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Kunrath MF, Farina G, Sturmer LBS, Teixeira ER. TiO 2 nanotubes as an antibacterial nanotextured surface for dental implants: Systematic review and meta-analysis. Dent Mater 2024; 40:907-920. [PMID: 38714394 DOI: 10.1016/j.dental.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 04/14/2024] [Accepted: 04/30/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVES Nanotechnology is constantly advancing in dental science, progressing several features aimed at improving dental implants. An alternative for surface treatment of dental implants is electrochemical anodization, which may generate a nanotubular surface (TiO2 nanotubes) with antibacterial potential and osteoinductive features. This systematic review and meta-analysis aims to elucidate the possible antibacterial properties of the surface in question compared to the untreated titanium surface. SOURCES For that purpose, was performed a systematic search on the bases PubMed, Lilacs, Embase, Web Of Science, Cinahl, and Cochrane Central, as well as, manual searches and gray literature. STUDY SELECTION The searches resulted in 742 articles, of which 156 followed for full-text reading. Then, 37 were included in the systematic review and 8 were included in meta-analysis. RESULTS Fifteen studies revealed significant antibacterial protection using TiO2 nanotube surfaces, while 15 studies found no statistical difference between control and nanotextured surfaces. Meta-analysis of in vitro studies demonstrated relevant bacterial reduction only for studies investigating Staphylococcus aureus in a period of 6 h. Meta-analysis of in vivo studies revealed three times lower bacterial adhesion and proliferation on TiO2 nanotube surfaces. CONCLUSIONS TiO2 nanotube topography as a surface for dental implants in preclinical research has demonstrated a positive relationship with antibacterial properties, nevertheless, factors such as anodization protocols, bacteria strains, and mono-culture methods should be taken into consideration, consequently, further studies are necessary to promote clinical translatability.
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Affiliation(s)
- Marcel F Kunrath
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; School of Health and Life Sciences, Post-Graduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil; School of Technology, Post-Graduate Program in Materials Technology and Engineering, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Georgia Farina
- School of Health and Life Sciences, Post-Graduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luiza B S Sturmer
- School of Health and Life Sciences, Post-Graduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduardo R Teixeira
- School of Health and Life Sciences, Post-Graduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Shen Z, Xu Y, Qian XN, Zhou YH, Zhou Y, Zhou JY, Liu Y, Zhang SM, Qiu J. Enhanced osteogenic and antibacterial properties of titanium implant surface modified with Zn-incorporated nanowires: Preclinical in vitro and in vivo investigations. Clin Oral Implants Res 2024; 35:427-442. [PMID: 38314615 DOI: 10.1111/clr.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 01/02/2024] [Accepted: 01/19/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE This study aimed to synthesize zinc-incorporated nanowires structure modified titanium implant surface (Zn-NW-Ti) and explore its superior osteogenic and antibacterial properties in vitro and in vivo. MATERIALS AND METHODS Zn-NW-Ti was synthesized via displacement reactions between zinc sulfate solutions and the titanium (Ti) surface, which was pretreated by hydrofluoric acid etching and hyperthermal alkalinization. The physicochemical properties of the Zn-NW-Ti surface were examined. Moreover, the biological effects of Zn-NW-Ti on MC3T3-E1 cells and its antibacterial property against oral pathogenic bacteria (Staphylococcus aureus, Porphyromonas gingivalis, and Actinobacillus actinomycetemcomitans) compared with sandblasted and acid-etched Ti (SLA-Ti) and nanowires modified Ti (NW-Ti) surface were assessed. Zn-NW-Ti and SLA-Ti modified implants were inserted into the anterior extraction socket of the rabbit mandible with or without exposure to the mixed bacterial solution (S. aureus, P. gingivalis, and A. actinomycetemcomitans) to investigate the osteointegration and antibacterial performance via radiographic and histomorphometric analysis. RESULTS The Zn-NW-Ti surface was successfully prepared. The resultant titanium surface appeared as a nanowires structure with hydrophilicity, from which zinc ions were released in an effective concentration range. The Zn-NW-Ti surface performed better in facilitating the adhesion, proliferation, and differentiation of MC3T3-E1 cells while inhibiting the colonization of bacteria compared with SLA-Ti and NW-Ti surface. The Zn-NW-Ti implant exhibited enhanced osseointegration in vivo, which was attributed to increased osteogenic activity and reduced bacterial-induced inflammation compared with the SLA-Ti implant. CONCLUSIONS The Zn-incorporated nanowires structure modified titanium implant surface exhibited improvements in osteogenic and antibacterial properties, which optimized osteointegration in comparison with SLA titanium implant surface.
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Affiliation(s)
- Zhe Shen
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Yan Xu
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Xin-Na Qian
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Yi-Heng Zhou
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - You Zhou
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Jie-Yi Zhou
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Yao Liu
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Song-Mei Zhang
- Department of Comprehensive Care, Tufts University School of Dental Medicine Boston, Massachusetts, USA
| | - Jing Qiu
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
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Wu H, Yu M, Zhang S, You M, Xiong A, Feng B, Niu J, Yuan G, Yue B, Pei J. Mg-based implants with a sandwiched composite coating simultaneously facilitate antibacterial and osteogenic properties. J Mater Chem B 2024; 12:2015-2027. [PMID: 38304935 DOI: 10.1039/d3tb02744a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Insufficient antibacterial effects and over-fast degradation are the main limitations of magnesium (Mg)-based orthopedic implants. In this study, a sandwiched composite coating containing a triclosan (TCS)-loaded poly(lactic acid) (PLA) layer inside and brushite (DCPD) layer outside was prepared on the surface of the Mg-Nd-Zn-Zr (denoted as JDBM) implant. In vitro degradation tests revealed a remarkable improvement in the corrosion resistance and moderate degradation rate. The drug release profile demonstrated a controllable and sustained TCS release for at least two weeks in vitro. The antibacterial rates of the implant were all over 99.8% for S. aureus, S. epidermidis, and E. coli, demonstrating superior antibacterial effects. Additionally, this coated JDBM implant exhibited no cytotoxicity but improved cell adhesion and proliferation, indicating excellent cytocompatibility. In vivo assays were conducted by implant-related femur osteomyelitis and osseointegration models in rats. Few bacteria were attached to the implant surface and the surrounding bone tissue. Furthermore, the coated JDBM implant exhibited more new bone formation than other groups due to the synergistic biological effects of released TCS and Mg2+, revealing excellent osteogenic ability. In summary, the JDBM implant with the sandwiched composite coating could significantly enhance the antibacterial activities and osteogenic properties simultaneously by the controllable release of TCS and Mg2+, presenting great potential for clinical transformation.
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Affiliation(s)
- Han Wu
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Mengjiao Yu
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Shutao Zhang
- Department of Bone and Joint Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Mingyu You
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Ao Xiong
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Boxuan Feng
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Jialin Niu
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Guangyin Yuan
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Bing Yue
- Department of Bone and Joint Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jia Pei
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
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Zhou B, Jiang X, Zhou X, Tan W, Luo H, Lei S, Yang Y. GelMA-based bioactive hydrogel scaffolds with multiple bone defect repair functions: therapeutic strategies and recent advances. Biomater Res 2023; 27:86. [PMID: 37715230 PMCID: PMC10504735 DOI: 10.1186/s40824-023-00422-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
Currently, the clinical treatment of critical bone defects attributed to various causes remains a great challenge, and repairing these defects with synthetic bone substitutes is the most common strategy. In general, tissue engineering materials that mimic the structural, mechanical and biological properties of natural bone have been extensively applied to fill bone defects and promote in situ bone regeneration. Hydrogels with extracellular matrix (ECM)-like properties are common tissue engineering materials, among which methacrylate-based gelatin (GelMA) hydrogels are widely used because of their tunable mechanical properties, excellent photocrosslinking capability and good biocompatibility. Owing to their lack of osteogenic activity, however, GelMA hydrogels are combined with other types of materials with osteogenic activities to improve the osteogenic capability of the current composites. There are three main aspects to consider when enhancing the bone regenerative performance of composite materials: osteoconductivity, vascularization and osteoinduction. Bioceramics, bioglass, biomimetic scaffolds, inorganic ions, bionic periosteum, growth factors and two-dimensional (2D) nanomaterials have been applied in various combinations to achieve enhanced osteogenic and bone regeneration activities. Three-dimensional (3D)-bioprinted scaffolds are a popular research topic in bone tissue engineering (BTE), and printed and customized scaffolds are suitable for restoring large irregular bone defects due to their shape and structural tunability, enhanced mechanical properties, and good biocompatibility. Herein, the recent progress in research on GelMA-based composite hydrogel scaffolds as multifunctional platforms for restoring critical bone defects in plastic or orthopedic clinics is systematically reviewed and summarized. These strategies pave the way for the design of biomimetic bone substitutes for effective bone reconstruction with good biosafety. This review provides novel insights into the development and current trends of research on GelMA-based hydrogels as effective bone tissue engineering (BTE) scaffolds for correcting bone defects, and these contents are summarized and emphasized from various perspectives (osteoconductivity, vascularization, osteoinduction and 3D-bioprinting). In addition, advantages and deficiencies of GelMA-based bone substitutes used for bone regeneration are put forward, and corresponding improvement measures are presented prior to their clinical application in near future (created with BioRender.com).
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Affiliation(s)
- Bixia Zhou
- Department of Plastic Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, PR China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, PR China
| | - Xulei Jiang
- Department of Plastic Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, PR China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, PR China
| | - Xinxin Zhou
- Department of Plastic Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, PR China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, PR China
| | - Wuyuan Tan
- Department of Plastic Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, PR China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, PR China
| | - Hang Luo
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha, 410083, PR China
| | - Shaorong Lei
- Department of Plastic Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, PR China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, PR China.
| | - Ying Yang
- Department of Plastic Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, PR China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, PR China.
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha, 410083, PR China.
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5
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Hu X, Ke C, Zhong J, Chen Y, Dong J, Hao M, Chen Q, Ni J, Peng Z. Nano selenium-doped TiO 2 nanotube arrays on orthopedic implants for suppressing osteosarcoma growth. Front Bioeng Biotechnol 2023; 11:1252816. [PMID: 37731757 PMCID: PMC10508061 DOI: 10.3389/fbioe.2023.1252816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
Osteosarcoma, the most common primary malignant bone tumor, is characterized by malignant cells producing osteoid or immature bone tissue. Most osteosarcoma patients require reconstructive surgery to restore the functional and structural integrity of the injured bone. Metal orthopedic implants are commonly used to restore the limb integrity in postoperative patients. However, conventional metal implants with a bioinert surface cannot inhibit the growth of any remaining cancer cells, resulting in a higher risk of cancer recurrence. Herein, we fabricate a selenium-doped TiO2 nanotube array (Se-doped TNA) film to modify the surface of medical pure titanium substrate, and evaluate the anti-tumor effect and biocompatibility of Se-doped TNA film. Moreover, we further explore the anti-tumor potential mechanism of Se-doped TNA film by studying the behaviors of human osteosarcoma cells in vitro. We provide a new pathway for achieving the anti-tumor function of orthopedic implants while keeping the biocompatibility, aiming to suppress the recurrence of osteosarcoma.
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Affiliation(s)
- Xiaodong Hu
- Affiliated Li Huili Hospital, Ningbo University, Ningbo, China
| | - Chunhai Ke
- Affiliated Li Huili Hospital, Ningbo University, Ningbo, China
| | - Jiaqi Zhong
- Affiliated Li Huili Hospital, Ningbo University, Ningbo, China
| | - Yujiong Chen
- Affiliated Li Huili Hospital, Ningbo University, Ningbo, China
| | - Jieyang Dong
- Affiliated Li Huili Hospital, Ningbo University, Ningbo, China
| | - Mingming Hao
- Affiliated Li Huili Hospital, Ningbo University, Ningbo, China
- Ningbo Institute of Innovation for Combined Medicine and Engineering (NIIME), Ningbo Medical Centre Lihuili Hospital, Ningbo University, Ningbo, China
| | - Qi Chen
- Ningbo Regen Biotech, Co, Ltd, Ningbo, Zhejiang, China
| | - Jiahua Ni
- Ningbo Regen Biotech, Co, Ltd, Ningbo, Zhejiang, China
| | - Zhaoxiang Peng
- Affiliated Li Huili Hospital, Ningbo University, Ningbo, China
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6
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Gulati K, Chopra D, Kocak-Oztug NA, Verron E. Fit and forget: The future of dental implant therapy via nanotechnology. Adv Drug Deliv Rev 2023; 199:114900. [PMID: 37263543 DOI: 10.1016/j.addr.2023.114900] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
Unlike orthopedic implants, dental implants require the orchestration of both osseointegration at the bone-implant interface and soft-tissue integration at the transmucosal region in a complex oral micro-environment with ubiquitous pathogenic bacteria. This represents a very challenging environment for early acceptance and long-term survival of dental implants, especially in compromised patient conditions, including aged, smoking and diabetic patients. Enabling advanced local therapy from the surface of titanium-based dental implants via novel nano-engineering strategies is emerging. This includes anodized nano-engineered implants eluting growth factors, antibiotics, therapeutic nanoparticles and biopolymers to achieve maximum localized therapeutic action. An important criterion is balancing bioactivity enhancement and therapy (like bactericidal efficacy) without causing cytotoxicity. Critical research gaps still need to be addressed to enable the clinical translation of these therapeutic dental implants. This review informs the latest developments, challenges and future directions in this domain to enable the successful fabrication of clinically-translatable therapeutic dental implants that would allow for long-term success, even in compromised patient conditions.
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Affiliation(s)
- Karan Gulati
- The University of Queensland, School of Dentistry, Herston, QLD 4006, Australia.
| | - Divya Chopra
- The University of Queensland, School of Dentistry, Herston, QLD 4006, Australia
| | - Necla Asli Kocak-Oztug
- The University of Queensland, School of Dentistry, Herston, QLD 4006, Australia; Istanbul University, Faculty of Dentistry, Department of Periodontology, 34116 Istanbul, Turkey
| | - Elise Verron
- Nantes Université, CNRS, CEISAM, UMR 6230, 44000 Nantes, France
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7
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Wu N, Gao H, Wang X, Pei X. Surface Modification of Titanium Implants by Metal Ions and Nanoparticles for Biomedical Application. ACS Biomater Sci Eng 2023; 9:2970-2990. [PMID: 37184344 DOI: 10.1021/acsbiomaterials.2c00722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Implant surface modification can improve osseointegration and reduce peri-implant inflammation. Implant surfaces are modified with metals because of their excellent mechanical properties and significant functions. Metal surface modification is divided into metal ions and nanoparticle surface modification. These two methods function by adding a finishing metal to the surface of the implant, and both play a role in promoting osteogenic, angiogenic, and antibacterial properties. Based on this, the nanostructural surface changes confer stronger antibacterial and cellular affinity to the implant surface. The current paper reviews the forms, mechanisms, and applications of nanoparticles and metal ion modifications to provide a foundation for the surface modification of implants.
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Affiliation(s)
- Nan Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hongyu Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xu Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xibo Pei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
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Chen K, Ge W, Zhao L, Kong L, Yang H, Zhang X, Gu X, Zhu C, Fan Y. Endowing biodegradable Zinc implants with dual-function of antibacterial ability and osteogenic activity by micro-addition of Mg and Ag (≤ 0.1 wt.%). Acta Biomater 2023; 157:683-700. [PMID: 36521674 DOI: 10.1016/j.actbio.2022.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Infection remains the devastating complications associated with surgical fixation of bones fractured during trauma. In this study, we report a low-alloyed Zn-Mg-Ag that simultaneously has optimized strength degeneration profiles during degradation, outstanding antibacterial efficacy and osteogenic activity. Our results showed that Zn-0.05Mg-0.1Ag alloy had favorable mechanical properties (UTS: 247.8 ± 1.6 MPa, Elong.: 35 ± 2.2 %) and presented a better hold of mechanical integrity than pure Zn during 28 days corrosion, 2.6 % vs. 18.7 % reduction. After one-year of natural aging, the alloy still preserved an elongation of 24.07 ± 3.84 %. As verified by microbial cultures, Zn-0.05Mg-0.1Ag alloy demonstrated high antibacterial performance against Gram-positive and Gram-negative strains, as well as antibiotic-resistant strains (MRSA) in vitro and in vivo due to the synergistic antibacterial actions of Zn2+ and Ag+. Meanwhile, Zn-Mg-Ag alloy also exhibited enhanced viability, osteogenic differentiation, and gene expressions of osteoblasts in vitro, as well as promoted osteogenic activity than pure Zn in the femoral condyle defect repair model. The co-releasing of Zn, Mg and Ag ions did not induce toxic side effects. Collectively, low alloyed Zn-0.05Mg-0.1Ag indicated long-lasting mechanical integrity during degradation, and presented the ability to synergistically inhibit bacteria and promote osteogenesis, possessing tremendous potential in treating implant-associated infections. STATEMENT OF SIGNIFICANCE: Infection after fracture fixation (IAFF) remains the most common and serious side effects of orthopedic surgery. Additionally, widespread antibiotic use contributes to the development of multi-drug resistant bacteria such as methicillin-resistant staphylococcus aureus (MRSA), which exacerbates IAFF treatment and prevention. IAFF treatment and prevention remain clinically challenging, so implants with dual antibacterial and osteogenic functions are in high demand. The antibacterial efficacy and osteogenic activity of low-alloyed Zn-Mg-Ag (≤0.1 wt.% Mg, Ag) alloys were investigated in vitro and in vivo. The results showed that micro addition of Mg and Ag could significantly improve osseointegration function, mechanical properties, and antibacterial performance. These quantification findings shed new light on the development and understanding of dual functional Zn-based orthopedic implants.
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Affiliation(s)
- Kai Chen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Wufei Ge
- Department of Orthopedics, The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, China
| | - Li Zhao
- Beijing Advanced Innovation Center for Materials Genome Engineering, Institute for Advanced Materials and Technology, University of Science and Technology Beijing, Beijing 100083, China
| | - Lingtong Kong
- Department of Orthopedics, The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, China
| | - Hongtao Yang
- School of Engineering Medicine, Beihang University, Beijing 100083, China
| | - Xianzuo Zhang
- Department of Orthopedics, The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, China
| | - Xuenan Gu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China.
| | - Chen Zhu
- Department of Orthopedics, The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, China.
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; School of Engineering Medicine, Beihang University, Beijing 100083, China.
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9
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Li Y, Chen L, Lin M, Wang C, Zhang R, Li Y, Zou Q. Micro-CT analysis of osteomyelitis of rabbit tibial for model establishment and biomaterials application in tissue engineering. Heliyon 2022; 8:e12471. [PMID: 36643303 PMCID: PMC9834739 DOI: 10.1016/j.heliyon.2022.e12471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/08/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
Osteomyelitis is one of the most difficult diseases to treat in orthopedics field. The construction of animal models of osteomyelitis is now more mature but still lacks a deeper criterion other than "successful infection". In this work, rabbit tibial osteomyelitis model with S. aureus infection was established. Whole tibia, cortical bone around bone window, and tibial condyle were characterized in considerable detail using micro-CT and other means at 2/4/6 weeks, respectively. The results show that in addition to the obvious inflammatory response and bone destruction, osteomyelitis caused some other effects on compact and cancellous bone, and in particular, changes in bone mineral density after infection were of interest. Although the modeling groups all exhibited osteolysis and bone loss, their overall bone mineral density averages and those of the control groups were mostly in the range of 870 mg/cm3 to 920 mg/cm3, without statistical difference. The results suggest that overall bone mineral density is determined by both bone destruction conditions and the amount of dead bone deposition. This work provides a reference basis for the selection of time points for the subsequent animal models establishment and some valuable reference indicators of the application of biomaterials in tissue engineering.
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Affiliation(s)
- Yufan Li
- Analytical and Testing Center, Nano Biomaterials Research Center, Sichuan University, No. 29 Jiuyanqiao Wangjiang Road, Chengdu, Sichuan, 610064, China
| | - Li Chen
- Analytical and Testing Center, Sichuan University, No. 29 Jiuyanqiao Wangjiang Road, Chengdu, Sichuan, 610064, China
| | - Mingyue Lin
- Analytical and Testing Center, Nano Biomaterials Research Center, Sichuan University, No. 29 Jiuyanqiao Wangjiang Road, Chengdu, Sichuan, 610064, China
| | - Chenxin Wang
- Analytical and Testing Center, Nano Biomaterials Research Center, Sichuan University, No. 29 Jiuyanqiao Wangjiang Road, Chengdu, Sichuan, 610064, China
| | - Rui Zhang
- Analytical and Testing Center, Nano Biomaterials Research Center, Sichuan University, No. 29 Jiuyanqiao Wangjiang Road, Chengdu, Sichuan, 610064, China
| | - Yubao Li
- Analytical and Testing Center, Nano Biomaterials Research Center, Sichuan University, No. 29 Jiuyanqiao Wangjiang Road, Chengdu, Sichuan, 610064, China
- Corresponding author.
| | - Qin Zou
- Analytical and Testing Center, Nano Biomaterials Research Center, Sichuan University, No. 29 Jiuyanqiao Wangjiang Road, Chengdu, Sichuan, 610064, China
- Corresponding author.
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10
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Noreen S, Wang E, Feng H, Li Z. Functionalization of TiO 2 for Better Performance as Orthopedic Implants. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6868. [PMID: 36234208 PMCID: PMC9573462 DOI: 10.3390/ma15196868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
This review mainly focuses on the surface functionalization approaches of titanium dioxide (TiO2) to prevent bacterial infections and facilitate osteointegration simultaneously for titanium (Ti)-based orthopedic implants. Infection is one of the major causes of implant failure. Meanwhile, it is also critical for the bone-forming cells to integrate with the implant surface. TiO2 is the native oxide layer of Ti which has good biocompatibility as well as enriched physical, chemical, electronic, and photocatalytic properties. The formed nanostructures during fabrication and the enriched properties of TiO2 have enabled various functionalization methods to combat the micro-organisms and enhance the osteogenesis of Ti implants. This review encompasses the various modifications of TiO2 in aspects of topology, drug loading, and element incorporation, as well as the most recently developed electron transfer and electrical tuning approaches. Taken together, these approaches can endow Ti implants with better bactericidal and osteogenic abilities via the functionalization of TiO2.
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Affiliation(s)
| | | | | | - Zhou Li
- Correspondence: (H.F.); (Z.L.)
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11
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Yang Y, Li M, Zhou B, Jiang X, Zhang D, Luo H, Lei S. Novel Therapeutic Strategy for Bacteria‐Contaminated Bone Defects: Reconstruction with Multi‐Biofunctional GO/Cu‐Incorporated 3D Scaffolds. ADVANCED THERAPEUTICS 2022. [DOI: 10.1002/adtp.202200043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ying Yang
- Department of Plastic Surgery Xiangya Hospital Central South University Changsha 410008 P.R. China
- State Key Laboratory of Powder Metallurgy Central South University Changsha 410083 P.R. China
| | - Min Li
- Department of Oncology Changsha Central Hospital University of South China Changsha 410006 P.R. China
| | - Bixia Zhou
- Department of Plastic Surgery Xiangya Hospital Central South University Changsha 410008 P.R. China
| | - Xulei Jiang
- Department of Plastic Surgery Xiangya Hospital Central South University Changsha 410008 P.R. China
| | - Dou Zhang
- Department of Oncology Changsha Central Hospital University of South China Changsha 410006 P.R. China
| | - Hang Luo
- Department of Oncology Changsha Central Hospital University of South China Changsha 410006 P.R. China
| | - Shaorong Lei
- Department of Plastic Surgery Xiangya Hospital Central South University Changsha 410008 P.R. China
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12
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Xu Z, Jiang X. Osteogenic TiO2 composite nano-porous arrays: A favorable platform based on titanium alloys applied in artificial implants. Colloids Surf A Physicochem Eng Asp 2022. [DOI: 10.1016/j.colsurfa.2022.128301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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13
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Yang Y, Li M, Luo H, Zhang D. Surface-Decorated Graphene Oxide Sheets with Copper Nanoderivatives for Bone Regeneration: An In Vitro and In Vivo Study Regarding Molecular Mechanisms, Osteogenesis, and Anti-infection Potential. ACS Infect Dis 2022; 8:499-515. [PMID: 35188739 DOI: 10.1021/acsinfecdis.1c00496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
It has been previously reported that graphene oxide/copper nanoderivative (GO/Cu)-incorporated chitosan/hyaluronic acid scaffolds might be promising wound dressings for the management of infected wound healing. The aim of the present research is to deeply explore the potential antimicrobial mechanisms and synergistic osteogenic activity, as well as the in vivo anti-infective behavior of GO/Cu nanocomposites, making them possible candidates for establishing implantable biomaterials for the repair of infected bone defects. The antibacterial mechanisms of the nanocomposites were explored through the examination of membrane integrity, oxidative stress, and metabolic enzyme activities. Then, the cytocompatibility with bone mesenchymal stem cells (rBMSCs) and osteogenic potential were confirmed, and a subcutaneous bacterial infection model in rats was also established to verify the in vivo anti-infective property and biosafety of the nanocomposites. It was found that leakage of adenosine triphosphate, proteins, and reducing sugars from the bacterial cells, indicative of damaged permeability of bacterial membranes, and promoted production of reactive oxygen species and disordered metabolic enzyme activities in response to oxidative stress were possible molecular mechanisms responsible for the synergistic antibacterial effects of the GO/Cu nanocomposites. Additionally, good cytocompatibility with rBMSCs and promoted osteogenic differentiation were found in GO/Cu nanocomposites (mass ratio = 2:1), which also demonstrated satisfactory in vivo anti-infective performance, reduced inflammation, and acceptable biosafety. Based on our results, damaged bacterial membranes, increased ROS production, and disorders of crucial enzyme metabolism were the main antibacterial mechanisms involved in the bacterium-killing events caused by the GO/Cu nanocomposites, which also showed enhanced osteogenic activity, in vivo anti-infective capability, and acceptable cytocompatibility and biosafety. Therefore, GO/Cu (2:1) nanocomposites are a potential strategy for improving the biological performance of current bone substitutes used for combating bacterial-contaminated bone defects.
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Affiliation(s)
- Ying Yang
- Department of Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
- State Key Laboratory of Powder Metallurgy, Research Institute of Powder Metallurgy, Central South University, Changsha 410083, China
| | - Min Li
- Department of Oncology, Changsha Central Hospital, University of South China, Changsha 410006, China
| | - Hang Luo
- State Key Laboratory of Powder Metallurgy, Research Institute of Powder Metallurgy, Central South University, Changsha 410083, China
| | - Dou Zhang
- State Key Laboratory of Powder Metallurgy, Research Institute of Powder Metallurgy, Central South University, Changsha 410083, China
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14
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Sun Y, Yang Y, Jiang W, Bai H, Liu H, Wang J. In Vivo Antibacterial Efficacy of Nanopatterns on Titanium Implant Surface: A Systematic Review of the Literature. Antibiotics (Basel) 2021; 10:antibiotics10121524. [PMID: 34943736 PMCID: PMC8698789 DOI: 10.3390/antibiotics10121524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Bionic surface nanopatterns of titanium (Ti) materials have excellent antibacterial effects in vitro for infection prevention. To date, there is a lack of knowledge about the in vivo bactericidal outcomes of the nanostructures on the Ti implant surfaces. Methods: A systematic review was performed using the PubMed, Embase, and Cochrane databases to better understand surface nanoscale patterns’ in vivo antibacterial efficacy. The inclusion criteria were preclinical studies (in vivo) reporting the antibacterial activity of nanopatterns on Ti implant surface. Ex vivo studies, studies not evaluating the antibacterial activity of nanopatterns or surfaces not modified with nanopatterns were excluded. Results: A total of five peer-reviewed articles met the inclusion criteria. The included studies suggest that the in vivo antibacterial efficacy of the nanopatterns on Ti implants’ surfaces seems poor. Conclusions: Given the small number of literature results, the variability in experimental designs, and the lack of reporting across studies, concluding the in vivo antibacterial effectiveness of nanopatterns on Ti substrates’ surfaces remains a big challenge. Surface coatings using metallic or antibiotic elements are still practical approaches for this purpose. High-quality preclinical data are still needed to investigate the in vivo antibacterial effects of the nanopatterns on the implant surface.
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Affiliation(s)
- Yang Sun
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
| | - Yang Yang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
- Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Disease, The Second Hospital of Jilin University, Changchun 130041, China
| | - Weibo Jiang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
| | - Haotian Bai
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
| | - Jincheng Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
- Correspondence:
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Zhang Y, Gulati K, Li Z, Di P, Liu Y. Dental Implant Nano-Engineering: Advances, Limitations and Future Directions. NANOMATERIALS (BASEL, SWITZERLAND) 2021; 11:2489. [PMID: 34684930 PMCID: PMC8538755 DOI: 10.3390/nano11102489] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/08/2021] [Accepted: 09/18/2021] [Indexed: 12/27/2022]
Abstract
Titanium (Ti) and its alloys offer favorable biocompatibility, mechanical properties and corrosion resistance, which makes them an ideal material choice for dental implants. However, the long-term success of Ti-based dental implants may be challenged due to implant-related infections and inadequate osseointegration. With the development of nanotechnology, nanoscale modifications and the application of nanomaterials have become key areas of focus for research on dental implants. Surface modifications and the use of various coatings, as well as the development of the controlled release of antibiotics or proteins, have improved the osseointegration and soft-tissue integration of dental implants, as well as their antibacterial and immunomodulatory functions. This review introduces recent nano-engineering technologies and materials used in topographical modifications and surface coatings of Ti-based dental implants. These advances are discussed and detailed, including an evaluation of the evidence of their biocompatibility, toxicity, antimicrobial activities and in-vivo performances. The comparison between these attempts at nano-engineering reveals that there are still research gaps that must be addressed towards their clinical translation. For instance, customized three-dimensional printing technology and stimuli-responsive, multi-functional and time-programmable implant surfaces holds great promise to advance this field. Furthermore, long-term in vivo studies under physiological conditions are required to ensure the clinical application of nanomaterial-modified dental implants.
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Affiliation(s)
- Yifan Zhang
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China;
| | - Karan Gulati
- School of Dentistry, The University of Queensland, Herston, QLD 4006, Australia;
| | - Ze Li
- School of Stomatology, Chongqing Medical University, Chongqing 400016, China;
| | - Ping Di
- School of Dentistry, The University of Queensland, Herston, QLD 4006, Australia;
| | - Yan Liu
- Laboratory of Biomimetic Nanomaterials, Department of Orthodontics, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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16
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Wang B, Wu Z, Wang S, Wang S, Niu Q, Wu Y, Jia F, Bian A, Xie L, Qiao H, Chang X, Lin H, Zhang H, Huang Y. Mg/Cu-doped TiO 2 nanotube array: A novel dual-function system with self-antibacterial activity and excellent cell compatibility. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 128:112322. [PMID: 34474873 DOI: 10.1016/j.msec.2021.112322] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 01/29/2023]
Abstract
Many studies were conducted to change the surface morphology and chemical composition of Ti implants for the improvement of antibacterial ability and osseointegration between medical Ti and surrounding bone tissue. In this study, we successfully prepared a novel dual-function coating on pure Ti surface, i.e. Cu and Mg-co-doped TiO2 nanotube (TN) coating, by combining anodisation and hydrothermal treatment (HT), which could act as a delivery platform for the sustained release of Cu and Mg ions. Results showed that the amounts of Cu and Mg were about 5.43 wt%-6.55 wt% and 0.69 wt%-0.73 wt%, respectively. In addition, the surface morphology of Cu and Mg-co-doped TN (CuMTN) coatings transformed into nanoneedles after HT for 1 h. Compared with TN, CuMTN had no change in roughness and remarkable improved hydrophilicity. Antibacterial tests revealed that CuMTN had an antibacterial rate of more than 93% against Escherichia coli and Staphylococcus aureus, thereby showing excellent antibacterial properties. In addition, CuMTN could induce the formation of apatite well after being immersed in simulated body fluid, showing good biological activity. Preosteoblasts (MC3T3-E1) cultured on CuMTN-coated Ti demonstrated better proliferation and osteogenic differentiation than pristine and as-anodised specimens. To the best of our best knowledge, this study had successfully attempted to combine anodisation and HT, introduce Cu/Mg elements and functionalise Ti-based implant surfaces with enhanced hydrophilicity, osteogenesis and antimicrobial properties that can meet clinical needs for the first time.
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Affiliation(s)
- Bingbing Wang
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China
| | - Zongze Wu
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China
| | - Shuo Wang
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China
| | - Saisai Wang
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China
| | - Qimeng Niu
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China
| | - Yuwei Wu
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China
| | - Fenghuan Jia
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China
| | - Anqi Bian
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China
| | - Lei Xie
- School of Medicine, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Haixia Qiao
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China
| | - Xiaotong Chang
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China
| | - He Lin
- School of Chemistry and Materials Science, Ludong University, Yantai 264025, China
| | - Hui Zhang
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China.
| | - Yong Huang
- College of Lab Medicine, Hebei North University, Key Laboratory of Biomedical Materials of Zhangjiakou, Zhangjiakou 075000, China.
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17
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Gulati K, Zhang Y, Di P, Liu Y, Ivanovski S. Research to Clinics: Clinical Translation Considerations for Anodized Nano-Engineered Titanium Implants. ACS Biomater Sci Eng 2021; 8:4077-4091. [PMID: 34313123 DOI: 10.1021/acsbiomaterials.1c00529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Titania nanotubes (TNTs) fabricated on titanium orthopedic and dental implants have shown significant potential in "proof of concept" in vitro, ex vivo, and short-term in vivo studies. However, most studies do not focus on a clear direction for future research towards clinical translation, and there exists a knowledge gap in identifying key research challenges that must be addressed to progress to the clinical setting. This review focuses on such challenges with respect to anodized titanium implants modified with TNTs, including optimized fabrication on clinically utilized microrough surfaces, clinically relevant bioactivity assessments, and controlled/tailored local release of therapeutics. Further, long-term in vivo investigations in compromised animal models under loading conditions are needed. We also discuss and detail challenges and progress related to the mechanical stability of TNT-based implants, corrosion resistance/electrochemical stability, optimized cleaning/sterilization, packaging/aging, and nanotoxicity concerns. This extensive, clinical translation focused review of TNTs modified Ti implants aims to foster improved understanding of key research gaps and advances, informing future research in this domain.
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Affiliation(s)
- Karan Gulati
- The University of Queensland, School of Dentistry, Herston, Queensland 4006, Australia
| | - Yifan Zhang
- Department of Oral Implantology, Peking University School and Hospital of Stomatology and National Clinical Research Centre for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ping Di
- Department of Oral Implantology, Peking University School and Hospital of Stomatology and National Clinical Research Centre for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yan Liu
- Laboratory of Biomimetic Nanomaterials, Department of Orthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Sašo Ivanovski
- The University of Queensland, School of Dentistry, Herston, Queensland 4006, Australia
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18
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Understanding and optimizing the antibacterial functions of anodized nano-engineered titanium implants. Acta Biomater 2021; 127:80-101. [PMID: 33744499 DOI: 10.1016/j.actbio.2021.03.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 12/15/2022]
Abstract
Nanoscale surface modification of titanium-based orthopaedic and dental implants is routinely applied to augment bioactivity, however, as is the case with other cells, bacterial adhesion is increased on nano-rough surfaces. Electrochemically anodized Ti implants with titania nanotubes (TNTs) have been proposed as an ideal implant surface with desirable bioactivity and local drug release functions to target various conditions. However, a comprehensive state of the art overview of why and how such TNTs-Ti implants acquire antibacterial functions, and an in-depth knowledge of how topography, chemistry and local elution of potent antibiotic agents influence such functions has not been reported. This review discusses and details the application of nano-engineered Ti implants modified with TNTs for maximum local antibacterial functions, deciphering the interdependence of various characteristics and the fine-tuning of different parameters to minimize cytotoxicity. An ideal implant surface should cater simultaneously to ossoeintegration (and soft-tissue integration for dental implants), immunomodulation and antibacterial functions. We also evaluate the effectiveness and challenges associated with such synergistic functions from modified TNTs-implants. Particular focus is placed on the metallic and semi-metallic modification of TNTs towards enabling bactericidal properties, which is often dose dependent. Additionally, there are concerns over the cytotoxicity of these therapies. In that light, research challenges in this domain and expectations from the next generation of customizable antibacterial TNTs implants towards clinical translation are critically evaluated. STATEMENT OF SIGNIFICANCE: One of the major causes of titanium orthopaedic/dental implant failure is bacterial colonization and infection, which results in complete implant failure and the need for revision surgery and re-implantation. Using advanced nanotechnology, controlled nanotopographies have been fabricated on Ti implants, for instance anodized nanotubes, which can accommodate and locally elute potent antibiotic agents. In this pioneering review, we shine light on the topographical, chemical and therapeutic aspects of antibacterial nanotubes towards achieving desirable tailored antibacterial efficacy without cytotoxicity concerns. This interdisciplinary review will appeal to researchers from the wider scientific community interested in biomaterials science, structure and function, and will provide an improved understanding of controlling bacterial infection around nano-engineered implants, aimed at bridging the gap between research and clinics.
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Wang Y, Zhang J, Gao T, Zhang N, He J, Wu F. Covalent immobilization of DJK-5 peptide on porous titanium for enhanced antibacterial effects and restrained inflammatory osteoclastogenesis. Colloids Surf B Biointerfaces 2021; 202:111697. [PMID: 33756295 DOI: 10.1016/j.colsurfb.2021.111697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Currently, implant-related bone infection characterized by aggravated infection-induced inflammatory responses and osteolysis, remains a severe challenge in orthopedic surgery, especially in patients with osteoporosis. Attempts to control such responses using biomaterials with combined immunomodulatory and anti-bacterial properties may provide novel strategies. Herein, DJK-5, a class of host defense peptides (HDPs) with established antimicrobial and immunomodulatory functions, was introduced into porous Ti alloy. Our results indicated that the DJK-5 immobilized surfaces showed intrinsically multifunctional properties, including antibacterial ability, anti-inflammation, biocompatibility and osteolysis-inhibiting properties. The results demonstrated that the antibacterial efficiency of DJK-5 functionalized surfaces was over 90 % for both Gram-positive and Gram-negative bacteria. Specifically, DJK-5 functionalized samples also possessed the excellent anti-bacterial activity against a mixture of bacterial strains, including S. aureus, S. epidermidis and P. aeruginosa, with an antibacterial rate against mixed bacteria reaching 91.36 %, as well as reduced biofilm formation. The remarkable anti-bacterial efficacy was likely based on the direct anti-bacterial effect of DJK-5, which destroyed the integrity of bacteria membranes, leading to the leakage of intracellular materials. Additionally, the immobilized DJK-5 surfaces could indirectly kill bacteria through promoted macrophage capacity to bacteria uptake. Furthermore, DJK-5 functionalized surfaces suppressed inflammatory reaction by decreasing the release of pro-inflammatory factors and increasing the secretions of anti-inflammatory factors, and thereby impeded the activation of NF-κB signal pathway, which resulted in the disruption of the actin rings and decreased Tracp5b expressions. Based on these promising findings, the multi-functional DJK-5 immobilized titanium represents an efficient alternative to realize better osseointegration in sever implant-associated bacterial infections.
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Affiliation(s)
- Yao Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, PR China
| | - Junwei Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, PR China
| | - Tao Gao
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, PR China
| | - Nihui Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, PR China
| | - Jing He
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, PR China.
| | - Fang Wu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, PR China.
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Li Y, Wang S, Dong Y, Mu P, Yang Y, Liu X, Lin C, Huang Q. Effect of size and crystalline phase of TiO 2 nanotubes on cell behaviors: A high throughput study using gradient TiO 2 nanotubes. Bioact Mater 2020; 5:1062-1070. [PMID: 32695936 PMCID: PMC7363987 DOI: 10.1016/j.bioactmat.2020.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/16/2022] Open
Abstract
The research of TiO2 nanotubes (TNTs) in the field of biomedicine has been increasingly active. However, given the diversity of the nanoscale dimension and controversial reports, our understanding of the structure-property relationships of TNTs is not yet complete. In this paper, gradient TNTs with a wide diameter range of 20-350 nm were achieved by bipolar electrochemistry and utilized for a thorough high-throughput study of the effect of nanotube dimension and crystalline phase on protein adsorption and cell behaviors. Results indicated that protein adsorption escalated with nanotube dimension whereas cell proliferation and differentiation are preferred on small diameter (<70 nm) nanotubes. Large diameter anatase nanotubes had higher adsorption of serum proteins than as-prepared ones. But only as-prepared small diameter nanotubes presented slightly higher cell proliferation than corresponding annealed nanotubes whereas there was no discernible difference between as-prepared and annealed nanotubes on cell differentiation for the entire gradient. Those findings replenish previous research about how cell responses to TNTs with a wide diameter range and provide scientific guidance for the optimal design of biomedical materials.
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Affiliation(s)
- Yanran Li
- Research Institute for Biomimetics and Soft Matter, Fujian Provincial Key Laboratory for Soft Functional Materials Research, Department of Physics, College of Physical Science and Technology, Xiamen University, Xiamen, 361005, China
| | - Si Wang
- Research Institute for Biomimetics and Soft Matter, Fujian Provincial Key Laboratory for Soft Functional Materials Research, Department of Physics, College of Physical Science and Technology, Xiamen University, Xiamen, 361005, China
| | - Yuanjun Dong
- Research Institute for Biomimetics and Soft Matter, Fujian Provincial Key Laboratory for Soft Functional Materials Research, Department of Physics, College of Physical Science and Technology, Xiamen University, Xiamen, 361005, China
| | - Ping Mu
- Research Institute for Biomimetics and Soft Matter, Fujian Provincial Key Laboratory for Soft Functional Materials Research, Department of Physics, College of Physical Science and Technology, Xiamen University, Xiamen, 361005, China
| | - Yun Yang
- Research Institute for Biomimetics and Soft Matter, Fujian Provincial Key Laboratory for Soft Functional Materials Research, Department of Physics, College of Physical Science and Technology, Xiamen University, Xiamen, 361005, China
| | - Xiangyang Liu
- Research Institute for Biomimetics and Soft Matter, Fujian Provincial Key Laboratory for Soft Functional Materials Research, Department of Physics, College of Physical Science and Technology, Xiamen University, Xiamen, 361005, China
- Department of Physics, National University of Singapore, 2 Science Drive 3, 117542, Singapore
| | - Changjian Lin
- State Key Laboratory for Physical Chemistry of Solid Surfaces, Department of Chemistry, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
| | - Qiaoling Huang
- Research Institute for Biomimetics and Soft Matter, Fujian Provincial Key Laboratory for Soft Functional Materials Research, Department of Physics, College of Physical Science and Technology, Xiamen University, Xiamen, 361005, China
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21
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Yang Y, Dong Z, Li M, Liu L, Luo H, Wang P, Zhang D, Yang X, Zhou K, Lei S. Graphene Oxide/Copper Nanoderivatives-Modified Chitosan/Hyaluronic Acid Dressings for Facilitating Wound Healing in Infected Full-Thickness Skin Defects. Int J Nanomedicine 2020; 15:8231-8247. [PMID: 33149572 PMCID: PMC7604465 DOI: 10.2147/ijn.s278631] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Wound healing, especially of infected wounds, remains a clinical challenge in plastic surgery. This study aimed to manufacture a novel and multifunctional wound dressing by combining graphene oxide/copper nanocomposites (GO/Cu) with chitosan/hyaluronic acid, providing significant opportunities for the therapy of wound repair in wounds with a high risk of bacterial infection. METHODS In this study, GO/Cu-decorated chitosan/hyaluronic acid dressings (C/H/GO/Cu) were prepared using sodium trimetaphosphate (STMP) crosslinking and the vacuum freeze-drying method, and chitosan/hyaluronic acid dressings (C/H) and GO-incorporated chitosan/hyaluronic acid dressings (C/H/GO) served as controls. The surface characterization, in vitro degradation under various pH values, antimicrobial potential, cytocompatibility and in vivo therapeutic efficacy in a bacteria-infected full-thickness skin defect model were systematically evaluated. RESULTS Our experimental results indicated that the acidic environment facilitated the release of copper (CuNPs and Cu2+) from the dressings, and prepared C/H/GO/Cu dressings exhibited significant in vitro antimicrobial activities against the two tested bacterial strains (ATCC35984 and ATCC25923). All three dressings showed satisfactory cytocompatibility with mouse fibroblasts (NIH/3T3-L1). Moreover, remarkably accelerated wound healing was found in the C/H/GO/Cu group, with controlled inflammatory infiltration and improved angiogenesis in granulation tissues. In addition, no pathological damage was noted in the tissue structures of the tested organs (heart, lung, liver and kidney) in any of the four groups. CONCLUSION Collectively, GO/Cu-incorporated chitosan/hyaluronic acid dressings suggested a synergistic antimicrobial efficacy and acceptable biocompatibility both in vitro and in vivo, as well as a significantly accelerated healing process of bacteria-infected wounds. Thus, the multifunctional C/H/GO/Cu composite is expected to be a potential alternative for wound dressings, especially for the management of intractable wounds caused by bacterial infection.
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Affiliation(s)
- Ying Yang
- State Key Laboratory of Powder Metallurgy, Research Institute of Powder Metallurgy, Central South University, Changsha410083, People’s Republic of China
- Department of Plastic Surgery, Xiangya Hospital, Central South University, Changsha410008, People’s Republic of China
| | - Zhonggen Dong
- Department of Orthopedic Surgery, Second Xiangya Hospital, Central South University, Changsha410011, People’s Republic of China
| | - Min Li
- Department of Oncology, Changsha Central Hospital, University of South China, Changsha410004, People’s Republic of China
| | - Lihong Liu
- State Key Laboratory of Powder Metallurgy, Research Institute of Powder Metallurgy, Central South University, Changsha410083, People’s Republic of China
- Department of Orthopedic Surgery, Second Xiangya Hospital, Central South University, Changsha410011, People’s Republic of China
| | - Hang Luo
- State Key Laboratory of Powder Metallurgy, Research Institute of Powder Metallurgy, Central South University, Changsha410083, People’s Republic of China
| | - Pu Wang
- Department of Plastic Surgery, Xiangya Hospital, Central South University, Changsha410008, People’s Republic of China
| | - Dou Zhang
- State Key Laboratory of Powder Metallurgy, Research Institute of Powder Metallurgy, Central South University, Changsha410083, People’s Republic of China
| | - Xinghua Yang
- Department of Plastic Surgery, Xiangya Hospital, Central South University, Changsha410008, People’s Republic of China
| | - Kechao Zhou
- State Key Laboratory of Powder Metallurgy, Research Institute of Powder Metallurgy, Central South University, Changsha410083, People’s Republic of China
| | - Shaorong Lei
- Department of Plastic Surgery, Xiangya Hospital, Central South University, Changsha410008, People’s Republic of China
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Luque-Agudo V, Fernández-Calderón MC, Pacha-Olivenza MA, Pérez-Giraldo C, Gallardo-Moreno AM, González-Martín ML. The role of magnesium in biomaterials related infections. Colloids Surf B Biointerfaces 2020; 191:110996. [PMID: 32272388 DOI: 10.1016/j.colsurfb.2020.110996] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 01/09/2023]
Abstract
Magnesium is currently increasing interest in the field of biomaterials. An extensive bibliography on this material in the last two decades arises from its potential for the development of biodegradable implants. In addition, many researches, motivated by this progress, have analyzed the performance of magnesium in both in vitro and in vivo assays with gram-positive and gram-negative bacteria in a very broad range of conditions. This review explores the extensive literature in recent years on magnesium in biomaterials-related infections, and discusses the mechanisms of the Mg action on bacteria, as well as the competition of Mg2+ and/or synergy with other divalent cations in this subject.
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Affiliation(s)
- Verónica Luque-Agudo
- University of Extremadura, Department of Applied Physics, Badajoz, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain; University Institute of Extremadura Sanity Research (iNube), Badajoz, Spain
| | - M Coronada Fernández-Calderón
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain; University Institute of Extremadura Sanity Research (iNube), Badajoz, Spain; University of Extremadura, Department of Biomedical Science, Badajoz, Spain
| | - Miguel A Pacha-Olivenza
- University of Extremadura, Department of Biomedical Science, Badajoz, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain; University Institute of Extremadura Sanity Research (iNube), Badajoz, Spain
| | - Ciro Pérez-Giraldo
- University of Extremadura, Department of Biomedical Science, Badajoz, Spain; University Institute of Extremadura Sanity Research (iNube), Badajoz, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain
| | - Amparo M Gallardo-Moreno
- University of Extremadura, Department of Applied Physics, Badajoz, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain; University Institute of Extremadura Sanity Research (iNube), Badajoz, Spain.
| | - M Luisa González-Martín
- University of Extremadura, Department of Applied Physics, Badajoz, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain; University Institute of Extremadura Sanity Research (iNube), Badajoz, Spain
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