Evaluation of the osteogenesis and osseointegration of titanium alloys coated with graphene: an in vivo study

Effect of micro-arc oxidation coatings with graphene oxide and graphite on osseointegration of titanium implants-an in vivo study

Background

This in vivo study evaluated the effect of graphene oxide and graphite coatings, coupled with the micro-arc oxidation (MAO) surface roughening technique, known for their mechanical strength, chemical stability, and antibacterial properties. The main objective was to assess the degree of improvement in osseointegration of titanium implants resulting from these interventions.

Materials and methods

In this study, 32 female rats were utilized and randomly allocated into four groups (n = 8 each): machined surface titanium implants (control), those roughened by the MAO method, those coated with graphene oxide-doped MAO, and those with a graphite-doped MAO coating. Titanium implants were surgically placed in the right tibia of the rats. Rats undergoing no additional procedures during the 4-week experimental period were sacrificed at the end. Then, the implants and surrounding bone tissues were separated and embedded in acrylic blocks for reverse torque analysis. Using a digital torque device, the rotational force was applied to all samples using a hex driver and racquet until implant separation from the bone occurred, with the corresponding values recorded on the digital display. Then, statistical analysis was performed to analyze the data.

Results

No statistically significant difference between the groups was observed in the biomechanical bone-implant connection levels (N/cm) (P = 0.268). Post-hoc tests were not required because no discernible differences were identified between the groups.

Conclusion

Within the scope of this study, implants treated with the MAO method, along with those coated with graphene oxide- and graphite-doped MAO method, did not exhibit significant superiority in terms of osseointegration compared to machined surface titanium implants.

Calycosin alleviates titanium particle-induced osteolysis by modulating macrophage polarization and subsequent osteogenic differentiation

Periprosthetic osteolysis (PPO) caused by wear particles is one of the leading causes of implant failure after arthroplasty. Macrophage polarization imbalance and subsequent osteogenic inhibition play a crucial role in PPO. Calycosin (CA) is a compound with anti-inflammatory and osteoprotective properties. This study aimed to evaluate the effects of CA on titanium (Ti) particle-induced osteolysis, Ti particle-induced macrophage polarization and subsequent osteogenic deficits, and explore the associated signalling pathways in a Ti particle-stimulated calvarial osteolysis mouse model using micro-CT, ELISA, qRT-PCR, immunofluorescence and western blot techniques. The results showed that CA alleviated inflammation, osteogenic inhibition and osteolysis in the Ti particle-induced calvarial osteolysis mouse model in vivo. In vitro experiments showed that CA suppressed Ti-induced M1 macrophage polarization, promoted M2 macrophage polarization and ultimately enhanced osteogenic differentiation of MC3T3-E1 cells. In addition, CA alleviated osteogenic deficits by regulating macrophage polarization homeostasis via the NF-κB signalling pathway both in vivo and in vitro. All these findings suggest that CA may prove to be an effective therapeutic agent for wear particle-induced osteolysis.

Analyzing the Surface Topography of Hafnium Nitride Coating on Titanium Screws: An In Vitro Analysis

Background The use of surface coatings to enhance the properties lacking in titanium has attracted significant focus in recent times. Hafnium nitride (HfN) coatings could be explored as promising in the osteoinductive properties of titanium implants. HfN exhibits excellent mechanical attributes, such as hardness and wear resistance, and is often used as a coating on high-end equipment for protection. The findings from this research may carve a new path for the production and optimization of HfN coatings to enhance the longevity and augment properties of implant materials. Thus, the present study was orchestrated to elucidate the surface morphology of HfN coating, ultimately contributing to the advancement of dental implant biomaterials. Materials and methods A total of twenty samples of medical grade commercially pure titanium screws (2 mm diameter and 7 mm length) were procured from G. R. Bioure Surgical System Pvt. Ltd., Ravali, Uttar Pradesh, India, and ten samples were reacted with HfN (0.1 M) (Nano Research Elements, Kurukshetra, Haryana, India) in 100% ethanol and stirred continuously for about 48 hours. Then these screw samples were immersed in the prepared colloidal suspension and sintered for two hours at 400 degrees centigrade. The implant screws were affixed onto metal supports. The magnifications for photomicrographs at ×30, ×200, ×1,500, ×3,000, and ×5,000 were standardized. Elementary semi-quantitative analysis of both dental implants was conducted using energy-dispersive X-ray spectrometry (EDX) coupled with the field emission scanning electron microscope (FE-SEM) equipment (JEOL Ltd., Akishima, Tokyo, Japan). The software used for the analysis of the obtained images is SEM Center. Results The surface analysis using the scanning electron microscope (SEM) showed the coating of HfN over titanium screws. The difference in surface morphology of both the group of implant screws can be visualized under 40.0 and 10.0 mm working distance (WD) for both groups. The surface analysis using the EDX of uncoated titanium screws shows five elements in the spectrum: titanium (Ti), oxygen (O), aluminum (Al), carbon (C), and vanadium (V). The EDX of the HfN-coated screws has two additional metals dispersed in the spectrum, hafnium (Hf). The element characteristics are tabulated with their apparent concentration, k ratio, line type, weight percentage, standard label, and factory label for uncoated titanium screws and HfN-coated titanium screws. Conclusion The study evaluated HfN coating over medical grade commercially pure titanium. The surface topography of coated versus uncoated was visualized. The scanning electron microscope (SEM) images showed a homogenous coating over the titanium surfaces, and the EDX showed elemental dispersion of the coated implant. The study aims to provide a comprehensive understanding of the coating's surface morphology, which will aid in the development of more durable and biocompatible implants. This thereby provides a promising scope for further research of this novel metal coating for use in the biomedical sectors, specifically for dental implants.

Effects of hydroxyapatite-coated porous titanium scaffolds functionalized by exosomes on the regeneration and repair of irregular bone

As a traditional bone implant material, titanium (Ti) and its alloys have the disadvantages of lack of biological activity and susceptibility to stress shielding effect. Adipose stem cells (ADSCs) and exosomes were combined with the scaffold material in the current work to effectively create a hydroxyapatite (HA) coated porous titanium alloy scaffold that can load ADSCs and release exosomes over time. The composite made up for the drawbacks of traditional titanium alloy materials with higher mechanical characteristics and a quicker rate of osseointegration. Exosomes (Exos) are capable of promoting the development of ADSCs in porous titanium alloy scaffolds with HA coating, based on experimental findings from in vitro and in vivo research. Additionally, compared to pure Ti implants, the HA scaffolds loaded with adipose stem cell exosomes demonstrated improved bone regeneration capability and bone integration ability. It offers a theoretical foundation for the combined use of stem cell treatment and bone tissue engineering, as well as a design concept for the creation and use of novel clinical bone defect repair materials.

Electroactive Hydroxyapatite/Carbon Nanofiber Scaffolds for Osteogenic Differentiation of Human Adipose-Derived Stem Cells

Traditional bone defect treatments are limited by an insufficient supply of autologous bone, the immune rejection of allogeneic bone grafts, and high medical costs. To address this medical need, bone tissue engineering has emerged as a promising option. Among the existing tissue engineering materials, the use of electroactive scaffolds has become a common strategy in bone repair. However, single-function electroactive scaffolds are not sufficient for scientific research or clinical application. On the other hand, multifunctional electroactive scaffolds are often complicated and expensive to prepare. Therefore, we propose a new tissue engineering strategy that optimizes the electrical properties and biocompatibility of carbon-based materials. Here, a hydroxyapatite/carbon nanofiber (HAp/CNF) scaffold with optimal electrical activity was prepared by electrospinning HAp nanoparticle-incorporated polyvinylidene fluoride (PVDF) and then carbonizing the fibers. Biochemical assessments of the markers of osteogenesis in human adipose-derived stem cells (h-ADSCs) cultured on HAp/CNF scaffolds demonstrate that the material promoted the osteogenic differentiation of h-ADSCs in the absence of an osteogenic factor. The results of this study show that electroactive carbon materials with a fibrous structure can promote the osteogenic differentiation of h-ADSCs, providing a new strategy for the preparation and application of carbon-based materials in bone tissue engineering.

Antibacterial activity, cytocompatibility, and thermomechanical stability of Ti40Zr10Cu36Pd14 bulk metallic glass

This paper envisions Ti40Zr10Cu36Pd14 bulk metallic glass as an oral implant material and evaluates its antibacterial performance in the inhabitation of oral biofilm formation in comparison with the gold standard Ti-6Al-4V implant material. Metallic glasses are superior in terms of biocorrosion and have a reduced stress shielding effect compared with their crystalline counterparts. Dynamic mechanical and thermal expansion analyses on Ti40Zr10Cu36Pd14 show that these materials can be thermomechanically shaped into implants. Static water contact angle measurement on samples' surface shows an increased surface wettability on the Ti-6Al-4V surface after 48 ​h incubation in the water while the contact angle remains constant for Ti40Zr10Cu36Pd14. Further, high-resolution transmission and scanning transmission electron microscopy analysis have revealed that Ti40Zr10Cu36Pd14 interior is fully amorphous, while a 15 ​nm surface oxide is formed on its surface and assigned as copper oxide. Unlike titanium oxide formed on Ti-6Al-4V, copper oxide is hydrophobic, and its formation reduces surface wettability. Further surface analysis by X-ray photoelectron spectroscopy confirmed the presence of copper oxide on the surface. Metallic glasses cytocompatibility was first demonstrated towards human gingival fibroblasts, and then the antibacterial properties were verified towards the oral pathogen Aggregatibacter actinomycetemcomitans responsible for oral biofilm formation. After 24 ​h of direct infection, metallic glasses reported a >70% reduction of bacteria viability and the number of viable colonies was reduced by ∼8 times, as shown by the colony-forming unit count. Field emission scanning electron microscopy and fluorescent images confirmed the lower surface colonization of metallic glasses in comparison with controls. Finally, oral biofilm obtained from healthy volunteers was cultivated onto specimens' surface, and proteomics was applied to study the surface property impact on species composition within the oral plaque.

Synthetic materials in craniofacial regenerative medicine: A comprehensive overview

The state-of-the-art approach to regenerating different tissues and organs is tissue engineering which includes the three parts of stem cells (SCs), scaffolds, and growth factors. Cellular behaviors such as propagation, differentiation, and assembling the extracellular matrix (ECM) are influenced by the cell's microenvironment. Imitating the cell's natural environment, such as scaffolds, is vital to create appropriate tissue. Craniofacial tissue engineering refers to regenerating tissues found in the brain and the face parts such as bone, muscle, and artery. More biocompatible and biodegradable scaffolds are more commensurate with tissue remodeling and more appropriate for cell culture, signaling, and adhesion. Synthetic materials play significant roles and have become more prevalent in medical applications. They have also been used in different forms for producing a microenvironment as ECM for cells. Synthetic scaffolds may be comprised of polymers, bioceramics, or hybrids of natural/synthetic materials. Synthetic scaffolds have produced ECM-like materials that can properly mimic and regulate the tissue microenvironment's physical, mechanical, chemical, and biological properties, manage adherence of biomolecules and adjust the material's degradability. The present review article is focused on synthetic materials used in craniofacial tissue engineering in recent decades.

Ternary MXene-loaded PLCL/collagen nanofibrous scaffolds that promote spontaneous osteogenic differentiation

Conventional bioinert bone grafts often have led to failure in osseointegration due to low bioactivity, thus much effort has been made up to date to find alternatives. Recently, MXene nanoparticles (NPs) have shown prominent results as a rising material by possessing an osteogenic potential to facilitate the bioactivity of bone grafts or scaffolds, which can be attributed to the unique repeating atomic structure of two carbon layers existing between three titanium layers. In this study, we produced MXene NPs-integrated the ternary nanofibrous matrices of poly(L-lactide-co-ε-caprolactone, PLCL) and collagen (Col) decorated with MXene NPs (i.e., PLCL/Col/MXene), as novel scaffolds for bone tissue engineering, via electrospinning to explore the potential benefits for the spontaneous osteogenic differentiation of MC3T3-E1 preosteoblasts. The cultured cells on the physicochemical properties of the nanofibrous PLCL/Col/MXene-based materials revealed favorable interactions with the supportive matrices, highly suitable for the growth and survival of preosteoblasts. Furthermore, the combinatorial ternary material system of the PLCL/Col/MXene nanofibers obviously promoted spontaneous osteodifferentiation with positive cellular responses by providing effective microenvironments for osteogenesis. Therefore, our results suggest that the unprecedented biofunctional advantages of the MXene-integrated PLCL/Col nanofibrous matrices can be expanded to a wide range of strategies for the development of effective scaffolds in bone tissue regeneration.

Development of Graphene-Based Materials in Bone Tissue Engineaering

Bone regeneration-related graphene-based materials (bGBMs) are increasingly attracting attention in tissue engineering due to their special physical and chemical properties. The purpose of this review is to quantitatively analyze mass academic literature in the field of bGBMs through scientometrics software CiteSpace, to demonstrate the rules and trends of bGBMs, thus to analyze and summarize the mechanisms behind the rules, and to provide clues for future research. First, the research status, hotspots, and frontiers of bGBMs are analyzed in an intuitively and vividly visualized way. Next, the extracted important subjects such as fabrication techniques, cytotoxicity, biodegradability, and osteoinductivity of bGBMs are presented, and the different mechanisms, in turn, are also discussed. Finally, photothermal therapy, which is considered an emerging area of application of bGBMs, is also presented. Based on this approach, this work finds that different studies report differing opinions on the biological properties of bGBMS due to the lack of consistency of GBMs preparation. Therefore, it is necessary to establish more standards in fabrication, characterization, and testing for bGBMs to further promote scientific progress and clinical translation.

Graphene for Antimicrobial and Coating Application

Graphene is a versatile compound with several outstanding properties, providing a combination of impressive surface area, high strength, thermal and electrical properties, with a wide array of functionalization possibilities. This review aims to present an introduction of graphene and presents a comprehensive up-to-date review of graphene as an antimicrobial and coating application in medicine and dentistry. Available articles on graphene for biomedical applications were reviewed from January 1957 to August 2020) using MEDLINE/PubMed, Web of Science, and ScienceDirect. The selected articles were included in this study. Extensive research on graphene in several fields exists. However, the available literature on graphene-based coatings in dentistry and medical implant technology is limited. Graphene exhibits high biocompatibility, corrosion prevention, antimicrobial properties to prevent the colonization of bacteria. Graphene coatings enhance adhesion of cells, osteogenic differentiation, and promote antibacterial activity to parts of titanium unaffected by the thermal treatment. Furthermore, the graphene layer can improve the surface properties of implants which can be used for biomedical applications. Hence, graphene and its derivatives may hold the key for the next revolution in dental and medical technology.

Chemically modified mRNA beyond COVID-19: Potential preventive and therapeutic applications for targeting chronic diseases

Chemically modified mRNA represents a unique, efficient, and straightforward approach to produce a class of biopharmaceutical agents. It has been already approved as a vaccination-based method for targeting SARS-CoV-2 virus. The COVID-19 pandemic has highlighted the prospect of synthetic modified mRNA to efficiently and safely combat various diseases. Recently, various optimization advances have been adopted to overcome the limitations associated with conventional gene therapeutics leading to wide-ranging applications in different disease conditions. This review sheds light on emerging directions of chemically modified mRNAs to prevent and treat widespread chronic diseases, including metabolic disorders, cancer vaccination and immunotherapy, musculoskeletal disorders, respiratory conditions, cardiovascular diseases, and liver diseases.

Implant-bone-interface: Reviewing the impact of titanium surface modifications on osteogenic processes in vitro and in vivo

Titanium is commonly and successfully used in dental and orthopedic implants. However, patients still have to face the risk of implant failure due to various reasons, such as implant loosening or infection. The risk of implant loosening can be countered by optimizing the osteointegration capacity of implant materials. Implant surface modifications for structuring, roughening and biological activation in favor for osteogenic differentiation have been vastly studied. A key factor for a successful stable long-term integration is the initial cellular response to the implant material. Hence, cell-material interactions, which are dependent on the surface parameters, need to be considered in the implant design. Therefore, this review starts with an introduction to the basics of cell-material interactions as well as common surface modification techniques. Afterwards, recent research on the impact of osteogenic processes in vitro and vivo provoked by various surface modifications is reviewed and discussed, in order to give an update on currently applied and developing implant modification techniques for enhancing osteointegration.

Reduced thrombogenicity of surface-treated Nitinol implants steered by altered protein adsorption

Blood-contacting medical implants made of Nitinol and other titanium alloys, such as neurovascular flow diverters and peripheral stents, have the disadvantage of being highly thrombogenic. This makes the use of systemic (dual) anti-platelet/anticoagulant therapies inevitable with related risks of device thrombosis, bleeding and other complications. Meeting the urgent clinical demand for a less thrombogenic Nitinol surface, we describe here a simple treatment of standard, commercially available Nitinol that renders its surface ultra-hydrophilic and functionalized with phosphate ions. The efficacy of this treatment was assessed by comparing standard and surface-treated Nitinol disks and braids, equivalent to flow diverters. Static and dynamic (Chandler loop) blood incubation tests showed a drastic reduction of thrombus formation on treated devices. Surface chemistry and proteomic analysis indicated a key role of phosphate and calcium ions in steering blood protein adsorption and avoiding coagulation cascade activation and platelet adhesion. A good endothelialization of the surface confirmed the biocompatibility of the treated surface. STATEMENT OF SIGNIFICANCE: Titanium alloys such as Nitinol are biocompatible and show favorable mechanical properties, which led to their widespread use in medical implants. However, in contact with blood their surface triggers the activation of the intrinsic coagulation cascade, which may result in catastrophic thrombotic events. The presented results showed that a phosphate functionalization of the titanium oxide surface suppresses the activation of both coagulation cascade and platelets, avoiding the subsequent formation of a blood clot. This novel approach has therefore a great potential for mitigating the risks associated to either thrombosis or bleeding complications (due to systemic anticoagulation) in patients with cardiovascular implants.

Potential of Carbon-Based Nanocomposites for Dental Tissue Engineering and Regeneration

While conventional dental implants focus on mechanical properties, recent advances in functional carbon nanomaterials (CNMs) accelerated the facilitation of functionalities including osteoinduction, osteoconduction, and osseointegration. The surface functionalization with CNMs in dental implants has emerged as a novel strategy for reinforcement and as a bioactive cue due to their potential for mechanical reinforcing, osseointegration, and antimicrobial properties. Numerous developments in the fabrication and biological studies of CNMs have provided various opportunities to expand their application to dental regeneration and restoration. In this review, we discuss the advances in novel dental implants with CNMs in terms of tissue engineering, including material combination, coating strategies, and biofunctionalities. We present a brief overview of recent findings and progression in the research to show the promising aspect of CNMs for dental implant application. In conclusion, it is shown that further development of surface functionalization with CNMs may provide innovative results with clinical potential for improved osseointegration after implantation.

Biological sealing and integration of a fibrinogen-modified titanium alloy with soft and hard tissues in a rat model

Percutaneous or transcutaneous devices are important and unique, and the corresponding biological sealing at the skin-implant interface is the key to their long-term success. Herein, we investigated the surface modification to enhance biological sealing, using a metal sheet and screw bonded by biomacromolecule fibrinogen mediated via pre-deposited synthetic macromolecule polydopamine (PDA) as a demonstration. We examined the effects of a Ti-6Al-4V titanium alloy modified with fibrinogen (Ti-Fg), PDA (Ti-PDA) or their combination (Ti-PDA-Fg) on the biological sealing and integration with skin and bone tissues. Human epidermal keratinocytes (HaCaT), human foreskin fibroblasts (HFF) and preosteoblasts (MC3T3-E1), which are closely related to percutaneous implants, exhibited better adhesion and spreading on all the three modified sheets compared with the unmodified alloy. After three-week subcutaneous implantation in Sprague-Dawley (SD) rats, the Ti-PDA-Fg sheets could significantly attenuate the soft tissue response and promote angiogenesis compared with other groups. Furthermore, in the model of percutaneous tibial implantation in SD rats, the Ti-PDA-Fg screws dramatically inhibited epithelial downgrowth and promoted new bone formation. Hence, the covalent immobilization of fibrinogen through the precoating of PDA is promising for enhanced biological sealing and osseointegration of metal implants with soft and hard tissues, which is critical for an orthopedic percutaneous medical device.

3D Printing in alloy design to improve biocompatibility in metallic implants

3D Printing (3DP) or additive manufacturing (AM) enables parts with complex shapes, design flexibility, and customization opportunities for defect specific patient-matched implants. 3DP or AM also offers a design platform that can be used to innovate novel alloys for application-specific compositional modifications. In medical applications, the biological response from a host tissue depends on a biomaterial's structural and compositional properties in the physiological environment. Application of 3DP can pave the way towards manufacturing innovative metallic implants, combining structural variations at different length scales and tailored compositions designed for specific biological responses. This study shows how 3DP can be used to design metallic alloys for orthopedic and dental applications with improved biocompatibility using in vitro and in vivo studies. Titanium (Ti) and its alloys are used extensively in biomedical devices due to excellent fatigue and corrosion resistance and good strength to weight ratio. However, Ti alloys' in vivo biological response is poor due to its bioinert surface. Different coatings and surface modification techniques are currently being used to improve the biocompatibility of Ti implants. We focused our efforts on improving Ti's biocompatibility via a combination of tantalum (Ta) chemistry in Ti, the addition of designed micro-porosity, and nanoscale surface modification to enhance both in vitro cytocompatibility and early stage in vivo osseointegration, which was studied in rat and rabbit distal femur models.

Hydroxyapatite reinforced Ti6Al4V composites for load-bearing implants

Titanium has been used in various biomedical applications; however, titanium exhibits poor wear resistance, and its bioinert surface slows osseointegration in vivo. In this study, directed energy deposition (DED)-based additive manufacturing (AM) was used to process hydroxyapatite (HA) reinforced Ti6Al4V (Ti64) composites to improve biocompatibility and wear resistance simultaneously. Electron micrographs of the composites revealed dense microstructures where HA was observed at the β-phase grain boundaries. Hardness increased by 57% and 71% for 2 and 3 wt.% HA in Ti64 composites, respectively. XRD analysis revealed no change in the phases with the addition of HA, when compared to the control. Tribological studies displayed an increase in contact resistance (CR) due to an in situ formed HA-based tribofilm, reduction in wear rate when testing in Dulbecco's Modified Eagle Medium (DMEM) with a ZrO₂ counter wear ball, <1% wear ball volume loss, and suppression of cohesive shear failure of the Ti matrix. Histomorphometric analysis from a rat distal femur study revealed an increase in the osteoid surface over the bone surface (OS/BS) for 3 wt.% HA composite over the control Ti64 from 9 ± 1% to 14 ± 1%. Additionally, from push-out testing, the shear modulus was observed to increase from 17 ± 3 MPa for control Ti64 to 32 ± 5 MPa for the 3 wt.% HA composite after 5-weeks in vivo. The present study demonstrates that the addition of HA in Ti64 can simultaneously improve bone tissue-implant response and wear resistance.

Graphene-Based Antimicrobial Biomedical Surfaces

Biomedical application of graphene derivatives have been intensively studied in last decade. With the exceptional structural, thermal, electrical, and mechanical properties, these materials have attracted immense attention of biomedical scientists to utilize graphene derivatives in biomedical devices to improve their performance or to achieve desired functions. Surfaces of graphene derivatives including graphite, graphene, graphene oxide and reduce graphene oxide have been demonstrated to pave an excellent platform for antimicrobial behavior, enhanced biocompatibility, tissue engineering, biosensors and drug delivery. This review focuses on the recent advancement in the research of biomedical devices with the coatings or highly structured polymer nanocomposite surfaces of graphene derivatives for antimicrobial activity and sterile surfaces comprising an entirely new class of antibacterial materials. Overall, we aim to highlight on the potential of these materials, current understanding and knowledge gap in the antimicrobial behavior and biocompatibility to be utilized of their coatings to prevent the cross infections.

Graphene-Doped Poly (Methyl-Methacrylate) (Pmma) Implants: A Micro-CT and Histomorphometrical Study in Rabbits

Background—the graphene-doping procedure represents a useful procedure to improve the mechanical, physical and biological response of several Polymethyl methacrylate (PMMA)-derived polymers and biomaterials for dental applications. The aim of this study was to evaluate osseointegration of Graphene doped Poly(methyl methacrylate) (GD-PMMA) compared with PMMA as potential materials for dental implant devices. Methods—eighteen adult New Zealand white male rabbits with a mean weight of approx. 3000 g were used in this research. A total of eighteen implants of 3.5 mm diameter and 11 mm length in GD-PMMA and eighteen implants in PMMA were used. The implants were placed into the articular femoral knee joint. The animals were sacrificed after 15, 30 and 60 days and the specimens were evaluated by µCT and histomorphometry. Results—microscopically, all 36 implants, 18 in PMMA and 18 in DG-PMMA were well-integrated into the bone. The implants were in contact with cortical bone along the upper threads, while the lower threads were in contact with either newly formed bone or with marrow spaces. The histomorphometry and µCT evaluation showed that the GP-PMMA and PMMA implants were well osseointegrated and the bone was in direct contact with large portions of the implant surfaces, including the space in the medullary canal. Conclusions—in conclusion, the results suggest that GD-PMMA titanium surfaces enhance osseointegration in rabbit femurs. This encourages further research to obtain GD-PMMA with a greater radiopacity. Also, further in vitro and vivo animal studies are necessary to evaluate a potential clinical usage for dental implant applications.

Interactions Between 2D Materials and Living Matter: A Review on Graphene and Hexagonal Boron Nitride Coatings

Two-dimensional material (2DM) coatings exhibit complex and controversial interactions with biological matter, having shown in different contexts to induce bacterial cell death and contribute to mammalian cell growth and proliferation in vitro and tissue differentiation in vivo. Although several reports indicate that the morphologic and electronic properties of the coating, as well as its surface features (e.g., crystallinity, wettability, and chemistry), play a key role in the biological interaction, these kinds of interactions have not been fully understood yet. In this review, we report and classify the cellular interaction mechanisms observed in graphene and hexagonal boron nitride (hBN) coatings. Graphene and hBN were chosen as study materials to gauge the effect of two atomic-thick coatings with analogous lattice structure yet dissimilar electrical properties upon contact with living matter, allowing to discern among the observed effects and link them to specific material properties. In our analysis, we also considered the influence of crystallinity and surface roughness, detailing the mechanisms of interaction that make specific coatings of these 2DMs either hostile toward bacterial cells or innocuous for mammalian cells. In doing this, we discriminate among the material and surface properties, which are often strictly connected to the 2DM production technique, coating deposition and post-processing method. Building on this knowledge, the selection of 2DM coatings based on their specific characteristics will allow to engineer desired functionalities and devices. Antibacterial coatings to prevent biofouling, biocompatible platforms suitable for biomedical applications (e.g., wound healing, tissue repairing and regeneration, and novel biosensing devices) could be realized in the next future. Overall, a clear understanding on how the 2DM coating's properties may modulate a specific bacterial or cellular response is crucial for any future innovation in the field.

Hydrothermally grown TiO2-nanorods on surface mechanical attrition treated Ti: Improved corrosion fatigue and osteogenesis

Current bioactive modifications of Ti-based materials for promoting osteogenesis often decrease corrosion fatigue strength (σ_cf) of the resultant implants, thereby shortening their service lifespan. To solve this issue and accelerate the osteogenesis process, in the present study, a TiO₂ nanorods (TNR)-arrayed coating was hydrothermally grown on optimal surface mechanical attrition treated (SMATed) titanium (S-Ti). The microstructure, bond integrity, residual stress distribution, and corrosion fatigue of TNR-coated S-Ti (TNR/S-Ti) and the response of macrophages and bone marrow-derived mesenchymal stem cells (BMSCs) to TNR/S-Ti were investigated and compared with those of mechanically polished Ti (P-Ti), S-Ti, and TNR-coated P-Ti (TNR/P-Ti). S-Ti showed a nanograined layer and an underlying grain-deformed region with residual compressive stress, which was sustained even when it was hydrothermally coated with TNR. TNR on S-Ti showed nanotopography, composition, and bond strength almost identical to those of P-Ti. While TNR/P-Ti showed a considerable decrease in σ_cf compared to P-Ti, TNR/S-Ti exhibited an improved σ_cf which was even higher than that of P-Ti. Biologically, TNR/S-Ti enhanced adhesion, differentiation, and mineralization of BMSCs, and it also promoted adhesion and M1-to-M2 transition of macrophages as compared to S-Ti and P-Ti. With rapid phenotype switch of macrophages, the level of proinflammatory cytokines decreased, while anti-inflammatory cytokines were upregulated. In co-culture conditions, the migration, differentiation, and mineralization of BMSCs were enhanced by increased level of secretion factors of macrophages on TNR/S-Ti. The modified structure accelerated bone apposition in rabbit femur and is expected to induce a favorable immune microenvironment to facilitate osseointegration earlier; it can also simultaneously improve corrosion fatigue resistance of Ti-based implants and thereby enhance their service life.

Applications of Graphene and Its Derivatives in Bone Repair: Advantages for Promoting Bone Formation and Providing Real-Time Detection, Challenges and Future Prospects

During continuous innovation in the preparation, characterization and application of various bone repair materials for several decades, nanomaterials have exhibited many unique advantages. As a kind of representative two-dimensional nanomaterials, graphene and its derivatives (GDs) such as graphene oxide and reduced graphene oxide have shown promising potential for the application in bone repair based on their excellent mechanical properties, electrical conductivity, large specific surface area (SSA) and atomic structure stability. Herein, we reviewed the updated application of them in bone repair in order to present, as comprehensively, as possible, their specific advantages, challenges and current solutions. Firstly, how their advantages have been utilized in bone repair materials with improved bone formation ability was discussed. Especially, the effects of further functionalization or modification were emphasized. Then, the signaling pathways involved in GDs-induced osteogenic differentiation of stem cells and immunomodulatory mechanism of GDs-induced bone regeneration were discussed. On the other hand, their applications as contrast agents in the field of bone repair were summarized. In addition, we also reviewed the progress and related principles of the effects of GDs parameters on cytotoxicity and residues. At last, the future research was prospected.

Graphene–Chitosan Hybrid Dental Implants with Enhanced Antibacterial and Cell-Proliferation Properties

Dental implants are widely used tooth replacement tools owing to their good oral rehabilitation and reconstruction capacities. Since dental implants are designed as a replacement for natural teeth, multi-functional abilities are desired to achieve successful implant treatment with improved osseointegration through promotion of mammalian cell activity and prevention of bacterial cell activity. In this study, we developed a graphene–chitosan hybrid dental implant (GC hybrid implant) using various concentrations of graphene, which demonstrated the different surface properties including increased wettability and roughness. Importantly, the GC hybrid implant under the optimal condition (i.e., 1% GC hybrid implant) could significantly promote osteoblast proliferation while reducing biofilm formation and bacterial activity. Our study demonstrates the potential of using this GC hybrid implant as a new type of dental implant, which can offer an effective design for the fabrication of advanced dental implants.

Image-based design and 3D-metal printing of a rat hip implant for use in a clinically representative model of joint replacement

The aim of this study was to obtain micro-computed tomography derived measurements of the rat proximal femur, to create parameterized rat hip implants that could be surgically installed in a clinically representative small animal model of joint replacement. The proximal femoral anatomy of N = 25 rats (male, Sprague-Dawley, 390-605 g) was quantified. Key measurements were used to parameterize computer-aided design models of monoblock rat femoral implants. Linear regression analysis was used to determine if rat hip dimensions could be predicted from animal weight. A correlation analysis was used to determine how implants could be scaled to create a range of sizes. Additive manufacturing (3D printing) was used to create implants in medical-grade metal alloys. Linear regressions comparing rat weight to femoral head diameter and neck-head axis length revealed a significant nonzero slope (P < .05). Pearson's correlation analysis revealed five significant correlations between key measurements in the rat femur (P < .05). Implants were installed into both cadaveric and live animals; iterative design modifications were made to prototypes based on these surgical findings. Animals were able to tolerate the installation of implants and were observed ambulating on their affected limbs postoperatively. Clinical significance: We have developed a preclinical rat hip hemiarthroplasty model using image-based and iterative design techniques to create 3D-metal printed implants in medical-grade metal alloys. Our findings support further development of this model for use as a low-cost translational test platform for preclinical orthopaedic research into areas such as osseointegration, metal-on-cartilage wear, and periprosthetic joint infection.

Osteo-Compatibility of 3D Titanium Porous Coating Applied by Direct Energy Deposition (DED) for a Cementless Total Knee Arthroplasty Implant: in Vitro and in Vivo Study

Direct energy deposition (DED) technology has gained increasing attention as a new implant surface technology that replicates the porous structure of natural bones facilitating osteoblast colonization and bone ingrowth. However, concerns have arisen over osteolysis or chronic inflammation that could be caused by Cobalt-chrome (CoCr) alloy and Titanium (Ti) nanoparticles produced during the fabrication process. Here, we evaluated whether a DED Ti-coated on CoCr alloy could improve osteoblast colonization and osseointegration in vitro and in vivo without causing any significant side effects. Three types of implant CoCr surfaces (smooth, sand-blasted and DED Ti-coated) were tested and compared. Three cell proliferation markers and six inflammatory cytokine markers were measured using SaOS2 osteoblast cells. Subsequently, X-ray and bone histomorphometric analyses were performed after implantation into rabbit femur. There were no differences between the DED group and positive control in cytokine assays. However, in the 5-bromo-2′-deoxyuridine (BrdU) assay the DED group exhibited even higher values than the positive control. For bone histomorphometry, DED was significantly superior within the 1000 µm bone area. The results suggest that DED Ti-coated metal printing does not affect the osteoblast viability or impair osseointegration in vitro and in vivo. Thus, this technology is biocompatible for coating the surfaces of cementless total knee arthroplasty (TKA) implants.

Graphene Oxide Enhances Chitosan-Based 3D Scaffold Properties for Bone Tissue Engineering

The main goal of bone tissue engineering (BTE) is to refine and repair major bone defects based on bioactive biomaterials with distinct properties that can induce and support bone tissue formation. Graphene and its derivatives, such as graphene oxide (GO), display optimal properties for BTE, being able to support cell growth and proliferation, cell attachment, and cytoskeleton development as well as the activation of osteogenesis and bone development pathways. Conversely, the presence of GO within a polymer matrix produces favorable changes to scaffold morphologies that facilitate cell attachment and migration i.e., more ordered morphologies, greater surface area, and higher total porosity. Therefore, there is a need to explore the potential of GO for tissue engineering applications and regenerative medicine. Here, we aim to promote one novel scaffold based on a natural compound of chitosan, improved with 3 wt.% GO, for BTE approaches, considering its good biocompatibility, remarkable 3D characteristics, and ability to support stem cell differentiation processes towards the bone lineage.

Early osteointegration evaluation of porous Ti6Al4V scaffolds designed based on triply periodic minimal surface models

BACKGROUND

The graded porous structures were designed using triply periodic minimal surfaces models to mimic the biomechanical properties of bone. The mechanical properties and bone formation ability were evaluated to explore the feasibility of the design method in bone tissue engineering.

METHODS

The scaffolds were designed using a P-surface with different pore sizes. All materials were fabricated using 3D printing technology and the mechanical properties were tested by an electronic universal testing device. The biomechanical properties were then analyzed by finite element method, while the ontogenesis of the material in vivo was examined by implanting the scaffolds for five weeks in pigs.

RESULTS

According to the obtained results, the pore size ranged between 100 μm to about 700 μm and porosity were around 49.54%. The graded porous architectures can decrease the stiffness of implants and reduce the stress shielding effect. In addition, these porous structures can stimulate bone ingrowth and achieve a stable interface between implants and surrounding bone tissues after 5 weeks' implantation. The micro-CT results also demonstrated the obviously bone formation around all the porous structures.

CONCLUSION

To sum up, the triply periodic minimal surfaces based graded porous structure is effective in decreasing the stress shielding effect, promoting early osteogenesis and osteointegration. This is the first research to explore the effect of this kind of porous structures on bone formation in vivo where the obtained results supported the previous theoretical research on the application potential in bone tissue engineering.

THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE

Porous architecture designed using triply periodic minimal surface models can achieve gradually changed pore size and appropriate porosity for bone regeneration. This kind of structure can mimic the Young's modulus of natural bone tissue, improve the stress transmission capability and dismiss the stress shielding effect. It also can stimulate the early bone integration in vivo and enhance the binding force between bone and implants, which may bring a new design method for orthopaedic implants and their surface structure.

Acellular mineralized allogenic block bone graft does not remodel during the 10 weeks following concurrent implant placement in a rabbit femoral model

OBJECTIVES

Due to bone loss, endosseous implants often require addition of a bone graft to support adequate primary fixation, bone regeneration, and osseointegration. The aim of this study was to compare effectiveness of autogenic and allogenic bone grafts when used during simultaneous insertion of the implant.

MATERIALS AND METHODS

4-mm-diameter rabbit diaphyseal bone autografts or allografts (n = 16/group) with a 3.2-mm pre-drilled hole in the center were placed into a 4 mm defect in the proximal femur of 3.5 kg male New Zealand White rabbits. Machined 3.2 × 10 mm grit-blasted, acid-etched titanium-aluminum-vanadium (Ti6Al4V) implants were placed. Control implants were placed into progressively drilled 3.2-mm holes in the contralateral limbs. Post-insertion day 70, samples were analyzed by micro-CT and calcified histology, or by mechanical torque and push-out testing followed by decalcified histology.

RESULTS

Both grafts were integrated with the native bone. Micro-CT showed less bone volume (BV) and bone volume/total volume (BV/TV) in the allograft group, but histology showed no differences in BV or BV/TV between groups. Allograft lacked living cells, whereas autograft was cellularized. No difference was found in maximum removal torque between groups. Compressive loading at the graft-to-bone interface was significantly lower in allograft compared with autograft groups.

CONCLUSIONS

There was less bone in contact with the implant and significantly less maximum compressive load in the allograft group compared with autograft. The allograft remained acellular as demonstrated by empty lacunae. Taken together, block allograft implanted simultaneously with an implant produces a poorer quality bone compared with autograft.

Direct comparison of additively manufactured porous titanium and tantalum implants towards in vivo osseointegration

Material properties of implants such as volume porosity and nanoscale surface modification have been shown to enhance cell-material interactions in vitro and osseointegration in vivo. Porous tantalum (Ta) and titanium (Ti) coatings are widely used for non-cemented implants, which are fabricated using different processing routes. In recent years, some of those implants are being manufactured using additive manufacturing. However, limited knowledge is available on direct comparison of additively manufactured porous Ta and Ti structures towards early stage osseointegration. In this study, we have fabricated porous Ta and Ti6Al4V (Ti64) implants using laser engineered net shaping (LENS™) with similar volume fraction porosity to compare the influence of surface characteristics and material chemistry on in vivo response using a rat distal femur model for 5 and 12 weeks. We have also assessed whether surface modification on Ti64 can elicit similar in vivo response as porous Ta in a rat distal femur model for 5 and 12 weeks. The harvested implants were histologically analyzed for osteoid surface per bone surface. Field emission scanning electron microscopy (FESEM) was done to assess the bone-implant interface. The results presented here indicate comparable performance of porous Ta and surface modified porous Ti64 implants towards early stage osseointegration at 5 weeks post implantation through seamless bone-material interlocking. However, a continued and extended efficacy of porous Ta is found in terms of higher osteoid formation at 12 weeks post-surgery.

Additively manufactured calcium phosphate reinforced CoCrMo alloy: Bio-tribological and biocompatibility evaluation for load-bearing implants

Cobalt-chromium-molybdenum (CoCrMo) alloys are widely used in load-bearing implants; specifically, in hip, knee, and spinal applications due to their excellent wear resistance. However, due to in vivo corrosion and mechanically assisted corrosion, metal ion release occurs and accounts for poor biocompatibility. Therefore, a significant interest to find an alternative to CoCrMo alloy exists. In the present work we hypothesize that calcium phosphate (CaP) will behave as a solid lubricant in CoCrMo alloy under tribological testing, thereby minimizing wear and metal ion release concerns associated with CoCrMo alloy. CoCrMo-CaP composite coatings were processed using laser engineered net shaping (LENS™) system. After LENS™ processing, CoCrMo alloy was subjected to laser surface melting (LSM) using the same LENS™ set-up. Samples were investigated for microstructural features, phase identification, and biocompatibility. It was found that LSM treated CoCrMo improved wear resistance by 5 times. CoCrMo-CaP composites displayed the formation of a phosphorus-based tribofilm. In vitro cell-material interactions study showed no cytotoxic effect. Sprague-Dawley rat and rabbit in vivo study displayed increased osteoid formation for CoCrMo-CaP composites, up to 2 wt.% CaP. Our results show that careful surface modification treatments can simultaneously improve wear resistance and in vivo biocompatibility of CoCrMo alloy, which can correlate to a reduction of metal ion release in vivo.

Cinaciguat in combination with insulin induces a favorable effect on implant osseointegration in type 2 diabetic rats

The osseointegration process of implant is seriously impaired in type 2 diabetes mellitus (T2DM) that causes high failure rate, and insufficiency exists in current insulin therapy, creating a demand for new bone-synergistic agent. Cinaciguat, a novel type of soluble guanylate cyclase (sGC) activator, plays a vital role in glucose metabolism, inflammation control and bone regeneration. We hypothesized that the combined application of cinaciguat and insulin could reverse poor implant osseointegration in diabetes. To test this hypothesis, streptozotocin-induced diabetic rats were placed implants in the femur, and divided into five groups: control, T2DM, cinaciguat-treated T2DM (7 μg/kg), insulin-treated T2DM (12 IU/kg), cinaciguat plus insulin combination-treated T2DM (7 μg/kg and 12 IU/kg respectively), according to different treatment received. The weight and glucose levels of rats were evaluated at fixed times, and plasma level of cyclic guanosine monophosphate (cGMP) was determined before euthanasia. Three months after therapy, the femurs were isolated for pull-out test, environmental scanning electron microscope observation, microscopic computerized tomography evaluation and various histology analysis. Results revealed that diabetic rats showed the highest blood glucose level and lowest cGMP content, which led to the worst structural damage and least osseointegration. Combined treatment could attenuate the diabetes induced hyperglycemia to be normal, restore the cGMP content, protein kinase G II (PKG II) expression, phosphodiesterase-5 (PDE5) activity and ameliorate the mechanical strength, the impaired bone microarchitecture and osseointegration to the highest level. Meanwhile, monotreatment (insulin or cinaciguat) also showed restorative effect, but less. Our findings demonstrated that the cGMP/PKG II signaling pathway activated by cinaciguat mediated the favorable effects of the combined application on improving implant fixation under T2DM condition.

Polydopamine coating promotes early osteogenesis in 3D printing porous Ti6Al4V scaffolds

BACKGROUND

Titanium implants are widely used in orthopedic and dental for more than 30 years. Its stable physicochemical properties and mechanical strength are indeed appropriate for implantation. However, the Bioinertia oxidized layer and higher elastic modulus often lead to the early implantation failure.

METHODS

In this study, we proposed a simple design of porous structure to minimize the disparity between scaffold and natural bone tissue, and introduced a one-step reaction to form a polydopamine (PDA) layer on the surface of titanium for the purpose of improving osteogenesis as well. The porous scaffolds with pore size of 400 µm and porosity of 44.66% were made by additive manufacturing. The cell behavior was tested by seeding MC3T3-E1 cells on Ti6Al4V films for 15 days. The biomechanical properties were then analyzed by finite element (FE) method and the in vivo osteogenesis effect was accordingly evaluated by implanting the scaffolds for 5 weeks in rabbits.

RESULTS

According to the achieved results, it was revealed that the immersion for 40 min with dopamine could significantly improve the cell adhesion. The proposed method for design of porous structure can avoid the stress shielding effect and bone growth inside the PDA coating scaffolds, which were observed at the early stage of bone healing process.

CONCLUSIONS

It can be concluded that the proposed PDA coating method is effective in promoting early osteogenesis, as well as being easy to operate, and can be helpful in the future clinical application of titanium implants.

Nerve electrical stimulation enhances osseointegration of implants in the beagle

Dental implantation has been the primary method for the treatment of tooth loss, but longer than 3 months healing times are generally required. Because immediate load implants are suitable only for certain categories of implant patients, it has value to develop a novel method to facilitate the implant-bone osseointegration process. Cylindrical titanium implants were implanted in the tooth sockets of beagles, and microelectrode stimulation of the sympathetic nerves in the infraorbital nerve was performed after implantation for 1 week. The authors found that one-sided nerve stimulation was shown to evoke consistent electric potential changes in both sides of the infraorbital nerves. Moreover, after 4 weeks of implantation, more new bone was clearly observed around the implants in the beagles that received electrical stimulation treatment than was observed in the control animals. Furthermore, a higher mineralization density was measured in the new peri-implant bone tissues of the stimulated beagles when compared to controls. These results demonstrate that the simple and safe physical method of microelectrode stimulation to sympathetic nerves can promote the formation of new bone and the osseointegration of implants. This technique is worth promoting and has the potential to reduce the healing time of dental implantation in future clinical cases.

Microporous Coatings of PEKK/SN Composites Integration with PEKK Exhibiting Antibacterial and Osteogenic Activity, and Promotion of Osseointegration for Bone Substitutes

To improve the antibacterial and osteogenic activities of poly(etherketoneketone) (PEKK), concentrated sulfuric acid (H₂SO₄) suspension with silicon nitride (SN) microparticle was utilized to modify PEKK surface. Through sulfonation reaction, microporous coatings of PEKK/SN composites were created on PEKK surface, which were integrated with PEKK substrate. The results showed that the content of SN in the microporous coatings increased with the increase of SN content in H₂SO₄ suspension (PKS without SN, PKSC5 and PKSC10 with 5 and 10 wt % SN content in H₂SO₄) and that the surface roughness and hydrophilicity of microporous coatings on PEKK were significantly improved with the SN content increasing. In addition, the microporous coating of PKSC10 with high SN content exhibited excellent antibacterial activity due to the synergistic action of the presence of amino (-NH₂) and sulfonic acid (-SO₃H) groups as well as the improvement of protein absorption. Moreover, the microporous coating of PKSC10 obviously stimulated adhesion, proliferation, and osteogenic differentiation of rat bone mesenchymal stem cells. Furthermore, histological and push-out load evaluation indicated that the microporous coating of PKSC10 significantly promoted osteogenesis and osseointegration in vivo. The results suggested that the microporous coating of PKSC10 with high SN content display good biocompatibility, antibacterial and osteogenic activities, and osseointegration ability, which would have great potential for bone substitutes.

Effects of thermal treatment on the adhesion strength and osteoinductive activity of single-layer graphene sheets on titanium substrates

In recent years, dental implants have become the preferred approach for the restoration of missing teeth. At present, most dental implants are made of pure titanium, and are affected by peri-implantitis and bone resorption, which usually start from the implant neck, due to the complex environment in this region. To address these issues, in this study we modified the surface of titanium (Ti) implants to exploit the antibacterial and osteoinductive effects of single-layer graphene sheets. Chemical vapor deposition (CVD)-grown single-layer graphene sheets were transferred to titanium discs, and a method for improving the adhesion strength of graphene on Ti was developed due to compromised adhesion strength between graphene and titanium surface. A thermal treatment of 2 h at 160 °C was found to enhance the adhesion strength of graphene on Ti to facilitate clinical transformation. Graphene coatings of Ti enhanced cell adhesion and osteogenic differentiation, and imparted antibacterial activity to Ti substrate; these favorable effects were not affected by the thermal treatment. In summary, the present study elucidated the effects of a thermal treatment on the adhesion strength and osteoinductive activity of single-layer graphene sheets on titanium substrates.

Impact of surface topography and coating on osteogenesis and bacterial attachment on titanium implants

Titanium (Ti) plays a predominant role as the material of choice in orthopaedic and dental implants. Despite the majority of Ti implants having long-term success, premature failure due to unsuccessful osseointegration leading to aseptic loosening is still too common. Recently, surface topography modification and biological/non-biological coatings have been integrated into orthopaedic/dental implants in order to mimic the surrounding biological environment as well as reduce the inflammation/infection that may occur. In this review, we summarize the impact of various Ti coatings on cell behaviour both in vivo and in vitro. First, we focus on the Ti surface properties and their effects on osteogenesis and then on bacterial adhesion and viability. We conclude from the current literature that surface modification of Ti implants can be generated that offer both osteoinductive and antimicrobial properties.