TNR. TNR on S-Ti showed nanotopography, composition, and bond strength almost identical to those of P-Ti. While TNR/P-Ti showed a considerable decrease in σ_cf compared to P-Ti, TNR/S-Ti exhibited an improved σ_cf which was even higher than that of P-Ti. Biologically, TNR/S-Ti enhanced adhesion, differentiation, and mineralization of BMSCs, and it also promoted adhesion and M1-to-M2 transition of macrophages as compared to S-Ti and P-Ti. With rapid phenotype switch of macrophages, the level of proinflammatory cytokines decreased, while anti-inflammatory cytokines were upregulated. In co-culture conditions, the migration, differentiation, and mineralization of BMSCs were enhanced by increased level of secretion factors of macrophages on TNR/S-Ti. The modified structure accelerated bone apposition in rabbit femur and is expected to induce a favorable immune microenvironment to facilitate osseointegration earlier; it can also simultaneously improve corrosion fatigue resistance of Ti-based implants and thereby enhance their service life.

Surface and mechanical properties of a nanostructured citrate hydroxyapatite coating on pure titanium

The presence of a biomimetic HAP coating on titanium surface, which reduces the structural stiffness, is essential to improve implants biocompatibility and osteointegration. In this study, new citrate-HAP (cHAP) coatings were produced by a simple hydrothermal method on pure titanium (Ti) surface, without requiring any additional pretreatment on this metal surface. The formed cHAP coatings consisting of nanorod-like hydroxyapatite particles, conferred nanoroughness and wettability able to endow improved biological responses. Indeed, the presence of citrate species in the precipitate medium seems to be responsible for controlling the morphology of the new coatings. The presence of citrate groups on the surface of cHAP coatings, identified by chemical composition analysis, due to their implication in bone metabolism can additionally bring an add-value for bone implant applications. From a mechanical point of view, the Finite Element algorithm showing that cHAP coatings tend to decrease the mechanical stress at pure Ti, further favors these new coatings applicability. Overall, the simple and expedite strategy used to developed new biomimetic coatings of citrate-HAP resulted in improved physicochemical, morphological and mechanical properties of Ti, which can endeavor improved implantable materials in bone healing surgical procedures.

Mechanical Assessment of Fatigue Characteristics between Single- and Multi-Directional Cyclic Loading Modes on a Dental Implant System

Mechanical testing based on ISO 14801 standard is generally used to evaluate the performance of the dental implant system according to material and design changes. However, the test method is difficult to reflect on the clinical environment because the ISO 14801 standard does not take into account the various loads from different directions during chewing motion. In addition, the fracture pattern of the implant system can occur both in the horizontal and the vertical directions. Therefore, the purpose of this study was to compare fatigue characteristics and fracture patterns between single directional loading conditions based on the ISO 14801 standard and multi-directional loading condition. Firstly, the static test was performed on five specimens to derive the fatigue load, and the fatigue load was chosen as 40% of the maximum load measured in the static test. Subsequently, the fatigue test was performed considering the single axial/occlusal (AO), AO with facial/lingual (AOFL) and AO with mesial/distal (AOMD) directions, and five specimens were used for each fatigue loading modes. In order to analyze the fatigue characteristics, the fatigue cycle at the time of specimen fracture and displacement change of the specimen every 500 cycles were measured. Field emission scanning electron microscopy (FE-SEM) was used to analyze the fracture patterns and the fracture surface. Compared to the AO group, the fatigue cycle of the AOFL and AOMD groups showed lower about five times, while the displacement gradually increased with every 500 cycles. From FE-SEM results, there were no different surface morphology characteristics among three groups. However, the AOMD group showed a vertical slip band. Therefore, our results suggest that the multi-directional loading mode under the worst-case environment can reproduce the vertical fracture pattern in the clinical situation and may be essential to reflect on the dental implant design including connection types and surface treatments.

Effects of aspirin-loaded graphene oxide coating of a titanium surface on proliferation and osteogenic differentiation of MC3T3-E1 cells

Graphene oxide (GO) has attracted considerable attention for biomedical applications such as drug delivery because of its two-dimensional structure, which provides a large surface area on both sides of the nanosheet. Here, a new method for titanium (Ti) surface modification involving a GO coating and aspirin (A) loading (A/Ti-GO) was developed, and the bioactive effects on mouse osteoblastic MC3T3-E1 cells were preliminarily studied. The X-ray photoelectron spectrometry indicated new C-O-N, C-Si-O-C, and C-N=C bond formation upon GO coating. Remarkably, the torsion test results showed stable bonding between the GO coating and Ti under a torsional shear force found in clinical settings, in that, there was no tearing or falling off of GO coating from the sample surface. More importantly, through π-π stacking interactions, the release of aspirin loaded on the surface of Ti-GO could sustain for 3 days. Furthermore, the A/Ti-GO surface displayed a significantly higher proliferation rate and differentiation of MC3T3-E1 cells into osteoblasts, which was confirmed by a water-soluble tetrazolium salt-8 (WST-8) assay and alkaline phosphatase activity test. Consequently, Ti surface modification involving GO coating and aspirin loading might be a useful contribution to improve the success rate of Ti implants in patients, especially in bone conditions.

Unravelling the effect of macro and microscopic design of dental implants on osseointegration: a randomised clinical study in minipigs

Several dental implants are commercially available and new prototype design are constantly being fabricated. Nevertheless, it is still unclear what parameters of the design affect most the osseointegration of dental implants. The purpose of this study is to assess the effects of the microscopic and macroscopic design of dental implants in the osseointegration by comparing three macroscopic designs (Straumann tissue level (STD), essential cone (ECD) and prototype design (PD)) and six surface treatments. A total of 96 implants were placed in 12 minipigs. The implant stability quotient (ISQ), was assessed at the time of implantation, as well as at 2, 4 and 8 weeks. Histomorphometric and statistical analyses were conducted at the different sacrifice times, being 2, 4 and 8 weeks, to analyse the bone to implant contact (BIC), the bone area density (BAT) and the density of bone outside the thread region (ROI). The macroscopic design results showed higher ISQ values for the ECD, whereas the histomorphometric analysis showed higher ossoeintegration values for the STD. Regarding the microscopic design, both Sandblasted plus acid etching (hydrochloric/sulphuric acid) in a nitrogen atmosphere (SLActive) and Shot-blasted or bombarded with alumina particles and posterior alkaline immersion and thermal treatment (ContacTi) showed superior results in terms of osseointegration and reduced the osseointegration times from 8 weeks to 4 weeks compared to the other analysed surfaces. In conclusion, each of the macroscopic and microscopic designs need to be taken into account when designing novel dental implants to enhance the osseointegration process.

An Overview of the Mechanical Integrity of Dental Implants

With the growing use of dental implants, the incidence of implants' failures grows. Late treatment complications, after reaching full osseointegration and functionality, include mechanical failures, such as fracture of the implant and its components. Those complications are deemed severe in dentistry, albeit being usually considered as rare, and therefore seldom addressed in the clinical literature. The introduction of dental implants into clinical practice fostered a wealth of research on their biological aspects. By contrast, mechanical strength and reliability issues were seldom investigated in the open literature, so that most of the information to date remains essentially with the manufacturers. Over the years, implants have gone through major changes regarding the material, the design, and the surface characteristics aimed at improving osseointegration. Did those changes improve the implants' mechanical performance? This review article surveys the state-of-the-art literature about implants' mechanical reliability, identifying the known causes for fracture, while outlining the current knowledge-gaps. Recent results on various aspects of the mechanical integrity and failure of implants are presented and discussed next. The paper ends by a general discussion and suggestions for future research, outlining the importance of mechanical considerations for the improvement of their future performance.

Mechanical assessment of grit blasting surface treatments of dental implants

This paper investigates the influence of surface preparation treatments of dental implants on their potential (mechanical) fatigue failure, with emphasis on grit-blasting. The investigation includes limited fatigue testing of implants, showing the relationship between fatigue life and surface damage condition. Those observations are corroborated by a detailed failure analysis of retrieved fracture dental implants. In both cases, the negative effect of embedded alumina particles related to the grit-blasting process is identified. The study also comprises a numerical simulation part of the grit blasting process that reveals, for a given implant material and particle size, the existence of a velocity threshold, below which the rough surface is obtained without damage, and beyond which the creation of significant surface damage will severely reduce the fatigue life, thus increasing fracture probability. The main outcome of this work is that the overall performance of dental implants comprises, in addition to the biological considerations, mechanical reliability aspects. Fatigue fracture is a central issue, and this study shows that uncontrolled surface roughening grit-blasting treatments can induce significant surface damage which accelerate fatigue fracture under certain conditions, even if those treatments are beneficial to the osseointegration process.

Corrosion fatigue of biomedical metallic alloys: mechanisms and mitigation

Cyclic stresses are often related to the premature mechanical failure of metallic biomaterials. The complex interaction between fatigue and corrosion in the physiological environment has been subject of many investigations. In this context, microstructure, heat treatments, plastic deformation, surface finishing and coatings have decisive influence on the mechanisms of fatigue crack nucleation and growth. Furthermore, wear is frequently present and contributes to the process. However, despite all the effort at elucidating the mechanisms that govern corrosion fatigue of biomedical alloys, failures continue to occur. This work reviews the literature on corrosion-fatigue-related phenomena of Ti alloys, surgical stainless steels, Co-Cr-Mo and Mg alloys. The aim was to discuss the correlation between structural and surface aspects of these materials and the onset of fatigue in the highly saline environment of the human body. By understanding such correlation, mitigation of corrosion fatigue failure may be achieved in a reliable scientific-based manner. Different mitigation methods are also reviewed and discussed throughout the text. It is intended that the information condensed in this article should be a valuable tool in the development of increasingly successful designs against the corrosion fatigue of metallic implants.