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Alizadeh S, Shahbaz M, Kavanlouei M, Rahimi SS, Kim SS. Advancing Dental Implant Design: A Comprehensive Study of Machining Parameters, Corrosion Behavior, and Microstructural Evaluation. ACS Biomater Sci Eng 2024; 10:5381-5389. [PMID: 39041183 DOI: 10.1021/acsbiomaterials.4c00696] [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: 07/24/2024]
Abstract
In this research, we investigate the impact of varying machining parameters [depth of cutting (mm) and spindle rotation speed (rpm)] on the microstructure and electrochemical behavior of Ti6Al4V-ELI dental implants. This comprehensive study employs an approach, leveraging potentiodynamic methods and electrochemical impedance spectroscopy, to analyze corrosion behavior in a phosphate-buffered saline solution. To further deepen our understanding of corrosion kinetics, we used an alternating current circuit model, based on a simple Randles equivalent circuit. This model elucidates the corrosion interface interactions of the Ti6Al4-V-ELI alloy implant within the PBS solution. In addition, our research delves into the microstructural implications of different machining parameters, utilizing scanning electron microscopy and X-ray diffraction (XRD) techniques to reveal significant phase changes. The changes in texture were examined qualitatively by comparing the intensities of the peaks of the XRD pattern. A detailed correlation analysis further links the machining parameters with the corrosion properties of dental implants, offering a comprehensive perspective rarely explored in the existing literature. The results obtained for the three samples showed that the corrosion resistance would be higher by increasing the machining depth and the spindle rotation and that the corrosion current would be lower. As a result, a lower corrosion rate was obtained. Finally, experimental results from electrochemical analyses are compared and discussed.
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Affiliation(s)
- Shaghayegh Alizadeh
- Department of Materials Science and Engineering, Faculty of Engineering, Urmia University, Urmia 5756151818, Iran
| | - Mehrdad Shahbaz
- Department of Materials Science and Engineering, Faculty of Engineering, Urmia University, Urmia 5756151818, Iran
| | - Majid Kavanlouei
- Department of Materials Science and Engineering, Faculty of Engineering, Urmia University, Urmia 5756151818, Iran
| | | | - Sang Sub Kim
- Department of Materials Science and Engineering, Inha University, Incheon 22212, Korea
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2
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Maxwell A, Modi P, Sequeira K, Punja M, Lewis S. A Novel In Situ Gelling System of Quercetin/Sulfobutyl-Ether-β-Cyclodextrin Complex-Loaded Chitosan Nanoparticles for the Treatment of Vulvovaginitis. Assay Drug Dev Technol 2024. [PMID: 39029498 DOI: 10.1089/adt.2024.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Affiliation(s)
- Amala Maxwell
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Prachi Modi
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Karishma Sequeira
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Masuma Punja
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Shaila Lewis
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Astasov-Frauenhoffer M, Marot L, Sanchez F, Steiner R, Lohberger B, Bornstein MM, Wagner RS, Kühl S, Mukaddam K. Effects of nanomodified titanium surfaces considering bacterial colonization and viability of osteoblasts and fibroblasts. J Biomed Mater Res A 2024. [PMID: 38925622 DOI: 10.1002/jbm.a.37768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
This study investigates nanostructured titanium surfaces (Ti2 spikes) that promote the viability of osteoblasts and fibroblasts and prevent bacterial colonisation. Helium ion irradiation was adopted to produce nanometric-sized cones on titanium. Human osteoblasts (hFOB) and human gingiva fibroblasts (hGF) were used for analysis. A viability and a cytotoxicity assay were conducted to evaluate the lactate dehydrogenase (LDH) activity and assess cell damage in Ti2 spikes compared to titanium discs with a sandblasted and acid-etched (Ti2 SLA) surface. The antibacterial activity was investigated against Escherichia coli, Streptococcus mutans, Fusobacterium nucleatum, and Porphyromonas gingivalis. In the course of the cultivation, both hGF and hFOB demonstrated significantly reduced viability on the Ti2 spikes surface. hGF cells exhibited a slight but significant increase in LDH release. In contrast, hFOB showed reduced cytotoxicity on this surface. On the Ti2 spikes surface, hGF cells exhibited a significant reduction in gene expression of VCL, Src-1, and ITGα5. However, the integrin subunits ITGα1 and ITGα3 showed upregulation on the Ti2 spikes surface. The Ti2 spikes surface significantly increased the expression of almost all osteogenic markers. The results of conventional culturing demonstrated a statistically significant decrease in the number of viable cells for S. mutans, F. nucleaum, and greater quantities of P. gingivalis on Ti2 spikes surface compared to control. However, no such reduction was detected for E. coli. The long-term success of implants relies on establishing and maintaining hard and soft peri-implant tissues. Ti2 spikes represent a novel and promising approach to enhance osseointegration and optimize biocompatibility.
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Affiliation(s)
- Monika Astasov-Frauenhoffer
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
| | - Laurent Marot
- Department of Physics, University of Basel, Basel, Switzerland
| | - Fabien Sanchez
- Department of Physics, University of Basel, Basel, Switzerland
| | - Roland Steiner
- Department of Physics, University of Basel, Basel, Switzerland
| | - Birgit Lohberger
- Department of Orthopedics and Trauma, Medical University Graz, Graz, Austria
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
| | | | - Sebastian Kühl
- Department of Oral Surgery, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
| | - Khaled Mukaddam
- Department of Oral Surgery, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
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4
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Wu KZ, Le Z, Myint B, Chan B, Liu L, Huang H, Sing SL, Tay A. Bioactive coating provides antimicrobial protection through immunomodulation and phage therapeutics. Mater Today Bio 2024; 26:101022. [PMID: 38525309 PMCID: PMC10959705 DOI: 10.1016/j.mtbio.2024.101022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024] Open
Abstract
Medical implant-associated infections (IAI) is a growing threat to patients undergoing implantation surgery. IAI prevention typically relies on medical implants endowed with bactericidal properties achieved through surface modifications with antibiotics. However, the clinical efficacy of this traditional paradigm remains suboptimal, often necessitating revision surgery and posing potentially lethal consequences for patients. To bolster the existing anti-IAI arsenal, we propose herein a chitosan-based bioactive coating, i.e., ChitoAntibac, which exerts bacteria-inhibitory effects either through immune modulation or phage-directed microbial clearance, without relying on conventional antibiotics. The immuno-stimulating effects and phage-induced bactericidal properties can be tailored by engineering the loading dynamic of macrophage migration inhibitory factor (MIF), which polarizes macrophages towards the proinflammatory subtype (M1) with enhanced bacterial phagocytosis, and Staphylococcal Phage K, resulting in rapid and targeted pathogenic clearance (>99.99%) in less than 8 h. Our innovative antibacterial coating opens a new avenue in the pursuit of effective IAI prevention through immuno-stimulation and phage therapeutics.
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Affiliation(s)
- Kenny Zhuoran Wu
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, 119276, Singapore
| | - Zhicheng Le
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, 119276, Singapore
- Institute for Health Innovation & Technology, National University of Singapore, 117599, Singapore
| | - Ba Myint
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, 119276, Singapore
- Institute for Health Innovation & Technology, National University of Singapore, 117599, Singapore
| | - Brian Chan
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, 119276, Singapore
| | - Ling Liu
- Institute for Health Innovation & Technology, National University of Singapore, 117599, Singapore
| | - Hua Huang
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
- Electrophysiology Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, 117456, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore: Level 5, Centre for Life Sciences, 28 Medical Drive, 117456, Singapore
| | - Swee Leong Sing
- NUS Tissue Engineering Program, National University of Singapore, 117510, Singapore
- Department of Mechanical Engineering, College of Design and Engineering, National University of Singapore, 117575, Singapore
| | - Andy Tay
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, 119276, Singapore
- Institute for Health Innovation & Technology, National University of Singapore, 117599, Singapore
- NUS Tissue Engineering Program, National University of Singapore, 117510, Singapore
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5
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Wang J, Ninan N, Nguyen NH, Nguyen MT, Sahu R, Nguyen TT, Mierczynska-Vasilev A, Vasilev K, Truong VK, Tang Y. Biomimetic Bacterium-like Particles Loaded with Aggregation-Induced Emission Photosensitizers as Plasma Coatings for Implant-Associated Infections. ACS APPLIED MATERIALS & INTERFACES 2024; 16:18449-18458. [PMID: 38578282 DOI: 10.1021/acsami.3c19484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Developing novel antibacterial strategies has become an urgent requisite to overcome the increasing pervasiveness of antimicrobial-resistant bacteria and the advent of biofilms. Aggregation-induced emission-based photosensitizers (AIE PSs) are promising candidates due to their unique photodynamic and photothermal properties. Bioengineering structure-inherent AIE PSs for developing thin film coatings is still an unexplored area in the field of nanoscience. We have adopted a synergistic approach combining plasma technology and AIE PS-based photodynamic therapy to develop coatings that can eradicate bacterial infections. Here, we loaded AIE PSs within biomimetic bacterium-like particles derived from a probiotic strain, Lactobacillus fermentum. These hybrid conjugates are then immobilized on polyoxazoline-coated substrates to develop a bioinspired coating to fight against implant-associated infections. These coatings could selectively kill Gram-positive and Gram-negative bacteria, but not damage mammalian cells. The mechanistic studies revealed that the coatings can generate reactive oxygen species that can rupture the bacterial cell membranes. The mRNA gene expression of proinflammatory cytokines confirmed that they can modulate infection-related immune responses. Thus, this nature-inspired design has opened a new avenue for the fabrication of a next-generation antibacterial coating to reduce infections and associated burdens.
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Affiliation(s)
- Jianzhong Wang
- Institute for NanoScale Science and Technology, Medical Device Research Institute, College of Science and Engineering, Flinders University, South Australia 5042, Australia
- College of Veterinary Medicine, Jilin Provincial Engineering Research Center of Animal Probiotics, Jilin Provincial Key Laboratory of Animal Microecology and Healthy Breeding, Engineering Research Center of Microecological Vaccines (Drugs) for Major Animal Diseases, Ministry of Education, Jilin Agricultural University, Changchun 130118, China
| | - Neethu Ninan
- Biomedical Nanoengineering Laboratory, College of Medicine and Public Health, Flinders University, South Australia 5042, Australia
| | - Ngoc Huu Nguyen
- Biomedical Nanoengineering Laboratory, College of Medicine and Public Health, Flinders University, South Australia 5042, Australia
| | - Manh Tuong Nguyen
- Biomedical Nanoengineering Laboratory, College of Medicine and Public Health, Flinders University, South Australia 5042, Australia
| | - Resmarani Sahu
- Biomedical Nanoengineering Laboratory, College of Medicine and Public Health, Flinders University, South Australia 5042, Australia
| | - Tien Thanh Nguyen
- Biomedical Nanoengineering Laboratory, College of Medicine and Public Health, Flinders University, South Australia 5042, Australia
| | - Agnieszka Mierczynska-Vasilev
- The Australian Wine Research Institute, Waite Precinct, Hartley Grove cnr Paratoo Road, Glen Osmond, South Australia 5064, Australia
| | - Krasimir Vasilev
- Biomedical Nanoengineering Laboratory, College of Medicine and Public Health, Flinders University, South Australia 5042, Australia
| | - Vi Khanh Truong
- Biomedical Nanoengineering Laboratory, College of Medicine and Public Health, Flinders University, South Australia 5042, Australia
| | - Youhong Tang
- Institute for NanoScale Science and Technology, Medical Device Research Institute, College of Science and Engineering, Flinders University, South Australia 5042, Australia
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6
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Wu Y, Liu P, Mehrjou B, Chu PK. Interdisciplinary-Inspired Smart Antibacterial Materials and Their Biomedical Applications. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2305940. [PMID: 37469232 DOI: 10.1002/adma.202305940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
The discovery of antibiotics has saved millions of lives, but the emergence of antibiotic-resistant bacteria has become another problem in modern medicine. To avoid or reduce the overuse of antibiotics in antibacterial treatments, stimuli-responsive materials, pathogen-targeting nanoparticles, immunogenic nano-toxoids, and biomimetic materials are being developed to make sterilization better and smarter than conventional therapies. The common goal of smart antibacterial materials (SAMs) is to increase the antibiotic efficacy or function via an antibacterial mechanism different from that of antibiotics in order to increase the antibacterial and biological properties while reducing the risk of drug resistance. The research and development of SAMs are increasingly interdisciplinary because new designs require the knowledge of different fields and input/collaboration from scientists in different fields. A good understanding of energy conversion in materials, physiological characteristics in cells and bacteria, and bactericidal structures and components in nature are expected to promote the development of SAMs. In this review, the importance of multidisciplinary insights for SAMs is emphasized, and the latest advances in SAMs are categorized and discussed according to the pertinent disciplines including materials science, physiology, and biomimicry.
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Affiliation(s)
- Yuzheng Wu
- Department of Physics, Department of Materials Science and Engineering and Department of Biomedical Engineering, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, 999077, China
| | - Pei Liu
- Department of Physics, Department of Materials Science and Engineering and Department of Biomedical Engineering, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, 999077, China
| | - Babak Mehrjou
- Department of Physics, Department of Materials Science and Engineering and Department of Biomedical Engineering, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, 999077, China
| | - Paul K Chu
- Department of Physics, Department of Materials Science and Engineering and Department of Biomedical Engineering, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, 999077, China
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7
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Wood J, Bright R, Palms D, Barker D, Vasilev K. Damage Behavior with Atomic Force Microscopy on Anti-Bacterial Nanostructure Arrays. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:253. [PMID: 38334525 PMCID: PMC10857006 DOI: 10.3390/nano14030253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
The atomic force microscope is a versatile tool for assessing the topography, friction, and roughness of a broad spectrum of surfaces, encompassing anti-bacterial nanostructure arrays. Measuring and comparing all these values with one instrument allows clear comparisons of many nanomechanical reactions and anomalies. Increasing nano-Newton-level forces through the cantilever tip allows for the testing and measuring of failure points, damage behavior, and functionality under unfavorable conditions. Subjecting a grade 5 titanium alloy to hydrothermally etched nanostructures while applying elevated cantilever tip forces resulted in the observation of irreversible damage through atomic force microscopy. Despite the damage, a rough and non-uniform morphology remained that may still allow it to perform in its intended application as an anti-bacterial implant surface. Utilizing an atomic force microscope enables the evaluation of these surfaces before their biomedical application.
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Affiliation(s)
- Jonathan Wood
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia;
| | - Richard Bright
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Dennis Palms
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Dan Barker
- Corin Australia, Sydney, NSW 2153, Australia;
| | - Krasimir Vasilev
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
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Bright R, Hayles A, Wood J, Palms D, Barker D, Vasilev K. Interplay between Immune and Bacterial Cells on a Biomimetic Nanostructured Surface: A "Race for the Surface" Study. ACS APPLIED BIO MATERIALS 2023; 6:3472-3483. [PMID: 37384836 DOI: 10.1021/acsabm.3c00351] [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: 07/01/2023]
Abstract
Biomaterial-associated infection is an ever-increasing risk with devasting consequences for patients. Considerable research has been undertaken to address this issue by imparting antibacterial properties to the surface of biomedical implants. One approach that generated much interest over recent years was the generation of bioinspired bactericidal nanostructures. In the present report, we have investigated the interplay between macrophages and bacteria on antibacterial nanostructured surfaces to determine the outcome of the so-called "race for the surface". Our results showed that macrophages can indeed outcompete Staphylococcus aureus via multiple mechanisms. The early generation of reactive oxygen species by macrophages, downregulation of bacterial virulence gene expression, and the bactericidal nature of the nanostructured surface itself collectively acted to help the macrophage to win the race. This study highlights the potential of nanostructured surfaces to reduce infection rates and improve the long-term success of biomedical implants. This work can also serve as guidance to others to investigate in vitro host-bacteria interactions on other candidate antibacterial surfaces.
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Affiliation(s)
- Richard Bright
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Andrew Hayles
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Jonathan Wood
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide, SA 5095, Australia
| | - Dennis Palms
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Dan Barker
- Corin Australia, Sydney, NSW 2153, Australia
| | - Krasimir Vasilev
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide, SA 5095, Australia
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Fabrication of Nanostructured Polycaprolactone (PCL) Film Using a Thermal Imprinting Technique and Assessment of Antibacterial Function for Its Application. Polymers (Basel) 2022; 14:polym14245527. [PMID: 36559894 PMCID: PMC9788332 DOI: 10.3390/polym14245527] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
In the use of the medical devices, it is essential to prevent the attachment of bacteria to the device surface or to kill the attached bacteria. To kill bacteria, many researchers have used antibiotics or studied nanostructure-based antibacterial surfaces, which rely on mechanical antibacterial methods. Several polymers are widely used for device fabrication, one of which is polycaprolactone (PCL). PCL is biocompatible, biodegradable, easy to fabricate using 3D printing, relatively inexpensive and its quality is easily controlled; therefore, there are various approaches to its use in bio-applications. In addition, it is an FDA-approved material, so it is often used as an implantable material in the human body. However, PCL has no inherent antibacterial function, so it is necessary to develop antibacterial functions in scaffold or film-based PCL medical devices. In this study, process parameters for nanopillar fabrication were established through a simple thermal imprinting method with PCL. Finally, a PCL film with a flexible and transparent nanopillar structure was produced, and the mechano-bactericidal potential was demonstrated using only one PCL material. PCL with nanopillars showed bactericidal ability against Escherichia coli (E. coli) and Bacillus subtilis (B. subtilis) bacteria cultured on its surface that resulted in membrane damage and death due to contact with nanopillars. Additionally, bacteriostatic results were shown to inhibit bacterial growth and activity of Staphylococcus aureus (S. aureus) on PCL nanostructured columns. The fabricated nanopillar structure has confirmed that mechanically induced antibacterial function and can be applied to implantable medical devices.
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Strategies to Mitigate and Treat Orthopaedic Device-Associated Infections. Antibiotics (Basel) 2022; 11:antibiotics11121822. [PMID: 36551479 PMCID: PMC9774155 DOI: 10.3390/antibiotics11121822] [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: 11/11/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Orthopaedic device implants play a crucial role in restoring functionality to patients suffering from debilitating musculoskeletal diseases or to those who have experienced traumatic injury. However, the surgical implantation of these devices carries a risk of infection, which represents a significant burden for patients and healthcare providers. This review delineates the pathogenesis of orthopaedic implant infections and the challenges that arise due to biofilm formation and the implications for treatment. It focuses on research advancements in the development of next-generation orthopaedic medical devices to mitigate against implant-related infections. Key considerations impacting the development of devices, which must often perform multiple biological and mechanical roles, are delineated. We review technologies designed to exert spatial and temporal control over antimicrobial presentation and the use of antimicrobial surfaces with intrinsic antibacterial activity. A range of measures to control bio-interfacial interactions including approaches that modify implant surface chemistry or topography to reduce the capacity of bacteria to colonise the surface, form biofilms and cause infections at the device interface and surrounding tissues are also reviewed.
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Jones CF, Quarrington RD, Tsangari H, Starczak Y, Mulaibrahimovic A, Burzava ALS, Christou C, Barker AJ, Morel J, Bright R, Barker D, Brown T, Vasilev K, Anderson PH. A Novel Nanostructured Surface on Titanium Implants Increases Osseointegration in a Sheep Model. Clin Orthop Relat Res 2022; 480:2232-2250. [PMID: 36001022 PMCID: PMC10476811 DOI: 10.1097/corr.0000000000002327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/28/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND A nanostructured titanium surface that promotes antimicrobial activity and osseointegration would provide the opportunity to create medical implants that can prevent orthopaedic infection and improve bone integration. Although nanostructured surfaces can exhibit antimicrobial activity, it is not known whether these surfaces are safe and conducive to osseointegration. QUESTIONS/PURPOSES Using a sheep animal model, we sought to determine whether the bony integration of medical-grade, titanium, porous-coated implants with a unique nanostructured surface modification (alkaline heat treatment [AHT]) previously shown to kill bacteria was better than that for a clinically accepted control surface of porous-coated titanium covered with hydroxyapatite (PCHA) after 12 weeks in vivo. The null hypothesis was that there would be no difference between implants with respect to the primary outcomes: interfacial shear strength and percent intersection surface (the percentage of implant surface with bone contact, as defined by a micro-CT protocol), and the secondary outcomes: stiffness, peak load, energy to failure, and micro-CT (bone volume/total volume [BV/TV], trabecular thickness [Tb.Th], and trabecular number [Tb.N]) and histomorphometric (bone-implant contact [BIC]) parameters. METHODS Implants of each material (alkaline heat-treated and hydroxyapatite-coated titanium) were surgically inserted into femoral and tibial metaphyseal cancellous bone (16 per implant type; interference fit) and in tibial cortices at three diaphyseal locations (24 per implant type; line-to-line fit) in eight skeletally mature sheep. At 12 weeks postoperatively, bones were excised to assess osseointegration of AHT and PCHA implants via biomechanical push-through tests, micro-CT, and histomorphometry. Bone composition and remodeling patterns in adult sheep are similar to that of humans, and this model enables comparison of implants with ex vivo outcomes that are not permissible with humans. Comparisons of primary and secondary outcomes were undertaken with linear mixed-effects models that were developed for the cortical and cancellous groups separately and that included a random effect of animals, covariates to adjust for preoperative bodyweight, and implant location (left/right limb, femoral/tibial cancellous, cortical diaphyseal region, and medial/lateral cortex) as appropriate. Significance was set at an alpha of 0.05. RESULTS The estimated marginal mean interfacial shear strength for cancellous bone, adjusted for covariates, was 1.6 MPa greater for AHT implants (9.3 MPa) than for PCHA implants (7.7 MPa) (95% CI 0.5 to 2.8; p = 0.006). Similarly, the estimated marginal mean interfacial shear strength for cortical bone, adjusted for covariates, was 6.6 MPa greater for AHT implants (25.5 MPa) than for PCHA implants (18.9 MPa) (95% CI 5.0 to 8.1; p < 0.001). No difference in the implant-bone percent intersection surface was detected for cancellous sites (cancellous AHT 55.1% and PCHA 58.7%; adjusted difference of estimated marginal mean -3.6% [95% CI -8.1% to 0.9%]; p = 0.11). In cortical bone, the estimated marginal mean percent intersection surface at the medial site, adjusted for covariates, was 11.8% higher for AHT implants (58.1%) than for PCHA (46.2% [95% CI 7.1% to 16.6%]; p < 0.001) and was not different at the lateral site (AHT 75.8% and PCHA 74.9%; adjusted difference of estimated marginal mean 0.9% [95% CI -3.8% to 5.7%]; p = 0.70). CONCLUSION These data suggest there is stronger integration of bone on the AHT surface than on the PCHA surface at 12 weeks postimplantation in this sheep model. CLINICAL RELEVANCE Given that the AHT implants formed a more robust interface with cortical and cancellous bone than the PCHA implants, a clinical noninferiority study using hip stems with identical geometries can now be performed to compare the same surfaces used in this study. The results of this preclinical study provide an ethical baseline to proceed with such a clinical study given the potential of the alkaline heat-treated surface to reduce periprosthetic joint infection and enhance implant osseointegration.
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Affiliation(s)
- Claire F. Jones
- Centre for Orthopaedic and Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- School of Mechanical Engineering, The University of Adelaide, Adelaide, Australia
| | - Ryan D. Quarrington
- Centre for Orthopaedic and Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Helen Tsangari
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Yolandi Starczak
- Centre for Orthopaedic and Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Adnan Mulaibrahimovic
- Centre for Orthopaedic and Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Anouck L. S. Burzava
- STEM, University of South Australia, Adelaide, Australia
- Future Industries Institute, University of South Australia, Adelaide, Australia
| | - Chris Christou
- Preclinical, Imaging and Research Laboratories, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Alex J. Barker
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | | | - Richard Bright
- STEM, University of South Australia, Adelaide, Australia
- Future Industries Institute, University of South Australia, Adelaide, Australia
| | | | | | - Krasimir Vasilev
- STEM, University of South Australia, Adelaide, Australia
- Future Industries Institute, University of South Australia, Adelaide, Australia
| | - Paul H. Anderson
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- Future Industries Institute, University of South Australia, Adelaide, Australia
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12
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Hasan J, Bright R, Hayles A, Palms D, Zilm P, Barker D, Vasilev K. Preventing Peri-implantitis: The Quest for a Next Generation of Titanium Dental Implants. ACS Biomater Sci Eng 2022; 8:4697-4737. [PMID: 36240391 DOI: 10.1021/acsbiomaterials.2c00540] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Titanium and its alloys are frequently the biomaterial of choice for dental implant applications. Although titanium dental implants have been utilized for decades, there are yet unresolved issues pertaining to implant failure. Dental implant failure can arise either through wear and fatigue of the implant itself or peri-implant disease and subsequent host inflammation. In the present report, we provide a comprehensive review of titanium and its alloys in the context of dental implant material, and how surface properties influence the rate of bacterial colonization and peri-implant disease. Details are provided on the various periodontal pathogens implicated in peri-implantitis, their adhesive behavior, and how this relationship is governed by the implant surface properties. Issues of osteointegration and immunomodulation are also discussed in relation to titanium dental implants. Some impediments in the commercial translation for a novel titanium-based dental implant from "bench to bedside" are discussed. Numerous in vitro studies on novel materials, processing techniques, and methodologies performed on dental implants have been highlighted. The present report review that comprehensively compares the in vitro, in vivo, and clinical studies of titanium and its alloys for dental implants.
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Affiliation(s)
- Jafar Hasan
- Academic Unit of STEM, University of South Australia, Mawson Lakes, SA 5095, Australia
| | - Richard Bright
- Academic Unit of STEM, University of South Australia, Mawson Lakes, SA 5095, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Andrew Hayles
- Academic Unit of STEM, University of South Australia, Mawson Lakes, SA 5095, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Dennis Palms
- Academic Unit of STEM, University of South Australia, Mawson Lakes, SA 5095, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Peter Zilm
- Adelaide Dental School, University of Adelaide, Adelaide, 5005, South Australia, Australia
| | - Dan Barker
- ANISOP Holdings, Pty. Ltd., 101 Collins St, Melbourne VIC, 3000 Australia
| | - Krasimir Vasilev
- Academic Unit of STEM, University of South Australia, Mawson Lakes, SA 5095, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
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13
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Bright R, Hayles A, Wood J, Palms D, Brown T, Barker D, Vasilev K. Surfaces Containing Sharp Nanostructures Enhance Antibiotic Efficacy. NANO LETTERS 2022; 22:6724-6731. [PMID: 35900125 DOI: 10.1021/acs.nanolett.2c02182] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The ever-increasing rate of medical device implantations is met by a proportionately high burden of implant-associated infections. To mitigate this threat, much research has been directed toward the development of antibacterial surface modifications by various means. One recent approach involves surfaces containing sharp nanostructures capable of killing bacteria upon contact. Herein, we report that the mechanical interaction between Staphylococcus aureus and such surface nanostructures leads to a sensitization of the pathogen to the glycopeptide antibiotic vancomycin. We demonstrate that this is due to cell wall damage and impeded bacterial defenses against reactive oxygen species. The results of this study promise to be impactful in the clinic, as a combination of nanostructured antibacterial surfaces and antibiotics commonly used in hospitals may improve antimicrobial therapy strategies, helping clinicians to prevent and treat implant-associated infections using reduced antibiotic concentrations instead of relying on invasive revision surgeries with often poor outcomes.
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Affiliation(s)
- Richard Bright
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide 5095, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Andrew Hayles
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide 5095, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Jonathan Wood
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide 5095, South Australia, Australia
| | - Dennis Palms
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide 5095, South Australia, Australia
| | - Toby Brown
- Corin Australia, Pymble 2073, New South Wales, Australia
| | - Dan Barker
- Corin Australia, Pymble 2073, New South Wales, Australia
| | - Krasimir Vasilev
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide 5095, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
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14
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Huang LZY, Elbourne A, Shaw ZL, Cheeseman S, Goff A, Orrell-Trigg R, Chapman J, Murdoch BJ, Crawford RJ, Friedmann D, Bryant SJ, Truong VK, Caruso RA. Dual-action silver functionalized nanostructured titanium against drug resistant bacterial and fungal species. J Colloid Interface Sci 2022; 628:1049-1060. [PMID: 36049281 DOI: 10.1016/j.jcis.2022.08.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/20/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
HYPOTHESIS Titanium and its alloys are commonly used implant materials. Once inserted into the body, the interface of the biomaterials is the most likely site for the development of implant-associated infections. Imparting the titanium substrate with high-aspect-ratio nanostructures, which can be uniformly achieved using hydrothermal etching, enables a mechanical contact-killing (mechanoresponsive) mechanism of bacterial and fungal cells. Interaction between cells and the surface shows cellular inactivation via a physical mechanism meaning that careful engineering of the interface is needed to optimse the technology. This mechanism of action is only effective towards surface adsorbed microbes, thus any cells not directly in contact with the substrate will survive and limit the antimicrobial efficacy of the titanium nanostructures. Therefore, we propose that a dual-action mechanoresponsive and chemical-surface approach must be utilised to improve antimicrobial activity. The addition of antimicrobial silver nanoparticles will provide a secondary, chemical mechanism to escalate the microbial response in tandem with the physical puncture of the cells. EXPERIMENTS Hydrothermal etching is used as a facile method to impart variant nanostrucutres on the titanium substrate to increase the antimicrobial response. Increasing concentrations (0.25 M, 0.50 M, 1.0 M, 2.0 M) of sodium hydroxide etching solution were used to provide differing degrees of nanostructured morphology on the surface after 3 h of heating at 150 °C. This produced titanium nanospikes, nanoblades, and nanowires, respectively, as a function of etchant concentration. These substrates then provided an interface for the deposition of silver nanoparticles via a reduction pathway. Methicillin-resistant Staphylococcous aureus (MRSA) and Candida auris (C. auris) were used as model bacteria and fungi, respectively, to test the effectiveness of the nanostructured titanium with and without silver nanoparticles, and the bio-interactions at the interface. FINDINGS The presence of nanostructure increased the bactericidal response of titanium against MRSA from ∼ 10 % on commercially pure titanium to a maximum of ∼ 60 % and increased the fungicidal response from ∼ 10 % to ∼ 70 % in C. auris. Introducing silver nanoparticles increased the microbiocidal response to ∼ 99 % towards both bacteria and fungi. Importantly, this study highlights that nanostructure alone is not sufficient to develop a highly antimicrobial titanium substrate. A dual-action, physical and chemical antimicrobial approach is better suited to produce highly effective antibacterial and antifungal surface technologies.
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Affiliation(s)
- Louisa Z Y Huang
- School of Science, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia
| | - Aaron Elbourne
- School of Science, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia.
| | - Z L Shaw
- School of Engineering, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia
| | - Samuel Cheeseman
- School of Science, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia
| | - Abigail Goff
- School of Engineering, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia
| | - Rebecca Orrell-Trigg
- School of Science, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia
| | - James Chapman
- School of Science, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia
| | - Billy J Murdoch
- RMIT Microscopy and Microanalysis Facility, RMIT University, Melbourne, Victoria 3000, Australia
| | - Russell J Crawford
- School of Science, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia
| | - Donia Friedmann
- School of Science, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia; School of Chemical Engineering, UNSW Engineering, UNSW, Sydney, New South Wales 2052, Australia
| | - Saffron J Bryant
- School of Science, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia
| | - Vi Khanh Truong
- School of Science, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
| | - Rachel A Caruso
- School of Science, College of STEM, RMIT University, Melbourne, Victoria 3000, Australia.
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Bio-Inspired Nanostructured Ti-6Al-4V Alloy: The Role of Two Alkaline Etchants and the Hydrothermal Processing Duration on Antibacterial Activity. NANOMATERIALS 2022; 12:nano12071140. [PMID: 35407257 PMCID: PMC9000892 DOI: 10.3390/nano12071140] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 12/19/2022]
Abstract
Inspired by observations that the natural topography observed on cicada and dragonfly wings may be lethal to bacteria, researchers have sought to reproduce these nanostructures on biomaterials with the goal of reducing implant-associated infections. Titanium and its alloys are widely employed biomaterials with excellent properties but are susceptible to bacterial colonisation. Hydrothermal etching is a simple, cost-effective procedure which fabricates nanoscale protrusions of various dimensions upon titanium, depending on the etching parameters used. We investigated the role of etching time and the choice of cation (sodium and potassium) in the alkaline heat treatment on the topographical, physical, and bactericidal properties of the resulting modified titanium surfaces. Optimal etching times were 4 h for sodium hydroxide (NaOH) and 5 h for potassium hydroxide (KOH). NaOH etching for 4 h produced dense, but somewhat ordered, surface nanofeatures with 75 nanospikes per µm2. In comparison, KOH etching for 5 h resulted sparser but nonetheless disordered surface morphology with only 8 spikes per µm2. The NaOH surface was more effective at eliminating Gram-negative pathogens, while the KOH surface was more effective against the Gram-positive strains. These findings may guide further research and development of bactericidal titanium surfaces which are optimised for the predominant pathogens associated with the intended application.
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