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Cui C, Zhao Y, Bai Z, Yan J, Qin D, Peng H, Liu Y, Tong J, Sun L, Wu X, Li B. The Effect of Antibacterial-Osteogenic Surface Modification on the Osseointegration of Titanium Implants: A Static and Dynamic Strategy. ACS Biomater Sci Eng 2024; 10:4093-4113. [PMID: 38829538 DOI: 10.1021/acsbiomaterials.3c01756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Titanium (Ti) and its alloys are widely used biomaterials in bone repair. Although these biomaterials possess stable properties and good biocompatibility, the high elastic modulus and low surface activity of Ti implants have often been associated with infection, inflammation, and poor osteogenesis. Therefore, there is an urgent need to modify the surface of Ti implants, where changes in surface morphology or coatings loading can confer specific functions to help them adapt to the osseointegration formation phase and resist bacterial infection. This can further ensure a healthy microenvironment for bone regeneration as well as the promotion of immunomodulation, angiogenesis, and osteogenesis. Therefore, in this review, we evaluated various functional Ti implants after surface modification, both in terms of static modifications and dynamic response strategies, mainly focusing on the synergistic effects of antimicrobial activities and functionalized osteogenic. Finally, the current challenges and future perspectives are summarized to provide innovative and effective solutions for osseointegration and bone defect repair.
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Affiliation(s)
- Chenying Cui
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
| | - Yifan Zhao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
| | - Ziyang Bai
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
| | - Jingyu Yan
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
| | - Danlei Qin
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
| | - Hongyi Peng
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
| | - Yingyu Liu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
| | - Jiahui Tong
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
| | - Lingxiang Sun
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
| | - Xiuping Wu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
| | - Bing Li
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, Shanxi, China
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Kheirmand-Parizi M, Doll-Nikutta K, Gaikwad A, Denis H, Stiesch M. Effectiveness of strontium/silver-based titanium surface coatings in improving antibacterial and osteogenic implant characteristics: a systematic review of in-vitro studies. Front Bioeng Biotechnol 2024; 12:1346426. [PMID: 38486866 PMCID: PMC10937591 DOI: 10.3389/fbioe.2024.1346426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction: Due to the high incidence of implant failures, dual functionalization of titanium surfaces with antibacterial and osteogenic agents, like silver (Ag) and strontium (Sr), has gained significant attention in recent years. However, so far, the combined antibacterial and osteoinductive effectiveness of Ag/Sr-based titanium surface coatings has only been analyzed in individual studies. Methods: This systematic review aims to evaluate the existing scientific literature regarding the PICOS question "Does dual incorporation of strontium/silver enhances the osteogenic and anti-bacterial characteristics of Ti surfaces in vitro?". As a result of a web-based search adhering to the PRISMA Guidelines using three electronic databases (PubMed, Scopus, and Web of Science) until March 31, 2023, a total of 69 publications were identified as potentially relevant and 17 of which were considered appropriate for inclusion into this review. Results and Discussion: In all included publications, the use of Sr/Ag combination showed enhanced osteogenic and antibacterial effects, either alone or in combination with other agents. Moreover, the combination of Sr and Ag shows potential to synergistically enhance these effects. Nevertheless, further studies need to validate these findings under clinically more relevant conditions and evaluate the mechanism of antimicrobial and osteogenic activity of Sr/Ag combination.
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Affiliation(s)
- Marjan Kheirmand-Parizi
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
| | - Katharina Doll-Nikutta
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
| | - Amit Gaikwad
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
| | - Hannah Denis
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
| | - Meike Stiesch
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
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Zhai Y, Zhang H, Liu T, Zou C, Zhou C. Mechanical property of Ti6Al4V cylindrical porous structure for dental implants fabricated by selective laser melting. Comput Methods Biomech Biomed Engin 2024:1-19. [PMID: 38178700 DOI: 10.1080/10255842.2023.2300686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
The commonly used titanium alloy dental implants currently apply solid structures. However, issues such as stress shielding and stress concentration may arise due to the significant difference in elastic modulus between the implant and host. In order to address these problems, this paper proposes five porous structures based on the Gibson-Ashby theoretical model. We utilized selective laser melting technology to shape a porous structure using Ti-6Al-4V material precisely. The mechanical properties of the porous structure were verified through simulation and compression experiments. The optimal porous structure, which best matched the human bone, was a circular ring structure with a pillar diameter of 0.6 mm and a layer height of 2 mm. The stress and strain of the porous implant on the surrounding cortical and cancellous bone under different biting conditions were studied to verify the effectiveness of the optimal circular ring porous structure in alleviating stress shielding in both standard and osteoporotic bone conditions. The results confirm that the circular ring porous structure meets implant requirements and provides a theoretical basis for clinical dental implantation.
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Affiliation(s)
- Yun Zhai
- Department of Mechanical Engineering, Dalian Jiaotong University, Dalian, China
| | - Hao Zhang
- Department of Mechanical Engineering, Dalian Jiaotong University, Dalian, China
| | - Tong Liu
- Department of Mechanical Engineering, Dalian Jiaotong University, Dalian, China
| | - Cong Zou
- Department of Stomatology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Changchun Zhou
- National Engineering Research Centre for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, China
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Wen X, Liu Y, Xi F, Zhang X, Kang Y. Micro-arc oxidation (MAO) and its potential for improving the performance of titanium implants in biomedical applications. Front Bioeng Biotechnol 2023; 11:1282590. [PMID: 38026886 PMCID: PMC10662315 DOI: 10.3389/fbioe.2023.1282590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Titanium (Ti) and its alloys have good biocompatibility, mechanical properties and corrosion resistance, making them attractive for biomedical applications. However, their biological inertness and lack of antimicrobial properties may compromise the success of implants. In this review, the potential of micro-arc oxidation (MAO) technology to create bioactive coatings on Ti implants is discussed. The review covers the following aspects: 1) different factors, such as electrolyte, voltage and current, affect the properties of MAO coatings; 2) MAO coatings affect biocompatibility, including cytocompatibility, hemocompatibility, angiogenic activity, corrosion resistance, osteogenic activity and osseointegration; 3) antibacterial properties can be achieved by adding copper (Cu), silver (Ag), zinc (Zn) and other elements to achieve antimicrobial properties; and 4) MAO can be combined with other physical and chemical techniques to enhance the performance of MAO coatings. It is concluded that MAO coatings offer new opportunities for improving the use of Ti and its alloys in biomedical applications, and some suggestions for future research are provided.
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Affiliation(s)
- Xueying Wen
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Yan Liu
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Fangquan Xi
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Xingwan Zhang
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Yuanyuan Kang
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
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van Hengel IAJ, van Dijk B, Modaresifar K, Hooning van Duyvenbode JFF, Nurmohamed FRHA, Leeflang MA, Fluit AC, Fratila-Apachitei LE, Apachitei I, Weinans H, Zadpoor AA. In Vivo Prevention of Implant-Associated Infections Caused by Antibiotic-Resistant Bacteria through Biofunctionalization of Additively Manufactured Porous Titanium. J Funct Biomater 2023; 14:520. [PMID: 37888185 PMCID: PMC10607138 DOI: 10.3390/jfb14100520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023] Open
Abstract
Additively manufactured (AM) porous titanium implants may have an increased risk of implant-associated infection (IAI) due to their huge internal surfaces. However, the same surface, when biofunctionalized, can be used to prevent IAI. Here, we used a rat implant infection model to evaluate the biocompatibility and infection prevention performance of AM porous titanium against bioluminescent methicillin-resistant Staphylococcus aureus (MRSA). The specimens were biofunctionalized with Ag nanoparticles (NPs) using plasma electrolytic oxidation (PEO). Infection was initiated using either intramedullary injection in vivo or with in vitro inoculation of the implant prior to implantation. Nontreated (NT) implants were compared with PEO-treated implants with Ag NPs (PT-Ag), without Ag NPs (PT) and infection without an implant. After 7 days, the bacterial load and bone morphological changes were evaluated. When infection was initiated through in vivo injection, the presence of the implant did not enhance the infection, indicating that this technique may not assess the prevention but rather the treatment of IAIs. Following in vitro inoculation, the bacterial load on the implant and in the peri-implant bony tissue was reduced by over 90% for the PT-Ag implants compared to the PT and NT implants. All infected groups had enhanced osteomyelitis scores compared to the noninfected controls.
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Affiliation(s)
- Ingmar Aeneas Jan van Hengel
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| | - Bruce van Dijk
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Khashayar Modaresifar
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| | | | | | - Marius Alexander Leeflang
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| | - Adriaan Camille Fluit
- Department of Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Lidy Elena Fratila-Apachitei
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| | - Iulian Apachitei
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| | - Harrie Weinans
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Amir Abbas Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
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Shao H, Zhang T, Gong Y, He Y. Silver-Containing Biomaterials for Biomedical Hard Tissue Implants. Adv Healthc Mater 2023; 12:e2300932. [PMID: 37300754 DOI: 10.1002/adhm.202300932] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/22/2023] [Indexed: 06/12/2023]
Abstract
Bacterial infection caused by biomaterials is a very serious problem in the clinical treatment of implants. The emergence of antibiotic resistance has prompted other antibacterial agents to replace traditional antibiotics. Silver is rapidly developing as an antibacterial candidate material to inhibit bone infections due to its significant advantages such as high antibacterial timeliness, high antibacterial efficiency, and less susceptibility to bacterial resistance. However, silver has strong cytotoxicity, which can cause inflammatory reactions and oxidative stress, thereby destroying tissue regeneration, making the application of silver-containing biomaterials extremely challenging. In this paper, the application of silver in biomaterials is reviewed, focusing on the following three issues: 1) how to ensure the excellent antibacterial properties of silver, and not easy to cause bacterial resistance; 2) how to choose the appropriate method to combine silver with biomaterials; 3) how to make silver-containing biomaterials in hard tissue implants have further research. Following a brief introduction, the discussion focuses on the application of silver-containing biomaterials, with an emphasis on the effects of silver on the physicochemical properties, structural properties, and biological properties of biomaterials. Finally, the review concludes with the authors' perspectives on the challenges and future directions of silver in commercialization and in-depth research.
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Affiliation(s)
- Huifeng Shao
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
- Zhejiang Guanlin Machinery Limited Company, Anji, Hangzhou, 313300, China
| | - Tao Zhang
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Youping Gong
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Yong He
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
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Yang S, Jiang W, Ma X, Wang Z, Sah RL, Wang J, Sun Y. Nanoscale Morphologies on the Surface of 3D-Printed Titanium Implants for Improved Osseointegration: A Systematic Review of the Literature. Int J Nanomedicine 2023; 18:4171-4191. [PMID: 37525692 PMCID: PMC10387278 DOI: 10.2147/ijn.s409033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023] Open
Abstract
Three-dimensional (3D) printing is serving as the most promising approach to fabricate personalized titanium (Ti) implants for the precise treatment of complex bone defects. However, the bio-inert nature of Ti material limits its capability for rapid osseointegration and thus influences the implant lifetime in vivo. Despite the macroscale porosity for promoting osseointegration, 3D-printed Ti implant surface morphologies at the nanoscale have gained considerable attention for their potential to improve specific outcomes. To evaluate the influence of nanoscale surface morphologies on osseointegration outcomes of 3D-printed Ti implants and discuss the available strategies, we systematically searched evidence according to the PRISMA on PubMed, Embase, Web of Science, and Cochrane (until June 2022). The inclusion criteria were in vivo (animal) studies reporting the osseointegration outcomes of nanoscale morphologies on the surface of 3D-printed Ti implants. The risk of bias (RoB) was assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE's) tool. The quality of the studies was evaluated using the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. (PROSPERO: CRD42022334222). Out of 119 retrieved articles, 9 studies met the inclusion criteria. The evidence suggests that irregular nano-texture, nanodots and nanotubes with a diameter of 40-105nm on the surface of porous/solid 3D-printed Ti implants result in better osseointegration and vertical bone ingrowth compared to the untreated/polished ones by significantly promoting cell adhesion, matrix mineralization, and osteogenic differentiation through increasing integrin expression. The RoB was low in 41.1% of items, unclear in 53.3%, and high in 5.6%. The quality of the studies achieved a mean score of 17.67. Our study demonstrates that nanostructures with specific controlled properties on the surface of 3D-printed Ti implants improve their osseointegration. However, given the small number of studies, the variability in experimental designs, and lack of reporting across studies, the results should be interpreted with caution.
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Affiliation(s)
- Shiyan Yang
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Weibo Jiang
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Xiao Ma
- Department of Orthopedics, the China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Zuobin Wang
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun, Jilin, 130000, People's Republic of China
| | - Robert L Sah
- Department of Bioengineering, University of California-San Diego, La Jolla, CA, 92037, USA
- Center for Musculoskeletal Research, Institute of Engineering in Medicine, University of California-San Diego, La Jolla, CA, 92037, USA
| | - Jincheng Wang
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Yang Sun
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
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Garmendia Urdalleta A, Van Poll M, Fahy N, Witte-Bouma J, Van Wamel W, Apachitei I, Zadpoor AA, Fratila-Apachitei LE, Farrell E. The response of human macrophages to 3D printed titanium antibacterial implants does not affect the osteogenic differentiation of hMSCs. Front Bioeng Biotechnol 2023; 11:1176534. [PMID: 37415788 PMCID: PMC10319998 DOI: 10.3389/fbioe.2023.1176534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Macrophage responses following the implantation of orthopaedic implants are essential for successful implant integration in the body, partly through intimate crosstalk with human marrow stromal cells (hMSCs) in the process of new bone formation. Additive manufacturing (AM) and plasma electrolytic oxidation (PEO) in the presence of silver nanoparticles (AgNPs) are promising techniques to achieve multifunctional titanium implants. Their osteoimmunomodulatory properties are, however, not yet fully investigated. Here, we studied the effects of implants with AgNPs on human macrophages and the crosstalk between hMSCs and human macrophages when co-cultured in vitro with biofunctionalised AM Ti6Al4V implants. A concentration of 0.3 g/L AgNPs in the PEO electrolyte was found to be optimal for both macrophage viability and inhibition of bacteria growth. These specimens also caused a decrease of the macrophage tissue repair related factor C-C Motif Chemokine Ligand 18 (CCL18). Nevertheless, co-cultured hMSCs could osteogenically differentiate without any adverse effects caused by the presence of macrophages that were previously exposed to the PEO (±AgNPs) surfaces. Further evaluation of these promising implants in a bony in vivo environment with and without infection is highly recommended to prove their potential for clinical use.
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Affiliation(s)
- Amaia Garmendia Urdalleta
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, TU Delft, Delft, Netherlands
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Mathijs Van Poll
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, TU Delft, Delft, Netherlands
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Niamh Fahy
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Applied Science, Technological University of the Shannon: Midlands Midwest, Limerick, Ireland
| | - Janneke Witte-Bouma
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Willem Van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Iulian Apachitei
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, TU Delft, Delft, Netherlands
| | - Amir A. Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, TU Delft, Delft, Netherlands
| | - Lidy E. Fratila-Apachitei
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, TU Delft, Delft, Netherlands
| | - Eric Farrell
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Wang YR, Yang NY, Sun H, Dong W, Deng JP, Zheng TX, Qi MC. The effect of strontium content on physicochemical and osteogenic property of Sr/Ag-containing TiO 2 microporous coatings. J Biomed Mater Res B Appl Biomater 2023; 111:846-857. [PMID: 36455234 DOI: 10.1002/jbm.b.35195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/17/2022] [Accepted: 11/06/2022] [Indexed: 12/05/2022]
Abstract
Strontium (Sr) is the most common element introduced into TiO2 coatings to strengthen the osteogenic property of titanium implants. However, the optimal Sr content and its effect on osteogenic and physicochemical properties of the coatings need to be clarified. In the current study, TiO2 microporous coatings with different contents of Sr (9.64-21.25 wt %) and silver (Ag) (0.38-0.75 wt %) were prepared via micro-arc oxidation technique. Sr contents did not change physicochemical properties of the coatings, including surface microstructure, micropore size and distribution, phase composition, roughness and hydrophilicity. Meanwhile, higher Sr contents (18.23-21.25 wt %) improved cytocompatibility, proliferation and alkaline phosphatase (ALP) activity of preosteoblasts, even the coatings underwent 30 days' PBS immersion. Furthermore, higher Sr contents facilitated preosteoblast growth and spreading, which are essential for their proliferation and osteogenic differentiation. Therefore, it is promising to incorporate higher Sr content (18.23-21.25 wt %) within TiO2 microporous coatings to improve their osteogenic capability.
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Affiliation(s)
- Yi-Rui Wang
- Department of Oral & Maxillofacial Surgery, College of stomatology, North China University of Science and Technology, Tangshan City, People's Republic of China
| | - Nuo-Ya Yang
- Department of Oral & Maxillofacial Surgery, College of stomatology, North China University of Science and Technology, Tangshan City, People's Republic of China
| | - Hong Sun
- Department of Pathology, college of basic medicine, North China University of Science and Technology, Tangshan, China
| | - Wei Dong
- Department of Oral & Maxillofacial Surgery, College of stomatology, North China University of Science and Technology, Tangshan City, People's Republic of China
| | - Jiu-Peng Deng
- Department of Oral & Maxillofacial Surgery, College of stomatology, North China University of Science and Technology, Tangshan City, People's Republic of China
| | - Tian-Xia Zheng
- Department of Oral & Maxillofacial Surgery, College of stomatology, North China University of Science and Technology, Tangshan City, People's Republic of China
| | - Meng-Chun Qi
- Department of Oral & Maxillofacial Surgery, College of stomatology, North China University of Science and Technology, Tangshan City, People's Republic of China
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10
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Liu X, Huang H, Zhang J, Sun T, Zhang W, Li Z. Recent Advance of Strontium Functionalized in Biomaterials for Bone Regeneration. Bioengineering (Basel) 2023; 10:bioengineering10040414. [PMID: 37106601 PMCID: PMC10136039 DOI: 10.3390/bioengineering10040414] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Bone defect disease causes damage to people’s lives and property, and how to effectively promote bone regeneration is still a big clinical challenge. Most of the current repair methods focus on filling the defects, which has a poor effect on bone regeneration. Therefore, how to effectively promote bone regeneration while repairing the defects at the same time has become a challenge for clinicians and researchers. Strontium (Sr) is a trace element required by the human body, which mainly exists in human bones. Due to its unique dual properties of promoting the proliferation and differentiation of osteoblasts and inhibiting osteoclast activity, it has attracted extensive research on bone defect repair in recent years. With the deep development of research, the mechanisms of Sr in the process of bone regeneration in the human body have been clarified, and the effects of Sr on osteoblasts, osteoclasts, mesenchymal stem cells (MSCs), and the inflammatory microenvironment in the process of bone regeneration have been widely recognized. Based on the development of technology such as bioengineering, it is possible that Sr can be better loaded onto biomaterials. Even though the clinical application of Sr is currently limited and relevant clinical research still needs to be developed, Sr-composited bone tissue engineering biomaterials have achieved satisfactory results in vitro and in vivo studies. The Sr compound together with biomaterials to promote bone regeneration will be a development direction in the future. This review will present a brief overview of the relevant mechanisms of Sr in the process of bone regeneration and the related latest studies of Sr combined with biomaterials. The aim of this paper is to highlight the potential prospects of Sr functionalized in biomaterials.
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Wang H, Zheng TX, Yang NY, Li Y, Sun H, Dong W, Feng LF, Deng JP, Qi MC. Osteogenic and long-term antibacterial properties of Sr/Ag-containing TiO 2 microporous coating in vitro and in vivo. J Mater Chem B 2023; 11:2972-2988. [PMID: 36919628 DOI: 10.1039/d2tb01658c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Bacterial infection and poor osseointegration are two critical issues that need to be solved for long-term use of titanium implants. As such, Sr/Ag-containing TiO2 microporous coatings were prepared on a Ti alloy surface in the current study via a single-step microarc oxidation technique. The coatings showed both good cytocompatibility in vitro and biosafety in vivo. Sr/Ag incorporation brought no significant change in the surface micromorphology and physicochemical properties, but endowed the coating with strong osteogenic activity and long-term antibacterial capability in vitro. Furthermore, the osteogenic and antibacterial capability of the coating was also confirmed in vivo. In a rat osseointegration model, new bone formation, implant-bone contact, removal torque and bone mineralization were all significantly increased in the M-Sr/Ag group when compared with those in group M, although they were slightly lower than those in group M-Sr. In a periimplantitis model, no rats suffered infection in the M-Sr/Ag group after 3 months of osseointegration and 5 weeks of bacterial inoculation period, when compared to 100% and 75% infection rates in M and M-Sr groups, respectively. In addition, active bone remodeling and many mesenchymal cells were observed in the M-Sr group, suggesting good bone regeneration potential in Sr-containing coatings in the case of controlled periimplantitis. Overall, the Sr/Ag-containing TiO2 microporous coating is valuable for preventing periimplantitis and improving implant reosseointegration, and is therefore promising for long-term and high quality use of titanium implants.
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Affiliation(s)
- Huan Wang
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, 21, Bohai Road, District of Caofeidian (063210), Tangshan City, Hebei Province, P. R. China.
| | - Tian-Xia Zheng
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, 21, Bohai Road, District of Caofeidian (063210), Tangshan City, Hebei Province, P. R. China.
| | - Nuo-Ya Yang
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, 21, Bohai Road, District of Caofeidian (063210), Tangshan City, Hebei Province, P. R. China.
| | - Ying Li
- Department of Stomatology, First Hospital of Qinhuangdao, Qinhuangdao City, Hebei Province, China
| | - Hong Sun
- Department of Pathology, College of Basic Medicine, North China University of Science and Technology, Tangshan, Hebei Province, China
| | - Wei Dong
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, 21, Bohai Road, District of Caofeidian (063210), Tangshan City, Hebei Province, P. R. China.
| | - Li-Fang Feng
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, 21, Bohai Road, District of Caofeidian (063210), Tangshan City, Hebei Province, P. R. China.
| | - Jiu-Peng Deng
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, 21, Bohai Road, District of Caofeidian (063210), Tangshan City, Hebei Province, P. R. China.
| | - Meng-Chun Qi
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, 21, Bohai Road, District of Caofeidian (063210), Tangshan City, Hebei Province, P. R. China.
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12
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Enhanced Bactericidal Effect of Calcinated Mg-Fe Layered Double Hydroxide Films Driven by the Fenton Reaction. Int J Mol Sci 2022; 24:ijms24010272. [PMID: 36613712 PMCID: PMC9820372 DOI: 10.3390/ijms24010272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Osteogenic and antibacterial abilities are the permanent pursuit of titanium (Ti)-based orthopedic implants. However, it is difficult to strike the right balance between these two properties. It has been proved that an appropriate alkaline microenvironment formed by Ti modified by magnesium-aluminum layered double hydroxides (Mg-Al LDHs) could achieve the selective killing of bacteria and promote osteogenesis. However, the existence of Al induces biosafety concerns. In this study, iron (Fe), an essential trace element in the human body, was used to substitute Al, and a calcinated Mg-Fe LDH film was constructed on Ti. The results showed that a proper local alkaline environment created by the constructed film could enhance the antibacterial and osteogenic properties of the material. In addition, the introduction of Fe promoted the Fenton reaction and could produce reactive oxygen species in the infection environment, which might further strengthen the in vivo bactericidal effect.
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13
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Putra NE, Leeflang MA, Ducret V, Patrulea V, Fratila-Apachitei LE, Perron K, Ye H, Zhou J, Apachitei I, Zadpoor AA. Preventing Antibiotic-Resistant Infections: Additively Manufactured Porous Ti6Al4V Biofunctionalized with Ag and Fe Nanoparticles. Int J Mol Sci 2022; 23:13239. [PMID: 36362029 PMCID: PMC9654018 DOI: 10.3390/ijms232113239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 08/20/2024] Open
Abstract
Implant-associated infections are highly challenging to treat, particularly with the emergence of multidrug-resistant microbials. Effective preventive action is desired to be at the implant site. Surface biofunctionalization of implants through Ag-doping has demonstrated potent antibacterial results. However, it may adversely affect bone regeneration at high doses. Benefiting from the potential synergistic effects, combining Ag with other antibacterial agents can substantially decrease the required Ag concentration. To date, no study has been performed on immobilizing both Ag and Fe nanoparticles (NPs) on the surface of additively manufactured porous titanium. We additively manufactured porous titanium and biofunctionalized its surface with plasma electrolytic oxidation using a Ca/P-based electrolyte containing Fe NPs, Ag NPs, and the combinations. The specimen's surface morphology featured porous TiO2 bearing Ag and Fe NPs. During immersion, Ag and Fe ions were released for up to 28 days. Antibacterial assays against methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa showed that the specimens containing Ag NPs and Ag/Fe NPs exhibit bactericidal activity. The Ag and Fe NPs worked synergistically, even when Ag was reduced by up to three times. The biofunctionalized scaffold reduced Ag and Fe NPs, improving preosteoblasts proliferation and Ca-sensing receptor activation. In conclusion, surface biofunctionalization of porous titanium with Ag and Fe NPs is a promising strategy to prevent implant-associated infections and allow bone regeneration and, therefore, should be developed for clinical application.
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Affiliation(s)
- Niko E. Putra
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Marius A. Leeflang
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Verena Ducret
- Microbiology Unit, Department of Botany and Plant Biology, University of Geneva, 30 Quai Ernest-Ansermet, 1211 Geneva, Switzerland
| | - Viorica Patrulea
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK
| | - Lidy E. Fratila-Apachitei
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Karl Perron
- Microbiology Unit, Department of Botany and Plant Biology, University of Geneva, 30 Quai Ernest-Ansermet, 1211 Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1 Rue Michel Servet, 1211 Geneva, Switzerland
- Section of Pharmaceutical Sciences, University of Geneva, 1 Rue Michel Servet, 1211 Geneva, Switzerland
| | - Hua Ye
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK
| | - Jie Zhou
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Iulian Apachitei
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Amir A. Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
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14
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Antibacterial and Cytocompatible: Combining Silver Nitrate with Strontium Acetate Increases the Therapeutic Window. Int J Mol Sci 2022; 23:ijms23158058. [PMID: 35897634 PMCID: PMC9331456 DOI: 10.3390/ijms23158058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023] Open
Abstract
Microbial infection and insufficient tissue formation are considered to be the two main causes of dental implant failure. Novel studies have focused on designing dual-functional strategies to promote antibacterial properties and improve tissue cell response simultaneously. In this study, we investigated the antibacterial properties and cytocompatibility of silver nitrate (AgNO3) and strontium acetate (SrAc) in a mono-culture setup for dental application. Additionally, we defined the therapeutic window between the minimum inhibitory concentration against pathogenic bacteria and maximum cytocompatible dose in the case of combined applications in a co-culture setup. Antibacterial properties were screened using Aggregatibacter actinomycetemcomitans and cell response experiments were performed with osteoblastic cells (MC3T3) and fibroblastic cells (NIH3T3). The osteoinductive behavior was investigated separately on MC3T3 cells using alizarin red staining. A therapeutic window for AgNO3 as well as SrAc applications could be defined in the case of MC3T3 cells while the cytocompatibility of NIH3T3 cells was compromised for all concentrations with an antibacterial effect. However, the combined application of AgNO3/SrAc caused an enhanced antibacterial effect and opened a therapeutic window for both cell lines. Enhanced mineralization rates could be observed in cultures containing SrAc. In conclusion, we were able to demonstrate that adding SrAc to AgNO3 not only intensifies antibacterial properties but also exhibits bone inductive characteristics, thereby offering a promising strategy to combat peri-implantitis and at the same time improve osseointegration in implant therapy.
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15
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Abstract
Ti-6Al-4V (Ti64) alloy is one of the most widely used orthopedic implant materials due to its mechanical properties, corrosion resistance, and biocompatibility nature. Porous Ti64 structures are gaining more research interest as bone implants as they can help in reducing the stress-shielding effect when compared to their solid counterpart. The literature shows that porous Ti64 implants fabricated using different additive manufacturing (AM) process routes, such as laser powder bed fusion (L-PBF) and electron beam melting (EBM) can be tailored to mimic the mechanical properties of natural bone. This review paper categorizes porous implant designs into non-gradient (uniform) and gradient (non-uniform) porous structures. Gradient porous design appears to be more promising for orthopedic applications due to its closeness towards natural bone morphology and improved mechanical properties. In addition, this paper outlines the details on bone structure and its properties, mechanical properties, fatigue behavior, multifunctional porous implant designs, current challenges, and literature gaps in the research studies on porous Ti64 bone implants.
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16
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Borciani G, Ciapetti G, Vitale-Brovarone C, Baldini N. Strontium Functionalization of Biomaterials for Bone Tissue Engineering Purposes: A Biological Point of View. MATERIALS 2022; 15:ma15051724. [PMID: 35268956 PMCID: PMC8911212 DOI: 10.3390/ma15051724] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 02/04/2023]
Abstract
Strontium (Sr) is a trace element taken with nutrition and found in bone in close connection to native hydroxyapatite. Sr is involved in a dual mechanism of coupling the stimulation of bone formation with the inhibition of bone resorption, as reported in the literature. Interest in studying Sr has increased in the last decades due to the development of strontium ranelate (SrRan), an orally active agent acting as an anti-osteoporosis drug. However, the use of SrRan was subjected to some limitations starting from 2014 due to its negative side effects on the cardiac safety of patients. In this scenario, an interesting perspective for the administration of Sr is the introduction of Sr ions in biomaterials for bone tissue engineering (BTE) applications. This strategy has attracted attention thanks to its positive effects on bone formation, alongside the reduction of osteoclast activity, proven by in vitro and in vivo studies. The purpose of this review is to go through the classes of biomaterials most commonly used in BTE and functionalized with Sr, i.e., calcium phosphate ceramics, bioactive glasses, metal-based materials, and polymers. The works discussed in this review were selected as representative for each type of the above-mentioned categories, and the biological evaluation in vitro and/or in vivo was the main criterion for selection. The encouraging results collected from the in vitro and in vivo biological evaluations are outlined to highlight the potential applications of materials’ functionalization with Sr as an osteopromoting dopant in BTE.
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Affiliation(s)
- Giorgia Borciani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
- Correspondence: ; Tel.: +39-051-6366748
| | - Gabriela Ciapetti
- Biomedical Science and Technologies Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
- Laboratory for Nanobiotechnology, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Chiara Vitale-Brovarone
- Department of Applied Science and Technology, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy;
| | - Nicola Baldini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
- Biomedical Science and Technologies Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
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17
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Porous Titanium by Additive Manufacturing: A Focus on Surfaces for Bone Integration. METALS 2021. [DOI: 10.3390/met11091343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Additive manufacturing (AM) is gaining increasing interest for realization of customized porous titanium constructs for biomedical applications and, in particular, for bone substitution. As first, the present review gives a short introduction on the techniques used for additive manufacturing of Ti/Ti-Alloys (Direct Energy Deposition—DED, Selective Laser Melting—SLM and Electron Beam Melting—EBM) and on the main bulk properties of additively manufactured titanium porous structures. Then, it discusses the main advancements in surface modifications of additively manufactured titanium constructs for bone contact applications. Even if specific surface modifications of constructs from AM are currently not widely explored, it is a critical open issue for application in biomedical implants. Some thermal, chemical, electrochemical, and hydrothermal treatments as well as different coatings are here described. The main aim of these treatments is the development of surface micro/nano textures, specific ion release, and addition of bioactivity to induce bone bonding and antibacterial activity. Physicochemical characterizations, in vitro bioactivity tests, protein absorption, in vitro (cellular/bacterial) and in vivo tests reported in the literature for bare and surface modified AM Ti-based constructs are here reviewed. Future perspectives for development of innovative additively manufactured titanium implants are also discussed.
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18
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Mina-Aponzá S, Castro-Narváez SP, Caicedo-Bejarano LD, Bermeo-Acosta F. Study of Titanium-Silver Monolayer and Multilayer Films for Protective Applications in Biomedical Devices. Molecules 2021; 26:4813. [PMID: 34443400 PMCID: PMC8399690 DOI: 10.3390/molecules26164813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
The search for coatings that extend the useful life of biomedical devices has been of great interest, and titanium has been of great relevance due to its innocuousness and low reactivity. This study contributes to the investigation of Ti/Ag films in different configurations (monolayer and multilayer) deposited by magnetron sputtering. The sessile droplet technique was applied to study wettability; greater film penetrability was obtained when Ag is the external layer, conferring high efficiency in cell adhesion. The morphological properties were characterized by SEM, which showed porous nuclei on the surface in the Ag coating and crystals embedded in the Ti film. The structural properties were studied by XRD, revealing the presence of TiO2 in the anatase crystalline phase in a proportion of 49.9% and the formation of a silver cubic network centered on the faces. Tafel polarization curves demonstrated improvements in the corrosion current densities of Ag/Ti/Ag/Ti/Ag/Ti/Ag/Ti and Ti/Ag compared to the Ag coating, with values of 0.1749, 0.4802, and 2.044 nA.m-2, respectively. Antimicrobial activity was evaluated against the bacteria Pseudomonas aeruginosa and Bacillus subtilis and the yeasts Candida krusei and Candida albicans, revealing that the Ti/Ag and Ag/Ti/Ag/Ti/Ag/Ti/Ag/Ti coatings exhibit promise in biomedical material applications.
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Affiliation(s)
- Sebastián Mina-Aponzá
- Faculty of Basic Sciences, Campus Pampalinda, Universidad Santiago de Cali, Cali 760035, Colombia; (S.M.-A.); (L.D.C.-B.); (F.B.-A.)
- Electrochemistry and Environment Research Group (GIEMA), Universidad Santiago de Cali, Cali 760035, Colombia
| | - Sandra Patricia Castro-Narváez
- Faculty of Basic Sciences, Campus Pampalinda, Universidad Santiago de Cali, Cali 760035, Colombia; (S.M.-A.); (L.D.C.-B.); (F.B.-A.)
- Electrochemistry and Environment Research Group (GIEMA), Universidad Santiago de Cali, Cali 760035, Colombia
| | - Luz Dary Caicedo-Bejarano
- Faculty of Basic Sciences, Campus Pampalinda, Universidad Santiago de Cali, Cali 760035, Colombia; (S.M.-A.); (L.D.C.-B.); (F.B.-A.)
- Mycology Research Group (GIM), Universidad Santiago de Cali, Cali 760035, Colombia
| | - Franklin Bermeo-Acosta
- Faculty of Basic Sciences, Campus Pampalinda, Universidad Santiago de Cali, Cali 760035, Colombia; (S.M.-A.); (L.D.C.-B.); (F.B.-A.)
- Physics Statistics and Mathematics Research Group (GIFEM), Universidad Santiago de Cali, Cali 760035, Colombia
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19
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Šalandová M, Hengel IAJ, Apachitei I, Zadpoor AA, Eerden BCJ, Fratila‐Apachitei LE. Inorganic Agents for Enhanced Angiogenesis of Orthopedic Biomaterials. Adv Healthc Mater 2021; 10:e2002254. [PMID: 34036754 DOI: 10.1002/adhm.202002254] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/30/2021] [Indexed: 01/02/2023]
Abstract
Aseptic loosening of a permanent prosthesis remains one of the most common reasons for bone implant failure. To improve the fixation between implant and bone tissue as well as enhance blood vessel formation, bioactive agents are incorporated into the surface of the biomaterial. This study reviews and compares five bioactive elements (copper, magnesium, silicon, strontium, and zinc) with respect to their effect on the angiogenic behavior of endothelial cells (ECs) when incorporated on the surface of biomaterials. Moreover, it provides an overview of the state-of-the-art methodologies used for the in vitro assessment of the angiogenic properties of these elements. Two databases are searched using keywords containing ECs and copper, magnesium, silicon, strontium, and zinc. After applying the defined inclusion and exclusion criteria, 59 articles are retained for the final assessment. An overview of the angiogenic properties of five bioactive elements and the methods used for assessment of their in vitro angiogenic potential is presented. The findings show that silicon and strontium can effectively enhance osseointegration through the simultaneous promotion of both angiogenesis and osteogenesis. Therefore, their integration onto the surface of biomaterials can ultimately decrease the incidence of implant failure due to aseptic loosening.
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Affiliation(s)
- Monika Šalandová
- Additive Manufacturing Laboratory Department of Biomechanical Engineering Faculty of Mechanical, Maritime, and Materials Engineering Delft University of Technology Mekelweg 2 Delft 2628 CD The Netherlands
| | - Ingmar A. J. Hengel
- Additive Manufacturing Laboratory Department of Biomechanical Engineering Faculty of Mechanical, Maritime, and Materials Engineering Delft University of Technology Mekelweg 2 Delft 2628 CD The Netherlands
| | - Iulian Apachitei
- Additive Manufacturing Laboratory Department of Biomechanical Engineering Faculty of Mechanical, Maritime, and Materials Engineering Delft University of Technology Mekelweg 2 Delft 2628 CD The Netherlands
| | - Amir A. Zadpoor
- Additive Manufacturing Laboratory Department of Biomechanical Engineering Faculty of Mechanical, Maritime, and Materials Engineering Delft University of Technology Mekelweg 2 Delft 2628 CD The Netherlands
| | - Bram C. J. Eerden
- Department of Internal Medicine Erasmus Medical Center Doctor Molewaterplein 40 Rotterdam 3015 GD The Netherlands
| | - Lidy E. Fratila‐Apachitei
- Additive Manufacturing Laboratory Department of Biomechanical Engineering Faculty of Mechanical, Maritime, and Materials Engineering Delft University of Technology Mekelweg 2 Delft 2628 CD The Netherlands
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20
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Abstract
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.
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21
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Losic D. Advancing of titanium medical implants by surface engineering: recent progress and challenges. Expert Opin Drug Deliv 2021; 18:1355-1378. [PMID: 33985402 DOI: 10.1080/17425247.2021.1928071] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction:Titanium (Ti) and their alloys are used as main implant materials in orthopedics and dentistry for decades having superior mechanical properties, chemical stability and biocompatibility. Their rejections due lack of biointegration and bacterial infection are concerning with considerable healthcare costs and impacts on patients. To address these limitations, conventional Ti implants need improvements where the use of surface nanoengineering approaches and the development of a new generation of implants are recognized as promising strategies.Areas covered:This review presents an overview of recent progress on the application of surface engineering methods to advance Ti implants enable to address their key limitations. Several promising surface engineering strategies are presented and critically discussed to generate advanced surface properties and nano-topographies (tubular, porous, pillars) able not only to improve their biointegration, antibacterial performances, but also to provide multiple functions such as drug delivery, therapy, sensing, communication and health monitoring underpinning the development of new generation and smart medical implants.Expert opinion:Recent advances in cell biology, materials science, nanotechnology and additive manufacturing has progressively influencing improvements of conventional Ti implants toward the development of the next generation of implants with improved performances and multifunctionality. Current research and development are in early stage, but progressing with promising results and examples of moving into in-vivo studies an translation into real applications.
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Affiliation(s)
- Dusan Losic
- School of Chemical Engineering and Advanced Materials, The University of Adelaide, Engineering North Building, Adelaide, SA, Australia.,ARC Research Hub for Graphene Enabled Industry Transformation, The University of Adelaide, Engineering North Building, Adelaide, SA, Australia
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22
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van Hengel IAJ, Tierolf MWAM, Fratila-Apachitei LE, Apachitei I, Zadpoor AA. Antibacterial Titanium Implants Biofunctionalized by Plasma Electrolytic Oxidation with Silver, Zinc, and Copper: A Systematic Review. Int J Mol Sci 2021; 22:3800. [PMID: 33917615 PMCID: PMC8038786 DOI: 10.3390/ijms22073800] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Patients receiving orthopedic implants are at risk of implant-associated infections (IAI). A growing number of antibiotic-resistant bacteria threaten to hamper the treatment of IAI. The focus has, therefore, shifted towards the development of implants with intrinsic antibacterial activity to prevent the occurrence of infection. The use of Ag, Cu, and Zn has gained momentum as these elements display strong antibacterial behavior and target a wide spectrum of bacteria. In order to incorporate these elements into the surface of titanium-based bone implants, plasma electrolytic oxidation (PEO) has been widely investigated as a single-step process that can biofunctionalize these (highly porous) implant surfaces. Here, we present a systematic review of the studies published between 2009 until 2020 on the biomaterial properties, antibacterial behavior, and biocompatibility of titanium implants biofunctionalized by PEO using Ag, Cu, and Zn. We observed that 100% of surfaces bearing Ag (Ag-surfaces), 93% of surfaces bearing Cu (Cu-surfaces), 73% of surfaces bearing Zn (Zn-surfaces), and 100% of surfaces combining Ag, Cu, and Zn resulted in a significant (i.e., >50%) reduction of bacterial load, while 13% of Ag-surfaces, 10% of Cu-surfaces, and none of Zn or combined Ag, Cu, and Zn surfaces reported cytotoxicity against osteoblasts, stem cells, and immune cells. A majority of the studies investigated the antibacterial activity against S. aureus. Important areas for future research include the biofunctionalization of additively manufactured porous implants and surfaces combining Ag, Cu, and Zn. Furthermore, the antibacterial activity of such implants should be determined in assays focused on prevention, rather than the treatment of IAIs. These implants should be tested using appropriate in vivo bone infection models capable of assessing whether titanium implants biofunctionalized by PEO with Ag, Cu, and Zn can contribute to protect patients against IAI.
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Affiliation(s)
- Ingmar A. J. van Hengel
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands; (M.W.A.M.T.); (L.E.F.-A.); (I.A.); (A.A.Z.)
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