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Zhao L, Uchtman M, Aretakis A, Selberg C, McCarthy JJ, Whitlock PW. Maintenance of acetabular correction following PAO: a multicenter study comparing stainless-steel and titanium screws. J Hip Preserv Surg 2024; 11:140-143. [PMID: 39070209 PMCID: PMC11272636 DOI: 10.1093/jhps/hnae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 07/30/2024] Open
Abstract
Stainless-steel screws are commonly used for fragment fixation during periacetabular osteotomy (PAO) at our institutions. Titanium is reserved for patients with documented nickel allergies. Titanium screws possess a significantly lower Young's modulus than stainless steel and, therefore, potentially less resistance to physiologic loading. Thus, we hypothesized that the use of titanium screws might be associated with changes in acetabular correction prior to healing. The aim of this study was to compare the maintenance of acetabular correction following PAO using stainless-steel or titanium screws. A documented nickel allergy was confirmed with an allergy specialist. Patients' age at surgery, gender and BMI were collected. The lateral center-edge angle of Wiberg (LCEA), medial center-edge angle (MCEA), anterior wall index (AWI), posterior wall index (PWI) and Tönnis angle were measured. The delta value for radiographic parameters was calculated as the difference between values immediately post-operation and at 6 months post-operation. Only age at surgery (P < 0.001) and the pre-operative LCEA (P = 0.013) were significantly different between groups (Tables I and II). The remaining pre- and post-operative radiological measurements were similar (Table II). Comparison of delta values at 6 months follow-up indicated no significant differences between screw types (Table III). No patients in the titanium group had a trans-iliac retrograde screw included in their construct (P = 0.003). All patients healed from their osteotomies. The use of titanium screws in patients with an allergy to nickel was not associated with differences in acetabular correction or the rate of osseous union rates despite its lower inherent mechanical properties.
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Affiliation(s)
- Lei Zhao
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Molly Uchtman
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Alexander Aretakis
- Orthopaedics Institute, Children’s Hospital Colorado, 13123 E 16th Ave, Aurora, Aurora 80045, USA
| | - Courtney Selberg
- Orthopaedics Institute, Children’s Hospital Colorado, 13123 E 16th Ave, Aurora, Aurora 80045, USA
| | - James J McCarthy
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Patrick W Whitlock
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
- Department of Biomedical Engineering, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH 45219, USA
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Kandaswamy E, Harsha M, Joshi VM. Titanium corrosion products from dental implants and their effect on cells and cytokine release: A review. J Trace Elem Med Biol 2024; 84:127464. [PMID: 38703537 DOI: 10.1016/j.jtemb.2024.127464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Titanium is considered to be an inert material owing to the ability of the material to form a passive titanium oxide layer. However, once the titanium oxide layer is lost, it can lead to exposure of the underlying titanium substructure and can undergo corrosion. SUMMARY The article explores the role of titanium ions and particles from dental implants on cells, cytokine release, and on the systemic redistribution of these particles as well as theories proposed to elucidate the effects of these particles on peri-implant inflammation based on evidence from in-vitro, human, and animal studies. Titanium particles and ions have a pro-inflammatory and cytotoxic effect on cells and promote the release of pro-inflammatory mediators like cytokines. Three theories to explain etiopathogenesis have been proposed, one based on microbial dysbiosis, the second based on titanium particles and ions and the third based on a synergistic effect between microbiome and titanium particles on the host. CONCLUSION There is clear evidence from in-vitro and limited human and animal studies that titanium particles released from dental implants have a detrimental effect on cells directly and through the release of pro-inflammatory cytokines. Future clinical and translational studies are required to clarify the role of titanium particles and ions in peri-implant inflammation and the etiopathogenesis of peri-implantitis.
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Affiliation(s)
- Eswar Kandaswamy
- Department of Periodontics, LSUHSC, School of Dentistry, 100 Florida Avenue, New Orleans, LA 70119, USA
| | - M Harsha
- Department of Oral Pathology & Microbiology, Yogita Dental College & Hospital, Naringi Riverside, At Post Tal Dist. SH104, Khed, Maharashtra 415709, India
| | - Vinayak M Joshi
- Department of Periodontics, LSUHSC, School of Dentistry, 100 Florida Avenue, New Orleans, LA 70119, USA.
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Kao A, Tawse-Smith A, Ma S, Duncan WJ, Reid M, Atieh MA. Quantity and Size of Titanium Particles Released from Different Mechanical Decontamination Procedures on Titanium Discs: An In Vitro Study. Dent J (Basel) 2024; 12:123. [PMID: 38786521 PMCID: PMC11119952 DOI: 10.3390/dj12050123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Complications such as peri-implantitis could ultimately affect the survival of a dental implant. The prevention and treatment of peri-implant diseases require managing bacterial biofilm and controlling environmental risks, including the presence of pro-inflammatory titanium (Ti) particles in the peri-implant niche. Objectives included the evaluation of the size and quantity of Ti particles released from moderately roughened Ti surfaces during common mechanical surface decontamination methods. One hundred and forty moderately roughened Ti discs were divided into seven groups (n = 20 per group); six groups received mechanical decontamination procedures (ultrasonic scaling (US) with a metal tip and poly-ether-ketone (PEEK) under low and medium power settings, air-polishing with erythritol powder, and Ti brush), and the control group underwent air-water spray using a dental triplex. The rinsing solution was collected for Ti mass analysis using inductively coupled plasma mass spectrometry (ICPMS), as well as for Ti particle size and count analysis under scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS). US metal tip instrumentation generated 34.00 ± 12.54 μg and 34.44 ± 6.08 μg of Ti under low and medium power settings, respectively. This amount of Ti generation was significantly higher than other instrumentation methods. The mean Ti particle size of the US groups ranged from 0.89 ± 0.27 μm to 1.25 ± 0.24 μm. No statistically significant difference was found in the particle size among US groups and Ti brush group (1.05 ± 0.11 μm), except for US with the PEEK tip, where a significantly smaller mean particle diameter was found at the low power setting (0.89 ± 0.27 μm). Mechanical instrumentation can produce Ti particulates and modify the implant surfaces. US using a metal tip generated the highest amount of Ti with smaller Ti size particles compared to all other commonly used mechanical surface instrumentations. The EDS analysis confirmed Ti in PEEK US tips. It can be suggested that deterioration from the PEEK US tip and Ti brush, as observed under SEM, is an additional source of Ti release during Ti surface decontamination.
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Affiliation(s)
- Anthony Kao
- Sir John Walsh Research Institute, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand; (A.K.); (S.M.); (W.J.D.); (M.A.A.)
| | - Andrew Tawse-Smith
- Sir John Walsh Research Institute, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand; (A.K.); (S.M.); (W.J.D.); (M.A.A.)
| | - Sunyoung Ma
- Sir John Walsh Research Institute, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand; (A.K.); (S.M.); (W.J.D.); (M.A.A.)
| | - Warwick J. Duncan
- Sir John Walsh Research Institute, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand; (A.K.); (S.M.); (W.J.D.); (M.A.A.)
| | - Malcolm Reid
- Department of Chemistry and Centre for Trace Element Analysis, Department of Geology, Dunedin 9054, New Zealand;
| | - Momen A. Atieh
- Sir John Walsh Research Institute, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand; (A.K.); (S.M.); (W.J.D.); (M.A.A.)
- Department of Oral Diagnostics and Surgical Sciences, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
- School of Dentistry, University of Jordan, Amman 11942, Jordan
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Chato-Astrain J, Toledano-Osorio M, Alaminos M, Toledano M, Sanz M, Osorio R. Effect of functionalized titanium particles with dexamethasone-loaded nanospheres on macrophage polarization and activity. Dent Mater 2024; 40:66-79. [PMID: 37914549 DOI: 10.1016/j.dental.2023.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effect of titanium micro particles (TiP) previously functionalized with nanoparticles doped with dexamethasone (Dex) and doxycycline (Dox), on macrophage polarization and activity. METHODS Macrophages RAW264.7 were cultured in the presence TiP loaded with dexamethasone -NPs (Dex)- and doxycycline -NPs (Dox)-, and as control, TiP with or without doped NPs. Cells were tested with and without previous bacterial lipopolysaccharide endotoxin (LPS) stimulation. Their morphology, proliferation, cytotoxicity, phenotypic change, and cytokines release were assessed by LIVE/DEAD, DNA release, metabolic activity, brightfield and scanning electron microscopy. The test Kruskall-Wallis was used for comparisons, while the cytokine expression profiles were examined by hierarchical clustering (p < 0.05). RESULTS Upon exposure with TiP macrophages were activated and polarized to M1, but without depicting cytotoxic effects. The particles were phagocytised, and vacuolized. When exposed to functionalised TiP with NPs(Dex) and NPs(Dox), the ratio M1/M2 was up to forty times lower compared to TiP alone. When exposed to LPS, TiP reduced cell viability in half. Functionalised TiP with NPs(Dex) inhibited the cytokine release exerted by TiP on macrophages. When macrophages were exposed to functionalised TiPs with NPs(Dex) with and without LPS, the effect of TiP on cytokine secretion was inhibited. SIGNIFICANCE Functionalised TiPs with NPs(Dex) and NPs(Dox) may potentially have beneficial effects on modulating titanium and LPS-related inflammatory reactions.
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Affiliation(s)
- Jesús Chato-Astrain
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria IBS. Granada, Granada, Spain
| | - Manuel Toledano-Osorio
- Dental School, Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, Granada 18071, Spain..
| | - Miguel Alaminos
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria IBS. Granada, Granada, Spain
| | - Manuel Toledano
- Instituto de Investigación Biosanitaria IBS. Granada, Granada, Spain; Dental School, Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, Granada 18071, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group. University Complutense of Madrid, Madrid, Spain
| | - Raquel Osorio
- Instituto de Investigación Biosanitaria IBS. Granada, Granada, Spain; Dental School, Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, Granada 18071, Spain
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Aparicio-Alonso M, Torres-Solórzano V, Méndez-Contreras JF, Acevedo-Whitehouse K. Scanning Electron Microscopy and EDX Spectroscopy of Commercial Swabs Used for COVID-19 Lateral Flow Testing. TOXICS 2023; 11:805. [PMID: 37888657 PMCID: PMC10610828 DOI: 10.3390/toxics11100805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023]
Abstract
The chemical composition of COVID test swabs has not been examined beyond the manufacturer's datasheets. The unprecedented demand for swabs to conduct rapid lateral flow tests and nucleic acid amplification tests led to mass production, including 3D printing platforms. Manufacturing impurities could be present in the swabs and, if so, could pose a risk to human health. We used scanning electron microscopy and energy dispersive X-ray (EDX) spectroscopy to examine the ultrastructure of seven assorted brands of COVID test swabs and to identify and quantify their chemical elements. We detected eight unexpected elements, including transition metals, such as titanium and zirconium, the metalloid silicon, as well as post-transition metals aluminium and gallium, and the non-metal elements sulphur and fluorine. Some of the elements were detected as trace amounts, but for others, the amount was close to reported toxicological thresholds for inhalation routes. Experimental studies have shown that the detrimental effects of unexpected chemical elements include moderate to severe inflammatory states in the exposed epithelium as well as proliferative changes. Given the massive testing still being used in the context of the COVID pandemic, we urge caution in continuing to recommend repeated and frequent testing, particularly of healthy, non-symptomatic, individuals.
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Affiliation(s)
- Manuel Aparicio-Alonso
- Medical Direction and Healthcare Responsibility, Centro Médico Jurica, Santiago de Querétaro 76100, Mexico
| | - Verónica Torres-Solórzano
- Unit for Basic and Applied Microbiology, Universidad Autónoma de Querétaro, Santiago de Querétaro 76140, Mexico;
| | | | - Karina Acevedo-Whitehouse
- Unit for Basic and Applied Microbiology, Universidad Autónoma de Querétaro, Santiago de Querétaro 76140, Mexico;
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Cionca N, Meyer J, Michalet S, Varesio E, Hashim D. Quantification of titanium and zirconium elements in oral mucosa around healthy dental implants: a case-control pilot study. Clin Oral Investig 2023; 27:4715-4726. [PMID: 37270723 PMCID: PMC10415439 DOI: 10.1007/s00784-023-05099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/29/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Metallic particles are detected in different sites of the oral cavity, mainly in patients with peri-implantitis lesions. The aim of this pilot study was to analyze the levels of titanium and zirconium elements in the oral mucosa around healthy implants and to investigate the impact of titanium exogenous contamination on the measurements. MATERIALS AND METHODS Forty-one participants were included in this three-phase study. Two groups of subjects were defined according to presence of titanium or zirconia implants (n: 20) or without any implants nor metallic restorations (n:21). Thirteen patients (n: 5 with zirconia implant; n: 3 with titanium implants; n: 5 control group) took part to the first part designed to optimize and validate the method of detecting titanium (Ti) and zirconium (Zr) elements in the oral mucosa and gingival tissues by the Inductively Coupled Plasma Mass Spectrometry (ICPMS). The second phase compared the levels of Ti and Zr concentrations in patients with implants (n: 12) and without implants (n: 6) who were controlled for their intake of titanium dioxide (TiO2). The last step included ten control subjects without any metallic devices to measure the concentration of Ti and Zr before and after having candies containing TiO2. RESULTS In the first phase, concentrations of Ti and Zr were below the limit of detection (LOD) in most cases, 0.18 μg/L and 0.07 μg/L respectively. In the titanium group, two out of three subjects displayed concentrations above the LOD, 0.21 μg/L and 0.66 μg/L. Zr element was only found in patients with zirconia implants. After controlling the intake of TiO2, all concentrations of Ti and Zr were below the limit of quantification (LOQ). Moreover, in patients with no implants, the Ti concentration in gingiva cells was superior for 75% of the samples after having a TiO2 diet. CONCLUSIONS Zirconium was only found in patients with zirconia implants, whereas titanium was detected in all groups even in subjects with no titanium implants. Zirconium and titanium elements were not detected in patients who were controlled for their intake of food and their use of toothpaste irrespective of the presence of implants or not. For 70% of the patients, the titanium detection was directly influenced by the intake of TiO2 contained candies. CLINICAL RELEVANCE When analyzing titanium particles, it is necessary to pay attention to the risk of contamination bias brought by external products. When this parameter was controlled, no titanium particles were detected around clinically healthy implants.
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Affiliation(s)
- Norbert Cionca
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Julien Meyer
- Mass Spectrometry Core Facility (MZ 2.0), Faculty of Sciences, University of Geneva, Geneva, Switzerland
| | - Sophie Michalet
- Mass Spectrometry Core Facility (MZ 2.0), Faculty of Sciences, University of Geneva, Geneva, Switzerland
| | - Emmanuel Varesio
- Mass Spectrometry Core Facility (MZ 2.0), Faculty of Sciences, University of Geneva, Geneva, Switzerland
| | - Dena Hashim
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Olander J, Barkarmo S, Hammarström Johansson P, Wennerberg A, Stenport VF. Inflammatory Gene Profile and Particle Presence in Peri-Implant Mucosa: a Pilot Study on 9 Patients. J Oral Maxillofac Res 2023; 14:e2. [PMID: 37969950 PMCID: PMC10645473 DOI: 10.5037/jomr.2023.14302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
Objectives The purpose of this pilot study is to compare gene expression in mucosa around dental implants with zirconia abutment to titanium and investigate presence of particles in mucosa samples and on implant heads. Material and Methods Ten patients with a single implant supported prosthesis connected to zirconia or titanium abutments were invited at the five-year control. A clinical examination and a survey on experience of function and appearance were conducted. A mucosa biopsy taken in close vicinity to the implant were analysed by real-time polymerase chain reaction (qPCR) and presence of particles in a scanning electron microscope/energy-dispersive X-ray spectroscope (SEM/EDX). Cytological smear samples were collected and analysed through inductively coupled plasma mass spectrometry (ICP-MS) to investigate presence of particles on implant heads. Results In total, 9 patients participated in the study, five with titanium abutments and four with zirconia abutments. All patients were satisfied with function and aesthetics. Titanium and iron particles were detected in mucosa biopsies. The ICP - MS analysis demonstrated presence of zirconia and titanium. Several proinflammatory genes were upregulated in the zirconia abutment group. Conclusions Around zirconia abutments a slight increase in proinflammatory response and amount of wear particles was seen as compared to titanium. Wear particles of titanium were present in all soft tissue samples, however zirconia particles only in the samples from implants heads/mucosa with zirconia abutments.
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Affiliation(s)
- Julia Olander
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
| | - Sargon Barkarmo
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
| | - Petra Hammarström Johansson
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
| | - Ann Wennerberg
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
| | - Victoria Franke Stenport
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
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Fischer KR, Büchel J, Gubler A, Liu CC, Sahrmann P, Schmidlin PR. Nonsurgical cleaning potential of deep-threaded implants and titanium particle release: A novel in vitro tissue model. Clin Oral Implants Res 2023; 34:416-425. [PMID: 36757141 DOI: 10.1111/clr.14045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To measure the efficiency of three cleaning modalities on two implant designs with similar diameters but different thread depths as well as the presence of titanium particles. METHODS Sixty dyed implants (30 × 4.8 apically tapered (ATAP) and 30 × 5.0 fully tapered (FTAP)) were fixed in plastic models. The horizontal bone defects were surrounded with porcine soft tissue. Three instrumentation modalities were used to clean for 150 s: Curette (CUR), ultrasonic scaler (US), and air powder waterjet device (APWJ) with erythritol powder. Afterward, implants were photographed and scanning electron microscopic (SEM) images were taken. Titanium in the soft tissues was quantified in dissolved samples and histologically confirmed. RESULTS For ATAP and FTAP implants, the percentage of the cleaned surface was 26.4 ± 3.0 and 17.1 ± 2.4% for CUR, 33.7 ± 3.8% and 28.1 ± 2.3% for US, and 45.5 ± 4.1% and 24.7 ± 3.8% for APWJ, respectively. SEM images showed significant implant surface changes, especially after instrumentation with CUR and US, whereas APWJ had little to no effect. Most titanium residues were found after cleaning ATAP implants with CUR (152.0 ± 75.5), followed by US (89.5 ± 73.8) and APWJ (0.3 ± 0.8). For the FTAP implants, respective values accounted for 129.5 ± 58.6 μg and 67.0 ± 14.4 μg for CUR and US, respectively. No titanium residues were detected on ATAP with APWJ. CONCLUSION Based on in vitro data, erythritol-powered APWJ still appears to be the most efficient and gentle cleaning method. All three instruments, however, were found to have unprocessed areas depending on different implant designs, hence, clinical relevance for non-surgical approaches remains challenging and warrants further improvement.
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Affiliation(s)
- Kai R Fischer
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
| | - Jasmin Büchel
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
| | - Andrea Gubler
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
| | - Chun Ching Liu
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
| | - Philipp Sahrmann
- Clinic for Periodontology, Endodontology and Cariology, University Center of Dental Medicine, University of Basel, Basel, Switzerland
| | - Patrick R Schmidlin
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
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Toledano-Serrabona J, Bosch BM, Díez-Tercero L, Gil FJ, Camps-Font O, Valmaseda-Castellón E, Gay-Escoda C, Sánchez-Garcés MÁ. Evaluation of the inflammatory and osteogenic response induced by titanium particles released during implantoplasty of dental implants. Sci Rep 2022; 12:15790. [PMID: 36138061 PMCID: PMC9500064 DOI: 10.1038/s41598-022-20100-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
Implantoplasty is a mechanical decontamination technique that consists of removing the threads and polishing and smoothing the dental implant surface. During implantoplasty there is a large release of titanium metal particles that might provoke a proinflammatory response and reduce the viability of osteogenic cells. We analyze the inflammatory and osteogenic response induced by Ti6Al4V particles released during implantoplasty and by as-received commercially pure Ti particles. Macrophages stimulated with metal particles obtained by implantoplasty and with as-received Ti particles showed an increased proinflammatory expression of TNF-α and a decreased expression of TGF-β and CD206. Regarding cytokine release, there was an increase in IL-1β, while IL-10 decreased. The osteogenic response of Ti6Al4V extracts showed a significant decrease in Runx2 and OC expression compared to the controls and commercially pure Ti extracts. There were no relevant changes in ALP activity. Thus, implantoplasty releases metal particles that seems to induce a pro-inflammatory response and reduce the expression of osteogenic markers.
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Affiliation(s)
- Jorge Toledano-Serrabona
- Department of Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Begoña M Bosch
- Bioengineering Institute of Technology, International University of Catalonia, Sant Cugat del Vallès, Spain
| | - Leire Díez-Tercero
- Bioengineering Institute of Technology, International University of Catalonia, Sant Cugat del Vallès, Spain
| | - F Javier Gil
- Bioengineering Institute of Technology, International University of Catalonia, Sant Cugat del Vallès, Spain.
- Faculty of Dentistry, International University of Catalonia, Sant Cugat del Vallès, Spain.
| | - Octavi Camps-Font
- Department of Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Eduard Valmaseda-Castellón
- Department of Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Cosme Gay-Escoda
- Department of Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Mª Ángeles Sánchez-Garcés
- Department of Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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10
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Physicochemical and Biological Characterization of Ti6Al4V Particles Obtained by Implantoplasty: An In Vitro Study. Part I. MATERIALS 2021; 14:ma14216507. [PMID: 34772034 PMCID: PMC8585232 DOI: 10.3390/ma14216507] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 02/07/2023]
Abstract
Implantoplasty is a mechanical decontamination technique that consists of polishing the supra-osseous component of the dental implant with peri-implantitis. This technique releases metal particles in the form of metal swarf and dust into the peri-implant environment. In the present in vitro study, the following physicochemical characterization tests were carried out: specific surface area, granulometry, contact angle, crystalline structure, morphology, and ion release. Besides, cytotoxicity was in turn evaluated by determining the fibroblastic and osteoblastic cell viability. As a result, the metal debris obtained by implantoplasty presented an equivalent diameter value of 159 µm (range 6–1850 µm) and a specific surface area of 0.3 m2/g on average. The particle had a plate-like shape of different sizes. The release of vanadium ions in Hank’s solution at 37 °C showed no signs of stabilization and was greater than that of titanium and aluminum ions, which means that the alloy suffers from a degradation. The particles exhibited cytotoxic effects upon human osteoblastic and fibroblastic cells in the whole extract. In conclusion, metal debris released by implantoplasty showed different sizes, surface structures and shapes. Vanadium ion levels were higher than that those of the other metal ions, and cell viability assays showed that these particles produce a significant loss of cytocompatibility on osteoblasts and fibroblasts, which means that the main cells of the peri-implant tissues might be injured.
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Alhamad M, Barão VAR, Sukotjo C, Cooper LF, Mathew MT. Ti-Ions and/or Particles in Saliva Potentially Aggravate Dental Implant Corrosion. MATERIALS 2021; 14:ma14195733. [PMID: 34640130 PMCID: PMC8510105 DOI: 10.3390/ma14195733] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
The corrosive titanium products in peri-implant tissues are a potential risk factor for peri-implantitis. There is very limited information available on the effect of the corrosion and wear products on the dental implant corrosion. Therefore, we determined the influence of Ti-ions and Ti-particles on Ti corrosion. Eighteen commercially pure-Ti-grade-2 discs were polished to mirror-shine. Samples were divided into six groups (n = 3) as a function of electrolytes; (A) Artificial saliva (AS), (B) AS with Ti-ions (the electrolyte from group A, after corrosion), (C) AS with Ti-particles 10 ppm (D) AS with Ti-particles 20 ppm, (E) AS with Ti-ions 10 ppm, and (F) AS with Ti-ions 20 ppm. Using Tafel’s method, corrosion potential (Ecorr) and current density (Icorr) were estimated from potentiodynamic curves. Electrochemical Impedance Spectroscopy (EIS) data were used to construct Nyquist and Bode plots, and an equivalent electrical circuit was used to assess the corrosion kinetics. The corroded surfaces were examined through a 3D-white-light microscope and scanning electronic microscopy. The data demonstrated that the concentration of Ti-ions and corrosion rate (Icorr) are strongly correlated (r = 0.997, p = 0.046). This study indicated that high Ti-ion concentration potentially aggravates corrosion. Under such a severe corrosion environment, there is a potential risk of increased implant associated adverse tissue reactions.
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Affiliation(s)
- Mostafa Alhamad
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Valentim A. R. Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo 13414-903, Brazil;
| | - Cortino Sukotjo
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Department of Prosthodontics, School of Dental Medicine, Bahçeşehir University, Istanbul 34353, Turkey
- Correspondence: (C.S.); (M.T.M.)
| | - Lyndon F. Cooper
- Department of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Mathew T. Mathew
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Correspondence: (C.S.); (M.T.M.)
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Hu X, Xu L, Fu X, Huang J, Ji P, Zhang Z, Deng F, Wu X. The TiO 2-μ implant residual is more toxic than the Al 2O 3-n implant residual via blocking LAP and inducing macrophage polarization. NANOSCALE 2021; 13:8976-8990. [PMID: 33973606 DOI: 10.1039/d1nr00696g] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Medical device residuals cause harmful effects and diseases in the human body, such as Particle Disease (PD), but the biological interaction of different types of particles is unclear. In this study, after a biological interaction screen between different particles, we aimed to explore the mechanism of the biological interaction between different types of particles, and the effect of a proteasome inhibitor on PD. Our studies showed that the titanium oxide microscale particle (Ti-μ) was more toxic than the aluminum oxide nanoscale particle (Al-n). Al-n activated LAP, attenuated the macrophage M1 polarization, inhibited the activator of the NF-κB pathway, and blocked the secretion of inflammatory factors and apoptosis in vitro, and also prevented the inflammation tissue disorder and aseptic loosening in vivo induced by Ti-μ. What is more, Bortezomib blocked apoptosis, secretion of inflammatory factors and the activation of the NF-κB pathway induced by TiO2 micro particles. Al-n-induced autophagy could play the function in the efficient clearance of dying cells by phagocytosis, and serves in dampening M1 polarization-related pro-inflammatory responses. While the Ti alloy medical implant and devices are applied worldwide, the toxicity of Ti-μ and its interaction with Al-n could be considered in the implant design, and Bortezomib was a potential therapeutic for PD.
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Affiliation(s)
- Xiaolei Hu
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, China. and Department of Orthodontics, College of Stomatology, Chongqing Medical University, Chongqing, China and Key Laboratory of Clinical Laboratory Science, Ministry of Education, College of Laboratory Medicine, Chongqing Medical University, China
| | - Ling Xu
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, China. and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, China and Department of Prosthodontics, Stomatological Hospital of Chongqing Medical University, China
| | - Xuewei Fu
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, China. and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, China and Department of Prosthodontics, Stomatological Hospital of Chongqing Medical University, China
| | - Jiao Huang
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, China. and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, China and Department of Periodontology, College of Stomatology, Chongqing Medical University, China
| | - Ping Ji
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, China. and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, China and Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Zhiwei Zhang
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, China. and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, China and Department of Periodontology, College of Stomatology, Chongqing Medical University, China
| | - Feng Deng
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, China. and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, China and Department of Orthodontics, College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Xiaomian Wu
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, China. and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, China and Department of Orthodontics, College of Stomatology, Chongqing Medical University, Chongqing, China
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13
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The Possible Role of Vitamin D Deficiency in Early Implant Failure. BIOMED RESEARCH INTERNATIONAL 2021. [DOI: 10.1155/2021/6639523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background. Dental implants are one of the most successful treatments for restoring tooth function and beauty. Identifying the causes of dental implant failure is useful and vital. This review was aimed at studying the possible role of vitamin D in early implant failure. Method and Material. This review was designed based on the PRISMA guideline. Data was collected using keywords including implant, vitamin D, deficiency, failure, dental, OR tooth in international databases including PubMed, Scopus, Web of Science, Cochrane, and Embase, until 2020. Based on the inclusion and exclusion criteria, data were extracted and gathered in a checklist. Results. Finally, twelve studies were selected from five different countries. In 6 studies (2 animal studies and four human studies), there was no significant relationship between vitamin D deficiency and dental implant failure. In the other six studies (1 animal study and five human studies), there was a significant relationship in this regard. Conclusion. It is difficult to conclude the association between vitamin D and implant failure based on the literature’s researches. However, vitamin D appears to play an essential role in implant success through its effects on immune system modulation.
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Zhou Z, Shi Q, Wang J, Chen X, Hao Y, Zhang Y, Wang X. The unfavorable role of titanium particles released from dental implants. Nanotheranostics 2021; 5:321-332. [PMID: 33732603 PMCID: PMC7961127 DOI: 10.7150/ntno.56401] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/10/2021] [Indexed: 12/17/2022] Open
Abstract
Titanium is considered to be a metal material with the best biological safety. Studies have proved that the titanium implanted in the bone continuously releases titanium particles (Ti particles), significantly increasing the total titanium content in human body. Generally, Ti particles are released slowly without causing a systemic immune response. However, the continuous increased local concentration may result in damage to the intraepithelial homeostasis, aggravation of inflammatory reaction in the surrounding tissues, bone resorption and implant detachment. They also migrate with blood flow and aggregate in the distal organ. The release of Ti particles is affected by the score of the implant surface structure, microenvironment wear and corrosion, medical operation wear, and so on, but the specific mechanism is not clear. Thus, it difficult to prevent the release completely. This paper reviews the causes of the Ti particles formation, the damage to the surrounding tissue, and its mechanism, in particular, methods for reducing the release and toxicity of the Ti particles.
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Affiliation(s)
- Zilan Zhou
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, China
| | - Quan Shi
- Institute of Stomatology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, China
| | - Xiaohang Chen
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, China
| | - Yujia Hao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, China
| | - Yuan Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, China
| | - Xing Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, China
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Custom-Made Zirconium Dioxide Implants for Craniofacial Bone Reconstruction. MATERIALS 2021; 14:ma14040840. [PMID: 33578685 PMCID: PMC7916391 DOI: 10.3390/ma14040840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/18/2022]
Abstract
Reconstruction of the facial skeleton is challenging for surgeons because of difficulties in proper shape restoration and maintenance of the proper long-term effect. ZrO2 implant application can be a solution with many advantages (e.g., osseointegration, stability, and radio-opaqueness) and lacks the disadvantages of other biomaterials (e.g., metalosis, radiotransparency, and no osseointegration) or autologous bone (e.g., morbidity, resorption, and low accuracy). We aimed to evaluate the possibility of using ZrO2 implants as a new application of this material for craniofacial bone defect reconstruction. First, osteoblast (skeleton-related cell) cytotoxicity and genotoxicity were determined in vitro by comparing ZrO2 implants and alumina particle air-abraded ZrO2 implants to the following: 1. a titanium alloy (standard material); 2. ultrahigh-molecular-weight polyethylene (a modern material used in orbital surgery); 3. a negative control (minimally cytotoxic or genotoxic agent action); 4. a positive control (maximally cytotoxic or genotoxic agent action). Next, 14 custom in vivo clinical ZrO2 implants were manufactured for post-traumatologic periorbital region reconstruction. The soft tissue position improvement in photogrammetry was recorded, and clinical follow-up was conducted at least 6 years postoperatively. All the investigated materials revealed no cytotoxicity. Alumina particle air-abraded ZrO2 implants showed genotoxicity compared to those without subjection to air abrasion ZrO2, which were not genotoxic. The 6-month and 6- to 8-year clinical results were aesthetic and stable. Skeleton reconstructions using osseointegrated, radio-opaque, personalized implants comprising ZrO2 material are the next option for craniofacial surgery.
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16
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A Possible Relationship between Peri-Implantitis, Titanium Hypersensitivity, and External Tooth Resorption: Metal-Free Alternative to Titanium Implants. Case Rep Dent 2021; 2021:8879988. [PMID: 33552604 PMCID: PMC7847357 DOI: 10.1155/2021/8879988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/09/2020] [Accepted: 01/09/2021] [Indexed: 11/17/2022] Open
Abstract
Titanium dental implant surface does not remain unaltered but may corrode and release ions or particles which trigger soft and hard tissue damage. Titanium may induce clinically relevant hypersensitivity in patients chronically exposed. A 56-year-old female patient presented peri-implantitis around a single titanium implant positioned three years earlier. Despite nonsurgical therapy, a rapid bone loss associated with pain and swelling occurred, and adjacent teeth presented external resorption. Compromised teeth were removed, and three titanium implants were inserted. Six months later, the patient complained about high mucosa sensitivity and implant exposure. At clinical and radiographic examinations, tissue inflammation and vertical bone loss involved the new implants and the process of external resorption affected the teeth. The blood test confirmed titanium hypersensitivity. Titanium implants were removed, and 5 zirconia implants were placed. No sign of bone loss or tooth resorption was recorded at clinical and radiographic control during 18 months of follow-up.
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17
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Nelson K, Hesse B, Addison O, Morrell AP, Gross C, Lagrange A, Suárez VI, Kohal R, Fretwurst T. Distribution and Chemical Speciation of Exogenous Micro- and Nanoparticles in Inflamed Soft Tissue Adjacent to Titanium and Ceramic Dental Implants. Anal Chem 2020; 92:14432-14443. [PMID: 32970419 DOI: 10.1021/acs.analchem.0c02416] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Degradation of the implant surface and particle release/formation as an inflammation catalyst mechanism is an emerging concept in dental medicine that may help explain the pathogenesis of peri-implantitis. The aim of the present study was a synchrotron-based characterization of micro- and nanosized implant-related particles in inflamed human tissues around titanium and ceramic dental implants that exhibited signs of peri-implantitis. Size, distribution, and chemical speciation of the exogenous micro- and nanosized particle content were evaluated using synchrotron μ-X-ray fluorescence spectroscopy (XRF), nano-XRF, and μ-X-ray absorption near-edge structure (XANES). Titanium particles, with variable speciation, were detected in all tissue sections associated with titanium implants. Ceramic particles were found in five out of eight tissue samples associated with ceramic implants. Particles ranged in size from micro- to nanoscale. The local density of both titanium and ceramic particles was calculated to be as high as ∼40 million particles/mm3. μ-XANES identified titanium in predominantly two different chemistries, including metallic and titanium dioxide (TiO2). The findings highlight the propensity for particle accumulation in the inflamed tissues around dental implants and will help in guiding toxicological studies to determine the biological significance of such exposures.
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Affiliation(s)
- Katja Nelson
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Bernhard Hesse
- Xploraytion GmbH, Bismarckstrasse 10-12, 10625 Berlin, Germany.,European Synchrotron Radiation Facility (ESRF), 71 avenue des Martyrs, 38043 Grenoble, France
| | - Owen Addison
- Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, Great Maze Pond, SE1 9RT London, U.K
| | - Alexander P Morrell
- Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, Great Maze Pond, SE1 9RT London, U.K
| | - Christian Gross
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Adrien Lagrange
- Xploraytion GmbH, Bismarckstrasse 10-12, 10625 Berlin, Germany
| | - Vanessa I Suárez
- European Synchrotron Radiation Facility (ESRF), 71 avenue des Martyrs, 38043 Grenoble, France
| | - Ralf Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Tobias Fretwurst
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
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18
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Markowska-Szczupak A, Endo-Kimura M, Paszkiewicz O, Kowalska E. Are Titania Photocatalysts and Titanium Implants Safe? Review on the Toxicity of Titanium Compounds. NANOMATERIALS 2020; 10:nano10102065. [PMID: 33086609 PMCID: PMC7603142 DOI: 10.3390/nano10102065] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022]
Abstract
Titanium and its compounds are broadly used in both industrial and domestic products, including jet engines, missiles, prostheses, implants, pigments, cosmetics, food, and photocatalysts for environmental purification and solar energy conversion. Although titanium/titania-containing materials are usually safe for human, animals and environment, increasing concerns on their negative impacts have been postulated. Accordingly, this review covers current knowledge on the toxicity of titania and titanium, in which the behaviour, bioavailability, mechanisms of action, and environmental impacts have been discussed in detail, considering both light and dark conditions. Consequently, the following conclusions have been drawn: (i) titania photocatalysts rarely cause health and environmental problems; (ii) despite the lack of proof, the possible carcinogenicity of titania powders to humans is considered by some authorities; (iii) titanium alloys, commonly applied as implant materials, possess a relatively low health risk; (iv) titania microparticles are less toxic than nanoparticles, independent of the means of exposure; (v) excessive accumulation of titanium in the environment cannot be ignored; (vi) titanium/titania-containing products should be clearly marked with health warning labels, especially for pregnant women and young children; (vi) a key knowledge gap is the lack of comprehensive data about the environmental content and the influence of titania/titanium on biodiversity and the ecological functioning of terrestrial and aquatic ecosystems.
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Affiliation(s)
- Agata Markowska-Szczupak
- Department of Chemical and Process Engineering, West Pomeranian University of Technology in Szczecin, Al. Piastów 42, 71-065 Szczecin, Poland;
- Correspondence: (A.M.-S.); (E.K.)
| | - Maya Endo-Kimura
- Institute for Catalysis, Hokkaido University, N21, W10, Sapporo 001-0021, Japan;
| | - Oliwia Paszkiewicz
- Department of Chemical and Process Engineering, West Pomeranian University of Technology in Szczecin, Al. Piastów 42, 71-065 Szczecin, Poland;
| | - Ewa Kowalska
- Institute for Catalysis, Hokkaido University, N21, W10, Sapporo 001-0021, Japan;
- Correspondence: (A.M.-S.); (E.K.)
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Lullini G, Cammisa E, Setti S, Sassoli I, Zaffagnini S, Marcheggiani Muccioli GM. Role of pulsed electromagnetic fields after joint replacements. World J Orthop 2020; 11:285-293. [PMID: 32572365 PMCID: PMC7298453 DOI: 10.5312/wjo.v11.i6.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/14/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
Although the rate of patients reporting satisfaction is generally high after joint replacement surgery, up to 23% after total hip replacement and 34% after total knee arthroplasty of treated subjects report discomfort or pain 1 year after surgery. Moreover, chronic or subacute inflammation is reported in some cases even a long time after surgery. Another open and debated issue in prosthetic surgery is implant survivorship, especially when related to good prosthesis bone ingrowth. Pulsed Electro Magnetic Fields (PEMFs) treatment, although initially recommended after total joint replacement to promote bone ingrowth and to reduce inflammation and pain, is not currently part of usual clinical practice. The purpose of this review was to analyze existing literature on PEMFs effects in joint replacement surgery and to report results of clinical studies and current indications. We selected all currently available prospective studies or RCT on the use of PEMFs in total joint replacement with the purpose of investigating effects of PEMFs on recovery, pain relief and patients’ satisfaction following hip, knee or shoulder arthroplasty. All the studies analyzed reported no adverse effects, and good patient compliance to the treatment. The available literature shows that early control of joint inflammation process in the first days after surgery through the use of PEMFs should be considered an effective completion of the surgical procedure to improve the patient’s functional recovery.
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Affiliation(s)
- Giada Lullini
- Laboratorio di Analisi del Movimento e di valutazione funzionale protesi, IRCCS Istituto Ortopedico Rizzoli - DIBINEM - University of Bologna, Bologna 40100, Italy
| | - Eugenio Cammisa
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli - DIBINEM - University of Bologna, Bologna 40100, Italy
| | - Stefania Setti
- Laboratory of Clinical Biophysics, IGEA S.p.A. Clinical Biophysics, 41012 Carpi (Mo), Italy
| | - Iacopo Sassoli
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli - DIBINEM - University of Bologna, Bologna 40100, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli - DIBINEM - University of Bologna, Bologna 40100, Italy
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Wang S, Yang J, Lin T, Huang S, Ma J, Xu X. Excessive production of mitochondrion‑derived reactive oxygen species induced by titanium ions leads to autophagic cell death of osteoblasts via the SIRT3/SOD2 pathway. Mol Med Rep 2020; 22:257-264. [PMID: 32468046 PMCID: PMC7248520 DOI: 10.3892/mmr.2020.11094] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 04/04/2020] [Indexed: 12/29/2022] Open
Abstract
The incidence of peri-implant bone loss is high, and is a difficult condition to treat. Previous studies have shown that titanium (Ti) ions released from implants can lead to osteoblast cell damage, but the specific mechanisms have not been elucidated. The present study established a Ti ion damage osteoblast cell model. The levels of mitochondrion-derived reactive oxygen species (mROS) and autophagy, cell viability and the sirtuin 3 (SIRT3)/superoxide dismutase 2 (SOD2) pathway were examined in this model. It was found that Ti ions decreased osteoblast viability. Moreover, with increased Ti ion concentration, the expression levels of microtubule associated protein 1 light chain 3α (LC3) progressively increased, P62 decreased, autophagic flow increased and mROS levels increased. After the addition of an autophagy inhibitor Bafilomycin A1 and Mito-TEMPO, a mitochondrial antioxidant, the production of mROS was inhibited, the level of autophagy was decreased and cell activity was improved. In addition, with increased Ti ion concentration, the activity of SOD2 decreased, the acetylation level of SOD2 increased, the SIRT3 mRNA and protein expression levels decreased, and the activity of SIRT3 was significantly decreased. Furthermore, it was demonstrated that SIRT3 overexpression reduced the acetylation of SOD2 and increased the activity of SOD2, as well as reducing the production of mROS and the expression level of LC3, thus increasing cell viability. Therefore, the present results suggested that excessive production of mROS induced by Ti ions led to autophagic cell death of osteoblasts, which is dependent on the SIRT3/SOD2 pathway.
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Affiliation(s)
- Siqian Wang
- Department of Implantology, School and Hospital of Stomatology, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong 250012, P.R. China
| | - Jingyuan Yang
- Department of Implantology, School and Hospital of Stomatology, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong 250012, P.R. China
| | - Tingting Lin
- Department of Prothodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Shengbing Huang
- Department of Prothodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Jianfeng Ma
- Department of Prothodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Xin Xu
- Department of Implantology, School and Hospital of Stomatology, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong 250012, P.R. China
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21
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Li X, Tang L, Ye Myat Thu, Chen D. Titanium Ions Play a Synergistic Role in the Activation of NLRP3 Inflammasome in Jurkat T Cells. Inflammation 2020; 43:1269-1278. [DOI: 10.1007/s10753-020-01206-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Souza JGS, Costa Oliveira BE, Bertolini M, Lima CV, Retamal-Valdes B, de Faveri M, Feres M, Barão VAR. Titanium particles and ions favor dysbiosis in oral biofilms. J Periodontal Res 2019; 55:258-266. [PMID: 31762055 DOI: 10.1111/jre.12711] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/20/2019] [Accepted: 10/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the effect of titanium (Ti) particles and ions on oral biofilm growth and composition. BACKGROUND Particles and ions of Ti released from dental implants can trigger unfavorable biological responses in human cells. However, their effect on oral biofilms composition has not been tested. METHODS In this blind in situ study, volunteers wore a palatal appliance containing Ti disks for 7 days to allow biofilm formation. Disks were then collected and biofilms were treated, in vitro, with Ti particles (0.75% and 1%), ions (10 and 20 ppm), or a combination of both (1% particles + 20 ppm ions). Biofilms exposed only to medium was used as control group. After 24 hours, biofilms were collected and analyzed by checkerboard DNA-DNA hybridization. Direct effects of Ti particles and ions on biofilm/cellular morphology were evaluated by transmission electron microscopy (TEM). RESULTS Ti particles affected biofilm composition, increasing population of four bacterial species (P < .05), while Ti ions showed higher levels of putative pathogens from the orange complex with reduction in species from the yellow complex (P < .05), compared with control. The combination of particles + ions increased green complex and reduced yellow complex proportions (P < .05). TEM showed clusters of particles agglomerated in extracellular environment, while Ti ions were precipitated in both extracellular and intracellular sites. CONCLUSIONS Ti products, especially Ti ions, have the potential to change the microbiological composition of biofilms formed on Ti surfaces. Therefore, the presence of Ti products around dental implants may contribute to microbial dysbiosis and peri-implantitis.
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Affiliation(s)
- João G S Souza
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Bárbara E Costa Oliveira
- Department of Physiological Science, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Martinna Bertolini
- Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Carolina Veloso Lima
- Department of Physiological Science, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Belén Retamal-Valdes
- Dental Research Division, Department of Periodontology, Guarulhos University, Guarulhos, Brazil
| | - Marcelo de Faveri
- Dental Research Division, Department of Periodontology, Guarulhos University, Guarulhos, Brazil
| | - Magda Feres
- Dental Research Division, Department of Periodontology, Guarulhos University, Guarulhos, Brazil
| | - Valentim A R Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
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Zandim-Barcelos DL, Carvalho GGD, Sapata VM, Villar CC, Hämmerle C, Romito GA. Implant-based factor as possible risk for peri-implantitis. Braz Oral Res 2019; 33:e067. [PMID: 31576951 DOI: 10.1590/1807-3107bor-2019.vol33.0067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 11/21/2022] Open
Abstract
Peri-implantitis is currently a topic of major interest in implantology. Considered one of the main reasons of late implant failure, there is an emerged concern whether implant characteristics could trigger inflammatory lesion and loss of supporting bone. The purpose of this narrative review is to provide an evidence based overview on the influence of implant-based factors in the occurrence of peri-implantitis. A literature review was conducted addressing the following topics: implant surface topography; implant location; occlusal overload; time in function; prosthesis-associated factors (rehabilitation extension, excess of cement and implant-abutment connection); and metal particle release. Although existing data suggests that some implant-based factors may increase the risk of peri-implantitis, the evidence is still limited to consider them a true risk factor for peri-implantitis. In conclusion, further evidences are required to a better understanding of the influence of implant-based factors in the occurrence of peri-implantitis. Large population-based studies including concomitant analyses of implant- and patient-based factors are required to provide strong evidence of a possible association with peri-implantitis in a higher probability. The identification of these factors is essential for the establishment of strategies to prevent peri-implantitis.
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Affiliation(s)
- Daniela Leal Zandim-Barcelos
- Universidade Estadual Paulista - Unesp, Araraquara School of Dentistry, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | - Gabriel Garcia de Carvalho
- Universidade Estadual Paulista - Unesp, Araraquara School of Dentistry, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | - Vitor Marques Sapata
- Universidade de São Paulo - USP, Dental School, Department of Stomatology, São Paulo, Brazil
| | - Cristina Cunha Villar
- Universidade de São Paulo - USP, Dental School, Department of Stomatology, São Paulo, Brazil
| | - Christoph Hämmerle
- University of Zurich, Clinic for Fixed and Removable Prosthodontics and Dental Material Science, Zurich, Switzerland
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24
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Wang X, Li Y, Feng Y, Cheng H, Li D. Macrophage polarization in aseptic bone resorption around dental implants induced by Ti particles in a murine model. J Periodontal Res 2019; 54:329-338. [PMID: 30635919 DOI: 10.1111/jre.12633] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/01/2018] [Accepted: 12/10/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Titanium particles/ions detected in peri-implant tissues have been considered as a potential etiologic factor for crestal bone loss around oral implants. However, the definite impact of titanium wear particles on the health of surrounding structures remains undetermined. The purpose of this study was to investigate the effects of titanium particles-induced foreign body reaction on peri-implant bone level and the related mechanism by using clodronate liposomes to deplete macrophages. MATERIAL AND METHODS Sprague Dawley rats with custom-made titanium screw implanted in bilateral maxillary first molar area for 4 weeks to obtain osseointegration were randomly divided into four groups. Twenty microgram titanium particles were introduced into the peri-implant tissue to induce aseptic foreign body reaction, and macrophages were depleted by the local injection of 100 μL clodronate liposome immediately and re-injection every 3 days until the sacrifice of the rats (Ti + LipClod group). Titanium-injected rats also treated with phosphate buffer solution (Ti + PBS) or empty liposome (Ti + Lip) as well as rats injected with PBS alone (Control) were included as controls. Eight weeks later, animals were sacrificed and samples containing implants were collected. Half of the samples were analyzed radiologically to measure bone level change, and macrophage markers (CD68, CCR7, CD163) was also characterized by immunofluorescence to evaluate macrophage number, density, and phenotype distribution (CCR7+M1/CD163+M2). The rest of the samples were used to determine the relative mRNA expression levels of TNF-α, IL-1β, IL-6, and RANKL with real-time PCR analysis. RESULTS No obvious bacterial contamination was found in all titanium-injected areas, and the implant survival rate was 100% with no implant loss. Compared with Ti + PBS and Ti + Lip group, macrophage density (1.64 ± 0.86%) infiltrated into peri-implant tissue and bone loss (0.17 ± 0.03 mm) around implant decreased significantly in the Ti + LipClod group. Immunofluorescence analysis showed that more macrophage infiltrated into peri-implant tissue in the Ti + PBS and Ti + Lip groups, predominantly with M1 phenotype. In contrast, the macrophage density was lower and M2 phenotype was dominant in the Control group, while macrophages density was significantly reduced and the M1 type macrophages were slightly more than M2 type in the Ti + LipClod group. Accordingly, TNF-α, IL-1β, IL6, and RANKL mRNA expression increased significantly in the Ti + PBS and Ti + Lip groups compared with Control and Ti + LipClod groups. CONCLUSIONS Titanium particles had a negative effect on peri-implant tissue by activating macrophages which induced an M1 macrophage phenotype promoting local secretion of inflammatory cytokines. It was found that clodronate liposome treatment attenuated the severity of inflammation and bone loss by depletion of macrophages. Therefore, the present study revealed the marked impact of macrophage polarization with respect to peri-implant bone loss caused by titanium particles.
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Affiliation(s)
- Xin Wang
- State Key Laboratory of Military Stomatology &National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi'an, China.,Department of Stomatology, the 901th Hospital, Hefei, China
| | - Yu Li
- State Key Laboratory of Military Stomatology &National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Yuan Feng
- State Key Laboratory of Military Stomatology &National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Haode Cheng
- State Key Laboratory of Military Stomatology &National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Dehua Li
- State Key Laboratory of Military Stomatology &National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi'an, China
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25
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Bosco G, Vezzani G, Mrakic Sposta S, Rizzato A, Enten G, Abou-Samra A, Malacrida S, Quartesan S, Vezzoli A, Camporesi E. Hyperbaric oxygen therapy ameliorates osteonecrosis in patients by modulating inflammation and oxidative stress. J Enzyme Inhib Med Chem 2018; 33:1501-1505. [PMID: 30274530 PMCID: PMC6171420 DOI: 10.1080/14756366.2018.1485149] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Early stages of avascular necrosis of the femoral head (AVNFH) can be conservatively treated with hyperbaric oxygen therapy (HBOT). This study investigated how HBOT modulates inflammatory markers and reactive oxygen species (ROS) in patients with AVNFH. Twenty-three male patients were treated with two cycles of HBOT, 30 sessions each with a 30 days break between cycles. Each session consisted of 90 minutes of 100% inspired oxygen at 2.5 absolute atmospheres of pressure. Plasma levels of tumor necrosis factor alfa (TNF-α), interleukin 6 (IL-6), interleukin 1 beta (IL-1β) and ROS production were measured before treatment (T0), after 15 and 30 HBOT sessions (T1 and T2), after the 30-day break (T3), and after 60 sessions (T4). Results showed a significant reduction in TNF-α and IL-6 plasma levels over time. This decrease in inflammatory markers mirrored observed reductions in bone marrow edema and reductions in patient self-reported pain.
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Affiliation(s)
- Gerardo Bosco
- a Environmental Physiology Lab , Department of Biomedical Sciences , University of Padova , Padua , Italy
| | - Giuliano Vezzani
- a Environmental Physiology Lab , Department of Biomedical Sciences , University of Padova , Padua , Italy
| | - Simona Mrakic Sposta
- b CNR Institute of Bioimaging and Molecular Physiology , Segrate (Milano) , Italy
| | - Alex Rizzato
- a Environmental Physiology Lab , Department of Biomedical Sciences , University of Padova , Padua , Italy
| | - Garrett Enten
- c Department of Anesthesiology , TEAMHealth Research Institute, TGH , Tampa , FL , USA
| | - Abdullah Abou-Samra
- d Morsani College of Medicine , University of South Florida , Tampa , FL , USA
| | - Sandro Malacrida
- a Environmental Physiology Lab , Department of Biomedical Sciences , University of Padova , Padua , Italy
| | - Silvia Quartesan
- a Environmental Physiology Lab , Department of Biomedical Sciences , University of Padova , Padua , Italy
| | - Alessandra Vezzoli
- b CNR Institute of Bioimaging and Molecular Physiology , Segrate (Milano) , Italy
| | - Enrico Camporesi
- c Department of Anesthesiology , TEAMHealth Research Institute, TGH , Tampa , FL , USA
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26
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Mombelli A, Hashim D, Cionca N. What is the impact of titanium particles and biocorrosion on implant survival and complications? A critical review. Clin Oral Implants Res 2018; 29 Suppl 18:37-53. [DOI: 10.1111/clr.13305] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Andrea Mombelli
- Division of Periodontology; University Clinics of Dental Medicine; University of Geneva; Geneva Switzerland
| | - Dena Hashim
- Division of Periodontology; University Clinics of Dental Medicine; University of Geneva; Geneva Switzerland
| | - Norbert Cionca
- Division of Periodontology; University Clinics of Dental Medicine; University of Geneva; Geneva Switzerland
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27
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Meng J, Zhou C, Hu B, Luo M, Yang Y, Wang Y, Wang W, Jiang G, Hong J, Li S, Wu H, Yan S, Yan W. Stevioside Prevents Wear Particle-Induced Osteolysis by Inhibiting Osteoclastogenesis and Inflammatory Response via the Suppression of TAK1 Activation. Front Pharmacol 2018; 9:1053. [PMID: 30319406 PMCID: PMC6169369 DOI: 10.3389/fphar.2018.01053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/31/2018] [Indexed: 12/28/2022] Open
Abstract
Aseptic loosening and periprosthetic osteolysis are the leading causes of total joint arthroplasty failure, which occurs as a result of chronic inflammatory response and enhanced osteoclast activity. Here we showed that stevioside, a natural compound isolated from Stevia rebaudiana, exhibited preventative effects on titanium particle-induced osteolysis in a mouse calvarial model. Further histological assessment and real-time PCR analysis indicated that stevioside prevented titanium particle-induced osteolysis by inhibiting osteoclast formation and inflammatory cytokine expression in vivo. In vitro, we found that stevioside could suppress RANKL-induced osteoclastogenesis and titanium particle-induced inflammatory response in a dose-dependent manner. Mechanistically, stevioside achieved these effects by disrupting the phosphorylation of TAK1 and subsequent activation of NF-κB/MAPKs signaling pathways. Collectively, our data suggest that stevioside effectively suppresses osteoclastogenesis and inflammatory response both in vitro and in vivo, and it might be a potential therapy for particle-induced osteolysis and other osteolytic diseases.
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Affiliation(s)
- Jiahong Meng
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Chenhe Zhou
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Bin Hu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Mengmeng Luo
- Department of Plastic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yute Yang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Yangxin Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Wei Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Guangyao Jiang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Jianqiao Hong
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Sihao Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Haobo Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Shigui Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Weiqi Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
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28
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Dodo CG, Meirelles L, Aviles-Reyes A, Ruiz KGS, Abranches J, Cury AADB. Pro-inflammatory Analysis of Macrophages in Contact with Titanium Particles and Porphyromonas gingivalis. Braz Dent J 2018; 28:428-434. [PMID: 29160393 DOI: 10.1590/0103-6440201701382] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/22/2017] [Indexed: 11/21/2022] Open
Abstract
During insertion of titanium dental implants, particles may shear from the implant to the periimplant region causing osteolysis, and their association with bacteria can exacerbate the inflammatory reaction. However, the association of a high invasive bacterium from the oral cavity, Porphyromonas gingivalis (Pg), and titanium particles remains unknown. This study evaluated pro-inflammatory reaction of human macrophages in contact with micro and nanoparticles of titanium associated with Porphyromonas gingivalis lipopolysaccharide (PgLPS). THP-1 cell were used and treated for 12, 24 and 48 h following 6 groups: Control(C), PgLPS (L); Microparticles (M); Nanoparticles (N); PgLPS and microparticles (LM); PgLPS and nanoparticles (LN). The following assays were carried out: i) cell viability using MTS, ii) cell morphology by SEM and iii) expression of tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β) and interleukin-6 (IL-6) by qRT-PCR and ELISA. For statistics two-way ANOVA followed by Tukey's test was used (p<0.05). After treatment, cells presented similar viability and morphology demonstrating that the treatments were not able to induce cell death. Gene expression was significantly higher for TNF-α and IL1-β after 12 h, and for IL-6 after 24 h in the N and LN groups. Cytokine production over time was an ascending curve for TNF-α with the peak at 48 h and IL1-β and IL-6 had a straight line among the time points, although cells from N group presented a significant production of IL-6 at 48 h. In conclusion, these results suggest that titanium nanoparticles stimulate stronger pro-inflammatory response in macrophages, independent of their association with LPS from P.gingivalis.
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Affiliation(s)
- Cindy Goes Dodo
- Department of Prosthodontics and Periodontology, Dental School of Piracicaba, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | | | | | - Karina Gonzalez Silvério Ruiz
- Department of Prosthodontics and Periodontology, Dental School of Piracicaba, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | | | - Altair Antoninha Del Bel Cury
- Department of Prosthodontics and Periodontology, Dental School of Piracicaba, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
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29
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Hingsammer L, Grillenberger M, Schagerl M, Malek M, Hunger S. Biomechanical testing of zirconium dioxide osteosynthesis system for Le Fort I advancement osteotomy fixation. J Mech Behav Biomed Mater 2018; 77:34-39. [DOI: 10.1016/j.jmbbm.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
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30
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Fretwurst T, Nelson K, Tarnow DP, Wang HL, Giannobile WV. Is Metal Particle Release Associated with Peri-implant Bone Destruction? An Emerging Concept. J Dent Res 2017; 97:259-265. [PMID: 29130804 DOI: 10.1177/0022034517740560] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Peri-implant diseases affecting the surrounding structures of endosseous dental implants include peri-implant mucositis and peri-implantitis. The prevalence of peri-implantitis ranges between 15% and 20% after 10 y, highlighting the major challenge in clinical practice in the rehabilitation of dental implant patients. The widespread nature of peri-implant bone loss poses difficulties in the management of biological complications affecting the long-term success of osseointegrated implant reconstructions. Metal and titanium particles have been detected in peri-implant supporting tissues. However, it remains unclear what mechanisms could be responsible for the elicitation of particle and ion release and whether these released implant-associated materials have a local and/or systemic impact on the peri-implant soft and hard tissues. Metal particle release as a potential etiologic factor has been intensively studied in the field of orthopedics and is known to provoke aseptic loosening around arthroplasties and is associated with implant failures. In dental medicine, emerging information about metal/titanium particle release suggests that the potential impact of biomaterials at the abutment or bone interfaces may have an influence on the pathogenesis of peri-implant bone loss. This mini-review highlights current evidence of metal particle release around dental implants and future areas for research.
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Affiliation(s)
- T Fretwurst
- 1 Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,2 Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - K Nelson
- 2 Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - D P Tarnow
- 3 College of Dental Medicine, Columbia University, New York, NY, USA
| | - H-L Wang
- 1 Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - W V Giannobile
- 1 Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,4 Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA
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31
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Graney PL, Roohani-Esfahani SI, Zreiqat H, Spiller KL. In vitro response of macrophages to ceramic scaffolds used for bone regeneration. J R Soc Interface 2017; 13:rsif.2016.0346. [PMID: 27466438 DOI: 10.1098/rsif.2016.0346] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/04/2016] [Indexed: 01/09/2023] Open
Abstract
Macrophages, the primary cells of the inflammatory response, are major regulators of healing, and mediate both bone fracture healing and the inflammatory response to implanted biomaterials. However, their phenotypic contributions to biomaterial-mediated bone repair are incompletely understood. Therefore, we used gene expression and protein secretion analysis to investigate the interactions in vitro between primary human monocyte-derived macrophages and ceramic scaffolds that have been shown to have varying degrees of success in promoting bone regeneration in vivo Specifically, baghdadite (Ca3ZrSi2O9) and strontium-hardystonite-gahnite (Sr-Ca2ZnSi2O7-ZnAl2O4) scaffolds were chosen as two materials that enhanced bone regeneration in vivo in large defects under load compared with clinically used tricalcium phosphate-hydroxyapatite (TCP-HA). Principal component analysis revealed that the scaffolds differentially regulated macrophage phenotype. Temporal changes in gene expression included shifts in markers of pro-inflammatory M1, anti-inflammatory M2a and pro-remodelling M2c macrophage phenotypes. Of note, TCP-HA scaffolds promoted upregulation of many M1-related genes and downregulation of many M2a- and M2c-related genes. Effects of the scaffolds on macrophages were attributed primarily to direct cell-scaffold interactions because of only minor changes observed in transwell culture. Ultimately, elucidating macrophage-biomaterial interactions will facilitate the design of immunomodulatory biomaterials for bone repair.
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Affiliation(s)
- Pamela L Graney
- Biomaterials and Regenerative Medicine Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA
| | - Seyed-Iman Roohani-Esfahani
- Biomaterials and Tissue Engineering Research Unit, School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, New South Wales 2026, Australia
| | - Hala Zreiqat
- Biomaterials and Tissue Engineering Research Unit, School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, New South Wales 2026, Australia
| | - Kara L Spiller
- Biomaterials and Regenerative Medicine Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA
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32
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Tschon M, Veronesi F, Contartese D, Sartori M, Martini L, Vincenzi F, Ravani A, Varani K, Fini M. Effects of pulsed electromagnetic fields and platelet rich plasma in preventing osteoclastogenesis in an in vitro model of osteolysis. J Cell Physiol 2017; 233:2645-2656. [PMID: 28786478 DOI: 10.1002/jcp.26143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/07/2017] [Indexed: 12/17/2022]
Abstract
Osteolysis is the main limiting cause for the survival of an orthopedic prosthesis and is accompanied by an enhancement in osteoclastogenesis and inflammation, due by wear debris formation. Unfortunately therapeutic treatments, besides revision surgery, are not available. The aim of the present study was to evaluate the effects of Pulsed Electro Magnetic Fields (PEMFs) and platelet rich plasma (PRP), alone or in combination, in an in vitro model of osteolysis. Rats peripheral blood mononuclear cells were cultured on Ultra High Molecular Weight Polyethylene particles and divided into four groups of treatments: (1) PEMF stimulation (12 hr/day, 2.5 mT, 75 Hz, 1.3 ms pulse duration); (2) 10% PRP; (3) combination of PEMFs, and PRP; (4) no treatment. Treatments were performed for 3 days and cell viability, osteoclast number, expression of genes related to osteoclastogenesis and inflammation and production of pro-inflammatory cytokines were assessed up to 14 days. PEMF stimulation exerted best results because it increased cell viability at early time points and counteracted osteoclastogenesis at 14 days. On the contrary, PRP increased osteoclastogenesis and reduced cell viability in comparison to PEMFs alone. The combination of PEMFs and PRP increased cell viability over time and reduced osteoclastogenesis in comparison to PRP alone. However, these positive results did not exceed the level achieved by PEMF alone. At longer time points PEMF could not counteract osteoclastogenesis increased by PRP. Regarding inflammation, all treatments maintained the production of pro-inflammatory cytokines at low level, although PRP increased the level of interleukin 1 beta.
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Affiliation(s)
- Matilde Tschon
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Deyanira Contartese
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Maria Sartori
- Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, Research Innovation and Technology Department (RIT), Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Lucia Martini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Fabrizio Vincenzi
- Department of Medical Sciences, Laboratory of Cellular and Molecular Pharmacology, University of Ferrara, Ferrara, Italy
| | - Annalisa Ravani
- Department of Medical Sciences, Laboratory of Cellular and Molecular Pharmacology, University of Ferrara, Ferrara, Italy
| | - Katia Varani
- Department of Medical Sciences, Laboratory of Cellular and Molecular Pharmacology, University of Ferrara, Ferrara, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Bologna, Italy
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33
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Veronesi F, Tschon M, Fini M. Gene Expression in Osteolysis: Review on the Identification of Altered Molecular Pathways in Preclinical and Clinical Studies. Int J Mol Sci 2017; 18:E499. [PMID: 28245614 PMCID: PMC5372515 DOI: 10.3390/ijms18030499] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023] Open
Abstract
Aseptic loosening (AL) due to osteolysis is the primary cause of joint prosthesis failure. Currently, a second surgery is still the only available treatment for AL, with its associated drawbacks. The present review aims at identifying genes whose expression is altered in osteolysis, and that could be the target of new pharmacological treatments, with the goal of replacing surgery. This review also aims at identifying the molecular pathways altered by different wear particles. We reviewed preclinical and clinical studies from 2010 to 2016, analyzing gene expression of tissues or cells affected by osteolysis. A total of 32 in vitro, 16 in vivo and six clinical studies were included. These studies revealed that genes belonging to both inflammation and osteoclastogenesis pathways are mainly involved in osteolysis. More precisely, an increase in genes encoding for the following factors were observed: Interleukins 6 and 1β (IL16 and β), Tumor Necrosis Factor α (TNFα), nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), Nuclear factor of activated T-cells, cytoplasmic 1 (NFATC1), Cathepsin K (CATK) and Tartrate-resistant acid phosphatase (TRAP). Titanium (Ti) and Polyethylene (PE) were the most studied particles, showing that Ti up-regulated inflammation and osteoclastogenesis related genes, while PE up-regulated primarily osteoclastogenesis related genes.
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Affiliation(s)
- Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Matilde Tschon
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy.
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Montes-Cobos E, Ring S, Fischer HJ, Heck J, Strauß J, Schwaninger M, Reichardt SD, Feldmann C, Lühder F, Reichardt HM. Targeted delivery of glucocorticoids to macrophages in a mouse model of multiple sclerosis using inorganic-organic hybrid nanoparticles. J Control Release 2016; 245:157-169. [PMID: 27919626 DOI: 10.1016/j.jconrel.2016.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/23/2016] [Accepted: 12/01/2016] [Indexed: 11/25/2022]
Abstract
Glucocorticoids (GC) are widely used to treat acute relapses in multiple sclerosis (MS) patients, but their application is accompanied by side effects due to their broad spectrum of action. Here, we report on the therapeutic option to apply GC via inorganic-organic hybrid nanoparticles (IOH-NP) with the composition [ZrO]2+[(BMP)0.9(FMN)0.1]2- (designated BMP-NP with BMP: betamethasone phosphate; FMN: flavinmononucleotide). We found that these BMP-NP have an increased cell type-specificity compared to free GC while retaining full therapeutic efficacy in a mouse model of MS. BMP-NP were preferentially taken up by phagocytic cells and modulated macrophages in vivo more efficiently than T cells. When GC were applied in the form of BMP-NP, treatment of neuroinflammatory disease in mice exclusively depended on the control of macrophage function whereas effects on T cells and brain endothelial cells were dispensable for therapeutic efficacy. Importantly, BMP-NP were not only active in mice but also showed strong activity towards monocytes isolated from healthy human volunteers. We conclude that application of GC via IOH-NP has the potential to improve MS therapy in the future.
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Affiliation(s)
- Elena Montes-Cobos
- Institute for Cellular and Molecular Immunology, University Medical Center Göttingen, 37073 Göttingen, Germany; Institute for Multiple Sclerosis Research and Neuroimmunology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Sarah Ring
- Institute for Cellular and Molecular Immunology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Henrike J Fischer
- Institute for Cellular and Molecular Immunology, University Medical Center Göttingen, 37073 Göttingen, Germany; Institute for Multiple Sclerosis Research and Neuroimmunology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Joachim Heck
- Institute of Inorganic Chemistry, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Judith Strauß
- Institute for Multiple Sclerosis Research and Neuroimmunology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Markus Schwaninger
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, 23562 Lübeck, Germany
| | - Sybille D Reichardt
- Institute for Cellular and Molecular Immunology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Claus Feldmann
- Institute of Inorganic Chemistry, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Fred Lühder
- Institute for Multiple Sclerosis Research and Neuroimmunology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Holger M Reichardt
- Institute for Cellular and Molecular Immunology, University Medical Center Göttingen, 37073 Göttingen, Germany.
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Fretwurst T, Grunert S, Woelber JP, Nelson K, Semper-Hogg W. Vitamin D deficiency in early implant failure: two case reports. Int J Implant Dent 2016; 2:24. [PMID: 27888492 PMCID: PMC5124022 DOI: 10.1186/s40729-016-0056-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/16/2016] [Indexed: 12/14/2022] Open
Abstract
An association between vitamin D deficiency and early dental implant failure is not properly verified, but its role in osteoimmunology is discussed. This article illustrates two case reports with vitamin D deficiency and early implant failure. Prior to implant placement, the first patient received crestal bone grafting with autologous material. Both patients received dental implants from different manufacturers in the molar region of the mandible. In the case of bone grafting in the first patient, all implants were placed in a two-stage procedure. All implants had to be removed within 15 days after implant placement. Vitamin D serum levels were measured: Both patients showed a vitamin D deficiency (serum vitamin D level <20 μg/l). After vitamin D supplementation, implant placement was successful in both patients. Prospective, randomized clinical trials must follow to affirm the relationship between vitamin D deficiency, osteoimmunology, and early implant failure.
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Affiliation(s)
- Tobias Fretwurst
- Department of Oral- and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg, D-79106, Germany.
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, USA.
| | - Sebastian Grunert
- Department of Oral- and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg, D-79106, Germany
| | - Johan P Woelber
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg, D-79106, Germany
| | - Katja Nelson
- Department of Oral- and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg, D-79106, Germany
| | - Wiebke Semper-Hogg
- Department of Oral- and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg, D-79106, Germany
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Vasconcelos DM, Ribeiro-da-Silva M, Mateus A, Alves CJ, Machado GC, Machado-Santos J, Paramos-de-Carvalho D, Alencastre IS, Henrique R, Costa G, Barbosa MA, Lamghari M. Immune response and innervation signatures in aseptic hip implant loosening. J Transl Med 2016; 14:205. [PMID: 27387445 PMCID: PMC4937545 DOI: 10.1186/s12967-016-0950-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/21/2016] [Indexed: 01/09/2023] Open
Abstract
Background Aseptic loosening (AL) of hip prosthesis presents inflammation and pain as sign and symptom similarly to arthritis pathologies. Still, the immune and innervation profiles in hip AL remain unclear and their interplay is poorly explored. Herein, local tissue inflammatory response, sensory and sympathetic innervation as well as associated local mediators were assessed in hip joint microenvironment underlying AL and compared to osteoarthritis (OA). Methods Histopathological analysis, immune cells (macrophages, T, B cells and PMNs) as well as sensory and sympathetic nerve fibers (SP+, CGRP+, TH+) distribution and profiles were analyzed on tissues retrieved from patients with failed hip prostheses due to AL (n = 20) and hip OA (n = 15) by immunohistochemistry. Additionally, transcriptional levels of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-12a, iNOS), anti-inflammatory cytokine (IL-10), osteoclastic factor (RANKL) and bone remodeling factor (TGF-β1) were locally evaluated by qRT-PCR. Serum TGF-β1 levels were assessed preoperatively by ELISA. Results Histopathological analysis revealed that tissues, aseptic interface membranes of AL patients had distinct tissue architecture and immune cells profile when compared to OA synovial tissues. Macrophages, T cells and B cells showed significant differences in tissue distribution. In OA, inflammation is mostly confined to the vicinity of synovial membrane while in AL macrophages infiltrated throughout the tissue. This differential immune profile is also accompanied with a distinct pattern of sensory and sympathetic innervation. Importantly, in AL patients, a lack of sympathetic innervation aseptic interface membranes without compensation mechanisms at cellular levels was observed with simultaneous reorganization of sensorial innervation. Despite the different histopathological portrait, AL and OA patients exhibited similar transcriptional levels of genes encoding key proteins in local immune response. Nevertheless, in both pathologies, TGF-β1 expression was prominent in sites where the inflammation is occurring. However, at systemic level no differences were found. Conclusion These findings indicate that AL patients exhibit different local inflammatory response and innervation signatures from OA patients in hip joint. These insights shed the light on neuro-immune interplay in AL and highlight the need to better understand this crosstalk to unravel potential mechanisms for targeted-therapies to improve hip joint lifetime and treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0950-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel M Vasconcelos
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Manuel Ribeiro-da-Silva
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,Serviço de Ortopedia e Traumatologia, Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - António Mateus
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Cecília Juliana Alves
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Gil Costa Machado
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Joana Machado-Santos
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Diogo Paramos-de-Carvalho
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Inês S Alencastre
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Rui Henrique
- ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Gilberto Costa
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Mário A Barbosa
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Meriem Lamghari
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal. .,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal. .,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
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Vasconcelos DM, Santos SG, Lamghari M, Barbosa MA. The two faces of metal ions: From implants rejection to tissue repair/regeneration. Biomaterials 2016; 84:262-275. [DOI: 10.1016/j.biomaterials.2016.01.046] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 12/20/2022]
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Wilson TG, Valderrama P, Burbano M, Blansett J, Levine R, Kessler H, Rodrigues DC. Foreign bodies associated with peri-implantitis human biopsies. J Periodontol 2016; 86:9-15. [PMID: 25224174 DOI: 10.1902/jop.2014.140363] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Peri-implantitis is an inflammatory condition that can lead to implant loss. The aim of this descriptive retrospective study is to describe the histopathologic findings in soft tissue biopsies of implants with peri-implantitis. METHODS Thirty-six human peri-implantitis biopsies were analyzed using light microscopy (LM) and scanning electron microscopy (SEM). The composition of foreign materials found in the tissues was assessed using an energy dispersive x-ray spectrometer. RESULTS At the LM level, the inflammatory lesion of peri-implantitis was in most cases a mixture of subacute and chronic inflammation dominated by plasma cells. At the SEM level, radiopaque foreign bodies were identified in 34 of the 36 biopsies. The predominant foreign bodies found were titanium and dental cement. These foreign materials were surrounded by inflammatory cells. CONCLUSIONS At present, the exact mechanism for introduction of these materials and their role in peri-implantitis is unknown. Further research is warranted to determine their etiology and potential role in pathogenesis.
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Golasik M, Herman M, Piekoszewski W. Toxicological aspects of soluble titanium – a review of in vitro and in vivo studies. Metallomics 2016; 8:1227-1242. [DOI: 10.1039/c6mt00110f] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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40
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Examination of a biodegradable magnesium screw for the reconstruction of the anterior cruciate ligament: A pilot in vivo study in rabbits. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 59:1100-1109. [PMID: 26652469 DOI: 10.1016/j.msec.2015.11.037] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/28/2015] [Accepted: 11/13/2015] [Indexed: 11/24/2022]
Abstract
The reconstruction of the anterior cruciate ligament is, for the most part, currently performed with interference screws made of titanium or degradable polymers. The aim of this study was to investigate the use of biodegradable magnesium interference screws for such a procedure because of their known biocompatibility and reported osteoconductive effects. The left tibiae of each of 18 rabbits were implanted with a magnesium-based (MgYREZr-alloy) screw, and another 18 with a titanium-based control. Each group was divided into observation periods of 4, 12 and 24weeks. After sacrifice, μCT scans were acquired to assess the amount of the gas liberated and the degradation rate of the implant. Histological evaluations were performed to investigate the local tissue response adjacent to the implant and to assess the status of the attachment between the tendon and the bone tissue. The μCT scans showed that liberation of gas was most prominent 4weeks after implantation and was significantly decreased by 24weeks. All screws remained in situ and formed a sufficient connection with the tendon and sufficient osseous integration at 24weeks. Histological evaluations showed neither inflammatory reactions nor necrosis of the tendon. The results of this pilot study in rabbits indicate that this magnesium-based interference screw should be considered as an alternative to conventional implant materials.
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Fretwurst T, Buzanich G, Nahles S, Woelber JP, Riesemeier H, Nelson K. Metal elements in tissue with dental peri-implantitis: a pilot study. Clin Oral Implants Res 2015; 27:1178-86. [PMID: 26508041 DOI: 10.1111/clr.12718] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Dental peri-implantitis is characterized by a multifactorial etiology. The role of metal elements as an etiological factor for peri-implantitis is still unclear. The aim of this study was to investigate the incidence of metal elements in bone and mucosal tissues around dental Grade 4 CP titanium implants with signs of peri-implantitis in human patients. METHODS In this prospective pilot study, all patients were enrolled consecutively in two study centers. Bone and soft tissue samples of patients with peri-implantitis with indication for explantation were analyzed for the incidence of different elements (Ca, P, Ti, Fe) by means of synchrotron radiation X-ray fluorescence spectroscopy (SRXRF) and polarized light microscopy (PLM). The existence of macrophages and lymphocytes in the histologic specimens was analyzed. RESULTS Biopsies of 12 patients (seven bone samples, five mucosal samples) were included and analyzed. In nine of the 12 samples (75%), the SRXRF examination revealed the existence of titanium (Ti) and an associated occurrence with Iron (Fe). Metal particles were detected in peri-implant soft tissue using PLM. In samples with increased titanium concentration, lymphocytes were detected, whereas M1 macrophages were predominantly seen in samples with metal particles. CONCLUSION Titanium and Iron elements were found in soft and hard tissue biopsies retrieved from peri-implantitis sites. Further histologic and immunohistochemical studies need to clarify which specific immune reaction metal elements/particles induce in dental peri-implant tissue.
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Affiliation(s)
- Tobias Fretwurst
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Guenter Buzanich
- BAM Federal Institute for Materials Research and Testing, Berlin, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Navigation and Robotics, Charité Campus Virchow, Berlin, Germany
| | - Johan Peter Woelber
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, University Medical Center, Freiburg, Germany
| | | | - Katja Nelson
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Freiburg, Germany
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Inhibition of osteolysis after local administration of osthole in a TCP particles-induced osteolysis model. INTERNATIONAL ORTHOPAEDICS 2015; 40:1545-52. [PMID: 26498175 DOI: 10.1007/s00264-015-3021-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/12/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE Wear debris-induced osteolysis and aseptic loosening are the most frequent late complications of total joint arthroplasty leading to revision of the prosthesis. However, no effective measures for the prevention and treatment of particles-induced osteolysis currently exist. Here, we investigated the efficacy of local administration of osthole on tricalcium phosphate (TCP) particles-induced osteolysis in a murine calvarial model. METHODS TCP particles were implanted over the calvaria of ICR mice, and established TCP particles-induced osteolysis model. On days one, four, seven, ten and thirteen post-surgery, osthole (10 mg/kg) or phosphate buffer saline (PBS) were subcutaneously injected into the calvaria of TCP particles-implanted or sham-operated mice. Two weeks later, blood, the periosteum and the calvaria were collected and processed for bone turnover markers, pro-inflammatory cytokine, histomorphometric and molecular analysis. RESULTS Osthole (10 mg/kg) markedly prevented TCP particles-induced osteoclastogenesis and bone resorption in a mouse calvarial model. Osthole also inhibited the decrease of serum osteocalcin level and calvarial alkaline phosphatase (ALP) activity, and prevented the increase in the activity of tartrate resistant acid phosphatase (TRAP) and cathepsin K in the mouse calvaria. Furthermore, osthole obviously reduced the release of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) into the periosteum. Western blotting demonstrated TCP particles caused a remarkable endoplasmic reticulum (ER) stress response in the mouse calvaria, which was obviously blocked by osthole treatment. CONCLUSION These results suggest that local administration of osthole inhibits TCP particles-induced osteolysis in the mouse calvarial in vivo, which may be mediated by inhibition of the ER stress signaling pathway, and it will be developed as a new drug in the prevention and treatment of destructive diseases caused by prosthetic wear particles.
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Stankevich KS, Gudima A, Filimonov VD, Klüter H, Mamontova EM, Tverdokhlebov SI, Kzhyshkowska J. Surface modification of biomaterials based on high-molecular polylactic acid and their effect on inflammatory reactions of primary human monocyte-derived macrophages: Perspective for personalized therapy. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 51:117-26. [DOI: 10.1016/j.msec.2015.02.047] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/21/2015] [Accepted: 02/24/2015] [Indexed: 11/30/2022]
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Endoplasmic reticulum stress-mediated inflammatory signaling pathways within the osteolytic periosteum and interface membrane in particle-induced osteolysis. Cell Tissue Res 2015; 363:427-47. [PMID: 26004143 PMCID: PMC4735257 DOI: 10.1007/s00441-015-2205-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/23/2015] [Indexed: 12/29/2022]
Abstract
Aseptic loosening secondary to periprosthetic inflammatory osteolysis results from the biological response to wear particles and is a leading cause of arthroplasty failure. The origin of this inflammatory response remains unclear. We aim to validate the definite link between endoplasmic reticulum (ER) stress and particle-induced inflammatory signaling pathways in periprosthetic osteolysis. We examine the histopathologic changes of osteolysis and the expression of specific biomarkers for ER-stress-mediated inflammatory signaling pathways (IRE1α, GRP78/Bip, c-Fos, NF-κB, ROS and Ca(2+)). Moreover, pro-inflammatory cytokines (TNF-α, IL-1β and IL-6) and osteoclastogenic molecules (VEGF, OPG, RANKL and M-CSF) were assessed in clinical interface membranes and murine periosteum tissues. We found wear particles to be capable of inducing ER stress in macrophages within clinical osteolytic interface membranes and murine osteolytic periosteum tissues and to be associated with the inflammatory response and osteoclastogenesis. Blocking ER stress with sodium 4-phenylbutyrate (4-PBA) results in a dramatic amelioration of particle-induced osteolysis and a significant reduction of ER-stress intensity. Simultaneously, this ER-stress blocker also lessens inflammatory cell infiltration, diminishes the capability of osteoclastogenesis and reduces the inflammatory response by lowering IRE1α, GRP78/Bip, c-Fos, NF-κB, ROS and Ca(2+) levels. Thus, ER stress plays an important role in particle-induced inflammatory osteolysis and osteoclastogenic reactions. The pharmacological targeting of ER-stress-mediated inflammatory signaling pathways might be an appealing approach for alleviating or preventing particle-induced osteolysis in at-risk patients.
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Bitar D, Parvizi J. Biological response to prosthetic debris. World J Orthop 2015; 6:172-189. [PMID: 25793158 PMCID: PMC4363800 DOI: 10.5312/wjo.v6.i2.172] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 05/28/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
Joint arthroplasty had revolutionized the outcome of orthopaedic surgery. Extensive and collaborative work of many innovator surgeons had led to the development of durable bearing surfaces, yet no single material is considered absolutely perfect. Generation of wear debris from any part of the prosthesis is unavoidable. Implant loosening secondary to osteolysis is the most common mode of failure of arthroplasty. Osteolysis is the resultant of complex contribution of the generated wear debris and the mechanical instability of the prosthetic components. Roughly speaking, all orthopedic biomaterials may induce a universal biologic host response to generated wear débris with little specific characteristics for each material; but some debris has been shown to be more cytotoxic than others. Prosthetic wear debris induces an extensive biological cascade of adverse cellular responses, where macrophages are the main cellular type involved in this hostile inflammatory process. Macrophages cause osteolysis indirectly by releasing numerous chemotactic inflammatory mediators, and directly by resorbing bone with their membrane microstructures. The bio-reactivity of wear particles depends on two major elements: particle characteristics (size, concentration and composition) and host characteristics. While any particle type may enhance hostile cellular reaction, cytological examination demonstrated that more than 70% of the debris burden is constituted of polyethylene particles. Comprehensive understanding of the intricate process of osteolysis is of utmost importance for future development of therapeutic modalities that may delay or prevent the disease progression.
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Díaz-Rodríguez P, Landin M. Controlled release of indomethacin from alginate–poloxamer–silicon carbide composites decrease in-vitro inflammation. Int J Pharm 2015; 480:92-100. [DOI: 10.1016/j.ijpharm.2015.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/13/2015] [Indexed: 12/28/2022]
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