Apatite deposition on thermally and anodically oxidized titanium surfaces in a simulated body fluid

There Are over 60 Ways to Produce Biocompatible Calcium Orthophosphate (CaPO4) Deposits on Various Substrates

A The present overview describes various production techniques for biocompatible calcium orthophosphate (abbreviated as CaPO4) deposits (coatings, films and layers) on the surfaces of various types of substrates to impart the biocompatible properties for artificial bone grafts. Since, after being implanted, the grafts always interact with the surrounding biological tissues at the interfaces, their surface properties are considered critical to clinical success. Due to the limited number of materials that can be tolerated in vivo, a new specialty of surface engineering has been developed to desirably modify any unacceptable material surface characteristics while maintaining the useful bulk performance. In 1975, the development of this approach led to the emergence of a special class of artificial bone grafts, in which various mechanically stable (and thus suitable for load-bearing applications) implantable biomaterials and artificial devices were coated with CaPO4. Since then, more than 7500 papers have been published on this subject and more than 500 new publications are added annually. In this review, a comprehensive analysis of the available literature has been performed with the main goal of finding as many deposition techniques as possible and more than 60 methods (double that if all known modifications are counted) for producing CaPO4 deposits on various substrates have been systematically described. Thus, besides the introduction, general knowledge and terminology, this review consists of two unequal parts. The first (bigger) part is a comprehensive summary of the known CaPO4 deposition techniques both currently used and discontinued/underdeveloped ones with brief descriptions of their major physical and chemical principles coupled with the key process parameters (when possible) to inform readers of their existence and remind them of the unused ones. The second (smaller) part includes fleeting essays on the most important properties and current biomedical applications of the CaPO4 deposits with an indication of possible future developments.

Impacts of chemically different surfaces of implants on a biological activity of fibroblast growth factor-2-apatite composite layers formed on the implants

BACKGROUND

Implants coated with fibroblast growth factor-2 (FGF-2)-apatite composite layers were previously reported to enhance soft-tissue formation, bone formation, and angiogenesis around the implants owing to the biological activity of FGF-2. However, it is unclear whether the chemistries of the material and surface of implants have some impact on the retention of the biological activity of FGF-2 in FGF-2-apatite composite layers on them. Since magnitude of the impact should be evaluated for extensive application of the composite layer to coat various implants, following items were examined; (1) surface chemistries of six implants, (2) mitogenic activities of FGF-2 in FGF-2-apatite composite layers on the implants, and (3) improved synthesis method of the composite layer for retention of the mitogenic activity of FGF-2.

HYPOTHESIS

The biological activity of FGF-2 in the composite layer is affected by the chemistries of the material and surface of implants.

MATERIALS AND METHODS

Six commercial products of pins and screws having different surface chemistries were coated with FGF-2-apatite composite layers. The composite layers were quantitatively analyzed for calcium (Ca), phosphorus (P) and FGF-2, and also evaluated the mitogenic activities of FGF-2. Improvement of the synthesis method was then attempted using two pin products.

RESULTS

Each commercial product had a chemically and morphologically characteristic surface. FGF-2-apatite composite layers were formed on all the commercial products. Although the Ca, P, and FGF-2 contents (4.7±0.9μg/mm, 2.2±0.4μg/mm, and 21.1±3.7ng/mm, respectively) and the Ca/P molar ratios (1.69±0.01) of the composite layers were almost the same, rate of retention of the mitogenic activity of FGF-2 in the composite layers significantly decreased on some pin products (3/12-4/12). The decrease in rate of retention of the mitogenic activity of FGF-2 was prevented by a two-step synthesis method to form a composite layer on a precoating with calcium phosphate (9/12-12/12).

DISCUSSION

The chemistries of the implant surfaces had a significant impact on the retention of the mitogenic activity of FGF-2 in the composite layers formed on the implant. The two-step synthesis method was useful to retain mitogenic activity of FGF-2 regardless of the surface chemistries of the implants. The two-step synthesis method has potential to expand the applicability of FGF-2-apatite composite layers to a wider range of implants.

LEVEL OF EVIDENCE

III, Case control in vitro study.

Determination of Crystal-Field Splitting Induced by Thermal Oxidation of Titanium

The electronic structure of transition-metal oxides is a key component responsible for material's optical and chemical properties. Specifically for metal-oxide structures, the crystal-field interaction determines the shape, strength, and occupancy of electronic orbitals. Consequently, the crystal-field splitting and resulting unoccupied state populations can be foreseen as modeling factors of the photochemical activity. Herein, we study the formation of crystal-field effects during thermal oxidation of titanium in an ambient atmosphere and range of temperatures. The X-ray absorption spectroscopy is employed for quantitative analysis of average t_2g-e_g crystal-field splitting (Δoct) and relative t_2g/e_g bands occupancy. The obtained result shows that Δoct changes as a function of temperature from 1.97 eV for a passive oxide layer created on a Ti metal surface at room temperature to 2.41 eV at 600 °C when the material changes into the TiO₂ rutile phase. On the basis of XAS data analysis, we show that the Δoct values determined from L₂ and L₃ absorption edges are equal, indicating that the 2p_1/2 and 2p_3/2 core holes screen the t_2g and e_g electronic states in a similar manner.

Surface Characteristics and Bioactivity of Zirconia (Y-TZP) with Different Surface Treatments

Background:

Zirconia being a bio-inert material needs to be surface treated to render it more bioactive and enhance its osseointegration potential. However, bioactivity studies focusing on the ability of sandblasting and ultraviolet photofunctionalization (UVP) surface treatments in inducing apatite precipitation using simulated body fluid (SBF) are lacking.

Aim:

The aim of the study was to comparatively evaluate the effect of two different surface treatments—sandblasting with 50 µm alumina and UVP with ultraviolet C (UVC) light on the bioactivity of zirconia.

Materials and Methods:

A total of 33 discs with dimensions 10 mm × 2 mm were obtained from zirconia blanks (Amann Girrbach, Koblach, Austria) and randomly divided into three groups (n = 11), namely Group I (untreated), Group II (sandblasted), and Group III (UVP). Surface characteristics of representative test samples were analyzed using X-ray diffraction (XRD), atomic force microscopy (AFM), contact angle goniometry, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDX), to assess type of crystal phase of zirconia, surface roughness, wettability, surface topography, and elemental composition, respectively. SBF was prepared and calcium content in SBF (Ca-SBF) was determined using inductively coupled plasma mass spectrometry (ICP-MS).

Results:

Data were analyzed by one-way analysis of variance (ANOVA), post hoc Tukey honestly significant difference (HSD), and Student’s t test for statistical significance (P < 0.05, significant; P < 0.01, highly significant). Surface characteristics analyses revealed that XRD showed predominant tetragonal (t) zirconia crystal phase for all test groups. Mean surface roughness (Sa) of Group I was 41.83 nm, and it was significantly lesser than that of Group II (115.65 nm) and Group III (102.43 nm). Mean contact angles were 98.26°, 86.77°, and 68.03° for Groups I, II, and III, respectively, and these differences were highly significant. Mean pre-immersion Ca content in SBF was found to be 159 mg/L. Mean post-immersion Ca content was 70.10, 60.80, and 56.20 mg/L for Groups I, II, and III, respectively. Significant differences were found between Group I as compared to both Groups II and III. Bioactivity of Group III was marginally, but insignificantly higher with respect to Group II. Groups II and III were insignificant with respect to each other. Post-immersion XRD revealed predominant “t” phase, and SEM-EDX revealed well-formed, abundant calcium apatite layer on the treated samples as compared to that on untreated sample and an increasing Ca/P ratio from 1.15, 1.79 to 2.08, respectively from Group I to Group III.

Conclusion:

Within the limitations of this study, both sandblasting and UVP significantly and similarly improved bioactivity of zirconia as compared to the untreated samples, which was corroborated by the SEM-EDX results.

Bioinspired Fabrication of Calcium-Doped TiP Coating with Nanofibrous Microstructure to Accelerate Osseointegration

Bioinspired by the morphology of osteoclast-resorbed bone surfaces, we prepared a calcium-doped titanium phosphate (Ca-TiP) coating, which consists of a nanofibrous network, on titanium (Ti) substrate via a simple two-step hydrothermal method, trying to mimic natural bone compositionally and microstructurally. The in vitro studies show that the Ca-TiP coating with synergistic features of nanofibrous biomimetic topography and surface chemistry could elicit intensively osteogenic behavior and responses including enhanced cell adhesion, spreading, and proliferation as well as alkaline phosphatase (ALP) activity and up-regulated expression of bone-related genes, which inevitably benefit the formation of new bone and the quality of osseointegration. When the two control groups are compared in vivo, the significantly improved new bone formation in the early stage and the much stronger interfacial bonding with the surrounding bone for Ca-TiP coating suggest that Ca-TiP coating modified Ti implants hold great potential for orthopedic and dental applications.

Residual titanium flakes as a novel material for retention and recovery of rare earth and relatively rare earth elements

The aim of this study was the valorization of titanium flakes (waste) from titanium and titanium alloy ingot production factories and using in applications related to metals recovery as retention bed for some trace metals. The titanium flakes were anodized for surface nanostructuration with TiO₂ nanotubes and then annealed in order to increase the surface stability. The nanostructured titanium flakes were loaded and pressed in a retention column linked with inductively coupled plasma spectrometer (ICP-OES). This system allowed determination of trace elements such as beryllium, lanthanum, lutetium, and ytterbium from sample solutions. Beryllium recovery percentage was over 90%, while lanthanides have just a satisfactory recovery percentage (about 65% Yb and Lu and 50% La). The TiO₂ nanotube architecture was not affected during utilization being able to perform for a long time. A thermodynamic and kinetic study was done for beryllium due to its successful adsorption recovery percentage. The obtained results showed that the titanium waste is a promising material for rare earth and relatively rare earth elements retention and recovery. Graphical abstract Graphical abstract.

Titanium - castor oil based polyurethane composite foams for bone tissue engineering

Polyurethanes (PU) foams with titanium particles (Ti) were prepared with castor oil (CO) and isophorone diisocyanate (IPDI) as polymeric matrix, and 1, 3 and 5 wt.% of Ti. Composites were physicochemically and mechanically characterized and their biocompatibility assessed using human dental pulp stem cells (HDPSC). PU synthesis was confirmed by FTIR, but the presence of Ti was detected by RAMAN, X-ray diffraction (peak at 2θ = 40.2°) and by EDX-mapping. Materials showed three decomposition temperatures between 300 °C and 500 °C and their decomposition were not catalyzed by Ti particles. Compressive modulus (164-846 kPa), compressive strength (12.9-116.7 kPa) and density (128-240 kg/m³) tend to increase with Ti concentration but porosity was reduced (87% to 80%). Composites' foams were fully degraded in acid and oxidative media while remained stable in distilled water. HDPSC viability on all composites was higher than 80% up to 14 days while proliferation dropped up to 60% at 21 days. Overall, these results suggest that these foams can be used as scaffolds for bone tissue regeneration.

Rapid evaluation of bioactive Ti-based surfaces using an in vitro titration method

The prediction of implant behavior in vivo by the use of easy-to-perform in vitro methods is of great interest in biomaterials research. Simulated body fluids (SBFs) have been proposed and widely used to evaluate the bone-bonding ability of implant materials. In view of its limitations, we report here a rapid in vitro method based on calcium titration for the evaluation of in vivo bioactivity. Using four different titanium surfaces, this method identifies that alkaline treatment is the key process to confer bioactivity to titanium whereas no significant effect from heat treatment is observed. The presence of bioactive titanium surfaces in the solution during calcium titration induces an earlier nucleation of crystalline calcium phosphates and changes the crystallization pathway. The conclusions from this method are also supported by the standard SBF test (ISO 23317), in vitro cell culture tests using osteoblasts and in vivo animal experiments employing a pelvic sheep model.

Multifunctional Coatings and Nanotopographies: Toward Cell Instructive and Antibacterial Implants

In biomaterials science, it is nowadays well accepted that improving the biointegration of dental and orthopedic implants with surrounding tissues is a major goal. However, implant surfaces that support osteointegration may also favor colonization of bacterial cells. Infection of biomaterials and subsequent biofilm formation can have devastating effects and reduce patient quality of life, representing an emerging concern in healthcare. Conversely, efforts toward inhibiting bacterial colonization may impair biomaterial-tissue integration. Therefore, to improve the long-term success of medical implants, biomaterial surfaces should ideally discourage the attachment of bacteria without affecting eukaryotic cell functions. However, most current strategies seldom investigate a combined goal. This work reviews recent strategies of surface modification to simultaneously address implant biointegration while mitigating bacterial infections. To this end, two emerging solutions are considered, multifunctional chemical coatings and nanotopographical features.

Preparation and characterization of titanium-segmented polyurethane composites for bone tissue engineering

Segmented polyurethanes were prepared with polycaprolactone diol as soft segment and 4,4-methylene-bis cyclohexyl diisocyanate and l-glutamine as the rigid segment. These polyurethanes were filled with 1 wt.% to 5 wt.% titanium particles (Ti), physicochemically characterized and their biocompatibility assessed using human dental pulp stem cells and mice osteoblasts. Physicochemical characterization showed that composites retained the properties of the semicrystalline polyurethane as they exhibited a glass transition temperature (T_g) between -35°C and -45°C, melting temperature (T_m) at 52°C and crystallinity close to 40% as determined by differential scanning calorimetry. In agreement with this, X-ray diffraction showed reflections at 21.3° and 23.6° for polycaprolactone diol and reflections at 35.1°, 38.4°, and 40.2° for Ti particles suggesting that these particles are not acting as nucleating sites. The addition of up to 5 wt.% of Ti reduced both, tensile strength and maximum strain from 1.9 MPa to 1.2 MPa, and from 670% to 172% for pristine and filled polyurethane, respectively. Although there were differences between composites at low strain rates, no significant differences in mechanical behavior were observed at higher strain rate where a tensile stress of 8.5 MPa and strain of 223% were observed for 5 wt.% composites. The addition to titanium particles had a beneficial effect on both human dental pulp stem cells and osteoblasts viability, as it increased with the amount of titanium in composites up to 10 days of incubation.

Effects of Pre-Treatments on Bioactivity of High-Purity Titanium

Titanium and its alloys are frequently employed in medical and dental clinics due to their good tissue compatibility, including commercially available pure Ti, Ti6A4V, or Ti-15Zr-4Ta-4Nb. Yet, they may behave very differently when in contact with our plasma because of their own chemical composition. The present study was designed to compare the in vitro behavior of highly pure Ti (>99.99%; hpTi) with those of the above titanium specimens when they were subjected to heating in air (HT), H₂O₂ and heating (CHT), and heating in air after forming grooves on the surface (GT). Since one of the measures of material-tissue compatibility has been in vitro apatite formation in artificial plasma, like simulated body fluid (SBF) of the Kokubo recipe, the apatite deposition in SBF on their surface and in their grooves were examined in terms of the X-ray diffraction, scanning electron microscopy, and energy dispersion X-ray analysis. The results showed that hpTi was as active in in vitro apatite deposition as the other reference titanium samples mentioned above. Moreover, GT specimens of hpTi induced apatite deposition on the platform of the grooves as well as in the grooves. Therefore, hpTi was concluded to have better activity, and to be clinically applicable.

Corrosion of titanium: Part 2: Effects of surface treatments

Titanium is well known as one of the most corrosion-resistant metals. However, it can suffer corrosion attacks in some specific aggressive conditions. To further increase its corrosion resistance, it is possible either to modify its surface, tuning either thickness, composition, morphology or structure of the oxide that spontaneously forms on the metal, or to modify its bulk composition. Part 2 of this review is dedicated to the corrosion of titanium and focuses on possible titanium treatments that can increase corrosion resistance. Both surface treatments, such as anodization or thermal or chemical oxidation, and bulk treatments, such as alloying, are considered, highlighting the advantages of each technique.

Synergistic effects of fibronectin and bone morphogenetic protein on the bioactivity of titanium metal

To improve the biological properties of bioactive titanium metal, recombinant human bone morphogenetic protein 2(rhBMP-2) and fibronectin (Fn) were adsorbed on its surface solely or contiguously to modify the anodic oxidized titanium (AO-Ti), acid-alkali-treated titanium (AA-Ti), and polished titanium (P-Ti). It is found that the different bioactive titanium surface structures had great influence on protein adsorption. The adsorption amounts of BMP adsorbed solely and Fn/BMP adsorbed contiguously were AA-Ti > P-Ti > AO-Ti, and that for Fn adsorbed solely was AA-Ti ≈ P-Ti > AO-Ti. The conformation of proteins was changed remarkably after the adsorption. For BMP, the α-helix decreased on AA-Ti and stabilized on P-Ti and AO-Ti. For Fn, the β-sheet on PT-Ti and AA-Ti increased significantly. For Fn/BMP, the percentage of β-sheet on AA-Ti increased, and that of α-helix on all samples was stable. MSCs showed greater adhesion and spreading on Fn/BMP groups. MTT and Elisa tests showed that the synergistic effects of proteins made the cells proliferate and differentiate faster. It indicated both the surface structure and the synergistic effects of proteins could influence the biological properties of titanium metals. It provides research foundation for improving the biological properties of bioactive titanium metals by simultaneous application of several proteins. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2485-2498, 2017.

A comparative study of simulated body fluids in the presence of proteins

Simulated body fluid (SBF) is widely used as part of an in vitro method to evaluate implant materials such as their apatite forming ability (AFA), a typical indication of potential bone-bonding ability in vivo. We report the use of carbonate-buffered SBFs as potential solutions for implant evaluation and the effect of proteins, represented by bovine serum albumin (BSA) in SBFs on the formation of hydroxyapatite (HA). These solutions are buffered by the thermodynamic equilibrium with 5% CO₂ in an incubator, and result in a deposition of carbonated HA. Using several titanium-based surfaces, these solutions were studied in comparison with the widely-used SBF (ISO 23317). The presence of BSA strongly inhibited the formation of HA in traditional SBF, while HA can still be observed in carbonate-buffered SBFs. A kinetic study reveals that the inhibitory effect is concentration dependent with 0.1g/L and 1g/L of BSA having little effect on HA growth but a complete inhibition of HA formation at 5g/L of BSA, as tested using NaOH treated titanium with a known positive AFA. The decrease in solution pH and free calcium concentrations in SBFs due to the addition of BSA is not significant, suggesting other causes for the strong inhibitory effect.

STATEMENT OF SIGNIFICANCE

The successful use of simulated body fluids (SBFs) to evaluate potential bioactive implants relies on the better understanding of the heterogeneous nucleation and growth of hydroxyapatite in solution. Although a standardized recipe for SBF was developed over a decade ago, a few key issues remain to be understood, i.e. the behavior of carbonate-buffered SBFs having similar buffering mechanism as human blood, and the effect of proteins on hydroxyapatite formation on bioactive materials. This paper addresses these two issues and would help the reader better understand the subtleties in this domain and better interpret the results generated using SBFs.

Antibacterial properties of nanostructured Cu–TiO2surfaces for dental implants

The influence of copper derived TiO₂surfaces (nCu–nT-TiO₂) on the death of nosocomialStaphylococcus aureus(Sa) andEscherichia coli(Ec), was investigated.

Classification and Effects of Implant Surface Modification on the Bone: Human Cell-Based In Vitro Studies

Implant surfaces are continuously being improved to achieve faster osseointegration and a stronger bone to implant interface. This review will present the various implant surfaces, the parameters for implant surface characterization, and the corresponding in vitro human cell-based studies determining the strength and quality of the bone-implant contact. These in vitro cell-based studies are the basis for animal and clinical studies and are the prelude to further reviews on how these surfaces would perform when subjected to the oral environment and functional loading.

Microstructure and Characteristics of Calcium Phosphate Layers on Bioactive Oxide Surfaces of Air-Sintered Titanium Foams after Immersion in Simulated Body Fluid

We propose a simple and low-cost process for the preparation of porous Ti foams through a sponge replication method using single-step air sintering at various temperatures. In this study, the apatite-forming ability of air-sintered Ti samples after 21 days of immersion in simulated body fluid (SBF) was investigated. The microstructures of the prepared Ca-P deposits were examined by X-ray diffraction (XRD), field-emission scanning electron microscopy (FE-SEM), Fourier transform infrared (FTIR) spectroscopy, and cross-sectional transmission electron microscopy (TEM). In contrast to the control sample sintered in vacuum, which was found to have the simple hexagonal α-Ti phase, the air-sintered samples contained only the rutile phase. High intensities of XRD peaks for rutile TiO₂ were obtained with samples sintered at 1000 °C. Moreover, the air-sintered Ti samples had a greater apatite-forming ability than that of the Ti sample sintered in vacuum. Ti samples sintered at 900 and 1000 °C had large aggregated spheroidal particles on their surfaces after immersion in SBF for 21 days. Combined XRD, energy-dispersive X-ray spectroscopy, FTIR spectroscopy, and TEM results suggest that the calcium phosphate deposited on the rutile TiO₂ surfaces consist of carbonated calcium-deficient hydroxyapatite instead of octacalcium phosphate.

UV photofunctionalization promotes nano-biomimetic apatite deposition on titanium

Background

Although biomimetic apatite coating is a promising way to provide titanium with osteoconductivity, the efficiency and quality of deposition is often poor. Most titanium implants have microscale surface morphology, and an addition of nanoscale features while preserving the micromorphology may provide further biological benefit. Here, we examined the effect of ultraviolet (UV) light treatment of titanium, or photofunctionalization, on the efficacy of biomimetic apatite deposition on titanium and its biological capability.

Methods and results

Micro-roughed titanium disks were prepared by acid-etching with sulfuric acid. Micro-roughened disks with or without photofunctionalization (20-minute exposure to UV light) were immersed in simulated body fluid (SBF) for 1 or 5 days. Photofunctionalized titanium disks were superhydrophilic and did not form surface air bubbles when immersed in SBF, whereas non-photofunctionalized disks were hydrophobic and largely covered with air bubbles during immersion. An apatite-related signal was observed by X-ray diffraction on photofunctionalized titanium after 1 day of SBF immersion, which was equivalent to the one observed after 5 days of immersion of control titanium. Scanning electron microscopy revealed nodular apatite deposition in the valleys and at the inclines of micro-roughened structures without affecting the existing micro-configuration. Micro-roughened titanium and apatite-deposited titanium surfaces had similar roughness values. The attachment, spreading, settling, proliferation, and alkaline phosphate activity of bone marrow-derived osteoblasts were promoted on apatite-coated titanium with photofunctionalization.

Conclusion

UV-photofunctionalization of titanium enabled faster deposition of nanoscale biomimetic apatite, resulting in the improved biological capability compared to the similarly prepared apatite-deposited titanium without photofunctionalization. Photofunctionalization-assisted biomimetic apatite deposition may be a novel method to effectively enhance micro-roughened titanium surfaces without altering their microscale morphology.

Calcium phosphate crystallization on titania in a flowing Kokubo solution

Dry titania layers on air-oxidized titanium substrates have been found to be active enough to cause apatite to be deposited in Kokubo's simulated body fluid (SBF) in narrow confined spaces, such as those in narrow grooves and thin gaps. Such in vitro apatite deposition is the basis of the GRAPE(®) technique. The aim of the present study is to determine why GRAPE conditions favor apatite deposition when laminar SBF flow (at 0.01-0.3 ml/min) passes through a shallow channel (0.5 mm) between a pair of titanium substrates each with a dry layer of titania. Assessing the factors that control the heterogeneous nucleation process led to the proposal of the working hypothesis that there are nucleation pre-embryos, ion assemblies that can be stabilized to form embryos, on the titania layer but that they are removed by the SBF flow. Specimens were subjected to different combinations of processes. One combination was that titania layers were exposed to still or flowing SBF, and the other was that half of a specimen, the inlet or outlet side, was exposed to still or flowing SBF with the other half being covered. The surface morphologies of the specimens were then compared in detail. The conclusion was that exposure to still SBF for 2 days before exposure to flowing SBF was required for apatite to be deposited. Some complicated apatite deposition modes were observed, e.g., apatite was deposited even on areas unexposed to still SBF. All of the results were successfully interpreted using the working hypothesis. The conclusion was that the GRAPE(®) technique depends on the confined space holding pre-embryo and embryo assemblies.

Calcium orthophosphate deposits: Preparation, properties and biomedical applications

Since various interactions among cells, surrounding tissues and implanted biomaterials always occur at their interfaces, the surface properties of potential implants appear to be of paramount importance for the clinical success. In view of the fact that a limited amount of materials appear to be tolerated by living organisms, a special discipline called surface engineering was developed to initiate the desirable changes to the exterior properties of various materials but still maintaining their useful bulk performances. In 1975, this approach resulted in the introduction of a special class of artificial bone grafts, composed of various mechanically stable (consequently, suitable for load bearing applications) implantable biomaterials and/or bio-devices covered by calcium orthophosphates (CaPO4) to both improve biocompatibility and provide an adequate bonding to the adjacent bones. Over 5000 publications on this topic were published since then. Therefore, a thorough analysis of the available literature has been performed and about 50 (this number is doubled, if all possible modifications are counted) deposition techniques of CaPO4 have been revealed, systematized and described. These CaPO4 deposits (coatings, films and layers) used to improve the surface properties of various types of artificial implants are the topic of this review.

Effects of anodizing parameters and heat treatment on nanotopographical features, bioactivity, and cell culture response of additively manufactured porous titanium

Anodizing could be used for bio-functionalization of the surfaces of titanium alloys. In this study, we use anodizing for creating nanotubes on the surface of porous titanium alloy bone substitutes manufactured using selective laser melting. Different sets of anodizing parameters (voltage: 10 or 20V anodizing time: 30min to 3h) are used for anodizing porous titanium structures that were later heat treated at 500°C. The nanotopographical features are examined using electron microscopy while the bioactivity of anodized surfaces is measured using immersion tests in the simulated body fluid (SBF). Moreover, the effects of anodizing and heat treatment on the performance of one representative anodized porous titanium structures are evaluated using in vitro cell culture assays using human periosteum-derived cells (hPDCs). It has been shown that while anodizing with different anodizing parameters results in very different nanotopographical features, i.e. nanotubes in the range of 20 to 55nm, anodized surfaces have limited apatite-forming ability regardless of the applied anodizing parameters. The results of in vitro cell culture show that both anodizing, and thus generation of regular nanotopographical feature, and heat treatment improve the cell culture response of porous titanium. In particular, cell proliferation measured using metabolic activity and DNA content was improved for anodized and heat treated as well as for anodized but not heat-treated specimens. Heat treatment additionally improved the cell attachment of porous titanium surfaces and upregulated expression of osteogenic markers. Anodized but not heat-treated specimens showed some limited signs of upregulated expression of osteogenic markers. In conclusion, while varying the anodizing parameters creates different nanotube structure, it does not improve apatite-forming ability of porous titanium. However, both anodizing and heat treatment at 500°C improve the cell culture response of porous titanium.

Fabrication and characterization of porous Ti-7.5Mo alloy scaffolds for biomedical applications

Porous titanium and titanium alloys are promising scaffolds for bone tissue engineering, since they have the potential to provide new bone tissue ingrowth abilities and low elastic modulus to match that of natural bone. In the present study, porous Ti-7.5Mo alloy scaffolds with various porosities from 30 to 75 % were successfully prepared through a space-holder sintering method. The yield strength and elastic modulus of a Ti-7.5Mo scaffold with a porosity of 50 % are 127 MPa and 4.2 GPa, respectively, being relatively comparable to the reported mechanical properties of natural bone. In addition, the porous Ti-7.5Mo alloy exhibited improved apatite-forming abilities after pretreatment (with NaOH or NaOH + water) and subsequent immersion in simulated body fluid (SBF) at 37 °C. After soaking in an SBF solution for 21 days, a dense apatite layer covered the inner and outer surfaces of the pretreated porous Ti-7.5Mo substrates, thereby providing favorable bioactive conditions for bone bonding and growth. The preliminary cell culturing result revealed that the porous Ti-7.5Mo alloy supported cell attachment.

Influence of Surface Treatments on the Bioactivity of Ti

Several techniques have been described to modify the surface of titanium to make it more bioactive. Heat treatment (HT) and sodium hydroxide treatment (NaOH) have been used and can change the crystallinity and surface chemistry of titanium implants. However, no studies have systemically focused on comparing these different methods and their effect on the bioactivity of Ti. Therefore, in this study, Ti substrates were systematically treated using HT, NaOH, and a combination of HT and NaOH. The Ti plates were heat treated at various temperatures, and the plates were subjected to HT followed by soaking in NaOH or first soaked in NaOH and then heat treated. The morphology, crystallinity, hardness, water contact angle, and surface energy of the samples were analyzed as well as the bioactivity after immersion in PBS. Morphology and crystallinity changed with increasing temperature. The difference was most pronounced for the 800°C treated samples. The water contact angle decreased, and the surface energy increased with increasing temperature and was highest for 800°C. The rutile surface showed faster hydroxyapatite formation. NaOH treatment of the HT Ti samples increased the surface energy and improved its bioactivity further. Also, HT of NaOH samples improved the bioactivity compared to only HT.

Calcium orthophosphate coatings, films and layers

In surgical disciplines, where bones have to be repaired, augmented or improved, bone substitutes are essential. Therefore, an interest has dramatically increased in application of synthetic bone grafts. As various interactions among cells, surrounding tissues and implanted biomaterials always occur at the interfaces, the surface properties of the implants are of the paramount importance in determining both the biological response to implants and the material response to the physiological conditions. Hence, a surface engineering is aimed to modify both the biomaterials, themselves, and biological responses through introducing desirable changes to the surface properties of the implants but still maintaining their bulk mechanical properties. To fulfill these requirements, a special class of artificial bone grafts has been introduced in 1976. It is composed of various mechanically stable (therefore, suitable for load bearing applications) biomaterials and/or bio-devices with calcium orthophosphate coatings, films and layers on their surfaces to both improve interactions with the surrounding tissues and provide an adequate bonding to bones. Many production techniques of calcium orthophosphate coatings, films and layers have been already invented and new promising techniques are continuously investigated. These specialized coatings, films and layers used to improve the surface properties of various types of artificial implants are the topic of this review.

A novel composite porous coating approach for bioactive titanium-based orthopedic implants

Surface modification of titanium-based implants is considered a highly effective solution to enhance osseointegration. This study describes a novel Ti/hydroxyapatite (HA) composite porous coating produced using a cold spraying technique. Experimental results indicate desirable open-cell structure with 50-150 μm pore size and 60-65% macroporosity. In particular, the reinforced HA particles are exposed to the surface of the coating resulting in enhanced mineralization ability in simulated body fluid. None of the coatings displayed a cytotoxic response in SaOS-2 cells cultured in vitro for up to 48 h. The bond strength between the porous coating and the Ti substrate was found to be 20 MPa. These properties are comparative to or better than products currently on the market and thus this novel coating has potential use in orthopedics.

Titanium as a Reconstruction and Implant Material in Dentistry: Advantages and Pitfalls

Commercial pure titanium (cpTi) has been the material of choice in several disciplines of dentistry due to its biocompatibility, resistance to corrosion and mechanical properties. Despite a number of favorable characteristics, cpTi as a reconstruction and oral implant material has several shortcomings. This paper highlights current knowledge on material properties, passive oxidation film formation, corrosion, surface activation, cell interactions, biofilm development, allergy, casting and machining properties of cpTi for better understanding and potential improvement of this material for its clinical applications.

Formation of a bioactive calcium titanate layer on gum metal by chemical treatment

The so-called gum metal with the composition Ti-36Nb-2Ta-3Zr-0.3O is free from cytotoxic elements and exhibits a low elastic modulus as well as high mechanical strength. In the present study, it was shown that this alloy exhibited a high capacity for apatite formation in a simulated body fluid when subjected to 1 M NaOH treatment, 100 mM CaCl(2) treatment, heat treatment at 700°C, and then hot water treatment. The high apatite formation was attributed to the CaTi(2)O(5) which was precipitated on its surface, and found to be maintained even in a humid environment over a long period. The treated surface exhibited high scratch resistance, which is likely to be useful in clinical applications. The surface treatment had little effect on the unique mechanical properties described above. These results show that gum metal subjected to the present surface treatments exhibits a high potential for bone-bonding, which will be useful in orthopedic and dental implants.

Apatite-forming ability of titanium in terms of pH of the exposed solution

In order to elucidate the main factor governing the capacity for apatite formation of titanium (Ti), Ti was exposed to HCl or NaOH solutions with different pH values ranging from approximately 0 to 14 and then heat-treated at 600°C. Apatite formed on the metal surface in a simulated body fluid, when Ti was exposed to solutions with a pH less than 1.1 or higher than 13.6, while no apatite formed upon exposure to solutions with an intermediate pH value. The apatite formation on Ti exposed to strongly acidic or alkaline solutions is attributed to the magnitude of the positive or negative surface charge, respectively, while the absence of apatite formation at an intermediate pH is attributed to its neutral surface charge. The positive or negative surface charge was produced by the effect of either the acidic or alkaline ions on Ti, respectively. It is predicted from the present results that the bone bonding of Ti depends upon the pH of the solution to which it is exposed, i.e. Ti forms a bone-like apatite on its surface in the living body and bonds to living bone through the apatite layer upon heat treatment after exposure to a strongly acidic or alkaline solution.

Nanostructured biomaterials for tissue engineered bone tissue reconstruction

Bone tissue engineering strategies are emerging as attractive alternatives to autografts and allografts in bone tissue reconstruction, in particular thanks to their association with nanotechnologies. Nanostructured biomaterials, indeed, mimic the extracellular matrix (ECM) of the natural bone, creating an artificial microenvironment that promotes cell adhesion, proliferation and differentiation. At the same time, the possibility to easily isolate mesenchymal stem cells (MSCs) from different adult tissues together with their multi-lineage differentiation potential makes them an interesting tool in the field of bone tissue engineering. This review gives an overview of the most promising nanostructured biomaterials, used alone or in combination with MSCs, which could in future be employed as bone substitutes. Recent works indicate that composite scaffolds made of ceramics/metals or ceramics/polymers are undoubtedly more effective than the single counterparts in terms of osteoconductivity, osteogenicity and osteoinductivity. A better understanding of the interactions between MSCs and nanostructured biomaterials will surely contribute to the progress of bone tissue engineering.

Electrical implications of corrosion for osseointegration of titanium implants

The success rate of titanium implants for dental and orthopedic applications depends on the ability of surrounding bone tissue to integrate with the surface of the device, and it remains far from ideal in patients with bone compromised by physiological factors. The electrical properties and electrical stimulation of bone have been shown to control its growth and healing and can enhance osseointegration. Bone cells are also sensitive to the chemical products generated during corrosion events, but less is known about how the electrical signals associated with corrosion might affect osseointegration. The metallic nature of the materials used for implant applications and the corrosive environments found in the human body, in combination with the continuous and cyclic loads to which these implants are exposed, may lead to corrosion and its corresponding electrochemical products. The abnormal electrical currents produced during corrosion can convert any metallic implant into an electrode, and the negative impact on the surrounding tissue due to these extreme signals could be an additional cause of poor performance and rejection of implants. Here, we review basic aspects of the electrical properties and electrical stimulation of bone, as well as fundamental concepts of aqueous corrosion and its electrical and clinical implications.

A nitrogen doped TiO2 layer on Ti metal for the enhanced formation of apatite

Biomedical titanium metals subjected to gas under precisely regulated oxygen partial pressures (P(O2)) from 10(-18) to 10(5) Pa at 973 K for 1 h were soaked in a simulated body fluid (SBF), whose ion concentrations were nearly equal to those of human blood plasma, at 36.5°C for up to 7 days. The effect of oxygen partial pressures on apatite formation was assessed using X-ray diffraction (XRD), scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) measurements. After heating, the weight of the oxide layer (mainly TiO(2)) formed on the titanium metal was found to increase with increased oxygen partial pressure. Nitrogen (N)-doped TiO(2) (Interstitial N) was formed under a P(O2) of 10(-14) Pa. At lower P(O2) (10(-18) Pa), only a titanium nitride layer (TiN and Ti(2)N) was formed. After soaking in SBF, apatite was detected on heat-treated titanium metal samples. The most apatite was formed, based on the growth rate calculated from the apatite coverage ratio, on the titanium metal heated under a P(O2) of 10(-14) Pa, followed by the sample heated under a P(O2) of 10 and 10(4) Pa (in N(2)). The titanium metal heated under a P(O2) of 10(5) Pa (in O(2)) experienced far less apatite formation than the former three titanium samples. Similarly, very little weight change was observed for the titanium metal heated under a P(O2) of 10(-18) Pa (in N(2)). During the experimental observation period (5 days, 36.5°C, SBF), the following relationship held: The growth rate of apatite decreased in the order P(O2) of 10(-14) Pa > P(O2) of 10 Pa ≥ P(O2) of 10(4) Pa > P(O2) of 10(5) Pa > > P(O2) of 10(-18) Pa. These results suggest that N-doped TiO(2) (Interstitial N) strongly induces apatite formation but samples coated only with titanium nitride do not. Thus, controlling the formation of N-doped TiO(2) is expected to improve the bioactivity of biomedical titanium metal.

Nanostructured positively charged bioactive TiO2 layer formed on Ti metal by NaOH, acid and heat treatments

Nanometer-scale roughness was generated on the surface of titanium (Ti) metal by NaOH treatment and remained after subsequent acid treatment with HCl, HNO(3) or H(2)SO(4) solution, as long as the acid concentration was not high. It also remained after heat treatment. Sodium hydrogen titanate produced by NaOH treatment was transformed into hydrogen titanate after subsequent acid treatment as long as the acid concentration was not high. The hydrogen titanate was then transformed into titanium oxide (TiO(2)) of anatase and rutile by heat treatment. Treated Ti metals exhibited high apatite-forming abilities in a simulated body fluid especially when the acid concentration was greater than 10 mM, irrespective of the type of acid solutions used. This high apatite-forming ability was maintained in humid environments for long periods. The high apatite-forming ability was attributed to the positive surface charge that formed on the TiO(2) layer and not to the surface roughness or a specific crystalline phase. This positively charged TiO(2) induced apatite formation by first selectively adsorbing negatively charged phosphate ions followed by positively charged calcium ions. Apatite formation is expected on the surfaces of such treated Ti metals after short periods, even in living systems. The bonding of metal to living bone is also expected to take place through this apatite layer.

Relative influence of surface topography and surface chemistry on cell response to bone implant materials. Part 1: physico-chemical effects

Knowledge of the complexity of cell-material interactions is essential for the future of biomaterials and tissue engineering, but we are still far from achieving a clear understanding, as illustrated in this review. Many factors of the cellular or the material aspect influence these interactions and must be controlled systematically during experiments. On the material side, it is essential to illustrate surface topography by parameters describing the roughness amplitude as well as the roughness organization, and at the scales pertinent for the cell response, i.e., from the nano-scale to the micro-scale. Authors interested in this field must be careful to develop surfaces or methods systematically, allowing perfect control of the relative influences of surface topography and surface chemistry.

The effects of hydroxyl groups on Ca adsorption on rutile surfaces: a first-principles study

Hydroxyl groups on titanium surfaces have been believed to play an important role in absorbing Ca in solution, which is crucial in the formation of bioactive calcium phosphates both in vitro and in vivo. CASTEP, a first-principles density functional theory (DFT) code, was employed to investigate Ca adsorption on various rutile (110) surfaces in order to clarify how hydroxyl groups effect Ca adsorption. The surfaces modeled in the present study include a bare rutile (110) surface, a hydroxylated rutile (110) surface, an oxidized rutile (110) surface, and a rutile (110) surface bonded with mixed OH groups and water. The results reveal that not all OH groups favors to attract Ca adsorption and loosely bonded OH and water on a rutile surface actually combine with Ca during adsorption. An oxidized rutile surface has the highest ability to attract Ca atoms, which partially explains that alkali-treated Ti surfaces could induce hydroxyapatite formation in alkaline environments.

Effect of HCl concentrations on apatite-forming ability of NaOH-HCl- and heat-treated titanium metal

Titanium (Ti) metal was treated with water or HCl solutions after 5 M NaOH solution treatment and then subjected to heat treatment at 600 degrees C. The apatite-forming abilities of the treated Ti metals were examined in simulated body fluid. The apatite-forming ability of the Ti metal subjected to NaOH, water and heat treatment was lower than that of just NaOH and heat treatments. Ti metals subjected to NaOH, HCl and heat treatment showed apatite-forming abilities, which increased with increasing HCl concentrations up to the same level as that of NaOH- and heat-treated Ti metal. The former did not show a decrease in its apatite-forming ability, even in a humid environment for a long period, whereas the latter decreased its ability. The increase in the apatite-forming ability with increasing HCl concentrations suggests a different mechanism of apatite formation from that previously proposed.

Fabrication and characterization of oxygen-diffused titanium for biomedical applications

Although titanium has been successful as an orthopedic or dental implant material, performance problems still persist concerning implant-bone interfacial bonding strength. In this study a novel oxygen-diffused titanium (ODTi), fabricated by introducing oxygen into the titanium crystal lattice by thermal treatment, was investigated. The fabricated material is the result of a surface modification made on commercially pure titanium (cp Ti) previously coated with poly(vinyl alcohol) (PVA) by means of a thermal treatment performed at 700 degrees C in an ultra-pure argon atmosphere. The thermal treatment at 700 degrees C led to the formation of an anatase TiO(2) film on the cp Ti surface and a concentration gradient of oxygen into titanium. The surface of the fabricated ODTi consisted of an outer nanometric layer of anatase TiO(2) and an inner nanometric layer of Ti(2)O(x) (x<1) in which the oxygen is in solid solution with the titanium metal. It was found that ODTi possesses in vitro apatite formation ability after being soaked into simulated body fluid (SBF) solution. This apatite formation ability is attributed to the presence of the anatase TiO(2) outermost surface layer and to abundant hydroxyl groups (-OH) formed on the ODTi surface after immersion in SBF.

Bisphosphonate incorporation in surgical implant coatings by fast loading and co-precipitation at low drug concentrations

The objectives of the present work was to evaluate the possibility for fast loading by soaking of bisphosphonates (BPs) into hydroxylapatite (HA) implant coatings biomimetically grown on crystalline TiO(2) surfaces, and also investigate the influence of different BP loading concentrations in a buffer during co-precipitation of a calcium phosphate containing layer onto these surfaces. The co-precipitation method created coatings that contained BPs throughout most of the coating layer, but the presence of BPs in the buffer hindered the formation of a bulk HA-layer, thus resulting in very thin coatings most likely consisting of islands built up by a calcium phosphate containing BPs. The coatings biomimetically grown on TiO(2) surfaces, were shown to consist of crystalline HA. Soaking of these coatings during 15 min only in a low BPs concentration containing buffer yielded a concentration on the coating surface of the same order of magnitude as obtained with soaking during 60 min in significantly higher concentrated buffers. This could be of advantage during surgery since the operating surgeon could make a fast decision whether or not to include the drugs in the coating based on the need of the particular patient at hand. The BPs present on the surface of the fast-loaded HA coatings were found to be strongly bound, something which should be beneficial for in vivo use. Both the co-precipitation method and the fast loading by soaking method investigated here are promising techniques for loading of BPs onto surgical implants. The simplicity of both methods is an advantage since implants can have spatially complicated structures.

Biological Responses to New Advanced Surface Modifications of Endosseous Medical Implants

Implantable medical devices are increasingly important in the practice of modern medicine. However, patients with severely poor bone quality and quantity require highest implant osseointegration for the long-term success. A number of newly-developed advanced surface modifications of medical implants have recently been introduced to the medical implant system. Understanding the mechanisms by which osteogenic cells respond to such materials is therefore of major importance in developing the most effective materials to promote functional osseointegration. Diverse studies using materials with a wide range of new surface modification techniques have demonstrated the pivotal role of surface treatments in cell adhesion, proliferation and lineage specific differentiation. These events underlie the tissue responses required for bone healing following implant placement, with the interaction between adsorbed proteins on the implant surface and surrounding cells eliciting body responses to the treated implant surface. This review illustrates tissue responses to the implant material following implant placement and highlights cellular responses to new advanced implant surface modifications. Such information is of utmost importance to further develop several new advanced surface modifications to be used in the new era medical implantable devices.

Assessing surface area evolution during biomimetic growth of hydroxyapatite coatings

The surface area of biomimetically deposited hydroxyapatite (HA) coatings on metallic implants is important for the biological performance of the implant. Thus, a nondestructive method of assessing this quantity directly on the solid substrate would be highly valuable. The objective of this study was to develop such a method and for the first time assess the evolution of surface area of HA during biomimetic growth. The surface area of a TiO2-covered titanium substrate was measured prior to and following the biomimetic coating deposition using Ar gas adsorption at 77 K. The presence of HA on the surface was verified with scanning electron microscopy and X-ray diffraction. The specific surface area of the coating was found to increase linearly during 1 week of deposition at a rate of approximately 100 cm2 day-1 (g substrate)-1. The presented method may be used as a tool for studying the evolution in surface area of coatings on solid substrates during biomimetic deposition or other growth processes.

Mechanism and kinetics of apatite formation on nanocrystalline TiO2 coatings: a quartz crystal microbalance study

Apatite (Ca5(PO4)3OH) has long been considered as an excellent biomaterial to promote bone repairs and implant. Apatite formation induced by negatively charged nanocrystalline TiO2 coatings soaked in simulated body fluid (SBF) was investigated using in situ quartz crystal microbalance (QCM), scanning electron microscopy (SEM), Fourier-transformed infrared spectroscopy (FTIR), X-ray diffraction (XRD) and energy-dispersive X-ray spectroscopy (EDX) techniques, and factors affecting its formation such as pH, size of TiO2 particles and thickness of TiO2 coatings, were discussed in detail. Two different stages were clearly observed in the process of apatite precipitation, indicating two different kinetic processes. At the first stage, the calcium ions in SBF were initially attracted to the negatively charged TiO2 surface, and then the calcium titanate formed at the interface combined with phosphate ions, consequently forming apatite nuclei. After the nucleation, the calcium ions, phosphate ions and other minor ions (i.e. CO3(2-) and Mg2+) in supersaturated SBF deposited spontaneously on the original apatite coatings to form apatite precipitates. In terms of the in situ frequency shifts, the growth-rate constants of apatite (K1 and K2) were estimated, respectively, at two different stages, and the results were (1.96+/-0.14)x10(-3)s(-1) and (1.28+/-0.10)x10(-4)s(-1), respectively, in 1.5 SBF solution. It was found that the reaction rate at the first stage is obviously higher than that at the second stage.