In vitro and in vivo performance of a novel surface treatment to enhance osseointegration of endosseous implants

Dental implants in large animal models with experimental systemic diseases: A systematic review

This systematic review aims to identify and discuss the most used methodologies in pre-clinical studies for the evaluation of the implementation of dental implants in systemically compromised pigs and sheep. This study provides support and guidance for future research, as well as for the prevention of unnecessary animal wastage and sacrifice. Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) was used as a guideline; electronic searches were performed in PubMed, Scopus, Scielo, Web of Science, Embase, Science Direct, Brazilian Bibliography of Dentistry, Latin American and Caribbean Literature in Health Sciences, Directory of Open Access Journals, Database of Abstracts of Reviews of Effects, and gray literature until January 2022 (PROSPERO/CRD42021270119). Sixty-eight articles were chosen from the 2439 results. Most studies were conducted in pigs, mainly the Göttinger and Domesticus breeds. Healthy animals with implants installed in the jaws were predominant among the pig studies. Of the studies evaluating the effect of systemic diseases on osseointegration, 42% were performed in osteoporotic sheep, 32% in diabetic sheep, and 26% in diabetic pigs. Osteoporosis was primarily induced by bilateral ovariectomy and mainly assessed by X-ray densitometry. Diabetes was induced predominantly by intravenous streptozotocin and was confirmed by blood glucose analysis. Histological and histomorphometric analyses were the most frequently employed in the evaluation of osseointegration. The animal models presented unique methodologies for each species in the studies that evaluated dental implants in the context of systemic diseases. Understanding the most commonly used techniques will help methodological choices and the performance of future studies in implantology.

Enhanced osseointegration of drug eluting nanotubular dental implants: An in vitro and in vivo study

Faster and predictable osseointegration is crucial for the success of dental implants, especially in patients with compromised local or systemic conditions. Despite various surface modifications on the commercially available Titanium (Ti) dental implants, the bioactivity of Ti is still low. Thus, to achieve both biological and therapeutic activity on titanium surfaces, surface modification techniques such as titanium nanotubes have been studied as nanotube surfaces can hold therapeutic drugs and molecules. The main aim of the present research work is to study the early osseointegration around the novel Simvastatin drug eluting nanotubular dental implant. In the present research, the titanium nanotubes were fabricated on the screw-shaped dental implant surface and the Simvastatin drug was loaded into the nanotubes using the ultrasonication dip method. In vitro and In vivo studies were carried out on the modified dental implants. In vitro cell culture study reported enhanced osteogenic activity on the drug-loaded nanotube surface implants. The invivo animal studies were evaluated by micro-CT, histopathology, and reverse torque removal analysis methods. The test results showed faster osseointegration with the strong interface on the Simvastatin drug-loaded implant surface at 4 weeks of healing as compared to the control implants.

Dental implant surfaces treated with phosphoric acid can modulate cytokine production by blood MN cells

The study characterizes dental implant surfaces treated with phosphoric acid to assess the effects of acid treatment on blood cells and correlate them with cytokine levels. The implant surfaces examined were divided into untreated metal surface (US; n = 50), metal surface treated with phosphoric acid (ATS; n = 50) and cement surface (CS; n = 50) groups. The samples were characterized by scanning electron microscopy (SEM) and rheometry. The implants were incubated with human blood mononuclear cells for 24 h, with surface rinsing in the ATS treatment. Cell viability was determined by colorimetric methods and cytokines in the culture supernatant were quantified using flow cytometry. In the ATS group, the surface porosity and contact surface were increased and plaques were observed on the surface. The blood flow and viscosity curves were similar among the treatments, and the high cell viability rates indicate the biocompatibility of the materials used. An increase in the levels of IL-2, IL-4, IL-6, IL-10 and TNF-α was observed in the ATS and CS groups. There were positive correlations between IL-10 and IL-2 levels and between IL-10 and IL-4 levels in the culture supernatant of the ATS group. The results suggest that implant surface treatment with phosphoric acid activates the production of inflammatory cytokines. The increased cytokine levels can modulate the immune response, thereby improving biofunctional processes and promoting the success of dental implants.

Corrosion of Titanium: Part 1: Aggressive Environments and Main Forms of Degradation

Titanium has outstanding corrosion resistance due to the external natural oxide protective layer formed when it is exposed to an aerated environment. Despite this, titanium may suffer different forms of corrosion in severe environments: uniform corrosion, pitting and crevice corrosion, hydrogen embrittlement, stress-corrosion cracking, fretting corrosion and erosion. In this first review, forms of corrosion affecting titanium are analyzed based on a wide literature review. For each form of corrosion, the mechanism and most severe environment are reported according to the current understanding.

In the second part, this review will address the possible surface treatments that can increase corrosion resistance on commercially pure titanium: Electrochemical anodizing, thermal oxidation, chemical oxidation and bulk treatments such as alloying will be considered, highlighting the advantages of each technique.

Osteogenic Differentiation of Human Mesenchymal Stromal Cells on Surface-Modified Titanium Alloys for Orthopedic and Dental Implants

Purpose

Surface properties of titanium alloys, used for orthopedic and dental applications, are known to affect implant interactions with host tissues. Osteointegration, bone growth and remodeling in the area surrounding the implants can be implemented by specific biomimetic treatments; these allow the preparation of micro/nanostructured titanium surfaces with a thickened oxide layer, doped with calcium and phosphorus ions. We have challenged these experimental titanium alloys with primary human bone marrow stromal cells to compare the osteogenic differentiation outcomes of the cells once they are seeded onto the modified surfaces, thus simulating a prosthetic device-biological interface of clinical relevance.

Methods

A specific anodic spark discharge was the biomimetic treatment of choice, providing experimental titanium disks treated with different alkali etching approaches. The disks, checked by electron microscopy and spectroscopy, were subsequently used as substrates for the proliferation and osteogenic differentiation of human cells. Expression of markers of the osteogenic lineage was assessed by means of qualitative and quantitative PCR, by cytochemistry, immunohistochemistry Western blot and matrix metalloprotease activity analyses.

Results

Metal surfaces were initially less permissive for cell growth. Untreated control substrates were less efficient in sustaining mineralized matrix deposition upon osteogenic induction of the cells. Interestingly, bone sialo protein and matrix metalloprotease 2 levels were enhanced on experimental metals compared to control surfaces, particularly for titanium oxide coatings etched with KOH.

Discussion

As a whole, the KOH-modification of titanium surfaces seems to allow the best osteogenic differentiation of human mesenchymal stromal cells, representing a possible plus for future clinical prosthetic applications.

Wool-derived keratin hydrogel enhances implant osseointegration in cancellous bone

AIM

This study investigated whether a keratin hydrogel derived from wool enhances ossointegration of dental implants, using a cancellous bone model in sheep.

METHOD

Ten female sheep received one dental implant per hind leg in the distal femoral condyles. Test implants were coated with 1 mL of keratin hydrogel containing sulphonated keratin and hydroxyapatite; control implants remained uncoated; implants were not functionally loaded axially. Biomechanical stability was tested with resonance frequency analysis (RFA) at placement and euthanasia. Animals were sacrificed after 4 weeks and resin-embedded histomorphometry performed.

FINDINGS

Bone appeared denser and more mature around the keratin-treated test implants. Average % bone-implant contact was significantly increased for the test (58.1 ± 4.6 [SD]%) compared to control implants (34.4 ± 7.5%) (p = 0.01). RFA values were lower for control (76.5 ± 4.2 ISQ) than test implants (80.4 ± 1.4) after 4 weeks (p = 0.04).

CONCLUSION

the increase in osseointegration found in this model suggests that keratin hydrogel has the potential to enhance the successful osseointegration of dental implants placed into poor quality bone. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2447-2454, 2018.

Osteogenic response and osteoprotective effects in vivo of a nanostructured titanium surface with antibacterial properties

In implantology, as an alternative approach to the use of antibiotics, direct surface modifications of the implant addressed to inhibit bacterial adhesion and to limit bacterial proliferation are a promising tactic. The present study evaluates in an in vivo normal model the osteogenic response and the osteointegration of an anodic spark deposition nanostructured titanium surface doped with gallium (ASD + Ga) in comparison with two other surface treatments of titanium: an anodic spark deposition treatment without gallium (ASD) and an acid etching treatment (CTR). Moreover the study assesses the osteoprotective potential and the antibacterial effect of the previously mentioned surface treatments in an experimentally-induced peri-implantitis model. The obtained data points out a more rapid primary fixation in ASD and ASD + Ga implants, compared with CTR surface. Regarding the antibacterial properties, the ASD + Ga surface shows osteoprotective action on bone peri-implant tissue in vivo as well as an antibacterial effect within the first considered time point.

Characterization of hydroxyapatite containing a titania layer formed by anodization coupled with blasting

OBJECTIVES

The modification of dental implant surface by increasing the surface roughness or/and altering chemical composition have been attempted. Among them, hydroxyapatite (HA) coatings are typically bioactive. On the other hand, titania coatings have good corrosion resistance and biocompatibility. Therefore, the objective of this study was to fabricate HA containing a titania layer using an HA blasting and anodization method to benefit from the advantages of both, followed by surface characterization and biocompatibility.

MATERIALS AND METHODS

HA blasting was performed followed by microarc oxidation (MAO) using various applied voltages (100, 150, 200, 250 V). For surface characterization, the microstructure of the surface, surface phase and surface roughness were observed. Bonding strength was measured using a universal testing machine and potentiodynamic corrosion testing was performed. Biocompatibility was evaluated based on bioactivity and cell proliferation test.

RESULTS

The porous titanium oxide-containing HA was formed at 150 and 200 V. These surfaces were a lower corrosion current compared to the titanium treated only with HA blasting. In addition, composite treated titanium showed a rougher surface and tighter bonding strength compared to the titanium treated only with MAO. Biocompatibility demonstrated that HA/Titania composite layer on titanium showed a rapid HA precipitation and also enhanced cell proliferation.

CONCLUSIONS

These results suggested that HA containing titania layer on titanium had not only excellent physicochemical, mechanical and electrochemical properties, but also improved bioactivity and biological properties that could be applied as material for a dental implant system.

Surface modification by argon plasma treatment improves antioxidant defense ability of CHO-k1 cells on titanium surfaces

Titanium is one of the most used materials in implants and changes in its surface can modify the cellular functional response to better implant fixation. An argon plasma treatment generates a surface with improved mechanical proprieties without modifying its chemical composition. Oxidative stress induced by biomaterials is considered one of the major causes of implant failure and studies in this field are fundamental to evaluate the biocompatibility of a new material. Therefore, in this work, induction of oxidative stress by titanium surfaces subjected to plasma treatment (PTTS) was evaluated. The viability of CHO-k1 cells was higher on PTTS discs. Cells grown on titanium surfaces are subjected to intracellular oxidative stress. Titanium discs subjected to the plasma treatment induced less oxidative stress than the untreated ones, which resulted in improved cellular survival. These were associated with improved cellular antioxidant response in Plasma Treated Titanium Surface (PTTS). Furthermore, a decrease in protein and DNA oxidative damage was observed on cells grown on the roughed surface when compared to the smooth one. In conclusion, our data suggest that the treatment of titanium with argon plasma may improve its biocompatible, thus improving its performance as implants or as a scaffold in tissue engineering.

Mesenchymal stem cell differentiation on electrochemically modified titanium: an optimized approach for biomedical applications

PURPOSE

To speed up the osteointegration process, surface-treated titanium has been widely used in dental and orthopedic applications. The present work describes a new silicon-based anodic spark deposition (ASD) treatment and investigates the properties of the surfaces obtained, focusing on their capability to modulate the osteogenic differentiation potential of adult mesenchymal stem cells (MSCs).

METHODS

The surfaces examined were obtained from commercially pure grade 2 titanium by a single-step ASD (SUM) eventually followed by a thermal treatment in alkali solution (SUMNa), while acid-etched titanium (AE; NextMaterials s.r.l.) was selected as a control. Their morphology, elemental composition, crystallographic structure of the Ti2O layer, wettability and topography were evaluated by scanning electron microscopy, energy-dispersive X-ray spectroscopy, thin-film X-ray diffraction, contact angle measurements and laser profilometry, respectively. MSCs' response to surface properties was assessed by examining cell morphology and viability by scanning electron microscopy and Alamar Blue assay®, while their osteogenic differentiation potential was investigated by evaluating the levels of the enzyme alkaline phosphatase (ALP) and the degree of calcium accumulation by Alizarin Red-S (AR-S) staining.

RESULTS

The proposed ASD treatment has allowed the obtaining of surfaces with round-shaped micrometric pores, enriched in calcium, phosphorus and silicon and significantly more wettable than controls; furthermore, the treatment has been shown to promote MSC proliferation and the degree of in vitro mineralization.

CONCLUSIONS

The described ASD treatment may be an effective technique to modify the surface cues of titanium implants, aiming at enhancing the conveying of osteoprogenitor cells and their functional differentiation in bone cells.

Gene expression profiling and histomorphometric analyses of the early bone healing response around nanotextured implants

While in vitro studies have shown that nanoscale surface modifications influence cell fate and activity, there is little information on how they modulate healing at the bone-implant interface.

AIM

This study aims to investigate the effect of nanotopography at early time intervals when critical events for implant integration occur.

MATERIALS & METHODS

Untreated and sulfuric acid/hydrogen peroxide-treated machined-surface titanium alloy implants were placed in rat tibiae. Samples were processed for DNA microarray analysis and histomorphometry.

RESULTS

At both 3 and 5 days, the gene expression profile of the healing tissue around nanotextured implants differed from that around machined-surface implants or control empty holes, and were accompanied by an increase in bone-implant contact on day 5. While some standard pathways such as the immune response predominated, a number of unclassified genes were also implicated.

CONCLUSION

Nanotexture elicits an initial gene response that is more complex than suspected so far and favors healing at the bone-implant interface.

Microstructural and topographical characterization of different surface treatments of a surgical titanium alloy for dental implants

OBJECTIVE

To perform a topographical characterization of a titanium alloy subjected to different surface treatments using roughness evaluation, scanning electron microscopy, and atomic force microscopy.

MATERIALS AND METHODS

For each group, 6 discs of a titanium alloy had their surfaces modified by 4 treatments. All surfaces were blasted with Al2O3, cleaned, and the specimens were divided into 4 groups: G1, immersion in a standardized acid solution (SAS) (control group); G2, immersion in acetone, followed by immersion in SAS; G3, immersion in acetone, followed by immersion in SAS, followed by immersion in nitric acid; G4, immersion in acetone, followed by immersion in SAS, followed by immersion in sulfuric acid. Roughness parameters were determined with a roughness tester, and data were statistically analyzed using analysis of variance and Tukey tests (α = 5%).

RESULTS

Regarding the roughness parameters, no significant differences were found. Scanning electron microscopy and atomic force microscopy showed irregular surfaces with the presence of particles uniformly deposited on the surfaces.

CONCLUSION

A similar roughness pattern was created for all the groups. The images and topographic profiles indicated that all the groups showed high levels of roughness.

ELECTROHYDRODYNAMIC PROCESSING OF CALCIUM PHOSPHATES: COATING AND PATTERNING FOR MEDICAL IMPLANTS

Hydroxyapatite (HA)-coated metallic prostheses, which combine the osteoconductivity of HA and high strength of metallic alloys, have been increasingly the choice of joint replacement prostheses by surgeons as the general population lives longer. Surface modification of metallic implant surfaces is one of the key focal points to implantation technology. In addition to material chemistry, surface topography has been found to positively impact cellular response and is able to enhance the life time of the implant. Recently, a new technique, template-assisted electrohydrodynamic atomization (TAEA) spraying, developed using the principles of electrohydrodynamic atomization spraying, which is an electrically driven jet-based deposition method, is of considerable interest in surface topography formation. The process offers the attractive advantages of compatibility with micro-fabrication technology and versatility in pattern specification for advanced implant designs. This technology incorporates nanosized calcium phosphate to mimic the size and chemical composition of bone mineral in a micrometer-dimension pattern configuration to guide cellular responses. In vitro studies showed that both pillar and track nano Silicon-substituted HA (SiHA) patterns were able to encourage the attachment and growth of osteoblast cells, the track patterns provided the favourite surface for the initial cell attachment while a fast cell proliferation rate was found on the pillar pattern from day 1 to day 5 in comparison with that of a SiHA-coated surface. The alignment of actin cytoskeleton of osteoblast cells matched the orientation of the entire cell. The shear peel strength of the patterned interlocking nano-HA coating was found to be at least an order of magnitude higher than the conventional HA coating. Therefore, TAEA offers great potential for producing new coatings with a tailored surface topography, on both the micro- and nano-scale in a more cost effective way to enhance the performance of medical implants.

Efficacy of zosteric acid sodium salt on the yeast biofilm model Candida albicans

Candida albicans is the most notorious and the most widely studied yeast biofilm former. Design of experiments (DoE) showed that 10 mg/L zosteric acid sodium salt reduced C. albicans adhesion and the subsequent biofilm formation by at least 70%, on both hydrophilic and hydrophobic surfaces of 96-well plates. Indeed, biofilm imaging revealed the dramatic impact of zosteric acid sodium salt on biofilm thickness and morphology, due to the inability of the cells to form filamentous structures while remaining metabolically active. In the same way, 10 mg/L zosteric acid sodium salt inhibited C. albicans biofilm formation when added after the adhesion phase. Contrary to zosteric acid sodium salt, methyl zosterate did not affect yeast biofilm. In addition, zosteric acid sodium salt enhanced sensitivity to chlorhexidine, chlorine, hydrogen peroxide, and cis-2-decenoic acid, with a reduction of 0.5 to 8 log units. Preliminary in vitro studies using suitable primary cell based models revealed that zosteric acid sodium salt did not compromise the cellular activity, adhesion, proliferation or morphology of either the murine fibroblast line L929 or the human osteosarcoma line MG-63. Thus the use of zosteric acid sodium salt could provide a suitable, innovative, preventive, and integrative approach to preventing yeast biofilm formation.

In vitro cellular response and in vivo primary osteointegration of electrochemically modified titanium

Anodic spark deposition (ASD) is an attractive technique for improving the implant-bone interface that can be applied to titanium and titanium alloys. This technique produces a surface with microporous morphology and an oxide layer enriched with calcium and phosphorus. The aim of the present study was to investigate the biological response in vitro using primary human osteoblasts as a cellular model and the osteogenic primary response in vivo within a short experimental time frame (2 and 4 weeks) in an animal model (rabbit). Responses were assessed by comparing the new electrochemical biomimetic treatments to an acid-etching treatment as control. The in vitro biological response was characterized by cell morphology, adhesion, proliferation activity and cell metabolic activity. A complete assessment of osteogenic activity in vivo was achieved by estimating static and dynamic histomorphometric parameters at several time points within the considered time frame. The in vitro study showed enhanced osteoblast adhesion and higher metabolic activity for the ASD-treated surfaces during the first days after seeding compared to the control titanium. For the ASD surfaces, the histomorphometry indicated a higher mineral apposition rate within 2 weeks and a more extended bone activation within the first week after surgery, leading to more extensive bone-implant contact after 2 weeks. In conclusion, the ASD surface treatments enhanced the biological response in vitro, promoting an early osteoblast adhesion, and the osteointegrative properties in vivo, accelerating the primary osteogenic response.

Improving biocompatibility of implantable metals by nanoscale modification of surfaces: an overview of strategies, fabrication methods, and challenges

The human body is an intricate biochemical-mechanical system, with an exceedingly precise hierarchical organization in which all components work together in harmony across a wide range of dimensions. Many fundamental biological processes take place at surfaces and interfaces (e.g., cell-matrix interactions), and these occur on the nanoscale. For this reason, current health-related research is actively following a biomimetic approach in learning how to create new biocompatible materials with nanostructured features. The ultimate aim is to reproduce and enhance the natural nanoscale elements present in the human body and to thereby develop new materials with improved biological activities. Progress in this area requires a multidisciplinary effort at the interface of biology, physics, and chemistry. In this Review, the major techniques that have been adopted to yield novel nanostructured versions of familiar biomaterials, focusing particularly on metals, are presented and the way in which nanometric surface cues can beneficially guide biological processes, exerting influence on cellular behavior, is illustrated.

A novel multiphase anodic spark deposition coating for the improvement of orthopedic implant osseointegration: an experimental study in cortical bone of sheep

The effect of a new three-step anodic spark deposition process, labeled TiSpark, including two consecutive treatments performed first in a P solution and second in Ca solution, followed by an additional alkali etching step, was investigated for the improvement of osseointegration of commercial grade 2 titanium, machined (Ti) or Al(2)O(3) sandblasted (Ti-SA), cylindrical implants (12 mm in length and 4 mm in diameter) in cortical bone of 12 adult sheep. Histomorphometric and microhardness measurements were carried out at each experimental time (4, 8, and 12 weeks) to quantify the bone-to-implant contact around the implants as well as the newly bone hardness and bone maturation index. TiSpark treated surfaces were covered by a thick layer of crystalline anatase TiO(2) and by a further Ca/P layer. Bone tissue extends and grows on the surface of the TiSpark treated implants without any fibrous tissue, enhancing the short-term osseointegration properties of implant. Bone mineralization rate was also influenced by the chemical composition of implants and sandblasted materials presented the lowest bone maturation rate at the interface. Data suggests that the TiSpark treatment produces a modification of the Ti surface, which presents good bioactivity and may be suitable for achieving a stable implant osseointegration.