Atomic Layer Deposition of Bioactive TiO2 Thin Films on Polyetheretherketone for Orthopedic Implants

A comprehensive review on the State of the Art in the research and development of poly-ether-ether-ketone (PEEK) biomaterial-based implants

Polyetheretherketone (PEEK) is a preferred high-performance polymer in the spine, orthopedic, and craniomaxillofacial implant industry. However, despite its commendable mechanical properties, its bioinert nature limits the implants from integrating with neighboring tissues, impacting the implant's long-term performance. To address this limitation, various kinds of surface functionalization techniques have been developed over the years. Noteworthy efforts have been made to incorporate bioactive fillers in the PEEK matrix to develop standalone bioactive composites. In personalized medicine, significant advances have been made in the 3D Printing of PEEK implants. 3D-printed PEEK implants are now being developed at Point-of-Care, significantly reducing manufacturing and logistic time. Given the recent clinical follow-up updates and advancements in PEEK-based implants, PEEK implants are witnessing an important phase in its history. Recognizing this vital phase, this paper aims to comprehensively review the advancements of PEEK implants over the past decade. The review starts with an overview of the clinical impact of varying PEEK implants, followed by PEEK's surface functionalization techniques and engineering of PEEK-based bioactive composites. Next, this review describes the advancements made in the 3D printing of PEEK implants and points out the essential considerations that should be considered when developing 3D-printed PEEK-based implants. Finally, the review ends with an estimated projection about the future of PEEK-based implants. Readers are expected to gain an all-encompassing and in-depth understanding of PEEK biomedical implants' past, present, and future, enabling researchers to advance the research and development of PEEK-based implants in the required direction. STATEMENT OF SIGNIFICANCE: PEEK is a preferred high-performance polymer in the implant industry, with notable benefits over metallic and ceramic implants, such as bone-matching stiffness and durability. Significant strides have been made in the last decade to make PEEK implants bioactive and utilize 3D Printing to develop patient-specific implants. Given the recent advancements in PEEK-based implants, this review aims to provide an all-encompassing and in-depth understanding of PEEK biomedical implants' past, present, and future. It will comprehensively discuss the know-how gained from the clinical follow-up, the strategies to address the limitations of PEEK implants, and the essential considerations in 3D Printing of PEEK implants. This review will enable researchers to advance the research and development of PEEK implants in the required direction.

Fabrication of anodic and atomic layer deposition-alumina coated titanium implants for effective osteointegration applications

Biomimicking the chemical, mechanical, and topographical properties of bone on an implant model is crucial to obtain rapid and effective osteointegration, especially for the large-area fractures of the skeletal system. Titanium-based biomaterials are more frequently preferred in clinical use in such cases and coating these materials with oxide layers having chemical/nanotopographic properties to enhance osteointegration and implantation success rates has been studied for a long time. The objective of this study is to examine the high and rapid mineralization potential of anodized aluminum oxide (AAO) coated and atomic layer deposition (ALD)-alumina coated titanium substrates on large deformation areas with difficult spontaneous healing. AAO-coated titanium (AAO@Ti) substrates were fabricated via anodization technique in different electrolytes and their osteogenic potential was analyzed by comparing them to the bare titanium surface as a control. In order to investigate the effect of the ionic characters gained by the surfaces through anodization, the oxidized nanotopographic substrates were additionally coated with an ultrathin alumina layer via ALD (ALD@AAO@Ti), which is a sensitive and conformal coating vapor deposition technique. Besides, a bare titanium sample was also coated with pure alumina by ALD (ALD@Ti) to investigate the effect of nanoscale surface morphology. XPS analysis after ALD coating showed that the ionic character of each surface fabricated by anodization was successfully suppressed. In vitro studies demonstrated that, among the substrates investigated, the mineralization capacity of MG-63 osteosarcoma cells were highest when incubated on ALD-treated and bare AAO@Ti samples that were anodized in phosphoric acid (H3PO4_AAO@Ti and ALD@H3PO4_AAO@Ti). Mineralization on these substrates also increased consistently beginning from day 2 to day 21. Moreover, immunocytochemistry for osteopontin (OPN) demonstrated the highest expression for ALD@H3PO4_AAO@Ti, followed by the H3PO4_AAO@Ti sample. Consequently, it was observed that, although ALD treatment improves cellular characteristics on all samples, effective mineralization requires more than a simple ALD coating or the presence of a nanostructured topography. Overall, ALD@H3PO4_AAO@Ti substrates can be considered as an implant alternative with its enhanced osteogenic differentiation potential and rapid mineralization capacity.

Area Selective Atomic Layer Deposition for the Use on Active Implants: An Overview of Available Process Technology

Area-selective atomic layer deposition (ASD) is a bottom-up process that is of particular importance in the semiconductor industry, as it prevents edge defects and avoids cost-intensive lithography steps. This approach not only offers immense potential for the manufacture of active implants but can also be used to improve them. This review paper presents various processes that can be used for this purpose. It also identifies aspects that shall be considered when implementing such a process for medical applications. For example, the inherent selectivity can be used to produce new biosensors, the passivated ASD can be used to encapsulate polymer-based implants, and the activated ASD can be used to improve electrode performance. Finally, the aspects that shall be considered in a coating for active implants are highlighted. ASD therefore offers great potential for use on active implants.

A Comprehensive Review on Manufacturing and Characterization of Polyetheretherketone Polymers for Dental Implant Applications

Aging, tooth trauma, and pathological infections cause partial or total tooth loss, leading to the usage of dental implants for restoration treatments. As such, mechanical and tribological properties play an important role in the osseointegration and durability of these implants. Metallic and ceramic implants are shown to have mechanical properties much higher than the natural teeth structure, leading to stress shielding-related failure of an implant. Stress shielding occurs due to the difference in the elastic modulus between the implant material and the surrounding teeth structure, leading to bone loss and implant failure. The implant's properties (i.e., mechanical) should be as close as human teeth components. To achieve this, various materials and coatings are being developed and investigated. This review is a comprehensive survey of materials, manufacturing, coating techniques, and mechanical and tribological characterizations of dental implants, with a particular focus on polyetheretherketone (PEEK) as a potential alternative dental implant material. PEEK has mechanical properties similar to natural teeth, which make it a promising material for dental implants. The findings of this review suggest that PEEK offers superior biocompatibility, osseointegration, and wear resistance for implant applications. With the help of bioactive coatings, bone growth on the implant surface can be promoted. In addition, PEEK dental implants made using three-dimensional (3D) printing technology can significantly reduce the cost of implants, making them more affordable and increasing access to dental care, which can improve oral health significantly. In summary, this review highlights the potential of PEEK as a promising alternative dental implant material, and provides an overview of various techniques, testing, and future directions for PEEK dental implants.

Atomic layer deposited TiO2 nanofilm on titanium implant for reduced the release of particles

Objective: Titanium implants are widely used in surgeries for their biocompatibility and mechanical properties. However, excessive titanium particle release can cause implant failure. This study explores Atomic Layer Deposition (ALD) to coat commercially pure titanium (Cp-Ti) with TiO2, aiming to improve its frictional and corrosion resistance while reducing particle release. By comparing TiO2 films with varying ALD cycle numbers, we assess surface properties, particle release, friction, and corrosion performance, providing insights into mitigating particle release from implants. Methods: Cp-Ti surfaces were prepared and coated with TiO2 films of 100, 300, and 500 ALD cycles. Surface characterization involved SEM, EDX, and XRD. Friction was tested using SEM, nanoindentation, and ICP-MS. Corrosion resistance was evaluated through immersion tests and electrochemical analysis. Cytotoxicity was assessed using BMSCs. Results: Surface characterization revealed smoother surfaces with increased ALD cycles, confirming successful TiO2 deposition. Friction testing showed reduced friction coefficients with higher ALD cycles, supported by nanoindentation results. Corrosion resistance improved with increasing ALD cycles, as evidenced by electrochemical tests and reduced titanium release. Cytotoxicity studies showed no significant cytotoxic effects. Conclusion: ALD-coated TiO2 films significantly enhance frictional and corrosion resistance of titanium implants while reducing particle release. The study underscores the importance of ALD cycle numbers in optimizing film performance, offering insights for designing implants with improved properties.

Ultrathin TiO2 Coatings via Atomic Layer Deposition Strongly Improve Cellular Interactions on Planar and Nanotubular Biomedical Ti Substrates

This work aims to investigate the chemical and/or structural modification of Ti and Ti-6Al-4V (TiAlV) alloy surfaces to possess even more favorable properties toward cell growth. These modifications were achieved by (i) growing TiO2 nanotube layers on these substrates by anodization, (ii) surface coating by ultrathin TiO2 atomic layer deposition (ALD), or (iii) by the combination of both. In particular, an ultrathin TiO2 coating, achieved by 1 cycle of TiO2 ALD, was intended to shade the impurities of F- and V-based species in tested materials while preserving the original structure and morphology. The cell growth on TiO2-coated and uncoated TiO2 nanotube layers, Ti foils, and TiAlV alloy foils were compared after incubation for up to 72 h. For evaluation of the biocompatibility of tested materials, cell lines of different tissue origin, including predominantly MG-63 osteoblastic cells, were used. For all tested nanomaterials, adding an ultrathin TiO2 coating improved the growth of MG-63 cells and other cell lines compared with the non-TiO2-coated counterparts. Here, the presented approach of ultrathin TiO2 coating could be used potentially for improving implants, especially in terms of shading problematic F- and V-based species in TiO2 nanotube layers.

Atomic Layer Deposition of Tantalum Oxide Films on 3D-Printed Ti6Al4V Scaffolds with Enhanced Osteogenic Property for Orthopedic Implants

There is an evident advantage in personalized customization of orthopedic implants by 3D-printed titanium (Ti) and its alloys. However, 3D-printed Ti alloys have a rough surface structure caused by adhesion powders and a relatively bioinert surface. Therefore, surface modification techniques are needed to improve the biocompatibility of 3D-printed Ti alloy implants. In the present study, porous Ti6Al4V scaffolds were manufactured by a selective laser melting 3D printer, followed by sandblasting and acid-etching treatment and atomic layer deposition (ALD) of tantalum oxide films. SEM morphology and surface roughness tests confirmed that the unmelted powders adhered on the scaffolds were removed by sandblasting and acid-etching. Accordingly, the porosity of the scaffold increased by about 7%. Benefiting from the self-limitation and three-dimensional conformance of ALD, uniform tantalum oxide films were formed on the inner and outer surfaces of the scaffolds. Zeta potential decreased by 19.5 mV after depositing tantalum oxide films. The in vitro results showed that the adhesion, proliferation, and osteogenic differentiation of rat bone marrow mesenchymal stem cells on modified Ti6Al4V scaffolds were significantly enhanced, which may be ascribed to surface structure optimization and the compatibility of tantalum oxide. This study provides a strategy to improve the cytocompatibility and osteogenic differentiation of porous Ti6Al4V scaffolds for orthopedic implants.

In Vitro Study of Zirconia Surface Modification for Dental Implants by Atomic Layer Deposition

Zirconia is a promising material for dental implants; however, an appropriate surface modification procedure has not yet been identified. Atomic layer deposition (ALD) is a nanotechnology that deposits thin films of metal oxides or metals on materials. The aim of this study was to deposit thin films of titanium dioxide (TiO₂), aluminum oxide (Al₂O₃), silicon dioxide (SiO₂), and zinc oxide (ZnO) on zirconia disks (ZR-Ti, ZR-Al, ZR-Si, and ZR-Zn, respectively) using ALD and evaluate the cell proliferation abilities of mouse fibroblasts (L929) and mouse osteoblastic cells (MC3T3-E1) on each sample. Zirconia disks (ZR; diameter 10 mm) were fabricated using a computer-aided design/computer-aided manufacturing system. Following the ALD of TiO₂, Al₂O₃, SiO₂, or ZnO thin film, the thin-film thickness, elemental distribution, contact angle, adhesion strength, and elemental elution were determined. The L929 and MC3T3-E1 cell proliferation and morphologies on each sample were observed on days 1, 3, and 5 (L929) and days 1, 4, and 7 (MC3T3-E1). The ZR-Ti, ZR-Al, ZR-Si, and ZR-Zn thin-film thicknesses were 41.97, 42.36, 62.50, and 61.11 nm, respectively, and their average adhesion strengths were 163.5, 140.9, 157.3, and 161.6 mN, respectively. The contact angle on ZR-Si was significantly lower than that on all the other specimens. The eluted Zr, Ti, and Al amounts were below the detection limits, whereas the total Si and Zn elution amounts over two weeks were 0.019 and 0.695 ppm, respectively. For both L929 and MC3T3-E1, the cell numbers increased over time on ZR, ZR-Ti, ZR-Al, and ZR-Si. Particularly, cell proliferation in ZR-Ti exceeded that in the other samples. These results suggest that ALD application to zirconia, particularly for TiO₂ deposition, could be a new surface modification procedure for zirconia dental implants.

Biomaterials as Implants in the Orthopedic Field for Regenerative Medicine: Metal versus Synthetic Polymers

Patients suffering bone fractures in different parts of the body require implants that will enable similar function to that of the natural bone that they are replacing. Joint diseases (rheumatoid arthritis and osteoarthritis) also require surgical intervention with implants such as hip and knee joint replacement. Biomaterial implants are utilized to fix fractures or replace parts of the body. For the majority of these implant cases, either metal or polymer biomaterials are chosen in order to have a similar functional capacity to the original bone material. The biomaterials that are employed most often for implants of bone fracture are metals such as stainless steel and titanium, and polymers such as polyethene and polyetheretherketone (PEEK). This review compared metallic and synthetic polymer implant biomaterials that can be employed to secure load-bearing bone fractures due to their ability to withstand the mechanical stresses and strains of the body, with a focus on their classification, properties, and application.

Flexible Ultrathin Chip-Film Patch for Electronic Component Integration and Encapsulation using Atomic Layer-Deposited Al2O3-TiO2 Nanolaminates

Plasma-enhanced atomic layer deposition (PEALD) is utilized to improve the barrier properties of an organic chip-film patch (CFP) when it is used as an implant to prevent moisture and ions from migrating into the embedded electronic circuits. For this purpose, surface condition and material properties of eight modifications of Al2O3-TiO2 nanolaminates sequentially deposited on polyimide PI-2611 films are evaluated in detail. The effect of stress-induced warpage of the deposited Al2O3-TiO2 on the wafer level is calculated with the Stoney equation and reveals higher tensile stress values while increasing the thickness of Al2O3-TiO2 nanolaminates from 20 up to 80 nm. Contact angle measurement and atomic force microscopy are used to investigate the surface energy and wettability, as well as the surface morphology of polyimide-Al2O3-TiO2 interfaces. We show that plasma treatment of pristine polyimide leads to an enhanced adhesion force of the PEAL-deposited layer by a factor of 1.3. The water vapor transmission rate (WVTR) is determined by exposing the coated polyimide films to 85% humidity and 23 °C and yields down to 1.58 × 10-3 g(H2O)/(m2 d). The data obtained are compared with alternative coating processes using the polymers parylene-C and benzocyclobutene (BCB). The latter shows higher WVTR values of 1.2 × 10-1 and 1.7 × 10-1 g(H2O)/(m2 d) compared to the PEALD-PI-2611 systems, indicating lower barrier properties. Two Al2O3-TiO2 modifications with low WVTR values have been chosen for encapsulating the CFP substrates and exposing them in a long-time experiment to chemical and mechanical loads in a chamber filled with phosphate-buffered saline at 37 °C, pH 7.3, and a cyclically applied pressure of 160 mbar (∼120 mm Hg). The electrical leakage behavior of the CFP systems is measured and reveals reliable electrical long-term stability far beyond 11 months, highlighting the great potential of PEALD-encapsulated CFPs.

Surface Engineering of a Bioartificial Membrane for Its Application in Bioengineering Devices

Membrane technology is playing a crucial role in cutting-edge innovations in the biomedical field. One such innovation is the surface engineering of a membrane for enhanced longevity, efficient separation, and better throughput. Hence, surface engineering is widely used while developing membranes for its use in bioartificial organ development, separation processes, extracorporeal devices, etc. Chemical-based surface modifications are usually performed by functional group/biomolecule grafting, surface moiety modification, and altercation of hydrophilic and hydrophobic properties. Further, creation of micro/nanogrooves, pillars, channel networks, and other topologies is achieved to modify physio-mechanical processes. These surface modifications facilitate improved cellular attachment, directional migration, and communication among the neighboring cells and enhanced diffusional transport of nutrients, gases, and waste across the membrane. These modifications, apart from improving functional efficiency, also help in overcoming fouling issues, biofilm formation, and infection incidences. Multiple strategies are adopted, like lysozyme enzymatic action, topographical modifications, nanomaterial coating, and antibiotic/antibacterial agent doping in the membrane to counter the challenges of biofilm formation, fouling challenges, and microbial invasion. Therefore, in the current review, we have comprehensibly discussed different types of membranes, their fabrication and surface modifications, antifouling/antibacterial strategies, and their applications in bioengineering. Thus, this review would benefit bioengineers and membrane scientists who aim to improve membranes for applications in tissue engineering, bioseparation, extra corporeal membrane devices, wound healing, and others.

Biomimetic Mineralized Fiber Bundle-Inspired Scaffolding Surface on Polyetheretherketone Implants Promotes Osseointegration

The stress shielding effect caused by traditional metal implants is circumvented by using polyetheretherketone (PEEK), due to its excellent mechanical properties; however, the biologically inert nature of PEEK limits its application. Endowing PEEK with biological activity to promote osseointegration would increase its applicability for bone replacement implants. A biomimetic study is performed, inspired by mineralized collagen fiber bundles that contact bone marrow mesenchymal stem cells (BMMSCs) on the native trabecular bone surface. The PEEK surface (P) is first sulfonated with sulfuric acid to form a porous network structure (sP). The surface is then encapsulated with amorphous hydroxyapatite (HA) by magnetron sputtering to form a biomimetic scaffold that resembles mineralized collagen fiber bundles (sPHA). Amorphous HA simulates the composition of osteogenic regions in vivo and exhibits strong biological activity. In vitro results show that more favorable cell adhesion and osteogenic differentiation can be attained with the novelsurface of sPHA than with SP. The results of in vivo experiments show that sPHA exhibits osteoinductive and osteoconductive activity and facilitates bone formation and osseointegration. Therefore, the surface modification strategy can significantly improve the biological activity of PEEK, facilitate effective osseointegration, and inspire further bionic modification of other inert polymers similar to PEEK.

Evaluation of the Biocompatibility and Osteogenic Properties of Metal Oxide Coatings Applied by Magnetron Sputtering as Potential Biofunctional Surface Modifications for Orthopedic Implants

Biomaterials with adequate properties to direct a biological response are essential for orthopedic and dental implants. The surface properties are responsible for the biological response; thus, coatings with biologically relevant properties such as osteoinduction are exciting options to tailor the surface of different bulk materials. Metal oxide coatings such as TiO₂, ZrO₂, Nb₂O₅ and Ta₂O₅ have been suggested as promising for orthopedic and dental implants. However, a comparative study among them is still missing to select the most promising for bone-growth-related applications. In this work, using magnetron sputtering, TiO₂, ZrO₂, Ta₂O₅, and Nb₂O₅ thin films were deposited on Si (100) substrates. The coatings were characterized by Optical Profilometry, Scanning Electron Microscopy, Energy-Dispersive X-ray Spectroscopy, X-ray Photoelectron Spectroscopy, X-ray Diffraction, Water Contact Angle measurements, and Surface Free Energy calculations. The cell adhesion, viability, proliferation, and differentiation toward the osteoblastic phenotype of mesenchymal stem cells plated on the coatings were measured to define the biological response. Results confirmed that all coatings were biocompatible. However, a more significant number of cells and proliferative cells were observed on Nb₂O₅ and Ta₂O₅ compared to TiO₂ and ZrO_2. Nevertheless, Nb₂O₅ and Ta₂O₅ seemed to induce cell differentiation toward the osteoblastic phenotype in a longer cell culture time than TiO₂ and ZrO₂.

MG-63 and FetMSC Cell Response on Atomic Layer Deposited TiO2 Nanolayers Prepared Using Titanium Tetrachloride and Tetraisopropoxide

Titanium oxide nanocoatings were synthesized on the surface of monocrystalline silicon and ultra-fine-grained titanium by atomic layer deposition (ALD) using titanium tetrachloride (TiCl4) and titanium tetraisopropoxide (TTIP). The morphology of the samples was studied by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The structure and composition were studied by X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), contact angle measurements, and energy-dispersive spectroscopy (EDS). The cytological response of osteosarcoma MG-63 and human fetal mesenchymal stem cells (FetMSCs) were studied by analyzing their morphology, viability, and alkaline phosphatase activity with and without the use of medium-induced differentiation in the osteogenic direction. A significant influence of the precursor type and ALD temperature on the crystal structure, morphology, composition, and surface free energy of TiO2 nanocoatings was found. The biocompatibility of amorphous non-stoichiometric and partially crystalline stoichiometric TiO2 coatings was compared. Both types of cells showed faster adhesion and improved spreading on the surface for the samples from TTIP compared to those from TiCl4 at the early stages of cultivation (2 h) due to the difference in composition and higher surface free energy. No cytotoxic effect was found on both types of coatings, nor was there a noticeable difference in cell differentiation. All ALD coatings provided excellent biocompatibility and osteoconductive properties.

Regulation of Stem Cell Differentiation by Inorganic Nanomaterials: Recent Advances in Regenerative Medicine

Transplanting stem cells with the abilities of self-renewal and differentiation is one of the most effective ways to treat many diseases. In order to optimize the therapeutic effect of stem cell transplantation, it is necessary to intervene in stem cell differentiation. Inorganic nanomaterials (NMs), due to their unique physical and chemical properties, can affect the adhesion, migration, proliferation and differentiation of stem cells. In addition, inorganic NMs have huge specific surface area and modifiability that can be used as vectors to transport plasmids, proteins or small molecules to further interfere with the fate of stem cells. In this mini review, we summarized the recent advances of common inorganic NMs in regulating stem cells differentiation, and the effects of the stiffness, size and shape of inorganic NMs on stem cell behavior were discussed. In addition, we further analyzed the existing obstacles and corresponding perspectives of the application of inorganic NMs in the field of stem cells.