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Kurtz MA, Alaniz K, Kurtz PW, Wessinger AC, Moreno-Reyes A, Gilbert JL. Oxide degradation precedes additively manufactured Ti-6Al-4V selective dissolution: An unsupervised machine learning correlation of impedance and dissolution compared to Ti-29Nb-21Zr. J Biomed Mater Res A 2024; 112:1250-1264. [PMID: 37877770 DOI: 10.1002/jbm.a.37632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
Additively manufactured (AM) Ti-6Al-4V devices are implanted with increasing frequency. While registry data report short-term success, a gap persists in our understanding of long-term AM Ti-6Al-4V corrosion behavior. Retrieval studies document β phase selective dissolution on conventionally manufactured Ti-6Al-4V devices. Researchers reproduce this damage in vitro by combining negative potentials (cathodic activation) and inflammatory simulating solutions (H2O2-phosphate buffered saline). In this study, we investigate the effects of these adverse electrochemical conditions on AM Ti-6Al-4V impedance and selective dissolution. We hypothesize that cathodic activation and H2O2 solution will degrade the oxide, promoting corrosion. First, we characterized AM Ti-6Al-4V samples before and after a 48 h -0.4 V hold in 0.1 M H2O2/phosphate buffered saline. Next, we acquired nearfield electrochemical impedance spectroscopy (EIS) data. Finally, we captured micrographs and EIS during dissolution. Throughout, we used AM Ti-29Nb-21Zr as a comparison. After 48 h, AM Ti-6Al-4V selectively dissolved. Ti-29Nb-21Zr visually corroded less. Structural changes at the AM Ti-6Al-4V oxide interface manifested as property changes to the impedance. After dissolution, the log-adjusted constant phase element (CPE) parameter, Q, significantly increased from -4.75 to -3.84 (Scm-2(s)α) (p = .000). The CPE exponent, α, significantly decreased from .90 to .84 (p = .000). Next, we documented a systematic decrease in oxide polarization resistance before pit nucleation and growth. Last, using k-means clustering, we established a structure-property relationship between impedance and the surface's dissolution state. These results suggest that AM Ti-6Al-4V may be susceptible to in vivo crevice corrosion within modular taper junctions.
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Affiliation(s)
- Michael A Kurtz
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Kazzandra Alaniz
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Peter W Kurtz
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Audrey C Wessinger
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Aldo Moreno-Reyes
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Jeremy L Gilbert
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
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Onică N, Budală DG, Baciu ER, Onică CA, Gelețu GL, Murariu A, Balan M, Pertea M, Stelea C. Long-Term Clinical Outcomes of 3D-Printed Subperiosteal Titanium Implants: A 6-Year Follow-Up. J Pers Med 2024; 14:541. [PMID: 38793123 PMCID: PMC11122366 DOI: 10.3390/jpm14050541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
As an alternative to regenerative therapies, numerous authors have recently proposed bringing back subperiosteal implants. The aim of the study was to present our clinical experience with a subperiosteal jaw implant that needs minimal bone preparation and enables the rapid implantation of prosthetic teeth in edentulous, atrophic alveolar bone. The research included 36 complete or partial edentulous patients (61 subperiostal implants) over a period of 6 years. To create the patient-specific subperiostal implants design, DentalCAD 3.0 Galway software (exocad GmbH, Darmstadt, Germany) was used and fabricated with a Mysint 100 (Sisma S.p.A., Piovene Rocchette, Italy) by titanium alloy powder. The results showed that only 9 of the 36 cases were successful at 6-year follow-up, while 27 cases had complications, including exposure of the metal frame (early or delayed), mobility of the device prior to the first 4-6 months, and late mobility due to recurrent infections and progressive structure exposure; 1 case failed for reasons unrelated to the device. This study indicated that the prudent application of fully customized subperiosteal jaw implants is a dependable alternative for the dental rehabilitation of atrophic edentulous cases that necessitate bone grafts for traditional fixed dental implant solutions.
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Affiliation(s)
- Neculai Onică
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (N.O.); (G.L.G.); (A.M.); (M.B.); (C.S.)
| | - Dana Gabriela Budală
- Department of Implantology, Removable Dentures, Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Elena-Raluca Baciu
- Department of Implantology, Removable Dentures, Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Cezara Andreea Onică
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (N.O.); (G.L.G.); (A.M.); (M.B.); (C.S.)
| | - Gabriela Luminița Gelețu
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (N.O.); (G.L.G.); (A.M.); (M.B.); (C.S.)
| | - Alice Murariu
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (N.O.); (G.L.G.); (A.M.); (M.B.); (C.S.)
| | - Mihail Balan
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (N.O.); (G.L.G.); (A.M.); (M.B.); (C.S.)
| | - Mihaela Pertea
- Department of Plastic Surgery, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Carmen Stelea
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (N.O.); (G.L.G.); (A.M.); (M.B.); (C.S.)
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Fathi A, Nadian F, Ghorbani M, Razavi P, Mosharraf R, Ebadian B. Enhancing oral function: A case report on mandibular overdenture utilization with custom-made subperiosteal implant. J Prosthodont 2024. [PMID: 38650475 DOI: 10.1111/jopr.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/06/2024] [Indexed: 04/25/2024] Open
Abstract
Subperiosteal implants, previously set aside because of complications, are now emerging again as effective treatments for severe mandibular atrophy, aided by recent improvements in digital dentistry. Traditional dentures in such cases often face challenges with support and retention, necessitating complex regenerative procedures. This paper presents a case report of a 54-year-old male patient with significant mandibular atrophy who received a custom-made subperiosteal implant, showcasing promising results. The implant was precisely designed utilizing computed tomography (CT) scans, a 3D-printed model, the selective laser melting (SLM) technique, and constructed with biocompatible Ti6Al4V material. This innovative approach offered a practical solution, resulting in high patient satisfaction and no complications over a year of use.
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Affiliation(s)
- Amirhossein Fathi
- Department of Prosthodontics, Dental Materials Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farshad Nadian
- Department of Prosthodontics, Dental Materials Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Ghorbani
- School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pouyan Razavi
- Dental School, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Ramin Mosharraf
- Department of Prosthodontics, Dental Materials Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behnaz Ebadian
- Department of Prosthodontics, Dental Materials Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Kouhi M, de Souza Araújo IJ, Asa'ad F, Zeenat L, Bojedla SSR, Pati F, Zolfagharian A, Watts DC, Bottino MC, Bodaghi M. Recent advances in additive manufacturing of patient-specific devices for dental and maxillofacial rehabilitation. Dent Mater 2024; 40:700-715. [PMID: 38401992 DOI: 10.1016/j.dental.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Customization and the production of patient-specific devices, tailoring the unique anatomy of each patient's jaw and facial structures, are the new frontiers in dentistry and maxillofacial surgery. As a technological advancement, additive manufacturing has been applied to produce customized objects based on 3D computerized models. Therefore, this paper presents advances in additive manufacturing strategies for patient-specific devices in diverse dental specialties. METHODS This paper overviews current 3D printing techniques to fabricate dental and maxillofacial devices. Then, the most recent literature (2018-2023) available in scientific databases reporting advances in 3D-printed patient-specific devices for dental and maxillofacial applications is critically discussed, focusing on the major outcomes, material-related details, and potential clinical advantages. RESULTS The recent application of 3D-printed customized devices in oral prosthodontics, implantology and maxillofacial surgery, periodontics, orthodontics, and endodontics are presented. Moreover, the potential application of 4D printing as an advanced manufacturing technology and the challenges and future perspectives for additive manufacturing in the dental and maxillofacial area are reported. SIGNIFICANCE Additive manufacturing techniques have been designed to benefit several areas of dentistry, and the technologies, materials, and devices continue to be optimized. Image-based and accurately printed patient-specific devices to replace, repair, and regenerate dental and maxillofacial structures hold significant potential to maximize the standard of care in dentistry.
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Affiliation(s)
- Monireh Kouhi
- Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Isaac J de Souza Araújo
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, MI, United States
| | - Farah Asa'ad
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Oral Biochemistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lubna Zeenat
- School of Engineering, Deakin University, Geelong 3216, Australia; Department of Biomedical Engineering, IIT Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Sri Sai Ramya Bojedla
- Department of Biomedical Engineering, IIT Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Falguni Pati
- Department of Biomedical Engineering, IIT Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Ali Zolfagharian
- School of Engineering, Deakin University, Geelong 3216, Australia
| | - David C Watts
- School of Medical Sciences, University of Manchester, Manchester, UK
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, MI, United States; Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Mahdi Bodaghi
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK.
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Berger MB, Cohen DJ, Deng J, Srivas P, Boyan BD, Sandhage KH, Schwartz Z. Internal surface modification of additively manufactured macroporous TiAl6V4 biomimetic implants via a calciothermic reaction-based process and osteogenic in vivo responses. J Biomed Mater Res B Appl Biomater 2024; 112:e35322. [PMID: 37737450 DOI: 10.1002/jbm.b.35322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/23/2023]
Abstract
Three-dimensional macroporous titanium-aluminum-vanadium (TiAl6V4) implants produced by additive manufacturing (AM) can be grit blasted (GB) to yield microtextured exterior surfaces, with additional micro/nano-scale surface features provided by subsequent acid etching (AE). However, the line-of-sight nature of GB causes the topography of exterior GB + AE-modified surfaces to differ from internal GB-inaccessible surfaces. Previous in vitro studies using dense TiAl6V4 substrates indicated that a nonline-of-sight, calciothermic-reaction (CaR)-based process provided homogeneous osteogenic nanotextures on GB + AE surfaces, suggesting it could be used to achieve a homogeneous nanotopography on external and internal surfaces of macroporous AM constructs. Macroporous TiAl6V4 (3D) constructs were produced by direct laser melting and modified by GB + AE, with the CaR process then applied to 50% of constructs (3DCaR). The CaR process yielded nanoporous/nanorough internal surfaces throughout the macroporous constructs. Skeletally mature, male Sprague-Dawley rats were implanted with these constructs using a cranial on-lay model. Prior to implantation, a Cu++-free click hydrogel was applied to half of the constructs (3D + H, 3DCaR + H) to act as a challenge to osseointegration. Osseointegration was compared between the four implant groups (3D, 3DCaR, 3D + H, 3DCaR + H) at 4w. 3D + H implants exhibited lower bone volume (BV) and percent bone ingrowth (%BI) than the 3D implants. In contrast, osseointegrated 3DCaR + H implants had similar BV and %BI as the 3DCaR implants. Implant pull-off forces correlated with these results. In vitro analyses indicated that human bone marrow stromal cells (MSCs) exhibited enhanced production of osteoblast differentiation markers and factors associated with osteogenesis when grown on CaR-modified 3D substrates relative to control (TCPS) substrates. This work confirms that the CaR process provides osteogenic nanotextures on internal surfaces of macroporous 3D implants, and suggests that CaR-modified surfaces can promote osseointegration in cases where osteogenesis is impaired.
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Affiliation(s)
- Michael B Berger
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - D Joshua Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jingyao Deng
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Pavan Srivas
- School of Materials Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Barbara D Boyan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Kenneth H Sandhage
- School of Materials Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Periodontology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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6
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Huang YC, Huang YC, Ding SJ. Primary stability of implant placement and loading related to dental implant materials and designs: A literature review. J Dent Sci 2023; 18:1467-1476. [PMID: 37799926 PMCID: PMC10548003 DOI: 10.1016/j.jds.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/12/2023] [Indexed: 10/07/2023] Open
Abstract
A variety of implant placement and loading protocols are identified, ranging from immediate implant placement on the day of extraction to delayed placement for at least 6 months after complete healing. The method of assessment of implant placement and loading plays an important role in the implantation. The expected clinical outcomes depend largely on multiple factors, such as the macroscopic design of the implant, surgical technique, and the quality and quantity of local bone in contact with the implant, which would be described in detail. The purpose of this literature review was to explore the relationship between the factors influencing the implant placement stability and implant design. By understanding the original appearance of implant design and the stability requirements of implant placement, it is hoped that more research in the future can meet the needs of dentists and patients.
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Affiliation(s)
- Yu-Che Huang
- Institute of Oral Science, Chung Shan Medical University, Taichung, Taiwan
| | - Yen-Chang Huang
- Institute of Oral Science, Chung Shan Medical University, Taichung, Taiwan
| | - Shinn-Jyh Ding
- Institute of Oral Science, Chung Shan Medical University, Taichung, Taiwan
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
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7
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Yang S, Jiang W, Ma X, Wang Z, Sah RL, Wang J, Sun Y. Nanoscale Morphologies on the Surface of 3D-Printed Titanium Implants for Improved Osseointegration: A Systematic Review of the Literature. Int J Nanomedicine 2023; 18:4171-4191. [PMID: 37525692 PMCID: PMC10387278 DOI: 10.2147/ijn.s409033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023] Open
Abstract
Three-dimensional (3D) printing is serving as the most promising approach to fabricate personalized titanium (Ti) implants for the precise treatment of complex bone defects. However, the bio-inert nature of Ti material limits its capability for rapid osseointegration and thus influences the implant lifetime in vivo. Despite the macroscale porosity for promoting osseointegration, 3D-printed Ti implant surface morphologies at the nanoscale have gained considerable attention for their potential to improve specific outcomes. To evaluate the influence of nanoscale surface morphologies on osseointegration outcomes of 3D-printed Ti implants and discuss the available strategies, we systematically searched evidence according to the PRISMA on PubMed, Embase, Web of Science, and Cochrane (until June 2022). The inclusion criteria were in vivo (animal) studies reporting the osseointegration outcomes of nanoscale morphologies on the surface of 3D-printed Ti implants. The risk of bias (RoB) was assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE's) tool. The quality of the studies was evaluated using the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. (PROSPERO: CRD42022334222). Out of 119 retrieved articles, 9 studies met the inclusion criteria. The evidence suggests that irregular nano-texture, nanodots and nanotubes with a diameter of 40-105nm on the surface of porous/solid 3D-printed Ti implants result in better osseointegration and vertical bone ingrowth compared to the untreated/polished ones by significantly promoting cell adhesion, matrix mineralization, and osteogenic differentiation through increasing integrin expression. The RoB was low in 41.1% of items, unclear in 53.3%, and high in 5.6%. The quality of the studies achieved a mean score of 17.67. Our study demonstrates that nanostructures with specific controlled properties on the surface of 3D-printed Ti implants improve their osseointegration. However, given the small number of studies, the variability in experimental designs, and lack of reporting across studies, the results should be interpreted with caution.
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Affiliation(s)
- Shiyan Yang
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Weibo Jiang
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Xiao Ma
- Department of Orthopedics, the China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Zuobin Wang
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun, Jilin, 130000, People's Republic of China
| | - Robert L Sah
- Department of Bioengineering, University of California-San Diego, La Jolla, CA, 92037, USA
- Center for Musculoskeletal Research, Institute of Engineering in Medicine, University of California-San Diego, La Jolla, CA, 92037, USA
| | - Jincheng Wang
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Yang Sun
- Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
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Calazans Neto JV, Reis ACD, Valente MLDC. Osseointegration in additive-manufactured titanium implants: A systematic review of animal studies on the need for surface treatment. Heliyon 2023; 9:e17105. [PMID: 37484223 PMCID: PMC10361303 DOI: 10.1016/j.heliyon.2023.e17105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
The objective of the systematic review is to find an answer to a question: "Do surface treatments on titanium implants produced by additive manufacturing improve osseointegration, compared to untreated surfaces?". This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA 2020) and was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022321351). Searches were performed in PubMed, Scopus, Science Direct, Embase, and Google Scholar databases on March 22nd, 2022. Articles were chosen in 2 steps by 2 blinded reviewers based on previously selected inclusion criteria: articles in animals that addressed the influence of surface treatments on osseointegration in implants produced by additive manufacturing. Articles were excluded that (1) did not use titanium surface, 2) that did not evaluate surface treatments, 3) that did not described osseointegration, 4) Studies with only in vitro analyses, clinical studies, systematic reviews, book chapters, short communications, conference abstracts, case reports and personal opinions.). 1003 articles were found and, after applying the eligibility criteria, 17 were used for the construction of this review. All included studies found positive osseointegration results from performing surface treatments on titanium. The risk of bias was analyzed using the SYRCLE assessment tool. Surface treatments are proposed to promote changes in the microstructure and composition of the implant surface to favor the adhesion of bone cells responsible for osseointegration. It is observed that despite the benefits generated by the additive manufacturing process in the microstructure of the implant surface, surface treatments are still indispensable, as they can promote more suitable characteristics for bone-implant integration. It can be concluded that the surface treatments evaluated in this systematic review, performed on implants produced by additive manufacturing, optimize osseointegration, as it allows the creation of a micro-nano-textured structure that makes the surface more hydrophilic and allows better contact bone-implant.
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Affiliation(s)
| | | | - Mariana Lima da Costa Valente
- Corresponding author. Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, FORP-USP. Av. Do Café, s/n, 14040Ribeirão Preto, Brazil.
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9
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Berger MB, Cohen DJ, Snyder K, Sions J, Boyan BD, Schwartz Z. Bone marrow stromal cells are sensitive to discrete surface alterations in build and post-build modifications of bioinspired Ti6Al4V 3D-printed in vitro testing constructs. J Biomed Mater Res B Appl Biomater 2023; 111:829-845. [PMID: 36372947 DOI: 10.1002/jbm.b.35194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/13/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
Current standards in bone-facing implant fabrication by metal 3D (M3D) printing require post-manufacturing modifications to create distinct surface properties and create implant microenvironments that promote osseointegration. However, the biological consequences of build parameters and surface modifications are not well understood. This study evaluated the relative contributions of build parameters and post-manufacturing modification techniques to cell responses that impact osseointegration in vivo. Biomimetic testing constructs were created by using a M3D printer with standard titanium-aluminum-vanadium (Ti6Al4V) print parameters. These constructs were treated by either grit-blasting and acid-etching (GB + AE) or GB + AE followed by hot isostatic pressure (HIP) (GB + AE, HIP). Next, nine constructs were created by using a M3D printer with three build parameters: (1) standard, (2) increased hatch spacing, and (3) no infill, and additional contour trace. Each build type was further processed by either GB + AE, or HIP, or a combination of HIP treatment followed by GB + AE (GB + AE, HIP). Resulting constructs were assessed by SEM, micro-CT, optical profilometry, XPS, and mechanical compression. Cellular response was determined by culturing human bone marrow stromal cells (MSCs) for 7 days. Surface topography differed depending on processing method; HIP created micro-/nano-ridge like structures and GB + AE created micro-pits and nano-scale texture. Micro-CT showed decreases in closed pore number and closed porosity after HIP treatment in the third build parameter constructs. Compressive moduli were similar for all constructs. All constructs exhibited ability to differentiate MSCs into osteoblasts. MSCs responded best to micro-/nano-structures created by final post-processing by GB + AE, increasing OCN, OPG, VEGFA, latent TGFβ1, IL4, and IL10. Collectively these data demonstrate that M3D-printed constructs can be readily manufactured with distinct architectures based on the print parameters and post-build modifications. MSCs are sensitive to discrete surface topographical differences that may not show up in qualitative assessments of surface properties and respond by altering local factor production. These factors are vital for osseointegration after implant insertion, especially in patients with compromised bone qualities.
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Affiliation(s)
- Michael B Berger
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - D Joshua Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kyle Snyder
- Commonwealth Center for Advanced Manufacturing, Virginia, USA
| | - John Sions
- Commonwealth Center for Advanced Manufacturing, Virginia, USA
| | - Barbara D Boyan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA.,Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Periodontology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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10
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Strappa EM, Memè L, Cerea M, Roy M, Bambini F. Custom-made additively manufactured subperiosteal implant. Minerva Dent Oral Sci 2022; 71:353-360. [PMID: 36345834 DOI: 10.23736/s2724-6329.22.04640-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Subperiosteal implants were introduced in the last century. Poor clinical results led those implants to be progressively abandoned. Recently, several Authors suggested a revival of subperiosteal implants as an alternative to regenerative procedures. The purpose of this study was to describe the clinical application of custom-made additively manufactured subperiosteal implant for fixed prosthetic rehabilitation of edentulous maxilla. Plaster models of the upper and the lower arch were scanned, as well as the mock-up. Digital Imaging and Communications in Medicine data obtained from cone beam computed tomography were processed through the thresholding procedure. The design of the subperiosteal implant was drawn on the stereolithographic model and scanned. Once the digital project of the subperiosteal implant was completed, it was sent to additive manufacturing. After the surgery, the patient was strictly monitored for up to 2 years. The outcomes were assessed based on the incurrence of biological and mechanical complications, postoperative complications, and implant survival. The patient did not suffer from postoperative complications. Neither biological nor mechanical complications occurred during the follow-up period. At the end of the study, the implant was still in function. Custom-made subperiosteal implants could be considered as an alternative to regenerative procedures for the rehabilitation of severe bone atrophy. Further studies are needed in the future to confirm the positive outcome.
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Affiliation(s)
| | - Lucia Memè
- Department of Clinical Sciences and Stomatology, Marche Polytechnic University, Ancona, Italy
| | | | - Marco Roy
- Department of Prosthodontics, Poznań University of Medical Sciences, Poznań, Poland
| | - Fabrizio Bambini
- Department of Clinical Sciences and Stomatology, Marche Polytechnic University, Ancona, Italy
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11
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Ogura N, Berger MB, Srivas P, Hwang S, Li J, Cohen DJ, Schwartz Z, Boyan BD, Sandhage KH. Tailoring of TiAl6V4 Surface Nanostructure for Enhanced In Vitro Osteoblast Response via Gas/Solid (Non-Line-of-Sight) Oxidation/Reduction Reactions. Biomimetics (Basel) 2022; 7:biomimetics7030117. [PMID: 36134921 PMCID: PMC9496476 DOI: 10.3390/biomimetics7030117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022] Open
Abstract
An aging global population is accelerating the need for better, longer-lasting orthopaedic and dental implants. Additive manufacturing can provide patient-specific, titanium-alloy-based implants with tailored, three-dimensional, bone-like architecture. Studies using two-dimensional substrates have demonstrated that osteoblastic differentiation of bone marrow stromal cells (MSCs) is enhanced on surfaces possessing hierarchical macro/micro/nano-scale roughness that mimics the topography of osteoclast resorption pits on the bone surface. Conventional machined implants with these surfaces exhibit successful osseointegration, but the complex architectures produced by 3D printing make consistent nanoscale surface texturing difficult to achieve, and current line-of-sight methods used to roughen titanium alloy surfaces cannot reach all internal surfaces. Here, we demonstrate a new, non-line-of-sight, gas/solid-reaction-based process capable of generating well-controlled nanotopographies on all open (gas-exposed) surfaces of titanium alloy implants. Dense 3D-printed titanium-aluminum-vanadium (TiAl6V4) substrates were used to evaluate the evolution of surface nanostructure for development of this process. Substrates were either polished to be smooth (for easier evaluation of surface nanostructure evolution) or grit-blasted and acid-etched to present a microrough biomimetic topography. An ultrathin (90 ± 16 nm) conformal, titania-based surface layer was first formed by thermal oxidation (600 °C, 6 h, air). A calciothermic reduction (CaR) reaction (700 °C, 1 h) was then used to convert the surface titania (TiO2) into thin layers of calcia (CaO, 77 ± 16 nm) and titanium (Ti, 51 ± 20 nm). Selective dissolution of the CaO layer (3 M acetic acid, 40 min) then yielded a thin nanoporous/nanorough Ti-based surface layer. The changes in surface nanostructure/chemistry after each step were confirmed by scanning and transmission electron microscopies with energy-dispersive X-ray analysis, X-ray diffraction, selected area electron diffraction, atomic force microscopy, and mass change analyses. In vitro studies indicated that human MSCs on CaR-modified microrough surfaces exhibited increased protein expression associated with osteoblast differentiation and promoted osteogenesis compared to unmodified microrough surfaces (increases of 387% in osteopontin, 210% in osteocalcin, 282% in bone morphogenic protein 2, 150% in bone morphogenic protein 4, 265% in osteoprotegerin, and 191% in vascular endothelial growth factor). This work suggests that this CaR-based technique can provide biomimetic topography on all biologically facing surfaces of complex, porous, additively manufactured TiAl6V4 implants.
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Affiliation(s)
- Naotaka Ogura
- School of Materials Engineering, Purdue University, W. Lafayette, IN 47907, USA
| | - Michael B. Berger
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Pavan Srivas
- School of Materials Engineering, Purdue University, W. Lafayette, IN 47907, USA
| | - Sunghwan Hwang
- School of Materials Engineering, Purdue University, W. Lafayette, IN 47907, USA
| | - Jiaqi Li
- School of Materials Engineering, Purdue University, W. Lafayette, IN 47907, USA
| | - David Joshua Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
- Correspondence: (Z.S.); (B.D.B.); (K.H.S.)
| | - Barbara D. Boyan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
- Correspondence: (Z.S.); (B.D.B.); (K.H.S.)
| | - Kenneth H. Sandhage
- School of Materials Engineering, Purdue University, W. Lafayette, IN 47907, USA
- Correspondence: (Z.S.); (B.D.B.); (K.H.S.)
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12
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The Biological Basis for Surface-dependent Regulation of Osteogenesis and Implant Osseointegration. J Am Acad Orthop Surg 2022; 30:e894-e898. [PMID: 35383608 PMCID: PMC9464448 DOI: 10.5435/jaaos-d-21-00523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
Bone marrow stromal cells are regulated by the chemical and physical features of a biomaterial surface. When grown on titanium (Ti) and Ti alloy surfaces, such as titanium-aluminum-vanadium, with specific topographies that mimic the microscale, mesoscale, and nanoscale features of an osteoclast resorption pit, they undergo a rapid change in cell shape to assume a columnar morphology typical of a secretory osteoblast. These cells exhibit markers associated with an osteoblast phenotype, including osteocalcin and osteopontin, and they secrete factors associated with osteogenesis, including bone morphogenetic protein 2, vascular endothelial growth factor, and neurotrophic semaphorins. The pathway involves a shift in integrin expression from α5β1 to α2β1 and signaling by Wnt5a rather than Wnt3a. Conditioned media from these cultures can stimulate vasculogenesis by human endothelial cells and osteoblastic differentiation of marrow stromal cells not grown on the biomimetic substrate, suggesting that the surface could promote osteogenesis in vivo through similar mechanisms. In vivo studies using a variety of animal models confirm that implants with biomimetic surfaces result in improved osseointegration compared with Ti implants with smooth surfaces, as do meta-analyses comparing clinical performance of implant surface topographies.
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13
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Bai L, Zheng L, Ji P, Wan H, Zhou N, Liu R, Wang C. Additively Manufactured Lattice-like Subperiosteal Implants for Rehabilitation of the Severely Atrophic Ridge. ACS Biomater Sci Eng 2022; 8:912-920. [PMID: 34984904 DOI: 10.1021/acsbiomaterials.1c00962] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Subperiosteal implants represent an alternative implant approach for cases with severe bone atrophy. Although some successful clinical cases have been reported, the biomechanical stability of subperiosteal implants remains unclear, and more data are needed to confirm the feasibility of this approach. Therefore, this study investigated the biomechanical characteristics of subperiosteal implants based on histological observation, clinical cases, and finite element analysis. Finite element analysis indicated that subperiosteal implants with a lattice-like structure could better disperse the stress to the underlying bone surface. A novel customized subperiosteal implant was then digitally designed and fabricated using an additive manufacturing technology. Six beagle dogs received such customized subperiosteal implants. Histological and microcomputed tomography examination showed new bone growth into and around the implant. Patient-specific subperiosteal implants were placed into the edentulous mandibular bone, with immediate loading. The implant was functional, without pain or infection, over a 12 month observation period. Images taken 12 months post-operatively showed new bone formation and osseointegration of the device. This indicated that 3D-printed lattice-like subperiosteal implants have sufficient stability for the rehabilitation of severely atrophic ridges.
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Affiliation(s)
- Liyun Bai
- Department of Stomatology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, China.,College of Stomatology, Chongqing Medical University, Chongqing 401147, China
| | - Lingling Zheng
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China.,ChongQing GongGangZhiHui Additive Manufacturing Technology Research Institute, Chongqing 400060, China
| | - Ping Ji
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China
| | - Haoyuan Wan
- Department of Stomatology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, China
| | - Nazi Zhou
- Department of Stomatology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, China.,College of Stomatology, Chongqing Medical University, Chongqing 401147, China
| | - Rui Liu
- Department of Stomatology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, China
| | - Chao Wang
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China.,Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beihang University, Beijing 100191, China
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14
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Lewallen EA, Trousdale WH, Thaler R, Yao JJ, Xu W, Denbeigh JM, Nair A, Kocher JP, Dudakovic A, Berry DJ, Cohen RC, Abdel MP, Lewallen DG, van Wijnen AJ. Surface Roughness of Titanium Orthopedic Implants Alters the Biological Phenotype of Human Mesenchymal Stromal Cells. Tissue Eng Part A 2021; 27:1503-1516. [PMID: 33975459 PMCID: PMC8742309 DOI: 10.1089/ten.tea.2020.0369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/05/2021] [Indexed: 11/12/2022] Open
Abstract
Metal orthopedic implants are largely biocompatible and generally achieve long-term structural fixation. However, some orthopedic implants may loosen over time even in the absence of infection. In vivo fixation failure is multifactorial, but the fundamental biological defect is cellular dysfunction at the host-implant interface. Strategies to reduce the risk of short- and long-term loosening include surface modifications, implant metal alloy type, and adjuvant substances such as polymethylmethacrylate cement. Surface modifications (e.g., increased surface rugosity) can increase osseointegration and biological ingrowth of orthopedic implants. However, the localized responses of cells to implant surface modifications need to be better characterized. As an in vitro model for investigating cellular responses to metallic orthopedic implants, we cultured mesenchymal stromal/stem cells on clinical-grade titanium disks (Ti6Al4V) that differed in surface roughness as high (porous structured), medium (grit blasted), and low (bead blasted). Topological characterization of clinically relevant titanium (Ti) materials combined with differential mRNA expression analyses (RNA-seq and real-time quantitative polymerase chain reaction) revealed alterations to the biological phenotype of cells cultured on titanium structures that favor early extracellular matrix production and observable responses to oxidative stress and heavy metal stress. These results provide a descriptive model for the interpretation of cellular responses at the interface between native host tissues and three-dimensionally printed modular orthopedic implants, and will guide future studies aimed at increasing the long-term retention of such materials after total joint arthroplasty. Impact statement Using an in vitro model of implant-to-cell interactions by culturing mesenchymal stromal cells (MSCs) on clinically relevant titanium materials of varying topological roughness, we identified mRNA expression patterns consistent with early extracellular matrix (ECM) production and responses to oxidative/heavy metal stress. Implants with high surface roughness may delay the differentiation and ECM formation of MSCs and alter the expression of genes sensitive to reactive oxygen species and protein kinases. In combination with ongoing animal studies, these results will guide future studies aimed at increasing the long-term retention of widely used titanium materials after total joint arthroplasty.
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Affiliation(s)
- Eric A. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biological Sciences, Hampton University, Hampton, Virginia, USA
| | | | - Roman Thaler
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jie J. Yao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Wei Xu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet M. Denbeigh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Asha Nair
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Jean-Pierre Kocher
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert C. Cohen
- Digital, Robotics, and Enabling Technologies, Stryker Orthopedics, Mahwah, New Jersey, USA
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David G. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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15
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Shaikh MQ, Nath SD, Akilan AA, Khanjar S, Balla VK, Grant GT, Atre SV. Investigation of Patient-Specific Maxillofacial Implant Prototype Development by Metal Fused Filament Fabrication (MF 3) of Ti-6Al-4V. Dent J (Basel) 2021; 9:dj9100109. [PMID: 34677171 PMCID: PMC8534331 DOI: 10.3390/dj9100109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
Additive manufacturing (AM) and related digital technologies have enabled several advanced solutions in medicine and dentistry, in particular, the design and fabrication of patient-specific implants. In this study, the feasibility of metal fused filament fabrication (MF3) to manufacture patient-specific maxillofacial implants is investigated. Here, the design and fabrication of a maxillofacial implant prototype in Ti-6Al-4V using MF3 is reported for the first time. The cone-beam computed tomography (CBCT) image data of the patient’s oral anatomy was digitally processed to design a 3D CAD model of the hard tissue and fabricate a physical model by stereolithography (SLA). Using the digital and physical models, bone loss condition was analyzed, and a maxillofacial implant initial design was identified. Three-dimensional (3D) CAD models of the implant prototypes were designed that match the patient’s anatomy and dental implant requirement. In this preliminary stage, the CAD models of the prototypes were designed in a simplified form. MF3 printing of the prototypes was simulated to investigate potential deformation and residual stresses. The patient-specific implant prototypes were fabricated by MF3 printing followed by debinding and sintering using a support structure for the first time. MF3 printed green part dimensions fairly matched with simulation prediction. Sintered parts were characterized for surface integrity after cutting the support structures off. An overall 18 ± 2% shrinkage was observed in the sintered parts relative to the green parts. A relative density of 81 ± 4% indicated 19% total porosity including 11% open interconnected porosity in the sintered parts, which would favor bone healing and high osteointegration in the metallic implants. The surface roughness of Ra: 18 ± 5 µm and a Rockwell hardness of 6.5 ± 0.8 HRC were observed. The outcome of the work can be leveraged to further investigate the potential of MF3 to manufacture patient-specific custom implants out of Ti-6Al-4V.
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Affiliation(s)
- Mohammad Qasim Shaikh
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
| | - Subrata Deb Nath
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
| | - Arulselvan Arumugam Akilan
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
| | - Saleh Khanjar
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
| | - Vamsi Krishna Balla
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
- Bioceramics and Coating Division, CSIR-Central Glass and Ceramic Research Institute, 196 Raja S.C. Mullick Road, Kolkata 700 032, India
| | | | - Sundar Vedanarayanan Atre
- Materials Innovation Guild, University of Louisville, Louisville, KY 40208, USA; (M.Q.S.); (S.D.N.); (A.A.A.); (S.K.); (V.K.B.)
- Correspondence:
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16
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Zhang Z, Gan Y, Guo Y, Lu X, Li X. Animal models of vertical bone augmentation (Review). Exp Ther Med 2021; 22:919. [PMID: 34335880 PMCID: PMC8290405 DOI: 10.3892/etm.2021.10351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022] Open
Abstract
Vertical bone augmentation is an important challenge in dental implantology. Existing vertical bone augmentation techniques, along with bone grafting materials, have achieved certain clinical progress but continue to have numerous limitations. In order to evaluate the possibility of using biomaterials to develop bone substitutes, medical devices and/or new bone grafting techniques for vertical bone augmentation, it is essential to establish clinically relevant animal models to investigate their biocompatibility, mechanical properties, applicability and safety. The present review discusses recent animal experiments related to vertical bone augmentation. In addition, surgical protocols for establishing relevant preclinical models with various animal species were reviewed. The present study aims to provide guidance for selecting experimental animal models of vertical bone augmentation.
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Affiliation(s)
- Zepeng Zhang
- Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, P.R. China
| | - Yaxin Gan
- Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, P.R. China
| | - Yarong Guo
- Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, P.R. China
| | - Xuguang Lu
- Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, P.R. China
| | - Xianqi Li
- Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, P.R. China.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Matsumoto Dental University, Shiojiri, Nagano 399-0781, Japan
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17
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Cleemput S, Huys SEF, Cleymaet R, Cools W, Mommaerts MY. Additively manufactured titanium scaffolds and osteointegration - meta-analyses and moderator-analyses of in vivo biomechanical testing. Biomater Res 2021; 25:18. [PMID: 34112248 PMCID: PMC8191027 DOI: 10.1186/s40824-021-00216-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Maximizing osteointegration potential of three-dimensionally-printed porous titanium (3DPPT) is an ongoing focus in biomaterial research. Many strategies are proposed and tested but there is no weighted comparison of results. Methods We systematically searched Pubmed and Embase to obtain two pools of 3DPPT studies that performed mechanical implant-removal testing in animal models and whose characteristics were sufficiently similar to compare the outcomes in meta-analyses (MAs). We expanded these MAs to multivariable meta-regressions (moderator analysis) to verify whether statistical models including reported scaffold features (e.g., “pore-size”, “porosity”, “type of unit cell”) or post-printing treatments (e.g., surface treatments, adding agents) could explain the observed differences in treatment effects (expressed as shear strength of bone-titanium interface). Results “Animal type” (species of animal in which the 3DPPT was implanted) and “type of post-treatment” (treatment performed after 3D printing) were moderators providing statistically significant models for differences in mechanical removal strength. An interaction model with covariables “pore-size” and “porosity” in a rabbit subgroup analysis (the most reported animal model) was also significant. Impact of other moderators (including “time” and “location of implant”) was not statistically significant. Discussion/conclusion Our findings suggest a stronger effect from porosity in a rat than in a sheep model. Additionally, adding a calcium-containing layer does not improve removal strength but the other post-treatments do. Our results provide overview and new insights, but little narrowing of existing value ranges. Consequent reporting of 3DPPT characteristics, standardized comparison, and expression of porosity in terms of surface roughness could help tackle these existing dilemmas. Graphical abstract ![]()
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Affiliation(s)
- Simon Cleemput
- Doctoral School of Life Sciences and Medicine, Vrije Universiteit Brussel, 1090, Brussels, Belgium. .,European Face Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium.
| | - Stijn E F Huys
- Engineering Science, Department of Mechanical Engineering, Section of Biomechanics, Catholic University of Leuven, 3000, Leuven, Belgium
| | - Robbert Cleymaet
- European Face Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium
| | - Wilfried Cools
- Interfaculty Center Data processing and Statistics, Vrije Universiteit Brussel, 1090, Brussels, Belgium
| | - Maurice Y Mommaerts
- European Face Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium
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18
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Oren D, Dror AA, Bramnik T, Sela E, Granot I, Srouji S. The power of three-dimensional printing technology in functional restoration of rare maxillomandibular deformity due to genetic disorder: a case report. J Med Case Rep 2021; 15:197. [PMID: 33845912 PMCID: PMC8040235 DOI: 10.1186/s13256-021-02741-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/15/2021] [Indexed: 11/11/2022] Open
Abstract
Background Thalassemia is an inherited autosomal recessive blood disorder causing abnormal formation of hemoglobin, known as a syndrome of anemia with microcytic erythrocytes. It is the most common genetic disorder worldwide, with a high prevalence among individuals of Mediterranean descent. The state of homozygosity of the beta-globin mutated gene is known as beta-thalassemia major, and these patients require regular blood transfusions and iron chelation therapy for survival. The rapid loss of red blood cells among affected individuals activates compensatory mechanisms of excessive medullary and extramedullary hematopoiesis, leading to severe skeletal bone deformity. Case presentation We present the case of a 39-year-old Bedouin male, diagnosed with beta-thalassemia major at infancy, with diagnosed homozygosity for the intervening sequence 2-1 (guanine > adenine) mutation. Since early infancy, he started receiving blood transfusions with a gradual increase in treatment frequency through adulthood due to the severe clinical progression of the disease. He was referred to the oral and maxillofacial surgery department at Galilee Medical Center to evaluate his facial deformity in the upper jaw and treat his severe periodontal disease. The patient presented maxillary overgrowth, and severe dental deformity resulted in progressive disfigurement and difficulty chewing, swallowing, and speaking. To address the challenge of surgical treatment, we utilized the advantage of three-dimensional planning and printing technology to simulate the optimal result. Resection of maxillary bone overgrowth and insertion of custom-made subperiosteal implants were followed by rehabilitation of both jaws to the patients' satisfaction at 3-year follow-up. Conclusions The ongoing implementation of state-of-the-art technologies such as virtual reality and three-dimensional printing has become a prominent component in surgical toolsets. Comprehensive case simulation and accurate planning before surgery will improve surgical results and patient satisfaction. This approach is highly advocated when approaching a case of rare maxillofacial deformity associated with either genetic or orphan diseases.
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Affiliation(s)
- Daniel Oren
- Oral and Maxillofacial Surgery, Oral Medicine Institute, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amiel A Dror
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Tania Bramnik
- Oral and Maxillofacial Surgery, Oral Medicine Institute, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eyal Sela
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Igal Granot
- Oral and Maxillofacial Surgery, Oral Medicine Institute, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Samer Srouji
- Oral and Maxillofacial Surgery, Oral Medicine Institute, Galilee Medical Center, Nahariya, Israel. .,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
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19
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Montoya C, Du Y, Gianforcaro AL, Orrego S, Yang M, Lelkes PI. On the road to smart biomaterials for bone research: definitions, concepts, advances, and outlook. Bone Res 2021; 9:12. [PMID: 33574225 PMCID: PMC7878740 DOI: 10.1038/s41413-020-00131-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 01/31/2023] Open
Abstract
The demand for biomaterials that promote the repair, replacement, or restoration of hard and soft tissues continues to grow as the population ages. Traditionally, smart biomaterials have been thought as those that respond to stimuli. However, the continuous evolution of the field warrants a fresh look at the concept of smartness of biomaterials. This review presents a redefinition of the term "Smart Biomaterial" and discusses recent advances in and applications of smart biomaterials for hard tissue restoration and regeneration. To clarify the use of the term "smart biomaterials", we propose four degrees of smartness according to the level of interaction of the biomaterials with the bio-environment and the biological/cellular responses they elicit, defining these materials as inert, active, responsive, and autonomous. Then, we present an up-to-date survey of applications of smart biomaterials for hard tissues, based on the materials' responses (external and internal stimuli) and their use as immune-modulatory biomaterials. Finally, we discuss the limitations and obstacles to the translation from basic research (bench) to clinical utilization that is required for the development of clinically relevant applications of these technologies.
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Affiliation(s)
- Carolina Montoya
- Department of Oral Health Sciences, Kornberg School of Dentistry, Temple University, Philadelphia, PA, 19140, USA
| | - Yu Du
- Department of Endodontology, Kornberg School of Dentistry, Temple University, Philadelphia, PA, 19140, USA
- Guangdong Provincial Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Affiliated Stomatological Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Anthony L Gianforcaro
- Bioengineering Department, College of Engineering, Temple University, Philadelphia, PA, 19122, USA
| | - Santiago Orrego
- Department of Oral Health Sciences, Kornberg School of Dentistry, Temple University, Philadelphia, PA, 19140, USA
- Bioengineering Department, College of Engineering, Temple University, Philadelphia, PA, 19122, USA
| | - Maobin Yang
- Department of Oral Health Sciences, Kornberg School of Dentistry, Temple University, Philadelphia, PA, 19140, USA
- Department of Endodontology, Kornberg School of Dentistry, Temple University, Philadelphia, PA, 19140, USA
- Bioengineering Department, College of Engineering, Temple University, Philadelphia, PA, 19122, USA
| | - Peter I Lelkes
- Department of Endodontology, Kornberg School of Dentistry, Temple University, Philadelphia, PA, 19140, USA.
- Bioengineering Department, College of Engineering, Temple University, Philadelphia, PA, 19122, USA.
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20
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Three-Dimensional Technology Applications in Maxillofacial Reconstructive Surgery: Current Surgical Implications. NANOMATERIALS 2020; 10:nano10122523. [PMID: 33339115 PMCID: PMC7765477 DOI: 10.3390/nano10122523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022]
Abstract
Defects in the oral and maxillofacial (OMF) complex may lead to functional and esthetic impairment, aspiration, speech difficulty, and reduced quality of life. Reconstruction of such defects is considered one of the most challenging procedures in head and neck surgery. Transfer of different auto-grafts is still considered as the “gold standard” of regenerative and reconstructive procedures for OMF defects. However, harvesting of these grafts can lead to many complications including donor-site morbidity, extending of surgical time, incomplete healing of the donor site and others. Three-dimensional (3D) printing technology is an innovative technique that allows the fabrication of personalized implants and scaffolds that fit the precise anatomy of an individual’s defect and, therefore, has attracted significant attention during the last few decades, especially among head and neck surgeons. Here we discuss the most relevant applications of the 3D printing technology in the oral and maxillofacial surgery field. We further show different clinical examples of patients who were treated at our institute using the 3D technology and discuss the indications, different technologies, complications, and their clinical outcomes. We demonstrate that 3D technology may provide a powerful tool used for reconstruction of various OMF defects, enabling optimal clinical results in the suitable cases.
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21
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Wu Y, Tang H, Liu L, He Q, Zhao L, Huang Z, Yang J, Cao C, Chen J, Wang A. Biomimetic titanium implant coated with extracellular matrix enhances and accelerates osteogenesis. Nanomedicine (Lond) 2020; 15:1779-1793. [PMID: 32705940 DOI: 10.2217/nnm-2020-0047] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: To evaluate the biological function of titanium implants coated with cell-derived mineralized extracellular matrix, which mimics a bony microenvironment. Materials & methods: A biomimetic titanium implant was fabricated primarily by modifying the titanium surface with TiO2 nanotubes or sand-blasted, acid-etched topography, then was coated with mineralized extracellular matrix constructed by culturing bone marrow mesenchymal stromal cells. The osteogenic ability of biomimetic titanium surface in vitro and in vivo were evaluated. Results: In vitro and in vivo studies revealed that the biomimetic titanium implant enhanced and accelerated osteogenesis of bone marrow stromal cells by increasing cell proliferation and calcium deposition. Conclusion: By combining surface topography modification with biological coating, the results provided a valuable method to produce biomimetic titanium implants with excellent osteogenic ability.
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Affiliation(s)
- Yu Wu
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
| | - Haikuo Tang
- Department of Oral & Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
| | - Lin Liu
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
| | - Qianting He
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
| | - Luodan Zhao
- Department of Stomatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, PR China
| | - Zhexun Huang
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
| | - Jinghong Yang
- Department of Prosthodontics, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
| | - Congyuan Cao
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
| | - Jie Chen
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
| | - Anxun Wang
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
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22
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Revilla‐León M, Sadeghpour M, Özcan M. A Review of the Applications of Additive Manufacturing Technologies Used to Fabricate Metals in Implant Dentistry. J Prosthodont 2020; 29:579-593. [DOI: 10.1111/jopr.13212] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Marta Revilla‐León
- Comprehensive Dentistry Department, College of DentistryTexas A&M University Dallas TX
- Gradute Prosthodontics, Department of Restorative Dentistry, School of DentistryUniversity of Washington Seattle WA
| | - Mehrad Sadeghpour
- Revilla Research Center Madrid Spain
- Private practice in Dallas Dallas TX
| | - Mutlu Özcan
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center for Dental and Oral MedicineUniversity of Zurich Zürich Switzerland
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23
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Borges GA, Webber LP, M Marques AE, Guerra EN, Castilho RM, Squarize CH. Pharmacological PTEN inhibition: potential clinical applications and effects in tissue regeneration. Regen Med 2020; 15:1329-1344. [PMID: 32223643 DOI: 10.2217/rme-2019-0065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although the human body can heal, it takes time, and slow healing and chronic wounds often occur. Thus, identifying novel therapies to aid regeneration is needed. Here, we conducted a systematic review following the Preferred Reporting Items for Systematic Reviews guidelines and assessed preclinical studies on phosphatase and tensin homolog (PTEN) inhibitors and their effects on tissue repair and regeneration. In conditions associated with neurodegeneration, tissue injury and ischemia, the PTEN-regulated PI3K/AKT signaling pathway is activated. The use of PTEN inhibitors resulted in better tissue response by reducing the healing time and lesion sizes or inducing neuronal regeneration. Notably, all studies included in this systematic review indicated that pharmacological inhibition of PTEN enhanced the repair process of the eye, lung, muscle and nervous system.
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Affiliation(s)
- Gabriel A Borges
- Laboratory of Epithelial Biology, Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109-1078, USA.,Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasília, Brasília, Brazil
| | - Liana P Webber
- Laboratory of Epithelial Biology, Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109-1078, USA
| | - Ana Elizia M Marques
- Laboratory of Epithelial Biology, Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109-1078, USA.,Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasília, Brasília, Brazil
| | - Eliete Ns Guerra
- Laboratory of Epithelial Biology, Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109-1078, USA.,Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasília, Brasília, Brazil
| | - Rogerio M Castilho
- Laboratory of Epithelial Biology, Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109-1078, USA.,The Michigan Medicine Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Cristiane H Squarize
- Laboratory of Epithelial Biology, Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109-1078, USA.,The Michigan Medicine Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
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24
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Influence of chemical composition on cell viability on titanium surfaces: A systematic review. J Prosthet Dent 2020; 125:421-425. [PMID: 32178882 DOI: 10.1016/j.prosdent.2020.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/23/2022]
Abstract
STATEMENT OF PROBLEM A consensus on which dental implant alloy and surface treatment provide the best cell viability is unclear. PURPOSE The purpose of this systematic review was to provide information on the influence of surface and intrinsic titanium alloy chemical components on cell viability. MATERIAL AND METHODS The PubMed, LILACS, COCHRANE library, and Science Direct databases were electronically searched for the terms dental implants AND titanium AND cytotoxicity. Inclusion criteria were research articles that studied titanium or its alloys for chemical composition and cell viability and were published in English between 1999 and 2019. Articles that did not study titanium and its alloys, articles with nondental or biomedical implants, and articles that were not found in their entirety were excluded. RESULTS A total of 1226 articles selected by title or abstract according to the inclusion and exclusion criteria resulted in 51 articles that were reduced to 27 after reading in full. The treatments analyzed were arc fusion, electron beam physical deposition, plasma electrolytic oxidation, coating addition, micro arc oxidation, anodization, thermochemical process, BMP-2 immobilization, pressure-assisted sintering, and alkali heat treatment. CONCLUSIONS The evaluated literature did not allow a determination of the best surface treatment for cell viability because of the heterogeneity of the studies regarding the type of alloy, cell used in the MTT assay, study, and implant purpose (biomedical or dental). The cytotoxic effect of chemical components was dependent on dose, time, size, temperature, and cell type. The niobium, tantalum, zirconium, and molybdenum elements have been most often added in the development of less toxic Ti alloys with lower modulus of elasticity and increased strength.
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25
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McGough MA, Boller LA, Groff DM, Schoenecker JG, Nyman JS, Wenke JC, Rhodes C, Shimko D, Duvall CL, Guelcher SA. Nanocrystalline hydroxyapatite-poly(thioketal urethane) nanocomposites stimulate a combined intramembranous and endochondral ossification response in rabbits. ACS Biomater Sci Eng 2020; 6:564-574. [PMID: 32405537 PMCID: PMC7220073 DOI: 10.1021/acsbiomaterials.9b01378] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Resorbable bone cements are replaced by bone osteoclastic resorption and osteoblastic new bone formation near the periphery. However, the ideal bone cement would be replaced by new bone through processes similar to fracture repair, which occurs through a variable combination of endochondral and intramembranous ossification. In this study, nanocrystalline hydroxyapatite (nHA)-poly(thioketal urethane) (PTKUR) cements were implanted in femoral defects in New Zealand White rabbits to evaluate ossification at 4, 12, and 18 months. Four formulations were tested: an injectable, flowable cement and three moldable putties with varying ratios of calcium phosphate to sucrose granules. New bone formation and resorption of the cement by osteoclasts occurred near the periphery. Stevenel's Blue and Safranin O staining revealed infiltration of chondrocytes into the cements and ossification of the cartilaginous intermediate. These findings suggest that nHA-PTKUR cements support combined intramembranous and endochondral ossification, resulting in enhanced osseointegration of the cement that could potentially improve patient outcomes.
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Affiliation(s)
- Madison A.P. McGough
- Department of Biomedical Engineering, Vanderbilt University, 2201 West End Ave, Nashville, TN 37235
| | - Lauren A. Boller
- Department of Biomedical Engineering, Vanderbilt University, 2201 West End Ave, Nashville, TN 37235
| | - Dustin M. Groff
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, 2201 West End Ave, Nashville, TN 37235
| | - Jonathan G. Schoenecker
- Vanderbilt Center for Bone Biology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37212
- Department of Orthopaedics, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37212
| | - Jeffry S. Nyman
- Vanderbilt Center for Bone Biology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37212
- Department of Orthopaedics, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37212
| | - Joseph C. Wenke
- U.S. Army Institute of Surgical Research, 3698 Chambers Rd, San Antonio, TX 78234
| | - Cheyenne Rhodes
- Medtronic Spinal & Biologics, 1800 Pyramid Pl, Memphis, TN 38132
| | - Dan Shimko
- Medtronic Spinal & Biologics, 1800 Pyramid Pl, Memphis, TN 38132
| | - Craig L. Duvall
- Department of Biomedical Engineering, Vanderbilt University, 2201 West End Ave, Nashville, TN 37235
| | - Scott A. Guelcher
- Department of Biomedical Engineering, Vanderbilt University, 2201 West End Ave, Nashville, TN 37235
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, 2201 West End Ave, Nashville, TN 37235
- Vanderbilt Center for Bone Biology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37212
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26
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Mangano C, Bianchi A, Mangano FG, Dana J, Colombo M, Solop I, Admakin O. Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series. 3D Print Med 2020; 6:1. [PMID: 31915946 PMCID: PMC6950914 DOI: 10.1186/s41205-019-0055-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To present the application of custom-made 3D-printed subperiosteal implants for fixed prosthetic restoration of the atrophic posterior mandible of elderly patients. Methods Between January 2017 and June 2018, all partially edentulous patients aged over 65 years, with two or more missing teeth in the posterior atrophic mandible, and who did not want to undergo bone regenerative procedures, were included in this study. These patients were rehabilitated with custom-made subperiosteal implants, designed from cone beam computed tomography (CBCT) and fabricated in titanium by means of direct metal laser sintering (DMLS). The outcome measures were fit and stability of the implants at placement, duration of the intervention, implant survival, and early and late complications. All patients were followed for 1 year after surgery. Results Ten patients (four males, six females; mean age 69.6, SD ± 2.8, median 69, 95% CI 67.9–71.6) were included in the study. The fit of the implants was satisfactory, with a mean rating of 7 out of 10 (SD ± 1.6, median 7, 95% CI 6–8). Only two implants had insufficient fit, because of the presence of scattering in the CBCT; however, they were adapted to the sites during the interventions. The mean duration of the intervention was 44.3 min (SD ± 19.4, median 37, 95% CI 32.3–56.3). At the one-year follow-up, no implants were lost (survival rate 100%). One implant presented immediate postoperative complications with pain, discomfort and swelling, and two patients experienced late complications, having their provisional restorations fractured during the temporisation phase. All these complications were minor in nature, but the final complication rate amounted to 30% (three of ten patients). Conclusions Although this study has limits (small patient sample and short follow-up), DMLS has proven to be an effective method for fabricating accurate subperiosteal implants, with high survival rates. This may represent an alternative treatment procedure in elderly patients with a severely atrophic posterior mandible, since it allows avoidance of regenerative bone therapies. Further studies are needed to confirm these outcomes.
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Affiliation(s)
- Carlo Mangano
- Department of Dental Sciences, University Vita Salute S. Raffaele, 20132, Milan, Italy
| | - Andrea Bianchi
- Department of Periodontology and Implantology, Istituto Stomatologico Italiano, 20122, Milan, Italy
| | - Francesco Guido Mangano
- Department of Prevention and Communal Dentistry, Sechenov First Moscow State Medical University, 119991, Moscow, Russia.
| | | | | | - Ivan Solop
- Department of Prevention and Communal Dentistry, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | - Oleg Admakin
- Department of Prevention and Communal Dentistry, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
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27
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Das S, Dholam K, Gurav S, Bendale K, Ingle A, Mohanty B, Chaudhari P, Bellare JR. Accentuated osseointegration in osteogenic nanofibrous coated titanium implants. Sci Rep 2019; 9:17638. [PMID: 31819073 PMCID: PMC6901521 DOI: 10.1038/s41598-019-53884-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 10/29/2019] [Indexed: 12/24/2022] Open
Abstract
Anchoring of endosseous implant through osseointegration continues to be an important clinical need. Here, we describe the development of superior endosseous implant demonstrating enhance osseointegration, achieved through surface modification via coating of osteogenic nanofibres. The randomized bio-composite osteogenic nanofibres incorporating polycaprolactone, gelatin, hydroxyapatite, dexamethasone, beta-glycerophosphate and ascorbic acid were electrospun on titanium implants mimicking bone extracellular matrix and subsequently induced osteogenesis by targeting undifferentiated mesenchymal stem cells present in the peri-implant niche to regenerate osseous tissue. In proof-of-concept experiment on rabbit study models (n = 6), micro-computed tomography (Micro-CT), histomorphometric analysis and biomechanical testing in relation to our novel osteogenic nanofibrous coated implants showed improved results when compared to uncoated controls. Further, no pathological changes were detected during gross examination and necropsy on peri-implant osseous tissues regenerated in response to such coated implants. The findings of the present study confirm that osteogenic nanofibrous coating significantly increases the magnitude of osteogenesis in the peri-implant zone and favours the dynamics of osseointegration.
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Affiliation(s)
- Siddhartha Das
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, Maharashtra, India.,Department of Chemical Engineering, Indian Institute of Technology Bombay, Mumbai, 400076, Maharashtra, India
| | - Kanchan Dholam
- Department of Dental and Prosthetic Surgery, Tata Memorial Centre, HBNI, Mumbai, 400 012, Maharashtra, India
| | - Sandeep Gurav
- Department of Dental and Prosthetic Surgery, Tata Memorial Centre, HBNI, Mumbai, 400 012, Maharashtra, India
| | - Kiran Bendale
- Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, 410 210, Maharashtra, India
| | - Arvind Ingle
- Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, 410 210, Maharashtra, India
| | - Bhabani Mohanty
- Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, 410 210, Maharashtra, India
| | - Pradip Chaudhari
- Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, 410 210, Maharashtra, India
| | - Jayesh R Bellare
- Department of Chemical Engineering, Indian Institute of Technology Bombay, Mumbai, 400076, Maharashtra, India. .,Wadhwani Research Centre for Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, Maharashtra, India.
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28
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Cohen DJ, Scott KM, Kulkarni AN, Wayne JS, Boyan BD, Schwartz Z. Acellular mineralized allogenic block bone graft does not remodel during the 10 weeks following concurrent implant placement in a rabbit femoral model. Clin Oral Implants Res 2019; 31:37-48. [PMID: 31545532 DOI: 10.1111/clr.13544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/22/2019] [Accepted: 09/08/2019] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- D Joshua Cohen
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Kayla M Scott
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Aniket N Kulkarni
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer S Wayne
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Barbara D Boyan
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Zvi Schwartz
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA.,Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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29
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Oliveira TT, Reis AC. Fabrication of dental implants by the additive manufacturing method: A systematic review. J Prosthet Dent 2019; 122:270-274. [PMID: 30928226 DOI: 10.1016/j.prosdent.2019.01.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
STATEMENT OF PROBLEM Placement of dental implants depends, among other factors, on anatomic conditions such as sufficient bone height and thickness. Thus, individualized dental implants seem to offer benefits for patients with alveolar bone resorption. Additive manufacturing has allowed for the fabrication of custom implants with microscale resolution and, although the efficiency of the process is unclear, is a potential process for manufacturing dental implants. PURPOSE The purpose of this systematic review was to evaluate the current situation of additive manufacturing techniques for fabricating dental implants. MATERIAL AND METHODS An electronic search was performed in the databases PubMed, Lilacs, Cochrane Library, and Science Direct, with the terms "additive manufacturing" AND "dental implants," "rapid prototyping" AND "dental implants," "3 D printing" AND "dental implants," "electron beam melting" AND "dental implants," "selective laser melting" AND "dental implants." The articles were screened, and the final selection of articles was obtained by using the inclusion and exclusion criteria. RESULTS The database search resulted in 1322 articles, which were screened for title and/or summary according to the inclusion criteria. From the selected 38 articles, 30 remained after applying the exclusion criteria. These were read completely, resulting in a selection of 13 articles for this systematic review. Owing to the great variety of articles with different objectives, the results were based on a descriptive analysis of the following topics: additive manufacturing technique and material, printed structure and implant design, implant characteristics, mechanical analysis, surface treatment, and osseointegration. CONCLUSIONS Additive manufacturing is a new technology that may solve many problems in diverse fields. In dentistry, however, further studies are needed to improve the method for manufacturing custom dental implants because no standard methodology is available. Moreover, the advantages and disadvantages of the process are not yet clearly defined.
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Affiliation(s)
- Thaisa T Oliveira
- Postgraduate student, Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Andréa C Reis
- Associate Professor, Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry, University of São Paulo (USP), Ribeirão Preto, Brazil.
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30
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Cheng A, Schwartz Z, Kahn A, Li X, Shao Z, Sun M, Ao Y, Boyan BD, Chen H. Advances in Porous Scaffold Design for Bone and Cartilage Tissue Engineering and Regeneration. TISSUE ENGINEERING. PART B, REVIEWS 2019; 25:14-29. [PMID: 30079807 PMCID: PMC6388715 DOI: 10.1089/ten.teb.2018.0119] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022]
Abstract
IMPACT STATEMENT Challenges in musculoskeletal tissue regeneration affect millions of patients globally. Scaffolds for tissue engineering bone and cartilage provide promising solutions that increase healing and decrease need for complicated surgical procedures. Porous scaffolds have emerged as an attractive alternative to traditional scaffolds. However, the success of advanced materials, use of biological factors, and manufacturing techniques can vary depending on use case. This review provides perspective on porous scaffold manufacturing, characterization and application, and can be used to inform future scaffold design.
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Affiliation(s)
- Alice Cheng
- Department of Biomedical Engineering, Peking University, Beijing, China
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
- Department of Periodontology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Adrian Kahn
- Department of Oral and Maxillofacial Surgery, University of Tel Aviv, Tel Aviv, Israel
| | - Xiyu Li
- Department of Biomedical Engineering, Peking University, Beijing, China
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Zhenxing Shao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Muyang Sun
- Department of Biomedical Engineering, Peking University, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Barbara D. Boyan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Haifeng Chen
- Department of Biomedical Engineering, Peking University, Beijing, China
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31
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Kelly CN, Evans NT, Irvin CW, Chapman SC, Gall K, Safranski DL. The effect of surface topography and porosity on the tensile fatigue of 3D printed Ti-6Al-4V fabricated by selective laser melting. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 98:726-736. [PMID: 30813077 DOI: 10.1016/j.msec.2019.01.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
Additive manufacturing (3D printing) is emerging as a key manufacturing technique in medical devices. Selective laser melted (SLM) Ti-6Al-4V implants with interconnected porosity have become widespread in orthopedic applications where porous structures encourage bony ingrowth and the stiffness of the implant can be tuned to reduce stress shielding. The SLM technique allows high resolution control over design, including the ability to introduce porosity with spatial variations in pore size, shape, and connectivity. This study investigates the effect of construct design and surface treatment on tensile fatigue behavior of 3D printed Ti-6Al-4V. Samples were designed as solid, solid with an additional surface porous layer, or fully porous, while surface treatments included commercially available rotopolishing and SILC cleaning. All groups were evaluated for surface roughness and tested in tension to failure under monotonic and cyclic loading profiles. Surface treatments were shown to reduce surface roughness for all sample geometries. However, only fatigue behavior of solid samples was improved for treated as compared to non-treated surfaces Irrespective of surface treatment and resulting surface roughness, the fatigue strength of 3D printed samples containing bulk or surface porosity was approximately 10% of the ultimate tensile strength of identical 3D printed porous material. This study highlights the relative effect of surface treatment in solid and porous printed samples and the inherent decrease in fatigue properties of 3D printed porous samples designed for osseointegration.
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Affiliation(s)
- Cambre N Kelly
- Department of Biomedical Engineering, Duke University, United States of America
| | - Nathan T Evans
- School of Materials Science and Engineering, Georgia Institute of Technology, United States of America
| | - Cameron W Irvin
- School of Materials Science and Engineering, Georgia Institute of Technology, United States of America; Renewable Bioproducts Institute, Georgia Institute of Technology, United States of America
| | - Savita C Chapman
- Department of Biomedical Engineering, Georgia Institute of Technology, United States of America
| | - Ken Gall
- Department of Mechanical Engineering and Materials Science, Duke University, United States of America
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Custom-Made Direct Metal Laser Sintering Titanium Subperiosteal Implants: A Retrospective Clinical Study on 70 Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5420391. [PMID: 29998133 PMCID: PMC5994585 DOI: 10.1155/2018/5420391] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/23/2018] [Indexed: 11/17/2022]
Abstract
Purpose To present a digital technique for the fabrication of custom-made subperiosteal implants and to report on the survival and complication rates encountered when using these fixtures. Methods The data used for this retrospective clinical study were derived from the medical records of five different private dental practices. Inclusion criteria were patients over the age of 60, treated with custom-made direct metal laser sintering (DMLS) titanium subperiosteal implants (Eagle-Grid®, BTK, Dueville, Vicenza) during a two-year period (2014-2015) and restored with fixed restorations; all enrolled patients needed to have complete pre- and postoperative clinical and radiographic documentation, with at least 2 years of follow-up. Exclusion criteria were smoking and bruxism. The main outcomes looked at were implant survival and complications. Results Seventy patients (39 males and 31 females, aged 62-79 years) who had been treated with custom-made DMLS titanium subperiosteal implants were enrolled in this study. After 2 years of follow-up, three implants were lost due to recurrent, untreatable infections; the survival rate was therefore 95.8% (67/70 implants). Four patients reported pain/discomfort/swelling after implant placement; the incidence of immediate postoperative complications was therefore 5.7% (4/70 implants). During the follow-up period, one patient suffered from recurrent infections classified as a biologic complication; the incidence of biologic complications was therefore 1.4% (1/67 surviving implants). Finally, four patients experienced prosthetic problems with their implant-supported restorations during the provisional phase (fracture of the acrylic restoration) and two patients had ceramic chipping of the definitive restoration; the incidence of prosthetic complications was therefore 8.9% (6/67 surviving implants). Conclusions Within the limits of the present study (limited follow-up time and low number of patients treated, retrospective design), the application of custom-made DMLS titanium subperiosteal implants showed satisfactory implant survival (95.8%) and low complication rates. Further studies are needed to confirm the positive outcomes found in this research.
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Wang Y, Cai X, Huang J, Zhou Y, Jiang T, Wang Y. Bone regeneration in critically sized rat mandible defects through the endochondral pathway using hydroxyapatite-coated 3D-printed Ti6Al4V scaffolds. RSC Adv 2018; 8:31745-31754. [PMID: 35548214 PMCID: PMC9085720 DOI: 10.1039/c8ra06508j] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/04/2018] [Indexed: 11/21/2022] Open
Abstract
The endochondral approach has been proved to be a promising pathway in bone tissue engineering. However, whether it is suitable for repairing critically sized mandible defects is unknown. We designed Ti6Al4V scaffolds with a suitable shape and pore size by a 3D-printing selective-laser-melting technique to implement this approach. In order to improve the surface bioactivity of the scaffolds, hydroxyapatite (HA) coatings (HA/L group and HA/H group) of different crystallite size were prepared on the scaffolds via electrochemical deposition. Rat bone mesenchymal stem cells (BMSCs) were seeded onto the scaffolds and chondrogenically differentiated in vitro for 4 weeks and then the scaffolds were implanted into critically sized rat mandible defects for 8 weeks. The bare scaffold and HA coatings were characterized with field emission scanning electron microscopy, water contact angle measurements and X-ray diffractometry. Cell proliferation results showed that the bioactivity of the HA coatings could better improve the growth rate of BMSCs compared with the bare surface. Additionally, safranin O staining showed abundant cartilage matrix and chondrocytes in the HA coated scaffold. Analyses using qPCR detected higher expression of chondrogenic-related gene Col2α1 and vegfα in the HA coated groups, especially in the HA/H group. Together these data demonstrate that the HA coating could improve the chondrogenic differentiation of BMSCs. In vivo, methylene blue staining of histological sections and micro-computed tomography revealed that the HA-coated groups, especially the HA/H group, increased new bone formation via endochondral ossification compared with the control group. Therefore, this strategy provides an alternative method to improve bone formation in mandible defects via the endochondral pathway and the scaffold with larger HA crystals was superior to those with smaller HA crystals. Bone regeneration in critically sized rat mandible defects through the endochondral pathway using hydroxyapatite-coated scaffolds.![]()
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Affiliation(s)
- Yan Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
| | - Xinjie Cai
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
| | - Jing Huang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
| | - Yi Zhou
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
| | - Tao Jiang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
| | - Yining Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
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Huang J, Zhang X, Yan W, Chen Z, Shuai X, Wang A, Wang Y. Nanotubular topography enhances the bioactivity of titanium implants. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 13:1913-1923. [DOI: 10.1016/j.nano.2017.03.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/07/2017] [Accepted: 03/26/2017] [Indexed: 12/19/2022]
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35
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Costa DG, Ferraz EP, Abuna RPF, de Oliveira PT, Morra M, Beloti MM, Rosa AL. The effect of collagen coating on titanium with nanotopography on in vitro
osteogenesis. J Biomed Mater Res A 2017. [DOI: 10.1002/jbm.a.36140] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Daniel G. Costa
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
| | - Emanuela P. Ferraz
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
| | - Rodrigo P. F. Abuna
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
| | - Paulo T. de Oliveira
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
| | - Marco Morra
- Nobil Bio Ricerche srl; Portacomaro Asti Italy
| | - Marcio M. Beloti
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
| | - Adalberto L. Rosa
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
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Cohen DJ, Cheng A, Sahingur K, Clohessy RM, Hopkins LB, Boyan BD, Schwartz Z. Performance of laser sintered Ti-6Al-4V implants with bone-inspired porosity and micro/nanoscale surface roughness in the rabbit femur. ACTA ACUST UNITED AC 2017; 12:025021. [PMID: 28452335 DOI: 10.1088/1748-605x/aa6810] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Long term success of bone-interfacing implants remains a challenge in compromised patients and in areas of low bone quality. While surface roughness at the micro/nanoscale can promote osteogenesis, macro-scale porosity is important for promoting mechanical stability of the implant over time. Currently, machining techniques permit pores to be placed throughout the implant, but the pores are generally uniform in dimension. The advent of laser sintering provides a way to design and manufacture implants with specific porosity and variable dimensions at high resolution. This approach enables production of metal implants that mimic complex geometries found in biology. In this study, we used a rabbit femur model to compare osseointegration of laser sintered solid and porous implants. Ti-6Al-4V implants were laser sintered in a clinically relevant size and shape. One set of implants had a novel porosity based on human trabecular bone; both sets had grit-blasted/acid-etched surfaces. After characterization, implants were inserted transaxially into rabbit femora; mechanical testing, micro-computed tomography (microCT) and histomorphometry were conducted 10 weeks post-operatively. There were no differences in pull-out strength or bone-to-implant contact. However, both microCT and histomorphometry showed significantly higher new bone volume for porous compared to solid implants. Bone growth was observed into porous implant pores, especially near apical portions of the implant interfacing with cortical bone. These results show that laser sintered Ti-6Al-4V implants with micro/nanoscale surface roughness and trabecular bone-inspired porosity promote bone growth and may be used as a superior alternative to solid implants for bone-interfacing implants.
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Affiliation(s)
- David J Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States of America
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Cheng A, Cohen DJ, Kahn A, Clohessy RM, Sahingur K, Newton JB, Hyzy SL, Boyan BD, Schwartz Z. Laser Sintered Porous Ti-6Al-4V Implants Stimulate Vertical Bone Growth. Ann Biomed Eng 2017; 45:2025-2035. [PMID: 28409291 DOI: 10.1007/s10439-017-1831-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/04/2017] [Indexed: 12/25/2022]
Abstract
The objective of this study was to examine the ability of 3D implants with trabecular-bone-inspired porosity and micro-/nano-rough surfaces to enhance vertical bone ingrowth. Porous Ti-6Al-4V constructs were fabricated via laser-sintering and processed to obtain micro-/nano-rough surfaces. Male and female human osteoblasts were seeded on constructs to analyze cell morphology and response. Implants were then placed on rat calvaria for 10 weeks to assess vertical bone ingrowth, mechanical stability and osseointegration. All osteoblasts showed higher levels of osteocalcin, osteoprotegerin, vascular endothelial growth factor and bone morphogenetic protein 2 on porous constructs compared to solid laser-sintered controls. Porous implants placed in vivo resulted in an average of 3.1 ± 0.6 mm3 vertical bone growth and osseointegration within implant pores and had significantly higher pull-out strength values than solid implants. New bone formation and pull-out strength was not improved with the addition of demineralized bone matrix putty. Scanning electron images and histological results corroborated vertical bone growth. This study indicates that Ti-6Al-4V implants fabricated by additive manufacturing to have porosity based on trabecular bone and post-build processing to have micro-/nano-surface roughness can support vertical bone growth in vivo, and suggests that these implants may be used clinically to increase osseointegration in challenging patient cases.
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Affiliation(s)
- Alice Cheng
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.,Department of Biomedical Engineering, Peking University, Beijing, China
| | - David J Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian Kahn
- Department of Oral Surgery, University of Tel-Aviv, Tel Aviv, Israel
| | - Ryan M Clohessy
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Kaan Sahingur
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Joseph B Newton
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Sharon L Hyzy
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Barbara D Boyan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA. .,Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA. .,School of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA.
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA.,Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Hyzy SL, Cheng A, Cohen DJ, Yatzkaier G, Whitehead AJ, Clohessy RM, Gittens RA, Boyan BD, Schwartz Z. Novel hydrophilic nanostructured microtexture on direct metal laser sintered Ti-6Al-4V surfaces enhances osteoblast response in vitro and osseointegration in a rabbit model. J Biomed Mater Res A 2016; 104:2086-98. [PMID: 27086616 DOI: 10.1002/jbm.a.35739] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 03/21/2016] [Accepted: 03/31/2016] [Indexed: 01/16/2023]
Abstract
The purpose of this study was to compare the biological effects in vivo of hierarchical surface roughness on laser sintered titanium-aluminum-vanadium (Ti-6Al-4V) implants to those of conventionally machined implants on osteoblast response in vitro and osseointegration. Laser sintered disks were fabricated to have micro-/nano-roughness and wettability. Control disks were computer numerical control (CNC) milled and then polished to be smooth (CNC-M). Laser sintered disks were polished smooth (LST-M), grit blasted (LST-B), or blasted and acid etched (LST-BE). LST-BE implants or implants manufactured by CNC milling and grit blasted (CNC-B) were implanted in the femurs of male New Zealand white rabbits. Most osteoblast differentiation markers and local factors were enhanced on rough LST-B and LST-BE surfaces in comparison to smooth CNC-M or LST-M surfaces for MG63 and normal human osteoblast cells. To determine if LST-BE implants were osteogenic in vivo, we compared them to implant surfaces used clinically. LST-BE implants had a unique surface with combined micro-/nano-roughness and higher wettability than conventional CNC-B implants. Histomorphometric analysis demonstrated a significant improvement in cortical bone-implant contact of LST-BE implants compared to CNC-B implants after 3 and 6 weeks. However, mechanical testing revealed no differences between implant pullout forces at those time points. LST surfaces enhanced osteoblast differentiation and production of local factors in vitro and improved the osseointegration process in vivo. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2086-2098, 2016.
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Affiliation(s)
- Sharon L Hyzy
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Alice Cheng
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia.,Department of Biomedical Engineering, Peking University, Beijing, China
| | - David J Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
| | | | - Alexander J Whitehead
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Ryan M Clohessy
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Rolando A Gittens
- Center for Biodiversity and Drug Discovery, Institute for Advanced Scientific Research and High Technology Services (INDICASAT AIP), Panama City, Panama
| | - Barbara D Boyan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia.,Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia.,University of Texas Health Science Center at San Antonio, San Antonio, Texas
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