Ion-beam-assisted deposition (IBAD) of hydroxyapatite coating layer on Ti-based metal substrate

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.

Functional engineering strategies of 3D printed implants for hard tissue replacement

Three-dimensional printing technology with the rapid development of printing materials are widely recognized as a promising way to fabricate bioartificial bone tissues. In consideration of the disadvantages of bone substitutes, including poor mechanical properties, lack of vascularization and insufficient osteointegration, functional modification strategies can provide multiple functions and desired characteristics of printing materials, enhance their physicochemical and biological properties in bone tissue engineering. Thus, this review focuses on the advances of functional engineering strategies for 3D printed biomaterials in hard tissue replacement. It is structured as introducing 3D printing technologies, properties of printing materials (metals, ceramics and polymers) and typical functional engineering strategies utilized in the application of bone, cartilage and joint regeneration.

Titanium Implants and Local Drug Delivery Systems Become Mutual Promoters in Orthopedic Clinics

Titanium implants have always been regarded as one of the gold standard treatments for orthopedic applications, but they still face challenges such as pain, bacterial infections, insufficient osseointegration, immune rejection, and difficulty in personalizing treatment in the clinic. These challenges may lead to the patients having to undergo a painful second operation, along with increased economic burden, but the use of drugs is actively solving these problems. The use of systemic drug delivery systems through oral, intravenous, and intramuscular injection of various drugs with different pharmacological properties has effectively reduced the levels of inflammation, lowered the risk of endophytic bacterial infection, and regulated the progress of bone tumor cells, processing and regulating the balance of bone metabolism around the titanium implants. However, due to the limitations of systemic drug delivery systems-such as pharmacokinetics, and the characteristics of bone tissue in the event of different forms of trauma or disease-sometimes the expected effect cannot be achieved. Meanwhile, titanium implants loaded with drugs for local administration have gradually attracted the attention of many researchers. This article reviews the latest developments in local drug delivery systems in recent years, detailing how various types of drugs cooperate with titanium implants to enhance antibacterial, antitumor, and osseointegration effects. Additionally, we summarize the improved technology of titanium implants for drug loading and the control of drug release, along with molecular mechanisms of bone regeneration and vascularization. Finally, we lay out some future prospects in this field.

Electrophoretic Deposition of Nanocrystalline Calcium Phosphate Coating for Augmenting Bioactivity of Additively Manufactured Ti-6Al-4V

Additive manufacturing (AM) is being widely explored for engineering biomedical implants. The microstructure and surface finish of additively manufactured parts are typically different from wrought parts and exhibit limited bioactivity despite the other advantages of using AM for fabrication. The aim of this study was to enhance the bioactivity of selective laser melted Ti-6Al-4V alloy by electrophoretic deposition of nanohydroxyapatite (nanoHAp) coatings. The deposition parameters were systematically investigated after the coatings were deposited on the as-manufactured surface or after polishing the surface of the additively-manufactured sample. The surfaces were coated with nanoHAp suspended in either ethanol or butanol using different voltages (10, 30, or 50 V) for varied deposition times. The formation of the nanoHAp coating was confirmed by Fourier-transform infrared spectroscopy and X-ray diffraction. Microstructural analysis revealed that several conditions of the coating led to crack formation. The coated samples were subsequently heat-treated to improve the integrity of the coating. Heat treatment led to crack formation in several conditions due to thermal shrinkages. Coatings prepared using butanol were more uniform and had minimal cracks compared with the use of ethanol. Nanoindentation confirmed good stability and integrity of the nanoHAP coatings on the as-manufactured and polished surfaces. The coating on the as-manufactured sample exhibited higher hardness and lower elastic modulus as compared with the coating on the polished sample. In vitro study revealed that the nanoHAp coating markedly enhanced the attachment, proliferation, and differentiation of preosteoblasts on the alloy. These results provide a viable route to enhancing the bioactivity through deposition of nanoHAp with important implications for engineering additively manufactured orthopedic and dental implants suitable for better clinical performance.

Titanium and Other Metal Hypersensitivity Diagnosed by MELISA® Test: Follow-Up Study

This study is aimed at proving the clinical benefit of the MELISA® test in the minimization or complete elimination of health problems in patients with confirmed hypersensitivity to metals used for tissue replacements. A group of 305 patients aged 20-75 years with previously proven metal hypersensitivity (initial MELISA® test), mainly to titanium and then to another fifteen metals, was chosen from the database at the Institute of Dental Medicine. From these patients, a final group of 42 patients agreed to participate in the study, 35 of which were female and 7 were male. The patients completed a special questionnaire aimed at information regarding change of health status from their last visit and determining whether the results of the initial MELISA® test and recommendations based on it were beneficial for patients or not. They were clinically examined, and peripheral blood samples were taken to perform follow-up MELISA® tests. Questionnaire data was processed, and the follow-up MELISA® test results were compared with the results of the initial MELISA® tests. For statistical analysis, the Fisher's exact test and paired T-test were used. Thirty-two patients reported that they followed the recommendations based on the results of the initial MELISA® tests, and of these, 30 patients (94%) confirmed significant health improvement. Six patients did not follow the recommendation, and from these, only one patient reported an improvement in his health problems. By comparison of the initial and follow-up MELISA® test results, it can be stated that the hypersensitivity to the given metal decreased or disappeared after the therapeutic interventions performed based on the initial MELISA® test results. The evaluation of the data obtained from patients in this study confirmed a significant clinical benefit of MELISA® test.

Low-Temperature Hydrothermal Treatment Surface Functionalization of the Ultrafine-Grained TiMo Alloys for Medical Applications

Hydroxyapatite (HAp) is the most widely used material for bio coating. The functional layer can be produced by many methods, however, the most perspective by its utility, easy to scale up, and simplicity aspects remains a hydrothermal treatment approach. In this work, an HAp coating was produced by low-temperature hydrothermal treatment on the ultrafine-grain beta Ti-xMo (x = 23, 27, 35 wt.%) alloys. The proposed surface treatment procedure combines acid etching, alkaline treatment (AT), and finally hydrothermal treatment (HT). The uniqueness of the approach relies on the recognition of the influence of the molar concentration of NaOH (5 M, 7 M, 10 M, 12 M) during the alkaline treatment on the growth of hydroxyapatite crystals. Obtained and modified specimens were examined structurally and microstructurally at every stage of the process. The results show that the layer after AT consist of titanium oxide and phases based on sodium with various phase relations dependent on NaOH concentration and base composition. The AT in 7 M and 10 M enables to obtain the HAp layer, which can be characterized as the most developed in terms of thickness and porosity. Finally, selected coated samples were investigated in terms of surface wettability test managed in time relation, which for the results confirm high hydrophilicity of the surfaces. Conducted research shows that the low-temperature hydrothermal processing could be considered for a possible adaptation in the drug encapsulation and delivery systems.

Biomimetic vs. Direct Approach to Deposit Hydroxyapatite on the Surface of Low Melting Point Polymers for Tissue Engineering

Polymers are widely used in many applications in the field of biomedical engineering. Among eclectic selections of polymers, those with low melting temperature (T_m < 200 °C), such as poly(methyl methacrylate), poly(lactic-co-glycolic acid), or polyethylene, are often used in bone, dental, maxillofacial, and corneal tissue engineering as substrates or scaffolds. These polymers, however, are bioinert, have a lack of reactive surface functional groups, and have poor wettability, affecting their ability to promote cellular functions and biointegration with the surrounding tissue. Improving the biointegration can be achieved by depositing hydroxyapatite (HAp) on the polymeric substrates. Conventional thermal spray and vapor phase coating, including the Food and Drug Administration (FDA)-approved plasma spray technique, is not suitable for application on the low T_m polymers due to the high processing temperature, reaching more than 1000 °C. Two non-thermal HAp coating approaches have been described in the literature, namely, the biomimetic deposition and direct nanoparticle immobilization techniques. In the current review, we elaborate on the unique features of each technique, followed by discussing the advantages and disadvantages of each technique to help readers decide on which method is more suitable for their intended applications. Finally, the future perspectives of the non-thermal HAp coating are given in the conclusion.

Substituted hydroxyapatite coatings of bone implants

Surface modification of orthopedic and dental implants has been demonstrated to be an effective strategy to accelerate bone healing at early implantation times. Among the different alternatives, coating implants with a layer of hydroxyapatite (HAp) is one of the most used techniques, due to its excellent biocompatibility and osteoconductive behavior. The composition and crystalline structure of HAp allow for numerous ionic substitutions that provide added value, such as antibiotic properties or osteoinduction. In this article, we will review and critically analyze the most important advances in the field of substituted hydroxyapatite coatings. In recent years substituted HAp coatings have been deposited not only on orthopedic prostheses and dental implants, but also on macroporous scaffolds, thus expanding their applications towards bone regeneration therapies. Besides, the capability of substituted HAps to immobilize proteins and growth factors by non-covalent interactions has opened new possibilities for preparing hybrid coatings that foster bone healing processes. Finally, the most important in vivo outcomes will be discussed to understand the prospects of substituted HAp coatings from a clinical point of view.

Randomized controlled clinical trial on calcium phosphate coated and conventional SLA surface implants: 1-year study on survival rate and marginal bone level

BACKGROUND

Calcium phosphate (CaP)-coated surface showed enhanced contact osteogenesis around dental implant and finally accelerate osseointegration in early healing phase.

PURPOSE

The aim of this randomized controlled trial was to compare the peri-implant marginal bone level around uncoated and CaP-coated sandblasted, large-grit, acid-etched (SLA) surface implants during the first year after placement.

MATERIALS AND METHODS

This study was performed upon 34 patients with randomized and double-blinded design. Clinical and radiographic examinations were performed immediately after implant placement, at re-entry after 3 months, and after 12 months to evaluate the initial stability and change in the marginal bone level. The distance from the implant shoulder to the top of the bone-to-implant contact was defined as the marginal bone level, and its alteration was measured at 1 year after implant installation.

RESULTS

None of the implants failed, and most of them showed a marginal bone loss of less than 1 mm. Small changes in the bone level were noted at all sites in the control and test groups, and there were no clinically significant differences in the changes in the marginal bone.

CONCLUSION

Both CaP-coated and uncoated SLA surface implants showed comparably successful marginal bone stability without any complications during the first year after placement.

Electro-deposition of bactericidal and corrosion-resistant hydroxyapatite nanoslabs

Herein, nanoscale hydroxyapatite (HA) with a slab-like morphology was synthesized, and its size was calculated to be in the range of 80-150 nm, as confirmed via scanning electron microscopy (SEM) and atomic force microscopy (AFM). The nanoscale HA with a slab-like structure has been referred as HA nanoslabs in the manuscript. The composition, crystallinity, wettability, bacterial resistance porosity, surface roughness and corrosion resistance of these HA nanoslabs were studied using energy dispersive spectroscopy (EDAX), X-ray diffraction (XRD), contact angle, colony count BET analyzer and profilometer and polarization techniques, respectively. The contact angle of the HA nanoslabs was found to be 22.6°, which indicated the hydrophilic nature of these nanoslabs. Their bacterial resistance was studied against the Salmonella typhi strain, and it was found that in the presence of the HA nanoslabs, the growth of the bacteria was hindered. For the corrosion resistance study, the HA nanoslabs were electro-deposited on a titanium alloy, used as a substrate. The deposition was carried out at varying currents, viz, 1 mA, 3 mA and 5 mA. The open circuit potential (OCP) and polarization were used for the estimation of the corrosion resistance of the bare and coated substrates. The corrosion potential started shifting towards noble potential, and the current density started decreasing with an increase in the electrochemical deposition current. This indicated good corrosion resistance of these nanoslabs.

Surface modification of titanium with hydroxyapatite layer induced by phase-transited lysozyme coating

Surface modification of titanium with a hydroxyapatite (HAP) coating can improve the bioactivity of pristine titanium. The traditional techniques for coating HAP on titanium involve nonmild treatments using strong bases or acids or high temperatures. In this study, the coating of HAP was carried out by a novel methodology called phase-transited lysozyme-assisted hydroxyapatite formation (PAH); in this process of biomimetic mineralization, the abundant functional carboxyl groups of phase-transited lysozyme (PTL) were responsible for the nucleation of HAP crystals by concentrating Ca²⁺ ions at the interface between PTL and CaCl₂ solution and for the subsequent growth of HAP crystals occurring in simulated body fluid (SBF). In vitro and in vivo experiments verified that the surface of titanium modified with the HAP/PTL-Ti multilayer was endowed with improved biocompatibility and osteoinductivity compared with those of pristine titanium. Therefore, PAH is a simple, rapid, low-cost and green process for the surface modification of titanium with an HAP coating and thus will be a promising methodology for the surface modification of titanium implants.

Enhancement of the Adhesive Strength between Ag Films and Mo Substrate by Ag Implanted via Ion Beam-Assisted Deposition

Silver-coated molybdenum is an optimum material selection to replace pure silver as solar cell interconnector. However, the low adhesive strength between Ag films and Mo substrate hinders the application of the interconnector, because it is difficult to form metallurgical bonding or compound in the film/substrate interface using conventional deposition. In order to improve the adhesion, some Ag particles were implanted into the surface of Mo substrate by ion beam-assisted deposition (IBAD) before the Ag films were deposited by magnetron sputtering deposition (MD). The objective of this work was to investigate the effect of different assisted ion beam energy on the film/substrate adhesive properties. In addition, the fundamental adhesion mechanism was illustrated. The results revealed that the adhesion between Ag films and Mo substrate could be greatly enhanced by IBAD. With the increase of the assisting ion beam energy, the adhesive strength first increased and then decreased, with the optimum adhesion being able to rise to 25.29 MPa when the energy of the assisting ion beam was 30 keV. It could be inferred that the combination of &ldquo;intermixing layer&rdquo; and &ldquo;implanted layer&rdquo; formed by the high-energy ion bombardment was the key to enhancing the adhesion between Ag films and Mo substrate effectively.

Electrochemical and biological characterization HA/Al2 O3 -YSZ nano-composite coatings using electrophoretic process

In this research work, hydroxyapatite/alumina/YSZ bio nanocomposite coatings on titanium substrate were created by electrophoretic deposition (EPD) and reaction bonding process. By using the EPD process, uniform green form coatings containing HA, yttria-stabilized zirconia (YSZ), and aluminum particles were produced on titanium. After oxidation of aluminum at 660°C and sintering at 850°C, a dense and adherent HA/Al₂ O₃ /YSZ coating was produced. Scanning electron microscopy, X-ray diffractometric and mechanical tests were employed to investigate the morphologies, compositions, hardness, toughness and bonding strength of the coatings. The corrosion studies and cell culturing experiment were carried out and the results show that the HA/YSZ/Al₂ O₃ coatings are more bioactive and more resistance to corrosion than HA coatings. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 1916-1922, 2018.

Fabrication of Antibacterial and Antiwear Hydroxyapatite Coatings via In Situ Chitosan-Mediated Pulse Electrochemical Deposition

Although bioinert titanium has been widely applied in orthopedics and related fields, its usage is limited by its unsatisfying osteoinductivity, anti-infection capability, and wear-resistance. Osteoinductive apatite coating can be fabricated on a titanium surface by electrochemical methods, but this causes bacterial adhesion and poor wear-resistance. On the basis of pulse electrochemical technology, a wear-resistance and antibacterial osteoinductive coating was fabricated through codeposition of hydroxyapatite (HA) and nano-Ag effectuated by the cohybridization ofchitosan (CS) with Ag⁺ and Ca²⁺. A composite coating formed with uniformly dispersed spherical nanoparticles was obtained at optimized deposition potential, Ag concentration, and apatite concentration. The nanocomposite coating shows excellent bioinductive activity; it promotes preferential growth on the (002) face, and needle-like ordered arrangement of apatite. Due to the mediation of CS hybridization, a compact structure is achieved in the HA/Ag composite coating which significantly enhances the wear-resistance of the coating and reduces the release of Ca²⁺ and Ag⁺. The antibacterial rate of the coating on Escherichia coli and Staphylococcus aureus is up to 99% according to the antibacterial test. In conclusion, a wear-resistant and long-term antibacterial bioactive nanocomposite coating is successfully fabricated on titanium surface through the strategy established in this study.

Prospective randomized clinical trial of hydrophilic tapered implant placement at maxillary posterior area: 6 weeks and 12 weeks loading

PURPOSE

Early loading of implant can be determined by excellent primary stability and characteristic of implant surface. The implant system with recently improved surface can have load application 4-6 weeks after installing in maxilla and mandible. This study evaluated the effect of healing period to the stability of hydrophilic tapered-type implant at maxillary posterior area.

MATERIALS AND METHODS

This study included 30 patients treated by hydrophilic tapered-type implants (total 41 implants at maxilla) and classified by two groups depending on healing period. Group 1 (11 patients, 15 implants) was a control group and the healing period was 12 weeks, and Group 2 (19 patients, 26 implants) was test group and the healing period was 6 weeks. Immediately after implant placement, at the first impression taking, implant stability was measured using Osstell Mentor. The patients also took periapical radiographs after restoration delivery, 12 months after restoration and final followup period. The marginal bone loss around the implants was measured using the periapical radiographs.

RESULTS

All implants were survived and success rate was 97.56%. The marginal bone loss was less than 1mm after 1 year postoperatively except the one implant. The stabilities of the implants were not correlated with age, healing period until loading, insertion torque (IT), the diameter of fixture and the location of implant. Only the quality of bone in group 2 (6 week) was correlated with the stability of implant.

CONCLUSION

Healing period of 6 weeks can make the similar clinical prognosis of implants to that of healing period of 12 weeks if bone quality is carefully considered in case of early loading.

Hydroxyapatite-TiO2 Hybrid Coating on Ti Implants

A hydroxyapatite (HA)-titania (TiO2) hybrid coating is developed to improve the biocompatibility of titanium (Ti) implants. The HA predeposited layer on Ti via electron beam (e-beam) evaporation is subsequently treated by micro-arc oxidation (MAO) to produce an HA-TiO2 hybrid layer on Ti. The e-beam-deposited HA layer has a thickness of ≈1 μm and was highly dense prior to MAO. By means of MAO treatment, a rough and porous TiO2 layer is formed beneath the HA layer with a simultaneous local dissolution of the HA layer. Due to the HA precoating, high concentrations of Ca and P are preserved on the coating surface. The osteoblast-like cells on the hybrid coating layer grow and spread favorably. The cell proliferation rate on the hybrid coatings is not much different from that on pure Ti or simple MAO-treated Ti. However, the alkaline phosphatase (ALP) activity of the cells is significantly higher ( p < 0.05) on the HA-TiO2 hybrid coatings than on either the pure Ti or the simple MAO-treated specimen, suggesting that the cellular activity on the hybrid coatings is improved.

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.

Chitosan/siRNA functionalized titanium surface via a layer-by-layer approach for in vitro sustained gene silencing and osteogenic promotion

Titanium surface modification is crucial to improving its bioactivity, mainly its bone binding ability in bone implant materials. In order to functionalize titanium with small interfering RNA (siRNA) for sustained gene silencing in nearby cells, the layer-by-layer (LbL) approach was applied using sodium hyaluronate and chitosan/siRNA (CS/siRNA) nanoparticles as polyanion and polycation, respectively, to build up the multilayered film on smooth titanium surfaces. The CS/siRNA nanoparticle characterization was analyzed first. Dynamic contact angle, atomic force microscopy, and scanning electron microscopy were used to monitor the layer accumulation. siRNA loaded in the film was quantitated and the release profile of film in phosphate-buffered saline was studied. In vitro knockdown effect and cytotoxicity evaluation of the film were investigated using H1299 human lung carcinoma cells expressing green fluorescent protein (GFP). The transfection of human osteoblast-like cell MG63 and H1299 were performed and the osteogenic differentiation of MG63 on LbL film was analyzed. The CS/siRNA nanoparticles exhibited nice size distribution. During formation of the film, the surface wettability, topography, and roughness were alternately changed, indicating successful adsorption of the individual layers. The scanning electron microscope images clearly demonstrated the hybrid structure between CS/siRNA nanoparticles and sodium hyaluronate polymer. The cumulated load of siRNA increased linearly with the bilayer number and, more importantly, a gradual release of the film allowed the siRNA to be maintained on the titanium surface over approximately 1 week. In vitro transfection revealed that the LbL film-associated siRNA could consistently suppress GFP expression in H1299 without showing significant cytotoxicity. The LbL film loading with osteogenic siRNA could dramatically increase the osteogenic differentiation in MG63. In conclusion, LbL technology can potentially modify titanium surfaces with specific gene-regulatory siRNAs to enhance biofunction.

Significance of calcium phosphate coatings for the enhancement of new bone osteogenesis--a review

A systematic analysis of results available from in vitro, in vivo and clinical trials on the effects of biocompatible calcium phosphate (CaP) coatings is presented. An overview of the most frequently used methods to prepare CaP-based coatings was conducted. Dense, homogeneous, highly adherent and biocompatible CaP or hybrid organic/inorganic CaP coatings with tailored properties can be deposited. It has been demonstrated that CaP coatings have a significant effect on the bone regeneration process. In vitro experiments using different cells (e.g. SaOS-2, human mesenchymal stem cells and osteoblast-like cells) have revealed that CaP coatings enhance cellular adhesion, proliferation and differentiation to promote bone regeneration. However, in vivo, the exact mechanism of osteogenesis in response to CaP coatings is unclear; indeed, there are conflicting reports of the effectiveness of CaP coatings, with results ranging from highly effective to no significant or even negative effects. This review therefore highlights progress in CaP coatings for orthopaedic implants and discusses the future research and use of these devices. Currently, an exciting area of research is in bioactive hybrid composite CaP-based coatings containing both inorganic (CaP coating) and organic (collagen, bone morphogenetic proteins, arginylglycylaspartic acid etc.) components with the aim of promoting tissue ingrowth and vascularization. Further investigations are necessary to reveal the relative influences of implant design, surgical procedure, and coating characteristics (thickness, structure, topography, porosity, wettability etc.) on the long-term clinical effects of hybrid CaP coatings. In addition to commercially available plasma spraying, other effective routes for the fabrication of hybrid CaP coatings for clinical use still need to be determined and current progress is discussed.

Dissolution behavior and early bone apposition of calcium phosphate-coated machined implants

Purpose

Calcium phosphate (CaP)-coated implants promote osseointegration and survival rate. The aim of this study was to (1) analyze the dissolution behavior of the residual CaP particles of removed implants and (2) evaluate bone apposition of CaP-coated machined surface implants at the early healing phase.

Methods

Mandibular premolars were extracted from five dogs. After eight weeks, the implants were placed according to drilling protocols: a nonmobile implant (NI) group and rotational implant (RI) group. For CaP dissolution behavior analysis, 8 implants were removed after 0, 1, 2, and 4 weeks. The surface morphology and deposition of the coatings were observed. For bone apposition analysis, block sections were obtained after 1-, 2-, and 4-week healing periods and the specimens were analyzed.

Results

Calcium and phosphorus were detected in the implants that were removed immediately after insertion, and the other implants were composed mainly of titanium. There were no notable differences between the NI and RI groups in terms of the healing process. The bone-to-implant contact and bone density in the RI group showed a remarkable increase after 2 weeks of healing.

Conclusions

It can be speculated that the CaP coating dissolves early in the healing phase and chemically induces early bone formation regardless of the primary stability.

Proteomic analysis of the biological response of MG63 osteoblast-like cells to titanium implants

Understanding of the interaction between human MG63 osteoblast-like cells and surfaces is necessary in the field of tissue engineering and biomaterials. Various titanium surfaces are widely used as not only implant materials, but also as miniscrews in orthodontics. Our goal was to assess the proteomic response of MG63 osteoblast-like cells to different titanium surfaces. MG63 osteoblast-like cells were cultured on three different titanium surfaces: a smooth surface (S), a sandblasted with large grit and acid-etched surface (SLA), and a surface coated with a thin layer of hydroxyapatite (HA). Cells grown on the rougher surfaces (SLA and HA) exhibited downregulated cell proliferation and morphological changes. In the proteomic analysis, cells grown on the SLA surface showed upregulated expression of protocadherin-β3 precursor, kinase insert domain receptor, fibroblast growth factor receptor-3, and insulin-like growth factor I, while the expression levels of cell adhesion kinase, collagen α-1(I) chain precursor, collagen type XI α2, and cadherin-11 were upregulated in cells grown on the HA surface. These proteins are known to be involved in osteoblast adhesion, growth, and differentiation. Thus, the surface properties of dental materials can influence the expression of proteins involved in osseointegration-related processes. Proteomic analysis may reveal changes in novel proteins that explain why osseointegration varies depending on surface properties.

Diamond as a scaffold for bone growth

Diamond is an attractive material for biomedical implants. In this work, we investigate its capacity as a bone scaffold. It is well established that the bioactivity of a material can be evaluated by examining its capacity to form apatite-like calcium phosphate phases on its surface when exposed to simulated body fluid. Accordingly, polycrystalline diamond (PCD) and ultrananocrystalline diamond (UNCD) deposited by microwave plasma chemical vapour deposition were exposed to simulated body fluid and assessed for apatite growth when compared to the bulk silicon. Scanning electron microscopy and X-ray photoelectron spectroscopy showed that both UNCD and PCD are capable of acting as a bone scaffold. The composition of deposited apatite suggests that UNCD and PCD are suitable for in vivo implantation with UNCD possible favoured in applications where rapid osseointegration is essential.

Mg ion implantation on SLA-treated titanium surface and its effects on the behavior of mesenchymal stem cell

Magnesium (Mg) is one of the most important ions associated with bone osseointegration. The aim of this study was to evaluate the cellular effects of Mg implantation in titanium (Ti) surfaces treated with sand blast using large grit and acid etching (SLA). Mg ions were implanted into the surface via vacuum arc source ion implantation. The surface morphology, chemical properties, and the amount of Mg ion release were evaluated by scanning electron microscopy (SEM), Auger electron spectroscopy (AES), Rutherford backscattering spectroscopy (RBS), and inductively coupled plasma-optical emission spectrometer (ICP-OES). Human mesenchymal stem cells (hMSCs) were used to evaluate cellular parameters such as proliferation, cytotoxicity, and adhesion morphology by MTS assay, live/dead assay, and SEM. Furthermore, osteoblast differentiation was determined on the basis of alkaline phosphatase (ALP) activity and the degree of calcium accumulation. In the Mg ion-implanted disk, 2.3×10(16) ions/cm(2) was retained. However, after Mg ion implantation, the surface morphology did not change. Implanted Mg ions were rapidly released during the first 7 days in vitro. The MTS assay, live/dead assay, and SEM demonstrated increased cell attachment and growth on the Mg ion-implanted surface. In particular, Mg ion implantation increased the initial cell adhesion, and in an osteoblast differentiation assay, ALP activity and calcium accumulation. These findings suggest that Mg ion implantation using the plasma source ion implantation (PSII) technique may be useful for SLA-treated Ti dental implants to improve their osseointegration capacity.

Hydroxylapatite nanoparticles: fabrication methods and medical applications

Hydroxylapatite (or hydroxyapatite, HAp) exhibits excellent biocompatibility with various kinds of cells and tissues, making it an ideal candidate for tissue engineering, orthopedic and dental applications. Nanosized materials offer improved performances compared with conventional materials due to their large surface-to-volume ratios. This review summarizes existing knowledge and recent progress in fabrication methods of nanosized (or nanostructured) HAp particles, as well as their recent applications in medical and dental fields. In section 1, we provide a brief overview of HAp and nanoparticles. In section 2, fabrication methods of HAp nanoparticles are described based on the particle formation mechanisms. Recent applications of HAp nanoparticles are summarized in section 3. The future perspectives in this active research area are given in section 4.

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.

Recent advances in research applications of nanophase hydroxyapatite

Hydroxyapatite, the main inorganic material in natural bone, has been used widely for orthopaedic applications. Due to size effects and surface phenomena at the nanoscale, nanophase hydroxyapatite possesses unique properties compared to its bulk-phase counterpart. The high surface-to-volume ratio, reactivities, and biomimetic morphologies make nano-hydroxyapatite more favourable in applications such as orthopaedic implant coating or bone substitute filler. Recently, more efforts have been focused on the possibility of combining hydroxyapatite with other drugs and materials for multipurpose applications, such as antimicrobial treatments, osteoporosis treatments and magnetic manipulation. To build more effective nano-hydroxyapatite and composite systems, the particle synthesis processes, chemistry, and toxicity have to be thoroughly investigated. In this Minireview, we report the recent advances in research regarding nano-hydroxyapatite. Synthesis routes and a wide range of applications of hydroxyapatite nanoparticles will be discussed. The Minireview also addresses several challenges concerning the biosafety of the nanoparticles.

Thin-layer hydroxyapatite deposition on a nanofiber surface stimulates mesenchymal stem cell proliferation and their differentiation into osteoblasts

Pulsed laser deposition was proved as a suitable method for hydroxyapatite (HA) coating of coaxial poly-ɛ-caprolactone/polyvinylalcohol (PCL/PVA) nanofibers. The fibrous morphology of PCL/PVA nanofibers was preserved, if the nanofiber scaffold was coated with thin layers of HA (200 nm and 400 nm). Increasing thickness of HA, however, resulted in a gradual loss of fibrous character. In addition, biomechanical properties were improved after HA deposition on PCL/PVA nanofibers as the value of Young's moduli of elasticity significantly increased. Clearly, thin-layer hydroxyapatite deposition on a nanofiber surface stimulated mesenchymal stem cell viability and their differentiation into osteoblasts. The optimal depth of HA was 800 nm.

Ti-Nb-Sn-hydroxyapatite composites synthesized by mechanical alloying and high frequency induction heated sintering

A β-type Ti-based composite, Ti-35Nb-2.5Sn-15-hydroxyapatite (HA), has been synthesized by mechanical alloying and powder metallurgy. The effects of milling time on microstructure, mechanical properties and biocompatibility of the sintered composites were investigated by scanning electronic microscopy (SEM), X-ray diffraction (XRD), microhardness tests, compression tests and cells culture. The results revealed when milling time increased, the homogeneity and relative density of the sintered composite increased, but the finished sintering temperature decreased. The compression Young's modulus of sintered composite from 12 h milled powders was about 22 GPa and its compression strength was 877 MPa. The cell culture results indicated cell viability for these sintered composites was very good. These results revealed the Ti-35Nb-2.5Sn-15HA composite could be useful for medical implants.

The effect of fibronectin-coated implant on canine osseointegration

Purpose

The purpose of this study was to characterize the osseointegration of the fibronectin-coated implant surface.

Methods

Sand-blasted, large-grit, acid-etched (SLA) surface implants, with or without a thin calcium phosphate and fibronectin coating, were placed in edentulous mandibles of dogs 8 weeks after extraction. All dogs were sacrificed forhistological and histomorphometric evaluation after 4- and 8-week healing periods.

Results

All types of implants were clinically stable without any mobility. Although the bone-to-implant contact and bone density of the SLA implants coated with calcium phosphate (CaP)/fibronectin were lower than the uncoated SLA implants, there were no significant differences between the uncoated SLA surface group and the SLA surface coated with CaP/fibronectin group.

Conclusions

Within the limits of this study, SLA surfaces coated with CaP/fibronectin were shown to have comparable bone-to-implant contact and bone density to uncoated SLA surfaces.

Improved biocompatibility of hydroxyapatite thin film prepared by aerosol deposition

Technical development for an efficient coating of bioactive materials improves the characteristics of a fully functional implant. The aim of this study was to investigate the osteoinductive effect of a newly developed hydroxyapatite (HA)-coating technique using aerosol deposition without post-heat treatment [room temperature (RT) group] on the titanium (Ti) dental implant in vitro and in vivo, compared with that of HA coating with post-heat treatment (HT-400 group) or machined surface (control group). Cell proliferation or attachment on the HA-coated Ti surface was assessed using tetrazolium salt, WST-8 or scanning electron microscopy (SEM). Human osteoblasts (HOB) on RT group were well attached and grew alike in the control or HT-400 group. The alkaline phosphatase activity of HOB cultured on RT and HT-400 group was significantly higher than the control group (p < 0.05). Evaluation by SEM, TEM, and XRD demonstrated that aerosol deposition facilitated HA particles to form a dense and uniform HA layer in the RT group despite no post-heating. In a rabbit tibia model (n = 3), the ratios of bone implant contact and bone area in the RT group (49.88%, 86.05%) were greater than in the HT-400 group (38.82%, 77.34%) or the control (28.31%, 73.86%). The finding of this study showed that the HA coating using aerosol deposition without post-heat treatment has a good biocompatibility, and provide a promoting strategy to enhance osseointegration in the application of the dental implant.

Enhanced bone forming ability of SLA-treated Ti coated with a calcium phosphate thin film formed by e-beam evaporation

With an electron-beam evaporation process, a calcium phosphate (Ca-P) thin film of approximately 500 nm thick was deposited on sand blasted with large grits and acid etched (SLA) Ti without changing the typical morphology of the SLA surface. Dissolution behavior was investigated by measuring the amount of dissolved phosphate ions with ion chromatography after immersing the SLA Ti sample coated with a Ca-P film in 1 ml de-ionized water maintained at 37 degrees C for different periods of soaking time, and the surface morphology was observed with field emission scanning electron microscopy. The amount of phosphate ions increased quickly right after immersion but began to decrease after 2 days of immersion by redeposition with Ca ions as apatite, and the amount of biomimetic apatite increased with the extended soaking time. The Saos-2 cell was more attached on the coated surface, and the in vivo evaluation was that the Ca-P deposited SLA implant greatly improved the new bone formation ability.

Biomimetic apatite formation on calcium phosphate-coated titanium in Dulbecco's phosphate-buffered saline solution containing CaCl(2) with and without fibronectin

Calcium phosphate (CaP) thin films with different degrees of crystallinity were coated on the surfaces of commercially pure titanium by electron beam evaporation. The details of apatite nucleation and growth on the coating layer were investigated in Dulbecco's phosphate-buffered saline solutions containing calcium chloride (DPBS) or DPBS with fibronectin (DPBSF). The surfaces of the samples were examined by field emission scanning electron microscopy, X-ray diffraction and X-ray photoelectron spectroscopy. The concentrations of fibronectin and calcium ions (Ca(2+)) were monitored by the bicinchoninic acid method (BCA) and use of a calcium assay kit (DICA-500), respectively. Apatite initially formed at the fastest rate on the CaP-coated samples with the lowest degree of crystallinity and reached the maximum Ca(2+) concentration after immersion in DPBS solution for 15min. After 15min the concentration of Ca(2+) decreased with the growth of apatite on the coating layers. For all the samples the maximum Ca(2+) concentration in the DPBS solutions decreased with increasing crystallinity and immersion time to reach the maximum concentration increased. The presence of fibronectin in the DPBS solutions delayed the formation and affected the morphology of the apatite. Fibronectin incorporated into apatite deposited on the surface of titanium did not affect its biological activity in terms of promoting osteoblast adhesion.

Deposition and investigation of functionally graded calcium phosphate coatings on titanium

A series of calcium phosphate coatings with graded crystallinity were deposited onto heated titanium substrates using ion beam assisted deposition. The microstructure of the coating was examined using transmission electron microscopy (TEM). The coating thickness was observed to be in a range of 594-694 nm. The degree of crystallinity and microstructural grain size of the coating showed a clear decrease with increasing distance from the substrate-coating interface. Fourier transform infrared spectroscopy (FTIR) confirmed the presence of PO(4)(3-), and X-ray photoelectron spectroscopy (XPS) analysis on the coating top surface showed that the atomic Ca/P ratio was in the range of 1.52+/-0.15 to 1.61+/-0.07. The biological response to the coatings was also evaluated using an osteoblast precursor cell culture test. More cells and a higher integrin expression of cell attachment sites were observed on the coating surface when compared to the control group (blank titanium surface). The pull-off test showed average adhesion strengths at the coating-substrate interface to be higher than 85.12+/-5.37 MPa. Nanoindentation tests indicated that the Young's moduli of all coatings are higher than 91.747+/-3.641 GPa and microhardness values are higher than 5.275+/-0.315 GPa. While the adhesion strength results helped us to identify the best setup for substrate temperature and processing parameters to begin the deposition, the culture test and XPS results helped identifying the optimum parameters for the last stage of deposition. TEM, X-ray diffraction, FTIR and nanoidentation results were used to further evaluate the quality of the coating and optimization of its processing parameters.

Effects of calcium phosphate coating to SLA surface implants by the ion-beam-assisted deposition method on self-contained coronal defect healing in dogs

The aim of this study was to evaluate the healing of self-contained coronal defects on a sand-blasted, large-grit, acid-etched (SLA) surface implant, which had a calcium phosphate (CaP) coating applied by ion-beam-assisted deposition (IBAD). We also evaluated the effect of heating the coating to different temperatures. The CaP-coated SLA implants exhibited a slightly larger bone healing capacity in the self-contained coronal defect than SLA implants, indicating that combining SLA surface implants and a CaP coating by the IBAD method had synergistic effects on bone healing. There was no difference in the healing capacity between 350 degrees C and 450 degrees C heat treatment of the coating layer.

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.

UV-enhanced bioactivity and cell response of micro-arc oxidized titania coatings

Using ultraviolet (UV) irradiation of micro-arc oxidized (MAO) titania coating in distilled water for 0.5 and 2h, we have achieved an enhanced bioactivity and cell response to titania surface. The MAO coating appears porous and predominantly consists of nanocrystallized anatase TiO(2). Compared with the MAO coating, the UV-irradiated coatings do not exhibit any obvious change in surface roughness, morphology, grain size and phase component; however, they have more abundant basic Ti-OH groups and become more hydrophilic because the water contact angle decreases significantly from 17.9+/-0.8 degrees to 0 degrees . In simulated body fluid (SBF), bonelike apatite-forming ability is significantly stronger on the UV-irradiated coatings than the MAO coating. SaOS-2 human osteoblast-like cell attachment, proliferation and alkaline phosphatase of the cell are greater on the UV-irradiated coatings relative to the MAO coating. UV irradiation of titania results in the conversion of Ti(4+) to Ti(3+) and the generation of oxygen vacancies, which could react with the absorbed water to form basic Ti-OH groups. The enhanced bioactivity and cell response of the UV-irradiated coatings are proven to result from abundant Ti-OH groups on the coating surfaces. After storing the UV-irradiated coatings in the dark for two weeks, the basic Ti-OH groups on the coatings slightly decrease in amount and can induce apatite formation after a short period of SBF immersion, and show relative long-term stability.