Retrospective clinical outcome of nanopolymorphic crystalline hydroxyapatite-coated and anodic oxidized titanium implants for 10 years

An Investigation into the Relative Efficacy of High-Velocity Air-Fuel-Sprayed Hydroxyapatite Implants Based on the Crystallinity Index, Residual Stress, Wear, and In-Flight Powder Particle Behavior

Due to its resemblance to the bone, hydroxyapatite (HA) has been widely used for bioactive surface modification of orthopedic implants. However, it undergoes significant thermal decomposition and phase transformations at a high operating temperature, leading to premature implant failure. This investigation uses high-velocity air-fuel (HVAF) spray, an emerging low-temperature thermal spray technique, to deposit HA over the Ti-6Al-4V substrate. Coating characteristics, such as the crystallinity index and phase analysis, were measured using X-ray diffraction, Raman analysis, and Fourier transform infrared spectroscopy, residual stress using the sin2ψ method, and tribological performance by a fretting wear test. The coating retained an over 90% crystallinity index, a crystallite size of 41.04 nm, a compressive residual stress of -229 ± 34.5 MPa, and a wear rate of 1.532 × 10-3 mm3 N-1 m-1. Computational in-flight particle traits of HA particles (5 to 60 μm) were analyzed using computational fluid dynamics; it showed that 90% of particles were deposited at a 700 to 1000 m/s velocity and a 900 to 1450 K temperature with a 2.1 ms mean residence time. In-flight particle oxidation was minimized, and particle impact deformation was maximized, which caused severe plastic deformation, forming crystalline, compressive residual stressed coatings. The thermal decomposition model of low-temperature HVAF-sprayed HA particles helped to understand the implants' crystallinity index, residual stress, and tribological characteristics. Hence, this experimental and computational analysis shows that the HVAF process can be a promising candidate for biomedical applications for having strong and durable implants.

There Are over 60 Ways to Produce Biocompatible Calcium Orthophosphate (CaPO4) Deposits on Various Substrates

A The present overview describes various production techniques for biocompatible calcium orthophosphate (abbreviated as CaPO4) deposits (coatings, films and layers) on the surfaces of various types of substrates to impart the biocompatible properties for artificial bone grafts. Since, after being implanted, the grafts always interact with the surrounding biological tissues at the interfaces, their surface properties are considered critical to clinical success. Due to the limited number of materials that can be tolerated in vivo, a new specialty of surface engineering has been developed to desirably modify any unacceptable material surface characteristics while maintaining the useful bulk performance. In 1975, the development of this approach led to the emergence of a special class of artificial bone grafts, in which various mechanically stable (and thus suitable for load-bearing applications) implantable biomaterials and artificial devices were coated with CaPO4. Since then, more than 7500 papers have been published on this subject and more than 500 new publications are added annually. In this review, a comprehensive analysis of the available literature has been performed with the main goal of finding as many deposition techniques as possible and more than 60 methods (double that if all known modifications are counted) for producing CaPO4 deposits on various substrates have been systematically described. Thus, besides the introduction, general knowledge and terminology, this review consists of two unequal parts. The first (bigger) part is a comprehensive summary of the known CaPO4 deposition techniques both currently used and discontinued/underdeveloped ones with brief descriptions of their major physical and chemical principles coupled with the key process parameters (when possible) to inform readers of their existence and remind them of the unused ones. The second (smaller) part includes fleeting essays on the most important properties and current biomedical applications of the CaPO4 deposits with an indication of possible future developments.

Signaling Pathway and Transcriptional Regulation in Osteoblasts during Bone Healing: Direct Involvement of Hydroxyapatite as a Biomaterial

Bone defects and periodontal disease are pathological conditions that may become neglected diseases if not treated properly. Hydroxyapatite (HA), along with tricalcium phosphate and bioglass ceramic, is a biomaterial widely applied to orthopedic and dental uses. The in vivo performance of HA is determined by the interaction between HA particles with bone cells, particularly the bone mineralizing cells osteoblasts. It has been reported that HA-induced osteoblastic differentiation by increasing the expression of osteogenic transcription factors. However, the pathway involved and the events that occur in the cell membrane have not been well understood and remain controversial. Advances in gene editing and the discovery of pharmacologic inhibitors assist researchers to better understand osteoblastic differentiation. This review summarizes the involvement of extracellular signal-regulated kinase (ERK), p38, Wnt, and bone morphogenetic protein 2 (BMP2) in osteoblastic cellular regulation induced by HA. These advances enhance the current understanding of the molecular mechanism of HA as a biomaterial. Moreover, they provide a better strategy for the design of HA to be utilized in bone engineering.

In Vitro Characterizations of Si4+ and Zn2+ Doped Plasma Sprayed Hydroxyapatite Coatings Using Osteoblast and Osteoclast Coculture

Osteoporosis is one of the most commonly identified bone disorders, which leads to an enhanced risk of bone fracture, especially for the older population. Hydroxyapatite (HA) coated titanium (Ti) alloys have been used widespread for load bearing applications like hip or knee replacements owing to their compositional similarity to natural bone; however, incorporation of osteoinductivity is still a challenge. The objective of this study is to evaluate the effects of SiO₂ and ZnO as dopants in HA coated Ti alloys on cellular osteoporotic conditions mimicked by an in vitro osteoblast and osteoclast coculture model. HA, Si-HA, and Zn-HA coatings showed adhesive bond strengths of 25.7 ± 1.9 MPa, 23.8 ± 2.3 MPa, and 22.9 ± 3.5 MPa, respectively. To study the effects of doped HA coatings on the simulated osteoporotic cellular condition, human mesenchymal stem cells (hMSCs) and monocytes (THP-1) were seeded simultaneously in a ratio of 1:4, respectively. Gene expressions studies were carried out with marker genes showing that the presence of the dopants in the HA coating enhanced osteoblast proliferation along with diminishing cell growth of osteoclasts. This study demonstrates the promising effects of SiO₂ and ZnO in plasma sprayed HA coatings on alleviating osteoporosis cellular conditions, which can potentially be used for load-bearing implants in aging patients whose bone resorption is more dominant than bone formation.

The use of hydroxyapatite bone substitute grafting for alveolar ridge preservation, sinus augmentation, and periodontal bone defect: A systematic review

OBJECTIVES

We determined and structurally analyzed the reported effect of hydroxyapatite (HA) bone substitute on alveolar bone regeneration. To the best of our knowledge, no systematic reviews have previously reported the bone regenerative effect of the HA bone substitute.

MATERIALS AND METHODS

A literature search was performed for articles published up to August 2015 using MEDLINE with the search terms "hydroxyapatite," "bone regeneration," and "alveolar bone" as well as their known synonyms. The inclusion criteria were set up for human trials with at least five patients. The literature search, eligible article selection, and data extraction were independently performed by two readers, and their agreement was reported by κ value.

RESULTS

Of the 504 studies found using the MEDLINE literature search, 241 were included for further steps (inter-reader agreement, κ = 0.968). Abstract screening yielded 74 studies (κ = 0.910), with 42 completely fulfilling the inclusion criteria (κ = 0.864). In a final step, 42 studies were further analyzed, with 17 and 25 studies with and without statistical analysis, respectively. The 17 studies reporting similar outcome measures were compared using the calculated 95% confidence intervals. The effect of HA on ridge preservation could not be evaluated.

CONCLUSIONS

The use of the HA bone substitute interfered with the normal healing process, with significant differences found for sinus augmentation but not for periodontal bone defects. Thus, a bone substitute with optimal bone regenerative properties for alveolar ridge or socket preservation, sinus augmentation, and periodontal bony defect should be developed.