Implants coated with bioactive glass by CO2-laser, an in vivo study

Osteointegration of functionalised high-performance oxide ceramics: imaging from micro-computed tomography

BACKGROUND

This study evaluated the osseointegration potential of functionalised high-performance oxide ceramics (HPOC) in isolation or coated with BMP-2 or RGD peptides in 36 New Zeeland female rabbits using micro-computed tomography (micro CT). The primary outcomes of interest were to assess the amount of ossification evaluating the improvement in the bone volume/ total volume (BV/TV) ratio and trabecular thickness at 6 and 12 weeks. The second outcome of interest was to investigate possible differences in osteointegration between the functionalised silanised HPOC in isolation or coated with Bone Morphogenetic Protein 2 (BMP-2) or RGD peptides.

METHODS

36 adult female New Zealand white rabbits with a minimum weight of three kg were used. One-third of HPOCs were functionalised with silicon suboxide (SiOx), a third with BMP-2 (sHPOC-BMP2), and another third with RGD (sHPOC-RGD). All samples were scanned with a high-resolution micro CT (U-CTHR, MILabs B.V., Houten, The Netherlands) with a reconstructed voxel resolution of 10 µm. MicroCT scans were reconstructed in three planes and processed using Imalytics Preclinical version 2.1 (Gremse-IT GmbH, Aachen, Germany) software. The total volume (TV), bone volume (BV) and ratio BV/TV were calculated within the coating area.

RESULTS

BV/TV increased significantly from 6 to 12 weeks in all HPOCs: silanised (P = 0.01), BMP-2 (P < 0.0001), and RGD (P < 0.0001) groups. At 12 weeks, the BMP-2 groups demonstrated greater ossification in the RGD (P < 0.0001) and silanised (P = 0.008) groups. Trabecular thickness increased significantly from 6 to 12 weeks (P < 0.0001). At 12 weeks, BMP-2 promoted greater trabecular thickness compared to the silanised group (P = 0.07), although no difference was found with the RGD (P = 0.1) group.

CONCLUSION

Sinalised HPOC in isolation or functionalised with BMP-2 or RGD promotes in vivo osteointegration. The sinalised HOPC functionalised with BMP-2 demonstrated the greatest osseointegration.

Effect of 20 μm thin ceramic coatings of hydroxyapatite, bioglass, GB14 and Beta-Tricalciumphosphate with copper on the biomechanical stability of femoral implants

In the present work, we test four thin coatings for titanium implants, namely, bioglass, GB14, Beta-Tricalciumphosphate (β-TCP) and hydroxyapatite (HA) with and without incorporated copper ions for their osteointegrative capacity. A rabbit drill hole model for time intervals up to 24 weeks was used in this study. Implant fixation was evaluated by measuring shear strength of the implant/bone interface. Quantitative histological analysis was performed for the measurements of bone contact area. Implants with and without copper ions were compared after 24 weeks. Thin coatings of GB14, HA or TCP on titanium implants demonstrated high shear strength during the entire test period of up to 24 weeks. Results confirmed osteointegrative properties of the coatings and did not reveal any negative effect of copper ions on osteointegration. The integration of copper in degradable osteoconductive coatings with a thickness of approx. 20 μm represents a promising method of achieving antibacterial shielding during the entire period of bone healing while at the same time improving osteointegration of the implants.

Periodontal Therapy Using Bioactive Glasses: A Review

This paper reviews the use of bioactive glasses as materials for periodontal repair. Periodontal disease causes bone loss, resulting in tooth loosening and eventual tooth loss. However, it can be reversed using bioactive glass, typically the original 45S5 formulation (Bioglass®) at the defect site. This is done either by plcing bioactive glass granules or a bioactive glass putty at the defect. This stimulates bone repair and causes the defect to disappear. Another use of bioactive glass in periodontics is to repair so-called furcation defects, i.e., bone loss due to infection at the intersection of the roots in multi-rooted teeth. This treatment also gives good clinical outcomes. Finally, bioactive glass has been used to improve outcomes with metallic implants. This involves either placing bioactive glass granules into the defect prior to inserting the metal implant, or coating the implant with bioactive glass to improve the likelihood of osseointegration. This needs the glass to be formulated so that it does not crack or debond from the metal. This approach has been very successful, and bioactive glass coatings perform better than those made from hydroxyapatite.

Application of bioactive glasses in various dental fields

Bioactive glasses are a group of bioceramic materials that have extensive clinical applications. Their properties such as high biocompatibility, antimicrobial features, and bioactivity in the internal environment of the body have made them useful biomaterials in various fields of medicine and dentistry. There is a great variation in the main composition of these glasses and some of them whose medical usage has been approved by the US Food and Drug Administration (FDA) are called Bioglass. Bioactive glasses have appropriate biocompatibility with the body and they are similar to bone hydroxyapatite in terms of calcium and phosphate contents. Bioactive glasses are applied in different branches of dentistry like periodontics, orthodontics, endodontics, oral and maxillofacial surgery, esthetic and restorative dentistry. Also, some dental and oral care products have bioactive glasses in their compositions. Bioactive glasses have been used as dental implants in the human body in order to repair and replace damaged bones. Other applications of bioactive glasses in dentistry include their usage in periodontal disease, root canal treatments, maxillofacial surgeries, dental restorations, air abrasions, dental adhesives, enamel remineralization, and dentin hypersensitivity. Since the use of bioactive glasses in dentistry is widespread, there is a need to find methods and extensive resources to supply the required bioactive glasses. Various techniques have been identified for the production of bioactive glasses, and marine sponges have recently been considered as a rich source of it. Marine sponges are widely available and many species have been identified around the world, including the Persian Gulf. Marine sponges, as the simplest group of animals, produce different bioactive compounds that are used in a wide range of medical sciences. Numerous studies have shown the anti-tumor, anti-viral, anti-inflammatory, and antibiotic effects of these compounds. Furthermore, some species of marine sponges due to the mineral contents of their structural skeletons, which are made of biosilica, have been used for extracting bioactive glasses.

A novel multi-structural reinforced treatment on Ti implant utilizing a combination of alkali solution and bioactive glass sol

OBJECTIVE

Alkali treatment and bioactive glass (BG) sol dip-coating are well-known individual methods for titanium (Ti) surface modification. In this study, a unique combination of alkali treatment and bioactive glass sol dip coating was applied to the Ti substrate, then the mechanical properties and cell responses were investigated.

METHODS

Based on the methods introduced above, the Ti substrate was treated by 6 mL of an NaOH 5 M aqueous solution for 24 h at 60 ̊C; this was followed by adding 1.2 mL of a BG 58S sol to form a novel combined nanostructure network covered by a thin BG layer. For the assessment of the formed coating layer, the morphology, elemental analysis, phase structure, adhesion property and the cell response of the untreated and treated surfaces were investigated.

RESULTS

The BG coating layer was reinforced by the nanostructure, fabricated through the alkali treatment. The results obtained by applying the combined modification method confirmed that the mechanical and biological properties of the fabricated surface demonstrated the highest performance compared to that of the unmodified and individually modified surfaces.

SIGNIFICANCE

The achieved upgrades for this method could be gained from the demanded porous nanostructure and the apatite transformation ability of the alkali treatment. Therefore, the hybridized application of the alkali-BG treatment could be introduced as a promising surface modification strategy for hard-tissue replacement applications.

Silica-Based Bioactive Glasses and Their Applications in Hard Tissue Regeneration: A Review

Regenerative medicine is a field that aims to influence and improvise the processes of tissue repair and restoration and to assist the body to heal and recover. In the field of hard tissue regeneration, bio-inert materials are being predominantly used, and there is a necessity to use bioactive materials that can help in better tissue-implant interactions and facilitate the healing and regeneration process. One such bioactive material that is being focused upon and studied extensively in the past few decades is bioactive glass (BG). The original bioactive glass (45S5) is composed of silicon dioxide, sodium dioxide, calcium oxide, and phosphorus pentoxide and is mainly referred to by its commercial name Bioglass. BG is mainly used for bone tissue regeneration due to its osteoconductivity and osteostimulation properties. The bioactivity of BG, however, is highly dependent on the compositional ratio of certain glass-forming system content. The manipulation of content ratio and the element compositional flexibility of BG-forming network developed other types of bioactive glasses with controllable chemical durability and chemical affinity with bone and bioactivity. This review article mainly discusses the basic information about silica-based bioactive glasses, including their composition, processing, and properties, as well as their medical applications such as in bone regeneration, as bone grafts, and as dental implant coatings.

Bioactive Glass Applications in Dentistry

At present, researchers in the field of biomaterials are focusing on the oral hard and soft tissue engineering with bioactive ingredients by activating body immune cells or different proteins of the body. By doing this natural ground substance, tissue component and long-lasting tissues grow. One of the current biomaterials is known as bioactive glass (BAG). The bioactive properties make BAG applicable to several clinical applications involving the regeneration of hard tissues in medicine and dentistry. In dentistry, its uses include dental restorative materials, mineralizing agents, as a coating material for dental implants, pulp capping, root canal treatment, and air-abrasion, and in medicine it has its applications from orthopedics to soft-tissue restoration. This review aims to provide an overview of promising and current uses of bioactive glasses in dentistry.

Bioactive Glass and Silicate-Based Ceramic Coatings on Metallic Implants: Open Challenge or Outdated Topic?

The overall success and long-term life of the medical implants are decisively based on the convenient osseointegration at the hosting tissue-implant interface. Therefore, various surface modifications and different coating approaches have been utilized to the implants to enhance the bone formation and speed up the interaction with the surrounding hosting tissues, thereby enabling the successful fixation of implants. In this review, we will briefly present the main metallic implants and discuss their biocompatibility and osseointegration ability depending on their chemical and mechanical properties. In addition, as the main goal of this review, we explore the main properties of bioactive glasses and silica-based ceramics that are used as coating materials for both orthopedic and dental implants. The current review provides an overview of these bioactive coatings, with a particular emphasis on deposition methods, coating adhesion to the substrates and apatite formation ability tested by immersion in Simulated Body Fluid (SBF). In vitro and in vivo performances in terms of biocompatibility, biodegradability and improved osseointegration are examined as well.

[Research and application progress of bioactive glass in bone repair]

Objective

To review the research and application progress of bioactive glass in bone repair.

Methods

The recently published literature concerning bioactive glass in bone repair was reviewed and summarized.

Results

Bioactive glass can classified different types, such as bioactive glass particulate, bioactive glass scaffold, bioactive glass coating, injectable bioactive glass cement, and bioactive glass delivery system. Bioactive glass has been well studied in the field of bone repair due to its excellent biological properties. Also, the remarkable progress has been made in various aspects.

Conclusion

Bioactive glass is a reliable material of bone repair and will play an even more important role in the future.

Bioactive-glass in periodontal surgery and implant dentistry

Bioactive-glass (B-G) is a material known for its favorable biological response when in contact with surrounding fibro-osseous tissues, due not only to an osteoconductive property, but also to an osteostimulatory capacity, and superior biocompatibility for use in human body. The objectives of this paper are to review recent studies on B-G in periodontal and implant therapy, describing its basic properties and mechanism of activity as well as discoursing about state of art and future perspective of utilization. From a demonstrated clinical benefit as bone graft for the elimination of osseous defects due to periodontal disease (intrabony/furcation defects) and surgeries (alveolar ridge preservation, maxillary sinus augmentation), to a potential use for manufacturing bioactive dental implants, possibly allowing wider case selection criteria together with improved integration rates even in the more challenging osteoporotic and medically compromised patients, this biomaterial represents an important field of study with high academic, clinical and industrial importance.

Coatings of titanium substrates with xCaO · (1 - x)SiO2 sol-gel materials: characterization, bioactivity and biocompatibility evaluation

The objective of this study has been to develop low temperature sol-gel coatings to modify the surface of commercially pure titanium grade 4 (a material generally used in dental application) and to evaluate their bioactivity and biocompatibility on the substrate. Glasses of composition expressed by the following general formula xCaO · (1 - x)SiO2 (0.0<x<0.60) have been prepared by means of the sol-gel route starting from tetraethyl orthosilicate and calcium nitrate tetrahydrate. Those materials, still in the sol phase, have been used to coat titanium substrates by means of the dip-coating technique. Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD) allowed the materials to be characterized and a microstructural analysis of the coatings obtained was performed using scanning electron microscopy (SEM). The potential applications of the coatings in the biomedical field were evaluated by bioactivity and biocompatibility tests. The coated titanium was immersed in simulated body fluid (SBF) for 21 days and the hydroxyapatite deposition on its surface was subsequently evaluated via SEM-EDXS analysis, as an index of bone-bonding capability. To investigate cell-material interactions, mouse embryonic fibroblast cells (3T3) were seeded onto the specimens and the cell viability was evaluated by a WST-8 assay.

Reprint of: Review of bioactive glass: From Hench to hybrids

Bioactive glasses are reported to be able to stimulate more bone regeneration than other bioactive ceramics but they lag behind other bioactive ceramics in terms of commercial success. Bioactive glass has not yet reached its potential but research activity is growing. This paper reviews the current state of the art, starting with current products and moving onto recent developments. Larry Hench's 45S5 Bioglass® was the first artificial material that was found to form a chemical bond with bone, launching the field of bioactive ceramics. In vivo studies have shown that bioactive glasses bond with bone more rapidly than other bioceramics, and in vitro studies indicate that their osteogenic properties are due to their dissolution products stimulating osteoprogenitor cells at the genetic level. However, calcium phosphates such as tricalcium phosphate and synthetic hydroxyapatite are more widely used in the clinic. Some of the reasons are commercial, but others are due to the scientific limitations of the original Bioglass 45S5. An example is that it is difficult to produce porous bioactive glass templates (scaffolds) for bone regeneration from Bioglass 45S5 because it crystallizes during sintering. Recently, this has been overcome by understanding how the glass composition can be tailored to prevent crystallization. The sintering problems can also be avoided by synthesizing sol-gel glass, where the silica network is assembled at room temperature. Process developments in foaming, solid freeform fabrication and nanofibre spinning have now allowed the production of porous bioactive glass scaffolds from both melt- and sol-gel-derived glasses. An ideal scaffold for bone regeneration would share load with bone. Bioceramics cannot do this when the bone defect is subjected to cyclic loads, as they are brittle. To overcome this, bioactive glass polymer hybrids are being synthesized that have the potential to be tough, with congruent degradation of the bioactive inorganic and the polymer components. Key to this is creating nanoscale interpenetrating networks, the organic and inorganic components of which have covalent coupling between them, which involves careful control of the chemistry of the sol-gel process. Bioactive nanoparticles can also now be synthesized and their fate tracked as they are internalized in cells. This paper reviews the main developments in the field of bioactive glass and its variants, covering the importance of control of hierarchical structure, synthesis, processing and cellular response in the quest for new regenerative synthetic bone grafts. The paper takes the reader from Hench's Bioglass 45S5 to new hybrid materials that have tailorable mechanical properties and degradation rates.

Bioactive glass particulate filler composite: Effect of coupling of fillers and filler loading on some physical properties

OBJECTIVES

The aim of this study was to investigate the effect of silanization of biostable and bioactive glass fillers in a polymer matrix on some of the physical properties of the composite.

METHODS

The water absorption, solubility, flexural strength, flexural modulus and toughness of different particulate filler composite resins were studied in vitro. Five different specimen groups were analyzed: A glass-free control, a non-silanized bioactive glass, a silanized bioactive glass, a non-silanized biostable glass and a silanized biostable glass groups. All of these five groups were further divided into sub-groups of dry and water-stored materials, both of them containing groups with 3wt%, 6wt%, 9wt% or 12wt% of glass particles (n=8 per group). The silanization of the glass particles was carried out with 2% of gamma-3-methacryloxyproyltrimethoxysilane (MPS). For the water absorption and solubility tests, the test specimens were stored in water for 60 days, and the percentages of weight change were statistically analyzed. Flexural strength, flexural modulus and toughness values were tested with a three-point bending test and statistically analyzed.

RESULTS

Higher solubility values were observed in non-silanized glass in proportion to the percentage of glass particles. Silanization, on the other hand, decreased the solubility values of both types of glass particles and polymer. While 12wt% non-silanized bioactive glass specimens showed -0.98wt% solubility, 12wt% silanized biostable glass specimens were observed to have only -0.34wt% solubility. The three-point bending results of the dry specimens showed that flexural strength, toughness and flexural modulus decreased in proportion to the increase of glass fillers. The control group presented the highest results (106.6MPa for flexural strength, 335.7kPA for toughness, 3.23GPa for flexural modulus), whereas for flexural strength and toughness, 12wt% of non-silanized biostable glass filler groups presented the lowest (70.3MPa for flexural strength, 111.5kPa for toughness). For flexural modulus on the other hand, 12wt% of silanized biostable glass filler group gave the lowest results (2.57GPa).

SIGNIFICANCE

The silanization of glass fillers improved the properties of the glass as well as the properties of the composite. Silanization of bioactive glass may protect the glass from leaching at early stage of water storage.

Review of bioactive glass: from Hench to hybrids

Bioactive glasses are reported to be able to stimulate more bone regeneration than other bioactive ceramics but they lag behind other bioactive ceramics in terms of commercial success. Bioactive glass has not yet reached its potential but research activity is growing. This paper reviews the current state of the art, starting with current products and moving onto recent developments. Larry Hench's 45S5 Bioglass® was the first artificial material that was found to form a chemical bond with bone, launching the field of bioactive ceramics. In vivo studies have shown that bioactive glasses bond with bone more rapidly than other bioceramics, and in vitro studies indicate that their osteogenic properties are due to their dissolution products stimulating osteoprogenitor cells at the genetic level. However, calcium phosphates such as tricalcium phosphate and synthetic hydroxyapatite are more widely used in the clinic. Some of the reasons are commercial, but others are due to the scientific limitations of the original Bioglass 45S5. An example is that it is difficult to produce porous bioactive glass templates (scaffolds) for bone regeneration from Bioglass 45S5 because it crystallizes during sintering. Recently, this has been overcome by understanding how the glass composition can be tailored to prevent crystallization. The sintering problems can also be avoided by synthesizing sol-gel glass, where the silica network is assembled at room temperature. Process developments in foaming, solid freeform fabrication and nanofibre spinning have now allowed the production of porous bioactive glass scaffolds from both melt- and sol-gel-derived glasses. An ideal scaffold for bone regeneration would share load with bone. Bioceramics cannot do this when the bone defect is subjected to cyclic loads, as they are brittle. To overcome this, bioactive glass polymer hybrids are being synthesized that have the potential to be tough, with congruent degradation of the bioactive inorganic and the polymer components. Key to this is creating nanoscale interpenetrating networks, the organic and inorganic components of which have covalent coupling between them, which involves careful control of the chemistry of the sol-gel process. Bioactive nanoparticles can also now be synthesized and their fate tracked as they are internalized in cells. This paper reviews the main developments in the field of bioactive glass and its variants, covering the importance of control of hierarchical structure, synthesis, processing and cellular response in the quest for new regenerative synthetic bone grafts. The paper takes the reader from Hench's Bioglass 45S5 to new hybrid materials that have tailorable mechanical properties and degradation rates.

Osteoblast proliferation and maturation on bioactive fiber-reinforced composite surface

The objective of this study was to evaluate the proliferation and osteogenic potential of bone-marrow derived osteoblast-like cells on fiber-reinforced composite (FRC) substrates with and without bioactive glass surface modification. Three FRC materials were fabricated for the study: (a) grit-blasted FRC, (b) grit-blasted FRC with bidirectional net reinforcement and (c) FRC with bioactive glass (BAG) coating. Rat bone-marrow derived osteoblast-like cells were harvested and cultured on experimental material plates and on cp. titanium plates (control) for 21 days. The materials' surfaces were characterized by roughness testing and scanning electron microscopy. Cell growth and differentiation kinetics were subsequently investigated by evaluating proliferation, alkaline phosphatase (ALP) activity, osteocalcin (OC) and bone sialoprotein (BSP) production. On day 14, the cell proliferation was significantly lower (P<0.05) on FRC-BAG than on titanium and FRC. The proliferation on the other three materials was equal throughout the experiment. The maximal ALP activities on FRC, FRC-Net, and titanium were observed on day 21, whereas FRC-BAG had already reached the maximal level on day 14. Expression of osteoblastic markers (OC, BSP) indicates that the fastest osteogenic differentiation takes place on FRC after 7 days. In contrast, a slower differentiation process was observed on titanium than on any other tested material (P<0.015) at 21 days, as was confirmed by increased mRNA expression of OC and BSP. It can be concluded that the proliferation and maturation of osteoblast-like cells on FRC appears to be comparable to titanium. Presence of BAG enhances cell maturation.

Comparison between sol-gel-derived anatase- and rutile-structured TiO2 coatings in soft-tissue environment

The bioactivity of the surface reactive TiO(2) coatings for medical implants can be locally modified by CO(2) laser processing to match with the properties of surrounding tissues. The TiO(2) coatings heat-treated at 500 degrees C exhibit in vitro bioactivity. With further CO(2) laser treatment they exhibit enhanced in vitro bioactivity. The aim of this in vivo study was to compare the performance of heat-treated anatase-structured TiO(2) coatings with preheat-treated and CO(2) laser-treated rutile-structured coatings in terms of their ability to attach soft connective tissues. The coatings were characterized with TF-XRD and AFM. TiO(2)-coated discs were implanted in rats. The samples were analyzed with routine histology, SEM-EDS, and TEM. In both groups, already at 3 days, soft connective tissues were in immediate contact with the surface. No thick crystalline CaP layer was detected by SEM-EDS, but a thin amorphous CaP layer was detected by XPS. No gap between the cell membrane and the coating could be observed in TEM pictures. No differences were observed between the anatase- and rutile-structured coatings in terms of tissue responses. Further studies are needed to verify if the tissues are adherent to the surface of the implant.

Load bearing capacity of bone anchored fiber-reinforced composite device

The purpose of this study was to evaluate the push-out load-bearing capacity of threaded fiber-reinforced composite (FRC) devices for use as bone-anchored devices. The purpose was also to evaluate the possibility to use bioactive glass (BAG) granules on the experimental FRC devices in terms the mechanical behavior. Three experimental FRC devices (n = 15) were fabricated for the study: (a) threaded device with smooth surface; (b) threaded device with BAG granules (S53P4, Vivoxid Ltd, Turku, Finland) and supplementary retention grooves, and (c) unthreaded device with BAG granules. Threaded titanium devices were used as controls. The FRC devices were prepared from a light-polymerized dimethacrylate resin reinforced with preimpregnated unidirectional and bidirectional E-glass fibers (EverStick, StickTech Ltd, Turku, Finland). Experimental and control devices were embedded into dental plaster to simulate bone before the mechanical push-out test was carried out. ANOVA and Weibull analysis were used for the statistical evaluation. Threaded FRC devices had significantly higher push-out strength than the threaded titanium device (p < .001). The push-out forces exceeding 2,500 N were measured for threaded FRC devices with supplementary grooves and BAG coating. No thread failures were observed in any FRC devices. The unthreaded FRC devices with BAG lost 70% of glass particles during the test, while no BAG particles were lost from threaded FRC devices. It can be concluded that threaded FRC devices can withstand high push-out forces in the dental plaster without a risk of thread failure under physiological load.

Effect of Hydroxyapatite porous characteristics on healing outcomes in rabbit posterolateral spinal fusion model

Hydroxyapatite (HA) has been commonly used as a bone graft substitute in various kinds of clinical fields. To improve the healing capability of HA, many studies have been performed to reveal its optimal structural characteristics for better healing outcomes. In spinal reconstruction surgery, non-interconnected porous HAs have already been applied as a bone graft extender in order to avoid autogenous bone harvesting. However, there have been few experimental studies regarding the effects of the structural characteristics of HA in posterolateral lumbar intertransverse process spine fusion (PLF). The aims of this study were to investigate the effect of HA porous characteristics on healing outcomes in a rabbit PLF model in order to elucidate appropriate structural characteristics of HA as a bone graft extender. Thirty-six adult female Japanese White rabbits underwent bilateral intertransverse process fusion at the level of L5-6 without internal fixation. We prepared three types of HA with different porosities: HA with 15% porosity (HA15%), HA with 50% porosity (HA50%), and HA with 85% porosity (HA85%), all of which were clinically available materials. The HA15% and HA50% had few interconnecting pores, whereas the HA85%, which was a recently developed material, had abundant interconnecting pores. All rabbits were randomly divided into the following four groups according to the grafted materials: (1) HA15% + autogenous bone, (2) HA50% + autogenous bone, (3) HA85% + autogenous bone, (4) pure autogenous bone graft. The animals were euthanized at 5 weeks after surgery, and post-mortem analyses including biomechanical testing, radiographical and histological evaluations were performed. There was no statistically significant difference in either fusion rate and/or bending stiffness among the three HA groups. However, in histological and radiological analyses, both bone ingrowth rate and direct bone bonding rate in the HA85% group were significantly higher than those in the HA15% and HA50% groups, despite the similar value of bone volume rate in fusion mass among the three HA groups. In the HA85% group, bone ingrowth was achieved throughout the implanted HAs via interconnecting pores and there was excellent unification between the HA granules and the newly mineralized bone. On the other hand, in the non-interconnected porous HA groups, only a little bone ingrowth could be seen at the peripheral pores of the implanted HA, and its surface was mostly covered with fibrous tissue or empty space. The current study demonstrated that the HA porous characteristics had an effect on the histological outcomes in a rabbit PLF model. We would like to conclude that the interconnected high porous structure seems to be promising for the environment of PLF in the point of producing fusion mass with higher cellular viability. This is because the HA85% is superior in terms of integration with the newly formed bone in fusion mass compared to the non-interconnected porous HAs. However, the porous modifications of HA have little influence on fusion rate and mechanical strength because primary stabilization of the fusion segment is mainly achieved by bridging bone between the adjacent transverse processes outside the implanted materials, rather than the degree of integration between the newly formed bone and the HA granules in PLF.

Phospholipids as implant coatings

Bio-interfaces such as bio-membranes are of outmost importance for a variety of live processes. Among them are cell-interactions which take place in, on or through cell membranes. Therefore we propose to cover metallic surfaces with phospholipids to facilitate cell-material interaction. Four lipids, 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC), 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphoethanolamine (POPE), 1-palmitoyl-2- oleoyl-sn-glycero-3-[phospho-L-serine] (POPS) and 1-palmitoyl-2-oleoyl-sn-glycero-3-phospho-rac-(1-glycerol) (POPG), were applied to four metallic growth substrates with different surface structure, roughness and porosity. The interaction of the osteosarcoma cell line MG-63 was investigated in terms of cell adhesion and viability (MTT (methylthiazolyldiphenyl-tetrazolium bromide) assay). While POPS in general had a negative influence, the most suitable combination in terms of viability per adherent MG-63 is the coating of porous Ti6Al4V material with the phospholipids POPE or POPC. The analysis of viability of mouse macrophages RAW 264.7 and their tumor necrosis factor alpha (TNF-alpha) release showed that the adhesion and viability is worst on POPS while the TNF-alpha release was highest. To elucidate the potential of phospholipids to prevent or support bacterial growth, the bacterial number of Gram positive and Gram negative bacteria was investigated. For lipid concentrations higher than 1 mM in solution a growth stimulating effect independent of the lipid type was detected. On a lipid coated surface the number of bacteria was reduced by 81%, 74% and 51% for POPC, POPG and POPE.