A novel coping metal material CoCrCu alloy fabricated by selective laser melting with antimicrobial and antibiofilm properties

Toxicological Risks of the Cobalt-Chromium Alloys in Dentistry: A Systematic Review

Background: The toxicological risk of Co-Cr dental alloys is actually a sensitive subject with the European regulatory changes, namely regulation (EU) 2017/745 and annex VI to the CLP regulation (EC) 1972/2008. Objectives: The objective of this review is to conduct a rigorous analysis of the cytocompatibility of cobalt-chromium (Co-Cr) dental alloys. Considering various parameters such as cytotoxicity, type IV hypersensitivity reaction, sensitization, and irritation, we investigated evidence of toxicity of Co-Cr in human dental applications. Data sources: Specific search strategies were performed in three electronic databases, namely Medline, Embase, and Web of Science, using a main restriction in the search regarding the publication date (1995-2022). Study selection: Out of a total of 836 articles, only 21 studies were selected and analyzed according to PRISMA methodology. Results: Among them, 10 in vitro studies using human samples and 11 in vivo studies on human patients were distinguished. Most of the in vitro studies confirmed that Co-Cr alloys have a good cytocompatibility compared to Ni alloys. Regarding the in vivo studies, it appeared that Co-Cr could rarely cause sensitization, irritation, and allergic reactions. Reactions were mainly observed for people allergic to Co or Cr. Nevertheless, titanium-based materials showed better results. Conclusions: This study proposes a new state of the art on Co-Cr dental alloys and will thus be very useful for carrying out additional studies. Relevance: This review will help practitioners in their daily clinical choice.

Inhibition efficiency of 304-Cu stainless steel against oral bacterial biofilm

PURPOSE

This study aims to evaluate the antibacterial properties of 304 Cu-bearing stainless steel (SS) with different Cu contents (0, 2.5, 4.5 wt.%) against oral biofilms of Streptococcus mutans (S. mutans), Streptococcus sanguinis (S. sanguinis), and their mixture.

METHODS

Bacterial biofilms on the surface of 304-Cu SS were characterized by plate counting, 4', 6-diamidino-2-phenylindole (DAPI) staining with aid of sanning electron microscopy (SEM) and 2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide inner salt (XTT). In addition, the inhibition zone method was also employed to evaluate the antibacterial properties of 304-Cu SS. Cell Counting Kit-8 (CCK-8) and flow cytometry were used to assess the cytotoxicity and apoptosis rate of 304-Cu SS, respectively.

RESULTS

304-4.5Cu SS could effectively inhibit the attachment, formation, activity, and metabolism of bacterial biofilm, possessing the best antibacterial properties exceeding 99.9% of antibacterial rate against S. mutans, S. sanguinis, and their mixture. The diameters of inhibition zones to S. mutans and S. sanguinis on the surface of 304-4.5Cu SS were 21.7 and 14.7 mm, respectively. The results of cell experiments in vitro showed that both 304-2.5Cu SS and 304-4.5Cu SS had no evident cytotoxicity with an identical grade 1. The apoptosis rate exhibited a gradually increased tendency with increase of the Cu content in 304 SS.

CONCLUSIONS

304-4.5Cu SS without cytotoxic effect on NIH3T3 cells has obvious antibacterial activity against S. mutans, S. sanguinis and their mixture.

CLINICAL SIGNIFICANCE

The Cu-bearing stainless steel provides a new solution to be used as oral orthodontic devices for inhibiting oral microflora imbalance and enamel demineralization.

Antibacterial metals and alloys for potential biomedical implants

Metals and alloys, including stainless steel, titanium and its alloys, cobalt alloys, and other metals and alloys have been widely used clinically as implant materials, but implant-related infection or inflammation is still one of the main causes of implantation failure. The bacterial infection or inflammation that seriously threatens human health has already become a worldwide complaint. Antibacterial metals and alloys recently have attracted wide attention for their long-term stable antibacterial ability, good mechanical properties and good biocompatibility in vitro and in vivo. In this review, common antibacterial alloying elements, antibacterial standards and testing methods were introduced. Recent developments in the design and manufacturing of antibacterial metal alloys containing various antibacterial agents were described in detail, including antibacterial stainless steel, antibacterial titanium alloy, antibacterial zinc and alloy, antibacterial magnesium and alloy, antibacterial cobalt alloy, and other antibacterial metals and alloys. Researches on the antibacterial properties, mechanical properties, corrosion resistance and biocompatibility of antibacterial metals and alloys have been summarized in detail for the first time. It is hoped that this review could help researchers understand the development of antibacterial alloys in a timely manner, thereby could promote the development of antibacterial metal alloys and the clinical application.

Recent Advances in Research on Antibacterial Metals and Alloys as Implant Materials

Implants are widely used in orthopedic surgery and are gaining attention of late. However, their use is restricted by implant-associated infections (IAI), which represent one of the most serious and dangerous complications of implant surgeries. Various strategies have been developed to prevent and treat IAI, among which the closest to clinical translation is designing metal materials with antibacterial functions by alloying methods based on existing materials, including titanium, cobalt, tantalum, and biodegradable metals. This review first discusses the complex interaction between bacteria, host cells, and materials in IAI and the mechanisms underlying the antibacterial effects of biomedical metals and alloys. Then, their applications for the prevention and treatment of IAI are highlighted. Finally, new insights into their clinical translation are provided. This review also provides suggestions for further development of antibacterial metals and alloys.

AVNP2 protects against cognitive impairments induced by C6 glioma by suppressing tumour associated inflammation in rats

Glioblastoma is a kind of malignant tumour and originates from the central nervous system. In the last century, some researchers and clinician have noticed that the psychosocial and neurocognitive functioning of patients with malignant gliomas can be impaired. Many clinical studies have demonstrated that part of patients, adults or children, diagnosed with glioblastoma will suffer from cognitive deficiency during their clinical course, especially in long-term survivors. Many nanoparticles (NPs) can inhibit the biological functions of tumours by modulating tumour-associated inflammation, which provokes angiogenesis and tumour growth. As one of the best antiviral nanoparticles (AVNPs), AVNP2 is the 2nd generation of AVNP2 that have been conjugated to graphite-graphene for improving physiochemical performance and reducing toxicity. AVNP2 inactivates viruses, such as the H1N1 and H5N1influenza viruses and even the SARS coronavirus, while it inhibits bacteria, such as MRSA and E. coli. As antimicrobials, nanoparticles are considered to be one of the vectors for the administration of therapeutic compounds. Yet, little is known about their potential functionalities and toxicities to the neurotoxic effects of cancer. Herein, we explored the functionality of AVNP2 on inhibiting C6 in glioma-bearing rats. The novel object-recognition test and open-field test showed that AVNP2 significantly improved the neuro-behaviour affected by C6 glioma. AVNP2 also alleviated the decline of long-term potentiation (LTP) and the decreased density of dendritic spines in the CA1 region induced by C6. Western blot assay and immunofluorescence staining showed that the expressions of synaptic-related proteins (PSD-95 and SYP) were increased, and these findings were in accordance with the results mentioned above. It revealed that the sizes of tumours in C6 glioma-bearing rats were smaller after treatment with AVNP2. The decreased expression of inflammatory factors (IL-1β, IL-6 and TNF-α) by Western blotting assay and ELISA, angiogenesis protein (VEGF) by Western blotting assay and other related proteins (BDNF, NF-ĸB, iNOS and COX-2) by Western blotting assay in peri-tumour tissue indicated that AVNP2 could control tumour-associated inflammation, thus efficiently ameliorating the local inflammatory condition and, to some extent, inhibiting angiogenesis in C6-bearing rats. In conclusion, our results suggested that AVNP2 could have an effect on the peri-tumor environment, obviously restraining the growth progress of gliomas, and eventually improving cognitive levels in C6-bearing rats.

Evaluation of corrosion resistance of Co-Cr alloys fabricated with different metal laser sintering systems

PURPOSE

The aim of this study was to evaluate the corrosion resistance of the specimens produced by five different commercial metal laser sintering (MLS) systems with their recommended Co-Cr alloy powders.

MATERIALS AND METHODS

The MLS machines and the alloy powders used were, ProX 100-ST2724G (St-Pro), Mysint 100-EOS SP2 (SP2-Mys), EOSINT 270-EOS SP2 (SP2-EOS), SLM 100-Starbond CoS (SB-SLM), and MLab Cusing-Remanium® Star (RS-MLab), respectively. Eight specimens from each group were prepared. Open circuit potential (Eocp) and electrochemical impedance spectroscopy (EIS) measurements of polished surfaces of the specimens were conducted in a three-electrode cell using a potentiostat-galvanostat in Fusayama-Meyer artificial saliva (AS). Specimens from each group were immersed in AS and de-ionized water for seven days. Eocp, charge transfer resistance (Rct) values, and released ions (µg/cm2 × 7d) in different solutions were determined. The specimen surfaces were observed with SEM/EDS. Results were analyzed statistically.

RESULTS

Eocp values have shifted to potentials that are more positive over time. Steady-state Eocp values were from high to low as follows, SB-SLM, SP2-Mys, SP2-EOS, RS-MLab, and ST-Pro, respectively. After 60 mins, RS-MLab specimens had the highest Rct value, followed by SP2-Mys, SB-SLM, SP2-EOS, and ST-Pro. In all groups, ion release was higher in AS than that in de-ionized water.

CONCLUSION

There were small differences among the corrosion resistances of the Co-Cr alloy specimens produced with MLS systems; meanwhile, the corrosion resistances were quite high for all specimens.

The effect of 3 wt.% Cu addition on the microstructure, tribological property and corrosion resistance of CoCrW alloys fabricated by selective laser melting

Microstructure, tribological property and corrosion resistance of orthopedic implant materials CoCrW-3 wt.% Cu fabricated by selective laser melting (SLM) process were systematically investigated with CoCrW as control. Equaxied γ-phase together with the inside {111} < 112 > type twin and platelet ε-phase was found in both the Cu-bearing and Cu-free alloys. Compared to the Cu-free alloy, the introduction of 3 wt.% Cu significantly increased the volume fraction of the ε-phase. In both alloys, the hardness of ε-phase zone was rather higher (~4 times) than that of γ-phase zone. The wear factor of 3 wt.% Cu-bearing alloy possessed smaller wear factor, although it had higher friction coefficient compared with Cu-free alloys. The ε-phase in the CoCr alloy would account for reducing both abrasive and fatigue wear. Moreover, the Cu-bearing alloy presented relatively higher corrosion potential E_corr and lower corrosion current density I_corr compared to the Cu-free alloy. Accordingly, 3 wt.% Cu addition plays a key role in enhancing the wear resistance and corrosion resistance of CoCrW alloys, which indicates that the SLM CoCrW-3Cu alloy is a promising personalized alternative for traditional biomedical implant materials.

Evaluation of promoting effect of a novel Cu-bearing metal stent on endothelialization process from in vitro and in vivo studies

Drug eluting stents (DES) have been extensively applied nowadays and reduce the incidence of in-stent restenosis (ISR) greatly as compared with bare metal stents (BMS). However, the development of DES is hindered by the risk of late stent thrombosis (LST) due to delayed re-endothelialization, while endothelialization is an important process related to ISR and LST after implantation. 316L is a traditional stent material without bioactivity and have a high risk of ISR. Cu is recognized for angiogenesis stimulation in these years. Hence a copper bearing 316L stainless steel (316L-Cu) was prepared and evaluated about its effect on endothelialization in this paper. Compared with traditional 316L, it was proved that 316L-Cu increased the proliferation of co-cultured human umbilical vein endothelial cells (HUVECs) at first day. Moreover, HUVECs stretched better on the surface of 316L-Cu. It also improved the expression of angiogenesis related genes and tube formation ability in vitro. 316L-Cu-BMS, DES and 316L-BMS were implanted in swine to evaluate the re-endothelialization ability in vivo. And 316L-Cu-BMS showed the best effect on endothelialization with good biosafety. Consequently, 316L-Cu is a kind of promising BMS material for coronary field.

Design and characterization of a novel nickel-free cobalt-base alloy for intravascular stents

Co-Cr-W-Ni alloy (L605) with high tensile strength is used in coronary stents. The thickness of individual strut of the stent is reduced which can decrease the stent restenosis rate. However, about 10% Ni element content in L605 is found to cause allergic reactions and pulmonary embolism, similar to the traditional 316L stainless steel. In this study, a novel nickel-free cobalt-base alloy Co-20Cr-12Fe-18Mn-2Mo-4W-N (wt%) was designed and fabricated in order to efficiently avoid the potential hazards of Ni element. Fe and Mn, essential elements of human body, were added in the alloy to substitute part of Co element. In comparison to L605 alloy, the tensile strength of the new alloy was higher than 1000MPa while elongation was above 55%. The pitting potential of the new alloy was measured close to 1000mV, also higher than that of L605 alloy. CCK-8 test indicated that the cytotoxicity of the new alloy is grade 1, reflecting that Co-20Cr-12Fe-18Mn-2Mo-4W-N alloy has no cytotoxic effects. There was no significant difference in the apoptosis rates between Co-20Cr-12Fe-18Mn-2Mo-4W-N and L605 alloy. The newly developed cobalt-base alloy showed excellent mechanical, corrosion resistance and biological properties, which could make it a desirable material for future clinical investigations.