Preliminary study on the corrosion resistance, antibacterial activity and cytotoxicity of selective-laser-melted Ti6Al4V- x Cu alloys

A novel titanium alloy for load-bearing biomedical implants: Evaluating the antibacterial and biocompatibility of Ti536 produced via electron beam powder bed fusion additive manufacturing process

Additive manufacturing (AM) of Ti-based biomedical implants is a pivotal research topic because of its ability to produce implants with complicated geometries. Despite desirable mechanical properties and biocompatibility of Ti alloys, one major drawback is their lack of inherent antibacterial properties, increasing the risk of postoperative infections. Hence, this research focuses on the Ti536 (Ti5Al3V6Cu) alloy, developed through Electron Beam Powder Bed Fusion (EB-PBF), exploring bio-corrosion, antibacterial features, and cell biocompatibility. The microstructural characterization revealed grain refinement and the formation of Ti2Cu precipitates with different morphologies and sizes in the Ti matrix. Electrochemical tests showed that Cu content minimally influenced the corrosion current density, while it slightly affected the stability, defect density, and chemical composition of the passive film. According to the findings, the Ti536 alloy demonstrated enhanced antibacterial properties without compromising its cell biocompatibility and corrosion behavior, thanks to Ti2Cu precipitates. This can be attributed to both the release of Cu ions and the Ti2Cu precipitates. The current study suggests that the EB-PBF fabricated Ti536 sample is well-suited for use in load-bearing applications within the medical industry. This research also offers an alloy design roadmap for novel biomedical Ti-based alloys with superior biological performance using AM methods.

Copper-containing titanium alloys promote the coupling of osteogenesis and angiogenesis by releasing copper ions

Previous investigations have reported on the ability of copper (Cu)-bearing biomaterials to accelerate vascular formation and bone regeneration. However, few studies have explored the effects of Cu-bearing materials on the interactions between angiogenesis and osteogenesis. Therefore, in this study, we prepared Cu-containing alloys using selective laser melting (SLM) technology and investigated the impact of preosteoblasts seeded on Ti6Al4V-4.5Cu alloy on angiogenesis. Our results indicated that Ti6Al4V-4.5Cu alloys increased the expression of proangiogenic genes and proteins in preosteoblasts, which further stimulated vascular formation in endothelial cells. Besides, we discovered that the biological effects of the Ti6Al4V-4.5Cu alloy were partly attributed to the release of Cu ions. In short, our research demonstrated the ability of Ti6Al4V-4.5Cu alloys to promote the coupling of angiogenesis and osteogenesis by releasing Cu ions.

Corrosion Behavior and Bio-Functions of the Ultrafine-Grained Ti6Al4V-5Cu Alloy with a Dual-Phase Honeycomb Shell Structure in Simulated Body Fluid

Titanium alloys are widely used in biomedical applications. However, cases of implant failure due to fatigue fracture and bacterial infection are common. In addition, implants are susceptible to metal ions (Al, V) released by long-term exposure to human body fluids, which causes neuropathy, mental disorders, and other diseases. Thus, development of novel materials to achieve long-term safety of implants is currently a research hotspot. Recently, our research group has developed an ultrafine-grained Ti6Al4V-5Cu alloy with a unique "dual-phase honeycomb shell" (DPHS) structure, which possesses high fatigue strength and stability. This study further affirmed its higher corrosion behavior, antibacterial properties, and cytocompatibility compared to the coarse-grained Ti6Al4V and Ti6Al4V-5Cu alloys. The ultrafine-grained structure of Ti6Al4V-5Cu having DPHS increased the proportion of phases (Cu-rich phases, β-phase, and Ti₂Cu intermetallic phase) with a lower surface potential. It was observed that the developed microstructure was conducive to a stable configuration of the oxide (passive) layer on the alloy surface. In addition, the low-phase interfacial energies of the ultrafine-grained structure with DPHS even facilitated the improvement of the denseness of the protective passive film and eventually enhanced the corrosion behavior. Besides, the fine-Cu-rich phases and the micro-galvanic couples formed between them and the matrix significantly increased the contact frequency of bacteria, thus increasing the contact sterilization efficiency of the ultrafine-grained Ti6Al4V-5Cu alloy. These results showed that the new ultrafine-grained Ti6Al4V-5Cu alloy has excellent corrosion resistance and biological functions for clinical application.

Effect of Heat Treatment on Osteoblast Performance and Bactericidal Behavior of Ti6Al4V(ELI)-3at.%Cu Fabricated by Laser Powder Bed Fusion

Cu addition to alloys for biomedical applications has been of great interest to reduce bacterial growth. In situ-alloyed Ti6Al4V(ELI)-3at.%Cu was successfully manufactured by laser powder bed fusion (L-PBF). Even so, post-heat treatments are required to avoid distortions and/or achieve required/desired mechanical and fatigue properties. The present study is focused on the investigation of microstructural changes in L-PBF Ti6Al4V(ELI)-3at.%Cu after stress relieving and annealing treatments, as well as their influence on osteoblast and bactericidal behavior. After the stress relieving treatment, a homogenously distributed β phase and CuTi₂ intermetallic precipitates were observed over the α' matrix. The annealing treatment led to the increase in amount and size of both types of precipitates, but also to phase redistribution along α lamellas. Although microstructural changes were not statistically significant, such increase in β and CuTi₂ content resulted in an increase in osteoblast proliferation after 14 days of cell culture. A significant bactericidal behavior of L-PBF Ti6Al4V(ELI)-3at.%Cu by means of ion release was found after the annealing treatment, provably due to the easier release of Cu ions from β phase. Biofilm formation was inhibited in all on Cu-alloyed specimens with stress relieving but also annealing treatment.

Corrosion and wear behavior of Ti-5Cu-xNb biomedical alloy in simulated body fluid for dental implant applications

The present study examined the corrosion and tribological behavior of novel Ti-5Cu-xNb alloy synthesized via powder metallurgy as a new biomedical material in a simulated bodily fluid (SBF) solution. The electrochemical impedance spectroscopy (EIS) study reveals the formation of two protective layers on the surface of alloys during the test. The alloys spontaneously produce a passivating oxide coating on their surfaces, and the breakdown potential (1.14-1.17 V) and re-passivation current density (2.07-3.04 μAcm^-2) were observed during the potentiodynamic polarization test. The highest corrosion resistance was observed for the alloy Ti-5Cu-10Nb (i_corr = 21.44 nA-cm^-2). The SEM and XPS analysis of the corroded surface showed the formation of oxide on the surfaces of the alloys. The samples were tested at 10 N, 15 N, and 20 N loads against the zirconia counterpart to investigate the effect of loading on friction and wear. The lowest coefficient of friction was obtained for Ti-5Cu-5Nb (0.25-0.41) at 20 N loading, while the maximum for Ti-5Cu-10Nb at 15 N load falls in the range of (0.71-0.25). Additionally, they present the wear rate in the range of (5.3 × 10^-8-1.45 × 10^-6 mm³/mm), in accordance with the change in microstructure and mechanical properties. However, the wear rate increases with the addition of niobium and reaches the maximum for Ti-5Cu-15Nb at 20 N loading condition, but it is relatively deficient compared to commonly used implant material. Therefore, it is suggested that this β-type Ti-5Cu-xNb alloy is a promising candidate, more suitable than the commercially used Ti and Ti-6Al-4V for dental applications.

Antibacterial Ti-Cu implants: A critical review on mechanisms of action

Titanium (Ti) has been widely used for manufacturing of bone implants because of its mechanical properties, biological compatibility, and favorable corrosion resistance in biological environments. However, Ti implants are prone to infection (peri-implantitis) by bacteria which in extreme cases necessitate painful and costly revision surgeries. An emerging, viable solution for this problem is to use copper (Cu) as an antibacterial agent in the alloying system of Ti. The addition of copper provides excellent antibacterial activities, but the underpinning mechanisms are still obscure. This review sheds light on such mechanisms and reviews how incorporation of Cu can render Ti-Cu implants with antibacterial activity. The review first discusses the fundamentals of interactions between bacteria and implanted surfaces followed by an overview of the most common engineering strategies utilized to endow an implant with antibacterial activity. The underlying mechanisms for antibacterial activity of Ti-Cu implants are then discussed in detail. Special attention is paid to contact killing mechanisms because the misinterpretation of this mechanism is the root of discrepancies in the literature.

Durable and Nontoxic Natural Rubber-Based Composites with Antibacterial Properties

Natural rubber latex (NRL) has prophylactic properties and is used to make pathogen-isolating products like condoms and surgical gloves. However, obtaining NRL and casting it into durable products are challenging. Consequently, progress in the research and development of medical NRL products has been slow. This study aims to strengthen NR and induce it with bactericidal properties. In this regard, we introduce inorganic whiskers into the NRL and synthesize whiskers/NR composites with strong mechanical and antibacterial properties. The method proposed herein is a template method, which can rapidly and efficiently reveal the antibacterial effect of the composite latex, providing convenience for research institutions and factories studying antibacterial latex. A complete system is established for studying the antibacterial medical NRL, and a precedent is set for the relevant products.

Additively manufactured metallic biomaterials

Metal additive manufacturing (AM) has led to an evolution in the design and fabrication of hard tissue substitutes, enabling personalized implants to address each patient's specific needs. In addition, internal pore architectures integrated within additively manufactured scaffolds, have provided an opportunity to further develop and engineer functional implants for better tissue integration, and long-term durability. In this review, the latest advances in different aspects of the design and manufacturing of additively manufactured metallic biomaterials are highlighted. After introducing metal AM processes, biocompatible metals adapted for integration with AM machines are presented. Then, we elaborate on the tools and approaches undertaken for the design of porous scaffold with engineered internal architecture including, topology optimization techniques, as well as unit cell patterns based on lattice networks, and triply periodic minimal surface. Here, the new possibilities brought by the functionally gradient porous structures to meet the conflicting scaffold design requirements are thoroughly discussed. Subsequently, the design constraints and physical characteristics of the additively manufactured constructs are reviewed in terms of input parameters such as design features and AM processing parameters. We assess the proposed applications of additively manufactured implants for regeneration of different tissue types and the efforts made towards their clinical translation. Finally, we conclude the review with the emerging directions and perspectives for further development of AM in the medical industry.

Copper-containing titanium alloys promote angiogenesis in irradiated bone through releasing copper ions and regulating immune microenvironment

Poor vascularization was demonstrated as a factor inhibiting bone regeneration in patients receiving radiotherapy. Various copper-containing materials have been reported to increase angiogenesis, therefore might improve bone formation. In this study, a Ti6Al4V-1.5Cu alloy was prepared using selective laser melting (SLM) technology. The immunomodulatory and pro-angiogenic effects of the Ti6Al4V-1.5Cu alloys were examined. In vitro, Ti6Al4V-1.5Cu stimulated vascular formation by restraining inflammatory factors and provoking angiogenic factors in non-irradiated and irradiated macrophages. In vivo, the angiogenic effects of the Ti6Al4V-1.5Cu alloy were confirmed using an irradiated rat femur defect model. Moreover, we found that the biological effects of the Ti6Al4V-1.5Cu alloy were partially due to the release of copper ions and associated with PI3K-Akt signaling pathway. In conclusion, this study indicated the potential of the Ti6Al4V-1.5Cu alloy to promote angiogenesis by releasing copper ions and inhibiting inflammation in normal and irradiated tissues.

Corrosion Resistance of Selective Laser Melted Ti6Al4V3Cu Alloy Produced Using Pre-Alloyed and Mixed Powder

Metallic elemental powder mixture and pre-alloyed metallic powder are both frequently used powder feedstock in the additive manufacturing process. However, little research has been conducted to compare the corrosion behavior of selective laser melting (SLM) alloys, fabricated by pre-alloyed metallic powder and mixed metallic powder. Hence, it is important to investigate the corrosion behavior of SLMed alloys, as well as the corresponding cast ingot, with the aim to better understand the feasibility of designing new materials. In this work, the SLM-produced Ti6Al4V3Cu alloys were manufactured using a metallic elemental powder mixture and pre-alloyed metallic powder, respectively. The corrosion behavior of the different Ti6Al4V3Cu alloys was investigated in following electrochemical tests and ion release measurements. The results showed that the Ti6Al4V3Cu alloy prepared by pre-alloyed metallic powder showed better corrosion resistance than that produced from mixed metallic powder. Moreover, the SLM-produced Ti6Al4V3Cu alloys performed significantly better in corrosion resistance than the cast Ti6Al4V3Cu. The results are expected to achieve a better understanding of the feasibility of designing new materials using mixed powders, contributing to reducing development costs and cycles.

Application of Copper Nanoparticles in Dentistry

Nanoparticles based on metal and metallic oxides have become a novel trend for dental applications. Metal nanoparticles are commonly used in dentistry for their exclusive shape-dependent properties, including their variable nano-sizes and forms, unique distribution, and large surface-area-to-volume ratio. These properties enhance the bio-physio-chemical functionalization, antimicrobial activity, and biocompatibility of the nanoparticles. Copper is an earth-abundant inexpensive metal, and its nanoparticle synthesis is cost effective. Copper nanoparticles readily intermix and bind with other metals, ceramics, and polymers, and they exhibit physiochemical stability in the compounds. Hence, copper nanoparticles are among the commonly used metal nanoparticles in dentistry. Copper nanoparticles have been used to enhance the physical and chemical properties of various dental materials, such as dental amalgam, restorative cements, adhesives, resins, endodontic-irrigation solutions, obturation materials, dental implants, and orthodontic archwires and brackets. The objective of this review is to provide an overview of copper nanoparticles and their applications in dentistry.

Insight Into Corrosion of Dental Implants: From Biochemical Mechanisms to Designing Corrosion-Resistant Materials

Purpose of Review

Despite advanced technologies to avoid corrosion of dental implants, the mechanisms toward the release of metals and their role in the onset of peri-implant diseases are still under-investigated. Effective knowledge on the etiopathogenesis of corrosive products and preventive strategies mitigating the risks for surface degradation are thus in dire need. This review aimed to summarize evidence toward biocorrosion in the oral environment and discuss the current strategies targeting the improvement of dental implants and focusing on the methodological and electrochemical aspects of surface treatments and titanium-based alloys.

Recent Findings

Recent studies suggest the existence of wear/corrosion products may correlate with peri-implantitis progress by triggering microbial dysbiosis, the release of pro-inflammatory cytokines, and animal bone resorption. Furthermore, current clinical evidence demonstrating the presence of metal-like particles in diseased tissues supports their possible role as a risk factor for peri-implantitis. For instance, to overcome the drawback of titanium corrosion, researchers are primarily focusing on developing corrosion-resistant alloys and coatings for dental implants by changing their physicochemical features.

Summary

The current state-of-art discussed in this review found corrosion products effective in affecting biofilm virulence and inflammatory factors in vitro. Controversial and unstandardized data are limitations, making the premise of corrosion products being essential for peri-implantitis onset. On the other hand, when it comes to the strategies toward reducing implant corrosion rate, it is evident that the chemical and physical properties are crucial for the in vitro electrochemical behavior of the implant material. For instance, it is foreseeable that the formation of films/coatings and the incorporation of some functional compounds into the substrate may enhance the material’s corrosion resistance and biological response. Nevertheless, the utmost challenge of research in this field is to achieve adequate stimulation of the biological tissues without weakening its protective behavior against corrosion. In addition, the translatability from in vitro findings to clinical studies is still in its infancy. Therefore, further accumulation of high-level evidence on the role of corrosion products on peri-implant tissues is expected to confirm the findings of the present review besides the development of better methods to improve the corrosion resistance of dental implants. Furthermore, such knowledge could further develop safe and long-term implant rehabilitation therapy.

In Vitro Characterization of In Situ Alloyed Ti6Al4V(ELI)-3 at.% Cu Obtained by Laser Powder Bed Fusion

The intensive cytotoxicity of pure copper is effectively kills bacteria, but it can compromise cellular behavior, so a rational balance must be found for Cu-loaded implants. In the present study, the individual and combined effect of surface composition and roughness on osteoblast cell behavior of in situ alloyed Ti6Al4V(ELI)-3 at.% Cu obtained by laser powder bed fusion was studied. Surface composition was studied using scanning electron microscopy, energy dispersive spectroscopy, and X-ray diffraction. Surface roughness measurements were carried out using confocal microscopy. In vitro osteoblast performance was evaluated by means of cell morphology observation of cell viability, proliferation, and mineralization. In vitro studies were performed at 1, 7, and 14 days of cell culture, except for cell mineralization at 28 days, on grounded and as-built (rough) samples with and without 3 at.% Cu. The addition of 3 at.% Cu did not show cell cytotoxicity but inhibited cell proliferation. Cell mineralization tends to be higher for samples with 3 at.% Cu content. Surface roughness inhibited cell proliferation too, but showed enhanced cell mineralization capacity and therefore, higher osteoblast performance, especially when as-built samples contained 3 at.% Cu. Cell proliferation was only observed on ground samples without Cu but showed the lowest cell mineralization.

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.

Advances in powder bed fusion 3D printing in drug delivery and healthcare

Powder bed fusion (PBF) is a 3D printing method that selectively consolidates powders into 3D objects using a power source. PBF has various derivatives; selective laser sintering/melting, direct metal laser sintering, electron beam melting and multi-jet fusion. These technologies provide a multitude of benefits that make them well suited for the fabrication of bespoke drug-laden formulations, devices and implants. This includes their superior printing resolution and speed, and ability to produce objects without the need for secondary supports, enabling them to precisely create complex products. Herein, this review article outlines the unique applications of PBF 3D printing, including the main principles underpinning its technologies and highlighting their novel pharmaceutical and biomedical applications. The challenges and shortcomings are also considered, emphasising on their effects on the 3D printed products, whilst providing a forward-thinking view.

Bacterial adhesion to biomaterials: What regulates this attachment? A review

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Bacterial adhesion to the surface of dental materials play a significant role in infections.

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The factors that govern microbial attachment involves different types of physical-chemical interactions and biological processes.

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Studying bacterial adhesion makes it possible to understand the mechanisms involved in attachment and helps in the search for technologies that promote antibacterial surfaces.

Bacterial attachment to biomaterials is of great interest to the medical and dental field due to its impact on dental implants, dental prostheses, and others, leading to the need to introduce methods for biofilm control and mitigation of infections. Biofilm adhesion is a multifactorial process and involves characteristics relevant to the bacterial cell as well as biological, chemical, and physical properties relative to the surface of biomaterials. Bacteria encountered different environmental conditions during their growth and developed interspecies communication strategies, as well as various mechanisms to detect the environment and facilitate survival, such as chemical sensors or physical detection mechanisms. However, the factors that govern microbial attachment to surfaces are not yet fully understood. In order to understand how bacteria interact with surfaces, as well as to characterize the physical-chemical properties of bacteria adhesins, and to determine their interrelation with the adhesion to the substrate, in recent years new techniques of atomic force microscopy (AFM) have been developed and helped by providing quantitative results. Thus, the purpose of this review is to gather current studies about the factors that regulate microbial adhesion to surfaces in order to offer a guide to studies to obtain technologies that provide an antimicrobial surface.

Toward Bactericidal Enhancement of Additively Manufactured Titanium Implants

Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.

Biological applications of copper-containing materials

Copper is an indispensable trace metal element in the human body, which is mainly absorbed in the stomach and small intestine and excreted into the bile. Copper is an important component and catalytic agent of many enzymes and proteins in the body, so it can influence human health through multiple mechanisms. Based on the biological functions and benefits of copper, an increasing number of researchers in the field of biomaterials have focused on developing novel copper-containing biomaterials, which exhibit unique properties in protecting the cardiovascular system, promoting bone fracture healing, and exerting antibacterial effects. Copper can also be used in promoting incisional wounds healing, killing cancer cells, Positron Emission Tomography (PET) imaging, radioimmunological tracing and radiotherapy of cancer. In the present review, the biological functions of copper in the human body are presented, along with an overview of recent progress in our understanding of the biological applications and development of copper-containing materials. Furthermore, this review also provides the prospective on the challenges of those novel biomaterials for future clinical applications.

Molecular mechanisms of osteogenesis and antibacterial activity of Cu-bearing Ti alloy in a bone defect model with infection in vivo

OBJECTIVE

The antibacterial activity of copper (Cu)-alloy biomaterials has shown a great potential in clinical application. Here, we evaluated the osteogenesis and antibacterial effects of Ti6Al4V-6.5wt%Cu alloy in an in vivo model of infected bone defects and determine their responsible proteins and pathways using proteomics.

METHODS

After bone defects were filled with Ti6Al4V and Ti6Al4V-6.5wt%Cu implants for 6 week, the tissue and bone samples around the implants were harvested for radiographic, micro-CT, histological, and bone-related gene expression analyses. An iTRAQ-based protein identification/quantification approach was used to analyze the osteogenic and antibacterial effects of Ti6Al4V-6.5wt%Cu alloy.

RESULTS

Imaging and histological results showed Ti6Al4V alloy induced a stronger inflammatory response than Ti6Al4V-6.5wt%Cu alloy; imaging results and osteogenic protein levels showed Ti6Al4V-6.5wt%Cu alloy exerted a stronger osteogenic effect. In vitro experiment, we found the Ti6Al4V-6.5wt%Cu had significant antibacterial effects and inhibited the activity of Staphylococcus aureus in the early stage. In addition, the bacterial biofilm formed in Ti6Al4V-6.5wt%Cu group was significantly lower than that in Ti6Al4V group. Proteomic screening of 4279 proteins resulted in 35 differentially expressed proteins for further examination which were mainly associated with the cellular process, metabolic process, stimulus response, and cellular component organization. In further exploration of the mechanism of osteogenic mineralization of Ti6Al4V-6.5wt%Cu alloy, we found out SDC4 and AGRN were the top two target proteins associated with osteogenic differentiation and bone mineralization.

CONCLUSION

Ti6Al4V-6.5wt%Cu alloy shows a great potential as a bone implant material due to its positive effects against bacterial infection and on bone formation.

THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE

At present, titanium alloys and other non-antibacterial metal materials are used in orthopedic internal fixation operations. Our study demonstrates that Ti6Al4V-6.5wt%Cu alloy has good antibacterial and osteogenic effects in vivo and in vitro. This means that Ti6Al4V-6.5wt%Cu alloy may become a new kind of antimicrobial metallic material as internal fixation material to continuously exert its antimicrobial effects and reduce the infection rate after clinical internal fixation.

Customized additive manufacturing of porous Ti6Al4V scaffold with micro-topological structures to regulate cell behavior in bone tissue engineering

Scaffold micro-topological structure plays an important role in the regulation of cell behavior in bone tissue engineering. This paper investigated the effect of 3D printing parameters on the scaffold micro-topological structure and its subsequent cell behaviors. By setting of different 3D printing parameters, i.e., the 3D printing laser power, the scanning interval and the thickness of sliced layers, the highest resolution up to 20 μm can be precisely fabricated. Scaffolds' characterization results indicated that the laser power affected the forming quality of melt tracks, the scanning interval distance determined the size of regularly arranged pores, and the thickness of sliced layers affected the morphological and structural characteristics. By regulating of these printing parameters, customized porous Ti6Al4V scaffold with varied hierarchical micro-topological structure can be obtained. In vitro cell culturing results showed that the regular porous micro-topological structure of scaffolds with the aperture close to cell size was more suitable for cell proliferation and adhesion. The overall distribution of cells on regular porous scaffolds was similar to the orderly arrangement of cultivated crops in the field. The findings suggested that customization of the scaffold provided an effective way to regulate cellular behavior and biological properties.

Tuning osteoporotic macrophage responses to favour regeneration by Cu-bearing titanium alloy in Porphyromonas gingivalis lipopolysaccharide-induced microenvironments

Guided bone regeneration in inflammatory microenvironments of osteoporotic patients with large alveolar bone defects remains a great challenge. Macrophages are necessary for alveolar bone regeneration via their polarization and paracrine actions. Our previous studies showed that Cu-bearing Ti6Al4V alloys are capable of regulating macrophage responses. When considering the complexity of oral microenvironments, the influences of Cu-bearing Ti6Al4V alloys on osteoporotic macrophages in infectious microenvironments are worthy of further investigations. In this study, we fabricated Ti6Al4V-Cu alloy by selective laser melting technology and used Porphyromonas gingivalis lipopolysaccharide (P.g-LPS) to imitate oral pathogenic bacterial infections. Then, we evaluated the impacts of Ti6Al4V-Cu on osteoporotic macrophages in infectious microenvironments. Our results indicated that Ti6Al4V-Cu not only inhibited the P.g-LPS-induced M1 polarization and pro-inflammatory cytokine production of osteoporotic macrophages but also shifted polarization towards the pro-regenerative M2 phenotype and remarkably promoted anti-inflammatory cytokine release. In addition, Ti6Al4V-Cu effectively promoted the activity of COMMD1 to potentially repress NF-κB-mediated transcription. It is concluded that the Cu-bearing Ti6Al4V alloy results in ameliorated osteoporotic macrophage responses to create a favourable microenvironment under infectious conditions, which holds promise to develop a GBR-barrier membrane for alveolar bone regeneration of osteoporosis patients.

Antibacterial effect of a copper-containing titanium alloy against implant-associated infection induced by methicillin-resistant Staphylococcus aureus

Implant-associated infection (IAI) induced by methicillin-resistant Staphylococcus aureus (MRSA) is a devastating complication in the orthopedic clinic. Traditional implant materials, such as Ti6Al4V, are vulnerable to microbial infection. In this study, we fabricated a copper (Cu)-containing titanium alloy (Ti6Al4V-Cu) for the prevention and treatment of MRSA-induced IAI. The material characteristics, antibacterial activity, and biocompatibility of Ti6Al4V-Cu were systematically investigated and compared with those of Ti6Al4V. Ti6Al4V-Cu provided stable and continuous Cu²⁺ release, at a rate of 0.106 mg/cm²/d. Its antibacterial performance against MRSA in vitro was confirmed by plate counting analysis, crystal violet staining, and scanning electron microscopic observations. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) analysis demonstrated that Ti6Al4V-Cu suppressed biofilm formation, virulence, and antibiotic-resistance of MRSA. The in vivo anti-MRSA effect was investigated in a rat IAI model. Implants were contaminated with MRSA solution, implanted into the femur, and left for 6 weeks. Severe IAI developed in the Ti6Al4V group, with increased radiological score (9.6 ± 1.3) and high histological score (10.1 ± 1.9). However, no sign of infection was found in the Ti6Al4V-Cu group, as indicated by decreased radiological score (1.3 ± 0.4) and low histological score (2.3 ± 0.5). In addition, Ti6Al4V-Cu had favorable biocompatibility both in vitro and in vivo. In summary, Ti6Al4V-Cu is a promising implant material to protect against MRSA-induced IAI.

Corrosion Behavior of As-Cast Ti–10Mo–6Zr–4Sn–3Nb and Ti–6Al–4V in Hank’s Solution: A Comparison Investigation

Newly developed Ti–10Mo–6Zr–4Sn–3Nb has fascinating mechanical properties to be used as a biomedical material. However, there is still a lack of investigation focusing on the corrosion behavior of Ti–10Mo–6Zr–4Sn–3Nb. In this work, the microstructure and corrosion behavior of as-cast Ti–10Mo–6Zr–4Sn–3Nb was investigated by optical microscopy, X-ray diffraction, and electrochemical measurements. Hank’s solution was used as the electrolyte. A classical as-cast Ti–6Al–4V was used as reference. The results showed that Ti–10Mo–6Zr–4Sn–3Nb has a higher corrosion potential and a lower corrosion current density compared with Ti–6Al–4V, indicating better corrosion resistance. However, after applying anodic potentials, Ti–10Mo–6Zr–4Sn–3Nb shows larger passivation current density in both potentiodynamic polarization and potentiostatic polarization tests. This is because more alloying elements contained in Ti–10Mo–6Zr–4Sn–3Nb trigger the production of a larger number of oxygen vacancies, resulting in a higher flux of oxygen vacancy. This finding illustrates that the passive film on Ti–10Mo–6Zr–4Sn–3Nb is less protective compared with that on Ti–6Al–4V when applying an anodic potential in their passivation range.

Biodegradable Zn-Cu alloys show antibacterial activity against MRSA bone infection by inhibiting pathogen adhesion and biofilm formation

Bone and joint-related infections remain the primary and most critical complications of orthopedic surgery. We have innovatively prepared Zn-Cu alloys to achieve outstanding material and antibacterial properties. In this study, we systematically assessed the material properties and antibacterial activity of these Zn-Cu alloys. Our results showed that the Zn-2Cu alloy had the best mechanical properties, biocompatibility, and osteogenic properties. Findings of microbial cultures, CLSM, SEM, and TEM indicated that Zn-2Cu alloy can inhibit both coagulase-positive and coagulase-negative staphylococci, as well as antibiotic-resistant strains (MRSA and MRSE), by preventing the bacteria adhesion and the biofilm formation. Zn-2Cu alloy could broadly affect the expression of MRSA genes associated with adhesion, autolysis, biofilm formation, virulence, and drug resistance. A rat femur intramedullary nail infection-prevention model was established and the Zn-2Cu alloy-treated group showed significant antibacterial activity against MRSA and reduced the inflammatory toxic side-effects and infection-related bone loss. Collectively, our results indicate the potential utility of Zn-Cu alloy implants with 2 wt% Cu in treating orthopedic infections. Statement of significance: Osteomyelitis is a serious complication of orthopedic surgeries. Wide use of antibiotics contributes to the appearance of multi-drug resistant strains like methicillin-resistant staphylococcus aureus (MRSA). Alternatively, anti-osteomyelitis implants with broad-spectrum antibacterial properties can be favorable. Here, the antibacterial performance of biodegradable Zn-Cu alloys was evaluated with four different bacteria strains including antibiotic-resistant strains (MRSA and MRSE). Zn-Cu alloys exert excellent bacterial killing capability in all strains. In a rat femur infection model, the alloy showed significant antibacterial activity against MRSA and reduced inflammatory toxic side-effects as well as infection-related bone loss. The antibacterial property of Zn-2Cu alloy was associated with inhibition of gene expression related to wall synthesis, adhesion, colonization, biofilm formation, autolysis, and secretion of virulence factors in MRSA.

[Three-dimensional printed Ti6Al4V-4Cu alloy promotes osteogenic gene expression through bone immune regulation]

OBJECTIVE

To investigate the effects of three-dimensional (3D) printed Ti6Al4V-4Cu alloy on inflammation and osteogenic gene expression in mouse bone marrow mesenchymal stem cells (BMSCs) and mouse mononuclear macrophage line RAW264.7.

METHODS

Ti6Al4V and Ti6Al4V-4Cu alloys were prepared by selective laser melting, and the extracts of the two materials were prepared according to the biological evaluation standard of medical devices. The effects of two kinds of extracts on the proliferation of mouse BMSCs and mouse RAW264.7 cells were detected by cell counting kit 8 method. After co-cultured with mouse BMSCs for 3 days, the expression of osteogenesis- related genes [collagen type Ⅰ (Col-Ⅰ), alkaline phosphatase (ALP), Runx family transcription factor 2 (Runx-2), osteoprotegerin (OPG), and osteopontin (OPN)] were detected by real-time fluorescence quantitative PCR. After co-cultured with mouse RAW264.7 cells for 1 day, the expressions of inflammation-related genes [interleukin 4 (IL-4) and nitric oxide synthase 2 (iNOS)] were detected by real-time fluorescence quantitative PCR, and the supernatants of the two groups were collected to detect the secretion of vascular endothelial growth factor a (VEGF-a) and bone morphogenetic protein 2 (BMP-2) by ELISA. The osteogenic conditioned medium were prepared with the supernatants of the two groups and co-cultured with BMSCs for 3 days. The expressions of osteogenesis-related genes (Col-Ⅰ, ALP, Runx-2, OPG, and OPN) were detected by real-time fluorescence quantitative PCR.

RESULTS

Compared with Ti6Al4V alloy extract, Ti6Al4V-4Cu alloy extract had no obvious effect on the proliferation of BMSCs and RAW264.7 cells, but it could promote the expression of OPG mRNA in BMSCs, reduce the expression of iNOS mRNA in RAW264.7 cells, and promote the expression of IL-4 mRNA. It could also promote the secretions of VEGF-a and BMP-2 in RAW264.7 cells. Ti6Al4V-4Cu osteogenic conditioned medium could promote the expressions of Col-Ⅰ, ALP, Runx-2, OPG, and OPN mRNAs in BMSCs. The differences were all significant ( P<0.05).

CONCLUSION

3D printed Ti6Al4V-4Cu alloy can promote RAW264.7 cells to secret VEGF-a and BMP-2 by releasing copper ions, thus promoting osteogenesis through bone immune regulation, which lays a theoretical foundation for the application of metal prosthesis.

Multi-material additive manufacturing technologies for Ti-, Mg-, and Fe-based biomaterials for bone substitution

The growing interest in multi-functional metallic biomaterials for bone substitutes challenges the current additive manufacturing (AM, =3D printing) technologies. It is foreseeable that advances in multi-material AM for metallic biomaterials will not only allow for complex geometrical designs, but also improve their multi-functionalities by tuning the types or compositions of the underlying base materials, thereby presenting unprecedented opportunities for advanced orthopedic treatments. AM technologies are yet to be extensively explored for the fabrication of multi-functional metallic biomaterials, especially for bone substitutes. The aim of this review is to present the viable options of the state-of-the-art multi-material AM for Ti-, Mg-, and Fe-based biomaterials to be used as bone substitutes. The review starts with a brief review of bone tissue engineering, the design requirements, and fabrication technologies for metallic biomaterials to highlight the advantages of using AM over conventional fabrication methods. Five AM technologies suitable for metal 3D printing are compared against the requirements for multi-material AM. Of these AM technologies, extrusion-based multi-material AM is shown to have the greatest potential to meet the requirements for the fabrication of multi-functional metallic biomaterials. Finally, recent progress in the fabrication of Ti-, Mg-, and Fe-based biomaterials including the utilization of multi-material AM technologies is reviewed so as to identify the knowledge gaps and propose the directions of further research for the development of multi-material AM technologies that are applicable for the fabrication of multi-functional metallic biomaterials. STATEMENT OF SIGNIFICANCE: Addressing a critical bone defect requires the assistance of multi-functional porous metallic bone substitutes. As one of the most advanced fabrication technology in bone tissue engineering, additive manufacturing is challenged for its viability in multi-material fabrication of metallic biomaterials. This article reviews how the current metal additive manufacturing technologies have been and can be used for multi-material fabrication of Ti-, Mg-, and Fe-based bone substitutes. Progress on the Ti-, Mg-, and Fe-based biomaterials, including the utilization of multi-material additive manufacturing, are discussed to direct future research for advancing the multi-functional additively manufactured metallic bone biomaterials.

Microstructure and Selective Corrosion of Alloy 625 Obtained by Means of Laser Powder Bed Fusion

The effect of microstructure on the susceptibility to selective corrosion of Alloy 625 produced by laser powder bed fusion (LPBF) process was investigated through intergranular corrosion tests according to ASTM G28 standard. The effect of heat treatment on selective corrosion susceptibility was also evaluated. The behavior was compared to commercial hot-worked, heat treated Grade 1 Alloy 625. The morphology of attack after boiling ferric sulfate-sulfuric acid test according to ASTM G28 standard is less penetrating for LPBF 625 alloy compared to hot-worked and heat-treated alloy both in as-built condition and after heat treatment. The different attack morphology can be ascribed to the oversaturation of the alloying elements in the nickel austenitic matrix obtained due to the very high cooling rate. On as-built specimens, a shallow selective attack of the border of the melt pools was observed, which disappeared after the heat treatment. The results confirmed similar intergranular corrosion susceptibility, but different corrosion morphologies were detected. The results are discussed in relation to the unique microstructures of LPBF manufactured alloys.

Investigation on the properties of borate bonding agents: Ti6Al4V-porcelain bonding, chemical durability and preliminary cytotoxicity

The purpose of this study was to investigate the properties of the borate bonding agents (BBAS) including chemical durability, biocompatibility and bonding characteristics of porcelain to Ti6Al4V. The bond strength was performed by the three-point bending test. And the chemical durability and ion release of BBAS were tested by chemical soaking and inductively coupled plasma optical emission spectrometry (ICP-OES), respectively. Moreover, cytotoxicity was evaluated by cell viability assay and cell adhesion using human osteosarcoma cells (MG-63) and cell counter kit-8 (CCK-8) assay. To investigate the influences of composition and microstructure changes on all the properties mentioned above, the ¹¹B and ²⁷Al spectra and infrared spectra of BBAS were measured by solid-state nuclear magnetic resonance (SSNMR) and Fourier transform infrared spectroscopy (FTIR), respectively. Combined with all these properties of BBAS, the optimal addition proportion of Al₂O₃ into BBAS is 20 mol%. The relative contents of [BO3], [BO4], [AlO4], [AlO5] and [AlO6] have great influences on these properties of BBAS. BBAS, possessing excellent chemical durability, good biocompatibility and low ion release and being an effective way to improve the Ti6Al4V-porcelain bond strength, have significant clinical potentials in porcelain fused to metal restorations.

Copper-Modified Ti6Al4 V Suppresses Inflammatory Response and Osteoclastogenesis while Enhancing Extracellular Matrix Formation for Osteoporotic Bone Regeneration

Copper has been reported to promote bone regeneration by increasing osteogenesis and decreasing inflammation and osteoclastogenesis. However, information on the effects of copper on osteoporotic cells involved in bone regeneration is scarce in the literature. In the current study, Ti6Al4 V-6 wt %Cu (Ti6Al4 V-Cu) was fabricated by selective laser melting (SLM) technology, and the effects of copper on the behaviors of osteoporotic and nonosteoporotic macrophages, osteoclasts, and osteoblasts were evaluated by comparison with Ti6Al4 V. Our results showed that Ti6Al4 V-Cu inhibited the activation, viability, and pro-inflammatory cytokine secretion of osteoporotic macrophages and decreased osteoclast formation and down-regulated osteoclast differentiation-related genes and proteins of osteoporotic osteoclasts. Furthermore, the bone extracellular matrix formation of osteoporotic osteoblasts was up-regulated by Ti6Al4 V-Cu. In conclusion, SLM-fabricated Ti6Al4 V-Cu exhibited excellent anti-inflammation and antiosteoclast capability, optimized extracellular matrix formation, and holds great potential for bone regeneration in osteoporotic patients.

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.

Effect of Cu on microstructure, mechanical properties, corrosion resistance and cytotoxicity of CoCrW alloy fabricated by selective laser melting

In the study, CoCrWCu alloys with differing Cu content (2, 3, 4 wt%) were prepared by selective laser melting using mixture powders consisting of CoCrW and Cu, aiming at investigating the effect of Cu on the microstructures, mechanical properties, corrosion behavior and cytotoxicity. The SEM observations indicated that the Cu content up to 3 wt% caused the Si-rich precipitates to segregate along grain boundaries and in the grains, and EBSD analysis suggested that the Cu addition decreased the recrystallization degree and increased the grain diameter and fraction of big grains. The tensile tests found that the increasing Cu content led to a decrease of mechanical properties compared with Cu-free CoCrW alloy. The electrochemical tests revealed that the addition of Cu shifted the corrosion potential toward nobler positive, but increased the corrosion current density. Also, a more protective passive film was formed when 2 wt% Cu content was added, but the higher Cu content up to 3 wt% was detrimental to the corrosion resistance. It was noted that there was no cytotoxicity for Cu-bearing CoCrW alloys to MG-63 cell and the cells could spread well on the surfaces of studied alloys. Meanwhile, the Cu-bearing CoCrW alloy exhibited an excellent antibacterial performance against E.coli when Cu content was up to 3 wt%. It is suggested that the feasible fabrication of Cu-bearing CoCrW alloy by SLM using mixed CoCrW and Cu powders is a promising candidate for use in antibacterial oral repair products. This current study also can aid in the further design of antibacterial Cu-containing CoCrW alloying powders.

Functionalization of Biomedical Ti6Al4V via In Situ Alloying by Cu during Laser Powder Bed Fusion Manufacturing

The modern medical industry successfully utilizes Laser Powder Bed Fusion (LPBF) to manufacture complex custom implants. Ti6Al4V is one of the most commonly used biocompatible alloys. In surgery practice, infection at the bone-implant interface is one of the key reasons for implant failure. Therefore, advanced implants with biocompatibility and antibacterial properties are required. Modification of Ti alloy with Cu, which in small concentrations is a proven non-toxic antibacterial agent, is an attractive way to manufacture implants with embedded antibacterial functionality. The possibility of achieving alloying in situ, during manufacturing, is a unique option of the LPBF technology. It provides unique opportunities to manufacture customized implant shapes and design new alloys. Nevertheless, optimal process parameters need to be established for the in situ alloyed materials to form dense parts with required mechanical properties. This research is dedicated to an investigation of Ti6Al4V (ELI)-1 at % Cu material, manufactured by LPBF from a mixture of Ti6Al4V (ELI) and pure Cu powders. The effect of process parameters on surface roughness, chemical composition and distribution of Cu was investigated. Chemical homogeneity was discussed in relation to differences in the viscosity and density of molten Cu and Ti6Al4V. Microstructure, mechanical properties, and fracture behavior of as-built 3D samples were analyzed and discussed. Pilot antibacterial functionalization testing of Ti6Al4V (ELI) in situ alloyed with 1 at % Cu showed promising results and notable reduction in the growth of pure cultures of Escherichia coli and Staphylococcus aureus.